Section 3 Medical Literature第三部分 医学文献
Part 1.
It has been nearly 20 years since the first cholecystectomy1) in 1987 and the first hysterectomy by laparoscopy2) in the world.Since then，laparoscopy has been applied widely in many fields of clinical medicine.Further researches have been made on this technique and dramatic achievements have been obtained.The minimally invasive surgery performed by laparoscopy is known to associate with the advantages of little local trauma:small incision，less disturbance to abdominal cavity，shorter operative time，and less blood loss.Recently，more attempts have been made to investigate body responses especially the immune response evoked by laparoscopic surgery.Because laparoscopic surgery is a kind of minimally invasive surgery，the physiologic response may，intuitively，be different from those for traditional open surgery.The C-reaction protein(CRP)is an independent relation to the extent of injury.The CRP rose approximately 4 to 12h after surgery and peaked at 24 to 72h.Subsequently，CRP remain elevated for approximately 2 weeks.IL-6 and TNF-α are known to be major mediators of inflammation，IL-6 is multi-effective cytokine in the network of cytokines，which can affect the growth and differentiation of various kinds of cells，and regulate the expression of genes.It can be secreted by many sorts of cells，such as macrophages，monocytes，T lymphocytes，B lymphocytes，endotheliocytes and fibroblasts.It is thought to be the primary mediator of inflammatories，which can primarily regulate the hepatic product of CRP.Serum IL-6 level is an early and sensitive marker of tissue damage.TNF-α is mainly produced by activated mono-macrophages，which shows many immune functions，including activation of inflammation.The activation of macrophages by surgery，especially in the peritoneal cavity，will increase the secretion of inflammatory mediators，such as IL-6 and TNF-α.In the present study，the levels of serum CRP，IL-6 and TNF-α increased significantly after laparoscopic or abdominal hysterectomy，while the changes were greater in AH group than in LH group with statistical significance.It may be indicated that the immune responses was less pronounced after a laparoscopic surgery compared to a conventional approach.Our research showed that the alterations of IL-6 and TNF-α peaked 24h post operation，and CRP at 72h.we presumed that IL-6 was not the only factor affecting the level of CRP，C3 complement levels may also associate with it.
注释：
1）cholecystectomy 胆囊切除术
2）laparoscopy 腹腔镜检查
Part 2.
Title:Evaluation of magnetic resonance cholangiopancreatography1) in patients with suspected bile duct obstruction prospectively
Content:
BACKGROUND:The value of magnetic resonance cholangiopancreatography(MRCP)is under debate.
AIMS:To assess the diagnostic accuracy of MRCP and endoscopic retrograde cholangiopancreatography(ERCP)2) and to determine whether MRCP may help to prevent unnecessary interventional procedures.
METHODS:
(1)Eighty-six patients with suspected common bile duct obstruction who presented between January and December 1996 were enrolled.
(2)Twenty-six were excluded due to anatomical reasons or because MRCP or ERCP could not be performed successfully.(https://www.daowen.com)
(3)Results of MRCP were interpreted by two radiologists and a gastroenterologist3) unaware of clinical diagnosis.
(4)Final diagnosis was determined by ERCP and histopathological4) findings or a follow up of at least 12 months.
RESULTS:
(1)MRCP images of diagnostic quality were obtained in all 60 patients.
(2)Thirteen patients had a clear bile duct.
(3)Sensitivity and specificity for the detection of any abnormality(n=47)were 89% and 92%，and for the detection of malignancy(n=27)81% and 100%，respectively.
(4)These results were equivalent to the respectively figures of ERCP(91% and 92% for any abnormality，and 93% and 94% for malignant diseases).
CONCLUSIONS:
(1)MRCP is as sensitive as ERCP in the evaluation of billary tract diseases.
(2)As the specificity of this non-invasive technique is close to 100%，MRCP may prevent inappropriate invasive explorations of the common bile duct and pancreatic duct.
注释：
1）magnetic resonance cholangiopancreatography 磁共振胰胆管造影术
2）endoscopic retrograde cholangiopancreatography 内镜逆行胰胆管造影术
3）gastroenterologist 胃肠病学家
4）histopathological 组织病理学的