如何努力提高膽囊切除術的質量仍是極其重要的臨床問題。隨著腹腔鏡膽囊切除術(LC)的廣泛開展及膽道外科邁向微創手術時代的今日，膽囊殘留病變的發生和危害依然存在，已成為膽道外科中不可忽視的問題。1 膽囊切除后的殘留病變如殘留膽囊、膽囊殘端結石、膽囊管結石、殘留膽囊頸部、膽囊管過長等，術后癥狀依然存在的患者，四處尋醫，常常被戴上“膽囊切除術后綜合征”的帽子，長期得不到有效的治療，其中絕大多數都是因為膽囊切除術的質量問題需要進行有效的治療，而不是膽囊切除術后綜合征的問題。....................
目的 探討胰性腦病的可能的發病機制、發病情況及防治措施.方法 計算機檢索中文科技期刊全文數據庫(1989～2004),收集有關胰性腦病的臨床研究,并進行統計分析.結果 共納入43篇文獻,435例患者.胰性腦病在重癥急性胰腺炎中的發病率遠高于輕癥急性胰腺炎;發病年齡趨向中、老年;病死率為43.67%;病因仍以膽系疾病為主;伴發低氧的幾率不高于未并發胰性腦病患者.結論 胰性腦病的發生可能是多因素共同作用的結果,仍需進一步探討其發病機制.血清髓鞘堿性蛋白有望成為有價值的診斷指標.防治以治療原發病急性胰腺炎為主,重在預防.胰酶抑制劑和早期營養支持有一定預防作用.
Tuberculosis (TB) is one of the major public health concerns worldwide. Since the development of precision medicine, the filed regarding TB control and prevention has been brought into the era of precision medicine. Although great progress has been achieved in the accurate diagnosis, treatment and management of TB patients, we have to face several challenges. We should seize the opportunity, and develop and improve novel measures in TB prevention on the basis of precision medicine. The accurate diagnosis criteria, treatment regimen and management of TB patients should be carried out according to the standard of precision medicine. We aim to improve the treatment of TB patients and prevent the transmission of TB in the community, thereby contributing to the achievement of the End TB Strategy by 2035.
With clinical medicine science transforming from traditional medicine to evidence-based medicine, how to practice evidence-based medicine has become a new challenge to clinical doctors. Therapy studies play an important part in clinical studies and how to practice evidence-based medicine in the therapy of diseases is an important question that doctors are concerned. This paper will introduce as on how to practice evidence-based medicine in the therapy of diseases.
膽道并發癥發生率的高低往往代表了一個肝移植中心的整體技術水平。歐美成熟的肝移植中心膽道并發癥發生率為7%~10%，1年生存率達到90%。來自中國肝移植登記注冊網（CTLR）的資料： 香港瑪麗醫院2006年統計了香港公民在大陸進行肝移植的148例患者，在長期隨訪中發現，有48%的受體發生了膽道并發癥，1年生存率只有59%； 說明目前肝移植膽道并發癥的防治仍然是亟待解決的難題。究其原因，還是對膽管微循環保護的研究不夠深入和并發癥發生的防治體系不夠完善，筆者就此談幾點體會。1膽管微循環保護的理論人體肝臟膽管及血管鑄型模型的研究顯示，膽管為動脈單一供血，肝固有動脈和胃十二指腸動脈終末支分出3點、9點動脈滋養肝外膽管，并構成肝門部膽管周圍血管叢(peribiliary vascular plexus,PVP)，膽管的動脈系統與門靜脈之間無明顯的交通血管，門靜脈在膽管的血液供應中作用有限 (圖1)。在動脈損傷時膽管很難從別的途徑獲得充分的血液供應，從而造成膽管的缺血性損傷。碳素墨汁灌注透明法顯示，肝門部每個肝葉膽管及其分叉部均有肝固有動脈的較大分支支配，肝動脈的分支與膽管壁微血管之間呈垂直的連接方式。膽管厚切片透明后可清楚地顯示出PVP的平面結構: 外層微血管直徑較粗，內層微血管象鏈條一樣排列，中層微血管連接在內、外層之間[３](圖2)。動脈血流從外層較粗大血管流入位于膽管黏膜下的內層微血管，它是膽管動脈的終末分支,由內層微血管滋養的膽管上皮細胞層是膽管最易受損的部位(Achilles heel)。所以，肝移植中膽管動脈灌洗非常重要，應盡可能選用能夠進入膽管黏膜內層血管網的低黏滯度灌注液。筆者研究證實了HCA液結合UW液灌注快速獲取無心跳供體（NHBD）的肝臟，其保存效果優于單用UW液、Celsior液或HTK液，采用價廉低黏滯度HCA液聯合UW液灌注，既能防止膽管PVP微血栓形成，又能充分發揮UW液對肝細胞和膽管細胞的保護作用.............................
Xenotansplantation has become a global focus because it may solve the formidable problems in allotransplantation, that is, the donor source. Hitherto clinical xenotransplantion has been in the stage of research with limited cases and unsatisfactory results. The difficulties which hinder the progress of xenotransplantation include: the ideal animal donor has not been found, it is rather difficult to control the rejections (hyperacute rejection, acute vascular rejection, perhaps acute cellular rejection and chronic rejection) after xenotransplantation compared with those after allotransplantation, some animal diseases might be transmitted to and do harm to human recipients, even the community. It is still unknown whether the functions of animal organs can substitute those of human organs permanently. Transgenic pigs on research and various measurements to suppress humoral and cellular immunity may be helpful in overcoming the problems of xenogeneic rejections. Animal diseases should be prevented, screened and treated, and animal models should be established to study the possibility of satisfactory working of animal organs in human body before clinical xenotransplantation is widely practised.
ObjectiveTo summarize the prevention and treatment of iatrogenic medial collateral ligament (MCL) injuries in total knee arthroplasty (TKA).MethodsThe relevant literature about iatrogenic MCL injuries in TKA was summarized, and the symptoms, causes, preventions, and treatments were analyzed.ResultsPreventions on the iatrogenic MCL injuries in TKA is significantly promoted. With the occurrence of MCL injuries, the femoral avulsion can be fixed with the screw and washer or the suture anchors; the tibial avulsion can be treated with the suture anchors fixation, bone staples fixation, or conservative treatment; the mid-substance laceration can be repaired directly; the autologous quadriceps tendon, semitendinosus tendon, or artificial ligament can be used for the patients with poor tissue conditions or obvious residual gap between the ligament ends; the use of implant with greater constraint can be the last alternative method.ConclusionNo consensus has been reached to the management of iatrogenic MCL injuries in TKA. Different solutions and strategies can be integrated and adopted flexibly by surgeons according to the specific situation.