中国患者内镜下括约肌切开术或胆管取石术后行胆囊切除术与保留胆囊术的比较

背景与目的：患有胆管结石或胆囊结石的患，经常在实施内镜下括约肌切开术或胆管取石术后被建议实施胆囊切除术。而保留胆囊的患仅有10％可能会由于胆管并发症而复诊。因此，对此类患是否需要行胆囊切除术尚存在争议。该研究中，作比较了经腹腔镜行胆囊切除术和保留胆囊手术的治疗策略。方法：将接受了内镜下括约肌切开术和胆管取石术后的患（年龄〉60岁）随机分为两组，一组给予早期腹腔镜下胆囊切除术，另一组为择期手术治疗。主要观察指标为远期胆管并发症，其他观察指标包括胆囊切除术后的不良事件，以及由于各种原因所导致的最终死亡。结果：共178例患纳入该研究（每组89例）。在89例腹腔镜胆囊切除组的患中有82例接受并完成了手术治疗，其中有16例转为开腹手术（20％）。8例患出现术后并发症（9％）。应用意向治疗分析，在中值为5年的随访期内，胆囊切除组的6例患（7％）由于远期胆管并发症而复诊（胆管炎n=5；胆绞痛n=1）。

Cholecystectomy or gallbladder in situ after endoscopic sphineterotomy and bile duet stone removal in Chinese patients

Esophageal cancer development after previous atresia repair is extremely rare in young patients. We present the clinical course of a patient who developed an adenocarcinoma of the esophagus at the age of 22 years, after repair of a tracheoesophageal fistula with esophageal atresia in the neonatal period. She developed a stricture of the esophageal anastomosis requiring frequent dilatations. Six years after an antireflux procedure because of a difficult treatable severe gastroesophageal reflux, an advanced adenocarcinoma was detected at the site of the end-to-end anastomosis of the previous atresia.