目的 探討成人先天性巨結腸的診斷和外科治療。 方法 回顧性分析1990年1月至2004年12月我院收治的8例成人先天性巨結腸患者的臨床資料。結果 男6例，女2例，年齡19~49歲，平均31歲，均行手術治療，其中2例因急性腸梗阻行結腸造瘺術，另6例患者行Duhamel手術一期切除，其中2例行Kocker鉗夾法，4例采用吻合器吻合，保留端腸管術中冰凍病理檢查均可見神經節細胞。8例患者隨訪至今無復發，生活質量佳，排便功能良好，男性患者無性功能障礙。結論 Duhamel手術是治療成人先天性巨結腸的有效方法，吻合器吻合可明顯減輕患者的痛苦，術后無復發，排便功能及性功能良好，值得臨床推廣。
目的 觀察吻合器痔上黏膜環形切除釘合術（PPH）治療直腸前突所致便秘的臨床療效。方法 回顧性分析我科2008年1月至2012年1月期間經PPH治療的104例女性直腸前突致便秘患者的手術經過及術后療效。結果 本組104例均手術順利，手術時間13～35min，平均21min；住院時間3～7d，平均4.5d；無直腸陰道瘺、肛周膿腫、肛門狹窄等并發癥發生。術后2周均常規行肛門指檢，3例局部輕度炎癥，給予抗炎對癥治療后癥狀消失。5例吻合口局部吻合釘未完全脫落，給予取出后不適癥狀消失。術后隨訪1～5年（平均3年），隨訪率為97.12%（101/104），臨床癥狀完全消失99例，治愈率為95.19%；癥狀好轉5例，該5例行排糞造影檢查，直腸前突均明顯減輕，且便秘癥狀明顯緩解。結論 PPH治療女性直腸前突所致便秘安全、有效，便秘癥狀緩解明顯，是一種適合臨床應用的手術方式。
ObjectiveTo systematically review the efficacy and safety of nickel-titanium shape memory alloy compression anastomosis clip (Ni-Ti CAC) for gastrointestinal anastomosis. MethodsThe Cochrane Library, PubMed, Web of Knowledge and CBM databases were searched for the randomized controlled trials (RCTs) that investigated the efficacy and safety of Ni-Ti CAC versus surgical stapler for gastrointestinal anastomosis. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data and evaluated the methodological quality of the included studies. Then meta-analysis was performed using RevMan 5.2. ResultsEight RCTs involving 457 patients were included in the meta-analysis. The results of meta-analysis showed that, compared with the surgical stapler group, the Ni-Ti CAC group was superior in operation time (MD=-8.30, 95%CI-15.58 to-1.02, P=0.03), food intake (MD=-0.37, 95%CI-0.70 to-0.03, P=0.03), bowel movement (MD=-1.13, 95%CI-1.67 to-0.59, P < 0.000 1), passing gas time (MD=-0.30, 95%CI-0.55 to-0.06, P=0.01), and length of hospital stay (MD=-1.04, 95%CI-1.35 to-0.74, P < 0.000 01), with significant differences. No significant difference was found in anastomosis time (MD=-1.84, 95%CI-3.91 to 0.22, P=0.08). As for safety, no significant difference was found in anastomosis-related complications between both groups. ConclusionCurrent evidence shows that Ni-Ti CAC achieves better efficacy and safety in gastrointestinal anastomosis compared with surgical stapler.
Objective To evaluate the role of curved-cutter-stapler in anus-preserving for low rectal cancer. Methods The clinical data of 32 patients with low rectal cancer from June 2007 to December 2008 who received low anterior resection and ultra low anterior resection by using curved-cutter-stapler were reviewed retrospectively. Results No operation death case, complete cutting and safe closure in all cases, one case was complicated with anastomotic leakage, and one case of rectovaginal fistula. Thirty patients were followed up 4 to 22 months after the operation, with an average time of 12.6 months, no hemorrhea of pelvic cavity and anastomotic stoma or anastomotic stenosis cases. Conclusion Curved-cutter-stapler has the advantages of complete cutting, safe closure and low complications, and easy being used in anus-preserving operation for low rectal cancer, which can increase the rate of anus-preserving.
Objective To evaluate the effect of mechanical suture in surgery of esophageal carcinoma,Methods Five hundred and sixty-eight cases of esophagogastrostomy and esophagojejunostomy for esophageal and cardiac carcinoma were collected in our hospital between January, 1988 and December, 2002. They were devided into two groups according to the methods of anastomoses, the group by stapler and the group with hand. The incidence of postoperative complications in the two groups was compared. Results The time of esophagogastrostomy, the total operating time, and postoperative fasting time of group by stapler were shorter than those of group with hand （Plt;0. 01）, and there was no statistically difference in the median hospitalized time after operation for two groups. The anastomotic leakage, anastomotic stricture, anastomotic bleeding , incidence of postoperative complications in respiration and circulation and mortality rate of group by stapler were lowed than those of group with hand （2.1%, 1.4%,0%,2.8% and 0.7% vs.6.8%,4.3%,1.4%,16.5% and 2.9%）. There was no statistical difference in the postoperative gastro-esophageal reflux for two groups （P 〉 0.05 ）. Conclusion The median time of esophagogastrostomy and the median operating time by stapler are decreased and the incidence of postoperative complications is decreased.
ObjectiveTo evaluate the safety of shearing fracture ligation combining procedure for prolapse and hemorrhoids （PPH） in treatment for mixed hemorrhoids via a multicenter clinical study. MethodsTwo hundred and fortysix patients with mixed hemorroids were included from four a level of firstclass hospitals, which were averagely divided into shearing fracture ligation combining PPH group, PPH group, and shearing fracture ligation group according to the order of admission. The occurrence status of rectovaginal fistula, urethrorectal fistula, postoperative bleeding, acute urinary retention, anorectal stenosis, and anal incontinence were observed. And the anal function was evaluated by the anorectal pressure measurement. ResultsNo rectovaginal fistula or urethrorectal fistula happened among three groups. No anorectal stenosis happened in the shearing fracture ligation combining PPH group or the PPH group. The score of anorectal stenosis and anal incontinence in these two groups were lower than those in the shearing fracture ligation group (Plt;0.05). The rate of postoperative bleeding in the shearing fracture ligation combining PPH group was lower than that in the shearing fracture ligation group (Plt;0.05). There were acute urinary retentions happened among three groups, but without significant differences among them (Pgt;0.05). The anal canal resting pressure after operation was lower than that before operation among three groups (Plt;0.01), which in the shearing fracture ligation combining PPH group was lower than that in the shearing fracture ligation group after operation (Plt;0.05). There were no significant differences of the rectum feeling capacity or maximum rectum capacity between the shearing fracture ligation combining PPH group and PPH group before and after operation (Pgt;0.05), but compared with the level before operation in the shearing fracture ligation group, the rectum feeling capacity obviously decreased after operation (Plt;0.05), the maximum rectum capacity obviously increased (Plt;0.05). There were no significant differences of the maxinum anal canal systolic blood pressure between before and after operation in three groups and among three groups (Pgt;0.05). ConclusionsThe operation of shearing fracture ligation combined with PPH can protect the tissue of rectal cushion, remain the normal anatomy structure of anal canal. It has better clinical effect and is much safer than other methods.
ObjectiveTo observe the effect of procedure for prolapse and hemorrhoids (PPH) combined with partial internal anal sphincterotomy (Abbreviated as combined therapy) in the treatment of severe mixed hemorrhoids complicated with high rectal and anal canal resting pressure.MethodsFrom January 2016 to June 2018, the patients with grade Ⅲ–Ⅳ mixed hemorrhoids who underwent surgical treatment in this hospital were selected for the prospective study, including 100 patients with high pressure (>70 mm Hg, 1 mm Hg=0.133 kPa) and 100 patients with low pressure (≤70 mm Hg), then which were divided into an experimental group and a control group according to the random number table method (with 50 cases in each group). The patients in the control group underwent the PPH and in the experimental group underwent the combined therapy. The therapeutic effect and perioperative indicators were observed in each group, Visual Analogue Scale (VAS) was used to evaluate the degree of pain before and after the operation, the incidence of complications and the recurrence rate of symptoms were observed, the factors influencing the therapeutic effect of combined therapy were analyzed.ResultsWhether for the patients with high or low rectal and anal canal resting pressure, although the operation time of the experimental group was significantly longer than that of the control group (t=8.996, P<0.001; t=8.927, P<0.001), the total effective rate was higher (χ2=7.294, P=0.007; χ2=6.775, P=0.009), the length of stay in hospital was shorter (t=11.922, P<0.001; t=11.442, P<0.001), the hospital expenses decreased significantly (t=2.226, P=0.028; t=2.562, P=0.012), the VAS score at 24 h and 72 h after operation were lower (24 h: t=12.659, P<0.001; t=12.191, P<0.001; 72 h: t=9.920, P<0.001; t=9.901, P<0.001), the incidence of postoperative complications was lower (χ2=7.484, P=0.006; χ2=11.416, P=0.001) in the experimental group as compared with the control group; there was no significant difference between the two groups (χ2=1.042, P=0.307; χ2=0.211, P=0.646). The course of disease and the grade of internal hemorrhoids were the independent factors influencing the marked efficiency of combined therapy (χ2=7.417, P=0.009; χ2=4.286, P=0.017).ConclusionsCombined therapy is effective in treatment of severe mixed hemorrhoids complicated with high rectal and anal canal resting pressure, it could accelerate recovery of patients and relieve pain. It should be paid attention to patients with long course of disease and severe degree of internal hemorrhoids.
【摘要】目的評估雙吻合器在直腸癌保肛術中的應用價值，并探討吻合口漏等并發癥的防治措施。方法對81例采用雙吻合器行直腸癌前切除術患者的臨床資料進行回顧性分析。結果全組術中腫瘤切除后遠端直腸的縫合、吻合過程順利，手術時間120～190 min,平均160 min。術后發生吻合口漏3例（3.7%），吻合口狹窄1例（1.2%），無手術死亡。結論雙吻合器技術可幫助外科醫生順利完成直腸癌前切除術中結直腸的吻合，并且安全、可靠。
Objective To compare the clinical effect of tissue selecting therapy stapler (TST) and procedure for prolapse and hemorrhoids (PPH) in treatment of hemorrhoid in Ⅲ-Ⅳ degree. Methods Clinical data of 80 cases of hemorrhoid in Ⅲ-Ⅳ degree who treated in The First Affiliated Hospital of Harbin Medical University from May 2015 to July 2015 were retrospectively collected. All the 80 cases were divided into TST group (n=40) and PPH group (n=40) according to the surgical types. The comparison of the clinical effect of 2 groups was performed. Results The operative time, hospital stay, intraoperative blood loss, anal fall bilge feeling score, postoperative pain score at 3 time points, and the incidence of anal secretions of TST group were lower or shorter than those corresponding indexes of PPH group (P<0.05). But there was no significant difference in cure rate, the incidence of urinary retention, the incidence of anal stenosis, the incidence of intractable pain, and satisfaction situation between the 2 groups (P>0.05). All of the cases were followed up for 3 months, during the follow-up period, no one suffered from rectal vaginal fistula, fecal incontinence, and recurrence. Conclusion TST and PPH both have satisfactory effect in treatment of hemorrhoid in Ⅲ-Ⅳ degree, but TST has advan- tages of less blood loss, shorter operative time, rapid postoperative recovery, and less pain.