Objective To study the advances in the relationship between the number of infiltrating dendritic cells and the postoperative prognosis of digestive malignant tumor. MethodsThe literature in recent years on the relationship between the number of infiltrating dendritic cells and the postoperative prognosis of digestive malignant tumor was reviewed.ResultsThe number of infiltrating dendritic cells among esophageal cancer,and gastric carcinoma,colonic cancer and pancreatic cancer was associated with a better prognosis.Conclusion The population density of dendritic cells among the malignant tissue could be regarded as an independent indicator in estimating the postoperative prognosis of malignant tumor.
Objective To investigate the prevention and treatment strategy of bile duct injury (BDI) in laparoscopic cholecystectomy (LC). MethodsLatest progress was reviewed based on recent documents and the experience on BDI in LC in our department. ResultsWith the popularity of LC, BDI in LC is increasing. The reasons include illegibility and variability of local anatomy in gallbladder trigone,injury caused by galvanothermy, as well as operator’s overconfidence. In order to prevent BDI, we should apply more blunt dissection, not to use electrocogulation if possible and to study local anatomy and its variance clearly. The common bile duct and common hepatic duct should be clearly identified. Intraoperative cholangiography, laparoscopic ultrasonography and hepatobiliary scintigraphy are selections as necessary.The treatment of BDI depends on the type of BDI and its site and local condition.The treatment includes end to end anastomosis, repairing the defect, choledochoduodenostomy, RouxenY choledochojejunostomy and so on. T tube should be maintained in place for more than half a year after operation.Conclusion The key to improve the prognosis of BDI is prevention and treatment in proper time and in correct way.
【Abstract】Objective To analysis the clinical characteristics, pathogenesis, diagnosis and treatment of acute acalculous cholecystitis.Methods Seventy-nine cases of acute acalculous cholecystitis from January 1996 to January 2003 were retrospectively reviewed.Results Of those 79 cases, 13 cases were treated nonoperatively and 66 cases were treated operatively. Twentythree cases were suppurative, 43 cases were gangrenous with perforation in 18 cases，which were proved by postoperative pathology. Seventysix cases were cured and 3 cases were dead. Conclusion Keeping vigilant alert, observing dynamically as well as appropriate operative intervention are effective to improve the prognosis of acute acalculous cholecystitis.
Objective To summarize contents of enhanced recovery after surgery (ERAS) and understand it’s status and prospect in application of patients with hepatolithiasis. Methods The descriptions of ERAS in recent years and applications in hepatolithiasis were reviewed. Results The ERAS programme mainly included the preoperative managements, such as the education, nutrition management, and gastrointestinal tract management; the intraoperative managements, such as the minimally invasive surgery, reasonable choice of anesthesia, infusion volume management, and maintenance of body temperature, analgesia, and preventing postoperative nausea and vomiting medication selection; the postoperative early feeding, early exercise, early extubation, multimodal analgesia, T tube management, reasonable discharge standard and follow-up management. Although the ERAS was rarely reported in patients with hepatolithiasis, it had some advantages of promoting recovery and improving patient satisfaction, and it was still effective and safe. Conclusions Application of ERAS concept in patients with hepatolithiasis has achieved precision management and individualized treatment during perioperative period. It could achieve a good short-term therapeutic effect and optimize medical management model. However, there are still some problems at the present stage in implementation and promotion of patients with hepatolithiasis, such as lacks of criteria and specifications, evidence-based medicine. It is needed to further strengthen communication and collaboration among multiple disciplinary teams so as to further improve ERAS programme and popularize it.
目的:探討腹腔鏡膽囊切除術（laparoscopic cholecystectomy，LC）致膽管損傷的原因、預防措施和經驗教訓。方法:分析2007年8月～2008年8月期間我院膽道外科收治的3例膽管嚴重損傷病例資料。結果:3例LC術致膽管嚴重損傷的患者均發生肝門部膽管狹窄，并均在肝門膽管成形后行膽管空腸Roux-en-Y吻合術，吻合口直徑2.0～3.0 cm。術后患者恢復良好，均順利出院，住院時間為10～15天。隨訪1～6個月，1例于術后2月出現肝區隱痛，口服消炎藥可控制，其余未見異常不適。結論:術中仔細辯清肝總管、膽總管與膽囊管的三者關系是預防LC術膽管損傷的關鍵。膽管空腸Roux-en-Y吻合術是處理膽管損傷的重要手術方式。LC術時，膽道外科醫生思想上要高度重視，不可盲目追求速度。
Objective To study the clinical diagnosis and treatment of juxtapapillary duodenal diverticula with biliary deseases.Methods Eighteen duodenal diverticulum treated in our department in recent 5 years were retrospectivly analyzed, especially investigated the postcholecystectomy cases whose symptoms were continuing existence after operatoins. Articles about the surgical treatment were reviewed. Results The total of 18 duodenal diverticulum with 17 cases of juxtapapillary duodenal diverticulum were included in this study. The ages of 12 cases were over 50 years old. Sixteen cases(88.89%) presented biliary stones. Seven cases once had performed cholecystectomy or cholecystectomy plus choledochotomy,but symptoms persisted after operations. The duodenal diverticulum were found by endoscopic retrograde cholangiopancreatography (ERCP) and hypotonic duodenography. Sixteen patients underwent surgical treatment with good effect. Conclusion The juxtapapillary duodenal diveticula has the close relationship with biliary stones. ERCP and hypotonic duodenogrphy are the most reliable methods to get the correct diagnosis. In case of recurrent common bile duct stones after operations or persisting billiary symptoms after cholecystectomy, the coexistence of juxtapapillary duodenal diverticulum should be ruled out. The surgical treatment is only considered for the duodenal diverticulum with complication.
Objective To investigate the feasibility of laparoscopic cholecystectomy through the transumbilical approach. MethodsThe clinical data of 18 patients underwent endoscopic cholecystectomy through only one transumbilical incision at West China Hospital were retrospectively analyzed. Results All of the operations were successfully completed without conversion to routine laparoscopic surgery or open surgery. The operation time was 40-130 （58±10） min. There was no intraoperative complication. The patients did well postoperatively and were discharged 1 day after operation. There was no postoperative complications and without visible abdominal scar on 1 month follow-up. Conclusions Laparoscopic cholecystectomy through the transumbilical approach is technically feasible and safe. But this technique is difficult, the patients should be selected carefully.
【摘要】 目的 加強輸血管理是保障血液合理利用和臨床用血安全的重要手段。 方法 通過對醫院臨床用血情況的分析，以減少手術輸血為切入點，采取強化意識，嚴控指征，完善術前準備，倡導自體輸血，加強考核管理等方式促進臨床合理用血。 結果 有效提升了醫療服務品質，保障醫療安全。 結論 其方法與措施此方法與措施供大型醫院醫療管理參考借鑒。【Abstract】 Objective Strengthening blood transfusion management is an important means to ensure reasonable blood usage and clinical security during blood use. Methods With reducing surgery blood transfusion as a breakthrough point, We promotes clinical reasonable blood use and medical service quality by strengthening awareness of health workers, controlling indicators strictly, perfecting preoperative preparation, initiating autologous blood transfusion, enhancing assessment and management, and so on. Results The medical service quality was improved and the medical safety was ensured. Conclusion The experience could provide a reference for medical management in large hospitals.
Rare diseases are mostly genetic disorders that often manifest in childhood, characterized by severe conditions, difficulties in diagnosis and treatment, and poor homogeneity in clinical management. Clinical research on rare diseases contributes to enhancing the diagnosis and treatment capabilities for rare diseases in China and promotes the development of rare disease medicine. Clinical research on rare diseases in China started relatively late, and there is currently no mature and comprehensive system for clinical research on rare diseases. This article analyzes the current state of clinical research on rare diseases in China, identifies existing problems and research difficulties, and proposes ideas and key measures for the construction of China’s clinical research system on rare diseases, aiming to provide opinions and suggestions for the construction of China’s clinical research system on rare diseases.
ObjectivesThis study aimed to analyze the evaluation data of 24 professional residency training bases of West China Hospital of Sichuan University(WCHSCU) so as to provide experience for construction of residency training base.MethodsBased on the evaluation criteria of standardized residency professional bases published by Chinese Medical Association in 2019, 24 professional bases of residency training in WCHSCU were evaluated in terms of base condition, teaching staff and process management.ResultsThe results showed that 41.67% of the 24 residency bases received a total score above 90 points, 16.67% were between 85 to 90 points, 20.83% were between 80 to 85 points, 8.33% were between 70 to 80 points, and 12.50% were between 60 to 70 points.ConclusionsThe residency training base construction of (WCHSCU) is satisfactory.