Objective To investigate the effect of laparoscopy combined with choledochoscopy on common bile duct (CBD) stones with primary suture of the CBD. Methods Totally 523 patients of gallbladder stone companied with CBD stones or choledochectasia (diameter ≥0.8 cm) from September 1998 to December 2008 were retrospectively analyzed. Results The primary suture of the CBD incision was successfully performed in 487 patients. The CBD stones were completely removed during the operation in 400 patients. Nothing was found in 87 cases. In 10 cases conversion to open surgery were performed and in 26 cases the T tube drainage was put into the CBD in choledocholithotomy. Average operative time was 90 min and average bleeding volume was 50 ml. All patients took food at 24 h, returned general activity on 2-3 d and discharged on 5 d after operation. Postoperative biliary leakage occurred in 29 cases with drainage average volume of 35 ml/d and continued 1-6 d, which were cured by non-operation therapy. Conclusions The primary suture of the CBD during the laparosocopy combined with choledochosopy in choledocholithotomy is a safe and effective operation with less invasion, less pain and quicker recovery. CBD incision suture without T tube drainage can be done when CBD stones are cleared completely and no stenosis is found in extrahepatic bile duct.
目的 探讨先天性胆总管囊肿(congenital choledochal cyst,CCC)术式选择与疗效的关系。方法 对1989年至1998年间38例CCC手术治疗病例进行回顾性研究。结果 38例中行胆肠Roux-Y吻合术20例，肝总管十二指肠高位大口吻合术18例。术后随机获随访31例。13例胆肠Roux-Y吻合术后随访3～7年，发现5例并发十二指肠溃疡，3例并发胆道逆行感染。18例肝总管十二指肠高位大口吻合术后随访2～5年，发现1例并发胆道逆行感染，无1例并发十二指肠溃疡。结论 由于肝总管十二指肠高位大口吻合术后远期并发十二指肠溃疡发生率较低，其与胆肠Roux-Y吻合术相比，是提高CCC患儿术后远期生活质量较理想的术式。
目的 探讨输尿管镜气压弹道碎石治疗胆总管下段嵌顿性结石的方法及疗效。方法 传统方法取石失败病例改用输尿管镜置入胆总管直视见到胆总管下段嵌顿性结石，气压弹道碎石，盐水冲洗出或钳夹出结石，并探查下段是否通畅。结果 清除结石时间5~10 min，成功率100%（19/19），术后2~4周拔T管，无切口感染、无胆道感染、无残留结石。结论 输尿管镜气压弹道碎石治疗胆总管下段嵌顿性结石，高效、安全，值得临床推广应用。
Three cases of common peroneal nerve injuries from sports were reported. All of the three cases were overlooked in their early treatment. The diagnosis was clarified 5 months to 33 years after injury. Because the chance of early repair was lost, they all were treated by tendon transfer with the hope to improve the function of foot. The mechanism of this type of injury and the problems related to the diagnosis and treatment were discussed.
Objective To investigate the feasibil ity of building the 3D reconstruction of short segment common peroneal nerve functional fascicles based on serial histological sections and computer technology. Methods Five cm of the common peroneal nerve in the popl iteal fossa, donated by an adult, was made into the serial transverse freezing sections(n=200) at an interval of 0.25 mm and 10 μm in thickness per section. Acetylchol inesterase staining was adopted and the nerve fascicles were observed by microscope. 2D panorama images were acquired by high-resolution digital camera under microscope (× 100) and mosaic software. Different functional fascicles were distinguished and marked on each section. The topographic database was matched by image processing software. The 3D microstructure of the fascicular groups of 5 cm common peroneal nerve was reconstructed using Amira 3.1 3D reconstruction software. Results Based on microanatomy and the results of acetylchol inesterase staining, this segmented common peroneal nerve functional fascicles was divided into sensory tract, motor tract, mixed tract and motor-predominating mixed tract. The cross merging was not evident in the nerve fascicles between deep peroneal nerve and superficial peroneal nerve, but existed within the functional fascicles of the deep peroneal nerve and the superficial peroneal nerve. The results of 3D reconstruction reflected the 3D structure of peripheral nerve and its interior functional fascicles factually, which displayed solely or in combination at arbitrary angles. Conclusion Based on serial histological sections and computer technology, the 3D microstructure of short-segment peripheral nerve functional fascicles can be reconstructed satisfactorily, indicating the feasibil ity of building 3D reconstruction of long-segmental peripheral nerve functional fascicles.
目的 探讨急性百草枯(PQ)中毒鼠肺组织病理损伤和肺组织血红素氧合酶-1（HO-1）的表达及三七总皂甙（PNS）的保护作用。 方法 150只SD雄性鼠分为正常对照组（C组）30只、PQ中毒组（PQ组）60只及PNS组60只。PQ组和PNS组一次性灌胃PQ 25 mg/kg染毒，C组给予等体积生理盐水灌胃。其中PNS组于染毒前15 min以PNS 50 mg/kg阴茎静脉注射保护，以后1次/d给药直至处死前；PQ组、C组分别在同时间点给予等体积生理盐水。观察各组大鼠在中毒后6、12 h，1、3、5、7 d肺组织病理改变，采用蛋白质印迹法分析肺组织HO-1蛋白表达和反转录-聚合酶链反应方法测定鼠肺组织HO-1 mRNA的表达。 结果 C组HO-1蛋白和HO-1 mRNA绝大多数标本有弱表达，个别标本不表达；与C组相比PQ组及PNS组HO-1蛋白和HO-1 mRNA表达增强，差异有统计学意义（P＜0.05）；PQ组HO-1蛋白和HO-1 mRNA的表达在1 d达高峰之后下降，第3天基本恢复到C组水平；PNS组与PQ组相似，但在6 h、12 h、1 d及3 d高于PQ组，差异有统计学意义（P＜0.05），至第5天和第7天二者相比差异无统计学意义（P＜0.05）。PQ组肺组织病理损伤评分在6、12 h，1、3 、5、7 d各亚组均高于PNS相应组，差异有统计学意义（P＜0.05），C组肺组织病理大致正常，与PQ组及PNS组相比，差异有统计学意义（P＜0.001）。 结论 HO-1参与PQ中毒所致急性肺损伤，PNS对PQ中毒所致急性肺损伤有保护作用。
目的总结胆总管探查术中对其下端狭窄和医源性穿通伤的处理经验。方法对我院1994～2001年行胆总管探查术发现下端狭窄和发生医源性穿通伤病例15例进行回顾性分析。结果11例处理恰当，疗效好； 4例处理错误，发生穿通伤而行胆总管十二指肠吻合，疗效差。结论术中发现胆总管下端狭窄应行术中造影或胆道镜检查以明确原因，切不可盲目用探条探查。若发生胆总管下端穿通伤应行穿孔修补、T管引流，有结石嵌顿者同时行Oddi’s括约肌切开取石。
Schwannoma originating from the common bile duct is rare. We presented a patient who was diagnosed with biliary cystadenoma preoperatively and pathologically confirmed as a choledochal Schwannoma, analyzed the CT and MRI imaging manifestations, and illustrated its anatomical and pathological basis, and to improve the understanding of clinicians and radiologists for choledochal Schwannoma.