目的 探討腹腔鏡膽囊切除術（laparoscopic cholecystectomy,LC）導致膽管損傷的原因及防治方法。方法 回顧性分析上海仁濟醫院2001～2006年期間1 253例LC中發生膽管損傷14例的臨床資料。結果 右肝管損傷6例，膽總管損傷4例，肝總管損傷4例。膽管損傷發生率為1.12%。結論 解剖學變異、病變的程度、手術者的技術原因和責任心是導致膽管損傷的重要原因； 術中仔細操作和解剖、及時發現膽管損傷并中轉手術，根據損傷的位置及程度選擇正確的處理方式是防治膽管損傷的關鍵。
Objective To review the advance of gene diagnosis and gene therapy on gastric cancer. Methods Literatures about the advance of gene diagnosis and therapy on gastric cancer were reviewed. Results Detection of tumor marker by gene technique is important for early diagnosis, follow-up and therapy evaluation of gastric cancer in clinic. But there are still many problems in gene therapy of gastric cancer. Conclusion Gene detection and gene therapy will become important supplementary means for diagnosis and treatment of gastric cancer.
ObjectiveTo evaluate the safety and efficiency of perioperative low molecular heparin (LMH) as the replacement of anticoagulant for patients with inguinal hernia. MethodsSixty-three patients with oblique inguinal hernia from April 2009 to April 2012 in this hospital were analyzed retrospectively.Seventeen cases because of other diseases were long-term oral aspirin anticoagulant therapy (aspirin group), 11 cases because of other diseases were long-term oral warfarin anticoagulant therapy (warfarin group), anticoagulant therapy was replaced by continuing LMH 7 d before operation in the aspirin group and the warfarin group.The other 35 cases did not take any anticoagulant therapy (control group). Results①The demography and preoperative international normalized ratio were similar among three groups (P > 0.05).②All the patients were followed-up.The duration of follow-up ranged from 12 months to 18 months.There were no statistical differences of the scrotal hematoma or subcutaneous hematoma, operation time, postoperative hospital stay, and VAS scoring among these three groups (P > 0.05).There was no recurrence in all the patients. ConclusionFor a long term application of anticoagulant in patients with oblique inguinal hernia, perioperative application of LMH instead of anticoagulant does not increase the risk of bleeding, and could prevent thrombosis.
目的 探討小腸瘺的外科綜合治療方法。方法 對我科2003年2月至2007年5月收治的24例小腸瘺患者的臨床資料進行回顧性分析。結果 24例患者中包括十二指腸瘺5例，空腸瘺7例，回腸瘺12例。予以營養支持、抗感染、腹腔引流和手術的綜合治療。治愈21例，死亡3例。結論 早期規范的外科綜合治療可明顯提高小腸瘺的治愈率。
ObjectiveTo explore the differential expressed lncRNA genes associated with formation of cholesterol gallstone, and analyze the biological functions of differential expressed lncRNA through bioinformatics.MethodsA total of 24 C57BL/6 mice were randomly divided into normal control group (n=8) and lithogenic group (n=16), which were treated with chow diets and lithogenic diets respectively for 5 weeks. After 5 weeks, mice of the lithogenic group were randomly divided into model control group (n=8) and ursodeoxycholic acid treatment group (n=8). Afterwards, mice of the normal control group were still fed with chow diets, mice of the model control group were fed with lithogenic diets, mice of the ursodeoxycholic acid treatment group were fed with ursodeoxycholic acid. After 2 weeks, collected liver tissues and gallbladder bile from the three groups, and observed gallbladder gross sample and analyzed lipids component of gallbladder bile, meanwhile detected the differential expressed lncRNA and analyzed the biological functions of differential expressed lncRNA through bioinformatics, including Gene ontology (GO) and kyoto encyclopedia of genes and genomes (KEGG) pathway analysis.ResultsWe successfully constructed the mice model of cholesterol gallstone. Total cholesterol level of gallbladder in the model control group had significantly higher than those of the normal control group and ursodeoxycholic acid treatment group (P<0.05), yet there was no significant difference between the normal control group and ursodeoxycholic acid treatment group (P=0.59). The levels of total bile acid, total bilirubin, and direct bilirubin had no significant difference among the three groups (P>0.05). There were 49 kinds of common overlapped difference lncRNA between the ursodeoxycholic acid treatment group and the model control group through differential expression analysis of lncRNA in liver tissues of the mice in three groups. GO and KEGG path analysis were performed separately by differential expressed lncRNA, and 88 kinds of GO terms and 18 kinds of pathways were significantly enriched from the model control group and the normal control group, 205 kinds of GO terms and 20 kinds of pathways were significantly enriched from the ursodeoxycholic acid treatment group and the normal control group.ConclusionsUrsodeoxycholic acid has therapeutic effect for cholesterol gallstone. Differential expressed lncRNAs play an important regulatory role in the formation of cholesterol gallstone and the prevention of gallstone formation by ursodeoxycholic acid treatment, which further lay the foundation in discussing specific mechanism regulated by lncRNA.
ObjectiveTo explore the expressions of transthyretin(TTR) mRNA and its protein in tissues of human gallbladder with cholesterol gallstones, and to explore its role in the formation of cholesterol gallstones. MethodsGallbladder were got from cases of cholesterol gallstones(cholesterol gallstones group, n=25) and cases underwent liver transplantation with normal gallbladder(normal control group, n=9) respectively, who were treated in Ren Ji Hospital and Huashan Hospital. Real time PCR(RT-PCR) and Western blot method were used to determine the expressions of TTR mRNA and its protein respectively. In addition, 2 kinds of artificial model bile system were established to test nucleation time(NT) and nucleation activity, which added TTR and albumin(ALB). ResultsThe expression levels of TTR mRNA and protein in cholesterol gallstones group were 1.51±0.78 and 3.95±0.09 respectively, which were both higher than those of normal control group(P<0.05). The NT were(14.5±1.3)d and(18.0±0.8)d in TTR group and ALB group in small model bile system(P<0.01), which was similar with comprehensive model bile system[(13.5±0.6)d vs. (18.5±1.3)d]. The nucleation activity were 0.81 and 0.73 in small model bile system and comprehensive model bile system respectively. ConclusionsExpression of TTR up-regulates in human gallbladder tissues of patients with cholesterol gallstones, and TTR plays role of nucleation in model bile system, which is related to the formation of cholesterol gallstones.