目的:总结疝环充填式无张力疝修补术治疗腹股沟疝的临床疗效。方法:对我院1999年4月至2008年8月采用疝环充填式无张力疝修补术治疗569例腹股沟疝患者的临床资料进行回顾性分析,对手术时间、伤口疼痛、术后自主能力的恢复、住院时间、并发症及复发率等进行观察。结果:与传统疝修补手术相比,具有方法简便,术后疼痛轻,恢复快, 住院时间短,并发症少,复发率低和更宽的手术指征等优点。结论:疝环充填式无张力疝修补术是一种治疗腹股沟疝的理想手术方法。
Objective To investigate the effect of laparoscopy combined with choledochoscopy on common bile duct (CBD) stones with primary suture of the CBD. Methods Totally 523 patients of gallbladder stone companied with CBD stones or choledochectasia (diameter ≥0.8 cm) from September 1998 to December 2008 were retrospectively analyzed. Results The primary suture of the CBD incision was successfully performed in 487 patients. The CBD stones were completely removed during the operation in 400 patients. Nothing was found in 87 cases. In 10 cases conversion to open surgery were performed and in 26 cases the T tube drainage was put into the CBD in choledocholithotomy. Average operative time was 90 min and average bleeding volume was 50 ml. All patients took food at 24 h, returned general activity on 2-3 d and discharged on 5 d after operation. Postoperative biliary leakage occurred in 29 cases with drainage average volume of 35 ml/d and continued 1-6 d, which were cured by non-operation therapy. Conclusions The primary suture of the CBD during the laparosocopy combined with choledochosopy in choledocholithotomy is a safe and effective operation with less invasion, less pain and quicker recovery. CBD incision suture without T tube drainage can be done when CBD stones are cleared completely and no stenosis is found in extrahepatic bile duct.
目的 总结纤维胆道镜对胆道术后残留结石的治疗作用。方法 应用纤维胆道镜治疗胆道术后残留结石108例。结果取石成功率96.9%，结石取净率80.5%。结论 纤维胆道镜对解决胆道术后残留结石有其重要作用，并可降低再手术率。
目的 探讨腹腔镜胆囊切除术(LC)同时同孔完成多脏器手术可能性及手术方法。方法 总结1993年3月至1999年4月完成LC 2 170例，其中LC同时同孔完成多脏器手术51例。结果 该51例手术全部成功，无1例术中中转开腹，除1例患者LC同时同孔行绝育手术后怀孕，其余无术中及术后并发症发生。结论 LC同时同孔完成多脏器手术实现了跨区域、多脏器同期手术，虽创伤范围增多，操作有一定的难度，仍具有微创外科的特点。一次完成多种手术，不明显增加患者的痛苦及费用，避免了患者在一种疾病治愈后再次住院手术治疗另一种疾病。
ObjectiveTo investigate the impact of clopidogrel resistance on the long-term prognosis in the elderly with acute coronary syndrome (ACS), as clopidogrel is widely used for secondary prevention in the patients with ACS, while studies on the relationship between clopidogrel resistance and long-term outcome in the elderly with ACS are limited. MethodsThree hundred elderly patients with ACS, aged from 70 to 95, with on average age of (81.3±6.4) years old, receiving clopidogrel (75 mg, once a day) over one month between January 2009 and December 2010 were followed up for major adverse cardiac events (MACE, including cardiac death, non-fatal re-myocardial infarction, angina, ischemia stroke/TIA, acute thrombosis and hemorrhage). Platelet aggregation was measured by light transmission aggregometry using adenosine diphosphate as a stimulus. According to the variation of platelet aggregation, the patients were divided into clopidogrel resistance group (<10%) and non-lopidogrel resistance group (≥10%). The median follow-up was 2 years. A Cox hazard proportional model was used to estimate time to outcome associated with clopidogrel resistance and MACE. ResultsThe incidence of clopidogrel resistance was 24.0% in our study population. Patients with diabetes, renal insufficiency, or a higher body mass index tended to have clopidogrel resistance. Compared with those patients without clopidogrel resistance, there was significantly increased MACE in patients with clopidogrel resistance (37.5%, 22.8%; P=0.032). Additionally, Cox hazard proportional model analysis demonstrated that clopidogrel resistance was an independently risk factor for MACE[HR=2.34, 95% CI (1.07, 4.57), P=0.016]. ConclusionDiabetes, renal insufficiency and high body max index are associated with clopidogrel resistance, which can predict the increased risk of MACE in elderly patients with ACS.