目的 评价全景复合式数字腹腔镜在单孔胆囊切除术中的可行性和安全性.方法 前瞻性选取2022年7月同济大学附属东方医院因胆囊结石并慢性胆囊炎行单孔腹腔镜胆囊切除术的患者84例,随机分成观察组(全景复合式数字腹腔镜)和对照组(普通光学腹腔镜),每组各42例.比较两组手术时间、单孔完成率、术中出血量、镜头擦拭次数、腹腔镜干扰操作满意度评分、视野满意度评分、图像质量评分、排气时间、并发症发生率、住院时间等指标.结果 观察组较对照组手术时间更短[(29.48±3.74)min vs(31.52±3.13)min,t=-2.724,P＜0.05],镜头擦拭次数更少[(1.00(0,1.25)vs 2.00(2.00,3.00),Z=-6.321,P＜0.001],术中出血量更少[2.00(2.00,3.25)mL vs 4.00(3.00,5.00)mL,Z=-3.341,P＜0.05];且观察组腹腔镜干扰操作满意度评分[(8.93±0.71)vs(8.00±0.83),t=5.517,P＜0.001]及视野满意度评分[(8.67±0.69)vs(7.48±0.83),t=7.145,P＜0.001]均明显高于对照组.观察组单孔完成率、图像质量评分、排气时间、并发症发生率及住院时间与对照组相比差异无统计学意义(均P＞0.05).结论 全景复合式数字腹腔镜用于胆囊切除术安全可行,视野调节范围大,器械干扰性低,更适合单孔胆囊切除手术.

胆汁酸主要在肝脏中合成,是胆汁的主要成分之一,其含量和成分的改变与胆固醇结石形成具有密切关系.亲水性胆汁酸在胆固醇结石的形成、治疗中起重要作用,其具有溶解胆汁中胆固醇并调节胆固醇饱和度的重要作用,减少成核异常及保护并改善胆囊收缩功能的作用.对亲水性胆汁酸对防治胆固醇结石形成的作用机制进行综述.

Objective To investigate the correlation between acute gastrointestinal injury severity and intestinal microenvironment in rabbits with severe multiple trauma.Methods A total of 60 New Zealand white rabbits were enrolled and randomly assigned into the experimental group (48 rabbits) and control group (12 rabbits).In experimental group,the models of traffic-induced injuries were successful made by using self-made small gravity traction colliders.There were nine rabbits with craniocerebral injury combined with damage of liver and spleen,three with four extremity fractures combined with damage of liver and spleen,12 with rib fractures combined with damage of lungs and pleural effusion,11 with epidural hematoma,contusion and laceration of brain as well as fractures of four extremities and pelvis,and nine with multiple fractures.The injuries had met the criteria of multiple severe traumas according to the injury severity score (ISS).The control group had similar condition with experimental group except for participation in injury model.The parameters at time points of 6,12,24 and 48 h after injury were observed.The parameters were:(1)Enzyme linked immunosorbent assay (ELISA) and high pressure liquid chromatography (HPLC) were used to detect the levels of diamine oxidase (DAO) and the ratio of lactulose to mannitol in urine in order to evaluate the permeability of intestinal mucosal barrier.(2) The small intestinal propulsive rate was detected by carbon pushing mcthod.The interstitial cells of Cajal in the snall intestine wall were observed by transmission electron microscopy.The expression of C-kit was detected by Western blot.By these means,the dynamic function of intestinal mucosal barrier was evaluated.(3) The damage degree of intestinal nucosal barrier was evaluated by pathological observation and Chiu score in the end of small intestine and colon.(4)The intestinal bacterial translocation was evaluated by intestinal microflora culture,mesenteric lymph nodes checking as well as translocation examination of liver and spleen.Results (1) The level of DAO plasma and urine lactulose/mannitol ratio at 6 h after injury increased to varied degrees,and reached the peak during 12-24 h,the correlation analysis of which showed that plasma DAO levels were positively correlated with AGI grade at 6,12 and 24 h (r =0.486 3,0.493 3,0.477 6,P ＜ 0.05).The ratio of urinary lactulose/ mannitol excretion was only positively correlated with AGI grade at 6 and 12 h (r =0.478 5,0.497 2,P ＜ 0.05).(2) The gastrointestinal transmission rate in the experimental group was (48.2 ± 5.2) ％,and that of the control group was (60.3 ± 3.0) ％.The gastrointestinal transmission rate of model group rabbits was significantly longer than that of control group (P ＜ 0.05).(3) The interstitial cells of Cajal decreased dramatically during 12-24 h after the injury,and the expression level of C-kit protein decreased consistently with the increase of AGI grade.(4) The intestinal and colonic mucosa tissues of the experimental group showed obvious necrosis at 12-24 h after injury,and the Chiu score increased gradually with the increase of AGI grade under light microscope.(5) The Enterobacter and Enterococcus in the experimental group increased significantly compared with that in the control group.But the numbers of Bifidobacterium,Lactobacillus,Lactobacillus,Bacteroides as well as the ratio of Bifidobacterium to Enterobacteriaceae significantly decreased(P ＜0.05).(6)The organ bacterial translocation rates were 24％,42％ and 62％ after injury in experimental group (P ＜0.05).Conclusions Acute gastrointestinal injury may occur early after severe multiple trauma,and the injury severity is closely related to the change of intestinal barrier function and bacterial translocation.Early attention and active correction of the change of intestinal microenvironment are of great importance for treatment of multiple trauma.

Objective:To study of the relationship among male climacteric syndrome, gonadal axis, and metabolic syndrome in animal experiments.Methods: hTe 6-month-old male rats were reared to 30-month-old to copy natural aging, metabolic syndrome and androgen supplement models. At 12, 18, 24, 30 months old sex hormones, hormone receptor levels, testis slices were tested and analyzed.Results: With the increase of age, T, FSH and LH of normal feeding group decreased, and testicular pathology showed degenerative changes. Serum T, FSH, LH levels of Testosterone fed groups continue to maintain a high level, but testicular androgen levels of RNA and protein levels were signiifcant decreased.Conclusion: Supplement of androgen can maintain gonadal axis, but cannot change the decline of testicular androgen receptor. Androgen supplement treatment cannot cure male climacteric syndrome. It is also essential to increase the male hormone receptor levels.