腹腔镜胆囊切除术联合胆总管探查在老年胆囊结石合并胆总管结石患者中的应用

目的 探讨腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)联合胆总管探查(laparoscopic common bile duct exploration,LCBDE)在老年患者中的安全性及有效性.方法 对2009年1月～2012年1月140例胆囊结石合并胆总管结石行LC联合LCBDE的临床资料进行回顾性分析,按年龄分为老年组(年龄≥65岁,n=42)和对照组(年龄＜65岁,n=98),比较2组手术时间、中转开腹率、术后并发症、术后住院时间、住院费用、术后死亡率有无差异.结果 老年组住院费用(17 149.7 ±8275.8)元,显著高于对照组(13 710.8 ±5228.4)元(t=2.964,P=0.004);老年组手术时间(100.2±25.8) min与对照组(106.3±48.3) min无统计学差异(t=-0.772,P=0.442);老年组中转开腹率7.1％ (3/42)与对照组7.1％ (7/98)无统计学差异(x2=0.000,P=1.000);老年组术后住院时间(13.0±4.5)d与对照组(11.9±4.1)d无统计学差异(t=1.412,P =0.160);老年组术后并发症发生率16.7％ (7/42)与对照组15.3％ (15/98)无统计学差异(x2=0.041,P=0.839).2组均无死亡病例.140例随访8 ～42个月,平均25.9月:老年组2例结石残留,其中1例术后3个月行体外冲击波碎石后胆道镜经T管窦道取出结石,1例术后2个月行ERCP+ EST取石;对照组无结石残留,1例术后20个月胆道结石复发,行ERCP+ EST取石.结论 LC联合胆总管探查不仅对年轻患者,对老年患者也是安全有效的.     

腹腔镜探查活检术在局部进展期胰腺癌诊治中应用分析

目的 探讨腹腔镜探查活检术在局部进展期胰腺癌（LAPC）诊断和治疗中的应用价值。方法 回顾性分析2017年1月至2020年6月福建医科大学附属协和医院基本外科收治的65例接受腹腔镜探查活检术的LAPC病人的临床资料,包括临床表现、血清肿瘤标记物、影像学检查、术中情况和术后情况等。结果 所有65例术前诊断为LAPC的病人的术中快速冰冻切片病理学检查结果均诊断为腺癌,包括胰腺穿刺活检51例（78.5%）、腹膜活检（腹壁、大网膜、肠系膜表面结节）8例（12.3%）,肝脏活检3例（4.6%）和区域淋巴结活检3例（4.6%）。11例（16.9%）病人在术中探查时发现存在隐匿性转移,包括3例肝转移和8例腹膜转移。所有病人术后无出血、腹腔感染、胰瘘等并发症。65例病人中有50例（76.9%）在活检术后接受了化疗,剔除5例合并旁路手术病人（一般术后2周以上接受化疗）外,手术与化疗之间的中位间隔时间为3 d。结论 对术前影像学评估为LAPC的病人行腹腔镜探查活检术安全且有效,还可发现隐匿性转移和缩短术后化疗等待时间,腹腔镜探查活检术可以作为LAPC获取病理学诊断和准确分期的常规方法之一。     

基于盐酸克林霉素注射剂不良反应监测数据探索聚类分析方法在药品不良反应监测中的应用

目的探索聚类分析方法在药品不良反应监测数据中的运用。方法选取9家生产企业（编码为A～I）生产的盐酸克林霉素注射剂不良反应／事件的监测数据,根据其不良反应信息采用聚类分析法将企业进行分组,以此发现不同生产企业产品致不良反应的特点。结果9家企业按照药品不良反应累及系统一器官归类为4组,且组问差异较大;各组企业药品致不良反应具有不同的特点。结论不同企业的生产工艺可能导致同种药品致不良反应的不同;聚类分析可以在药品不良反应监测中运用。     

Laparoscopic common bile duct exploration to treat choledocholithiasis in situs inversus patients: A technical review

Situs inversus (SI) is a rare congenital condition characterized by a mirror-image transposition of the major visceral organs. Since the 1990s, more than one hundred SI patients have been reported to have successfully undergone laparoscopic cholecystectomy. In these cases, the major problem is to overcome is the left-right condition for right-handed surgeons. Laparoscopic common bile duct exploration (LCBDE), an alternative to treat patients with bile duct stones, has shown equivalent efficacy and is less likely to cause pancreatitis than endoscopic retrograde cholangiopancreatography. Recent updated meta-analyses revealed that a shorter postoperative hospital stay, fewer procedural interventions, cost-effectiveness, a higher stone clearance rate, and fewer perioperative complications are additional advantages of LCBDE. However, the technique is technically demanding, even for skilled laparoscopic surgeons. Conducting LCBDE in patients with difficult situations, such as SI, is more complex than usual. We herein review published SI patients with choledocholithiasis treated by LCBDE, including our own experience, and this paper focuses on the technical aspects.     

分散式静脉用药调配中心的实践与创新简

目的保障临床用药安全、有效。方法比较分散式静脉用药调配中心（PIVAS）与传统集中模式PIVAS的异同及优缺点,总结分散式PIVAS的优势。结果与结论建立以科室为单位的分散式PIVAS,解决了集中模式的PIVAS工作时间安排、人员配备、运输通道的矛盾,降低了用药风险,保证了临床用药及时与安全。     

腹腔镜联合胆道镜治疗胆总管结石临床疗效分析

目的探讨腹腔镜联合纤维胆道镜治疗胆总管结石的可行性及临床疗效分析。方法选取2009年1月~2013年12月在我院行手术治疗胆总管结石患者144例。按手术方式的不同分组,行腹腔镜联合胆道镜治疗80例为观察组,开腹手术治疗64例为对照组。观察并比较两组：（1）手术情况：包括手术时间、术中失血量、术后排气时间、术后并发症情况、住院时间等。（2）治疗效果：包括术后胆总管通畅率、结石残余率、复发率,手术治愈率等。结果 144手术均获成功。其中观察组在术中出血量、术后胃肠功能恢复时间、术后并发症发生率、住院天数等方面均优于对照组（P〈0.05）。结论腹腔镜和胆道镜双镜联合治疗胆总管结石安全有效、损伤小、恢复快,术中出血少、疼痛反应轻、住院时间短及术后并发症少等优点。是目前治疗胆道结石较理想的微创术式。但术者需要掌握熟练的操作技能。     

Comparison of emergent versus elective laparoscopic common bile duct exploration for patients with or without nonsevere acute cholangitis complicated with common bile duct stones

Background

Laparoscopic common bile duct exploration (LCBDE) has already been established for the treatment of patients with common bile duct stones (CBDS) in elective situations. However, the effect of emergent LCBDE on those patients with nonsevere acute cholangitis has not been assessed. The aim of this study was to evaluate the effect of emergent LCBDE on patients with nonsevere acute cholangitis complicated with CBDS.

Methods

Seventy-two patients with CBDS admitted from January 2009 to December 2012 were included for this retrospective study. LCBDE of transductal approach for CBDS was performed to all patients. Thirty-seven patients underwent emergent LCBDE for nonsevere acute cholangitis and 35 patients underwent elective LCBDE. Duration of the procedure, complications, retained stone of bile duct, hospital stay, and total charges were compared between the two groups. In addition, the characteristics of patients underwent emergent LCBDE were also compared before and after surgery.

Results

There was no significant difference with regard to the diameter of common bile duct and number of CBDS from imaging and/or operative findings between the two groups. There was no conversion to open common bile duct exploration, no major bile duct injuries, and no mortality in both the group of patients. There was no significant difference in patients with or without acute or chronic cholecystitis, duration of surgery, overall hospital stay (16.41 ± 1.03 versus 14.54 ± 0.94, P > 0.05), and total charges (18,603 ± 1774.64 versus 14,951 ± 1257.09 Yuan in renminbi, P > 0.05) between the two groups. Four cases with retained stones were found in patients with emergent LCBDE and two in elective LCBDE patients. There were four cases of biliary leak in patients with emergent LCBDE and three cases in elective LCBDE group, respectively. However, there was no statistical difference between the two groups. The biliary leak was cured postoperatively after drainage. Control of septic symptoms was achieved in all patients after emergent LCBDE.

Conclusions

Our data indicated that emergent LCBDE is as safe and effective as elective LCBDE for the treatment of patients with nonsevere acute cholangitis complicated with CBDS.     

经脐入路腹腔镜胆总管探查一期缝合术后胆漏34例分析

目的分析经脐入路腹腔镜胆总管探查一期缝合术后胆漏并发症的发生及其治疗,探讨有效的防治措施。方法回顾性分析2008年11月至2013年3月,本院34例经脐入路腹腔镜胆总管探查一期缝合术后发生胆漏并发症患者的临床资料。结果胆漏发生率为22．7％（a4／150）。34例胆漏患者中,22例在术后24h内出现,12例在术后3～7d出现,经腹腔引流34例患者均治愈。结论严格掌握手术适应证,术中操作轻柔,认真仔细缝合胆总管以及加强营养支持等,是防治经脐入路腹腔镜胆总管探查一期缝合术后胆漏的有效措施。     

精索扭转的循证诊断与治疗

目的:系统评价精索扭转的诊断及处理方法。方法:计算机检索Cochrane图书馆、PubMed、维普资讯、CNKI,查找有关精索扭转的随机对照研究,检索时限均为1990~2012年,研究者对文献质量进行严格评价和资料提取,采用盲法分析。结果:共纳入27篇文献,3 541例患者纳入研究。结果表明:多普勒彩超在诊断阴囊急症明显优于常规超声,成为阴囊急症的首选影像学诊断方法;对任何年龄段的急性阴囊疼痛的患者均应行手术探查,没有足够的证据支持单侧精索扭转行对侧睾丸固定;精索扭转对于患侧睾丸生育功能的影响会随着患者年龄的增长而增加,对于健侧睾丸的影响尚存在争议。结论:对于有阴囊症状的患者应及时行阴囊多普勒彩超筛查,对于已确认精索扭转患者及阴囊急症患者应立即行阴囊手术探查,根据具体情况以决定是否行双侧睾丸固定术,对患者生育功能应加强随访。     

化毒清湿汤对复杂性肛瘘新型探查术后患者手术创面恢复功效研究

目的:研究化毒清湿汤对于复杂性高位肛瘘新型探查术后患者手术创面恢复及相关细胞因子水平的改善功效。方法: 从接受复杂性肛瘘新型探查术治疗的患者中选取104例纳入本次研究,入选患者随机均分为对照组与治疗组,对照组给予术后常规治疗,治疗组在对照组疗法的同时加用化毒清湿汤治疗,于术后2 d、15 d分别对比两组患者的创面面积、疼痛程度,观察创面愈合时间; 术后28 d评估两组疗效,同时观察两组患者术后2 d、28 d时血清细胞生长因子与炎性因子水平的变化。结果:治疗组总有效率98.08%高于对照组的86.54%(P<0.05); 术后15 d两组创面面积、疼痛VAS评分均有所降低且两组比较治疗组更低; 治疗组创面愈合时间为(23.71±5.57)d,对照组为(30.46±7.92)d,两组比较治疗组更低(P<0.05); 术后28 d两组各项细胞生长因子均有上升,组间比较治疗组更高,差异具有统计学意义(P<0.05); 术后28 d两组各项炎性因子均有好转,组间比较治疗组更优,差异具有统计学意义(P<0.05)。结论:化毒清湿汤可提高复杂性肛瘘新型探查术临床疗效,加快患者术后后创口愈合速度,进一步改善患者细胞生长因子与炎性因子的表达水平。