2024年 · 第62卷第10期

The patient, a 74-year-old female, was seen in Zhejiang Provincial People's Hospital on July 30, 2020 due to "dull pain in the upper abdomen for 2 months and palpitations for 7 days". The patient developed dull pain in the upper abdomen 2 months ago, and was treated with mosapride in another hospital, during which the symptoms did not improve. Gastroscopy showed: chronic non-atrophic gastritis; There are many protuberances and depressions of the gastric fundus mucosa, with disc-shaped protuberances of the mucosa about 1.3 cm ×1.0 cm in size and central depressions (Figure 1); Gastric polyps. Biopsy pathology showed chronic inflammation of gastric fundus mucosa with high-grade intraepithelial neoplasia and carcinogenesis of local superficial glands; Immunohistochemistry: HER2 negative, Ki-67 index about 25%, and some cells in the tumor were signet ring cell-like. Seven days ago, the patient developed chest tightness and palpitations, which were paroxysmal, with each attack for 2 to 3 minutes, accompanied by shortness of breath, dizziness, and upper abdominal pain. 2 months history of coronary heart disease, oral clopidogrel bisulfate and atorvastatin; History of hypertension 9 months, oral amlodipine besylate to control blood pressure. "Appendix surgery" was performed 30 years ago. Physical examination after admission: the heart rhythm was uniform, no pathological murmur was heard in the auscultation area of the heart valves, and no positive signs in the abdomen. Echocardiography showed no obvious abnormalities. Coronary CT angiography showed: multiple atheromatous plaque formation of coronary arteries, mild stenosis of anterior descending branch and right coronary artery, and mild stenosis of left main artery; Aortic sclerosis. Laboratory test: albumin 36.2 g/L, blood routine, infection screening, coagulation function, etc. No obvious abnormality.

The patient was a 21-year-old female, Tibetan. Due to "repeated right upper abdominal pain for 6 months, aggravated for 4 days", he went to the general surgery department of our hospital on April 8, 2024. The patient had intermittent right upper abdominal pain without obvious trigger 6 months ago, and the pain was aggravated after eating greasy food 4 days before admission, accompanied by radiating right shoulder and back pain. No fever, jaundice, nausea, vomiting. Physical examination: There was no yellowing stain on the skin and sclera, tenderness in the right upper abdomen, and positive Murphy sign. There were no obvious abnormalities in the laboratory results. The ultrasound results showed that the gallbladder wall was slightly thickened and there were multiple gallbladder stones. The results of magnetic resonance cholangiopancreatography (MRCP) showed that gallstones were accompanied by cholecystitis, and there were no obvious abnormalities in intrahepatic and extrahepatic bile ducts and pancreatic ducts, and the cystic duct structure seemed to be visible (Figure 1). After perfect preoperative preparation, laparoscopic cholecystectomy (LC) is proposed.