目的 探讨经皮经肝胆道镜(percutaneous transhepatic cholangioscopy,PTCS)取石术在治疗老年复杂性肝内外胆管结石病人中的方法、疗效及安全性.方法 回顾性分析2018年6月至2021年10月在武汉大学中南医院行一期扩张法PTCS取石术治疗的61例复杂性肝内外胆管结石病人资料,根据病人年龄分为老年组(≥60岁)及对照组(<60岁),比较两组病人临床资料及手术相关情况等,并进一步对老年组内不同年龄段病人的手术指标等进行比较分析.结果 老年组34例,对照组27例,老年组年龄为(70.3±6.7)岁,对照组年龄为(46.8±10.8)岁,差异有统计学意义(P<0.05);老年组合并有基础疾病率为47.1％(16/34),明显高于对照组的7.4％(2/27),差异有统计学意义(P<0.05).而老年组与对照组间PTCS穿刺成功率(97.1％ 比96.3％)、手术并发症发生率(19.3％ 比14.8％)、结石清除率(88.2％ 比88.9％)及PTCS术后住院时间[(6.53±5.18)d比(7.61±5.20)d]等差异均无统计学意义(均P>0.05).老年组内不同年龄段的手术并发症发生率、结石清除率及术后住院时间差异均无统计学意义(均P>0.05).结论 老年复杂肝内外胆管结石病人年龄大、合并基础疾病复杂,但行PTCS术并不增加手术并发症风险、结石残留率及术后住院时间,对于无法或不宜行常规手术的老年复杂肝内外胆管结石病人,一期法PTCS术效果良好,安全可行.

目的 探讨肝门部胆管癌根治术中联合血管切除重建的安全性和有效性.方法 回顾性分析2014年6月至2019年12月武汉大学中南医院收治的113例确诊为肝门部胆管癌的病人,包括行姑息治疗50例(姑息治疗组),行开腹肝门部胆管癌根治术63例,其中行联合血管切除重建的肝门部胆管癌根治术26例(联合血管切除重建组),行常规肝门部胆管癌根治术37例(常规根治组).比较常规根治组及联合血管切除重建组两组病人的手术时间、术中出血量、是否术中输血、术后肝功能恢复情况、术后严重并发症发生率、住院时间等围手术期情况以及两组病人术后90 d生存率,同时亦比较姑息治疗组、常规根治组、联合血管切除重建组三组病人术后1、3、5年的总生存率.结果 联合血管切除重建组病人手术时间、术中出血量和术中输血率均高于常规根治性切除组(P＜0.05),但在并发症发生率、住院时间以及术后90 d生存率差异无统计学意义(P＞0.05);常规根治组在术后第1、3、5天丙氨酸转氨酶(ALT)以及术后第1、3天天冬氨酸转氨酶(AST)低于联合血管切除重建组(P＜0.05),但在术后第7天的ALT值及术后第5 天、第7 天的AST值差异无统计学意义(P＞0.05);此外两手术组病人术后1、3、5年总存活率差异无统计学意义(P＞0.05),但两组病人术后1、3、5年总生存率均明显高于姑息治疗组(P＜0.01).结论 在仔细评估、选择合适病例前提下,肝门部胆管癌根治术中联合血管切除重建是安全的,而且可获得与不需要血管切除重建的肝门部胆管癌手术病人相似的疗效,行根治性手术的病人疗效优于行姑息性治疗的病人.

Background: Liver cancer is a common cause of cancer-related death all over the world. MGCD0103, a histone deacetylase inhibitor, exerts antitumor effect on various cancers. However, its role in liver cancer remains unclear. Methods: The effect of MGCD0103 on HepG2 and Huh7 cells was verified by several experiments such as cell viability assay, colony formation assay, cell cycle analysis, apoptosis analysis, reactive oxygen species (ROS) assay, western blotting, immunohistochemistry, and xenograft assay. Results: Cell viability and colony formation assays showed that MGCD0103 inhibited the proliferation of liver cancer cells in vitro. Flow cytometry and western blotting analysis demonstrated that MGCD0103 induced G2/M phase arrest and mitochondrial-related apoptosis. A pan-caspase inhibitor and ROS scavenger inhibited apoptosis induced by MGCD0103. What's more, MGCD0103 led to autophagy associated with cell death and an autophagy inhibitor inhibited apoptosis and autophagy induced by MGCD0103. Ultimately, MGCD0103 attenuated tumor growth but did not show significant systemic toxicity in animal model. Conclusions: MGCD0103 suppressed the growth of liver cancer cells in vitro and in vivo. It could serve as a novel therapeutic approach for liver cancer.

BACKGROUND:Postoperative gastrointestinal dysfunction remains a major determinant of the duration of stay after complex abdominal surgery. This study was performed to evaluate the effectiveness of heated fennel therapy in accelerating the recovery of gastrointestinal function.METHODS:This surgeon-blinded, prospective randomized controlled study included 381 patients with hepatobiliary, pancreatic, and gastric tumors who were divided into 2 groups. The patients in the experimental groups received heated fennel therapy, and those in the control groups received heated rice husk therapy. We compared the baseline characteristics, time to first postoperative flatus and defecation, fasting time, duration of postoperative hospital stay, grading of abdominal pain, classification of abdominal distension, inflammatory markers, and nutritional status indicators.RESULTS:The time to first flatus and first defecation and the fasting time were statistically significantly less in the heated fennel therapy group than those in the control groups (P < .05 each); and abdominal distension was also relieved in the experimental groups (P < .001). Heated fennel therapy had no obvious beneficial effect on inflammatory markers but improved the serum albumin (ALB) level of the patients at postop day 9 (P < .001). Among the patients with alimentary tract reconstruction, those in the heated fennel therapy group had a clinically important, lesser hospital stay than those in the control group (9.2 5 ± 5.1 versus 11.1 ± 6.4; P < .023).CONCLUSION:Heated fennel therapy facilitated the gastrointestinal motility function of patients early postoperatively.

目的:探讨同期多镜(腹腔镜、胆道镜、十二指肠子母镜)联合治疗梗阻型轻症急性胆源性胰腺炎(MABP)手术时机及其对临床疗效的影响.方法:将127例经同期多镜联合治疗的梗阻型MABP患者按手术时机分为早期组(观察组)、延期组(对照组),比较两组患者手术及术后相关临床指标.结果:两组患者均无结石残留.观察组与对照组在手术时间(min) [(89±13) vs (94±16)]、术中失血量(mL)[(57±15) vs (61±17)]、中转开腹率(8.6％ vs 7.2％)、术后5d血淀粉酶(U/L) [(117.1±16.7) vs (112.3±19.5)]、肠功能恢复时间(d)[(2.7±0.5)vs(2.8±0.4)]、鼻胆管拔管时间(d)[(5.5±2.0) vs(5.0±1.6)]、术后住院时间(d)[(6.6±1.8) vs (7.1±1.5)]及并发症率(3.5％ vs 4.3％)等方面差异无统计学意义(P＞0.05);而观察组总住院时间(d)明显短于对照组[(8.5±1.6)vs(16.4±2.5)],差异有统计学意义(P＜0.05).结论:对于梗阻型MABP而言,早期同期多镜联合手术治疗并不增加临床风险,安全可靠,并且可明显缩短总住院时间.

目的:探讨长链非编码RNA (lncRNA) HOST2对胰腺癌细胞增殖、迁移和侵袭的影响及机制.方法:qRT-PCR检测正常胰腺上皮细胞系HPDE6-C7及胰腺癌细胞系Panc-1、AsPC-1、BxPC-3、HPAC中lncRNA HOST2表达水平.将Panc-1细胞分别转染siRNA-HOST2(si-HOST2组)和阴性对照序列(阴性对照组)后,用MTT法测定细胞增殖,细胞划痕和Transwell实验测定细胞迁移和侵袭,Western blot测定上皮-间质转化(EMT)相关蛋白vimentin、Snail、Twist的表达.以无转染的Panc-1细胞为空白对照组.结果:与正常胰腺上皮细胞HPDE6-C7相比,lncRNA HOST2在各胰腺癌细胞系中的表达均明显上调(均P＜0.05).与空白对照组比较,si-HOST2组细胞增殖、迁移和侵袭能力均明显减弱,vimentin、Twist1、Snail蛋白相对表达量均明显下调(均P＜0.05),而阴性对照组上述指标均无明显变化(均P＞0.05).结论:lncRNA HOST2在胰腺癌细胞中高表达,且与胰腺癌增殖、迁移和侵袭密切相关,其机制可能与调节EMT相关蛋白的表达有关.

Objective To discuss the operation timing,clinical efficacy and safety of endoscopic retrograde cholangiopancreatography (ERCP) in the treatment of acute biliary pancreatitis.Methods Retrospective analyzed the clinical data of 65 acute biliary pancreatitis patients in First People's Hospital of Jiangxia District,Wuhan city form October 2015 to July 2017,there were 45 males and 30 females,the age was (46.35 ± 8.95) years (range,25-72 years).All patients were treated with ERCP,and divided into 24-72 h group (the time from onset to ERCP treatment 24-72 h) 16 cases,72-120 h group (the time from onset to ERCP treatment 72-120 h) 25 cases and ≥ 120 h group(the time from onset to ERCP treatment ≥ 120 h) 34 cases,recorded and compared the clinical indexes during and after operation,laboratory indexes before and after treatment,incidence of surgical complications,recurrence rate and mortality.The measurement data with normal distribution were expressed as mean ± standard deviation (Mean ± SD),the F test was used for comparison among the three groups,and the t test was used for comparison between the two groups,the count data were compared by x2 test,and the rank sum test was used to compare the incidence of surgical complications.Results The abdominal pain relief time,amylase recovery time,length of stay and hospitalization expenses of the 24-72 h group were (4.48 ± 1.29) d,(3.59 ± 1.22) d,(7.24±1.55) d and (1.55 ±0.31) ten thousand yuan respectively,the 72-120 h group were (7.35 ± 1.76) d,(4.91 ±1.37) d,(13.61 ±2.13) d,(2.02 ±0.37) ten thousand yuan respectively,the ≥120 h group were (11.21 ±2.02) d,(8.86±1.95) d,(21.58±2.86) d,(2.49±0.52) ten thousand yuan respectively,with significant differences between any two groups(P ＜0.05).The serum amylase,total bilirubin,c-reactive protein and white blood cell levels of the 24-72 h group were (319.65 ±58.93) U/L,(14.22 ± 2.84) μmol/L,(31.12 ± 5.35) mg/L and (6.84 ± 1.17) × 109/L respectively,the 72-120 h group were (362.87 ±63.37) U/L,(16.39 ± 3.14) μmol/L,(37.34 ± 6.12) mg/L and (7.93 ± 1.36) x 109/L respectively,the ≥ 120 h group were (452.61 ± 75.49) U/L,(20.28 ± 3.67) μmol/L,(46.19 ± 6.98) mg/L and (9.77 ± 1.52) x 109/L respectively,with significant differences between any two groups (P ＜ 0.05).The incidence of surgical complications,recurrence rate and mortality of the 24-72 h group were 25.00％ (4/16),12.50％ (2/16) and 0 (0/16) respectively,the 72-120 h group were 24.00％ (6/25),12.00％ (3/25) and 0 (0/25) respectively,the ≥120 h group were 29.41％ (10/34),20.59％ (7/34) and 5.88％ (2/34) respectively,with significant differences between 24-72 h group,72-120 h group and ≥ 120 h group (P ＜ 0.05);But there was no significant difference between the 24-72 h group and the 72-120 h group (P ＞0.05).Conclusion In the treatment of acute biliary pancreatitis within 24-72 h and 72-120 h are safe and effective,but the improvement of laboratory indexes within 24-72 h ERCP treatment is more obvious,the length of stay is shorter,the hospitalization expenses is more provincial,and with more clinical advantage.

Objective: To investigate the expression of long non-coding RNA BCAR4 (LncRNA BCAR4) in pancreatic carcinoma cells and its effects on proliferation and apoptosis of pancreatic carcinoma cells. Methods: The expressions of LncRNA BCAR4 in different pancreatic carcinoma cell lines (AsPC-1, HPAC, BxPC-3 and Panc-1) and normal pancreatic duct epithelial cells HPDE6-C7 were determined by qRT-PCR method. hTe pancreatic carcinoma AsPC-1 cells were transfected with BCAR4 siRNA or crambled sequences, with untransfected AsPC-1 cells as blank control, and then the cell proliferation and apoptosis were measured by CCK-8 assay and flow cytometry, and the protein expression levels of p-mTOR and p-P70S6K as well as phosphorylated mTOR (p-mTOR) and phosphorylated P70S6K (p-P70S6K) were detected by Western blot analysis. Results: The relative expression levels of LncRNA BCAR4 in all studied pancreatic carcinoma cell lines were signiifcantly higher than that in normal pancreatic duct epithelial HPDE6-C7 cells (allP<0.05). Atfer BCAR4 siRNA transfection, AsPC-1 cells exhibited decreased proliferation, increased apoptosis rate and down-regulated p-mTOR and p-P70S6K expressions (allP<0.05). Conclusion: LncRNA BCAR4 expression is increased in pancreatic carcinoma cells. High LncRNA BCAR4 expression can promote proliferation and inhibit apoptosis of the pancreatic carcinoma cells, and the mechanism may be associated with its up-regulating phosphorylation level of mTOR/P70S6K pathway.

目的:观察肝细胞癌组织中10-11转位酶1(TET1)的表达水平,并探讨其与临床病理特征间的关系及临床意义.方法:应用定量RT-PCR及组织芯片免疫组化技术检测126例肝细胞癌(HCC)及癌旁组织中TET1的mRNA、蛋白表达水平,分析其与临床病理特征间的关系.结果:HCC中TET1 mRNA表达相对强度[0.07(0.01,0.14)]较癌旁组织[1(1,1)]明显下降(P＜0.05);HCC中77.0％(97 /126) TET1蛋白低表达,而癌旁组织中72.2％(91/126)TET1呈高表达,HCC中TET1蛋白的表达水平明显低于癌旁组织(P＜0.05);HCC中TET1蛋白表达水平与性别、年龄、乙肝、肝硬化、肿瘤包膜等临床病理特征间无明显相关(P＞0.05);而与肿瘤大小、血管侵犯情况及临床分期等因素间显著相关(P＜0.05);多因素Logistic回归分析发现,TNM分期是TET1低表达的独立危险因素(P=0.000,OR=12.508,95％CI:3.484-44.914).结论:TET1在HCC中表达下调,并可能对HCC的发生发展具有重要作用.

Objective To investigate the effect of histone deacetylase inhibitor MGCD0103 on the growth inhibition of hepatocellular carcinoma cell line BEL7402.Methods BEL7402 cells were treated with different concentrations (0,0.1,1.0,5.0,10.0,50.0,100.0 μmol/L) of MGCD0103 for 24,48,or 72 h and their growth was tested by cell counting kit-8 (CCK-8) assay.Cell viability and half maximal inhibitory concentration were then calculated.Cell tumorigenicity of BEL7402 cells treated with MGCD0103 for 48 h was tested using colony formation assay.The distribution of cell cycle and the apoptosis rate of BEL7402 cells treated with MGCD0103 for 48 h were analyzed by flow cytometry.Results MGCD0103 inhibited the growth of BEL7402 cells in a dase-dependent manner.The half maximal inhibitoryconcentrations for MGCD0103 at 24,48,and 72 h were (19.36 ± 2.13),(9.12 ± 0.87) and (4.95 ± 0.45) μmol/L respectively.MGCD0103 attenuated cell tumorigenicity of BEL7402 cells.MGCD0103 influenced the cell cycle distribution of BEL7402 cells and caused G2/M phase arrest.After treatment,the proportion of G2/M phase cells was increased from (7.83 ± 0.41)％ to (15.84 ± 1.69) ％ (P =0.001).MGCD0103 triggered apoptosis of BEL7402 cells.The apoptosis rate was (6.23 ± 0.66) ％ (control group),(9.02±1.03)％ (1 μmol/L) (P=0.017),(15.93±1.77)％ (5 μmol/L) (P=0.001),and (35.30 ±2.68)％ (20 μmol/L) (P =0.000),respectively.Conclusion MGCD0103 has inhibitory effect on the growth of BEL7402 cells.

Oxaliplatin-based systemic chemotherapy has been proposed to have efficacy in hepatocellular carcinoma (HCC). We investigated the combination of vorinostat and oxaliplatin for possible synergism in HCC cells. SMMC7721, BEL7402, and HepG2 cells were treated with vorinostat and oxaliplatin. Cytotoxicity assay, tumorigenicity assay in vitro, cell cycle analysis, apoptosis analysis, western blot analysis, animal model study, immunohistochemistry, and quantitative PCR were performed. We found that vorinostat and oxaliplatin inhibited the proliferation of SMMC7721, BEL7402, and HepG2 cells. The combination index (CI) values were all <1, and the dose-reduction index values were all greater than 1 in the three cell lines, indicating a synergistic effect of combination of the two agents. Coadministration of vorinostat and oxaliplatin induced G2/M phase arrest, triggered caspase-dependent apoptosis, and decreased tumorigenicity both in vitro and in vivo. Vorinostat suppressed the expression of BRCA1 induced by oxaliplatin. In conclusion, cotreatment with vorinostat and oxaliplatin exhibited synergism in HCC cells. The combination inhibited cell proliferation and tumorigenicity both in vitro and in vivo through induction of cell cycle arrest and apoptosis. Our results predict that a combination of vorinostat and oxaliplatin may be useful in the treatment of advanced HCC.

Objective To investigate the expression and clinical significance of Scavenger receptor class A,member 5 (SCARA5) in patients with hepatocellular carcinoma (HCC),and to explore the relationship between methylation status of SCARA5 gene promoter and its protein expression.Methods SCARA5 expression in tumor and matched adjacent non-cancerous liver tissues from 112 patients with HCC was deteced by immunohistochemistry using tissue microarray technology.The relationship between the protein expression of SCARA5 and the clinical,pathological features in patients with HCC was also analyzed.The promoter methylation patterns of SCARA5 gene in tumor and matched adjacent non-cancerous liver tissues were also measured by methylation-specific PCR technique.Results Negative and weak staining of SCARA5 was observed in 77.7％ (87/112) of the HCC tissue samples,contrast to 25.0％ (28/112) in the adjacent non-cancerous liver tissue samples.SCARA5 was significantly decreased in HCC tissues (P ＜ 0.01).The expression of SCARA5 was not obviously related to sex,age,hepatitis B virus (HBV) status,liver cirrhosis,or capsular invasion (P ＞ 0.05).However,the expression of SCARA5 was significantly correlated with tumor size,vascular invasion,Edmondson-Steiner grade and TNM stage (P ＜ 0.05).Methylation of SCARA5 gene promoter was found in 60.7％ of the all tumor tissue samples.However,methylation was only found in 11.6％ of the adjacent non-tumor samples,which was significantly lower than that in tumor tissue samples (P ＜ 0.05).Meanwhile,the expression of SCARA5 in tumor tissue samples was negatively correlated with promoter methylation status (P ＜ 0.05).Conclusion It suggests that the decreased expression of SCARA5 may have an important role in the development of HCC,and the promoter methylation of SCARA5 gene may be one of the reasons for the decreased expression of SCARA5.

目的 探讨肝切除术后并发胆漏的危险因素,为制定有效的防治措施提供参考依据.方法 回顾性分析2012年1月至2014年12月收治的109例行肝切除术患者的临床资料,根据有无术后胆漏分为胆漏组(23例)和无胆漏组(86例),比较两组患者的一般资料,并通过多因素Logistic回归分析法分析术后并发胆漏的独立危险因素.结果 109例肝切除术患者中发生术后胆漏23例,发生率21.10％,其中20例经保守治疗治愈,3例患者经皮穿刺腹腔灌洗引流治愈.年龄、肝硬化、脂肪肝、切除范围、手术时间、术前血浆白蛋白水平、手术日总输液量与术后胆漏的发生有密切关系(P ＜0.05或P＜0.01);多因素Logistic回归分析结果显示,肝硬化(OR=4.323)、脂肪肝(OR =4.215)、术前血浆白蛋白水平低(OR =5.991)、手术日总输液量大(OR =7.145)是发生术后胆漏的独立危险因素(P＜0.05或P＜0.01).结论 肝硬化、脂肪肝、术前血浆白蛋白水平低及手术日总输液量大是肝切除术患者发生术后胆漏的独立危险因素,在术前要积极改善患者的血浆白蛋白水平,对肝硬化、脂肪肝进行适当治疗,并严格控制手术日总输液量.

Objective To analyze the changes of cellular immunity in malignant obstructive jaundice patients with endoscopic retrograde cholangiopancreatography(ERCP),percutaneous transhepat-iccholangial drainage(PTCD)and open surgery. Methods A total of 120 patients with malignant obstruc-tive jaundice were selected and they were randomly divided into four groups according to different treat-ment methods for high- or low-level obstructive jaundice. Fasting venous blood were taken at the day before the operation,one day after the operation,one week after the operation and two weeks after the operation. The levels of LPS,sIL-2R and CD8 + CD28 - T cells in blood samples were respectively recorded. Blood samples from another 30 healthy donors were tested as controls. Results The levels of LPS and sIL-2R and CD8 + CD28 - T cells in patients were significantly higher than the controls. At the second week after operation,the levels of these indicators were significantly decreased(P < 0. 05),but they were still higher than healthy controls. Patients with ERCP treatment had the greatest reduction than the other groups(P <0. 05). Conclusion The cellular immunity of malignant obstructive jaundice patients is decreased and ERCP treatment may enable a faster recovery of the immunity.

Hepatolithiasis is a kind of mixed stone disease which mainly depends on pigment stone.However,the etiology is not clear and the pathogenesis is very complex.A lot of studies confirmed that helicobacter pylori played an important role in the occurrence and development of disease.This paper mainly expounds the problems concerning the characteristic of helicobacter pylori and its connection with hepatolithiasis, its state in the formation of hepatolithiasis.

Objective To explore the effects of different pneumoperitoneum pressures on bilirubin and transaminase and shoulder pain of the patients after laparoscopic cholecystectomy ( LC ) . Methods The patients were chosen from Zhongnan Hospital Affiliated to Wuhan university who received LC under different pneumoperitoneum pressures from Apr. 2012 to Apr. 2014,and they were divided into low pressure group(65 cases) and high pressure group(65 cases) by random number method. The pneumoperitoneum pressure of high pressure group was maintained at 14-16 mmHg(1 mmHg =0. 133 kPa),of low pressure group was maintained at 8-12 mmHg. The alanine aminotransferase( ALT) ,aspartate aminotransferase( AST) ,total bili-rubin( TBIL) and direct bilirubin( DBIL) were compared before the operation and on the first and third day after surgery. The incidence of complications such as shoulder pain was compared. Results The serum levels of ALT,AST and TBIL were significantly elevated after the operation in both groups(P <0. 05),and the three parameters of the high pressure group elevated more apparently(P<0. 05). The serum levels of ALT, AST and TBIL of the two groups were significantly elevated on the first after surgery(P<0. 05),but signifi-cantly decreased on the third day after surgery(P <0. 05). The serum levels of DBIL had no significant differences between the two groups pre-and post-operative(P>0. 05). The rate of the shoulder pain of the high pressure group(26. 2%) was significantly higher than that of the low pressure group(4. 6%)(P <0. 05). Conclusion Low pneumoperitoneum pressure has smaller impact on the bilirubin and transaminase and the incidence of shoulder pain was lower.

目的 评价十二指肠乳头球囊扩张术及十二指肠乳头括约肌切开术治疗胆源性胰腺炎的疗效.方法 通过检索近10年PubMed、Cochrane Library、Medline、Web of Science、万方数据库、维普中文科技期刊全文数据库、中国学术期刊全文数据库,对纳入研究的方法学进行评价.研究者对纳入文献的质量进行严格评价和资料提取,使用Review manager 5.0软件对符合质量标准的RCTs行Meta分析.结果 6个RCT共546名病人纳入研究,其中治疗组(十二指肠乳头球囊扩张术)273例,对照组(十二指肠乳头括约肌切开术)273例,两组病人均行常规对症支持治疗.Meta分析结果显示:治疗组与对照组相比,病人术后1d腹痛情况及术后1年复发胆管结石的差异具有统计学意义.结论 十二指肠乳头球囊扩张术可显著提升胆源性胰腺炎的疗效、改善预后.

Objective To investigate the effects of ulinastatin on peri-operation period ’ s barrier function of plasma endotoxin level and intestinal mucosa in patients with obstructive jaundice .Methods Sixty-three cases of patients with ob-structive jaundice were randomly divided into experimental group with 34 cases, and control group with 29 cases.All patients were treated with operation of biliary tract obstruction , biliary drainage , postoperative routine treatment , experimental group combined with ulinastatin , 100 000 U dissolved in 5%glucose injection 250 ml, intravenous drip , 2 times a day, treatment for 7 d.Detected the level of plasma endotoxin and diamine oxidase ( DAO) activity at 1 d before operation , after 3 d, 7 d af-ter operation both in the 2 groups, and urinary lactulose and mannitol (L/M) ratio at 1 d before operation, 7 d after operation bothinthe2groups.Results 2groupsat1dbeforetheoperation,nostatisticalsignificancedifferenceofplasmaendotoxin level, DAO activity and urinary L/M ratio were found ( P >0.05), 3 d,7 d after operation, 2 groups of endotoxin level , DAO activity were decreased compared with 1 d before operation( P <0.05),and the experimental group decreased signifi-cantly than control group( P <0.05).7 d after operation, 2 groups’ urinary L/M ratio was significantly lower than the 1 d before operation( P <0.05),and the experimental group decreased more obviously than control group ( P <0.05).The total clinical effective rate in experimental group was significantly higher than that of the control group (94.1%vs.75.8%, P <0.05).Conclusion Ulinastatin can decrease the plasma endotoxin level in patients with obstructive jaundice , reduce intesti-nal permeability , and reduce the intestinal barrier function injury .

Objective To determine the efficacy of biliary tube irrigation (BTI) after endoscopic retrograde cholangiopancreatography (ERCP) to prevent the recurrence in patients with choledocholithiasis.Methods The study included 142 patients with choledocholithiasis admitted to the department of hepatobiliary surgery from 2008.1 to 2010.1.Patients were divided into BTI group (n =71) and non-BTI group (n =71).The BTI after ERCP was executed in BTI group,while the usual management in non-BTI group.All the patients were followed up bimonthly in 24 months after discharge and the recurrent time of choledocholithiasis was documented.According to the follow-up results,the patients were assigned into recurrent group and non-recurrent group.Results After follow-up,there were 40 and 102 patients in the recurrent group and non-recurrent group respectively.As compared with non-recurrent group,the age,body mass index,number of patients with papillary diverticulum,diameter of common bile duct (CBD) and number of stones were increased,while the number of patients undergoing BTI were decreased,in recurrent group (all P ＜ 0.01).The multiple logistic regression analysis demonstrated that the augmented diameter of CBD [relative risk(RR) =1.35,95％ confidence interval (CI):1.12-1.48,P ＜0.01],with papillary diverticulum (RR =1.42,95％ CI:1.26-1.61,P ＜ 0.01),without BTI (RR =1.54,95％ CI:1.31-1.77,P ＜ 0.01) and increased number of stones (RR =1.46,95％ CI:1.35-1.57,P ＜ 0.01) were the independent risk factors of recurrence of common duct stone in patients with choledocholithiasis undergoing ERCP operation.The area under the ROC curve (AUC) of without-BTI to predict the recurrence of choledocholithiasis was 0.65 9 (P ＜ 0.01,95％ CI:0.613-0.693).The Kaplan-Meier survival curve showed that the recurrence of choledocholithiasis was enhanced in non-BTI group (39.44％ vs.16.90％,P ＜0.05).Conclusion The BTI after ERCP operation could reduce the recurrence of common duct stone in patients with choledocholithiasis.

目的 探讨经皮胆道镜下液电碎石取石术(EHL)中常见不良反应和并发症的预防及治疗对策.方法 回顾性分析429例行EHL中57例出现各种不良反应和并发症的患者资料.腹痛36例经肌注杜冷丁或阿托品对症处理;恶心、呕吐25例暂停操作,或控制注水速度、降低注水量、降低电压能量等;畏寒、发热11例,开放T管引流,必要时应用抗生素;胆道出血17例,12例停止操作,5例静脉应用止血药;胆道镜置入困难5例,4例经硬质导管扩张后置镜,1例无法进镜,行ERCP术;术后腹膜炎2例,重新放置引流管引流.结果 57例患者经对症处理,相应症状缓解,完成EHL,无再次手术病例.结论术前积极准备,术中术后及时处理不良反应或并发症,可改善EHL治疗效果.