目的總結腹腔鏡下經腹腹膜前疝修補術（TAPP）中腹膜前間隙的創建體會。 方法回顧性分析2011年4月至2013年5月期間筆者所在醫院實施的38例腹腔鏡下TAPP患者的臨床資料。 結果本組共施行腹腔鏡下TAPP 38例（48側），單側手術時間為45～90 min，平均65.4 min。術中未發生大出血、腹腔臟器損傷等情況。術后發生并發癥3例，均為腹股溝區血清腫，經穿刺引流后均治愈。術后第3 d復發1例。隨訪時間1～25個月（平均16.2個月），未發生補片感染、補片侵蝕、腸梗阻、腸瘺、慢性疼痛、睪丸萎縮等并發癥。 結論腹膜前間隙的創建是腹腔鏡下TAPP手術成功、降低術后并發癥發生率的關鍵。
目的探討腹腔鏡膽總管探查(LCBDE)取石與內鏡(ERCP、EST)膽總管取石的適用范圍，以及中西醫結合治療膽總管結石的療效。方法25例膽囊結石合并膽總管結石患者，其中23例行腹腔鏡膽囊切除(LC)+LCBDE，2例因高齡、膽總管直徑lt;1.0 cm并伴有高血壓和糖尿病不能耐受長時間手術而先選擇ERCP+EST，后擇期行LC。8例膽囊結石合并膽總管結石伴膽源性胰腺炎患者先行ERCP+EST，其中3例EST取石失敗而行LC+LCBDE。4例膽囊結石合并膽總管結石伴急性化膿性膽管炎患者先在內鏡下置鼻膽管引流，病情穩定后行LC+LCBDE。4例單純膽總管結石患者行ERCP+EST。手術按常規方法進行。術后均給予口服中藥。結果30例行LC+LCBDE患者，均獲得治愈，術后無膽管殘留結石。14例行ERCP+EST治療膽總管結石患者中11例EST取石成功，3例失敗后行LC+LCBDE。41例患者均獲得治愈。平均隨訪6個月，無膽管結石復發、膽管狹窄及其他并發癥發生。結論LCBDE和EST治療膽總管結石微創、安全、有效，同時結合中藥治療，有利患者術后恢復。LCBDE較內鏡膽總管取石成功率高，其與選擇病例和嚴格掌握各自適應證有關。
Objective To investigate the diagnostic significance of fine needle aspiration cytology (FNAC) combined with BRAFV600E gene detection in the diagnosis of cervical lymph node metastasis of thyroid cancer. Methods Atotal of 140 patients with suspected cervical lymph node metastasis of thyroid cancer were collected as the research objects, and all patients were given ultrasound-guided FNAC and detection of BRAFV600E gene. The significance of the diagnosis was analyzed according to the gold standard after pathological examination. Results All the 140 patients underwent surgical treatment. For FNAC, the sensitivity was 63.6% (84/132), the specificity was 100% (8/8), the accuracy was 65.7% (92/140), the positive predictive value was 100% (84/84), and the negative predictive value was 14.3% (8/56). For detection of BRAFV600E gene, the sensitivity was 84.8% (112/132), the specificity was 100% (8/8), the accuracy was 85.7% (120/140), the positive predictive value was 100% (112/112), and the negative predictive value was 28.5% (8/28). For FNAC combined with BRAFV600E gene detection, the sensitivity was 90.9% (120/132), the specificity was 100% (8/8), the accuracy was 91.4% (128/140), the positive predictive value was 100% (120/120), and the negative predictive value was 40.0% (8/20). The area under curve of receiver operating characteristic for FNAC, detection of BRAFV600E gene, and FNAC combined with BRAFV600E gene detection were 0.818, 0.924, and 0.955, respectively. Conclusion FNAC combine with BRAFV600E gene detection improves the accuracy of neck lymph node metastasis in patients with thyroid cancer, which is worthyof performed.