目的 探讨腹腔镜胆囊切除术（laparoscopic cholecystectomy,LC）导致胆管损伤的原因及防治方法。方法 回顾性分析上海仁济医院2001～2006年期间1 253例LC中发生胆管损伤14例的临床资料。结果 右肝管损伤6例，胆总管损伤4例，肝总管损伤4例。胆管损伤发生率为1.12%。结论 解剖学变异、病变的程度、手术者的技术原因和责任心是导致胆管损伤的重要原因； 术中仔细操作和解剖、及时发现胆管损伤并中转手术，根据损伤的位置及程度选择正确的处理方式是防治胆管损伤的关键。
ObjectiveTo review the advances of lymphocinesia in the abdominal cavity infection. MethodsDomestic and foreign literatures about the research of lymphocinesia in the abdominal cavity infection were collected and reviewed. ResultsBacterial translocation occurred when abdominal infection happened. At early phase, bacteria and endotoxin translocation could return and arrive the other tissues or organs through the lymphatic system. The peritoneal lymphatic stomata played an important role in lymphatic circulation, with strong absorption function and immune function. ConclusionsThe theory of lymphatic channels and lymphatic stomata immune pathway is a beneficial supplement to the theory that bacterial and endotoxin can spread to whole body through portal vein pathway, and combination of the 2 kinds of theories can explain the abdominal infection-related systematic infection better. Research of abdominal infection intervention which embarked on the lymphatic pathways would be a promising field.
ObjectiveTo summarize the mechanism of neutrophil extracellular traps (NETs) in hepatic ischemia-reperfusion injury (HIRI) and the research progress in targeting NETs to reduce HIRI, providing valuable reference for reducing HIRI. MethodThe related literatures at home and abroad about the role of NETs in the pathogenesis of HIRI and target NETs to alleviate HIRI were retrieved and reviewed. ResultsHIRI usually appeared in the process of liver surgery and was a common clinical problem, which occured in situations such as liver surgery, organ transplantation, liver ischemia and so on. This kind of injury would lead to tissue necrosis, inflammatory response and oxidative stress, which was a major cause of hepatic dysfunction and multiple organ failure after hepatic surgery, greatly increases the complications and mortality after hepatic surgery. NETs played a crucial role in the aseptic inflammatory response induced by hepatic ischemia/reperfusion. During hepatic ischemia-reperfusion, neutrophils promoted inflammatory cascade reactions and cytokine storms by forming NETs, exacerbating damage caused by hepatic ischemia-reperfusion. At present, some experimental and clinical studies had shown that inhibiting the formation of NETs or eliminating the formed NETs could alleviate the hepatic ischemia-reperfusion injury and improve the prognosis. ConclusionsTargeting NETs may become a new method for treating hepatic ischemia-reperfusion injury. In the future, it is foreseeable that more experiments and clinical trials will be conducted on targeted NETs for the treatment of hepatic ischemia-reperfusion injury. And gradually establish more comprehensive and effective treatment strategies, thereby providing new ways to improve the prognosis of hepatic surgery patients in clinical practice.
目的 讨论B型超声定位下颈内静脉穿刺置管的经验。方法 回顾我中心2008年11月至2009年4月期间采用B型超声定位行颈内静脉置管的286例患者的临床资料。结果 一次性穿刺成功率为99.3%（284/286），置管成功率为100%（286/286）； 穿刺时间50 s~12 min，平均106.8 s； 带管时间5～64 d，平均13 d； 未出现血气胸、皮下血肿等并发症。结论 B型超声定位下颈内静脉穿刺操作简单、方便、安全，适用于各级别医院。在颈短肥胖，被动体位情况下，B型超声定位下置管优势大于传统的盲探法及彩色多普勒超声引导下置管法。
目的探讨晚期恶性梗阻性黄疸减黄、保肝的处理方式。方法回顾性分析我科2008年1月至2009年10月期间收治的80例恶性梗阻性黄疸患者，根据肿瘤部位、患者身体、经济条件等确定无法行根治性手术者，采用不同的减黄术式。结果本组80例患者中，9例行PTCD，42例行PTBS，29例行ERBD。并发症发生情况: PTBS组有15例，ERBD组6例，PTCD组2例。PTCD组的住院时间和住院费用明显低于PTBS组和ERBD组(Plt;0.05)。结论晚期恶性梗阻性黄疸，一经确诊，尽早处理，微创引流减黄是首选方式。
Objective To summarize the experience of the surgical treatment of complex congenital heart diseases in 29 newborns. Methods Twenty-nine newborns were operated on for various congenital heart diseases, ages were from 3 to 28 d. There were ventricular septal defect 3 cases, D-transposition of the great arteries (D-TGA) 10 cases, pulmonary atresia (PA) 1 case,tricuspid atresia 3 cases, single ventricle 1 case, tetralogy of Fallot 6 cases, endocardial cushion defect 4 cases and truncus arteriosus 1 case. All patients were combined with atrial septal defect and patent ductus arteriosus. All operations were performed under hypothermic cardiopulmonary bypass. Results The operative mortality was 13.8%(4/29). One case with D-TGA and 1 case with PA succumbed due to low cardiac output syndrome, and 2 cases due to acute respiratory distress syndrome and low blood oxygen saturation. Twenty-five cases were discharged. Follow-up was completed in 19 patients,with a duration of 1-31 months, all patients have been normal. Conclusion Anesthesia and cardiopulmonary bypass should be performed smoothly and satisfactorily in newborn babies for cardiac surgery. Surgical manipulation should be accurate with less trauma and well protection of myocardium and lung is important.
Objective To investigate the characteristic of the expression of facilitative glucose transporter 1 （Glut1） in bronchial aveolar carcinoma （BAC） and the relationship between expression of Glutl and fluorine-18 fluorodeoxyglucose （18F-FDG） uptake. Methods Twenty patients with BAC were imaged with 18F-FDG positron emission tomography （PET） before surgery. Maximum standard uptake value （SUVmax） and mean standard uptake value （SUVmean ） of tumor and standard uptake value of normal lung （SUVIung） were measured. The expression of Glutl was studied in paraffin sections by streptavidin peroxidase （SP） immunohistochemistry. Results All tumors of the patients could be detected by ^18F-FDG-PET. 18F-FDG uptake of tumor was higher than that of normal lung （SUV SUV and SUVlong were 3.09± 1.35, 2.37±1.03 and 0.39±0.09 respectively）. The expression of Glutl were positive in all tumors （73. 8%± 14. 8% of positive cell rate, 2. 8 ± 0. 9 grade of staining intensity）. Predominantly cytoplasm positive with weak staining intensity were observed in many tumors. Glutl negtive were observed in normal bronchial and lung parenchyma. Positive correlations were found among 18F-FDG uptake, Glut1 expression and tumor size （P〈0. 01）. Conclusion Glutl expression with peculiarity in BAC is correlate with 18F-FDG uptake.
ObjectiveTo analyze the cause of complications for patients with advanced malignant biliary obstruc-tion treated with percutaneous transhepatic implantation of biliary stent (PTBS) and summarize the experiences of comp-lications of the treatment. MethodThe complications of 59 patients firstly treated with percutaneous transhepatic cholangial drainage (PTCD) then with PTBS in 156 cases of advanced malignant biliary obstruction from January 2010 to January 2013 in this hospital were analyzed retrospectively. ResultsFifty-nine cases of complications were occurred in 156 cases of advanced malignant biliary obstruction, the incidence was 37.8%, including biliary infection in 26 cases, bile duct bleeding in 17 cases, liver failure in 5 cases, renal failure in 4 cases, acute pancreatitis in 4 cases, stent displa-cement in 2 cases, bile duct perforation in 1 case.Three cases died in 59 patients with complications, 56 cases were improved after symptomatic treatment. ConclusionPTCD combined with PTBS is a safe and effective treatment of advanced malignant biliary obstruction, the reasonable perioperative management is very important to reduce the occurrence of complications.
Objective To expand the utilization of minimally invasive technologies for parapancreatic abscess, and summarize the application experience of choledochoscope for treatment of parapancreatic abscess. Methods The clinical data and treatment effectiveness of 36 patients with parapancreatic abscess from Dec. 2000 to Dec. 2008 were analyzed retrospectively. These patients had experienced percutaneous puncture and been placed drainage tube under the ultrasound guidance first, then expanded the sinus tract gradually, and performed debridement by choledochoscope. The flexibility of choledochoscope was used to remove the necrotic tissue and pyogenic membrane repeatedly by clamping, netting and vacuum aspiration in every domain. Results Thirty-six patients were performed percutaneous puncture and placed drainage tube, 3 cases were given canalis singularis, 7 cases were double tube, 26 cases were over three tube. The debridement times were 3-14 by choledochoscope, average 5.6 times. There were 6 cases with improving systemic symptoms, blood routine and temperature recovering normal, and drink and food recovering, then discharged from hospital with tube after 1-2 times of debridement. Length of stay was 25-132 d, average 76 d. The curing rate was 91.7% (33/36). Two cases were turned into open surgery because of broad necrotic tissue range combined with many abdominal cavity abscess with good postoperative recovery and cured. One case was dead of severe multiple organ failure combination. There were 2 patients with hemorrhage, 3 patients with external intestinal fistula. Conclusions The debridement of choledochoscope for parapancreatic abscess treatment is a simple, flexible and effective method. It changes the viewpoint that parapancreatic abscess can be cured only by operation drainage, decreases the patients’ trauma and accomplishes the idea of damage control by minimally invasive technologies.