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Objective To evaluate the efficacy and safety of antibacterial drugs conservative therapy versus appendectomy for treating simple acute appendicitis(AA).Methods Randomized controlled trials (RCT) on antibacterial drugs conservative therapy versus appendectomy for treating simple AA were retrieved from CBM (1978 June 2015),CNKI (1979-June 2015),Medline (1950-June 2015),Pubmed (1950-June 2015),Embase (1970-June 2015) and Cochrane library (issue 2,2015) by computer.The included RCTs were performed the data extraction according to the criteria of the Cochrane handbook by two researchers.Then the included d/literatures were performed the quality assessment and the extracted effective data were performed the meta analysis.Results Six RCTs were included involving 1510 patients with AA,among them,767 cases were treated with antibacterial drugs and 743 cases were treated with appendectomy.Compared with surgical treatment,the effect rate of antibacterial medication conservative therapy was decreased by 25.00％ (RD=-0.25,95％ CI:-0.35--0.14),the recurrence rate was increased by 48.43 times (OR=48.43,95％CI:16.94-138.44),the loss time of labor force was shortened by 1.52 d (MD=-1.52,95％ CI:-3.02 0.02),but the occurrence rate of complications(RD=-0.06,95％CI:-0.15 0.03),pain time(MD=-0.76,95％CI:-3.31 1.79),hospital stay time (MD=4.60,95％CI:-0.89 10.09) and sick leave time(MD=-2.39,95％CI:-5.62-0.84) had no statistical differences between the two kinds of treatment method(P＞0.05).Conclusion Appendectomy may be the gold standard method for treaung simple AA.
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0.05);but as comparing with high dose group there is obvious significance(P
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Objective To analysis the clinical characteristics, pathogenesis, diagnosis and treatment of acute acalculous cholecystitis.Methods Seventy-nine cases of acute acalculous cholecystitis from January 1996 to January 2003 were retrospectively reviewed.Results Of those 79 cases, 13 cases were treated non-operatively and 66 cases were treated operatively. Twenty-three cases were suppurative, 43 cases were gangrenous with perforation in 18 cases,which were proved by postoperative pathology. Seventy-six cases were cured and 3 cases were dead. Conclusion Keeping vigilant alert, observing dynamically as well as appropriate operative intervention are effective to improve the prognosis of acute acalculous cholecystitis.
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Objective To study the regulatory ability of peroxisome proliferator-activated receptor ?(PPAR?) ligands to the inflammatory response in human gallbladder epithelial cells. Methods Culture human gallbladder epithelial cells and identify them . Cells were treated for 24 hours with 0, 10 ?mol/L, 20 ?mol/L, 30 ?mol/L, 50 ?mol/L and 100 ?mol/L of Ciglitazone during cellular growth peak(5th day), then stimulated them with hIL-1? 5 ng/ml for 2 hours and measured the concentration of IL-6、IL-8 and TNF-? in cellular supernatants by riadioimmunoassay. Results Contrasted with control group, the expression of IL-6 and IL-8 in each test group were inhibited ((P
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Objective To study the clinical diagnosis and treatment of juxtapapillary duodenal diverticula with biliary deseases. Methods Eighteen duodenal diverticulum treated in our department in recent 5 years were retrospectivly analyzed, especially investigated the postcholecystectomy cases whose symptoms were continuing existence after operatoins. Articles about the surgical treatment were reviewed. Results The total of 18 duodenal diverticulum with 17 cases of juxtapapillary duodenal diverticulum were included in this study. The ages of 12 cases were over 50 years old. Sixteen cases(88.89%) presented biliary stones. Seven cases once had performed cholecystectomy or cholecystectomy plus choledochotomy,but symptoms persisted after operations. The duodenal diverticulum were found by endoscopic retrograde cholangiopancreatography (ERCP) and hypotonic duodenography. Sixteen patients underwent surgical treatment with good effect. Conclusion The juxtapapillary duodenal diveticula has the close relationship with biliary stones. ERCP and hypotonic duodenogrphy are the most reliable methods to get the correct diagnosis. In case of recurrent common bile duct stones after operations or persisting billiary symptoms after cholecystectomy, the coexistence of juxtapapillary duodenal diverticulum should be ruled out. The surgical treatment is only considered for the duodenal diverticulum with complication.
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Objective To intensify clinical evaluation on the manifestation, diagnosis and treatment of primary malignant duodenal tumors. Method The clinical data of 81 patients with primary malignant duodenal tumors from 1990 to 2002 were analyzed retrospectively. Result Tumors located above, around and below the duodenal papilla accounted for 16%, 78%, 6% respectively. The common clinical presentations were weight loss(72%)?abdominal pain(64%)?jaundice(45%)?alimentary tract bleeding(40%)?vomiting(33%) and anemia(24%). The preoperative diagnosis rate was 80%. Pancreatoduodenectomy was performed in 54 cases, bypass operation in 21 cases, segmental duodenectomy and simple laparotomy in 2 cases each. The postoperative 3- and 5- year survival rate was 36% and 21% for patients undergoing curative resection. In those with bypass operation, the survival time was between 1～18 months. Two cases undergoing segmental duodenectomy died within one year. Conclusion Patients usually lack special symptoms and signs, early diagnosis is fairly difficult, pancreaticoduodenectomy performed for purpose of curative resection could improve the prognosis of this malignancy.