目的 探讨中成药胆宁片在内镜保胆取石术(CGPC)后预防胆囊结石复发的作用,及其与牛磺熊去氧胆酸(TUDCA)的差异.方法 纳入2016年11月-2020年1月在北京大学首钢医院符合条件的CGPC后患者1868例,按取出结石的类型分为两个队列,A队列为取出胆固醇为主的结石,B队列为取出胆色素为主的结石,将每个队列中的患者随机分为两组,DN组口服胆宁片(1.8 g/次,3次/d),TU组口服TUDCA(500 mg/次,1次/d),疗程为180 d,随访时间为36个月,记录胆囊结石复发及胆囊壁厚度的变化情况.结果 两种药物相互比较,在A队列,A-DN组与A-TU组的胆囊结石复发率无明显差异;在B队列,B-DN组的胆囊结石复发率明显低于B-TU组.在两个队列中,DN组术后半年的平均胆囊壁厚度均明显薄于TU组.结论 CGPC后应用胆宁片有助于缓解术后胆囊炎症,能够有效地降低胆囊结石复发率,在预防胆色素为主的胆囊结石复发方面优于TUDCA.

笔者单位尝试采用不同的磁铁压迫吻合方法治愈2例不适宜常规手术的肠梗阻病人.现报告如下. 1 病历简介 例1.病人女性,83岁.腹痛、腹胀、停止排气、停止排便2d于2018-01-21入院.腹部CT:升结肠远段占位性病变,致肠梗阻,肝内多发转移,腹水(图1a).诊断:结肠癌并肠梗阻、肝转移癌、腹水.予以禁食水、持续胃肠减压、静脉输液等治疗.放置肠梗阻减压管于空肠内,逐渐深入,最终到达回肠内.肠镜检查:横结肠见不规则隆起,充满肠腔,表面充血、糜烂;内镜不能通过(图1b).因病人高龄、结肠癌晚期并肠梗阻、肝转移癌、腹水,不适宜手术切除;病人不接受肠造瘘、且生活质量差,签署知情同意书后行磁铁压迫吻合术.

目的探讨经B超诊断的单纯胆囊结石患者行内镜保胆取石术前MRCP检查的适应证。方法回顾性分析该院2005年1月～2010年7月1490例经B超诊断的单纯胆囊结石患者术前经磁共振胰胆管造影(MRCP)发现的胆总管小结石30例的病历资料。结果 1490例经B超诊断的单纯胆囊结石患者中行MRCP检查发现30例无症状胆总管小结石,占2.01%,这30例胆囊结石患者均有多发细小结石(0.6cm及以下),胆总管小结石直径(0.50±0.08)cm。结论 B超发现单纯胆囊多发细小结石(0.6cm及以下)者是术前MRCP检查的适应证,有可能发现无症状的胆总管小结石。

Objective: To make magnetic compression anastomosis between the small intestines as a novel treatment, using the advances in interventional radiology. Methods: One magnet was put into the ileum of an adult dog, another magnet was put into the colon of the dog, the ileum between the two magnets was ligatured causing a complete obstruction of the small intestine. Two magnets were immediately attracted towards each other transmurally, so that the walls of intestine were compressed together. Results: Two magnets compressed the stricture transmurally, causing gradual ischemic necrosis of the stricture. The ischemic necrosis created an anastomosis between the two magnets. The magnets of 2 300～2 770 gauss were discharged from the anal 6～14 days after the procedure. There was a complete fistula between the ileum and the colon. The magnets of 3 200 gauss were discharged 3- 4 days post the procedure, and two dogs were died of perforation on colon caused by the magnets of 3 200 gauss. Conclusion: Magnetic compression anastomosis(MCA)is a novel interventional method that creates an anastomosis between the small intestine and the colon. The magnets from 2 300～2 770 gauss are safe. MCA could be applied in patients.

OBJECTIVE:To discuss the feasibility of the operation of minimal invasive with gallbladder preserved via choledochoscopy.METHODS:From February 1992 to June 2006, there were 760 patients who underwent cholecystolithiasis treated with the minimal invasive operation with gallbladder preserved via choledochoscopy, among which there were 428 males and 332 females, aged from 18 to 81 years old. All cases were diagnosed by ultrasonography and their gallbladder functions were proved normal by the examination of oral cholecystography or ECT before operation. In the operation gallstones were removed from gallbladder completely.RESULTS:There were 612 cases who were followed up for 1-15 years and the follow-up rate was 80.5%. All patients recovered well after operation. The post-operation rate of recurrence of gallstone was 0.49%, 4.39%, 5.83%, 6.60%, 7.21% and 8.38% within the first year, the second year, the third year, the fifth year, the seventh year and the ninth year respectively, rate of recurrence of gallstone were 10.11% within both the tenth and the fifteenth year.CONCLUSIONS:The minimal invasive operation with gallbladder preserved via choledochoscopy is effective to cholecystolithiasis patients whose gallbladder function is normal. It is a feasible operation that preserves the normal functional gallbladder and improves the patients' life quality.

我们为了在临床上开展磁铁压迫吻合术治疗不宜手术或拒绝手术的肠梗阻,进一步探讨磁铁压迫吻合治疗的作用原理,建立了磁铁压迫吻合术治疗肠梗阻的模型.

Objective:Proinflammatory cytokines such as tumor necrosis factor-α(TNF-α) and interleckin 1-β(IL-1β)play an important role in the development of hepatic failure after extensive liver resection.FR167653 has been characterized as a potent suppressant of TNF-α and IL-1β.In the present study,we explored the possibility that FR167653(FR) attenuates an acute liver injury induced by the injection of Lipopolysaccharide (LPS) after partial hepatectomy in cirrhotic rats.Methods:Dimethylnitrosamine-induced cirrhotic rats received LPS 48h after 70% hepatectomy to prepare a lethal posthepatectomy acute liver failure model.FR was administered intravenously at 3mg/(kg·hour)for 150min,starting 30min before LPS challenge.Results:FR significantly improved the survival rate of rats at 48h after LPS challenge.Serum lev-els of alanine transaminase(ALT),aspartate transaminase(AST),TNF-α and IL-1β were[FK(WB00015。142mmZQ1mm]significantly lower in the FR-treated group than that in the control group.Histopathologically,liver tissue damage was milder in the FR-treated group than that in the control group.Conclusion:The results indicate that treatment with FR ameliorates an acute liver injury induced by the injection of endotoxin after partial hepatectomy in cirrhotic rats.

Objective:To assess the safety,benefits and utility of laparoscopic transcystic duct exploration and biliary drainage,and the useage of the C-tube(cystic duct tube) for patients with common bile duct(CBD) calculi.Methods:A retrospective review of 89 consecutive patients who underwent laparoscopic common bile duct exploration between 1995 and 2004 was conducted.Results:Laparoscopic transcystic duct exploration with C-tube drainage was accomplished in 39 patients and laparoscopic choledochotomy with T-tube drainage in 35 patients.Primary closure of the choledochotomy or the cystic duct after laparoscopic transcystic duct exploration with different drainage methods facilitated the procedure in 15 patients.There was no bile-leakage in 39 cases which underwent the C tube procedure,but 4 bile leaks occurred in 35 cases with T-tube drainage.The drainage period (8±4.5)days in the C-tube group was significantly shorter than that in the T-tube group(24±5.6)days(P<0.001).Conclusions:Most of the patients with CBD calculi can be treated successfully by means of the transcystic technique with choledochoscopy,with no increase in morbidity and a shortened hospital stay than the patients who undergo laparoscopic choledochotomy with T-tube drainage.The transcystic technique with choledochoscopy,not only suits the biliary drainage after exploration of CBD,but also has a wide application in biliary surgery.

In the present study, the effect of FR167653, a novel suppressive agent against interleukin-1beta (IL-1beta) and tumor necrosis factor-alpha (TNF-alpha), on liver regeneration was investigated in rats after partial hepatectomy (PH). Doses of 1, 3 and 5 mg/kg per h FR167653 (FR-1, FR-3 and FR-5, respectively) were given intravenously 30 min before PH, while the control was given normal saline. Serum chemistries were serially monitored, and liver regeneration was evaluated by remnant liver weight ratio, proliferating cell nuclear antigen (PCNA) labeling index and mitotic index. Accumulation of IL-1beta and TNF-alpha messenger RNA (mRNA) in the remnant liver was also measured. In FR167653-treated groups, the releases of alanine transaminase (ALT) and aspartate transaminase (AST) were lower. The PCNA labeling index was enhanced by FR167653-administration in a dose-dependent manner, FR-3 and FR-5 groups showed significantly higher peak DNA synthesis than the control group at 24 h post-PH (P<0.01). The mitotic index was also enhanced by FR167653-administration in a dose-dependent manner. In FR-5 group, the remnant liver weight ratio was significantly higher than that in the control group (P<0.05). The accumulation of IL-1beta messenger RNA (mRNA) in the remnant liver was obviously suppressed in FR-3 and FR-5 groups, but the expression of TNF-alpha mRNA was not apparently reduced. In conclusion, FR167653 ameliorates liver injury and enhances liver regeneration after PH in rats.