Objective To investigate the treatment of intractable bile duct stones. Methods Of the total 149 cases of biliary stones, some are multiple bile duct stones,large stones,stones obstructed in the duodenal ampulla or residuary stones after T-tube surgery, others are associated with small papilla or papilla with neighoring diverticulum. All the stones were extracted with several endoscopic methods, such as choledochoscopy during or after operation, mechanical lithotripsy after EST(endoscopic sphincterotomy), biliary mother-baby endoscopy, ENBD(endoscopic nasobiliary drainage) or biliary-duodenum internal drainage. Results In general, extrahepatic bile duct stones were effectively removed in 94. 6% cases. In 19 out of 20 cases, stones were completely removed with choledochoscopy during operation; In 35 out of 40 cases stones were fully extracted through T-tube endoscopy, and in 72 of 76 cases stones were thoroughly removed with mechanical lithotripsy after EST. Conclusion The intractable bile duct stones can be effectively managed with combined endoscopic therapy, which is attributed to the high success rate in removing biliary stones and should be popularized in this field.

Objective To explore the safety and effectiveness of enhanced recovery after surgery (ERAS) in the perioperative nursing of cerebral glioma patients. Methods ERAS optimized nursing was developed based on ERAS of other specialties combined with neurosurgical features. A total of 80 cerebral glioma patients recruited in the Department of Neurosurgery of Tang Du Hospital from June 2016 to April 2017 were investigated and divided into the experimental group (40 cases) and control group (40 cases) using the envelope random sampling with the registration number assigned when a patient was admitted to the hospital. Patients in the control group were treated with routine treatment, while patients in the experimental group received the ERAS nursing. The complications, nursing satisfaction rate, the time of taking food, removing urine tube, stopping the infusion and hospital stay were compared between two groups. Results There was no significant difference in the occurrence of complications between two groups (P>0.05). The nursing satisfaction rate was 82.5% in the experimental group and 62.5% in the control group with significant difference between two groups (P<0.05). The rate of removing urine tube within 24 hours after surgery was 85.0% in the experimental group and 25.0% in the control group; the bed activity rates within 3 days after surgery in the experimental and control groups were 95.0% and 30.0% respectively; the differences between two groups were statistically significant (P<0.05). The time of taking food, stopping the infusion and hospital stay in the experimental group were significantly shorter than those of the control group (P<0.05). Conclusions The application of ERAS in the perioperative nursing of cerebral glioma patients is safe and effective, which allows faster rehabilitation, and reduces postoperative hospital stay and hospitalization costs.