Search

腹腔镜胆总管切开取石术对患者术后胃肠道功能恢复、应激反应及血流动力学的影响

目的 探讨腹腔镜胆总管切开取石术对患者术后胃肠道功能恢复、应激反应及血流动力学的影响。 方法 回顾性分析笔者所在医院于 2016 年 1 月至 2016 年 12 月期间收治的 78 例胆总管结石患者的临床资料，按照术式分为开腹组（行开腹胆总管切开取石术）与腹腔镜组（行腹腔镜胆总管切开取石术），各 39 例，比较 2 组患者的手术疗效、手术前后的应激反应指标和血流动力学指标。 结果 腹腔镜组患者的术中出血量、术后镇痛次数、胃肠道功能恢复时间及术后住院时间均少于（短于）开腹组（P<0.01）；腹腔镜组手术前后的血清皮质醇水平、血清游离三碘甲状腺原氨酸（FT3）水平及平均动脉压（MAP）的差值均较开腹组低（P<0.05），而手术前后心率（HR）的差值较开腹组高（P<0.05）。 结论 相比开腹胆总管切开取石术，腹腔镜胆总管切开取石术更利于改善患者的血清皮质醇及 FT3 水平，减轻应激反应，改善血流动力学情况，促进术后胃肠道功能的恢复，值得临床推广。

颈部Castleman病1例报道

Application Value of Rouviere Groove Guide Positioning in Laparoscopic Cholecystectomy

目的　探讨腹腔镜胆囊切除术中避免胆管损伤新方法的安全性。方法　回顾性分析2008年1月至2012年1月期间笔者所在医院采用Rouviere沟引导定位的方法进行腹腔镜胆囊切除术患者的临床资料，并在手术时间和术后并发症发生率方面与同期传统手术组病例相比较。结果　与传统手术组比较，Rouviere沟引导组患者的手术时间缩短，术后并发症发生率及中转开腹率降低，其差异均有统计学意义（P＜0.05）。结论　采用Rouviere沟引导定位法进行腹腔镜胆囊切除术能有效缩短手术时间，减少胆管损伤的发生概率，值得在临床推广应用。

Diagnosis and treatment of occult carcinoma of the thyroid with neck lymph node metastasis as the first symptom

Objective To investigate the optimal diagnosis and treatment strategy of occult carcinoma of the thyroid (OCT) with neck lymph node metastasis as the first symptom. Method In order to discuss the optimal diagnosis and treatment strategy of OCT with neck lymph node metastasis as the first symptom, we collected 35 cases and analyzed their characteristics, diagnostic methods, operative schemes, metastasis situation, and death situation. Results Of the 35 cases, 28 cases went to hospital because of swollen lymph nodes, and other 7 cases were discovered by color Doppler ultrasound in medical examination. Thyroid nodules were found by color Doppler ultrasound in 32 cases, 3 cases were found no thyroid nodule. Lymph node of 23 cases were determined by ultrasound-guided fine-needle aspiration biopsy (US-FNAB), and 16 cases (69.56%) were diagnosed as metastasis of thyroid carcinoma or suspicious metastasis by US-FNAB. Thyroid biopsy were done in 21 cases, and 11 cases (52.38%) were diagnosed as thyroid carcinoma or suspicious thyroid carcinoma by fine needle aspiration biopsy. Of the 35 cases, 19 cases were performed total thyroidectomy and functional neck lymph node dissection, 11 cases were performed resection of unilateral thyroid and isthmus and regional neck lymph node dissection, 5 cases were performed nonstandard operations. All cases were followed up for 3–10 years after operation, and the median time was 7-year. During follow up period, 10 cases suffered from reccurrence. Among them, 3 cases reoccurred in the nonstandard operation group, 5 cases reoccurred in resection of unilateral thyroid and isthmus and regional neck lymph node dissection group, 3 cases reoccurred in total thyroidectomy and functional neck lymph node dissection group. There were 3 cases died. Among them, there was 1 case in each group of nonstandard operation group, resection of unilateral thyroid and isthmus and regional neck lymph node dissection group, and total thyroidectomy and functional neck lymph node dissection group. The recurrence rate of total thyroidectomy and functional neck lymph node dissection group was markedly lower than those of resection of unilateral thyroid and isthmus and regional neck dissection group (χ2=4.751,P<0.05) and nonstandard operation group (χ2=5.874,P<0.05). While there was no significance difference of the recurrence rate between the resection of unilateral thyroid and isthmus and regional neck dissection group and nonstandard operation group (χ2=0.291,P>0.05). There was no significance difference in the mortality among the three groups (P>0.05). Conclusion US-FNAB and intraoperation rapid frozen pathological section are important methods for diagnosis of OCT with neck lymph node metastasis as the first symptom, and standard operation is an principal treatment method for it.