63 normal human gallbladders (non-stone group) and 47 inflammed cholesterol stone gallbladders(stone group) were assayed for the amount of macrophages(ΜΦ),the levels of tumor necro-sis factor (TNF) and interleukin 1(1L-1).It was found that in stone group,the amount of ΜΦ was significantly higher than in non-stone group(ΜΦ4101.90±295.72 vs 572.13±30.07AU,Plt;0.01).The levels of TNF and 1L-1 released mainly from the MΦ in stone group were also significantly increased in comparison with those in non-stone group(TNF 18.12±2.03 vs 4.45±0.39ng/mg,Plt;0.001;1L-1 102.42±7.84 vs 66.75±9.50u/mg protein,Plt;0.05).These results suggest that the activited ΜΦ and increases of TNF,1L-1 may be closely related to the inflammatory reaction in gallbladders and the formation of cholesterol gallstones.
ObjectiveTo investigate clinical efficacy and advantages and disadvantages of primary closure with two endoscopes (1aparoscope+choledochoscope) or three endoscopes (laparoscope+choledochoscope+duodenoscope) through the cystic duct for treatment of gallbladder stone with secondary common bile duct (CBD) stones.MethodsThe clinical data of 83 patients with gallbladder stones with secondary CBD stones treated by two or three endoscopes combined with CBD exploration and lithotomy and primary closure through cystic duct from January 2017 to December 2018 in the Chengdu Second People’s Hospital were collected retrospectively. Among them, 41 patients were treated by two endoscopes mode (two endoscopes group), 42 cases were treated by three endoscopes mode (three endoscopes group).ResultsThere were no significant differences in the general conditions such as the gender, age, preoperative diameter of CBD, chronic diseases, etc. between the two and three endoscopes group (P>0.05). All 83 cases underwent the operations successfully and recovered well. The success rate of operation, stone clearance rate, drainage volume of abdominal drainage tube on day 1 after the operation, time of abdominal drainage tube removal after the operation, and hospitalization time had no significant differences between these two groups (P>0.05). The time of operation, intraoperative bleeding volume, and the postoperative pancreatitis rate in the three endoscopes group were significantly more (or higher) than those in the two endoscopes group (P<0.05), but the condition of liver function recovered after the operation was better than that in the two endoscopes group (P<0.05).ConclusionsWith the strict control of the operation indications, it is safe and feasible to use two or three endoscopes through the cystic duct pathway and primary closure of CBD for treatment of gallbladder stone with secondary CBD stones. However, the choice of operative methods of two or three endoscopes should be based on the general situation of the patients before and during the operation.
From the March of 1993 to the May of 1994, we had performed laparoscopic cholecystectomy (LC) for 200 patients of the age ranged 19-77 years. In these cases, 12 had previous abdominal surgery; 3 cases had hepatic cysts; 11 cases had stones in the neck of gall bladders. We had successfully performed LC for 190 cases (95%). But we also had some unsuccesful experiences, including accidental injury to the stomach or duodenum, and bleeding from cystic arteris of the gallbladder. Operation (LC) was abandoned in one patient because of severe cardiac arrhyshmia developed during operation, and billiary tract injury was found postoperatively in three patients with no postoperative death. The operative indications and technical problems of LC are discussed in detail and measures in avoiding injury to billiary or GI tract from LC are introduced.
目的探讨腹腔镜胆道再次手术的适应证、手术方法及临床效果。方法回顾性分析我院2003年2月至2010年11月期间46例腹腔镜胆道再次手术患者的临床资料，对术中及术后结果进行总结。结果本组45例在腹腔镜下完成手术，1例中转开腹。手术时间为45～270 min(平均120 min)，残株胆囊切除时间为(40±10) min，胆总管切开取石+T管引流时间为(150±50) min，胆总管切开取石+等离子碎石+T管引流时间为(180±40) min，术后出血及漏胆腹腔镜探查术时间为（40±15）min。结石一次性取尽23例，术后残余结石2例，住院4～21 d，平均8.6 d。胆管残余结石患者在术后1个月后经T管瘘道用胆道镜取石。术中十二指肠球部损伤3例，及时发现修补; 术后出现右侧胸腔积液4例、肺部感染2例和漏胆1例，均经非手术治疗痊愈。术后电话随访6～24个月（平均15个月），未见异常。结论腹腔镜胆道再次手术可行，并具有创伤小、恢复快等优点，但术前应严格掌握手术适应证，对手术医生的技术要求也较高。
目的 探讨急诊条件下胆囊结石合并胃恶性肿瘤的诊断与治疗。方法 回顾性分析6例因胆囊结石行胆囊切除、术中意外发现胃恶性肿瘤患者的临床资料及治疗过程。结果 6例患者中5例发现胃癌，1例发现原发性胃恶性淋巴瘤。5例施行胃癌根治术，1例施行全胃切除术，无术后并发症，术后定期化疗，随访6～43个月，至术后随访截止日（2008年12月）均存活。结论 老年胆囊结石患者应注意合并胃恶性肿瘤的可能，胆囊切除术中仔细探查胃及周围器官极为重要，同时施行根治性切除是最佳选择。
目的 了解单纯胆囊切除术患者围手术期抗菌药物的使用情况及合理性，促进临床合理用药。 方法 对昆明医学院第二附属医院2004年7～9月期间出院的661例单纯胆囊切除术患者应用抗菌药物的合理性进行回顾性分析。结果 胆囊切除患者抗菌药物应用共涉及9大类39个品种，使用率为100%。预防用药380例（57.49%），其中单用38例(10.00%)，平均用药6.55 d，平均住院时间10.79 d； 两联281例(73.95%)，平均用药6.49 d，平均住院时间12.30 d； 三联57例(15.00%)，平均用药6.52 d，平均住院时间11.75 d； 四联4例(1.05%)，平均用药6.75 d，平均住院时间9.00 d。感染治疗281例(42.51%)，其中单用10例(3.56%)，平均用药9.60 d，平均住院时间15.10 d； 两联206例(73.31%)，平均用药11.25 d，平均住院时间15.79 d； 三联56例(19.93%)，平均用药15.23 d，平均住院时间15.23 d； 四联9例(3.20%)，平均用药13.00 d，平均住院时间21.78 d。结论 单纯胆囊切除术患者抗菌药物使用存在一些不合理现象，应按围手术期给药方案进行。加强抗菌药物使用的管理和监督，不仅减少耐药菌株及不良反应的产生，而且对降低医药费用具有积极的意义。
目的 了解单纯胆囊切除术围手术期应用预防性抗生素的作用。方法 对我院普外一科1998年1月至1999年12月2年间所施行的642例择期单纯胆囊切除术围手术期抗生素的使用、细菌培养结果和切口感染情况进行回顾性分析。结果 642例根据其抗生素应用情况分为未用抗生素组(n＝220)、术前30分钟一次性给药组(n＝200)和术后3天持续用药组(n＝222) 3组，3组患者之性别、年龄构成情况、全身状况及发生术后切口感染情况间的差异均无显著性意义(Ｐ＞0.05)； 对642例中随机选择52例行术中胆囊胆汁培养，结果47例无细菌生长。结论 对单纯胆囊切除术患者术前无感染前提下，不用或仅术前30分钟一次性使用抗生素是安全可行的，这对缩短患者住院日，减少其医疗费用具有积极的意义。