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Potential value of POSSUM scoring system in assessment of surgical outcome
The outcome of surgical intervention is not solely dependent on the abilities of the surgeon in isolation. The patient's physiological status, the disease that requires surgical correction, the nature of the operation, and the preoperative and postoperative support services have a major effect on the ultimate outcome [1].
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小儿纵隔及支气管淋巴结结核所致严重呼吸窘迫的外科处理
小儿肺部感染结核后可出现纵隔淋巴结之瘤样增生或液化坏死,并能造成严重气管压迫及致命性呼吸困难,本文报告4例,均经紧急剖胸而获得治愈.在危重情况下应除外喉梗阻,气管异物.支气管淋巴结结核是小儿肺结核原发综合征的一部分,在有效的抗痨治疗下如仍有明显的、进行性的气管压迫症状,有必要考虑行手术切除.
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小儿急性坏死性胰腺炎的外科处理
小儿急性坏死性胰腺炎是一种少见疾病(1),我院小儿外科近几年收治了2例重型患儿,经过积极手术治疗,均获痊愈.
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保留翼钩及腭腱膜修复小儿腭裂115例总结
理想的腭裂修复不仅应封闭裂隙,而更重要的是创造良好的发音条件.重建正常的腭咽解剖结构是获得优良发音的必要条件.我院自1969年7月到1982年5月共收治小儿腭裂115例.
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Ⅳ期胃癌患者转化治疗的现状与问题
当前Ⅳ期胃癌患者实施转化治疗成为了研究热点,它是指技术或肿瘤学上初始不可切除或边界可切除的患者,通过有效化疗后实现R0切除。目前,虽然新化疗药物和分子靶向药物有效改善了Ⅳ期胃癌患者的预后,但是结果仍旧差强人意。通过发展和改善化疗方案,Ⅳ期胃癌患者越来越多的实现了转化治疗。但是,目前尚无Ⅳ期胃癌患者在转化治疗中获益的确凿证据。为明确进展期胃癌患者手术干预的意义,我们对63例行S-1/顺铂或S-1/紫杉醇的Ⅳ期胃癌患进行回顾性分析。结果显示:患者中位生存期(MST)为16.5个月,而S-1/顺铂和S-1/紫杉醇两组MST无统计学差异。其中27例患者实施了胃切除,无严重围手术期并发症发生。对于化疗敏感的患者,行手术切除患者MST有效延长。这表明:对于Ⅳ期胃癌患者,给予S-1基础化疗方案后转化手术安全有效。同时,我们也对Ⅳ期胃癌患者转化手术后辅助化疗的疗效进行研究。行转化手术的Ⅳ期胃癌患者MST为31.2个月,而转化手术后辅助化疗的Ⅳ期胃癌患者MST为12.5月。单药S-1和双药联合患者之间MST无差异。49例患者中36例复发,31例患者接受了转化手术后2线化疗。相较于只接受一线化疗的患者,接受二线治疗患者的无复发生存期更长。总的来说,辅助化疗意义尚需进一步的研究证实。目前我们正在进行S-1基础化疗后转化治疗的Ⅱ期观察性队列研究。更进一步,在亚洲临床肿瘤学协会(FACO)覆盖的亚洲国家中[包括日本临床肿瘤学会( JSCO)、韩国临床肿瘤学会(KACO)、中国临床肿瘤学会(CSCO)、日本胃癌学会( JGCA)、韩国胃癌协会(KGCA)及中国抗癌协会(CACA),一项大型回顾和前瞻性队列研究正在进行。
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Objective: To recognize diagnostic factors of acute abdomen and investigate the control methods. Methods: A total of 8 patients caused by mesenteric vascular lesions were treated, followed up and analyzed on. Results: Six patients were operated on and confirmed pathologically; of two cases being superior mesenteric arterial embolism with abdominal aorta straddle and arterial embolism in both lower extremities (1 case died of whole bowel gangrene in 5 hours postoperatively, another one was recovered smoothly by resection of 60cm necrotic jejunum, removal of emboli in both iliofemoral artery, thrombolysis, and anticoagulatant therapy postoperatively); one patient with mesenteric artery thrombosis; of two cases with mesenteric venous thrombosis (1 case was removal of emboli and thrombolysis, anticoagulatant therapy postoperatively, another one was resection of 95% small intestine), one case with false aneurysm in superior mesenteric artery, resection of aneurysm and permutation of artificial blood vessel was performed successfully. The remained 2 cases with mesenteric vascular insufficiency were recovered by anticoagulatant and antispasmodic therapy. Seven cases cured. Conclusions: Mesenteric vascular diseases were relatively uncommon, symptoms and signs showed to be rather nonspecific, therefore, one should not merely rely on them for accurate diagnosis. Uhrasonography, CT are the sensitive examinations and benefit to diagnosis. Early interventions such as resecting bowel gangrene involved their mesentery and anticoagulant therapy may be essential to reduce the fatality and recurrence.