目的探讨腹腔镜胆总管探查(LCBDE)取石与内镜(ERCP、EST)胆总管取石的适用范围，以及中西医结合治疗胆总管结石的疗效。方法25例胆囊结石合并胆总管结石患者，其中23例行腹腔镜胆囊切除(LC)+LCBDE，2例因高龄、胆总管直径lt;1.0 cm并伴有高血压和糖尿病不能耐受长时间手术而先选择ERCP+EST，后择期行LC。8例胆囊结石合并胆总管结石伴胆源性胰腺炎患者先行ERCP+EST，其中3例EST取石失败而行LC+LCBDE。4例胆囊结石合并胆总管结石伴急性化脓性胆管炎患者先在内镜下置鼻胆管引流，病情稳定后行LC+LCBDE。4例单纯胆总管结石患者行ERCP+EST。手术按常规方法进行。术后均给予口服中药。结果30例行LC+LCBDE患者，均获得治愈，术后无胆管残留结石。14例行ERCP+EST治疗胆总管结石患者中11例EST取石成功，3例失败后行LC+LCBDE。41例患者均获得治愈。平均随访6个月，无胆管结石复发、胆管狭窄及其他并发症发生。结论LCBDE和EST治疗胆总管结石微创、安全、有效，同时结合中药治疗，有利患者术后恢复。LCBDE较内镜胆总管取石成功率高，其与选择病例和严格掌握各自适应证有关。
目的总结腹腔镜下经腹腹膜前疝修补术（TAPP）中腹膜前间隙的创建体会。 方法回顾性分析2011年4月至2013年5月期间笔者所在医院实施的38例腹腔镜下TAPP患者的临床资料。 结果本组共施行腹腔镜下TAPP 38例（48侧），单侧手术时间为45～90 min，平均65.4 min。术中未发生大出血、腹腔脏器损伤等情况。术后发生并发症3例，均为腹股沟区血清肿，经穿刺引流后均治愈。术后第3 d复发1例。随访时间1～25个月（平均16.2个月），未发生补片感染、补片侵蚀、肠梗阻、肠瘘、慢性疼痛、睾丸萎缩等并发症。 结论腹膜前间隙的创建是腹腔镜下TAPP手术成功、降低术后并发症发生率的关键。
Objective To investigate the diagnostic significance of fine needle aspiration cytology (FNAC) combined with BRAFV600E gene detection in the diagnosis of cervical lymph node metastasis of thyroid cancer. Methods Atotal of 140 patients with suspected cervical lymph node metastasis of thyroid cancer were collected as the research objects, and all patients were given ultrasound-guided FNAC and detection of BRAFV600E gene. The significance of the diagnosis was analyzed according to the gold standard after pathological examination. Results All the 140 patients underwent surgical treatment. For FNAC, the sensitivity was 63.6% (84/132), the specificity was 100% (8/8), the accuracy was 65.7% (92/140), the positive predictive value was 100% (84/84), and the negative predictive value was 14.3% (8/56). For detection of BRAFV600E gene, the sensitivity was 84.8% (112/132), the specificity was 100% (8/8), the accuracy was 85.7% (120/140), the positive predictive value was 100% (112/112), and the negative predictive value was 28.5% (8/28). For FNAC combined with BRAFV600E gene detection, the sensitivity was 90.9% (120/132), the specificity was 100% (8/8), the accuracy was 91.4% (128/140), the positive predictive value was 100% (120/120), and the negative predictive value was 40.0% (8/20). The area under curve of receiver operating characteristic for FNAC, detection of BRAFV600E gene, and FNAC combined with BRAFV600E gene detection were 0.818, 0.924, and 0.955, respectively. Conclusion FNAC combine with BRAFV600E gene detection improves the accuracy of neck lymph node metastasis in patients with thyroid cancer, which is worthyof performed.