目的:对比分析腹腔镜袖状胃切除术(LSG)与胃旁路术(LRYGB)治疗肥胖症合并2型糖尿病的近、远期疗效.方法:选取2015年1月至2017年12月收治的80例患者进行前瞻性研究,分别行LSG(LSG组)与LRYGB(LRYGB组),每组40例.对比分析两组患者恢复、减重、血糖下降情况及疗效.结果:LSG组手术时间、术中出血量、住院时间及术后首次进食时间优于LRYGB组(P<0.05);与术前相比,术后6、12、36个月两组患者空腹C肽、空腹血糖、胰岛素抵抗指数及糖化血红蛋白、甘油三酯、血清总蛋白、体重、BMI、腰围、臀围及腰臀比均下降(P<0.05),多余体重减少百分比、血清白蛋白、前白蛋白及谷丙转氨酶增加(P<0.05);两组间差异无统计学意义(P>0.05).结论:LSG与LRYGB治疗2型糖尿病的近远期疗效相近,安全性均较高;但LSG相对简便且术后康复快,可优先考虑.

目的:探讨3D打印技术在复杂胃肠道肿瘤手术中的应用价值.方法:选取医院收治的20例复杂胃肠道肿瘤患者临床资料,应用三维建模软件将患者的CT二维图像重建成三维图像,并且部分使用3D打印设备打印出模型.通过观察肿瘤与邻近腹腔内重要脏器及腹部大血管等之间的关系进行术前病情评估,并协助制定手术方案.在手术中比较三维重建及打印结果与实际的肿瘤病变情况的区别.结果:对20例复杂胃肠道肿瘤患者均完成三维图像重建,其中有8例患者完成3D模型打印.20例患者的3D图像重建及3D打印模型均能够较为准确的显示肿瘤的解剖部位以及其与邻近重要脏器、血管的毗邻关系,与手术中的实际探查情况基本一致,且均顺利完成手术.结论:3D打印技术应用在复杂胃肠道肿瘤手术的术前评估中,有助于实现术中精准治疗,提高手术成功率,减少手术并发症,对指导复杂胃肠道肿瘤手术具有一定的临床意义.

目的 探讨长链非编码RNA(lncRNA)抗分化非编码RNA(ANCR)对结直肠癌(CRC)细胞生物学行为的影响及其作用机制.方法 收集50例CRC患者的癌组织和癌旁组织,通过RT-qPCR检测组织中ANCR和叉头框蛋白O1(FOXO1)的表达水平并进行Pearson相关性分析.利用RNA拉下和RNA免疫沉淀实验(RIP)确认ANCR是否可与FOXO1相互作用.将经过慢病毒包装的ANCR和FOXO1慢病毒质粒转染至人CRC细胞系SW480细胞中,细胞分为6组:对照组(未转染),NC组(转染慢病毒质粒空载),ANCR组(转染pHRi-ANCR),sh-ANCR组(转染pHRi-sh-ANCR),FOXO1组(pHRi-FOXO1),sh-ANCR+sh-FOXO1组(同时转染pHRi-sh-ANCR和pHRi-sh-FOXO1).RT-qPCR检测过表达和抑制ANCR后FOXO1的表达水平,5-乙炔基-2′脱氧尿嘧啶核苷(EdU)标记技术和流式细胞术分别检测各组细胞增殖、细胞周期和细胞凋亡情况.Western blot检测B淋巴细胞瘤-2(BCL-2)、BCL2相关蛋白X(BAX)、细胞周期蛋白D1(cyclin D1)及人P27蛋白(P27)的表达情况.结果 与癌旁组织相比,CRC组织中ANCR表达明显增加,FOXO1表达明显减少(P<0.01),二者表达水平负相关(P<0.01).ANCR能够结合并抑制FOXO1表达.与NC组相比,sh-ANCR组和FOXO1组细胞增殖数减少,细胞阻滞于G0/G1期,细胞凋亡数增多,BAX和P27增多,BCL-2和cyclin D1减少(P<0.05).与sh-ANCR组相比,sh-ANCR+sh-FOXO1组上述指标得到逆转(P<0.05).结论 lncRNA ANCR在CRC中表达升高并通过调控FOXO1的表达调控CRC细胞的细胞增殖和凋亡.

[目的]探讨近端胃大部切除间置空肠代胃对近端胃癌患者术后胃肠功能及近期生存情况的影响.[方法]回顾性分析2013年8月至2017年5月本院收治的105例近端胃癌患者的临床资料,根据治疗方法的不同分为对照组(根治性全胃切除+食管空肠Roux-en-Y吻合手术,n=43)和观察组(近端胃大部分切除间置空肠代胃手术,n=62).比较两组患者的围术期情况、术后并发症发生情况;比较两组患者胃肠功能,包括两组患者术前和术后3个月胃肠激素[胃泌素(GAS)、胃动素(M L T)]水平、术后排气时间;比较两组患者术后1年、2年生存率.[结果]观察组手术时间长于对照组,术中出血量、淋巴清扫数目低于对照组,差异有统计学意义(P<0.05);两组患者手术切口长度比较,差异无统计学意义(P>0.05).术后3个月,两组患者GAS、MLT水平均低于术前,观察组GAS水平高于对照组,差异有统计学意义(P<0.05);两组MLT水平及术后排气时间比较,差异无统计学意义(P>0.05).观察组患者倾倒综合征、Roux滞留综合征及反流性食管炎发生率均明显低于对照组,差异均有统计学意义(P<0.05).观察组术后1年、2年生存率分别为95.16％(59/62)、90.32％(56/62),对照组分别为90.70％(39/43)、83.72％(36/43),两组比较差异均无统计学意义(P>0.05).[结论]近端胃大部切除间置空肠代胃治疗近端胃癌临床疗效更显著,可降低患者术后倾倒综合征、Roux滞留综合征及反流性食管炎发生率,是一种较为理想的近端胃癌术后消化道重建方式.

目的 探讨3D打印技术在存在重要血管侵犯的胃肠道恶性肿瘤术前评估中的作用.方法 选取医院2017年1月～2019年6月期间收治的80例侵犯重要血管的晚期胃肠道恶性肿瘤患者,分为3D打印模型组(A组,n=30,将患者病变部位重建为CT三维图像,并用3D打印技术制造病变出模型,观察肿瘤与邻近腹部大血管间的关系以行术前评估、制定手术方案)和普通影像学检查组(B组,n=50,患者仅进行三维重建,并接受传统手术方式治疗).两组患者术前均进行新辅助化疗.术后对两组患者的手术时间、术中并发症和预后进行评估.结果 A组手术时间较B组短,但差异无统计学意义(P＞0.05).A组术中出血量比B组少、住院时间短于B组(P＜0.05).A组术后癌胚抗原(CEA)及癌抗原19-9(CA-199)水平与B组相比较低(P＜0.05).术后3个月世界卫生组织生存质量测定简表(WHOQOL-BREFl)结果显示,A、B两组术后比较A组更具优势(P＜0.05).自制量表评分,血管系统细节呈现平均(7.9±0.6)分,病变组织位置与周围组织关系呈现平均(7.9±1.2)分,逼真度平均(7.7±0.2)分.胃癌患者术后与实际肿瘤直径对比,三维模型的误差为(2.6±0.1)mm.直肠癌患者术后与实际肿瘤直径对比,三维模型的误差为(2.4±0.3)mm.结论 应用3D打印技术能够对有重要血管侵犯的胃肠道恶性肿瘤经术前进行精准评估,可提前预测术中可能出现的风险,并改善患者临床结局,因此3D打印技术在此类手术中应用前景广阔.

目的:探讨减孔腹腔镜治疗直肠癌的疗效及对第三间隙效应的影响研究.方法:选择2014年12月至2017年12月我院接诊的直肠癌患者95例作为研究对象,以简单随机分组法分为观察组(n=50)和对照组(n=45),对照组使用传统开腹直肠癌根治术进行治疗,观察组采用减孔腹腔镜直肠癌根治术进行治疗.比较两组手术时间、术中出血量、淋巴结清扫数量、首次通气时间、下床活动时间、住院时间、血清白蛋白、总蛋白、前白蛋白、电解质情况、液体出入量及入出量差、并发症发生情况及患者满意度.结果:两组患者淋巴结清扫数量无显著性差异;观察组患者手术时间高于对照组,术中出血量、首次通气时间、下床活动时间及住院时间均显著低于对照组(P<0.05);两组患者术后Na+、K+、Ca+和蛋白水平均无明显差异(P>0.05);两组患者液体出入量及差值均具有统计学意义(P<0.05);观察组患者并发症总发生率为6.00％,显著低于对照组的28.89％;观察组患者满意度为98.00％,明显高于对照组的66.67％(P<0.05).结论:在直肠癌患者中使用减孔腹腔镜、开腹手术后的第三间隙效应均有不同程度的异常,但减孔腹腔镜手术可减少住院时间及并发症,且患者满意度较高,值得推广与运用.

Objective To explore the influence of posture intervention on the gastrointestinal function and complication in patients with colon cancer after laparoscopic cholecystectomy.Methods 96 patients with colon cancer from October 2013 to October 2015 in Sichuan Mianyang 404 Hospital were selected as the research objects,all of them were randomly divided into control group and study group by random number table,with 48 cases in each group.The control group was received conventional nursing,the study group was received posture intervention on the basis of the control group.The postoperative abdominal distension,gastrointestinal function,operation medical cost,and postoperative complications of two groups were copared.Results After different treatment,the rate of postoperative abdominal distension of the study group was significantly lower than that of control group (P ＜ 0.05).The postoperative anal exhaust time,bowel sound recovery time and gastrointestinal peristalsis recovery time of the study group were significantly shorter than those of control group (P ＜ 0.05).However,there were no significant differences on anesthesia time,operation time and blood loss between the two groups (P ＞ 0.05).Moreover,after intervention,the hospital stay,ambulation time and medical cost were significantly lower in study group as compared with control group (P ＜ 0.05).The complication rate of the study group were significantly lower than that of the control group (P ＜ 0.05).Conclusion The implementation of the posture intervention can significantly shorter the hospital stay,decrease the incidence of abdominal distension and complications,enhance the recovery of patients'gastrointestinal function,and improve life quality of patients.It is worthy of clinical application.

Objective:The application of a combined ultrasound and pneumatic lithotripter for cholelithiasis was investigated.Methods:A total of 59 cases of cholelithiasis diagnosed by ultrasonography and CT were included in the study.All the patients had surgical treatment from January 2013 to December 2015,in which 30 patients were treated with a combined ultrasound and pneumatic lithotripter protocol (EMS group),and 29 patients were treated with traditional choledochoscope protocol(control group).All the patients were followed up for 3 months postoperation.The outcomes of patients in EMS group and control group were compared.Results:The postoperative stone free rate after the first operation is higher in EMS group than in control group(P＜0.05).The operation time and total lengths of hospital stay were shorter in EMS group than in control group(P＜0.05).There was no significant difference in intraoperative hematobilia rate,intraoperative bile duct injury rate,postoperative biliary tract infection rate,hepatic biochemical index and mortality between two groups(P＞0.05).Conclusion:The combined ultrasound and pneumatic lithotripter is useful for treatment of cholelithiasis.

Objective:The application of rotation cutting method in laparoscopic splenectomy for splenomegaly with cirrhosis of the liver was investigated.Methods :A total of 69 cases of splenomegaly with cirrhosis of the liver diagnosed by imaging were included in the study. 36 patients were treated with rotation cutting method (B group),and 33 patients were treated with traditional small incision method (A group).All the patients were followed up for 3 months after operation.The outcomes of patients in B group and A group were compared. Results:The operation time and anesthesia time was longer in B group than in A group.There was no significant difference in postoperative hospital stay,spleen weight (kg),spleen remnant rate,blood loss (ml),postoperative blood ammonia,live function,hepatic encephalopathy rate,and mortality between two groups.Conclusion:Rotation cutting method is safe and effective in the laparoscopic splenectomy of splenomegaly with cirrhosis of the liver patients.

Objective To study the expression level of D-dimer (D-D) and carbohydrate antigen 724 (CA724) before and after surgery and its clinical significance in peripheral blood of patients with gastric cancer. Methods Fif-ty-six patients of gastric cancer from January 2014 to March 2015 treated in our hospital were selected as the research subjects (gastric cancer group). Another 56 patients with benign gastric disease and 56 healthy subjects were included in the benign gastric disease group and healthy control group. D-D and CA724 level were compared between the three groups, and the relationship between pathological indexes of gastric cancer and D-D and CA724 levels were analyzed. The related factors of elevated D-D and CA724 levels in patients with gastric cancer were also analyzed. Results Be-fore treatment, D-D and CA724 levels in gastric cancer group and benign gastric disease group were significantly higher than those in healthy control group, and the D-D and CA724 levels in gastric cancer group were significantly higher than those in benign gastric disease group (P<0.05). After treatment, D-D and CA724 levels in gastric cancer group were sig-nificantly higher than those in healthy control group (P<0.05), while D-D and CA724 levels in benign gastric disease group showed no significant difference with those in health control group (P>0.05). D-D and CA724 levels in gastric cancer patients with serosa infiltration were significantly higher than those in patients with stroma and myometrial inva-sion, and the levels were also significantly higher in patients with lymph node metastasis than patients without lymph node metastasis and in patients with poor differentiation than patients with medium or high differentiation (all P<0.05). Taking elevated D-D and CA724 levels in gastric cancer patients as the dependent variable and the serosa invasion, lymph node metastasis, low differentiation as the independent variable, logistic regression analysis showed serosa inva-sion and lymph node metastasis, and low differentiation were the related factors of elevated D-D and CA724 levels in pa-tients with gastric carcinoma differentiation (P<0.05). The sensitivity and accuracy of gastric cancer was 83.93%, 83.93% for CA724 alone (with CA724 of 6.90 U/mL as the critical value,) and 82.21%, 82.21% for D-D alone (with0.50 mg/L as the critical value). For combined detection of D-D and CA724, the sensitivity and accuracy were 96.43%(54/56), 96.43%(54/56), which were significantly higher than those for D-D or CA724 alone (χ2 D-D alone=5.973,χ2CA724 alone=4.940, P<0.05). Conclusion Monitoring of D-D and CA724 index in peripheral blood of patients with gastric carcino-ma can reflect the disease situation, which is worthy of recommendation.

目的 探讨腹腔镜脾切除术治疗肝硬化巨脾的临床疗效及安全性.方法 选取符合手术条件的肝硬化巨脾患者21例,均实施腹腔镜脾切除术,观察患者术中情况及术后恢复情况.结果 21例患者均顺利完成手术,其中1例中转开腹.术后均无严重并发症,均顺利恢复出院,术后随访脾功能亢进表现明显改善.结论 腹腔镜脾切除术治疗肝硬化巨脾具有创伤小、术后恢复快、并发症发生率低、预后良好等特点,值得临床推广应用.

目的：探讨妊娠晚期合并高脂血症性重症急性胰腺炎的治疗措施。方法回顾性分析2005年1月至2015年1月该院收治的妊娠晚期合并高脂血症性重症胰腺炎患者32例的临床资料。对胎肺成熟的足月胎儿及时终止妊娠，未足月者先给予保守治疗，胰腺炎病情好转者继续待产至足月，保守治疗无效者及时终止妊娠并进行外科手术。结果经治疗后患者胰腺炎症状、体征及三酰甘油、C反应蛋白、血白细胞计数及急性生理学及慢性健康状况评分系统（APACHEⅡ）评分指标均明显好转。32例患者中治愈31例，死亡1例，治愈率为96.9％。保守治疗治愈27例，孕妇及胎儿均存活；保守治疗无效行手术治疗5例，其中1例孕妇及胎儿均死亡，1例孕妇存活，胎儿死亡，其余3例孕妇及胎儿均存活。结论对于晚期妊娠合并高脂血症性重症急性胰腺炎的治疗，应及时制订适合该疾病的综合性治疗方案，有助于提高该疾病治愈率及孕妇胎儿存活率。

Objective To discuss the effect of different digestive tract reconstruction methods on postoperative gallbladder contraction function in patients with gastric cancer. Methods Sixty patients with gastric cancer undergoing radical gastrectomy in our hospital from August 2010 to August 2014 were selected as research subjects. The patients were divided into group A (n=23) and group B (n=37) on the basis of digestive tract reconstruction method after gastrec-tomy. The group A was treated with BillrothⅠoperation, and the group B was treated with dual channel reconstruction. The patients were followed up for one year after surgery. The gallbladder volume, gallbladder contraction function, se-rum cholecystokinin (CCK) level, symptoms were compared between the two groups. Results The gallbladder volume in group A was (20.89±3.12) ml, (21.23±8.10) ml, (23.64±7.88) ml, (24.94±5.32) ml, (27.84±8.81) ml at 3 d, 7 d, 1 month, 6 months and 12 months after operation, which was significantly higher than that before operation [(17.15 ± 8.24) ml] and those in group B [(17.20±7.94) ml, (17.19±7.22) ml, (17.18±7.99) ml, (17.19±8.54) ml, (17.20±8.20) ml, respectively]. The differences were statistically significant (P<0.05). The gallbladder emptying rate in group A after operation was 13.04%, 17.39%, 13.04%, 17.39%, 21.74%at 3 d, 7 d, 1 month, 6 months and 12 months after operation, which was sig-nificantly lower than that in group B of 37.84%, 43.24%, 40.54%, 43.24%, 48.65%(P<0.05). The serum CCK level in the group A after operation was (5.32 ± 0.84) pmol/L, (5.35 ± 0.76) pmol/L, (5.36 ± 0.82) pmol/L, (5.38 ± 0.77) pmol/L, (5.36 ± 0.79) pmol/L, which was significantly higher than that in group B of (4.45 ± 0.39) pmol/L, (4.50 ± 0.62) pmol/L,(4.48±0.41) pmol/L, (4.47±0.84) pmol/L, (4.51±0.33) pmol/L (P<0.05). The incidences of digestive tract symptoms and gallbladder stones in group A were 43.48%, 34.78%, which were significantly higher than those in group B of 2.70%, 0%, and the differences were statistically significant (P<0.05). Conclusion The implementation of dual channel recon-struction in gastric cancer surgery is beneficial to the recovery of gallbladder contraction function, which can improve the quality of life and is worth recommending.