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??Objective:To investigate the role of arachidonic acid metabolism in Crohn’s disease complicated by intestinal fistula. Methods:By immunohistochemical methods, we examined the expression pattern of major arachidonic acid metabolizing enzymes in 17 samples of Crohn;s disease with associated intestinal fistula. Results:Arachidonic acid metabolizing enzymes were universally present in Crohn’s disease intestines,and the spatial distribution of cyclooxygenase??2,5??lipoxygenase and 15??lipoxygenase??1 expression followed sequential arrangement in Crohn’s ulcer. Conclusion:The regulated distribution of these enzymes indicated protective roles for cyclooxygenase 2 and 15??lipoxygenase??1 and deleterious roles for 5??lipoxygenase in Crohn’s disease.     

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随着腹腔镜操作技术的提高，胆囊颈部结石嵌顿伴急性胆囊炎也成为了腹腔镜胆囊切除术（LC）的适应证。2001年11月至2006年4月，我们对34例胆囊颈结石嵌顿伴急性胆囊炎病人行LC，疗效较好。报告如下。     

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肝腺瘤是少见的肝脏良性肿瘤 ,至 1997年国外文献报道 30 0例 ,国内报道总计 42例。因本病症状无特异性 ,术前鉴别诊断时很难与肝脏恶性肿瘤相区别。为加强对该病的认识 ,现将本院收治的 4例报告如下。1　临床资料　　我院自 1990～ 1999年共诊治肝细胞腺瘤 4例。见表 1。2　讨论　　文献报告肝腺瘤几乎全部发生于女性 ,有报告 ,避孕药中所含的乙烯雌二醇甲酯与肝腺瘤的发病增多有关[1,2 ] 。但德国学者Ｈｅｉｎｅｍａｎｎ[9] 等经过 7年的多中心调查研究发现 ,长时间服用口服避孕药并未增加肝细胞腺瘤的发病率。本组中 2例女性均无长期口服…     

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重症急性胰腺炎 (SAP)的治疗仍存在一定困难。及时正确的处理包括手术干预可改善病情 ,处理不当则有可能导致严重并发症而使病情更为复杂。我院曾收治 1例胆石性胰腺炎病人 ,先后出现过许多种并发症 ,经历了 6次手术 ,艰难曲折地治疗 1年多才得以痊愈。现报道如下。1　病历简介病人男性 ,5 0岁。主诉“右上腹痛 10年 ,再发 3天 ,伴呕吐、发热、黄染” ,于 1997年 10月 3日入院。诊为“慢性胆囊炎急性发作” ,于次日急诊行胆囊切除和胆总管探查、T管引流术。术中自胆总管下端取出直径 0 8cm结石 2枚 ,胆囊内结石呈泥沙样 ,并发现胰头肿大…     

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目的探讨肿瘤大小对早期胃癌预后的影响。方法自1995年4月至2006年6月,福建医科大学附属协和医院胃外科对159例早期胃癌病人施行根治术。应用ROC曲线选取肿瘤大小的最佳截点。对病人预后因素进行单因素及多因素分析,对影响病人预后的独立因素进行分层分析。结果通过ROC曲线筛选出早期胃癌肿瘤直径最佳截点为23mm,其中肿瘤直径<23mm病人84例(小直径组),肿瘤直径≥23mm者75例(大直径组)。小直径和大直径组的术后5年存活率分别为98.8%和80.6%,差异具有统计学意义(P<0.01)。通过COX比例风险模型分析显示,肿瘤大小、浸润深度、淋巴结转移是影响全组病人预后的独立危险因素(P<0.05)。进一步分层分析发现,无淋巴结转移或浸润黏膜下层的早期胃癌病人,大直径组的5年存活率低于小直径组(P<0.01)。结论肿瘤直径大小的截点为23mm时,可显著影响无淋巴结转移或浸润黏膜下层的早期胃癌病人的预后。     

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??Laparoscopic resection in gastric stromal tumors: a report of 32 cases ZHAO Ying??YUE Yuan-yi?? WANG Qiang??et al. Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang 110004, China
Corresponding author??FENG Yong??E-mail: Fengy@sj-hospital.org
Abstract Objective To study the result of laparoscopic resection in gastric stromal tumors (GSTs), and discuss the value of laparoscopic resection in GSTs. Methods The clinical data of 32 cases of GST performed laparoscopic resection from January 2009 to November 2010 at Shengjing Hospital of China Medical University were analyzed. The operative time, intraoperative blood loss, postoperative exhaust time, intake time and hospital stay were explored. Results The mean operative time of laparoscopic resection for GSTs was ??65.5±9.8??mins. The intraoperative blood loss was??49.7±7.5??mL. The exhaust time was ??24.8±3.7??hours. The time of liquid food intake was ??26.8±3.4??hours. The length of hospital stay was ??6.3±1.1??days. During the follow-up of 1-25 months, there was no postoperative recurrence. Conclusion Laparoscopic resection of GSTs could be performed safely and effectively, which is feasible choice in the treatment for GSTs.     

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??Risk factors for operative management with blunt liver injury: A report of 102 cases HUANG Chao??ZHANG Kun??JIANG Yi. Department of Hepatobiliary Surgery??Fuzong Medical College of Fujian Medical University??Fuzhou General Hospital of Nanjing Military Command, Fuzhou 350025, China
Corresponding author??ZHANG Kun??E-mail??zhangkun73@aliyun.com
Abstract Objective To investigate the risk factors for operative management with blunt liver injury. Methods One hundred and two cases of blunt liver injury admitted in the Fuzhou General Hospital of Nanjing Military Command between October 1??2003 and May 1??2016 were reviewed retrospectively. The grading of the liver injury was verified by using surgical operation or CT scans. According to whether were operative management??and depending on the American Association for the Surgery of Trauma-organ injury scale (AAST-OIS) and imaging Becker rating??all the cases were divided into operative management group and non-operative management group??including 23 cases of grade ??33 cases of grade ??24 cases of grade ??18 cases of grade ????and 4 cases of grade ??. Univariate and multivariate Logistic analysis were performed to investigate correlative factors of operative management with blunt liver injury to identify independent risk factors of operative management with blunt liver injury. Using receiver operating characteristic curse??it determined the threshold of independent risk factors of operative management with blunt liver injury. Results Univariate analysis showed that correlative factors of operative management with blunt liver injury include alanine aminotransferase??aspartate aminotransferase??hemoglobin??hematocrit??serum potassium??heart rate??systolic blood pressure??the American Society for Surgery of Trauma-organ injury scale??peritoneal irritation??merger intraperitoneal other organ damage. Pearson product-moment correlation coefficient analysis showed that levels of serum potassium and sodium were correlated negatively??levels of blood pressure and heart rate were correlated negatively??levels of alanine aminotransferase and aspartate aminotransferase were correlated positively??and the liver grading and peritoneal irritation were correlated positively in both groups. Alanine aminotransferase??serum potassium and systolic blood pressure of the best threshold of operative management with blunt liver injury were 171.5 U/L??3.625 mmol/L??96.5 mmHg ??1 mmHg=0.133 kPa??respectively by the ROC curve. Logistic multivariate regression analysis showed that blood pressure <96.5mmHg??serum potassium <3.625 mmol / L??merger intraperitoneal other organ damage and peritoneal irritation were independent risk factors for operative management with blunt liver injury. Conclusion Blood pressure <96.5 mmHg??serum potassium <3.625 mmol/ L??merger intraperitoneal other organ damage and peritoneal irritation were the high risk factors of operative management with blunt liver injury.     

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目的总结1997年11月至2011年12月复旦大学附属华东医院开展开放式腹股沟疝无张力修补术4438例的临床经验。方法根据各种不同类型的开放式腹股沟疝无张力修补术,对4438例腹股沟疝采用相对应的不同补片进行手术治疗,对不同术式的手术时间、术后疼痛、疝复发、血肿、血清肿、慢性疼痛、生殖系统并发症等及其他相关并发症进行观察、总结及数据分析。结果无手术死亡病例。术后平均随访33.7个月,术后血肿18例(0.40%),血清肿45例(1.01%),切口感染或愈合不良16例(0.40%),缺血性睾丸炎3例(0.07%)。复发14例(0.32%),慢性疼痛7例(0.60%),异常勃起1例(0.02%);3例睾丸疼痛(0.07%)。结论开放式无张力疝修补术治疗腹股沟疝安全有效,不同术式的疗效及并发症发生率情况接近,开展技术早期需特别注意预防手术并发症,对不同的病例宜采用个体化治疗方案,以期达到最佳的治疗效果。