目的 探讨尾侧入路的全腹膜外腹腔镜脐疝平片修补术(TEA)的临床疗效.方法 选择浙江省金华市中心医院2020年7月～2022年1月行TEA术治疗脐疝的患者12例,全身麻醉后按TEP术镜推法建立腹膜前间隙至Cooper韧带,耻骨联合上方尾侧置入主视孔,朝头侧向上分离,暴露脐疝疝囊并回纳内容物,立体缝合关闭脐疝缺损,将补片完整覆盖脐疝缺损,排气结束.结果 12例均完成尾侧入路完全腹膜外腹腔镜脐疝平片修补,手术时间62～169分钟,中位时间126分钟,脐疝缺损直径1.5～3.0cm,中位数2.0cm,术中出血量10～30mL,中位数17mL,术后6～12小时下床活动,术后住院3～5天,中位时间4天.术后脐部积液2例,皮下穿刺抽吸后包块消失;尿潴留1例,留置尿管2天后拔除,无补片排斥反应、无出血、无肠梗阻及肠瘘等严重并发症发生.12例均随访12～18个月,中位数16个月,无复发.结论 尾侧入路完全腹膜外腹腔镜脐疝平片修补术安全可行,逆向建腔及尾侧入路操作难度相对较低,临床应用前景良好.

目的 分析侧腹壁疝的临床特点及治疗策略选择.方法 回顾性分析2018年7月至2020年1月8例侧腹壁疝患者的临床资料.结果 8例患者均顺利完成侧腹壁疝修补术,其中2例患者行开放腹膜前补片修补法(Sublay术),1例行开放肌前置网修补法(Onlay术),3例行腹腔镜下腹腔内补片置入术(IPOM),2例行腹腔镜下Sublay术[(全腹膜外补片修补术(TES);经腹腹膜外补片修补术(TAS)].8例患者术后均恢复良好,无切口感染,术后无牵拉疼痛感,临床症状消失.术后平均随访12.83个月,无复发.结论 侧腹壁疝的多样化使疝外科医师很难找到适用所有侧腹壁疝的修补技术.疝外科医师应根据患者不同情况进行全面的术前评估,从而制定个体化的手术方案.

To investigate the application of totally visceral sac separation (TVS) in the treatment of ventral hernia, to summarize the operation procedure and to analyze its safety and effectiveness. Twenty-one consecutive primary and secondary ventral hernias cases were repaired using the TVS procedure from December 2019 to December 2020. A large mesh should be placed in retrorectus sublay or underlay preperitoneal using the minimally invasive procedure. The indications for this procedure include umbilical, incisional hernia, linea alba hernia, lumbar hernia, and parastomal hernia. All the operations were successful, of which 2 cases were converted to laparotomy because of the failure of anterior peritoneal cavity construction and the difficulty of anterior defect closure. The mean operation time was 140 mins (70-260 min), postoperative pain was mild, and the mean visual analogue scale(VAS) was 2.5 (1-4) on the first postoperative day. There were no recurrent cases during the follow-up for more than 6 months. TVS procedure is safe and highly reproducible. Without expensive anti-adhesion mesh and fixation tacker, the technology of TVS is a good technique for the surgical treatment of ventral hernia.

目的 探讨腹腔镜肝切除术与开腹肝切除术治疗肝细胞性肝癌的疗效差异.方法 选取2015年11月至2017年6月在我院接受手术治疗的肝细胞性肝癌患者152例的资料进行回顾性分析,根据手术方法将其分为对照组(n=76)及试验组(n=76).对照组采用开腹肝切除术,试验组采用腹腔镜肝切除术.比较两组的围术期相关指标、术前、术后1d的肝功能、炎症指标变化情况、术后并发症发生情况、未复发生存时间及总生存时间.结果 试验组的手术时间、失血量、切口长度、术后下床时间、术后进食时间、住院时间均短于对照组,差异有统计学意义(P<0.05).术后1 d两组患者的谷丙转氨酶(ALT)、谷草转氨酶(AST)、白细胞计数(WBC)、降钙素原(PCT)均升高,术后1 d试验组患者的ALT、AST、WBC、PCT均低于对照组,差异有统计学意义(P<0.05).试验组术后并发症总发生率低于对照组,差异有统计学意义(P<0.05).试验组未复发生存时间和总生存时间均长于对照组,差异有统计学意义(P<0.05).结论 利用腹腔镜肝切除术治疗肝细胞性肝癌,患者术后恢复速度快,安全性良好,有助于提升其生存时间,改善远期预后.

血清糖抗原19-9(CA19-9)和癌胚抗原(CEA)检测具有便捷、快速、成本低、易普及、等优点，在基层医院中容易实现。本研究回顾性分析金华市人民医院收治的723例患者的临床资料，评估血清CA19-9和CEA对胰腺癌患者的诊断价值。结果表明，胰腺癌患者的血清CA19-9水平高于非胰腺癌患者，在出现淋巴结转移的患者中CA19-9的阳性表达率高于CEA的阳性表达率。血清CA19-9在基层医院对胰腺癌患者的筛查价值更高，CEA对病期进展的评估有辅助作用。

目的:探讨基于快速康复外科的腹腔镜胆囊切除和日间手术的特点.方法:将快速康复外科指导下的于2017年4月1日至2018年3月30日行腹腔镜胆囊切除术的99例患者根据手术方式分为日间手术组(43例)和常规组(56例),分析2组手术时间、再入院病例、住院相关费用的差异.结果:日间手术组手术时间(38.55±11.52)min,住院费用(9692±1279)元,药费(1628±515)元,检查治疗费(8064±1070)元;常规组住院时间(5.52±2.24)d,手术时间(42.03±18.82)min,住院费用(12184.03±3576)元,药费(2610±806.56)元,检查治疗费(9574±3345)元.2组间手术时间和再入院例数差异无统计学意义(P>0.05),而住院费用、药费和检查治疗费差异均有统计学意义(P<0.01).结论:腹腔镜胆囊切除日间手术不增加术后并发症的发生,且能显著降低住院费用及药费、检查治疗费.

目的 探讨影响腹腔镜胆囊切除术(LC)难度的相关因素.方法 统计2017年4月1日至2017年10月1日在金华市中心医院行LC的患者病历资料,用SPSS 19.0统计软件进行相关性分析,分析影响LC难度的因素.结果 根据入组的标准,共收集病例资料107例.研究发现,疼痛到手术的时间[(3.93±4.78) min,P=0.022]、术前C-反应蛋白(CRP)[(15.29±32.49)mg/L,P<0.001]、术前白细胞(WBC)[(7.05±3.13) ×109个/L,P<0.001]、纤维蛋白原(FIB)[(3.22±0.82)g/L,P=0.003]、国际标准化比值(INR)[(1.03±0.08, P<0.001)]、胆囊是否增大、胆囊壁厚度[(0.19±0.26)cm,P<0.001)]与LC手术时间明显相关.结论 LC的难度需综合评估,在通常情况下,当疼痛发作的时间延长,CRP、WBC、FIB、INR数值升高,及胆囊壁增厚或胆囊增大时,手术难度会升高;LC的难度与是否有胆囊炎发作病史,肌酐(Cr)、谷丙转氨酶(ALT)、谷草转氨酶水平(AST),及胆囊结石大小和数量等因素无关.

目的 探索胰腺钝性损伤的诊治经验.方法 收集金华市中心医院2012年1月至2016年12月间收治的胰腺钝性损伤病例,统计诊断方法、损伤机制、手术信息、术后并发症、住院时间等资料.结果共收集24例胰腺钝性损伤病例,其中男17例,女7例;18例为交通意外损伤.16.7％的病例出现胰瘘,CT诊断胰腺损伤的敏感性约91.7％.86.4％的病例血清淀粉酶升高,在监测腹水淀粉酶和尿淀粉酶的患者中,腹水和尿淀粉酶均有升高.16例行手术探查.均治愈出院.结论 胰腺损伤早诊断对预后至关重要.如果高度怀疑胰腺损伤,那么在一定的时间(3 d)内行剖腹探查术是十分必要的,可以降低胰腺相关并发症发生率,减少住院时间.

胃癌是外科高发病、常见病,治疗多以外科手术切除为主.1994年Kitano等[1]报道了首例腹腔镜下胃癌切除术.腹腔镜胃癌根治术因较传统开腹胃癌根治术具有微创优势,术后疼痛轻、恢复快和住院时间短,越来越多的外科医师采用腹腔镜辅助手术.

Introduction: Accessory spleens which are common and separate from the main body of the spleen, are the healthy splenic tissues and usually smaller than 2cm. Here, we report a case of liver cirrhosis and hypersplenism with a huge accessory spleen. This case report and literature review describes the management of the enlarged accessory spleen. Presentation of case: We report the case of a 47-year-old man who presented with discomfort in the left upper abdomen and hypodynamia for more than 3 months. The color Doppler sonography and abdominal contrast-enhanced computed tomography (CT) revealed a well-marginated ovoid mass, approximately 13.0 cm x 8.0 cm x 5.0cm between stomach and spleen. The patient underwent the laparoscopic splenectomy because of liver cirrhosis and hypersplenism. The result that the mass is the enlarged accessory spleen was confirmed by pathological diagnosis. Clinical symptoms were relieved in 1 month after operation. Discussion: Accessory spleens could enlarge to more than 10cm in patients with liver cirrhosis. CT and laparoscope can be used for preoperative, intraoperative diagnosis of accessory spleens. Laparoscopic splenectomy associated huge accessory splenectomy is one of the effective treatments of patients with liver cirrhosis and hypersplenism. Conclusion: Because such a large accessory spleen is rare, to a certain extent, it renders diagnosis more difficult. If we are familiar with its character, unnecessary treatment can be avoided. (C) 2017 The Authors. Published by Elsevier Ltd on behalf of Surgical Associates Ltd.

Hepatic eosinophilic granuloma (HEG) is a rare benign liver disease,which belongs to histocytosis.Preoperative diagnosis of HEG was difficult because its clinical manifestation was not characteristic.In this article,the clinical data of 1 patient with HEG who was treated at the Jinhua Municipal Central Hospital of Zhejiang Province in September 2012 were retrospectively analyzed,and the diagnosis,differential diagnosis and treatment for HEG were investigated.

患者男,20岁.因“下腹痛伴肛门停止排便排气2d”入院.下腹痛呈阵发性胀痛,逐渐加剧至难以忍受,伴恶心、呕吐.体检:急性面容,腹部膨隆,右下腹压痛,无明显反跳痛,肠鸣音活跃.实验室检查结果均正常.腹部CT平扫见肠管扩张、积气.诊断为急性肠梗阻,急诊剖腹探查.术中见腹腔内有较多淡黄色渗液,距回盲部50 cm处小肠系膜上有一直径约6 cm包块,与周围肠管之间有一粘连束带并形成闭环,部分肠管进入闭环致肠梗阻,梗阻以上肠管明显扩张(图1).松解粘连束带,切除肿块,冲洗腹腔后关腹.术后恢复顺利.切除的肿块为实性组织伴出血,病理报告为肠系膜异位胰腺组织伴坏死(图2)。

目的 探讨血清直接胆红素、间接胆红素与吲哚菁绿排泄试验结果的相关性及可能的机制.方法 通过对61例黄疸患者进行吲哚菁绿清除试验,收集黄疸患者的各项资料,运用偏相关性分析的统计学方法,以15 min吲哚菁绿滞留率(ICGR15)、直接胆红素(DBIL),间接胆红素(IBIL)为变量,探讨其间的相关性及可能的影响机制.结果 控制变量IBIL时,ICGR15与DBIL相关系数为0.362(P＜ 0.01),ICGR15与DBIL呈正相关;当控制变量DBIL时,ICGR15与IBIL不相关(P＞ 0.05).结论 ICGR15可随血清胆红素增加而升高,尤其当DBIL升高时.如何用ICGR15准确评价肝功能尚需进一步研究.

目的探讨肝有效血流量、总胆红素、乙型肝炎、血浆总蛋白等因素对吲哚菁绿排泄试验的影响及可能的机制。方法通过对127例患者进行吲哚菁绿清除试验,运用多元线性回归的统计学方法,以15 min吲哚菁绿滞留率(ICGR15)为变量,以肝有效血流量(EHBF)、血浆总蛋白(TP)、总胆红素(TBIL)、乙型肝炎(HBV)为自变量,综合分析多个独立因素对吲哚菁绿排泄试验的影响及可能的机制。结果回归模型ICGR15=25.469-20.520 EHBF+0.044 TBIL+4.217 HBV;F=70.734,P<0.01;修正R2=0.624,所拟合的回归方程具有统计学意义。结论吲哚菁绿清除试验与肝有效血流量呈负相关,与总胆红素水平以及是否患有乙型肝炎呈负相关。其机制可能是总胆红素与吲哚菁绿竞争性结合载体,与乙肝导致的肝硬化及其肝血流量变化有关,而血浆总蛋白对吲哚菁绿清除试验的影响尚需进一步研究。

BACKGROUND:Pancreatic carcinoma possesses one of the highest lethality rates, highest drug-resistance, and highest incidence rates. The objective of this research was to enhance the efficacy and drug-resistance for pancreatic carcinoma by using inhibition of SIRT1 combined with gemcitabine therapy methods.METHODS:Three pancreatic carcinoma cells (PANC-1 cells, BxPC-3 cells, and SW1990 cells) received treatment with physiological saline, inhibition of SIRT1, gemcitabine, and combination therapy with inhibition of SIRT1 and gemcitabine in vitro; then BxPC-3 pancreatic cancer xenogeneic mice also received treatment with physiological saline, inhibition of SIRT1, gemcitabine, and combination therapy with inhibition of SIRT1 and gemcitabine in vivo.RESULTS:The cleaved poly ADP ribose polymerase (PARP)-1 effect of drug in pancreatic carcinoma cells was significantly different (P < 0.05) and the efficacy in descending order was the combination therapy with inhibition of SIRT1 and gemcitabine, inhibition of SIRT1, and gemcitabine. The BxPC-3 pancreatic cancer xenogeneic mice model received treatment with physiological saline, inhibition of SIRT1, gemcitabine, and combination therapy with inhibition of SIRT1 and gemcitabine in vivo and the results showed that the tumor volumes decreased and the survival rate within 45 days increased according to the order of the given drugs and the difference was significant (P < 0.05).CONCLUSION:Combination therapy with inhibition of SIRT1 and gemcitabine could improve efficacy and survival time in a BxPC-3 pancreatic cancer xenogeneic mice model, compared with single inhibition of SIRT1, or single gemcitabine therapy. The combination therapy method is a potential treatment method for pancreatic carcinoma.