目的 观察左侧结肠癌伴急性肠梗阻一期手术的疗效，探讨理想的手术治疗方法。方法 回顾性分析四川大学华西医院2007年1月至2009年11月期间收治的46例左侧结肠癌伴急性肠梗阻患者一期手术切除吻合的临床资料。结果 46例均未实施术中结肠灌洗，而行彻底的无污染肠减压法。其中行根治性切除一期吻合35例，姑息性切除一期吻合11例。术后发生吻合口漏3例，切口感染6例，肺部感染2例，盆腔积液1例，均经非手术方法治愈。全组手术无死亡病例。结论 左侧结肠癌伴急性肠梗阻一期切除吻合，用彻底的无污染肠减压法替代结肠灌洗是安全、可行的。
摘要:目的：回顾性分析比较左半结肠癌急性梗阻一期手术与同期左半结肠癌根治术患者的手术临床资料,探讨左半结肠癌急性梗阻一期手术的可行性。方法： 回顾性将我中心2004年1月至2007年3月收治的59例左半结肠癌急性梗阻一期手术病例分为A组,将同期226例左半结肠癌根治术病例分为B组,比较两组之间清除淋巴结数、术后进食时间、吻合口漏发生率、肺部感染率、切口感染率、住院时间、复发和转移率。结果： 在上述观察指标中,在A组分别为（133±18）枚,（36±09）d,1/59（169%）,4/59（678%）,2/59（339%）,(124±09)d,6/59（1017%）；B组分别为128±15,32±08,1/226（044%）,8/226（354%）,6/226（265%）,117±15,23/226（1062%）；经统计学处理,两组间没有显著性差异。结论：术中合理应用结肠灌洗,良好的手术技巧,术后积极辅助治疗,左半结肠癌急性梗阻一期手术是安全可行的,可避免二次手术带给患者的痛苦,术后并发症也无明显增加。Abstract: Objective: Retrospective analysis and comparison of acute obstruction of left colon cancer onestage surgery and the same period a radical mastectomy in patients with left colon cancer surgery clinical data,To study the possibility of acute obstruction of left colon cancer onestage surgery. Methods:A retrospective of my center from January 2004 to March 2007 were treated 59 cases of acute obstruction of left colon cancer onestage surgery patients were divided into A group, will be left over the same period 226 cases of radical resection of colon cancer patients were divided into group B, compare the number of lymph nodes removed between the two groups, after the consumption of time, the incidence of anastomotic leakage, pulmonary infection, incision infection, length of stay, recurrence and metastasis rate. Results: Observed in the above indicators, in the A group were 133±18,36±09,1/59 (169%),4/59 (678%), 2/59 (339%),124±09,6/59 (1017%); B group were 128±15,32±08,1/226 (044%), 8/226 (354%), 6/226 (265%), 117±15,23/226 (1062%); Statistical analysis between the two groups there was no significant difference. Conclusion: Rational application of intraoperative colonic irrigation, good surgical technique, postoperative adjuvant treatment of active, acute obstruction of left colon cancer onestage surgery is a safe and feasible, it may avoid the second operation to bring the patient’s pain, postoperative complications and no increased significantly.
ObjectiveTo analyze and compare the clinical efficacy and safety between one-stage operation and staged operation in the treatment of tandem spinal stenosis (TSS).MethodsThe data of 39 patients with TSS were retrospectively analyzed, who were definitely diagnosed and treated surgically between February 2011 and March 2016 in the Affiliated Hospital of Southwest Medical University. According to whether one-stage decompression was performed, the patients were divided into group A (cervical and lumbar vertebral canal decompression procedures were performed in one stage, n=21) and group B (cervical and lumbar spinal canal decompression procedures were performed in two stages with a time interval of 3-6 months, n=18). Both one-stage and staged operations were performed by the same surgical team. The Nurick scores, Japanese Orthopedic Association (JOA) scores of cervical spine and lumbar spine, and Oswestry Disability Index (ODI) before operation and in postoperative follow-up, postoperative JOA improvement rate, and perioperative indicators were recorded and compared.ResultsAll patients completed the operations successfully, and the lengths of follow-up were all longer than 12 months. There was no significant difference in gender, age, body mass index, preoperative duration of symptoms, preoperative Kang grade, preoperative Schizas grade, preoperative underlying diseases, preoperative cervical or lumbar spine JOA score, preoperative ODI, preoperative Nurick score, decompression segment or distribution, or length of follow-up between the two groups (P>0.05). The Nurick score, JOA score of cervical and lumbar spine, and ODI at one year after operation and the last follow-up were significantly improved compared with those before operation. The one-year after operation improvement rates of JOA of cervical and lumbar spine in group A were significantly higher than those in group B [cervical spine: (70.55±9.28)% vs. (55.29±7.82)%, P<0.05; lumbar spine: (69.50±4.95)% vs. (51.58±7.62)%, P<0.05], but there was no significant difference in the improvement rate of JOA between the two groups at the last follow-up (P>0.05). There was no significant difference in Nurick score or ODI between the two groups at one year after operation or the last follow-up (P>0.05). There was no significant difference in the average length of hospital stay between the two groups [(15.67±3.40) vs. (15.72±1.57) d, P>0.05]. The operation time [(293.10±43.83) vs. (244.44±22.29) min] and intraoperative bleeding [(533.33±180.51) vs. (380.56±38.88) mL] in group A were significantly higher than those in group B (P<0.05). The incidence of postoperative complications of group A was higher than that of group B (57.1% vs. 16.7%, P<0.05).ConclusionsCompared with staged surgery, one-stage operation in the treatment of TSS has a significant improvement in neurological function and clinical efficacy in short-term follow-up, but there is no significant difference in long-term follow-up. Staged surgery has the advantages of shorter operation time, less intraoperative blood loss, lower postoperative complication rate, and higher safety.
目的 探讨经阑尾结肠灌洗一期切除吻合治疗梗阻型左半结肠癌的效果。 方法 回顾性分析2009年1月至2011年12月期间于笔者所在医院行经阑尾结肠灌洗＋左半结肠切除术的46例梗阻型左半结肠癌患者（灌洗组）及行左半结肠切除术的114例无梗阻型左半结肠癌患者（对照组）的临床资料，比较2组患者的效果指标。 结果 2组均无围手术期死亡及吻合口漏发生。灌洗组和对照组的术中出血量〔（195±64）mL比（184±66）mL〕、术后住院时间〔（10.6±4.2）d比（10.1±3.3）d〕、住院费用（22 310元比22 650元）、切口感染率〔4.3%（2/46）比3.5%（4/114）〕、腹腔积液发生率〔4.3%（2/46）比2.6%（3/114）〕及总并发症发生率〔8.7%（4/46）比6.1%（7/114）〕的差异均无统计学意义（P＜0.05），但灌洗组的手术时间〔（156.7±16.6）min比（120.6±15.9）min〕及术后肛门排气时间较长（78 h比70 h），P＜0.05。 结论 经阑尾结肠灌洗一期切除吻合治疗梗阻型左半结肠癌安全、有效及便捷，值得临床推广应用。
目的 采用腹腔镜、内镜联合技术处理胆囊结石合并肝外胆管结石，对同期及分期治疗的结果进行比较。方法 患者60例，其中同期处理36例，分期处理24例。术前诊断依据B超、ERCP或MRCP检查，术中诊断依据术中胆道镜检查和胆道造影，全部病例均诊断为慢性胆囊炎合并胆总管结石。同期手术者直接行腹腔镜胆囊切除术，胆道镜和（或）造影检查后行腹腔镜经胆囊管或胆总管胆道镜取石，闭合胆管开口或放置T管。分期手术者先行或者后行ERCP+经内镜乳头切开术/经内镜乳头气囊扩张术取石，再行常规的腹腔镜胆囊切除术。结果 60例患者腹腔镜胆囊切除术均成功，同期手术者手术时间40～90 min，平均68 min，术后发生1例漏胆； 分期手术者2次手术时间共60～120 min，平均80 min。同期手术者手术时间明显短于分期手术者（P＜0.01），而术后并发症发生情况二者间差异则无统计学意义（Pgt;0.05）。同期手术者住院费用较少（P＜0.01），同时在胆总管一期缝合或胆囊管一期结扎的情况下，住院时间相对较短（P＜0.01）。结论 腹腔镜胆囊切除术＋腹腔镜下胆道镜胆总管探查术或经胆囊管探查术同期治疗胆囊结石合并肝外胆管结石安全可靠，值得进一步研究、推广。
ObjectiveTo explore an method and the effectiveness of surgical treatment of thoracic and lumbar tuberculosis complicated with severe kyphotic deformity (Cobb angle≥55°) and paraplegia. MethodsBetween January 2009 and January 2013, 13 cases of thoracic and lumbar tuberculosis complicated with severe kyphotic deformity and paraplegia were treated by one-stage posterior vertebral column resection (PVCR), debridement, bone grafting, and instrumentation fixation. Of 13 patients, 7 were male and 6 were female with an average age of 23.5 years (range, 14-49 years). The disease duration was 13-38 months (mean, 19 months). The Cobb angle of kyphosis was (65.23±7.95)°. The visual analogue scale score (VAS) was 7.38±0.31. In 13 patients with incomplete paraplegia, 1 case was classified as Frankel grade B, 7 cases as grade C, and 5 cases as grade D. The lesion involved 2 vertebrae bodies in 7 cases (T8, 9 in 1 case, T11, 12 in 2 cases, and T12, L1 in 4 cases), 3 vertebrae bodies in 4 cases (T10-12 in 2 cases, T9-11 in 1 case, and T11-L1 in 1 case), and 4 vertebrae bodies in 2 cases (T4-7 in 1 case and T6-9 in 1 case). Imaging examination showed paravertebral abscess in 10 cases. ResultsHealing of incision by first intention was obtained in all patients. The neurological injury and pulmonary infection occurred in 3 cases and 2 cases respectively, which were cured after symptomatic treatment. Thirteen patients were followed up 12-48 months (mean, 17 months). The erythrocyte sedimentation rate restored to normal level in all cases at 3-7 months after operation. All the patients achieved bony fusion at 10-20 months (mean, 14 months) after operation. No fixation loosening, displacement, or fracture occurred during follow-up. Common toxic symptom of tuberculosis disappeared, and there was no recurrence of local tuberculosis. The Cobb angle of kyphosis was corrected to (22.38±1.76)° at 1 week and (22.15±1.83)° at last follow-up, showing significant difference when compared with preoperative one (P < 0.05). There was no significant difference in Cobb angle of kyphosis between at 1 week after operation and at last follow-up (P > 0.05). The Frankel grading was grade B in 1 case, grade C in 10 cases, and grade D in 2 cases at 1 week after operation; and it was grade D in 1 case and grade E in 12 cases at last follow-up; significant differences were found between at pre-and post-operation (P < 0.05), and between at 1 week after operation and at last follow-up (P < 0.05). The VAS score was 4.08±0.76 at 1 week and 0.62±0.14 at last follow-up, showing significant differences between at pre-and post-operation (P < 0.05) and between at 1 week after operation and at last follow-up (P < 0.05). ConclusionOne-stage PVCR, debridement, bone grafting, and instrumentation fixation is proved to be successful in treating thoracic and lumbar tuberculosis complicated with severe kyphotic deformity and paraplegia.
ObjectiveTo investigate the short-term effectiveness of one-stage radical debridement and total hip arthroplasty (THA) in the treatment of active tuberculosis of the hip. MethodsBetween January 2006 and June 2011,one-stage radical debridement and THA were performed on 12 cases (12 hips) of active tuberculosis of the hip.There were 7 males and 5 females,aged 18-60 years (mean,46.3 years).The disease duration ranged from 6 to 24 months (mean,10.5 months).According to Babhulkar and Pande staging criteria,5 cases were at stage Ⅲ and 7 cases were at stage IV.One case had sinus,and 2 cases had previous pulmonary tuberculosis.Preoperative hip range of motion was (35.83±9.25)°; hip Harris score was 36.83±6.44.Erythrocyte sedimentation rate (ESR) was 45-90 mm/1 h (mean,62.4 mm/1h); C-reactive protein (CRP) was 19-50 mg/L (mean,33.6 mg/L).Perioperatively all the patients accepted the regular anti-tuberculous medication. ResultsThe results of histopathological examination and PCR detection were positive for tuberculosis bacillus.Postoperatively the incisions healed primarily.All the patients were followed up 25-60 months (mean,40.8 months).The ESR and CRP returned to normal level with no liver injury.Tuberculosis recurrence occurred in 1 patient at 4 months after operation,which was cured after revision.X-ray film showed no prosthesis shift,prosthesis loosening,or sinus tract.At 18-24 months after operation,the bilateral sides had the same bone density,which was similar to that at the final follow-up.Hip range of motion was significantly improved to (107.08±13.56)° (t=14.571,P=0.000).Hip Harris score was significantly increased to 88.00±10.78 (t=16.750,P=0.000). ConclusionA combination of one-stage radical debridement and THA is a safe method to treat active tuberculosis of the hip,which can relief symptoms and improve hip function,with low recurrence and satisfactory short-term effectiveness.
Objective To explore the clinical effect of combining medial and lateral canthoplasty with blepharoptosis correction at onestage for congenital blepharophimosis syndrome. Methods From January 2002 to May 2006, 26 patients(52 sides) with congenital blepharophimosis syndrome were treated. There were 16 males and 10 females, aging from 3 to 35 years (mean 8.5 years). They were all bilateral blepharoptosis significantly. The palpebral muscle force was 03 mm; the transverse dimension and vertical dimension of the palpebral fissue were 13-22 mm and 2-4 mm; the intercanthal distance was 33-44 mm; the levator function was 1-3 mm. Results Twenty-six patients underwent medial canthoplasty and blepharoptosis correction, of them, 12 patients were also given lateral canthoplasty at one-stage. The postoperative transverse dimension and vertical dimension of the palpebral fissue were 6-8 mm and 24-32 mm, respectively. The intercanthal distance was 29-34 mm. The levator function was 46 mm. The supratarsal fold in the upper lid was natural. With a follow up of 3 months to 4 years，all patients were satisfied with their results. Conclusion One-stage surgical treatment of combining medial and lateral canthoplasty with blepharoptosis correction can achieve good result for blepharophimosis syndrome with a shortened treatment time.
目的 观察和评估一期手术治疗肛门直肠周围脓肿的临床疗效。方法 回顾性分析我院2001年1月至2006年10月期间107例实施一期手术的肛门直肠周围脓肿患者的临床资料。结果 所有患者均行一次性根治手术，术后切口换药。住院时间9～28 d，平均18.5 d。术后随访3～36个月，平均19.5个月，1例术后形成瘘管，2例术后脓肿复发，此3例经再次手术治愈，无复发； 术后一次性治愈率达97.2%（104/107）。结论 一期手术治疗肛门直肠周围脓肿较单纯切开引流手术能明显地缩短术后感染控制时间，降低术后脓肿的复发率和肛瘘的发生率，减轻患者的痛苦。