目的探讨急性肠系膜上静脉血栓形成(acute superior mesenteric venous thrombosis,ASMVT)的临床诊治经验。方法回顾性分析天津医科大学总医院普通外科2014年1月至2017年10月收治的36例ASMVT患者的临床资料,比较非手术治疗组和手术治疗...目的探讨急性肠系膜上静脉血栓形成(acute superior mesenteric venous thrombosis,ASMVT)的临床诊治经验。方法回顾性分析天津医科大学总医院普通外科2014年1月至2017年10月收治的36例ASMVT患者的临床资料,比较非手术治疗组和手术治疗组患者的临床资料及预后差异。结果本组36例ASMVT患者在诊断后均立即予抗凝治疗,治疗后再通率42%。手术治疗组21例,其中急诊手术9例,延迟性肠切除12例。非手术治疗组与手术治疗组患者在入院时血红蛋白值相比差异有统计学意义[(124±29)g/L比(93±13)g/L,t=3.880,P=0.006]。急诊手术组较延迟性肠切除组切除肠管距离长[(65±58)cm比(13±6)cm,t=2.700,P=0.035],小肠双腔造瘘多(6例比1例,x^2=7.875,P=0.016),术后并发症发生率高(56%比8%,x^2=5.619,P=0.046),但两组在住院时间、住院费用、术后复发率、死亡率方面相比差异均无统计学意义(均P>0.05)。结论在ASMVT的患者中,早期积极抗凝治疗有可能避免肠切除、或者缩小肠切除范围。经积极抗凝治疗仍有肠梗阻的患者如能过渡到延迟性、确定性肠切除手术可能是最佳的治疗方式。展开更多
BACKGROUND Right hemicolectomy or ileocecal resection are used to treat benign conditions like Crohn’s disease(CD)and malignant ones like colon cancer(CC).AIM To investigate differences in pre-and peri-operative fact...BACKGROUND Right hemicolectomy or ileocecal resection are used to treat benign conditions like Crohn’s disease(CD)and malignant ones like colon cancer(CC).AIM To investigate differences in pre-and peri-operative factors and their impact on post-operative outcome in patients with CC and CD.METHODS This is a sub-group analysis of the European Society of Coloproctology’s prospective,multi-centre snapshot audit.Adult patients with CC and CD undergoing right hemicolectomy or ileocecal resection were included.Primary outcome measure was 30-d post-operative complications.Secondary outcome measures were post-operative length of stay(LOS)at and readmission.RESULTS Three hundred and seventy-five patients with CD and 2,515 patients with CC were included.Patients with CD were younger(median=37 years for CD and 71 years for CC(P<0.01),had lower American Society of Anesthesiology score(ASA)grade(P<0.01)and less comorbidity(P<0.01),but were more likely to be current smokers(P<0.01).Patients with CD were more frequently operated on by colorectal surgeons(P<0.01)and frequently underwent ileocecal resection(P<0.01)with higher rate of de-functioning/primary stoma construction(P<0.01).Thirty-day post-operative mortality occurred exclusively in the CC group(66/2515,2.3%).In multivariate analyses,the risk of post-operative complications was similar in the two groups(OR 0.80,95%CI:0.54-1.17;P=0.25).Patients with CD had a significantly longer LOS(Geometric mean 0.87,95%CI:0.79-0.95;P<0.01).There was no difference in re-admission rates.The audit did not collect data on post-operative enhanced recovery protocols that are implemented in the different participating centers.CONCLUSION Patients with CD were younger,with lower ASA grade,less comorbidity,operated on by experienced surgeons and underwent less radical resection but had a longer LOS than patients with CC although complications'rate was not different between the two groups.展开更多
BACKGROUND Complications of Crohn’s disease such as intestinal obstruction,fistula or perforation often need surgical treatment.Nearly 70%-80%patients with Crohn’s disease would receive surgical treatment during the...BACKGROUND Complications of Crohn’s disease such as intestinal obstruction,fistula or perforation often need surgical treatment.Nearly 70%-80%patients with Crohn’s disease would receive surgical treatment during the lifetime.However,surgical treatment is incurable for Crohn’s disease.The challenge of recurrence postoperatively troubles both doctors and patients.Over 50%patients would suffer recurrence postoperatively.Some certain risk factors are associated with recurrence of Crohn’s disease.AIM To evaluate the risk factors for endoscopic recurrence and clinical recurrence after bowel resection in Crohn’s disease.METHODS Patients diagnosed Crohn’s disease and received intestinal resection between April 2007 and December 2013 were included in this study.Data on the general demographic information,preoperative clinical characteristics,surgical information,postoperative clinical characteristics were collected.Continuous data are expressed as median(inter quartile range),and categorical data as frequencies and percentages.Kaplan-Meier method was applied to estimate the impact of the clinical variables above on the cumulative rate of postoperative endoscopic recurrence and clinical recurrence,then log-rank test was applied to test the homogeneity of those clinical variables.Multivariate Cox proportional hazard regression analysis was performed to identify the risk factors of postoperative endoscopic recurrence and clinical recurrence.RESULTS A total of 64 patients were included in this study.The median follow-up time for the patients was 17(9.25-25.75)mo.In this period,41 patients(64.1%)had endoscopic recurrence or clinical recurrence.Endoscopic recurrence occurred in 34(59.6%)patients while clinical recurrence occurred in 28(43.8%)patients,with the interval between the operation and recurrence of 13.0(8.0-24.5)months and 17.0(8.0-27.8)mo,respectively.In univariate analysis,diagnosis at younger age(P<0.001),disease behavior of penetrating(P=0.044)and preoperative use of anti-tumor necrosis factor(TNF)(P=0.展开更多
The aim of this paper is to present the case of a female patient, 14 years of age, who developed a megarectum and overflow of fecal incontinence as a consequence of chronic and severe constipation, after the surgical ...The aim of this paper is to present the case of a female patient, 14 years of age, who developed a megarectum and overflow of fecal incontinence as a consequence of chronic and severe constipation, after the surgical repair of her vestibular fistula at the age one. The huge rectum was resected than dissected down to the pelvic floor and a new anus was reconstructed via a posterior sagittal anorectoplasty with excellent results.展开更多
文摘目的探讨急性肠系膜上静脉血栓形成(acute superior mesenteric venous thrombosis,ASMVT)的临床诊治经验。方法回顾性分析天津医科大学总医院普通外科2014年1月至2017年10月收治的36例ASMVT患者的临床资料,比较非手术治疗组和手术治疗组患者的临床资料及预后差异。结果本组36例ASMVT患者在诊断后均立即予抗凝治疗,治疗后再通率42%。手术治疗组21例,其中急诊手术9例,延迟性肠切除12例。非手术治疗组与手术治疗组患者在入院时血红蛋白值相比差异有统计学意义[(124±29)g/L比(93±13)g/L,t=3.880,P=0.006]。急诊手术组较延迟性肠切除组切除肠管距离长[(65±58)cm比(13±6)cm,t=2.700,P=0.035],小肠双腔造瘘多(6例比1例,x^2=7.875,P=0.016),术后并发症发生率高(56%比8%,x^2=5.619,P=0.046),但两组在住院时间、住院费用、术后复发率、死亡率方面相比差异均无统计学意义(均P>0.05)。结论在ASMVT的患者中,早期积极抗凝治疗有可能避免肠切除、或者缩小肠切除范围。经积极抗凝治疗仍有肠梗阻的患者如能过渡到延迟性、确定性肠切除手术可能是最佳的治疗方式。
文摘BACKGROUND Right hemicolectomy or ileocecal resection are used to treat benign conditions like Crohn’s disease(CD)and malignant ones like colon cancer(CC).AIM To investigate differences in pre-and peri-operative factors and their impact on post-operative outcome in patients with CC and CD.METHODS This is a sub-group analysis of the European Society of Coloproctology’s prospective,multi-centre snapshot audit.Adult patients with CC and CD undergoing right hemicolectomy or ileocecal resection were included.Primary outcome measure was 30-d post-operative complications.Secondary outcome measures were post-operative length of stay(LOS)at and readmission.RESULTS Three hundred and seventy-five patients with CD and 2,515 patients with CC were included.Patients with CD were younger(median=37 years for CD and 71 years for CC(P<0.01),had lower American Society of Anesthesiology score(ASA)grade(P<0.01)and less comorbidity(P<0.01),but were more likely to be current smokers(P<0.01).Patients with CD were more frequently operated on by colorectal surgeons(P<0.01)and frequently underwent ileocecal resection(P<0.01)with higher rate of de-functioning/primary stoma construction(P<0.01).Thirty-day post-operative mortality occurred exclusively in the CC group(66/2515,2.3%).In multivariate analyses,the risk of post-operative complications was similar in the two groups(OR 0.80,95%CI:0.54-1.17;P=0.25).Patients with CD had a significantly longer LOS(Geometric mean 0.87,95%CI:0.79-0.95;P<0.01).There was no difference in re-admission rates.The audit did not collect data on post-operative enhanced recovery protocols that are implemented in the different participating centers.CONCLUSION Patients with CD were younger,with lower ASA grade,less comorbidity,operated on by experienced surgeons and underwent less radical resection but had a longer LOS than patients with CC although complications'rate was not different between the two groups.
基金Science and Technology Planning Project of Guangdong Province,No.20160916Medical Science Research Grant from the Health Department of Guangdong Province,No.A2018007
文摘BACKGROUND Complications of Crohn’s disease such as intestinal obstruction,fistula or perforation often need surgical treatment.Nearly 70%-80%patients with Crohn’s disease would receive surgical treatment during the lifetime.However,surgical treatment is incurable for Crohn’s disease.The challenge of recurrence postoperatively troubles both doctors and patients.Over 50%patients would suffer recurrence postoperatively.Some certain risk factors are associated with recurrence of Crohn’s disease.AIM To evaluate the risk factors for endoscopic recurrence and clinical recurrence after bowel resection in Crohn’s disease.METHODS Patients diagnosed Crohn’s disease and received intestinal resection between April 2007 and December 2013 were included in this study.Data on the general demographic information,preoperative clinical characteristics,surgical information,postoperative clinical characteristics were collected.Continuous data are expressed as median(inter quartile range),and categorical data as frequencies and percentages.Kaplan-Meier method was applied to estimate the impact of the clinical variables above on the cumulative rate of postoperative endoscopic recurrence and clinical recurrence,then log-rank test was applied to test the homogeneity of those clinical variables.Multivariate Cox proportional hazard regression analysis was performed to identify the risk factors of postoperative endoscopic recurrence and clinical recurrence.RESULTS A total of 64 patients were included in this study.The median follow-up time for the patients was 17(9.25-25.75)mo.In this period,41 patients(64.1%)had endoscopic recurrence or clinical recurrence.Endoscopic recurrence occurred in 34(59.6%)patients while clinical recurrence occurred in 28(43.8%)patients,with the interval between the operation and recurrence of 13.0(8.0-24.5)months and 17.0(8.0-27.8)mo,respectively.In univariate analysis,diagnosis at younger age(P<0.001),disease behavior of penetrating(P=0.044)and preoperative use of anti-tumor necrosis factor(TNF)(P=0.
文摘The aim of this paper is to present the case of a female patient, 14 years of age, who developed a megarectum and overflow of fecal incontinence as a consequence of chronic and severe constipation, after the surgical repair of her vestibular fistula at the age one. The huge rectum was resected than dissected down to the pelvic floor and a new anus was reconstructed via a posterior sagittal anorectoplasty with excellent results.
