目的:探讨腹腔镜脾部分切除术(LPS)在脾脏良性病变治疗中的应用价值.方法:选取2019年1月至2021年12月收治的脾脏良性病变患者64例,按随机数字表法分为两组,各32例.对照组予以腹腔镜全脾切除术(LTS)治疗,观察组接受LPS治疗.比较两组手术情况,手术前后免疫功能、生活质量及并发症发生情况.结果:观察组手术时间长于对照组,术中出血量多于对照组,术后排气时间、排便时间及住院时间短于对照组,差异有统计学意义(P<0.05);观察组术后CD3+、CD4+、CD4+/CD8+水平高于对照组,CD8+水平低于对照组,差异有统计学意义(P<0.05);观察组术后生理、心理、社会及环境领域评分高于对照组,差异有统计学意义(P<0.05);观察组并发症发生率低于对照组,差异有统计学意义(P<0.05).结论:采用LPS治疗脾脏良性病变能缩短患者术后排气、排便及住院时间,减轻患者免疫功能损害,减少并发症发生,加快患者生活质量恢复.

目的 研究外伤性肝破裂患者腹腔镜修补术后并发症的危险因素.方法 收集2017年4月至2020年10月本院102例外伤性肝破裂患者作为研究对象,患者均接受腹腔镜下修补术,记录并发症发生情况.采用Logistic多因素分析法探讨其术后并发症的危险因素,并建立指数方程,分析其判断并发症的应用价值.结果 102例患者中,共发生并发症38例,发生率为37.25％,其中术后感染14例,术后胆漏12例,出血8例,肝脓肿4例.Logistic多因素分析结果显示,受伤至入院时间、失血量、低血压持续时间及Alb水平是影响术后并发症的独立影响因素(P<0.05).根据Logistic多因素分析结果建立指数方程Y=0.603 X1+0.654 X2+0.471 X3+0.798 X4+0.899 X5(X1=受伤至入院时间,X2=失血量,X3=肝破裂分级,X4=低血压持续时间,X5=Alb).ROC分析结果显示指数方程判断术后并发症的AUC为0.796(SE=0.066,95％C I=0.666～0.926,P<0.001).结论 外伤性肝破裂患者腹腔镜下修补术后并发症发生率较高,其并发症与受伤至入院时间、失血量、肝破裂分级、低血压持续时间及A lb水平相关.

目的 探究半乳糖凝集素9(Galectin-9)、NADPH氧化酶1(NOX-l)mRNA在胆囊癌中表达变化及与癌细胞生物学行为指标的关系.方法 选取本院胆囊癌患者84例,检测对比癌组织与与距离癌组织边缘5 cm左右的癌旁正常组织中Galectin-9、NOX-1 mRNA相对表达量,分析癌组织中Galectin-9 mRNA与NOX-1 mRNA关联性及两者与临床病理特征、癌细胞生物学行为指标的关系.结果 癌组织中Galectin-9 mRNA相对表达量低于癌旁正常组织,NOX-1 mRNA相对表达量高于癌旁正常组织,差异有统计学意义(P＜0.05);癌组织中Galectin-9 mRNA与NOX-1 mRNA呈负相关(r-=-0.688,P＜0.001);Galectin-9 mRNA与临床分期、淋巴结转移、分化程度显著相关(P＜0.05);NOX-1 mRNA与临床分期、淋巴结转移、分化程度、肿瘤浸润深度显著相关(P＜0.05);Galectin-9 mRNA与p-STAT3、Bcl-2、MMP-7 mRNA呈负相关,NOX-1 mRNA 与p-STAT3、Bcl-2、MMP-7 mRNA呈正相关(P＜0.05).结论 Galectin-9 mRNA下调、NOX-1mRNA上调可能是胆囊癌发生的重要机制,且两者表达水平与临床病理特征、生物学行为指标密切相关,能为临床诊治提供有效信息.

Objective:To compare the efficacy and safety of laparoscopic combined with duodenoscope (IO-ERCP/EST+ LC) and laparoscopic combined with intraoperative choledochoscope (LC/LCBDE+ IOC) in the treatment of gallstones and choledocholithiasis in the elderly.Methods:From October 2017 to October 2020, clinical data of 80 elderly patients with gallstones and choledocholithiasis were analyzed retrospectively. According to different surgical plans, 40 cases were divided into the group A (IO-ERCP/EST+ LC), and 40 cases were divided into group B (LC/LCBDE+ IOC). Statistical software SPSS21.0 were used for data analysis. Measurement data such as intraoperative and postoperative indicators, liver function indicators and other measurement data were expressed as (±s), and were examined by independent t test. Chi-square test were performed for the analysis of postoperative complications, stones Counting data such as clearance rate and stone residual rate. A P value of <0.05 was considered statistically significant difference.Results:The operation time in group A were significantly shorter than that of group B (P<0.05). There were no statistically significant difference between groups in terms of postoperative complications such as stone removal rate, residual stone rate, postoperative bleeding, perforation, bile leakage, pancreatitis and cholangitis (P>0.05). There were no statistically significant difference between groups in terms of liver function levels of bilirubin, ALT, AST, and ALPbefore and after the operation (P>0.05); The postoperative exhaust time of group A was shorter than that of group B, and the hospitalization time and cost of group A were higher than that of group B, with statistically significant differences (P<0.05).Conclusions:The IO-ERCP/EST+ LC treatment has a shorter operation time and quicker postoperative recovery, however the hospitalization cost is relatively high. Clinically, the most reasonable and optimal program choice should be made according to the specific conditions of the patient.

目的:探讨腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)后并发症的预防与处理.方法:回顾分析2004年1月至2015年1月施行的1 351例LC的临床资料,其中胆囊结石慢性胆囊炎1 041例,胆囊息肉145例,结石合并息肉18例,急性胆囊炎147例.结果:62例(4.6％)中转开腹,17例(1.3％)术后发生并发症,其中胆道损伤2例,分别行胆管空肠Roux-en-Y吻合术及胆道探查、T管引流;2例胆漏,1例再次开腹缝扎,1例保守治疗;腹腔内出血1例,再次开腹止血;腹壁切口出血2例,缝合止血;2例胆管残余结石,保守治疗;1例出现腹壁结石感染,予以切除;2例术后出现肠梗阻,保守治疗;切口感染5例,保守治疗.术后患者均治愈出院.结论:严格把握手术适应证、规范手术操作、必要时中转开腹可减少LC术后并发症的发生.

Objective To study and evaluate clinical efficacy of percutaneous transhepatic insertion of baliary stent in treating malignant baliary obstructive jaundice.Methods 45 maligant obstructive jaundice patients were performed PTIBS,which included cholangiocarcinoma 32 cases and carcinoma of head of pancreas 13 cases.The total bilirubin(TBIL) were detected to observe the efficacy of lessening jaundice.Results 42 patients were planted stent successed.The successful rate was 93.3%,4 of them were inserted 2 stents.The stents opened well while the bile drainaged smoothly,TBIL decreased obviously after operation 1 to 4 weeks,the jaundice were relieved obviously.One case died because of abdominal cavity bleeding,hemobilia 2 cases,biliary leak 2 cases,pancreatitis 3 cases,the infection of baliary duct 8 cases.According to the follow-up,the mean survival time was 11.8 months and the longest was 24 months.Conclusion PTBIS was a safe and effective treatment for maligant biliary obstructive patients and it prolonged the survival time and lessened the bitness and improved quality of life.

Objective To summarize the clinical experience and methods by analyzing treatment of SAP(severe acute pancreatitis).Methods Retrospective analysis of 168 cases with severe acute pancreatitis treatment in our hospital in past 5 years(from Oct.2006 to Oct.2011).Results In all 168 cases,142 cases were cured by medical treatment while 9 patients died,14 cases were cured by surgery(including ERCP + EST,cholecystectomy and common bile duct exploration,or laparoscopic cholecystectomy after ERCP or pancreatic necrosis debridement treatment) while 3 patients died.Of all patients,12 cases with gastrointestinal bleeding,20 cases with acute renal failure,ARDS 12 cases,liver function abnormal 98 cases,MODS 18 cases,3 cases with pancreatic pseudocyst huge cyst,3 cases with pancreatic leakage.Conclusion Treatment of severe acute pancreatitis was mainly with non-surgical treatment,if necessary,take traditional surgery,endoscopic surgery and laparoscopic surgery treatment.

Objective To explore the methods of diagnosis and treatment of pancreatic injuries.Methods The clinical data of 73 cases with pancreatic injuries in the past 9 years were analyzed retrospectively.Results All cases include 66 male and 7 female aged between 12-60 years old,blunt trauma in 67 cases and penetrating injuries in 6 cases.Of all cases,35 cases with shock while 56 cases with three or more organ damage.There were 48 cases of pancreatic trauma in grade 1,15 in grade 2,4 in grade 3,4 in grade 4,2 in grade 5.Five patients(6.8%) with only pancreatic trauma,meanwhile 68 patients(93.2%) were combined with other organ injuries.Preoperative diagnosis was made only in five cases(6.8%).Operation was performed in 69 cases.8 cases complicated with pancreatic leakage,4 cases with abscess around the pancreas,and 3 cases with pancreatic pseudocyst.64 cases were cured(87.7%) and 7 cases died(9.6%) after the operation.Conclusion For early diagnosis of pancreatic trauma,it is important to be aware of potential for this injury after abdominal trauma.The dynamic B-mode ultrasonography,enhancement CT and MRCP are important methods in diagnosing pancreatic injury.The key procedure for improving prognosis and reducing the postoperative complications is to take timely and rational operative procedures according to the degrees and regions of pancreatic trauma.