目的 探讨结肠粪性穿孔的发病原因、临床特点、诊断和治疗方法。方法 回顾性分析广州市第一人民医院2012年1月—2015年1月收治的12例结肠粪性穿孔病人的临床资料。结果 本组病人共12例,均因腹膜炎体征行剖腹或腹腔镜探查术,术中根据Maurer标准诊断为结肠粪性溃疡穿孔。本组病人术后治愈出院10例,治愈率为83.3%,2例80岁以上病人因感染中毒性休克、多器官功能衰竭分别于术后第2天及第3天在重症监护病房死亡,死亡率为16.7%,术后主要合并症为肺炎(10例,83.3%)及胸腔积液(12例,100%)。结论 在临床工作中,了解结肠粪性穿孔发生的危险因素,及时进行有针对性的辅助检查,快速手术干预是降低病死率的关键。

Objective To explore the causes, clinical characteristics, diagnosis and treatment of stercoral perforation of colon. Methods The clinical data of 12 cases of stercoral perforation of colon from Jan 2012 to Jan 2015 were retrospectively analyzed. Results There were twelve patients who were diagnosed stercoral perforation of colon according to accurate diagnostic criteria during the open or laparoscopic operation. Of the 12 cases, 10 cases (83.3%) were cured, 2 cases (16.7%) died because of septic shock and multiple organ failure in the intensive care unit. After operation 10 cases (83.3%) had pulmonary infection and 12 cases (100%) had pleural effusion. Conclusion The key of improve the prognosis of stercoral perforation of colon depends on the full understanding of risk factors, proper preoperative examination and prompt surgical procedures.

目的 探讨胰腺神经鞘瘤的临床特点和诊治方法。方法 总结并回顾性分析我院肝胆外科收治的胰腺神经鞘瘤患者1例及文献报道的71例患者临床资料。结果 共计72例胰腺神经鞘瘤患者纳入总结和分析。患者平均年龄54岁(范围17～89岁),其中女性40例(56%)。临床表现包括上腹痛、体重减轻,或体检偶然发现胰腺肿物。肿瘤平均大小6.1 cm(1～20 cm)。肿瘤位于胰头部29例(40%)、胰体/尾部32例(44%),沟突部6例(8%)。肿瘤表现为实性肿物27例(38%)、囊性28例(39%)、囊实性10例(14%)。2例通过术前超声内镜下穿刺活检病理确诊,其余均为手术后标本病理诊断证实。手术治疗行胰十二指肠切除术23例、局部剜除术16例、胰体尾切除术15例、胰腺中段切除1例。5例 (7%) 患者术后病理为恶性神经鞘瘤,恶性组肿瘤大小明显大于良性组[(13.8±6.2)cm vs (5.6±4.1)cm,P=0.0004)]。手术切除患者术后随访3～65月,均无肿瘤复发、转移及患者死亡。结论 胰腺神经鞘瘤临床表现缺少特异性,术前诊断困难,肿瘤大小与良恶性具有明显相关性,手术治疗可取得良好效果。

Objective To analyze clinical presentation, diagnosis, treatment options, and outcome of pancreatic schwannoma. Methods A retrospective study of clinical data of a case in our hospital and 71 cases reported in literature with pancreatic schwannoma. Results 72 cases were analysed. The mean age was 54 years (range 17-89 years), with 56 % of patients being female. Mean tumor size was 6.1 cm (range 1-20 cm). Tumor location was the head (29 cases), body and tail (32 cases), and uncinate process (6 cases). 27 cases exhibited solid tumors and 28 cases exhibited cystic tumors. Treatment included pancreaticoduodenectomy (23 cases), distal pancreatectomy (15 cases), enucleation (16 cases). 5 cases (7%) were malignant schwannoma. Tumor size of malignant group was significant larger than benign group (13.8±6.2 cm vs 5.6±4.1 cm,P=0.0004). There was no local recurrence metastasis,or death at the follow-up after operation (range 3-65 months). Conclusion The clinical manifestations of pancreatic schwannoma are lack of specificity and preoperative diagnosis remains difficulty. The tumor size was significantly related to classification of malignant or benign. Pancreatic schwannoma has satisfactory prognosis with surgical treatment.

目的 探讨重症急性胰腺炎诊治特点。方法 回顾性分析13例重症急性胰腺炎患者临床资料,包括一般资料、生化检测及影像资料、治疗措施与预后结果,纳入标准为急性胰腺炎合并器官衰竭＞48 h(改良Marshall评分≥2分)。结果 重症急性胰腺炎患者一般资料中普遍突出存在心率增快(121.07±28.09)次/分、APACHE II评分偏高(18.92±7.34),病因排序则是高脂血症(38.5%)＞胆石症(30.8%)＞酒精性(23.1%),SAP合并ARDS发生率可达46.2%,合并AKI则高达69.2%;WBC(12.60±5.57)×10⁹/L、CRP(138.16±67.06)mg/L及PCT(15.76±27.33)ng/L等炎症指标升高提示SAP普遍存在炎症反应,影像学中69.2%患者合并发生肺炎及腹腔积液则提示多处感染部位,其他脏器指标异常升高也提示SAP患者心肺肝肾均存在不同程度的受损;接受CRRT治疗及呼吸支持可分别达46.2%及76.9%,7天内死亡例数为1例(7.7%),28天内死亡例数为4例(30.8%),ICU及总住院时间为(10.77±7.38)及(19.61±13.40)天。结论 重症急性胰腺炎是全身及局部性的炎症反应累及全身各个脏器的急性复杂病变,以合并发生ARDS及AKI为临床特征,需要多器官功能保护与替代、外科干预等多学科综合协作治疗。

Objective To evaluate characteristics of diagnosis and treatment on severe acute pancreatitis. Methods To respective analysis clinical data of 13 patients with severe acute pancreatitis. The data included baseline characteristics, biochemical tests and imaging data, treatment and prognosis, inclusion criteria for acute pancreatitis with organ failure > 48 h (modified Marshall score > 2). Results Higher heart rate(121.07±28.09) times/min and APACHEII scores(18.92±7.34) were universally found in SAP, which primary disease contained hyperlipidemia (38.5%) > cholelith disease (30.8%) > alcohol (23.1%) with incidence of ARDS and AKI being 46.2% and 69.2%; Higher inflammatory biomarkers including WBC(12.60±5.57)×10⁹/L, CRP(138.16±67.06)mg/L and PCT(15.76±27.33)ng/L indicated widespread inflammation with many infection sites revealing by 69.2% pneumonia and peritoneal effusion on imaging; Other abnormally biochemical index prompted some injury of viscera including heart, lungs, kidney and liver; 1 case suffered death within 7 days and 4 cases also did within 28 days, ICU and total length of hospital stay was (10.77±7.38) and (19.61±13.40) days, CRRT treatment and respiratory support respectively reached 46.2% and 46.2%. Conclusion Severe acute pancreatitis is a acute complex pathological changes on various organs induced by acute systemic and local inflammation with feature of mergence with the ARDS and AKI, which need the multidisciplinary integrated collaborative treatment on organ function protection and sustain and surgical intervention.

        儿童孤立性直肠溃疡综合征（SRUS）是一种较为罕见的慢性直肠疾病,儿童发病率低且缺乏明确统计学数据。该病主要表现为便血、排黏液便和排便不尽感,临床诊断较为困难,常易误诊为其他疾病。其发病机制尚不明确,可能与排便习惯异常、直肠黏膜异常、血管异常以及遗传易感性等多种因素有关,其中 CHEK2 基因的 p.H371Y 突变可能在发病机制中起关键作用。诊断需综合病史、体格检查以及排粪造影、超声内镜、肠镜检查与组织病理活检等多种辅助检查手段。治疗上目前尚无统一指南,主要包括改善饮食和排便习惯、生物反馈治疗、药物治疗、内镜下治疗和外科手术治疗等,但总体治疗难度较大且复发率较高。本文对儿童 SRUS 的流行病学、发病机制、临床表现、诊断和治疗等方面的研究进展进行综述,旨在提高临床医师对该病的诊疗水平,为未来进一步的研究提供参考依据。

       Solitary rectal ulcer syndrome（SRUS）in children is a chronic and benign disease of the rectum characterized by ulcers. The clinical incidence of SRUS in children is not high, but it is prone to misdiagnose and miss diagnosis,which can delay the optimal treatment opportunity. This article reviews the research progress on the epidemiology,pathogenesis, clinical manifestations, diagnosis and treatment of SRUS in children, aiming to improve the diagnostic and therapeutic level of clinicians.