目的 探讨术后早期炎症性肠梗阻的诊断和治疗。方法 对我院1995年至1999年间收治的16例术后早期炎症性肠梗阻患者的临床资料进行回顾性分析。结果 15例患者经胃肠减压、抗生素、理疗、肾上腺皮质激素及中药等治疗治愈，平均治疗时间11天； 中转手术治疗1例，无1例肠坏死。结论 术后早期炎症性肠梗阻的特点有： ①多在手术后7天左右出现梗阻症状，多由腹腔内炎症所致广泛粘连引起； ②症状以腹胀为主，腹痛相对较轻，较少发生肠绞窄； ③治疗应首选非手术疗法。
ObjectiveTo explore the clinical efficacy of two procedures in thoracoscopic anterior mediastinal tumor resection. MethodsA retrospective study was conducted on patients who underwent thoracoscopic anterior mediastinal tumor resection at the Department of Thoracic Surgery, the 910th Hospital of Joint Logistics Support Force from October 2016 to January 2024. Patients were divided into two groups according to the surgical approach: a modified approach group (bilateral intercostal ports+two subcostal ports) and a classic subxiphoid approach group (one subxiphoid port+two subcostal ports). Perioperative data and postoperative improvement of myasthenia gravis (MG) subgroup were compared between the two groups. ResultsA total of 55 patients were included, including 27 males and 28 females with a mean age of 47.5 (21-72) years. There were 23 patients in the modified approach group and 32 patients in the classic subxiphoid approach group. The modified approach group had shorter operation time (129.0±20.5 min vs. 148.9±16.7 min, P<0.001), less intraoperative blood loss (63.0±16.6 mL vs. 75.0±10.8 mL, P<0.001), shorter postoperative drainage tube removal time (3.1±0.4 d vs. 3.9±0.6 d, P<0.001) and shorter postoperative hospital stay (4.2±0.4 d vs. 5.0±0.6 d, P<0.001), and lower proportion of intraoperative cardiac dysfunction [4 (17.4%) vs. 14 (43.8%), P=0.040]. There was no statistical difference in maximum diameter of tumor resected (4.5±1.7 cm vs. 4.0±0.9 cm, P=0.193) and postoperative drainage volume (396.4±121.5 mL vs. 399.9±161.3 mL, P=0.932). There was 1 patient of perioperative collateral injury in the modified approach group (pericardial injury), and 6 patients in the classic subxiphoid approach group (1 patient of diaphragm injury, 1 patient of liver contusion, 4 patients of pericardial injury). There was no statistical difference in pain scores at 24 h, 48 h and 72 h after surgery (P>0.05). The postoperative improvement of myasthenia gravis symptoms in the modified approach group was better than that in the classic subxiphoid approach group at 1 year after surgery (complete stable remission rate: 77.8% vs. 50.0%; effective rate: 100.0% vs. 91.6%). No conversion to open chest surgery occurred in either group, and there were no postoperative rehospitalizations or deaths related to surgery within 30 days after surgery in both groups. ConclusionThe modified approach is safe and controllable with more open surgical field and more reliable complete resection range than the classic subxiphoid approach group.