解剖外腋-股、股-股动脉旁路移植术治疗主髂动脉闭塞症

目的探讨解剖外腋股、股股动脉旁路移植术治疗主髂动脉闭塞症的疗效。方法采用解剖外旁路移植术治疗主髂动脉闭塞症患者３２例。１８例腹主动脉或两侧髂动脉闭塞者采用腋股动脉旁路术，其中２例为腋两股动脉旁路术；１４例单侧髂动脉闭塞者采用股对侧股动脉旁路术。采用腋股动脉旁路的患者，术中８例用真丝人造血管移植，１０例用聚四氟乙烯（ＧｏｒｅＴｅｘ）人造血管；股股动脉旁路术中６例用真丝人造血管移植，１例用自体大隐静脉，７例用ＧｏｒｅＴｅｘ人造血管。结果术后５年随访时，股股动脉旁路术通畅率为７８％，其中真丝人造血管与ＧｏｒｅＴｅｘ人造血管通畅率无明显差异；腋股动脉旁路术中，８例真丝人造血管均已闭塞，１０例ＧｏｒｅＴｅｘ人造血管中１例闭塞，１例发生腹股沟部假性动脉瘤。结论解剖外动脉旁路移植术操作简单，创伤小，无腹部手术并发症，手术安全，术后恢复快。真丝人造血管的使用应限于短段的股股动脉旁路术     

剖解外腋—股,股—股动脉旁路移植术治疗主髂动脉闭塞症

目的 探讨剖解外腋－股、股－股动脉旁路移植术治疗主髂动脉闭塞症的疗效。方法 采用解剖外旁路移植术治疗主骼动脉闭塞症患者３２例。１８例腹主动脉或两侧髂动脉闭塞者采用腋－股动脉旁路术,其中２例为腋－两股动脉旁路术;１４例单侧髂动脉闭塞者采用股－对侧股动脉旁路术。采用腋－肌动脉旁路的患者,术中８例用真丝人造血管移植,１０例四氟乙烯（Ｇｏｒｅ－Ｔｅｘ）人造血管;股－股动脉旁路术中６例用真丝人造血管移植,１     

267例主髂动脉闭塞的手术治疗经验

目的 探讨肾动脉开口水平以下腹主动脉闭塞及髂动脉闭塞的手术方式选择及治疗经验。方法 回顾性分析267例主、髂动脉闭塞患者的临床资料。结果 267例患者全部行手术治疗。行腹主动脉－髂（股）动脉人工血管转流术145例,髂动脉－股动脉人工血管转流术40例,股动脉－股动脉人工血管转流术45例,腋动脉－股动脉人工血管转流术37例。总有效率为96．5％,围手术期病死率为3．5％。267例中178例得到随访,平均随访时间5年9个月,人工血管通畅率为82．0％。结论 符合正常血液动力学手术的主要术式是腹主动脉－（双）髂、股动脉人工血管转流术,对于年老、体弱者,特别是全身一般状况较差,伴有冠心病、高血压、脑动脉硬化、脑梗塞等慢性疾病的患者,应采用腋动脉－（双）髂股动脉人工血管转流术或股动脉－股动脉人工血管转流术,可明显减低手术病死率。     

下肢动脉硬化性闭塞症的外科治疗

自１９８８年１月至１９９２年１２月，我们共收治下肢动脉硬化性闭塞症２７例，涉及３８条肢体。男性２５例，女性２例，年龄４７～７２岁。动脉闭塞的部位以髂总、髂外动脉到股浅动脉这一段最多，占６８．％；其次为腹主动脉到双髂动脉，占２６．３％。全部病例均作了动脉旁路移植术；腹主－髂或股动脉、髂册和股－动脉等方式。手术治疗总有效率８６．８％；其中显效７６．３％。无效和恶化者１３．２％，多因远侧动脉有广泛狭窄和闭塞所致；这类病人不宜作动脉旁路移植术。在股总或股浅动脉闭塞时，应尽量利用股深动脉，作股深动脉成形术或腹主动脉＋股深动脉人工血管搭桥术。作股－动脉搭桥时，常用大隐静脉，需注意其厚度能否耐受动脉高压，以免以后破裂引起大出血。     

微创技术结合外科手术治疗重症下肢缺血

目的 探讨术中血管微创治疗技术结合外科手术治疗重症下肢缺血的初步临床经验。方法 1999年7月至2000年10月,采用术中同时行髂动脉腔内微创治疗技术(球囊扩张和支架植入)结合肢体远端动脉重建术治疗广泛多节段动脉硬化闭塞症15例(20条肢体)。结果 术中17条髂动脉微创介入治疗均获成功,11条肢体同时行股-腘动脉人工血管旁路术,3条肢体行股-股-腘动脉人工血管旁路系列转流术,5条肢体行股深动脉成形术。其中有1条肢体股-腘动脉旁路术失败。本组患者无重要脏器并发症和手术死亡。平均随访时间8个月(1-16个月),髂动脉腔内支架通畅率100％,3条股-股动脉耻骨上人工血管转流均通畅,而股-腘动脉人工血管通畅率78．6％,截肢率10．0％。结论 术中髂动脉腔内微创介入治疗技术同时结合远端动脉重建术是治疗广泛多节段动脉硬化闭塞症的害全右特肯沸．     

腋-股动脉旁路移植救治慢性重症下肢缺血

目的 探讨腋-股动脉转流救治慢性重症下肢缺血的疗效。方法 回顾性分析1995年1月至2002年11月的63例主髂动脉闭塞患者行腋-单股和腋-双股动脉人工血管旁路移植的临床资料。结果 44例出院时静息痛消失，19例患者间歇跛行消失，平均踝/肱比从术前的0、18(0-0．49)提高到0．68(0．29～1．04)。本组肢体救治率87．4％，截肢率7．9％。3例死亡，手术死亡率是4．7％。1、3、5年通畅率分别为93．2％、79．8％、64．1％。结论 因主髂动脉闭塞导致慢性重症下肢缺血的高危患者，通过腋-股动脉人工血管旁路移植可有效的挽救肢体和生命。     

术中髂动脉支架结合股动脉旁路术治疗多节段动脉硬化闭塞症

目的 探讨术中髂动脉腔内成形及支架植入结合股-Guo动脉旁路术治疗多节段动脉硬化闭塞症的初步临床经验。方法 采用术中同时行髂动脉腔内成形和支架植入结合股-Guo动脉旁路术治疗多节段动脉硬化闭塞症10例（12条肢体）。结果 术中11条髂动脉行腔内成形和支架植入均获成功,9条肢体行股-Guo动脉人工血管旁路术,3条肢体行股-股-Guo动脉人工血管旁路系列转流术;1条肢体股-Guo动脉旁路术失败,本组患者无重要脏器并发症和手术死亡。平均随访时间6个月（1-12个月,髂动脉腔内支架通畅率100%;3条股-股动脉耻骨上人工血管转流均通畅;而股-Guo动脉人工血管通畅率83.3%;截肢率8.3%。结论 术中髂动脉腔内支架结合股-Guo动脉旁路术是治疗多节段动脉硬化闭塞症的安全、有效方法。     

Leriche综合征33例诊治分析

目的 总结33例Leriche综合征的诊断治疗。方法 回顾性分析33例Leriche综合征患者的临床资料。结果 79．9％患者有间歇性跛行症状，70．4％男患有阳萎症状。彩色多普勒超声、特别是结合螺旋CTA和MRA检查能够帮助诊断。主动脉造影或DSA检查对疾病状况及手术方式的选择有帮助。手术需全面考虑患者的全身状态以及受累血管的条件。本组25例行手术治疗，包括12例行腹主-髂总动脉Y型人工血管移植术，6例行腹主—双侧股动脉旁路术，4例行腋-双侧股动脉旁路手术，2例仅行Fogarty导管取栓术，另有1例行腹主动脉人工血管间置术加肾动脉成形术。髂主-髂总动脉人工血管移植术效果最好，1年通畅率100％，5年通畅率仍为75．0％。腋—股架桥术5年通畅率仅为37．5％。8例未行手术治疗者均于5个月内死亡。结论 早期诊断、及时及全面的综合治疗是提高Leriche综合征血管移植术后远期通畅率的关键。     

下肢动脉人工血管旁路术后再闭塞的治疗经验

目的总结治疗下肢动脉人工血管旁路术后再闭塞的治疗经验,探索合理的治疗策略。方法回顾性总结19例下肢动脉人工血管旁路术后再闭塞的病例,分析再闭塞的原因,并根据原因选择再次手术的方式。其中4例行人工血管取栓术,5例行人工血管取栓＋远端吻合口成形术,3例行人工血管取栓＋股深动脉扩大成形术,2例行新的人工血管旁路术,1例行髂外动脉内膜剥脱术,2例行骨髓干细胞移植,2例由于肢体广泛坏死,行1期截肢术。在术后进行规律的随访以明确手术的效果。结果19例患者术后1年中定期随访。除2例截肢外,14例围手术期获得了1期成功,成功率82．4％,3例（17．6％）手术失败,术后1年内死亡2例,病死率10．5％。术后1年随访时,人工血管通畅6例,血管通畅率35．3％,保肢率76．4％（13例）。结论人工血管旁路术后再闭塞的治疗比较棘手,术前有效地评估闭塞原因、选择正确的手术方式和良好的随访计划是保持患者肢体功能和生存质量的重要因素。     

腹腔镜下左髂总动脉-股动脉人工血管旁路移植治疗髂外动脉闭塞症一例

目的总结腹腔镜下人工血管旁路移植治疗髂外动脉闭塞症的手术技巧和临床效果。方法 2011年12月,收治1例57岁髂外动脉硬化闭塞症男性患者。患者双下肢间歇性跛行;下肢动脉造影示左髂外动脉闭塞,右髂总动脉狭窄;心电图示窦性心律,完全性右束支传导阻滞,ST段改变;踝肱指数(ankle brachial index,ABI):左侧0.59,右侧0.54。于全麻下行腹腔镜下左髂总动脉-股动脉人工血管旁路移植术。结果术后人工血管通畅,吻合口无漏血,患者跛行症状明显改善。术后1周左侧ABI增加至1.09;术后1个月血管造影显示血管通畅。结论腹腔镜下主-髂动脉重建既保留开腹动脉旁路移植效果好的特点,又具有腔内支架成形创伤小、术后恢复快的优点。     

Resected periampullary adenocarcinoma: 5-year survivors and their 6- to 10-year follow-up

BACKGROUND: Many studies have reported 5-year survival data after pancreaticoduodenectomy for periampullary adenocarcinoma. This study evaluates 10-year survival in patients surviving 5 years after initial surgery. METHODS: We reviewed all patients undergoing pancreaticoduodenectomy for periampullary adenocarcinoma from April 1970 to July 1999 at a single institution. All 5-year survivors were identified, and their subsequent 5-year survival was compared with the actuarial survival of the general population starting at 70 years of age. RESULTS: Nine hundred fifteen patients underwent pancreaticoduodenectomy for periampullary adenocarcinoma. Follow-up was complete on 890 patients. There were 201 (23%) 5-year survivors with a median age of 65 years at initial surgery; 51% were male and 92% were Caucasian. For the 5-year survivors, the carcinoma origin was pancreatic in 46%, ampullary in 25%, distal bile duct in 17%, and duodenal in 12%. For all 5-year survivors, the subsequent 5-year actuarial survival rate was 65%, with a median survival after achieving the 5-year landmark of 7.9 additional years. The subsequent 5-year survival by site of tumor origin was 55% for pancreatic, 66% for ampullary, 74% for bile duct, and 85% for duodenal cancer. For the age-matched population, the 5-year survival rate was 87% (P<.001 when compared with those with all periampullary cancers). CONCLUSIONS: While the 5-year survival rate for all patients with resected periampullary adenocarcinoma is only 23%, these data imply that attainment of the 5-year survival landmark carries with it an improved survival for the subsequent 5 years. While the survival rate was less than that of the age-matched population, 65% of 5-year survivors survived 5 more years, bringing them to the 10-year postresection landmark.     

Hepatic transplantation for primary and metastatic cancers of the liver.

Long-term results of transplantation for primary and metastatic hepatic malignancies were evaluated retrospectively in 637 patients. Recurrence rates and 2-year and 5-year patient survival rates were calculated. The overall recurrence rate was 40%, with 81% of deaths from recurrence occurring within 2 years after transplantation. Best results were obtained with uncommon tumors: incidental hepatomas (13% recurrence; 57% 2-year and 5-year follow-up); epithelioid hemangioendotheliomas (33% recurrence; 82% and 43% 2-year and 5-year survival); hepatoblastomas (33% recurrence; 50% 2-year and 5-year survival); and fibrolamellar hepatomas (39% recurrence; 60% and 55% 2-year and 5-year survival). Hemangiosarcomas had 64% recurrence, and all patients died within 27.5 months. Tumors metastatic to the liver had 59% recurrence, with 38% and 21% 2-year and 5-year survival rates. Transplantation should be abandoned for hemangiosarcomas and most metastatic tumors, except possibly for some slowly growing neuroendocrine tumors. The usual hepatomas had 39% recurrence with 2-year and 5-year survival rates of 30% and 18%, respectively. Cholangiocarcinomas had 44% recurrences with 2-year and 5-year survival rates of 30% and 17%, respectively. Transplantation for hepatomas and cholangiocarcinomas should be reserved for patients with favorable risk factors or when combined with well-defined chemotherapy protocols before and after operation.     

Role of potassium concentration in cardioplegic solutions in mediating endothelial damage

We studied the effect of potassium concentration in cardioplegic solutions on endothelial function by examining its influence on 5-hydroxytryptamine- (5-HT) and nitroglycerin-induced vasodilation in the isolated rat heart. Forty-eight rat hearts were perfused on a modified Langendorff preparation. After a baseline record of increase in coronary flow induced by 10(-7) M 5-HT and 10 micrograms/mL nitroglycerin, the hearts were perfused for 30 or 60 minutes with either St. Thomas' solution or Bretschneider solution containing 20 mmol/L of potassium or for 30 minutes with either solution containing 30 mmol/L of potassium (n = 8 in each). Initially, 5-HT and nitroglycerin caused a 39.0% +/- 3.3% and 39.7% +/- 2.8% increase in coronary flow, respectively. After 30 or 60 minutes' perfusion with St. Thomas' solution containing 20 mmol/L of potassium, there was little change in the response to 5-HT or nitroglycerin (5-HT, 43.1% +/- 4.1%; nitroglycerin, 38% +/- 3.2%). Similarly, perfusion with Bretschneider solution (20 mmol/L K+) for 30 or 60 minutes did not alter the degree of vasodilation (5-HT, 39.2% +/- 2.9%; nitroglycerin, 38.0% +/- 3.3%). However, perfusion with St. Thomas' solution containing 30 mmol/L of potassium for 30 minutes abolished the endothelial-dependent 5-HT-induced vasodilation (5-HT, -1.6% +/- 1.4%; nitroglycerin, 36.9% +/- 2.2%). Perfusion with Bretschneider solution (30 mmol/L K+) gave similar results (5-HT, -2.1% +/- 1.2%; nitroglycerin, 36.4% +/- 1.7%). We conclude that the concentration of potassium in cardioplegic solutions plays a critical role in causing functional endothelial damage.     

氟尿嘧啶免疫聚乳酸纳米微粒抗肿瘤效应的研究

目的利用载氟尿嘧啶（5-FU）免疫聚乳酸（PEA）纳米微粒（NPs），观察其对严重联合免疫缺陷病（SCID）鼠人胃癌移植模型的治疗效应。方法超声乳化法合成的载5-FU的抗血管内皮生长因子（VEGF）单克隆抗体纳米微粒，建立SCID鼠人胃癌移植肿瘤模型，观察药物对高表达VEGF胃癌移植肿瘤模型的治疗效应及其不良反应。结果空白对照组、未载药空纳米微粒组、5-FU组（20mg／kg）、抗VEGF单克隆抗体-未载药空纳米微粒组、抗VEGF单克隆抗体组、载5-FU纳米微粒组、5-FU（20mg／kg）加抗VEGF单克隆抗体组及抗VEGF单克隆抗体-载5-FU纳米微粒组（20mg／kg）的抑瘤率分别为0、6．61％、24．26％、27．94％、35．29％、37．50％、39．71％和52．21％，且载5-FU的抗VEGF单克隆抗体纳米微粒组和未载药纳米微粒组的血白细胞数量及肝肾功能与空白对照组相比，差异无统计学意义（P〈0.05）；而含5-FU原药组血白细胞数量较空白对照组和抗VEGF单克隆抗体-载5-FU纳米微粒组下降34．43％和37．38％（P〈0.05）：而肝转氨酶升高93．17％和66．56％。治疗组与对照组癌细胞凋亡指数相比，以抗VEGF单克隆抗体．载5-FU纳米微粒组更为明显，差异有统计学意义（P〈0.05）；含抗VEGF抗体的实验组微血管密度明显低于含5-FU药组和对照组（P〈0.05）。结论载5-FU抗VEGF单克隆抗体纳米微粒可提高5-FU的抑瘤率，并通过抑制肿瘤的血管生成，诱导肿瘤细胞凋亡，增加疗效，有效降低5-FU的骨髓抑制和肝肾功能损害作用．是一种安全的新型药物纳米级靶向制剂。     

The influence of mitochondrial KATP-channels in the cardioprotection of preconditioning and postconditioning by sevoflurane in the rat in vivo

Volatile anesthetics induce myocardial preconditioning and can also protect the heart when given at the onset of reperfusion-a practice recently termed "postconditioning." We investigated the role of mitochondrial KATP (mKATP)-channels in sevoflurane-induced cardioprotection for both preconditioning and postconditioning alone and whether there is a synergistic effect of both. Rats were subjected to 25 min of coronary artery occlusion followed by 120 min of reperfusion. Infarct size was determined by triphenyltetrazolium staining. The following protocols were used: 1) preconditioning (S-Pre, n = 10, achieved by 2 periods of 5 min sevoflurane administration (1 MAC) followed by 10 min of washout); 2) sevoflurane postconditioning (1 MAC of sevoflurane given for 2 min at the beginning of reperfusion; S-Post, n = 10); 3) administration before and after ischemia (S-Pre + S-Post, n = 10). Protocols 1-3 were repeated in the presence of 5-hydroxydecanoate (5HD), a specific mKATP-channel-blocker (S-Pre + S-Post + 5HD, S-Pre + 5HD: n = 10; S-Post + 5HD: n = 9). Nine rats served as untreated controls (CON) or received 5HD alone (5HD, n = 10). Both S-Pre (23% +/- 13% of the area at risk, mean +/- sd) and S-Post (18% +/- 5%) reduced infarct size compared with CON (49% +/- 11%, both P < 0.05). S-Pre + S-Post resulted in a larger reduction of infarct size (12% +/- 5%, P = 0.054 versus S-Pre) compared with administration before or after ischemia alone. 5HD diminished the protection in all three sevoflurane treated groups (S-Pre + 5HD, 35% +/- 12%; S-Post + 5HD, 44% +/- 12%; S-Pre + S-Post + 5HD, 46% +/- 14%;) but given alone had no effect on infarct size (41% +/- 13%). Sevoflurane preconditioning and postconditioning protects against myocardial ischemia-reperfusion injury. The combination of preconditioning and postconditioning provides additive cardioprotection and is mediated, at least in part, by mKATP-channels.     

ChildA级单个直径≤5cm肝细胞肝癌行肝移植与肝切除的预后比较

目的比较ChildA级、单个、直径≤5cm肝细胞肝癌行肝移植与肝切除术的预后。方法回顾性分析笔者所在医院肝移植中心2007～2011年期间行肝切除术及肝移植术的ChildA级、单个、直径≤5cm肝细胞肝癌患者的临床资料,比较2组患者术后无瘤生存率及总体生存率。结果本研究共纳入263例患者,其中肝移植组36例,肝切除组227例。肝移植组与肝切除组患者术后1、3及5年无瘤生存率分别为91．7％、85．3％及81．0％和80．6％、59．8％及50．8％,肝移植组高于肝切除组（P=-0．003）;术后1、3及5年总体生存率分别为100％、87．5％及83．1％和96．9％、83．8％及76．1％,2组间差异无统计学意义伊=0．391）。以肿瘤直径〈3em为标准再予以分析,其肝移植组与肝切除组术后1、3及5年无瘤生存率分别为92．3％、92．3％及92．3％和80．2％、62．5％及50．5％,肝移植组高于肝切除组（P=-0．019）;术后1、3及5年总体生存率分别为100％、91．7％及91．7％和97．7％、87．5％及79．5％,2组间差异也无统计学意义（p0．470）。结论ChildA级、单个、直径≤5cm肝细胞肝癌患者肝切除术后复发率高于肝移植,但两种治疗方式的术后总体生存率相似。     

Neurotoxicity of intrathecally administered bupivacaine involves the posterior roots/posterior white matter and is milder than lidocaine in rats

BACKGROUND AND OBJECTIVES: Clinical and laboratory studies suggest that lidocaine is more neurotoxic than bupivacaine. However, histological evidence of their comparative neurotoxicity is sparse. We thus pathologically and functionally compared the intrathecal neurotoxicity of these agents. METHODS: Rats received 0.12 microL/g body weight lidocaine (0%, 2%, 10%, or 20%) or bupivacaine (0%, 0.5%, 2.5%, or 5%) in distilled water via an intrathecal catheter. The influence of high osmolarity was also examined using 5% bupivacaine in 20% glucose solution (5% BG) and a control 25% glucose solution. The L3 spinal cord, the posterior and anterior roots, and the cauda equina were examined by light and electron microscopy. Walking behavior and sensory threshold were investigated as neurofunctional tests. RESULTS: The posterior root and posterior white matter showed axonal degeneration in rats treated with 10% and 20% lidocaine and 5% bupivacaine in distilled water (5% BDW) and in 5% BG, but not in rats treated with 2% lidocaine, 0.5% and 2.5% bupivacaine, distilled water, or 25% glucose solution. The histological damages were more severe in 20% lidocaine-treated rats than in 5% bupivacaine-treated rats. The damage of posterior white matter was observed only when the posterior root was severely injured. No significant difference of histological findings was observed between 5% BDW and 5% BG. Functional abnormalities were found only in rats treated with 20% lidocaine. CONCLUSIONS: The neurotoxic lesions caused by bupivacaine and lidocaine were indistinguishable in the primary site and the extending pattern, such as axonal degeneration originating from the posterior roots and extending to the posterior white matter. The intrathecal neurotoxicity is greater in lidocaine than in bupivacaine.     

Survival rate of bladder tumors--an analysis of 2304 patients with bladder tumors in the Tokai Urological Cancer Registry

During the 7 years from 1980 to 1986, 2860 cases of bladder tumors were registered in the Tokai Urological Cancer Registry. Among the 2860 cases, 2304 cases were selected from the registered cases for the present study. The 5-year relative (actual) survival rates were 73.8% (61.9%) of all patients; 48.9% (42.4%) in those with malignant neoplasma of urinary bladder excluding transitional cell carcinoma; 48.8% (41/3%) in those with mixed tumor. In patients with transitional cell carcinoma, the 5-year relative (actual survival rates were 93.7% (78.8%) for G1, 87.2% (74.1%) for G2 and 47.3% (38.9%) for G3. As to staging, the 5-year survival rates were 101.9% (88.0%), 87.6% (75.3%), 57.9% (47.8%), 33.7% (28.2%) and 6.1% (5.0%) in patients with stage of Ta, T1, T2, T3 and T4, respectively. The tumors with muscle infiltration and high grade malignancy obviously deteriorated patients' survival. The 5-year relative (actual) survival rate for patients treated with TUR was 98.1% (82.2%). As to grading, the 5-year survival rates were 102.2% (86.6%) for G1, 104.3% (88.3%) for G2 and 56.9% (48.3%) for G3. The 5-year survival rates of those with Ta, T1 and T2 were 103.9% (89.7%), 96.0% (82.6) and 61.1% (49.1%), respectively. The 5-year relative (actual) survival rate for patients undergoing total cystectomy was 62.4% (52.3%). In those patients, the 5-year survival rates were 96.7% (80.9%) for G1, 63.6% (55.7%) for G2 and 55.4% (47.1%) for G3. As to staging, the 5-year survival rates were 102.3% (90.6%), 77.8% (68.2%), 56.3% (47.9%), 41.8% (34.9%) and 15.2% (13.1%) in patients with stage of Ta, T1, T2, T3 and T4, respectively. The 3 and 5-year relative (actual) survival rates in patients with advanced bladder tumors were 5.3% (4.8%) and 0.87% (0.73%), respectively.     

5-ALA for photodynamic photorejuvenation--optimization of treatment regime based on normal-skin fluorescence measurements

BACKGROUND AND OBJECTIVES: Photodynamic therapy using 20% 5 aminolevulinic acid (5-ALA) has recently been introduced as a new tool in optical skin rejuvenation. The primary objective of this study was to optimize incubation time, the topical delivery mechanism (vehicle) and the concentration of 5-ALA by detecting the dynamic changes of normal skin after 5-ALA application. The secondary objective was to develop a treatment regime which minimizes post-treatment photosensitivity. STUDY DESIGN/MATERIALS AND METHODS: Skin fluorescence distribution patterns after topical application of low concentrations of 5-ALA (0.5% and 1% preparations encapsulated in liposomes), were investigated. Twenty percent 5-ALA in moisturizing cream was used as a control. Ten healthy volunteers participated, and skin fluorescence was documented by fluorescent photography. The fluorescent intensity was measured in % of maximum obtained fluorescence after 3 hours 5-ALA application. RESULTS: Skin fluorescence intensity after topical application of 0.5% and 1% non-occluded liposome-encapsulated 5-ALA application was heterogeneous distributed and reached saturation level after approximate 2 hours. The maximal fluorescence for 0.5% and 1% 5-ALA treated areas was 4.2% (SD: 3.5%) and 2.4% (SD: 2%), respectively, and this difference was statistically significant (P = 0.036). The fluorescence decayed linearly shortly (within 15 minutes) after end of application and was back to baseline within 8 hours. In contrast, the fluorescence of areas treated more than 1 hour with 20% 5-ALA was very uniform and a linear relationship (r2 = 0.998) to the incubation time (0-3 hours) was registered. Furthermore, fluorescence intensity (15.2-57.9%) continued to increase after the end of 5-ALA application. The maximum fluorescence reach a level of 1.6-9 times the fluorescence measured by end of the 5-ALA application and occurred 8:13 hours (SD: 0:49 hours) after the end of 20% 5-ALA application. The average skin surface fluorescence induced by the liposome-encapsulated 0.5% 5-ALA applied for longer than 2 hours, was found to be statistically equal (P = 0.47) to the average measured skin surface fluorescence (4.2%) obtained after 30 minutes exposure to 20% 5-ALA cream (4.3%). CONCLUSION: Changing the 5-ALA vehicle from a moisturizing cream to liposome encapsulation, the 5-ALA concentration can be lowered by a factor of 40, and still induce the same skin fluorescence and at the same time eliminates the need for occlusion. The low post-treatment fluorescence also suggests a significantly reduced risk of post-treatment phototoxicity.     

胰头癌手术范围对预后的影响

目的: 探讨胰头癌切除范围对预后的影响。方法: 对比分析95例胰头癌患者中44例行经典胰十二指肠切除及51例行扩大胰十二指肠切除的生存期、手术并发症和死亡率等。结果: 扩大切除组和经典切除组术后1、3、5年存活率分别为72.5%、45%、17.5%和47.73%、19.35%、6.45%,两组间比较差异有显著性,扩大切除组1、3、5年存活率较经典切除组明显提高(P<0.05);两组手术并发症和死亡率 分 别 为 29.41%、5.88%和25%、4.55%,二者比较差异无显著性。结论: 扩大切除能改善胰头癌患者的预后。