【摘要】 目的 探討早期微創腹腔置管灌洗在重癥急性胰腺炎（severe acute pancreatitis，SAP）治療中，對減輕炎性反應的作用。 方法 選擇2007年1月-2009年6月收治的SAP患者56例，隨機分為早期微創腹腔置管灌洗組（灌洗組，n=28）和常規治療組（對照組，n=28）；兩組同時給予生長抑素，抑酸，抗感染，保持水、電解質及酸堿平衡等綜合治療，灌洗組在常規治療基礎上早期予以微創腹腔置管灌洗。檢測兩組治療前及治療后2、5、7 d C反應蛋白（C-reactrve protein，CRP）、血清腫瘤壞死因子α（tumor necrosis factor α，TNF-α）、 白細胞介素6（interleukin，IL-6）、IL-8水平。 結果 兩組治療前CRP、TNF-α、IL-6、IL-8水平差異無統計學意義（Pgt;0.05），治療后2、5、7 d比較差異有統計學意義（Plt;0.05）。 結論 早期微創腹腔置管灌洗操作簡便易行、創傷小、療效佳，對減輕SAP所致的全身炎性反應具有較好效果，是治療SAP有效方法之一。【Abstract】 Objective To explore the effect of the early minimally invasive peritoneal lavage in severe acute pancreatitis (SAP) from Januany 2007 to June 2009. Methods A total of 56 cases of SAP were randomly divided into early minimally invasive peritoneal lavage group (lavage group, n=28) and conventional treatment group (control group, n=28). The patients were given comprehensive treatment, including somatostatin, acid suppression, anti-infection, and maintaining water, electrolyte, and acid alkali balance.In lavage group, the patients were treated with early minimally invasive peritoneal lavage in addition.The levels of C reactive protein(CRP), serum tumor necrosis factor α (TNF-α), interleukin 6 (IL-6), and interleukin 8(IL-8)were detected before and 2, 5, 7 days after tretment. Results There was no significant difference in CRP, TNF-α, IL-6, or IL-8 before treament between the two groups (Pgt;0.05). There were significant differences in CRP, TNF-α, IL-6, and IL-8 after treatment between the two groups (Plt;0.05). Conclusion Early minimally invasive peritoneal lavage is a simple, minially invasive, and effective techinique in treating SAP.
Objective To evaluate the role of curved-cutter-stapler in anus-preserving for low rectal cancer. Methods The clinical data of 32 patients with low rectal cancer from June 2007 to December 2008 who received low anterior resection and ultra low anterior resection by using curved-cutter-stapler were reviewed retrospectively. Results No operation death case, complete cutting and safe closure in all cases, one case was complicated with anastomotic leakage, and one case of rectovaginal fistula. Thirty patients were followed up 4 to 22 months after the operation, with an average time of 12.6 months, no hemorrhea of pelvic cavity and anastomotic stoma or anastomotic stenosis cases. Conclusion Curved-cutter-stapler has the advantages of complete cutting, safe closure and low complications, and easy being used in anus-preserving operation for low rectal cancer, which can increase the rate of anus-preserving.