三镜联合治疗急性胆源性胰腺炎的体会

目的:探讨腹腔镜、胆道镜、十二指肠镜联合治疗急性胆源性胰腺炎的微创治疗方法及疗效。方法:51例急性胆源性胰腺炎患者均在入院后24小时内行十二指肠镜检查,并予行经内镜鼻胆管引流术(ENBD)。结果:内镜联合手术成功47例,占92.2%;中转开腹4例。术后6个月以上的随访,均健康生活和正常工作,无结石复发。结论:腹腔镜、胆道镜、十二指肠镜联合微创治疗胆源性胰腺炎疗效明确,是完全可靠的方法。     

用于筛选顺式反应元件的慢病毒启动子报告载体随机文库的构建

【摘要】 目的 建立含有随机序列与miniCMV融合的启动子,驱动抗生素耐药基因的表达;用于筛选和寻找不同处理条件下的反应性元件。方法 设计针对Puromycin抗性基因,即嘌呤霉素N 乙酰转移酶基因（puromycin N acetyl transferase gene, PAC）的引物,扩增目的条带并通过PacI+Pme1限制性内切酶克隆至目的载体pWPI;然后,设计并合成接头序列+20N随机序列+ miniCMV的融合片段,通过PCR的方法得到双链序列,并进行酶切,通过Cla1+PacI克隆入前述pWPI PAC载体。克隆得到的载体组合即为慢病毒反应元件筛选报告载体文库。在此基础上,我们将报告载体文库转染细胞,并进行超声照射。超声照射剂量为10min,100mW/cm2。每天一次,一共照射3天。每次超声照射后,对细胞进行puromycin处理。4天后,收集超声照射存活细胞,提取DNA,PCR扩增含有20N的序列并进行测序鉴定。结果 我们成功设计了一套文库构建方案,初步构建了20N随机序列+ miniCMV +Puromycin抗性基因的文库。将该文库转染细胞,超声照射后可以增加转染有对超声反应克隆细胞中抗性基因表达;我们通过获取Puromycin处理后的存活细胞,发现了潜在的对超声反应的调控元件。结论 我们构建的20N随机序列+ miniCMV +Puromycin抗性基因文库,可以用于筛选对超声等特定条件有表达调控反应的顺式反应元件;进而为该元件控制基因表达提供依据。     

彩色多普勒超声在腘窝囊肿诊断中的价值

目的探讨彩色多普勒超声在腘窝囊肿诊断中的价值。方法回顾性分析19例经手术、病理证实的腘窝囊肿患者声像图特点。结果19例21个病灶囊壁和分隔不规则增厚,19例囊腔内透声差,呈细密点状弱回声;彩色多普勒显示增厚的囊壁及分隔内未探及血流信号。结论腘窝囊肿的彩色多普勒（CDFI）声像图表现有一定特征性,可作为腘窝囊肿的首选检查方法。     

腹腔镜手术与开腹手术在肝细胞癌中应用的Meta分析

目的评价腹腔镜手术与开腹手术治疗肝细胞癌的疗效及安全性。方法应用循证医学的系统评价方法,对2002年1月至2012年12月在国内外医学期刊发表的有关围术期腹腔镜手术与开腹手术在肝细胞癌中的临床病例对照研究进行质量评价。结果纳入19个病例对照研究的疗效,纳入文献的总体方法学质量较高。Meta分析结果显示,与开腹手术相比较,腹腔镜肝切除术未能显著缩短手术时间(SMD=-0.39,95%CI-0.94^-0.15,P=0.15),减少术中出血量(SMD=-0.76,95%CI-0.92-0.15,P=0.15),减少术中出血量(SMD=-0.76,95%CI-0.92^-0.59,P=0.03),缩短住院时间(SMD=-0.86,95%CI-1.31-0.59,P=0.03),缩短住院时间(SMD=-0.86,95%CI-1.31^-0.98,P<0.00001),减少肛门排气时间(SMD=-0.87,95%CI-1.18-0.98,P<0.00001),减少肛门排气时间(SMD=-0.87,95%CI-1.18^-0.56,P<0.00001)。结论腹腔镜手术能够最大限度地降低手术对患者内环境的影响,患者的出院时间、肛门排气时间均显著少于开腹切除组。     

腹腔镜肾癌根治性切除术后的护理体会

目的探讨腹腔镜肾癌根治性切除术的护理要点。方法总结4例腹腔镜肾癌根治性切除术及9例后腹腔镜肾癌根治性切除术的护理经验,制定手术前后护理程序。结果 13例肾癌患者均手术成功,康复出院。结论做好肾癌患者的术前心理辅导,积极术前准备,术后密切监测患者的护理指标变化,随时做出相应处理,可帮助患者早日治愈康复。     

Accidental ingestion of magnetic foreign body in a pediatric patient: A potentially fatal attraction

Foreign body ingestion is one of the most common pediatric emergencies. As part of their cognitive development, infants and toddlers are extremely curious and constantly explore their surroundings through their senses, namely taste. The ubiquity of toys containing magnetic elements consecutively meant an increase in the cases of children ingesting said magnets. While most ingested foreign bodies, including a single magnet, will spontaneously traverse the gastrointestinal tract without problems, some may give rise to grave and potentially life-threatening complications; the latter is often seen in the presence of 2 or more magnets or paramagnetic material. The diagnosis of ingestion of magnetic foreign bodies remains a challenge, given its often ambiguous history and presentation; nonetheless, their abundance, gravity, and preventability of their complications alone should render physicians vigilant and keep a low threshold of suspicion.     

超声定位在经皮肾镜取石术中的应用

目的：探讨超声定位在经皮肾镜取石术中的应用效果。方法选取我院2014年1月至2015年3月期间行经皮肾穿刺钬激光碎石术患者215例。所有患者采用超声定位引导下行经皮肾穿刺,建立通道,术中协助处理残余结石。结果所有患者均成功建立经皮肾通道,行钬激光碎石清石,其中1针穿刺成功185例,2针穿刺成功21例,多针穿刺成功9例。一步扩张法建立通道后置入内窥镜行钬激光碎石术,一期结石清除率为75.3%(162/215),二期结石清除率为92.1%(198/215)。术后出现2例继发性出血,经行超选择性肾动脉栓塞后治愈。术后住院时间6~9 d,平均7.5 d。随访全部病例2~12个月,腰部疼痛、血尿等症状均消失,无结石复发。结论超声定位引导下经皮肾穿刺具有使用灵活方便、定位准确、成功率高的优点。其可避开穿刺路径上的脏器及帮助术中寻找结石,但超声较X线直观性差,需要掌握一定的操作技巧才可灵活使用。     

Coexistence of primary central nervous system lymphoma and primary breast lymphoma: Clinical presentation,imaging features,and treatment management

The presence of synchronous dual hematological diseases is an uncommon finding. We report an unusual case of coexistence of primary central nervous system lymphoma and primary breast lymphoma without systemic involvement in an immunocompetent patient. To our knowledge a similar case has not yet been reported in the literature. We especially focus on presenting the imaging features, the associated clinical findings and treatment management of each entity, with the aim of raising awareness on these two rare types of lymphomas and the possibility of their coexistence.     

Stapled diverticulectomy for solitary caecal diverticulitis

Caecal diverticulitis is an uncommon phenomenon in western countries. The clinical diagnosis is often difficult as it mimics other acute abdominal conditions like appendicitis, colitis or neoplasia. Diagnosis is often made at operation. Operative strategy has been controversial and there is no broad consensus emerging. We report the case of a 71-year-old woman, known to have chronic obstructive pulmonary disease, who presented acutely with right iliac fossa pain. A clinical diagnosis of appendicitis was made. At laparoscopy, a solitary, inflamed, gangrenous caecal diverticulum was found. A laparoscopic stapled diverticulectomy was performed. The patient made a steady post-operative recovery. Histology confirmed diverticulitis. We conclude that stapled diverticulectomy for solitary caecal diverticulitis is a safe and effective surgical strategy when confronted with this scenario.     

高龄胃癌患者腹腔镜胃切除术安全性与近期疗效

目的:评价为高龄胃癌患者行腹腔镜胃切除术的安全性及近期疗效.方法:回顾分析2008年7月-2011年12月87例行胃切除术高龄(≥70岁)胃癌患者的临床资料,其中39例行腹腔镜手术(腔镜组),48例行开腹手术(开腹组),比较两组患者的一般情况、手术指标、术后恢复情况、并发症情况及治疗效果.结果:两组患者性别、中位年龄、术前合并症、ASA术前危险度评分、疾病类型均无明显差异(均P＞0.05).与开腹组比较,除平均手术时间无明显差异外(P＞0.05),腔镜组术中平均出血量(73 mL vs.309 mL),肠功能恢复时间(4.1 d vs.5.5 d),进流食时间(4.2 d vs.6d),平均住院时间( 19.1 d vs.25.2 d),术后心肺并发症发生率(28.2％ vs.56.3％)均明显减少(均P＜0.05).平均随访29个月,腹腔镜组和开腹组患者总生存率分别是57.1％和65.9％ (P＞0.05).结论:为高龄患者行腹腔镜胃癌切除术安全可行,可减少患者术中出血量,降低术后心肺并发症的发生率,加快术后胃肠功能恢复.