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胃恶性间质瘤致失血性休克1例报道

患者，男，48岁，因腹痛、腹胀1 d，头昏、乏力3 h时入院。无恶心、呕吐、呕血、便血、畏寒、发热及外伤史。既往无胃十二指肠溃疡、胃炎及肝炎史。查体: T 36 ℃，P 110次/分，R 24次/分，BP 90/50 mm Hg(1 mm Hg=0.133 kPa）。面色苍白，四肢厥冷，神志清醒。腹部膨隆，全腹有压痛，反跳痛，肝脾均未扪及，肝、肾区无叩痛，肝浊音界存在，移浊（+），肠鸣活跃。WBC 12.9×109/L， N 0.112, L 0.888, HGB 103 g/L, PLT 133×109/L，血淀粉酶32 u/L。腹腔穿刺抽出不凝血。B超检查示腹腔积液，肝脾形态、大小正常，实质回声均匀，未见占位病变。以“腹腔积血（原因待查）”在积极抗休克治疗的同时急诊在全麻下行剖腹探查术。术中见： 腹腔内积血约2 500 ml，血凝块聚积于胃底及肝脏处，胃底后壁可扪及一质硬包块，约

Laparoscopic Cholecystectomy in the Presence of Cholecystoenteric Fistula （Report of 5 Cases）

ObjectiveTo introduce the experience in diagnosing and treating cholecystoenteric fistula (CEF) during laparoscopic cholecystectomy (LC). MethodsFive cases with CEF in a series of 4 200 LC cases were reviewed.All of the five patients were proved to have CEF during operations.There were four cholecystoduodenal fistulas and one cholecystocolic fistula. One case with cholecystoduodenal fistula was treated by a suturing of the fistula under laparoscopy; 1 case was closed with titaniun and 2 cases were converted to laparotomy and fistulectomy.The patient with cholecystocolic fistula clips was treated by a suturing of the fistula under laparoscopy. ResultsAll the patients had got good recovery without complications.Conclusion CEF is a rare complication of cholelithiasis.If the diagnosis is made before operation, open operation might be a better choice.But if the diagnosis was made during the LC operation, suture closure or clip closure or stapler closure of CEF under laparoscope might be chosen for an experienced surgeon.

心包脓肿破溃致急性脓胸诊治一例

Ultrasound evaluation of endometrial receptivity to predict the clinical pregnancy outcome of IVF-ET: a meta-analysis

Objective To systematically review the endometrial receptivity evaluated by transvaginal ultrasound and predict the clinical pregnancy outcome of in vitro fertilization-embryo transfer (IVF-ET). Methods PubMed, The Cochrane Library, EMbase, Web of Science, CNKI, WanFang Data and VIP databases were electronically searched to collect studies on transvaginal ultrasound evaluation of endometrial receptivity to predict the clinical pregnancy outcome of IVF-ET from inception to December 1st, 2021. Two researchers independently screened literature, extracted data and evaluated the risk of bias of the included studies. RevMan 5.4 software and Stata 16.0 software were used to perform meta-analysis. Results A total of 24 cohort studies and 1 case-control study were included. The total sample size was 6 632 cases, including 3 340 in non-pregnancy group and 3 292 in pregnancy group. The results of meta-analysis showed that there was no difference in endometrial volume (MD=−0.11, 95%CI −0.33 to 0.11, P=0.34) or uterine artery S/D (MD= −0.04, 95%CI −0.17 to 0.09, P=0.55) between the two groups. The endometrial thickness measured on human chorionic gonadotrophin (HCG) day in the non-pregnant group (MD=−0.48, 95%CI −0.77 to −0.18, P=0.001) was thinner than that in the pregnant group. On embryo transfer (ET) day, uterine artery pulsatility index (PI) (MD=0.08, 95%CI 0.02 to 0.15, P=0.01) and resistance index (RI) (MD=0.01, 95%CI 0.01 to 0.01, P<0.000 01) were higher than those in the pregnancy group. Conclusion Endometrial volume and uterine artery S/D measured during IVF-ET were not correlated with clinical pregnancy outcome, while endometrial thickness measured on HCG day and uterine artery PI and RI measured on ET day were correlated with clinical pregnancy outcome. Transvaginal ultrasound evaluation of endometrial receptivity has a certain predictive value for clinical pregnancy outcome of IVF-ET. Due to the limited quality and quantity of included studies, more high-quality studies are needed to verify the above conclusion.