目的 探究胆囊癌切除术围手术期输血与术后生存和无瘤生存的关系.方法 回顾性分析2015年6月至2019年6月于浙江省金华市人民医院和甘肃省人民医院接受胆囊癌切除术治疗的72例患者临床资料,根据患者围手术期是否输血分为输血组33例和非输血组39例.采用倾向性评分匹配对两组基本资料进行匹配.比较两组一般资料及2年总生存率、无瘤生存率,采用Cox风险回归模型分析患者术后生存和无瘤生存的危险因素.结果 倾向性评分匹配后,72例患者中配对成功60例,输血组与未输血组各30例.两组一般资料比较,差异无统计学意义(P＞0.05).随访截至2021年6月,输血组、未输血组中位生存期分别为12、24个月.两组总生存期比较,差异有统计学意义(P＜0.05);两组无瘤生存期比较,差异有统计学意义(P＜0.05).Cox风险回归模型分析显示,在矫正TNM分期、肝侵犯因素后,围手术期输血使患者死亡风险增加2.021倍,使患者肿瘤复发风险增加1.762倍.结论 围手术期输血可降低胆囊癌切除术患者术后2年总生存率和无瘤生存率.

ObjectiveTo investigate laparoscopic transabdominal preperitoneal procedure(TAPP)value in the treatment of bilateral inguinal hernia.MethodsFrom July 2013 to December 2014 in our hospital,we performed TAPP treatment of bilateral inguinal hernia 21 cases. We established pneumoperitoneum after anesthesia,and satisfied the hernia contents back,and separated preperitoneal space,and free hernia,and free the spermatic cord or uterine round ligament,pubic separation gap(Retzius space)and the groin after a gap(Bogrus gap). At last the patch is complete coverage of bilateral pubic muscle hole,and weclosed the peritoneum cracks.Results21 cases were successfully completed by laparoscopic transabdominal preperitoneal procedure,including eight cases of intraoperative findings concealed hernia. The operation time 73~115min,the average 95min. The blood loss was 10 ~ 80 ml,average 32ml. Two cases developed hernial sac,and mass disappeared after subcutaneous aspiration. One case suffer from urinary retention,2d after indwelling catheter removal. Serious complications futile sheet rejection,no vital organs,vascular damage,no intestinal obstruction,abdominal hernia occurred. 19 cases were followed up 8 to 26 months,an average of 18 months,no recurrence.ConclusionsTAPP has its irreplaceable value bilateral inguinal hernia surgery in other waysand is safe,effective and feasible for bilateral inguinal hernia or suspected patients with bilateral inguinal hernia should be preferred.

OBJECTIVE To prospectively study the risk relationship between four kinds of routine testing of liver enzymes and HBV‐related liver cancer ,so as to provide a reference for the clinical diagnosis .METHODS Clinical data of 294 HBV patients treated in our hospital from Jun .2008 to Jun .2013 were collected .The relationship of four kinds of routine testing of liver enzymes (alanine aminotransferase [ALT ] , aspartate aminotransferase [AST ] ,alkaline phosphatase [ALP] ,and γ‐glutamine GGT [GGT ]) with clinicopathological characteristics of patients were evaluated .The predictive values of all four kinds of liver enzymes in HBV‐related liver cancer were analyzed by Kaplan‐Meier and logistic methods .RESULTS In 294 patients ,a total of 26 patients developed into liv‐er cancer at the end of follow‐up ,with the incidence of 8 .8% .In four kinds of liver enzymes ,GGT and ALP were independent risk factors for HBV‐related liver cancer .Prediction model (AG) based on ALP and GGT could effec‐tively predict the risks of liver cancer in patients with hepatitis B .CONCLUSION Serum GGT and ALP are predic‐tors of the occurrence of hepatitis B patients with liver cancer .

OBJECTIVE To explore the risk factors for postoperative nosocomial infections in patients of department of general surgery and put forward the coping strategies according to the related factors so as to reduce the infec‐tion rate .METHODS A total of 1 200 patients who underwent surgeries in department of general surgery from Jun 2012 to Jun 2015 were retrospectively analyzed .The univariate analysis and multivariate logistic regression analysis were performed for the incidence of postoperative infections ,distribution of specific infection sites ,and distribu‐tion of major species of pathogens .RESULTS Of the 1 200 patients ,71 had infections ,with the infection rate 5 .9% .The lower respiratory tract ,urinary tract ,and upper respiratory tract ranked the top 3 infection sites .To‐tally 96 strains of pathogens were isolated ,including 33 (34 .4% ) strains of gram‐positive bacteria ,62 (64 .6% ) strains of gram‐negative bacteria ,and 1 (1 .0% ) strain of fungus .The result of statistical analysis showed that the incidence of postoperative infection could be significantly influenced by the no less than 60 yeas of age ,BMI no less than 24 kg/m2 ,complication with underlying disease ,emergency surgery ,length of incision no less than 10 cm , operation duration no less than 3 hours ,invasive operations ,and length of hospital stay no less than 10 days (P<0 .05);the independent risk factors for the postoperative infection in the patients of department of general surgery included the no less than 60 yeas of age ,BMI no less than 24 kg/m2 ,length of incision no less than 10 cm ,and length of hospital stay no less than 10 days .CONCLUSION There are a variety of risk factors for the postoperative incision infections in the department of general surgery .It is necessary to take into account by starting from the self factor ,surgery factor ,health care worker factor and hospital management factor and strengthen the management of the surgery patients so as to reduce the infection rate .

目的:研究甲胎蛋白修饰的树突状细胞诱导抗肝癌的免疫作用.方法:选择12例健康志愿者随机分为观察组和对照组(n=6).对照组采用GM-CSF和IL-4继续培养,观察组加入AFP(甲胎蛋白)阳性的肝癌细胞株Bel-7402.分析两组细胞表型并观察CD80、CD86以及HLA-DR等表达,释放IFN-γ的激活T细胞数以及特异性抗肝癌CTLs的百分率.结果:观察组诱导的DCs成熟表型中CD80、CD86和HLA-DR的比率均显著高于对照组(P＜0.05),诱导CTLs结合表位肽A和表位肽B的阳性细胞数也均显著高于对照组(P＜0.05),而对照组中平均每105个T淋巴细胞可检测到的分泌IFN-γ的斑点数为(11.25±2.33)个,则显著低于观察组(P＜0.05).结论:甲胎蛋白修饰的树突状细胞在诱导抗肝癌免疫中疗效较好,值得临床推广.

目的：比较腹腔镜阑尾切除术（LA）与开腹阑尾切除术（OA）治疗急性阑尾炎的临床疗效。方法选取2013年1月至2014年3月该院收治且行阑尾切除术的310例急性阑尾炎患者，按手术方法不同分为OA 组和LA 组，每组155例。比较两组患者手术时间、术中出血量、肛门排气时间、术后下床活动时间、术后抗生素使用时间，术后切口感染、使用止痛药、腹腔残余感染情况，以及住院时间、住院费用等。结果两组患者的手术时间差别不大，差异无统计学意义；LA组患者的术中出血量、肛门排气时间、术后下床活动时间、术后抗生素使用时间、住院时间均明显少于OA组，术后切口感染率、止痛药使用率、腹腔残余感染率均明显低于OA 组，而住院费用明显高于OA 组，差异均有统计学意义。结论与OA 相比，LA 虽费用稍高，但创伤小，切口感染率低，患者术后恢复快，住院时间短。

结节性甲状腺肿手术治疗时若手术方式选择不当,易造成术后复发,再手术难度较大,并发症也增多.笔者于2000年2月至2007年12月期间共收治60例结节性甲状腺肿术后复发患者,现对其复发原因及防治措施作一分析、探讨.