腹腔黏液肿瘤患者多器官切除术后多部位导管相关血栓形成的临床护理

阑尾黏液性肿瘤发病率低,几乎无特异性临床表现,一旦囊肿破裂,囊液溢出,具有分泌功能的恶性细胞在腹腔内广泛散播种植,极易形成腹膜假黏液瘤,腹腔黏液肿瘤的出现给患者的治疗和护理带来很大的困难,严重者可出现恶病质、肠瘘等[1-2],此类患者常需置管维持营养。经外周静脉穿刺置入中心静脉导管(PICC)末端一般位于上腔静脉下1/3或上腔静脉与右心房交界处,临床中常用于需要输注刺激性强、渗透性高或黏稠度较高药物的患者[3]。2019年4月,我科收治了1例阑尾黏液肿瘤术后复发患者,置入输液港后发生导管移位及血栓形成,经多学科会诊,拔除输液港后由专科护士置入PICC,在严密观察和精心护理下,未形成导管血栓。

达芬奇机器人手术系统行直肠联合其他脏器切除4例报告

机器人外科是一项新兴技术，拓宽了腹腔镜技术在外科领域的应用。达芬奇机器人手术系统自2000年获得FDA 批准后，国外多家医疗机构陆续开展临床应用，其安全性与疗效已得到肯定与共识［1］。沈阳军区总医院自2011年引进该设备，普外科目前共完成达芬奇机器人手术180例，其中腹腔多器官联合切除4例，占2．2％。现将达芬奇机器人手术系统行脏器联合切除4例报道如下。

多器官联合切取

目的 :通过心肾、肝肾联合切取 ,探讨多器官联合切取对各器官移植的临床效果影响及手术方法的改进。方法 :对 6例供者进行多器官联合切取 ,给 2例终末心脏病患者 ,1例晚期肝硬化合并慢性肾功能衰竭患者 ,3例晚期肝硬化 ,11例终末尿毒症患者分别实施了心脏移植 ,肝肾联合移植 ,肝移植、肾移植。供体均采用心肾 ,肝肾联合切取。结果 :1例心脏移植病人恢复顺利 ,至今已存活 10个月 ,另 1个心脏移植病人供心复跳顺利 ,但因作心导管时不慎引起腹主动脉出血 ,最后病人死于休克。 1例肝肾联合移植病人供肝 ,供肾即刻即有胆汁 ,尿液流出 ,至今已存活 4个月。 3例肝移植及 11例肾移植病人均顺利恢复 ,人 /肝 ,人 /肾存活为 14个月。结论 :在器官缺乏情况下 ,联合切取心肾 ,肝肾可以充分利用器官 ,并取得很好的临床效果。原位灌注是目前多器官切取最好的方法。

多脏器联合切除治疗进展期胃癌16例报告

目的：观察采用多脏器联合切除治疗进展期胃癌的疗效。方法：回顾性总结进展期胃癌１６ 例，其中侵犯周围脏器（包括胰腺、肝脏、脾脏、结肠）单个１０ 例，２ 个４例，３个２ 例。均采用联合脏器切除。结果：手术无明显并发症，术后存活５ 年以上２例，３年３例，２年５ 例，１～１．５ 年４例。同期胃癌病变和脏器侵犯相仿病例只进行化疗者，５年生存率为０，３年２例，２年２例，１～１．５年１２例。结论：进展期胃癌联合脏器切除后的效果与侵犯脏器的数目有关，侵犯脏器越少其手术效果越好。对无手术禁忌症的患者，联合脏器切除比非手术治疗效果好。

Study of the Value of Combined Multiorgan Resection in Surgical Treatment of Carcinoma of the Gastric Cardia

OBJECTIVE:To determine the value of resection of combined visceral organs in surgical treatment of gastric cardiac carcinoma. METHODS:We retrospectively analyzed 217 random patients with car- cinoma of the gastric cardia who underwent a gastric cardiac resection.The patients had been treated as fol ows:186 with partial gastrectomy,31 with total gastrectomy,97 with a combined-visceral resection,of which 82 under- went a splenectomy plus partial pancreatectomy,10 with splenectomy alone and 5 with partial hepatectomy and diaphragmatectomy. RESULTS:The total patients were divided into 3 groups:128 with a gas- trectomy alone,10 with gastrectomy and splenectomy,and 82 with gastrec- tomy and splenectomy plus pancreatectomy.The operating times for these 3 groups were respectively 3.0 h,3.1 h and 3.8 h.The hospitalization times were respectively 23.8 d,31.2 d and 25.9 d.No differences in post-operative complications were found between these 3 groups.There were 92 patients who underwent a gastrectomy combined with a splenectomy and(or)the pancreatectomy,in which 92 No.10 lymph nodes were eliminated,with an average of one in each patient.Among the 125 patients not receiving a sple- nectomy but with elimination of lymph nodes,82 underwent a gastrectomy combined with partial pancreatectomy,of which 107 lymph nodes were elimi- nated for the No.11 group,with an average of 1.3 in each patient.There was a statisticaly significant difference between the 2 groups.The overal survival rates were similar in the 3 groups showing no statistical differences, but was higher in the Stage III patients with a combined resection of multi- organs.For patients in the Stage IV without resection of multi-organs,the survival rate was higher,but there was no significant difference between the 2 groups. CONCLUSION:It is difficult to determine precisely the involvement of para-tumorous organs with the eye during an operation.Combining a sple- nectomy with a pancreatectomy does not increase the post-operative compli- cations following surgical treatment for carcinoma of the gastric cardia.The combination of a splenectomy and partial pancreatectomy results in a higher survival rate and has an important significance for eliminating the lymph nodes of group 10 and 11,especially for patients in Stage III.In the applica- tion of a resection combining multi-organs,the doctor should make every effort to decrease the trauma and the complications based on the condition that the cancerous tissue is totally resected.

胰头癌根治术手术范围:标准还是扩大切除

标准的胰十二指肠切除术（pancreaticoduodenectomy）是胰头癌的主要治疗方式，其包括以下手术范围：胰头、钩突、十二指肠、第一段空肠、胆总管、胆囊、胃幽门、远端胃窦、标准淋巴结清扫、与肿瘤相邻的横结肠系膜软组织部分。