RESUMO
Objective To evaluate management stratagy for patients with traumatic splenic rupture.Methods The clinical data of 124 patients with traumatic splenic rupture admitted to the 422 Hospital of PLA from April 2008 to June 2016 were retrospectively analyzed.38 patients were treated conservatively,while 86 patients underwent surgery.To investigate impact factors of management strategy in patients with traumatic splenic rupture,clinical characteristics and CT features between the two groups were compared.Results Univariate analysis results showed that injury causes,blood pressure,at admission,pulse,CT grade and abdominocentesis were closely related with therapeutic scheme.And multivariate Logistic regression analysis results showed that pulse (OR =4.264,95％ CI 1.206-15.073),CT grade (OR =2.086,95％ CI 1.019-4.271) and abdominocentesis (OR =3.428,95％ CI 1.024-11.479) were the significant determining factors of therapeutic scheme in patients with traumatic splenic rupture.Surgical intervention was carried out in 86 patients accounting for 69.4％ of all patients.The rate of surgical intervention was 58.1％ in the patients with CT grade of 1 and 2,that was 94.7％ in patients with CT grade of 3 and 4.Conclusions Operative management is needed for most traumatic splenic rupture,patients those with hemodynamic stability and CT grade of 1 or 2 may be qualified for watchful non-operative management.
RESUMO
Objective To comparative analyze the anorectal function before and after anus-preserving laparoscopic rectal resection in ultra low rectal cancer.Methods Radical excision of ultra low rectal cancer was performed with ultrasonic scalpel on 43 patients based on the concept of TME and ultra low colorectal/ anal anastomosis was perfomed by applying the manual anastomosis with two operations out of anus.The time of guid being controlled in the rectus,rectual rest pressure (RRP),anal rest pressure (ARP) and anal maximal contraction pressure (AMCP) were tested before operation.The function of their rectus and anus was tested,including the number of bowel movement in one day of 1,3,6 months after operation,the time of guid being controlled in the rectus,RRP,ARP and AMCP after 3,6 months of operation et al.Results All the operations were finished successfully,four cases were converted to open surgery,but there was no serious damage.All cases were followed up for 6 to 36 months with average of 20 months.After 3 months of operation,the retention time of liquid in rectus,the defecate feel function,the anus control function,RRP and ARP was statistically significant (P ＜ 0.05) compared to them before operation,there was no statistical significance (including AMCP) (P ＞ 0.05) after 6 months of operation.The results of tests in annus and rectus were near normal level after 6 month of operation.Conclusion The manual anastomosis with two operations out of anus in the laparoscopic anal sphincter preserving resection of ultra low rectal cancer is safe,economical,effective,minimally invasive and shorter hospital stay,it is worth to be widely used.