外科手术考试试题

试题
一简答题
1.简述血管闭塞性脉管炎的分期
2.简述原发性肝癌姑息性切除适用于哪些情况
3.腹股沟直疝与斜疝的鉴别
4.TME
5.乳腺癌根治术手术切除范围
二将下列英文翻译为中文
Diabetes Increases Colorectal Cancer Risk for Women
Women with diabetes already have to manage a complex diagnosis and treatment protoco l. Now they may have another disconcerting diagnosis: colorectal cancer.
According to a study released Friday, women with diabetes are 1.5 times more likely to develop colorectal cancer -- in which cancerous tumors develop in the tissues of the colon or rectum -- than women who don't have the metabolic disorder.
The research was announced Friday at the American Association for Cancer Research's Sixth Annual International Conference on Frontiers in Cancer Prevention Research.
"We are just beginning to understand the role of insulin in the increased risk of many cancers," said Dr. Andrew Flood, the study's lead author and assistant professor of epidemiology and community health at the University of Minnesota School of Public Health.
"Our primary finding in this study was that a diagnosis of diabetes meant a 50 percent stronger chance of developing colorectal cancer."
Flood and his colleagues examined data from a large-scale cancer screening study known as the Breast Cancer Demonstration Project, which took place during the 1970s at 29 different medical facilities. They tracked the records of more than 45,000 female participants to identify how many women later developed colorectal cancer.
After adjusting for a number of variables, Flood said the results remained statistically significant, and he believes insulin has something to do with it.
"Elevated rates of insulin itself may promote the risk," he said.
Higher Insulin Means Higher Risk?
Dr. David Beck, chairman of the department of colon and rectal surgery at the Ochsner Clinic Foundation in New Orleans, agrees that insulin may play a role in cancer development.
"Insulin is important in cells' ability to use glucose, one of the cells' major energy source," he said. "Elevated glucose levels might support cell growth initially or may contribute to new blood vessel growth, which would allow cells to grow faster. This might be a factor in other cancer development."
To test the hypothesis that higher insulin levels -- common in people developing diabetes or people who have poorly managed glucose -- triggered cancerous polyps, Flood and his colleagues then examined other data from women who were later diagnosed with diabetes. They were surprised to find that women in this "prediabetic" stage did not actually have as high an increased risk.
三病例分析题
病例摘要：女性，22岁，12小时前被木块击中腹部，6小时来腹痛腹胀逐渐加重入院患者因车祸被木块击中腹部，腹壁挫伤后剧痛，休息后逐渐缓解，但半日后腹部又开始疼痛，持续压痛，伴有腹胀，且逐渐加重，来院就诊查体：T37.6℃,P82次/分，BP 120/80mmHg。

神清合作，头颈心肺未见异常，腹稍胀，腹式呼吸减弱，脐周可见挫伤痕迹，全腹均有压痛，而以腹中部最重，腹肌稍紧张，反跳痛较明显，肝浊音界存在，移动性浊音(±)，肠鸣音甚弱，听不清。

化验：Hb 120g/L, WBC 11×109/L 腹部平片，膈下未见明显游离气体 B超见肠间隙增宽腹腔穿刺有少量淡黄色液体
1.诊断及诊断依据
2.鉴别诊断
3.进一步需要做哪些检查
4.治疗原则有哪些
糖尿病妇女患大肠癌的可能性增加
糖尿病妇女已经有很多需要处理的复杂的诊断和治疗的指南。

而现在另一个令人闻风丧胆的诊断：大肠癌可能也要加入其中。

根据在周五公布的研究结果，糖尿病妇女罹患大肠癌（即在结肠或直肠组织癌组织的生长）的可能性要比那些没有代谢综合症的患者高1.5倍。

这个研究结果在周五召开的美国肿瘤协会的第六届世界癌症研究会议的肿瘤预防前沿会议上公布交流。

“我们刚刚开始了解胰岛素在增加其他肿瘤发生率中的作用。

”，Andrew Flood博士说。

Andrew Flood博士是这个研究的主持者，也是明尼苏达州大学公共卫生部的流行病学与社会保健专业的副教授。

“在这个研究中，最初我们发现：诊断为糖尿病的妇女，意味着发生结肠直肠癌的机会高50％。

”Flood博士和他的同事们研究了来自于大规模的肿瘤筛查研究－乳腺癌示例研究计划（the Breast Cancer Demonstration Project）的数据。

这个研究在70年代进行，有29个不同的医疗机构参与了这项研究。

他们追踪了至少45000名参与的妇女，以确定后来有多少妇女发生了结肠直肠癌。

在调整了那些可变因素后，Flood博士说，结果依然有显著的统计学差异，而且他相信胰岛素在这其中起了一些作用。

“胰岛素水平的升高本身也许就增加了危险性。

”他说。

高胰岛素水平意味着高危险性？
David Beck博士，是纽奥尔良市的Ochsner临床基金会的结肠和直肠外科的主席，他也认为胰岛素可能在肿瘤的进展中扮演了重要的角色。

“胰岛素对于细胞应用糖的能力而言是非常重要的。

糖被认为是细胞很大的能量的来源。

”，他说，“血糖水平的升高可能可以一开始支持细胞的生长或者与新生血管的生长有关，这些都能加速细胞的生长。

这也许是其他肿瘤生长的一个因素。

”
为了验证胰岛素升高是癌性息肉的促发因素（胰岛素水平的升高在那些发展中的糖尿病患者以及那些血糖控制不佳的糖尿病患者中十分的常见），Flood博士和他的同事们研究了从那些后来诊断为糖尿病患者的妇女身上得来的数据。

他们惊奇的发现，在那些所谓的“糖尿病前期”的妇女身上，没有发现大肠癌患病的危险性增加的现象。

一、诊断及诊断依据(8分)
(一)诊断腹部闭合性损伤：肠管破裂(小肠破裂可能性大) 4分 (二)诊断依据
1.腹中部直接受力外伤史 1分
2.腹痛，腹胀逐渐加重 1分
3.有腹膜刺激体征 1分
4.穿刺液不除外肠液 1分二、鉴别诊断(5分)
1.其他空腔脏器破裂 2分
2.单纯腹壁损伤 2分
3.肝损伤 1分三、进一步检查(4分)
1.重复腹腔穿刺 2分
2.腹腔灌洗检查 2分四、治疗原则(3分)
1.开腹探查 2分
2.行破裂肠壁缝合或肠段切除吻合术 1分。