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胰腺假性囊肿的外科治疗

目的探讨序贯式外内引流术治疗胰腺假性囊肿的指征，评价不同术式治疗胰腺假性囊肿的疗效。方法对85例胰腺假性囊肿患者的临床资料及随访结果进行分析。结果85例中，9例经非手术治愈，其余行外引流术22例，囊肿空肠/胃引流术53例（其中序贯式外内引流术24例），囊肿胃引流术后复发再次行囊肿空肠序贯式外内引流术1例。78例门诊随诊6个月～5年，7例随诊2～3个月。接受非手术及内引流术或序贯式外内引流术者无复发； 行囊肿外引流术的22例中，9例痊愈，13例因胰瘘或囊肿复发行瘘道或囊肿空肠/胃引流术痊愈。结论囊肿内引流术效果优良； 胃/空肠序贯式外内引流术兼具外、内引流术的优点，疗效优于外引流术而与内引流术相当。

胆漏95例诊治体会

Ａ　ＳＥＲＯＥＰＩＤＥＭＩＯＬＯＧＩＣＡＬ　ＳＵＲＶＥY　ＯＮ　ＨＥＰＡＴＩＴＩＳ　Ｂ　ＶＩＲＵＳ　ＩＮＦＥＣＴＩＯＮ　ＰＡＴＩＥＮＴ　ＩＮ　ＧＥＮＥＲＡＬ　ＳＵＲＧＲＹ　(ＣＬＩＮＩＣＡＬ　ＡＮＡＬＹＳＩＳ　ＯＦ ５２９７　ＣＡＳＥＳ）

Ｆｒｏｍ　１９９０　ｔｏ　１９９３，　ｗｅ　ｃａｒｒｉｅｄ　ｏｎ　ａ　ｓｅｒｏｅｐｉｄｅｍｉｏｌｏｇｉｃａｌ　ｓｕｒｖｅｙ　ｏｎ　ｈｅｐａｔｉｔｉｓ　Ｂ　ｖｉｒｕｓ　（ＨＢＶ）　ｉｎｆｅｃｔｉｏｎ　ｏｆ　５２９７　ｇｅｎｅｒａｌ　ｓｕｒｇｉｃａｌ　ｐａｔｉｅｎｔｓ．　Ｔｈｅ　ｒｅｓｕｌｔｓ　ｓｈｏｗｅｄ　ｔｈａｔ　ｔｈｅ　ｐｏｓｉｔｉｖｅ　ｒａｔｅｓ　ｏｆ　ＨＢｓＡｇ，　ａｎｔｉＨＢｓ　ａｎｄ ａｎｔｉＨＢｃ　ｗｅｒｅ　１９．４％　、３５．９％ ａｎｄ　４１．１％ｒｅｓｐｅｃｔｉｖｅｌｙ，　ａｎｄ　ｔｈｅ　ｏｖｅｒａｌｌ　ｒａｔｅ　ｏｆ　ＨＢＶ　ｉｎｆｅｃｔｉｏｎ　ｗａｓ　７０．５％，　ｗｈｉｃｈ　ｗａｓ　ｍｕｃｈ　ｈｉｇｈｅｒ　ｔｈａｎ　ｔｈａｔ　ｏｆ　ｔｈｅ　ｇｅｎｅｒａｌ　ｐｏｐｕｌａｔｉｏｎ．　Ｉｎ　ｐａｔｉｅｎｔｓ　ｗｉｔｈ　ｈｅｐａｔｏｂｉｌｉａｒｙ　ｏｒ　ｐａｎｃｒｅａｔｉｃ　ｄｉｓｅａｓｅｓ，　ｔｈｅ　ＨＢｓＡｇ，　ａｎｔｉＨＢｃ　ａｎｄ　ｔｈｅ　ｏｖｅｒａｌｌ　ｒａｔｅ　ｏｆ　ＨＢＶ　ｉｎｆｅｃｔｉｏｎ　ｗｅｒｅ　３４．２％、５６．１％、８０．３％ｒｅｓｐｅｃｔｉｖｅｌｙ，　ｗｈｉｃｈ　ｗｅｒｅ　ｈｉｇｈｅｒ　ｔｈａｎ　ｔｈｏｓｅ　ｏｆ　ｏｔｈｅｒ　ｇｅｎｅｒａｌ　ｓｕｒｇｉｃａｌ　ｐａｔｉｅｎｔｓ．

The Effects of Apoptosis and Proliferation on Choledochal Cyst

ObjectiveTo observe apoptosis and proliferation of choledochus wall epithelial cell and fibrocyte, to understand the effects of apoptosis and proliferation on choledochal cyst development.MethodsThirty two cases of cystic dilatation,35 cases of cylindrical dilatation，and 25 cases of cholangiectasis caused by choledocholith were collected. All specimens were offered by department of hepatobiliarypediatric surgery. The apoptosis related index (bcl2 and bax) and cell proliferation index (PCNA) were detected by the immunohistochemical technique; Apoptosis was detected by TUNEL method. ResultsThere was serious mucosal epithelial cell damage in cystic dilatation group. In cylindrical dilatation group there was a damage similar to that of the cystis dilatation group, but the damage was not serious. In control group there was little damage in the duct wall, but there was a low positive rate of apoptosis of 〔epithelium cell (2.74±1.00)% and fibroblast (2.95±0.87）%〕, and a low bcl2 and bax’s expression rate, and a high PCNA’s expression rate 〔epithelium cell (3.74±1.00)%, fibroblast (3.71±1.77)%〕. There was no obvious difference between cylindrical dilatation group and cystic dilatation group (Pgt;0.05): the PCNA’s expression rate was low 〔(0.99±0.51)% and (0.90±0.38)% respectively〕, the bax expression rate was high in remaining epithelial cell, and the positive rate of bax was apparently higher than that of bcl2 (P＜0.05), the positive rate of the apoptosis cell was high 〔(13.94±4.77)%, (7.51±3.46)%〕; the expression rate PCNA were high 〔(9.91±2.91)%,(9.70±3.18)%〕, and expression rate of bax’s was low in the fibre tissue, the positive rate of bcl2 was markedly higher than that of bax, and the positive rate of the apoptosis cell was low 〔(3.74±2.12)%,(4.46±2.41)%〕. There were no marked difference between the two groups (Pgt;0.05). The expression of bcl2 and bax had marked difference both in cylindrical dilatation group and cystic dilatation group and as compared to control group (P＜0.05). ConclusionApoptosis has certain promoting effect in the course of choledochal cyst formation.