紧邻主胰管的胰腺囊性肿瘤局部切除的初步经验：附4例报告

背景与目的:胰腺囊性肿瘤手术方案多有争议,紧邻主胰管的胰腺囊性肿瘤的手术病例报道较少,临床仍在积累经验。本文总结近年来笔者科室在治疗紧邻主胰管的胰腺囊性肿瘤的经验教训,探讨紧邻主胰管的胰腺囊性肿瘤行胰腺局部切除的手术效果及治疗经验。方法:回顾性分析收治的4例紧邻主胰管的胰腺囊性肿瘤行胰腺局部切除术患者的临床资料,总结运用胰腺局部切除治疗紧邻主胰管的胰腺囊性肿瘤的经验教训。结果:2例患者术后快速出院,均在术前放置胰管内支撑管;另外2例患者出现了主胰管损伤伴B级胰瘘,术前均未放置胰管内支撑管,其中1例患者术后放置胰管内支撑管后胰瘘量明显减少,此2例患者均长期带管后胰瘘自行愈合。结论:对于紧邻主胰管的胰腺囊性肿瘤,尤其是良性及低度恶性的囊性肿瘤,施行胰腺局部切除是安全有效的;术前放置胰管内支撑管对于术中辨认主胰管、减少主胰管损伤、预防胰瘘发生有积极作用;发生主胰管损伤后,胰瘘给予长期带管引流,有自行修复机会,部分患者可避免二次手术。     

Different optical properties between human hepatocellular carcinoma tissues and non-tumorous hepatic tissues <Emphasis Type="Italic">In Vitro</Emphasis>

There has been an ongoing search for clinically acceptable methods for the accurate,efficient and simple diagnosis and prognosis of hepatocellular carcinoma(HCC).Optical spectroscopy is a technique with potential clinical applications to diagnose cancer diseases.The purpose of this study was to obtain the optical properties of HCC tissues and non-tumorous hepatic tissues and identify the difference between them.A total of 55 tissue samples(HCC tissue,n=38;non-tumorous hepatic tissue,n=17) were surgically resected from patients with HCC.The optical parameters were measured in 10-nm steps using single-integrating-sphere system in the wavelength range of 400 to 1800 nm.It was found that the optical properties and their differences varied with the wavelength for the HCC tissue and the non-tumorous hepatic tissue in the entire wavelength range of research.The absorption coefficient of the HCC tissue(1.48±0.99,1.46±0.88,0.86±0.61,2.15±0.53,0.54±0.10,0.79±0.15 mm-1) was significantly lower than that of the non-tumorous hepatic tissue(2.79±1.73,3.13±1.47,3.06±2.79,2.57±0.55,0.62±0.10,0.93±0.16 mm-1) at wavelengths of 400,410,450,1450,1660 and 1800 nm,respectively(P<0.05).The reduced scattering coefficient of HCC tissue(5.28±1.70,4.91±1.54,1.26±0.35 mm-1) and non-tumorous hepatic tissue(8.14±3.70,9.27±3.08,2.55±0.57 mm-1) was significantly different at 460,500 and 1800 nm respectively(P<0.05).These results show different pathologic liver tissues have different optical properties.It provides a better understanding of the relationship between optical parameters and physiological characteristics in human liver tissues.And it would be very useful for developing a non-invasive,real-time,simple and efficient way for medical management of HCC in the future.     

胰岛素瘤诊治分析：附72例报告

目的:探讨胰岛素瘤的诊断和外科治疗方法。方法:回顾性分析我院31年余诊治的72例胰岛素瘤的临床资料。结果:84.72%有典型的Whipple三联征表现。80.56%血浆免疫反应性胰岛素/血糖(IRI/G)比值>0.3。术前定位诊断方法的阳性率分别为:腹部超声78.13%,CT(平扫或增强)60.97%,多排螺旋CT胰腺灌注100%,MRI 37.50%,内镜超声(EUS)72.73%,选择性动脉造影(DSA)28.57%。术中超声联合扪诊诊断阳性率92.31%。肿瘤最大直径≤2 cm者占88.75%。37.5%的肿瘤位于胰头颈部,27.50%位于胰体部,35.0%位于胰尾部。81.58%的病例可行胰岛素瘤局部剜除术。病理诊断均为胰岛素瘤,65例(90.28%)为功能性胰岛素瘤,7例(9.72%))为无功能性胰岛素瘤;4例(5.56%)为多发性肿瘤,2例(2.78%)恶性倾向,1例(1.39%)合并多发性内分泌肿瘤1型(MEN-1)。结论:Whipple三联征和IRI/G>0.3可作为胰岛素瘤定性诊断的主要依据。应联合应用超声,CT,多排螺旋CT胰腺灌注,MRI,内镜超声和DSA多种方法进行术前定位。术中超声联合扪诊是简单有效的定位诊断方法。肿瘤的局部剜除术是多数胰岛素瘤的最佳手术治疗方式。     

miR-96的表达对肝细胞癌细胞迁移和侵袭的影响

目的:探讨miR-96在肝细胞癌(HCC)细胞中的表达及作用。方法:用qRT-PCR测定miR-96在不同HCC细胞系(HepG2、7721、huh7)及正常肝细胞系L02中的表达;将HepG2细胞分别转染miRNA随机序列(阴性对照组)、miR-96模拟物(miR-96模拟物组)和miR-96抑制物(miR-96抑制物组)后,用细胞划痕实验及Transwell细胞侵袭实验分别检测细胞迁移及侵袭能力,qRT-PCR及Western blot分别测定PTPN9 mRNA及蛋白的表达。结果:miR-96在各肝癌细胞系中的相对表达量均明显高于其在正常肝细胞系L02的相对表达量(均P0.01)。与阴性对照组比较,细胞划痕愈合率在miR-96模拟物组明显升高,而在miR-96抑制物组明显降低(均P0.05);侵袭细胞数在miR-96模拟物组明显增多,而在miR-96抑制物组明显减少(均P0.05);PTPN9 mRNA与蛋白相对表达量在miR-96模拟物组均明显下调,而在miR-96抑制物组均明显上调(均P0.05)。结论:miR-96在HCC细胞中表达升高,并可能通过下调PTPN9表达促进HCC细胞的迁移与侵袭。