胰腺区域血管结染后动脉灌注化疗可行性的动物实验研究

背景与目的：胰腺癌是预后很差的消化道肿瘤，常规的全身化疗效果很不理想。本实验探讨幼猪胰腺区域血管结扎后动脉灌注化疗的安全性和可行性。方法：14只幼猪分为3组，A组和B组分别行胃十二指肠动脉及脾动脉结扎并置管；C组行左耳缘静脉穿刺。3组动物分别自上述途径，60min内滴注氟尿嘧啶（5-FU）（20mg／kg）。用药后抽取门静脉和颈静脉血及胰腺组织测5-FU浓度；灌注前后抽取颈静脉血测淀粉酶、胰岛素、葡萄糖水平；取胰腺标本行组织病理检A、结果：80min和100min时，A组和B组门静脉药物浓度显著高于C组（P〈0．05，P〈0．01）。颈静脉血5-FU浓度住20min、40min和60min时，A组和B组均明显低于C组：A组和B组胰腺组织内5-FU浓度均明显高于C组（P〈0．01）。各组于灌注前、灌注开始后2h、灌注后24h淀粉酶、胰岛素、葡萄糖水平均无明显变化。区域灌注后HE染色下多数标本中胰腺组织正常，少数出现不同程度胰腺组织水肿，无明显坏死改变。ABC免疫组化染色下胰岛结构亦多正常，少数胰岛内出现淋巴细胞，个别有胰岛β细胞轻度受损。结论：胰腺区域血管结扎后灌注化疗与全身化疗相比极大增高胰腺组织内的5-FU浓度，显著降低灌注期间周围循环中药物浓度，不影响血清淀粉酶、胰岛素、葡萄糖水平，对胰腺组织、胰岛β细胞无明显损伤。     

经皮股动脉穿刺胃左动脉插管药物灌注治疗晚期贲门癌的初步观察

本文报告经皮股动脉穿刺选择性胃左动脉插管药物灌注治疗晚期贲门腺癌10例,以同期经周围静脉化疗的晚期贲门腺癌16例为对照,灌注或化疗药物均为5-氟脲嘧啶 丝裂霉素。结果表明胃左动脉灌注者全身反应小,能缓解吞咽困难症状,可使个别病人肿瘤缩小,提高手术切除率。故认为经皮股动脉穿刺胃左动脉插管灌注化疗是治疗晚期贲门癌的可行方法之一。     

对介入性热疗安全温度的实验研究

 目的　研究 6 0℃的灌注液经肝动脉行灌注性热疗后 ,肝脏活检及肝功各项指标的变化情况 ,为临床灌注性热化疗提供安全数据。方法　经犬肝动脉灌注入 6 0℃生理盐水 2 0 0 ml,30分钟灌完。比较灌注前后肝脏穿刺活检及肝功的动态变化情况。结果　谷丙、谷草转氨酶于灌注后开始升高 ,之后逐渐恢复 ,一周后全部恢复正常 ,而胆红素、白蛋白、γ- GT则无明显变化。肝脏活检也呈可逆性变化。结论　经肝动脉 6 0℃灌注液介入性热疗对肝脏损伤轻微 ,临床应用此温度下的灌注性热化疗是安全的。     

兔肝VX2瘤两种介入性热化疗方法的对比实验研究

目的:研究两种经动脉热灌注化疗方法对兔肝VX2移植瘤的热化疗的协同效率。方法:用新西兰大白兔建立肝VX2肿瘤模型,经股动脉插管,导管头置于兔肝动脉,DSA证实肿瘤供血动脉后,分3组(每组10只),分别给予常温100ml生理盐水+阿霉素(ADM)灌注、60℃热生理盐水100ml+阿霉素连续灌注、60℃热生理盐水100ml+阿霉素间歇性灌注。灌注过程中,测量两60℃热灌注化疗组肿瘤组织内43℃-45℃持续时间,灌注后即时检测各组肿瘤组织内阿霉素浓度。结果:灌注后肿瘤组织内阿霉素浓度(μg/ml):60℃间歇性热灌注化疗组为17.622±1.368,60℃连续热灌注化疗组12.013±2.237,常温灌注化疗组11.519±1.225。60℃间歇热灌注化疗组高于60℃连续热灌注化疗组(P<0.05),60℃连续热灌注化疗组高于常温灌注化疗组(P>0.05)。瘤体温度43℃-45℃持续时间(min):60℃间歇性热灌注化疗组为11.3±3.3,60℃连续热灌注化疗组4.1±2.7,60℃间歇性热灌注化疗组为60℃连续热灌化疗组近3倍。两60℃热灌注化疗组兔的呼吸、心率、体温变化无明显差异。结论:经动脉间歇性热灌注化疗方法是一种更有效的介入性热化疗方法。     

经动脉持续灌注化疗治疗中晚期胰腺癌的临床分析

 目的 比较经动脉持续灌注化疗和全身静脉化疗治疗中晚期胰腺癌的临床疗效，探讨选择性动脉持续灌注化疗的临床应用价值。方法 51例中晚期胰腺癌，其中25例采用经动脉持续灌注吉西他滨和5-Fu方案，26例采用经外周静脉灌注吉西他滨和5-Fu方案。应用世界卫生组织实体瘤疗效评定标准评价疗效，肿瘤体积测量采用MRI或CT。使用临床受益反应（CBR）对疼痛、体力状况及体重改变情况作出综合评价。采用WH0抗肿瘤药物急性与亚急性毒性分级标准对不良反应进行评价。结果 动脉灌注化疗组的有效率（32．0％）高于外周静脉化疗组（23．1％），但差异无显著性。动脉灌注化疗组的临床受益率（80．0%）高于外周静脉化疗组（50．0％），差异有显著性。6个月、9个月、1年的累积生存率和中位生存时间，动脉灌注化疗组高于外周静脉化疗组，差异有显著性。按WHO分级标准，两组患者不良反应之间无显著性的差异。结论 经动脉持续灌注吉西他滨和5-Fu较外周静脉灌注吉西他滨和5-Fu能提高中晚期胰腺癌的临床受益率和生存期，其方法安全可靠，且不良反应少。     

动脉灌注化疗合并放射治疗中晚期食管癌36例

[目的]比较中晚期食管癌采用单纯放射治疗与放疗同时合并动脉灌注化疗的临床反应、疗效及生存期。[方法]对36例经胃境及病理证实的中晚期食管癌采用总D_T60Gy～70Gy／6～7周6MV－15MV－X线照射，同时采用经皮穿刺左支气管动脉、食管固有动脉或胃左动脉插管，沿导管灌注阿霉素、丝裂霉素、5氮脲嘧啶或鬼臼乙甙、顺铂等化疗药物，3－4周一次，2次一个疗程。同时选用工例仅用单纯放射治疗为同期对照。[结果]单纯疗组38例中CR＋PR共11例，有效率为28．9％；放疗合并动脉灌注化疗组36例中CR＋PR共16例，有效率为44．4％，两组比较放化组有效率明显高于单放组。两组病人随访18个月，单放组生存率为26．3％，放化组生存率为47．2％。而一年生存率放化组明显高于单放组。[结论]放疗合并动脉灌注化疗治疗中晚期食管癌疗效及生存期高于单纯放疗，值得临床进一步应用。     

组织特异性CD/5-FC系统热化疗治疗裸鼠结肠癌肝转移瘤的安全性

目的: 探讨组织特异性胞嘧啶脱氨酶/5-氟胞嘧啶(CD/5-FC)系统热化疗对裸鼠结肠癌肝转移模型治疗的安全性.方法:30只裸鼠经门静脉注射转染CD基因的人结肠癌LOVO细胞,建立结肠癌肝转移模型,随机分为对照组、热化疗组和化疗组,分别经腹腔注射生理盐水、43 ℃前药5-FC和室温前药5-FC[均为500 mg/(kg·d)]进行治疗.治疗21 d后处死裸鼠,取各组裸鼠肝脏转移瘤组织、正常肝组织及胃、肺、胰腺、小肠及大肠组织作病理检测;RT-PCR检测各组织的CD基因表达.结果:常规病理检测显示对照组肝转移瘤组织细胞生长活跃,热化疗组较化疗组肝转移瘤细胞生长受抑制更明显;3组裸鼠正常肝组织及胃、肺、胰腺、小肠和大肠组织均呈正常形态,无明显病理改变.RT-PCR检测显示,3组肝脏转移瘤组织CD基因表达稳定,均见154 bp条带;显示3组裸鼠正常肝组织及胃、肺、胰腺、小肠和大肠组织均无CD基因表达.结论:组织特异性CD/5-FC系统热化疗明显提高了CD基因表达的靶向性,减少了热化疗引起的正常组织损伤,该治疗系统有较好的安全性.     

术前介入治疗预防胃癌术后复发的疗效评价

[目的]探讨术前介入治疗预防胃癌术后复发的临床意义。[方法]74例可根治性手术切除的胃癌患者分为两组,一组在根治性切除术前行经胃动脉灌注化疗(GAI)或经胃动脉灌注化疗栓塞(GAI GAE)．另一组直接行根治性切除术，观察介入治疗后患者的临床反应，比较两组患者术后相同时间复发率的差异。[结果]22例术前行GAI治疗的患者出现一过性恶心、呕吐，14例行GAI GAE治疗的患者恶心、呕吐较重，有4例出现黑便．经保守治疗后症状消失；36例术前介入治疗的患者术后6、12、18、24个月的复发率分别为0、2．8％、11．1％、25．0％，38例直接行根治性切除术的患者分别为5．3％、10．5％、23．7％、39．5％，两组患者术后远期复发率存在显著差异。[结论]胃癌切除前行介入治疗(胃动脉灌注化疗或胃动脉灌注化疗栓塞)安全有效．对减少术后复发有显著的临床效果．值得推广．     

组织特异性CD/5-FC系统热化疗治疗裸鼠结肠癌肝转移瘤的安全性

目的:探讨组织特异性胞嘧啶脱氨酶/5氟胞嘧啶(CD/5FC)系统热化疗对裸鼠结肠癌肝转移模型治疗的安全性。方法： 30只裸鼠经门静脉注射转染CD基因的人结肠癌LOVO细胞,建立结肠癌肝转移模型,随机分为对照组、热化疗组和化疗组,分别经腹腔注射生理盐水、43 ℃前药5FC和室温前药5FC\[均为500 mg/（kg·d）\]进行治疗。治疗21 d后处死裸鼠,取各组裸鼠肝脏转移瘤组织、正常肝组织及胃、肺、胰腺、小肠及大肠组织作病理检测; RTPCR检测各组织的CD基因表达。结果：常规病理检测显示对照组肝转移瘤组织细胞生长活跃,热化疗组较化疗组肝转移瘤细胞生长受抑制更明显;3组裸鼠正常肝组织及胃、肺、胰腺、小肠和大肠组织均呈正常形态,无明显病理改变。RTPCR检测显示,3组肝脏转移瘤组织CD基因表达稳定,均见154 bp条带;显示3组裸鼠正常肝组织及胃、肺、胰腺、小肠和大肠组织均无CD基因表达。结论：组织特异性CD/5FC系统热化疗明显提高了CD基因表达的靶向性,减少了热化疗引起的正常组织损伤,该治疗系统有较好的安全性。     

碘油栓塞致大鼠肝肿瘤细胞凋亡和动态病理观察

目的　研究经肝动脉碘油灌注栓塞后大鼠肝肿瘤病理学表现 ,观察肿瘤细胞凋亡情况。方法　 4 1只Walker 2 5 6大鼠肝癌模型随机分为 6组 :对照组 6只大鼠经胃十二指肠肝动脉灌注 76 %泛影葡胺 0 .2～ 0 .3ml;实验组肝动脉灌注栓塞超液态碘油 0 .5ml/kg与泛影葡胺乳剂 (1∶1) ,按碘油栓塞后 0 ,1,3,5 ,10d分为 5组 ,每组 7只。光镜和透射电镜分别观察大鼠肝肿瘤组织病理 ,检测凋亡细胞。结果　与对照组比较 ,实验组大鼠的肿瘤增长率 (GR)受到抑制 ,栓塞 3d组GR为 2 8% ,对照组为 133%。 3～ 10d组肿瘤坏死程度加重 (P <0 .0 1) ,10d组有 1例完全坏死 ,栓塞后早期炎症反应明显 ,后期出现纤维包裹和分隔。 1～ 10d组有 17例大鼠的凋亡细胞计数为阳性 ,主要位于肿瘤周边 ,呈典型细胞凋亡形态学特征。结论　经肝动脉单纯灌注栓塞碘油可引起大鼠肝肿瘤不同程度坏死 ,诱导肿瘤细胞凋亡可能是其另一种重要作用机制。     

Case of gastric perforation after TAI (trancatheter arterial infusion) of SMANCS with special reference to accessory left gastric artery

In 1993, a 55-year-old-man was diagnosed with chronic active hepatitis (HCV). In January 1999, a solitary hepatocellular carcinoma (HCC) was discovered in his liver S8, and a sub-segmental hepatectomy was performed. In July 1999, multiple recurrences in the liver were noticed, and on August 6, 1999, the first SMANCS-TAE was performed. After that, PEIT was added, and then on July 18, 2000 and November 9, 2000, a second and third SMANCS-TAE were carried out, respectively. This time multiple HCCs in the bilateral lobes were discovered, and the 4 th SMANCS-TAE was undergone on April 12, 2001. On a celiac angiogram, the right hepatic artery was shown to have been obliterated by the last TAE. In addition, accessory left gastric artery (accessory LGA) originating in the left hepatic artery (LHA) proximal to the umbilical point (UP) could be seen. So we advanced a microcatheter to the LHA distal to the accessory LGA and injected SMANCS (0.8 mg) into the left hepatic artery. On April 24, he was admitted to hospital by ambulance due to severe upper abdominal pain. The muscular defense was noticed, and an air pocket under the diaphragm was indicated on an X-ray. An emergency total gastrectomy and R-Y re-construction were performed under the diagnosis of gastric perforation. A hole of approximately 10 cm in diameter was found in the anterior wall between the cardia and the upper body, and the accessory left gastric artery (LGA) was obliterated. The principal known side effects of SMANCS are fever, nausea and vomiting. However, as far as this writer has investigated, gastric perforation has never been reported. SMANCS presumably can flow into the stomach wall through the accessory LGA, triggering necrosis of the gastric wall due to circulatory damage. Although arterial infusion of SMANCS is an effective treatment, it causes considerable vascular damage, so intensive follow-up treatment is necessary.     

环氧合酶-2对胃癌血管内皮生长因子及血管形成的影响

 目的　探讨环氧合酶 2 (COX 2 )对胃癌血管内皮生长因子 (VEGF)的表达及血管生成的影响。方法　应用免疫组织化学技术检测胃癌组织中COX 2 ,VEGF表达和微血管密度 (MVD)。结果　COX 2在62 .2 %胃癌组织中表达增高 ,COX 2表达与VEGF表达显著相关 (γS=0 .5 85 ,P <0 .0 1 ) ,且COX 2和VEGF均阳性的胃癌组织MVD(64.0± 2 5 .4)亦明显高于两者均阴性者 (3 0 .7± 1 1 .5 ) (P <0 .0 1 )。结论　胃癌组织中存在COX 2的高表达 ,COX 2通过增加VEGF表达而促进肿瘤血管形成     

阿霉素介入性化疗与热化疗对兔肝VX-2移植癌改良模型作用的比较研究

 目的　评价介入性热化疗对兔肝癌的抑瘤效果。方法　将VX 2瘤细胞接种于 6 0只新西兰白兔肝右叶 ,建立兔肝癌模型 ,随机分 4组 ,每组 15只。利用导管经肝动脉分别给生理盐水、37℃盐水 +阿霉素、6 0℃热生理盐水及ADM溶液 (6 0℃ )于不同组 ,1周后后观察各组肿瘤体积及血清AST水平 ,观察荷瘤兔的存活期。结果　ADM溶液 (6 0℃ )热灌注组生长率 (0 .5 3± 0 .2 1)与对照组 (3.4 8± 1.17)相比有显著性差异 (P <0 .0 1) ,与栓塞组 (1.13± 0 .2 3)、ADM溶液 (37℃ )灌注组 (1.0 9± 0 .2 6 ) )相比亦有显著性差异 (P<0 .0 5 )。ADM溶液 (6 0℃ )热灌注组存活期 (5 0 .0± 2 .0d)与对照组 (40 .5± 3.0d)相比差异有显著性 (P <0 .0 5 )。ADM溶液 (6 0℃ )热灌注组血清AST水平治疗前后变化与其它各组相比无显著性差异 (P >0 .0 5 ) ,与对照组相比有显著性差异 (P <0 .0 5 )。结论　ADM溶液 (6 0℃ )热灌注组可大大降低肿瘤生长率 ,延长...     

TIMP-1、CDw75表达与胃癌侵袭转移关系的研究

 目的　探讨TIMP 1、CDw75在胃癌组织中的表达及其与胃癌浸润、转移和临床分期的关系。方法　用免疫组化法检测TIMP 1、CDw75抗原在 5 4例胃癌组织及其相应正常胃粘膜中的表达。结果　胃癌组织中TIMP 1、CDw75抗原的表达均显著高于相应的正常胃粘膜组织 (P <0 .0 5 ) ,且TIMP 1表达与肿瘤浸润深度 (χ2 =13.4 10 ,P <0 .0 5 )、胃癌TNM分期 (χ2 =30 .0 0 0 ,P <0 .0 1)显著相关。CDw75抗原表达与肿瘤浸润深度 (χ2 =9.314 ,P <0 .0 5 )、临床TNM分期 (χ2 =10 .0 2 9,P <0 .0 5 )及淋巴结转移 (χ2 =9.6 10 ,P <0 .0 1)显著相关。结论　胃癌组织中TIMP 1、CDw75的表达能较好的反映肿瘤的生物学进展 ,联合检测TIMP 1、CDw75可以帮助判断肿瘤的浸润、转移及患者的预后     

Laparoscopic-assisted radical gastrectomy for distal gastric cancer

A 48-year-old female patient was diagnosed with a superficial depressed type early gastric cancer (type IIc) of 1.0 cm at the gastric angle as indicated by gastroscopy. Laparoscopic-assisted greater omentum-preserving D2 radical gastrectomy was performed in combination with Billroth I reconstruction under general anesthesia for the distal gastric cancer on April 5, 2013. The postoperative recovery was satisfying without complications. The patient was discharged seven days after surgery.Key Words: Early gastric cancer, gastrectomy, laparoscopic-assisted, D2 lymph node dissectionAs a novel minimally invasive surgical technique, laparoscopic radical gastrectomy is associated with such advantages as less injury, reduced postoperative pain, lower impact on immune function, rapid recovery of gastrointestinal function, and short hospital stay. In 1997, Goh and coworkers conducted D2 radical gastrectomy for advanced gastric cancer under laparoscope, which demonstrated the safety and feasibility in terms of the technique. In their reviews, Topal (1) and Huscher (2) also confirmed the above conclusion, and they suggested that the long-term survival outcomes of laparoscopic-assisted radical gastrectomy were similar to those of open surgery. Laparoscopic-assisted radical gastrectomy has now been recognized for treating gastric cancer with an invasion depth of T2 or less, without evidence of lymph node metastases in preoperative examination (3). On April 5, 2013, we conducted laparoscopic-assisted gastrectomy for a patient with early gastric cancer (type IIc). The postoperative recovery was satisfying. The details are as follows:A 48-year-old woman was admitted to our hospital due to “upper abdominal dull pain with acid reflux for more than a month”. Gastroscopy suggested a superficial depressed type early gastric cancer of 1.0 cm at the gastric angle. Biopsies indicated adenocarcinoma at the gastric angle. Endoscopic ultrasound indicated disordered structure of the submucosal layer of the gastric lesion at the gastric angle. CT scan suggested slightly thickened gastric wall at the gastric angle, without enlargement of lymph nodes around the stomach or liver metastasis. Preoperative staging: T1bN0M0. On April 5, 2013, laparoscopic-assisted D2 radical gastrectomy was conducted under general anesthesia for the distal gastric cancer.During the surgery (Video 1), the patient was placed in a supine position with legs apart. Following general anesthesia, CO₂ pneumoperitoneum was established at 12 cm water column. Laparoscopic exploration showed no peritoneal dissemination or liver metastasis nodules, so the surgeons decided to perform D2 radical resection while preserving the greater omentum. The gastrocolic ligament was cut open 2-3 cm away from the greater curvature through to the lower pole of the spleen. The left gastroepiploic vessels were denuded, and the left gastroepiploic artery was ligated and cut at the root. The station number 4sb lymph nodes were dissected. The greater curvature was denuded, and station number 4d lymph nodes were dissected.Open in a separate windowVideo 1Laparoscopic-assisted radical gastrectomy for distal gastric cancerThe lymph nodes in the inferior area of the pylorus were then dissected. The station number 14v lymph nodes were typically not dissected in the standard D2 radical surgery. The anterior pancreaticoduodenal fascia was stripped close to the head of the pancreas to reveal the right gastroepiploic vein. During the separation, the non-working face of the ultrasonic scalpel was pointed towards the pancreas. Caution was made to avoid injury to the small vessels on the surface of the pancreas, particularly to the anterior superior pancreaticoduodenal vein. The right gastroepiploic vein was denuded, and transected before its junction with the pancreaticoduodenal vein. The right gastroepiploic artery was then denuded. The small vessels and subpyloric vessels emerging from the gastroduodenal artery and entering the posterior wall of the duodenum were treated first. This could reduce bleeding when separating the right gastroepiploic artery. After the right gastroepiploic artery was denuded, ligated and cut, the lower edge of the duodenum was denuded, and the station number 6 lymph nodes were dissected. The gastroduodenal artery was stripped to its root in an inverse direction. The common hepatic artery was dissected, and the right gastric artery was separated near the bifurcation, but was not transected for the moment.A piece of sterile gauze was placed on the lesser sac to flip the stomach downward. The pylorus and the superior region of the duodenum were denuded, then the small omentum was opened, and the gauze was clearly visible. The duodenum was first transected, and the stomach was flipped to the left side to reveal the structure more clearly from the upper edge of the pancreas to the posterior wall of the lesser sac.The anterior hepatoduodenal capsule was opened and the proper hepatic artery was divided. The right gastric artery was further denuded, ligated and cut at the root. The station number 5 lymph nodes were dissected. With the assistant gently lifting the gastropancreatic fold, the surgeon began to separate the superficial fascia on the upper edge of the pancreas. The gastropancreatic fold was dissected, and the coronary vein and the left gastric artery were denuded. After the coronary vein was denuded, a clamp was applied to the root and the vessel was transected. The left gastric artery was denuded from the periphery. An absorbable clamp was applied to 0.5 cm above its root and the vessel was transected so that the clamp would not slip off. The station number 7 lymph nodes were dissected.The lesser sac was opened until the right edge of the cardia. The peritoneal reflection was opened to the anterior part of the right crus of the diaphragm to provide an accurate anatomic plane for the subsequent dissection of the station number 9 lymph nodes. The station number 12a lymph nodes were then dissected. The proper hepatic artery was gently pulled to the right side, and the fascia to the left was separated to naturally reveal the left anterior wall of the portal vein. The separation was continued along the upper edge of the fascia from the left side of the portal vein to the celiac artery, during which the stations number 12a and 8a lymph nodes were dissected en bloc. After the dissection, the entrance of the portal vein, splenic vein and coronary vein was clearly visible. The two stations were gently retracted to the left side, and the lymph nodes to the right of the celiac artery were dissected along the plane established anterior to the crus in the above steps, and the anterior region of the celiac artery was then dissected.Afterwards, the lymph nodes proximal to the splenic artery were then dissected (number 11p). The fascia at the upper edge of the pancreas was separated towards the pancreatic tail to expose the splenic artery. It should be noted that there were several curves along the splenic artery to the splenic hilum, especially the largest one of 3 to 4 cm to the root, which was hidden behind the pancreas with lymph nodes inside that should not be omitted. Hence, we dissected the lymph nodes surrounding the splenic artery from both the anterior and the posterior directions. The dissection from posterior to anterior areas beginning from the left crus of the diaphragm would help ensure that the lymph nodes at the curves were not omitted. The supplying vessels along the lymph nodes around the splenic artery could be directly transected with the ultrasonic scalpel. After dissection, the lymph nodes were lifted to the anterior right side. The separation was then continued towards the cardia so that lymph nodes to the posterior and right of the cardia could be dissected. The right side of the cardia and the lesser curvature of the stomach were denuded, and the stations number 1 and 3 were dissected. At this point, the laparoscopic operation was is complete. An auxiliary incision of about 5 cm was made inferior to the xiphoid for the removal of the entire specimen. A Tyco 25# circular gastrointestinal stapler was used to complete the Billroth I anastomosis.The whole operation lasted 3 hours and 10 minutes, with intraoperative blood loss of 20 mL, and no blood transfusion was delivered. The patient was able to ambulate three days after surgery. Liquid diet was prescribed on the 5th day and semi-liquid diet on the 6th day. The patient was discharged seven days after surgery without postoperative complications. Postoperative pathology showed a superficial depressed type moderately to poorly differentiated adenocarcinoma with superficial ulceration at the junction of the antrum and the gastric body on the lesser curvature side (size 1 cm × 1 cm × 0.2 cm), invading the submucosa. Chronic inflammation was noted in 2 (suprapyloric), 1 (subpyloric), 5 (lesser curvature), 3 (greater curvature), 2 (close to the left gastric artery), 1 (close to the common hepatic artery), 2 (close to the splenic artery), 2 (close to the celiac artery), 1 (12a), 1 (4sb), and 2 (to the right of the cardia) lymph node. Both upper and lower margins were negative. Postoperative pathological staging was T1bN0M0.     

Two case reports-a control of the bleeding from advanced gastric cancer, unable to undergo resection, but was possible by transcatheter arterial embolization (TAE)

CASE 1: A 61-year-old man having advanced gastric cancer was presented with massive hematemesis. We could not control bleeding by gastrointestinal endoscopic hemostatic therapy, so we performed a transcatheter arterial embolization (TAE). We performed embolization on the left gastric artery. CASE 2: A 58-year-old man having advanced gastric cancer was presented with hematemesis. We could not control bleeding by gastrointestinal endoscopic procedure, so we conducted TAE. We performed embolization on the left gastric artery and right gastric artery. In both cases, hemostasis was achieved by TAE, and effectively controlled the bleeding from advanced gastric cancer.     

人胃癌及癌前病变中NF-KappaB和c-myc蛋白的表达与意义

 目的　探讨胃癌及癌前病变中NF κB亚单位 p6 5蛋白和c myc蛋白的表达及相互关系。 方法　用免疫组化法检测 4 1例胃癌及 2 5例相应非癌组织的 p6 5和c myc蛋白。 结果　 (1)正常胃粘膜→肠型化生→不典型增生→胃癌中 ,两种蛋白的阳性表达率渐次升高 ,且增生组、胃癌组与正常组相比差异分别有显著性 ,肠化与胃癌组间也有显著性差异 (P <0 .0 5 ) ;(2 )胃癌中 ,两种蛋白的表达在低未分化、进展期、有淋巴结转移和浸润至浆膜层的肿瘤中显著增高 (P <0 .0 5 ) ;(3)肠化、增生和胃癌中 ,两者的表达分别具有中到强正相关 (rs=0 .6 12～ 0 .84 5 ,P <0 .0 1)。结论　NF κBp6 5蛋白活性表达的增加是胃癌发生中的早期事件 ,c myc基因产物可能作为其效应子 ,在胃癌的发生发展中发挥重要作用     

经导管胃左动脉持续灌注化疗治疗全身化疗失败的不可切除贲门癌的疗效及安全性

目的观察经导管胃左动脉持续灌注化疗治疗全身化疗失败的不可切除贲门癌的疗效及安全性。方法回顾性分析临沂市肿瘤医院2019年6月至2021年6月收治的经全身化疗失败的不可切除贲门癌患者24例，均合并不同程度进食梗阻症状，所有患者均接受FOLFOX方案经导管胃左动脉（必要时选择胃右动脉，胃网膜左、右动脉，左膈下动脉和胃后、短动脉等优势动脉）持续灌注化疗，应用Stooler标准评估患者进食梗阻症状变化情况；记录患者的生存时间、不良反应及生活质量变化。结果随访截至2022年3月，24例患者行介入治疗2～6次，平均（3.79±1.16）次，首次治疗后1周，梗阻症状缓解率100%，中位持续缓解时间143 d。治疗2个周期后，患者客观缓解率为45.83%（11/24），疾病控制率为95.83%（23/24）；肿瘤标志物（癌胚抗原、糖类抗原19 9、糖类抗原72 4）在术后7、30 d均较术前下降，术后30 d基本降至正常范围。6、12、24个月生存率分别为91.7%、53.2%、8.3%，中位生存时间13.0个月。治疗2个周期后，患者疼痛、恶心呕吐、食欲减退症状均有改善，生活质量明显提高。术后不良反应主要为腹痛、恶心、呕吐及骨髓抑制，均≤2级，均经对症治疗后好转。结论经导管胃左动脉持续灌注化疗治疗全身化疗失败的不可切除贲门癌的近期疗效     

胃血管解剖及其在食管癌管状胃重建中的应用

  目的  本研究旨在了解胃血管, 尤其是胃网膜右动脉的解剖情况, 为食管癌术中管状胃的重建提供参考。  方法  解剖由上海医学院提供的尸体28具, 其中男性18具、女性10具。分别观察并测量各条胃供血动脉的直径及长度, 胃网膜右动脉的长度及其与胃大弯长度的比值, 观察胃网膜左、右动脉的吻合情况。  结果  最终可测得胃左动脉为25条, 直径为3.40(2.10~6.40) mm; 胃右动脉21条, 直径为1.97(0.68~3.56) mm; 胃网膜左动脉26条, 直径为1.87(0.80~2.96) mm; 胃网膜右动脉28条, 直径为2.82 (1.58~4.80) mm, 长度为216.71(120~318) mm; 胃大弯长度为356.39(248~487) mm。胃网膜右动脉长度与胃大弯长度的平均比值为0.61(0.45~0.82)。28具尸体中, 17具发现胃网膜左、右动脉的终支有吻合支, 占60.7%。  结论  通过尸体解剖, 对胃的供应血管进行观察和统计, 计算得到胃各供应血管长度和直径, 推测胃网膜右动脉平均提供胃大弯侧61%的血供, 在60.7%的标本中发现有胃网膜左、右动脉的吻合支。通过基础解剖数据, 以期为食管癌术中管状胃血供的估算及管状胃的最佳重建提供参考。      

胃原发非何杰金氏淋巴瘤的诊治

 目的　探讨胃原发NHL临床表现的共同规律和有效的诊断方法。方法　对 4 5例胃原发NHL进行回顾性分析 ,生存率计算用寿命表法。结果　 39例患者行胃镜或X线造影 8例确诊 ,诊断率仅 2 0 .5 1%。根治术 +化疗和 /或放疗 5年以上生存率达 92 .85 % ,非根治术 +化疗和 /或放疗 5年以上生存率为72 .72 %。结论　胃镜、X线造影仍是最有价值的诊断手段。根治术 +化疗或放疗是有效的治疗方法 ,影响本病预后因素与临床病理分型、浸润胃壁深度、治疗措施、组织学类型相关 ,与肿块大小无明显相关