目的 探讨鱼胆汁对兔肾脏的影响及其机制。 方法 将实验新西兰大耳白兔随机分为灌胃组（GP组，n=19）与静脉注射组（VI组，n=15），根据体重分别按3 mL/kg、0.3 mL/kg的剂量通过灌胃或耳缘静脉注射方式给予鱼胆汁。采集鱼胆汁处理前与处理后1～5 h的血标本，测定肾功能、酸碱平衡及电解质指标，记录GP组每个采样点前20 min尿量及鱼胆汁处理前、处理后5 h的尿常规。鱼胆汁处理后5 h处死动物取肾做病理学检查。 结果 给予一定量鱼胆汁后5 h内，两组兔血肌酐（Scr）、尿素氮、K+呈升高趋势（P均＜0.05），而血HCO3?浓度呈下降趋势（P＜0.05），其中VI组兔Scr、血K+改变早于GP组。GP组记录尿量明显下降，尿pH值升高，蛋白定量试验、隐血试验结果均呈阳性。两组兔肾组织病理检查均显示肾小球血管充盈，少量中性粒细胞浸润；肾小管水肿及间质充血，部分有局灶性出血，肾间质损伤较肾小球更为严重。 结论 无论经由消化道还是血管给予实验兔鱼胆汁均可导致急性肾功能损伤，与鱼胆汁造成急性肾实质损伤、特别是肾小管间质损伤有关。
ObjectiveTo compare the differences of curative effect, cosmetic effect, and shoulder-neck function protection effect between video-assisted lateral neck dissection (VALND) and traditional open thyroid surgery(OTS) in the treatment of papillary thyroid carcinoma (PTC) with lateral cervical lymph node metastasis. MethodsFifty patients with unilateral PTC accompanied by ipsilateral cervical lymph node metastasis who underwent sternal incision approach VALND at Fudan University Shanghai Cancer Center and Pudong Hospital Affiliated to Fudan University from January 2013 to December 2019 were collected. And 100 patients with unilateral PTC and ipsilateral cervical lymph node metastasis who underwent OTS during the same period were randomly selected at a ratio of 1:2 using the random number method. All patients underwent unilateral thyroid lobectomy (or total thyroid lobectomy) + isthmus resection + central area (Zone Ⅵ) and cervical lymph node dissection on the affected side (zones Ⅱ-Ⅴ). The therapeutic effects were compared between the two groups. ResultsCompare to OTS group, the operation time of VALND group was longer (218.3 min±86.6 min vs. 185.7 min±42.8 min, P=0.002), but the hospital stay was shortened (6.1±2.2 d vs. 7.3±1.6 d, P<0.001). In terms of surgical efficacy, there were no statistically significant differences between VALND group and OTS group in the number of lymph node dissections, the number of lymph node metastases, and the postoperative tumor recurrence rate (P>0.05). As for surgical safety, the two groups had similar rates of postoperative complications including recurrent laryngeal nerve injury, hypoparathyroidism, postoperative hematoma and infection(P>0.05). In terms of postoperative recovery, the scar color, vascular distribution, thickness, and softness, as well as in shoulder stiffness, tightness, pain, and numbness in VALND group were significantly lower than those in OTS group (P<0.05). ConclusionsFor PTC patients with lateral cervical lymph node metastasis, there is no significant difference in surgical efficacy and safety between VALND and OTS. However, VALND group shows obvious advantages in reducing the length of cervical incisions, improving cosmetic effects, and protecting cervical and shoulder functions. Therefore, VALND through the sternal notch approach has high promotion and application value in clinical practice.