目的总结完全腹腔镜下胆管空肠Roux-en-Y吻合的适应证、禁忌证、技术要点、安全性、并发症的预防及治疗效果。 方法回顾性分析2008年6月至2013年12月期间于笔者所在医院科室接受腹腔镜下胆管空肠Roux-en-Y吻合术的67例患者的临床资料。 结果67例患者中，66例完全在腹腔镜下完成手术，1例于放置蓝蝶后在手助下完成。手术时间144～253 min，平均152 min；术中出血30～220 mL，平均70 mL；术后住院时间6～11 d，平均8.1 d；住院费用2.0～2.5万元，平均2.1万元。术后发生漏胆3例，均经引流后痊愈；术后无肠瘘、出血、腹腔感染、肠梗阻等发生。术后20例患者获访，随访时间5～20个月，中位数为13个月。随访期间发生胆管炎2例，无吻合口狭窄发生。 结论对胆总管囊肿、胆总管下端良性狭窄、胆总管结石伴胆管扩张、壶腹部周围癌等需行胆肠吻合患者施行腹腔镜胆总管空肠Roux-en-Y吻合术是可行的，其手术费用稍高，但患者术后恢复快，且具有微创优势。
Since its discovery in early 2020, the coronavirus disease 2019 (COVID-19) has spread rapidly around the world and is now a global challenge. As early respiratory rehabilitation can improve the patient’s respiratory function and quality of life, it deserves proper attention. Aimed to provide reference for the clinical rehabilitation, this paper summarizes the rehabilitation goals, rehabilitation treatments, nutrition therapy and psychotherapy for different types of COVID-19, on the basis of brief describing the etiological, pathological mechanism, clinical features and medical treatment.
Compared with open surgery, laparoscopic radical resection of the body and tail pancreatic cancer is gradually being accepted due to its shorter hospital stay, reduced intraoperative blood loss, and comparable perioperative and oncological prognosis. The proposal of radical antegrade modular pancreatosplenectomy (RAMPS) has established a standardized approach for resection scope and lymph node dissection in pancreatic body and tail cancers. Studies have confirmed that RAMPS surgery can achieve a higher N1 station lymph node dissection, R0 margin ratio, and satisfactory patient survival rates. Furthermore, RAMPS has demonstrated oncological advantages in terms of postoperative local control. Laparoscopic RAMPS (LRAMPS) has been shown to be technically feasible and to yield long-term oncologic outcomes comparable to open RAMPS. An increasing number of studies have evaluated LRAMPS as the standard surgical modality for resectable body and tail pancreatic cancers. This article discusses the main points and challenges of LRAMPS surgery, and presents some personal experiences.
In order to provide more standardized guidance for the management of patients with chronic hepatitis B (CHB) in China and to achieve the World Health Organization’s goal of “eliminating viral hepatitis as public health threats by the year 2030”, the Hepatology and Infectious Diseases Societies of the Chinese Medical Association organized experts to update the guideline for the prevention and treatment of CHB, emphasizing more extensive screening for hepatitis B virus (HBV) markers in the general population and more active antiviral treatment for HBV-infected patients. This article introduced and studied the key update points of the new guideline.