目的 总结对粪石性小肠梗阻患者的诊治经验。方法 对我院2000～2012年期间收治的45例成人粪石性小肠梗阻患者的病史、X射线表现、CT表现、治疗情况等进行回顾性分析。结果 本组有22例患者发病前曾进食柿子、山楂或黑枣，7例有胃部手术史，9例患有糖尿病。39例行腹部CT，其中35例可见小肠扩张与萎陷肠管移行区椭圆形斑点状团块。22例经非手术治疗缓解，随访2～3个月无肠梗阻复发；23例行剖腹探查，其中1例于术后21 d死于急性呼吸窘迫综合征，其余均治愈。结论 进食富含鞣酸食物史、胃部手术史、糖尿病史、典型螺旋CT表现是诊断的关键因素，部分患者可经保守治疗缓解，若保守治疗无效，则行手术探查，手术应先试行手法碎石，并全程探查胃肠道以避免多发粪石残留。
Objective To evaluate the efficacy of preoperative concurrent chemoradiotherapy combined with total mesorectal excision （TME） in treatment for locally advanced lower rectal cancer. Methods The clinical data of 31 patients with locally advanced lower rectal cancer received concurrent chemoradiotherapy from January 2009 to December 2011 in this hospital were analyzed retrospectively. Conventional fraction radiotherapy with total dose 50 Gy and chemotherapy with mFOLFOX6 or CapeOX regimen were taken. The efficacy was assessed by recording results of clinical and pathological examination. The function of sphincter was also recorded. Results All 31 patients underwent TME operation. The complication morbidity and mortality was 12.9% （4/31） and 3.2% （1/31），respectively. As a result of the preoperative management，the tumor was reduced by an average of 21.9%， down-regulation of T stage was observed in 48.4% （15/31） patients，the frequency of lymph node metastasis decreased from 83.9% （26/31） to 38.7% （12/31）. Pathological complete response was observed in 5 patients （16.1%） and the total response rate was 74.2% （23/31），grade 3/4 toxicity was occurred in 2 （6.5%） patients. 84.6% （22/26） of patients underwent sphincter preservation surgery reserved good function of sphincter. Conclusions Preoperative concurrent chemoradiotherapy combined with TME in treatment for locally advanced lower rectal cancer is effective and safe，which can lead to pathological complete response，decrease the tumor stage and the rate of lymph node metastasis，and can also increase the efficacy of operation.
ObjectiveTo discuss the indications of the nonoperative management for perforated peptic ulcer. MethodsClinical data of 145 patients with perforated peptic ulcer, aged below 70 years old, with first attack and onset timelt;12 h , admitted to our hospital between January 2002 and December 2009, were analyzed respectively. Patients who were negative for fluid of abdominopelvic cavity in ultrasound examination and leakage in watersoluble contrast examination received nonoperative management, otherwise underwent operation directly (If the patients were being on medication for the ulcer, they should also go directly to surgery). Non-operative patients were converted to operation if the symptom had not relieved during the first 12 h. When admitted , the APACHE Ⅱ score was calculated for all patients. ResultsSeventy-four and 71 patients underwent non-operative management and operation directly respectively. Sex, age, onset time, perforation site and so on were comparable between the two groups （Pgt;0.05）, while APACHE Ⅱ score over 8 was 25.7% and 76.1% respectively with significant difference (P=0000). In nonoperative group, 11 (149%) patients were converted to operation. The mortality (4.1% vs 9.8%, P=0.203), mobility (16.2% vs 25.3%, P=0.175), hospital stay 〔(11.4±2.5) d vs (11.3±1.3) d, P=0.447〕, and cost 〔(11 657.3±2 826.4) yuan vs (10 013.0±1 877.4) yuan, P=0.212〕 between two groups had also no significant difference. The mean APACHE Ⅱ score was significant different between the survivors and the dead (9.3 vs 20.2, P=0.000). APACHE Ⅱ score was positively related to mortality and morbility （r=0.98, P=0.000； r=0.52, P=0.000）. ConclusionsNon-operative management is a safe and effective way in selected patients with perforated peptic ulcer, such as APACHE Ⅱ score ≤8, negative for fluid of abdominopelvic cavity in ultrasound examination, and leakage in water-soluble contrast examination. APACHE Ⅱ score is an important factor in prognosis of these patients.