Objective:To investigate the effect of peritoneal peritoneal hernia repair（TAPP）in the treatment of incarcerated inguinal hernia.Methods:A total of 76 patients with incarcerated inguinal hernia from June 2018 to March 2022 were selected and divided into control group（receiving open tension-free hernia repair）and TAPP group（receiving TAPP）by random number table method，with 38 patients in each group. SPSS 25.0 software was used for data processing. Measurement data such as perioperative indicators，visual analogue scale（VAS）score 24 hours after surgery，inflammation indicators were expressed as（xˉ±s），and independent sample t test was performed. The statistical data of postoperative complications were expressed by［n（%）］using χ2 test. P < 0.05 was considered statistically significant.Results:The intraoperative blood loss，length of hospital stay，postoperative gastrointestinal function recovery time，time to get out of bed and 24h VAS scores in TAPP group were lower than those in control group（P < 0.05）. Immediately after surgery，the levels of procalcitonin（PCT）and C-reactive protein（CRP）in 2 groups were higher than those before surgery，but those in TAPP group were lower than those in control group（P < 0.05）. There was no significant difference in the incidence of postoperative complications between the two groups（P > 0.05）.Conclusion:TAPP is effective in the treatment of incarcerated inguinal hernias，with faster postoperative recovery，less pain and no increase in postoperative complications.

Objective:To investigate the effect of Chaishao-Shugan-Lidan-Paishi Decoction assisted with laparoscopic cholecystectomy in the treatment of chronic cholecystitis with gallstones. Methods:According to the random number table method, 198 cases of chronic cholecystitis combined with cholecystolithiasis were admitted to our hospital from January 2016 to January 2019 and were divided into two groups, 99 cases in each group. Laparoscopic cholecystectomy was performed in both group. Then the control group was treated with Ursodeoxycholic Acid, and the observation group was treated with Chaishao-Shugan-Lidan-Paishi Decoction on the basis of the control group. Both groups were treated for 8 weeks. The clinical efficacy was evaluated after the treatment TCM symptoms and signs were scored before and after the treatment; the levels of TNF-α, IL-6, hs-CRP, gastrin (GAS), motilin (MOT) and somatostatin (SST) were detected by double antibody sandwich ELISA, and the adverse reactions during the treatment were recorded. Results:The total effective rate of the observation group was 94.9% (94/99), the control group was 82.8% (82/99), the difference between the two groups was statistically significant ( χ2=7.364, P=0.007). The score of the right flank pain, the level of upset and irritable condition, the sense of fullness of epigastric cavity, greasiness, nausea and vomiting, belching score after the treatment in the observation group were significantly lower than those in the control group ( t values were 7.229, 4.773, 4.442, 2.302, 5.887, 4.235, respectively, P<0.05 or P<0.01). After the treatment, the levels of serum TNF-α, IL-6, hs-CRP in the observation group were significantly lower than those in the control group ( t values were 9.330, 18.425, 26.886, respectively, all Ps<0.05), and the levels of serum GAS (104.53 ± 2.13 ng/L vs. 96.61 ± 3.29 ng/L, t=20.106) and MOT (386.60 ± 9.42 ng/L vs. 345.50 ± 12.80 ng/L, t=25.731) in the observation group were significantly higher than those of the control group, SST (40.05 ± 4.39 ng/L vs. 48.42 ± 5.11 ng/L, t=12.362) in the observation group was significantly lower than that of the control group ( P<0.01). No serious adverse reactions occurred during the treatment period in both groups. Conclusion:Chaishao-Shugan-Lidan-Paishi Decoction assisted laparoscopic cholecystectomy in the treatment of chronic cholecystitis with gallstones can improve the clinical symptoms, inhibit inflammation, improve gastrointestinal function, improve clinical efficacy.

目的 探讨血清降钙素原(PCT)对肝胆手术后患者腹腔感染的预测效果.方法 选取2015年12月-2017年12月在医院就诊的肝胆外科手术患者218例为研究对象.采集患者一般临床资料,无菌操作采集患者静脉血并检测血清PCT水平.结果 全部行肝胆外科手术的218例患者中,22例(10.09％)患者出现术后腹腔感染(腹腔感染组),196例(89.91％)未发生术后腹腔感染,其中150例(68.81)无任何感染(未感染组),46例(21.10％)为其他感染(其他感染组).术后1d、3d、5d和7d,腹腔感染组、其他感染组和未感染组血清PCT水平比较均存在显著性差异(P＜0.05);术后1d、3d、5d,三组两两比较均存在显著性差异(P＜0.05).ROC曲线结果显示术后1天PCT诊断肝胆外科患者术后腹腔感染曲线下面积为0.841,选取3.3μg/L作为阈值(最佳截断值),其诊断灵敏度为0.836和特异度为0.803.结论 术后监测血清PCT水平有助于早期预测肝胆外科手术患者腹腔感染的发生,术后第3天PCT＞1 22 μg/L诊断术后腹腔感染发生的效能最优.

目的：研究血清降钙素原（procalcitonin，PCT）检测对重症胰腺炎抗生素治疗的指导价值。方法选择33例确诊重症胰腺炎患者，随机分为标准组和对照组，观察两组患者治疗效果及病情转归情况。结果两组患者在治愈率、病死率方面比较无显著性差异（P＞0.05）。结论 PCT是判断SAP是否合并细菌感染的可靠指标，根据PCT指导SAP的抗生素应用，具有快速简便、及时、准确的优点，以PCT指导SAP中抗生素的治疗，可有效减少抗生素的不合理使用。

Objective To discusses the reason and prevention and treatment Methods of bleeding in various operations when carrying out cholecystectomy operation with Laparoscopy and analyzes by reviewing the reason,treatment measures and effect of bleeding in 16cases of LC.Methods Dissect carefully the arteria cystica and Branch vessel during operation and find the bleeding points.Timely treat with the bleeding by means of jaw ligation coagulation bleeding.Result 10 cases(62.5%) damage the arteria cystica when shearing off cystic duct,and in 4cases(25%) damage the arteria cystica branch and bleed when separating the gallbladder bed,in 1case(6.25%) the gallbladder perforator vessel bleeds and in 1case the abdominal wall trocar hole bleeds.Among all the cases no Conversion to open surgery and no Bile duct injury and no secondary hemorrhage in 15cases.There is 1case of bleeding of abdominal wall trocar hole,which is verified to stop by way of twice searching into the abdomen.Conclusion Arteria cystica bleeding is the common reason of operation bleeding when carrying out cholecystectomy in Laparoscopy.Good effect can be taken only if the operator masters the skill of Laparoscopy operation and its relevant treatment measures.

Objective This text discusses the matters to be attended to when carrying out laparoscopy cholecystectomy and the dissection and operation of posterior ealot's triangle of gallbladder.Methods Analyze by reviewing the clinical material of 520 cases of laparoscopy cholecystectomy through posterior ealot's triangle cystic duct dissection.Result 502 cases of LC are smoothly finished through posterior ealot's triangle cystic duct dissection,including 18 cases of conversion to open surgery(4%),4cases of postoperative complications(0.76%).Conclusion Posterior ealot's triangle cystic duct dissection during laparoscopy cholecystectomy is a safe operation method easy to be mastered.

<正>腹腔镜胆囊切除术(LC)已成为治疗胆囊良性疾病的"金标准"之一[1]。我院2010年8月至2011年10月,行复杂胆囊腹腔镜术62例,现将治疗体会报道如下。临床资料1一般资料62例患者,男39例,女23例,年龄31～72岁,平均年龄51.62±14.10岁。单纯性胆囊炎及胆囊结石31

我院自2000年1月～2005年12月行平片无张力疝修补术70例,现将治疗体会介绍如下.