【摘要】目的探討不同病理狀態下結石嵌頓性膽囊炎腹腔鏡膽囊切除術(laparoscopic cholecystectomy,LC)的臨床應用價值。方法回顧性分析2001年1月〖CD3/5〗2009年10月期間172例結石嵌頓性膽囊炎患者行腹腔鏡手術的臨床資料。結果腹腔鏡手術成功164例,成功率為9535％,中轉開腹8例,中轉率為465％。術中出血1例,術后并發膽漏1例,膽管殘余結石1例,切口感染1例,并發癥發生率為233％(4/172),無膽管損傷,無死亡。結論LC治療結石嵌頓性膽囊炎安全、可行,但必須嚴格掌握手術適應證、時機和技巧。適時中轉手術是提高手術成功率、降低并發癥的關鍵。
目的 觀察帕瑞昔布鈉與舒芬太尼用于無痛胃鏡麻醉的安全性和有效性及對患者滿意度的影響，為提高臨床無痛胃鏡麻醉的安全性和舒適性提供依據。 方法 采取前瞻性隨機雙盲對照方法，納入2011年8月－12月擬行無痛胃鏡檢查的患者120例，隨機分為3組。患者于胃鏡檢查開始前口服利多卡因膠漿，靜脈注射舒芬太尼、帕瑞昔布鈉或生理鹽水10 mL。檢查時靜脈注射異丙酚。記錄患者檢查過程中生命體征、異丙酚使用量、誘導時間、檢查時間、蘇醒時間、醫師以及患者滿意度、舒適度等數據。 結果 舒芬太尼組檢查中各時間點平均動脈壓明顯低于帕瑞昔布組（P=0.029），血管活性藥物用量明顯高于帕瑞昔布組（P=0.036）。醫師以及患者滿意度舒芬太尼組和帕瑞昔布組相當，且均高于對照組（P＜0.05）。除嗆咳外，帕瑞昔布組其他不良反應的發生率明顯低于舒芬太尼組（P＜0.05）。 結論 實施無痛胃鏡檢查前15 min靜脈注射帕瑞昔布鈉0.6 mg/kg或舒芬太尼0.10 μg/kg均可以獲得滿意的麻醉效果，麻醉醫師和患者及家屬的滿意度明顯增高，且帕瑞昔布對呼吸和循環的影響更小，安全性更高。
Objective To explore changes and challenges on management of chronic pancreatitis. Methods The updated clinical guidelines and the latest research findings were collected and reviewed. Results The proposition of a new mechanistic definition and identification of an early stage give us a novel insight into chronic pancreatitis. The intraductal pancreatic calcifications has been regarded as the most reliable ultrasonography and CT features of chronic pancreatitis. In addition, the endoscopic ultrasonography is also of great value. The present surgical strategies are established on the concepts of step-up approach and damage control. The surgery perform better than the endoscopic treatment in the long-term outcome, but the timing course of surgery need to be further investigated. Conclusions Early diagnosis and treatment plays a critical role in cases of chronic pancreatitis. More patients of chronic pancreatitis should be treated in a multidisciplinary team as future perspectives.
Hip fracture in the elderly is a disease with a high mortality rate and a high complication rate. Its main treatment method is surgery. The concept of enhanced recovery after surgery runs through the perioperative period of elderly patients with hip fracture. Elderly patients with hip fracture should be scheduled for surgery as soon as possible after admission to enhance postoperative functional recovery. Preoperative ambulation and postoperative exercise can reduce postoperative complications and mortality, shorten the length of hospital stay, and promote functional recovery.
ObjectiveTo explore the safety and practicality of intestinal autotransplantation (IATx) combined with radical tumor resection in the treatment of intraperitoneal tumors involving vital blood vessels. MethodThe research progress on indications, preoperative evaluation, ex vivo organ preservation techniques, and mesenteric vascular reconstruction techniques for IATx from January 1996 to August 2023 both domestically and internationally was reviewed. ResultsThe IATx had become a feasible surgical option for the patients with intraperitoneal tumors involving vital blood vessels (more than 180° involving the root of the superior mesenteric artery). The related studies had identified that the intraperitoneal tumors involving vital blood vessels mainly originated from the pancreas, mesentery, and retroperitoneum. Establishing a multidisciplinary team for preoperative assessment of IATx could aid to establish a valuable diagnostic and treatment system. The keypoints of IATx mainly included IATx preparation (cutting and ligating mesenteric blood vessels), in vivo tumor resection, cryopreservation of intestine in vitro, vascular and gastrointestinal reconstruction after IATx, which was different viewpoints in the different literature, such as the selection of in vivo/in vitro tumor resection, mesenteric vascular reconstruction, and portal or vena cava drainage. However, there was a consensus that the optimal solution for ex vivo organ preservation technology was improved solutions relevant to UW. At present, the hot ischemia time of intestine graft was shortened, the incidence of postoperative intestinal graft loss was reduced, and the postoperative survival of patients was gradually extended. But there were still some unresolved complications, such as early graft loss, pancreatic leakage, delayed gastric emptying, postoperative bleeding, etc. ConclusionsIATx combined with tumor resection for intraperitoneal tumors involving vital blood vessels is feasible through carefully preoperative evaluation and surgical planning, which could provide a good clinical and prognostic result. But this operation requires higher technical requirements and might only be performed in centers with rich experience in intestinal transplantation.
ObjectiveTo summarize the advantages of double-layer detector spectral CT (DLCT) as compared with conventional CT in disease diagnosis and its research status in the diagnosis of gastric cancer. MethodThe literature relevant research was summarized, including the clinical application of DLCT and its clinical research in the diagnosis of gastric cancer. ResultsThe image quality of DLCT was better than that of conventional CT examination. Its virtual non-contrast could display gastric cancer lesions and evaluate lymph node metastasis. The number of CT scans of patient was reduced by DLCT, correspondingly the radiation dose received by patients was reduced, and the examination time of patient was shortened. The iodine uptake in the tissues could visually be observed by the iodine concentration map in the DLCT and be quantitatively analyzed, which could provide a new option for noninvasive evaluation of angiogenesis in the gastric cancer. The DLCT scanning provided a material decomposition image, the different iodine absorption of normal gastric mucosa and gastric cancer could be reflected by the material decomposition image. The enhancement degree and blood supply of lesions could be effectively reflected by quantitative measurement of iodine concentration and thus the benign and malignant changes of the gastric diseases were effectively identified. The DLCT could distinguish the structure of the gastric wall, which could show the depth of invasion of malignant gastric lesions to the gastric wall and whether the adjacent tissues and organs were involved or not. Through the homology analysis of abnormal lymph nodes and suspicious metastases in the abdominal cavity through the related parameters of the DLCT could more accurately determine the clinical TNM stage of the gastric cancer before surgery. ConclusionsIn recent years, DLCT has shown a better morphological diagnostic efficiency than conventional CT in clinical application. Its virtual non-contrast, iodine concentration, effective atomic number, and other parameters characteristics make it show obvious advantages in gastric cancer, such as evaluation of angiogenesis of gastric cancer, differentiation of benign and malignant gastric diseases, clinical staging of gastric cancer, and other applications. In future, with more usable parameters research and continuous accumulation of clinical application about DLCT in clinic, which can better serve clinical work.
Objective To introduce the research status of the immunomodulatory role of various immune cells and stromal cells in the tumor microenvironment in the progression of hepatocellular carcinoma. Method The related basic and clinical research literatures on the correlation between various immune cells and stromal cells in the tumor microenvironment and the occurrence, development and prognosis of hepatocellular carcinoma were reviewed and summarized. Results Immune cells and stromal cells in the tumor microenvironment have obvious complexity and diversity. Inhibitory immune cells in various immunosuppressive environments and stimulating immune cells that exert anti-tumor effects jointly promote or inhibit the occurrence and progression of hepatocellular carcinoma. Conclusions The exact role of various immune cells in the tumor microenvironment in hepatocellular carcinoma remains to be further studied. With the continuous accumulation of relevant research results, more patients with hepatocellular carcinoma will benefit from immunotherapy.
目的 探討在Sprague-Dawley大鼠右心房注射緩激肽對呼吸的影響。 方法 7～9 d和21～23 d大鼠在迷走神經完整和迷走神經切斷的情況下從右心房注射緩激肽，觀察呼吸指標的變化。 結果 ① 右心房注射緩激肽后，7～9 d大鼠出現呼吸暫停，而在21～23 d大鼠僅出現呼吸抑制（P＜0.05）；② 切斷迷走神經后，右心房注射緩激肽在兩組大鼠均不再出現呼吸暫停。 結論 右心房注射緩激肽在7～9 d大鼠產生呼吸暫停，且依賴于迷走神經的完整性。
ObjectiveTo onstructe a prognostic model for gastric cancer based on disulfidoptosis-related genes. MethodsFirstly, transcriptome data and clinical data were obtained from the TCGA and GEO databases to explore the expression of disulfidoptosis-related genes in gastric cancer tissues and normal tissues, as well as their impact on the overall survival (OS) of gastric cancer patients. Subsequently, two clusters of disulfidoptosis-related gene were determined by consensus clustering, key genes were further selected by using LASSO regression, and a multivariate Cox proportional hazards regression model was constructed to predict OS. ResultsAmong the 24 kinds of disulfidoptosis-associated genes, 16 exhibited statistically significant differences in expression between gastric cancer tissues and normal tissues (P<0.05), and results of univariate Cox proportional hazards regression model showed that 9 kinds of disulfidoptosis-associated genes were associated with OS (P<0.05). The 24 kinds of disulfidoptosis-associated genes were grouped into 2 clusters by using the consensus clustering algorithm, with 299 differentially expressed genes between the two clusters. In the training set, 14 genes were determined by using LASSO regression to construct the OS prediction model, and risk scores were calculated. The OS of the high-risk group was significantly worse than that of the low-risk group (P<0.05), and this prediction model also had a high area under the curve value in the validation set. ConclusionsThe OS prediction model based on disulfidoptosis-associated genes can predict the prognosis of gastric cancer patients.
ObjectiveTo conduct a systematical evaluation and meta-analysis of the relation between serum total cholesterol (TC) level and the risk of gastric cancer. MethodsThe PubMed, Embase, Web of Science, and Cochrane Library databases were searched from inception to March 5, 2023. Two independent reviewers performed the literature search, identification, and screening, as well as performed the quality assessment and data extraction. ResultsA total of 12 studies with 5 143 671 participants and 40 551 patients with gastric cancer were included in the meta-analysis. The results of meta analysis showed that 9 studies reported that the elevated serum TC level decreased the risk of gastric cancer [OR (95%CI) was 0.91 (0.85, 0.98)], and 5 studies reported that the decreased serum TC level increased the risk of gastric cancer [OR (95%CI) was 1.93 (1.17, 3.18)]. Also the results of the subgroup analyses showed that the decreased serum TC level increased the risk of gastric cancer in the studies with cohort study, larger overall sample sizes and gastric cancer sample sizes, with longer duration of follow-up, and in those with habits of alcohol and smoking [0.89 (0.87, 0.92), 0.90 (0.87, 0.94), 0.90 (0.87, 0.93), 0.86 (0.82, 0.90), 0.90 (0.87, 0.93), and 0.90 (0.87, 0.93), respectively] , which was consistent with the overall results. In contrast, there was no statistical difference in the relation between the elevated serum TC level decreased the risk of gastric cancer between male and female patients in the gender subgroup. ConclusionsThe results of this systematical evaluation and meta-analysis suggest that serum TC level [135–294 mg/dL (3.49–7.62 mmol/L)] may be a protective factor for gastric carcinogenesis. The risk of gastric carcinogenesis may be increased when serum TC level decreases, and this change is a long-term and insidious process.