内镜微创保胆取息肉术治疗胆囊息肉的临床应用

目的 评价内镜保胆取息肉及术后中药调理治疗胆囊息肉的临床应用价值.方法 通过小切口开腹或腹腔镜,切开胆囊底,应用纤维胆道镜摘除,包肉,保留功能良好的胆囊,术后5～10 d服中药调理治疗1～2个月.结果 17例成功进行内镜保胆摘除息肉,无严重并发症,3～5d痊愈出院.随访1～2年,B超复查胆囊壁≤3mm,未发现息肉复发;1例术中冷冻活检提示乳头状癌,改行胆囊癌根治术.结论 内镜保胆取息肉结合中药调理治疗胆囊息肉,具有创伤小、安全性高、并发症少等优点、尤其可明确胆囊息肉的性质,为胆囊癌的早期诊断、早期治疗提供一种简单可行的方法 ,值得推广.     

硬质胆道镜联合腹腔镜保胆取石治疗胆囊结石、胆囊息肉的78例疗效观察

目的观察硬质胆道镜联合腹腔镜保胆取石治疗胆囊结石、胆囊息肉的临床疗效。方法 48例胆囊结石与30例胆囊息肉患者行硬质胆道镜保留胆囊、取净结石和息肉手术,术后定期复查腹部彩超。结果 78例患者中1例(1.28%)因结石位于胆囊颈且嵌顿中转行胆囊切除,其余均顺利手术;1例(1.28%)术后2月发现胆囊颈内残余结石,行腹腔镜胆囊切除术;胆囊息肉术后病理检查均为良性息肉。结论硬质胆道镜取石、取息肉术方法简单、安全、可行,是保留胆囊功能的有效方法。     

胆囊保留性手术与意外胆囊癌

目的 探讨内镜微创保胆手术意外发现胆囊癌的处理方法.方法 对2004年1月～2009年2月5例内镜微创保胆手术术中发现的胆囊癌患者进行临床分析.结果 5例意外胆囊癌患者中.术前诊断慢性结石性胆囊炎3例、慢性结石性胆囊炎合并胆囊息肉1例、单纯胆囊息肉1例.术后病理分期:NevinⅡ期1例、NevinⅢ期3例、NevinⅤ期1例.至随访截止,2人死亡,3人存活,最长者已26个月,仍存活.结论 具有胆囊癌高危因素的患者应行开腹胆囊切除术,提倡内镜微创保胆术中对可疑病灶进行冷冻切片病理学检查,对意外胆囊癌患者建议施行根治性胆囊切除术.     

内镜保胆取息肉术后息肉复发的相关因素分析

目的 分析内镜保胆取息肉术后息肉复发的相关危险因素。方法 选择保定市第二医院收治的保胆取息肉术治疗胆囊息肉患者,从随访满1年以上的患者里随机抽取胆囊息肉复发病例和未复发病例,进行回顾性统计分析。先用χ2检验进行单因素分析,再行Logistic多因素回归分析。结果 单因素分析结果显示,胆囊息肉阳性家族史、吸烟史、油腻饮食及相关息肉病理类型,与保胆术后息肉复发具有相关性（均P <0.05）。多因素分析显示,胆囊息肉家族史、吸烟及息肉病理类型与微创内镜保胆取息肉术后息肉复发相关（均P <0.05）。结论 胆囊息肉家族史、吸烟及胆固醇性息肉是内镜保胆取息肉术后息肉复发的危险因素。     

内镜微创保胆手术中几种特殊情况的处理

目的 通过探讨内镜微创保胆手术中几种特殊情况的处理,完善保胆手术方法,提高成功率.方法 胆囊壶腹部嵌顿结石使用碎石器破碎后取出,壁间结石使用活检钳撕开胆囊黏膜后取出,胆囊内细碎结石使用结石吸附器吸出,胆囊息肉使用电活栓钳切除,息肉切除后创面出血使用球形电极凝固.结果 胆囊壶腹部结石嵌顿患者55例经碎石后取出结石,壁间结石患者235例(607处)经钳夹全部取净,胆囊内细碎小结石97例经吸引全部取出.胆囊息肉切除后创面出血187例全部止血彻底.使内镜微创保胆手术得以顺利实施.结论 内镜微创保胆手术的不断创新,解决了手术中存在的问题,使内镜微创保胆手术更加完善,保胆成功率更高,并发症更少.     

腹腔镜联合胆道镜保胆取石和取息肉术58例临床分析

随着胆囊的多种生理功能得到证实,保胆手术已成为胆结石或胆囊息肉的主要治疗方向。而腹腔镜和胆道镜广泛应用于临床,使双镜联合微创保胆取石、取息肉成为可能。我院2006年1月～2009年12月行保胆取石和取息肉术58例,临床效果满意,现报告如下。     

彩色多普勒超声在确定微创保胆手术禁忌证中的应用价值

目的探讨彩色多普勒超声在确定腹腔镜（或小切口）、胆道镜联合微创行保留胆囊切除息肉或取出结石手术方法禁忌证的应用价值。方法回顾性分析2007年1月至2009年12月来我院拟行微创保胆手术患者1476例,术前均常规进行肝脏、胆囊、胆管、胰腺彩色多普勒超声检查。结果1476例患者中1461例实施手术,其中行腹腔镜（或小切口）、胆道镜联合微创保留胆囊切除息肉和／或取出结石手术1185例;行胆囊切除手术276例。彩色多普勒超声术前诊断微创保胆手术适应证准确率为95．27％,禁忌证准确率为93．48％,总准确率为94．93％。15例未实施手术,其彩色多普勒超声诊断结果与CT／MRI诊断结果一致。结论彩色多普勒超声能够在微创保胆手术术前充分显示患者胆囊及胆管情况,检出具有微创保胆手术禁忌证病例,以其简便、安全无害、准确性高而成为微创保胆手术术前必选的检查方法。     

腹腔镜联合电子胆道镜微创保胆取石(息肉)术256例护理配合

目的:探讨腹腔镜联合电子胆道镜微创保胆取石(息肉)术患者的护理配合技巧及效果。方法:对256例胆囊结石(息肉)患者行腹腔镜联合电子胆道镜微创保胆取石(息肉)术,给予精心护理配合。结果:本组13例改行腹腔镜下胆囊切除术(LC),1例因息肉快速病理结果为恶性改行开腹手术,余242例均成功完成保胆取石(息肉)术,手术时间25~120 min,术后切口愈合良好,患者满意手术效果。结论:良好的护理配合是保障腹腔镜联合电子胆道镜微创保胆取石(息肉)术成功的关键。     

微创内镜保胆取息肉术治疗胆囊息肉的临床疗效、并发症及远期预后

目的研究分析微创内镜保胆取息肉术治疗胆囊息肉的临床疗效、并发症及远期预后,为胆囊息肉临床有效治疗提供科学指导。方法回顾性分析2012年6月至2015年6月诊治的125例胆囊息肉患者临床资料,随机将其分为两组。对照组55例行腹腔镜胆囊切除术治疗,研究组70例行微创内镜保胆取息肉术。对比两组患者围术期指标、并发症、胆囊壁厚度与胆囊收缩功能改善以及远期预后效果。结果研究组手术时间、肠功能恢复时间、肛门排气时间、住院时间依次为(50.01±11.84)min、(21.23±3.14)h、(17.62±4.25)h、(4.15±1.25)d均短于对照组(62.12±3.14)min、(42.26±4.25)h、(27.55±5.14)h、(9.82±3.25)d,出血量(11.25±2.47)ml、术后VAS评分(2.67±1.25)分均少于对照组(17.26±3.02)ml、(7.56±1.81)分(P0.01);两组术后胆囊壁厚度、胆囊收缩功能均改善,且研究组改善优于对照组(P0.01);研究组息肉复发7.14%低于对照组25.45%。结论微创内镜保胆取息肉术治疗胆囊息肉效果显著,未发生胆瘘、出血等严重并发症,且可改善患者胆囊收缩功能,降低息肉复发率,具有临床推广价值。     

腹腔镜辅助下胆道镜微创保胆取石(息肉)术患者的护理

目的 探讨腹腔镜辅助下胆道镜微创保胆取石(息肉)术患者的护理方法及效果.方法 对31例微创保胆取石(息肉)患者进行充分的术前准备,加强心理护理,术后密切观察病情变化及精心护理.结果 31例患者中,成功行微创保胆手术27例,成功率87.10%,3例患者由于腹腔粘连、慢性炎性反应较重,中转为腹腔镜胆囊切除术.结论 微创保胆取石(息肉)术能保留胆囊功能,改善患者预后,从而提高患者的生活质量.     

基于SEER数据库分析手术治疗和内镜切除治疗表浅食管鳞癌的长期疗效

目的 基于SEER数据库分析Tis及T1期食管鳞癌患者接受手术或内镜治疗后的生存情况,以期为食管癌的早期治疗提供参考.方法 从美国SEER数据库获取2004年至2012年初次病理确诊为食管鳞癌的病例,均有完整T及N分期信息、无远处转移、预后和随访信息完整、肿瘤原发灶治疗信息完整.主要结局为食管癌特异性死亡.用Cox回归...     

99mTc-EHIDA SPECT 30 min胆囊显像对内镜微创保胆手术治疗胆石症的指导价值

目的探讨~(99m)Tc-EHIDA SPECT 30 min胆囊显像对内镜微创保胆手术治疗胆石症的指导价值。方法回顾性分析因胆石症行胆囊~(99m)Tc-EHIDA SPECT显像的患者791例。其中,男388例,女403例,年龄(53.5±29.5)岁。对比分析~(99m)Tc-EHIDA SPECT 30 min胆囊显影结果与保胆治疗的情况。结果胆石症患者中,633例~(99m)Tc-EHIDA SPECT 30 min胆囊显影,提示胆囊管通畅,而158例患者~(99m)Tc-EHIDA SPECT 30 min胆囊未显影,提示胆囊功能异常。SPECT显示胆囊功能是否正常与保胆手术治疗胆石症之间的符合率为80.03%(633/791)。SPECT胆囊显影组与未显影组保胆率比较,差异有统计学意义(2=95.66,P=0.000),其优势比(OR)为7.91(95%CI:4.99～12.55)。结论~(99m)Tc-EHIDA SPECT 30 min胆囊显像是一种安全、快速、简便和非创伤性的检查方法,能够有效判断胆囊功能状态,对内镜微创保胆手术治疗胆石症有一定的指导作用。     

腹腔镜联合胆道镜在保胆取石（息肉切除）术中的应用

[目的]探讨腹腔镜联合胆道镜保胆取石（息肉切除）术的临床应用价值.[方法]将本院2008年12月至2009年11月行腹腔镜联合胆道镜保胆取石（息肉切除）术并有完整随访资料的149例患者分为胆囊结石组（A组）、胆囊结石合并息肉组（B组）、胆囊息肉组（C组）;并对临床资料进行回顾性分析.[结果]全部病例均顺利行腹腔镜联合胆道镜保胆取石（息肉切除）术,术后1例患者出现腹壁蜂窝织炎,经治疗后痊愈.1例患者出现右下肢深静脉血栓,经保守治疗而愈.术后随访52～63个月,A组内单发结石与多发结石分别复发1例（3.33％）、18例（23.68％）,差异有统计学意义（P ＜0.05）.A组结石复发19例（17.92％）,B组结石复发7例（43.75％）,差异有统计学意义（P ＜0.05）.B组息肉复发1例（6.25％）,C组息肉复发1例（3.70％）,差异无统计学意义（P＞0.05）.[结论]腹腔镜联合胆道镜保胆取石（息肉切除）术安全、微创、有效;胆囊结石合并息肉不推荐行保胆取石（息肉切除）术.     

超声引导下乳腺微创旋切术筛查早期乳腺癌的应用价值

目的：探讨超声引导下乳腺微创旋切术筛查早期乳腺癌的应用效果。方法：对2016年6月至2019年12月于临邑县人民医院行超声检查乳腺疾病的628例病患进行研究，对其检出的829个直径小于10mm的乳腺微小结行乳腺微创旋切术，随即采用冰冻切片对切除标本做病理分析，参照病理结果确定手术方法。术后做常规病理检查并对良性病变者随访1年。结果：经乳腺微创旋切术筛查后术区出现血肿4例，其中活动性出血1例。冰冻切片筛查出701个乳腺纤维腺瘤、54个乳腺浸润性癌、31个乳腺腺病、27个乳腺导管内乳头状瘤、19个乳腺不典型增生、以及9个乳腺导管内癌和7个乳腺小叶原位癌。对所有病患实施手术治疗、术后随访1年经彩超检查良性结节病患术区良好，3例恶性结节病患复检出现远处转移。结论：通过超声引导下乳腺微创旋切术筛查早期乳腺癌准确性高，其具创伤小、安全性高、诊断率高的优势，值得临床在早期乳腺癌筛查中大量应用。     

鼻内镜下可吸收鼻窦药物支架手术对慢性鼻窦炎伴鼻息肉患者鼻腔菌群及预后的影响

目的 分析鼻内镜下可吸收鼻窦药物支架手术对慢性鼻窦炎伴鼻息肉患者鼻腔菌群及预后的影响。方法 选择2018年11月－2021年3月于该院耳鼻喉科就诊的80例慢性鼻窦炎伴鼻息肉患者纳入研究,依据随机数表法随机分为实验组和对照组,每组40例,对照组患者行鼻内镜Messerklinger微创手术,实验组患者在鼻内镜Messerklinger微创手术结束前将可吸收鼻窦药物支架置入。比较两组患者住院时间、鼻黏膜恢复时间及鼻腔恢复通气时间,以及不同治疗方式对于鼻腔黏膜菌群的影响,依据术后3周全部患者的临床表现进行疗效对比。结果 实验组住院时间、鼻黏膜恢复时间及鼻腔恢复通气时间均明显少于对照组（P < 0.05）。实验组术后鼻腔内弯曲杆菌属、肠球菌属阳性率明显低于对照组（P < 0.05）;实验组术后鼻腔内假单胞菌属、嗜血杆菌属、葡萄球菌属与对照组比较,差异无统计学意义（P > 0.05）。实验组术后治疗效果明显优于对照组（P < 0.05）。结论 鼻内镜下可吸收鼻窦药物支架手术治疗慢性鼻窦炎伴鼻息肉,可以明显促进鼻黏膜上皮化,降低术后患者鼻腔内弯曲菌属、肠球菌属阳性率,治疗效果显著,值得临床推广应用。     

The role of ERCP and laparoscopic cholecystectomy in gallstone-related pancreatitis

Summary

Laparoscopic surgery has become the routine for elective cholecystectomy, but its place in the management of gallstone-related pancreatitis has not yet been identified. We prospectively assessed a minimally invasive treatment regime for gallstone pancreatitis combining endoscopic retrograde cholangiopancreatography (ERCP) and laparoscopic cholecystectomy, over a 24 month period. Twenty-two patients were found to have gallstone pancreatitis. The mean age was 52 ± 18 years. All patients presented with abdominal pain. Five were jaundiced. The Ranson score severity of pancreatitis averaged 1.6 (range 0–6). Our management protocol was to perform ERCP when clinical and biochemical markers had settled, followed by laparoscopic cholecystectomy during the same admission. The time interval between presentation and ERCP was 8.9d (range 2–15d), ERCP to surgery was 4.5d (range 2–35d) and surgery to discharge was 4d (range 1–21 d). The median hospital stay was 16d. ERCP showed stones in the common bile duct in five patients, four of whom had them removed at ERCP. Twenty patients underwent laparoscopy. The gallbladder was removed in 18 and two required conversion (one pseudocyst, one cystic artery bleed). Two patients had elective open cholecystectomy (one pseudocyst, one previous surgery). Only one patient developed a post-operative complication (pseudocyst). The majority of patients had multiple small stones in their gallbladder and it was not possible to predict the presence of common bile duct stones prior to ERCP. No patient developed post-operative pancreatitis. There was no mortality. This study shows that combined ERCP and laparoscopic cholecystectomy is an efficient and safe minimally invasive management for gallstone pancreatitis.     

超声引导下穿刺活检对获得性免疫缺陷综合征患者合并淋巴结肿大的病因诊断价值

目的： 经超声引导下穿刺活检分析获得性免疫缺陷综合征（acquired immunodeficiency syndrome，AIDS）患者合并淋巴结肿大的病因。方法： 对2017年4月至2020年12月在上海市公共卫生临床中心行超声引导下穿刺活检的130例AIDS合并淋巴结肿大患者的病理诊断及实验室指标等进行回顾性分析，进而分析超声引导下穿刺活检对该类患者淋巴结肿大病因的诊断价值。结果： 130例患者中，最终诊断良性病变82例（63.1%），包括淋巴结核56例，非结核分枝杆菌感染7例，马尔尼菲篮状菌感染6例，坏死性淋巴结炎5例，隐球菌感染2例，巨细胞病毒感染2例，金黄色葡萄球菌感染、淋巴组织增生、淋巴囊肿、EB病毒感染各1例；恶性肿瘤36例（27.7%），包括淋巴瘤17例（其中弥漫大B细胞淋巴瘤、Burkitt淋巴瘤各5例，浆母细胞淋巴瘤、小淋巴细胞性淋巴瘤及间变大细胞淋巴瘤各1例，另4例未分型），转移性肿瘤17例，卡波西肉瘤2例；病因类型不明确12例，其中病理检查提示11例为良性病变、1例为肿瘤性坏死。130例患者淋巴结肿大病因总诊断率达90.8%。所有患者无并发症。结论： 超声引导下穿刺活检对AIDS合并淋巴结肿大患者淋巴结肿大病因诊断率高，且微创安全，对于该类患者淋巴结肿大临床早期诊断及精准治疗具有较高价值，值得临床推广应用。     

Minimally invasive surgical approach for radicalization of incidental post-cholecystectomy gallbladder carcinoma: safety,feasibility and outcomes

Background and aims: Gallbladder carcinoma is a rare but aggressive malignant neoplasm. The incidence of intra- or post-operative incidental gallbladder carcinoma diagnosis following laparoscopic cholecystectomy is estimated to be 1–2%. Aggressive re-resection is warranted as the majority of patients have residual disease either in the liver or the lymph nodes. However the use of a minimally invasive surgical approach (MISA) to perform a radicalization in these patients has not been investigated yet. We retrospectively analyzed surgical and oncologic outcome of a small selected cohort of patients with incidental gallbladder carcinoma whom underwent redo radicalization surgery by MISA.

Material and methods: From April 2012 to June 2014 at our department six patients (three females and three males) with incidental findings of gallbladder carcinoma pT1b (stage I) following laparoscopic cholecystectomy, and referred to our center from other secondary-level referral hospitals, underwent a redo surgery for radicalization by means of laparoscopic (n. 3) or robotic approach (n. 3). A retrospective analysis of prospective collected data was performed.

Results: The redo procedure consisted of a liver resection (segments IVb?+?V) and lymph nodes clearance of hepatoduodenal hilum and common hepatic artery. Conversion rate was zero. Median operative time was 290 (250–310) min. Estimate blood loss was 175 (100–350) ml. Total hospital stay was 6 (5–10) days. All liver resections were performed without inflow vascular clamping. One patient was re-operated for hemoperitoneum while peri-operative mortality was zero. Oncologically, an R0 resection was always achieved with a mean number of lymph nodes retrieved of 17,5 (14–22). The stage of the neoplasm was confirmed in all cases but one, who was found to have a pN1 status (stage IIIb). At 21 (6–32) months follow-up all patients are alive and no recurrence has been observed.

Conclusions: Our data suggest that radicalization of patients with stage I incidental postoperative gallbladder carcinoma can be done by a MISA without compromising the oncologic outcome. Larger studies are needed to validate these results.     

Minimally invasive surgery vs laparotomy in patients with colon cancer residing in high-altitude areas

BACKGROUNDColon cancer is associated with a higher incidence among residents in high-altitude areas. Hypoxic environment at high altitudes inhibits the phagocytic and oxygen-dependent killing function of phagocytes, thereby increasing the inflammatory factors, inhibiting the body’s innate immunity and increasing the risk of colon cancer. AIMTo examine the effect of minimally invasive surgery vs laparotomy in patients with colon cancer residing in high-altitude areas. METHODSNinety-two patients with colon cancer in our hospital from January 2019 to February 2021 were selected and divided into the minimally invasive surgery and laparotomy groups using the random number table method, with 46 patients in each group. Minimally invasive surgery was performed in the minimally invasive group and laparotomy in the laparotomy group. Operative conditions, inflammatory index pre- and post-surgery, immune function index and complication probability were measured. RESULTSOperative duration was significantly longer and intraoperative blood loss and recovery time of gastrointestinal function were significantly less (all P < 0.05) in the minimally invasive group than in the laparotomy group. The number of lymph nodes dissected was not significantly different. Before surgery, there were no significant differences in serum C-reactive protein, interleukin-6 and tumor necrosis factor-α levels between the groups, whereas after surgery, the levels were significantly higher in the minimally invasive group (26.98 ± 6.91 mg/L, 146.38 ± 11.23 ng/mL and 83.51 ± 8.69 pg/mL vs 41.15 ± 8.39 mg/L, 186.79 ± 15.36 ng/mL and 110.65 ± 12.84 pg/mL, respectively, P < 0.05). Furthermore, before surgery, there were no significant differences in CD3+, CD4+ and CD4+/CD8+ levels between the groups, whereas after surgery, the levels decreased in both groups, being significantly higher in the minimally invasive group (55.61% ± 4.39%, 35.45% ± 3.67% and 1.30 ± 0.35 vs 49.68% ± 5.33%, 31.21% ± 3.25% and 1.13 ± 0.30, respectively, P < 0.05). Complication probability was significantly lower in the minimally invasive group (4.35% vs 17.39%, P < 0.05). CONCLUSIONLaparoscopic minimally invasive procedures reduce surgical trauma and alleviate the inflammatory response and immune dysfunction caused by invasive operation. It also shortens recovery time and reduces complication probability.     

379例结肠憩室病的临床特点及内镜表现

目的通过回顾电子结肠镜检出结肠憩室患者的资料,分析结肠憩室发病特点及其与伴发疾病的相关性。方法回顾性分析2014年6月-2019年5月该院13 638例行电子结肠镜检查的内镜资料,采用SPSS 19.0统计软件分析结肠憩室患者检出情况及内镜下组织表现,以及其与伴发疾病的相关性。结果共发现结肠憩室379例,检出率为2.78%,呈逐年升高趋势,由1.79%增长至3.35%,第5年较第1年检出率明显提高(P 0.05)。结肠憩室发病与结肠息肉、结肠癌、结肠脂肪瘤、结肠黏膜黑变病和肠道手术史呈正相关(P 0.05),与缺血性结肠炎无明显相关性(P 0.05)。结论 5年间电子结肠镜下结肠憩室检出率明显升高,结肠憩室检出率与结肠息肉、结肠癌、结肠脂肪瘤、结肠黑变病及肠道手术史均有相关性。