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甲状腺乳头状癌伴咽后淋巴结转移1例报道

腹腔镜胆总管切开取石术对患者术后胃肠道功能恢复、应激反应及血流动力学的影响

目的 探讨腹腔镜胆总管切开取石术对患者术后胃肠道功能恢复、应激反应及血流动力学的影响。 方法 回顾性分析笔者所在医院于 2016 年 1 月至 2016 年 12 月期间收治的 78 例胆总管结石患者的临床资料，按照术式分为开腹组（行开腹胆总管切开取石术）与腹腔镜组（行腹腔镜胆总管切开取石术），各 39 例，比较 2 组患者的手术疗效、手术前后的应激反应指标和血流动力学指标。 结果 腹腔镜组患者的术中出血量、术后镇痛次数、胃肠道功能恢复时间及术后住院时间均少于（短于）开腹组（P<0.01）；腹腔镜组手术前后的血清皮质醇水平、血清游离三碘甲状腺原氨酸（FT3）水平及平均动脉压（MAP）的差值均较开腹组低（P<0.05），而手术前后心率（HR）的差值较开腹组高（P<0.05）。 结论 相比开腹胆总管切开取石术，腹腔镜胆总管切开取石术更利于改善患者的血清皮质醇及 FT3 水平，减轻应激反应，改善血流动力学情况，促进术后胃肠道功能的恢复，值得临床推广。

成功救治妊娠晚期脾动脉瘤自发性破裂1例报道

腹膜后局灶型Castleman病1例报道

Total Thyroidectomy plus Prophylactic Central Lymph Node Dissection in Treatment of Multifocal Papillary Thyroid Carcinoma: A Clinical Analysis of 103 Cases

ObjectiveTo analyze the clinical and pathological features of multifocal papillary thyroid carcinoma, and to assess the value and safety of total thyroidectomy plus prophylactic central lymph node dissection in the treatment of multifocal papillary thyroid carcinoma. MethodsClinical data of 103 patients with multifocal papillary thyroid carcinoma, who underwent total thyroidectomy plus prophylactic central lymph node dissection in Affliated Dongfeng Hospital from June 2011 to February 2015 were collected retrospectively. Preoperative ultrasound showed that all patients didn't suffered from cervical lymph node metastasis. ResultsAmong 103 patients who underwent total thyroidectomy plus central lymph node dissection, the unilateral multiple lesions were found in 55 patients (53.40%), and the bilateral multiple lesions were found in 48 patients (46.60%). A total of 31 patients (30.10%) were confirmed to have central lymph node metastasis after operation, central lymph node metastasis only located in the same side of multifocal papillary thyroid carcinoma in 16 patients (29.10%), but of 15 patients (31.25%) with 2-side of multifocal papillary thyroid carcinoma, 7 patients suffered from 2-side central lymph node metastasis and 8 patients suffered from 1-side central lymph node metastasis. Thirty patients (12.62%) suffered from transient postoperative hypocalcemia after operation, and returned to normal for longest of 2 weeks; 1 patient (0.97%) suffered from parathyroid permanent damage; 18 patients (17.48%) suffered from transient recurrent laryngeal nerve palsy, no one suffered from permanent recurrent laryngeal nerve injury; 3 patients (2.91%) suffered from postoperative transient drinking cough. All of 103 patients were followed up for 5 months to 4 years, and the postoperative follow-up rate was 100%. During the follow-up period, 3 patients (2.91%) suffered from cervical lymph node metastasis in side region of neck. ConclusionTotal thyroidectomy plus prophylactic central lymph node dissection plays an important role in the treatment of multifocal papillary thyroid carcinoma.

胰腺癌组织中 Beclin-1 mRNA 和 miR-216a 的表达及 VEGF 蛋白表达与 p-MAPK-ERK1/2信号通路的关系

目的 探讨腺癌、鳞癌、黏液性囊腺瘤、慢性胰腺炎和正常胰腺组织中胰腺癌相关基因的表达。 方法 回顾性收集 2012 年 1 月至 2017 年 4 月期间于湖北医药学院附属东风医院肝胆胰外科住院行手术治疗的 40 例胰腺疾病患者的术中标本，其中腺癌、鳞癌、黏液性囊腺瘤、慢性胰腺炎和正常胰腺组织各 8 例。采用实时荧光定量 PCR 和基因芯片法检测 5 组组织中 Beclin-1 mRNA 和 microRNA（miR）-216a 的表达。对以上组织行原代细胞培养，分为空白对照组和 PD98095 组（加入 PD98095 抑制剂），采用 Western blot 法检测细胞中血管内皮生长因子（VEGR）与磷酸化细胞外调节蛋白激酶 1/2（p-ERK1/2）的表达。 结果 与正常对照组比较，腺癌组和鳞癌组组织中 Beclin-1 mRNA 和 miR-216a 的表达水平较低（P<0.05），腺癌组、鳞癌组、黏液性囊腺瘤组和慢性胰腺炎组组织中 Beclin-1 mRNA 和 miR-216a 的表达水平比较差异无统计学意义（P>0.05）。与同类组织的空白对照组比较，腺癌组和鳞癌组加入 PD98095 后，细胞中 p-ERK1/2 和 VEGF 蛋白的表达水平下调（P<0.05），但黏液性囊腺瘤组、慢性胰腺炎组和正常对照组加入 PD98095 前后细胞中 p-ERK1/2 及 VEGF 蛋白的表达水平变化不大（P>0.05）。 结论 Beclin-1 mRNA、miR-216a 和 VEGF 蛋白的表达与胰腺癌的发生发展可能有关。

Clinical study on timing of thyroid stimulating hormone inhibition therapy after unilateral thyroid lobectomy in patients with low-risk papillary thyroid microcarcinoma

ObjectiveTo explore the best timing of thyroid stimulating hormone (TSH) inhibition therapy by analyzing the trend of TSH level changes after unilateral thyroid lobectomy in patients with low-risk papillary thyroid microcarcinoma (PTMC).MethodsThe clinical data of patients with low-risk PTMC who underwent unilateral thyroid lobectomy in the Dongfeng Hospital Affiliated to Hubei Medical College from September 2016 to December 2018 were retrospectively analyzed. The TSH of all patients were measured before operation and in month 1, 3, and 6 after operation, respectively, and the change trend was analyzed.ResultsAccording to the inclusion and exclusion criteria, a total of 271 patients with low-risk PTMC were included in this study. The TSH level in month 1 after operation was higher than that of before operation [(2.93±1.09) mU/L versus (2.05±0.76) mU/L, t=19.9, P<0.001]. Among the 129 patients with TSHlevel ≤2.0 mU/L before operation, 56.6% (73/129) of them still had the TSH level ≤2.0 mU/L in month 1 after operation, 45.0% (58/129) in month 3 after operation and 39.5% (51/129) in month 6 after operation.ConclusionsTSH level of patient with low-risk PTMC is increased after lobectomy, so individualized TSH inhibition treatment should be formulated. For patients with TSH level>2.0 mU/L before operation, oral levothyroxine sodium tablets should be taken immediately after operation. For patients with preoperative TSH level ≤2.0 mU/L, TSH level should be dynamically monitored, and whether and when to start oral TSH inhibition therapy should be decided according to results of TSH level.

Association of -2548 G/A Polymorphism of Leptin Gene with Cholesterol Gallstones

ObjectiveTo explore the relationship between the -2548 G/A functional polymorphism in the 5′ promoter region of the leptin gene and gallstones. Methods　The -2548 G/A polymorphisms of leptin gene were determined by polymerase chain reactionrestriction fragment length polymorphism technology (PCRRFLP) in 118 patients with cholesterol gallstones and 53 normal control subjects. Then the allele and genotype distribution were studied. Results The distribution of leptin2458 G/A in two groups was statistically significantly different: the genotype frequency of AA+GA of patients in gallstone group was higher than that in control group (χ2=4.251, P=0.039). AA+AG genotype had 2.813 times greater risk for gallstone disease compared with GG genotype (OR=2.813, 95% CI=1.020-7.757). Allele frequency distribution in the two groups was different: the allele frequency of A of patients in gallstone group was higher than that in control group (χ2=5.791, P=0.016). The risk of gallstone disease in the A alleles carriers was 1.777 times as higher as the carriers of G alleles (OR=1.777, 95% CI=1.110-2.844). ConclusionThe -2548 G/A polymorphism in the 5′ promoter region of leptin gene is significantly correlated with the gallstones. The A alleles of leptin may be a genetic factor which contributes to individual susceptibility for gallstone, while the G alleles of leptin may be a genetic factor that prevents people from gallstone.

Effects of Neck Hyperextension Position on Hemodynamics of Vertebral Artery Following Thyroidectomy and Correlation Between Change of Hemodynamics and Postoperative Nausea and Vomiting

Objective　To approach the effect of neck hyperextension position on hemodynamics of vertebral artery following thyroidectomy， and analyze the correlation between the change of hemodynamics and nausea and vomiting. Methods　One hundred and fifty-eight patients with preparing for thyroidectomy （thyroidectomy group） and 89 patients with laparoscopic cholecystectomy （LC， LC group） were selected. The anesthesia method and the anesthesia drugs were the same in two groups. The indexes of hemodynamics of the bilateral vertebral artery at 6 h before and after thyroidectomy were measured. The difference of nausea and vomiting was observed and compared in two groups. Results　The average blood flow velocity of the bilateral vertebral artery reduced and the blood flow decreased at 6 h after thyroidectomy as compared with at 6 h before thyroidectomy （P＜0.05）. The rates of nausea and vomiting of 0，2， 3， 4 times in the thyroidectomy group were significantly higher than those in the LC group （P＜0.05， P＜0.01）. The durations of nausea and vomiting of 1， 2， 3， 4 times in the thyroidectomy group were also significantly longer than those in the LC group （P＜0.01）. There was a positive correlation between the nausea and vomiting and the changes of blood flow velocity or blood flow （change of blood flow velocity：rs=0.697， P=0.03；change of blood flow：rs=0.897， P=0.01）. Conclusions　There is a certain effect of the neck hyperextension position on hemodynamics of the bilatreal vertebral artery， and which might affect the nausea and vomiting following thyroidectomy.

Application Value of Rouviere Groove Guide Positioning in Laparoscopic Cholecystectomy

目的　探讨腹腔镜胆囊切除术中避免胆管损伤新方法的安全性。方法　回顾性分析2008年1月至2012年1月期间笔者所在医院采用Rouviere沟引导定位的方法进行腹腔镜胆囊切除术患者的临床资料，并在手术时间和术后并发症发生率方面与同期传统手术组病例相比较。结果　与传统手术组比较，Rouviere沟引导组患者的手术时间缩短，术后并发症发生率及中转开腹率降低，其差异均有统计学意义（P＜0.05）。结论　采用Rouviere沟引导定位法进行腹腔镜胆囊切除术能有效缩短手术时间，减少胆管损伤的发生概率，值得在临床推广应用。