Object:To investigate the relationship between the expression of serum CA19-9 and the prognosis of choledocholithiasis treated by laparoscopy combined with choledochoscopy.Methods:In this study,100 patients with choledocholithiasis underwent laparoscopy combined with choledochoscopy were recruited and 38 patients with recurrence of choledocholithiasis and 62 patients with non-recurrence of choledocholithiasis were recruited.According to the retrospective cohort principle,the level of CA19-9 in patients with recurrence and the relationship between the potential impact factors.SPSS 17.0 software was used to complete the relevant statistical analysis.Results:The levels of CA19-9 in recurrent group and non-relapse group before and after operation were significantly higher than that in recurrence group (22.36 ± 2.68 pg · ml-1,(20.37 ± 2.97 μg · ml-1).The level of CA19-9 in the relapse group was lower than that in the non-relapse group (P ＜ 0.05).The level of CA19-9 in the relapse group decreased to 20.33 ± 3.11 μg · ml-1,(18.74 ± 3.04 iμg · ml-1),recurrence group was higher than that of non-recurrence group (P ＜ 0.01).Meanwhile,CA19-9 level in both groups was significantly lower than preoperative level,and the positive rate was significantly lower,P & It;0.01.Multivariate logistic regression analysis showed that the risk of recurrence of choledocholithiasis was 1.428 (1.267 ～ 1.609) times higher than that of patients with elevated serum CA19-9 level,which was an independent risk factor,P ＜0.001;jaundice,Overweight and obesity,previous history of bursitis and hypertension were also risk factors for recurrence of common bile duct stones.The OR values were 1.410 (1.043 ～ 1.906),1.095 (1.082 ～ 1.108),1.095 (1.082 ～ 1.108) and 1.048 (OR =1.043 ～ 1.054),P ＜ 0.05).In addition,age increased and men showed weak protective factors,OR values were close to 1,0.959 (0.953 ～ 0.965) and 0.770 (0.722 ～ 0.820),respectively.Conclusion:The increase of CA19-9 level is associated with the prognosis of recurrence for choledocholithiasis,and is influenced by jaundice and otherpotential factors.

目的：探讨 LBL、PBL、CBL 3种教学方法在临床专科学生普通外科教学中分阶段应运的效果及意义。方法在临床专科学生普通外科教学中分别在临床见习时使用 LBL 教学法，在临床实习时采用 PBL 教学法，在“3+2”培养时采用 CBL 教学法。结果临床专科学生对普通外科教学的满意度提高，对普通外科疾病的认识加深，临床思维能力及临床技能提高。结论不同教学法在临床专科学生普通外科教学中分阶段应运效果满意，较传统教学方法优势明显。

目的 探讨胆囊切除术中经胆囊管行胆道造影的临床应用价值以及注意事项.方法 回顾性分析96例行胆囊切除术中实施了经胆囊管胆道造影术的患者临床资料.结果 造影发现胆总管结石18例,行胆总管切开探查取出结石及T管引流术；发现右肝管损伤1例,行右肝管修补术,愈后良好,无胆漏；其余77例造影阴性病人行单纯胆囊切除.所有患者均康复出院,无死亡病例.结论 胆囊切除术中经胆囊管行胆道造影,可减少胆管残留结石,避免胆道阴性探查,及时发现、处理胆道损伤,减少并发症,避免发生严重后果.

目的 探讨经脐单孔腹腔镜胆囊切除术的安全性.方法 2010年10月～2012年12月我院行经脐单孔腹腔镜胆囊切除术42例.于脐右缘沿脐孔做长2.5 cm弧形切口,置入通道器建立气腹.采用直针带线自右上腹胆囊体表投照点垂直刺入腹腔,将直针引入体内后,于胆囊底部穿过浆肌层(尽量不穿透全层,以免胆汁外漏),再将直针穿出体外,固定缝线,将胆囊底部提起,便于显露胆囊三角区.置入1把预成形分离钳及可转弯分离钳,解剖出胆囊管及胆囊动脉后,可吸收夹分别夹闭胆囊管和胆囊动脉,普通钛夹夹闭远端胆囊管,离断胆囊管,电钩断开胆囊动脉后,夹住胆囊壶腹部,将胆囊向右侧展开,顺行切除胆囊.结果 2例因为局部解剖不清,改为两孔手术,其余40例均成功.手术时间40～135 min;出血10～50 ml.1例切口感染,其余无并发症发生.除1例合并糖尿病因切口感染延期出院外,其余患者均在术后2d出院.42例随访,10例随访1年,25例随访3个月,7例随访1个月,患者恢复良好,无不良反应发生,切口美观.结论 经脐单孔手术安全可行,只要病例选择适当,使用专用器械完全可以达到传统LC的治疗效果,切口美观,达到无瘢痕目的.

1996～2006年,我们共收治胰腺外伤患者27例.现将其诊治体会报告如下. 资料与方法:本组中男23例、女4例,年龄4～50岁.车祸伤14例,坠落伤4例,挤压伤4例,脚踢伤1例,刀刺伤4例;合并脾破裂9例,肠系膜根部及腹膜后血肿14例,肝破裂5例,十二指肠破裂4例,胆总管断裂1例,结肠破裂3例,胃破裂及肾破裂各2例,胸外伤5例,四肢及脊柱骨折6例,颅脑外伤1例,肠系膜上动静脉及门静脉损伤4例;21例合并失血性休克.

目的分析医源性胆管损伤的原因、诊断、治疗及预防。方法对22例医源性胆管损伤进行回顾性分析。结果胆管损伤仍以胆囊切除术为主,主要原因是:主客观两方面因素。各种类型的胆管损伤应采取不同的方法及早处理。手术方法以胆管断端对端吻合及胆肠Roux-Y吻合术为主。术中发现最重要,以胆管断端对端吻合为首选;对术后黄疸的患者,应考虑到有胆管梗阻,PTC检查可明确诊断并能确定梗阻部位,手术方法以胆肠Roux-Y吻合术为主。对胆瘘的患者尽早做腹腔引流术,3个月后再做胆管重建术,以胆肠Roux-Y吻合术为主。结论预防胆管损伤是关键。应正确掌握胆管损伤的早期诊断及处理方法。术中诊断最重要,手术方法以胆管断端对端吻合及胆肠Roux-Y吻合术为主要术式。

胆总管切开探查T管引流是肝胆外科常见的手术,拔除T管后胆漏的发生率并不高,文献报道不足1%[1].但是一旦出现处理不当,后果会很严重甚至危及生命.

腹部卒中(abdominal apoplexy)是指腹腔内血管自发性破裂出血.因为出血部位多发生在血管分支处与脑卒中的机理有相似之处而得名.它不包括异位妊娠、自发性肝脾肾破裂以及腹主动脉瘤破裂出血.

腹部卒中(abdominal apoplexy)是指腹腔内血管自发性破裂出血,临床罕见.我们收治2例,报告如下.

目的:探讨术后早期炎性肠梗阻的病因、诊断、治疗及预防.方法:分析12例术后早期炎性肠梗阻,结合文献,总结临床特点及表现,提出诊断、治疗及预防措施.结果:12例病人经胃肠减压,肠外营养支持,应用生长抑素、肾上腺皮质激素等治疗,均痊愈.平均治愈时间为15.8天.结论:术后早期炎性肠梗阻是一种机械性与动力性同时存在的粘连性肠梗阻,经保守治疗绝大多数均能治愈,若无肠绞窄坏死征象,保守治疗至少2周以上,而不应急于手术.

患者,男,50岁.因阵发性右上腹绞痛15天,伴寒战、高热,无黄疸,于2000年8月1日住院.5年前有黄疸病史,经治疗好转.查体:右上腹及剑突下轻压痛,Murphy征(+).血象:WBC 18.3×109/L,Hb 140g/L.GGT 444U/L,AKP 9.10μmol* s-1/L,TBil 8.94μmol/L,DBil 4.50μmol/L.尿常规:Bil() UBG(+).B超:胆囊7.0cm×3.0cm,壁毛糙.肝外胆管直径3.5cm,下端可见结石影.择期手术.术中见胆囊颈部与胃前壁小弯侧致密粘连,切开胆囊底部,见少量泥沙样结石,胆囊颈与胃前壁形成内瘘,瘘口直径0.8cm,剪断内瘘,修补胃瘘口,逆行切除胆囊.探查胆总管直径约4.0 cm,末端堵塞,取出大量泥沙样结石及数块黑结石,直径0.5～3.0cm.造影无结石残留并置T管引流,术后2周拔管,痊愈出院.