Objective:To investigate the relationship between energy metabolism and sex hormone levels in patients with polycystic ovary syndrome after 3D laparoscopic sleeve gastrectomy（LSG）.Methods:A total of 68 patients with PCOS from June 2021 to June 2022 were selected as the study objects and divided into operation group and non-operation group according to different treatment methods，with 34 patients in each group. All patients were treated with letrozole，and patients in operation group were treated with 3D LSG on this basis. SPSS 20.0 software was used for statistical analysis. Measurement data such as sex hormone level and metabolic index were expressed as（xˉ±s），and independent sample t test was performed. Rank Sum test was used for treatment effect，χ2 test was used for other statistical data. Spearman correlation was used to analyze the correlation between postoperative metabolic indexes and sex hormone levels. P<0.05 was considered to be statistically significant.Results:The total effective rate of operation group（88.2%）was significantly higher than that of non-operation group（67.6%），and the difference was statistically significant（P=0.041）. After treatment，the levels of luteinizing hormone（LH），testosterone（T），follicle-stimulating hormone（FSH），estradiol（E2）and progesterone（P）in 2 groups were significantly decreased（P<0.05），but the levels of LH，T，FSH，E2 and P in surgery group were significantly lower than those in non-surgery group（P<0.05）. After treatment，the body mass index，abdominal circumference，hip circumference，fat content，weight without fat，respiratory quotient and resting energy metabolism of patients in the surgery group were significantly lower than those in the non-surgery group（P<0.05），and the above indexes were positively correlated with LH，T，FSH，E2 and P.Conclusion:There was a significant correlation between the body energy metabolism after 3D LSG and the sex hormone levels in PCOS patients.

目的 探究miR-4792对胰腺癌增殖、 迁移和侵袭的影响.方法 下载GSE59856和GSE71533数据集,取上调表达的交集基因miR-4792,构建稳定过表达miR-4792的胰腺癌细胞系PANC-1、SW1990,采用CCK-8实验和Transwell小室实验检测细胞增殖、 迁移和侵袭能力,通过裸鼠皮下种植瘤模型检测过表达miR-4792对肿瘤体内生长的影响,经Targetscan预测miR-4792的靶基因,下载GSE62452、TCGA数据集,筛选出基因β-淀粉样前体蛋白裂解酶1(beta-site APP cleaving enzyme-1,BACE1),分析其表达与胰腺癌恶性临床表型的关系,并验证miR-4792与BACE1的靶向关系.结果 与miR-NC组比较,miR-4792组miR-4792水平升高,细胞增殖能力、 迁移及侵袭细胞数均增加,肿瘤体积变化趋势明显增强,肿瘤组织体积、重量及miR-4792水平升高(P<0.05).Targetscan预测miR-4792的靶基因为BACE1,其表达与胰腺癌复发、 增殖、 无进展生存期、 预后、M分期及G分期密切相关(P<0.05).双荧光素酶报告基因实验证明,miR-4792可直接作用于靶基因BACE13′UTR下调其表达,与miR-NC组比较,miR-4792组BACE1 mRNA及蛋白表达降低(P<0.05).与miR-4792组比较,miR-4792+BACE1组BACE1蛋白表达增加,细胞增殖能力、 迁移及侵袭细胞数均降低(P<0.05);但miR-4792+BACE1组和miR-NC组上述指标的比较,差异无统计学意义(P>0.05).结论 miR-4792在胰腺癌中表达上调,其过表达可促进胰腺癌细胞的增殖、 迁移和侵袭,可能与靶向下调BACE1有关.

目的 观察腹腔镜下改良空回肠旁路术治疗2型糖尿病的临床疗效.方法 选取2019年1—12月我院诊断2型糖尿病患者,根据BMI指标分为对照(偏胖)组(25 kg/m2≤BMI<28 kg/m2)及观察(标准)组(19 kg/m2≤BMI<25 kg/m2),其中对照组29例,观察组39例,比较两组术前、术后6个月血糖(空腹血糖、餐后2 h血糖)、血脂水平与BMI、术后并发症、血糖控制方式及糖尿病并发症转归.结果 术后6个月观察组的空腹血糖为(5.17±0.34)mmol/L,餐后2 h血糖为(7.19±0.60)mmol/L,对照组为(6.12±0.37)mmol/L、(8.34±0.84)mmol/L,两组比较,差异有统计学意义(P<0.05);组内比较,随访时观察组HDL-C(1.79±0.24)mmol/L,TG(2.71±0.32)mmol/L,LDL-C(1.92±0.20)mmol/L,BMI(20.79±1.24)kg/m2,对照组为(1.11±0.20)mmol/L、(2.85±0.56)mmol/L、(2.23±0.25)mmol/L、(28.41±3.20)kg/m2,与术前比较,差异有统计学意义(P<0.05).结论 腹腔镜下改良空回肠旁路术可以较为明显地改善2型糖尿病患者的血糖、血脂水平,改善术后血糖控制方式及并发症的转归,但相对于肥胖的2型糖尿病患者,其体重并未得到较好的改善.

Objective To investigate the clinical outcome of Roux-en-y gastric bypass surgery (RYGB) on the physiological indexes and insulin resistance of patients with type 2 diabetes mellitus (T2DM) and obesity. Methods From October 2012 to December 2017, 86 patients with T2DM and obesity were enrolled in the present study, who underwent laparoscopic Roux-en-Y gastric bypass surgery. Statistical analysis were performed by using SPSS18.0 software. 6 months and 12 months after operation, measurement data such as Glucose and lipid metabolism indexs, pancreatic beta cell function index (HOMA-beta) and insulin resistance index were expressed as mean±standard deviation and were examined by independent t test. A P value of <0.05 was considered as statistically significant. Results 6 and 12 months after operation, the body weight (BMI) of patients decreased from (33.9±2.6) kg/m2 to (27.7±2.7) kg/m2 and (26.9±3.1) kg/m2 respectively. Indexes of glucose metabolism such as FPG, 2hPG, fasting insulin and HbA1c were decreased significantly after operation (P<0.05). Indexes of lipid metabolism such as TC, TG, LDL-C and HOMA-IR were decreased significantly after operation (P<0.05). However HDL-C and HOMA-β were increased significantly after operation (P<0.05). Conclusion RYGB could improve the glucose and lipid metabolism indexes, increase homa-beta cell function and reduce insulin resistance in T2DM patients with obesity. Key words: Diabetes mellitus; Obesity; Anastomosis, roux-en-Y; Gastric bypass; Insulin resistance

Objective To investigate the effects of two types of laparoscopic cholecystolithotomy on the inflammatory factors and T lymphocyte subsets in patients with cholecystolithiasis. Methods A prospective study was conducted, patients enrolled in gallstone from July 2016 to July 2017 in Jingmen Second People’s Hospital who underwent laparoscopic cholelithotomy, as the complete group, and those underwent laparoscopic assisted cholecystolithotomy, as the assisted group, with 50 cases in each group. The level of T lymphocyte subsets (CD3+, CD4+ and CD8+) and the changes of inflammatory factors were compared between the two groups. Results (1) Intraoperative blood loss (7.6±0.8) ml and operative time (51.38±0.9) min in the complete group were significantly lower than those in the assisted group (13.5±2.9) ml, (61.27±1.3) min, the differences were statistically significant (statistical value=44.229, 4.651, P=0.016, 0.023). (2) 1 day after surgery, CD3+ and CD4+ levels were significantly decreased, CD8+ level increased significantly (P<0.05). Postoperative 5 d, CD3+ and CD4+ levels in assisted group were increased, but still significantly lower than the preoperative level, while CD8+ was decreased, but still higher than preoperation (P<0.05). The complete group on postoperative 1 and 5 d, CD3+ and CD4+ levels were significantly higher than those of the assisted group, but CD8+ level lower than the assisted group, the difference was statistically significant (P<0.05). (3) The levels of Hs-CRP, IL-6 and TNF-α on postoperative 1 d in the two groups were significantly increased (P<0.05). 5 d after operation, there was no significant difference of the three indicators compared with preoperation in the complete group, while for the assisted group the three indicators were still higher than preoperation (P<0.05). The complete group was significantly lower than that of the assisted group 1 and 5 d after operation, and the differences were statistically significant (P<0.05). Conclusion Laparoscopic cholelithotomy is more effective than laparoscopic cholecystolithotomy, and has less influence on inflammatory factors and T lymphocyte subsets in patients. Key words: Cholelithiasis; Laparoscopy; Cholecystolithotomy

目的 比较腹腔镜辅助保胆取石术与完全腹腔镜下保胆取石术治疗胆囊结石的临床疗效. 方法 选取2015年9月～ 2016年9月我科收治的95例胆囊结石患者,随机分为两组,其中48例行完全腹腔镜下保胆取石术(实验组),47例行腹腔镜辅助保胆取石术(对照组).比较两组手术相关指标、胆囊收缩功能及血清炎性因子变化情况. 结果 实验组术中出血量、手术时间及术后胃肠功能恢复时间均少于对照组,术后1月、6月及12月的胆囊功能明显优于对照组(P＜0.05).两组术后1d Hs-CRP、IL-6和TNF-α水平均显著高于术前,对照组术后5d三项指标亦显著高于术前(P＜0.05),实验组术后1d和术后5d均显著低于对照组(P＜0.05). 结论 腹腔镜辅助与完全腹腔镜下保胆取石术治疗胆囊结石均是安全可行的手术方式,而后者更有助于术后胆囊功能恢复,对患者手术创伤及机体各项炎性因子影响更小,值得临床推广应用.

>2型糖尿病（type 2 cdiabetes mellitus,T2DM）历来被视为一种内科疾病,近年来美国及欧洲已广泛采用胃转流术（gastric bypass,GBF）治疗肥胖伴T2DM的患者,治愈率达83%～86%。湖北省荆门市第二人民医院对2008年3月至2011年3月收治的13例T2DM患者行GBP手术治疗,取得满意疗效,现总结报道如下。一般资料13例患者中男6例,女7例,年龄38～60（平均49.2）岁,临床确诊T2DM时间为4～8（平均6.5）年;并发高血压4例,糖尿病眼底病变3例,糖尿病足2例,糖尿病肾病2例,胆总管结石1例,胃癌1例;BMI大于或等于30 kg/m 2 者9例。治疗方法术前3 d所有患者停用口服降糖药,改用

Objective:To evaluate the efficacy of the surgical treatment for patients with type 2 diabetic.Methods:Retrospective analysing of the clinical data of 11 patients with type 2 diabetes who had surgical treatment in our hospital.The changes of the preoperative and postoperative blood glucose,glycosylated hemoglobin(HbA1c),insulin resistance index(IRI) of patients were compared.Results:After gastric bypass(GBP),fasting plasma glucose(FBG) were decreased from(12.4±2.6)mmol/L(pre operative) to(6.3±1.4)mmol/L(post operative),and the 2 h plasma glucose(2 h PG) were decreased from(16.1±3.7)mmol/L(pre operative) to(8.5±3.2)mmol/L(post operative).After 6 months,HbA1c were decreased from(7.9±1.5)mmol/L(pre operative) to(6.8±0.6)mmol/L(post operative),IRI were decreased from(6.6±0.9)mmol/L(pre operative) to(3.2±0.4)mmol/L(post operative),there were all statistical significance(all P0.01).8 cases(72.8%) were cured,3 cases(27.2%) improved.Conclusion:Gastric bypass is effective,safe and feasible for patients with type 2 diabetes.

例1,患者男,58 岁,因"阵发性腹痛4 d"于2011 年3 月9 日入院,既往有高血压及糖尿病病史10 年余,入院前4 d 出现下腹部持续性疼痛,阵发性加剧,伴恶心,无呕吐及腹泻,给予禁食、抗炎、对症治疗后,腹痛缓解,但夜间自觉腹痛症状明显,2 d前进食少量流质饮食后腹痛再次加剧.查体:腹平软,无压痛及反跳痛,肝脾肋下未及,肠鸣音3 ～5 次/min,未闻及气过水声及高调肠鸣音.

腹膜假性黏液瘤(psetldomyxoma peritonei,PMP)是一种临床罕见疾病,以黏液外分泌性细胞在腹膜或网膜种植而导致腹膜内大量胶冻状黏稠腹腔积液为特征.1864年,Rokitansky首先报道并命名为PMP.2010年09月我院手术确诊1例,现报道如下.

目的探讨结肠憩室急诊病例一期手术的临床疗效。方法回顾性分析14例结肠憩室急诊病例的临床资料。其中盲肠憩室穿孔3例,升结肠憩室穿孔2例、脓肿1例,降结肠憩室梗阻2例,乙状结肠憩室穿孔2例、出血2例、梗阻2例,均行一期手术切除后吻合。结果全组手术顺利,有2例切口感染,1例肺部感染,所有患者均痊愈出院,无吻合口瘘及腹腔感染等严重并发症发生。结论对具备适应证的结肠憩室急诊病例施行一期手术切除吻合是可行的、安全的。

神经鞘瘤又称雪旺细胞瘤或神经膜瘤,属临床罕见肿瘤[1],发生于消化道者极少见.我院于2009年1月手术确诊1例胃壁神经鞘瘤,治疗后临床痊愈出院,现报道如下.

前列腺癌(prostate cancer,Pca)的内分泌治疗已有60多年的历史,自1941年加拿大医生Huggins和Hodges首次报道以来,Pca的内分泌治疗即在临床上得到了广泛应用[1].目前,内分泌治疗仍是晚期Pca的主要治疗手段,其目的在于减少或消除雄激素对癌细胞生长的促进作用.主要包括去势治疗、抗雄激素药物治疗、最大雄激素阻断、间歇性雄激素阻断及雄激素非依赖性前列腺癌的治疗等.本文就目前这一领域研究的最新观点加以综述.

Objective To investigate the surgical management and its effects of colon diverticulum.Methods Clinical data of fourteen patients with colon diverticulum who underwent surgical management were analyzed retrospectively. The location of the diverticulum included 5 cases of typhlon,3 of ascending colon,2 of descending colon and 4 of sigmoid colon. All patients had surgical treatments including 5 of diverticulum resection and colocolic anastomosis ,3 of ileocecal junction resection and ileum-ascending colon end-to-end anastomosis,2 of right hemicolectomy,and 4 of sigmoid colon diverticula resection with Hartmann's operation. Result All the surgeries were successful and got good curative effects. Conclusions Surgical treatment is rational for colon diverticulum with such complications as perforation,hemorrhage,abscess and celiac infection. Different methods should be chosen according to the position,size,complications of the diverticulum and the infection extent of the abdomen.

<正>1临床资料患者女,74岁,因"右上腹疼痛伴黄疸2月余",于2007年6月25日入院。查体:消瘦,轻度贫血貌,皮肤、巩膜黄染,浅表淋巴结未触及肿大,腹平软,右上腹压痛,无反跳痛及肌紧张,腹部未触肿块。实验室检查:总胆红素(TBIL)130!mol/L,直接胆红素(DBIL)90!mol/L,碱性磷酸酶(ALP)280 U/L。腹部超声及MRI提示:胆总管结石并扩张。术前诊断:胆总管结石。剖腹探查见:肝边缘钝厚,胆总管上段明显扩张可触及结石,术中行胆道镜提示胆总管下段炎性狭窄,胃窦部可触及直径2.5 cm质硬肿块,活动好,与周围无粘连,周围无肿大淋巴结。术中切除肿

胸壁结核是胸壁软组织、肋骨和胸骨结核性感染的总称,是一种继发性疾病,多表现为结核性寒性脓肿或慢性胸壁窦道.我院于2007年2月收治1例结核性胸腔积液患者,因诊断性胸穿抽液后引起右侧胸壁结核性寒性脓肿,现报告如下.