腹腔镜胆囊切除术与内窥镜逆行胰胆管造影术/内窥镜下Oddi括约肌切开取石术联合治疗胆囊结石合并胆总管结石

目的 探讨腹腔镜胆囊切除术(LC)与内窥镜逆行胰胆管造影术(ERCP)/内窥镜下Oddi括约肌切开取石术(EST)联合治疗胆囊结石合并胆总管结石的临床价值.方法 回顾性分析2005年1月至2010年8月应用LC和ERCP/EST联合治疗胆囊结石合并胆总管结石48例患者的临床资料.结果 48例患者中ERCP成功46例,LC完成45例,术后恢复快,住院时间短,46例随访3～12个月无结石残留及严重并发症发生.结论 联合LC与ERCP/EST的优势,治疗胆囊结石合并胆总管结石符合微创外科理念,具有住院时间短、创伤小、患者恢复快等优点,是目前治疗胆囊结石合并胆总管结石较为理想的选择.

Abstract：

Objective To discuss the clinical value of laparoscopic cholecystectomy (LC) combined with endoscopic retrograde cholangiopancreatography (ERCP)/endoscopic Oddi sphincterotomy (EST) on treating choledocholithiasis with cholecystolithiasis. Method The clinical data of 48 patients with choledocholithiasis complicated by cholecystolithiasis treated with LC combined with ERCP/EST from January 2005 to August 2010 was collected and analyzed retrospectively. Results Forty-six patients achieyed success by ERCP,and 45 patients finished LC,all patients underwent LC combined with ERCP/EST were recovered more rapidly,with shorter hospital stays. No severe complications or residual stone and refluent cholangitis in the follow-up of 3-12 months of 46 patients. Conclusions Combining the advantages of LC with ERCP/EST treating patients with choledocholithiasis complicated by cholecystolithiasis,according to the theoretics of minimally invasive surgery, with less invasive and the advantages of shorter hospital stays and rapid recovery. It is the comparatively ideal choice for the treatment of choledocholithiasis complicated by cholecystolithiasis at present.     

Effects of Baduanjin combined with limb function exercise on trunk control and living ability of stroke patients with hemiplegiaCSCD

Objective To explore the effect of Baduanjin combined with limb function exercise on trunk control and living ability of stroke patients with hemiplegia. Methods From September 2019 to March 2021, a total of 86 stroke patients with hemiplegia admitted into the First Affiliated Hospital of Zhengzhou University who met the inclusion criteria were selected and divided into the control group and the experimental group with 43 cases in each group according to the random number table method. The control group was given limb function exercise, while the experimental group was given Baduanjin combined with limb function exercise, and the intervention time was 6 weeks. The Trunk impairment scale (TIS), Berg balance scale (BBS), Fugl‑Meyer assessment of motor function (FMA), Barthel index (BI) scores and the thicknesses of transverse abdominis and multifidus muscle were compared between the two groups before and after the intervention. Results After the intervention, the TIS, BBS, FMA and BI scores of the experimental group were significantly higher than that of the control group [(19.52±2.68) vs (16.78±2.51) points, (43.19±5.03) vs (35.62±4.89) points, (71.24±7.39) vs (59.26±6.35) points, (69.52±6.81) vs (62.31± 6.46) points], the thickness of transversus abdominis and multifidus were significantly greater than that in the control group [(2.76±0.39) vs (2.39±0.35) mm, (24.37±1.69) vs (23.67±1.45) mm] (all P< 0.05). Conclusion Baduanjin combined with limb function exercise can improve the trunk control ability, balance function, motor function and daily life ability of stroke patients with hemiplegia. © 2021 Journal of Clinical Otorhinolaryngology Head and Neck Surgery. All rights reserved.     

快速康复外科在结直肠癌手术中的应用

目的 探讨快速康复外科在结直肠癌手术中的应用.方法 选取80例结直肠癌手术患者,按随机数字表法分为观察组和对照组,每组40例,分别采用快速康复外科治疗及传统方法 治疗,比较两组术后首次排气、排便时间及住院时间、术后并发症发生率、再住院率及住院费用.结果 观察组首次排气、排便时间及住院时间[分别为(2.7±0.9)、(2.9±0.1)、(5.8±1.0)d]明显短于对照组[分别为(3.9±0.5)、(4.2±0.3)、(8.3±1.2)d],术后并发症发生率[7.5%(3/40)]及住院费用[(1.83±0.22)万元]也明显低于对照组[分别为27.5%(11/40)、(2.35±0.36)万元],差异均有统计学意义(P＜0.05).结论 采用快速康复外科技术可以有效促进结直肠癌患者术后胃肠道功能的恢复,减少并发症的发生并节省住院费用.

Abstract：

Objective To investigate the feasibility of fast-track surgery in colorectal surgery.Methods Eighty consecutive patients with colorectal cancer admitted for colorectal surgery were divided into two groups by random digits table with 40 cases each. Group A was treated with the new concept of fasttrack surgery and group B was treated with the traditional methods of operation. The time of postoperative bowel venting and defecation,hospital stay time, the rate of complication, the rate of readmission and the total cost during hospitalization were compared. Results The time of postoperative bowel venting and defecation,hospital stay time were shorter in group A [(2.7 ± 0.9), (2.9 ± 0.1 ), (5.8 ± 1.0) d,respectively]than those in group B [( 3.9 ± 0.5 ), (4.2 ± 0.3 ), ( 8.3 ± 1.2) d, respectively] and the rate of complication and the total cost during hospitalization in group A [7.5%(3/40), ( 1.83 ± 0.22) ten thousand yuan] were lower than those in group B[27.5%(11/40), (2.35 ± 0.36) ten thousand yuan](P＜ 0.05). Conclusion The new concept of fast-track surgery can accelerate recovery after colorectal resection,reduce the rate of overall complications and total cost during hospitalization.     

两种新型非生物型人工肝治疗慢性乙型重型肝炎疗效观察

Objective To explore the clinical effects of two new treatment methods of non-biologic artificial liver [slower plasma exchange (PE) combined with continuous veno-venous hemofiltration (CWH), and coupled plasma exchange filtration adsorption (CPEFA)] in treatment of chronic severe hepatitis B patients. Methods 130 patients with chronic severe hepatitis B were divided into three groups. 44 patients were treated with a parallel circuit of being combined slower PE and CWH based on the conservation medical therapy (group A). 43 patients were treated with CPEFA based on the conservation medical therapy (group B). 43 patients received PE with conservative medical therapy (group C). The clinical symptoms, signs, liver function, blood sodium concentration, effective rates and survival rates in three groups were surveyed before and after treatment. Results The symptom and signs of the majority in the above different groups improved. In group A and B, hyponatremia of patients were improved, the effective rates (within 6 months after the treatment) were 70.45% and 72.09% respectiverly. There was no statistical difference between the two groups (χ2=0.10,P>0.05), the survival rates(6 months) were 45.45% and 46.51% respectively and there was no statistical difference (χ2 = 0.08, P > 0.05). In group C, patients' hyponatremia did not change, the effective rate (51.16%)was obviously lower than those in group A and B (χ2 = 7.55,9.31, P < 0.01) and the total survival rate(6 months) was 30.23% also lower than those in group A, B (χ2 = 4.80,6.10, P < 0.05). Conclusions Being combined slower PE and CWH with a parallel circuit and CPEFA are two new, safe and effective methods of non-biologic artificial liver treatment.     

拉米夫定联合阿德福韦酯与恩替卡韦治疗慢性乙型肝炎疗效比较

Objective To analyze the effect of lamivudine combined with adefovir and entecavir in treatment of chronic hepatitis B patients, to provide the basis for felicitous treatment. Methods 120 cases of chronic hepatitis B patients were divided into two groups(lamivudine combined with adefovir group and entecavir group) according to the method of treatment. The clinical data of two groups were recorded, including the cases of ALT normalization, HBeAg negative conversion and HBV DNA below to the detection level in different treatment time. Results After 3, 6, 12 months of treatment, there was no statistical difference between the two groups in ALT normalization ( x2 = 2.194,2.353,3.339, P＞ 0.05); and there was no statistical difference in the incidence of HBeAg negative after 3,6,12.18 months of treatment too(x2 = 0.054,0.139,0.326,0.152, P ＞ 0.05). There was no statistical difference in the incidence of HBV DNA returned to nagative after 6,12, 18,24 months trentment ( x2 = 0.348,0.348,2.236,0.776, P ＞ 0.05). Conclusions There was no difference in the ALT normalization, the incidence of HBeAg negative conversion and the incidence of HBV DNA retumed to nagative in lamivudine combined with adefovir and entecavir for chronic hepatitis B.     

预注帕瑞昔布用于腹腔镜疝修补术后镇痛的效果

Objective To investigate the effect of pretreatment with parecoxib for postoperative analgesia in patients undergoing laparoscopic hernia repair. Methods Sixty patients undergoing laparoscopic hernia repair were assigned in two groups by random digits table with 30 cases each. The patients in pretreating group received parecoxib 40 mg intravenously before anesthesia, and in control group with the same capacity of normal saline. All patients were anesthetized with combined spinal epidural blockage and tranquilized with pethidine, droperidol and diazepam. Postoperative pain of the abdomen incision was assessed by visual analogue scale (VAS) and the pain of shoulder or back was judged by a 4 grade scale. Side-effects, supplement analgesic, passage of gas by anus 24 h after surgery were observed as well. Results The abdomen incision VAS at 4,8,12,24 h after surgery in pretreating group were lower than those in control group (P ＜ 0.05). And the incidence of pain of shoulder or back was lower in pretreating group (13.3% ,4/30) than that in control group (33.3% ,10/30)(P ＜0.05). While the cases needing supplement analgesic also decreased in pretreating group (13.3% ,4/30) compared with control group (40.0%, 12/30)(P ＜ 0.05). And the side effects and passage of gas by anus 24 h after surgery had no significant difference in two groups. Conclusion Pretreatment with parecoxib in patients undergoing laparoscopic hernia repair may relieve the postoperative incision pain and the pain of shoulder or back while reducing the analgesic supplement without side effects.     

高压氧联合化疗对卵巢上皮性癌疗效研究

Objective To discuss the therapentic efficacy of hyperbaric oxygen combined with PC program in newly diagnosed epithelial ovarian cancer patients. Methods Fifty-eight patients with epithelial ovarian cancer were divided into two groups by random digits table: HBO group(30 cases) and PC group(28cases). HBO group were exposed to hyperbaric oxygen of 2 standard atmospheric pressure 60 min, then given chemotherapy 25-30 min after extravehicular: cyclophosphamide 1000 mg/m2 + cisplatin 75 mg/m2.PC group with the same regimen without hyperbaric oxygen therapy were analyzed. The two groups were compared in the efficacy and 3-year survival rate, progression-free survival and adverse reactions. Results The total effective rate, not controlled rate, recurrence rate,recurrence time, 3-year survival rate in HBO group [83.3%(25/30),6.7%(2/30),33.3%(10/30), (21.0 ± 0.8) months,43.3%(13/30)] were better than those in PC group [67.9% (19/28), 17.9% (5/28), 46.4% (13/28), (18.0 ± 0.6) months, 17.9% (5/28)] (P ＜0.05), progression-free survival and overall survival time in HBO group were longer than those in PC group (P ＜0.05) and adverse reactions rate in HBO group was lower than that in PC group (P ＜0.05).Conclusions The hyperbaric oxygen combined with PC programs are better than PC programs in advanced epithelial ovarian cancer chemotherapy response rate, progression-free survival time and 3-year survival rates in ovarian cancer adjuvant chemotherapy. HBO can significantly reduce the PC's hematological toxicity and toxicity of the digestive system.     

不同时间注射咪唑安定防止全麻病人术中知晓的效果和对麻醉苏醒的影响

To study the effects of Midazolam in preventing patients under combined anesthesia from awareness and affect for regain consciousness in different time iv. Methods 45 patients under combined anesthesia were divided random equally into three groups: C, D1 and D2. These patients were induced and intubated with Fentanyl, Vercurium, Propofol iv. In group D1 Midazolam iv in the meantime induction, in group De Midazolam iv after induction 30 min, while in gropu C were not iv Midazolam.The anesthetic sum, time from operation and to extubation, awareness and recall were compared with C and D1, D2. Result It is beneficial that to add midazolam in combined anesthesia to avoid awareness and/recall. The effects are different in refrain from awareness and affect for recover), time with the different time iv. Conclusion It is best that midazolam iv in the meantime induction to prevent from awareness, reduce anesthetic sum, shorten the anesthesia recovery time and steady patients condition.     

内外源性β-葡萄糖醛酸酶与原发性胆总管结石的关系

目的 探讨内外源性β-葡萄糖醛酸酶(β-G)与原发性胆总管结石的关系.方法 应用改良Fishman法检测35例原发性胆总管结石患者(试验组)和11例胆囊息肉患者(对照组)胆总管内胆汁中内外源性β-G活性.结果 试验组和对照组手术当天胆汁中内源性β-G活性分别为(7859.1±738.5)、(2174.9±348.4)U/L(P＜0.01);外源性β-G活性分别为(6786.1±544.3)、(1504.7±655.7)U/L(P＜0.01);试验组中13例急性患者手术当天与术后第7天胆汁中外源性β-G活性分别为(8935.7±845.9)、(2176.1±956.7)U/L(P＜0.05);22例慢性患者分别为(5137.2±540.7)、(1838.8±733.3)U/L(P＜0.05);急性患者手术当天胆汁中外源性β-G活性明显高于慢性患者(P＜0.05).结论 内、外源性β-G参与原发性胆总管结石的形成.

Abstract：

Objective To explore the role of endogenous and exogenous β-glucuronidase( β-G) in the development of primary common duct stones.Method Using modified Fishman method to test the activities of the endogenous and exogenous β -G in 35 patients with primary common duct stones(experimental group) and 11 patients with cystic polypus (control group) respectively.Results The activities of endogenous β -G in the bile of experimental group and control group were (7859.1 ± 738.5 ),(2174.9 ± 348.4 ) U/L(P ＜0.01).While the activities of exogenous β-G in experimental group and control group were (6786.1 ±544.3),(1504.7 ±655.7) U/L (P ＜0.01).In experimental group,there were significant statistical differences in the activities of the exogenous β -G in the sample obtained on the day of operation and 7 days after operation from 13 cases with the acute inflammation [(8935.7 ± 845.9),(2176.1 ± 956.7) U/L]and from 22 cases with the chronic inflammation [(5137.2 ±540.7),(1838.8 ±733.3) U/L],and there were significant higher in the activities of the exogenous β -G in the sample obtained on the day of operation from the acute inflammation compared to those from the chronic inflammation (P ＜ 0.05 ).Conclusions There is obvious correlation between either endogenous or exogenous β -G with primary common duct stones.And the endogenous β -G might be one of the fundamental cause in the development of primary common duct stones. c inflammation (P ＜     

腹腔镜联合内镜治疗58例胆囊结石合并胆总管结石

目的 探讨腹腔镜胆囊切除术(LC)前应用内镜oddis扩约肌切开取石术(EST)联合治疗胆囊结石合并胆总管结石的疗效.方法 回顾性分析58例胆囊结石合并胆总管结石应用LC联合EST治疗的临床资料.结果 本组均先行EST取石无严重并发症后2～3 d行LC.58例中55例(94.83%)EST、LC联合治疗成功,无中转开腹及严重并发症.住院时间6～15(7.2±2.4)d.结论 LC术前应用EST联合治疗胆囊结石合并胆总管结石效果安全可靠.     

腹腔镜联合胆道镜治疗胆囊结石合并胆总管结石的临床价值分析

目的探讨腹腔镜联合胆道镜治疗胆囊结石合并胆总管结石的临床价值。方法选取我院收治的胆囊结石合并胆总管结石的患者80例,随机分为观察组(n=40)和对照组(n=40)。观察组采用腹腔镜联合胆道镜治疗,对照组采用传统开腹手术治疗。比较两组患者的术中出血量、手术时间、术后肛门排气时间、住院时间和术后并发症发生率。结果观察组的术中出血量显著少于对照组,手术时间、术后肛门排气时间、住院时间显著短于对照组(P <0.05)。观察组的术后并发症发生率显著低于对照组(P <0.05)。结论腹腔镜联合胆道镜治疗胆囊结石合并胆总管结石的疗效显著,对患者的创伤小,患者术后恢复快,并发症发生率低,值得推广应用。     

经十二指肠镜括约肌切开术后选择腹腔镜胆囊切除术的手术时机探讨

目的 探讨经十二指肠镜括约肌切开术（EST）后选择腹腔镜胆囊切除术（LC）的手术时机.方法 胆囊结石合并胆总管结石患者240例按随机数字表法分为三组,均行EST联合LC,每组80例,分别于EST术后3d（A组）,7d（B组）,30d（C组）行LC,并对比各组术中和术后相关临床资料情况.结果 B组LC手术时间（52.5±6.4） min,明显较A组（35.8±5.7） min、C组（34.6±2.6） min延长,差异有统计学意义（P＜0.01）;B组中转开腹率10.0％（8/80）,较A组1.3％（1/80）、C组1.3％（1/80）明显增高,差异有统计学意义（P＜0.05）;B组术中出血量（51.7土4.8）ml,较A组（27.9±6.4） ml、C组（28.2±3.6） ml明显增多,差异有统计学意义（P＜0.01）.C组的住院总费用（15 361.2±1007.8）元,较A组（10 085.1±695.4）元、B组（10632.4±855.9）元明显增加,差异有统计学意义（P＜0.01）.结论 EST术后3d行LC可降低手术难度与中转开腹率,缩短手术时间,手术安全有效,优势明显.     

腹腔镜联合纤维胆道镜对高龄胆总管结石伴胆囊结石的治疗效果观察

目的:探究腹腔镜联合纤维胆道镜对高龄胆总管结石伴胆囊结石的治疗效果。方法:选取2017年6月~2018年6月在本院进行就诊的76例高龄胆总管结石伴胆囊结石患者作为研究对象,按照入院顺序将其分为对照组和观察组,对照组患者给予开腹手术治疗,观察组患者给予腹腔镜联合纤维胆道镜治疗,观察两组患者住院时间、胃肠功能恢复时间和术中出血量情况,对比治疗效果。结果:观察组患者胃肠功能恢复时间、住院时间和术中出血量均显著少于对照组,且差异具有统计学意义(P<0.05)。结论:针对高龄胆总管结石伴胆囊结石患者,临床给予腹腔镜联合纤维胆道镜治疗效果显著。     

EST和LC联合应用治疗胆囊合并胆管结石

[目的]探讨联合应用十二指肠镜oddi括约肌切开术（endoscopic sphinctertomy,EST）和腹腔镜胆囊切除术（iaparoscopie cholecystectomy,LC）一期治疗胆囊合并胆总管继发结石的方法和价值。[方法]对68例胆囊结石合并胆总管结石的病人先行ERCP、EST清除胆管结石后立即入手术室行LC手术。[结果]68例均顺利完成EST和LC,术中、术后无严重并发症发生,术后2～4d出院。[结论]联合应用EST和LC一期治疗胆囊和胆总管结石病切实可行,该法具有手术成功率高、不延长麻醉时间、住院时短等优点。     

腹腔镜联合胆道镜治疗胆囊结石合并胆总管结石的临床效果

目的:探讨胆囊结石合并胆总管结石实施腹腔镜联合胆道镜治疗的应用价值.方法:纳入本院2019年5月～2020年5月接收的44例胆囊结石合并胆总管结石患者,随机将其分为对照组与观察组各22例.对照组患者行开腹手术治疗,将腹腔镜+胆道镜应用于观察组患者中,对组间患者各项手术指标进行对比.结果:观察组术中出血量(37.52±1...     

腹腔镜联合胆道镜治疗胆囊结石合并胆总管结石的临床疗效

目的:探讨对胆囊结石合并胆总管结石运用腹腔镜联合胆道镜治疗的效果。方法:挑选2018年4月~2019年4月本市两家三甲医院收治的60例胆囊结石合并胆总管结石患者,选择双盲法把患者分成观察组与对照组,各30例。对照组采取传统开腹手术治疗,观察组选择腹腔镜联合胆道镜治疗,对两种治疗手段的成效进行比对。结果:观察组术中出血量远少于对照组,而胃肠道恢复功能时长、肛门恢复排气时长、住院时间都较对照组更短(P<0.05)。分析两组术后并发症情况,观察组并发症发生率显著低于对照组(P<0.05)。结论:针对胆囊结石合并胆总管结石患者,临床选择腹腔镜联合胆道镜治疗,可以有效清除结石,改善病情。     

LC联合术中ERCP同期治疗老年病人胆囊结石合并胆总管结石的临床研究

目的:探讨老年胆囊结石合并胆总管结石病人接受腹腔镜胆囊切除术(LC)联合内窥镜逆行性胆胰管造影术(ERCP)治疗后的恢复情况。方法:选取本院2018年4月~2019年1月收治的102例老年病人胆囊结石合并胆总管结石患者作为研究对象,分为观察组(LC联合术中ERCP同期治疗)和对照组(全腹腔镜下胆囊切除+胆总管探查+T管引流术,LC+LCBDE)各51例,观察两组患者的治疗效果。结果:与对照组相比,观察组患者的术后胆瘘发生率(1.56%<15.69%)、残余结石率(0<13.73%)相对更低(P<0.05),卧床时间[(2.15±0.32)d<(2.97±0.56)d]和住院时间[(4.02±4.19)d<(6.33±2.04)d]相对更短(P<0.05)。结论:在老年胆囊结石合并胆总管结石病人的临床治疗中,LC联合术中ERCP同期治疗是一种良好的选择,既可以有效清除结石,又能够降低治疗风险,帮助患者快速、良好的恢复健康。     

腹腔镜治疗胆囊结石急性发作的疗效观察

目的探讨腹腔镜治疗胆囊结石急性发作的临床疗效。方法选取2010年6月——2013年6月间于我院行手术治疗的胆囊结石急性发作患者112例,按期就诊顺序进行编号并随机分为对照组（56例）和观察组（56例）,对照组患者行传统开腹胆囊切除术,观察组患者行腹腔镜下胆囊切除术,观察两组患者各临床指标。结果观察组患者手术时间（89.44±9.47）min、出血量（33.67±8.15）mL、疼痛分数（2.64±1.01）分均明显少于对照组患者相应指标（109.45±10.47）min、（124.52±9.48）mL、（5.84±2.05）分,且观察组患者排气时间（2.86±0.68）d、下床时间（1.89±0.98）d、住院时间（7.02±2.04）d均明显短于对照组患者相应指标（5.42±1.24）、（3.08±1.22）、（15.34±3.58）d,组件差异在统计学上均有意义（P〈0.05）;观察组患者残石率（5.36%）与对照组（3.57%）相差不明显（P〉0.05）,而起并发症发生率明（3.57%）显低于对照组（10.71%）,差异有统计学意义（P〈0.05）。结论腹腔镜治疗胆囊结石急性发作安全、有效,术后并发症少、患者痛苦小、恢复快,值得推广。     

腹腔镜胆囊切除术治疗胆囊结石合并胆囊炎的临床观察

目的:探讨腹腔镜胆囊切除术治疗胆囊结石合并胆囊炎的临床疗效。方法:将某医院收治的260例胆囊结石合并胆囊炎的患者按照治疗方法的不同分为腹腔镜胆囊切除术治疗组(LC组)和开腹胆囊切除术治疗组(OC组),比较两组的临床疗效。结果:LC组的手术时间、术后排气时间、下床活动时间、术后进食时间、抗生素应用时间及住院时间均较OC组减少,术中出血量、疼痛评分、术后3天内最高体温及并发症例数较OC组降低,差异有统计学意义(P0.05)。结论:腹腔镜胆囊切除术治疗胆囊结石合并胆囊炎出血少,恢复快,并发症少,在临床值得推广。