分析肾细胞癌胆囊转移患者的临床特征、治疗及预后情况。计算机检索PubMed、中国知网、万方医学网建库至2020年1月肾细胞癌胆囊转移相关文献。分析患者症状、治疗、术后生存等情况。Kaplan-Meier法绘制生存曲线，生存率比较采用log-rank检验。最终纳入英文文献45篇，中文文献10篇，包括64例患者，汇总本中心1例，共计65例肾细胞癌胆囊转移患者。65例患者中，男性44例，女性21例，年龄(61.8±11.2)岁。65例患者中异时性胆囊转移48例(73.8%)，异时性转移患者的转移时间间隔为[ M( Q1， Q3)]61(31，96)个月。44例(67.7%)患者无明显症状。孤立性胆囊转移患者37例(57.8%，37/64)，合并其他部位转移27例(42.2%，27/64)。65例患者均行手术治疗，其中56例(86.2%)行单纯胆囊切除，8例(12.3%)行扩大切除术，1例(1.5%)行胆囊部分切除。术后45例(69.2%)患者完成随访，随访时间[ M( Q1， Q3)]15(6，33)个月，29例(64.4%，29/45)患者无瘤生存，6例(13.3%，6/45)患者带瘤生存，10例(22.2%，10/45)患者死亡。45例患者术后1、3、5年累积生存率分别为84.4%、72.3%、57.8%。无症状患者( n＝34)术后累积生存率优于有症状患者( n＝11)，孤立性胆囊转移患者( n＝23)术后累积生存率优于多处转移患者( n＝21)，差异均有统计学意义(χ 2＝17.79、5.04， P<0.001， P＝0.025)。肾细胞癌胆囊转移在临床上很罕见。多数患者无明显症状且转移时间晚。无症状、孤立性胆囊转移的患者预后较好，应积极行手术治疗，以改善预后。

胃癌是我国最常见的恶性肿瘤之一,2020年统计数据表明,胃癌发病率和病死率在各种恶性肿瘤中均位居第三,全球每年新发胃癌病例约120万,我国约占其中的40％.我国早期胃癌占比很低,仅约20％,大多数发现时已是进展期,患者总体5年生存率不足50％[1].转移性胃癌是指胃癌一经确诊便伴随着远处转移,无法行根治性手术,预后极差,患者总体中位生存期不足1年[2].对于转移性胃癌,目前公认采取以全身抗肿瘤药物治疗为主的综合治疗,延长患者生存时间和改善生存质量[3].近年来随着转化治疗概念的提出、治疗策略的改变,一些转移性胃癌患者的不可切除因素得以缓解,获得根治性手术切除的机会,达到手术学治愈.大连医科大学附属大连市友谊医院近期收治1例胃癌广泛肝脏转移无法手术切除的患者,经过转化治疗后成功手术并达到手术学治愈,现将诊治经过报道如下,旨在为胃癌肝转移患者的转化治疗方案提供参考.

Objective:To investigate the epidemiological characteristics, diagnosis, treat-ment and prognosis of gallbladder cancer in China from 2010 to 2017.Methods:The single disease retrospective registration cohort study was conducted. Based on the concept of the real world study, the clinicopathological data, from multicenter retrospective clinical data database of gallbladder cancer of Chinese Research Group of Gallbladder Cancer (CRGGC), of 6 159 patients with gallbladder cancer who were admitted to 42 hospitals from January 2010 to December 2017 were collected. Observation indicators: (1) case resources; (2) age and sex distribution; (3) diagnosis; (4) surgical treatment and prognosis; (5) multimodality therapy and prognosis. The follow-up data of the 42 hospitals were collected and analyzed by the CRGGC. The main outcome indicator was the overall survival time from date of operation for surgical patients or date of diagnosis for non-surgical patients to the end of outcome event or the last follow-up. Measurement data with normal distribu-tion were represented as Mean±SD, and comparison between groups was conducted using the t test. Measurement data with skewed distribution were represented as M( Q1, Q3) or M(range), and com-parison between groups was conducted using the U test. Count data were described as absolute numbers or percentages, and comparison between groups was conducted using the chi-square test. Univariate analysis was performed using the Logistic forced regression model, and variables with P<0.1 in the univariate analysis were included for multivariate analysis. Multivariate analysis was performed using the Logistic stepwise regression model. The life table method was used to calculate survival rates and the Kaplan-Meier method was used to draw survival curves. Log-rank test was used for survival analysis. Results:(1) Case resources: of the 42 hospitals, there were 35 class A of tertiary hospitals and 7 class B of tertiary hospitals, 16 hospitals with high admission of gallbladder cancer and 26 hospitals with low admission of gallbladder cancer, respectively. Geographical distribution of the 42 hospitals: there were 9 hospitals in central China, 5 hospitals in northeast China, 22 hospitals in eastern China and 6 hospitals in western China. Geographical distribution of the 6 159 patients: there were 2 154 cases(34.973%) from central China, 705 cases(11.447%) from northeast China, 1 969 cases(31.969%) from eastern China and 1 331 cases(21.611%) from western China. The total average number of cases undergoing diagnosis and treatment in hospitals of the 6 159 patients was 18.3±4.5 per year, in which the average number of cases undergoing diagnosis and treatment in hospitals of 4 974 patients(80.760%) from hospitals with high admission of gallbladder cancer was 38.8±8.9 per year and the average number of cases undergoing diagnosis and treatment in hospitals of 1 185 patients(19.240%) from hospitals with low admission of gallbladder cancer was 5.7±1.9 per year. (2) Age and sex distribution: the age of 6 159 patients diagnosed as gallbladder cancer was 64(56,71) years, in which the age of 2 247 male patients(36.483%) diagnosed as gallbladder cancer was 64(58,71)years and the age of 3 912 female patients(63.517%) diagnosed as gallbladder cancer was 63(55,71)years. The sex ratio of female to male was 1.74:1. Of 6 159 patients, 3 886 cases(63.095%) were diagnosed as gallbladder cancer at 56 to 75 years old. There was a significant difference on age at diagnosis between male and female patients ( Z=-3.99, P<0.001). (3) Diagnosis: of 6 159 patients, 2 503 cases(40.640%) were initially diagnosed as gallbladder cancer and 3 656 cases(59.360%) were initially diagnosed as non-gallbladder cancer. There were 2 110 patients(34.259%) not undergoing surgical treatment, of which 200 cases(9.479%) were initially diagnosed as gallbladder cancer and 1 910 cases(90.521%) were initially diagnosed as non-gallbladder cancer. There were 4 049 patients(65.741%) undergoing surgical treatment, of which 2 303 cases(56.878%) were initially diagnosed as gallbladder cancer and 1 746 cases(43.122%) were initial diagnosed as non-gallbladder cancer. Of the 1 746 patients who were initially diagnosed as non-gallbladder cancer, there were 774 cases(19.116%) diagnosed as gallbladder cancer during operation and 972 cases(24.006%) diagnosed as gallbladder cancer after operation. Of 6 159 patients, there were 2 521 cases(40.932%), 2 335 cases(37.912%) and 1 114 cases(18.087%) undergoing ultrasound, computed tomography (CT) or magnetic resonance imaging (MRI) examination before initial diagnosis, respec-tively, and there were 3 259 cases(52.914%), 3 172 cases(51.502%) and 4 016 cases(65.205%) undergoing serum carcinoembryonic antigen, CA19-9 or CA125 examination before initially diagnosis, respectively. One patient may underwent multiple examinations. Results of univariate analysis showed that geographical distribution of hospitals (eastern China or western China), age ≥72 years, gallbladder cancer annual admission of hospitals, whether undergoing ultrasound, CT, MRI, serum carcinoembryonic antigen, CA19-9 or CA125 examination before initially diagnosis were related factors influencing initial diagnosis of gallbladder cancer patients ( odds ratio=1.45, 1.98, 0.69, 0.68, 2.43, 0.41, 1.63, 0.41, 0.39, 0.42, 95% confidence interval as 1.21-1.74, 1.64-2.40, 0.59-0.80, 0.60-0.78, 2.19-2.70, 0.37-0.45, 1.43-1.86, 0.37-0.45, 0.35-0.43, 0.38-0.47, P<0.05). Results of multivariate analysis showed that geographical distribution of hospitals (eastern China or western China), sex, age ≥72 years, gallbladder cancer annual admission of hospitals and cases undergoing ultrasound, CT, serum CA19-9 examination before initially diagnosis were indepen-dent influencing factors influencing initial diagnosis of gallbladder cancer patients ( odds ratio=1.36, 1.42, 0.89, 0.67, 1.85, 1.56, 1.57, 0.39, 95% confidence interval as 1.13-1.64, 1.16-1.73, 0.79-0.99, 0.57-0.78, 1.60-2.14, 1.38-1.77, 1.38-1.79, 0.35-0.43, P<0.05). (4) Surgical treatment and prognosis. Of the 4 049 patients undergoing surgical treatment, there were 2 447 cases(60.435%) with complete pathological staging data and follow-up data. Cases with pathological staging as stage 0, stage Ⅰ, stage Ⅱ, stage Ⅲa, stage Ⅲb, stage Ⅳa and stage Ⅳb were 85(3.474%), 201(8.214%), 71(2.902%), 890(36.371%), 382(15.611%), 33(1.348%) and 785(32.080%), respectively. The median follow-up time and median postoperative overall survival time of the 2 447 cases were 55.75 months (95% confidence interval as 52.78-58.35) and 23.46 months (95% confidence interval as 21.23-25.71), respectively. There was a significant difference in the overall survival between cases with pathological staging as stage 0, stage Ⅰ, stage Ⅱ, stage Ⅲa, stage Ⅲb, stage Ⅳa and stage Ⅳb ( χ2=512.47, P<0.001). Of the 4 049 patients undergoing surgical treatment, there were 2 988 cases(73.796%) with resectable tumor, 177 cases(4.371%) with unresectable tumor and 884 cases(21.833%) with tumor unassessable for resectabi-lity. Of the 2 988 cases with resectable tumor, there were 2 036 cases(68.139%) undergoing radical resection, 504 cases(16.867%) undergoing non-radical resection and 448 cases(14.994%) with operation unassessable for curative effect. Of the 2 447 cases with complete pathological staging data and follow-up data who underwent surgical treatment, there were 53 cases(2.166%) with unresectable tumor, 300 cases(12.260%) with resectable tumor and receiving non-radical resection, 1 441 cases(58.888%) with resectable tumor and receiving radical resection, 653 cases(26.686%) with resectable tumor and receiving operation unassessable for curative effect. There were 733 cases not undergoing surgical treatment with complete pathological staging data and follow-up data. There was a significant difference in the overall survival between cases not undergoing surgical treatment, cases undergoing surgical treatment for unresectable tumor, cases undergoing non-radical resection for resectable tumor and cases undergoing radical resection for resectable tumor ( χ2=121.04, P<0.001). (5) Multimodality therapy and prognosis: of 6 159 patients, there were 541 cases(8.784%) under-going postoperative adjuvant chemotherapy and advanced chemotherapy, 76 cases(1.234%) under-going radiotherapy. There were 1 170 advanced gallbladder cancer (pathological staging ≥stage Ⅲa) patients undergoing radical resection, including 126 cases(10.769%) with post-operative adjuvant chemotherapy and 1 044 cases(89.231%) without postoperative adjuvant chemo-therapy. There was no significant difference in the overall survival between cases with post-operative adjuvant chemotherapy and cases without postoperative adjuvant chemotherapy ( χ2=0.23, P=0.629). There were 658 patients with pathological staging as stage Ⅲa who underwent radical resection, including 66 cases(10.030%) with postoperative adjuvant chemotherapy and 592 cases(89.970%) without postoperative adjuvant chemotherapy. There was no significant difference in the overall survival between cases with postoperative adjuvant chemotherapy and cases without postoperative adjuvant chemotherapy ( χ2=0.05, P=0.817). There were 512 patients with pathological staging ≥stage Ⅲb who underwent radical resection, including 60 cases(11.719%) with postoperative adjuvant chemotherapy and 452 cases(88.281%) without postoperative adjuvant chemotherapy. There was no significant difference in the overall survival between cases with postoperative adjuvant chemo-therapy and cases without post-operative adjuvant chemo-therapy ( χ2=1.50, P=0.220). Conclusions:There are more women than men with gallbladder cancer in China and more than half of patients are diagnosed at the age of 56 to 75 years. Cases undergoing ultrasound, CT, serum CA19-9 examination before initial diagnosis are independent influencing factors influencing initial diagnosis of gallbladder cancer patients. Preoperative resectability evaluation can improve the therapy strategy and patient prognosis. Adjuvant chemotherapy for gallbladder cancer is not standardized and in low proportion in China.

胆囊息肉样病变(PLG),简称胆囊息肉,是临床常见的胆道系统疾病,随着影像学检查的普及,胆囊息肉的发病率近些年有所升高,目前国内外指南推荐大于10 mm的胆囊息肉行手术治疗,但是术后病理发现胆囊癌的病例却是极少的,因此近些年许多学者建立了预测胆囊息肉良恶性的预测模型,对于判断胆囊息肉的良恶性具有一定的帮助.本文对目前常见的预测模型及近年来研究进展做一综述.

目的 探讨双镜联合保胆取石术治疗胆囊结石的临床效果.方法 收集2016年1月至2018年12月100例胆囊结石患者,随机分组.开腹胆囊切除手术方案组(n=50)采取开腹胆囊切除手术方案,双镜联合保胆取石术组(n=50)实施胆囊结石的双镜联合保胆取石术.分析胆囊结石手术实施的平均时间、手术的整体出血水平、手术之后恢复排气的平均时间、整体住院的天数;治疗前后患者生活质量量表不同维度的评分值;胆汁反流性胃炎、腹胀、腹泻、感染等并发症.结果 双镜联合保胆取石术组生活质量量表不同维度的评分值、胆囊结石手术实施的平均

目前关于胆囊切除术后原发性胆总管结石的定义是明确的,但其诊断标准却多种多样,不同作者参照不同标准,给临床研究和比较带来困难.有研究得出胆囊切除术后原发性胆总管结石高发的结论,致使相当数量患者担心胆囊切除后易再发原发性胆总管结石而拒绝胆囊切除手术,导致更为不良的后果.因此明确其诊断标准,为我们探究二者间的关系,进一步指导临床工作具有重大意义.本文结合文献从胆囊切除术后原发性胆总管结石的诊断标准、发病率、发病机制以及胆囊切除与原发性胆总管结石的关系四个方面加以综述.

Many clinicians have the following 4 misconceptions about the incidence and epedemil trend of gallbladder cancer.(1) The incidence of gallbladder cancer and extrahepatic bile duct carcinoma is considered as the incidence of gallbladder cancer.(2) The gallbladder cancer is the common malignant tumor of the digestive system.(3) The gallbladder cancer is the most common malignant tumor of biliary tract system.(4) The incidence of gallbladder cancer is increasing year by year.Based on the latest annual report of the 2016 Chinese Cancer Registry Annual Report,published by the National Cancer Center (NCCR),combined with previous annual reports and the data of the incidence of gallbladder and extrahepatic bile duct cancer in the related articles,supplemented by clinical data,the author points out that the incidence of gallbladder cancer in China is about 1.00-1.30 per 100 000.It is pointed out that gallbladder cancer is not the most common cancer in the digestive and biliary systems.The incidence of gallbladder cancer has not been significantly increased in recent years,and its 5-year relative survival rate has been reduced by 0.9％ since 2003.Although the incidence of gallbladder cancer is low,the malignant degree is high and the prognosis is poor.It highlights the lack of effective treatment for the disease,and further hints that we should strengthen the necessity of early diagnosis and treatment of gallbladder cancer.

1 病例介绍 患者女,56岁,以"突发右腰部疼痛伴恶心36 h,加重6 h"就诊. 查体:体温36.7 ℃,右侧腹部压痛,右下腹部反跳痛、肌紧张,Murphy征阴性,肝肾区无叩痛.急诊血WBC 10.05×109/L, N 82.5％,予抗感染、止痛治疗后缓解,6 h前患者右侧腰部疼加重伴右下腹疼痛,尿常规正常,彩超示右肾盂轻度积水伴右侧输尿管上段扩张. 急诊以"急性阑尾炎"收入院. 由于腰痛尚不能除外泌尿系病变,未行急诊手术,予抗感染、解痉止痛治疗后缓解,行全腹、盆腔CT示右肾盂及输尿管积液扩张,阑尾未见肿大,周围无渗液;泌尿系CTU示L4水平右髂总动脉右侧条片状软组织密度影包绕,动脉期轻度强化,静脉期明显强化, 部分包绕右侧输尿管中段致其上方输尿管扩张;肝肾功能正常,IgG4阴性,诊断为腹膜后纤维化,停用抗生素,继续止痛解痉治疗后患者腰、腹部疼痛消失出院. 门诊随访4年未再发作,肾功能、尿常规正常,超声检查肾盂输尿管扩张,包绕髂血管软组织影无明显进展.

In order to prevent the canceration of gallbladder polyps or avoid the misdiagnosis of gallbladder cancer,the mainstream practice is cholecystectomy for polyps larger than 1 cm,while gallbladder polyps larger than 0.5 cm as an indication of gallbladder preserving surgery.The reasons for this result is that we put the diameter of more than 1 cm of gallbladder polyps as high risk factors for prediction of gallbladder carcinoma,and we ignored the characteristics of gallbladder polyps that most of them are not gallbladder cancer or are not cancerous even larger than 1 cm.We analysed the high risk factors for gallbladder cancer on the basis of variety of clinical data,and we believe that the most valuable indicator of gallbladder cancer are the growth time of gallbladder polyps,the age of the patients,the combination of gallstones,the single polyps,and the sex.Polyps diameter greater than 1 cm are not a high risk factor for gallbladder cancer.We can use these five high risk factors to manage gallbladder polyps and reduce unnecessary cholecystectomy and gallbladder preserving surgery.

Objective: To investigate the natural evolution process of polypoid lesion of the gallbladder, so as to provide a reference for determination of its indications for surgery. <br> Methods: Two-hundred patients with polypoid lesions of the gallbladder who had consecutive ultrasonographic data within 3 years were collected. hTe ultrasonic characteristics of the changes in size and number of their lesions were analyzed. <br> Results: Among the 200 patients with polypoid lesion, 79 cases (39.5%) had single lesion, and 121 cases (60.5%) multiple lesions. The diameter of lesion in 113 cases (56.5%, that included 45 cases with single lesion) was ≥5 mm, in 87 cases (43.5%) was <5 mm, and in none of them was >1 cm. During 3 years of follow-up, the lesions were found to be reduced in size in 8 cases, disappeared in 10 cases and unchanged in 161 cases, which accounted&nbsp;for 89.5% (179/200) of the whole group. hTe lesions were found to be enlarged in only 21 cases (10.5%), but no lesion was greater than 1 cm. <br> Conclusion: hTe majority of polypoid lesions of the gallbladder grow very slowly and are benign lesions, and can be managed by regular follow-up with no need of surgical treatment.

Objective To study the feasibility of applying laparoscopic partial cholecystectomy to treatment of chronic non-calculous cholecystitis. Methods From November 2009 to June 2015, 21 cases with chronic non-calculous cholecystitis, gallbladder deformity and adenomyomatosis were treated by partial cholecystectomy under laparoscope and choledochoscope. All the patients had deformity of gall bladder and evident chronic inflammation at the distal-end of gallbladder. The function of the remain gallbladder was normal:ductus cysticus being unobstructed, the thickness of the gallbladder wall ≤ 3 mm and contractibility of gallbladder test ≥ 30%. The proportion of the gallbladder lesion accounted for≤1/3 in 11 cases (52.4%),≤1/2 in 3 cases (14.1%) and≤2/3 in 7 cases (33.3%). The deformity part was cut off, the remained part was normal under choledochoscope. 4-0 absorbable thread was used to suture the gallbladder with two consecutive layers. Results The operations were performed successfully in all the patients. The operation time was (110 ± 18) min,the exhaust time was (21.4 ± 2.8) h; and the patients weredischarged 7 days after operation. The patients were followed up for 6-66 months. The preoperative clinical symptoms of the patients disappeared. There was no postoperative complication in the cases. The gallbladder had compensatory dilatation with the volume to (56.67 ± 23.2) cm3 which was significantly larger than the preoperative volume [(48.26 ± 21.58) cm3, = -9.38, < 0.05]. The postoperative contractibility of gallbladder was enhanced after operation [(50.19 ± 4.27)%vs (45.67 ± 6.87)%, =-5.22, <0.05]. Conclusions Partial cholecystectomy with combined laparoscopy and choledochoscopy is an effective method in treating chronic non-calculous cholecystitis with the indications, and it has a great significance in protecting gallbladder and its function.

The detection rate of polypoid lesions of gallbladder has increased.In order to prevent malignancy or to avoid missed diagnosis of gallbladder carcinoma,the mainstream of the current practice is recommended for cholecystectomy if polyps are larger than 1 cm,and polyps larger than 0.5 cm is the indication for gallbladder-preserving operation.But the recommendations mentioned above are not quite reasonable,because most of polyps removed are the cholesterol ones which rarely become malignant.Besides,early intervention may lead to over-treatment and high risk of serious complications after surgery.Thus,surgery may bring additional trauma and risks to patients with cholesterol polyps of the gallbladder.Taken together,we should strictly determine the operation indications for gallbladder polyps and surgery may be appropriate for high-risk patients only.

目的：观察经皮肝穿刺胆道引流术（PTCD）治疗梗阻性黄疸的疗效。方法回顾性分析不能手术治疗的恶性梗阻性黄疸患者53例，男30例，女23例，平均年龄67岁，所有患者均经临床确诊，全部行PTCD治疗。结果53例患者均胆道穿刺成功，置入引流管。血清总胆红素下降至50μmol/L以下46例，无明显下降5例，升高2例。结论 PTCD缓解梗阻性黄疸效果明显，为不能手术治疗的恶性梗阻性黄疸安全/有效方法，但对于合并肝细胞性黄疸患者治疗效果差。

A new minimally invasive gallbladder-preserving operation has emerged for the treatment of gallbladder stones,but fundamentally it is a replica of the previous gallbladder preservation method.The gallbladder aids in digestion but is not essential for life.Its function should not be exaggerated and should not instigate trivial reasons for its preservation.Most patients undergoing cholecystectomy maintain a good quality of life.The causes,mechanisms,and prevention of gallstone formation remains mysterious,so a high recurrence rate after gallbladder-preserving operation is difficult to avoid.A full cholecystectomy can avoid recurrence complications and the benefits outweigh the risks.A discussion of the benefits and complications must be initiated to evaluate both treatment modalities for gallstones.

脾脓肿是临床上一种少见的脾脏感染性疾病,容易延误诊断和治疗.作者对本院1994年以来收治的4例脾脓肿的临床资料进行回顾性分析,并结合文献报道如下.

BACKGROUND:Biliary stricture following liver transplantation is mainly focus on biliary stoma stricture; while, balloon dilatation temporarily keeps biliary tract open but not works out a solution at all.OBJECTIVE: To discuss the diagnosis and treatment of postoperative biliary stricture after orthotopie liver transplantation by the endoscope technique.DESIGN, TIME AND SETTING: A case analysis, which was performed at Dalian Liver and Gall Surgical Institute. Ten patients hospitalized from the Department of Liver and Gall Surgery of Dalian Friendship Hospital and four patients hospitalized from the Department of Organ Transplantation of Tianjin First Central Hospital were diagnosed as biliary stricture after orthotopic liver transplantation.PARTICIPANTS: Among 14 patients, 10 males and 4 females with mean age of 46 years provided end-to-end biliary anastomose.METHODS: Fourteen cases of postoperative biliary stricture after orthotopic liver transplantation were analyzed and diagnosed by endoscope technique. And by endoscope technique, the stricture was supported with tube after balloon dilatation.MAIN OUTCOME MEASURES: Bile duct mucous membrane under T-tube radiography and endoscope; calculary distribution and bile duct mucous membrane at stoma; healing of biliary stoma of donors and recipients; inflammatory edema and stricture; recheck of above-mentioned parameters after stricture expansion by endoscopic stone extraction technique.RESULTS: Thirteen cases of postoperative biliary stricture after orthotopic liver transplantation were analyzed and diagnosed by endoscope technique, including one was induced by calculus, and one non-stoma stricture. One case was treated with balloon dilation; biliary infection and jaundice occurred in 2 cases after endoscopic sphincterotomy (EST) + basket lithotripsy + endoscopic nasobiliary drainage (ENBD), so operations or fibrocholedochoscope treatments had to be carried out. By T tube radiography, in 1 case there was strip-like negative simulacrum or no stricture, well-healed anastomosis and good mucous membranel transition; poor or no intrahepatic visualization were found in 2 cases, so anastomosis dilation was processed after the calculi removal by fibrocholedochoscope, stricture disappeared in 3 or 4 months; in 8 cases there were blur extrahepatic or intrahepatic biliary visualization, cord-like, column or branch-like negative simulacrum in biliary ducts and sign of non-anastomosis stricture, after removal of calculi, anastomosis stricture and congestion, edema were found, all these disappeared after average 2.5 months of dilation; the other 1 case was found stricture by T the radiography, but no calculi was found with fibrocholedochoscope, finally the Ttube was removed after 2 months of stricture dilation.CONCLUSION: Endoscopy is significant to directly reflect and reliably diagnose postoperative biliary stricture and effectively treat biliary stricture by anastomosis dilation.

胆管狭窄一直是胆道外科棘手的问题,肝移植术后也面临着同样的问题,手术解决较困难,而内镜技术的应用给胆管狭窄的诊治带来了新方法[1]. 一、资料与方法 1.一般资料:选择2001年7月至2005年10月肝移植术后发生胆管狭窄的友谊医院患者10例,外院4例,其中男10例,女4例,平均年龄46.1岁.

Objective To summarize the experience of diagnosis and surgical treatment of acute lung injury after orthotopic liver transplantation.Methods The diagnosis and treatments of 5 patients in 25 after orthotopic liver transplatation were retrospectively reviewed.Results 5 of a total of 25 patients(20%)were diagnosed with ALI after orthotopic liver transplatation.All patients recovered after receiving appropriate treatment.Conclusion The occurrence of ALI is related to the operative trauma,the quantity of blood loss in operation,great quantity fluid infusion,lung infection,hypercoagulability.Systemic treatment especially control of fluid infusion strictly is necessary for the patients with ALI besides the oxygen therapy.

Objective To investigate the effects of octreotide combinated with TACE(transcatheter hepatic arterial chemoembolization) in the treatment of advanced hepatocellular carcinoma(HCC).Methods 100 patients with advanced HCC were randomized into study and control group who were all treated by TACE.Study group: 50 cases were treated with lipiodol(10~20 ml) combinated with octreotide 0.5 mg.Control group: 50 cases were treated with lipiodol(10~20 ml) combinated with a chemotherapeutic drug(5-FU 500~1000mg,MMC 10~20 mg,CBP 200~400 mg).Results The statistical difference was present between the two groups from the serum levels of hyaluronic acid(HA),pro-callagen type Ⅲ peptide(PCⅢ),type Ⅳ collagen(C-Ⅳ),laminin(LN),alpha-fetoprotein(AFP) as well as the diameters of tumors and cumulative survival.Octreotide did not have significant effects on liver function,renal function,hemopoietic system and gastrointestinal tract of patients.Conclusion Compared with routine TACE,octreotide combinated with TACE in the treatment of advanced HCC appears to be more beneficial and less side effect.

外科感染是人类最古老的疾病,在控制外科感染方面我们已经取得了巨大的进步,但外科感染反而变得越来越复杂,我们面临的挑战也越来越严峻。面对挑战,我们应该采取全方位的对策。