壁层腹膜细胞刷的研制及临床应用

壁层腹膜细胞刷的研制及临床应用马述春张兴荣胡和平陈伟忠朱梁刘苏张忠兵临床诊治腹水患者的首要环节是确定其良恶性，这需要细胞学和（或）组织学依据。细胞学检查常规行腹腔穿刺抽取腹水查脱落细胞，但检出率低，且检得的是陈旧性细胞，形态模糊，不易确定其良恶性。为...     

腹膜活检在良恶性腹水鉴别中的临床实用价值

目的 评价比较同步进行的腹膜活检、腹水肿瘤标志物测定、腹水脱落细胞学检查在良恶性腹水鉴别诊断中的临床实用价值.方法 152例腹水原因待查患者,经B超检查均有不同程度及不同部位的腹膜增厚,采用超声穿刺探头引导下于增厚的腹膜处进行活检,组织石蜡包埋,HE染色后作病理学诊断,腹水肿瘤细胞学检查采用腹水离心后沉渣包埋免疫组化染色.腹水肿瘤标志物AFP、CEA、CA199、CA125检测采用电化学发光法.结果 腹膜活检检出阳性率为100%(146/146),明显高于腹水脱落细胞学检查的阳性率17.12%(25/146),差异有显著性(P<0.01),腹水肿瘤标志物AFP、CEA在恶性腹水中有明显升高,但敏感性和特异性均较差,CA199和CA125的值在良恶性腹水中差异无显著性.故认为腹水肿瘤标志物临床应用价值有限.结论 对于原因不明的伴有腹膜增厚的腹水的诊断,腹膜穿刺活检是一种最有临床价值的首选诊断方法 .     

活组织细胞学检查对肺癌的诊断价值

报告９４例肺癌病人活组织印片、刷片细胞学检查，单独或联合检查结果。印检、刷检和活检的阳性率分别为７１．２％，６５．９％和７２．３％，无差异性，活检＋印检阳性率为９０．４％，活检＋印检＋刷检阳性率最高为９２．５％。结果提示：联合检查可提高诊断的阳性率；印检对肺癌的诊断是一项简便有效的检查方法。     

胆管癌的影像学、组织细胞学及肿瘤标记物检测的对比性研究

目的 通过各种影像学、组织细胞学及血清和胆汁肿瘤标记物的对比性研究，探索诊断胆管癌价值高、经济实用的方法。方法 32例胆管癌患者进行BUS、CT、MRCP检查；检测血清与胆汁CEA、CA19-9；再行ERCP并细胞刷检、组织活检及胆汁脱落细胞检查。结果 影像学检查对胆管狭窄部位的判定：BUS、CT、MRCP、ERCP分别为68．8％、75％、87．5％和90．6％；而43．8％．59．4％、78．1％及84．4％能明确提供影像诊断；细胞刷检、活检及胆汁脱落细胞的阳性率分别为56．3％、46．9％和15．6％。血清、胆汁CEA取ICA19-9阳性率分别为40．6％，59．4％。46．9％及78．1％。结论 超声和CT能初步提示病变部位及性质，MRCP和ERCP均为胆管癌定位诊断的良好方法，通过ERCP进行组织细胞学检查可为疾病提供定性诊断，胆汁和血清的肿瘤标记物尤其是胆汁CA19-9升高有助于诊断。     

腹膜活检在腹水病因诊断中的意义

腹水的常见病因有肝硬化、结核性腹膜炎、恶性肿瘤腹膜转移或种植、腹膜恶性肿瘤等，一般通过病史、常规辅助检查以及腹水脱落细胞检查等能明确病因，但临床上仍有不少病例通过以上检查不能明确诊断，以至于影响治疗。我科开展腹膜活检术以来共对34例不明原因的腹水患者进行了腹膜活检，其中30例明确了病因，确诊率达到88．24％，为治疗提供了明确的依据，现将结果报告如下。     

闭式经皮胸膜刷检诊断恶性胸腔积液

目的 :评价胸膜刷检对恶性胸腔积液的诊断价值。方法 :38例疑是恶性胸腔积液的病人作胸膜刷检、活检和胸液细胞学检查。结果 :38例患者中 30例被确诊为恶性胸腔积液 ,胸膜刷检阳性率为 83% ,明显高于活检阳性率 6 0 % (P <0 .0 5 ) ,也高于脱落细胞学检查 6 6 % (P >0 .0 5 )。联合三种方法的阳性率为 86 .6 %。结论 :闭式经皮胸膜刷检是一种简单、安全、有效的方法 ,对诊断恶性胸腔积液价值较大     

胸膜活检术联合胸膜刷检术对恶性胸腔积液的诊断价值

目的评价胸膜活检和胸膜刷检对恶性胸腔积液的诊断价值.方法对临床确诊的40例恶性胸腔积液病例行胸膜活检、胸膜刷检和胸水细胞学检查,比较各种方法和组合对肿瘤细胞的阳性率.结果单项检测阳性率以胸膜刷检最高(77.5%),高于胸水细胞学检查(62.5%),但两者相差无显著性(χ2=2.14,P＞0.05);高于胸膜活检(52.5%),两者有显著性差异(χ2= 5.49,P＜0.05).联合胸膜活检和胸膜刷检,阳性率提高为82.5%,与细胞学和胸膜活检相比有显著差异(χ2分别为4.01和8.21,P分别＜0.05和0.01);与胸膜刷检相比阳性率虽有增高,但差异无显著性(P＞0.05).如3种方法联合应用,阳性率为90.0%.结论胸膜活检和胸膜刷检联合应用是一种简单、安全、有效的方法,对诊断恶性胸腔积液有较大的应用价值.     

肺癌所致恶性胸腔积液联合诊断方法分析

目的 探讨联合应用临床常用的胸膜活检、胸水脱落细胞学检查和胸水与血清肿瘤标志物癌胚抗原（CEA）测定等检查方法，在诊断肺癌所致的恶性胸腔积液中的应用价值。方法 回顾性分析2001年1月～2005年4月经病理组织学或细胞学确诊的52例肺癌引起恶性胸脏积液患者的临床资料、诊断方法及化验结果，对比分析其诊断价值。结果 肺腺癌是引起恶性胸腔积液最多见的原因。胸膜活检的诊断阳性率为42．3％～69．2％，随着活检次数的增加累积阳性率也增加；朐水脱落细胞学检查的病理诊断阳性率为73.1％；以上两种方法联合的诊断阳性率为78．8％；胸水CEA、血清CEA、胸水CEA／血清CEA〉1．5对恶性胸腔积液的联合诊断阳性率为80．8％；以上多项检查方法联合对恶性胸腔积液的诊断阳性率为92．3％。结论 胸膜活检、胸水脱落细胞学检查、胸水CEA和血清CEA的测定，以及胸水CEA／血清CEA〉1.5的比值等多项联合，对肺癌所致的恶性胸腔积液的诊断阳性率高。     

恶性腹膜间皮瘤的诊断与治疗（附10例报道）

目的：提高对恶性腹膜间皮瘤(MPM)的认识。方法：总结10例MPM的诊治经验，结合文献对其诊断和治疗进行讨论。结果：根据临床表现、影像学检查、腹水检查常规和脱落细胞学、腹膜穿刺活检及腹腔镜检查结果，术前6例怀疑为MPM，4例确诊：MPM。10例行剖腹探查术，其中9例行肿瘤灭减和肿瘤切除，术后均辅以化疗。2例行免疫治疗。随访6例，5例生存18个月以上。结论：根据临床表现及辅助检查，术前不易确诊MPM，确诊本病需依靠腹膜穿刺活检及腹腔镜检查。治疗以肿瘤灭减和肿瘤切除为主，辅以化疗免疫治疗。     

经内镜胆管细胞刷检和组织活检诊断胆管癌的价值

目的评价经内镜胆管细胞刷检、组织活检诊断胆管癌的价值。方法对30例经手术或临床随访确诊为胆管癌的患者行胆管细胞刷检、组织活检、细胞刷检＋组织活检联合检查。结果30例胆管癌患者行胆管细胞刷检阳性率为36．7％,胆管组织活检阳性率为43．3％,细胞刷检和组织活检阳性率差异无统计学意义（χ^2=0．278,P=0．598）。细胞刷检＋组织活检联合检查阳性率为64．1％,联合检查与单独细胞刷检比较差异有统计学意义（χ^2=4．267,P=0．039）,联合检查与单独组织活检比较差异无统计学意义（χ^2=2．411,P=0．121）。结论经内镜组织活检联合细胞刷检能进一步提高胆管癌诊断的阳性率,对诊断胆管癌有重要的价值。     

Comparison of peritoneal free gastric cancer cells＇ detecting rates between laparoscopically assisted and open radical gastrectomy

Objective： To compare laparoscopic gastrectomy and conventional surgery on the dissemination and seeding of tumor cells. Methods：Intraoperative peritoneal lavage cytologic examination was performed in 65 patients with gastric cancer, during laparoscopic gastrectomy （n = 34） and conventional surgery （n = 31）. Cytology was examined twice, immediately after opening the peritoneal cavity and just before closing the abdomen. Saline was poured into the peritoneal cavity, and 100 ml fluid was retrieved after irrigation. Laparoscopic instruments were lavaged after surgery with 100 ml saline. Carbon dioxide （COz） was derived through the trocar side orifice after pneumoperitoneum during laparoscopic gastrectomy and filtered through 100 ml saline. Cytologic examination of the filtrate was performed after the filtration process. Results： The incidence of positive cytology during laparoscopic surgery was 32.26% in the preoperative lavage and 22.58% in the postoperative lavage. The incidence of positive cytology during conventional surgery was 41.18% before lavage and 26.47% after lavage. Only one positive cytology was detected in the CO2 filtrate gas. The incidence of positive cytology in the lavage of the instruments during laparoscopic surgery was 6.45 %. Conclusion： During gastric laparoscopic surgery, CO2 pneumoperitoneum does not affect tumor cell dissemination and seeding. In this study, laparoscopic techniques used in gastric cancer surgery were not associated with a higher risk for intraperitoneal dissemination of cancer cells than the conventional surgery.     

Expression of survivin mRNA in peritoneal lavage fluid from patients with gastric carcinoma

Background Peritoneal dissemination is the most common pattern of metastasis in advanced gastric carcinoma with serosal invasion. In the present study, we reported the clinical relevance of a new diagnostic method involving RT-PCR, using survivin as the target gene, for the detection of free cancer cells in peritoneal washes. Methods Intraoperative peritoneal washes were obtained from 48 patients who underwent surgery for gastric cancer. RT-PCR analysis with primers specific for survivin and conventional cytologicalexaminations were both performed. Results Survivin mRNA was not detected in any peritoneal wash samples from patients with benign disease, but was detected in 28 of 48 samples taken from patients with gastric cancer and in all metastastic nodules. Survivin expression in the peritoneal cavity significantly correlated with depth of cancer invasion, lymph node metastasis, and TNM stage. There were 92% of clinically evident peritoneal metastasis cases showed detectable survivin expression. The combination of survivin RTPCR and cytological examination yielded positive results in 66.7% (32/48) of patients with gastric cancer, much higher than the results produced by cytological method alone. Conclusions Survivin mRNA detected in peritoneal lavage fluid might indicate the presence of free cancer cells in the peritoneal cavity. The high sensitivity of the RT-PCR-based survivin assay suggests that survivin serves as a molecular marker for detecting peritoneal micrometastasis. Its ubiquitous expression in peritoneal cancer cells and metastatic nodules also suggests a promising future therapeutic strategy based on survivin inhibition for cases of gastric cancer involving peritoneal metastasis.     

腹腔液中层粘连蛋白含量与胃癌病理及腹膜转移相关因素的关系

目的探讨胃癌腹腔液中层粘连蛋白含量与其病理生物学行为及腹膜转移相关因素的关系.方法术中收集50例胃癌和10例胃良性病变的腹水或腹腔冲洗液,采用放射免疫技术检测上清液中层粘连蛋白、CEA蛋白(p-CEA)含量,同时进行腹腔冲洗细胞学(peritoneal lavage cytology,PLC)和病理学检查.结果层粘连蛋白含量与胃癌组织学类型、生长方式、浸润深度及淋巴结转移呈正相关.PLC和p-CEA阳性组层粘连蛋白含量均高于阴性(P＜0.05);肉眼腹膜转移的10例中层粘连蛋白均显著升高.全组层粘连蛋白含量升高者占68%,明显高于p-CEA(44%)和PLC(34%)的阳性率.结论腹腔液中的层粘连蛋白是反映胃癌生物学行为的分子标志物,与胃癌腹膜转移密切相关,其预测腹膜亚临床转移的灵敏性优于p-CEA和PLC.     

细胞DNA定量分析在鉴别良恶性胸腹水中的应用价值

目的：通过与液基细胞学( LBC)诊断比较,探讨细胞DNA定量分析技术( DNA-ICM)在良恶性胸腹水诊断中的应用价值。方法收集417例胸腹水标本,分别采用 LBC和DNA-ICM两种方法判定其良恶性,并将两种结果进行对比。结果417例胸腹水标本均经临床或病理诊断证实,213例为恶性,204例为良性。 DNA-ICM在胸腹水良恶性诊断中的敏感度、特异度、准确度、阳性预测值、阴性预测值分别为89．7%、100%、94．7%、100%、90．3%;而 LBC 分别为63．4%、81．9%、72．4%、78．5%、68．2%;两者之间敏感度、特异度、准确度、阳性预测值、阴性预测值差异均有统计学意义(P<0．01)。结论 DNA-ICM在诊断胸腹水良恶性方面有较大应用价值,与LBC联合使用可提高胸腹水阳性检出率,降低漏诊率。     

免疫组织化学染色在妇科盆腹腔积液细胞学诊断中的应用

目的探讨免疲组化染色在妇科腹腔脱落细胞学诊断中的应用价值。方法选取45例盆腹腔积液及腹腔冲洗液中有异型细胞的女性病例,对液体离心沉淀后,沉淀物石蜡包埋,切片后进行CK7,CK20,Calretinin,WT1,p53,ER,PR,CK5／6的免疫组织化学染色检测。结果在含有肿瘤细胞的阳性病例组中,CK7,WT1和p53有较高的阳性表达率,阳性率分别为89.3％,62．9％和68．4％。而在未找到肿瘤细胞的阴性病例组中,CK7,Calretinin和CK5,6阳性表达率较高,分别为72．7％,71．4％和57．1％。结论盆腹腔积液的沉淀细胞团块经包埋切片后,可以用于免疫组织化学染色,对于盆腹腔渗出液的细胞学诊断具有帮助。     

MicroRNA在腹膜透析中的研究进展

腹膜透析是终末期肾病患者的主要治疗方式之一,因有能更好地保护残余肾功能等优势,具有广泛的应用前景。但长期腹膜透析容易出现多种并发症,其中腹膜透析相关性腹膜炎是最常见的并发症之一,反复发生的炎症刺激会加速腹膜纤维化的发展,最终导致超滤衰竭,腹膜透析失败。MicroRNA（miRNA）属于非编码RNA的一种,在炎症及纤维化过程中的作用备受关注,众多miRNA参与了腹膜炎症及纤维化过程。新近研究显示,腹膜透析过程中,多种miRNA的表达谱发生了改变。该文就miRNA在腹膜透析中的研究进展进行综述。     

腹膜转运特性对非糖尿病腹膜透析患者营养状态的影响

目的探讨尿毒症腹膜转运特性对非糖尿病腹膜透析患者营养的影响。方法根据腹膜平衡试验（PET），将31例腹膜透析患者腹膜分为低转运（L）、低平均转运（LA）、高平均转运（HA）、高转运（n）4种类型，比较4种转运特性腹膜透析患者腹透6个月后血清白蛋白（ALB）、血清转铁蛋白（TF）、血红蛋白（Hb）、主观综合性营养评倘法（SGA）。结果高转运腹膜组与低转运、低平均转运、高平均转运组比较，ALB、TF、Hb、SGA均显著降低（P〈0．05）；高转运腹膜组与低转运组比较，ALB、TF、、SGA均显著降低（P〈0．05）。结论在溶质清除相同的条件下，腹膜转运性高的腹透患者营养状况明显差于腹膜转运低的腹透患者。     

腹膜透析管置入灌洗引流治疗以累积腹膜腔为主要表现的重症急性胰腺炎

目的探讨腹膜透析管置入灌洗引流治疗以累积腹膜腔为主要表现的重症胰腺炎的效果。方法回顾性分析84例以累积腹膜腔为主要表现的重症胰腺炎病例,治疗以腹膜透析管置入灌洗引流为主。结果全部患者顺利渡过急性炎症反应期,出现重症胰腺炎后期并发症共38例,经后续治疗全部治愈。结论腹膜透析管置入行腹腔灌洗引流能在创伤更小的基础上治疗重症胰腺炎,能够顺利地帮助病人渡过急性炎症反应期,值得在临床上推广。     

腹膜转运功能对连续性不卧床腹膜透析患者营养状况的影响

目的：探讨腹膜转运功能对连续性不卧床腹膜透析（ＣＡＰＤ）患者营养状况的影响。方法：将４６例ＣＡＰＤ患者按腹膜平衡试验（ＰＥＴ）结果分为Ⅰ组（高和较高转运率）和Ⅱ组（较低转运率），比较其尿素ＫＴ／Ｖ、蛋白分解率（ＰＣＲ）血清白蛋白（Ａｌｂ）、前清蛋白（ＰＡ）和转铁蛋白（Ｔｆ）水平。结果：两组在残余肾功能（ＲＲＦ）透析剂量和尿素ＫＴ／Ｖ方面无差异，Ⅰ组血清Ａｌｂ和ＰＣＲ显著低于Ⅱ组。结论：腹膜透性较高者更易发生蛋白营养不良。     

The Effect of Ligustrazine on Peritoneal Transport in Peritoneal dialysis

In order to investigate the effect of ligustrazine (Lig)i.p.on peritoneal permeability in peritoneal dialysis and its side effects,creatinine was given intravenously and continuously to maintain the high plasma creatinine level.All the rabbits were divided into three groups:normal control group (goup A),group B treated with 0.12% Lig and group C treated with 0.24% Lig.The peritoneal dialysis of all rabbits lasted 2h.The plasma and dialysate levels of glucose,protein and creatining were observed immediate,30min,60min,90min,120min after dialysis.Creastinine dialysate/plasma ratio (D/P),protein D/P ratio,grucose D/Do at different time points after dialysis and creatinine mass transfer area coefficient (MTAC) at 120min were calculated.The structures of peritoneum were observed under optical microscope and electron microscope after continuously intraperitoneal injection of Lig for 14 days.The results showed that the 90-min and 12-min creatinine D/P ratios in the group C were higher than in the group A.The 120-min creatinine MATC in the group C was higher than in the group A.The rabbits treated with Lig did not show significant structure changes of peritoneum and signs of peritoneal irritation.It was suggested that Lig could increase mass transfer ability of peritoneum without significant side effects.