瘘

Palatal fistulae were repaired by this method, 4 pedicled superior-anteriorly and 14 pedicled posteriorly, 7 of which got velopharyngeal incompetence correction at the same time. Results All of the patients got satisfactory fistula closure except 3 complications. One flap got partly necrosis and two got fistulae at the hard palate. However, the fistula sizes were reduced greatly and one has been re-repaired well by the transferred buccinator musculomucosal flap one year later.

结果：共修复腭瘘患者18例；其中15例腭部瘘孔获得关闭，颊肌黏膜瓣成活良好，无感染、腮腺导管损伤或阻塞、面神经损伤，无张口受限、瘢痕挛缩及咀嚼障碍；2例因岛状颊肌粘膜瓣远端愈合不良再次出现硬腭前端瘘口，但面积较原来明显减小，其中1例再发腭瘘应用已转移到腭部的颊肌粘膜瓣组织行二次手术修复后愈合；1例岛状颊肌粘膜瓣部分坏死。

Abstract］ objective to discuss the influencing factors of healing up of anastomosis between traditional and morden ideas and question the more reasonable method of intestinal tract preparation in stage one operation.methods twenty-six patients with colon cancer were divided into 3 groups:colostomy group（8 cases）,washing group (9 cases) and suction group (9 cases).all the patients underwent colectomy plus stage one anastomosis and exteriorization with different interoperative preparation with which we compared the healing up of anastomosis within the three groups.results there were 3 cases having fistula in the colostomy group （8 cases）;one case in the washing group,but all the patients in the suction groups gained stage one healing up.conclusion as a method of emergency interoperative peparation,stool suction has a better healing up of anastomosis than colostomy and washing;it is advantageous to observe the healing up of anastomosis through colectomy plus stage one anastomosis and colon-outlying.

目的 探讨影响吻合口愈合因素的传统与现代观念并进一步探讨一期手术中更为合理的肠道准备方式。方法 26例降结肠癌分为造瘘组（8例）、冲洗组（9例）和粪便吸引组（9例）三组，术中分别采用3种不同方式行紧急肠道准备，所有病人均采用结肠切除一期吻合加外置的方法，对比观察三组病人的吻合口愈合情况。结果造瘘组（8例）有3例发生瘘，冲洗组有1例发生瘘，粪便吸引组全部一期愈合。结论粪便吸引作为一种术中紧急肠道准备方法，其吻合口愈合情况优于前两组；结肠一期吻合加外置的方法有利于观察吻合口的情况。

Methods Modification I:Transverse incision was chosen on epigastirc,a piece of about 3×5 cm fascil strip with pedical as well as bilateral anterior and posterior sheath of recus and peritoneum was pulled through transverse mesocolon functioning as the supporting stick of traditional loop ostomy.The colon of ostomy was buried subcutaneously,stoma was opened instantly or secondarily depending on the patients′s condition.

一、选择上腹部正中线横向切口，将腹白线两旁的腹直肌前、后鞘连同腹膜切成3×5cm的带蒂筋膜条穿过横结肠系膜并缝合固定，替代传统袢式造瘘的支撑棒，造瘘肠段埋于皮下，根据病情需要直接或二期开放造瘘口，余手术操作基本同传统袢式造瘘术。

Based on John Morris's study, 3 cases were gradel, 6 cases were grade 2, 3 cases were grade 3, 2 cases were grade 4, and 1 case was grade 5. Only 2 cases had a perianal abscess.

根据John Morris等的分类方法，15例患者中，l级肛瘘3例，2级肛瘘6例，3级肛瘘3例，4级肛瘘2例，5级肛瘘1例，其中2例为单纯肛周脓肿。

Three, congenital anorectal atresia: This is because of bad or abnormal embryonic development due to congenital diseases, children with anal atresia completely, and some combined vestibular rectal fistula, rectal-perineal fistula or rectovaginal fistula, boys still rectal fistula and other bladder deformity.

三、先天性肛门直肠闭锁：这是由于胚胎发育不良或异常所致的先天性疾病，患儿肛门完全闭锁，有的合并直肠前庭瘘、直肠会阴瘘或直肠阴道瘘，男孩还有直肠膀胱瘘等畸形。

Patients with congenital anal atresia and concomitant rectovaginal or rectoperineal fistula were undertaken Z shape plastic operation with fistula reserved. 2 patients with rectovaginal or rectoperineal fistula were removed and closed fistual and repaired os of fistula.

采用Z成形术修复先天性肛门狭窄9例，保留瘘口瘘道＋Z成形术修复先天性肛门闭锁伴直肠阴道瘘或直肠会阴瘘5例，彻底切除瘘管、分层闭合瘘道、修复瘘口治疗单纯性直肠阴道瘘或直肠会阴瘘2例。

Cases happened in 76 cases suffering the not prophylactic terminal ileum stoma patients and the patients was concrescence after treating with colon transversum stoma, abdomen-perinaeum association ectomy, nutrition and partly washing.

未施行预防性末端回肠造瘘的76例患者中吻合口瘘发生率11.896（9例），分别予以横结肠造瘘、腹会阴联合切除术及营养支持与局部冲洗引流治疗后愈合；出现吻合口瘘后的平均住院时间为27（15-60）天。

According to the principles of classification of urethral damages, the urinary fistulae after kidney transplantation was classified in terms of the cause, location and extent of them.

文章根据尿道损伤疾病分类的原理，将肾移植后尿瘘分别按照尿瘘病因、尿瘘部位、病变程度等进行分类；讨论了肾移植后尿瘘经久不愈的原因以及诊断时应注意的几个问题。

One anastomotic leakage patient operated again in Hartmans' way because of huge anastomotic leakage and sepses symptom;another patient went out of the hospital with the conduct-pipeline of antesacrum because of incurable leakage through intestinal nutrition,TPN and conservative treatment,its leakage was curable after two months;another patient appeared the leakage of rectal vagina which was remedied after six months;the other 20 anastomotic leakages were recovered by conducting, local washing,taking food,treating accompanying illness.

结果 263例中发生吻合口瘘23例，占8.7%。1例吻合口瘘口大，出现全身中毒症状再行Hartmans手术；1例吻合口瘘经肠内营养、肠外静脉营养等保守治疗，瘘口未愈，带骶前引流管出院，2个月后愈合；1例出现直肠阴道瘘，6个月后行阴道修补术；其他20例吻合口瘘经骶前引流、冲洗、加强营养、伴随疾病治疗均痊愈出院。

One anastomotic leakage patient operated again in Hartmans' way because of huge anastomotic leakage and sepses symptom;another patient went out of the hospital with the conduct-pipeline of antesacrum because of incurable leakage through intestinal nutrition,TPN and conservative treatment,its leakage was curable after two months;another patient appeared the leakage of rectal vagina which was remedied after six months;the other 20 anastomotic leakages were recovered by conducting, local washing,taking food,treating accompanying illness.

结果 263例中发生吻合口瘘23例，占8.7%。1例吻合口瘘口大，出现全身中毒症状再行Hartmans手术；1例吻合口瘘经肠内营养、肠外静脉营养等保守治疗，瘘口未愈，带骶前引流管出院，2个月后愈合；1例出现直肠****瘘，6个月后行****修补术；其他20例吻合口瘘经骶前引流、冲洗、加强营养、伴随疾病治疗均痊愈出院。

The split between the two groups can hardly be papered over.

这两个团体间的分歧难以掩饰。

This approach not only encourages a greater number of responses, but minimizes the likelihood of stale groupthink.

这种做法不仅鼓励了更多的反应，而且减少跟风的可能性。