目的 提高对腹茧症的认识和临床诊治水平。方法 回顾性分析我院1995～2008年期间收治的9例腹茧症患者的临床资料。结果 9例患者中5例以急、慢性肠梗阻症状为主要表现，结合CT、彩超、腹部X线平片等检查，2例术前诊断为腹茧症。9例患者经手术治疗后均获得成功。8例得到随访，随访时间6～84个月,平均(26±13)个月，2例分别于术后3及10个月出现肠梗阻，经保守治疗后治愈，其余无相关手术并发症发生。结论 患者反复有肠梗阻表现而梗阻原因不明或出现腹部包块，需结合合理的影像学检查考虑腹茧症的可能； 手术是本病诊断和治疗的有效手段。
ObjectiveTo investigate the clinicopathological characteristics and prognosis of elderly patients with colon cancer. MethodsThe clinicopathological and followup data of patients with colon cancer were compared retrospectively between those older than 60 years (405 patients) and those younger than 40 years (146 patients). ResultsFamily history, comorbidities, preoperative intestinal obstruction, and differentiation grade were significantly different between two groups (P＜0.05). The 5-year survival rate of patients in elder group and younger group was 64.9% and 56.8% respectively, and there was significant difference （P＜0.05）. The multivariate analysis indicated that the independent predictors of survival were comorbidities, perioperative CEA level, preoperative intestinal obstruction, tumor gross type, lymph node metastasis, hepatic metastasis, and TNM stage. ConclusionPatients older than 60 years with colon cancer have unique clinicopathological characteristics and better prognosis. The independent predictors of survival are comorbidities, perioperative CEA level, preoperative intestinal obstruction, tumor gross type, lymph node metastasis, hepatic metastasis, and TNM stage.
Objective To discuss the clinicopathologic risk factors related to local recurrence of rectal cancer after radical surgery. Methods The complete clinicopathologic data of 368 patients with rectal cancer from January 2004 to April 2011 in this hospital were retrospectively analyzed by univariate and multivariate analysis methods. Results There were 73 cases suffered from local recurrence and accounted for 19.84% （73/368） of rectal cancer during the same period. Univariate analysis results showed that gender， tumor from anal margin， tumor circumference， TNM staging， histology type， vessel infiltration， tumor perforation， stomal leak， and chemoradiotherapy were associated with postoperative recurrence （P＜0.05）. Multivariate analysis results showed that tumor from anal margin， tumor circumference， TNM staging， histology type， vessel infiltration， tumor perforation， and chemoradiotherapy were prognostic factor for local recurrence of rectal cancer （P＜0.05）. Conclusions There are many factors related to postoperative local recurrence， but the most dangerous factor is vessel infiltration.
目的 探讨老年患者特发性结肠穿孔的临床特点。方法回顾性分析我科2000年5月至2010年5月期间收治的28例特发性结肠穿孔老年患者的临床资料。 结果28例患者中男16例，女12例; 年龄60～87岁，中位年龄69.2岁。所有患者表现为急性腹痛或腹膜炎； 术前5例确诊，23例误诊； 均行急诊剖腹探查手术，穿孔位于乙状结肠与直肠交界处有18例，位于降结肠4例，乙状结肠中段5例，直肠上段1例。 8例行穿孔部位结肠外置，再择期行二次手术； 16例行乙状结肠下段及直肠上段切除、结肠造瘘术； 4例行病变部位一期切除吻合、回盲部导管减压引流术。术后病理报告: 结肠壁局灶性炎性反应坏死，穿孔边缘清楚，肌层断裂整齐，黏膜剥脱，其中10例伴黏膜溃疡。 住院时间为2～4周，平均2.6周。 20例患者痊愈出院，死亡8例，其中4例死于中毒性休克，2例因吻合口漏并发腹腔脓肿死于严重感染和多器官功能衰竭，2例死于并发肺部感染、呼吸衰竭。 结论诊断性腹腔穿刺及CT检查对老年患者的特发性结肠穿孔诊断极为重要，一旦确诊或疑诊应尽早手术治疗。
【摘要】 目的 探讨急性假性结肠梗阻的临床诊断与治疗。方法 回顾性分析24例急性假性结肠梗阻患者的临床资料。结果 24例患者均有机械性肠梗阻的临床表现。12例经保守治疗治愈； 6例经结肠镜结合中西医药物治疗治愈； 6例行手术治疗，其中4例因误诊为器质性结肠梗阻而手术，2例死亡。结论 要提高对急性假性结肠梗阻的认识，多数急性假性结肠梗阻可通过非手术方法治愈，在采取积极保守治疗的同时，通过临床仔细分析可与器质性结肠梗阻相鉴别，要严密观察患者腹部体征，防止肠穿孔等并发症的发生。
Objective To investigate the pathological features， diagnosis， treatment， and prognosis of multiple primary colorectal cancer （MPCC）. Methods Clinical data of 41 patients with MPCC treated in The Fourth Affiliated Hospital and The First Affiliated Hospital of China Medical University from Aug. 1993 to Mar. 2009 were retrospectively analyzed. Results Forty one patients with MPCC， including 29 patients with synchronous colorectal cancer （SCC） and 12 patients with metachronous colorectal cancer （MCC）， accounted for 1.8% （41/2 340） of colorectal cancer during the same period of time， and with adenomatous polyps in 19 cases and polyps canceration in 10 cases. Among 29 patients with SCC， 15 cases （51.7%） were diagnosed by preoperative fiberoptic colonoscopy， 9 cases （31.0%） were diagnosed by preoperative fiberoptic colonoscopy， abdomen CT， and barium enema， 5 cases （17.2%） were diagnosed by intraoperative exploration and intraoperative fiberoptic colonoscopy， respectively. All of the 12 patients with MCC were diagnosed by preoperative fiberoptic colonoscopy and abdomen CT. For 29 patients with SCC， tumor locations were from proximal appendix to distal rectum， but 12 patients with MCC were adverse. Sixty-five （77.4%） tumors were tubular or papillary adenocarcinoma， and 56 （66.7%） tumors were well and moderately differentiated adenocarcinoma. The TNM stage of most tumors （72） was stageⅡ or Ⅲ phase， account for 85.7%. Radical surgeries were performed in 37 patients and palliative surgeries in 4 patients， and there were no complications after operation. During the follow-up for 3-5 years （mear 3.6 years）， the overall survival rate of 3- and 5-year were 48.8% （20/41） and 34.1% （14/41）， respectively. In detail， 3-year survival rate of SCC group and MCC group were 48.3% （14/29） and 50.0% （6/12）， respectively；5-year survival rate were 31.0% （9/29） and 41.7% （5/12）， respectively. Conclusions Cause of MPCC has not been clear， but it has possible relationship with adenomatous polyps. Preoperative fiberoptic colonoscopy， abdomen CT， and barium enema are very important for patients with SCC， and intraoperative fiberoptic colonoscopy is also necessary. Patients with MCC should enhance postoperative follow-up with fiberoptic colonoscopy. Further more， radical resection should be performed as early as possible.
Objective To investigate the relationship between the expressions of mismatch repair （MMR） genes （include hMLH1 and hMSH2） and clinicopathological features and prognosis of hereditary nonpolyposis colorectal cancer （HNPCC）. Methods Immunohistochemistry method （Elivision-two step） was used to test expressions of hMLH1 and hMSH2 proteins （both hMLH1 and hMSH2 protein-positive delimited as MMR protein-positive） in 48 patients with HNPCCaccording to revised Bethesda guidelines， and analyzed the relationship between the expression of MMR protein and clinicopathological features and prognosis of HNPCC. Results Loss rate of hMLH1 protein （20.83%，10/48） was signi-ficantly higher than that of hMSH2 protein （8.33%，4/48）， Ρ＜0.05， and positive expression rate of MMR protein was 70.83% （34/48）. Expression of MMR protein was related with tumor infiltration depth （Ρ＜0.05）. Survival rate of patients with expression and without expression of MMR protein was 85.29% （29/34） and 85.71% （12/14）， respectively， the survival curves of them didn’t significantly differed from each other （Ρ＞0.05）. Conclusions Loss rate of hMLH1 protein is higher than that of hMSH2 protein. Expre ssions of hMLH1 and hMSH2 protein are related with tumor infiltration depth， but not related with prognosis.
Objective To investigate the features of extracolonic carcinoma spectrum in Northeast Chinese with hereditary nonpolyposis colorectal cancer. Methods The extracolonic carcinoma spectrum’s characteristics of 85 families registered in strict conformity with the HNPCC Amsterdam criteriaⅡwere analyzed retrospectively. Results In the 85 HNPCC families， the tumorous patients were 509 cases，the primary tumors were 589 cases， among the total consisted of 219 cases of colon cancer， 91 cases of rectal cancer，and 279 cases of extracolonic cancer， the most common extracolonic carcinoma was lung cancer. Conclusions Extracolonic carcinoma is an important part of cancer spectrum in HNPCC family， and the common extracolonic carcinoma in Northeast of Chinese are lung cancer， gastric cancer， endometrial cancer， liver cancer， and esophagus carcinoma.
ObjectiveTo investigate the effects of problem-intervention-outcome (P-I-O) teaching method on the normalization training of new nurses. MethodsA total of 101 new nurses from 2011 to 2013 were included in this research. Forty-two new nurses who were invited from August 2011 to July 2012 were distributed into group A, and 59 new nurses who were invited from August 2012 to July 2013 were distributed into group B. Both groups accepted normalization training. Group B accepted P-I-O teaching at the same time. We assessed the differences in operating, theory, attendance, the rates of harmful events and the degree of satisfaction between the two groups. ResultsTheory and operating between the two groups had significant differences (t=3.44, 2.86; P<0.05). Attendance, rates of harmful events and the degree of satisfaction all had significant differences between the two groups (t=2.94, χ2=8.45, Z=-2.05; P<0.05). ConclusionThe application of P-I-O teaching method in the normalization training of new nurses can stimulate their study interest and enthusiasm, transit their role faster, as well as reduce the rates of clinical harmful events and elevate the quality of care. Thus, it is worthy of being popularized in clinical nursing care.