目的 探讨纤维胆道镜下微爆破碎石治疗肝内外胆管难取性结石的疗效和安全性。方法 对笔者所在医院2007年4月至2011年12月期间收治的58例肝内外胆管难取性结石患者，行纤维胆道镜下体内微爆破碎石治疗，对其治疗效果进行回顾性分析。结果 58例肝内外胆管难取性结石患者的碎石成功率为100%（58/58）。27例胆总管结石患者的取石成功率为100%（27/27），31例肝内胆管结石患者的取石成功率为93.5%（29/31）。术后均无窦道穿孔、胆道大出血及胆瘘发生，术后出现胆管黏膜渗血6例，出现畏寒、发热3例，出现一过性腹泻2例。42例患者获访，随访时间3～38个月，平均21个月。2例患者分别于术后6个月和9个月出现胆管炎，行B超及磁共振胰胆管成像（MRCP）检查，均未发现肝内外胆管结石及胆管狭窄；1例患者于术后3年行B超检查，发现胆总管下端有1枚直径为0.5cm的结石；其余患者均无腹痛、发热、黄疸等症状，均未发生结石复发及胆管狭窄。结论 纤维胆道镜下微爆破碎石可有效治疗术中及术后胆管难取性结石，安全性好。
ObjectiveTo investigate influencing factors of postoperative cognitive dysfunction (POCD) in elderly patients underwent laparoscopic surgery. MethodsThe elderly patients underwent laparoscopic surgery were collected in the Daye City People's Hospital and Yangxin County People's Hospital from September 14, 2014 to January 1, 2016 and the Traditional Chinese Medicine Hospital of Daye City from June 19, 2014 to January 1, 2016. Factors included in the registration of patients in general and a variety of influencing factors during perioperative period were recorded. The independent factors associated with POCD were analyzed by multivariate logistic regression analysis. ResultsThree hundred and seventy-eight elderly patients underwent laparoscopic surgery were included according to the inclusion and exclusion criteria, of which 43 patients with POCD and 335 patients without POCD within 3 days after laparoscopic surgery. The baseline data had no significant differences between the patients with POCD and without POCD. The cerebral infarction, preoperative fear, preemptive analgesia, use of dexmedetomidine before laparoscopic surgery, general anesthesia combined with epidural anesthesia, operation time, low SpO2 during anesthesia induction, PaCO2 after pneumoperitoneum, postoperative patient controlled epidural analgesia (PCEA), postoperative VAS score on day 3 were associated with the POCD (P < 0.05). The results of logistic regression analysis showed that the preemptive analgesia, use of dexmedetomidine before laparoscopic surgery, general anesthesia combined with epidural anesthesia, and postoperative PCEA were the independent protective factors of the POCD (P < 0.05). The operation time and PaCO2 after pneumoperitoneum were the independent risk factors of the POCD (P < 0.05). ConclusionFor elderly patients underwent laparoscopic surgery, clinicians should be alert to occurrence of POCD according to the influence factors of it, and timely screen relevant scale so as to early diagnose and early intervent and effectively delay progress of patient's POCD.