Objective To explore the method of surgical treatment and endoluminal repairs of infrarenal abdominal aortic aneurysm (AAA)so as to improve the safety of surgical treatment. Methods The information of surgical treatment was analysed restrospectively in 195 cases of infrarenal AAA treated from January 1981 to December 2004. Of the patients, 155 were males, 40 were females with a mean age of 56.5 years. The diametersof the aneurysm were larger than 5 cm in 183 patients (93.8%) and 4 to 5 cm in12 patients (6.2%). Of the 175 patients who underwent selective operation, graft replacements were performed in 139 and endovascular aneurysmal repairs in 36. Twenty patients (10.3%) suffering from aneurysm rupture were given emergency operation. Results There were 6 deaths in the patients underdingselective operation(6/175, 4.3%) and in those undergoing emergengcy surgery (6/20, 30%) respectively within 30 days. The other patients were followed up from 1 month to 21 years ( 8.7 years on average), and there were 16 deaths (8.9%) during the follow-up. Nodeath was found in the endoluminal repaired group. Endoleak occurred in 8 patients, including 5 cases of type Ⅰand 3cases of type Ⅱ. After 6 months, CT scan showed that endoleak disappeared in 6 and rernained in 2. Late type Ⅱ endoleak occurred in 1 and endoleak disappearedafter endoluminal embolization. Conclusion With improvement of vascular surgical technique and development of endogafting, the safety of AAA both on surgicaland interventional means would be improved.
【摘要】目的探讨脾脓肿的易感因素、诊断与治疗。方法对1990年6月至2002年8月收治的11例脾脓肿患者资料进行回顾性分析。结果11例患者中8例行手术或穿刺治疗，3例保守治疗。10例患者治愈或好转出院，1例保守治疗无效死于败血症。结论加强对脾脓肿的认识是提高本病早期诊断的关键，脾切除是治疗脾脓肿的首选方式。
甲状腺可发生多种疾病，治疗方法各异，其中，适宜外科治疗者主要是甲状腺肿瘤，尤其是恶性肿瘤，甲状腺功能亢进症虽然有些也采用外科治疗，但并非该病的唯一治疗方法。甲状腺肿瘤外科治疗所采用的术式及病例选择等，至今国内、外仍存在一些不同见解。现就甲状腺肿瘤的外科治疗现状进行重点讨论，并就今后发展略抒己见。
胆总管在穿过十二指肠壁时与胰管汇合，汇合后略膨大，称Vater壶腹（简称壶腹）。壶腹及其外周环绕的括约肌向十二指肠肠腔突出，使十二指肠粘膜隆起形成十二指肠乳头。在壶腹周围（包括壶腹），上述组织结构所发生的肿瘤统称为壶腹周围肿瘤，并以恶性居多。壶腹周围的恶性肿瘤包括来自壶腹、胆总管下端、十二指肠乳头和胰头的癌肿，临床上把前三者连同胰头癌统称为壶腹周围癌。目前，外科手术仍是治疗壶腹部肿瘤的主要手段，提高壶腹部肿瘤的外科治疗技术水平是患者获得治愈的唯一途径。壶腹部肿瘤因其组织来源不同其生物学行为亦表现出很大差异，应根据壶腹部肿瘤的不同组织来源、生物学行为及其发展阶段作出合理的外科治疗。
目的 为进一步探讨老年急性结肠癌性肠梗阻的诊断及外科治疗方法，总结经验教训。方法 对我院1993~2005年收治的38例老年急性结肠癌性肠梗阻患者的临床资料进行回顾性分析。结果 38例老年急性结肠癌性肠梗阻患者，手术行一期切除吻合23例，肿瘤姑息性切除4例，单纯结肠双腔造口2例，Hartmann手术9例。术后发生并发症6例，其中切口感染5例，经换药愈合； 发生吻合口漏1例，最终死于腹腔感染、多器官功能衰竭。其余32例术后恢复良好。结论 提高对老年急性结肠癌性肠梗阻的认识，选择合理术式，加强围手术期处理，是减少手术并发症的发生、降低死亡率的重要措施。
目的 探讨原发性骶前肿瘤的诊断及外科治疗。方法 回顾性分析徐州医学院附属医院普外科1980年1月至2012年7月期间收治的50例原发性骶前肿瘤患者的临床资料，并结合文献复习进行讨论。结果 原发性骶前肿瘤的术前诊断主要依靠直肠指检、B超、CT、MRI等相关检查。手术采用经骶尾部入路22例，经下腹部正中入路22例，经腹、骶尾部联合入路6例。肿瘤被完整切除33例，行部分切除10例，未切除7例。并发症有术中出血、直肠损伤，术后切口感染、脓肿形成等。结论 骶前肿瘤如无禁忌证均应行手术治疗。充分的术前评估、合理选择手术入路、多学科协作以及对术中和术后并发症的充分认识是手术成功的关键。
Objective To explore the diagnostic methods, therapy and the prognostic factors for the ruptured abdominal aortic aneurysm (RAAA). Methods The clinical data of 23 patients (males 15, females 8, age range 35-78, mean age 65) with RAAA below the level of renal arteries, who were treated with surgery, were collected from April 1999 to December 2005 and were analyzed retrospectively. Seven cases had a history of RAAA, 6 cases had pulsating abdominal masses; 15 cases were diagnosed by emergency Doppler ultrasonic examination or CT. All of the patients underwent emergency surgical operation: The ruptures of the abdominal aorta below the level of renal arteries were obstructed by using clamp ring or using transluminal ballon according to conditions of each patient. The aritficial vascular graft was then taken after the control of hemorrhage. Results There were 9 (39%) patients died within 30 d after the emergency operation. The causes of death included acute renal failure because of hemorrhagic shock (4 cases), multiple organ failure (3 cases), and respiratory-circulatory failure (2 cases).Conclusion Surgery may be an effective treatment for RAAA. The critical step of the operation was to control hemorrhage by obstructing the proximal end of the aortic rupture according to the conditions of each patient. The main postoperative complications and causes of death include acute cardiovascular and cerebrovascular diseases, renal failure and pneumonia.
肝门部胆管癌（hilar cholangiocarcinoma），又称Klaskin癌，是指起源于左右肝管、分叉部和肝总管上段胆管上皮的恶性肿瘤，约占胆管癌的60%~70%［1］。由于其临床表现隐匿，早期难以被发现。目前根治性手术是最有效的提高其生存率的治疗方式，随着肝门部胆管癌R0切除率的不断升高，5年生存率不断提高［2，3］，但仍有不少问题有待于解决……
目的 探讨胰腺囊性肿瘤的诊断及外科治疗方法。方法 对我院2003年4月至2012年4月期间收治的19例胰腺囊性肿瘤患者的临床资料进行回顾性分析。结果 本组19例患者中浆液性囊腺瘤8例，黏液性囊腺瘤5例，导管内乳头状黏液瘤4例，实性假乳头状瘤1例，囊腺癌1例。行B超或CT发现胰腺占位病变。位于胰头部5例，胰体部8例，胰尾部6例。行肿瘤摘除术4例，保留脾脏的胰体尾切除术5例，胰体尾＋脾脏切除手术3例，胰十二指肠切除术6例，1例囊腺癌患者因肝脏转移伴腹腔广泛转移、侵犯大血管而肿瘤不能切除仅行胃空肠、胆肠吻合。术后发生胰瘘2例，腹腔感染1例，经保守治疗后康复出院。无围手术期死亡病例。19例患者均进行了随访，随访时间6～80个月，平均45.2个月。1例囊腺癌合并肝脏转移患者于术后7个月死亡，其余良性肿瘤患者均未见复发，最长已存活5年。结论 胰腺囊性肿瘤主要靠影像学检查发现，手术切除是理想的治疗方法，选择合适的术式有助于避免术后并发症的发生和改善预后。