目的:探究生长抑素、乌司他汀联合氧化苦参碱对重症胰腺炎肠粘膜屏障损伤的改善及HMGB1水平的影响.方法:随机选取120例重症胰腺炎患者作为研究对象,简单随机分组分为观察组与对照组.对照组予以基础治疗,观察组在对照组基础上联合氧化苦参碱治疗.观察两组患者白细胞恢复正常时间、炎症因子水平、肠黏膜屏障损伤指标水平.结果:观察组治疗总有效率为93.33％显著高于对照组,P<0.05;观察组腹痛缓解时间(3.58±1.02)d、首次排便时间(3.09±0.68)d、血淀粉酶恢复正常时间(4.58±1.45)d、白细胞恢复正常时间(5.05±1.33)d均显著低于对照组,P<0.05;治疗后,观察组TNF-α(887.65±133.24)ng/L、IL-6(64.75±22.31)ng/L、IL-1(388.65±83.06)ng/L、HMGB1(32.43±23.67)μg/mL均显著低于对照组水平,P<0.05;治疗后,观察组患者血清DAO(8.16±2.04)U/L、血清D-乳酸(6.51±0.53)mg/L、肉毒素(16.42±6.87)EU/L均显著低于对照组水平,P<0.05.结论:针对重症胰腺炎患者予以氧化苦参碱联合基础治疗,临床疗效显著,可显著降低炎症因子水平,改善患者肠黏膜屏障功能,值得临床推广使用.

目的 探讨乙型肝炎病毒相关性慢加急性肝衰竭(HBV-ACLF)患者血清角蛋白18(K-18)水平变化及其对患者预后的预测价值.方法 2015年1月～2017年1月我院收治的HBV-ACLF患者100例,另选择性别和年龄相匹配的慢性乙型肝炎(CHB)患者30例和健康人30例.采用酶联免疫吸附试验法检测血清K18(M30和M65)水平.随访3 m.应用受试者工作特征曲线(ROC)分析M30/M65比值和终末期肝病模型(MELD)预测患者预后的效能.结果 ACLF患者血清M30、M65水平和M30/M65比值分别为(1.0±0.1)lg U/L、(3.4±0.3)lg U/L和(0.3±0.1),与CHB患者[分别为(2.1±0.1)lg U/L、(3.3±0.2)lg U/L和(0.6±0.0)]或者健康人[分别为(2.1±0.1)lg U/L、(2.1±0.1)lg U/L和(1.0±0.2)]比,有显著性统计学差异(P<0.05);68例生存患者MELD评分为(18.2±.0),显著低于32例死亡患者的[(26.1±3.3),P<0.05],血清M65水平为(2.9±0.2)lg U/L,显著低于死亡患者的[(4.1±0.5)lg U/L,P<0.05],M30/M65比值为(0.4±0.1),显著高于死亡患者的[(0.2±0.1),P<0.05];MELD评分预测ACLF患者死亡的截断点为23.21,其AUC为0.650,预测的灵敏度、特异度和正确性分别为85.5％、65.0％和72.0％,而M30/M65比值预测ACLF患者死亡的截断点为0.30,其AUC为0.875,预测的灵敏度、特异度和正确性分别为94.5％、85.0％和85.0％,显著优于MELD评分(P<0.05).结论 K18(M30和M65)与肝脏疾病的严重程度有关.早期检测血清M30和M65水平可能有助于对HBV-ACLF患者预后的判断.

目的:探究曲安奈德辅助激光治疗增生性瘢痕(HS)的疗效及对转化生长因子β1(TGF-β1)的影响.方法:选取2016年6月-2018年6月在笔者医院外科就诊的70例HS患者,随机分为曲安奈德组(35例)和激光组(35例).所有患者均给予醋酸曲安奈德局部注射治疗,激光组患者则在此基础上给予CO2点阵激光治疗.观测并比较两组患者的改良温哥华瘢痕量表(VSS)评分、简明健康状况调查量表(SF-36)评分、瘢痕厚度以及TGF-β1相对含量.结果:治疗后,两组患者的VSS评分、瘢痕厚度、TGF-β1相对含量均减少,且激光组的VSS评分、瘢痕厚度及TGF-β1相对含量均显著低于曲安奈德组(P<0.05).治疗后,两组患者的SF-36评分均增加,且激光组的SF-36评分显著高于曲安奈德组(P<0.05).结论:曲安奈德辅助CO2点阵激光治疗HS患者具有良好疗效,可有效降低VSS评分以及瘢痕厚度,改善患者生活质量,还可有效降低瘢痕组织中TGF-β1相对含量,值得进一步研究与临床应用.

目的 观察聚桂醇泡沫硬化剂双针法治疗大囊型淋巴管畸形的疗效.方法 回顾性分析2015年1月至2017年1月咸阳市第一人民医院普通外科收治的16例大囊型淋巴管畸形患者的临床诊治资料.结果 所有患者经过1~2次治疗均治愈,囊腔完全消失,所有患者无严重不良反应和并发症.结论 聚桂醇泡沫硬化剂双针法治疗大囊型淋巴管畸形是一种安全有效的方法.

Objective To investigate the clinical effect of laparoscopic versus open hepatectomy in the treatment of patients with regional hepatolithiasis. Methods A total of 87 patients with regional hepatolithiasis who were admitted to The First People′s Hospital of Xianyang from January 2010 to June 2017 were enrolled. Among these patients,38 underwent laparoscopic hepatectomy(laparoscopic group)and 49 underwent open hepatectomy(open group). Propensity score matching was conducted to balance confounding factors between the two groups and then the perioperative indices were compared between the two groups. The t-test was used for comparison of continuous data between groups,and the chi-square test or Fisher′s exact test was used for comparison of categorical data between groups. Results A total of 27 pairs of patients were matched successfully. There were no significant differences between the two groups in the type of hepatectomy,a com-bination with common bile duct exploration,rate of intraoperative hepatic portal occlusion,time of operation,rate of intraoperative blood transfusion,intraoperative stone clearance rate,total postoperative complications,and incidence of serious complication(all P>0.05). Compared with the open group,the laparoscopic group had significantly lower intraoperative blood loss(126.4 ± 18.7 ml vs 143.2 ± 24.1 ml,t=2.862,P=0.006)and shorter length of hospital stay(11.7 ± 2.3 d vs 13.4 ± 1.9 d,t=2.961,P=0.004). Conclusion Lapa-roscopic hepatectomy has a comparable clinical effect to open hepatectomy in the treatment of regional hepatolithiasis and has the advantages of low intraoperative blood loss and rapid postoperative recovery.

目的 比较腹腔镜肝切除术与传统开腹肝切除术治疗原发性肝癌患者的炎症因子、肝功能及c反应蛋白的差异.方法 根据患者肝切除方式的不同,836例原发性肝癌患者分为腹腔镜肝切除术组(77例)和传统开腹肝切除术组(759例),对比分析两组患者的血清炎症因子、肝功能及C反应蛋白(CRP)水平的差异.结果 在术前,两组患者的血清炎症因子、肝功能及CRP水平无统计学差异;而在术后1、3、7天,腹腔镜肝切除术患者的血清指标水平均显著低于传统开腹肝切除术组.结论 对于原发性肝癌患者的治疗,相较传统开腹肝切除术,腹腔镜肝切除术引起的炎性应激以及肝脏损伤更轻.

Objective To investigate the effect of hydroxyethyl starch on the early change of plasma albumin and in-flammatory mediators in patients with gastrointestinal cancer after radical resection. Method 90 patients with gastroin-testinal tumor were randomized to be administered with intravenous infusion of hydroxyethyl starch (n=45, study group) or equivalent 0.9％NaCl (n=45, control group) immediately following radical resection (n=45) for 7 consecutive days, im-munoturbidimetry was utilized to detect the postoperative serum albumin level in early stage;enzyme-linked immunosor-bent assay was used to detect the C-reactive protein (CRP), interleukin (IL)-6 and tumor necrosis factor (TNF)-αlevels before and after treatment, the clinical curative effect, the change of postoperative plasma albumin and inflammatory me-diators were compared between the two groups. Result Before surgery, the level of plasma albumin, IL-6 and TNF-αwere similar between the two groups (P>0.05). In 1, 3, 5 and 7 d after surgery, the plasma albumin level was significantly higher in study group than control group (P<0.05). In 7 d after surgery, the CRP and IL-6 level were lower (P<0.05), while TNF-α was higher in study group than in control group (P<0.05). The incidence of complications was 6.67％ in study group, which was comparable with that in control group at 8.89％(P>0.05). Conclusion For patients who under-went radical resection for gastrointestinal tumor, early intravenous infusion of hydroxyethyl starch is effective to improve the postoperative prognosis, which may regulate the level of plasma albumin and inflammatory mediators.

目的：探讨持续负压封闭引流技术（VSD）联合创面灌洗术在深部复杂性创面修复中的临床应用效果。方法将50例深部复杂性创面患者，随机分为观察组（采用VSD负压封闭引流技术并联合创面灌洗）和对照组（采用常规换药及清洁方法治疗），每组各25例。分别观察两组治疗前后创面情况、换药次数及予手术关闭创面的时间；比较术后创面愈合时间、住院时间及治疗效果。结果术前创面予关闭的手术时间、换药次数均显著低于对照组（P<0.05）；术后创面愈合时间、住院时间及总治愈率均显著高于对照组（P<0.05）。结论持续负压吸引联合创面灌洗术，对于深部复杂创面治疗能够缩短术前准备时间、术后创面愈合时间、住院时间、减少换药次数，并能提高Ⅱ期手术治愈率，可在临床上推广应用。

目的:探究血必净注射液对梗阻性黄疸大鼠血清内毒素(ETX)及肿瘤坏死因子-α(TNF-α)水平的影响.方法:选取雄性SD大鼠60只,随机分为假手术(A)组、梗阻性黄疸(B)组、血必净干预(C)组,每组20只.A组不结扎胆总管,B、C两组结扎胆总管.术后七天,C组每日皮下注射血必净4 mL/Kg,A组、B组用等量生理盐水替代,持续用药一周.实验两周后,检测和比较各组大鼠血清ETX、TNF-α、总胆红素(TBIL)及直接胆红素(DBIL)水平.结果:术后两周,A组血清TBIL、DBIL水平显著低于B、C两组;B组血清TBIL、DBIL水平显著高于C组,差异均有统计学意义(P＜0.05).B组血清ETX和TNF-α水平显著高于A、C组,差异均有统计学意义(P＜0.05).结论:血必净注射液可能通过降低血清ETX和TNF-α含量改善梗阻性黄疸.

目的 探讨胆道术后胆管狭窄内镜治疗的临床价值,评价内镜治疗胆道术后良性胆管狭窄的临床效果,初步建立术后胆管狭窄的内镜治疗方案,为临床医师选择治疗方案提供参考.方法 2011年10月至2014年9月胆道术后胆管狭窄患者37例,均行X线、B超、CT常规检查,并经内镜逆行胰胆管造影(ERCP)或磁共振胰胆管造影(MRCP)检查确诊的肝外胆管狭窄的患者.分别行内镜下治疗(A组)和开腹手术治疗(B组).随访观察两组患者治疗前后肝功能指标的变化、术后并发症及术后疗效.结果 两组患者术后并发症发生率比较差异有统计学意义(P＜0.05),患者术前、术后1周肝功能比较差异有统计学意义(P＜0.05),两组随访后优良率比较差异无统计学意义(P＞0.05).A组优良率92.3％,B组优良率81.8％.结论 内镜下治疗胆管狭窄与手术治疗结果相当,但在条件允许下内镜治疗优于开腹手术治疗,内镜治疗具有微创,患者恢复快,并发症少等优点,但内镜下治疗尚不能完全替代手术治疗.