医源性胆管损伤诊治分析

目的探讨医源性胆管损伤的原因、治疗及预防。方法回顾分析23例医源性胆管损伤。结果医源性胆管损伤多发生于胆囊切除术，胆道解剖异常、局部病理因素、术中出血及麻醉欠佳、患者体型等为其客观因素；而本组人为因素非常明显，损伤与过分自信、草率，盲目追求小切口、高速度有关。不同类型的胆管损伤应采取不同方法及早处理；术中发现者，可行裂口修补或端端吻合、T管支撑引流术，强调置管时间不少于6个月。对胆漏先行胆道及腹腔引流术，3个月后再作胆道重建术，手术方法以胆管空肠Roux—en—Y吻合最为理想。术后黄疸病例行胆管空肠Roux—cn—Y吻合术，疗效佳。结论提高医生对胆管损伤的警觉性，术中解剖清楚，是预防医源性胆管损伤的关键。     

上海市胆道癌病理形态特征的初步观察:附487例分析

目的研究上海市区居民胆道癌病理形态特征和鉴别诊断.方法自1997年6月～2001年5月在上海市区开展基于全人群的胆道癌病例-对照研究,总共收集病理切片1 228例,包括胆道癌487例(其中胆囊癌322例,肝外胆管癌105例和壶腹癌60例),胆道结石和胆囊炎对照病例721例,胆道腺瘤20例,由中、美资深病理医师复查,按世界卫生组织1991年胆囊和肝外胆管肿瘤组织学分型进行分类.结果病理标本以切除标本为主,肿瘤大小为多数小于4 cm,组织学类型中70%以上为腺癌,肿瘤组织学分级以高分化和中分化占绝大多数,TNM分期中0～Ⅱ期的胆囊癌和肝外胆管癌约占1/3,壶腹癌近2/3.病理复查结果显示诊断过头占1.8%,诊断不足占0.6%,漏诊占0.1%;随访结果显示根治术后的5年生存率:胆囊癌40.7%、肝外胆管癌11.1%和壶腹癌26.9%.结论病理复查可以统一诊断标准,提高确诊率,为全人群病例-对照研究和多学科协作积累经验.     

不同微创手术方法治疗输尿管上段嵌顿性结石的疗效对比

目的对比3种微创术式治疗输尿管上段嵌顿性结石的临床疗效,为临床手术方式的选择提供理论依据。方法选取我院收治的141例输尿管上段嵌顿性结石患者,采用随机数字表法将其随机分为A、B、C 3组,每组各47例。A组患者接受经尿道输尿管镜碎石术（URSL）,B组患者接受微创经皮肾穿刺取石术（MPCNL）,C组患者接受后腹腔镜输尿管切开取石术（RLU）。对比3组患者的手术时间、术后住院天数、术后体外冲击波碎石治疗情况、术后结石清除率以及并发症的发生情况等。结果 A组的手术时间为（51.59±17.13）min,显著短于C组（P〈0.05）;A组的术后住院天数为（5.62±1.17）d,显著长于C组而短于B组（P〈0.05）;A组有36.17%的患者术后需要接受体外冲击波碎石治疗,显著高于B组和C组（P〈0.05）;A组术后3 d和1个月的结石清除率分别为51.06%和82.98%,均显著低于B组和C组（P〈0.05）。A组术后并发症的发生率为14.89%,B组术后并发症的发生率为8.51%,C组术后并发症的发生率为6.38%;3组患者术后并发症发生率的差异没有统计学意义（P〉0.05）。结论对于结石位置较低、体积较小,可采用URSL进行治疗;结石靠近肾盏或者合并有重度肾积水的患者,可采用MPCNL进行治疗;对于穿刺风险大或者URSL、MPCNL治疗失败的患者,可采用RLU进行治疗。     

Intrahepatic cholangiocarcinoma: current management and emerging therapies

Introduction: Intrahepatic cholangiocarcinoma (iCCA) is a malignancy with an increasing incidence and a high-case fatality. While surgery offers the best hope at long-term survival, only one-third of tumors are amenable to surgical resection at the time of the diagnosis. Unfortunately, conventional chemotherapy offers limited survival benefit in the management of unresectable or metastatic disease. Recent advances in understanding the molecular pathogenesis of iCCA and the use of next-generation sequencing techniques have provided a chance to identify ‘target-able’ molecular aberrations. These novel molecular therapies offer the promise to personalize therapy for patients with iCCA and, in turn, improve the outcomes of patients.

Area covered: We herein review the current management options for iCCA with a focus on defining both established and emerging therapies.

Expert commentary: Surgical resection remains as an only hope for cure in iCCA patients. However, frequently the diagnosis is delayed till advanced stages when surgery cannot be offered; signifying the urge for specific diagnostic tumor biomarkers and targeted therapies. New advances in genomic profiling have contributed to a better understanding of the landscape of molecular alterations in iCCA and offer hope for the development of novel diagnostic biomarkers and targeted therapies.     

Review of brachytherapy complications – Upper gastrointestinal tract

While brachytherapy applications are not widely used for cancer diagnoses in the upper GI tract (including the esophagus, liver, stomach, and pancreas), they have a clear role in palliation and symptom management and occasionally definitive locoregional treatment. With the increasing use of image-guided techniques, the incidence of side effects and complications has shown to be lower than many other alternative treatment modalities, making brachytherapy approaches a preferred treatment option. This review examines procedural complications and acute and chronic adverse effects from radiation associated with esophageal, hepatobiliary, and pancreatic brachytherapy and their management.     

经尿道治疗下尿路结石现状与进展

膀胱结石发病率约占整个泌尿系结石的5%,随着腔内器械和碎石设备不断改进,绝大多数膀胱结石可通过内镜下处理。钬激光的出现使直径4cm的结石碎石成功率有了较大提高。超声气压弹道碎石比钬激光更高效,操作时间更短,损伤更小,出血更少。碎石通道也不乏创新之处,如AH-1取石系统、JQL鞘等。本文就经尿道治疗下尿路结石的现状与进展做一综述。     

后腹腔镜输尿管切开取石治疗嵌顿性输尿管下段结石伴感染的临床体会

目的探讨后腹腔镜输尿管切开取石治疗嵌顿性输尿管下段结石伴有感染的安全性、有效性及实用性。方法回顾性分析2017年6月至2019年6月我科收治的6例诊断为嵌顿性输尿管下段结石伴有感染的病例资料,其中4例术前行体外冲击波碎石术(ESWL)治疗失败,2例术前尿培养阳性且伴有发热,尿常规WBC均为++~+++,均采用后腹腔镜下输尿管下段结石切开取石术,记录其手术时间、术后肠功能恢复时间、总住院天数及相关并发症。结果6例患者行经腹膜后腹腔镜下输尿管下段结石切开取石术均获得成功,无一例中转经腹入路腹腔镜下输尿管切开取石或开放手术。手术时间为55~100 min(平均82.5 min);术后肠功能恢复时间为1~2 d(平均1.7 d),总住院时间7~13 d(平均8.5 d)。其中1例术后拔除尿管后出现腰痛、发热,考虑为前列腺增生、尿潴留、尿液返流所致尿外渗,予保留导尿后症状消失。随访时间3~12个月,均无结石复发、输尿管狭窄等严重并发症。结论经后腹腔入路腹腔镜输尿管下段切开取石术安全可行,创伤小、恢复快,尤其适用于伴感染的输尿管结石患者,值得临床推广,但对术者的腹膜后解剖及腔镜技术提出了更高要求。     

Levels of BAFF in Serum in Primary Biliary Cirrhosis and Autoimmune Diabetes

Levels of the B-cell activating cytokine BAFF are increased in serum in various autoimmune disease, and particularly Sjögren's syndrome in which there is evident B-lymphocyte proliferation. Studies in two autoimmune disease in which B-cell proliferation is less evident, primary biliary cirrhosis (PBC), and adult-onset Type 1 diabetes, showed serum levels of BAFF to be mostly in the normal range. A single raised level among eight sera tested in one patient studied with autoimmune hepatitis (AH) coincided with a relapse of the disease. Increased levels of BAFF in human sera, indexing a potent antigenic drive on B-cell production and survival in some autoimmune diseases, may mark only particular stages in the evolution of such diseases.