目的 评估不同腹腔穿刺引流(APD)时机对中度重症胰腺炎伴腹水患者预后转归的影响.方法 以2019年9月-2021年5月安徽医科大学附属安庆医院收治的84例中度重症胰腺炎患者作为研究对象.根据患者入院1周内是否行腹腔穿刺引流术将其分为APD组(56例)和非APD组(28例),另外将APD组依据穿刺时间分为0～3天内APD组和4～7天内APD组,比较三组患者住院时间、住院费用、炎症指标(CRP、WBC、PCT、IL-6、TNF-α)、器官衰竭程度、进阶率及死亡率.结果 0～3天内APD组患者病死率为0,进阶率为7.1％,低于4～7天内APD组的3.58％、32.14％及非APD组的17.86％、35.71％,差异有统计学意义(P<0.05);0～3天内APD组器官的衰竭程度优于4～7天内APD组和非APD组,差异有统计学意义(P<0.05);0～3天内APD组WBC、CRP、PCT、IL-6、TNF-α降低优于4～7天内APD组和非APD组,差异有统计学意义(P<0.05);0～3天APD组住院时间、住院费用低于4～7天内APD组和非APD组,差异有统计学意义(P<0.05).结论 对于明显伴有腹腔积液的中度重症胰腺炎患者,早期最佳的腹腔穿刺引流时间窗为0～3天内,该法可改善中度重症胰腺炎患者的预后,降低其炎症水平,提高其生存率.

目的 探讨上腹部闭合性损伤外科救治中的治疗策略及方法,降低死亡率,改善预后.方法 选取67例上腹部闭合性损伤患者,分类评估,术前诊断及外科治疗进行回顾分析.结果 患者平均有效救治时间为(49.6±15.2)min,平均住院时间为(17.6±5.2)d;67例患者救治成功率为89.5％(60/67),好转率为6％(4/67),死亡率4.5％(3/67).本组患者并发症:术口感染1.5％(1/67),术后肺部感染7.5％(5/80),术后肝脓肿1.5％(1/67),肠粘连4.5％(3/67),腹腔间隙综合征1.5％,(1/67),创伤后胰腺炎假性囊肿形成1.5％(1/67).结论 早期快速准确诊断及合理的外科治疗能够有效地降低死亡率,提高抢救成功率,改善预后,取得良好的治疗效果.

目的 观察比较不同CO2气腹压力对腹腔镜胆总管探查术后患者肝功能与肠功能的影响.方法 前瞻性分析2018年1月至2019年6月安徽医科大学附属安庆医院普外科符合标准的45例腹腔镜胆总管探查术患者,采用随机对照的方法分为两组,A组23例(气腹压力为8～12 mmHg),B组22例(气腹压力为13～15 mmHg),比较两组患者术后肝功能、血清前白蛋白(PA)及肠功能恢复情况.结果 与B组比,A组术后第1天血清ALT[(55.51±19.43)U/L vs(69.90±19.82)U/L,P=0.018]、AST[(58.26±16.09)U/L vs(71.64±19.43)U/L,P=0.009]、血清TBIL[(23.44±7.88)μmol/L vs(32.48±13.96)μmol/L,P=0.010],均明显降低(P<0.05).两组术后第4天血清ALT、AST、TBIL均基本恢复至正常水平.两组PA水平均在术后第1天有所下降,组间差异无统计学意义(P>0.05).术后第4天PA值,A组明显高于B组[(34.90±5.67)mg/dL vs(28.08±4.41)mg/dL,P<0.05)],A组术后肠鸣音恢复时间[(11.22±3.42)h vs(18.50±5.87)h,P<0.001]、排气时间[(15.74±2.94)h vs(22.95±5.33)h,P<0.001]均短于B组(P<0.05).两组手术时间[(68.52±15.57)min vs(60.45±16.85)min,P=0.10]差异无统计学意义(P>0.05).结论 8～12 mmHg气腹压力对腹腔镜胆总管探查术患者肝功能、前白蛋白的影响相对较小,适当的低气腹压更利于腹腔镜胆总管探查术患者的早期恢复.

目的:探讨双歧杆菌三联活菌制剂对上消化道穿孔病人术后恢复的安全性及有效性.方法:选择60例上消化道穿孔病人作为研究对象,按照随机数字表法分成观察组和对照组,各30例,对照组病人在基础治疗方案之上加入术后早期肠内营养,观察组在对照组基础上加入双歧杆菌三联活菌制剂的治疗.检测白细胞总数(WBC)、中性粒细胞比例、C反应蛋白(CRP)、降钙素原(PCT)、白细胞介素6(IL-6)、CD3+T细胞、CD4+T细胞、CD8+T细胞、CD4+/CD8+等指标,并记录住院时间及术后并发症发生率.结果:术前及术后第1、4天,2组病人WBC、中性粒细胞比例、CRP、PCT、IL-6水平及外周血T淋巴细胞亚群水平差异均无统计学意义(P>0.05).术后第4天,观察组病人的中性粒细胞比例和IL-6水平低于对照组(P<0.05).术后第7天,2组病人的WBC及中性粒细胞比例均基本恢复正常,差异无统计学意义(P>0.05),观察组病人的CRP、PCT及IL-6水平低于对照组(P<0.05～P<0.01).术后第4、7天,观察组CD3+、CD4+T淋巴细胞比例、CD4+/CD8+较对照组高(P<0.05～P<0.01),CD8+T淋巴细胞比例明显低于对照组(P<0.01).观察组病人的住院时间和术后并发症发生率低于对照组(P<0.01和P<0.05).结论:双歧杆菌三联活菌制剂用于上消化道穿孔病人术后的治疗,能增强病人的免疫力,减少全身炎症反应,增强肠道屏障,促进肠道功能快速恢复,降低术后并发症发生率,值得临床应用.

目的 探讨上消化道穿孔术后早期序贯性肠内营养支持的疗效.方法 选取安徽医科大学附属安庆医院普外科2017年1月-2019年4月收治的上消化道穿孔患者71例.将按随机数字表法分为两组,观察组36例,对照组35例.观察组术前留置液囊空肠营养管,术后经空肠营养管进行序贯性肠内营养支持治疗;对照组术前留置普通胃管,术后给予全肠外营养支持治疗.于术前和术后第7天检测两组患者的体质量指数、前白蛋白、血清白蛋白、术后肛门排气时间、体质量下降情况、住院时间、住院总费用及禁食期每日补液量.结果 两组患者的性别、年龄、体质量指数及穿孔部位差异无统计学意义(P均>0.05).术后第7天两组患者的各营养指标较术前均有所升高(P<0.05);观察组体质量指数、血清白蛋白及前白蛋白的升高幅度显著高于对照组(P<0.05).两组患者术后肛门排气时间[(3.0±0.8)dvs(3.6±0.7)d]、术后住院时间[(5.2±2.3)dvs(7.3±2.6)d]、住院总费用[(12905±2723)元vs(15251±2742)元]及禁食期补液量[(2063±241)ml vs(2224±264)ml]比较,观察组均明显低于对照组,差异有统计学意义(P均<0.05).观察组并发症发生率低于对照组(22.2％vs 31.4％),但差异无统计学意义(P>0.05).结论 上消化道穿孔术后患者早期应用序贯性肠内营养支持能更好地改善营养状况,加速术后的康复.

目的 研究对中度重症急性胰腺炎(MSAP)患者应用序贯性早期肠内营养(SEEN)支持疗法的临床疗效.方法 将2018年5月～2019年7月在安徽医科大学附属安庆医院普外科住院的67例符合条件的患者随机分为序贯性早期肠内营养组33例(A组)和早期肠内营养组34例(B组). A组给予序贯性早期肠内营养支持,B组给予早期肠内营养支持.比较两组前白蛋白(PAB)、白蛋白(ALB)、淋巴细胞(CD3+、CD4+)、降钙素原(PCT)、白细胞(WBC)、C反应蛋白(CRP)、肿瘤坏死因子α(TNF-α)、白介素6(IL-6)、胃肠道不耐受情况及住院天数.结果 入院第1天,两组PAB、ALB、CD3+、CD4+、PCT、WBC、CRP、TNF-α、IL-6比较,差异无统计学意义(P＞0.05);第3天,A组PCT、WBC、CRP、TNF-α、IL-6 均低于B 组,而CD3+、CD4+、PAB、ALB均高于B组,但差异无统计学意义(P＞0.05);第7、11天,A组PCT、WBC、CRP、TNF-α、IL-6均低于B组,而CD3+、CD4+、PAB、ALB均高于B组(P＜0.05);A组患者胃肠道不耐受发生率及住院天数均少于B组(P＜0.05).结论 对MSAP患者行序贯性早期肠内营养支持治疗较早期肠内营养支持更有助于降低胃肠道不耐受的发生率,促进蛋白质合成,改善全身炎症反应和免疫功能低下状态,减少住院的天数.

目的 探讨受体相关共激酶3(RAC3)在结直肠癌(CRC)组织中的表达水平及CRC患者对亚叶酸钙联合氟尿嘧啶、奥沙利铂(FOLFOX)方案敏感性的影响.方法 采用荧光实时定量PCR (qRT-PCR)检测48对CRC临床组织标本中RAC3的表达水平,采用x2检验分析其表达水平与临床病理特征之间的关系.运用免疫组化法检测125例初次评估无法手术切除且行术前新辅助化疗(FOLFOX方案)2～3个月的CRC患者的RAC3蛋白表达水平,获检组织标本由结/直肠镜活检获得,并为病理证实为CRC.回顾性分析RAC3表达水平与CRC患者对FOLFOX方案治疗反应的相关性.结果 qRT-PCR显示CRC组织中RAC3水平明显高于癌旁正常黏膜上皮组织(P＜0.01);其表达水平与肿瘤较晚分期(P =0.041)、微血管侵犯(P =0.014)、淋巴结转移(P=0.030)相关.Kaplan-Meier生存分析显示RAC3表达增高的CRC患者术后总体生存期(OS)缩短.免疫组化显示RAC3蛋白的阳性表达率显著高于正常黏膜上皮组织,且RAC3蛋白阳性表达的CRC患者对FOLFOX方案敏感性低于RAC3蛋白阴性表达者(P＜0.05).结论 RAC3在CRC组织中表达明显升高,并与CRC患者对FOLFOX化疗方案的临床反应有关,可能是CRC精准治疗策略中一个潜在的生物标志物.

Objective:To investigate the effect of early postoperative enteral nutrition (EEN) on laparoscopic and open radical gastrectomy.Methods:From January 2015 to December 2016,68 patients with gastric cancer admited in Anqing Hospital,Anhui Medical University,were randomized into laparoscopic group (33 cases) and open group (35 cases).The following parameters were collected:(1) Surgical outcomes and complications;(2) EEN tolerance;(3) postoperative nutritional status;(4) starting time of postoperative chemotherapy.Results:There was no significant difference between groups in terms of operation time,number of lymph node,postoperative complications such as anastomotic fistula,pulmonary infection,incision infection (P ＞ 0.05);whereas the intraoperative blood loss was significantly less in laparoscopic group (P ＜ 0.01).(2) EEN tolerance:Postoperative discomforts,such as abdominal distension,diarrhea and other symptoms occurred significantly less in laparoscopic group (P ＜ 0.01),and time for TEN is significantly shorter (P ＜ 0.01).(3) Postoperative nutritional status:On the 7th day after operation,the nutrition status of the laparoscopic group improved earlier.There was significant difference regarding the detected blood level of prealbumin and C-reactive protein between the two groups (P ＜ 0.01).On the 14th day after operation,the nutritional status of the laparoscopic group improved significantly.The body weight,the right upper arm muscle circumference and the albumin were significantly different between two groups (P ＜ 0.05).(4) The number of cases receiving chemotherapy in patients with advanced gastric cancer was significantly higher in laparotomy group than that with open distal gastrectomy.Conclusion:Laparoscopic surgery for gastric cancer reduces surgical trauma,and leads to better EEN tolerance and earlier achieved TEN,which is conducive to improving postoperative nutritional status,as well as providing good conditions for adjuvant chemotherapy.

Objective To summarize the experience of combined approaches to laparoscopic splenectomy (LS) following a standardized technique by operative position changes. Methods The clinical data of 47 patients who underwent LS in Anqing Hospital from Jul. 2014 to Jun. 2017, were retrospectively analyzed. The LS was performed by adjusting the patients' operative position twice, thus realizing a combined approach, as well as by using a standardized 3-step technique. Results Forty-six patients performed LS successfully, with only one patient having an additional small incision to complete the operation. Operation duration was (91.49±11.96) min. Intraoperative bleeding was (279.89±102.44) mL and no uncontrollable bleeding was found. The postoperative time of anus aerofluxus was (2.13±0.21) d. The duration of postoperative indwelling drainage catheter was (4.77±1.52) d. No pancreatic leakage or intra-abdominal hemorrhage was found, and only reactive pleural effusion was reported in 7 cases. Postoperative hospitalization length was (7.79±1.28) d. No death was found in all patients during follow-up (1 to 35 months). Conclusion The combined approach for programmed LS has high success rate, low incidence of postsurgical complications, and short recovery time. It is a convenient and effective procedure that can be further expanded, especially in basic-level hospital.

Objective To evaluate the effect of early enteral nutrition (EEN) supplemented with glutamine (Gln) for patients with severe acute pancreatitis (SAP) on systemic inflammatory response and immune function. Methods Forty-nine SAP patients admitted to the General Surgery of Anqing Hospital Affiliated to Anhui Medical University from Oct. 2015 to May. 2017 were randomly divided into the experimental group (24 cases) and the control group (25 cases). EEN combined with Gln was used in the experimental group and only EEN was used in the control group. Blood samples from all the patients were collected for analysis of inflammatory markers [C-Reactive protein (CRP), procalcitonin (PCT), Interleukin-6 (IL-6), Interleukin-8 (IL-8), tumor necrosis factor-α (TNF-α)] and immune indices (CD3+, CD4+, CD4+/CD8+) on the day l, 6 and 11 after admission, and their differences were compared between the two groups. Results (1) On the first day after admission,compared with the control group, there was no significant difference of systemic inflammation markers (including CRP, PCT, IL-6, IL-8, TNF-α) and immune parameters (CD3+, CD4+, CD4+/CD8+) in the experimental group. (2) On day 6, the levels of inflammatory markers CRP [(56.31±18.04) mg/L vs (98.12±11.54) mg/L, P=0.037], IL-6 [(45.87±10.99) pg/mL vs (54.72±4.77) mg/L, P=0.026), IL-8 [(45.15±9.27) ng/mL vs (59.03±4.87) ng/mL, P=0.013], TNF-α [(24.35±7.15) pg/mL vs (32.41±4.22) pg/mL, P=0.010] and PCT [(1.11±0.49) ng/mL vs (1.50±0.30) mg/L, P=0.024] in the experimental group were significantly lower than those in the control group. In addition, levels of immune indices CD3+ [(63.42±2.86)％ vs (54.67±1.76)％, P=0.035], CD4+ [(43.69±1.83)％ vs (40.08±1.08)％, P=0.014] and CD4+/CD8+ [(2.25±0.39) vs (1.87±0.22), P=0.006] were significantly higher in the experimental group. (3) On day 11, the levels of CRP [(16.81±7.56) mg/L vs (43.01±2.74) mg/L, P=0.009], IL-6 [(29.39±7.92) pg/mL vs (38.29±5.33) pg/mL, P=0.020], IL-8 [(30.73±9.26) ng/mL vs (39.69±5.26) ng/mL, P=0.018], TNF-α [(13.87±5.67) pg/mL vs (20.35±3.82) pg/mL, P=0.019] and PCT [(0.34±0.11) ng/mL vs (0.95± 0.29) ng/mL, P=0.035] in the experimental group were also significantly lower than those in the control group. And the levels of CD3+ [(69.68±1.87)％ vs (61.14±1.21)％, P=0.017], CD4+ [(54.27±3.23)％ vs (45.30±1.59)％, P=0.007] and CD4+/CD8+ [(2.98±0.51) vs (2.01±0.28), P=0.012] in the experimental group were also significantly higher.Conclusion For patients with severe acute pancreatitis, EEN combined with Gln is superior to EEN alone in reducing systemic inflammatory response and improving immune function.

BACKGROUND AND AIM:Long non-coding RNA zinc finger antisense 1 (ZFAS1) is frequently amplified in hepatocellular carcinoma and promotes metastasis by increasing zinc finger E-box binding homeobox 1 (ZEB1), which can potentiate the progression of epithelial-to-mesenchymal transition (EMT). However, the expression pattern and role of ZFAS1 in colonic cancer remains unknown. The present study aimed to investigate the role of ZFAS1 and its clinical significance in colonic cancer. METHODS:Paired clinical colonic cancer tissue samples and clinicopathologic characteristics of 73 patients were analyzed. Quantitative real-time polymerase chain reaction analysis was used to evaluate expression levels of ZFAS1 in colonic cancer tissues, cell lines, and plasma. ZEB1 and EMT-related markers expression levels also were explored. Cell biology assays were used to explore the biologic consequences of ZFAS1 in regulating cell proliferation and invasion, as well as the roles in regulating EMT. RESULTS:Zinc finger antisense 1 was up-regulated in colonic cancer tissues compared with adjacent mucosa (P < 0.01), and its expression level was significantly correlated with TNM stage, vascular invasion, and lymph node metastasis (P < 0.05). ZFAS1 and ZEB1 were also increased in patients' plasma. Moreover, ZFAS1 promoted proliferation, invasion, and impeded apoptosis. Knockdown of ZFAS1 decreased expression of ZEB1 and increased the epithelial markers E-cadherin, ZO-1 while decreasing mesenchymal markers vimentin and N-cadherin. CONCLUSIONS:Long non-coding RNA ZFAS1 may function as an oncogene by modulating ZEB1 to induce EMT. Manipulation of ZFAS1 level may be a novel approach to suppress colonic cancer progression. In addition, ZFAS1 in plasma has the potential to be a diagnostic biomarker of colonic cancer.

目的 分析早期梗阻型急性胆源性胰腺炎(ABP)患者应用不同治疗方法治疗的效果.方法 回顾性分析安徽医科大学附属安庆医院2013年7月至2015年1月收治的60例梗阻型ABP患者临床资料,根据不同治疗方法分为非手术治疗组、开腹手术组和内镜下十二指肠乳头括约肌切开术(EST)治疗组,每组20例;依据Ranson标准及APACHEⅡ评分,将患者分为轻型组(34例)及重型组(26例).对比各组患者住院时间、腹痛缓解时间、血淀粉酶恢复时间、病死率、半年内胰腺炎复发率及胰腺炎并发症发生情况.结果 轻型组患者比较:非手术治疗组住院时间、腹痛缓解时间及血淀粉酶恢复时间均长于开腹手术组、EST治疗组(P均＜0.05),而开腹手术组和EST治疗组比较差异无统计学意义(P均＞0.05).重型组患者比较:非手术治疗组住院时间、腹痛缓解时间及血淀粉酶恢复时间均长于开腹手术组、EST治疗组(P均＜0.05),且开腹手术组均长于EST治疗组(P均＜0.05).非手术治疗组患者死亡率为15.0％,开腹手术组为5.0％,EST治疗组为5.0％,3组患者死亡率比较差异无统计学意义(P＞0.05).开腹手术组患者并发症发生率、胰腺炎复发率均低于非手术治疗组(P均＜0.05);EST治疗组并发症发病率、胰腺炎复发率均低于非手术治疗组,均高于开腹手术组,但差异均无统计学意义(P均＞0.05).结论 梗阻型ABP患者非手术治疗后,须早期行开腹手术或EST解决胆道梗阻.同时,对于早期胆道手术方式的选择,需根据患者实际疾病及机体应激状态、年龄等综合因素做出科学选择,以便进行针对性治疗,促进患者预后康复.

目的：探讨谷氨酰胺联合肠内营养对胃癌患者术后血清C反应蛋白（CRP）及免疫功能的影响。方法将行胃癌根治术患者共42例随机化分为谷氨酰胺联合肠内营养组（A组）和肠内营养组（B组），分别于术前第1天，术后第1、7天晨同一时间空腹抽取外周静脉血分别检测血清CRP、IgA、IgM、IgG、T淋巴细胞亚群（CD4＋、CD8＋、CD4＋／CD8＋值）。结果术后第1天两组的免疫指标都比术前第1天降低，术后第7天回升。血清CRP较术前第1天明显上升，术后第7天明显下降。术后第7天，谷氨酰胺联合肠内营养组IgG、CD4＋、CD4＋／CD8＋均比肠内营养组显著升高（P＜0．05）；谷氨酰胺联合肠内营养组患者术后血清CRP水平比肠内营养组显著偏低（P＜0．05）。两组感染并发症差异无统计学意义（P＞0．05）。结论谷氨酰胺联合肠内营养能够有效的改善胃癌患者术后免疫功能，减少术后炎症反应，促进术后快速康复。

Objective To compare the clinical effect of laparoscopic splenectomy and open splenectomy in thetreatment of patients with hypersplenism caused by liver cirrhosis so as to provide a reference for surgical treatment for liver cirrhosis -induced hypersplenism. Methods Forty -six patients who received surgical treatment for hypersplenism caused by liver cirrhosis from January 2012 to December 2015 were chosen as the research subjects, and were divided into observation group and control group ( = 23 in each group) using the random number table method. The control group underwent open splenectomy, while the observation group underwent laparoscopic splenectomy. Surgery related indicators, liver function, inflammatory reaction and immune function were compared between the two groups. Results The operation time of the observation group was longer than that of the control group ( < 0.05). The extubation time and postoperative hospitalizatio n time of the observation group were significantly shorter than those of the control group ( < 0.05). The incision pain of the observation group was milder than that of the control group ( <0.05). The detection of liver function revealed serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST), total bilirubin and direct bilirubin (Dbil) levels were significantly lower than those of the control group 1 d after operation ( < 0.05); ALT, AST and Dbil levels in the observation group were significantly lower than those of the control group 7 d after operation ( < 0.05). Detection of inflammatory immune function showed 1 and 3 days after operation, white blood cell count (WBC), C reactive protein (CRP), and CD8+T cell percentage of the observation group were significantly lower than those of the control group ( < 0.05) ; CD4+T cell percentage and CD4 +/CD8 + T cell ratio were signific antly higher than those of the control group ( < 0.05). Conclusions Laparoscopic splenectomy is helpful in relieving pain of patients, reducing influence on liver function and inflammatory response, protecting immune function, and promoting recovery of patients after operation.

目的:探讨在下腔静脉滤器保护下,观察置管溶栓与经足背静脉溶栓对下肢深静脉血栓形成(DVT)治疗早期临床疗效的对比.方法:选取84例DVT患者随机分为置管溶栓组以及足背静脉溶栓组.观察两组患者的静脉通畅度及临床症状改善情况并评价其早期疗效.结果:置管溶栓组静脉通畅度及临床症状改善情况均优于足背静脉溶栓组,差异有统计学意义(P＜ 0.01).结论:在下腔静脉滤器保护下,相比足背静脉溶栓,置管溶栓能更迅速改善静脉回流障碍,早期疗效显著.

Objective:To investigate the cause,diagnosis and treatment of acute acalculous cholecystitis(AAC). Methods:43 cases of AAC from 2004 to 2009 were analyzed retrospectively. Results:40 cases were diagnosed by B-ultrasonograph,the positive rate of diagnosis was 87.50%(35/40),8 cases were diagnosed by CT,the positive rate of diagnosis was 75.00%.All of them underwent operations,cholecystectomy was performed in 39 patients,cholecystostomy in 2.subtotal cholecystectomy in 2.All of them were cured. Conclusion:The cause of AAC is very complication,the preoperative diagnosis is difficult,it is easy to be misdiagnosed.Surgeon should pay more attention to AAC.B—ultrasonograph is the first choice of the diagnosis of AAC,CT can give a hand to diagnosis.The early operation resection is the most effective method.

目的 探讨胆汁回输联合早期肠内营养(early enteral nutrition,EEN)对良性梗阻性黄疸患者术后血清C反应蛋白(C-reactive protein,CRP)及免疫功能的影响.方法 将57例术后行胆汁外引流的良性梗阻性黄疸患者随机分为胆汁回输组(A组)、EEN组(B组)、胆汁回输联合早期肠内营养组(联合组,C组),分别于术前1 d,术后第1、3、7天晨同一时间空腹抽取外周静脉血10 mL,测定CRP、C3、C4、IgA、IgM、IgG、T淋巴细胞亚群(CD3+,CD4+,CD8+,CD4+/CD8+值).观察患者病情转归情况,统计术后感染发生率.结果 联合组患者术后血清CRP水平低于EEN组及胆汁回输组(P＜0.05).联合组与EEN组相比较,其T淋巴细胞功能恢复更迅速、恢复程度更高(P＜ 0.05),免疫球蛋白及补体系统术后恢复较快(P＜0.05);联合组与单纯胆汁回输组比较,两组术后免疫球蛋白及补体系统的恢复,在速度和程度上的差异不具有统计学意义(P＞ 0.05).联合组术后感染发生率低于EEN组及胆汁回输组(P＜ 0.05).结论 胆汁回输联合早期肠内营养能有效改善良性梗阻性黄疸患者的体液及细胞免疫功能,减轻术后炎症反应,降低术后感染发生率,促进术后快速康复.

十二指肠间质瘤是起源于十二指肠间叶组织的非定向分化性肿瘤,占小肠间质瘤的10％～20％,临床报道较少;而十二指肠间质瘤合并主胰管变异的病例则更为罕见,我院收治1例十二指肠间质瘤合并主胰管变异患者,现报道如下. 病例 患者,男,74岁,因“呕血黑便五小时”入院.体检:皮肤巩膜无黄染,体表未扪及肿大淋巴结.心肺无明显异常.腹部平软,未扪及肿块,腹部无压痛及反跳痛,肝脾肋下未及,Murphy征阴性,无移动性浊音,肠鸣音活跃.实验室检查:血白细胞8.8×109/L,血红蛋白64 g/L,血小板120×109/L,肝功能:总胆红素8.1 μmol/L,白蛋白32.5g/L,胆碱酯酶4 503 IU/L.腹部MRI:十二指肠占位性病变(图1A、1B),MRCP:主胰管开口位于胆总管上方,考虑主胰管经副乳头开口(图1C).

Objective To study the effect of early enteral nutrition(EEN) for severe acute pancreatitis(SAP) patients on serum C-reactive protein(CRP) and T lymphocyte subsets.Methods Forty-five SAP patients were randomly divided into the experimental group(22 cases) and the control group(23 cases).The experimental group was treated with EEN.The control group were treated with early parenteral nutrition(PN),and EN was given after gastrointestinal function restored(usually after admission 5 to 7 d).On the day 1,5,7 and 11 after admission,the patients of two groups were tested serum CRP and T lymphocyte subsets(CD3,CD4+,CD4+/CD8+ ratio).Results Three patients were excluded experiment,and the other 42 cases were cured.The average hospitalization days and costs in experimental group were lower than that in control group(P<0.05).The serum levels of CRP and T lymphocyte subsets,on the first day,were not statistically significant differences between two groups(P>0.05).On the 5th,7th and 11th hospitalization day,the serum CRP level was lower in experimental group than that in control group(P<0.05),and the T lymphocyte subsets(CD3,CD4+,CD4+/CD8+ ratio) levels were higher in experimental group than those in control group(P<0.05).Conclusion This experiment shows that,by comparing experimental group with control group,the treatment for SAP patients with EEN is better in reducing inflammation on the acute reaction period and better in improving immune function.

目的 研究早期肠内营养(EEN)对重症急性胰腺炎(SAP)患者血清C反应蛋白(CRP)及T淋巴细胞亚群的影响.方法 将45例SAP患者随机分为实验组(22例)和对照组(23例).实验组给予EEN,对照组给予肠外营养(PN),待患者排气排便后给予EN(通常于入院后5～7d).于入院后第1、5、7、11天,检测两组患者血清CRP及T淋巴细胞亚群(CD3、CD4+、CD4+/CD8+值).结果 除3例排除实验,余42例SAP患者治愈.平均住院日及住院费用,实验组低于对照组(P＜0.05).两组间比较,血清CRP、T淋巴细胞亚群,在第1天的差异无统计学意义(P＞0.05)；第5、7、11天血清CRP水平,实验组低于对照组(P＜0.05),T淋巴细胞亚群(CD3、CD4+、CD4+/CD8+值)水平实验组高于对照组(P＜ 0.05).结论 给予EEN能更好地降低SAP患者急性反应期炎症反应,提高免疫功能.