Objective To investigate the prevention and treatment strategy of bile duct injury (BDI) in laparoscopic cholecystectomy (LC). MethodsLatest progress was reviewed based on recent documents and the experience on BDI in LC in our department. ResultsWith the popularity of LC, BDI in LC is increasing. The reasons include illegibility and variability of local anatomy in gallbladder trigone,injury caused by galvanothermy, as well as operator’s overconfidence. In order to prevent BDI, we should apply more blunt dissection, not to use electrocogulation if possible and to study local anatomy and its variance clearly. The common bile duct and common hepatic duct should be clearly identified. Intraoperative cholangiography, laparoscopic ultrasonography and hepatobiliary scintigraphy are selections as necessary.The treatment of BDI depends on the type of BDI and its site and local condition.The treatment includes end to end anastomosis, repairing the defect, choledochoduodenostomy, RouxenY choledochojejunostomy and so on. T tube should be maintained in place for more than half a year after operation.Conclusion The key to improve the prognosis of BDI is prevention and treatment in proper time and in correct way.
ObjectiveTo summarize the research advancement of peroxisome proliferator-activated receptor γ (PPARγ) agonists inhibiting transforming growth factor-β (TGF-β)-induced organ fibrosis. MethodsThe related literatures on PPARγ agonists inhibiting TGF-β-induced organ fibrosis were reviewed. ResultsTGF-β was a major fibrosispromoting cytokine, which could promote a variety of organ fibrosis. PPARγ agonists could effectively block TGFβ signal transduction, and then suppressed organ fibrosis well. ConclusionsThe main antifibrotic mechanism of PPARγ agonists is to inhibit TGF-β signal transduction. The studies on this mechanism will help promoting the clinical application of PPARγ agonists, and provide a new way of the treatment for organ fibrosis.
【摘要】 目的 加强输血管理是保障血液合理利用和临床用血安全的重要手段。 方法 通过对医院临床用血情况的分析，以减少手术输血为切入点，采取强化意识，严控指征，完善术前准备，倡导自体输血，加强考核管理等方式促进临床合理用血。 结果 有效提升了医疗服务品质，保障医疗安全。 结论 其方法与措施此方法与措施供大型医院医疗管理参考借鉴。【Abstract】 Objective Strengthening blood transfusion management is an important means to ensure reasonable blood usage and clinical security during blood use. Methods With reducing surgery blood transfusion as a breakthrough point, We promotes clinical reasonable blood use and medical service quality by strengthening awareness of health workers, controlling indicators strictly, perfecting preoperative preparation, initiating autologous blood transfusion, enhancing assessment and management, and so on. Results The medical service quality was improved and the medical safety was ensured. Conclusion The experience could provide a reference for medical management in large hospitals.
目的:探讨腹腔镜胆囊切除术（laparoscopic cholecystectomy，LC）致胆管损伤的原因、预防措施和经验教训。方法:分析2007年8月～2008年8月期间我院胆道外科收治的3例胆管严重损伤病例资料。结果:3例LC术致胆管严重损伤的患者均发生肝门部胆管狭窄，并均在肝门胆管成形后行胆管空肠Roux-en-Y吻合术，吻合口直径2.0～3.0 cm。术后患者恢复良好，均顺利出院，住院时间为10～15天。随访1～6个月，1例于术后2月出现肝区隐痛，口服消炎药可控制，其余未见异常不适。结论:术中仔细辩清肝总管、胆总管与胆囊管的三者关系是预防LC术胆管损伤的关键。胆管空肠Roux-en-Y吻合术是处理胆管损伤的重要手术方式。LC术时，胆道外科医生思想上要高度重视，不可盲目追求速度。