Objective To compare the efficacy of incision healing by abdominal wall closure measure without suturing subcutaneous fat layer and the traditional abdominal wall closure measure. Methods Four hundreds patients underwent operation of abdominal median incision and abdominal paramedian incision from Sep. 2010 to Sep. 2012 in our department were randomly assigned to observation group （n=199） and control group （n=201）. The patients in obser- vation group underwent abdominal wall closure measure without suturing subcutaneous fat layer， and those of control group were subjected to abdominal wall closure by traditional layer suture technique. Comparison of efficacy of incision healing in the 2 groups was performed. Results The incidences of fat liquefication 〔1 （0.5%） vs.18 （9.0%）〕， incision swelling 〔3 （1.5%） vs.16 （8.0%）〕， incision induration 〔1 （0.5%） vs.15 （7.5%）〕， and dehiscence of wound 〔0 （0） vs.9 （4.5%）〕 in observation group were significantly lower than those of control group （P＜0.01）， but there was no significant difference in incidence of subcutaneous hematoma 〔2 （1.0%） vs.0 （0）， P＞0.05〕. The rate of primary healing in obser-vation group was significantly higher than those of control group 〔199 （100%） vs.186 （92.5%）， P＜0.01〕. Duration of abdominal closure 〔（13.0±1.6） min vs.（18.0±2.2） min〕 and postoperative hospital stay 〔（7.7±1.3） days vs.（9.6±1.9） days〕 were all shorter than those of control group （P＜0.01）. Conclusion The abdominal wall closure measure without suturing subcutaneous fat layer is obviously more effective to the traditional layer suture technique， which is a suture way worthy to spread.
目的观察持续冲洗负压引流技术在腹部外科应用的临床效果。方法回顾性分析2006年1月至2011年3月期间我院将自制双套管实施持续冲洗负压引流技术应用于172例腹部外科患者的临床资料。结果全部患者的消化道瘘均治愈，瘘道愈合的平均时间为36 d。治疗过程中，1例患者出现上消化道出血，另1例出现腹腔出血，无腹腔感染、皮肤破溃感染、脓毒症等并发症。结论采用持续冲洗负压引流的双套管制作简单，经济有效，在腹部外科中对术后肠瘘、出血、胆汁漏及感染的防治具有重要临床意义。
医学影像学是临床医学科学中发展较快的学科之一。为了将影像检查技术合理、高效、及时地应用于临床，为患者服务，需要影像医师与临床医师的密切合作。在具有一定学术地位和雄厚技术力量的本院放射科的鼎力支持与合作下，本刊自2003年第1期起增设“腹部影像”专栏，旨在为腹部外科医师和腹部影像医师搭建起一个学术交流的桥梁，促进相互了解、认识、渗透与合作，使腹部外科医师能及时了解到影像学检查手段的进展和影像医学的发展，又能使影像医师了解到腹部外科医师对影像检查的具体要求，从而一方面使影像学检查技术更好地为腹部外科服务，另一方面又使腹部外科促进影像学检查的合理化和提高影像诊断水平。基于这一宗旨，本栏目将着重推出一些具有特色、图文并茂的综述性文章，作为让腹部外科医师了解腹部影像学现状与进展的的窗口。同时，我们也将选登一些与腹部外科密切相关、临床实用性比较强的腹部影像学方面的原著介绍给腹部外科医师。此外，有关影像学检查的新技术、新方法以及它们在腹部疾病诊治中的临床应用的短篇文章或报道也将是我们选稿的重点。我们殷切希望，本刊增设的这一新栏目能够得到外科医师和影像医师的认可和支持，并让大家从中获得有用的信息。我们相信，在主编、各位编委和杂志编辑部的共同努力下，特别是有广大读者的支持和鼓励，背靠华西放射的雄厚技术力量，我们有信心把腹部影像专栏办好，实现它的宗旨，更好地为临床工作服务。
To evaluate the process from systemic inflammatory response syndrome (SIRS) to multiple organ dysfunction syndrome (MODS) and probe the therapeutic strategies for elderly patients, we retrospectively studied the clinical data of SIRS and MODS in 292 elderly patients with surgical abdominal emergency. Results: On admission, the morbidity rate of SIRS was 41.1%. Afterwards the morbidity rate of MODS was 14.2%, and the mortality rate of the elderly patients with SIRS was 11.7%. After 48 hours of therapy, MODS was developed in 40.5% of the cases also with SIRS. Of all the 292 elderly patients, 19 cases (6.5%) developed MODS and 16 patients (84.2%) died. Conclusion: The outcome of the patients with surgical abdominal emergency may be improved if SIRS is early diagnosed, the cause of SIRS after 48 hours therapy is well defined and the body inflammatory response is properly regulated.
This paper reports hat there are 55 cases of complex obdominal surgical diseases in 1422 patients admited for cholecystectomy. 16 of 55 were maliglant diseases, such as gastric carcinoma, gallbladder carcinoma, pancreatic carcinoma, etc, and the others were benigh diseases (cholecysto-duodenal fistula, cholecysto-transverse colonic fistula, petic ulcer…).All the 1422 patients operated in by open cholecystectomy and the mentioned complex obdominal surgical diseases were treated at the samw operative time with cholecystectomy. Such complex surgical diseases could not be treated at the same time, if the operations were laparoscopic chlecystectomy.
【摘要】 目的 探讨强化益生元膳食纤维的肠内营养在腹部外科术后患者中的临床应用。 方法 2008年7月-2010年11月30例接受腹部外科中等以上手术的患者术前随机分为研究组和对照组，每组15例。研究组患者于术后接受肠内营养，并予以强化益生元膳食纤维；对照组只接受相同的肠内营养支持。观察指标为术后感染并发症、胃肠道并发症、住院时间、抗生素治疗时间、C反应蛋白水平和病死率等。 结果 研究组术后住院时间为（10±5） d，对照组为（15±7） d，两组差异有统计学意义（t=2.251，P=0.033）；研究组C反应蛋白水平为（6.6±3.2） mg/L，对照组为（9.8±2.1） mg/L，两组差异有统计学意义（t=3.238，P=0.003）；研究组抗生素治疗时间为（5.0±3.5） d，对照组为（6.0±4.8） d，两组差异无统计学意义（t=0.652，P=0.520）。两组均无死亡病例；术后研究组2例发生感染并发症，对照组3例，两组感染并发症发生率差异无统计学意义（P=1.000）。两组患者均能耐受经肠内补充营养素。 结论 与常规肠内营养比较，给予强化益生元膳食纤维的肠内营养能减少腹部外科术后患者的住院时间，降低急性期炎症反应。【Abstract】 Objective To investigate the effect of early enteral supply of prebiotic fiber in patients undergoing major abdominal surgery. Methods Between July 2008 and November 2010, 30 patients undergoing major gastrointestinal surgery were randomized into the study group and the control group before operation with 15 patients in each group. Prebiotic fiber was administered combined with enteral nutrition support for patients in the study group. Patients in the control group only received conventional enteral nutrition without fiber. The main endpoints included the development of bacterial infection, the duration of hospital stay, antibiotic therapy, the serum level of C-reaction protein (CRP), side effects of the enteral nutrition and morbidity. Results Compared with the control group, the median duration of hospital stay was shorter in the study group [(15±7) days in the control group vs. (10±5) days in the study group; t=2.251, Plt;0.05]. The mean level of CRP was also lower in the study group [(6.6±3.2) mg/L] than that in the control group [(9.8±2.1) mg/L] (t=3.238, Plt;0.05). The enteral nutrition and fibers were well tolerated. The incidence of infectious complications (3 cases in the control group vs. 2 cases in the study group) and the median duration of antibiotic therapy [(6.0±4.8) days in the control group vs. (5.0±3.5) days in the study group] were not significantly different between the two groups (t=0.652, Pgt;0.05). No patients died in both the two groups. Conclusion Compared with the conventional enteral nutrition, early enteral supply of prebiotic fiber can reduce the duration of hospital stay and acute phase response.
目的探讨哈乐预防腹部手术后尿潴留的临床价值。方法哈乐组于拔尿管前1 d开始用哈乐0.2 mg，1次/d，3～5 d； 对照组未予特殊药物治疗。比较2组的尿潴留发生率、尿路感染发生率、住院时间和副作用。结果哈乐组未发生尿潴留，对照组尿潴留发生率为28%，差异有统计学意义(P＜0.05)。哈乐组无一例发生尿路感染，对照组有5例（20%），2组间差异无统计学意义（Pgt;0.05）。哈乐组术后平均住院时间为（10.7±3.3） d，对照组为（11.6±3.0) d，2组间差异亦无统计学意义（Pgt;0.05）。 结论哈乐可明显减少尿潴留的发生率，是预防腹部手术后尿潴留的有效药物。