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腹腔鏡膽總管切開取石術對患者術后胃腸道功能恢復、應激反應及血流動力學的影響

目的 探討腹腔鏡膽總管切開取石術對患者術后胃腸道功能恢復、應激反應及血流動力學的影響。 方法 回顧性分析筆者所在醫院于 2016 年 1 月至 2016 年 12 月期間收治的 78 例膽總管結石患者的臨床資料，按照術式分為開腹組（行開腹膽總管切開取石術）與腹腔鏡組（行腹腔鏡膽總管切開取石術），各 39 例，比較 2 組患者的手術療效、手術前后的應激反應指標和血流動力學指標。 結果 腹腔鏡組患者的術中出血量、術后鎮痛次數、胃腸道功能恢復時間及術后住院時間均少于（短于）開腹組（P<0.01）；腹腔鏡組手術前后的血清皮質醇水平、血清游離三碘甲狀腺原氨酸（FT3）水平及平均動脈壓（MAP）的差值均較開腹組低（P<0.05），而手術前后心率（HR）的差值較開腹組高（P<0.05）。 結論 相比開腹膽總管切開取石術，腹腔鏡膽總管切開取石術更利于改善患者的血清皮質醇及 FT3 水平，減輕應激反應，改善血流動力學情況，促進術后胃腸道功能的恢復，值得臨床推廣。

頸部Castleman病1例報道

Diagnosis and treatment of occult carcinoma of the thyroid with neck lymph node metastasis as the first symptom

Objective To investigate the optimal diagnosis and treatment strategy of occult carcinoma of the thyroid (OCT) with neck lymph node metastasis as the first symptom. Method In order to discuss the optimal diagnosis and treatment strategy of OCT with neck lymph node metastasis as the first symptom, we collected 35 cases and analyzed their characteristics, diagnostic methods, operative schemes, metastasis situation, and death situation. Results Of the 35 cases, 28 cases went to hospital because of swollen lymph nodes, and other 7 cases were discovered by color Doppler ultrasound in medical examination. Thyroid nodules were found by color Doppler ultrasound in 32 cases, 3 cases were found no thyroid nodule. Lymph node of 23 cases were determined by ultrasound-guided fine-needle aspiration biopsy (US-FNAB), and 16 cases (69.56%) were diagnosed as metastasis of thyroid carcinoma or suspicious metastasis by US-FNAB. Thyroid biopsy were done in 21 cases, and 11 cases (52.38%) were diagnosed as thyroid carcinoma or suspicious thyroid carcinoma by fine needle aspiration biopsy. Of the 35 cases, 19 cases were performed total thyroidectomy and functional neck lymph node dissection, 11 cases were performed resection of unilateral thyroid and isthmus and regional neck lymph node dissection, 5 cases were performed nonstandard operations. All cases were followed up for 3–10 years after operation, and the median time was 7-year. During follow up period, 10 cases suffered from reccurrence. Among them, 3 cases reoccurred in the nonstandard operation group, 5 cases reoccurred in resection of unilateral thyroid and isthmus and regional neck lymph node dissection group, 3 cases reoccurred in total thyroidectomy and functional neck lymph node dissection group. There were 3 cases died. Among them, there was 1 case in each group of nonstandard operation group, resection of unilateral thyroid and isthmus and regional neck lymph node dissection group, and total thyroidectomy and functional neck lymph node dissection group. The recurrence rate of total thyroidectomy and functional neck lymph node dissection group was markedly lower than those of resection of unilateral thyroid and isthmus and regional neck dissection group (χ2=4.751,P<0.05) and nonstandard operation group (χ2=5.874,P<0.05). While there was no significance difference of the recurrence rate between the resection of unilateral thyroid and isthmus and regional neck dissection group and nonstandard operation group (χ2=0.291,P>0.05). There was no significance difference in the mortality among the three groups (P>0.05). Conclusion US-FNAB and intraoperation rapid frozen pathological section are important methods for diagnosis of OCT with neck lymph node metastasis as the first symptom, and standard operation is an principal treatment method for it.

Application Value of Rouviere Groove Guide Positioning in Laparoscopic Cholecystectomy

目的　探討腹腔鏡膽囊切除術中避免膽管損傷新方法的安全性。方法　回顧性分析2008年1月至2012年1月期間筆者所在醫院采用Rouviere溝引導定位的方法進行腹腔鏡膽囊切除術患者的臨床資料，并在手術時間和術后并發癥發生率方面與同期傳統手術組病例相比較。結果　與傳統手術組比較，Rouviere溝引導組患者的手術時間縮短，術后并發癥發生率及中轉開腹率降低，其差異均有統計學意義（P＜0.05）。結論　采用Rouviere溝引導定位法進行腹腔鏡膽囊切除術能有效縮短手術時間，減少膽管損傷的發生概率，值得在臨床推廣應用。