【摘要】目的探讨不同病理状态下结石嵌顿性胆囊炎腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)的临床应用价值。方法回顾性分析2001年1月〖CD3/5〗2009年10月期间172例结石嵌顿性胆囊炎患者行腹腔镜手术的临床资料。结果腹腔镜手术成功164例,成功率为9535％,中转开腹8例,中转率为465％。术中出血1例,术后并发胆漏1例,胆管残余结石1例,切口感染1例,并发症发生率为233％(4/172),无胆管损伤,无死亡。结论LC治疗结石嵌顿性胆囊炎安全、可行,但必须严格掌握手术适应证、时机和技巧。适时中转手术是提高手术成功率、降低并发症的关键。
目的 观察帕瑞昔布钠与舒芬太尼用于无痛胃镜麻醉的安全性和有效性及对患者满意度的影响，为提高临床无痛胃镜麻醉的安全性和舒适性提供依据。 方法 采取前瞻性随机双盲对照方法，纳入2011年8月－12月拟行无痛胃镜检查的患者120例，随机分为3组。患者于胃镜检查开始前口服利多卡因胶浆，静脉注射舒芬太尼、帕瑞昔布钠或生理盐水10 mL。检查时静脉注射异丙酚。记录患者检查过程中生命体征、异丙酚使用量、诱导时间、检查时间、苏醒时间、医师以及患者满意度、舒适度等数据。 结果 舒芬太尼组检查中各时间点平均动脉压明显低于帕瑞昔布组（P=0.029），血管活性药物用量明显高于帕瑞昔布组（P=0.036）。医师以及患者满意度舒芬太尼组和帕瑞昔布组相当，且均高于对照组（P＜0.05）。除呛咳外，帕瑞昔布组其他不良反应的发生率明显低于舒芬太尼组（P＜0.05）。 结论 实施无痛胃镜检查前15 min静脉注射帕瑞昔布钠0.6 mg/kg或舒芬太尼0.10 μg/kg均可以获得满意的麻醉效果，麻醉医师和患者及家属的满意度明显增高，且帕瑞昔布对呼吸和循环的影响更小，安全性更高。
Objective To explore changes and challenges on management of chronic pancreatitis. Methods The updated clinical guidelines and the latest research findings were collected and reviewed. Results The proposition of a new mechanistic definition and identification of an early stage give us a novel insight into chronic pancreatitis. The intraductal pancreatic calcifications has been regarded as the most reliable ultrasonography and CT features of chronic pancreatitis. In addition, the endoscopic ultrasonography is also of great value. The present surgical strategies are established on the concepts of step-up approach and damage control. The surgery perform better than the endoscopic treatment in the long-term outcome, but the timing course of surgery need to be further investigated. Conclusions Early diagnosis and treatment plays a critical role in cases of chronic pancreatitis. More patients of chronic pancreatitis should be treated in a multidisciplinary team as future perspectives.
目的:观察相同剂量不同浓度的罗哌卡因用于腰丛坐骨神经联合阻滞的临床效果。方法:择期行单侧下肢手术的患者90例,年龄18~65岁,ASAⅠ或Ⅱ级,随机分为3组(n=30):A组给予0.3 ％的罗哌卡因腰丛36 mL、坐骨神经24 mL,B组给予0.36 ％的罗哌卡因腰丛30 mL、坐骨神经24 mL,C组给予0.4％罗哌卡因腰丛27 mL、坐骨神经18 mL。分别于给药后2、5、10、15、20、25、30、35 min测定下肢的感觉、运动评分以及感觉阻滞的时间和运动阻滞的时间。结果:三组患者阻滞起效时间无明显差别,高容量组完全阻滞的持续时间短于低容量组;高容量低浓度组患者完全阻滞率高于低容量组,但达到完全阻滞时间长于低容量组。结论:在剂量相同时罗哌卡因的浓度和容量会影响腰丛和坐骨神经的阻滞 效果;高容量罗哌卡因更有利于达到良好的感觉阻滞。
ObjectiveTo evaluate if intravenous lidocaine can reduce the stress response induced by fiberoptic bronchoscopy in patients under general anesthesia. MethodsSixty patients undergoing fiberoptic bronchoscopy under unconsciousness between November 2013 and July 2014 were randomly divided into two groups: lidocaine group (n=30) and control group (n=30). Patients in the lidocaine group received an intravenous injection of lidocaine for 1 mg/kg during induction and then continuous intravenous infusion of 2% lidocaine with a dose of 3 mg/(kg·h). The same volume of saline was given to patients of the control group in the same way. Laryngeal mask airway was placed after anesthesia induction. Variables of heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure, and pulse oxygen saturation were observed and recorded at five time points: before induction, immediately after induction, immediately after laryngeal mask airway placement, fiberoptic bronchoscopy across tracheal carina and before leaving examination room. Complications including cough reflex, toxicity reaction of local anesthetics, and injection pain were also observed. ResultsThe examination was successfully completed in all patients. Blood pressure and heart rate increased in all patients when fiberoptic bronchoscopy got across tracheal carina. There were no statistically significant differences in the two groups (P>0.05). Patients in the two groups had no statistic difference in tinnitus and numbness of tongue (P>0.05). Compared with the control group, patients in the lidocaine group had lower incidence of injection pain (P<0.05). ConclusionIntravenous lidocaine cannot suppress stress response induced by fiberoptic bronchoscopy effectively.
Hip fracture in the elderly is a disease with a high mortality rate and a high complication rate. Its main treatment method is surgery. The concept of enhanced recovery after surgery runs through the perioperative period of elderly patients with hip fracture. Elderly patients with hip fracture should be scheduled for surgery as soon as possible after admission to enhance postoperative functional recovery. Preoperative ambulation and postoperative exercise can reduce postoperative complications and mortality, shorten the length of hospital stay, and promote functional recovery.
Objective To introduce the research status of the immunomodulatory role of various immune cells and stromal cells in the tumor microenvironment in the progression of hepatocellular carcinoma. Method The related basic and clinical research literatures on the correlation between various immune cells and stromal cells in the tumor microenvironment and the occurrence, development and prognosis of hepatocellular carcinoma were reviewed and summarized. Results Immune cells and stromal cells in the tumor microenvironment have obvious complexity and diversity. Inhibitory immune cells in various immunosuppressive environments and stimulating immune cells that exert anti-tumor effects jointly promote or inhibit the occurrence and progression of hepatocellular carcinoma. Conclusions The exact role of various immune cells in the tumor microenvironment in hepatocellular carcinoma remains to be further studied. With the continuous accumulation of relevant research results, more patients with hepatocellular carcinoma will benefit from immunotherapy.
ObjectiveTo summarize the advantages of double-layer detector spectral CT (DLCT) as compared with conventional CT in disease diagnosis and its research status in the diagnosis of gastric cancer. MethodThe literature relevant research was summarized, including the clinical application of DLCT and its clinical research in the diagnosis of gastric cancer. ResultsThe image quality of DLCT was better than that of conventional CT examination. Its virtual non-contrast could display gastric cancer lesions and evaluate lymph node metastasis. The number of CT scans of patient was reduced by DLCT, correspondingly the radiation dose received by patients was reduced, and the examination time of patient was shortened. The iodine uptake in the tissues could visually be observed by the iodine concentration map in the DLCT and be quantitatively analyzed, which could provide a new option for noninvasive evaluation of angiogenesis in the gastric cancer. The DLCT scanning provided a material decomposition image, the different iodine absorption of normal gastric mucosa and gastric cancer could be reflected by the material decomposition image. The enhancement degree and blood supply of lesions could be effectively reflected by quantitative measurement of iodine concentration and thus the benign and malignant changes of the gastric diseases were effectively identified. The DLCT could distinguish the structure of the gastric wall, which could show the depth of invasion of malignant gastric lesions to the gastric wall and whether the adjacent tissues and organs were involved or not. Through the homology analysis of abnormal lymph nodes and suspicious metastases in the abdominal cavity through the related parameters of the DLCT could more accurately determine the clinical TNM stage of the gastric cancer before surgery. ConclusionsIn recent years, DLCT has shown a better morphological diagnostic efficiency than conventional CT in clinical application. Its virtual non-contrast, iodine concentration, effective atomic number, and other parameters characteristics make it show obvious advantages in gastric cancer, such as evaluation of angiogenesis of gastric cancer, differentiation of benign and malignant gastric diseases, clinical staging of gastric cancer, and other applications. In future, with more usable parameters research and continuous accumulation of clinical application about DLCT in clinic, which can better serve clinical work.