Objective:To investigate the application of indocyanine green fluorescence imaging and negative carbon nano imaging in the identification of parathyroid glands during secondary surgery for recurrent thyroid cancer.Methods:Fifty patients with recurrent thyroid cancer undergoing secondary surgery from January 2018 to December 2021 were selected as the study objects，and were divided into two groups with 25 patients in each group by paired grouping method. Indocyanine green fluorescence imaging technology was used in the observation group and negative carbon nanography technology was used in the control group. SPSS 20.0 software was used to complete all data analysis. Postoperative complications and other statistical data were represented by（examples）. Comparison between groups was performed by χ2 test. Perioperative indicators，serum parathyroid hormone（PTH），blood calcium levels and other measurement data were represented by（xˉ±s），and independent t test was performed for comparison between groups. P<0.05 was statistically significant.Results:The accuracy of parathyroid identification in the observation group was significantly higher than that in the control group（χ2=4.635，P=0.031）. The operation cost in observation group was significantly lower than that in control group（P<0.05）. Compared with preoperative，serum PTH and blood calcium levels in 2 groups were significantly decreased 3 days and 1 month after surgery，and control group was significantly lower than observation group（P<0.05）. The total incidence of postoperative complications in observation group was significantly lower than that in control group（P<0.05），and the incidence of hypoparathyroidism was significantly lower than that in control group［1（4.0%）vs. 8（32.0%），P=0.027］.Conclusion:Identification of parathyroid glands by indocyanine green fluorescence imaging technique during secondary surgery for recurrent thyroid cancer can improve the accuracy of parathyroid identification，reduce intraoperative injuries，and reduce the incidence of postoperative hypoparathyroid function，and has more economic advantages，which is worthy of clinical promotion.

Breast cancer (BC) is the most diagnosed carcinoma in women worldwide, which is characterized with a high incidence rate and poor prognosis. MicroRNAs (miRNAs) are promising biomarkers for early detection of BC. In this study, we demonstrated that MiR1294 was downregulated in BC. Moreover, we revealed that MiRNA1294 significantly suppressed cell proliferation, migration and invasion. Animal models revealed that MiRNA1294 reduced tumor formation. In addition, we found that ERK signaling was involved in the regulatory role of MiRNA1294 in BC. In conclusion, MiRNA1294 acted as a tumor suppressor in BC, which might serve as a potential target for the development of anti-neoplastic therapies in BC.

目的:探讨快速康复外科(FTS)理念的应用对行腹腔镜结直肠癌手术患者治疗效果及对C反应蛋白(CRP)和白细胞介素-6(IL-6)水平的影响.方法:将本院2016年9月-2019年3月收治的125例结直肠癌将行直肠手术患者选为研究对象,按照模球法将其分为参照组(n=62)和观察组(n=63),围术期参照组给予常规管理模式,观察组给予FTS管理模式.比较两组手术前后CRP和IL-6水平,比较两组患者排便时间等预后指标及并发症发生率.结果:手术前两组患者CRP及IL-6水平差异无统计学意义(P>0.05),手术后3 d,两组上述指标水平较手术前均显著升高(P<0.05),观察组显著低于参照组(P<0.05);观察组排便、排气及住院时间均显著优于参照组(P<0.05);观察组并发症发生率(6.35％)显著低于参照组(20.97％),差异有统计学意义(P<0.05).结论:腹腔镜结直肠手术围术期结合FTS理念管理可显著降低患者炎症应激反应及并发症的发生率,对患者康复进程具有积极的促进作用.

近年来由于人们的饮食习惯、生活习惯发生改变,导致胆囊内结石引起的疾病发病率呈明显上升趋势,而且随着人口老年化日趋严重,使得该疾病发病率进一步提高.有关研究表明65 岁以上老年人群胆囊结石发病率高达30％,而且大部分胆囊结石患者同时伴有胆总管结石,导致治疗方案变得更加复杂,患者需要及时通过手术治疗,以保证其生命安全[1-2].传统的开腹手术治疗方式具有较大创伤性,而且患者往往康复速率缓慢,住院时间与恢复时间均较长,增加术后感染风险性.随着腹腔镜技术在临床上广泛应用,通过腹腔镜治疗胆囊结石合并胆总管结石逐渐取得了较为理想的效果.为了进一步了解ERCP+LC,LC+LCBDE 微创取石术在患者中的应用效果,现对本院收治的80 例患者进行研究,现报告如下.

目的 检测胆石症合并胆道感染患者的病原菌分布情况及其耐药性,分析其发病的危险因素,为感染的控制及合理用药提供参考. 方法 选取本院2016年8月至2019年2月收治并行手术治疗的胆石症合并胆道感染的患者200例,检测其胆汁中病原菌并进行耐药性试验;统计患者的性别、年龄、既往胆石症史、结石数、手术时间等信息,分析其与胆道感染的相关性. 结果 200例胆石症合并胆道感染患者的胆汁标本病原菌培养阳性163例,阳性率为81.5％.共培养出病原菌188株,其中革兰阴性菌(G-)142株,占75.5％;革兰阳性菌(G+)41株,占21.8％;真菌5株,占2.7％.G-菌中以大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌多见,3种菌对阿莫西林、氨苄西林舒巴坦、氨曲南、头孢唑啉、庆大霉素等11种抗菌药物的耐药率为11.1％～100％,对哌拉西林他唑巴坦、阿米卡星、头孢替坦、厄他培南的耐药率为0～8.1％.G+菌中以粪肠球菌和屎肠球菌多见,2种菌对青霉素G、氨苄西林、克林霉素、左氧氟沙星等8种抗菌药物的耐药率为16.7％～90.5％,对利奈唑烷、替加环素、万古霉素均敏感.单因素分析显示,年龄、既往胆结石史、结石数、手术时间是胆石症合并胆道感染发生的危险因素(P＜0.05). 结论 胆石症合并胆道感染的致病菌菌谱广且存在一定的耐药性,明确病原菌分布及其耐药性有利于临床合理使用药物进行治疗;感染的发生与高龄、既往胆结石史、较多的结石数和较长的手术时间等因素相关,可为该病的预防和控制提供参考.

近年来随着老年人口比例不断增加,腹股沟疝发病率明显上升,该疾病属于临床常见病,会对患者的消化系统功能产生影响,患者临床表现主要为便秘、腹痛、腹部坠胀等,会对患者的日常生活、工作带来较大的影响,而且还会导致患者生活质量大大折扣,因此患者需要及时接受手术治疗,减少病情对其自身健康产生影响.目前临床上主要通过手术方式治疗该疾病,随着腹腔镜技术不断提高,在腹股沟疝患者中应用TAPP、TEP手术治疗能够进一步提升患者治疗效果[1].但是面对2种手术治疗方式,外科医生尚有争议.其实上述2种手术方式均能够有效腹股沟疝术,但是由于2种手术路径不同,具有其各自的特点,从而容易产生差异.为了能够进一步了解TAPP、TEP手术治疗效果,分析2种手术治疗的优缺点,现对本院收治的80例患者进行研究,现报告如下.

目的 分析左氧氟沙星不同用药方法对阑尾炎术后切口感染及血清学指标的影响.方法 选取医院普外科收治的阑尾炎手术患者116例,随机分为A组和B组,每组58例.2组患者术前30 min均静脉滴注左氧氟沙星,A组术后静脉滴注左氧氟沙星注射液,每天1次;B组术后静脉滴注左氧氟沙星注射液,每天2次.比较2组术后切口感染发生率及血清学指标变化.结果 A组术后切口感染率为1.72％,低于B组的17.24％(P<0.05);A组术后血清白细胞介素-8(IL-8)、肿瘤坏死因子-α(TNF-α)及可溶性黏附因子(sICAM-1)水平低于B组(P<0.05).结论 术后单次静脉滴注400 mg左氧氟沙星可降低阑尾炎术后切口感染发生率,改善机体血清炎性因子表达.

目的 探讨腹腔镜下完全腹膜外修补膜股沟疝的临床应用效果,以期为临床上腹股沟疝治疗方案的选择提供依据.方法 选择2015年5月至2017年5月福建医科大学附属宁德市医院普外科收住的98例腹股沟疝患者为研究对象,根据随机数表法分为对照组和观察组,每组49例,对照组患者常规行开放腹股沟疝无张力修补术,观察组患者则采用腹腔镜下完全腹膜外腹股沟疝修补术,比较两组患者围手术期指标及复发情况.结果 观察组患者手术时间为(68.5±13.4)min,长于对照组的(52.8±10.5)min,差异有统计学意义(P<0.05);观察组患者术中出血量为(13.9±4.3)mL、术后12 h VAS评分为(2.4±0.8)分,均明显少于对照组的(24.8±7.4)mL、(3.9±1.2)分,术后下床时间为(14.2±4.2)h,术后住院时间为(4.2±1.3)d,均明显短于对照组的(17.9±5.7)h和(7.4±2.5)d,差异均有统计学意义(P<0.05);观察组患者术后并发症发生率为6.12％,明显低于对照组的18.37％,差异有统计学意义(P<0.05);两组患者随访期间均无复发病例.结论 腹腔镜下完全腹膜外疝修补术治疗腹股沟疝具有创伤小、术后疼痛轻、术后并发症发生率低及术后恢复快的优势.

目的 分析快速康复外科(FTS)在胆石症中的应用价值.方法 选取2015年5月-2017年5月于医院普外科接受手术治疗的胆石症患者384例.依据患者围术期处理方式不同分为观察组和对照组各192例.观察组实施FTS围术期处理方法,对照组实施传统围术期处理方法,比较2组术后排气时间、下床活动时间、平均住院时间、平均住院费用及术后并发症.结果 观察组术后排气时间、下床活动时间及平均住院天数均短于对照组,平均住院费用低于对照组,差异均有统计学意义(P<0.05).观察组并发症发生率为25.00％低于对照组的47.92％,差异有统计学意义(χ2=7.3570,P<0.05).结论 胆石症患者应用FTS围术期处理方法能够显著提升术后临床效果,降低不良反应,促进患者恢复,值得临床推广应用.

Objective To evaluate the safety and efficiency of fast tract surgery(FTS)in elder patients(more than 75 years old)receiving laparoscopic radical resection of colon cancer.Methods Eighty elder patients with colon cancer undergoing laparoscopic colectomy were divided into two groups:FTS group(n=40)and conventional care group(n=40).Main outcome measure including the postoperative first flatus time,postoperative hospital stay and complication rate.Statistical difference was evaluated via t test and chi-square testResults.All patients participated in this trial were cured.Compared to the conventional group,patients in FTS group had significantly earlier first flatus and shorter postoperative hospital stay(P<0.05).The incidence of postoperative complication in FTS was significantly higher than in conventional group(P<0.01).Conclusion FTS can effectively accelerate postoperative rehabilitation,shorten hospital stay In elder patients.But in postoperative complications,elder people cannot benefit from FTS.Therefore,popularization of FTS in elder patients should be more careful.

随着国内医疗水平的提高,越来越多地市级医院开始开展腹部大手术.由于此类患者术前多伴有营养不良、基础疾病,术后长期禁食、肠外营养支持,加之广泛使用广谱抗菌药物及各种侵入性操作,使腹部大手术后真菌性败血症的发生率逐年增多.真菌性败血症早期诊断困难,病死率高,应引起广大普外科医生的重视.我院总结3例腹部大手术后真菌性败血症的处理经验,现报告如下.

目的：分析回盲部憩室炎患者的误诊原因。方法回顾性分析医院2014年9月－2015年9月收治的误诊为急性阑尾炎患者17例的临床资料，分析误诊产生的原因。结果17例回盲部憩室炎患者误诊原因为病史询问不详细3例（17．6％），未能充分掌握疾病临床特点6例（35．3％），相关辅助检查不足8例（47．1％）。结论回盲部憩室炎临床表现与急性阑尾炎相似，较易发生误诊，应在诊断过程中准确的区分回盲部憩室炎与急性阑尾炎，从而给予患者适当的治疗，促进患者痊愈。

目的:探讨快速康复外科理念在肝切除围手术期处理中的应用效果.方法:选择2014年5月-2015年8月在笔者所在科进行肝叶切除手术的患者100例,随机分为传统组和快速康复组,每组50例.比较分析两组患者术后24 h疼痛指数、首次排气时间、术后住院时间、住院费用及术后并发症情况.结果:手术后,快速康复组术后24 h疼痛指数、首次排气时间、术后住院时间、住院费用、术后并发症发生情况均明显优于传统组,差异均有统计学意义(P<0.05).结论:快速康复外科理念在肝切除围手术期处理中具有明显的积极作用,值得临床广泛运用.

目的：观察生长抑素在腹部手术后肠梗阻治疗中的应用效果。方法将腹部手术后肠梗阻患者72例，随机分为试验组和对照组各36例，对照组给予常规保守治疗，试验组在此基础上加用生长抑素。观察2组患者胃肠减压量、肛门恢复排气时间、住院时间、腹痛缓解时间及腹胀缓解时间，随访1年，观察复发情况。结果治疗后试验组患者胃肠减压量少于对照组，肛门恢复排气时间、住院时间、腹痛缓解时间、腹胀缓解时间均短于对照组，试验组患者随访1年后复发率低于对照组，差异均有统计学意义（P ＜0．05）。结论临床应用保守方式治疗腹部手术后肠梗阻患者时，加用生长抑素具有良好的治疗效果，医师应予以重视。

Objective To analyze and discuss the difficulties and skills of laparoscopic total abdominal hernia repair (TEP). Methods Group selection the clinical data of 194 TEP patients admitted to our hospital from August 2010 to October 2015 were retrospectively analyzed. The operation difficulties encountered during operation and the corresponding surgical tech-niques were analyzed and summarized. Results 194 patients, 2 patients with peritoneal rupture transfer of transabdominal preperitoneal hernia repair (TAPP). 2 cases of patients with postoperative complications occurred in 2 cases of scrotal hematoma, hernia sac remnant hematoma. Operation time 40~140min, average time (94.26 ±15.02) min, length of stay in hospital 5~8d, average length of stay (6.19±1.41). Conclusion The key of TEP operation is how to set up the clearance of the peritoneum, separate the hernia sac, place and fix the patch and so on.

目的 分析伊马替尼耐药晚期胃肠间质瘤的治疗策略.方法 回顾性分析本院2013年1月~2013年12月收治的伊马替尼耐药晚期胃肠间质瘤患者30例的临床治疗,观察治疗患者的方法 及疗效,分析治疗策略.结果 30例患者中,采用手术切除治疗7例,采用伊马替尼增量治疗11例,采用舒尼替尼治疗12例.随访可知,手术治疗7例患者OS中位时间(87.5±6.1)周;伊马替尼增量治疗11例OS中位时间(93.2±8.4)周;舒尼替尼治疗12例OS中位时间(90.5±7.7)周.结论 临床治疗伊马替尼耐药晚期胃肠间质瘤患者时可采用的治疗方法 比较多,应依据患者的实际情况选择恰当的治疗方式,提升治疗效果,延长患者生存期.

Objective:To explore the difference of curative effect of laparoscopic total extraperitoneal surgery and transabdominal preperitoneal hernia repair for treatment of inguinal hernia.Methods:120 patients with primary hernia were selected,they were randomly divided into laparoscopic total extraperitoneal surgery group and transabdominal preperitoneal hernia repair group with 60 cases in each,we compared the treatment effect of the two groups.Results:The operation time of laparoscopic total extraperitoneal surgery was significantly shorter than that of transabdominal preperitoneal hernia repair(P<0.05),there was no significant difference between the two groups in complications.Conclusion:Laparoscopic total extraperitoneal surgery had many advantages,such as short operation time and rapid recovery of patients.

目的:探讨腹腔镜联合胆道镜微创手术对胆囊结石患者胆盐转运因子胆盐输出泵(BSEP)、多重耐药蛋白2(MRP2)和牛黄胆酸钠转运蛋白(NTCP)水平的影响.方法:选取我院普外科收治的胆囊结石患者20例排除手术和麻醉禁忌症,予腹腔镜联合胆道镜微创手术治疗.治疗结束后,对比治疗前后患者BSEP、MRP2、NTCP水平变化.结果:①治疗后患者肝脏组织中BSEP、MRP2水平明显比治疗前升高,差异有统计学意义(P＜0.05);②治疗后患者肝组织中NTCP水平与治疗前水平无明显变化,差异无统计学意义(P＞0.05).结论:腹腔镜联合胆道镜微创手术治疗胆囊结石能升高患者胆盐转运因子BSEP、MRP2水平,提高患者术后对胆盐的转运和胆汁酸的代谢,降低胆囊结石复发率,对临床具有指导意义,值得临床推广.

目的:探讨成人特发性巨结肠的发生原因、临床特点及其手术处理方法。方法:对2005至2011年我院收治的成人特发性巨结肠15例临床资料进行回顾分析。结果:男8例,女7例,年龄19-68岁。合并乙状结肠扭转3例。15例均有不同程度的腹痛、腹胀和肛门停止排气排便,14例有恶心、呕吐。结论:成人特发性巨结肠是以高度腹胀为主的肠梗阻表现,术中行全结肠灌洗,行巨结肠一期切除吻合安全可行。

为总结吻合器痔上黏膜环切术(PPH)治疗重度痔的经验,回顾2009年1月至2011年2月于我院接受PPH治疗的120例重度痔患者资料,对其手术时间、术后住院时间和术后出血、尿潴留、剧烈疼痛、复发等情况进行分析.结果显示,本组120例患者全部治愈.平均手术时间为(24.63±5.40) min；术后平均住院时间为(4.97±1.49)d.术后大出血(＞300ml)1例,尿潴留30例,剧烈疼痛6例,无肛门狭窄、大便失禁发生.术后随访1个月至2年,均无复发.结果表明,PPH治疗重度痔操作简单易行、手术时间短、患者痛苦小、恢复快,疗效肯定.但要严格掌握PPH适应症,加强术中操作及术后并发症的防治.