Objective To investigate the diagnosis and treatment of ectopic opening of the common bile duct in the duodenal bulb.Methods The clinical data of 3 patients who were admitted to the Binzhou People's Hospital and 9 patients who were admitted to the Tianjin People's Hospital from January 2006 to December 2013 with ectopic opening of the common bile duct in the duodenal bulb were retrospectively analyzed.Seven patients had choledocholithiasis and 5 had stenosis at the end of common bile duct.The medical histories and clinical features in patients were analyzed and routine blood test and serum liver function test were done.All the patients received the endoscopic retrograde cholangiopancreatography (ERCP) examination and were cured.All the patients were followed up via outpatient examination and telephone interview up to August 2014.Results Six patients had histories of cholangitis recurrence and 2 had histories of duodenal ulcer recurrence.All the patients had pain in the right hypochondriac region of the abdomen.Seven patients had fever,chills,skin yellowing sclera and tenderness in the right hypochondriac region of the abdomen.The levels of alkaline phosphatase (ALP) and glutamyltranspeptidase (GGT) in 11 patients,the levels of TBil and DBil in 8 patients and the count of WBC in 7 patients were increased.(1) The results of ERCP showed as follows:there was no papillar opening at the second and third segment of duodenum.The crack-like opening located at the duodenal post-bulb with rough and erosive mucosal surfaces and intermittent outflow of bile.Duodenal ulcer was detected in 5 patients and duodenal bulb metamorphosis in 3 patients.All the 12 patients received successfully intubations.(2)The results of retrograde cholangiography showed as follows:the end of common bile duct of 12 patients was taper and sickle-shaped.Intra-and extrahepatic bile duct dilation was detected in 10 patients,choledocholithiasis in 7 patients and clear findings for the pancreatic duct in 5 patients.Among the 12 patients,8 received balloon dilation (5 with stenosis at the end of common bile duct,3 with choledocholithiasis),3 received laparoscopic common bile duct exploration (LCBDE) combined with cholangioenterostomy due to diameter of stone more than 1.5 cm and ectopic opening stenosis of the common bile duct in the duodenal bulb.One patient was treated by percutaneous transhepatic cholangiography (PTC) lithotomy of common bile duct after unsuccessful ERCP without bleeding and pancreatitis-related complications.The symptoms of cholangitis in 3 patients were alleviated after balloon dilation,2 patients had recurrence of cholangitis and were cured by Roux-en-Y cholangioenterostomy.The mean open surgery time and mean duration of postoperative hospital stay in 5 patients were 85 minutes (range,60-150 minutes) and 10 days (range,8-14 days),respectively.All the 12 patients were followed up with a median time of 38 months (range,8-90 months).During the follow-up,10 patients survived well without recurrence of cholangitis and cholelithiasis.Two patients had recurrence of cholangitis at postoperative month 2 and month 14,including 1 patient with the recurrence of common bile duct sand-like stones,and they were readmitted to hospital and treated by Roux-en-Y cholangioenterostomy without recurrence by follow-up.Conclusions The clinical symptoms of ectopic opening of the common bile duct in the duodenal bulb included recurrence of cholangitis,duodenal ulcer history,pain in the right hypochondriac region of the abdomen,skin yellowing sclera,abnormal liver function,crack-like openings in the duodenal bulb by ERCP examination with outflow of bile,cholangiography-guided taper and sickle-shaped end of common bile duct.The treatment should be aimed at the concomitant diseases.

Multidiscipline team ( MDT ) provides comprehensive, cross-discipline treatment solutions and effective diagnosis for major, complicated and rare diseases, featuring significantly clinical outcomes. It deserves efforts on how to introduce MDT from clinical work to hospital administration. To this end, this article discussed the application of MDT model at large-scale public hospital administration. MDT hospital administration teams, and such management methods as project management and PDCA, as well as information technology systems were called into play. These measures have effectively resolved long-standing roadblocks commonly encountered, and removed horizontal barriers, sharply raising work efficiency.

On the background of high-quality development of public hospitals,the prevention and control of infectious diseases and various public health emergencies have become normal,which puts higher requirements on the emergency handling and management capacity of public hospitals.Large Grade three A hospitals should establish and improve the emergency com-mand system,improve the emergency plan system,strengthen training and drills,and improve the ability to deal with various public health emergencies and disasters,so as to protect people's health.This paper expounds the specific practice process,a-chievements and thinking of the special work of improving hospital emergency ability,summarizes and puts forward the methods of improving hospital emergency ability,in order to provide reference for emergency management of other hospitals.

Hospital evaluation is a method of hospital quality and safety management,which aims at strengthening the quality of medical services,improving the scientific management level of hospitals,and promoting the standardized,normative,scientific and modern development of hospitals.By summarizing the practice of hospital evaluation,it is recommended to apply the hospital evaluation methods,total quality management concepts,and continuous improvement concepts to routine work,and combine them with the modern hospital management system to provide reference value for the tertiary evaluation of hospitals and medical quality and safety management.