Objective To investigate whether intraductal electrocautery incision （IEI） could decrease the recurrence of post-liver transplant anastomotic strictures （PTAS） after conventional endoscopic intervention of balloon dilatation （BD） and plastic stenting （PS）. Methods The clinical data of 27 patients with PTAS who were given endoscopic treatment of BD＋PS or IEI＋BD＋PS in our hospital from January 2007 to October 2011 were reviewed retrospectively. Results The treatment of BD＋PS was initially successful in 9 of 11 （81.8%） cases， but showed recurrence in 5 of 9 （55.6%）. The treatment of IEI＋BD＋PS was initially successful in 14 of 16 （87.5%） cases, and the recurrence was observed only in 3 of 14 （21.4%）. The total diameter of inserted plastic stents in IEI＋BD＋PS group was significantly greater than that in BD＋PS group 〔（12±3.2） Fr vs. （8±1.3） Fr，P=0.039〕. All recurrences were successfully retreated by IEI＋BD＋PS. Procedure-related complications included pancreatitis in 5 cases （18.5%）, cholangitis in 8 cases （29.6%）, bleeding after EST in 1 cases （3.7%）, which were all cured with medical treatment. No complications related to intraductal endocautery incision procedure such as bleeding and perforation were observed. Median follow-up after completion of endoscopic therapy was 22 months （range 1-49 months）. Conclusions Intraductal electrocautery incision is an effective and safe supplement to balloon dilatation and plastic stenting treatment of PTAS, which can decrease the recurrence of anastomotic strictures in conventional endoscopic intervention.
目的 探讨腹腔镜下联合胆道镜微创保胆取石术治疗胆囊结石的疗效。方法 解放军第452医院普外科2005年1月至2010年1月期间行腹腔镜保胆取石术治疗胆囊结石患者70例，与同期行腹腔镜胆囊切除术的患者对比，观察2组的手术时间、术中出血量、术后住院时间、住院费用及术后饮食恢复时间。结果 在术中出血量及术后饮食恢复时间上，保胆取石组明显少于或短于胆囊切除组（P＜0.05）；在手术时间、术后住院时间及住院费用上2组间差异无统计学意义（P＞0.05）。结论 相比胆囊切除术，腹腔镜联合胆道镜保胆取石术创伤较小且恢复较快，但是保胆取石术后结石的复发有待长期观察和研究。
ObjectiveTo investigate the protective effect of Roux-en-Y gastric bypass surgery on early damage of renal tissue in type 2 diabetes mellitus rats, and explore the mechanism of the protective effects. MethodsDiabetes mellitus animal models were induced by intraperitoneal injection of streptozotocin (STZ, 35 mg /kg) and a high-fat diet.Diabetic rats were divided into three groups randomly (digital table method): diabetes control group (n=8), sham operation group (n=8), and Roux-en-Y gastric bypass group (n=14).Another 8 normal SD rats as the normal control group.The fasting blood glucose, serum total cholesterol (TC), triglyceride (TG), and free fatty acid (FFA) were measured before operation and in 8 weeks after operation; plasma BUN and Cr were measured respectively before operation and in 4 and 8 weeks after operation in each group rats, 24 h urine microalbumin and urine 8-hydroxydeoxyguanosine were measured respectively before operation and in 8 weeks after operation in each group rats.Renal pathological changes were observed and the indexes of kidney hypertrophy, the mean glomerular area (MGA), and the mean glomerular volume (MGV) were analyzed in 8 weeks after operation.The expressions of fibronectin, typeⅣcollagen (CoⅣ), transforming growth factor-β1 (TGF-β1), intercellular adhesion molecule-1(ICAM-1), nicotinamide adenine dinucleotide phosphate oxidase 4 (NOX4), and Bcl-2 protein in renal tissues were investigated by immunohistochemical staining. ResultsRoux-en-Y gastric bypass surgery could reduce the blood glucose, blood lipid, MGA, MGV, and the index of kidney hypertrophy of diabetic rats significantly (P < 0.05), improved renal pathological morphology and kidney function (P < 0.05), reduced the protein expressions of fibronectin and CoⅣ, decreased the protein expressions of TGF-β1, ICAM-1, and NOX4, and increased the protein expression of Bcl-2. ConclusionRoux-en-Y gastric bypass surgery can improve kidney function and the pathological damage of diabetes rats, its mechanism may be related to inhibition the protein expressions of TGF-β1, ICAM-1, and NOX4, and increase the protein expression of Bcl-2.