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带蒂食指背侧皮瓣鼻再造

DIAGNOSIS AND TREATMENT OF DUODENAL ULCER AWAY FROM THE BULB(REPORT OF 25 CASES)

目的 探讨十二指肠球部远端溃疡的诊断和选择合适的手术治疗。方法 对我院25例十二指肠球部远端溃疡的临床资料进行了分析。结果 术前行上消化道X线钡餐检查8例，提示十二指肠球部溃疡4例，幽门梗阻2例； 纤维胃镜检查9例，发现十二指肠球部远端溃疡7例。术前确诊7例，误诊18例。20例曾行非手术治疗，但效果差，并出现溃疡并发症，如出血、穿孔、梗阻性黄疸、胆囊内瘘、幽门梗阻、急性胰腺炎等。本次手术治愈25例，1例术后9天并发输入、输出襻粘连性肠梗阻，经再次手术而愈。结论 纤维胃镜检查是诊断本病的主要方法，手术是该病的重要治疗措施。

第二掌骨背侧岛状皮瓣修复拇指掌侧及虎口区皮肤软组织缺损

目的 总结采用第2 掌骨背侧岛状皮瓣修复拇指掌侧及虎口区皮肤软组织缺损的方法及疗效。 方法 2006 年5 月－ 2008 年5 月，采用第2 掌骨背侧岛状皮瓣修复拇指掌侧及虎口区皮肤软组织缺损19 例。男12 例，女7 例；年龄15 ～ 42 岁，平均27 岁。机器压砸伤18 例，虎口区组织挛缩1 例。压砸伤患者中，拇指末节缺损11 例，拇指近节缺损5 例；虎口区皮肤缺损2 例；皮肤软组织缺损范围为2.2 cm 1.0 cm ～ 3.8 cm 2.4 cm。压砸伤患者均为受伤后3 h 内手术，虎口区组织挛缩患者为伤后6 个月手术。术中皮瓣切取范围为2.8 cm 1.2 cm ～ 4.0 cm 2.6 cm，供区采用中厚皮片游离植皮修复。 结果 术后皮瓣及供区皮片均顺利成活，创面Ⅰ期愈合。术后患者均获随访，随访时间6 ～ 24 个月。拇指外形饱满，感觉恢复至S2+；屈伸、外展、对掌、对指功能良好。虎口张开度为80 ～ 85°。 结论 第2 掌骨背侧岛状皮瓣修复拇指掌侧及虎口区皮肤软组织缺损具有手术操作简便、皮瓣质量好、术后皮瓣成活率高等优点，可获得较好疗效。

The Complicated Pancreaticoduodenectomy

远节指骨内生性软骨瘤临床分析

总结远节指骨内生性软骨瘤的临床特点及治疗方法。 方法 2000 年1 月－ 2008 年4 月，收治7 例远节指骨内生性软骨瘤患者。男2 例，女5 例；年龄5 ～ 35 岁。中指3 例，环指2 例，示、小指各1 例。其中4 例多发，合并其他掌、指骨内生性软骨瘤；3 例单发。术中取手指侧方入路，刮除肿瘤，其中2 例肿瘤横径gt; 1 cm 者移植冻干异体髂骨块修复肿瘤刮除后造成骨折和骨缺损。 结果 术后切口均Ⅰ期愈合。患者均获随访，随访时间6 ～ 24 个月。患指外形均满意，骨质均愈合，肿瘤无复发。除2 例植骨患指因固定时间较长，远指间关节屈伸受限外，余患指活动无明显影响。 结论 远节指骨内生性软骨瘤早期手术可获得良好效果。

TREATMENT OF TRAUMATIC DUODENAL RUPTURE(REPORT OF 12 CASES)

目的 探讨创伤性十二指肠破裂的死亡原因及破裂口修补后易再破裂的原因。方法 对广西省北海市人民医院近8年来所作的12例十二指肠破裂手术进行回顾性分析。结果 全组病例中，治愈9例，死亡3例。死因： ①合并伤过重； ②单纯修补术后破裂口渗漏，继发腹腔感染； ③多处破裂被遗留，造成高位肠瘘。结论 对创伤性十二指肠破裂患者，①应首先处理重要合并伤； ②对十二指肠破裂应详细检查，防止遗留多发性破裂伤； ③十二指肠旷置减压术能有效降低十二指肠内压，减少胰液和胆汁分泌，提高破裂口的愈合率。

Pancreatoduodenectomy with Retained Duodenal Papilla

目的　介绍保留十二指肠乳头的胰十二指肠切除术。 方法　对2例重型十二指肠合并胰腺损伤患者行保留十二指肠乳头的胰十二指肠切除术。结果　无手术死亡,术后无胰瘘等严重并发症,均痊愈出院。结论　对胆总管完整、十二指肠乳头尚存的重型胰十二指肠损伤患者，急诊手术行保留十二指肠乳头的胰十二指肠切除是值得考虑和应用的安全手术方法。

Primary Duodenal Adenocarcinoma

Objective To improve the diagnosis and treatment of primary adenocarcinoma of the duodenum. MethodsLiteratures were reviewed.ResultsThe morbidity of primary duodenal adenocarcinoma was low and its clinical manifestation had no characteristics.The most effective methods in the diagnosis of the disease were gastrointestinal radiography and endoscopy with the accuracy of 88% and 89% respectively.The disease could be cured by resection of the lesion. The selection of operative type depended on the stage and position of the tumor.Radical resection and tumor stage played an important role in the prognosis.Conclusion Early diagnosis and rational operation are the major ways to improve the resectability and to modify the therapeutic result.

IMPROVEMENT AND APPLICATION OF RETROGRADE ISLAND SKIN FLAP WITH AR TERIA POLLICIS DORSALIS IN ITS PEDICLE

Since 1992, the retrograde island skin flap with its pedicle containing the arteria pollicis dorsalis was used to repair 6 cases of the fingertip defects and the results were successful. The skin measured from 1.5cm x 2cm to 4cm x 3.5cm. From the followup, the external appearance of the thumbs looked nice, no limitation of joint motions was noticed and the pain sensation was recovered. The major improvement of this operation was that the donor skin was chosen from the dorsum of the first and second metacarpal bones, thus it was not necessary to divide the tendon of the extensor pollicis brevis, so that the operative procedure was simple and the postoperative functional recovery was rapid.

Value of geriatric nutritional risk index in predicting postoperative complications after pancreaticoduodenectomy in the elderly

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.