目的 探讨改良反穿刺技术用于经自然腔道取出标本(nature orifice specimen extraction surgery,NOSES)的全腹腔镜结直肠切除术的安全性和可行性.方法 回顾性分析2019年1～12月47例全腹腔镜结直肠切除术资料,病灶下缘距齿状线5 cm 5例,病灶位于直肠乙状结肠交界部、乙状结肠42例.肿瘤直径1.0～5.0 cm,平均2.8 cm.使用改良反穿刺技术,在腹腔镜下切开结肠壁,将抵钉座置入结肠,连接杆头端自结肠对系膜缘反向穿出,完成经肛门肠管吻合.结果 47例手术均获得成功,无中转开腹,手术时间40～280 min(平均98 min),抵钉座置入时间2～5 min(平均3.4 min),术后住院时间7～18 d(平均9.8 d).吻合口漏4例,保守治疗治愈,无其他并发症发生.术后随访3～12个月(平均7.9月),无并发症及复发.结论 改良反穿刺技术应用在全腹腔镜结直肠切除术中安全可靠,降低腹腔镜手术难度.

目的 旨在探讨miR-199a在结直肠癌(CRC)发生过程中的分子机制.方法 用miR-199a模拟物转染至CRC细胞系.通过MTT和Transwell实验鉴定CRC细胞的增殖和迁移能力.Western blot和qRT-PCR检测相关基因的表达水平.双荧光素酶法报告实验鉴定miR-199a与结缔组织生长因子(CTGF)的作用关系.结果 miR-199a在CRC细胞系中下调表达,过表达miR-199a可以显著抑制CRC的上皮间质转化(EMT)和血管生成.CTGF是miR-199a的直接靶点.过表达CTGF可抵消miR-199a对EMT和血管生成的抑制作用.结论 miR-199a通过直接靶向CTGF抑制CRC细胞的EMT和血管生成.

Objective To observe the clinical efficacy of autologous materials in the repair of non-circumferential bile duct defects in Mirizzi syndrome.Methods The clinical data of 21 cases of Mirizzi syndrome with bile duct defect were analyzed retrospectively,who were treated with different autologous materials.There were 18 cases with type Ⅱ,of whom 15 cases were given gallbladder pedicle flap repair and 3 cases received umbilical vein flap repair.There were 3 cases with type Ⅲ,of whom 2 cases were treated with gallbladder pedicle flap repair and 1 case was given umbilical vein flap repair.The T tubes were placed for 4 to 9 months postoperatively in all cases.Results The operation was successfully performed in all the 21 patients without any death.After operation,the bile leakage occurred in 1 patient of type Ⅲ,who underwent biliary bladder flap repair and the leakage was healed after 2 weeks drainage.All cases were treated with T cholangiography.The patients were followed up for 1 to 6 years,which showed no case with abdominal pain,jaundice or bile duct stricture.Conclusion Repairing the non-circumferential bile duct defects with autologous materials is effective and safe in the patients with Mirizzi syndrome.

Objective: To discuss clinical results and surgical experience of laparoscopic totally extraperitoneal( TEP) inguinal hernia repair. Methods: The clinical data of 310 patients( 321 inguinal hernias) who underwent TEP repair from Jan. 2011 to Jan. 2014 were retrospectively analyzed. There were 301 males and 9 females with the average age of( 63. 1 ± 15. 7) years old. 310 cases were divided into three groups of early,middle and late stage according to the time sequence of receiving operations. Results: No conversion to open surgery was observed,but 7( 2. 2%) TEP converted to transabdominal preperitoneal approach. The average operative time was( 65.6 ±10.6) min. Postoperative hospital stay was( 3.1 ±1.9) d. All patients returned to unrestricted activities in two weeks. The accumulative number of operative complications was 35( 10. 9%). Intraoperatively,2 cases( 0. 6%) of complications were observed,including 1 case of vas deferens injury and 1 case of inferior epigastric artery bleeding. Postoperatively,there were 33 cases( 10. 3%) of complications,including 21 cases( 6. 5%) of seroma or hematoma,7 cases( 2. 2%) of urinary retention,5 cases( 1. 6%) of transient paresthesia. The follow-up period ranged from 5 to 41 months( median 23 months). No patient was lost during the investigation. During the follow-up,7 cases( 2. 2%) of recurrence were observed. Compared with the mean operative time,total complication rate and recurrence rate of patients in group of early stage,those in group of middle and late stage were both significantly less( P 0. 5). Conclusions: TEP technique is safe,effective and worth promoting with challenging handling and a long learning curve.

Objective To observe the clinical effect of MC and LC in treatment of elderly patients with cholelithiasis and dise~s the best treatment in elderly patients with cholelithiasis.Methods Of 798 elderly patients with cholelithiasis,412 patients were divided into MC group with minilaparotomy cholecystectomy treatment,and 386 patients were divided into LC group with laparoseopic cholecystectomy treatment,then compare clinical effect and complications after operation.Results There was no significant differences in incision length,operative time,blood loss,bed time,hospital stay(all P＜0.05);There Was significant statistical significance in cost of treatment,complications after operation(all P＜0.05).Conclusion Minilaparotomy cholecystectomy was suitable for elderly patients with cholelithiasis,and it Was good at cost of treatment,complications after operation.

Objective Establishing new treatment mode for remedying acute subdural hematoma,studying and assessing the effectiveness of the new treatment mode.Methods Retraspectively analysed 126 cases of acute subdural hematoma who were treated by new treatment mode,contrasted with 238 cases who were treated by traditional treatment mode for establishing a new treatment mode for remedying acute subdural hematoma and evaluated the curative effects of the mode by statisticsly analysing results,times of craniotomy and hospitalization time.Results There were no significant difference between mild cases of two groups.Compression of hematoma were lessened,absorption time were shortened and hospitalization time were reduceed among the moderate and severes cases of new mode group.Craniotomy were avoided in some of the cases.Geting enough preparation time before craniotomy ,motality were lowered and improved curative effect.Conclusion The new treatment mode for remedying acute subdural hematoma notablely improved curative effects,shorten compression time on brain,reduced times of craniotomy and average hospitalization time.Providing a new consideration and way for rescuing acute subdural hematoma.

患者女,47岁.因左下肢疼痛3个月入院.体检:意识清楚,血压130/80 mm Hg,神经系统检查无明显异常.辅助检查:出凝血功能正常.MRI提示,L4髓外硬脊膜下肿瘤.经术前准备后,于连续硬膜外麻醉下行L4脊髓肿瘤切除、椎弓根螺钉固定、外引流术.术中见肿瘤位于硬膜下髓外,大小为15 mm×10 mm×10 mm.顺利将其切除,间断缝合硬脊膜,将1根外引流管置于硬脊膜外.术中出血约400 ml,未予以输血.术后5 h,患者突然出现意识模糊伴全身抽搐,口吐白沫,测血压145/80 mm Hg, 心率76次/min,双侧瞳孔等大等圆,光反应迟钝,右侧Babinski征阳性.引流液为血性液体,量为700 ml.进行头部CT检查提示:左侧额顶部硬膜外血肿,同侧脑室受压,中线右移,出血量约60 ml.急行开颅血肿清除术,术中未见颅脑原发损伤,未见硬脑膜血管异常.术后予以头低足高位,常规抗感染,神经营养等治疗.术后1个月痊愈出院,肿瘤病理学诊断为神经鞘瘤.