目的 探討腹腔鏡術中聯合結腸鏡治療結直腸小占位病變的可行性和臨床應用價值。方法對我院2006年12月至2009年5月期間23例行腹腔鏡聯合結腸鏡手術的結直腸小占位病變患者的臨床資料進行回顧性分析。結果 所有患者均在腹腔鏡下完成手術，無中轉開腹。 手術時間80～200 min，平均140 min; 出血80~120 ml，平均100 ml。 9例息肉病變行局灶切除，術中經快速冰凍切片病理證實4例早期癌及10例不典型增生均行相應腸段切除。 術后1例出現輕度肺炎，經積極抗炎對癥治療后痊愈，其余患者恢復良好。 所有患者術后第1天即離床活動，住院時間5～10 d，平均7 d。結論 腹腔鏡術中聯合結腸鏡治療結直腸占位是安全可行的，有助于結直腸病灶及切緣的準確定位，可縮短手術時間，值得臨床進一步推廣應用。
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.
ObjectiveTo explore the influence factors of gallstone. MethodsClinical data of 511 patients who were admitted to our hospital from Apr. 2015 to Apr. 2016 were retrospectively analyzed. ResultsOf 511 patients, there were 274 patients with gallstone (gallstone group) and 237 patients without gallstone (control group). Univariate analysis results showed that, no significant difference of age, gender, and diabetes was found between gallstone group and control group (P > 0.050), but the levels of serum total cholesterol (TC), triglyceride (TG), low density lipoprotein (LDL-C), and fasting blood glucose (FBG) were significantly higher in patients of gallstone group (P < 0.050), but the level of serum high density lipoprotein (HDL-C) was significantly lower in patients of gallstone group (P=0.001). Logistic regression results showed that four factors including diabetes〔OR=4.491; 95% CI is (2.021, 9.976); P < 0.001〕, the serum TC〔OR=2.548; 95% CI is (1.944, 3.338); P < 0.001〕, HDL-C〔OR=0.115; 95% CI is (0.056, 0.237); P < 0.001〕, and FBG〔OR=1.277; 95% CI is (1.086, 1.502); P=0.003〕 entered the final regression model after controlling confounding factors. The results showed that patients who combined with diabetes, high levels of serum TC and FBG, and low level of serum HDL-C, had higher ratio of galls-tone. ConclusionDiabetes, high-level of serum TC and FBG, low-level of serum HDL-C were risk factors of gallstone.
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 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.
Objective The aim of this research was to explore the relationship between type D personality and symptom duration/emergency admissions/mental health status/quality of life (QOL) in Chinese rectal cancer patients. Methods Rectal cancer patients who were treated in our hospital form Oct. 2010 to Oct. 2012 were selected prospectively, and then their type D personality was measured with the 14-item Type D Personality Scale (DS14). Mental health status was measured with the Hospital Anxiety and Depression Scale (HADS). The QOL was assessed longitudinally by using the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 and QLQ-CR38 questionnaires at the baseline and 6 months after diagnosis. Comparison between the type D personality group and non-type D personality group in social-demographic characteristics, clinicopathological features, mental health status, and QOL was performed. Results Of the 596 patients (92%) who responded, 131 patients (22%) had type D personality. ① Compared with non-type D personality group, the proportions of patients with duration of symptoms ≥1 month, without medical insurance, and emergency admissions in type D personality group were all higher, as well as the poor economic situation and more complication ( P<0.050). ② EORTC QLQ-C30. At the baseline, scores of role function, emotional function, cognitive function, social function, and overall health status in type D personality group were all lower than those of non-type D personality group ( P<0.050), but scores of fatigue, constipation, and financial difficulties in type D personality group were all higher than those of non-type D personality group ( P<0.050). In 6 months after diagnosis, scores of role function, emotional function, cognitive function, social function, and overall health status in type D personality group were all lower than those of non-type D personality group ( P<0.050), but scores of fatigue, insomnia, constipation, and financial difficulties in type D personality group were all higher than those of non-type D personality group ( P<0.050). ③ EORTC QLQ-CR38. At the baseline, score of expectation for the future in type D personality group was lower than that of non-type D personality group ( P<0.001), but score of urinary problems in type D personality group was higher in type D personality group than that of non-type D personality group ( P<0.001). In 6 months after diagnosis, scores of expectation for the future and sexual function in type D personality group were both lower than those of non-type D personality group ( P<0.050), but scores of urinary problems, gastrointestinal symptoms, male sexual dysfunction, and excretion difficulties in type D personality group were all higher than those of non-type D personality group ( P<0.050). ④ At the baseline and 6 months after diagnosis, the incidences of anxiety and depression in type D personality group were all higher than those of non-type D personality group at the same time point ( P<0.001). In type D personality group, the incidences of anxiety and depression in 6 months after diagnosis were both higher than baseline ( P<0.001). Conclusion Type D personality may be a general vulnerability factor to screen for subgroups at risk for longer SD and emergency admissions in clinical practice of rectal cancer patients, and it was associated with poor QOL and poor mental health status.
目的 探討自制雙套管持續沖洗負壓引流治療胰腺術后胰瘺的效果。 方法 回顧性分析2008 年 8 月至2014 年3 月期間于筆者所在醫院接受自制雙套管持續沖洗負壓引流治療的12 例胰瘺患者的臨床資料，總 結效果。 結果 12 例患者均接受雙套管持續沖洗負壓引流治療，治療期間引流管若有堵塞，可拔出體外清理。所 有患者均于拔管后治愈。更換雙套管早期（1 ～ 3 d）患者發熱等感染癥狀明顯緩解，引流10 ～ 22 d 后引流量逐漸 減少。出院后所有患者均獲訪6 個月，患者恢復良好，胰瘺部位包裹吸收，無并發癥發生。 結論 自制雙套管持續 沖洗負壓引流治療胰腺術后胰瘺的效果滿意，安全可行。
目的 總結經臍單切口腹腔鏡闌尾切除術的技術要點。方法 回顧性分析2012年1月至12月期間中國醫科大學附屬第四醫院收治并行經臍單切口腹腔鏡闌尾切除術的55例闌尾炎患者的臨床資料。結果 54例患者手術均獲成功，1例患者因腹膜后闌尾而中轉為3孔法。手術時間為（40.6±12.3） min （35～90min），住院時間為（4.5±1.3） d （3～6d），住院費用為（1.2±0.3）萬元（0.8～1.5萬元），術后均無并發癥發生。術后49例患者獲訪，隨訪時間為1～6個月，平均4.8個月。術后患者均恢復良好，臍部瘢痕不明顯，美容效果較滿意。結論 采用通用器械行經臍單切口腹腔鏡闌尾切除術安全、可行，美容效果較佳。
ObjectiveTo investigate the proportion of peripheral blood CD4+CD25+ regulatory T cells (Tregs) in patients with pancreatic head carcinoma, the dynamic changes of these cells before and after pancreatoduodenectomy were also analyzed. MethodsThe proportions of peripheral blood CD4+CD25+ Tregs in patients with pancreatic head carcinoma and normal individuals were examined by using flow cytometric analysis. The CD4+/CD8+ ratio was also studied before and after operation. ResultsThe patients with pancreatic head carcinoma showed higher ratio of CD4+CD25+ and CD4+CD25high Tregs compared with normal control before operation (Plt;0.05). However, the percentage of these T cells reduced significantly after pancreatoduodenectomy, which was most obviously on the 3rd day after operation (Plt;0.01, Plt;0.05). After operation, CA199 level began to decrease, which was obvious on the fourteen day after operation. This tendency of CD4+CD25high Tregs changes was similar to that of CA199. The patients showed an decreased ratios of CD4+/CD8+ compared with normal controls, which further declined after operation, and reached the lowest point on the seventh day after operation (Plt;0.05). ConclusionsPancreatoduodenectomy may be helpful for the recovery of antitumor immunity. The perioperative period of patients with pancreatic head carcinoma may be a beneficial windowphase for immune intervention and Tregs may be served as target cells.