应用胰管盆式内引流术治疗慢性胰腺炎18例疗效分析

目的 探讨胰管盆式内引流术在慢性胰腺炎治疗中的应用及疗效。方法 回顾性分析2016年12月至2019年6月湖南省人民医院行胰管盆式内引流术治疗的18例慢性胰腺炎病人的临床资料。合并胰管结石16例,合并胰周假性囊肿18例,合并胰周脓肿5例。均行胰管盆式内引流术。结果 18例病人均顺利完成胰管盆式内引流术,手术时间为（3.5±1.2）h,术中出血量为（153.8±30.7）mL。术后6例（33.3%）病人带管出院,其余病人术后拔管时间（8.0±1.5）d;有1例（5.6%）病人术后连续3 d桥袢引流管引流少量暗红色液体,予以保守治疗后愈合,其余病人均未出现并发症,无死亡病例。18例病人均获得随访,随访时间为1~28个月,效果满意,有1例（5.6%）术后27个月时再发胰腺炎,经保守治疗好转,其余病人未再发胰腺炎。结论 采用胰管盆式内引流术一期处理慢性胰腺炎急性发作亚急性期病人,可缩短治疗时间,且有效缓解病人腹痛症状,防止胰腺炎复发,保护胰腺内外分泌功能,改善病人生存质量。     

瑞士EMS碎石清石系统治疗肾结石120例临床分析

目的观察采取瑞士EMS三代碎石清石系统治疗肾结石疗效,并分析其安全性。方法选择本院于2013年1月至2014年1月收治的肾结石患者240例为研究对象(结合临床表现及相关影像学的表现,符合肾结石诊断标准),按照数字随机法分为两组,每组120例。观察组采取瑞士EMS三代碎石清石系统治疗,对照组采取钬激光碎石术治疗,比较两组患者疗效差异。结果经统计,观察组患者手术时间、术中出血量分别为(61.4±27.4)min、(159.4±43.5)m L,均少于对照组,均P<0.05。观察组痊愈89(74.2%),有效29例(24.2%),总有效率118例(98.3%),明显高于对照组105例(87.5%),P<0.05。观察组术后出现腹胀、恶心、呕吐7例,发热11例,感染9例,并发症27例(22.5%)与对照组并发症30例(25.0%)比较无明显差异,P>0.05。结论瑞士EMS三代碎石清石系统治疗肾结石疗效较佳,手术时间短,成功率高,具有重要临床价值。     

Serology and ultrasound for diagnosis of choledocholithiasis

Introduction

Magnetic resonance cholangiopancreatography (MRCP) is not a routine investigation to exclude choledocholithiasis unless there is clinical or biochemical suspicion of common bile duct (CBD) stones. This study attempted to determine which radiological or serological parameters best predicted CBD stones.

Methods

All patients undergoing MRCP from 2005 to 2011 were selected. Patients with pancreatitis were excluded. Liver function tests (LFTs) at admission and prior to MRCP were recorded, as was abdominal ultrasonography and MRCP results. Parameters measured routinely on LFTs included alkaline phosphatase (ALP), alanine transaminase (ALT) and bilirubin. Receiver operating characteristic curve area analysis (area under the curve [AUC]) and chi-squared analysis were undertaken.

Results

Overall, 195 patients were identified, 71 of whom had CBD stones on MRCP. Raised ALP levels on admission demonstrated a correlation with CBD stones (AUC: 0.619, odds ratio [OR]: 3.16, p=0.06). At ultrasonography, a dilated CBD (OR: 3.76, p<0.001) and intrahepatic duct dilation (OR: 5.56, p<0.001) were highly significant predictors. However, only 37% of patients had a dilated CBD on ultrasonography. Ongoing elevation of LFT parameters, particularly ALP (AUC: 0.707, OR: 4.64, p<0.001) and ALT (AUC: 0.646, OR: 5.40, p<0.001), displayed a significant correlation with CBD stones.

Conclusions

Ongoing (even if minor) elevations of liver function test parameters should prompt the need to exclude CBD stones even in the presence of a normal CBD diameter on ultrasonography.     

钙的作用机理及如何安全补钙的研究现状

钙是人体不可或缺的重要元素,钙的作用机理十分复杂,虽然多年来国内外大量研究已证实钙对机体各个系统正常生理功能的调节作用,但仍有许多问题有待解决。对于人体缺钙及如何安全补钙的问题,尚存在较大争议。本文通过综述形式,总结近年来国内外对钙的作用机理及补钙争议的相关研究,并探讨如何安全补钙及钙剂的选择,期待为大众正确认识“钙”提供依据。     

B超引导下经皮肾镜治疗160例上尿路结石分析

目的 探讨B超引导下经皮肾镜联合气压弹道碎石取石术治疗泌尿系上尿路结石的临床疗效和安全性.方法 回顾分析本院自2010年1月至2013年12月收治的160例泌尿系结石患者的临床资料,B超引导下定位进行经皮肾镜下气压弹道碎石、取石治疗.结果 160例除1例外均一期成功建立经皮肾通道.平均手术时间95min,术中出血平均100mL,平均住院时间12.5d,1次取净结石146例,2次取净5例,总结石清除率为94.4％,无气胸、腹腔脏器损伤等并发症发生.结论 B超引导下经皮肾镜碎石取石术是治疗泌尿系上尿路结石的有效方法,其成功率高、操作简单、患者创伤小、安全,值得临床推广应用.     

双镜联合保胆取石术与腹腔镜胆囊切除术治疗胆囊结石患者疗效对比分析*

目的 比较采取双镜联合保胆取石术与腹腔镜胆囊切除术治疗胆囊结石患者的疗效。方法 2015年2月～2020年2月我院收治的78例胆囊结石患者,其中36例接受腹腔镜联合胆道镜保胆取石术,另42例接受腹腔镜胆囊切除术,术后随访12个月。采用ELISA法或双抗体夹心免疫发光法检测血清皮质醇(COR)和C反应蛋白(CRP)。结果 观察组手术时间和住院费用分别为(53.3±17.7)min和(3.2±0.5)万元,显著长于或高于对照组【(36.7±10.8)min和(2.3±0.4)万元,P＜0.05】,术后进食和肛门排气时间分别为(2.8±0.9)h和(14.9±3.2)h,均显著短于对照组【分别为(3.3±0.7)h和(19.3±4.1)h,P＜0.05】;在术后3 d,观察组血清CRP和COR水平分别为(11.2±3.1)mg/L和(195.6±30.8)ng/mL,显著低于对照组【分别为(19.0±4.9)mg/L和(211.6±32.7)ng/mL,P＜0.05】;术后2周行超声检查,发现观察组患者胆囊功能完好,无结石残留;随访3个月,观察组患者出现切口感染、腹泻、反流性胃炎、胆道出血和急性胰腺炎等并发症发生率为11.1%,显著低于对照组【31.0%,P＜0.05】;在随访12个月末,观察组结石复发为2.8%。结论 采取双镜联合保胆取石术治疗胆囊结石患者可能更有利于患者胃肠功能的恢复,减少术后并发症的发生,值得进一步探索。     

Hot melt extrusion: An industrially feasible approach for casting orodispersible film

Over the recent few decades, many groups of formulation scientists are concentrating on rapid release dosage forms in oral cavity. Among all fast release dosage forms, orodispersible films are successful to attract pharmaceutical industry due to ease of formulation and extension patent life. Films are popular in patients too because of quick onset and user friendliness of dosage form. From the beginning, solvent casting has been selected as method of choice for manufacturing of orodispersible films. Solvent casting has been proved as a benchmark technology because of ease in product development, process optimization, process validation and technology transfer to production scale despite of some drawbacks like more number of unit operations involved and consumption of large quantity of solvents with controlled limits of organic volatile impurities in final formulation. The application of hot-melt extrusion (HME) in the pharmaceutical industry is consecutively increasing due to its proven innumerable advantages like solvent free continuous process with fewer unit operations and better content uniformity. Very few development activities has been initiated in the field of hot melt extruded orodispersible films so far. This extensive review covers detailed discussion of heavy duty industrial extruders, selection of downstream equipments, selection of excipients, common problems found in formulations and their remedies. Successive part of review addresses identification of critical quality attributes, quality target profile of product, criticality in selection of process parameters and material for substantial simulation in laboratory scale and production for successful technology transfer.     

三种影像学方法诊断肝外胆管结石比较研究

目的 探讨采用超声、腹部CT和磁共振胆管成像(MRCP)诊断肝外胆管结石的效能。方法 2017年3月～2019年2月在我院治疗的肝外胆道梗阻性病变患者107例,术前行腹部超声、CT和MRCP检查,以术后病理学检查为金标准,采用ROC曲线分析腹部超声、CT和MRCP诊断肝外胆管结石的效能。结果 本组病例经手术后病理学检查,诊断肝外胆管结石59例;超声、CT和MRCP诊断结石分别为64.4%、67.8%和84.7%(P<0.05);对于直径≤8 mm的结石,MRCP的诊断率为80.0%(32/40),显著高于超声诊断的60.0%(24/40)或腹部CT诊断的57.5%(23/40),MRCP对结石的定位准确率为84.8%(50/59),也显著高于超声检查的66.1%(39/59)或腹部CT检查的67.8%(40/59,P<0.05);MRCP诊断的灵敏度、特异度和准确率分别为84.8%(50/59)、89.6%(43/48)和86.9%(93/107),显著高于超声检查【分别为64.4%(38/59)、83.3%(40/48)和72.9%(78/107),P<0.05】或腹部CT检查【分别为67.8%(40/59)、81.3%(39/48)和73.8%(79/107),P<0.05】。结论 MRCP诊断肝外胆管结石的效能较高,优于腹部CT或超声检查,尤其是对直径≤8 mm的小结石,应该引起重视。     

Laboratory Study on the Stability of Large-Size Graded Crushed Stone under Cyclic Rotating Axial Compression

In this paper, the stability of large-size graded crushed stone used for road base or cushioning under repeated load is investigated. Using an in-house developed device, large-size crushed stone mix was compacted and molded by the vibration and rotary compaction method. Cyclic rotating axial compression was applied, and the shakedown theory was used to study the cumulative deformation of the large-size crushed stone specimens. The effects of gradation parameters on the cumulative strain and stability behavior were analyzed, and the critical stability and failure loads were determined according to the shakedown theory. The test results indicate that there are three obvious instability behavior stages of large-size graded crushed stone under cyclic rotating axial compression: elastic stability, plastic creep, and incremental plastic failure. Large-size graded crushed stone has a higher critical stability load stiffness than conventional-size graded crushed stone. The critical shakedown load of the specimen is mainly affected by the skeleton structure performance, and the critical failure load by the properties of the crushed stone material. Increasing the content and compactness of large-size crushed stone in the specimen can improve the stiffness and stability performance, and to achieve improvements, the content of large-size crushed stone should be controlled between 22% and 26%. The critical shakedown load increases with the increase in the California bearing ratio (CBR) value, while, on the other hand, the CBR value has little relationship with the critical failure load.