男性居民吸烟、饮酒水平与胆石症患病关系

目的 探讨男性居民吸烟、饮酒水平与胆石症患病的关系。方法 在广东省人群脂肪肝现况调查的基础上,选取成年男性居民,对其吸烟、饮酒水平与胆石症关系进行分析。结果 男性居民胆石症的患病率随着每天吸烟量的增加而升高（趋势χ^25.542,P=0.019）,同时随着年吸烟总量的增加而不断升高（趋势χ^27.302,P=0.007）,排除胆石症常见影响因素年龄和肥胖的影响后每天吸烟量以及年吸烟总量仍然是胆石症的危险因素（每天吸烟量OR=1.269,95%CI：1.018～1.580;吸烟总量OR=1.295,95%CI：1.020～1.646）。饮酒与胆石症的关系是少量和适量饮酒（〈40g/d）可降低男性居民的胆石症的发病,但大量饮酒（≥40g/d）反而会刺激胆石症的形成,呈现“V”形分布。排除胆石症常见影响因素年龄和肥胖的影响后,少量和适量饮酒的保护作用仍然存在（OR=0.537,95%CI：0.313～0.920）。每次饮酒量限制在20g内对胆石症的保护作用最强（OR=0.370,95CI：0.145～0.942）。每周饮酒频率不宜超过7次,饮酒年龄不宜过早,饮酒总年数不宜超过35a。结论 不吸烟、少量或适量饮酒可能对减少男性胆石症患病率有重要作用。     

Laparoscopic cholecystectomy after coronary artery bypass grafting using the right gastroepiploic artery: report of a case

A laparoscopic cholecystectomy (LC) was successfully performed on a 61-year-old man who had undergone coronary artery bypass grafting (CABG) using the right gastroepiploic artery (RGEA). He complained of right hypochondralgia 20 days after CABG. Gallstones were diagnosed and a cholecystectomy was performed 9 months after CABG. Under general anesthesia, the operation was performed using a pneumoperitonium. When a laparoscope was inserted, the RGEA pedicle could be clearly recognized. The pedicle obstructed the operating field and made the working space narrower than usual. No ST changes on the electrocardiogram were seen during LC, especially during the initiation of pneumoperitonium, the insertion of the ports, or when retracting the gallbladder. The postoperative course was uneventful. To avoid complications, care should be taken not to stretch the RGEA pedicle during LC, and careful monitoring of the electrocardiogram is also necessary. It is difficult to view the operating field and the RGEA pedicle together. It is therefore better to insert another laparoscope for concomitant monitoring of the RGEA pedicle. Received: June 25, 2001 / Accepted: January 8, 2002     

Small intestinal transit does not adequately represent postoperative paralytic ileus in rats

Small intestinal transit (SIT) has often been regarded as an index of pathophysiological state of postoperative ileus (PI) in rats. The reliability of SIT as an index of PI was examined in the present study. PI was induced via abdominal surgery (i.e., laparotomy with evisceration and manipulation) in rats. For one group of PI-induced rats, SIT of a charcoal test meal was measured. When necessary, the physical state (i.e., severity and site of distension) of the gastrointestinal (GI) tract in each rat was visually examined. For another group of PI-induced rats, abdominal X-ray radiographs were obtained after introducing the barium sulfate suspension. The abdomen was then opened and the physical state of the GI tract was visually examined. The SIT was decreased in most of the PI-induced rats, and the GI distension was observed, with substantial intersubject variations, in all of the PI-induced rats. However, no linear relationship was evident between the SIT and the severity of GI distension (e.g., at 20 h after PI induction). Instead, the severity and site of GI distension could be monitored by the X-ray radiology. Therefore, the use of SIT as an index of Pi should be substantially limited.     

Recurrent gallstone ileus: a case report

Gallstone ileus is a rare complication of recurrent gallstone cholecystitis and usually occurs in elderly female patients. Recurrent gallstone ileus occurs in 5% of patients with a previous episode of gallstone ileus and is associated with a mortality of 20%. We present a 52-year-old female with recurrent gallstone ileus 1 year after her initial episode. Electronic Publication     

胰胆管合流异常及其相关疾病

胰胆管合流异常是一种胆管和胰管在十二指肠壁外汇合的先天性畸形。由于失去了Oddi括约肌的控制,胆汁和胰液可以相互返流从而引起胆总管扩张症,胆道结石,胆道肿瘤及其胆源性胰腺炎等疾病。     

一个大型胆囊结石病家系的遗传特征及流行病学分析

目的调查某胆囊结石(胆石)病家系的遗传特点及流行病学特征。方法对该家系进行问卷调查、体格检查及实验室检查。结果该家系四代共113人(男55人,女58人),胆石患者33例(男13例,女20例),女性发病率(34.48%)高于男性(23.64%),但差异无统计学意义。和先证者有血缘关系的亲属中Ⅱ、Ⅲ代发病率52%,明显高于配偶的发病率(20%),P=0.003。先证者Ⅰ级亲属遗传度86.38%±46.46%。患者平均体重指数(25.06±2.59)kg/m2,显著高于非胆石病者平均体重指数(22.69±3.24)kg/m2,P=0.012。胆石病患者中有高血压、高血脂病史者明显多于非胆石病者,差异有统计学意义,P值分别为<0.01和0.017。糖尿病病史、饮酒习惯、喜油腻饮食在胆石病患者和非胆石病者中无差异。胆石病患者血糖平均值(5.35±0.77)mmol/L。血胆固醇和甘油三酯在胆石病患者和非胆石病者中无差异。结论该家系胆石病具有明显家族聚集性,符合常染色体显性遗传特点;性别、肥胖、高血压和高血脂病史是该家系的危险因素。     

胆石性肠梗阻的分析和诊治

目的 :分析胆石性肠梗阻的临床表现 ,探讨其诊断和治疗方法。方法 :对我院 1 980～ 2 0 0 0年收治的 1 8例胆石性肠梗阻患者资料作回顾性分析 ,其中 1 6例行肠壁切开取石术 ,同时行胆肠内瘘修补 5例、小肠部分切除 2例 ;2例以中药大承气汤治愈。结果 :本组 1 8例胆石性肠梗阻患者均治愈 ,无死亡。 1 2例随访 2～ 3年均无复发和出现胆系症状。结论 :胆石性肠梗阻以高龄女性好发、病程较长、常有中间腹痛缓解期的病史是其临床特点。术前诊断较困难 ,腹部平片、 B超有助于诊断 ,CT有较为特殊的表现 (Rigler三联征 )。解除结石梗阻是中西医结合治疗的主要目的。手术应以安全有效的肠壁切开取石术为主     

腹部手术后早期肠梗阻防治策略

目的总结腹部手术后早期肠梗阻治疗经验，探讨诊断、治疗、预防原则。方法回顾分析36例术后早期肠梗阻病例治疗方法。结果36例病例中，32例为早期炎性肠梗阻，4例手术治疗，其中3例为肠扭转、内疝等机械性因素所致，手术治愈，1例为早期炎性肠梗阻，术后出现腹腔内出血并再次出现炎性肠梗阻。结论术后早期肠梗阻约90％为早期炎性肠梗阻，应行保守治疗，避免手术，10％为肠扭转、内疝机械性因素所致需急诊手术，防止肠坏死发生。     

Hepatic derangement following N‐Acetylcysteine enemas in an infant with cystic fibrosis

We discuss an infant with MI secondary to cystic fibrosis, who was managed surgically by a double barrel ileostomy for mid – small bowel atresia and developed severe faecal impaction in the post – operative period. The faecal impaction was treated successfully with oral NAC and 0.2% NAC contrast enemas. The patient's liver function tests revealed a dramatic increase in transaminases and bilirubin contemporaneous with the administration of the enemas. The levels showed a spontaneous improvement after discontinuation. This is only the second reported case of hepatotoxicity secondary to NAC enemas in the literature. While our experience offers modest support for the use of NAC, its efficacy is not yet proven and paediatric surgeons using NAC in the enema form need to closely monitor liver function contemporaneous with this agent's administration and adjust their treatment accordingly.