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胰腺假性囊腫的外科治療

目的探討序貫式外內引流術治療胰腺假性囊腫的指征，評價不同術式治療胰腺假性囊腫的療效。方法對85例胰腺假性囊腫患者的臨床資料及隨訪結果進行分析。結果85例中，9例經非手術治愈，其余行外引流術22例，囊腫空腸/胃引流術53例（其中序貫式外內引流術24例），囊腫胃引流術后復發再次行囊腫空腸序貫式外內引流術1例。78例門診隨診6個月～5年，7例隨診2～3個月。接受非手術及內引流術或序貫式外內引流術者無復發； 行囊腫外引流術的22例中，9例痊愈，13例因胰瘺或囊腫復發行瘺道或囊腫空腸/胃引流術痊愈。結論囊腫內引流術效果優良； 胃/空腸序貫式外內引流術兼具外、內引流術的優點，療效優于外引流術而與內引流術相當。

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．

膽漏95例診治體會

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.