个体化护理影响胆结石手术患者心理状态、生活质量的临床效果分析

目的 探讨个体化护理在胆结石手术患者中的应用效果及对心理状态、生活质量的影响。方法 选择2016年4月~2017年12月入我院治疗的胆结石手术患者40例,随机分为观察组和对照组,每组20例。比较两组患者SAS和SDS评分以及生理健康、心理状态、社会关系、周围环境、独立能力等生活质量评分。结果 护理7 d后,两组患者SAS和SDS评分均低于护理前,且观察组SAS和SDS评分分别为（36.85±2.96）分和（27.94±4.61）分,低于对照组的（53.29±3.51）分和（46.73±5.38）分,差异具有统计学意义（P＜0.05）。两组患者护理后生理健康、心理状态、社会关系、周围环境、独立能力评分均高于护理前,且观察组高于对照组,差异具有统计学意义（P＜0.05）。结论 将个体化护理用于胆结石手术患者中,能改善患者心理状态,提高患者生活质量。     

Alkaline sphingomyelinase(NPP7) in hepatobiliary diseases: A field that needs to be closely studied

Alkaline sphingomyelinase cleaves phosphocholine from sphingomyelin, platelet-activating factor, lysophosphatidylcholine, and less effectively phosphatidyl-choline. The enzyme shares no structure similarities with acid or neutral sphingomyelinase but belongs to ectonucleotide pyrophosphatase/phosphodiesterase(NPP) family and therefore is also called NPP7 nowadays. The enzyme is expressed in the intestinal mucosa in many species and additionally in human liver. The enzyme in the intestinal tract has been extensively studied but not that in human liver. Studies on intestinal alkaline sphingomyelinase show that it inhibits colonic tumorigenesis and inflammation, hydrolyses dietary sphingomyelin, and stimulates cholesterol absorption. The review aims to summarize the current knowledge on liver alkaline sphingomyelinase in human and strengthen the necessity for close study on this unique human enzyme in hepatobiliary diseases.     

胆囊切除术中胆总管探查阴性的分析

目的探讨胆囊切除术时胆总管探查阴性的原因。方法回顾分析本院1998年6月至2003年12月31例胆总管探查阴性病人的临床资料。结果导致阴性探查的原因有急性水肿性胰腺炎9例,慢性胰腺炎6例,梗阻性胆囊炎6例,细小胆囊结石7例,胆总管胆汁浑浊2例,胆总管旁淋巴结肿大1例。结论胆总管内外因素可引起胆总管探查阴性,术中经胆囊管胆道造影等能减少胆总管的阴性探查。     

Laparoscopic treatment of an upper gastrointestinal obstruction due to Bouveret’s syndrome

Bouveret’s syndrome is an extremely rare type of gallstone-induced ileus with atypical clinical manifestations,such as abdominal distension and pain,nausea and vomiting,fever or even gastrointestinal bleeding,which may easily be misdiagnosed. In the present case,a 55-year-old male was admitted to the hospital with upper gastrointestinal obstructive symptoms but without pain,fever,jaundice or melena. At first,gastrolithiasis and peptic ulcer combined with pyloric obstruction were suspected after gastroscopy revealed a large,hard stone in the duodenal bulb. A revised diagnosis of Bouveret’s syndrome was made following abdominal computed tomography. Subsequently,the patient exhibited a good postoperative recovery after laparoscopic duodenotomy for gallstone removal and subtotal cholecystectomy. The condition of the patient remained stable after being followed up for 6 mo. The successful application of laparoscopic therapy to treat Bouveret’s syndrome has seldom been reported. Laparoscopic enterolithotomy is safe and effective,with good patient tolerability,rapid postoperative recovery and few wound-related complications. The laparoscopic treatment of Bouveret’s syndrome is worth exploring.     

肝硬化患者腹腔镜胆囊切除术36例临床分析

目的 探讨腹腔镜胆囊切除术（LC）在治疗肝硬化患者中的临床效果.方法 对2005年1月～2010年8月间在笔者所在医院就诊的36例Child-Pugh A、B级肝硬化行LC的患者进行分析.结果 36例患者顺利完成LC,其中3例行胆囊大部分切除,3例因术中止血困难而中转开腹.所有患者术后无胆道损伤、术后再出血及肝功能衰竭等严重并发症.术后出现腹水3例,穿刺孔出血2例.结论 充分做好术前准备,准确掌握手术适应证,熟练的手术技巧,肝硬化患者行LC是安全的,对于肝功能A、B级须切除胆囊者应首选LC.     

Gender and metabolic differences of gallstone diseases

AIM： To investigate the risk factors for gallstone disease in the general population of Chengdu, China. METHODS： This study was conducted at the West China Hospital. Subjects who received a physical examination at this hospital between January and December 2007 were included. Body mass index, blood pressure, fasting plasma glucose, serum lipid and lipoproteins concentrations were analyzed. Gallstone disease was diagnosed by ultrasound or on the basis of a history of cholecystectomy because of gallstone disease. Unconditional logistic regression analysis was used to investigate the risk factors for gallstone disease, and the Chi-square test was used to analyze differences in the incidence of metabolic disorders between subjects with and without gallstone disease. RESULTS： A total of 3573 people were included, 10.7% （384/3573） of whom had gallstone diseases. Multiple logistic regression analysis indicated that the incidence of gallstone disease in subjects aged 40-64 or ≥65 years was significantly different from that in those aged 18-39 years （P 〈 0.05）; the incidence was higher in women than in men （P 〈 0.05）. In men,a high level of fasting plasma glucose was obvious in gallstone disease （P 〈 0.05）, and in women, hypertriglyceridemia or obesity were significant in gallstone disease （P 〈 0.05）. CONCLUSION： We assume that age and sex are profoundly associated with the incidence of gallstone disease; the metabolic risk factors for gallstone disease were different between men and women.     

Successful endoscopic treatment of colonic gallstone ileus using electrohydraulic lithotripsy

The surgical management of gallstone ileus is complex and potentially highly morbid.Initial management requires enterolithotomy and is generally followed by fistula resection at a later date.There have been reports of gallstone extraction using various endoscopic modalities to relieve the obstruction,however,to date,there has never been a published case of endoscopic stone extraction from the colon using electrohydraulic lithotripsy.In this report,we present the technique employed to successfully perform an...     

原发性胆囊癌100例报告

本文报告我院近30年(1956～1986)原发性胆囊癌 100例。该病居我院消化道癌第五位。胆囊癌病因相关因素较多,但以胆囊粘膜的慢性刺激和胆酸代谢紊乱较为重要,其早期诊断困难,对高危人群进行B 超切面显像监测值得推崇。为了防止漏诊,胆囊切除术中应常规剖视胆囊标本并送病理检查。胆囊癌早期倾向局部转移,应力争根治切除。为防患于未然,作者提出二级预防建议。