目的 評價CT及MRI在中晚期膽囊癌周圍臟器侵襲和轉移中的診斷價值。方法 回顧性分析我院2003年3月至2010年6月期間收治的經手術病理證實的中晚期膽囊癌患者45例，所有患者術前均同時行CT和MRI檢查。結果 ①在診斷膽囊癌方面，CT診斷符合率為93.33% （42/45），MRI診斷符合率為88.89% （40/45），二者比較差異無統計學意義（χ2=0.287 2，P＞0.05）。②在診斷膽囊癌轉移的敏感度方面，肝臟直接浸潤和轉移診斷方面CT為72.00% （18/25），MRI為92.00% （23/25）；膽管受侵診斷方面CT為83.33% （5/6），MRI為100% （6/6）；胰腺轉移診斷方面CT為100% （3/3），MRI為100% （3/3）；淋巴結轉移診斷方面CT為70.00% （7/10），MRI為90.00% （9/10）；腹膜、網膜轉移診斷方面CT為33.33% （1/3），MRI為33.33% （1/3）。診斷膽囊癌轉移的總診斷符合率CT為72.34%（34/47），MRI為89.36% （42/47），MRI明顯高于CT （χ2=4.083 3，P＜0.05）。結論 MRI在診斷膽囊癌方面與CT相當，但在診斷腫瘤侵犯鄰近器官及轉移方面MRI略優于CT。
目的 探討老年人結腸脾曲綜合征的診治方法。方法 對1993年9月至2003年9月收治的22例老年人結腸脾曲綜合征患者的臨床資料進行回顧性分析。結果 臨床表現為便秘伴腹痛、腹脹、消瘦、頭痛、頭暈、心悸、腹膜炎等； X線鋇劑灌腸造影檢查示結腸脾曲過高、迂曲成角，甚至扭轉，可伴有橫結腸冗長。行橫結腸與降結腸側側吻合術，切除冗長結腸，隨訪2～8年，療效滿意。結論 對老年結腸脾曲綜合征患者，鋇劑灌腸檢查應是常規檢查，一旦確診，應手術治療。
Objective To investigate the possibility of laparoscopic cholecystectomy （LC） on porcelain gallbladder. Methods Twenty-four cases of porcelain gallbladder， who were operated in China Medical University， including 13 LC cases， from 2006 to 2008 were retrospectively reviewed. Results Of 24 porcelain gallbladder cases (0.48%) in 4964 cholecystectomy patients， calcification of gallbladder in 87.50%(21/24) patients was diagnosed by ultrasonography. Of 13 patients who were cured by LC, one suffered from postoperative leak bile, no metastasis were found by following up 12 or 14 months in two gallbladder carcinoma cases. Conclusion There’s specificity of ultrasonographic image in porcelain gallbladder, in which LC is safe to be performed and routine frozen pathology during operation is necessary.
目的探討超聲引導下經皮經肝膽囊穿刺引流術（PTGD）聯合二期腹腔鏡膽囊切除術（LC）治療急性膽囊炎的安全性和可行性。 方法回顧性分析我院2008年7月至2013年7月期間對急性膽囊炎先行PTGD后二期LC的117例患者的臨床資料。 結果本組117患者PTGD術后均成功實施二期LC，PTGD術順利，無并發癥發生，PTGD管平均留置時間27.4 d（21～31 d）。LC采用單孔法33例，三孔法84例，全部病例均治愈。手術平均時間為48.5 min（32～92 min），腹腔引流管拔除平均時間為2.3 d（2～4 d）。無中轉開腹者，無膽管損傷、出血、膽汁漏等并發癥發生。病理結果為急性膽囊炎。本組隨訪患者無術后并發癥。 結論超聲引導下PTGD聯合二期LC治療急性膽囊炎安全、有效。
Objective To explore the clinical value and experience of ultrasound guided combined with laparoscopic microwave ablation in treatment for special site liver cancer．Methods The clinical data of 9 patients with liver cancer treated by ultrasound guided combined with laparoscopic microwave ablation in our hospital from February 2008 to October 2010 were analyzed retrospectively．Results There were 6 cases of primary liver cancer， 3 cases of metastatic hepatic carcinoma. Eight cases of multiple tumors， 1 case of single tumor．There were one or more lesions invading liver capsular，a total of 13 lesions in all the patients． Among them，6 lesions located in diaphragm， 3 closed to bowel， 2 neared stomach，1 located in gallbladder bed and 1 in hilar．No serious complications and no death happened during operation．The following-up time was （9.2±4.7） months （4 to 18 months）， there were 2 lesions of part residual， including 1 case of microwave ablation again，1 case of percutaneous ethanol ablation， and 11 lesions of complete ablation （84.6%，11/13） 1 month after operation by CT examination．Four cases recurred 3 months after operation by CT examination， including 2 cases of microwave ablation again，1 case of percutaneous ethanol ablation，1 patient with pulmonary metastasis and giving up treatment，1 patient with poor liver function and died of liver failure 6 months after operation；1 patient with multiple lesions died of brain metastases 10 months after operation； the rest were still alive．Conclusions Ultrasound guided combined with laparoscopic microwave ablation is a safe and effective method in the treatment for special site liver cancer，the curative effect is good and worth of spread．
目的比較單孔腹腔鏡與傳統腹腔鏡膽囊切除術的臨床效果。 方法選取2012年9月至2013年5月期間于我院就診的膽囊良性疾病患者，分別接受單孔腹腔鏡膽囊切除術（單孔腹腔鏡組，45例）和傳統腹腔鏡膽囊切除術（傳統腹腔鏡組，48例），分別觀察并對比2組患者的手術時間、術中出血量、術后（6 h和24 h）疼痛評分、止疼藥物的應用率、術后住院時間及患者對切口的滿意度。 結果2組患者術前的一般特征差異無統計學意義（P＞0.05）。單孔腹腔鏡組的手術時間明顯長于傳統腹腔鏡組〔（59.11±14.15）min比（40.21±11.11）min，P=0.00〕，術后6 h疼痛評分及止痛藥物應用率均明顯低于傳統腹腔鏡組〔6 h疼痛評分：（3.33±1.41）分比（4.60±1.30）分，P=0.00；止痛藥物應用率：6.67%（3/45）比31.25%（15/48），P=0.04〕，術后患者對切口的滿意度評分明顯高于傳統腹腔鏡組〔（4.76±6.00）分比（2.60±0.76）分，P=0.02〕。單孔腹腔鏡組和傳統腹腔鏡組的術中出血量、術后24 h疼痛評分及術后住院時間比較差異均無統計學意義〔術中出血量：（14.67±4.80）mL比（13.85±3.85）mL，P=0.36；24 h疼痛評分：（1.60±0.65）分比（1.80±0.70）分，P=0.14；術后住院時間：（3.11±0.77）d比（3.06±0.67）d，P=0.75〕。2組均無并發癥發生。 結論單孔腹腔鏡較傳統腹腔鏡膽囊切除術可減輕術后疼痛，美容效果好，且并不增加手術風險。
Objective To investigate the effects of hand assistant laporoscopic splenectomy plus pericardial devascularization on systemic stress responses. Methods Forty patients with cirrhotic portal hypertension were selected， 20 cases of which were underwent hand assistant laparoscopic splenectomy plus pericardial devascularization (LAP group)， and the other 20 were underwent open splenectomy plus pericardial devascularization (OP group). The levels of blood glucose （BG）, insulin (Ins), triiodothyronine （T3）, tetraiodothyronine （T4）, corticosteroid （CS） and other related clinical data were measured before operation and on day 1-3 after operation, which were compared between two groups. Results There was no statistical significance between two groups on those levels before operation. On day 1 after operation， BG and CS level in both two groups were higher than those before operation (P＜0.05), but they were recovered on day 2 after operation in LAP group (Pgt;0.05), and on day 3 after operation in OP group (Pgt;0.05). BG and CS level in OP group were markedly higher than those in LAP group on day 2 after operation (P＜0.05). On day 1 after operation， Ins, T3 and T4 level of two groups were lower than those before operation (P＜0.05), but they were recovered on day 2 after operation in LAP group (Pgt;0.05) and on day 3 after operation in OP group (Pgt;0.05). Ins, T3 and T4 level in OP group were lower than those in LAP group on day 2 after operation (P＜0.05). There was no significant difference in operation time between two groups (Pgt;0.05). But laparoscopic surgery had more advantages than conventional open surgery such as reducing bleeding quantity in operation, shortening recovery time of bowel and urinary bladder function and the length of stay. Conclusion Compared with laparotomy, the laparoscope not only imposes less impact on physical stress system, but also makes recovery after operation more quickly.
ObjectiveThrough the analysis of quantitative and functional changes in peripheral blood CD4+ CD25+FOXP3+ regulatory T cells (Treg) of early HCC patients before and after operation, to discuss the operation effect on the immune function from the aspect of immune suppression. MethodsExtracted the lymphocytes of peripheral blood in HCC patients before and after operation (case group, n=15) and normal people (control group, n=5 cases), and analyze the number and function of Treg by flow cytometer after extracellular (CD4, CD25) and intracellular (FOXP3) staining. ResultsCD4+CD25+ T cells and CD25+FOXP3+ T cells in preoperative peripheral blood in case group were significantly higher than those in control group (12.43±2.57)% vs. (5.56±1.02)%, (5.14±1.4)% vs. (2.18±0.83)%, Plt;0.05). These two cells decreased at 1 week after operation. 〔(10.56±2.13)%, (4.28±1.08)%〕, but there was not statistically significant (Pgt;0.05), they decreased significantly at 2 weeks after operation 〔(7.30±0.89)%, (3.43±0.83)%， Plt;0.05〕. CD8+ T cells and CD4+CD25- T cells in preoperative peripheral blood in case group were significantly lower than those in control group 〔（23.42±1.80）% vs. （29.22±2.26）%， （36.14±1.12）% vs. （43.69±2.78）%， Plt;0.05〕， These two cells decreased significantly at 2 weeks after operation 〔（27.15±1.71）%， （40.30±2.00）%〕. The analysis on the Treg and AFP correlation found that they have low correlation (r=048, Plt;0.05 ). ConclusionsThe hepatectomy can improve the immune response of HCC patient. Treg may have a certain auxiliary significance in the diagnosis, treatment and prognosis of patients with hepatocellular carcinoma.
目的 探討孤立性纖維性腫瘤的診斷及外科治療方法。方法 回顧我院10年來經手術切除并行病理檢查確診為孤立性纖維性腫瘤的病例資料，就其診斷和外科治療方法進行總結與分析。結果 共16例次患者，腫瘤分別位于胸腔、腹股溝、后腹膜、外陰、頸部、下肢等部位，無明顯特異的臨床癥狀。所有病例均行手術完全切除腫瘤，術后經病理學檢查和免疫組化染色檢查確診。對患者定期隨訪，其中2例分別于術后5年和7年腫瘤復發，2例分別隨訪3年和5年后失訪，2例患者分別于隨訪的第9個月和16個月因全身多發轉移死亡，其余患者仍在隨訪中。結論 孤立性纖維性腫瘤大多數病例表現為局部緩慢生長的無痛性腫塊，無明顯的臨床癥狀，術前診斷較困難，目前僅能依靠術后免疫組化檢查確診，手術切除是最佳的治療方法。