术前补充益生菌对肠道手术患者术后肠道菌群 及肠黏膜屏障功能的影响

目的探讨术前补充益生菌对肠道手术患者术后肠道菌群及肠黏膜屏障功能的影响。方法选取肠道手术患者86例,随机分为观察组和对照组各43例。两组患者术前予以常规肠道准备,术后给予等营养支持及抗生素等治疗。观察组患者术前7 d开始加用双歧杆菌三联活菌胶囊温水口服,630 mg/次,2次/d。观察两组患者术后肠道功能恢复及感染并发症情况,并比较术前7 d及术后首次自然排便时两组患者肠道菌群数量及肠黏膜屏障指标变化。结果观察组患者术后肠鸣音恢复时间、肛门排气时间、排便时间均短于对照组(均P0.05),术后感染并发症的发生率低于对照组(P0.05)。术后首次自然排便时两组患者肠道双歧杆菌、乳杆菌数量及B/E值显著低于术前7 d时,大肠埃希菌数量高于术前7 d时(均P0.05),且观察组患者术后双歧杆菌、乳杆菌数量及B/E值均高于对照组,大肠埃希菌数量明显少于对照组(P0.05)。术后首次自然排便时两组患者血清D-乳酸和DAO水平高于术前7 d时(P0.05),且观察组患者术后D-乳酸和DAO水平低于对照组(P0.05)。结论肠道手术患者术前补充益生菌可调节肠道菌群,降低肠黏膜通透性,改善其肠道功能,减少术后感染并发症的发生率。     

Intestinal motor disorders associated with cyclical bacterial overgrowth in a rat model of enteritis

The aims of this study were: 1) to obtain an experimental model reproducing the characteristics of chronicity and spontaneous relapses found in inflammatory bowel disease (IBD) and 2) to correlate these changes with intestinal motility and bacteria translocation. For this purpose, two groups of Sprague-Dawley rats were used: a treated group that received two subcutaneous injections of indomethacin (7.5 mg/kg) 48 h apart and a control group that received saline. Blood leukocytes, TNF, and fecal parameters were monitored for 90 days after treatment. In treated rats, a cyclic oscillation of blood leukocytes and TNF concomitant with an inverse correlation of fecal output was observed. Treated rats were then selected either during their highest or lowest blood leukocyte values for motor activity and microbiological evaluation. Controls were obtained in age-matched rats. Rats with high leukocyte levels showed a decrease of motor activity. In contrast, animals with low leukocyte levels presented hypermotility. Bacterial overgrowth accompanied by bacterial translocation was found in the group with high leukocytes, whereas no differences were observed between the control and indomethacin groups during the lowest leukocyte phase. We obtained a model of IBD characterized by a chronic cyclic oscillation of intestinal motility, flora, and inflammatory blood parameters. During the high-leukocyte stage, motor activity decrease is related to bacterial translocation. This phase is followed by a reactive one characterized by hypermotility associated with a decrease in both bacterial growth and leukocytes. However, as in IBD, this reaction seems unable to prevent a return to relapse.     

Intestinal motility after intraduodenal and intrajejunal feeding]

Post-prandial intestinal motility, analysed through two electromyographic parameters, duration of inhibition of myoelectric complex (DIMC) and percentage of spike potentials (PSP), was studied after ingestion of glucids, proteins and lipids. Post-prandial intestinal motility depends on both chemical nature and caloric load of nutriments: DICM depends on those two factors but PSP only depends on nature of nutriments. Post-prandial intestinal motility also depends on route of administration of nutriments. Intra-jejunal administration versus intra-duodenal administration increases DIMC observed for glucids and proteins, diminishes DIMC observed for lipids and diminishes PSP observed for glucids and proteins. These results indicate a specificity of intestinal post-prandial motility with characteristics of nutriments. Intestinal digestion and absorption of nutriments, just as hormonal secretion in response to intestinal passage of nutriments could explain such a specificity.     

腹腔镜阑尾切除术与开腹阑尾切除术治疗急性阑尾炎的疗效比较

目的:比较腹腔镜阑尾切除术和开腹阑尾切除术治疗急性阑尾炎的临床疗效。方法:选取2012年3月-2014年3月我院收治的急性阑尾炎患者127例,按照随机数字表法分为两组,观察组63例行腹腔镜阑尾切除手术,对照组64例行开腹阑尾切除手术,比较两组的手术效果及术后并发症情况。结果:两组的手术时间差异无统计学意义(P0.05),观察组术中出血量、肛门排气时间及住院时间均低于对照组,差异有统计学意义(P0.05)。两组治疗后VAS评分较治疗前有不同程度的降低,且观察组低于对照组,差异有统计学意义(P0.05)。观察组切口感染、肠梗阻以及腹腔脓肿发生率均低于对照组,差异有统计学意义(P0.05),而两组腹腔内出血、阑尾残端瘘的发生率比较,差异无统计学意义(P0.05)。结论:腹腔镜阑尾切除术治疗急性阑尾炎具有手术效果好、预后快及术后并发症少等特点,值得临床推广使用。     

Travel stress alters the intestinal migrating myoelectric complex in rats: antagonist effect of trimebutine.

A novel stress model was developed that may closely resemble a real-life situation. Intestinal motility was monitored in rats before and after a 12 hour train voyage (travel stress). Travel stress reduced the duration of phase III of the intestinal MMC by 30% (3.2 +/- 0.3 vs 4.7 +/- 0.6 min; p less than 0.001) while the durations of phase I and II were unaffected. This effect persisted for two days. Phase III duration returned to basal values after 3 days indicating a reversible alteration on intestinal migrating myoelectric complex (MMC). The infusion of trimebutine at a flow rate of 166 micrograms/kg/h during the stress exposure abolished the changes observed in the duration of phase III of the MMC; the infusion of diazepam (16.6 micrograms/kg/h) had no effect. These results indicate that the travel stress model may be similar to common life events that induce alterations of intestinal motility. Furthermore, trimebutine prevented the reduction of phase III duration induced by travel stress suggesting its possible action on mechanisms involved in the mediation of the stress-induced intestinal motility changes.     

生长抑素联合双歧杆菌四联活菌治疗急性胰腺炎的效果及对肠粘膜屏障功能的影响

目的:探究生长抑素联合双歧杆菌四联活菌治疗急性胰腺炎的效果及对肠粘膜屏障功能的影响。方法:选取2015年8月～2018年8月我院收治的急性胰腺炎患者98例,根据患者入院先后顺序分为两组。对照组患者给予生长抑素治疗,观察组在对照组的基础上联合双歧杆菌四联活菌片治疗。比较两组患者的临床治疗效果,临床症状和指标的恢复时间及胃肠动力的恢复情况,治疗前后D-乳酸、二胺氧化酶(DAO)和尿乳果糖和甘露醇的比值(L/M)水平的变化。结果:治疗后,观察组患者的总有效率显著高于对照组(P0.05),腹痛、腹胀、腹膜刺激征、血淀粉酶和尿淀粉酶恢复正常时间均显著短于对照组(P0.05)。治疗后,两组患者的血清D-乳酸、DAO和L/M水平均较治疗前显著下降,且观察组以上指标均显著低于对照组(P0.05)。此外,观察组患者的腹内压显著低于对照组,肠鸣音恢复时间显著短于对照组,胃肠减压引流量显著低于对照组(P0.05)。结论:与单用生长抑素相比,生长抑素联合双歧杆菌四联活菌可更迅速缓解急性胰腺炎患者的临床症状及指标,恢复胃肠动力,并显著改善患者的肠粘膜屏障功能,利于患者的康复。     

"Right" stay in hospital after sugery: randomised controlled trial.

A randomised controlled trial was carried out on 100 patients to compare the effects of discharge after certain pre-specified clinical criteria had been fulfilled--"right" stay--with those of discharge at an arbitrary 10 days after surgery--"fixed" stay. The operations concerned (cholecystectomy and vagotomy) were more hazardous than those previously included in studies of early discharge. Patients in the right-stay group were discharged, on average, 7-6 days after operation--that is, two days earlier than those in the fixed-stay group. In terms of clinical progress, social factors such as return to work, and the acceptability to patients and relatives of the implications of right stay, patients in this group fared as well as those in the fixed-stay group, and in some respects slightly better. Right stay entailed the transfer of some work from hospital to community medical and nursing staff, but this also was acceptable. The concept and use of the right-stay principle is of value in planning the postoperative discharge of suitable patients.     

自制滴水双套管持续负压引流技术应用于全胃切除术后的效果评价

目的：目前全胃切除术术后患者腹腔引流多数是放置普通单管引流,然而术后预防性放置滴水双套管的价值还存在争议。现对滴水双套管应用于全胃切除术后腹腔引流的效果进行系统评价。方法：选取我院2011年9月-2013年9月开腹全胃切除患者100例为研究对象,随机分为实验组和对照组,实验组术毕放置两根滴水双套管,左右各一根,对照组常规放置普通橡胶引流管两根,比较两组术后退烧药物应用次数,平均每日引流量,腹腔感染发生率,置管时间,术后平均住院时间,严重并发症发生率。结果：对照组50例患者中,有1例出现十二指肠残端瘘合并腹腔出血。1例切口感染,3例腹腔积液。实验组50例中,有1例出现胃食管吻合口瘘并切口感染。术后前7天应用退烧药物（体温超过38.5摄氏度时应用）的平均次数（1.85±1.10）d,差异有统计学意义（P〈0.05）。平均每日引流量（145.50±15.45）ml,差异有统计学意义（P〈0.05）。平均拔管时间（9.90±2.75）d,但差异无统计学意义（P〉0.05）。平均术后住院时间（13.98±2.09）d,差异有统计学意义（P〈0.05）,吻合口瘘发生率两组无差异。结论：对于全胃切除患者,术后预防性放置滴水双套管,可明显减轻术后腹腔积液产生的体温升高,缩短住院时间,有效防止腹腔感染的发生,虽不能降低严重并发症的发生率,但可以起到及时发现及时处理的作用,避免二次手术。值得在临床上推广。     

行政干预对Ⅰ类切口围术期预防性使用抗菌药物的影响

目的:探讨行政干预对I类切口围术期预防性使用抗菌药物的影响。方法:2011年4月～6月对全院手术科室进行行政干预,具体做法:卫生行政部门与医院一把手、医院与手术科室主任、科室主任与科室执业医生分别签订目标责任状;医院配合全国抗菌药物临床应用专项整治活动方案进行全员培训,并对医师进行抗菌药物临床应用培训并考核合格后,授予其相应级别的抗菌药物处方权,明确各级医师使用抗菌药物的处方权限;由医务科牵头与院感染科、药剂科、质控科联合对I类切口手术患者预防使用抗菌药物情况进行检查,定期实施目标奖罚,责任到科室主任和临床医生。然后抽取我院2010年7月～12月(行政干预前)和2011年7月～12月(行政干预后)I类切口手术病历各210份,参考《抗菌药物临床应用指导原则》、卫办医政发[2009]38号通知对420例I类切口手术患者预防使用抗菌药物情况进行回顾性分析。结果:行政干预前(2010年7月～12月)I类切口围手术期预防性抗菌药物的使用率达83.81%(176/210),术后抗菌药物使用时间在2～7天者占69.52%,大于7天者占6.67%;行政干预后(2011年7月～12月)210例患者预防使用抗菌药物使用率为30%(63/210),显著低于未使用行政干预的Ⅰ类切口术患者(P<0.05),围术期术后抗菌药物使用时间在2～7天者占16.67%,没有1例患者用药超过7天,抗菌药物的使用时间较未使用行政干预的Ⅰ类切口术患者显著缩短(P<0.05)。结论:有效的行政干预可以强化临床医生合理应用抗菌药物的意识,提高合理用药的水平,明显降低I类切口预防性抗菌药物的使用率,缩短抗菌药物的使用疗程。     

Use of antibiotics for the prevention of postoperative suppurative complications in planned surgery

Two methods for antibiotic prophylaxis in scheduled surgical treatment were studied comparatively. In the main group antibiotic prophylaxis with respect to 621 operations was started simultaneously with premedication, the duration of the course being defined by the operation type. With respect to 252 pure operations antibiotics were not used in 69.8 per cent of the cases or used for 2-3 days in 27.8 per cent of the cases. With respect to 253 conditionally pure operations shorter courses of antibiotic prophylaxis, i.e. for 2-3 days were used in 50.2 per cent of the cases. In the control group the antibiotics were used after operations in mean therapeutic doses, the duration of the course being defined by the clinical findings. The number of purulent complications in the main group decreased, while the amounts of the antibiotics used were much lower.     

异丙酚复合布托啡诺辅助腰硬联合麻醉用于妇科腹腔镜手术

目的探讨异丙酚复合布托啡诺辅助腰硬联合麻醉应用于妇科腹腔镜手术的安全性和优越性。方法将50例行妇科腹腔镜手术患者随机分为两组,B组为异丙酚复合布托啡诺辅助腰硬联合麻醉组,F组为异丙酚复合芬太尼辅助腰硬联合麻醉组。术中保证患者睡眠、无体动。观察两组术中有无呼吸抑制、舌后坠及恶心呕吐,记录各时段生命体征及气腹时间、苏醒时间、异丙酚总用量。结果两组患者各时段的MAP、HR、RR、SpO2变化均在正常范围内。B组呼吸抑制、舌后坠、寒战发生率显著低于F组（P〈0.05）,异丙酚总用量显著少于F组（P〈0.05）。结论异丙酚复合布托啡诺辅助腰硬联合麻醉能为妇科短时间腹腔镜手术提供安全满意的麻醉效果。     

Laparoscopic cholecystectomy as a safe and effective treatment for severe acute cholecystitis.

OBJECTIVE--To evaluate the feasibility and safety of laparoscopic cholecystectomy in severe acute cholecystitis. DESIGN--Analysis of data collected prospectively from a consecutive series of 350 laparoscopic operations. SETTING--Two general surgical units in a teaching hospital. SUBJECTS--31 patients with a diagnosis of severe acute cholecystitis based on clinical examination, investigation results, and operative findings. INTERVENTIONS--Initial intravenous fluids and broad spectrum antibiotics followed by laparoscopic cholecystectomy within 72 hours of presentation. MAIN OUTCOME MEASURES--Failure to complete the operation laparoscopically, length of postoperative stay in hospital, early postoperative morbidity, interval from operation to full activity, and return to work. RESULTS--Laparoscopic cholecystectomy was attempted in 19 patients with empyema of the gall bladder and 12 who had severe cholecystitis which failed to settle on medical management. A total of 29 operations were successfully completed with two conversions to open surgery. Two minor postoperative complications occurred, and one case of retained common bile duct stones with jaundice was treated by endoscopic retrograde cholangiopancreatography and papillotomy. Median postoperative hospital stay was two days, with return to normal activity in seven days and to work in two weeks. There were no deaths related to the operation. CONCLUSIONS--In the presence of severe acute cholecystitis laparoscopic cholecystectomy is feasible in most patients, with minimal risk of injury to surrounding structures and considerable benefits. It is recommended that laparoscopic cholecystectomy should be attempted in these patients when appropriate surgical skill is available.     

Effects of juice from Morinda citrifolia (Noni) on gastric emptying in male rats

The effects of juice from Morinda citrifolia (noni) on gastric emptying, gastrointestinal transit, and plasma level of cholecystokinin (CCK) in rats were studied. Male rats were given noni by gavage at levels of 0.25, 1, or 4 ml/kg once per day for one or 7 days. The rats in the control group were given water, while the rats in the experimental group were fasted overnight before measurement of gastrointestinal motility. Gastrointestinal motility was assessed in rats 15 min after intragastric instillation of a test meal containing charcoal (10%) and Na251CrO4 (0.5 microCi/ml). Gastric emptying was determined by measuring the amount of radiolabeled chromium contained in the small intestine as a percentage of the initial amount received. Then, gastrointestinal transit was evaluated by calculating the geometric center of distribution of the radiolabeled marker. Finally, blood samples were collected for measurement of CCK by radioimmunoassay. The administration of noni at 0.25 ml/kg, but not at 1 ml/kg and 4 ml/kg, for 1 day significantly inhibited gastric emptying. In contrast, gastric emptying was significantly inhibited by oral noni (0.25, 1, or 4 ml/kg) for 7 days. Intraperitoneal injection of lorglumide (5 or 10 mg/kg), a selective CCK1 receptor antagonist, effectively attenuated the noni-induced inhibition of gastric emptying. The intestinal transit and body weight, food intake, water intake, urine volume as well as feces weight were not altered by the administration of noni either acutely or chronically, but the administration of oral noni (1 ml/kg) for 7 days increased the level of plasma CCK in male rats. These results suggest that oral noni inhibits gastric emptying in male rats via a mechanism involving stimulation of CCK secretion and CCK1 receptor activation.     

添加丙氨酰谷氨酰胺的胃肠外营养对存在营养风险的胃癌根治术患者免 疫功能、营养状态及术后恢复的临床意义*

目的:本研究旨在探讨NRS评分大于5分的胃癌根治术患者围手术期应用丙氨酰谷氨酰胺(Ala-Gln)强化的肠外营养对免疫功能、营养状况及术后恢复情况的临价值。方法:NRS-2002评分大于5分的胃癌患者60例,随机分为两组,每组30例。术前开始给予肠外营养支持,5日后手术,手术方式为根治性胃切除,包括远端胃大部切除术和全胃切除术。术后继续给予常规肠外营养。只有实验组给予谷氨酰胺双肽每日20克。于入院时和手术后第6日测量CD4、CD8、CD4/CD8、IgG、IgA、IgM淋巴细胞计数等免疫指标,血清总蛋白、白蛋白、谷丙转氨酶、总胆红素、血肌酐等肝肾功能指标,观察手术恢复过程及术后并发症发生情况。结果:采用谷氨酰胺强化的试验组CD4、CD8等免疫指标恢复情况显著优于对照组。二者一过性肝功能损伤发生率无明显差异。但试验组白蛋白较对照组恢复迅速。试验组术后肠蠕动恢复较对照组快,术后腹泻发生率较低。两组在术后抗生素应用时间、术后感染等发病率方面未显示统计学差异。结论:对存在营养风险的胃癌患者进行围手术期静脉营养支持时添加谷氨酰胺制剂可明显改善患者的免疫状况,促进术后恢复减少手术并发症。     

Daunomycin, cytosin-arabinoside and VP-16 (DAV) for myeloid blast crisis of CML

Nine patients with myeloid blast crisis of Philadelphia chromosome-positive chronic myelocytic leukemia received 1-3 courses of intensive induction chemotherapy with DAT (daunomycin, cytosin-arabinoside and 6-thioguanin) or DAV (daunomycin, cytosin-arabinoside and VP-16). Eight patients responded with clearing of blasts from peripheral blood giving a response rate of 89%. However, bone marrow aplasia with less than 5% blasts was seen in only 2 patients. These 2 patients subsequently received an allogeneic bone marrow transplant and achieved complete remissions of 3 and 6 month duration. All patients died due to progression of blast crisis. Median survival of the group was 164 days. These results were compared to a historical control group of 31 patients with myeloid blast crisis treated with vincristine and prednisone. Despite a significantly better response rate with DAV or DAT (8 of 9 versus 9 of 31, p = 0.01) survival was not significantly different than that of the control group.     

Prolonged antibacterial action of polymer coated suture materials]

The antimicrobial activity of capromed, a surgical polymer-coated sutural material containing dioxidine, quinoxidine or gentamicin was studied in vitro and in vivo. Capromed was shown to be active against the hospital strains of S. aureus, E. coli, Proteus spp., Klebsiella spp. and P. aeruginosa. The antimicrobial activity of ADH and AG threads was preserved for 3 to 4 days after implantation. The DH-2 and G-2 threads preserved their activity for 6 to 7 days. It was concluded that the duration of thread antimicrobial activity depended on the properties of the polymer coating the thread. Capromed was applied to 280 operation wounds in 275 patients. There was no wound suppuration in the group of patients after pure operations (n = 62). In the group of patients after conditionally pure operations (n = 130) suppuration was observed in 2 patients (1.3 per cent). In patients with contaminated wounds (n = 88) suppuration in 5 of them (5.7 per cent) was recorded. The total number of the purulent complications after using capromed in surgical operations amounted to 2.5 per cent. In the control group purulent complications were stated in 8.2 per cent of the cases.     

Treatment of Crohn's disease with an unrefined-carbohydrate,fibre-rich diet.

Thirty-two patients with Crohn''s disease were treated with a fibre-rich, unrefined-carbohydrate diet in addition to conventional management and followed for a mean of four years and four months. Their clinical course was compared retrospectively with that of 32 matched patients who had received no dietary instruction. Hospital admissions were significantly fewer and shorter in the diet-treated patients, who spent a total of 111 days in hospital compared with 533 days in the non-diet-treated control group. Whereas five of the controls required intestinal operation, only one diet-treated patient needed surgery. This is in strong contrast to general experience with this disease. Treatment with a fibre-rich, unrefined-carbohydrate diet appears to have a favourable effect on the course of Crohn''s disease and does not lead to intestinal obstruction.     

复方薏苡仁方对小鼠肠道菌群及 微环境的调节作用研究

目的观察复方薏苡仁方调节小鼠肠道菌群功能及胃肠运动的效果,并考察复方薏苡仁方对小鼠盲肠内容物pH及肠黏膜结构等肠道内环境的影响。方法参照《保健食品检验与评价技术规范》(2003版)的规定进行调节肠道菌群实验和小肠墨汁推进试验,检测小鼠盲肠内容物pH,并对肠道黏膜结构进行病理形态学观察。结果 (1)与给样前相比,复方薏苡仁方中、高剂量组肠杆菌数和低、高剂量组肠球菌数均明显减少(P0.05),中、高剂量组乳杆菌数和双歧杆菌数均明显或显著增加(P0.05或P0.01),且高剂量组乳杆菌数和中、高剂量组双歧杆菌数明显高于阳性对照组(P0.05);(2)复方薏苡仁方各剂量组小鼠盲肠内容物pH值均显著降低(P0.01),且均低于阳性对照组,其中低、高剂量组差异有统计学意义(P0.05或P0.01);(3)与正常对照组相比,复方薏苡仁方低、中、高剂量组小鼠十二指肠、空肠、回肠绒毛长度/隐窝深度比值(A/V)均明显或显著增加(P0.05或P0.01),且中、高剂量组十二指肠、空肠及回肠A/V比值明显或显著高于阳性对照组(P0.05或P0.01);(4)与模型对照组相比,复方薏苡仁方各剂量组小鼠小肠推进率均显著增加(P0.01),且均高于阳性对照组(P0.01)。结论复方薏苡仁方对调节肠道菌群及改善肠道微环境具有一定的促进作用。     

Mechanical Intestinal Obstruction in a Porcine Model: Effects of Intra-Abdominal Hypertension. A Preliminary Study

Introduction

Mechanical intestinal obstruction is a disorder associated with intra-abdominal hypertension and abdominal compartment syndrome. As the large intestine intraluminal and intra-abdominal pressures are increased, so the patient’s risk for intestinal ischaemia. Previous studies have focused on hypoperfusion and bacterial translocation without considering the concomitant effect of intra-abdominal hypertension. The objective of this study was to design and evaluate a mechanical intestinal obstruction model in pigs similar to the human pathophysiology.

Materials and Methods

Fifteen pigs were divided into three groups: a control group (n = 5) and two groups of 5 pigs with intra-abdominal hypertension induced by mechanical intestinal obstruction. The intra-abdominal pressures of 20 mmHg were maintained for 2 and 5 hours respectively. Hemodynamic, respiratory and gastric intramucosal pH values, as well as blood tests were recorded every 30 min.

Results

Significant differences between the control and mechanical intestinal obstruction groups were noted. The mean arterial pressure, cardiac index, dynamic pulmonary compliance and abdominal perfusion pressure decreased. The systemic vascular resistance index, central venous pressure, pulse pressure variation, airway resistance and lactate increased within 2 hours from starting intra-abdominal hypertension (p<0.05). In addition, we observed increased values for the peak and plateau airway pressures, and low values of gastric intramucosal pH in the mechanical intestinal obstruction groups that were significant after 3 hours.

Conclusion

The mechanical intestinal obstruction model appears to adequately simulate the pathophysiology of intestinal obstruction that occurs in humans. Monitoring abdominal perfusion pressure, dynamic pulmonary compliance, gastric intramucosal pH and lactate values may provide insight in predicting the effects on endorgan function in patients with mechanical intestinal obstruction.     

MESS评分在肢体严重软组织损伤治疗中的应用评估

目的:探讨MESS评分在治疗肢体严重软组织损伤中的应用价值。方法:回顾性分析我科2010年8月至2014年5月收治的50例肢体严重软组织损伤患者的临床资料,其中男34例,女16例,年龄23~53岁,平均38岁。所有患者入院时均采用MESS评分表进行评分,根据病情给予清创、保肢或截肢以及创面修复等系列治疗,并随访3个月~3年。按照治疗结果将患者分为保肢组、Ⅰ期截肢组和Ⅱ期截肢组,分析和比较三组的MESS分值、住院天数、手术次数、并发症的发生率及患者满意率。结果:保肢组32例,MESS评分6-11分,平均8.63±1.26分。截肢组18例,MESS评分11-14分,其中Ⅰ期截肢组10例,平均12.60±0.97分;Ⅱ期截肢组8例,平均12.88±0.83分。保肢组患者的MESS分值显著低于Ⅰ期截肢组(P0.05)和Ⅱ期截肢组(P0.05)。此外,保肢组患者满意率显著高于Ⅰ期截肢组(P0.05)和Ⅱ期截肢组(P0.05)。而Ⅰ期截肢组的住院时间、手术次数和并发症发生率均短于或少于Ⅱ期截肢组,患者满意率高于Ⅱ期截肢组(P0.05)。结论:对于MESS评分11分的患者行保肢治疗可收到满意的效果,而对MESS评分11分的患者,采取Ⅰ期截肢的治疗效果优于Ⅱ期截肢。