目的用POSSUM、P-POSSUM、Cr-POSSUM及ACPGBl 评分系统分别预测结直肠癌手术风险的效果探讨分析。方法选取150例结直肠癌患者，术前以POSSUM、P-POSSUM、Cr-POSSUM及ACPGBI评分系统分别对结直肠癌患者并发症发生率、死亡率进行前瞻性预测，并与术后实际并发症、死亡率进行对照。结果 POSSUM评分系统预测并发症的发生率（76例、50．67％）及死亡率（42例、28．00％）分别显著高于实际并发症率（38例、25．33％，P＜0．01）及死亡率（7例、4．67％，P＜0．01）。但老年患者的并发症预测发生率与实际发生率差异统计学无意义，P-POSSUM、Cr-POSSUM及ACPGBI评分系统预测死亡率（分别为9例、6．00％，10例、6．67％及11例、7．33％）与实际死亡率（7例、4．67％）差异无统计学意义。结论 P-POSSUM、Cr-POSSUM及ACPGBI评分系统均能较准确地预测结直肠癌患者手术死亡率，而POSSUM评分系统可能高估了直肠癌患者的术后并发症发生率及手术死亡率。

Objective To introduce a special kind of refractory pelvic abscess after rectal surgery and discuss its clinical characteristics and therapy. Methods The clinical characteristics, follow-up data and prognosis of 6 cases of refractory pelvic abscess admitted from October 2011 to February 2016 in Department of General Surgery, Beijing Chao Yang Hospital, Capital Medical University(5 cases)and Department of General Surgery,Beijing Luhe Hospital(1 case) were analyzed retrospectively. Results Four cases were cured by enterostomy and clearance of infection tissue in surgical operation. After the closing of intestinal stoma, 1 case of pelvic abscess relapsed and was performed reenterostomy and clearance but was unhealed. One case was under the treatment of debriding pelvic abscess through the rectal anastomotic leakage, but was unhealed. Conclusion In comparison with common pelvic abscess, the refractory pelvic abscess has such features as a long medical history, more complications, complex therapies, delayed healing and poor prognosis. During the rectal surgery, if no active bleeding happened, the hemostatic gauze or material should not be placed in the pelvic. And it’s the key point to prevent the kind of refractory pelvic abscess.

结直肠癌发病率和病死率在国内外有逐年上升趋势。世界范围内，每年约有120万新发和60万死亡病例[1]。在我国，结直肠癌的发病率现在年平均增长4%，估计每年有40万新发病例。2004-2005年全国第三次死因回顾抽样调查显示，结直肠癌占恶性肿瘤死亡原因第五位，死亡率达到7.42/10万[2]。手术后的复发和转移是导致治疗失败的主要原因，传统的放、化疗效率低，毒副作用大，远远不能满足临床需求。近半个世纪，结直肠癌的治疗方式已经从单纯的手术切除转向由手术治疗为主，放、化疗和生物治疗等为辅助治疗手段的多学科联合治疗[3]。

BACKGROUND:Recent studies have shown that extralevator abdominoperineal resection has the potential for reduced circumferential resection margin involvement, intraoperative bowl perforation, and local recurrence rates; however, it has been suggested that extended resection may be associated with increased morbidity because of the formation of a larger perineal defect.OBJECTIVE:This study was undertaken to demonstrate the feasibility and complications of extralevator abdominoperineal resection for locally advanced low rectal cancer in China.DESIGN:This was a prospective cohort study.SETTING:The study was conducted at 7 university hospitals throughout China.PATIENTS:A total of 102 patients underwent this procedure for primary locally advanced low rectal cancer between August 2008 and October 2011.MAIN OUTCOME MEASURES:The main outcome measures comprised circumferential resection margin involvement, intraoperative perforation, postoperative complications, and local recurrence.RESULTS:The most common complications included sexual dysfunction (40.5%), perineal complications (23.5%), urinary retention (18.6%), and chronic perineal pain (13.7%). Chronic perineal pain was associated with coccygectomy (p < 0.001), and the pain gradually eased over time. Reconstruction of the pelvic floor with biological mesh was associated with a lower rate of perineal dehiscence (p = 0.006) and overall perineal wound complications (p = 0.02) in comparison with primary closure. A positive circumferential margin was demonstrated in 6 (5.9%) patients, and intraoperative perforations occurred in 4 (3.9%) patients. All circumferential margin involvements and intraoperative perforations were located anteriorly. The local recurrence was 4.9% at a median follow-up of 44 months (range, 18-68 months).LIMITATIONS:This was a nonrandomized, uncontrolled study.CONCLUSIONS:Extralevator abdominoperineal resection performed in the prone position for low rectal cancer is a relatively safe approach with acceptable circumferential resection margin involvement, intraoperative perforations, and local recurrences. Reconstruction of the pelvic floor with biological mesh might lower the rate of perineal wound complications (see Video, Supplemental Digital Content 1, http://links.lww.com/DCR/A161).

<正>1996年6月~2010年6月,我院对175例中晚期直肠癌患者施行Miles手术,术后发生造瘘口旁疝18例。现对其术后造瘘口旁疝发生原因分析如下。临床资料:本组直肠癌行Miles手术患者175例,男97

目的探讨分析大肠癌手术后并发症的成因及防治.方法总结北京市通州区潞河医院1992年至2005年大肠癌手术后出现并发症患者105例,进行分析和探讨.结果总结大肠癌手术并发症的相关因素,着重阐述了术后切口感染,骶前静脉出血,吻合口瘘,输尿管损伤,肠梗阻及内科并发症的成因、预防及治疗手段.

巨大食管裂孔疝是指1/3以上的胃疝入胸腔内[1].1994年1月～2001年2月我科开胸手术治疗9例,疗效满意,现报道如下.

目的探讨胃大部切除术后食管癌的手术方式.方法对10例单纯胃大部切除术后食管癌和2例胃大部切除+脾切除术后食管癌采用两种不同术式.结果两种术式均取得成功,无吻合口瘘及切缘癌残留发生.结论残胃与脾胰体尾联合移入胸腔与食管吻合治疗单纯胃大部切除术后食管癌是一种可靠、实用的手术方法;以回结肠动脉为供血管,末段回肠+右半结肠代食管术,治疗胃大部切除+脾切除术后食管癌有其临床可行性.

目的:总结食管贲门肿瘤32例外科治疗的经验体会.方法:根据肿瘤的部位、长度、范围、有无转移及病人全身情况,选择不同的手术方式.结果:手术时间2.5～8小时,32例无手术死亡.结论:制定合理手术方案,术中尽量根治切除,术后配合放疗、化疗等综合治疗可以提高疗效.