目的:分析胆囊结石患者行微创保胆取石术后结石复发的情况及影响因素,评估保胆取石术的可行性.方法:收集2019年12月—2021年10月在我院接受保胆手术治疗的患者171例,进行为期1年的术后随访,分成13例复发组,158例未复发组.比较两组的性别、年龄、家族史、高血压、糖尿病、体质量指数(BMI)、结石数量、胆囊壁毛糙、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)及服用中药情况,采用多因素Logistic回归分析结石复发的相关因素.结果:患者术后1年复发率为7.6％(13/171).两组结石数量、胆囊壁毛糙、TG、HDL-C、家族史、服用中药差异有统计学意义(P＜0.05).多因素Logistic回归分析显示:胆囊结石数量＞1 个(OR=11.585,95％CI=1.578～85.030,P=0.016)、TG水平高(OR=4.139,95％CI=1.402～12.220,P=0.010)、有胆囊结石家族史(OR=8.785,95％CI=1.238-62.345,P=0.030)是保胆术后结石复发的独立危险因素,服用中药(OR=0.059,95％CI=0.008-0.433,P=0.005)可以降低术后结石的复发率.结论:对于有强烈保胆意愿的患者,行保胆取石术是有效的,但有一定的复发风险,保胆取石术胆囊结石数量多、TG水平高、有家族史是保胆取石术后结石复发的独立危险因素,服用排石汤可降低复发风险,具有风险因素的患者应谨慎行保胆取石术,或术后针对危险因素进行预防性治疗.

目的:探讨普外科手术切口感染因素及防范管理措施.方法:通过对2013年5月至2014年5月在浙江省立同德医院普外科进行手术治疗的76例手术切口感染患者的临床资料进行回顾性分析,选择同期在浙江省立同德医院进行普外科手术治疗的无切口感染的患者为对照组,观察比较影响普外科手术切口感染的因素.结果:实验组患者年 龄、体质指数、手术时间、住院时间、不良心理反应、不合理应用抗菌药物、Ⅲ类手术较对照组患者明显增加,血红蛋白水平和白蛋白水平明显低于对照组患者,差异具有统计学意义(P＜0.05);两组患者切口长度和性别比较无统计学意义(P＞0.05).结论:年龄、不良心理状态、体质指数、手术时间、血红蛋白、不合理应用抗菌药物、Ⅲ类手术均是引发普外科手术切口感染的危险因素,针对普外科手术切口感染的高危因素采取积极的防护干预措施,降低手术切口感染发生率.

To investigate the safety and efficacy of laparoscopic splenectomy and portaazygous devascularization, we studied laparoscopic splenectomy and porto-azygos devascularization patients within the peri-operative period. Clinical data and curative effect are detailed alongside statistical analysis. The laparoscopic splenectomy and porto-azygos devascularization operation time was 2.56 + 0.62 hours. The intraoperative bleeding and anal exhaust time was 149.5 + 32.7ml 3.47 + 1.32 days, and the hospitalization time was 5.05 + 1.22 days. When the spleen volume was greater than or equal to 1.5 liters, the rate of open abdominal surgery increased significantly. After 1, 2, 3, and 4 years of follow-up, cumulative recurrence bleeding rates were 0, 5.20%, 9.98%, and 15.83%, respectively. Laparoscopic splenectomy and pericardial devascularization is safe, effective, and feasible, and it can be confirmed by enhanced spiral computed tomography (CT). Whether spleen volume greater than 1.5L is suited to laparoscopic surgery requires further research.

目的：探讨4－羟基－2，2，6，6－四甲基哌啶（ Tempol）治疗急性重症胰腺炎的临床机制和作用。方法选取60例急性重症胰腺炎患者，根据治疗方法进行分组，对照组患者给予常规的大黄和芒销方法治疗，观察组患者给予抗氧化剂Tempol方法治疗，比较两组患者治疗前后的临床相关指标，以及Tempol治疗对JNK 信号通路活化和氧化损伤程度影响情况。结果观察组的c－jun磷酸化水平以及组织中丙二醛含量和超氧化物歧化酶含量显著低于对照组；观察组患者的白细胞计数、血淀粉酶、尿淀粉酶、胰脂肪酶、C反应蛋白以及酶蛋白酶原激活肽明显降低，且显著低于对照组，血清钙含量明显升高且显著高于对照组，差异均有统计学意义（ P＜0.05）。结论 Tempol治疗急性重症胰腺炎可以有效改善机体的JNK信号通路和氧化损伤情况，在临床应用上效果显著，具有一定的研究价值。

目的：探讨抗氧化剂N－乙酰半胱氨酸对急性重症胰腺炎大鼠的疗效及JNK信号通路活化的影响。方法选择清洁级C57BL／6雄性SD大鼠56只，随机分为空白对照组8只，开腹后仅翻动胰腺，不做任何处理，然后立即关腹；胰腺炎组24只，采用10％的L－精氨酸腹腔注射法诱导大鼠急性重症胰腺炎模型；治疗组24只，于模型制备前30 min内腹腔注射5％的N－乙酰半胱氨酸（200 mg／kg）进行预处理，然后再进行急性重症胰腺炎大鼠模型制备；胰腺炎组和治疗组选取3、6、12 h 3个时间点各8只分为3个小组，观察各组大鼠血清胰淀粉酶、病理学改变、组织中磷酸化c－jun蛋白水平、丙二醛含量TNF－α、IL－6的变化。结果胰腺炎组大鼠各时间点的各项指标明显高于空白对照组；治疗组大鼠3、6 h血浆IL－6水平明显低于胰腺炎组，6、12 h胰腺组织病理学评分均明显低于胰腺炎组，其余各指标明显低于胰腺炎组（ P＜0.05）。结论急性重症胰腺炎大鼠血清胰淀粉酶、病理学及相关指标均发生了明显的改变，N－乙酰半胱氨酸通过清除氧自由基、减少TNF－α和IL－6的产生等机制对急性重症胰腺炎大鼠发挥治疗和保护作用，还通过改变组织中磷酸化c－jun蛋白水平来影响JNK信号通路的活化。

Objective:To evaluate the effects of different optional time leading to complication and con-version to laparotomy by laparoscopic cholecystectomy in acute calculous cholecystitis. Methods:Search all of domestic and international research literatures on different optional time by laparoscopic cholecystectomy about the Chinese from 1991 to 2013. The random effects model was selected for conducting the meta-analysis, to calculate the OR and 95%CI of different optional time leading to complication and conversion to laparotomy. Results:Overall 23 articles were eligible and were included into the meta-analysis, There was signiifcant statisti-cal difference in complication (OR=0.47, 95%CI=0.35~0.62, P<0.001) and conversion to laparotomy (OR=0.27, 95%CI=0.20~0.37, P<0.001) between the<72 h group and>72 h group. Conclusion:Meta-analysis shows that in the laparoscopic cholecystectomy progress, the surgical outcome is best within 72 h, which can reduce the complication and decline the conversion.

目的 观察Tempol对大鼠急性重症胰腺炎的疗效及对JNK通路的影响.方法 90只大鼠随机分为空白组10只、模型组40只和Tempol组40只.模型组和Tempol组腹腔注射L-精氨酸建立大鼠急性重症胰腺炎模型,空白组注射等量生理盐水;Tempol组于模型建立前5 min按100 mg/kg血管注射Tempol,模型组则注射等量生理盐水.检测模型建立后3、12、24、36 h血清淀粉酶、底物磷酸化c-jun蛋白、丙二醛(MDA)水平.结果 空白组血清淀粉酶水平为(1 082.9 ±523.3) U/L,模型组和Tempol组各时间点淀粉酶水平均高于空白对照组(P<0.01),而Tempol组各时间点淀粉酶水平均显著低于模型组(P<0.01);空白组磷酸化c-jun蛋白水平为0.33 ±0.12,Tempol组各时间点磷酸化c-jun蛋白水平均显著低于模型组(P<0.01);空白组组织中MDA水平为(5.13 ±0.48)mmol/L,Tempol组各时间点MDA水平均显著低于模型组(P<0.01).结论 Tempol可通过抑制JNK的活化治疗急性重症胰腺炎.

目的:探讨益肠汤联合常规治疗对腹腔镜胆囊切除术(LC)后胃肠道功能恢复的影响.方法:将128例接受LC术后患者随机分为两组,对照组(41例)采用补液、抗感染等常规治疗,治疗组(41例)在此基础上加用益肠汤治疗.比较分析两组的术后胃肠功能恢复情况、血浆胃泌素水平及不良反应.结果:与对照组比较,治疗组禁食时间、肠呜音恢复时间、排气时间及排便时间均显著缩短(P＜0.05);术后1d、2d、3d,治疗组血浆胃泌素水平均显著高于对照组(P＜0.05);治疗组恶心、腹痛的发生率为4.7％、6.3％,显著高于对照组17.2％、20.3％(P＜0.05).结论:LC术后患者在常规治疗的基础上,口服益肠汤可促进胃肠功能恢复,减少术后并发症.

肠外瘘是临床较为严重的一种并发症,常发生于肠梗阻术后、胃肠道恶性肿瘤、炎症性肠病、创伤等[1].我们在早期经肠道应用石蜡油促进肠道蠕动功能恢复的过程中,探讨石蜡油对诊断肠外瘘的价值,现报道如下.一、资料与方法1.一般资料:收集2010年5月至2013年5月我院接受治疗的87例患者为研究对象,其中男40例,女47例,年龄19 ～ 67岁;原有疾病:腹部外伤35例,胃肠道恶性肿瘤20例,肠梗阻32例。

A male patient aged 26 years received intramuscular infusion of ketorolac tromethamine 30 mg for abdominal pain.About 5 minutes after injection finish,the patient felt dizziness and weakness.Meanwhile,he developed generalised sweating and syncope.His blood pressure was 65/40 mm Hg and heart rate was 108 beats/min.He was immediately given oxygen inhalation,intravenous infusion of epinephrine,dexamethasone,and metaraminol,and intramuscular promethazine.About 30 minutes later,the patient came to his senses and his symptoms gradually improved with a blood pressure of 105/75 mm Hg and a heart rate of 80 beats/min.Thereafter,no discomfort recurred.

OBJECTIVE To analyze clinical efficacy of Wentong method combined with penicillin in the treatment of the breast cysts secondary infections and its impact on serum CRP concentrations.METHODS Totally 72patients with breast cysts secondary infections from Jul 2011to 2012Jul in the hospital were randomly divided into observation group and control group,with 36cases in each,and the control group was given penicillin for treatment,while the observation group was given the Wentong method combined penicillin for treatment.The clinical effects and serum CRP concentrations were compared between the two groups.RESULTS Totally 31cases(86.11%)of the observation group were cured,which was higher than 27cases(75.00%)of the control group,the difference was significant(P<0.05).After the treatment,the serum CRP concentrations and the WBC of the two groups were better than before(P<0.05).After treatment,the serum CRP of the observation group was(8.17±5.33)mg/L significantly better than(18.05±15.72)mg/L of the control group,the difference was significant(P<0.05).3dand 7dafter treatment,it has significant different between the two groups in serum CRP concentrations(P<0.05),and the observation group was better than the control group.There was significant difference in serum CRP concentration after 3dcompared with after 7d(P<0.05).CONCLUSION Wentong method combined with penicillin in the treatment of breast cysts secondary infections has better clinical efficacy than single penicillin treatment,and it is safe and reliable,which is worthy be promoted.

肠内早期营养对于急性胰腺炎,尤其是对重症急性胰腺炎的成功救治具有十分重要的作用[1].急性胰腺炎病情愈重,胃"瘫痪"程度愈重,肠内营养早期无法经口直接给予,否则会加重患者病情,甚至因呕吐而窒息.如何及早将肠内营养液送入空肠,困惑着临床医师.

目的:探讨液囊空肠导管在炎性肠梗阻治疗中的应用。方法:对45例术后早期炎性肠梗阻患者经鼻插入液囊空肠导管至胃腔,接上负压引流。在减压过程中,导管自行从胃腔进入十二指肠直至空肠上段,有效将胃和肠腔内的液体充分引流,在导管到达空肠上段后,酌情给予石蜡油及中药。结果:全组患者保守治疗成功。41例患者在插管引流、注入石蜡油及中药24h后肠梗阻缓解,3～7d痊愈,占91%。4例患者在插管引流、注入石蜡油及中药48h后肠梗阻缓解,9～14d痊愈,占9%。结论:经鼻插入液囊空肠导管行胃、肠内减压及经导管注入石蜡油及中药治疗炎性肠梗阻是一种有效、简便、迅速、安全有效的治疗措施,值得进一步研究推广。

合理早期肠内营养支持有助于降低手术并发症.常用的胃管需持续减压,待肠道功能恢复后才进行肠内营养支持.我院将液囊空肠导管用于上消化道手术,与传统的置管方法相比,具有较多的优点和实用性.

通过对胃切除术患者的临床观察,介绍一种无创性、胃空肠同步操作,自动分离的胃空肠管(液囊空肠导管).

探讨低位直肠肿瘤保留肛门的一种新术式--引推法的疗效.腹盆腔分离范围同Miles术,然后经肛门引入一根特制的带子,其顶部抵达肿瘤远端近切端的中点,用7号或10号丝线贯穿带子的顶部并将肠襻加以结扎.理顺肠管及系膜血管后,会阴组术者将肛门的带子往外牵引,同时将直肠往肛门方向推送,直至推出肛门外.在预定的部位平面或斜面离断直肠,丝线单层间断缝合,吻合完毕后,将直肠及其吻合口重新推入盆腔内.全部患者在术后9～16d恢复排便控制功能,无并发症.结果表明,引推法是切除低位直肠肿瘤保留肛门的一种较理想术式,值得推广应用.

在复杂手术结束前,多需放置空肠导管进行术后治疗[1].我们在总结前人经验的基础上,研制成一种可经鼻自行进入空肠的导管-液囊空肠导管.现介绍如下.