乳头括约肌小切开联合大气囊扩张在 肝外胆管大结石内镜治疗中的作用

目的 探讨乳头括约肌小切开联合大气囊扩张术在肝外胆管大结石内镜治疗中的安全性及有效性。方法 87例肝外胆管结石直径≥1.0 cm患者采用奇偶数法分为两组，奇数组43例接受乳头括约肌小切开联合大气囊扩张术取石治疗，偶数组44例接受乳头括约肌切开取石治疗，比较两组间结石取净率、取石次数、机械碎石率、结石嵌顿率、操作时间及早期并发症发生情况。结果 观察组4例出现高淀粉酶血症，3例出现轻症急性胰腺炎，并发症发生率为16.3%（7/43）；对照组中，有3例出现高淀粉酶血症，2例出现轻症急性胰腺炎，3例出血，并发症发生率为18.2%（8/44），差异无显著性（P >0.05），但出血率比较差异有显著性（P <0.05）。观察组结石取净率、结石嵌顿率、机械碎石率、二次取石率、操作时间分别为97.7%（42/43）、0%（0/43）、4.6%（2/43）、0%（0/43）及（35.2±5.2）min；对照组对应为97.7%（43/44）、6.8%（3/44）、18.1%（8/44）、13.6%（6/44）及（45.1±4.0）min，除结石取净率比较差异无显著性（P >0.05），其他4项比较差异均有显著性（P <0.05）。结论 乳头括约肌小切开联合大气囊扩张术在肝外胆管大结石内镜治疗中安全有效，操作简便。     

螺旋状套石篮辅助输尿管软镜钬激光碎石术治疗单侧直径大于1厘米输尿管上段结石临床研究

目的探讨螺旋状套石篮辅助输尿管软镜钬激光碎石术(FURL)治疗单侧直径1.0 cm输尿管上段结石临床疗效及安全性。方法研究对象选取该院2012年1月-2015年12月收治的单侧直径1.0 cm输尿管上段结石患者共140例,以随机抽签法分为对照组(70例)和观察组(70例),分别采用FURL术单用和在此基础上加用螺旋状套石篮辅助治疗;比较两组患者围手术期临床指标、碎石成功率、结石清除率、结石上移率及术后并发症发生率等。结果观察组患者手术时间明显长于对照组,差异具有统计学意义(P0.05);两组患者术中出血量和住院时间比较差异无统计学意义(P0.05);观察组患者碎石成功率和结石清除率均明显高于对照组,差异具有统计学意义(P0.05);观察组患者结石上移率明显低于对照组,差异具有统计学意义(P0.05);同时两组患者术后并发症发生率比较差异无统计学意义(P0.05)。结论螺旋状套石篮辅助FURL术治疗单侧直径1.0 cm输尿管上段结石可有效提高结石清除效果,降低结石上移风险,且未增加术后并发症发生概率。     

Determinants for gallstone formation – a new data cohort study and a systematic review with meta-analysis*

Objective: Only few determinants of gallstone formation have been identified in cohort studies. The aim was to identify further determinants for gallstones in a Danish cohort and to perform a meta-analysis of results from existing cohorts.

Material and methods: Data from a cohort study was used. Gallstone incidence was assessed through repeated ultrasound examinations. Body mass index (BMI), blood pressure, self-rated health, lifestyle variables, blood lipids, and use of female sex hormones were measured at the baseline examination. Statistical analyses included logistic regression. Based on a prospective protocol, a systematic review of the literature was performed identifying all articles dealing with determinants of incident gallstones. Meta-analyses of comparable determinants were performed through fixed effect models.

Results: Participants with no gallstones at baseline and with at least one re-examination were followed-up completely (mean 11.6 years, N?=?2848). The overall cumulative incidence of gallstones was 0.60% per year. Independent positive determinants for incident gallstones were age, female sex, non-high density lipoprotein (non-HDL) cholesterol, and gallbladder polyps. In addition, BMI was positively associated in men. The systematic review additionally identified associations for comorbidities, parity, and dietary factors. Meta-analysis confirmed the significant associations for incident gallstones and age, female sex, BMI, and non-HDL cholesterol. No significant associations were found for blood pressure, smoking, alcohol consumption, HDL cholesterol, or triglycerides in meta-analyses.

Conclusions: Age, female sex, BMI, non-HDL cholesterol, and polyps are independent determinants for gallstone formation. Incident gallstones and the metabolic syndrome share common risk factors. More studies are needed for further exploration.     

膀胱软镜在复杂性肾结石开放手术中的应用

目的：探讨膀胱软镜在复杂性肾结石开放手术中的应用价值。方法：将膀胱软镜应用于复杂性肾结石开放手术中辅助结石取出及检查28例，术中经膀胱软镜探查，并配合钳夹冲洗肾盏切开等方法取出结石。结果：28例均获得成功，术后行B超及X片复查，仅2例结石残留。结论：肾多发结石开放手术中配合膀胱软镜检查可以提高手术成功率，减少结石残留率，减少对患者损伤，是一种安全有效的方法，同时还能对其他病变起到检查及治疗作用。     

23例胃癌合并胆囊结石的手术治疗分析

目的比较对胃癌合并胆囊结石患者进行同时摘除胆囊联合胃部手术的临床治疗效果。方法根据患者的病情将其分划为胃癌合并胆囊结石和单纯性胃癌两种类型,将上述两种类型的患者分为实验组和观察组,观察组由单纯性胃癌患者组成,实验组由胃癌合并胆囊结石患者组成,每组各23例;对观察组患者采用传统常规手术治疗方式,对实验组患者采用同时摘除胆囊的联合胃部手术治疗方式。结果两组患者在术后2d引流量,术后住院时间和不良反应发生率等指标比较,差异均不存在统计学意义(P>0.05)。结论同时摘除胆囊联合胃部手术治疗方式不会影响患者术后引流量,延长住院时间和增加术后不良反应发生率等异常事件,此方法安全可靠,值得在临床治疗过程中,大范围推广使用。     

经皮肾镜治疗肾复杂性结石并发症的不同诱因早期护理干预的效果分析

目的 探讨经皮肾镜治疗肾复杂性结石患者针对并发症的不同诱因早期护理干预效果.方法 将我院2009年3月至2012年3月收治的100例采用经皮肾镜治疗复杂性结石的患者随机分为两组,对照组给予常规护理,实验组给予早期针对性护理干预,观察比较两组患者的护理效果.结果 实验组能减少并发症的发生,患者并发症能够更快治愈.患者的焦虑程度降低,对我院护理工作的满意度更高,与对照组比较有显著差异,P＜ 0.05.结论 经皮肾镜治疗肾复杂性结石手术患者针对并发症的不同诱因实施早期护理干预,具有较好的效果.     

Diagnosis of Gallbladder Perforation—a Puzzle!

Gallstone disease is common and complications frequently encountered include acute cholecystitis, acute pancreatitis, and cholangitis, but gallbladder perforation (GBP) is rare. A definitive diagnosis is uncommon before surgery and morbidity and mortality associated with this condition are high. Reported incidence ranges between 2 and 10.6 % in patients with acute cholecystitis but is higher in patients managed conservatively. We report here five patients with GBP to show the difficulty in making an early diagnosis.     

胆囊切除与脂质代谢异常的研究进展

胆囊结石病与代谢异常相关。胆囊切除术仍是目前胆石病的主要治疗方法，但其对机体特别是脂质代谢如胆汁酸、三酰甘油、胆固醇代谢会产生影响，甚至导致代谢疾病如增加非酒精性脂肪肝（non-alcoholic fatty liver disease, NAFLD）的发生风险。本文对胆囊切除与脂质代谢的关系作一综述。     

输尿管镜硬镜结合钬激光治疗100例输尿管结石临床分析

目的:探讨并分析输尿管镜硬镜结合钬激光治疗输尿管结石患者的临床疗效和安全程度,并为临床应用提供依据。方法:对100例输尿管患者运用输尿管镜硬镜结合钬激光治疗的过程进行临床性的回顾性分析。结果:93例患者手术成功,7例患者失败,对此7例患者根据病情,分别采取不同的治疗方法后,患者的结石全部排除。结论:输尿管镜硬镜结合钬激光治疗输尿管结石是一种安全有效的微创性的手术方法,能显著提高碎石成功率,改善患者预后,且仪器操作简便,手术时间明显缩短,故临床上应予以广泛使用。