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大面积皮肤撕脱伤的治疗

近指间关节离断瘵皮肤血管缺损不规则植六例

Clinical Application of Metallic Endobiliary Stents in Treatment for Obstructive Jaundice

全内脏反位腹腔镜下左肝及胆囊切除1例报告

腹腔镜胆囊切除术治疗急性坏疽性胆囊炎的临床分析

目的 探讨腹腔镜胆囊切除术治疗急性坏疽性胆囊炎的可行性及手术技巧。 方法 回顾分析2004年9月－2014年8月经腹腔镜胆囊切除术治疗急性坏疽性胆囊炎的89例患者的临床资料。 结果 89例患者中，83例顺利行腹腔镜胆囊切除术，6例中转开腹，中转开腹率6.74%。83例顺利行腹腔镜胆囊切除术的患者手术时间60～150 min，平均120 min；顺行切除45例，逆行切除20例，顺行逆行结合切除18例；术中胆囊穿刺减压78例，胆囊坏疽穿孔处减压5例；72例Calot三角瘢痕样致密粘连，吸引器钝性分离解剖Calot三角65例，横断胆囊壶腹部或壶腹部前后贯通逆行分离胆囊颈管13例，剖开胆囊协助分离胆囊颈管5例，残留胆囊床部分胆囊壁的胆囊切除15例；1例术后发生胆漏经引流后痊愈，1例脐部戳孔感染。术后平均住院时间4 d。 结论 术中胆囊减压，保持术野清晰，灵活应用吸引器钝性分离，顺行逆行分离结合，胆囊壶腹部前后贯通或离断等多种手术技巧，有利于提高急性坏疽性胆囊炎行腹腔镜胆囊切除术的安全性。

巨大毒性结节性甲状腺肿的手术体会

目的总结巨大毒性结节性甲状腺肿的手术治疗经验。 方法回顾性分析笔者所在医院2005年1月至2014年6月期间收治的25例巨大毒性结节性甲状腺肿患者的临床资料。 结果25例患者均顺利完成手术，手术时间90～180 min，平均120 min；术后住院时间4～10 d，平均6 d。20例行双侧甲状腺近全切除术，5例行双侧甲状腺全切除术；3例劈开胸骨，3例行气管切开；术中2例发生大出血。术后病理学检查示2例合并微小乳头状癌。术后均无甲状腺危象发生。术后1例复发病例出现单侧喉返神经损伤，1例出现短期饮水呛咳，4例出现手足麻木。术后25例患者均获访，随访时间为1～10年，平均5.5年。1例发生单侧喉返神经损伤者于术后1.5年声音基本代偿，随访期间所有患者均无甲状腺功能亢进及甲状腺结节复发。 结论采用手术治疗巨大毒性结节性甲状腺肿时需要充分的术前准备，充分的手术暴露，并灵活应用各种手术技巧，以保证手术安全。

腹腔引流管拔除困难的原因分析及处理方法（附22例报道）

目的探讨腹腔引流管拔除困难的原因及临床处理方法。 方法回顾性分析笔者所在医院2003年7月至2015年5月期间22例腹部手术后腹腔引流管拔除困难患者的临床资料，总结分析其原因及处理方法。结果本组患者中引流管拔除时间为术后4～7 d者6例，7～10 d者16例。引流管拔除困难的原因1例为固定引流管的缝线从引流管穿过，4例为腹壁戳孔偏小，2例为引流管扭曲，9例为组织嵌入引流管内口或引流管侧孔（其中5例为纤维条索，4例为大网膜），6例无法确定原因。5例通过持续均匀用力牵引拔除，1例拆除缝合固定线拔除，8例通过旋转、来回牵拉或推送引流管拔除，8例应用持续重力牵引法拔除，无并发副损伤。 结论灵活应用各种方法来处理难以拔除的引流管，持续重力牵引法适宜于常规方法不能拔除的引流管。减少不必要的引流管放置，放置引流管时注意其细节和及时拔除引流管可避免引流管的拔除困难。

Effects of Celecoxib on Proliferation of Human Colonic Cancer Cells and on The Hepatic Metastasis of Animal Model

Objective　 To evaluate the potential roles of celecoxib on proliferation and cell cycle progression of colon adenocarcinoma cells and on the hepatic metastasis of nude mice. Methods　The human colon cancer cells HT-29 and HCT-116 were employed in the study. After treatment with celecoxib, the inhibitory effects of celecoxib on the proliferation of cancer cells were quantified by MTT assay, and the cell cycle progression was detected by flow cytometry, tumor cells were inoculated in nude mice, and the hepatic metastasis was detected. Results　①Celecoxib inhibited the proliferation of the tumor cells in time and dose-dependent manners （P＜0.05，P＜0.01）. The inhibitory effect on HT-29 cells was ber than that on HCT-116 cells （P＜0.05）. ②Celecoxib changed cell cycle progression of both kinds of cells, and decreased the proliferation index of both kinds of cells too. ③Celecoxib could inhibit the growth of the hepatic metastatic tumor obviously. Conclusion　Celecoxib may inhibit the activity of cyclooxygenase-2, and resulting in the inhibition of division and proliferation, apoptosis of tumor cells and interfering in metastasis and relapse of colon cancer.

克-特综合征 8例治疗体会

我院自1999～2005年共收治克-特综合征（Klipple Trenaunay syndrome，KTS）8例，男5例，女3例； 年龄3～32岁，平均19.6岁。......

Effects of Nimesulide on Expression of Matrix Metalloproteinase- 2 in Human Colonic Cancer Cell Lines

【Abstract】Objective To investigate the effects of selective cyclooxygenase-2 (COX-2) inhibitor nimesulide on the proliferation of colon adenocarcinoma cells in vitro and the expression of matrix metalloproteinase-2 (MMP-2). Methods The human colon cancer cell lines HT-29 and HCT-116 were employed in the study, grouped as nimesulide group, DMSO control group and blank control group. After treatment with nimesulide, the inhibitory effect of nimesulide on the proliferation of cancer cells was quantified by MTT assay, and the expression of MMP-2 in the cells was detected by quantitative zymography. Results Nimesulide inhibited the proliferation of HT-29 and HCT-116 cells in time and dosedependent manners. The inhibitory effect on HT-29 cells was ber than that on HCT-116 cells. Nimesulide downregulated the MMP-2 expression in HT-29 cells, whereas the expression in HCT-116 cells remained unchanged. Conclusion Nimesulide can obviously inhibit the growth of colon cancer HT-29 cells with positive COX-2 protein, suggesting that nimesulide may downregulate the expression of MMP-2 by inhibiting the activity of COX-2.