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find Author "马炳强" 4 results
  • 毒死蜱中毒致胃瘢痕挛缩行全胃切除术1例报道

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  • Application of Routine or Selective Intraoperative Cholangiography in Laparoscopic Cholecystectomy

    Objective To explore whether the intraoperative cholangiography (IOC) should be applied in laparoscopic cholecystectomy routinely or selectively. Methods Data of routine IOC group (1 520 patients)and selective IOC group (457 patients)in laparoscopic cholecystectomy were collected and analyzed, including cholangiography time, success rate, common bile duct stones rate, open cholecystectomy rate, and hospital stay after operation. All IOC cases were performed by home-made cholangiography appliance or infusion needle. Results There were no significant differences between routine IOC group and selective IOC group on cholangiography time, success rate, open cholecystectomy rate, and hospital stay after operation (P>0.05). However, compared with routine IOC group, the common bile duct stones rate, anatomic variation rate, and iatrogenic damage rate were significantly higher in selective IOC group (28.25% vs. 13.43%, 10.71% vs. 7.43%, 2.05% vs. 1.02%, P<0.05). Conclusions For avoiding iatrogenic bile duct damage and residual stones, routine IOC should be applied in early-stage of laparoscopic cholecystectomy, and IOC should be applied selectively when the surgeon have LC technique at their finger ends.

    Release date:2016-09-08 10:36 Export PDF Favorites Scan
  • 肠内和(或)肠外营养支持方式对胆管癌 患者术后免疫功能的影响

    目的 探讨肠内营养(EN)和(或)肠外营养(PN)支持方式对胆管癌患者术后免疫功能的影响。 方法 将 2014 年 11 月至 2017 年 6 月期间来甘肃省人民医院普外科就诊的胆管癌患者按照纳入标准及剔除标准进行筛选并纳入研究,所有纳入研究的患者采用随机数字表法分为 PN+EN 联合治疗组(简称 PN+EN 组,n=26)及 PN 组(n=30)2 组。纳入研究的患者手术后使用以代谢支持为基础的营养支持方式,于术前第 1 天(以下简称术前)、术后第 1、3 及 7 天时检测 2 组患者的免疫功能(包括 CD3+、CD4+、CD8+、CD4+/CD8+、IgM、IgG、IgA)并进行比较。 结果 ① 2 组患者的术前基线资料以及手术方式、手术时间、术中出血量及术后第 1 天 NRS 评分比较差异均无统计学意义(P>0.05)。② 2 组患者细胞免疫指标比较:在 PN+EN 组,与术前比较,CD3+、CD4+ 和 CD4+/CD8+ 均于术后第 1 天下降(P<0.05),从第 3 天开始上升,至第 7 天时均高于术前(P<0.05)。而在 PN 组,术后第 3 天时,CD3+ 和 CD8+ 继续下降,至第 7 天时上升,但仍低于术前(P<0.05); CD4+和CD4+/CD8+ 第 3 天时开始上升,至第 7 天时仍低于术前(P<0.05)。2 组患者术前及术后第 1 天的 CD3+、CD4+、CD8+ 和 CD4+/CD8+ 比较差异均无统计学意义(P>0.05),术后第 3 天和术后第 7 天时 PN+EN 组患者的 CD3+、CD4+、CD8+及CD4+/CD8+ 均明显高于 PN 组(P<0.05)。③ 2 组患者体液免疫指标比较:在 PN+EN 组,与术前比较,从术后第 1 天开始 IgG、IgA 和 IgM 下降(P<0.05),从第 3 天开始上升,至第 7 天时均高于术前(P<0.05);在 PN 组,与术前比较,从术后第 1 天开始持续下降(P<0.05),至第 7 天时 IgA 和 IgM 略有升高,但仍低于术前(P<0.05)。2 组患者术前及术后第 1 天的 IgG、IgM 和 IgA 比较差异均无统计学意义(P>0.05),术后第 3 天和术后第 7 天时 PN+EN 组患者的 IgG、IgM 和 IgA 均明显高于 PN 组(P<0.05)。 结论 胆管癌患者术后实施 EN 和 PN 联合支持治疗较单独实施 PN 更有助于患者免疫功能的恢复。

    Release date:2018-06-15 10:49 Export PDF Favorites Scan
  • Repair of invading inferior vena cava with round ligament of liver for treatment of intrahepatic cholangiocarcinoma: a case of MDT discussion

    Objective To summarize the multi disciplinary team (MDT) discussion in the treatment of intrahepatic cholangiocarcinoma (ICC) involving inferior vena cava (IVC). Method The clinical data of a difficult ICC patient diagnosed and treated in Gansu Provincial Hospital in September 2020 were analyzed retrospectively, and the clinical features, diagnosis, treatment decision and prognosis of ICC were summarized. Results The patient was initially diagnosed as liver malignant tumor, which invaded the right adrenal gland and inferior vena cava. After MDT discussion, the patient decided to undergo surgical treatment, and successfully underwent radical resection of liver tumor combined with right adrenal gland and partial inferior vena cava and vascular reconstruction. The operation lasted 300 minutes, and the intraoperative bleeding was about 600 mL. The results of postoperative pathological examination indicated that it conformed to ICC, and carcinomatous tissues involvement could be seen in inferior vena cava and adrenal gland. The patient had no complication after operation and was discharged from hospital at 2 weeks after operation. The patient had been followed up for half a year and had been regularly treated with gemcitabine combined with platinum for 6 phases. No tumor recurrence or metastasis had been found. Conclusions The onset of ICC is concealed and its invasiveness is strong. The preliminary diagnosis can be determined by imaging examination combined with detection of tumor markers. Radical surgery is the main treatment. After MDT discussion, the formulation of a comprehensive treatment plan, including surgical strategy, local treatment and systemic treatment, can improve the prognosis and prolong the survival time of patients.

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