目的 探讨胆总管结石合并胆囊结石老年患者的治疗方案的选择及疗效.方法 回顾性分析2017年2月至2019年11月于平度市人民医院确诊为胆囊结石合并胆总管结石 66 例老年患者资料,根据手术方式不同分成观察组(n=34)和对照组(n=32),观察组采用分步内镜下乳头括约肌切开术(endoscopic sphincteropapillotomy,EST)联合腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)治疗,对照组采用LC联合腹腔镜胆总管探查取石术(laparoscopic common bile duct exploration T-tube choledochotomy,LCBDE)治疗.比较两组的总手术时间、术后引流管留置时间、术中出血量、术后住院时间、腹腔镜中转开腹、结石清除率、术后并发症(包括发热、胆漏、胰腺炎).结果 观察组患者的总手术时间、引流管留置时间、术后住院时间均短于对照组,术中出血量少于对照组,术中中转开腹率低于对照组,差异均有显著性(P<0.05).两组患者的结石清除率及术后并发症发生率无显著差异(P>0.05).结论 EST+LC和LC+LCBDE均能较好地治疗老年患者胆囊结石合并胆总管结石,但在医师技术和手术设备均具备的条件下,选择EST+LC治疗胆总管结石合并胆囊结石对老年患者更加有益.

Objective To study the application of captopril block renin-angiotensin system (RAS) on liver function in mice liver resection and HGF and the influence of TNF alpha mRNA expression. Methods 40 male CBA mice from 2014 June to 2014 De-cember, randomly divided into control group and research group, two groups are 70% hepatectomy, team daily dose of 750 mg/kg captopril in abdominal cavity, the amount of normal saline control group daily injection, compared two groups of postoperative 3 d, 6 d cereal third transaminase (ALT), aspertate aminotransferase (AST), and other liver function markers, and HGF, TNF alpha mR-NA expression level. Results After the resection of liver in mice serum ALT, AST, TNF alpha mRNA expression level, HGFmRNA have change. Conclusion Mice after partial liver resection RAS blocking conducive to regulating liver function, reduce the inci-dence of inflammation.

Objective To probe into the effect of the application of captopril blocking rennin-renin angiotensin system (RAS) on liver regeneration and liver function of mouse that has undergone partial hepatectomy. Methods Prepared model of postoperative partial hepatectomy mouse. The experimental group was administered captopril by intraperitoneal injection and conditions on liver regeneration and liver function change were measured respectively at the 1st, 3 rd, 5 th, 7 th and 9th day following the operation. The results were compared with that of the control group. Statistical methods were used to analyze the effect of RAS blockade on liver regeneration and liver function. Results Since the 3rd day following the operation, RAS blockade had significantly increased the liver weight ratio (t=7.006, P=0.000), while captopril had reduced the liver weight ratio by the 7th day. Since the 3rd following the operation, the application of captopril blocking RAS had significantly reduced the level of ALT, AST and BIL. The experimental group had obviously higher albumin than the control group (P=0.013), however, the level of serum alkaline phosphatase remained unchanged. Since the 7th day, ALP had begun to decline, while there remained no significant variation in ALT and AST. Compared with the control group, the experimental group had obviously lower IL-6 expression in mouse hepatic tissues (χ2=7.500, P=0.006), there was statistical difference between the two. Conclusion RAS blockade will facilitate the incipient liver regeneration of postoperative hepatectomy mouse, and also boost the incipient liver function restoration of mouse that has received the partial hepatectomy.

目的:探讨应用卡托普利阻断肾素-血管紧张素系(RAS)统后对肝切除术小鼠肝功能及白介素6(IL-6)表达的影响.方法:制备肝部分切除术后小鼠模型,实验组予以卡托普利腹腔内注射,对照组予以生理盐水,分别于术后1、3、5、7、9天测定肝功能治疗及IL-6表达的变化,与对照组比较,应用统计学方法分析RAS阻断对肝功能标志物及炎性因子的影响.结果:两组术后第1天开始,肝功能各项指标均上升,但对照组上升更明显;实验组术后第1、3天ALT、AST、TBIL与对照组比较,有统计学差异(均P＜0.05),ALP与对照组比较无统计学差异(P＞0.05);第5天实验组ALP下降,ALT、AST、ALP与对照比较差异均有统计学意义(P＜0.05);第5天开始两组TBIL无统计学差异(P＞0.05);术后第7天开始两组ALT、AST未再出现统计学差异(P＞0.05).结论:RAS阻断可促进肝部分切除小鼠早期肝脏功能恢复,减缓肝脏损伤后炎症反应.

目的 建立体外培养大鼠侧脑室下区神经干细胞的方法,观察大鼠侧脑室下区神经干细胞的膜兴奋性.方法 无血清培养方法体外分离、纯化孕15～16 d wistar胎鼠的侧脑室下区神经干细胞,用免疫荧光鉴定干细胞标记蛋白nestin表达情况、用tuj-1和GFAP免疫染色研究体外NSC的分化情况;取第二代神经干细胞给予DiBAC4(3)染色后,经高浓度氯化钾刺激,激光共聚焦显微镜动态扫描,观察侧脑室神经干细胞的兴奋性.结果 采用无血清培养基体外分离的神经干细胞具有自我增殖、多向分化潜能等干细胞一般特点,且表达干细胞的标记蛋白nestin;采用DiBAC4(3)染色,高浓度钾刺激后,细胞荧光强度无显著变化,即细胞膜电位无明显改变,神经干细胞具有不易兴奋性.结论 采用无血清培养方法成功分离扩增大鼠脑内神经干细胞;由大鼠侧脑室分离而来的神经干细胞具有不易兴奋性.

Objective To summarize the experience of treat spontaneous pneumothorax by thoracoscope operation. Methods To analyze 96 cases spontaneous pneumothorax from Jan,2000 to Dec,2006. Results All 96 cases were cured, no patient die. Conclusions Treat spontaneous pneumothorax by thoracoscope operation could avoid open chest operation, and have the characteristic of decreasing traumatic,fast recovery,less complication,and could shorten the length of stay.