目的 总结对粪石性小肠梗阻患者的诊治经验。方法 对我院2000～2012年期间收治的45例成人粪石性小肠梗阻患者的病史、X射线表现、CT表现、治疗情况等进行回顾性分析。结果 本组有22例患者发病前曾进食柿子、山楂或黑枣，7例有胃部手术史，9例患有糖尿病。39例行腹部CT，其中35例可见小肠扩张与萎陷肠管移行区椭圆形斑点状团块。22例经非手术治疗缓解，随访2～3个月无肠梗阻复发；23例行剖腹探查，其中1例于术后21 d死于急性呼吸窘迫综合征，其余均治愈。结论 进食富含鞣酸食物史、胃部手术史、糖尿病史、典型螺旋CT表现是诊断的关键因素，部分患者可经保守治疗缓解，若保守治疗无效，则行手术探查，手术应先试行手法碎石，并全程探查胃肠道以避免多发粪石残留。
Objective To investigate the anti-rejection effect and the mechanism of triptolide （TPT） on islet allo- grafts in a murine model. Methods BALB/c mice were used as islet donor. C57BL/6 mice were rendered diabetic by streptozotocin （STZ） injection， and transplanted with islets under the left kidney capsule. The recipients were randomly （method of random digits table） divided into three groups （n=8）. The mice in the treatment groups were injected intrap-eritoneally with TPT at 50 μg/kg （low-dose TPT group， L-TPT group） or 100 μg/kg （high-dose TPT group， H-TPT group） daily in the first 5 days and then on alternate days until 14 days；while the mice in control group were given vehicles （1% tween 80）. Blood glucose after operation were monitored. The grafts were defined as rejection when two consecutive reading of blood glucose＞20 mmol/L. The left kidney of three recipients in each group were resected for pathological examination. The proportion of CD4＋CD25＋Foxp3＋ regulatory T cells in spleen tissues were tested by flow cytometry. Results The median survival time of islet allografts from the control group， L-TPT group， and H-TPT group were 12.6 days （9-16 days）， 21.4 days （14-27 days） ， and 27.6 days （19-34 days）， respectivly. The percentageof CD4＋CD25＋Foxp3＋regulatory T cells in spleen tissues of three groups were （5.2±0.6）%， （12.0±1.3）%， and（15.7±1.8）%， respectivly. Compared with control group， the median survival time of islet transplantation in mice exte-nded and the proportion of CD4＋CD25＋Foxp3＋ regulatory T cells in spleen tissues increased （P＜0.05）. Conclusions TPT could increase the percentage of CD4＋CD25＋Foxp3＋ regulatory T cells， reduce the rejection after islet transplanta-tion， and prolong the survival time of islet transplantation in mice. The immunosuppressive effect of TPT shows a dose-dependent.