急性胆囊炎是常见的急腹症之一。近年来,随着微创技术的进步和外科医师腹腔镜水平的提升,腹腔镜下胆囊切除术已成为治疗急性胆囊炎的金标准,因其创伤小、操作简单、术后恢复快而备受推崇。但对于高龄、合并严重基础疾病的高危患者而言,...急性胆囊炎是常见的急腹症之一。近年来,随着微创技术的进步和外科医师腹腔镜水平的提升,腹腔镜下胆囊切除术已成为治疗急性胆囊炎的金标准,因其创伤小、操作简单、术后恢复快而备受推崇。但对于高龄、合并严重基础疾病的高危患者而言,急诊行LC存在着较高的手术风险。超声引导下经皮经肝胆囊穿刺引流术能够有效减轻胆囊压力、迅速缓解感染症状,目前已逐渐成为有手术禁忌的患者首选的治疗措施。本文对PTGBD的现状和问题进行综述,并对其未来前景进行讨论。Acute cholecystitis is one of the common acute abdominal diseases. In recent years, with the advancement of minimally invasive technology and the improvement of surgeons’ laparoscopic level, laparoscopic cholecystectomy has become the gold standard for the treatment of acute cholecystitis, which is highly respected because of its small trauma, simple operation, and fast postoperative recovery. However, for high-risk patients of advanced age and combined with severe underlying diseases, there is a high surgical risk of performing LC in emergency. Ultrasound-guided percutaneous transhepatic gallbladder puncture and drainage (PTGBD) can effectively reduce gallbladder pressure and rapidly alleviate the symptoms of infection, and has gradually become the preferred therapeutic measure for patients with contraindications to surgery. This article reviews the current status and problems of PTGBD and discusses its future prospects.展开更多
急性胆囊炎是普外科急腹症中的常见疾病,腹腔镜胆囊切除术(LC)是其主要治疗方法。然而,围术期感染仍然是术后并发症的重要风险因素。抗生素在急性胆囊炎围术期应用的研究旨在明确其预防策略、最佳使用时机及效果。研究表明,合理使用预...急性胆囊炎是普外科急腹症中的常见疾病,腹腔镜胆囊切除术(LC)是其主要治疗方法。然而,围术期感染仍然是术后并发症的重要风险因素。抗生素在急性胆囊炎围术期应用的研究旨在明确其预防策略、最佳使用时机及效果。研究表明,合理使用预防性抗生素能够降低手术部位感染(SSI)率,特别是在高风险患者中。然而,预防性抗生素的普遍应用存在争议,一些研究显示其并不能显著降低低风险患者的术后感染率。尽管如此,抗生素在围术期的选择和使用仍需基于患者具体情况和感染风险。本文综述了抗生素在急性胆囊炎围术期应用的现状与进展,为临床医生提供参考,以优化抗生素使用策略,减少术后感染和抗生素耐药性风险。Acute cholecystitis is a common disease in general surgery acute abdomen, and laparoscopic cholecystectomy (LC) is its main treatment. However, perioperative infection remains an important risk factor for postoperative complications. The study on the perioperative use of antibiotics in acute cholecystitis aims to clarify its preventive strategies, optimal timing of use and effectiveness. Studies have shown that the judicious use of prophylactic antibiotics can reduce the rate of surgical site infection (SSI), especially in high-risk patients. However, the generalized use of prophylactic antibiotics is controversial, and some studies have shown that they do not significantly reduce postoperative infection rates in low-risk patients. Nonetheless, the selection and use of antibiotics in the perioperative period needs to be based on patient-specific circumstances and infection risk. This article reviews the current status and progress of antibiotic use in the perioperative period of acute cholecystitis to provide clinicians with a reference to optimize antibiotic use strategies and reduce the risk of postoperative infection and antibiotic resistance.展开更多
文摘急性胆囊炎是常见的急腹症之一。近年来,随着微创技术的进步和外科医师腹腔镜水平的提升,腹腔镜下胆囊切除术已成为治疗急性胆囊炎的金标准,因其创伤小、操作简单、术后恢复快而备受推崇。但对于高龄、合并严重基础疾病的高危患者而言,急诊行LC存在着较高的手术风险。超声引导下经皮经肝胆囊穿刺引流术能够有效减轻胆囊压力、迅速缓解感染症状,目前已逐渐成为有手术禁忌的患者首选的治疗措施。本文对PTGBD的现状和问题进行综述,并对其未来前景进行讨论。Acute cholecystitis is one of the common acute abdominal diseases. In recent years, with the advancement of minimally invasive technology and the improvement of surgeons’ laparoscopic level, laparoscopic cholecystectomy has become the gold standard for the treatment of acute cholecystitis, which is highly respected because of its small trauma, simple operation, and fast postoperative recovery. However, for high-risk patients of advanced age and combined with severe underlying diseases, there is a high surgical risk of performing LC in emergency. Ultrasound-guided percutaneous transhepatic gallbladder puncture and drainage (PTGBD) can effectively reduce gallbladder pressure and rapidly alleviate the symptoms of infection, and has gradually become the preferred therapeutic measure for patients with contraindications to surgery. This article reviews the current status and problems of PTGBD and discusses its future prospects.
文摘急性胆囊炎是普外科急腹症中的常见疾病,腹腔镜胆囊切除术(LC)是其主要治疗方法。然而,围术期感染仍然是术后并发症的重要风险因素。抗生素在急性胆囊炎围术期应用的研究旨在明确其预防策略、最佳使用时机及效果。研究表明,合理使用预防性抗生素能够降低手术部位感染(SSI)率,特别是在高风险患者中。然而,预防性抗生素的普遍应用存在争议,一些研究显示其并不能显著降低低风险患者的术后感染率。尽管如此,抗生素在围术期的选择和使用仍需基于患者具体情况和感染风险。本文综述了抗生素在急性胆囊炎围术期应用的现状与进展,为临床医生提供参考,以优化抗生素使用策略,减少术后感染和抗生素耐药性风险。Acute cholecystitis is a common disease in general surgery acute abdomen, and laparoscopic cholecystectomy (LC) is its main treatment. However, perioperative infection remains an important risk factor for postoperative complications. The study on the perioperative use of antibiotics in acute cholecystitis aims to clarify its preventive strategies, optimal timing of use and effectiveness. Studies have shown that the judicious use of prophylactic antibiotics can reduce the rate of surgical site infection (SSI), especially in high-risk patients. However, the generalized use of prophylactic antibiotics is controversial, and some studies have shown that they do not significantly reduce postoperative infection rates in low-risk patients. Nonetheless, the selection and use of antibiotics in the perioperative period needs to be based on patient-specific circumstances and infection risk. This article reviews the current status and progress of antibiotic use in the perioperative period of acute cholecystitis to provide clinicians with a reference to optimize antibiotic use strategies and reduce the risk of postoperative infection and antibiotic resistance.
文摘神经生长因子(never growth factor,NGF)可促进损伤外周神经的修复并加速轴突和髓鞘的再生,但对外周神经损伤前期作用的研究报道较少。本研究主要探究在损伤外周神经前期,NGF能否加速施旺细胞(Schwann cells,SCs)对髓鞘碎片的清除及其调控机制。将坐骨神经损伤的Wistar雄性大鼠连续5 d给予NGF治疗,并运用分子生物学检测手段分析损伤坐骨神经内部髓鞘碎片的清除,细胞的凋亡及内质网应激(endoplasmic reticulum stress,ERS)的表达和变化。免疫荧光分析结果显示,与模型组相比,NGF给药组显著加速髓鞘碎片的清除,并促进SCs的增殖(46.33±5.68 vs.66.69±8.76,P<0.05 for MPZ;47.58±4.52 vs.37.69±2.50,P<0.01for GFAP)。TUNEL免疫组化证实,NGF可有效抑制SCs的凋亡(25±4 vs.37±6,P<0.05),Western印迹结果显示,模型组坐骨神经内部内质网应激水平被过度激活,给予NGF治疗后,相关蛋白质表达被逆转(1.03±0.03 vs.1.24±0.07,P<0.01 for PDI;1.16±0.16 vs.1.48±0.10,P<0.05 for GRP-78;1.33±0.11 vs.1.76±0.17,P<0.01 for Caspase-12;1.01±0.05vs.1.39±0.16,P<0.01 for CHOP)。上述结果证实,NGF可通过抑制内质网应激减少神经组织内细胞的凋亡,并加速髓鞘碎片的清除,促进外周神经损伤的修复。
