目的 探讨腹股沟难复疝和嵌顿疝手术并发症的防治。方法 回顾性分析笔者所在医院2005年1月至2012年1月期间收治的69例腹股沟疝行手术治疗患者的临床资料。难复疝37例，嵌顿疝32例（其中Richter疝3例、Littre疝1例、Maydl疝3例 、Amyand疝1例）。结果 69例患者均行手术治疗，其中行单纯疝囊高位结扎术3例，Shouldice法修补术10例，Lichtenstein术7例，无张力充填式疝修补术43例，Modified Kugel补片修补术6例。术后1例死亡。术后早期并发症13例，包括肠管损伤3例、腹股沟神经损伤4例、血清肿4例、切口感染2例； 晚期并发症9例，包括慢性疼痛2例、缺血性睾丸炎1例及疝复发6例。结论 术前对于复杂性嵌顿疝和滑动疝经验不足，术后对于并发症的预防性处理不足是导致术中、术后并发症的主要原因。正确认识复杂性嵌顿疝和滑动疝，以及正确选择网片可减少难复疝和嵌顿疝手术并发症的发生。
目的对单层吻合在消化道手术中临床应用的安全性和实用性进行评价。方法对该院1 600例消化道单层吻合术的临床资料进行回顾性分析，并结合国内外文献进行讨论。结果全组1 600例消化道单层吻合手术均顺利完成，发生吻合口漏25例（1.56%），吻合口狭窄3例（0.19%），无一例发生吻合口大出血。结论消化道单层吻合不会增加吻合口漏的发生率，并能减少吻合口狭窄、梗阻和出血，是安全、实用且有效的吻合方法。
Since 1987, One hundred and fifty-four patients suffered from alopecia, neck and facial scar, and nasal defect had been treated with skin soft tissue expansion. The incidence of complication was decreased markedly, compared to previons report which was 11.7%. Two cases of this group were given up this procedure. The lessous learned from these case were as following. Strictly evaluated the case according to the indication, examined the expander carefully, improved the techniques to inbed the expander and infilled the sailine, those of which could obtain satisfactory result.
目的 探讨预防慢性肛裂手术并发症的技巧。方法 回顾性分析近3年笔者所在单位收治的63例慢性肛裂患者的临床资料，男21例，女42例，年龄（34±12）岁（17～51岁），均行肛裂切除术，并在处理内括约肌时采用橡皮筋结扎法，观察术后并发症的发生情况。 结果 所有患者术后恢复良好，无一例出现术后大出血、肛裂复发、肛门失禁等并发症。 结论 通过采用橡皮筋结扎法处理内括约肌，避免了术后并发症的发生，该方法值得推广。
ObjectiveTo evaluate the predictive value of the geriatric nutritional risk index (GNRI) for postoperative overall and severe complications after pancreaticoduodenectomy (PD) in the elderly patients with pancreatic cancer. MethodsThe clinical data of the elderly (65 years old or more) patients with pancreatic cancer underwent PD were retrospectively collected, who were admitted to the Fifth Affiliated Hospital of Xinjiang Medical University from January 2017 to October 2021. The incidences of postoperative overall and severe complications (Clavien-Dindo grade Ⅲ–Ⅴ was defined as severe complications) were summarized. The univariate and multivariate logistic regression models were used to analyze whether GNRI was a risk factor for overall and severe complications after PD. The area under the receiver operating characteristic curve (AUC) was used to evaluate the ability of GNRI to distinguish whether overall or severe complications occurred after PD and to confirm the optimal threshold. Then the patients were assigned into a high nutritional risk group (greater than the optimal threshold) and low nutritional risk group (the optimal threshold or less) based on this. Simultaneously, the clinical outcomes of the two groups were compared. ResultsIn this study, 190 elderly patients with pancreatic cancer were enrolled, 95(50.0%) of whom developed complications, including 28(29.5%) cases of serious complications. The results of multivariate logistic regression model analysis showed that the decreased GNRI was a risk factor for the occurrence of overall and severe complications after PD for the elderly patients [OR(95%CI)=0.361(0.154, 0.848), P=0.019; OR(95%CI)=0.906(0.834, 0.983), P=0.018]. The AUC of GNRI for assessing the occurrence of overall and severe complications was 0.765 and 0.715, respectively, with the optimal critical values of 98 and 96, respectively. Compared with the low nutritional risk group, the high nutritional risk group had higher postoperative total hospitalization costs (Z=–2.37, P=0.019), higher occurrences of overall complications (χ2=44.61, P<0.001) and severe complications (χ2=29.39, P＜0.001). ConclusionsIn elderly patients with pancreatic cancer underwent PD, incidence of serious complications is not lower. GNRI has a good discriminative value in terms of postoperative overall and severe complications. When preoperative GNRI is 98 or less and GNRI is 96 or less, patients should be given early preoperative nutritional support treatment in time.
Ｏｕｒ ｔｅｃｈｎｉｑｕｅ ｆｏｒ ａｕｘｉｌｉａｒｙ ｌｉｖｅｒ ｔｒａｎｓｐｌａｎｔａｔｉｏｎ ｗａｓ ｂａｓｅｄ ｏｎ ｔｈｅ ｔｅｃｈｎｉｑｕｅ ｄｅｓｃｒｉｂｅｄ ｂｙ Ｈｅｓｓ ｗｉｔｈ ｔｈｅ ｅｘｃｅｐｔｉｏｎ ｏｆ ｔｈｅ ｌｅｎｇｔｈ ｏｆ ｔｈｅ ｃｕｆｆ ｏｆ ｔｈｅ ｇｒａｆｔ ｖｅｎａ ｃａｖａ ａｎｄ ｅｓｔａｂｌｉｓｈｍｅｎｔ ｏｆ ｔｈｅ ｐｏｒｔａｌ ｖｅｉｎ ａｎａｓｔｏｍｏｓｉｓ．Ａ ｔｏｔａｌ ｏｆ ６０ ａｕｘｉｌｉａｒｙ ｌｉｖｅｒ ｔｒａｎｓｐｌａｎｔａｔｉｏｎｓ ｗｅｒｅ ｐｅｒｆｏｒｍｅｄ，ｏｆ ｗｈｉｃｈ ２４ ｗｅｒｅ ｄｅｆｉｎｉｔｉｖｅ ｏｐｅｒａｔｉｏｎ．Ｉｎ ｔｈｅ ５ ｄｅｆｉｎｉｔｉｖｅ ｏｐｅｒａｔｉｏｎｓ ｔｈｅ ｇｒａｆｔｓ ｓｕｒｖｉｖａｌ ａｓｓｅｓｓｅｄ ｂｙ ９７ｍＴｃｓｏｄｉｕｍ ｐｈｙｔａｔｅ ｄｅｍｏｎｓｔｒａｔｅｄ ａ １ｗｅｅｋ ｓｕｒｖｉｖａｌ ｏｆ １００％．Ｈｏｗ ｔｏ ｒｅｄｕｃｅ ｔｈｅ ｃｏｍｐｌｉｃａｔｉｏｎｓ ｉｎ ａｕｘｉｌｉａｒｙ ｌｉｖｅｒ ｔｒａｎｓｐｌａｎｔａｔｉｏｎ ｉｎ ｒａｔｓ ｉｓ ｄｉｓｃｕｓｓｅｄ ｉｎ ｔｈｅ ａｒｔｉｃｌｅ．