患者女性，81岁。因排便不适、大便带血被诊断为直肠癌，癌肿距齿状线6cm，但患者有高血压、心肌梗死、脑梗死右侧肢体偏瘫病史，需行的治疗方法是（）
A.经腹会阴联合直肠癌根治术
B.经腹直肠癌切除术
C.拉下式直肠癌切除术
D.经腹直肠癌切除、人工肛门、远端封闭手术
E.挂线疗法
参考答案：D
解析：根据病史结合肛管直肠疾病治疗原则，第1题患者系肛瘘患者，宜采取挂线治疗；第2题患者高龄，既往有高血压、心梗、脑梗史，直肠癌肿不宜行根治性手术，故行经腹直肠癌切除、人工肛门、远端封闭手术；第3题患者中年男性，直肠癌癌肿距齿状线有12cm，故宜行经腹直肠癌切除术；第4题肛管癌，癌肿位于腹膜返折下，故采用经腹会阴联合直肠癌根治术。
Ever since I was little, my favorite season was winter. I loved to play in the snow and enjoy the hot chocolate. ____36_____, winter never gave me the special gift of snow on my birthday. I would ask my grandmother ____37____ it didn’t snow on my birthday. She would laugh and tell me I asked too many questions. ___38____one day, she promised that she would make it snow on my next birthday. That year, ____39____ my birthday, my grandmother died. I was sad but angry because she had promised to make it snow. The day of my sixth birthday, I woke up and ran to the window, hoping to see just one snowflake. But there was no snow. I felt mad at my grandmother. She had broken a promise. But my sixteenth birthday, I had lost all hope of getting my snow, even though I still wished for ___40____. During my party, I stayed with my friends and family and was truly happy. I ___41___ the best time ever! Then I saw the white snow ____42___down all around. I was so excited that I ran around screaming and laughing. My friends all laughed ____43___me, but I didn’t care. When I ___44____home, my grandpa said he had a gift for me. I was ___45___ because he had given me a gift. It was a small white box, which looked old. I opened it. There was a crystal snowflake(水晶雪花) with a card that said, “Happy Birthday.” How could this be? My grandpa said it was my grandmother’s final ___46____ on my “sweet sixteenth”. I cried. I was ___47_____ that my smiling grandmother angel was and had been watching over me.
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