目的 評價全直腸系膜切除術在直腸癌手術中的價值。方法 回顧性分析148例中下段直腸癌接受全直腸系膜切除術的情況。結果 148例平均失血150 ml（50～600 ml），平均手術時間4.3 h，保肛103例（69.6%），其中Dixon術96例，改良Bacon術7例。術后發生吻合口漏3例（2.9%），全組發生切口感染（包括會陰切口、造瘺口）5例（3.4%）。隨訪2年以上的病例117例，局部復發8例（6.8%），其中保肛86例中局部復發2例（2.3%），非保肛31例中局部復發6例（19.4%），無尿潴留及性功能喪失，無手術死亡。結論 全直腸系膜切除術使直腸癌患者更容易達到治愈，局部控制及保留括約肌，保留性功能和膀胱功能的標準，且出血少，不增加手術時間及吻合口漏和切口感染。
目的 探討局麻下經胸前入路行腔鏡甲狀腺手術的體會。方法 對2009年3月至2010年3月期間四川省南充市中心醫院普外科收治的28例在局麻下行腔鏡甲狀腺手術患者術中及術后情況進行回顧性分析。結果 1例因術中冰凍檢查發現為甲狀腺癌而轉開放性手術未納入分析。視覺模擬鎮痛評分（VAS）: 術中評分結果為0～5分，平均2.2分; 術后評分結果為0～3分，僅2例口服布洛芬緩釋膠囊鎮痛，其余25例未使用鎮痛藥物。手術時間為95～215 min，平均117 min; 術中出血量為50～150 ml，平均84 ml。術后引流量為25～70 ml，平均34 ml； 引流管放置時間為2～4 d。住院時間平均4.5 d。術后頸部及胸壁皮下無瘀血、腫脹，無聲嘶、嗆咳。經隨訪2~10個月（平均8個月），未見切口處明顯瘢痕。結論 局麻下經胸前入路行腔鏡甲狀腺手術切實可行，并具有良好的美容效果。
Objective To analyze inducing factors and clinical characteristics of deep venous thrombosis (DVT) and to explore clinical value of soluble cell surface differentiation antigen 40 ligand (sCD40L) in early diagnosis of DVT. Methods The patients with the DVT of lower extremity who had not received the anticoagulant and thrombolytic therapy in the Nanchong Central Hospital from January 2012 to January 2017 were collected, these patients were divided into an early-acute stage, mid-acute stage, late-acute stage, and subacute stage according to the clinical course of DVT. The sCD40L expression in the peripheral blood of DVT patients were detected by the enzyme linked immunosorbent assay. Results There were 100 patients with the DVT were included, including 31 cases of early-acute stage, 26 cases of mid-acute stage, 21 cases of late-acute stage, and 22 cases of subacute stage; 66 patients with the peripheral type, 28 patients with the central type, and 6 patients with the mixed type. ① The fracture, malignant tumor, long time in the bed following the thoracic or abdominal operation, joint replacement, and caesarean section were the successively main risk factors of the DVT. ② The early-acute stage of DVT was more common in the fracture patients, the mid- and late-acute stage of DVT often occurred in the joint replacement sufferer, and the subacute stage of DVT was usually found in the malignant tumor patients. ③ The sCD40L expression in the patients with the different stage DVT was signifiantly higher than that in the control group (20 healthy people in the physical examination, P<0.05). Furthermore, there was a significant difference in the different stage DVT patients (F=26.57, P=0.02), that is, the expression of sCD40L was the highest in the early-acute stage of DVT, and then gradually reduced (P<0.05). ④ The sCD40L expression had a significant difference among the central type DVT, mixed type DVT, and peripheral type DVT (F=12.51, P=0.02), which in the peripheral type DVT was significantly higher than that of the central type DVT (P<0.05) and mixed type DVT (P<0.05), but had no difference between the central type DVT and the mixed type DVT (P>0.05). ConclusionsCD40L might act as a blood index of early diagnosis and judgement of extent of DVT, especially be helpful in early-acute stage of DVT.