连续性肾脏替代疗法治疗重症急性胰腺炎的效果观察

目的观察连续性肾脏替代疗法（CRRT）对重症急性胰腺炎（SAP）的治疗效果。方法38例SAP患者随机分为传统组（n=19）和CRRT组（n=19）,检测两组在治疗前后的血清TNF-αI、L-6水平、APACHEⅡ评分和血气分析指标变化,并对两组的预后进行评价。结果治疗后72 h,传统组的血清TNF-α、IL-6水平明显高于治疗前,CRRT组的血清TNF-αI、L-6水平则明显低于治疗前,CRRT组的APACHEⅡ评分下降较传统组明显,差异均有统计学意义（P〈0.01）;治疗后两组的pH、HCO3-、PaO2和PaO2/FiO2值均明显高于治疗前,但以CRRT组增加更为明显（P〈0.05或0.01）;CRRT组的机械通气、手术冲洗引流及死亡人数也比传统组少,但差异未达统计学意义（P〉0.05）。结论CRRT治疗能降低SAP患者血清TNF-αI、L-6等炎症因子水平,减轻全身炎症反应,可改善SAP患者的预后。

Study of continuous renal replacement therapy in patients with severe acute pancreatitis

Objective To study the mechanism and effect of continuous renal replacement therapy（CRRT） in severe acute pancreatitis（SAP）.Methods Thirty-eight SAP patients were randomly divided into two groups： traditional treatment group（n=19） and CRRT treatment group（n=19）.The traditional group was treated with the traditional therapy,while the CRRT group was treated with both the traditional therapy and CRRT.The TNF-α,IL-6,arterial blood gas analysis and APACHE Ⅱscore were observed.Results 72h after the treatment,the serum level of TNF-α and IL-6 significantly increased in the traditional group and decreased in the CRRT group;the APACHE II score of the CRRT group decreased more than that of the traditional group（P〈0.01）.The pH,HCO-3 and PaO2/FiO2 value significantly increased in the two groups,with more increase in the CRRT group than those in the traditional group（P〈0.01）.Five patients died in the traditional group,more than three patients who died in the CRRT group（P〈0.01）.Conclusion CRRT could reduce the serum levels of cytokine TNF-α and IL6 and the general inflammatory reaction in SAP patients,and improve their prognosis.
Early diagnosis and treatment of primary carcinoma of gallbladderJI Ren,NI Yon,WANG Cheng-you,ZHANG Min-jie（Department of Hepatobiliary Sugery,The Second People＇s Hospital of Shenzhen,Shenzhen 518035,China）
Objective To explore the early diagnosis and treatment of primary carcinoma of gallbladder（PCG）.Methods The clinical data of 36 surgical PCGs from July 2001 to July 2008 in our hospital were collected and retrospectively analyzed.Results 80.6%（29/36）PCG was accompanied with gallstone.The most common initial symptom was bellyache,accounting for 52.8%（19/36）;the second was jaundice,accounting for 38.9%（14/36）.The accurate diagnosis rate of BUS,CT and MR was 52.9%,57.1% and 52.9%,respectively.The accurate diagnosis rate was 58.3 % before operation（21/36）.Conclusion The early diagnosis of PCG is very difficult.The highest accurate d