目的:探究金茵利胆胶囊对肝内胆汁淤积的治疗作用,以及对过氧化物酶体增殖物激活受体-γ(PPARγ)/核因子-κB(NF-κB)通路的影响.方法:将40只SD大鼠随机分为正常组、模型组、金茵利胆胶囊组、阳性药组,每组10只,模型组、金茵利胆胶囊(0.54 g/kg)组、阳性药(0.1 g/kg熊去氧胆酸)组大鼠采用ANIT灌胃复制肝内胆汁淤积大鼠模型,金茵利胆胶囊组大鼠给予0.54 g/kg金茵利胆胶囊灌胃,阳性药组大鼠给予0.1 g/kg熊去氧胆酸灌胃,7 d后采集标本进行指标检测.酶联免疫吸附试验(ELISA)检测总胆红素(TBil)、总胆汁酸(TBA)、天门冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)水平;苏木精-伊红(HE)染色观察肝组织病理学变化;蛋白质免疫印迹技术(Western Blot)检测肝组织中PPARγ、NF-κB p65亚基、胆酸代谢相关蛋白胆盐出口泵(Bsep)、牛磺胆酸钠协同转运蛋白(Ntcp)和多药耐药相关蛋白2(Mrp2)的表达;ELISA检测血清中肿瘤坏死因子-α(TNF-α)和白细胞介素-1β(IL-1β)的水平.结果:与正常组比较,模型组大鼠肝组织可见大量炎性细胞浸润和肝细胞坏死,血清TBil、TBA、AST、ALT、TNF-α和IL-1β水平均明显升高,肝组织PPARγ、Bsep、Ntcp和Mrp2蛋白表达显著降低,NF-κB p65蛋白表达显著升高(均P<0.05);与模型组比较,金茵利胆胶囊组和阳性药组大鼠肝组织中炎性细胞浸润减少,肝细胞形态基本正常,血清TBil、TBA、AST、ALT、TNF-α和IL-1β水平明显降低,肝组织PPARγ、Bsep、Ntcp和Mrp2蛋白表达显著升高,NF-κB p65蛋白表达显著降低(均P<0.05).结论:金茵利胆胶囊可通过调控PPARγ/NF-κB通路,减轻肝内胆汁淤积大鼠肝组织炎症反应,改善肝损伤情况.

目的 探讨快速康复外科(FTS)在腹腔镜再次胆道探查术中的应用价值.方法 将52例有胆道结石手术史需行腹腔镜再次胆道探查术的胆总管结石患者分为FTS组(28例)和对照组(24例).FTS组采用快速康复的围术期处理方法,对照组采用传统的围术期处理方法.记录两组患者术后下床时间、排气排便时间、恢复进食时间、住院时间及费用,对比血清前清蛋白(PA)、体重下降情况等营养指标,观察术后并发症发生情况和镇痛效果.结果 与对照组比较,FTS组术后排便时间、下床时间、排气时间、进食时间明显提前,住院时间明显缩短,住院费用大幅降低,差异均有统计学意义(P<0.05).两组术前、术后第3天PA水平无明显差异(P>0.05),FTS组术后第5天体重下降较对照组小(P<0.05).FTS组并发症发生率低于对照组(P<0.05).两组患者镇痛效果比较差异有统计学意义(P<0.05),FTS组患者恶心、呕吐的发生率明显低于对照组(P<0.05).结论 FTS联合腹腔镜再次胆道探查术可降低并发症发生率,缩短住院时间,减少住院费用,手术安全性较高,患者康复较快.

肝外胆管结石的治疗方式逐渐多元化、微创化,以腹腔镜、胆道镜、十二指肠镜为代表的“三镜”联合手术已取代传统开放手术越来越多的应用于临床.随着超声内镜、3D腹腔镜、机器人手术系统、SpyGlass内镜系统等高科技产品的应用,更加充分体现了胆道外科的微创优势.手术医师需熟悉微创技术的优劣,遵循个体化原则制定合理的治疗方案.

目的 了解当前细菌性肝脓肿和胆道感染的病原菌及药敏试验结果差异,便于指导临床治疗.方法 回顾性收集和分析2012年3月至2018年9月重庆市人民医院收治的64例细菌性肝脓肿和269例胆道感染病人的细菌培养和药敏试验资料及相关临床资料.结果 细菌性肝脓肿检出细菌52株(7种),包括肺炎克雷伯菌31株(59.6％)、链球菌8株(15.4％)、铜绿假单胞菌7株(13.5％)、其他6株(11.5％),其中革兰阴性菌占78.8％,革兰阳性菌占21.2％.胆道感染检出细菌123株(13种),包括大肠埃希菌47株(38.2％)、肺炎克雷伯菌30株(24.4％)、阴沟肠杆菌13株(10.6％)、其他33株(26.8％),其中革兰阴性菌占81.3％,革兰阳性菌占18.7％.细菌性肝脓肿的革兰阴性菌耐药率较低的抗生素包括:阿米卡星(0.0％)、厄他培南(0.0％)、亚胺培南(2.2％)、头孢他啶(4.4％)、头孢吡肟(4.4％)、氨曲南(6.7％)、哌拉西林/他唑巴坦(8.9％)、头孢替坦(8.9％)、左氧氟沙星(8.9％)、妥布霉素(11.1％)等,胆道感染革兰阴性菌耐药率较低的抗生素包括:阿米卡星(0.0％)、厄他培南(0.0％)、亚胺培南(4.2％)、哌拉西林/他唑巴坦(5.3％)、妥布霉素(6.3％)等.两种感染多重耐药菌株比例分别为38.5％、30.9％(P>0.05).结论 两种感染的致病菌均以革兰阴性菌为主,但细菌性肝脓肿的致病菌以肺炎克雷伯菌最常见,胆道感染的致病菌以大肠埃希菌最常见.对两种感染的革兰阴性菌均较敏感的抗生素包括阿米卡星、厄他培南、亚胺培南、哌拉西林/他唑巴坦、妥布霉素.不同之处在于:头孢他啶、头孢吡肟、头孢替坦、氨曲南和左氧氟沙星对引起细菌性肝脓肿的革兰阴性菌较敏感,但对引起胆道感染的革兰阴性菌敏感性较差.

目的 探讨快速康复外科(FTS)应用于行腹腔镜胆总管探查一期缝合术(LBEPS)围术期的安全性及效果.方法 选择2017年11月至2019年8月该院肝胆外科行LBEPS的患者80例,根据不同治疗方案将其分为两组,其中围术期予以FTS治疗方案的患者40例为FTS组,予以常规方案治疗的患者40例为对照组.分析比较两组间患者围术期并发症发生及术后下床时间、肛门排气时间、排便时间、进食时间、住院时间、住院费用、镇痛效果,以及血清前清蛋白、术后5 d体重下降情况等营养指标,以评估FTS在行LBEPS患者的疗效及安全性.结果 两组患者术后均康复出院.与对照组比较,FTS组患者术后下床时间、肛门排气时间、排便时间、进食时间提前,住院时间缩短,住院费用降低,营养状况良好,镇痛效果好,上述指标明显优于对照组(P<0.05);FTS组术后并发症总发生率明显低于对照组(20.00％vs.52.50％,P<0.05),其中肺部感染、尿路感染的发生率明显低于对照组(5.00％vs.20.00％、2.50 vs.15.00％,P<0.05),但两组患者胆漏、切口感染、腹腔感染、心脑血管并发症发生率比较差异无统计学意义(P>0.05).结论 FTS在LBEPS围术期应用安全、有效,可进一步加速患者的康复.

目的 分析加速康复外科(ERAS)对腹腔镜胆总管探查一期缝合病人康复及应激反应的影响.方法 回顾性分析2016年5月至2019年4月重庆市人民医院肝胆外科行腹腔镜胆总管探查一期缝合术60例病人临床资料.根据康复方式分为ERAS组(30例),对照组(30例),ERAS组采用ERAS理念进行围手术期管理,对照组则按照常规方法管理.对比两组间病人下床时间、肛门排气时间、进食时间、住院时间、住院费用、术后并发症,术前和术后第1、3、5天外周血白细胞介素(IL)-6、C反应蛋白(CRP)及白细胞计数(WBC)等.结果 两组均顺利完成手术.ERAS组术后下床时间、排气时间、进食时间提前,术后住院时间缩短,住院费用显著降低.术后并发症发生率(26.7％比50％)低于对照组,术后镇痛效果优于对照组,差异有统计学意义(P<0.05).术后第1、3、5天,ERAS组IL-6和CRP低于对照组,分别为(80.05±27.84)μg/L比(191.47±118.26)μg/L、(52.78±33.28)μg/L比(112.98±63.89)μg/L、(18.11±8.20)μg/L比(55.80±38.62)μg/L,以及(30.46±16.37)mg/L比(56.38±38.12)mg/L、(80.05±27.84)mg/L比(113.88±68.44)mg/L、(43.60±22.49)mg/L比(66.59±35.72)mg/L,差异有统计学意义(P<0.05).结论 ERAS理念应用于腹腔镜胆总管探查一期缝合病人,能够减轻术后应激反应,减少术后并发症,加速病人康复.

目的 了解胆道产超广谱β内酰胺酶(ESBLs)细菌感染的现状及有关危险因素,便于指导临床治疗.方法 回顾性收集肝胆外科胆汁细菌培养所得101株大肠埃希菌、肺炎克雷伯菌和产酸克雷伯菌的药敏试验资料及相应患者的有关临床资料,进行单因素分析和多因数分析.结果 101株胆道细菌产ESBLs发生率为34.7％(35/101),其中大肠埃希菌产ESBLs发生率为54.2％(32/59).产ESBLs胆道细菌在总体上较敏感的抗生素包括氨基糖苷类(阿米卡星敏感率100.0％、妥布霉素敏感率82.9％、庆大霉素敏感率80.0％)和碳青霉烯类(厄他培南敏感率94.3％、亚胺培南敏感率88.6％),另外头孢替坦和哌拉西林/他唑巴坦敏感性也较高(88.6％、77.1％).单因素分析发现年龄(≥60岁)、高脂血症、入院前100 d内曾经使用抗生素、本次感染发作后使用抗生素≥7 d和胆道感染细菌种类与胆道细菌产ESBLs有关(P＜0.05).多因数分析发现年龄(≥60岁)、入院前100 d内曾经使用抗生素、本次感染发作后使用抗生素≥7 d和胆道感染细菌种类与胆道细菌ESBLs有关(P＜0.05).结论 胆道细菌产ESBLs发生率较高,对胆道产ESBLs细菌较敏感的抗生素包括阿米卡星、厄他培南、亚胺培南、头孢替坦和哌拉西林/他唑巴坦.胆道产ESBLs细菌感染的危险因素包括年龄(≥60岁)、入院前100 d内曾经使用抗生素、本次发作后使用抗生素≥7d、胆道感染细菌种类.

Objective To understand whether it had differences in bile culture and drug susceptibility test between patients with community-acquired acute cholecystitis and patients with community-acquired acute cholangitis at present.Methods 169 patients with community-acquired acute cholecystitis and the 97 patients with community-acquired acute cholangitis in our department were selected prospectively,in which 16 patients suffered from both community-acquired acute cholecystitis and community-acquired acute cholangitis.Bile sample was extracted in operations and delivered to perform aerobic culture and drug sensitivity test.The bile samples coming from cholecyst were divided into group A,while the bile samples coming from bile duct were divided into group B.Results The positive rates of bile culture in group A and group B were separately 24.9% and 64.9%(P<0.05).The result of the sample coming from cholecyst and the result of the sample coming from bile duct were not the same in 4 patients of the 16 patients who suffered from both community-acquired acute cholecystitis and community-acquired acute cholangitis simultaneously.The main bacteria of acute cholecystitis included Escherichia coli(28.0%),Klebsiella pneumonia(24.0%)and Enterococcus faecium(16.0%).The main bacteria of acute cholangitis included Escherichia coli(39.7%),Klebsiella pneumonia(19.2%)and Enterobacter cloacae(12.3%).The antibiotics which were lowly resistant to gram negative bacteria in the two groups(A and B) included amikacin(0%/0%),ertapenem(0%/0%),imipenem(0%/7.0%)and piperacillin/tazobactam(0%/7.0%).The antibiotics which had lower resistant rates to gram positive bacteria in the two groups included tigecycline(0%/0%)and linezolid(0%/0%).The proportions of the multidrug-resistant strains in the two groups were separately 24.0% and 35.6%(P>0.05).Conclusion Some difference exist in the results of bile culture between patients with community-acquired acutecholecystitis and patients with community-acquired acute cholangitis,but the main bacteria of the both two types of biliary tract infection are Escherichia coli and Klebsiella pneumonia.The drug resistance is serious in the both infections,and the most sensitive antibiotics to gram negative bacteria include amikacin,ertapenem,imipenem,piperacillin/tazobactam,and the most sensitive antibiotics to gram positive bacteria include tigecycline,linezolid in the both infections.

Objective To evaluate the anaerobic culture of bile specimens in 151 cases.Methods From September 2014 to January 2016,89 patients(group A)suffering from community-acquired acute biliary infection and 62 patients(group B) suffering from biliary tract disease without biliary infection were selected prospectively in our hospital.All bile samples were colleted for anaerobic culture.Results In group A,anaerobic bacteria were found only in 2 samples of the 54 samples collected from acute cholecystitis(the positive rate 3.7%),while anaerobic bacterium was found only in 1 sample of the 35 samples collected from acute cholangtitis.In group B,anaerobic bacterium was found only in 1 sample of the 54 samples collected from chronic cholecystitis(the positive rate 1.9%),while anaerobic bacterium was not found in the 8 samples collected from bile duct without acute bilary infection.The positive rate of bile anaerobic culture in group A and group B were separately 3.4% and 1.6%(P>0.05).Conclusion The positive rate of biliary anaerobes are lower in biliary tract infection,the technology and equipment need improvement.

目的 了解社区获得性胆道感染细菌多重耐药的现状及有关危险因素,便于指导临床用药.方法 回顾性收集从2014年4月至2016年9月重庆市人民医院三院院区肝胆外科对社区获得性胆道感染患者进行胆汁细菌培养所得146株细菌的药敏试验资料及患者的有关临床资料(年龄、体质指数、是否患糖尿病、是否患高血压、是否患高脂血症、是否患恶性肿瘤、是否曾经住院、是否胆道感染反复发作3次以上、胆道感染部位、是否胆囊肿大/胆总管扩张、是否低蛋白血症、感染细菌种类、入院前90 d内是否使用抗生素、本次胆道感染发作后是否使用抗生素、本次胆道感染发作后是否长时间使用抗生素7 d以上),并对可能的有关因素进行单因素分析和多因数logistic回归分析.结果 本研究共发现多重耐药菌株43株,其构成如下:大肠埃希菌72.1%、肺炎克雷伯菌4.7%、阴沟肠杆菌4.7%、其他18.6%.多重耐药总发生率为29.4%(43/146),其中大肠埃希菌60.8%、肺炎克雷伯菌7.1%、阴沟肠杆菌11.8%、其他16.0%.多重耐药的大肠埃希菌对各种抗生素的敏感率从高到低依次如下:阿米卡星100.0%、亚胺培南90.3%、厄他培南90.3%、头孢替坦83.9%、哌拉西林/他唑巴坦77.4%.单因素分析发现年龄(≥60岁)、胆道感染部位(胆管)、胆囊肿大/胆总管扩张、低蛋白血症、胆道感染细菌种类(大肠埃希菌)、本次胆道感染发作后长时间(≥7 d)使用抗生素与胆道多重耐药细菌感染有关(P<0.05).多因数分析发现年龄(≥60岁)、胆道感染细菌种类(大肠埃希菌)、本次发作后长时间(≥7 d)使用抗生素与胆道多重耐药细菌感染有关(P<0.05).结论 社区获得性胆道感染多重耐药情况较严重,主要多重耐药菌为大肠埃希菌,对多重耐药大肠埃希菌敏感性较高的抗生素依次为阿米卡星、亚胺培南、厄他培南、头孢替坦和哌拉西林/他唑巴坦.年龄(≥60岁)、感染细菌种类和本次发作后长时间(≥7 d)使用抗生素是胆道细菌多重耐药的危险因素.

Objective:To investigate the efficacy oflaparoscopic common bile duct exploration (LCBDE) under the concept of fast-track surgery (FTS) in elderly patients.Methods:The clinical data of 35 elderly patients undergoing LCBDE under FTS perioperative management from September 2013 to September 2016 (FTS group) and 31 patients undergoing LCBDE with traditional perioperative management during September 2011 to August 2013 (traditional group) were retrospectively analyzed.The relevant clinical variables between the two groups of patients were compared.Results:In FTS group compared with traditional group,the time to postoperative ambulation (15.34 h vs.26.94 h),and time to first anal gas passage (23.09 h vs.36.65 h),defecation (53.83 h vs.62.03 h) and food intake (22.91 h vs.53.29 h) as well as the length of hospital stay (6.29 d vs.9.42 d) and hospitalization costs (17 200 yuan vs.25 400 yuan) were all significantly reduced (all P＜0.05).In addition,the postoperative nutritional indexes,overall incidence of complications and analgesic effects in the FTS group were all superior to those in traditional group (all P＜0.05).Conclusion:LCBDE under the FTS protocol is safe and effective for elderly patients.However,the principle of individuation should also be followed for improving the patients' compliance,and the multi-disciplinary cooperation should be enhanced.

Objective To analyze the current status of bacterial spectrum and drug resistance in community-acquired biliary tract infection to provide a basis for clinical medication .Methods The patients with community-acquired biliary tract infection (ex-periment group) and the patients with biliary tract diseases without biliary tract infection (control group) derived from the native ar-ea treated in this hospital from September 2014 to January 2016 were selected .The bile juice was intraoperatively extracted for con-ducting the bacterial culture and drug susceptibility test .Results Thirteen specieses (60 strains) of bacteria were isolated in the ex-periment group .The top 3 specieses were Escherichia coli (35 .0% ) ,Klebsiella pneumonia (21 .7% ) and Enterobacter cloacae (10 .0% ) .Eight specieses (13 strains) of bacteria were isolated in the control group .The top 3 specieses were Escherichia coli (30 .8% ) ,Klebsiella pneumonia(15 .4% ) and Lactococcus garvieae (15 .4% ) .The proportions of drug resistant strains in the two groups were 95 .0% and 84 .6% respectively (P>0 .05) .The proportions of multiple drug resistant strains in the two groups were 30 .0% and 7 .7% respectively(P>0 .05) .The occurrence rates of multiple drug resistance in the top 3 specieses of bacteria in the experiment group were 61 .9% ,7 .7% and 16 .7% respectively .Conclusion The bacterial spectra of community-acquired acute bili-ary tract infection in the native area are dominated by Gram negative bacteria .The total bacterial drug resistance is serious ,but the drug resistance situation in different bacteria pathogens is different .

Objective To explore the clinical effect of postoperative TACE combined with hepatic carcinectomy in the treatment of primary carcinoma of the liver with portal vein tumor thrombus and to analyze its prognostic factors. Method From April 2008 to April 2011, 123 primary carcinoma of the liver with portal vein tumor thrombus patients admitted in our hospital were divided into combination group and control group according to the different cancer therapeutics. Patients in combination group were treated with hepatic carcinectomy with postoperative TACE while patients in control group accepted hepatic carcinectomy only. Compared the short-term e?cacy for 3 months and the postoperative survival rate of the two groups. Analyzed the prognostic factors by single factor analysis and multiple Logistic regression analysis. Result The total control rate of 3 months after operation, the 1-, 2- and 3-year survival rates of combination group were higher than control group (P < 0.05). Single factor analysis showed that hepatic vein tumor thrombus, tumor thrombus type, number of tumor, diameters of tumor and postoperative TACE were prognostic factors (P < 0.05). And the multiple Logistic regression analysis showed that hepatic vein tumor thrombus, tumor thrombus type and postoperative TACE were independent prognostic factors (P < 0.05). Conclusion In the treatement of primary carcinoma of the liver with portal vein tumor thrombus, hepatic carcinectomy combined with postoperative TACE should be applied as soon as possible to prolonging survival period of patients. Hepatic vein tumor thrombus, tumor thrombus type are the independent prognostic factors of hepatocellular carcinoma with portal vein tumor thrombus.

Objective To observe the effect of somatostatin on liver function in patients after splenectomy combined with de-vascularization.Methods The clinical data of 48 patients with liver cirrhosis,portal hypertension and esophageal varices were retro-spectively analyzed,26 cases (somatostatin group)were used somatostatin after splenectomy combined with devascularization,and the other 22 cases (control group)were not used.The changes of serum albumin (Alb),alanine aminotransferase (ALT),aspartate transaminase (AST),prothrombin activity (PTA)and total bilirubin (TBIL)was observed.Results All patients recovered well af-ter surgery,and no deaths occurred.However,ALT,AST and TBIL of using somatostatin group were significantly reduced than those of control group(P <0.05),Alb and PTA were also improved significantly (P <0.05).Conclusion The combination of som-atostatin can not only reduce postoperative portal pressure,control of bleeding,but also to be significantly promote recovery of liver function.

目的:探讨腹腔镜和胆道镜及十二指肠镜联合治疗急性梗阻性化脓性胆管炎(AOSC)的临床效果.方法:选取2007年3月～2014年3月我院收治的100例AOSC患者,根据手术方法的不同与患者的意愿分为研究组50例与对照组50例,研究组采用腹腔镜和胆道镜及十二指肠镜联合治疗,对照组采用开腹胆囊切除及胆道探查术.观察两组的生化指标、术后并发症、切口感染率、术后残石率.结果:研究组白细胞计数(WBC)、血直接胆红素(DBIL)、丙氨酸转氨酶(ALT)、谷氨酰转肽酶(GT)、天冬氨酸转氨酶(AST)明显低于对照组(P＜0.05).研究组术后并发症、切口感染明显少于对照组(P＜0.05).两组术后1年残石比较差异无统计学意义(P＞0.05).结论:腹腔镜和胆道镜及十二指肠镜联合治疗AOSC患者具有创伤小、愈合恢复快、并发症发生率低、预后好等优点.

目的：研究分析影响巨大肝癌肝动脉栓塞化疗（TACE）联合微波消融的疗效和预后的危险因素。方法连续纳入2011年1月至2014年6月在该院无手术指征的巨大肝癌患者48例作为研究对象。采用随机数表法随机均分为对照组和试验组各24例，术前基线资料比较差异无统计学意义（P＞0．05）。所有患者先行 TACE 治疗，试验组在对照组的治疗基础上于 TACE治疗后残存病灶给予微波消融。试验组随访3年，比较两组患者术后并发症的发生率以及1年、3年生存率，采用 Log-rank 法检验和 Cox 比例风险分析法对可能影响患者生存情况的危险因素进行分析。结果48例患者共计接受61次微波消融治疗，每例患者1～4次，平均（1．27±0．89）次。治疗后，试验组1年、3年生存率显著高于对照组，试验组中位生存月数显著长于对照组（P＜0．05）。检测主要并发症，其中，试验组右肩酸痛及包膜下出血发生率显著低于对照组（P ＜0．05），根据 Log-rank 法检验可能对患者生存预后造成影响的因素，结果发现，Child-pugh 分级为 A 级、无门脉栓子以及初次 TACE 术后4 d 清蛋白下降水平小于或等于4 g／L 者的中位生存时间均分别显著高于 Child-pugh 分级为 B 级、有门脉栓子以及初次 TACE 术后4 d 清蛋白下降水平大于4 g／L 者，差异均有统计学意义（P＜0．05）。根据 Cox 比例风险分析法对预后因素实施分析，显示 Child-pugh 分级为 B 级和有门脉栓子，以及初次 TACE 术后4 d 清蛋白下降水平大于4 g／L 均是影响患者生存预后的独立危险因素。结论对巨大肝癌患者 TACE 治疗后联合给予微波消融治疗，可获得较好疗效，但应关注影响患者生存的危险因素，值得临床重视。

Objective To compare the operation situation of pancreatico duodenectomy (PD) and pylorus‐preserving pancreatico duodenectomy (PPPD) ,and analyze the clinical efficacy of PPPD .Methods Data of 47 patients with periampullary carcinoma and pancreatic head carcinoma underwent pancreatico duodenectomy from January 2010 to December 2013 were retrospectively analyzed and divided into PPPD group (20 cases) and PD group (27 cases) according to different surgery method .Then compare the situa‐tion of intra‐operative and post‐operative situation in two groups of patients .Results The operation time of PPPD group was sig‐nificantly lower than that of PD group (P<0 .05);the incidence of postoperative complication rate of PPPD group was obviously lower than PD group (P< 0 .05);and postoperative infection rate of PPPD group was significantly lower than PD group (P<0 .05);there was no significant difference between two groups in pancreatic leakage ,bile leakage ,gastrointestinal leakage ,post oper‐ative bleeding ,mortality and the incidence of delayed gastric emptying after surgery (P>0 .05) .Conclusion PPPD operation could shorten the operation time ,promote post‐operative recovery ,lower complication rates and shorten hospitalization time ,and could al‐so help to improve the nutritional status of patients ,improve the postoperative quality of life of patients ,thus it should be further promoted .

目的:研究三镜联合手术方案治疗肝外胆道结石患者的临床疗效及预后情况分析.方法:选择从1999年5月至2014年5月在我院接受治疗的肝外胆道结石患者300例进行回顾性分析.所有患者均接受三镜联合手术方案治疗,290例患者成功接受手术,其中先行经内镜十二指肠乳头造影/切开术(ERCP/EST),然后行腹腔镜胆囊切除术(LC)(先ERCP/EST后LC组)103例,先行LC,然后行ERCP/EST(先LC后ERCP/EST组)73例,同时行LC和ERCP/EST(LC与ERCP/EST同时组)114例.分析患者整体手术情况,对比各组手术相关指标、结石取出情况及并发症.结果:300例患者中,10例因结石过大、缩窄乳头炎、出血及怀疑胆囊癌因素中转开腹.三组手术时间、术中出血量、住院时间与住院费用指标相比,差异均无统计学意义(均P＞0.05),成功取出结石率及并发症发生率三组相比,差异均无统计学意义(均P＞0.05).结论:通过不同手术顺序的三镜联合手术方案治疗肝外胆道结石,临床疗效及患者的预后情况均较好,值得在临床推广应用.

[ABSTRACT]Objective: To evaluate the clinical efficacy of mannatide injection as an immune-modulator in the treatment of postoperative infection.Methods:According to the inclusion and exclusion standard, 98 postoperative patients were chosen, on whom a retrospective study about mannatide injection was conducted.Other 98 patients after undergoing the same surgeries served as the control group.Postoperative infection,hospitalization,wound healing,using of antibiotics and immunocyte level in serum of both groups were evaluated.Results:The total infection rate (11.8%),respiratory infection rate (7.1%) and wound infection rate (3.1%) of treatment group dosed with immune-modulator were lower than that of the control group (33.6%, 16.3% and 15.3% ).There was no difference in urinary tract infection (1.4% vs 1.4%).The average stay (6.5d),and the time of using antibiotic (4.1d) of the treatment group were both shorter than that of the control group (8.2d and 5.2d) Healing rate of the treatment group was much higher than the control group.Detecting immune cells showed both CD4+,and NK cell levels of immunomodulatory group were higher than the control group.Conclusion:Mannatide could definitely reduce postoperative infection, help wound healing and shorten the course of disease.The mechanism maybe related to activation of immunity.

<正>内窥镜逆行胆胰管造影(Endoscopic retrograde cholangiopancreatography,ERCP)分为诊断性ERCP和治疗性ER-CP。诊断性ERCP的并发症主要为急性胰腺炎(0.66%),其次为化脓性胆管炎(0.33%)[1]。治疗性ERCP并发症主要为出血、穿孔和化脓性胆管炎[1]。本例为诊断性ERCP,同时发生肺