目的 探討魚膽汁對兔腎臟的影響及其機制。 方法 將實驗新西蘭大耳白兔隨機分為灌胃組（GP組，n=19）與靜脈注射組（VI組，n=15），根據體重分別按3 mL/kg、0.3 mL/kg的劑量通過灌胃或耳緣靜脈注射方式給予魚膽汁。采集魚膽汁處理前與處理后1～5 h的血標本，測定腎功能、酸堿平衡及電解質指標，記錄GP組每個采樣點前20 min尿量及魚膽汁處理前、處理后5 h的尿常規。魚膽汁處理后5 h處死動物取腎做病理學檢查。 結果 給予一定量魚膽汁后5 h內，兩組兔血肌酐（Scr）、尿素氮、K+呈升高趨勢（P均＜0.05），而血HCO3?濃度呈下降趨勢（P＜0.05），其中VI組兔Scr、血K+改變早于GP組。GP組記錄尿量明顯下降，尿pH值升高，蛋白定量試驗、隱血試驗結果均呈陽性。兩組兔腎組織病理檢查均顯示腎小球血管充盈，少量中性粒細胞浸潤；腎小管水腫及間質充血，部分有局灶性出血，腎間質損傷較腎小球更為嚴重。 結論 無論經由消化道還是血管給予實驗兔魚膽汁均可導致急性腎功能損傷，與魚膽汁造成急性腎實質損傷、特別是腎小管間質損傷有關。
ObjectiveTo compare the differences of curative effect, cosmetic effect, and shoulder-neck function protection effect between video-assisted lateral neck dissection (VALND) and traditional open thyroid surgery (OTS) in the treatment of papillary thyroid carcinoma (PTC) with lateral cervical lymph node metastasis. MethodsFifty patients with unilateral PTC accompanied by ipsilateral cervical lymph node metastasis who underwent sternal incision approach VALND at Fudan University Shanghai Cancer Center and Pudong Hospital Affiliated to Fudan University from January 2013 to December 2019 were collected. And 100 patients with unilateral PTC and ipsilateral cervical lymph node metastasis who underwent OTS during the same period were randomly selected at a ratio of 1∶2 using the random number method. All patients underwent unilateral thyroid lobectomy (or total thyroid lobectomy) + isthmus resection + central area (zone Ⅵ) and cervical lymph node dissection on the affected side (zones Ⅱ–Ⅴ). The therapeutic effects were compared between the two groups. ResultsCompare to OTS group, the operation time of VALND group was longer ［(218.3±86.6) min vs. (185.7±42.8) min, P=0.002］, but the hospital stay was shortened ［(6.1±2.2) d vs. (7.3±1.6) d, P<0.001］. In terms of surgical efficacy, there were no statistically significant differences between VALND group and OTS group in the number of lymph node dissections, the number of lymph node metastases, and the postoperative tumor recurrence rate (P>0.05). As for surgical safety, the two groups had similar rates of postoperative complications including recurrent laryngeal nerve injury, hypoparathyroidism, postoperative hematoma and infection(P>0.05). In terms of postoperative recovery, the scar color, vascular distribution, thickness, and softness, as well as in shoulder stiffness, tightness, pain, and numbness scores of VALND group were significantly lower than those in OTS group (P<0.05). ConclusionsFor PTC patients with lateral cervical lymph node metastasis, there is no significant difference in surgical efficacy and safety between VALND and OTS. However, VALND group shows obvious advantages in reducing the length of cervical incisions, improving cosmetic effects, and protecting cervical and shoulder functions. Therefore, VALND through the sternal notch approach has high promotion and application value in clinical practice.