Background: Due to the influence of traditional Chinese culture, many cholelithiasis patients refuse to undergo cholecystectomy. This has prompted surgeons to consider a new treatment option for gallstones, which preserves the gallbladder, termed as choledochoscopic gallbladder-preserving chol-ecystolithotomy. In this study, we reviewed the clinical outcomes of 23 years of single-center application of choledochoscopic gallbladder-preserving cholecystolithotomy.Methods: A total of 5,451 patients with chronic cholelithiasis were selected from 1992 to 2011 as per the inclusion criteria for the choledochoscopic gallbladder-preserving cholecystolithotomy study, and clin-icopathological and follow-up data were collected from 4,340 patients who underwent successful choledochoscopic gallbladder-preserving cholecystolithotomy. The endpoints of the follow-up were recurrence of stones, loss to follow-up, patient death, removal of the gallbladder for other reasons, or end of follow-up in December 2015.Results: All 4,340 cases underwent choledochoscopic gallbladder-preserving cholecystolithotomy with a mean procedure time of 79.6 +/- 35.4 minutes, among which 3,511 (80.9%) received at least 1 follow-up. The recurrence rate of gallstones gradually increased with increasing follow-up duration, with a recur-rence rate of 0.83% within 1 year after surgery and a maximal cumulative recurrence rate of 7.94% at 23 years. The 5-year cumulative recurrence rate of gallstones in the age group <= 20 years was 16.80%, which was significantly higher than those of other age groups, and the 5-year recurrence rate in the single gallstone group was 2.87%, which was significantly lower than that in the multiple gallstone group. Age and number of gallstones were independent risk factors for gallstone recurrence after choledochoscopic gallbladder-preserving cholecystolithotomy.Conclusion: The recurrence rate of gallstones after choledochoscopic gallbladder-preserving chol-ecystolithotomy is low, and most patients with recurrence are asymptomatic or have only mild symp-toms. Age and number of gallstones were independent risk factors. Choledochoscopic gallbladder -preserving cholecystolithotomy is a safe and effective surgical option for gallstone removal in patients who do not wish to undergo cholecystectomy.(c) 2022 Elsevier Inc. All rights reserved.

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.

目的 观察术前心理干预护理措施对内镜微创保胆中转胆囊切除术的胆囊结石患者术后焦虑状态的影响.方法 选取2018年2月1日至2019年9月30日在北京大学首钢医院治疗的360例患者,采用随机数字表法分为实验组和对照组,每组180例.对照组术前1d进行常规内镜微创保胆健康宣教,实验组术前1d在常规内镜微创保胆健康宣教的基础上进行术前心理干预.两组术后剔除术中保留胆囊患者258例,筛选出行内镜微创保胆中转胆囊切除术患者102例(对照组53例,实验组49例)作为最终研究对象.将两组干预前后焦虑自评量表评分(SAS)进行比较.结果 实验组干预后SAS评分低于干预前(P＜0.05),对照组干预后SAS评分低于干预前(P＜0.05).实验组干预后SAS评分低于对照组(P＜0.05).结论 术前心理干预护理措施可降低行内镜微创保胆中转胆囊切除术的胆囊结石患者术后焦虑的不良情绪,值得临床推广应用.

Cholelithiasis is a disease encountered commonly in clinical practice. In recent years, the incidence and recognition of cholelithiasis has increased annually, and the total global prevalence of cholelithiasis in adults has reached 10% to 20%.1 In 1987, the first laparoscopic cholecystectomy was conducted, which resulted in minimal trauma and rapid recovery. This approach demonstrated the superiority of and created a precedent for minimally invasive operations.2 Subsequently, many patients with cholelithiasis worldwide have undergone laparoscopic cholecystectomy.

BACKGROUND:Ligamentoid fibromatosis is a rare borderline tumor that occurs in the muscles, fascia, and aponeurosis. It is a kind of soft tissue tumor of fibrous origin, also known as invasive fibromatosis, desmoid fibroma, neurofibromatosis, etc. The tumor is between benign and malignant tumors and rarely has distant metastasis. Its characteristics are mainly local invasion, destruction and growth and easy recurrence. The World Health Organization defines it as a fibroblast cloning value-added lesion originating from deep soft tissue, which causes local invasion and growth leading to tissue reconstruction, extrusion and destruction of important structures and organs. The incidence rate accounts for 0.03% of all tumors and less than 3% of all soft tissue tumors. Definite diagnosis mainly depends on postoperative pathology. Surgical resection is still the main way to treat the disease, and a variety of nonsurgical treatment methods are auxiliary. Combined treatment can effectively reduce the risk of postoperative recurrence.CASE SUMMARY:The patient is a 57-year-old female. One week ago, she accidentally found a mass in the left upper abdomen while lying flat. There was no abdominal pain and abdominal distention, no fever, no black stool and blood in the stool and no nausea and vomiting. She had a 10-year history of glaucoma on the left side, underwent hysterectomy for uterine fibroids 5 years ago, had no hypertension, heart disease, diabetes, hepatitis or tuberculosis, had no history of smoking and had been drinking for 20 years.CONCLUSION:Accurate preoperative diagnosis is difficult, surgical resection is the main treatment, and a variety of nonsurgical treatment methods are auxiliary. Combined treatment can effectively reduce the risk of postoperative recurrence. The prognosis is still good, and the risk of recurrence of secondary surgery is greatly increased.

目的 比较保留胆囊条件下通过内镜逆行胰胆管造影/内镜下十二指肠乳头括约肌切开取石术(ERCP/EST)与腹腔镜下胆总管探查取石术(LCBDE)一期缝合术治疗胆囊结石合并胆总管结石的疗效.方法 选取105例胆囊结石合并胆总管结石患者,按随机数字表法分为ERCP组(53例)与LCBDE组(52例).在内镜微创保胆取石术的基础上,ERCP组术前行ERCP/EST治疗,LCBDE组行LCBDE一期缝合术治疗,比较两组临床治疗效果.结果 ERCP组手术成功率、一次取石成功率、并发症发生率分别为92.5％、86.8％、15.1％,LCBDE组则分别为96.2％、98.1％、9.6％,差异无显著性(P>0.05);两组平均住院时间比较,差异无显著性(P>0.05),而ERCP组术后平均带管时间显著短于LCBDE组(P<0.01).结论 针对胆囊结石合并胆总管结石患者采取ERCP与LCBDE两种术式各具有优势,治疗效果相当,并发症少,虽ERCP较LCBDE带管时间短,但ERCP适合结石少而小的患者,而LCBDE适合胆总管扩张的患者,应根据患者具体情况选择适合的手术方式.

胃癌根治术是治疗胃癌的有效方法,肝转移是影响胃癌根治术后患者预后的主要原因之一[1-3].本研究回顾性分析208例胃癌根治术后患者的随访资料,探讨不同临床病理因素对胃癌根治术后肝转移复发的预测价值。

【Objectives】 To investigate the clinical effect of cholecystostomy in endoscopic invasive cholecystolithotomy with gallbladder preserved.【Methods】 29 patients who underwent cholecystostomy in endoscopic invasive cholecystolithotomy with gallbladder preserved from 2005 to 2009 were reviewed.【Results】 In the 29 patients,27 of which gallbladder drainage tubes were removed without a hitch and gallbladders were preserved successfully.But the other 2 patients couldn't preserve gallbladders at last and had to undergo cholecystectomy.【Conclusions】 Once cholecystostomy is applied in endoscopic invasive cholecystolithotomy with gallbladder preserved according to different condition,it will increase the success rate of preserving gallbladder,and some patients who should undergo cholecystectomy as usual can preserve functional gallbladder.

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。