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.
【摘要】 目的 探討強化益生元膳食纖維的腸內營養在腹部外科術后患者中的臨床應用。 方法 2008年7月-2010年11月30例接受腹部外科中等以上手術的患者術前隨機分為研究組和對照組，每組15例。研究組患者于術后接受腸內營養，并予以強化益生元膳食纖維；對照組只接受相同的腸內營養支持。觀察指標為術后感染并發癥、胃腸道并發癥、住院時間、抗生素治療時間、C反應蛋白水平和病死率等。 結果 研究組術后住院時間為（10±5） d，對照組為（15±7） d，兩組差異有統計學意義（t=2.251，P=0.033）；研究組C反應蛋白水平為（6.6±3.2） mg/L，對照組為（9.8±2.1） mg/L，兩組差異有統計學意義（t=3.238，P=0.003）；研究組抗生素治療時間為（5.0±3.5） d，對照組為（6.0±4.8） d，兩組差異無統計學意義（t=0.652，P=0.520）。兩組均無死亡病例；術后研究組2例發生感染并發癥，對照組3例，兩組感染并發癥發生率差異無統計學意義（P=1.000）。兩組患者均能耐受經腸內補充營養素。 結論 與常規腸內營養比較，給予強化益生元膳食纖維的腸內營養能減少腹部外科術后患者的住院時間，降低急性期炎癥反應。【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.
醫學影像學是臨床醫學科學中發展較快的學科之一。為了將影像檢查技術合理、高效、及時地應用于臨床，為患者服務，需要影像醫師與臨床醫師的密切合作。在具有一定學術地位和雄厚技術力量的本院放射科的鼎力支持與合作下，本刊自2003年第1期起增設“腹部影像”專欄，旨在為腹部外科醫師和腹部影像醫師搭建起一個學術交流的橋梁，促進相互了解、認識、滲透與合作，使腹部外科醫師能及時了解到影像學檢查手段的進展和影像醫學的發展，又能使影像醫師了解到腹部外科醫師對影像檢查的具體要求，從而一方面使影像學檢查技術更好地為腹部外科服務，另一方面又使腹部外科促進影像學檢查的合理化和提高影像診斷水平。基于這一宗旨，本欄目將著重推出一些具有特色、圖文并茂的綜述性文章，作為讓腹部外科醫師了解腹部影像學現狀與進展的的窗口。同時，我們也將選登一些與腹部外科密切相關、臨床實用性比較強的腹部影像學方面的原著介紹給腹部外科醫師。此外，有關影像學檢查的新技術、新方法以及它們在腹部疾病診治中的臨床應用的短篇文章或報道也將是我們選稿的重點。我們殷切希望，本刊增設的這一新欄目能夠得到外科醫師和影像醫師的認可和支持，并讓大家從中獲得有用的信息。我們相信，在主編、各位編委和雜志編輯部的共同努力下，特別是有廣大讀者的支持和鼓勵，背靠華西放射的雄厚技術力量，我們有信心把腹部影像專欄辦好，實現它的宗旨，更好地為臨床工作服務。
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.
目的觀察持續沖洗負壓引流技術在腹部外科應用的臨床效果。方法回顧性分析2006年1月至2011年3月期間我院將自制雙套管實施持續沖洗負壓引流技術應用于172例腹部外科患者的臨床資料。結果全部患者的消化道瘺均治愈，瘺道愈合的平均時間為36 d。治療過程中，1例患者出現上消化道出血，另1例出現腹腔出血，無腹腔感染、皮膚破潰感染、膿毒癥等并發癥。結論采用持續沖洗負壓引流的雙套管制作簡單，經濟有效，在腹部外科中對術后腸瘺、出血、膽汁漏及感染的防治具有重要臨床意義。
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.
目的探討哈樂預防腹部手術后尿潴留的臨床價值。方法哈樂組于拔尿管前1 d開始用哈樂0.2 mg，1次/d，3～5 d； 對照組未予特殊藥物治療。比較2組的尿潴留發生率、尿路感染發生率、住院時間和副作用。結果哈樂組未發生尿潴留，對照組尿潴留發生率為28%，差異有統計學意義(P＜0.05)。哈樂組無一例發生尿路感染，對照組有5例（20%），2組間差異無統計學意義（Pgt;0.05）。哈樂組術后平均住院時間為（10.7±3.3） d，對照組為（11.6±3.0) d，2組間差異亦無統計學意義（Pgt;0.05）。 結論哈樂可明顯減少尿潴留的發生率，是預防腹部手術后尿潴留的有效藥物。