Objective:To study the changes in the sphincter of Oddi pressure in rabbits after bilateral vagus nerve trunk severance and the therapeutic effect of Qingre Lidan Decoction, to provide a new way for the treatment of sphincter of Oddi dysfunction.Methods:Twenty-four 1.5~2.0 kg New Zealand Large White rabbits of either gender were randomly selected and divided into the control group, the model group, and the treatment group. In the control group, only pyloroplasty was performed; in the model group and the treatment group, pyloroplasty plus bilateral vagus nerve trunk dissection at the level of the diaphragm were performed, and in the treatment group, one month of gavage treatment with Qingre Lidan Decoction was carried out 7 days after the operation. Multi-channel bio-signal acquisition system was used to record the pressure changes of the sphincter of Oddi in rabbits of each group; ELISA was used to detect the changes of inflammatory factors IL-6 and tumor necrosis factor TNF-α in the serum of rabbits.Results:The pressure of the sphincter of Oddi in the model group was significantly higher than those in the control group [low-pressure area: (51.95±0.35) mmHg (1 mmHg=0.133 kPa) vs (21.60±1.13) mmHg ( P<0.05) ; High pressure area: (60.75±0.49) mmHg vs (20.70±0.85) mmHg ( P<0.05)], the pressure of sphincter of Oddi in the treatment group of Qingre Lidan Decoction was lower than that of the model group [low-pressure area: (22.70±1.13) mmHg vs (51.95±0.35) mmHg ( P<0.05); high-pressure area: (32.15±0.49) mmHg vs (60.75±0.49) mmHg ( P<0.05)]. Serum IL-6 and TNF-αwere significantly elevated in the model group compared to the control group; IL-6 and TNF-α levels were decreased in the treatment group compared to the model group, and the differences were statistically significant ( P<0.05). Conclusion:Bilateral vagus nerve trunk severance leads to Oddi sphincter dysfunction, and treatment with Qingre Lidan Decoction could improve Oddi sphincter dysfunction.

探讨腹腔镜脾脏部分切除术治疗脾脏良性占位性病变的手术要点、适应证及疗效。回顾分析2015年1月至2020年6月大连医科大学附属第一医院3例脾囊肿、2例脾血管瘤患者资料，均行腹腔镜脾脏部分切除术，病变4例位于上极，1例位于下极，病变最大径(5.4±2.7)cm。5例患者均成功完成手术，手术时间(173.0±48.0)min，出血量(70.0±27.4)ml，术后住院时间(7.6±2.5)d，均无术后并发症。随访时长5~48个月，无病变复发及远期并发症。腹腔镜脾部分切除术治疗脾良性占位性病变安全可行、疗效肯定，能避免或减少发生脾切除后凶险性感染、血栓等严重并发症。

In December 2020, European Society for Clinical Nutrition and Metabolism (ESPEN) issued the latest practical guidelines for clinical nutrition in liver disease on the basis of the published ESPEN guidelines for clinical nutrition in liver disease and the latest clinical evidence. The guideline proposes 103 statements and recommendations for the nutritional and metabolic management of patients with acute liver failure, alcohol and nonalcoholic steatohepatitis, liver cirrhosis, and liver transplantation, which summarizes the principles and measures for clinical nutrition in diagnosis and treatment and provides more comprehensive guidance for nutrition program. Key words：Liver Disease； Malnutrition； Europe； Practice Guideline

急性胰腺炎和慢性胰腺炎是炎性胰腺疾病的两种主要形式,需要不同的营养治疗策略.近年来,对代谢、饮食、临床营养和胰腺关系的研究逐渐深入,急慢性胰腺炎的营养治疗也越来越受到重视.2020年1月欧洲临床营养和代谢学会(ESPEN)发布了最新的急慢性胰腺炎临床营养指南.这是在2002年急性胰腺炎的临床营养指南、2006年慢性胰腺炎的肠内营养指南、2009年胰腺胃肠外营养指南的基础上,进行高度总结发布的最新的急慢性胰腺炎临床营养指南.改版指南针对急慢性胰腺炎的31个关键问题提出了42条共识性建议和7个声明,主要涉及急慢性胰腺炎的临床营养风险评估、营养干预时机、干预途径、干预类型等治疗过程中的关键问题.较全面地总结和概括了最新的急慢性胰腺炎的临床营养诊治原则和诊疗措施,为急慢性胰腺炎的临床营养诊疗提供了更全面的指导.

探讨解建国教授以培土生金八法为指导思想来治疗肺部癌肿的临床经验.解建国教授出身于医学世家,为我国医学泰斗、首届国医大师张学文教授直嫡真传弟子,现为全国名中医,享受国务院政府特殊津贴,从事中医药治疗肿瘤的临床及科研工作40余年.解建国教授治疗肺部癌肿,倡导扶正抗癌,带瘤生存的治疗理念.扶正重在培土生金、以通为补、八法并用,抗癌重在软坚散结、消食化积,抗癌缩瘤.临证治疗肺癌、肺部结节、肺部毛玻璃样改变以及肺癌放化疗后防止癌肿复发等方面疗效显著.

解建国教授是国家级名老中医、辽宁省首届名中医,从事中医药治疗疑难顽怪病的临床及科研工作40余载.临床用药喜用药对,擅用药对.文章介绍解建国教授运用药对治疗癌症的经验.解老师临床治疗癌症,整体上以扶正缩瘤药对为基础,结合病变脏腑功能不同,以各脏腑药对为辅,同时结合病变症状表现不同,佐以对症效药药对.其所用药对之性味归经、剂量配比皆有深意,是充分考虑癌病及其病机特点,精研药物功效配伍,并通过长期临床实践所成的宝贵经验.特色鲜明,疗效确切,故加以总结整理,以飨同道.

Oddi括约肌功能障碍(sphincter of oddi dysfunction,SOD)是指Oddi括约肌失去正常生理功能,出现上腹部胆胰源性疼痛、餐后腹胀、肝或胰酶升高、胆总管扩张或胰腺炎发作等的临床综合征,多见于胆囊切除术后患者.尽管诊断和治疗该疾病的既定标准已应用于临床,但SOD作为一个疾病过程本身,其诊断方法和治疗手段一直都存在争议,部分原因是它的自然病程,疾病治疗过程及治疗结果在长期随访的大型对照研究中尚未明确证实,存在很多困惑.本文就近年来相关领域所取得的最新研究进展进行简要综述,旨在全面分析目前胆囊切除术后SOD的诊断治疗现状与存在的问题,并为医生诊断和治疗该疾病提供适当的建议.

Objective To study the clinicopathological features, diagnosis and surgical treatment of duodenal papilla neu-roendocrine tumors ( DPNETs) .Methods Clinical data of 3 DPNET patients and their surgical treatment outcome were ret-rospectively analyzed with related literatures reviewed.The patients were 68,66 and 52 years old.Main clinical symptoms included abdominal pain, diarrhea and upper gastrointestinal bleeding.Imaging studies of 2 cases revealed mass lesions in the descending part of duodenum.Esophagogastroduodenoscopy ( EGD) of the 3 cases indicated duodenal papilla lesions. Biopsies demonstrated neuroendocrine tumors by pathology. Results All patients underwent pancreaticoduodenectomy ( PD) .Pathological reports were G1 grade in 2 cases and G2 grade in 1 case.The patients were followed up after opera-tion.Of the 3 patients, two patients survived while the other patient died due to recurrence after 4 years and 8 months of surgery.Conclusion Duodenal papilla neuroendocrine tumor is relatively rare and does not have specific clinical manifesta-tions.Preoperative EGD is helpful for diagnosis.Surgical resection is the mainstay of treatment.

Objective To compare the safety and ef icacy of robot assisted surgery and laparoscopic surgery ingal bladder with respect to adult patients. Methods A systematic article search and review were performed. Foreign and Chinese database were used in our study.Published studies comparing robot assisted sugery versus laparoscopic surgery was eligible for inclusion. The main outcome were conversion rate, complication, blood loss and second outcomes were operation time, postoperative hospital stay. RevMan5.2 software was used to do statistical analysis. Results Five artical reporting data on 586 patients have been included in our study, There was no significant dif erences between robot assisted surgery and laparoscopic surgery in conversion rate, complication, bloodloss, operationtime, postoperative hospital stay. There was significant dif erence between robot assisted surgery and laparoscopic surgery in operative time. Conclusion Based on cur ent studies, we cannot concluded robot assisted surgery is bet er than laparoscopic surgery. We need more wel designed multicenter randomized control ed trial to assess the safety and ef icacy of robot-assisted surgery.

目的:观察芍药甙对高胆固醇血症(hypercholesterolemia,HC)家兔离体Oddi括约肌肌环收缩活动的影响.方法:纯种新西兰大耳白家兔16只随机分成两组:对照组(control,CON)和高胆固醇血症(hypercholesterolemia,HC)模型组各8只,CON组饲以标准饲料,HC组饲以标准饲料+胆固醇(cholesterol,Ch),共饲8周.分别取两组SO制备成离体肌环,放置于平滑肌恒温灌流浴槽中,观察累积浓度芍药甙对SO肌环的舒张反应.结果:当芍药甙浓度累积达(100nmol/L、1μmol/L、10μmol/L、100μmol/L)时,对两组的SO肌环都产生剂量依赖性舒张作用(P＜0.01).但是模型组明显弱于对照组.结论:在离体条件下,芍药甙对正常兔和高胆固醇血症兔Oddi括约肌肌环均能产生剂量依赖性舒张作用,但高胆固醇血症兔Oddi括约肌肌环舒张性较正常兔下降,具体作用机制有待进一步研究.

目的:探讨腹腔镜联合胆道镜微创手术对胆囊结石患者胆盐转运因子胆盐输出泵(BSEP)、多重耐药蛋白2(MRP2)和牛黄胆酸钠转运蛋白(NTCP)水平的影响.方法:选取我院普外科收治的胆囊结石患者20例排除手术和麻醉禁忌症,予腹腔镜联合胆道镜微创手术治疗.治疗结束后,对比治疗前后患者BSEP、MRP2、NTCP水平变化.结果:①治疗后患者肝脏组织中BSEP、MRP2水平明显比治疗前升高,差异有统计学意义(P＜0.05);②治疗后患者肝组织中NTCP水平与治疗前水平无明显变化,差异无统计学意义(P＞0.05).结论:腹腔镜联合胆道镜微创手术治疗胆囊结石能升高患者胆盐转运因子BSEP、MRP2水平,提高患者术后对胆盐的转运和胆汁酸的代谢,降低胆囊结石复发率,对临床具有指导意义,值得临床推广.

Objective It is to investigate the effect of blockers of voltage-gated potassium channels ( Kv) , large-conduct-ance calcium-activated potassium channel ( BKCa) on sphincter of Oddi ( sphincter of Oddi , SO) from rabbits muscle ten-sion rings, and to explore the regulatory effect of the active ingredients of traditional Chinese medicine paeoniflorin on them . Methods Isolated rabbit sphincter of Oddi muscle rings specimens were prepared and placed on the smooth muscle perfusion bath temperature to observe the contraction effect of Kv channel blocker 4-aminopyridine (4-AP), BKCa channel blocker tetraethylammonium chloride( TEA) on isolated rabbit SO muscle rings and the effects of paeoniflorin on the contraction effects induced by 4-AP and TEA.Resul ts 4-AP and TEA both could cause contraction of SO muscle rings , with the the concen-trations increased , the contraction degrees increased .The contraction effects induced by 4-AP and TEA could be inhibited by paeoniflorin .Conclusion In vitro condition , Kv channel and BKCa channel play a major role in the maintenance of sphincter of Oddi resting membrane potential of cells .Paeoniflorin may influence the relaxant responses of SO cells possibly through the regulation of Kv and BKCa channels .

目的:建立芍药甘草汤含药血清制备方法,并观察不同浓度芍药甘草汤含药血清对高胆固醇血症兔Oddi括约肌细胞内Ca2+浓度的影响.方法:利用高效液相色谱法(HPLC)测定芍药甘草汤灌胃后不同时间点兔血清中芍药苷、甘草酸血药浓度,以确定最佳采血时间.同时通过共聚焦显微镜观察不同浓度芍药甘草汤含药血清对高胆固醇血症兔Oddi括约肌细胞内Ca2+浓度变化的结果.结果:兔口服芍药甘草汤后芍药苷血药浓度在90min达到高峰,甘草酸血药浓度在60min达到高峰.高胆固醇血症组细胞内Ca2+浓度较正常组明显升高(P＜0.01),而芍药甘草汤含药血清可以明显降低细胞内的Ca2+浓度,随浓度增加而作用增强(P＜0.05).结论:芍药甘草汤通过降低细胞内的Ca2+浓度起到对ODDI括约肌功能紊乱的治疗作用.

[Objective] To investigate the the effect of Da Cheng Qi decoction to the intestinal transtit of acute necrotizing pancreatitis (ANP) in rat. [Methods] The modols of testing the intestinal transit of ANP in rat were established, and SD rat were divided in to sham operation group, model group and treatment group. After 48 hr, FITC dextran 10000 were injected into the duodenum, 25 min later, the levels of FITC dextran 10000 in 10-equal-part-intestine were tested, and the average geometric centre were calculated. [Results] The average geometric center of the fluorescent marker model group than the sham operation group were significantly more backward(P < 0.01), treatment group compared with the model group significantly more ahead(P < 0.01). Cecal contents of the culture to a significant increase in the total number of bacteria quantity model group aerobic and gram-negative bacteria, bacterial counts than the sham operation group group (P < 0.01), the treatment group significantly reduced compared with the model group (P < 0. 01). [Conclusions] There was decreased intestinal transtit in acute necrotizing pancreatitis. Da Cheng Qi decoction could increased intestinal transit.

<正>1临床资料患者女性,51岁。于10年前经常无明显诱因出现腹痛,为剑下阵发性隐痛,程度中等,无放射,与体位无关,弯腰抱膝位可减轻,以后上述症状反复出现。入院10 d前右上腹痛再发,性质同前,伴有恶心嗳气,未有呕吐。到当地医院就诊行CT检查示:"先天性胆管扩张症"。后来大连医科大学附属第一医院就诊,2012年3月21日门诊以"先天性胆管

目的 应用手术切口部分延期缝合法预防急诊腹部切口感染.方法 急诊手术采用切口部分延期缝合法161例患者(延期缝合组),手术结束缝合切口时,0.9％氯化钠冲洗切口,选择1处或2处垂直褥式缝合皮肤暂不打结开放,安放皮片引流,术后1 ～2d拔除皮片,4～5d打结关闭开放的皮肤,术后8～9d即可拆除后打结的缝线.观察手术时间、切口裂开及感染情况,并与急诊手术采用切口常规缝合法137例患者(常规缝合组)比较.结果 延期缝合组无切口感染和切口裂开发生,住院时间(13.4±1.6)d.常规缝合组发生切口感染23例,切口感染率16.79％,切口裂开7例,切口裂开率5.11％,住院时间(22.6±2.1)d.两组切口感染率、切口裂开率和住院时间比较差异有统计学意义(P＜0.05).结论 切口部分延期缝合能有效预防急诊手术切口感染.

缺血再灌注损伤是引起移植器官功能丧失进而影响预后的主要原因之一.本实验旨在研究大鼠胰十二指肠移植缺血再灌注后胰腺白细胞聚集、组织损伤、髓过氧化物酶(myloperoxidase,MPO)含量的变化及ICAM-1mRNA的表达规律,并探讨丹参注射液对其表达的影响. 实验资料 1.动物:健康雄性纯系SD大鼠,体重250～350 g,受体略大于供体,大连医科大学实验动物中心提供. 2.材料:链脲霉Lot 88H1177(Sigma Co.),a-血淀粉酶液体稳定试剂盒(AusBio Co.),MPO测定试剂盒(南京建成生物有限公司),mRNA提取试剂盒(Life Technologies Co.),RT-PCR试剂盒(Takara Co.),丹参注射液(批号950307,上海第一制药厂)。

目的 分析血清脂类、载脂蛋白指标异常与胆囊胆固醇结石病例对照比较.方法 选择经手术证实的47例胆囊胆固醇结石患者,并按相同年龄、性别和体质量指数与同期健康体检者(对照组)进行1∶1配对,两组均接受血脂(总胆固醇、甘油三脂、低密度脂蛋白、高密度脂蛋白)和载脂蛋白(A和B)指标检测.结果 胆囊胆固醇结石患者的血清总胆固醇、甘油三脂、低密度脂蛋白和载脂蛋白B浓度均明显高于对照组,而前者中高密度脂蛋白浓度则明显低于后者(P均<0.05～0.01).结论 胆囊胆固醇结石患者常伴有明确的血清脂类和载脂蛋白指标异常.

[Objective] This study is to investigate the role of oxygen free radicals in ischemia reperfusion of simultaneous pancreaticoduodenal-kidney transplantation(SPKT) in rat and the effect of sulvia mitiorrhiza.[Methods] The model of SPKT in rat was established.NS and sulvia mitiorrhiza-NS were used to perfuse and preserve the graft and injected intravenously to the recipients when transplantation.After 1 hour of transplantation,the levels of amylase,creatitine,SOD,GSH-PX,MDA in blood and in transplanted pancreas and kidney were examined.[Results] After operation,the levels of amylase,creatitine,MDA in blood and in transplanted pancreas,kidney increased significantly(P0.01),the levels of SOD,GSH-PX in blood and in transplanted pancreas,kidney decreased significantly(P0.01).Sulvia mitiorrhiza can improve these parameters,and more significant in the combined group.[Conclusions] Oxygen free radical is the important mechanism of ischemia reperfusion injury of SPKT in rat.Sulvia mitiorrhiza can antagonize the injury of oxygen free radicals,which is more significant in the combined group.