速度向量成像技术评价初诊2型糖尿病患者颈总动脉弹性的研究

目的:探讨速度向量成像(velocity vector imaging,VVI)技术评价初诊2型糖尿病患者颈总动脉(common carotid artery,CCA)弹性的应用价值。方法:选取60例初诊2型糖尿病患者,将其分为内中膜厚度(intima-media thickness,IMT)增加组(T2DM-1组)30例和IMT正常组(T2DM-2组)30例;另选取健康对照组30例。常规二维超声观测糖尿病患者与健康对照组的CCA内径、IMT及斑块情况;采用VVI技术对受检者行颈动脉超声检查,测量并记录右侧CCA管壁短轴方向二维图像前壁、前内侧壁、后内侧壁、后壁、后外侧壁、前外侧壁6个节段的径向最大速度(Vs)、切向最大应变(Smax)及切向最大应变率(SRmax),对各组相关参数进行统计学分析。结果:T2DM-1组IMT厚度显著高于T2DM-2组和对照组(P0.05);T2DM-2组IMT厚度与对照组差异无统计学意义(P0.05);T2DM-1组、T2DM-2组及对照组CCA内径测值差异无统计学意义(P0.05)。T2DM-1组患者CCA 6个节段的Vs、Smax和SRmax显著低于T2DM-2组和对照组(P0.05);T2DM-2组患者CCA 6个节段的Vs、Smax和SRmax显著低于对照组(P0.05)。结论:初诊2型糖尿病患者CCA二维形态未改变以前CCA弹性已经降低,VVI技术可用于评价CCA的弹性状态,能够早期发现初诊T2DM患者的CCA弹性降低。     

内镜与腹腔镜联合一期与二期治疗胆囊结石合并胆总管结石疗效的前瞻性研究

【摘要】 目的 探讨一期与二期腹腔镜联合内镜的不同治疗方法对胆囊结石同时合并胆总管结石患者的治疗疗效及安全性。 方法〓104例符合标准的患者分为2组:一期腹腔镜胆总管探查联合腹腔镜胆囊切除术(LCBDE+LC组,n=55)和二期内镜逆行性胰胆管造影术联合Oddi括约肌切开序贯腹腔镜胆囊切除术(ERCP/S+LC组,n=49)。分析探讨两组患者手术成功率、术后并发症和术后住院时间的差异。 结果〓两组患者在流行病学和临床病例特点方面无明显差异,提示两组患者具有可比性。LCBDE+LC组和ERCP/S+LC组的患者手术成功率相近(分别为90.0%和95.9%, P=0.309),但ERCP/S+LC组的患者结石清除率更高(分别为93.6%和80.0%, P=0.046),两组患者术后并发症发生率无明显差异。此外,两组患者在术后住院时间和总体住院费用方面亦相近。在术后随访期间,LCBDE+LC组和ERCP/S+LC组分别有5.9%(3/51)和6.3%(3/48)的患者发现胆总管结石残留,差异无显著的统计学意义。结论〓胆囊结石同时合并胆总管结石的一期和二期双镜联合治疗方法具有相近的成功率,术后并发症发生率相若,远期复发无明显差异,但二期双镜联合治疗的手术结石清除率更高。     

共同性水平斜视矫正与重睑成形术同期进行对容貌的美学影响

目的：探讨共同性水平斜视矫正与重睑成形术同期进行对容貌的美学影响。方法：首先根据斜视度数计算出相关眼肌后徙和缩短的量,再设计重睑线,然后行水平肌后徙和缩短调整矫正斜视,最后根据眼睑的厚薄选择三点式或切开法进行重睑成形术。结果：20例共同性水平斜视伴单睑患者中,13例斜视矫正与重睑成形术同期进行,7例行单纯斜视矫正术。其中8例共同性内斜视受术者,术后均得到正眼位矫正。12例共同性外斜视受术者中,1例矫正不足,范围5°～10°,余均正位,无复视现象发生。13例接受重睑成形术的患者中,5例选择三点式术式,8例选择切开法术式。术后均在3个月内恢复自然。同时接受斜视矫正与重睑成形术患者,术后外观改善较大,整体美容效果明显高于行单纯斜视矫正术患者。结论：对共同性水平斜视伴单睑患者,二者同期手术既节省时间、节省经费又能达到更好的美容效果,对有眼科基础的整形外科医生来说,应该建议患者接受同期手术治疗。     

Helena,the hidden beauty: Resolving the most common West Eurasian mtDNA control region haplotype by massively parallel sequencing an Italian population sample

The analysis of mitochondrial (mt)DNA is a powerful tool in forensic genetics when nuclear markers fail to give results or maternal relatedness is investigated. The mtDNA control region (CR) contains highly condensed variation and is therefore routinely typed. Some samples exhibit an identical haplotype in this restricted range. Thus, they convey only weak evidence in forensic queries and limited phylogenetic information. However, a CR match does not imply that also the mtDNA coding regions are identical or samples belong to the same phylogenetic lineage. This is especially the case for the most frequent West Eurasian CR haplotype 263G 315.1C 16519C, which is observed in various clades within haplogroup H and occurs at a frequency of 3–4% in many European populations.In this study, we investigated the power of massively parallel complete mtGenome sequencing in 29 Italian samples displaying the most common West Eurasian CR haplotype – and found an unexpected high diversity. Twenty-eight different haplotypes falling into 19 described sub-clades of haplogroup H were revealed in the samples with identical CR sequences. This study demonstrates the benefit of complete mtGenome sequencing for forensic applications to enforce maximum discrimination, more comprehensive heteroplasmy detection, as well as highest phylogenetic resolution.     

Unsuspected gallbladder carcinoma after laparoscopic cholecystectomy

Background/Purpose Many cases have been reported of disastrous port-site recurrence after laparoscopic cholecystectomy (LC) revealed unsuspected gallbladder carcinoma (GBC). Some investigators have reported that the prognosis of patients after LC showed unsuspected GBC is not worsened by laparoscopic procedures. We retrospectively reviewed our cases and the literature to reconfirm the intrinsic risks of LC for unsuspected GBC. Methods Of 1663 patients who underwent LC from January 1991 to December 2003 in a single institution, 9 (0.54%) with unsuspected GBC were reviewed. Results These 9 patients consisted of 5 men and 4 women, whose ages ranged from 58 to 87 years, with a median age of 73 years. Two patients with a pT1a tumor (limited to mucosa) and 2 patients with a pT1b tumor (muscle layer) underwent no further operation. The remaining 5 patients with a pT2 tumor (subserosa) underwent further operations with lymph node dissection. Five patients (2 patients with pT1b and 3 patients with pT2) developed recurrence and all of them died within a median period of 19 months (range 14–37 months) after LC. The causes of death were bone metastases in 1 patient (pT2), local recurrence in 2 patients (pT1b and pT2), and peritoneal metastasis in 2 patients (one elderly patient with pT1b who underwent laparoscopic common bile duct exploration, and one patient with pT2 in whom the cystic duct was damaged during surgery). Four patients (2 with pT1 and 2 with pT2) have been doing well with a median follow-up of 39.5 months (range 12–99 months) after LC. Conclusions Surgeons should always prevent bile spillage during LC and when removing the resected gallbladder. When laparoscopic common bile duct exploration is planned, especially for elderly women, surgeons should also bear in mind the increasing possibility of unsuspected GBC.     

肝外胆管结石的微创治疗

目的:探讨腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)+胆总管探查术(common bile ductexploration,CBDE)与内镜下Oddi括约肌切开术(endoscopic sphincterotomy,EST)联合LC治疗胆囊疾病合并胆总管结石的临床效果及术式选择。方法:2001年4月～2007年12月我院采用微创外科技术治疗胆囊结石合并胆总管结石患者66例,其中LC+CBDE组48例,EST组18例,比较两组患者的手术时间、术中出血量、术后肠功能恢复时间、术后住院天数、住院总费用、并发症发生率、结石消除率等指标。结果:LC+CBDE组与EST组手术时间、术中出血量、术后肠功能恢复时间、结石消除率等指标差异无显著性(P>0.05),LC+CBDE组住院总天数、住院总费用、并发症发生率明显少于EST组(P<0.01)。结论:两种术式各有其适应证和优缺点,胆总管直径<1.0cm时以行EST取石术为宜,2～5d后再行LC。既往有胆道手术史者亦EST取石为宜。胆总管直径>1.0cm,尤其是并存二级胆管结石者(无胆管狭窄)则宜行LC+CBDE。     

Congenital dilatation of the common bile duct and pancreaticobiliary maljunction—clinical implications

Clinical conditions and diagnosis  Congenital dilatation of the common bile duct is a disease in which the extrahepatic bile duct, or both the extra and intrahepatic bile ducts, is dilated in various ways. Pancreaticobiliary maljunction is a disease in which the pancreatic duct meets the bile duct outside of the duodenal wall beyond the sphincter Oddi. Recently, these diseases have been thought to be closely related to each other but to be different malformations. Biliary tract carcinoma, especially bile duct carcinoma, is found in about 30% of patients with congenital dilatation of the bile duct. The concomitance of bile and pancreatic juice and their stasis in the biliary tract induce cellular proliferation and reproduction and stimulate genetic alterations in biliary epithelium, which may play an important role in carcinogenesis of the bile duct. Therapeutic strategies  Endoscopic retrograde cholangiopancreatography is useful for examining pancreaticobiliary maljunction. The operation is dilated bile duct resection and hepaticojejunostomy, which ensure that pancreatic juice and bile do not mix in the bile duct. Gallbladder carcinoma develops in more than 90% of pancreaticobiliary maljunction without bile duct dilatation.     

Do Balance Board Training Programs Reduce the Risk of Ankle Sprains in Athletes?

Introduction Ankle sprains are the most common musculo-skeletal injury that occurs in athletes,particularly in sports that require jumping and landing on one foot such as soccer,and basketball(1-4).These injuries often result in significant time loss from participation,long-term disability,and have a major impact on health care costs and resources(5-8).     

内镜下乳头气囊扩张术治疗胆囊切除术后胆总管结石

目的　探讨经内镜乳头气囊扩张术 (EPBD)治疗胆囊切除术后胆总管结石的安全性和疗效。方法　对胆囊切除术后出现黄疸或胆管炎的 31例患者 ,利用EPBD结合取石篮、取石球囊或总攻方法 ,使梗阻于胆总管下段的结石排入肠道。结果　 31例患者全部顺利实施EPBD ,共排除结石37颗 ,4例行 2次扩张术 ,术后患者均痊愈出院 ,复查B超无结石残存或胆管扩张。结论　经内镜治疗胆囊切除术后胆总管结石 ,安全、无创、有效 ,有望成为治疗LC术后胆总管结石的首选方法     

腹腔镜胆总管探查术64例临床分析

目的总结腹腔镜胆总管探查术（laparoscopic common bile duct exploration,LCBDE）治疗胆总管结石的临床经验和疗效。方法回顾性分析64例施行LCBDE患者的临床资料。结果中转开腹3例,成功施行LCBDE 61例,其中行胆总管一期缝合．21例,T管引流40例。平均手术时间110（60～180）min,平均住院时间7（5～14）d。术后发生胆漏2例,胆总管残石3例。47例平均随访18个月,结石复发3例,经再手术治愈。结论LCBDE治疗胆总管结石创伤小、住院时间短、痛苦小,对符合手术适应证的患者而言,不失为一种安全有效的方法。