腹腔镜微创保胆取石术与开腹保胆取石术治疗胆囊结石的临床对比研究

目的比较腹腔镜微创保胆取石术与开腹保胆取石术治疗胆囊结石的疗效。方法回顾分析我院2012年5月至2015年7月行保胆取石术治疗胆囊结石患者82例,其中腹腔镜下完成40例(微创组),开腹下完成42例(开腹组)。观察两组手术时间、术后排气时间、术后住院时间、术后饮食恢复时间、住院费用、并发症、术后止痛剂使用比例。结果微创组手术时间显著长于开腹组(P < 0.01);微创组在术后排气时间、术后住院时间、术后饮食恢复时间均优于开腹组,且具有统计学意义(P< 0.05);微创组术后并发症发生率、术后止痛剂使用比例均显著显著低于开腹组(P < 0.01);微创组住院费用(8233+786)明显高于开腹组(6743+689)(P < 0.01)。结论腹腔镜微创保胆取石术具有创伤小、术后胃肠功能恢复快、住院时间短、并发症发生率低等优点,值得临床推广。     

腹腔镜保胆取石术治疗胆囊结石的临床研究

目的：探讨腹腔镜保胆取石术治疗胆囊结石的手术方法及可行性。方法：回顾性分析2008年4月2009年6月腹腔镜保胆取石术治疗胆囊结石的15例病人,在全身麻醉下采用常规建立气腹,按常规3孔法进行腹腔镜保胆取石术,术中常规在胆囊床下摆腹腔引流管。结果：15例均在完全腹腔镜下完成手术,其中单发胆囊结石11例（联合腹腔镜肝囊肿开窗术1例）,结石在35枚4例,无中转腹腔镜胆囊切除术。全组病人术后恢复良好,未出现严重并发症。结论：胆囊功能良好且胆囊结石较大、个数较少的病人可行腹腔镜保胆取石术,但应从宽掌握中转腹腔镜胆囊切除术指征,确保胆囊内无结石残留。     

胆宁片预防微创保胆取石术后结石复发的临床研究

目的：分析微创保胆取石手术后采用胆宁片对结石复发进行预防的临床效果。方法选取2010年3月-2012年11月南阳医学高等专科学校第一附属医院收治的58例微创保胆取石手术患者,随机分成观察组与对照组,每组29例。对照组在手术后对病情进行随访,观察组在手术后采用胆宁片进行预防,对比两组患者病情复发的情况。结果本组患者有55例患者成功取石,成功率为94.8%;患者完成保胆取石术后进行5～13个月的随访,观察组患者结石复发率为6.89%,对照组结石复发率为13.7%,观察组结石复发的概率明显低于对照组患者,差异有统计学意义（P＜0.05）。结论微创保胆取石手术后采用胆宁片对结石复发的情况进行预防,能够获得较为明显的效果。     

腹腔镜联合胆道镜行保胆取石术治疗胆囊结石临床研究

目的探讨腹腔镜联合胆道镜行保胆取石术治疗胆囊结石的临床疗效。方法胆囊结石患者76例随机分为两组,对照组采用常规腹腔镜胆囊切除术,观察组采用腹腔镜联合胆道镜行保胆取石术。结果患者住院时间、术中出血及术后至排气时间比较,观察组均优于对照组（P〈0．01）。结论胆囊结石患者采用腹腔镜联合胆道镜进行保胆取石术治疗可改善患者预后,提高术后生活质量。     

微创保胆取石术与腹腔镜胆囊切除术治疗胆囊多发结石的临床对比研究

目的 分析比较胆囊多发结石微创保胆取石术与腹腔镜胆囊切除术两种手术方式的临床治疗效果.方法 选取2011年6月至2014年6月期间于我院肝胆外科接受手术治疗的427例胆囊结石患者作为研究对象,根据手术方式不同分为微创保胆取石组(GPC组)和腹腔镜胆囊切除组(LC组),对两组患者的年龄、性别、手术情况、术后并发症情况、术后生存质量及结石复发等进行对比分析.结果 两组患者的性别、年龄差异无统计学意义(P＞0.05);LC组患者术中胆管损伤、术后胆瘘、腹腔内出血的发生率高于GPC组,但差异无统计学意义(P＞0.05);GPC组患者的平均手术时间和住院时间长于LC组,且差异具有统计学意义(P＜0.05);两种治疗手段均可有效缓解患者腹痛症状,但LC组患者术后易出现轻度腹泻症状,差异具有统计学意义(P＜0.05),GPC组患者术后有1例复发病例,差异无统计学意义(P＞0.05).结论 在严格把控手术适应症的情况下,实施腹腔镜联合胆道镜保胆取石术对于保留胆囊的正常生理功能,提高患者术后的生存质量具有重要意义,是一种安全、有效的胆囊结石治疗新手段.     

微创保胆取石术26例临床分析

目的评价微创保胆取石术的临床应用价值。方法选择性地进行腹腔镜辅助及全腹腔镜下联合胆道镜保胆取石术,保留功能良好的胆囊。结果 26例患者均治愈出院,出现切口脂肪液化2例,余无其他并发症。结论选择合适的患者,联合应用腹腔镜、胆道镜行微创保胆取石术治疗胆囊结石具有安全性高、创伤小、痛苦少、恢复快等特点,且可保留有功能的胆囊,是值得推广的治疗胆囊结石的良好方法。     

保胆取石术后结石复发相关因素及长期随访分析

目的探讨保胆取石术后结石复发情况及复发的高危因素。方法选择2000年1月—2006年1月我院收治的148例行保胆取石术的胆囊结石患者,随访6～12年观察结石复发率和复发的高危因素。结果 148例患者中54例结石复发,总复发率为36.49%。Logistic回归分析显示结石家族史、体质指数和糖尿病是胆结石复发的独立危险因素。结论保胆取石术是一种有效治疗胆囊结石的方法,但对伴有代谢综合征的胆结石患者应慎用保胆取石手术或术后采取防石药物治疗。     

腹腔镜下与开腹保胆取石术治疗胆囊结石的比较分析

目的探讨腹腔镜下保胆取石术与传统开腹保胆取石方法的效果差异。方法选择符合保胆取石手术条件的病例140例分为治疗组(腹腔镜下保胆取石术组)60例和对照组80例,对比分析两组手术时间、术后胃肠排气时间、住院时间,复发率等指标。结果治疗组手术时间略长于对照组,但是治疗组术后排气时间及术后住院时间比对照组要短(P<0.05),且复发率和术后并发症发生率明显低于对照组(P<0.05)。结论腹腔镜下保胆取石术具有术后住院时间短、术后并发症少、恢复快、创伤性小、安全等诸多优点,值得推广应用。     

腹腔镜下行保胆取石术治疗胆囊结石61例分析

目的:观察腹腔镜下保胆取石术治疗胆囊结石的临床疗效。方法:121例胆囊结石患者分为2组,观察组行腹腔镜下保胆取石术,对照组行开腹保胆取石术,对比2组患者临床指标。结果:观察组出血量、手术时间、肛门排气时间、住院时间、镇痛药物使用率、疼痛指数明显低于对照组,2组比较差异有统计学意义(P<0.05或0.01)。术后并发症发生率低。结论:腹腔镜保胆取石术创伤小、临床疗效明显、并发症少,值得临床推广。     

单孔腹腔镜保胆取石术的临床研究

目的：探讨单孔腹腔镜保胆取石手术治疗胆囊结石的可行性。方法分析我院10例单孔腹腔镜保胆取石术,术中采用经脐孔置入多通道套管及S型改良器械,可吸收缝线间断全层缝合或连续扣锁缝合胆囊壁,退出器械同时将结石经脐取出。结果10例手术均获成功,术后无出血、胆漏、疼痛等并发症发生,痊愈后无明显手术瘢痕,切口美观。所有患者均获门诊随访,目前无复发病例,效果满意。结论单孔腹腔镜保胆取石手术安全可行,既去除了结石又保留了胆囊功能,达到无明显手术瘢痕的美观效果,可临床推广。     

双镜联合保胆取石术结合消炎利胆片治疗胆囊结石的临床研究

目的探讨腹腔镜联合胆道镜保胆取石术后口服消炎利胆片对胆囊结石复发的影响。方法收集我院2007年5月至2010年10月行腹腔镜联合胆道镜保胆取石术97例患者的临床资料。患者在术后被分为两组,58例口服消炎利胆片（治疗组）,39例仅随访（对照组）。B超观察结石复发情况并检测肝肾功能变化。结果术后随访1～2年,治疗组结石复发率3.45%（2/58）,对照组结石复发率5.13%（2/39）,差异具有统计学意义（P〈0.01）。两组肝功能ALT、ALP、GGT、LDH及肾功能变化差异无统计学意义（P〉0.05）。结论腹腔镜联合胆道镜保胆取石术后口服消炎利胆片可预防结石复发,安全、有效,但长期疗效尚需进一步观察。     

腹腔镜辅助胆道镜保胆取石术结合优思弗治疗胆囊结石的临床研究

目的 研究腹腔镜辅助胆道镜保胆取石术结合优思弗对胆囊结石复发的影响,探讨其临床价值.方法 回顾分析我院2007年3月~2009年10月行腹腔镜辅助胆道镜保胆取石术53例的临床资料,术后2个月采用超声评价手术前后胆囊收缩功能的变化,术后口服优思弗胶囊500mg/d,服药8~12个月,观察其疗效.结果 术后2个月,73.58%(39/53)的患者胆囊收缩功能可恢复或接近正常.术后随访1~2年,3.77%(2/53)的患者结石复发,B超检查胆囊壁光滑无增厚(<3mm),胆囊功能正常.结论 腹腔镜辅助胆道镜保胆取石术结合服用优思弗可有效预防结石复发,但长期疗效尚需深入研究.     

复方益母草胶囊防治药物流产后出血的临床研究

目的观察复方益母草胶囊防治药物流产后阴道出血的临床效果。方法将符合研究标准的70例患者随机分为观察组和对照组各35例,对照组给予米非司酮和米索前列醇口服,观察组在其基础上服用复方益母草胶囊,观察两组患者的流产情况、孕囊排出时间、阴道出血时间、出血量及不良反应。结果观察组的孕囊排出时间及阴道出血天数短于对照组,药流后观察组出血量有效率高于对照组,不良反应发生率低于对照组,差异均有高度统计学意义（P〈0．01）。结论复方益母草胶囊防治药物流产后阴道出血安全有效。．     

腹腔镜下保胆取石术结合依泽替米贝术前口服对胆囊结石患者血清皮质醇及促肾上腺皮质激素表达的影响

目的研究腹腔镜保胆取石术联合术前口服依泽替米贝治疗胆囊结石的疗效以及对血清中皮质醇(Cor)和促肾上腺皮质激素(ACTH)表达的影响。方法选择2017年6月至2019年6月本院收治的100例胆囊结石患者,采用随机数字表法分为观察组与对照组各50例。对照组患者给予腹腔镜下保胆取石术,观察组在对照组的基础上术前口服依泽替米贝药物治疗4周。比较两组患者胆囊结石个数、直径和治疗疗效,并检测术后不良反应发生情况,并通过手术前后Cor和ACTH水平的变化比较两组术后应激反应水平及并发症发生情况。结果治疗后观察组治疗总有效率高于对照组(P<0.05);两组患者结石直径和个数均显著下降(P<0.05),且观察组结石数量和直径均低于对照组(P<0.05);治疗前两组患者血清Cor、ACTH水平比较差异无统计学意义(P>0.05);治疗后两组患者的Cor、ACTH水平均升高(P<0.05);且观察组Cor、ACTH水平显著低于对照组(P<0.05),证明机体术后应激反应得到缓解;两组不良反应和并发症发生率比较差异均无统计学意义(P>0.05)。结论腔镜保胆取石术前口服依泽替米贝治疗胆囊结石可有效提高治愈率,降低术后血清Cor和ACTH水平,减少机体应激反应,降低患者术后感染的可能性,存在进一步探究的价值。     

Study on effect of Yishen Capsule (益肾胶囊) in preventing recurrence of chronic glomerulonephritis

Objective:To observe the effect of Yishen Capsule (益肾胶囊,YSC) on preventing the recurrence of chronic glomerulonephritis (CGN) and to explore its mechanism preliminarily.Methods: CGN patients were assigned to the treated group (61 cases) and the control group (48 cases) and all of them were orally administered with 4 mg of Perindopril twice a day,but 3 capsules of YSC,thrice a day, were given additionally to patients in the treated group.The therapeutic course for both groups was 18 months.The recurrence rate of CGN at the 6th,12th,and 18th month in the two groups was observed and compared,and the changes of 24-h urinary protein quantity and T-lymphocyte subsets before and after treatment were observed as well.Results:(1) Comparison of recurrence rate between the two groups showed insignificant difference at the 6th month,but it did show significant difference at the 12th and the 18th month,which was significantly decreased in the treated group than in the control group (P<0.05,P<0.01);(2) The 24-h urinary protein quantity at the 18th month decreased significantly in both groups (P<0.05,P<0.01),but in the treated group was more significant (P<0.01);(3) T-lymphocyte subsets showed no obvious change in the control group after treatment (P>0.05),while in the treated group,it showed significant increase in CD3,CD4 and CD4/CD8 (P<0.05 or P<0.01) and significant decrease in CD8 (P<0.05),and also the difference after treatment in T-lymphocyte subsets between the two groups was significant (P<0.05 or P<0.01).Conclusion:YSC has marked effects in reducing the recurrence of CGN and in decreasing urinary protein,and its mechanism might be related with its function in regulating the ratio of T-lymphocyte subsets to enhance the immunity of patients.     

胆宁片预防微创保胆取石术后结石复发的临床观察

目的探讨胆宁片在预防微创保胆取石术后对胆囊结石复发的作用。方法收集我院2009年5月-2011年9月行保胆取石术98例患者的临床资料。患者术后被分为两组,54例口服胆宁片（治疗组）,44例仅随访（对照组）,B超观察两组结石复发情况。结果术后随访6-12个月,治疗组结石复发率为3.7%（2/54）,对照组结石复发率为6.8%（3/44）,差异有统计学意义（P〈0.05）。结论利用纤维胆道镜保胆取石,术后服用中成药胆宁片具有预防结石复发的作用。     

A clinical study on the effect of Jinshisan in dissolving gallstone) in dissolving gallstone

In order to evaluate the role and mechanism of Jinshisan(JSS) in gallstone dissolution, 325 cases of various types of gallstone patients were treated by a collaborating group. The therapeutic effect was observed by B-ultrasonography before and after treatment. The results showed: (1) among the 164 cases of extra/intrahepatic duct stone, 26 cases (15.85%) were cured; 73 cases (44.51%) were effective and 65 cases (39.63 %) were ineffective after being treated with JSS for 6.5 ± 3.9 months; (2) JSS made the stone disappear in 14 cases (9.5%) among 148 cases of gallbladder stone and was effective in 71 cases with total efficacy as 57.4%, which was better in comparison with ursodesoxycholic acid (UDCA); (3) the stones all disappeared only in 2 cases (5.9%) among the 35 cases with stones in multiple sites, with the total efficacy as 79.4%; (4) gallstone disappeared in 17 of 25 (68%) patients with size of stone ≤5mm, with only 4 of them ineffective; (5) the effect was better in those with treatment course >6 months; (6) analysis of bile showed that JSS could increase the amount of bile acid, decrease the bilirubin, mucous and bicarbonate radical in bile.     

胆总管结石术后复发的相关因素分析

目的探讨胆总管结石术后复发的危险因素,为胆总管结石术后复发的防治提供参考。方法对190例胆总管结石手术患者的临床资料进行回顾性分析,对术后复发的相关危险因素进行Logistic回归分析,筛选胆总管结石术后复发的相关危险因素。结果本组190例胆总管结石患者行EST手术治疗后,经2～5年随访有42例(22.1%)复发。单因素分析结果显示,年龄、结石数量、结石大小、胆石症家族史、缺乏运动、油腻饮食与术后复发有关;多因素Logistic回归法分析表明,结石≥10枚、结石<8 mm、有胆石症家族史、油腻饮食是胆总管结石术后复发的危险因素。结论术前要对上述危险因素加以重点评估,在考虑手术的同时还要考虑上述危险因素,这样可以降低胆总管结石术后复发率。     

Clinical study of xiongshao capsule in preventing restenosis after coronary interventional treatment

Objective

To evaluate the effect of Xiongshao Capsule in preventing clinical and angiographic restenosis after coronary angioplasty or/and stenting.

Methods

The total of 108 coronary heart disease patients with successful coronary angioplasty or/and stenting were randomly divided into the control group (55 cases, routine treatment) and the XS group (53 cases, routine treatment combined with XS). The recurrence of angina, clinical end-point events, changing of blood-stasis syndrome score (BSSS) and coronary angiography within 6 month after coronary angioplasty or/and stenting were observed.

Results

Follow-up angiography was performed in 42 patients including 18 cases in the XS group (restenosis was observed in 7 patients) and 24 cases in the control group (restenosis was observed in 17 patients), there was significant difference between the occurrence of restenosis in XS and that in control group (P < 0.05). The occurrence of clinical end-point events (death, nonfatal target lesion myocardial infarction, coronary artery bypass graft surgery, or repeat target-vessel angioplasty) in the XS group (18.8%) was significantly lower than that in the control group (40%)(P <0.05). The recurrent angina was observed in 13 cases in the XS group, there was significant difference as compared with 27 cases in the control group (P <0.05). There was also remarkable significance for the difference of base-line and follow-up BSSS between groups (P < 0. 01). Logistic multivariate stepwise regress analysis and multivariate regress analysis of the related factors with restenosis confirmed by coronary angiography showed that, the base-line BSSS and the difference of base-line and follow-up BSSS were important influencing factors on the occurrence of restenosis after interventional treatment (P < 0.05).

Conclusion

XS could markedly reduce the occurrence of angiographic restenosis, clinical end-point events and recurrent angina, improve condition of blood-stasis after coronary angioplasty or/and stenting. The severity of blood-stasis syndrome was an important influencing factor on the occurrence of restenosis. It still needs to be further demonstrated by large-scale, double-blinded, randomized and controlled study.     

产后逐瘀胶囊对人工流产术后康复的影响

目的 探讨产后逐瘀胶囊对人工流产术后孕妇康复的影响.方法 选取行人工流产术结束分娩的孕妇120例,随机分为治疗组及对照组,各60例,2组术后常规给予头孢拉定胶囊、奥硝唑片口服,治疗组在常规用药的基础上口服产后逐瘀胶囊,3粒/次,3次/d,2组均1周为1疗程,观察2组孕妇术后阴道出血量及时间,并采用彩色超声检测仪测量子宫三径、内膜厚度及子宫动脉血流动力学指标.结果 治疗组孕妇人工流产术后阴道血量及时间、术后子宫三径线显著低于对照组(P＜0.05);2组术后子宫内膜厚度比较无统计学意义(P＞0.05),治疗组术后2周子宫动脉收缩期峰值流速(PSV)显著高于对照组(P＜0.05),2组子宫动脉搏动指数(PI)、阻力指数(RI)比较无统计学意义(P＞0.05);治疗组随访月经复潮情况显著优于对照组(P＜0.05).结论 产后逐瘀胶囊可显著减少人工流产术后孕妇阴道出血量,缩短出血时间,并可有效改善子宫血流动力学指标,利于人工流产术后子宫康复及月经周期的恢复.