目的 探讨腹腔镜脾切除术治疗遗传性球形红细胞增多症的可行性、手术技巧及效果评价。方法 收集我科2006年1月至2008年1月收治的行腹腔镜脾切除术治疗的遗传性球形红细胞增多症患者18例的临床资料进行回顾性分析。结果 所有患者均顺利完成腹腔镜脾切除术。术中出血50～600 ml，平均200 ml。手术时间50～150 min，平均136 min（包括胆囊切除时间）。术后住院时间5～10 d，平均7.8 d,所有患者住院期间无暴发感染、胰漏等并发症发生。术后随访4～12个月，平均6.7个月，术前症状完全消失。结论 腹腔镜脾切除术是治疗遗传性球形红细胞增多症的一种安全有效的方法。
目的 探讨胆道术后肝内、外胆管狭窄的治疗方法。方法 回顾性分析吉林大学第一医院自2003年1月至2007年12月期间应用胆道镜对37例胆道术后肝内、外胆管狭窄患者行气囊扩张治疗的结果。结果 本组37例患者42处肝内、外胆管狭窄均行胆道镜下气囊导管扩张，29例（78.4%）系胆管狭窄伴肝内胆管结石，经气囊扩张后，胆道镜通过狭窄部位，取净远端胆管结石； 另8例（21.6%）系单纯胆管狭窄无结石,仅行导管扩张。本组成功率达97.3%（36/37）； 1例因胆汁性肝硬变伴弥漫性胆管狭窄扩张失败后行肝叶切除手术。27例狭窄仅需一次性扩张,9例因胆管多处严重狭窄而行多次扩张。全部患者均获随访，随访时间6~24个月,平均12个月，未见结石复发。结论 胆道镜下气囊导管扩张治疗胆管狭窄微创、直观、安全、简便易行且疗效可靠,是治疗胆管狭窄并取净结石的理想方法。但需注意操作方法及技巧，防止并发症的发生。
目的 总结肝硬变状态下腹腔镜胆囊切除术（LC）治疗胆囊疾病的经验。方法 回顾性分析30例肝硬变合并胆囊疾病患者行LC的临床资料。结果 30例患者中肝功能Child-Pugh A级8例，B级11例，C级11例。LC术后6例(20.0%)发生并发症，其中Child-Pugh B级2例,C级4例。治愈29例（96.7%）； 死亡1例(3.3%)，死亡者为Child-Pugh C级。结论 存在肝硬变时,肝功能Child-Pugh A及B级者行LC比较安全,C级风险较大,应列为手术禁忌。
ObjectiveTo investigate effects of sleeve gastrectomy (SG)-transit bipartition (SG-TB) and simple SG on bariatric and anti-diabetic and protective effect on esophagus reflux. MethodsA total of 36 male Sprague-Dawley rats were used to successfully induce the obesity with type 2 diabetes mellitus (T2DM) model by dietary feeding and receiving intraperitoneal injection of streptozotocin (35 mg/kg), then were randomly averagely divided into SG, SG-TB, and sham operation (SO) groups according to the surgical methods, and 8 rats from each procedure were randomly selected and included to use for experimental observation. The observation period was 12 weeks. The changes of terminal esophageal mucosa were observed at the 12th week after operation. The body weight and food intake were measured every 2 weeks after operation. The fasting blood glucose (FBG), oral glucose tolerance test (OGTT) and insulin tolerance test (ITT) blood glucose levels were measured before operation and at the 4th and 12th week after operation. And the changes of glucagon like peptide-1 (GLP-1) and insulin levels were measured before operation and at the 12th week after operation. ResultsThere were no significant differences in all indexes among the 3 groups before operation (P>0.05). ① No esophageal papillomatosis was observed in the SG-TB group at the 12th week after operation, but more severe esophageal papillomatosis was observed in the SG group, and the mucosal height in the SG-TB group was lower than that in the SG group (P<0.05). ② From the 4th week after operation, the body weight and food intake of the SG-TB group and SG group were lower than the SO group (P<0.05), and their changes of these two groups over time were generally stable. While no significant difference was found in the reduction of body weight between the SG-TB group and the SG group (P>0.05), however the food intakes of the SG-TB group were higher than the SG group at the 10th and 12th week after operation (P<0.05). ③ The levels of FBG, OGTT and ITT blood glucoses in the SG-TB group and SG group were lower than in the SO group at the 4th and 12th week after operation (P<0.05) and remained stable after operation. However, no significant difference was found in the FBG and ITT blood glucose level between the SG-TB group and the SG group (P>0.05), while the level of OGTT blood glucose in the SG-TB group was lower than that in the SG group at the 12th week after operation (P<0.05). ④ The levels of GLP-1 in the SG-TB group and SG group were higher than in the SO group and still higher than before operation (P<0.05), while the insulin levels were lower than in the SO group and lower than before operation (P<0.05). ConclusionsFrom preliminary results of this study, change of terminal esophageal mucosa after SG-TB is weaker than that of SG operation, and it is found that SG-TB surgery shows a better trend in blood glucose control as compared with SG operation. However, due to the limitations of sample size, further research and anti-reflux effect of SG-TB operation still need to be verified.
ObjectiveTo systematically review the relationship between cadmium (Cd) and childhood autism.MethodsPubMed, EMbase, Web of Science, The Cochrane Library, CNKI, VIP, WanFang Data and CBM were electronically searched to collect case-control studies on the relationship between Cd and childhood autism from inception to July 2019. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 8 case-control studies were included. The results of meta-analysis showed that whether the specimen was from whole blood, urine or hair, there were no correlations between Cd and childhood autism (MDblood=0.17, 95% CI −0.06 to 0.39, P=0.15; MDurine=−0.43, 95%CI −1.44 to 0.58, P=0.4; MDhair=−0.08, 95%CI −0.52 to 0.36, P=0.72).ConclusionsCurrent evidence shows that Cd concentration is not correlated with autism in children. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.