Background Laparoscopic common bile duct exploration (LCBDE) is a minimally invasive procedure for the removal of bile duct stones that is often performed by experienced hepatobiliary surgeons; beginners do not easily master this approach. Aim To investigate the effectiveness and practicality of a three-dimensional printed (3DP) anatomical model based on radiographic images in the training of LCBDE techniques and formulate standardized educational workflows. Methods Colored LCBDE training models were produced using 3DP technology. Twenty standardized training trainees were randomly divided into two groups: a 3DP model training group and a traditional laparoscopic simulation training group. Both groups received the same number of teaching hours. After a 4-weeks training course, the trainees’ subjective and objective progress in basic knowledge and manipulations were evaluated and compared. Results Compared with traditional laparoscopic simulation, 3DP model simulation training is of great significance in improving trainers' understanding of surgical procedures and cooperation during the operation. Trainees with 3DP models training demonstrated a significant improvement in their understanding of the key points of surgery (χ2 = 6.139, p = 0.013) and skills scores, especially in core procedural steps operation. More importantly, the trainees showed higher levels of satisfaction and self-confidence while assisting in the surgery. Conclusion With the development of 3DP models, improvements in the learning effect for theoretical understanding and practical skills were significant. The present study is the initial educational experience with 3DP models to facilitate the operational capabilities of the trainees for LCBDE.

背景与目的:胰管出血(HP)是罕见的上消化道出血的原因,目前尚无公认的诊疗标准.本研究总结近40年来文献报道的HP患者的临床特征,以期加深对HP的认识,提高早期识别与诊断的能力,为临床规范诊疗策略方面提供一定的理论依据.方法:收集1977年1月—2021年12月公开发表关于HP的相关文献,分析HP患者的病因、临床表现、实验室检查、影像学检查、诊断治疗及预后情况.结果:纳入文献151篇,共333例患者,其中男性267例,女性66例,男女比例约为4∶1;年龄3～94岁,平均45.9岁.病因以胰腺炎(82.3%)最常见,其中慢性胰腺炎占89.1%,其次为胰周动脉瘤(6.0%)和胰腺肿瘤(5.4%).最常见的临床表现为黑便(74.2%)和腹痛(53.8%).影像学诊断主要依靠上消化道内镜、腹部增强CT及腹腔相关动脉造影,282例行上消化道内镜检查,共140例(49.6%)可以经内镜检查明确诊断.204例行腹部CT检查,其中假性动脉瘤120例(58.8%)、假性囊肿46例(22.5%)、胰腺肿瘤15例(7.4%)、胰周动脉瘤13例(6.4%)、胰管结石4例(2.0%).193例患者行腹腔相关动脉造影检查,112例(58.0%)显示阳性结果.最常见出血源是脾动脉(41.2%),其次是胃十二指肠动脉(16.7%)、囊壁出血(9.9%)、胰十二指肠动脉(9.6%).36例患者选择保守治疗.180例患者尝试了介入治疗,147例(81.7%)患者成功;140例患者接受手术治疗.9例患者选择其他治疗方式.218例患者的随访结果显示,197例(91.4%)无复发性出血,13例(6.0%)再出血,5例(2.3%)死亡.结论:HP确诊较为困难,应结合病史、临床表现综合判断,必要时进行重复的影像学检查以提高诊断率.治疗以针对病因为主导的综合治疗为主,同时根据疾病的临床进程选择恰当的治疗方式.

Objective:To analyze the clinical effects of orthostomy preperitoneal repair and laparoscopic Sugarbaker in the treatment of parastostomy hernia.Methods:Sixty patients who underwent parastostomy hernia repair from January 2017 to April 2022 were retrospectively analyzed and divided into two groups with 30 cases each according to different operation methods. The observation group underwent in situ preperitoneal repair and the control group underwent laparoscopic Sugarbaker operation. All data were analyzed using SPSS 22.0 software. Measurement data of perioperative indexes，pain scores and ostomy function scores were represented by（xˉ±s），and independent t test was performed for comparison between groups. The number of postoperative complications and recurrence rate were compared among the data groups by χ2 test. P<0.05 was considered statistically significant.Results:The first exhaust time and hospitalization cost of the observation group were better than those of the control group，but the intraoperative blood loss and drainage tube removal time of the control group were better than those of the observation group，the difference was statistically significant（P<0.05）. The pain scores of the observation group were significantly lower than those of the control group at 1 d and 3 d after surgery，and the ostomy function scores at 7 d after surgery were significantly higher than those of the control group（P<0.05）. There was no significant difference in the total complication rate and recurrence rate between the two groups（P>0.05）.Conclusion:Compared with laparoscopic Sugarbaker，the treatment of parastostomy hernia with orthostomy preperitoneal repair results in less postoperative pain，faster recovery of intestinal function，better ostomy function，and less financial burden for patients.

Objective:The effects of longitudinal “U” suture，“Double R” and traditional pancreatic duct jejunal mucosa anastomosis in laparoscopic pancreaticoduodenectomy（LPD）were compared and analyzed.Methods:A total of 108 patients with LPD from January 2018 to April 2021 were selected and divided into U-shaped group，Double R group and traditional group by random number table method，36 patients in each group，U-shaped group underwent pancreaticojejunostomy by longitudinal “U” suture，Double R group underwent “Double R” pancreaticojejunostomy，and traditional group underwent traditional pancreaticojejunostomy. SPSS 22.0 was used for statistical analysis. Perioperative indicators and postoperative quality of life were expressed by（xˉ±s），one-wayANOVA was performed for comparison between multiple groups，and LSD-t test was performed for pairwise comparison between groups. Postoperative complications were analyzed by χ2 test. P<0.05 indicated statistically significant difference.Results:The operation time and pancreaticoenterostomy time of U-shaped group were shorter than those of Double R group and traditional group，and Double R group was shorter than traditional group（P<0.05）；The length of postoperative hospital stay in U-shaped group and Double R group was shorter than that in traditional group（P<0.05）；There was statistically significant difference in the total incidence of postoperative complications among the three groups（P<0.05），and the Double R group was significantly lower than the traditional group（χ2=5.791，P=0.016）；Three months after surgery，scores of physical function，psychological function，social function and material life status in Double R group were significantly higher than those in U-shaped group and traditional group，and U-shaped group was higher than traditional group（P<0.05）.Conclusion:Compared with longitudinal U-shaped suture，“Double R” pancreaticojejunostomy in LPD has advantages in reducing postoperative complications and improving postoperative quality of life of patients，although it can prolong the operation time and pancreaticojejunostomy time. Therefore，it is worthy of clinical application.

Objective:To evaluate the application value of radionuclide hepatobiliary imaging and ultrasonography in patients undergoing gallbladder-preserving surgery.Methods:Clinical data of 40 patients with cholecystolithiasis who underwent laparoscopic and rigid choledochoscopic cholelithotomy in the Second Affiliated Hospital of Air Force Medical University from June to December 2017 were retrospectively analyzed. Among them, 16 patients were male and 24 female, aged(42±13) years on average. The informed consents of all patients were obtained and the local ethical committee approval was received. All the patients received 99mTc-EHIDA radionuclide hepatobiliary imaging and abdominal ultrasound to evaluate the contractile function of gallbladder. According to the ultrasound results, patients with gallbladder contraction rate between 30% and 60% were assigned into group A (n=30) and those with gallbladder contraction rate >60% were allocated into group B (n=10). The gallbladder ejection fraction (GBEF) measured by radionuclide hepatobiliary imaging were compared by t test betweentwo groups. The correlation between two detections was analyzed by linear correlation analysis. The success of gallbladder-preserving surgery was considered as the gold standard for diagnosis. The diagnostic efficiency of two methods were statistically compared by the ROC curve.Results:33 patients underwent gallbladder-preserving cholelithotomy successfully, including 24 cases in group A and 9 cases in group B. GBEF was (32±19)% in group A and (61±11)% in group B, where significant difference was observed (t=2.200, P<0.05). The gallbladder contraction rate was positively correlated with GBEF (r=0.070, P<0.05). The area under ROC curve (AUC) of diagnosis by GBEF was 0.952, the specificity was 0.88, the sensitivity was 1.00, and the accuracy rate was 90%. The AUC of diagnosis by gallbladder contraction rate was 0.721, the specificity was 0.55, the sensitivity was 0.88, and the accuracy rate was 60%. Significant difference was noted between two AUCs (Z=3.299, P<0.05). During the 24-month follow-up, no recurrence of gallbladder stones occurred in group A and 1 case of recurrence was reported in group B at postoperative 20 months.Conclusions:Radionuclide hepatobiliary imaging can better evaluate the contractile function of gallbladder as well as the patency of biliary tract. Ultrasound examination is more reliable when the biliary tract is occluded. Radionuclide hepatobiliary imaging combined with ultrasound examination can provide more reliable reference for gallbladder-preserving cholelithotomy in patients with cholecystolithiasis.

背景与目的:胰瘘是胰体尾切除(DP)术后最常见并发症,其与患者的预后及转归有着密切的关系.因此,本研究在探讨DP术后胰瘘发生情况及其影响因素,为制订防治措施提供依据.方法:回顾性分析2015年1月—2021年2月中国人民解放军空军军医大学第二附属医院收治的99例因胰腺肿瘤行DP术患者的临床资料,统计患者术后胰瘘的发生率,对可能导致术后胰瘘发生的相关因素行单因素及多因素Logistic回归分析.结果:99例患者DP术后生化漏发生率为34.3％ (34/99),B级胰瘘发生率18.2％ (18/99),C级胰瘘发生率1.0％ (1/99).单因素分析结果示,年龄、手术时间、胰管直径及是否联合脾切与胰瘘发生明显有关(均P＜0.05),多因素Logistic回归分析结果示,年龄＜42岁(OR=0.955,95％CI=0.914～0.998)、手术时间≥253 min (OR=1.013,95％ CI=1.005～1.021)及联合脾切术(OR=4.152,95％ CI=1.043～16.535)为DP术后胰瘘的独立危险因素(均P＜0.05).结论:DP术后有一定的胰瘘发生率,年龄、手术时间、联合脾切是DP术后胰瘘的独立危险因素.这些危险因素评估对术后胰瘘的风险预测及防范措施的制定提供了一定的依据.

目的 探讨腹腔镜、胆道镜及十二指肠镜联合治疗肝外胆管结石的效果.方法 将我院收治的102例肝外胆管结石患者按照手术方式分为对照组和观察组,各51例.对照组采用腹腔镜治疗,观察组应用腹腔镜、胆道镜及十二指肠镜联合治疗.比较两组的治疗效果.结果 术后3 d,观察组MTL、CCK、CEA、CA19-9水平均优于对照组(P<0.05).两组胆道压力于术后1 d升高,术后3 d下降,但差异无统计学意义(P>0.05).术后3个月,观察组GLQI评分高于对照组(P<0.05).结论 腹腔镜、胆道镜及十二指肠镜联合治疗肝外胆管结石能有效降低CEA、CA19-9、CCK水平,对MTL的影响小,且不会引起胆道压力骤升,值得临床推广.

Objective To investigate the role of radionuclide hepatobiliary scintigraphy in the evaluation of gallbladder contraction function, and to provide a theoretical basis for preoperative evaluation of gallbladder contraction function in patients undergoing laparoscopic-hard endoscopic gallbladder-preserving cholecystolithotomy. Methods A total of 47 patients with gallstones who were admitted to The Second Affiliated Hospital of Air Force Medical University from June to December, 2016, and underwent 99mTc-EHIDA hepatobiliary imaging to evaluate gallbladder contraction function were enrolled. The radioactive count of the gallbladder was measured after fat meal and gallbladder contraction function was evaluated. A comparative analysis was performed based on intraoperative exploration and gallbladder-preserving outcome. Results A total of 26 patients with negative results of the EHIDA gallbladder contraction test underwent a successful gallbladder-preserving surgery, and some of them had no recurrence of stones after 24 months of follow-up. Among the 12 patients with impaired gallbladder contraction function shown by EHIDA, 1 underwent cholecystectomy due to roughness of the gallbladder wall and deposition of a large amount of cholesterol crystal, and 11 underwent gallbladder-preserving cholecystolithotomy. Among the 9 patients without the image of the gallbladder, 1 was found to have stones with a diameter of 2 cm embedded in the neck of the gallbladder by intraoperative exploration and underwent gallbladder-preservation surgery, and no recurrence of gallbladder stones was observed after 24 months of follow-up; the remaining 8 patients underwent cholecystectomy. Conclusion 99mTc-EHIDA hepatobiliary scintigraphy has a certain value in evaluating gallbladder contraction function, but it cannot be used as the only evidence for the selection of surgical approach. Laparoscopic-hard endoscopic intraoperative exploration is a strong evidence for the selection of gallbladder-preserving surgery, and formal industry standards can be developed.

目的 研究甲状腺乳头状癌(PTC)p53基因及蛋白的表达情况及临床意义.方法 选择143例该院住院手术切除的PTC石蜡标本,另外收集同期因甲状腺良性病变切除的正常甲状腺组织标本68例.分别采用免疫组化法及western blot法检测PTC组织和正常甲状腺组织中p53蛋白的表达情况;采用实时荧光定量聚合酶链反应(RT-PCR)测定PTC组织和正常甲状腺组织中p53 mRNA相对表达量;探讨p53蛋白表达与PTC临床病理特征的关系;采用Kaplan-Meier法进行生存分析,分析p53蛋白表达与PTC患者预后的关系.结果 免疫组化结果显示,p53蛋白在PTC组织中呈阳性表达;RT-PCR结果显示,PTC组织中的p53 mRNA表达高于正常甲状腺组织(P<0.05);western blot结果显示,p53蛋白在PTC组织中表达水平明显高于正常甲状腺组织(P<0.05).PTC组织中p53蛋白的表达水平与性别 、年龄 、肿瘤直径 、肿瘤分化程度无关(P>0.05),而与TNM分期 、淋巴结转移有关(P<0.05).Kaplan-Meier法生存分析显示,p53蛋白阳性表达组5年生存率明显低于p53蛋白阴性表达组(P<0.05).结论 p53基因及蛋白在PTC中大多表达上调,参与PTC的发生 、发展,影响患者预后,值得临床重视.

目的 系统评价螺旋CT及经食管超声心动图诊断疑似主动脉夹层人群的价值.方法 检索中英文数据库关于疑似主动脉夹层前瞻性诊断的研究,纳入文献质量以Quality Assessment of Diagnostic Accuracy Studies进行评估,以Review Manager及Meta-DiSc软件对纳入研究进行分析.结果 最终纳入15篇研究.Meta结果示,CT诊断主动脉夹层的灵敏度为0.98,95％ CI(0.93,0.98);特异度为0.91,95％ CI(0.87,0.95);阳性似然比为15.39,95％ CI(4.31,55.00);阴性似然比为0.06,95％ CI(0.03,0.10);诊断比值比为392.92,95％CI(66.31,2 328.34);曲线下面积为0.987 7;经食管超声心动图诊断主动脉夹层的灵敏度为0.94,95％CI(0.91,0.96);特异度为0.96,95％CI(0.93,0.98);阳性似然比为14.70,95％CI(7.65,28.24);阴性似然比为0.06,95％ CI(0.03,0.13);TEE的诊断比值比为324.06,95％ CI(97.42,1 077.97);曲线下面积为0.9811.CT和TEE诊断主动脉夹层价值差异无统计学意义(Z =0.3054,P＞0.05).结论 螺旋CT及经食管超声心动图对疑似主动脉夹层的人群均有较高的诊断价值.

目的 探究胆源性急性胰腺炎经普外手术治疗时机的临床效果.方法 选取本院2016年1月至2017年3月收治的胆源性急性胰腺炎患者88例作为研究对象,采用随机数字法将患者分为对照组(44例)和观察组(44例).对照组予以延期手术治疗,观察组予以早期手术治疗.比较两组患者的临床疗效.结果 治疗后,观察组的住院时间明显短于对照组,24 h引流量明显少于对照组,APACHEⅡ评分明显低于对照组,差异均具有统计学意义(P<0.05);观察组患者的并发症总发生率和病死率明显低于对照组,差异均具有统计学意义(P<0.05).结论 胆源性急性胰腺炎患者选取早期手术治疗能有效减少并发症发生,提高临床治疗疗效,值得临床推广.

BACKGROUND The colon plays a key role in regulating the homeostasis of bile acids. AIM The present study aims to evaluate the influence of colon cancer towards the homeostasis of bile acids. METHODS The free and conjugated bile acids were determined using ultraperformance LC (UPLC) coupled with ABI 4000 QTRAP triple quadrupole instruments. RESULTS The results showed that the free bile acids in serum of patients with colon cancers tend to increase, and the conjugated bile acids tended to decrease, especially for taurolithocholate (TLCA) (p<0.001). CONCLUSION The alteration of bile acids balance in colon cancers indicated the possibility of complicated diseases due to the disrupted balance of bile acids.

Metabolomics is a sophisticated technique recently applied for elucidation of mechanism of drug therapeutic role. The present study aims to investigate the metabolomics influence of acetaminophen-induced liver toxicity by glycyrrhizin (GL) which is a major sweet-tasting compound from liquorice root. The results showed that pre-treatment with GL for 15 days (800 mg/kg/day, i.p.) can efficiently prevents the acetaminophen (APAP)-induced metabolomics profile alteration, and inhibition of the elevation of bile acids components taurocholic acid (TCA) and tauro-muricholic acid (T-MCA) mainly contributed to this alteration. This phenomena well correlated with the protection of GL towards APAP-induced liver toxicity, as indicated by the improvement of histology change induced by APAP treatment. All these results indicated the potential mechanism of GL towards APAP-induced liver toxicity through reversing bile acids alteration induced by APAP treatment.

目的 回顾性总结使用硬质胆囊镜(硬镜)进行保胆手术治疗胆囊结石的经验与体会,并制定胆囊结石分级分期治疗策略(唐都经验/标准).方法 对该科2009年12月～2012年12月441例行硬镜取石保胆术患者进行回顾性分析.结果 441例胆囊结石患者均行手术治疗,其中11例失访,失访率为2.4％.6例患者出现术后并发症,其中胆囊结石复发2例(0.47％),胆囊周围积液3例(0.7％),胆漏1例(0.23％),其余424例效果均满意.结论 取石保胆术是一种尚有争议,但逐渐被认可的手术治疗方式,可以成为治疗胆囊结石的主要治疗方法.笔者制定的“GUW”胆囊结石分级分期治疗策略(唐都经验/标准)有望成为这一治疗方式的评价体系标准.

<正>副神经节瘤是起源于副神经节细胞的肿瘤,1908年Alezai's和Peyron首先报道了一组副神经节瘤病,1912年Pick建议将肾上腺内嗜铬细胞瘤命名为嗜铬细胞瘤,而肾上腺外嗜铬性肿瘤称副神经节瘤。一般将位于肾上腺外的副神经节瘤通常以其解剖部位命名,据相关学者统计,55.2%位于腹膜后区域;25.6%位于头颈部;5.6%位于膀胱;3.2%位于纵隔[1]。肝脏原发性副

目的:通过分析酒精性胰腺炎发病原因,寻找治疗酒精性胰腺炎最佳方法。方法:选择2009年3月～2012年3月在我院治疗酒精性胰腺炎60例患者的临床资料进行回顾分析。结果:60例患者通过保守治疗后,46例患者得到治愈,5例出现并发症状,9例患者转为手术治疗,总治愈率为76.7%。结论:医护人员要保持高度的责任心,了解酒精性胰腺炎的发病机制,并采取有效的治疗方法,帮助患者恢复健康。

目的:研究肝门部胆管癌的手术治疗方法及疗效。方法:2008年1月～2010年12月我院共对40例肝门部胆管癌患者进行手术治疗,观察并分析其疗效。结果:在该组病例中,选择手术切除术的患者30例,占75.0%;选择胆管内引流术的患者10例,占25.0%,行手术切除术的患者其生存中位时间及术后的生存率明显高于行内引流术的患者,手术切除组患者的临床疗效明显优于内引流组(P<0.05),差异具有统计学价值。结论:对肝门部胆管癌患者进行手术治疗具有极好的临床治疗效果,值得进一步推广及运用。