目的 总结开展腹腔镜下经胆囊管胆总管探查取石的手术技巧及应用体会。方法 回顾性分析笔者所在医院肝胆外科2010年7月至2012年12月期间行腹腔镜经胆囊管胆总管探查取石术的36例患者的临床资料。结果 30例病例经胆道探条扩张胆囊管后直接完成网篮取石，3例经胆囊管汇入胆总管处微切开完成取石，3例经胆道镜联合激光碎石完成手术。全组病例的手术时间为（110.88±25.99） min，术后住院时间为（6.59±1.18） d，均无严重操作相关并发症发生。结论 腹腔镜下经胆囊管胆总管探查取石术是安全可行的，若能综合各种技术，可提高手术的成功率。
目的探讨应用超普疝修补装置（UHS）行无张力疝修补的效果和手术体会。 方法回顾性分析2012年6月至2013年11月期间笔者所在医院采用UHS施行腹股沟疝无张力修补术41例患者的临床资料，观察手术时间、伤口疼痛、住院时间、住院费用、并发症发生率以及复发率。 结果手术时间25～100 min，平均48 min；患者术后1 d下床活动；术后有10例患者使用止痛药物；全组切口均一期愈合，无切口感染发生，有2例出现阴囊水肿；术后住院时间4～10 d，平均6 d；住院费用9 249.33～18 976.49元，平均11 428.47元。术后随访1～6个月，平均3个月，无一例复发。 结论UHS技术是目前较为理想的治疗腹股沟疝的手术方式。
Objective To investigate the role of KiSS-1 gene in the metastatic process of carcinoma of gallbladder and the clinicopathologic significance of KiSS-1 gene expression in carcinoma of gallbladder. Methods Pathological specimens from 59 gallbladder carcinoma tissues (13 hepatic invasion and 13 lymphatic invasion tissues were included), matched with 7 para-tumor and 6 normal gallbladder tissues, were examined for the expression of KiSS-1 gene by tissue microarray technique and immunohistochemistry (EnVision). Results The positive rate of KiSS-1 expression was down-regulated (P＜0.05) in tumor tissues, as compared with normal and para-tumor tissues. In carcinoma of gallbladder, the expression of KiSS-1 had no relationship with the gender, age, tumor size, histological grade or differentiation, and metastasis of lymph node, while was associated with the depth of infiltration, invasion of liver and the clinical stages (Nevin). In Ⅰ+Ⅱ, Ⅲ+Ⅳ and Ⅴ stage, the positive rates of KiSS-1 were 92.3%, 57.1% and 27.8% respectively, with an undeniably clear lowering tendency (P=0.002). Conclusion Down-regulating expression of KiSS-1 is closely associated with the processes of genesis, invasion and metastasis in carcinoma of gallbladder, and may participate in regulating these processes.
With the boom of information technology and data science, real-world evidence (RWE) which is produced using diverse real-world data (RWD) has become an important source for healthcare practice and policy decisions, such as regulatory and coverage decisions, guideline development, and disease management. The production of high-quality RWE requires not only complete, accurate and usable data, but also scientific and sound study designs and data analyses to enable the questions of interest to be reliably answered. In order to improve the quality of production and use of RWE, China REal world data and studies ALliance (ChinaREAL) has developed the first series of technical guidance for developing real-world data and subsequent studies. The efforts are ongoing which would ultimately inform better healthcare practice and policy decisions.