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變異性通氣的原理與應用價值

Choledochoscopic Balloon Dilatation for Treatment of Postoperative Stricture of Intra- and Extra-Hepatic Bile Duct

目的 探討膽道術后肝內、外膽管狹窄的治療方法。方法 回顧性分析吉林大學第一醫院自2003年1月至2007年12月期間應用膽道鏡對37例膽道術后肝內、外膽管狹窄患者行氣囊擴張治療的結果。結果 本組37例患者42處肝內、外膽管狹窄均行膽道鏡下氣囊導管擴張，29例（78.4%）系膽管狹窄伴肝內膽管結石，經氣囊擴張后，膽道鏡通過狹窄部位，取凈遠端膽管結石； 另8例（21.6%）系單純膽管狹窄無結石,僅行導管擴張。本組成功率達97.3%（36/37）； 1例因膽汁性肝硬變伴彌漫性膽管狹窄擴張失敗后行肝葉切除手術。27例狹窄僅需一次性擴張,9例因膽管多處嚴重狹窄而行多次擴張。全部患者均獲隨訪，隨訪時間6~24個月,平均12個月，未見結石復發。結論 膽道鏡下氣囊導管擴張治療膽管狹窄微創、直觀、安全、簡便易行且療效可靠,是治療膽管狹窄并取凈結石的理想方法。但需注意操作方法及技巧，防止并發癥的發生。

Laparoscopic Resection of Splenomegaly for Hereditary Spherocytosis (Report of 18 Cases)

目的 探討腹腔鏡脾切除術治療遺傳性球形紅細胞增多癥的可行性、手術技巧及效果評價。方法 收集我科2006年1月至2008年1月收治的行腹腔鏡脾切除術治療的遺傳性球形紅細胞增多癥患者18例的臨床資料進行回顧性分析。結果 所有患者均順利完成腹腔鏡脾切除術。術中出血50～600 ml，平均200 ml。手術時間50～150 min，平均136 min（包括膽囊切除時間）。術后住院時間5～10 d，平均7.8 d,所有患者住院期間無暴發感染、胰漏等并發癥發生。術后隨訪4～12個月，平均6.7個月，術前癥狀完全消失。結論 腹腔鏡脾切除術是治療遺傳性球形紅細胞增多癥的一種安全有效的方法。

Experience of Laparoscopic Cholecystectomy in Treatment of 30 Cases of Gallbladder Disease Combined with Cirrhosis

目的 總結肝硬變狀態下腹腔鏡膽囊切除術（LC）治療膽囊疾病的經驗。方法 回顧性分析30例肝硬變合并膽囊疾病患者行LC的臨床資料。結果 30例患者中肝功能Child-Pugh A級8例，B級11例，C級11例。LC術后6例(20.0%)發生并發癥，其中Child-Pugh B級2例,C級4例。治愈29例（96.7%）； 死亡1例(3.3%)，死亡者為Child-Pugh C級。結論 存在肝硬變時,肝功能Child-Pugh A及B級者行LC比較安全,C級風險較大,應列為手術禁忌。

Effect of sleeve gastrectomy-transit bipartition on diabetic rat with obesity and change of terminal esophageal mucosa

ObjectiveTo investigate effects of sleeve gastrectomy (SG)-transit bipartition (SG-TB) and simple SG on bariatric and anti-diabetic and protective effect on esophagus reflux. MethodsA total of 36 male Sprague-Dawley rats were used to successfully induce the obesity with type 2 diabetes mellitus (T2DM) model by dietary feeding and receiving intraperitoneal injection of streptozotocin (35 mg/kg), then were randomly averagely divided into SG, SG-TB, and sham operation (SO) groups according to the surgical methods, and 8 rats from each procedure were randomly selected and included to use for experimental observation. The observation period was 12 weeks. The changes of terminal esophageal mucosa were observed at the 12th week after operation. The body weight and food intake were measured every 2 weeks after operation. The fasting blood glucose (FBG), oral glucose tolerance test (OGTT) and insulin tolerance test (ITT) blood glucose levels were measured before operation and at the 4th and 12th week after operation. And the changes of glucagon like peptide-1 (GLP-1) and insulin levels were measured before operation and at the 12th week after operation. ResultsThere were no significant differences in all indexes among the 3 groups before operation (P>0.05). ① No esophageal papillomatosis was observed in the SG-TB group at the 12th week after operation, but more severe esophageal papillomatosis was observed in the SG group, and the mucosal height in the SG-TB group was lower than that in the SG group (P<0.05). ② From the 4th week after operation, the body weight and food intake of the SG-TB group and SG group were lower than the SO group (P<0.05), and their changes of these two groups over time were generally stable. While no significant difference was found in the reduction of body weight between the SG-TB group and the SG group (P>0.05), however the food intakes of the SG-TB group were higher than the SG group at the 10th and 12th week after operation (P<0.05). ③ The levels of FBG, OGTT and ITT blood glucoses in the SG-TB group and SG group were lower than in the SO group at the 4th and 12th week after operation (P<0.05) and remained stable after operation. However, no significant difference was found in the FBG and ITT blood glucose level between the SG-TB group and the SG group (P>0.05), while the level of OGTT blood glucose in the SG-TB group was lower than that in the SG group at the 12th week after operation (P<0.05). ④ The levels of GLP-1 in the SG-TB group and SG group were higher than in the SO group and still higher than before operation (P<0.05), while the insulin levels were lower than in the SO group and lower than before operation (P<0.05). ConclusionsFrom preliminary results of this study, change of terminal esophageal mucosa after SG-TB is weaker than that of SG operation, and it is found that SG-TB surgery shows a better trend in blood glucose control as compared with SG operation. However, due to the limitations of sample size, further research and anti-reflux effect of SG-TB operation still need to be verified.

The relationship between cadmium and childhood autism: a meta-analysis

ObjectiveTo systematically review the relationship between cadmium (Cd) and childhood autism.MethodsPubMed, EMbase, Web of Science, The Cochrane Library, CNKI, VIP, WanFang Data and CBM were electronically searched to collect case-control studies on the relationship between Cd and childhood autism from inception to July 2019. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 8 case-control studies were included. The results of meta-analysis showed that whether the specimen was from whole blood, urine or hair, there were no correlations between Cd and childhood autism (MDblood=0.17, 95% CI ?0.06 to 0.39, P=0.15; MDurine=?0.43, 95%CI ?1.44 to 0.58, P=0.4; MDhair=?0.08, 95%CI ?0.52 to 0.36, P=0.72).ConclusionsCurrent evidence shows that Cd concentration is not correlated with autism in children. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.