2016年 · 第54卷第12期

Male, 59 years old, was admitted to the Department of Gastroenterology of our hospital on November 30, 2015 due to "abdominal distension, vomiting with cessation of exhaustion and defecation for 5 days". Five days before admission, the patient developed distension and pain in the upper abdomen after catching cold, accompanied by nausea and vomiting, vomiting yellow-brown stomach contents, and the symptoms of distension and pain after vomiting were slightly relieved, and the anus stopped exhausting and defecating. He went to the local hospital for treatment. After symptomatic treatment, the symptoms did not improve significantly, so he went to our hospital for treatment. Prior history of gallbladder stones for 5 years, ultrasound 3 months before admission revealed gallbladder stones (maximum diameter 3.5 cm). Admission physical examination: abdominal swelling, soft abdomen, mild tenderness in the upper abdomen, no rebound pain, and no mass in the abdomen; Liver and spleen were not subcostal, Murphy's sign was negative, there was no percussion pain in liver and kidney area, abdominal percussion drum sound, and intestinal sound 4 times/min. After admission, considering the possibility of acute intestinal obstruction, fasting, gastrointestinal decompression, anti-infection, acid suppression, nutritional support and other treatments were given. Admission emergency examination of abdominal upright X-ray showed gastric retention dilatation. Enhanced CT scan of the upper abdomen on the second day of admission showed: biliary fistula, considered with gallstone intestinal obstruction (the plane of obstruction is located in the duodenum) (Figure 1，Figure 2)。 Considering Bouveret syndrome, he was transferred to hepatobiliary surgery for continued treatment. On December 5, 2015, he underwent cholecystectomy + duodenal repair + gastrojejunostomy + duodenostomy under general anesthesia. During the operation, he saw extensive edema, thickening and dense adhesion in the right upper abdomen, and the shape of the gallbladder disappeared, communicating with the duodenal bulb, containing 6.0 cm ×3.5 cm ×3.0 cm stones, completely obstructing the intestinal lumen, and obvious local edema and thickening (Figure 3，Figure 4)。 After operation, he was treated with fasting, gastrointestinal decompression, anti-infection, acid suppression, nutritional support, etc., and was successfully discharged from hospital on January 4, 2016. Discharge diagnosis: Bouveret syndrome.

A 65-year-old female was admitted to the hospital mainly for "2 years after radical resection of left renal pelvic tumor, 2 months after hematuria was found". Two years ago, due to left renal pelvic tumor, he underwent laparoscopic left kidney, ureter full length and bladder sleeve resection. Hematuria was found again two months ago. CT showed that the right renal pelvis occupied space. Tumor cells were detected in urine and NMP22 was positive. Preoperatively, the possibility of renal pelvic cancer was considered, and the patient required local treatment. Under flexible ureteroscope, multiple tiny masses were seen in the right upper renal calyx, and renal pelvic tumors were seen under ordinary white light (Figure 1), clearer under narrowband imaging (Figure 2)。 Holmium laser vaporization cauterized the tumor body, base and its periphery within 0.5 cm.

Does your center do TA-TME or laparoscopy for low rectal cancer?