Objective To explore the changes of CRP and PTC levels after laparoscopic or open appendectomy in children who had perforative appendicitis.Methods A prospective case-control study was performed.Seventy-eight children who were diagnosed as perforative appendicitis between June 2010 and October 2012 were assigned into the open appendectomy group(OA group) and laparoscopic appendectomy group(LA group) respectively at patients' or their parents' will.OA group and LA group included 38 and 40 cases respectively.The blood samples of all cases were collected half an hour before,24 h and 48 h after the operation respectively.ELISA and immunochromatography assays were used to detect the levels of CRP and PCT respectively.Results There was no significant difference between LA group and OA group in the preoperative levels of CRP and PCT(P>0.05).Compared to preoperative levles,the levels of CRP and PCT were significantly increased 24 h after surgery in both groups(P<0.05)with the levels of CRP in OA group being significantly higher than those in LA group(P=0.000).The levels of PCT in LA group 48 h after operation returned to preoperative levels(P>0.05)while the levels of CRP in LA group and the levels of CRP,PCT in OA group remained significantly higher than preoperative levels(P<0.05).Moreover,the levels of CRP and PCT in OA group 48 h after operation were significantly higher than those in LA group(P=0.000).Conclusion Compared with open surgery,the changes of CRP and PCT after laparoscopic surgery were minor.

Objective To investigate the influence of perioperative blood transfusion on the recurrence and prognosis for patients with gastric cancer undergoing gastrectomy.Methods 152 patients with gastric cancer were divided into transfused and non-transfused groups.The association between perioperative blood transfusion and the clinicopathologic data for these cases was analyzed retrospectively.The influence of perioperative blood transfusion on the recurrence and prognosis for patients was also evaluated.Results Perioperative blood transfusion was significantly related with tumor size,depth of invasion,lymph lode metastasis,TNM stage and preoperative anemia(P < 0.05).The rate of recurrence for patients with blood transfusion was significantly higher than those without blood transfusion(P < 0.001).The survival data showed that the 3-year overall survival rate was significantly lower in the transfused patients than the nontransfused(39.0% vs70.3%,P < 0.001).In multivariate Cox regression analysis,blood transfusion was found as an independent prognostic factor(P < 0.001).Conclusions Perioerative blood transfusion was closely associated with more recurrence and worse prognosis following gastric cancer surgery.It is advisable for us to appropriate transfusion maybe required.

Objective To investigate the surgical management and its effects of colon diverticulum.Methods Clinical data of fourteen patients with colon diverticulum who underwent surgical management were analyzed retrospectively. The location of the diverticulum included 5 cases of typhlon,3 of ascending colon,2 of descending colon and 4 of sigmoid colon. All patients had surgical treatments including 5 of diverticulum resection and colocolic anastomosis ,3 of ileocecal junction resection and ileum-ascending colon end-to-end anastomosis,2 of right hemicolectomy,and 4 of sigmoid colon diverticula resection with Hartmann's operation. Result All the surgeries were successful and got good curative effects. Conclusions Surgical treatment is rational for colon diverticulum with such complications as perforation,hemorrhage,abscess and celiac infection. Different methods should be chosen according to the position,size,complications of the diverticulum and the infection extent of the abdomen.

<正>1临床资料患者女,74岁,因"右上腹疼痛伴黄疸2月余",于2007年6月25日入院。查体:消瘦,轻度贫血貌,皮肤、巩膜黄染,浅表淋巴结未触及肿大,腹平软,右上腹压痛,无反跳痛及肌紧张,腹部未触肿块。实验室检查:总胆红素(TBIL)130!mol/L,直接胆红素(DBIL)90!mol/L,碱性磷酸酶(ALP)280 U/L。腹部超声及MRI提示:胆总管结石并扩张。术前诊断:胆总管结石。剖腹探查见:肝边缘钝厚,胆总管上段明显扩张可触及结石,术中行胆道镜提示胆总管下段炎性狭窄,胃窦部可触及直径2.5 cm质硬肿块,活动好,与周围无粘连,周围无肿大淋巴结。术中切除肿