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人体脂肪及α-糜蛋白酶联合腹腔灌注预防肠粘连的实验研究

The Value of Multi-slice Spiral CT Enterography in Diagnosing Crohn’ s Disease

目的　探讨多层螺旋CT（MSCT）在肠道Crohn病（CD）诊断中的应用价值。 方法　回顾性分析2009年2月－2012年2月经综合方法确诊为CD的41例患者的MSCT表现，分析病变肠管的部位、肠壁的厚度和增强后病变肠壁的强化程度及并发症。 结果　41例中，患病肠段多节段性受累36例（87.8%），单独小肠受累16例（39.0%），小肠和结肠同时受累23例（56.2%），单独结肠受累2例（4.8%），回肠末段受累36例（87.8%），盲肠或升结肠受累22例（53.7%）。41例肠壁均见不同程度的强化及环形增厚；28例（68.3%）表现肠壁分层；23例（56.1%）表现为系膜纤维脂肪增生、蜂窝织炎，16例（39.0%）系膜血管增多，呈“梳样征”，20例（48.8%）伴有系膜及腹膜后淋巴结肿大；6例（14.6%）并发不全肠梗阻，并发瘘管穿孔1例（2.4%）。 结论　MSCT可同时显示CD的小肠和结肠病变，对肠壁病变及肠腔外并发症的显示以及在判断病变活动性方面有独特的优越性，对指导临床治疗具有重要意义。

肺功能不全食管癌患者的围手术期处理

目的 探讨肺功能不全食管癌患者围手术期的治疗措施，总结治疗经验。 方法 回顾性分析武钢总医院2001年1月至2009年1月手术治疗76例肺功能不全食管癌患者的临床资料，其中男52例，女24例；年龄49～80岁，平均年龄62.5岁。术前经戒烟、预防和控制呼吸道感染、呼吸道雾化吸入或应用解痉化痰药物，呼吸功能锻炼和氧疗以改善肺功能。行左后外侧切口食管癌根治术26例，右胸前外侧切口、上腹部正中切口手术（Ivorlewis术式）33例，颈、胸、腹三切口手术17例，术后施行静脉自控镇痛(PCIA)、抗感染、解痉化痰、保持呼吸道通畅、营养支持和氧疗；部分患者予以呼吸支持。 结果 全组76例中，19例术后行机械通气支持，术后发生肺部并发症9例，心律失常5例，颈部吻合口漏1例；无围术期死亡，所有患者均痊愈出院。术后均获得随访，随访时间3～6个月，均恢复良好，无手术相关并发症。 结论 严谨的围手术期处理和肺保护是肺功能不全食管癌患者手术成功的重要因素。

悬吊拉钩在经腹行全胃及近端胃切除术中的应用体会

我院从1997年至今应用悬吊拉钩开腹切除胃中上部恶性肿瘤116例，男74例，女42例，年龄20～81岁，平均62岁。其中贲门癌38例，胃底癌11例，胃体癌67例。主要表现为上腹疼痛、腹胀、呕吐、呕血、解黑便及腹部包块等。术前均作胃镜或X线钡餐检查，术后病理学诊断浸润型腺癌6例，粘液型腺癌8例，溃疡型腺癌51例，低分化腺癌26例，印戒细胞癌13例，胃平滑肌肉瘤7例，胃恶性淋巴瘤4例，胃体低分化间质肉瘤1例。手术方法： 应用悬吊拉钩经腹行上半胃切除45例，全胃切除71例，其中联合脏器一期切除17例。近端胃大部切除术后食管断端与胃断端大弯侧吻合45例，全胃切除术后食管与空肠RouxenY吻合12例，端侧ρ型吻合及空肠、空吻Y型吻合27例，Braun’s吻合32例。

Laparoscopic-Assisted Radical Gastrectomy in Distant Gastric Cancer (Report of 18 Cases)

Objective　To investigate the feasibility and safety of laparoscopic-assisted gastrectomy for distant gastric cancer. Methods　All 18 patients with distant gastric cancer receiving laparoscopic-assisted gastrectomy were analyzed. Results　Laparoscopic-assisted distal gastrectomy was performed successfully in all patients. The mean operation time was (291.33±19.61) min. The mean blood loss was (151.32±71.78) ml. The mean numbers of harvested lymph node were 14.57±3.11. The mean time of gastrointestinal function recovery was (3.46±0.93) d, the mean out of bed activity time was (1.75±0.45) d. All patients were followed up for 1-24 months, mean 11 months. No local recurrence, trocar implant or distant metastasis happened. Conclusion　Laparoscopic-assisted gastrectomy is a feasible and safe surgical procedure combined with minimal trauma and fast recovery.

推进腓肠肌皮瓣修复跟腱开放性缺损

目的 探讨跟腱开放性缺损的治疗方法及临床效果。 方法 2001 年5 月－ 2008 年8 月，采用推进内外侧腓肠肌联合肌皮瓣治疗8 例外伤致跟腱开放性缺损。男5 例，女3 例；年龄15 ～ 36 岁，平均25 岁。左足3 例，右足5 例。伤后至手术时间为7 ～ 65 d。创面范围6.0 cm × 4.5 cm ～ 8.0 cm × 6.5 cm。跟腱缺损长度为5.0 ～ 7.5 cm，平均6.0 cm。术中肌皮瓣切取范围为22.5 cm × 7.8 cm ～ 28.0 cm × 11.5 cm，供区皮肤行V-Y 推进缝合。 结果 术后第2 天3 例肌皮瓣出现张力性水疱，经对症处理后成活；其余肌皮瓣均顺利成活，创面Ⅰ期愈合。供区切口Ⅰ期愈合。术后患者均获随访，随访时间6 个月～ 7 年，中位时间2 年3 个月。术后肌皮瓣质地、外观满意。末次随访时，按Arner-Lindholm跟腱损伤疗效评定标准，获优6 例，良2 例。 结论 内外侧腓肠肌联合肌皮瓣具有感觉、耐磨、对供区影响较小，是修复跟腱开放性缺损较理想的组织瓣。

肺部超声在重症患者的应用及研究进展

Short-term effectiveness of lateral raft plate combined with Jail screw fixation in treatment of tibial plateau collapse fractures involved posterior-lateral column

Objective To investigate the short-term effectiveness of proximal tibial lateral raft plate combined combined with or without Jail screw fixation in the treatment of tibial plateau collapse fractures involved posterior-lateral column. MethodsA retrospective analysis was performed on 106 patients (106 knees) with tibial plateau collapse fracture involved posterior-lateral column admitted between January 2016 and January 2021. According to the combination with Jail screw fixation or not, patients were divided into control group (treated by lateral raft plate without Jail screw fixation, 52 cases) and study group (treated by lateral raft plate with Jail screw fixation, 54 cases). There was no significant difference between the two groups in terms of gender, age, affected knee side, cause of injury, Schatzker classification, Tscherne-Gotzen classification, time from injury to operation, and preoperative lateral tibial plateau posterior slope angle (PSA), tibial plateau varus angle (TPVA), Rasmussen anatomical score (P>0.05). The operation time, cumulative fluoroscopy time, intraoperative blood loss, hospitalization stay, fracture healing time, complications, and lateral tibial plateau PSA, TPVA, Rasmussen anatomical score detected by X-ray films and CT before operation and at 1 year after operation of the two groups were recorded and compared. The number of cases of articular surface collapse in the two groups was recorded at 1 year after operation, and the effectiveness was evaluated by American Special Surgery Hospital (HSS) score. ResultsAll patients were followed up 12-32 months (mean, 19.5 months). There was no significant difference between the two groups in operation time, cumulative fluoroscopy time, intraoperative blood loss, hospitalization stay, and fracture healing time (P>0.05). There were 2 patients (3.7%) in the study group and 3 patients (5.8%) in the control group with superficial wound infection, which were cured after debridement and dressing change. There was no significant difference in the incidence between the two groups (χ2=0.252, P=0.616). There was no complication such as vascular and nerve injury, internal fixation failure, nonunion or malunion of fracture, and deep vein thrombosis of lower limbs in both groups. At 1 year after operation, 9 cases (17.3%) in the control group had joint collapse of 2-3 mm, while only 2 cases (3.7%) in the study group had joint collapse, showing significant difference (χ2=5.271, P=0.022). At 1 year after operation, the PSA, TPVA, and Rasmussen anatomical scores of the two groups were significantly improved when compared with preoperative ones (P<0.05); the differences of pre- and post-operative PSA, TPVA, Rasmussen anatomical score, and postoperative HSS score in the study group were significantly better than those in the control group (P<0.05). ConclusionThe lateral raft plate combined with or without Jail screw fixation can achieve satisfactory short-term effectiveness in the treatment of tibial plateau collapse fractures involved posterior-lateral column. Combined with Jail screw, it can enhance the fixation and avoid the occurrence of secondary articular surface collapse, which can be used as a better choice.