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先天性胆囊缺如 1 例报道

单孔腹腔镜诊治腹膜假性黏液瘤 2 例报道

目的 探讨腹膜假性黏液瘤的诊断与治疗方法。 方法 对中国医科大学附属盛京医院2014 和2015 年收治的 2 例腹膜假性黏液瘤患者的临床资料进行回顾性分析。 结果 2 例患者经其他检查均未明确诊断，后在单孔腹腔镜探查中明确诊断。手术切口长度为 2～3 cm，手术操作时间均约为 30 min，术中均无明显出血，术后均只使用非甾体类抗炎止痛药物 1 次。2 例患者均在术后 6 h 下床活动，24 h 内排气，48 h 内恢复至术前的生命体征平稳、饮食睡眠正常及可自主活动的状态。 结论 腹膜假性黏液瘤临床少见，组织来源不定，无特异性临床表现，常规检查诊断较为困难，单孔腹腔镜在腹膜假性黏液瘤的诊断与治疗中具有明显的优势。

Diagnosis and treatment of intra-abdominal aggressive fibromatosis: a report of 8 cases

Objective The aim of this article is to analyze the clinical characteristics of intra-abdominal aggressive fibromatosis and discuss its treatment methods. Methods Retrospective analysis of the clinical data in 8 cases of intra-abdominal aggressive fibromatosis who were confirmed by surgery and pathological diagnosis between Feb. 2011 and Mar. 2017 in Shengjing hospital was performed. Results Of the 8 cases (3 males and 5 females), there were 4 cases of simple abdominal pain (2 cases of repeated intermittent abdominal pain and 2 cases of acute abdominal pain), 3 cases of abdominal mass, and 1 case of relapses after surgery in outside hospital (others 7 cases were the first visit). The course of disease was 4 to 720 d, with median of 130 d. All cases underwent radical surgery, and the operative time was 92 to 493 min, with an average of 246 min. Intraoperative blood loss was 20 to 1 000 mL, with an average of 321 mL. The drainage tube placement time in all patients was 5 to 9 d, with an average of 6 d. The hospital stay was 11 to 75 d, with an average of 25 d. Two cases suffered from postoperatively appeared abdominal pain symptoms. All cases were followed-up for 6 to 40 months, with median of 23 months. During the follow-up period, 1 case relapsed on 212 dafter surgery, and the remaining 7 cases had no recurrence. Conclusion For intra-abdominal aggressive fibromatosis, it is difficult to make clear diagnosis before operation and surgery is the primary choice of treatment when symptom appeared.

Correlation between cholecystectomy or gallbladder disease and bile reflux gastritis

ObjectiveTo study the relationship among cholecystectomy/gallbladder disease and bile reflux gastritis.MethodsA retrospective collection of 123 patients with bile reflux gastritis who were diagnosed as outpatients and hospitalized from January 2014 to February 2019 in Shengjing Hospital Affiliated to China Medical University, and 221 patients with non-biliary reflux gastritis at the same period were collected. According to the gallbladder status, the patients were divided into three groups: gallbladder disease, cholecystectomy, and gallbladder disease-free group. The relationship between gallbladder status and bile reflux gastritis was analyzed.ResultsAmong 123 patients with bile reflux gastritis, there were 22 cases (17.89%) with cholecystectomy and 26 cases (21.14%) with gallbladder disease; 221 cases of non-biliary reflux gastritis with cholecystectomy in 7 cases (3.17%) and gallbladder disease in 30 cases (13.57%). Univariate analysis showed that the gallbladder status was different between the bile reflux gastritis group and the non-biliary reflux gastritis group (χ2=21.089, P<0.001). The study showed that the gallbladder status was related to the occurrence of bile reflux gastritis. In contrast, patients with cholecystectomy and gallbladder disease had a higher risk of occurrence than those with no gallbladder disease (OR>1, P<0.012 5). Independent risk factors were considered by logistic multivariate regression analysis, including cholecystectomy, gallbladder disease, and age (P<0.05).ConclusionsThere is a correlation between cholecystectomy/gallbladder disease and bile reflux gastritis. Cholecystectomy and gallbladder disease may be the independent risk factors for bile reflux gastritis.

单孔腹腔镜胆囊逆行切除术的学习曲线分析

目的 总结采用常规腹腔镜器械进行逆行切除法在单孔腹腔镜胆囊切除术中应用的学习曲线。 方法 回顾性分析中国医科大学附属盛京医院单一主刀医生于 2012 年 7 月至 2015 年 12 月期间施行的连续单孔腹腔镜手术的 120 例患者的临床资料，单孔腹腔镜胆囊切除术中采用常规腹腔镜器械进行胆囊逆行切除。 结果 所有患者的手术都顺利进行。手术施行期间，手术时间随手术例数增加而明显减少，10 例以后手术时间基本稳定。前期组和后期组患者的手术花费、帕瑞昔布钠剂量和美容评分比较差异均无统计学意义（P>0.05），但与前期组比较，后期组的手术时间较短，术中出血量较少，术后住院时间较短，中转多孔率和并发症发生率较低，视觉模拟评分（visual analogue scale，VAS）较低，差异均有统计学意义（P<0.05）。 结论 单孔腹腔镜胆囊切除术中采用常规腹腔镜器械进行胆囊逆行切除的学习曲线短，易于术者掌握。

经脐单孔腹腔镜阑尾切除术治疗急性 阑尾炎的应用价值及经验总结

目的 探讨经脐单孔腹腔镜阑尾切除术（SLA）在急性阑尾炎中的应用价值。 方法 回顾性分析笔者所在医院 2016 年 4 月至 2017 年 11 月期间收治的 70 例急诊入院且行经脐SLA的急性阑尾炎患者的临床资料。 结果 70 例患者顺利完成经脐SLA，无术中中转 3 孔或开腹患者。除 2 例患者手术时间超过 89 min 以外，其余患者平均手术时间 46 min；术中出血量平均 6 mL；术后进食时间平均 22 h；术后住院时间平均 2.8 d。出院后随访 3～22 个月，切口恢复较好，无脐部感染、阑尾残端瘘、阑尾残端周围脓肿形成、切口疝、肠梗阻等并发症发生。 结论 经脐SLA治疗急性阑尾炎安全、可靠，其具有疗效确切、创伤小、瘢痕隐秘、美观等优点。