目的 探讨瓷样胆囊腹腔镜手术治疗的技术和适应证。方法 对1995年1月至2009年1月期间我院收治的10例接受腹腔镜手术治疗的瓷样胆囊患者的临床资料进行回顾性分析。结果 10例瓷样胆囊均接受腹腔镜手术治疗，其中胆囊逆行切除6例, 胆囊大部切除2例，中转开腹2例（术中发生胆管损伤和发现胆囊癌各1例）。有1例术中冰冻检查证实为胆囊癌的患者经腹腔镜完整地切除胆囊。腹腔引流10例，仅1例发生漏胆，二次开腹手术探查见右肝管电灼伤，经放置T管引流，2周后痊愈。所有患者均痊愈出院, 无死亡病例。随访1.5~14年（平均11年），除1例胆囊癌患者于术后1.5年死亡，其余患者均恢复良好。结论 严格的适应证加上个体化的操作方法可以安全地完成腹腔镜瓷样胆囊切除术。
Objective To observe the effect of cisplatin in bletilla hyacinthine particle chemotherapy combined with 125I brachytherapy on short-and long-term outcomes and the toxic and side effects in advanced gastric cancer. Methods One hundred seventy-six patients with stage Ⅱ or stage Ⅲ advanced gastric cancer underwent curative surgical resection were included in this study. They were randomly divided into brachytherapy and chemotherapy group (n=48), intraperitoneal chemotherapy group (n=32) and intravenous chemotherapy group (n=48), and other patients who abandoned radiotherapy and chemotherapy and signed informed consent form by themselves were considered as control group (n=48). The short-and long-term outcomes and the toxic and side effects were observed and the survival of all patients was analyzed by Kaplan-Meier method and Log-Rank test. Results For short-term outcomes, the total effective rate in 4 groups were 95.83%, 71.88%, 64.58% and 52.08% respectively, and the difference was significant (Plt;0.05). For long-term outcomes, the 3 -and 5-year mortality rate was 37.50% and 56.30%, and 5-year median survival time was (14±4.51) months (95%CI: 14.419-4.512) in brachytherapy and chemotherapy group patients. The 3- and 5-year mortality rate was 78.12%and 93.75%and 5year median survival time was (10.6±1.13) months (95%CI: 10.620-1.163) in intraperitoneal chemotherapy group patients. The 3-and 5-year mortality rate was 79.21%and 95.80%and 5-year median survival time was (11±3.10) months (95%CI: 11.130-3.162) in intravenous chemotherapy group patients. The 3-and 5-year mortality rate was 87.50%and 95.83% and 5-year median survival time was (9±2.30) months (95%CI: 10.024-1.180) in control group patients. Compared with the vein chemotherapy group, the short distance puts the chemotherapy group disgusting vomit, the marrow to suppress, the liver function harm, the kidney function harm formation rate to reduce obviously (Plt;0.05). Conclusion Cisplatin in bletilla hyacinthine particle chemotherapy combined with 125I brachytherapy can reduce the toxic and side effects of drugs and prolong survival time of patients with advanced gastric cancer.