胆道镜结合微爆破碎石治疗复杂性胆道结石

目的:探讨微爆破碎石用于治疗复杂胆道结石的治疗体会。方法:在胆道镜直视下,分别在术中和术后对158例复杂的胆道结石患者进行微爆破碎石,然后用取石网取出碎石,泥沙状结石随液体流出或让其自行流入肠道。结果:158例患者156例取石成功。取石成功率98.73%。明显提高了胆道取石的成功率。无1例出现胆道穿孔、瘘道穿孔及胆道出血等严重并发症。结论:在胆道镜下,采用微爆破碎石术治疗复杂的胆道结石是一种安全、可靠、高效的方法,可以明显提高结石的取净率。     

胆道镜结合微爆破碎石治疗复杂性胆道结石

目的：探讨微爆破碎石用于治疗复杂胆道结石的治疗体会。方法：在胆道镜直视下,分别在术中和术后对158例复杂的胆道结石患者进行微爆破碎石,然后用取石网取出碎石,泥沙状结石随液体流出或让其自行流入肠道。结果：158例患者156例取石成功。取石成功率98.73%。明显提高了胆道取石的成功率。无1例出现胆道穿孔、瘘道穿孔及胆道出血等严重并发症。结论：在胆道镜下,采用微爆破碎石术治疗复杂的胆道结石是一种安全、可靠、高效的方法,可以明显提高结石的取净率。     

难取性胆道结石的微创治疗

目的:探讨胆道难取性结石微创治疗的方法、疗效和安全性。方法:回顾分析2005年12月至2010年11月采用腹腔镜、胆道镜、体内微爆破碎石仪联合治疗难取性胆道结石72例患者的临床资料,观察碎石成功率、结石取净率和并发症发生率。结果:碎石成功率100%,结石取净率97.2%,无胆道大出血、穿孔及胆漏等严重并发症发生。结论:腹腔镜、胆道镜、体内微爆破碎石仪可显著提高胆道难取性结石的治疗效果,安全可靠,为临床治疗胆道结石提供了更多选择。     

难取性胆道结石的微创治疗

目的：探讨胆道难取性结石微创治疗的方法、疗效和安全性。方法：回顾分析2005年12月至2010年11月采用腹腔镜、胆道镜、体内微爆破碎石仪联合治疗难取性胆道结石72例患者的临床资料,观察碎石成功率、结石取净率和并发症发生率。结果：碎石成功率100%,结石取净率97.2%,无胆道大出血、穿孔及胆漏等严重并发症发生。结论：腹腔镜、胆道镜、体内微爆破碎石仪可显著提高胆道难取性结石的治疗效果,安全可靠,为临床治疗胆道结石提供了更多选择。     

腹腔镜联合硬质胆道镜治疗复发性肝胆管结石的临床应用

目的:观察腹腔镜联合硬质胆道镜治疗复发性肝胆管结石的临床应用。方法:选取2013年1月-2014年1月期间在广州医科大学附属第一医院治疗的复发性肝胆管结石患者64例,随机分为研究组和对照组,研究组患者给予腹腔镜联合硬质胆道镜治疗,对照组患者采取开腹治疗。观察并比较两组患者的临床效果。结果:研究组患者手术出血量、手术时间、肛门排气时间、术后胆红素恢复时间、平均住院时间和抗生素应用时间均少于或短于对照组,差异均有统计学意义(均P0.05);研究组患者术后发生感染、胆漏、出血、结石残余与对照组比较差异均无统计学意义(均P0.05);研究组患者术后疼痛3例显著高于对照组的15例(P0.05)。结论:腹腔镜联合硬质胆道镜治疗复发性肝胆管结石对患者损伤小、手术过程中出血量少、结石取出率高、残留可能性小、结石复发率低、术后恢复快、并发症发生率低,其可行性和安全性高,适应范围广,值得推广应用。     

胆道镜联合腹腔镜治疗胆总管结石的疗效及预后

目的:观察胆道镜联合腹腔镜治疗胆总管结石的临床疗效以及预后情况,探讨胆道镜联合腹腔镜在胆总管结石治疗中的意义。方法:选择我院收治的胆总管结石患者共106例,根据手术方案分为两组,其中实验组共53例,采取胆道镜联合腹腔镜手术治疗;对照组共53例,给予腹腔镜手术治疗,记录两组的手术相关情况、术后并发症以及住院情况,应用统计学软件对两组数据进行分析。结果:1实验组的手术时间短于对照组,术中出血少于对照组,术后胃肠功能恢复正常时间短于对照组,差异具有统计学意义(P0.05);2实验组住院时间与住院费用均少于对照组,差异具有统计学意义(P0.05);3实验组术后并发症发生率为18.87%,显著低于对照组(35.85%),差异具有统计学意义(P0.05)。结论:胆道镜联合腹腔镜能够安全有效的治疗胆总管结石。     

腹腔镜联合胆道镜保胆取石术同期治疗胆囊结石与胆总管结石的疗效观察

目的：观察腹腔镜联合胆道镜保胆取石术同期治疗胆囊结石与胆总管结石的临床疗效。方法：随机将48例胆囊结石合并胆总管结石患者分为观察组和对照组,观察组采用腹腔镜联合胆道镜保胆取石术,对照组采用传统切开胆囊胆总管取石术。结果：观察组的手术时间（93．7±17．O）min明显小于对照组的（118．7±10．6）min,t=4．37,P=O．049〈0．05;观察组的术中出血量（91．7±27．3）mL明显小于对照组的（142．7±17．O）mL,t=-6．10,P=0．026〈0．05;观察组的肛门排气时间及住院时间明显小于对照组的,P〈0．05;观察组的切口感染率7．％明显小于对照组20．0％,x2=-7．05,P=0．008〈0．05;观察组的结石复发率3．6％明显小于对照组的15．0％,x2=-7．76,P=0．005〈0．05。结论：腹腔镜联合胆道镜保胆取石术同期治疗胆囊结石与胆总管结石的疗效良好,缩短手术时间,减少术中出血量,提高了安全可靠性,有利于患者术后康复。     

肝外胆管结石微创治疗的研究进展

肝外胆管结石是肝胆外科临床常见病,严重威胁患者健康。目前该病治疗主要以手术治疗为主,以往的手术方式主要以剖腹胆总管切开取石为主,但创伤较大,恢复较慢,后遗症较多。随着微创技术的发展,腹腔镜、胆道镜及十二指肠镜等微创治疗技术以其创伤小、恢复快等优势越来越多的被肝外胆管结石患者采用。微创治疗肝外胆管结石的方法也日趋多样化,如经消化内镜治疗,经腹腔镜治疗,腹腔镜联合消化内镜治疗及腹腔镜、胆道镜、十二指肠镜三镜联合治疗等。本文就肝外胆管结石治疗中各种微创技术的研究进展做一综述。     

多镜联合治疗胆总管结石合并胆囊结石的技术优势

目的探讨十二指肠镜、胆道镜、腹腔镜等多镜联合治疗胆总管结石合并胆囊结石的技术优势。方法采用腹腔镜胆总管探查术+腹腔镜胆囊切除术(LCBDE+LC)和内窥镜逆行胰胆管造影术+内窥镜下括约肌切开取石术+腹腔镜胆囊切除术(ERCP+EST+LC)两种术式治疗胆总管结石合并胆囊结石患者。结果有两组病例,其中LCBDE+LC组36例,本组术后胆道残余结石2例,后经T管窦道行胆道镜取石治愈。ERCP+EST+LC组54例,本组术后并发一过性高淀粉酶血症3例,发生急性轻型胰腺炎2例。结论多镜联合治疗胆总管结石合并胆囊结石具有创伤小、效果好、并发症少、恢复快的优点,多镜联合发挥出其独特技术优势,避免了因接受传统开腹手术而造成较大创伤的不合理治疗模式。     

腹腔镜联合胆道镜微创手术与开腹手术治疗胆囊结石合并胆总管 结石的疗效比较

目的:比较分析腹腔镜联合胆道镜微创手术与开腹手术治疗胆囊结石合并胆总管结石的疗效。方法:将2009年10月-2011年5月因胆囊结石合并胆总管结石行手术治疗的100例患者,分为微创手术组和开腹手术组,分析比较微创手术组与开腹手术组之间患者的手术时间、术后通气所需时间与镇痛药使用情况、住院时间与完全康复时间。结果:与开腹组相比:微创组患者的手术时间之间无明显差异;但微创组术后通气时间。住院时间与完全康复时间、镇痛药的使用率均明显短于或低于开腹组(P<0.05)。结论:对合适的患者,腹腔镜联合胆道镜微创手术入路治疗胆囊结石合并胆总管结石能够获得良好的效果,值得借鉴。     

SHA.LIN评分和S.T.O.N.E评分对经皮肾镜取石术结石清除率的预测价值比较

目的:比较SHA.LIN评分和S.T.O.N.E评分对经皮肾镜取石术结石清除率的预测价值。方法:选择我院于2016年1月-2017年12月期间行经皮肾镜取石术患者67例为研究对象,在术前对所有患者进行SHA.LIN评分和S.T.O.N.E评分。根据手术结果将患者分为结石清除组(n=49)和结石残留组(n=18),对两组患者的一般资料、SHA.LIN评分、S.T.O.N.E评分进行统计对比。采用多因素Logistic回归分析方法分析患者术后结石残留的影响因素。采用绘制ROC曲线的方法分析SHA.LIN评分和S.T.O.N.E评分对结石清除率的预测结果的敏感性和特异性。结果:67例患者术后结石清除者49例、结石残留者18例,结石清除率为73.13%。结石残留组患者手术时间、术中失血量、住院时间、结石最大截面积、最大累积截面积、结石解剖分布肾盂的发生率、受累肾盏数均高于结石清除组,穿刺通道长度低于结石清除组(P0.05)。结石清除组患者的SHA.LIN评分、S.T.O.N.E评分均低于结石残留组(P0.05)。经多因素Logistic回归分析显示,手术时间、术中失血量、SHA.LIN评分、S.T.O.N.E评分、受累肾盏数是结石残留的影响因素(P0.05)。通过绘制ROC曲线可知,SHA.LIN评分的敏感性为91.25%、特异性为89.12%、曲线下面积(AUC)为0.912(95%CI 0.869~0.948);S.T.O.N.E评分的敏感性为78.75%、特异性为84.24%、AUC为0.782(95%CI 0.690~0.871)。结论:经皮肾镜取石术患者结石清除率与SHA.LIN评分、S.T.O.N.E评分明显相关,两种评分系统均能预测患者的结石清除率,但SHA.LIN评分的敏感性、特异性高于S.T.O.N.E评分。     

输尿管镜钬激光碎石术后残留结石的危险因素分析

目的：分析与输尿管镜钬激光碎石术后致使结石残留相关的临床危险因素。方法：选取我院214例接受输尿管镜钬激光碎石术的输尿管结石患者进行回顾性分析,对14个特征性临床因素与结石残留的关系应用单因素方差分析进行评价,对存在相关性的临床因素再应用计算机COX比例风险模型进行多因素分析。结果：全组患者结石残留率为42．52％（91／214）。单因素方差分析：ESWL史、惠侧肾功能、结石位置、结石最大径、击碎后最大径、术后第1日输液量、术后第1日尿量、术后下床时间、术后解痉利尿药使用与术后结石残留相关（P值均〈0．05）;经过COX比例风险模型检测,患侧肾功能、结石位置、击碎后最大径、是结石残留的危险因素（P〈0．05）,而术后第1日尿量及术后解痉利尿药使用是结石残留的保护因素（P〈0．05）。结论：患侧肾功能不良、结石位于上段、击碎后直径仍大易导致残留结石,而术后第1天尿量较多且适当应用解痉利尿药能减少残留结石。     

Temperature trends and recent decline in body size of the stone marten Martes foina in Denmark

We studied a sample of 131 skulls of the stone marten Martes foina that were collected in Denmark between 1858 and 1999. Data were available for 37 years, but collection effort was not uniform throughout the study period and annual sample size varied between 1 and 27. We used principal component analysis (PCA) to combine the information of four skull measurements into a single variable (PC1). PC1 was then corrected for factors that significantly affected it (sex and longitude), and residual PC1 was used for further analysis in which we calculated trends in PC1 values during the study period. During the study period there was an increase in mean annual temperature in Denmark, but this increase was not continuous, as there was slight decrease in temperature between 1947 and 1965.We found that skull size (and by implication body size) of the stone marten in Denmark had two periods of decrease and these two periods coincide with the periods of increase in mean annual temperature. These results may indicate that body size of the stone marten is sensitive to the change in ambient temperature, either due to a change in food availability that was caused by the increase in temperature, or decreased its size in accordance with Bergmann's rule.     

输尿管上段嵌顿性结石两种微创钬激光碎石术临床疗效对比研究

目的:探讨应用钬激光在输尿管镜碎石术及微创经皮肾穿刺取石术处理输尿管上段嵌顿性结石的疗效和并发症的比较。方法:2009年2月～2011年6月我院182例输尿管上段嵌顿性结石患者,应用钬激光经URL治疗85例,MPCNL治疗97例,对两种方法疗效进行临床评价比较。结果:MPCNL术中一期碎石清除率为(93/97)95.88%,5例残石者残石大小0.2～0.4 mm,术后1月结石清除率为(97/97)100%,平均手术时间75±29 min,平均住院时间为12±5 d,平均住院费用14589±3284 RMB;URL术一期碎石清除率为(39/85)45.88%,46例残石者残石大小0.3～1.5 mm,需术后联合体外冲击波碎石术等治疗排石,术后1月结石清除率为(72/85)84.71%,平均手术时间102±43 min,平均住院时间为6±3 d,平均住院费用9086±1259 RMB。MPCNL术中有1例因穿刺后出血改行二期MPCNL术。URL术中输尿管扭曲、狭窄、息肉出血视野模糊不清,需改行切开取石术6例,结石移位到肾内改行MPCNL术11例。结论:对于嵌顿性输尿管上段结石,采用MPCNL和URL联合钬激光治疗各有其优缺点。MPCNL安全、高效、并发症少、创伤小、结石清除率高;URL相对具有恢复快、住院时间短、费用较低等优点,但结石移位发生率、残石率较高,需其他辅助方式治疗结石。因此输尿管上段嵌顿性结石的手术方式选择应根据结石位置、大小、梗阻程度、肾积水量、患者经济状况,术前检查结果,充分评估手术风险和难度,结合患者个体差异,术者的经验制定出最佳治疗方案。     

Association of Parathyroidectomy With 5-Year Clinically Significant Kidney Stone Events in Patients With Primary Hyperparathyroidism

ObjectivePatients with primary hyperparathyroidism (PHPT) are at increased risk of kidney stones. Guidelines recommend parathyroidectomy in patients with PHPT with a history of stone disease. This study aimed to compare the 5-year incidence of clinically significant kidney stone events in patients with PHPT treated with parathyroidectomy versus nonoperative management.MethodsWe performed a longitudinal cohort study of patients with PHPT in a national commercial insurance claims database (2006-2019). Propensity score inverse probability weighting-adjusted multivariable regression models were calculated.ResultsWe identified 7623 patients aged ≥35 years old with continuous enrollment >1 year before and >5 years after PHPT diagnosis. A total of 2933 patients (38.5%) were treated with parathyroidectomy. The cohort had a mean age of 66.5 years, 5953 (78.1%) were female, and 5520 (72.4%) were White. Over 5 years, the unadjusted incidence of ≥1 kidney stone event was higher in patients who were managed with parathyroidectomy compared with those who were managed nonoperatively overall (5.4% vs 4.1%, respectively) and among those with a history of kidney stones at PHPT diagnosis (17.9% vs 16.4%, respectively). On multivariable analysis, parathyroidectomy was associated with no statistically significant difference in the odds of a 5-year kidney stone event among patients with a history of kidney stones (odds ratio, 1.03; 95% CI, 0.71-1.50) or those without a history of kidney stones (odds ratio, 1.16; 95% CI, 0.84-1.60).ConclusionBased on this claim analysis, there was no difference in the odds of 5-year kidney stone events in patients with PHPT who were treated with parathyroidectomy versus nonoperative management. Time horizon for benefit should be considered when making treatment decisions for PHPT based on the risk of kidney stone events.     

Brain Galactolipid Content in a Patient with Pseudo-Arylsulfatase A Deficiency and Coincidental Diffuse Disseminated Sclerosis, and in Patients with Metachromatic, Adreno-, and Other Leukodystrophies

A 4-year old boy died of diffuse disseminated sclerosis (DDS) of the brain and was found to have also pseudoarylsulfatase A deficiency (PASAD) with about 20% residual arylsulfatase A (ASA) and cerebroside sulfatase (CS) activity. The reexamination of lipids did not show any sulfatide accumulation in the patient's organ extracts. Although the residual CS activity in the patient's extracts was clearly demonstrable only after partial purification, it was concluded that this activity protects organ tissues from sulfatide accumulation in PASAD, since in sulfatide lipidosis (metachromatic leukodystrophy, MLD) no residual CS activity was detectable. The study of residual ASA activity in the patient's fibroblasts by gel electrofocusing resulted in an almost normal enzyme microheterogeneity. However, the detailed study of the brain galactolipids in the patient revealed an elevated ratio of sulfatide/galactocerebroside content, despite the decrease of both lipids. In tissues of other patients with severe demyelinating diseases different from DDS and MLD, this galactolipid ratio was also found to be increased, especially in three patients with adrenoleukodystrophy. A general mechanism of this anomaly in severe demyelination is considered.     

热处理对水洞沟遗址石器原料力学性能的影响

宁夏水洞沟遗址的发现首次证实了旧石器时代东亚古人类的热处理行为。本文通过压缩实验和XRD(X射线衍射)检测,对宁夏水洞沟遗址区采集的白云岩石料热处理前后的力学性能进行了定量研究。结果表明,经过450℃热处理的白云岩石料材质更加均匀,硅质含量减小、钙质含量增加,抗压强度下降31%,最大应变提高27%,在应力-应变曲线上出现了明显的锯齿状波动现象。这些变化降低了打击石料所需的力度,使石料易于产生多次开裂,不容易发生一次性灾变破坏,为古人类调整打击点、打击方向和力度创造了机会,从而降低了打制难度,提高了石器的制作质量和效率。     

Periosteal biaxial residual strains correlate with bone specific growth rates in chick embryos

It has been proposed that periosteal residual tensile strains influence periosteal bone apposition and endochondral ossification. The role of bone growth rates on the development of residual strains is not well known. This study examined the relationships between specific growth rate and residual strains in chick tibiotarsi. We measured length and circumference during embryonic days 11-20 using microCT. Bones grew faster in length, with longitudinal and circumferential specific growth rates decreasing from 17 to 9% and 14 to 8% per day, respectively. To calculate residual strains, opening dimensions of incisions through the periosteum were analysed using finite element techniques. Results indicate that Poisson's ratio for an isotropic material model is between 0 and 0.04. For the model with Poisson's ratio 0.03, longitudinal and circumferential residual strains decreased from 46.2 to 29.3% and 10.6 to 3.9%, respectively, during embryonic days 14-20. Specific growth rates and residual strains were positively correlated (p<0.05).     

Lipase activity of resting cells of Aspergillus flavus after solvent washing; memory effects from endogenous substrate arising from the original growth medium

Aspergillus flavusresting cells were washed with solvents of different polarity for 2, 6, and 24 h and then suspended in isooctane containing either oleic acid and 1-propanol or 1-propanol alone. Propyl oleate and propyl linoleate were produced in all experiments after 24 h due to the presence of residual fatty acids originating from the sunflower oil used for growing the mycelium. After 24 h washing, most solvents produced a 70 to 90% decrease in lipase activity and a 0 to 99% decrease in the amount of residual acids. 0.7 M 1-propanol in hexane was the best washing solvent among all those assayed (93% remaining activity, 0.3% residual oleic acid).