胃肠道间质瘤的诊断和治疗

目的探讨胃肠道间质瘤的诊断及治疗。方法对1996年1月至2008年12月收治的32例胃肠道间质瘤患者的临床和病理资料进行回顾性分析。结果本组胃肠道间质瘤发生于胃25例,十二指肠3例,小肠4例;胃镜或十二指肠镜检查26例,发现病灶24例;B超、CT检查12例,诊断为胃肠道间质瘤10例。本组患者均行手术切除治疗,病理诊断为良性间质瘤15例,潜在恶性7例,恶性10例。CD117阳性表达率96.9％（31／32）,CD34阳性表达率90．6％（29／32）。有26例患者术后获得6～36个月随访,未见肿瘤复发和转移。结论内镜和影像学检查是诊断胃肠道间质瘤的主要方法,CD117和CD34阳性是确诊胃肠道间质瘤的重要依据．手术切除是治疗胃肠道间质瘤的有效手段。     

53例胃肠道间质瘤诊治体会

目的总结胃肠道间质瘤（GIST）的临床表现、诊断及治疗体会。方法对53例GIST病人的临床表现、病理结果、治疗方法及预后进行回顾性分析。结果本组GIST53例，其中34例位于胃，6例位于十二指肠，4例位于空肠，7例位于回肠。2例位于乙状结肠。术后病理诊断低度恶性15例（28．3％）、中度恶性11例（20．8％）、高度恶性27例（50．9％），随访时间6个月。6年，13例出现远处转移或局部复发，7例死亡。结论GIST缺乏特征性临床表现，术前确诊率低，其确诊依赖病理结果，目前GIST的治疗仍以手术切除局部病灶为主，预后与肿瘤大小、核分裂相和是否转移有关。     

胃肠道间质瘤26例临床诊治分析

目的：探讨胃肠道间质瘤的临床特点。方法：对1998年-2005年收治的26例胃肠道间质瘤病人的临床表现、手术处理及病理结果进行回顾性分析。结果：26例均行手术治疗的病人病理诊断良性13例（50％），潜在恶性5例（19％），恶性8例（31％），随访时间6个月至6年，5例出现远处转移或局部复发，4例死亡（均为恶性）。结论：缺乏特征性临床表现，术前确诊率较低，其确诊依赖病理结果。目前的治疗仍以手术切除为主，对复发或远处转移者积极再次手术可延长生存期。     

胃肠道间质瘤13例诊治分析

目的探讨胃肠道间质瘤的临床、病理特点以及对其诊断、良恶性的判定和治疗的探讨。方法回顾性分析2006年3月-2007年9月我院经手术切除、病理确诊的13例胃肠间质瘤病例，肿瘤直径〉10cm 2例均为恶性，5—10cm 5例（恶性4例，潜在恶性1例，），〈5cm 6例（潜在恶性2例，良性4例），核分裂≤5／50HPF 4例，〉5／50HPF 9例。结果免疫组化检测CD117阳性12例（92.3％），CD34阳性10例（76．9％），SMA阳性7例（53．8％），S-100阳性6例（46．2％）。结论胃肠道间质瘤诊断主要依靠免疫组化结果，良恶性的判断同肿瘤的大小、核分裂密切相关，治疗以手术切除为主。     

原发性小肠肿瘤47例临床分析

目的：探讨原发性小肠肿瘤的临床表现、诊断方法及预后。方法回顾性分析47例原发性小肠肿瘤患者的临床资料。结果47例原发性小肠肿瘤临床表现无特异性,术前确诊率为34．0％（16／47）。良性肿瘤占12．8％（6／47）,病理以腺瘤为主,预后好。恶性肿瘤占70．2％（33／47）,贫血是其较为突出的临床表现,病理主要为腺癌（29例,失访3例）,好发于十二指肠,预后差。26例腺癌患者1、2、3、5年生存率分别为67．4％、42．4％、29．4％、22．8％,中位生存期为20．3个月。间质瘤占17％（8／47）,主要来源于空肠,以腹部包块为主要表现,术后使用靶向药物有助于改善患者预后。结论小肠肿瘤发病率低,但以恶性为主,预后差,采取有效的检查手段尽早发现病灶并行手术切除是治疗的关键。     

胃肠道间质瘤23例临床诊治分析

目的探讨胃肠道间质瘤（GIST）的临床诊断与治疗。方法对2000年至2006年收治的23例GIST病人的临床表现、手术处理及病理结果进行回顾性分析。结果所有病人均行手术治疗。病理诊断良性6例（26．1％），交界性5例（21．7％），恶性12例（52．2％）。随访时间6个月至5年。6例出现远处转移或局部复发（其中4例再手术，2例正在口服格列卫治疗）。结论GIST缺乏特征性临床表现，术前确诊率低，其确诊依靠病理结果；目前治疗仍以手术为主，合理规范完整手术切除是最有效的治疗方法。     

胃间质瘤的外科治疗

目的 探讨胃间质瘤(GST)的临床病理特点和外科处理原则。方法 回顾分析经组织病理和免疫组化证实的42例GST的临床病理特点、术中所见与病理、手术方式及随访结果。结果 GST的临床表现无特异性，上消化道出血是最常见症状(47．62％)。术前内镜、CT、胃造影、活组织检查确诊率低，分别为7／40、5／28、2／14和4／40。瘤体直径≥5．5cm、腔外或腔内外生长、存在溃疡、肿瘤坏死在恶性和潜在恶性GST中的比例分别为20／28、21／28、13／28、20／28，而良性CST中分别为3／14、4／14、2／14、0／14。所有病例行手术治疗，切除率100％，无手术死亡，包括胃壁全层楔形切除8例，胃部分切除13例，大部切除16例，全胃切除5例。其中联合脏器切除5例，胃周淋巴结清扫11例，淋巴结转移2例。随访0．5～11年，随访38例，失访4例。胃壁复发、腹膜腔和肝转移各1例，再次手术。结论 胃间质瘤具有较为独特的组织学形态，免疫组化检测可确诊；瘤体直径≥5．5cm、腔外或腔内外生长、存在溃疡坏死、肿瘤质较软、表面血管怒张等为恶性可能。术中综合评估其生物学特性有助于判断良恶性；根治性手术切除是最根本的治疗原则。     

小肠间质瘤56例临床诊治分析

目的探讨小肠间质瘤的临床表现、病理免疫组化特征、多层螺旋CT和血管造影三维CT成像（3D—MSCTA）特征及治疗方法。方法回顾性分析本院56例小肠间质瘤患者的临床和病理及免疫组化资料。结果首诊以消化道出血和贫血者较多,共28例。小肠间质瘤位于十二指肠14例,空肠30例,回肠12例。肿瘤呈梭形细胞13例、上皮样细胞8例、多形性35例。免疫组化检查CD117、CD34、Vimentin呈弥漫性阳性表达,阳性率分别为92．9％、76．8％、96．4％;S-100、actin、desmin呈散在或灶性的阳性表达,阳性率分别为12．5％、14．3％、12．5％。多层螺旋CT检查小肠间质瘤检出率80．4％。56例患者均经手术切除小肠肿瘤,其中50例行肿瘤完整切除,6例行姑息性切除。结论小肠间质瘤缺乏特征性临床表现,术前确诊率较低,多层螺旋CT可提高小肠间质瘤检出率,其确诊依赖病理诊断和CD117等相关抗体免疫组织化学检测,手术为本病目前最佳的治疗方法。     

胰腺神经鞘瘤临床诊治分析

目的：探讨胰腺神经鞘瘤的临床特点和诊治方法。方法总结并回顾性分析我院肝胆外科收治的胰腺神经鞘瘤患者1例及文献报道的71例患者临床资料。结果共计72例胰腺神经鞘瘤患者纳入总结和分析。患者平均年龄54岁（范围17～89岁）,其中女性40例（56％）。临床表现包括上腹痛、体重减轻,或体检偶然发现胰腺肿物。肿瘤平均大小6．1 cm （1～20 cm）。肿瘤位于胰头部29例（40％）、胰体／尾部32例（44％）,沟突部6例（8％）。肿瘤表现为实性肿物27例（38％）、囊性28例（39％）、囊实性10例（14％）。2例通过术前超声内镜下穿刺活检病理确诊,其余均为手术后标本病理诊断证实。手术治疗行胰十二指肠切除术23例、局部剜除术16例、胰体尾切除术15例、胰腺中段切除1例。5例（7％）患者术后病理为恶性神经鞘瘤,恶性组肿瘤大小明显大于良性组[（13．8±6．2）cm vs （5．6±4．1）cm,P ＝0．0004）]。手术切除患者术后随访3～65月,均无肿瘤复发、转移及患者死亡。结论胰腺神经鞘瘤临床表现缺少特异性,术前诊断困难,肿瘤大小与良恶性具有明显相关性,手术治疗可取得良好效果。     

小肠间质瘤29例临床分析

目的 探讨小肠间质瘤的临床诊断及治疗方法.方法 回顾性分析29例小肠间质瘤的临床资料.结果 29例病人均行手术及甲磺酸伊马替尼辅助治疗.病理诊断为良性4例,交界性3例,恶性22例.淋巴结转移2例.免疫组化CD117（＋）92％（26/29）,CD34（＋）78％（22/29）.结论 小肠间质瘤的诊断依据为临床症状结合影像检查,病理可确诊.手术加药物辅助治疗效果好.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

Acupuncture Treatment of Vomiting

CASE HISTORY A female patient, 46 years old, head of the foreign affairs department of a certain university in Beijing, paid her first visit on October 9, 2006, with the chief complaint of vomiting for one month. She got vomiting after meals in early September. Before that, she had discomfortable sensation in the stomach due to angry with others, but she didn't pay much attention. Later, it developed into vomiting after eating. After the vomiting, the discomfort would be relieved, but with slight hypodynamia. She was once diagnosed as having 'neurogenic vomiting'. Having taken some western and Chinese drugs, the above symptoms were a little bit improved, but she would have nausea upon eating and with regurgitation. Because of the fear for vomiting, she did not dare to have food intake, with body weight reduction of 6 kilos in one month.     

Qiu Baoguo''''s Experience in Treating Consumptive Syndromes after Radio-Chemotherapies

Radiotherapy and chemotherapy are the important modern medical therapies for malignant tumors,yet they can also bring about serious local and systemic toxic side reactions so to decrease the patient;'s life quality,manifested by a series of consumptive symptoms.Having engaged in the combined work of Chinese and western medicine for nearly 50 years,the research fellow Qiu Baoguo in Henan Provincial Academy of TCM has developed his unique views on the TCM study of consumptive syndromes.The author of this essay had once the fortune tO follow Dr.Qiu in clinic,and specially would like to introduce in the following Dr.Qiu's experience in treating consumptive syndromes after radio-chemotherapies for patients with malignant tumor.     

Insomnia Due to Deficiency of Both the Heart and Spleen Treated by Acupuncture-Moxibustion and Chinese Tuina

OBJECTIVE: To observe therapeutic effects of the comprehensive therapy of acupuncture-moxibustion and Chinese Tuina for treatment of insomnia due to deficiency of both the heart and spleen. METHODS: 92 cases were divided randomly into the treatment group (treated by acupuncture-moxibustion and Chinese Tuina) and the control group (treated by acupuncture-moxibustion). RESULTS: The therapeutic effect of the treatment group was obviously superior to that of the control group (the CHI2 test showed P < 0.01). CONCLUSIONS: The comprehensive therapy of acupuncture-moxibustion and Chinese Tuina can give marked therapeutic effects for treatment of insomnia due to deficiency of both the heart and spleen.     

Analysis of CK-19,PDX-1,Nestin,Ngn3 in different donor islet purity in rats

Objective: To investigate if there are the CK-19, PDX-1, Nestin, Ngn3 positive cells in the donor islets of different purity in rats. Methods: Thirty male adult SD rats were randomly divided into 3 groups. Islets were isolated using digestion by ductal injection of collagenase. Group Ⅰ (n=10): Separating cell preparations were not purified, Group Ⅱ(n=10): Islet sediment was purified with 25% Ficoll400 ,Group Ⅲ (n=10): Islet sediment was purified with 25% and 11% Ficoll-400. The levels of protein of CK-19, PDX-1, Nestin and Ngn3 were detected by immunohistochemistry and the mRNA of CK-19, PDX-1, Nestin, Ngn3 was amplified by RT-PCR. Results: After two different purification methods applied, three islet preparations of different purities were obtained. The difference of islet purity was significant among various groups (P＜0.05). Compared with group Ⅱ and group Ⅲ,the protein and mRNA of CK-19, PDX-1, Nestin,Ngn3 were both higher in group Ⅰ; group Ⅲ was poorly expressed. Conclusions: The three different islet purity donor islet have different CK-19, PDX-1, Nestin, Ngn3 positive cells within them, indicating that there are some islet stem cells in the purified donor islet.     

Dr.Zhang Ren''''s Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

Luo Lingjie''''s Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.