Objective Using plastic surgery principal to prevent the deformed scars by general surgical operation.Methods 102 cases for each of plastic surgical technique group and the general surgical technique group(control group) were compared by using scar score. Evaluation Scale for grading of scar score in four grades was developed by ourselves. The plastic surgical technique involved incisional design, soft tissue dissection and incisional sutures.Results 92.2% cases in the plastic surgery technique group and 38.3% cases in the control group had a good outcome(P0.01).Two cases with excellent outcomes were introduced in detail.Conclusion It is feasible to use the plastic surgical technique instead of general surgical technique to prevent the deformed scars.

目的 探讨老年人胃癌的临床特点和治疗方法.方法回顾性分析我院 1971～ 2002年外科收治的年龄超过或等于 70岁的 452例胃癌患者的临床资料.结果主要临床表现为上腹疼痛、胞胀或不适 (74.3% ),以及消瘦 (53.3% )和食欲下降 (47.1% ).临床Ⅲ、Ⅳ期患者占 63.9%. 413例患者予以手术治疗,胃切除 316例 (76.5% ),其中根治性切除 231例 (73.1% ),姑息性切除 85例 (26.9% ).并存有重要器官慢性病变 238例 (52.7% ),出现术后并发症 194例 (47.0% ).手术患者 5年生存率 32.9%,其中胃切除患者为 43.0%,根治性切除患者为 57.9%,姑息性切除患者为 2.7%.结论老年胃癌患者多为临床Ⅲ、Ⅳ期;术后并发症发生率高.应提高早期诊断率;适宜的手术治疗是提高老年胃癌患者生存率的关键,但应做好围手术期处理.

To observe the clinical effects of health-supporting and pathogen-eliminating therapy in the relief of the toxic and negative effects of chemotherapy in treating breast cancer, 60 cases were randomized into two groups: treatment group in which Chinese medicine and chemotherapy were used and control group in which chemotherapy and its symptomatic treatment were given. The bone marrow suppression, nausea and vomiting, immunity and kidney function were observed in the two groups. Results: All above conditions improved more significantly in treatment group than in control group; however, the myocardial injury, liver-kidney functions and lymph metastasis were similar in both groups. It is revealed that health-supporting and pathogen-eliminating therapy can relieve the toxic and negative sides due to chemotherapy and boost the immunity.

目的探讨胃肠道间质瘤的临床表现、诊断、治疗和预后.方法回顾性分析1999年4月至2002年7月收治的15例胃肠道间质瘤的临床和病理资料.结果主要临床表现为腹部不适(7/15)、消化道出血(6/15).病变部位为胃13例,十二指肠1例,小肠1例.14例行手术治疗.15例镜下均见梭形细胞,其中良性9例,交界性4例,恶性1例,胃癌伴良性间质瘤1例.免疫组化CD117(+)73%, CD34(+)73%,SMA(-)73%,S-100(-)67%.随访率100%,病人均存活.结论内镜和影像学检查是发现胃肠道间质瘤病变的主要手段,术前确诊仍较困难,手术切除是病理确诊和治疗的主要方法.

Objective To explore the etiology and treatment of abdominal incisional hernia. Methods The clinical data of 130 cases of incisional hernia were analyzed retrospectively. Results The average age was 62.8% , 58.5% in female. The postoperative onset of incisional hernia was 56.2% within 1 year, 26.9% after 5 years. The hernia was 85.4% in longitudinal incision, 66.9% in lower abdominal incision. The incision secondary healing was 44.6% . 56 patients were repaired with synthetic material and their recurrent rate was 7.1% . Conclusion Incision secondary healing, obesity and diabetes, elevation of intraabdominal pressure, the aged, the female, longitudinal incision and lower abdominal incision are etiological factors of incisional hernia. To avoid infection of incision, prevent and cure increase of intraabdominal pressure, promote wound healing and ensure suture quality are the key of preventing incisional hernia. The patients with large incisional hernia must be repaired with synthetic mesh and subjected to perioperative management effectively to decrease the recurrence.

近年,随着老年医学的迅速发展,接受手术治疗的老年贲门癌病人不断增加,而呼吸衰竭(respiratory failure,RF)是术后较为常见、凶险的并发症之一[1].本文旨在分析可能导致老年贲门癌术后发生RF的高危因素.

目的探讨高龄腹部手术患者围手术期的处理.方法回顾性分析58例70岁以上腹部手术患者围手术期临床资料.结果 47例( 81.0%)术前有重要器官病变,主要是心血管疾病39例( 67.2%)、慢性阻塞性肺疾病18例( 31.0%),糖尿病15例( 25.9%).术后并发症主要在心血管系统18例( 31.0%),呼吸系统23例( 39.7%),伤口裂开2例.无吻合口瘘、伤口或腹腔感染发生.结论老年人腹部手术的主要危险因素是心肺疾病,其次原因是急诊手术、手术创伤、手术时间、年龄大、营养免疫状况低下.应根据老年生理病理的特点和器官功能的状态,术前全面评估和准备,术后加强监测和支持.

目的探讨≥70岁老年腹部外科病人合理的肠外营养(PN)治疗方法.方法 48例手术和33例非手术腹部外科病人,禁食且PN治疗≥5d,予非蛋白热卡20kcal·kg-1·d-1和蛋白质0.8～1.25g·kg-1·d-1治疗.结果 PN治疗能较好维持病人的血浆蛋白水平,对肝肾功能无明显影响,无明显代谢紊乱和不良反应.结论低热卡的PN治疗对老年腹部外科病人安全有效.

目的:探讨添加谷氨酰胺(Gln)双肽的低热量肠外营养(PN)在高龄腹部手术病人中的应用价值. 方法:40例病人随机分成研究组和对照组,各20例.所有病人术后第1～6天接受等热量83.6 kJ/(kg*d)、等氮0.16 g/(kg*d)的PN支持,研究组病人另增加0.3 g/(kg*d)的Gln双肽.术前及术后第1、7天检测血清白蛋白、前白蛋白、IgG、IgA和IgM,并进行淋巴细胞计数(LCC).计算术后第1、4、7天氮平衡. 结果:两组病人术后血清白蛋白和前白蛋白值均较术前下降,对照组下降明显(P<0.05);术后LCC均较术前升高,尤以研究组升高显著(P＜0.01).累积氮平衡研究组明显高于对照组(P＜0.05).未观察到不良反应或并发症. 结论:添加Gln双肽的低热量肠外营养在高龄腹部手术病人中使用安全,具有改善氮平衡、减轻术后血清蛋白水平下降和促进淋巴细胞计数恢复的作用.

目的探讨原发性大肠恶性淋巴瘤的临床特点、诊断、治疗和预后因素。方法回顾性分析21例大肠型淋巴瘤的临床、病理和预后资料。结果大肠型淋巴瘤的临床表现以腹痛、腹块及大便性状与习惯改变为主。病变主要位于盲肠(9例)和升结肠(8例)。21例均为非何杰金氏淋巴瘤。临床分期ⅠE期7例，ⅡE期8例，ⅢE期6例。术前误诊率81.0%。手术切除率81.0%。5年生存率32.6%。结论手术切除是本病诊断和临床分期的主要手段。治疗方法以手术切除加术后化放疗的综合治疗为主。临床分期、根治手术、恶性程度是影响疾病的预后因素。

磁共振(MRI)于九十年代初在国外逐渐被用于乳腺疾病检查，由于MRI具有极高的软组织分辨率。近年来，随着MRI软件、硬件的不断发展，脂肪抑制技术和对比增强剂的应用，使MRI诊断乳腺肿块的敏感性和特异性大大提高，对乳腺良、恶性疾病的鉴别能力较常规X线和B超检查更优越，因此成为较有发展前途的一种检查手段。我们总结了70例乳腺MRI检查结果，并对其价值进行探讨。 材料和方法 一、一般资料

肺癌单纯探查原因探讨及化疗泵应用唐志德刘桂兰刘国华李翔倪国兴作者单位：４５０００３河南省胸科医院（唐志德、刘桂兰、刘国华）；上海华东医院胸外科（李翔、倪国兴）目前，手术切除仍是治疗肺癌的首选方法，为提高手术切除率，减少剖胸探查率，我们总结４８例肺癌单...