【摘要】 目的 评价青年人颈动脉彩色多普勒超声检查的临床意义，并探讨青年人脑梗死与颈动脉粥样硬化的关系。 方法 2008年2月-2011年3月，对256例青年脑梗死患者进行颈动脉彩色多普勒超声检测，选择性别和年龄匹配的健康青年143例作对照组，比较两组人群颈动脉彩色多普勒超声特点的差异。 结果 脑梗死组颈动脉粥样硬化斑以中等、强回声斑块为主，斑块积分、血管壁内-中膜厚度（ITM值）及斑块检出率（34.77%，89例）均明显高于对照组（Plt;0.01）；脑梗死组颈动脉硬化狭窄率及血栓发生率明显高于对照组（Plt;0.05，lt;0.01）。 结论 青年脑梗死患者颈动脉粥样硬化及血栓形成发生率均高，提示青年脑梗死患者的发病主要原因与动脉粥样硬化有关。IMT值的增加、斑块的检出率及形态学特征等是颈动脉病变与脑梗死发生的有意义的检测指标，在青年人脑梗死的防治中是有参考意义较大的超声学指标。【Abstract】 Objective To assess the clinical significance of color Doppler ultrasonography in examining carotid arteries of young patients, and explore the relationship between cerebral infarction and carotid arteriosclerosis in young patients. Methods A total of 256 patients with cerebral infarction and 143 people without cerebral infarction diagnosed between February 2008 and March 2011 were assessed by color doppler ultrasonography. The ultrasonic characteristics of the two groups were compared and analyzed. Results Plaques incidence in cerebral infarction group was 81.43% which was higher than that in the control group. The most common sites of plaque formation were common carotid artery (CCA) bifurcate and the initial segment of internal carotid artery (ICA) in young people with cerebral infarction. In the cerebral infarction group, the rate of middle-echoic plaques was higher than that in the control group (Plt;0.05). The rate of low-grade carotid stenosis was higher in the cerebral infarction group than that in the control group (Plt;0.05). Conclusions Cerebral infarction occurrence in young people is closely correlated to carotid artery atherosclerosis. Ultrasonography can provide objective evidences for preventing and treating cerebral infarction.
世界首例成功的全胃切除及消化道重建术（结肠前食管空肠端侧吻合术）1897年由德国人Schlatter完成； 随后Briigham对重建的术式做出了最早的探索，这一食管十二指肠吻合术也是最早的保留十二指肠食物通道功能的术式（Billroth Ⅰ）； 1903年Moynihan提出应加行空肠输入-输出袢之间的侧侧吻合（Braun吻合）； 1947年Orr提出的Roux-en-Y术式是最经典的不保留十二指肠食物通道功能的术式，以它为基础的术式（Billroth Ⅱ）在全胃切除术后的消化道重建中占有主要地位［1］。......
Objective To investigate the significance and surgical skill for lymphadenectomy of No.12a lymph node around proper hepatic artery in gastric cancer. Methods Among data of stageⅣ gastric cancer patients who received curative R0 gastrectomy, sixty-eight patients performed gastrectomy with D2 lymph node dissection, including No.12a lymph node were identified. Experiences and understanding of No.12a lymphadenectomy for gastric cancer were concluded. Results The number of dissected No. 12a lymph node was 556 （5-11 per capita，mean 8.17 per capita） in 68 patients with stageⅣ gastric cancer, and the positive lymph node of No.12a was 33.27% （185/556）. There were no lymphadenectomy related complications： anastomotic leakage, lymphatic fistula， and postoperative hemorrhage in this series. Conclusions Being familiar with the anatomy around proper hepatic artery and intrathecal liberation of proper hepatic artery, ligation of left gastric vein and right gastric artery at its onset, and exposure of gastroduodenal artery’s root and anterior wall of portal vein are important to dissection of No.12a lymph nodes.
ObjectiveTo investigate the relationship between preoperative C-reactive protein (CRP)/albumin ratio (CAR) and National Institutes of Health (NIH) risk classification in patients with gastric stromal tumors.MethodsClinical data of 108 patients with gastric stromal tumors admitted to the First Affiliated Hospital of Kunming Medical University from February 2010 to November 2016 were retrospectively collected. With the median of CAR as the critical value, patients were divided into high CAR group (CAR>0.048) and low CAR group (CAR≤0.048). Then observed the general clinicopathological characteristics and survival status of patients with higher and lower CAR value.ResultsThere were significant differences in NIH classification, tumor diameter, and mitosis between the high CAR group and low CAR group (P<0.05). Compared with the low CAR group, the tumors in the high CAR group had larger diameter, higher mitotic figure, and higher NIH grade. Survival analysis showed that the prognosis of the low CAR group was better than that of the high CAR group (χ2=15.152, P<0.001).ConclusionsCAR is closely related to the malignant index and NIH risk classification of gastric stromal tumors. It can be used as an index for evaluating the malignant degree of gastric stromal tumors, and it is expected to be an important reference factor for clinical NIH risk classification and prognosis.
ObjectiveTo summarize the experience of diagnosis and treatment of a patient with liver and lung metastasis and retroperitoneal metastasis from right colon cancer.MethodsA retrospective analysis of a patient with liver, lung, and retroperitoneal metastasis from right colon cancer who received treatment at The First Affiliated Hospital of Kunming Medical University in August 2016 was conducted. In order to provide reference for domestic doctors to treat advanced colorectal cancer.ResultsAfter receiving several cycles of chemotherapy and three surgical resections of the primary and metastatic lesions before the MDT, the patient again found a retroperitoneal mass. After discussions of Department of Imaging, Oncology, Radiotherapy, and Gastrointestinal and Hernia Surgery, we thought that, at present, the treatment of the patient was mainly surgery and oral chemotherapy. So the patient underwent retroperitoneal tumor resection+abdominal adhesion release, and had been interviewed for 3 months. No recurrence or metastasis was found during follow-up.ConclusionThe therapy of liver-lung metastasis and retroperitoneal metastasis in right colon cancer are mainly based on surgical resection of lesions, postoperative combined with radiotherapy and chemotherapy, molecular targeted therapy, and postoperative monitoring of CEA changes.
ObjectiveTo investigate the surgical skills and clinical effects of the laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair in treatment of recurrent inguinal hernia with plug prefix mesh. MethodsThe clinical data such as operation time, intraoperative blood loss, postoperative hospital stay, and postoperative complications of 87 patients with recurrent inguinal hernia reoperated in laparoscopic TAPP after inguinal hernioplasty with plug prefix mesh (recurrent hernia group), in the Department of Gastroenterology and Hernia surgery of the First Affiliated Hospital of Kunming Medical University from January 2011 to December 2013, were retrospectively analyzed, which were compared with the 834 incipient inguinal hernia patients operated first by TAPP (incipient hernia group) at the same time. ResultsThe operations were completed successfully in all of the 921 patients without conversion to open surgery. The operation time and intraoperative blood loss in the recurrent hernia group were significantly more than those in the incipient hernia group (P=0.000, P=0.000), the postoperative hospital stay had no signifcant difference between two groups (P=0.057). No recurrences were observed in the recurrent hernia group and incipient hernia group for following-up of (31±4) months and (28±6) months, respectively. Compared with the incipient hernia group, the rates of postoperative pain on day 30 and seroma on day 1 and 3 were higher in the recurrent hernia group (P=0.001, P=0.040, P=0.003, respectively). There were no severe complications such as collateral damage, foreign body sensation, incision infection, intestinal obstruction and so on in the two groups. ConclusionsThe laparoscopic TAPP inguinal hernia repair is safe and effective for patients with recurrent inguinal hernia with plug prefix mesh. More skills are required to reduce the complications. The operation time and intraoperative blood loss in reoperated patients with recurrent inguinal hernia are more than those in patients with incipient inguinal hernia. The rates of seroma on day 1 and 3 are also higher.
ObjectiveTo study the efficacy, the operation skills, and the complications of laparoscopic totally extraperitoneal prosthesis (TEP). MethodsThe clinical data of 1 020 patients received TEP from April 2011 to March 2014 were retrospectively analyzed. The oral feeding time, out of bet time, operation time, hospital stay, hospitalization costs, postoperative complications, and so on were recorded. ResultsAmong the 1 020 patients, the types of hernias were 810 indirect inguinal hernias (including unilateral hernia and bilateral hernia), 118 direct inguinal hernias, 24 femoral hernias, and 68 recurrent inguinal hernias. The surgeries were basically successfully completed in all the patients, including 12 cases (both recurrent hernia) of conversion to laparoscopic transabdominal preperitoneal prosthesis (TAPP). All the patients could take food in a day and get out of bed on day 1 after operation. The unilateral operation time was (48±9.8) min, bilateral was (65±8.6) min. The postoperative hospital stay was 0.5-2.0 d, total hospital stay was (3.48±2.40) d, hospitalization costs was (8 958±1 685) yuan. Main complication was 61 (5.98%) cases of seroma, 48 (4.70%) cases of temporary nerve paresthesia, 23 (2.78%) cases of urinary retention, 9 (0.88%) cases of chronic pain, and 5 (0.49%) cases of abdominal artery injury. No incision infection, visceral injury, small intestinal obstruction, and other serious complications happened. No occurrence occurred with following-up for 1 year. Classification of different hernia complications, the statistical analysis showed that the total incidence of complications of the typeⅣwas highest, then which was in sequence of typeⅢ, typeⅡ, typeⅠ(P < 0.001). ConclusionLaparoscopic TEP is a safe, reasonable repair without tension with small incision, lighter abdominal interference, less pain, early return to normal activities, but it is a difficult technology and has a higher cost.