目的 研究直腸癌切除后腸吻合前進行腸腔灌洗的臨床作用。方法 對我院2006年6月至2007年2月期間連續56例行直腸癌低位前切除吻合的病例在切除原發灶、行遠端封閉吻合前行生理鹽水遠端腸腔灌洗，收集灌洗前、后2份標本分別涂片行細胞學檢查。結果 灌洗前收集液中觀察到腫瘤細胞或核異形細胞者7例，中性粒細胞者24例，上皮細胞者4例； 灌洗后所有患者的收集液中均未觀察到腫瘤細胞（P＜0.05），19例仍有少許中性粒細胞或上皮細胞。結論 低位直腸癌遠端腸腔有可能存在脫落的腫瘤細胞。對直腸癌患者手術切除病灶后吻合前行遠端腸腔灌洗的方法簡單易行，可以顯著減少或清除腸腔內可能殘留的腫瘤細胞，從而可避免此類原因所致的局部腫瘤復發，值得提倡。
Objective To discuss the value of biliary stent in treatment of malignant biliary obstruction with different pathways of bile duct stent insertion. Methods Fourty-two cases of malignant biliary obstruction whose biliary stent insertions were through operation (n=18), PTCD (n=17) and ERCP (n=7) respectively were reviewed retrospectively. Results The bile duct stents were successfully inserted in all patients through the malignant obstruction and achieved internal biliary drainage. Compared with the level of the bilirubin before operation, it decreased about 100 μmol/L one week after the stent insertion in all patients. Compared with the levels of glutamic oxalacetic transaminase, glutamic pyruvic transaminase, alkaline phosphatase and glutamyltranspeptidase before operation, they decreased 1 week after the stent insertion （Plt;0.05). The median survival time was 22 weeks. The average survival time was (32.89±33.87) weeks. Two patients died in hospital after PTCD, and the mortality was 4.76%. Complications included 8 cases of cholangitis, 3 cases of bile duct hemorrhage and 2 cases of hepatic failure. Conclusion The bile duct stent insertions through operation, PTCD and ERCP are all effective in relieving the bile duct construction with malignant biliary obstruction. Each method should be chosed according to the systemic and local condition for every patient so as to improve the safety and efficiency, and to decrease the occurrence of complications.