Objective To investigate the applied value of Choledochoscopy and electrohydraulic lithotripsy( EHL) in the operation of pancreatolithiasis. Methods The clinical data of diagnosis and treatment for pancretic duct stone in 46 patients treated in the Second Affiliated Hospital of University of South China from January 2002 to April 2014 were retro-spectively analyzed,two patients underwent pancreatic coduodenectomy ( Whipple) for being combined with pancreatic head carcinoma,one patient underwent resection of pancreatic tail and spleen and pancreatic stump jejunosomy(Pusetow)20 pa-tients underwent the pancreatic duct lithotomy,dredging main pancreatic duct and pancreatic enteric anastomosis combined with Roux-en-Y,with intraoperative choledochscopy being used jointly ( Choledochoscopy combined with Operation group ) . During the period of only with the pancreatic duct lithotomy,dredge main pancreatic duct and pancreatic enteric anastomosis combined with Roux-en-Y,and the data of these patients were originated in the data of 10 patients with pancreatolithiasis ( Routine group) ,and the data of 12 patients who were treated by Endoscopic retrograde cholangiopan-Creatography ( ER-CP) combined with extracorporeal shock wave lithotripsy ( ESWL) ( ERCP+ESWL group) were compared. Results The intraoperative blood loss was more than that in the ERCP+ESWL group[(120 ± 55. 9)mL vs(30 ± 15. 4)mL,(t=3. 228,P=0. 042) ],so the difference was significant (P=0. 042),but it was significantly less than that in the Routine group[(120 ± 55. 9)mL vs (583. 0 ± 135. 4)mL,(t= 5. 446,P=0. 032)]. The postoperative rate of residual stones in the Choledochoscopic lithotomy group was significantly lower than that in the ERCP+ESWL group and in the Routine group (P=0. 008)The postoperative rate of pain relief was significantly higher than that in the Routine group(90% vs 50%)and in the ERCP+ESWL group(90% vs 50%). Conclusion For the surgical treatment of pancreatolithiasis,it can signifi-cantly decrease the postoperative rate of residual stones and introperative blood loss,and increase the postoperative rate of pain relief in the midsection when Choledochoscopy and extracorporeal shock wave lithotripsy are used jointly.

Objective To compare the safety between radical gastrectomy with Laparoscope and laparotomy.Methods 80 patients with gastric cancer treated in two hospitals( the Second Affiliated Hospital of University of South China and Affiliated NanHua Hospital of University of South China) from April 2012 to March 2014 were spicilegiumed as objects of study. They were divided in to laparoscopy group( 50 cases of group A) and laparotomy group( 30 cases of group B) according to surgical method. Laparoscopy group was operated with classical laparoscope,the other one with laparotomy.Test the level of serum cortisol( Cor),Norepinephrine( NE),total antioxidant capacity( TAC),catalase( CAT) 1day before operation and 4W,8W after operation. Results were analyzed with statistics,to contrast that they have or not have statistic difference between two groups. Result Compared with laparotomy group,laparoscopy group was better in incision length,blood loss,postoperative recovery processes,etc. The difference was statistically significant( P 0. 05). There is no difference between two groups on the level of Cor,NE,TAC,CAT before operation( P 0. 05). The level of Cor,NE,TAC,CAT 4W,8W after surgical treatment has significant difference( P 0. 05). Conclusion Two methods can gain good clinical effect in early treatment. But compared with traditional laparotomy of gastric cancer,laparoscopic dissection has smaller wound,less blood loss,fewer complications,faster recovery and higher safety. It should be generalized.

目的：对腹腔镜胆囊切除术与开腹手术治疗急性胆囊炎的临床疗效进行对比分析。方法：回顾性分析笔者所在医院收治的185例急性胆囊炎患者的资料，根据手术方式不同分为观察组93例和对照组92例，观察组采取腹腔镜胆囊切除术，对照组采取开腹手术，比较两组患者切口长度、术中出血量、手术时间、住院时间及术后并发症发生率等指标的差异，进而分析其临床效果的组间差异。结果：观察组与对照组相比，其切口短、术中出血量少、手术时间短、住院时间短，差异有统计学意义(P<0.05)。观察组术后出现切口感染3例，合并急性胰腺炎2例，并发症发生率5.4%；对照组出现切口感染4例，并发症发生率4.3%。两组并发症发生率比较，差异无统计学意义(P>0.05)。观察组4例患者术中出现手术分离粘连不顺利，中途转开腹手术，中转开腹率4.3%。结论：腹腔镜手术治疗急性胆囊炎与开腹手术相比，具有切口小、出血量小、手术时间短、恢复时间快等优点，值得在临床上广泛推广。

目的观察塞来昔布(Celecoxib)和阿霉素(Adriamycin,ADM)合用对人乳腺癌MCF-7细胞裸鼠移植瘤生长的抑制作用,并初步探讨其作用机制.方法采用MCF-7细胞株建立人乳腺癌裸鼠模型,将35只成瘤雌性裸鼠随机分成7组:①对照组(生理盐水0.2ml);②ADM低剂量组(1.0 mg/kg);③ADM高剂量组(5mg/kg);④塞来昔布低剂量组(25mg/kg);⑤塞来昔布高剂量组(50mg/kg);⑥ADM低剂量组+塞来昔布低剂量组;⑦ADM低剂量组+塞来昔布高剂量组,隔天腹腔注射给药,共8次.于最后一次给药后48h处死各组小鼠,收集瘤标本行光镜观察,免疫组化检侧COX-2和VEGF蛋白表达情况.结果①各实验组肿瘤的生长明显受到抑制,瘤质量明显低于对照组(P<0.01).低、高剂量塞来昔布联合用药组较低剂量阿霉素组抑瘤作用明显增强(P<0.05),其瘤重抑制率分别为40.4%和76.8%,②免疫组化:高剂量塞来昔布组与对照组比较,COX-2和 VEGF的表达均下调,差异具有显著性(P<0.05),联合用药组该调节作用进一步增强(P=0.00).③不良反应:高剂量阿霉素组出现不良反应,其余各组无明显不良反应.结论塞来昔布能够增强阿霉素对人乳腺癌MCF-7细胞裸鼠移植瘤生长的抑制作用,其作用机制可能与塞来昔布抑制COX-2和VEGF的表达有关.

Objective To examine the effect of carbon dioxide pneumoperitoneum on local pancreas pathological changes, serum levels of amylase, IL-6, E-selectin and P-selectin in rats with severe acute pancreatitis (SAP). Methods Fifty healthy male SD rats were randomly divided into 3 groups: CO2 experiment group ( n =20): SAP was induced by injecting 5% sodium taurocholate through retrogradely common biliopancreatic ducts via duodenal papilla,and then CO2 pneumoperitoneum was established at a pressure of 12 mmHg for 30 min; SAP group ( n = 20): The rats were treated as same as CO2 experiment group, excepting CO2 pneumoperitoneum; Control group (n = 10): Abdomen was incised and nothing was done to duodenum and pancreas except for moving them softly. The blood samples were gathered for examining serum levels of amylase, IL-6, E-selectin and P-selectin, and histopathologic examination of pancreas was done.Results Compared with control group, the pancreatic pathologic histology score, serum levels of amylase,IL-6, E-selectin and P-selectin were significantly higher in the CO2 experiment group and SAP group (P =0.000). The levels of IL-6 were significantly lower in CO2 experiment group compared to SAP group (P =0. 000). There was no significant difference between CO2 experiment group and SAP group in pancreatic pathologic histology score( P =- 0.294), the levels of serum amylase ( P = 0.073 ), E-selectin and P-selectin. Conclusions CO2 pneumoperitoneum has no adverse effect on the changes of pathological histopathology and the levels of IL-6, E-selectin and P-selectin in SD rats with SAP.

目的 探讨脾切除术后发热的原因及诊治措施.方法 回顾性分析我科自2002年2月～2009年2月行脾切除术后发热的68例患者的临床资料.结果 发热主要原因与术后感染、门静脉及脾静脉血栓形成及脾热有关.结论 减少并及时处理上述情况可以较好的防治脾切除术后发热的发生.

【Objective】To evaluate the clinical effect of early endoscopic intervention to elderly patients with acute biliary pancreatitis.【Methods】Sixty elderly patients with acute biliary pancreatitis were randomly divided into 3 groups:Conservative treatment group (n =20); Early endoscopic treatment group (n =20); surgery group (n =20). To observe the index of mortality,complication rate,time of abdominal signs disappeared,hospital stay and recovery time of blood amylase. 【Results】Compared with conservative treatment group and surgery group,lower incidence of complications,shorter hospital stay,shorter time of abdominal signs disappeared in early endoscopic treatment group. There was no significant difference among three groups in mortality and recovery time of blood amylase.【Conclusions】Early endoscopic intervention can lower the incidence of complications,shorter the hospital stay.

Aim To explore the effects of probucol on liver protection and PPARα expression of atherosclerosis rabbits model. Methods 16 male New Zealand white rabbits were fed with 1% cholesterol,5% lard diet for 8 weeks,and then were randomly divided into two groups:high-fat group:maintained cholesterol diet for 6 weeks; probucol group:the same cholesterol diet mixed with 0.25 g/d probucol for 6 weeks. Control group was fed with normal diet for 14 weeks. This study detected the change of serum lipid profile,atherosclerotic plaque areas of aortas,histopathology and PPARα mRNA and protein expression of the livers at the end of the study. Results After 6 weeks treatment of probucol,the levels of total cholesterol (TC),high density lipoprotein cholesterol (HDLC),and low density lipoprotein cholesterol (LDLC) were reduced significantly compared with the high-fat group (P<0.05). The atherosclerotic plaque area of aortas and the histopathology of fatty liver were ameliorated in probucol group compared with high-fat group. The PPARα mRNA and protein expressions in the fatty livers of high-fat group were downregulated compared with control group,and probucol upregulated PPARα mRNA and protein expressions. Conclusion Probucol decreased the serum cholesterol and upregulated PPARα mRNA and protein expressions,which may inhibit the formation of plaques of aorta and fatty liver in atherosclerosis rabbits model.

目的探讨腹腔镜脾切除术的手术方法、安全性及临床效果。方法回顾性分析23例腹腔镜脾切除术的临床资料。结果22例成功完成腹腔镜脾切除术,1例中转开腹。手术时间80~260 m in,平均140m in。手术失血30~650 mL,平均130 mL。术后肠蠕动恢复时间12~48 h,术后平均住院5.5天。结论只要掌握好手术适应证及腹腔镜操作技巧,腹腔镜脾切除术是一种安全有效的微创外科手术方式。

妇产科学是一门临床主干课程,该课程教学具有内容多、概念抽象、实践性强等特点,学生难以全面掌握,改变传统的教学模式,利用三维可视化及内窥镜技术相结合的新的教学方法,能真实有效地显示盆部解剖学形态、结构及病理变化,图像逼真,能激发学生的学习兴趣,使学生们对所学知识印象深刻、记忆牢固。提高教学质量和教学效率,推动教学改革与发展。

Objective To investigate and summarize the clinical value and the operative experience of laparoscopic choladochlithotomy with T-tube drainage. Methods 78 cases who underwent laparoscopic choladochlithotomy and common bile duct exploration with T-tube drainage from September 2004 to February 2008 were retrospectively analyzed. Results The operation was successful in 77 cases(98.7%),1 cases were converted to open surgery.The duration of operation was 70～190min(averaged 95min).Bile leakage occurred in 1 case and was cured with conservative treatment.Residual stones were found in 1 case and a postoperative choledochoscopy was required.The patients could take food and walk on the second postoperative day and average postoperative hospital stay was 6.8 days.Follow-up checkups in 72 cases(92.3%) for 6～36months(mean 14.3 months) revealed no abdominal pain,fever,or jaundice. Conclusions The laparoscopic common bile duct exploration with T-tube drainage is a safe and effective operation with little injury and quick recovery.

Objective To observe the growth inhibitory effect of VBE-3,a lignan from the acetoacetate extract of Vitex negundo seed in human Hepatocellular Carcinoma HepG2 cell line in vitro.Methods The cell viability of HepG2 cell line and human embryo liver L-02 cell line were examined by MTT assay.The cell growth of both cell lines was determined by cell count method.Results VBE-3 significantly inhibited the cell viability of HepG2 cells in a concentration-dependent,and had little effective on L-02 cells.Meanwhile,VBE-3 also selectivity inhibited the cell growth of HepG2 cells in vitro.Conclusion VBE-3 selectivity inhibits the cell growth of HepG2 cells in vitro.

目的 探讨多次加热后对残存的肝癌HepG2细胞的多药耐药相关蛋白(MRP) 基因/蛋白表达的影响.方法 HepG2细胞43℃加热,每次80 min,2次/d,10个循环后,MTT法分析其对阿霉素的敏感性,免疫组化法检测细胞MRP蛋白的表达,RT-PCR法检测细胞MRP mRNA的表达.结果 热处理后的HepG2细胞对阿霉素产生化疗耐受性升高,MRP 基因/蛋白的表达增强.结论 热处理后HepG2细胞对化疗药物的耐受性可能与其MRP 基因/蛋白的表达增强有关.

Objective To investigate the effect of combination of Octreotide and sodium hyaluronate on TGF-β1 in postoperative intraperitoneal adhesions of rabbits.Method Forty eight of Newzeland rabbits were used to establish the postoperative abdominal adhesion model and divided into four groups:model control group;sodium hyaluraronate group;Octreotide group;octreotide and sodium hyaluronate group.Laparotomy operation after 14 days,the expression of TGF-β1 on the samples obtained from the adhesion sites were used by Immunohistoche mistric method and quantitative analysis of immunostaining.Results Octreotide group was lower than the model control group and the HA group on the expression of TGF-β1 on the samples obtained from the adhesion sites(P0.001).Combination of octreotide and sodium hyaluronate have no synergetic effect on the inhibitory expression of TGF-β1 protein(q1).Conclusions The preventive action of octreotide on the abdominal adhesion is mostly involved in the inhibitory expression of TGF-β1 protein,and that of sodium hyaluronate is mostly isolation action.both of which interfered with two progress step of the intraperitoneal adhesion iniliation and produced synergetic action.

Objective To investigate the effect of combination of Octreotide and sodium hyaluronate on TGF-β1 in postoperative intraperitoneal adhesions of rabbits.Method Forty eight of Newzeland rabbits were used to establish the postoperative abdominal adhesion model and divided into four groups:model control group;sodium hyaluraronate group;Octreotide group;octreotide and sodium hyaluronate group.Laparotomy operation after 14 days,the expression of TGF-β1 on the samples obtained from the adhesion sites were used by Immunohistoche mistric method and quantitative analysis of immunostaining.Results Octreotide group was lower than the model control group and the HA group on the expression of TGF-β1 on the samples obtained from the adhesion sites(P<0.001).Combination of octreotide and sodium hyaluronate have no synergetic effect on the inhibitory expression of TGF-β1 protein(q<1).Conclusions The preventive action of octreotide on the abdominal adhesion is mostly involved in the inhibitory expression of TGF-β1 protein,and that of sodium hyaluronate is mostly isolation action.both of which interfered with two progress step of the intraperitoneal adhesion iniliation and produced synergetic action.

s: [Objective] To investigate the proliferation rate of HepG2 cells after multiple thermotherapy and the possible reasons related to it. [Methods] After the HepG2 cells were treated by ten repeated cycles of heat exposure at 43 ℃ for 80 minutes twice a day, the doubing time of cells was analyzed, and the cells cycle and cyclin D1 were detected. [Results] The proliferation rate of HepG2 cell which treated with heat speeded up, the percentage of stage S and G2 in cell cycle increased, and the expression of cyclin D1 strengthened. [Conclusions] The speeded proliferation of HepG2 cells after multiple thermotherapy is related to its high percentage of DNA duplicated and dividing cell, and strengthened expression of cyclin D1.

食管贲门黏膜撕裂综合征,又称Mallory-Weiss syndrome(MWS),是一种较为少见的上消化道出血,易与上消化道其他出血性疾病混淆,因而易发生误诊、误治.我院普外科1982年1月至2006年6月共收治12例,术前均误诊.现报道如下.

Objective To investigate the ischemic injury of hepatic cell caused by hepatic artery occlusion.Methods The hepatic artery was occluded in 20 dogs via operation,while the portal vein remained patent.Specimens were gained from the right liver at four time points:before occlusion of the hepatic artery,20(minutes),40 minutes and 60 minutes after artery occlusion.Each specimen was examined by HE and BCL-2 by immunohistochemistry.The gray scale of BCL-2 in HE sections was detected.Results Hepatic cellular injury was obvious 20 minutes after occlusion of the hepatic artery.Irreversible hepatic cellular injury was(observed) 60 minutes after hepatic artery occlusion.The results showed that the gray scale of BCL-2 at every time point after hepatic artery occlusion were significantly different from that before hepatic artery occlusion(P0.0001).Besides,the hepatic cell injury and BCL-2 expression at 20 minutes and 40minutes after(occlusion) was significantly different from that of 60 minutes(P0.0001),respectively.Conclusions There was obvious hepatic cellular injury 20 minutes after hepatic artery occlusion,and irreversible hepatic cellular injury occured 60 minutes after hepatic artery occlusion.

为探讨修复肝总管狭窄或缺损有效的术式,笔者采用切开胆囊管并侧移的方法修复肝总管狭窄或缺损8例:其中肝总管狭窄并发重症急性胆管炎1例,肝总管狭窄反复并发梗阻性黄疸2例,LC术中肝总管损伤3例,Mirizzi综合征III型2例.术后4～7个月T管造影显示肝总管通畅无狭窄后拔管.术后1年B超检查,肝总管、胆总管通畅无狭窄.提示胆囊管壁转移修复肝总管狭窄或缺损的术式是可行的.

目的寻求特发性血小板减少性紫癜有效的、副作用少的治疗方法.方法对内科治疗疗效欠佳的16例患者行脾切除治疗.结果显效10例,良好3例,有效率81.3%.结论脾切除治疗特发性血小板减少性紫癜疗效好,副作用少.