【摘要】 目的 探討腹腔鏡膽總管探查一期縫合的可行性和適應證及臨床價值。 方法 回顧性分析2007年7月—2010年10月72例膽管結石患者的臨床資料，采用三孔法腹腔鏡膽總管探查術，術中膽道鏡配合膽道手術器械取石，一期縫合膽總管進行治療。 結果 72例手術均獲成功，無中轉開腹，4例出現術后膽漏，經腹腔引流3~5 d治愈，無嚴重并發癥。術后住院4~7 d（平均4.4 d）。72例均獲隨訪，隨訪時間1~24個月（平均10個月）。術后1個月B型超聲，未發現膽道狹窄及殘余結石。 結論 腹腔鏡膽總管探查術后一期縫合膽總管，安全、有效、微創效果顯著，是臨床微創治療膽囊結石合并膽管結石的一種理想術式，值得臨床推廣應用。其關鍵是術中取盡結石和把握適應證，同時需要術者熟練掌握膽道鏡技術及腹腔鏡下膽總管切開縫合、打結等技術。【Abstract】 Objective To discuss the feasibility, indications and clinical value of laparoscopic common bile duct exploration with primary suture. Methods We analyzed the clinical data of 72 patients with biliary duct stone treated from July 2007 to October 2010. Three-port laparoscopic common bile duct exploration with primary suture was adopted; choledochoscopy and open bile duct operation instruments were used to take out the stones during the operation; and the common bile duct was treated with primary suture after operation. Results All operations were carried out successfully without any case of conversion to open operation. Bile leakage occurred in four cases and was cured with abdominal drainage tube for three to five days without any severe complications. Postoperative hospitalization time ranged from four to seven days, averaging at 4.4 days. All patients were followed up for one to 24 months (averaging at 10 months). B-mode ultrasonography examination one month after operation showed no biliary tract stricture or residual stone. Conclusions Laparoscopic common bile duct exploration with primary suture is safe, reliable, minimally invasive, more effective, and can be regarded as an ideal operative method for the treatment of cholecystolithiasis combined with biliary duct stone in clinical practices. It is worth popularizing. The key elements for a successful operation lie in completely taking out the stones and having a sound knowledge of indications. Furthermore, surgeons should master the skills in choledochoscopy techniques, laparoscopic incision, suture and ligation.
ObjectiveTo observe the influence of three postoperative analgesia methods on the survival rate of replanted finger by flat digital subtraction angiography (DSA) medical imaging detection system.
MethodFrom July 2014 to July 2015, 342 patients were classified into gradeⅠ and gradeⅡ replantation in accordance with their physical condition and they were randomly divided into routine oral group, muscle injection group and analgesia group with 144 patients in each. Flat DSA was used to dynamically observe replantation after revascularization. Then we compared the three different analgesia methods in terms of psychological status of the patients, incidence of vascular crisis, occlusion rate, survival rate of replanted fingers. The function score of replanted fingers was evaluated for clinical efficacy.
ResultsCompared with the conventional oral group and muscle injection group, the incidence of vascular crisis in replanted fingers and thrombosis rate were significantly lower in the analgesia group which had a replanted finger survival rate of 96.69% and a normal mental condition rate of 78.07%. Six months after surgery, the rate of excellent and good follow-up was significantly higher than the conventional oral group and muscle injection group (P<0.017) .
ConclusionsThe 3-D technology of flat DSA can provide clear and reliable pictures of vessel revascularization status for replanted fingers. The use of continuous brachial plexus analgesia performs better than other methods of analgesia. Good analgesia can stabilize patients' anxiety and negative emotions, which is helpful to avoid excessive fluctuations in blood pressure induced by small artery spasm caused by blood clots and vascular crisis, thereby increasing the survival rate of replanted fingers and facilitating early rehabilitation of their function.
Objective
To establish a safe, effective, and economic feeder-free culture system which is suitable for the culture of human parthenogenetic embryonic stem cells (hPESCs) in vitro.
Methods
hPESCs were cultured with mTeSRTMl medium (control group) and human foreskin fibroblasts-conditional medium (hFFs-CM) (experimental group). The growth status of hPESCs in both feeder-free culture systems were observed with inverted microscope. Alkaline phosphatase (ALP) analysis and karyotype analysis were used to study the biological characteristics of hPESCs. The expression of hPESCs pluripotent marker Oct-4 was analyzed by RT-PCR. Differentiation experiment in vivo and in vitro was applied to observe the differentiation potential of hPESCs into three germ layers.
Results
hPESCs had regular morphology with difficulty in differentiation in both culture systems. No obvious difference was observed in morphology and expansion speed of hPESCs between 2 groups. After subcultured for 15 passages in vitro, hPESCs in 2 groups could maintain normal female diploid karyotype 46, XX and pluripotency. The expression of Oct-4 mRNA was positive in 2 groups. hPESCs in 2 groups could form embryonic body in differentiation experiment in vitro and could develop into teratomas containing three germ layers in nude mice.
Conclusion
Feeder-free culture system of hFFs-CM can sustain the growth of hPESCs and keep hPESCs undifferentiated state for long. A feeder-free culture system of hPESCs is successfully established, which can support the growth of hPESCs, reduce the contamination from animals, decrease the cost of culture, and satisfy the clinical large-scale application.
Objective To investigate the effect of ultrasound-guided intra-articular injection of shoulder joint combined with hydraulic dilatation in the treatment of frozen shoulder in different clinical stage. Methods The clinical data of patients with frozen shoulder diagnosed in Zigong Fourth People’s Hospital from January 2020 to January 2021 were collected retrospectively. The patients were divided into three groups according to the clinical stage of frozen shoulder (stage Ⅰ, stage Ⅱ and stage Ⅲ). All patients volunteered to receive ultrasound-guided intra-articular injection of shoulder joint combined with hydraulic dilatation for 3 consecutive times, with a 2-week interval for each treatment, and followed up for 6 months. Before treatment and 2 weeks, 4 weeks, 2 months, 4 months and 6 months after treatment, the patients were scored with Visual Analog Scale (VAS) and Active Range of Shoulder Motion (AROM), and the capsule thickness of shoulder were measured, respectively. Results A total of 150 patients were included, including 61 patients in stage Ⅰ, 74 patients in stage Ⅱ and 15 patients in stage Ⅲ. The thickness of shoulder joint capsule on the affected side was thicker than that on the healthy side (t=24.384, P<0.001). After treatment, the thickness of shoulder joint capsule and VAS score decreased (P<0.05), and the AROM score increased (P<0.05). Before treatment, the thickness of shoulder joint capsule in stageⅡpatients was higher than that in stageⅠand Ⅲ patients [(4.3±1.0) vs. (2.9±0.5) vs. (3.1±0.4) mm; F=57.195, P<0.001]. Four weeks, 2 months, 4 months and 6 months after treatment, the decrease of shoulder joint capsule thickness was the largest in stageⅡpatients (P<0.05). Compared with stageⅡand Ⅲ patients, stageⅠpatients had the highest VAS score before treatment (7.7±0.7 vs. 5.1±0.8 vs. 4.5±0.7; F=233.560, P<0.001). There was no significant difference in VAS scores among the three groups 4 weeks (F=1.679, P=0.190), 4 months (F=1.348, P=0.263) or 6 months (F= 0.940, P=0.393) after treatment, while there were significant differences in VAS scores among the three groups 2 weeks (F=66.924, P<0.001) and 2 months (F=9.598, P<0.001) after treatment. Compared with stageⅠand Ⅲ patients, stageⅡpatients had the lowest AROM score before treatment (15.2±1.8 vs. 23.5±1.9 vs. 26.1±3.5; F=343.718, P<0.001). Four weeks (F=0.034, P=0.967), 2 months (F=0.222, P=0.801), 4 months (F=0.634, P=0.532) or 6 months (F=0.001, P=0.999) after treatment, there was no significant difference in AROM scores among the three groups, while there was significant difference in AROM scores among the three groups 2 weeks after treatment (F=177.135, P<0.001).Conclusions Ultrasound-guided intra-articular injection of shoulder joint combined with hydraulic dilation has good efficacy in the treatment of frozen shoulder in different clinical stage. Early injection treatment can shorten the course of the disease and relieve the pain of patients during the course of the disease.
Since smart phones have been developed, significant advances in the function of mobile phone due to the development of software, hardware and accessories have been reached. Till now, smart phones have been engaged in daily life with an increasing impact. As a new medical model, mobile phone medicine is emerging and has found widespread applications in medicine, especially in diagnosing, monitoring and screening various diseases. In addition, mobile phone medical application shows great potential trend to improve healthcare in resource-limited regions due to its advantageous features of portability and information communication capability. Nowadays, the scientific and technological issues related to mobile phone medicine have attracted worldwide attention. In this review, we summarize state-of-the-art advances of mobile phone medicine with focus on its diagnostics applications in order to expand the fields of their applications and promote healthcare informatization.
