PET/CT与肿瘤患者个体化疗

PET／CT具有早期、特异性诊断肿瘤并能够监测肿瘤临床治疗效果的作用，已经成为目前最热门的临床医学影像设备，并且近三年来已经在我国得到大幅度增长。PET／CT和以解剖结构为基础的传统影像设备成像原理和机制具有本质的区别，特别是新型探针的不断推出，PET／CT在临床最重要的作用是在DNA、RNA和蛋白质水平对肿瘤进行特异性的诊断和指导临床进行个性化治疗。     

肿瘤乏氧与乏氧检测研究现状

乏氧是人和动物肿瘤共有的特征。实验观察与测定表明，几乎所有的实体肿瘤中均有乏氧细胞存在，乏氧细胞在实体瘤中是常见现象。分子生物学研究发现，乏氧不仅使肿瘤产生针对放、化疗的保护蛋白，增加对放、化疗的抵抗性，而且使肿瘤内氧调节蛋白（OPR）、血管内皮生长因子（VEGF）等表达增加，从而使肿瘤自身的侵袭性也增加。自Thomlison和Grayp发现在恶性肿瘤中存在低氧细胞以来，     

快速康复外科在结直肠癌择期手术中的应用效果

Objective To investigate the clinical application of fast track surgery in patients undergoing elective colorectal carcinoma surgery. Methods Seventy patients with colorectal carcinoma requiring colorectal resection were randomized into two groups: fast-track group (35 cases) and conventional care group (35 cases). Results Sixty-two patients finished the study, 32 cases in fast-track group and 30 cases in conventional care group. The median and average time to the first passage of flatus (2±1 vs. 4±2, P<0.01), the first passage of stool (3.8±1.6 vs. 6.4±2.5, P=0.0007), resumption of normal diet [(4±2) vs. (8.2±2.2), P<0.01] and the length of postoperative stay (6±1 days vs. 11.7±3.8 days, P<0.01) were much shorter in the fast-track group than in the conventional care group. The preoperative incidence of thirst (2/32 vs. 23/30, P<0.01), hunger (5/32 vs. 20/30, P<0.01) and postoperative infectious complications (2/32 vs. 8/30, P=0.04) were much lower in the fast-track group than in the conventional care group. Conclusion Fast track surgery in patients undergoing elective colorectal resection was safe and effective.     

结直肠癌伴同时性肝转移的治疗

Objective To investigate the clinical pathologic characters of colorectal cancer with simultaneous hepatic metastasis and the prognosis. Methods From Aug. 1994 to Dec. 2006, 2019 cases of colorectal carcinoma were admitted, among them there were 166 patients of colorectal cancer with synchronous liver metastases receiving surgical therapy. Results were analyzed retrospectively using the software of SPSS. Results These 166 patients with synchronous liver metastases from colorectal cancer accounted for 8.1% of all 2019 patients of colorectal cancer admitted. Multivariate analysis demonstrated that CEA level before surgery、depth of invasion、 pathological type and Ducks' stage were the key risk factors predicting simultaneous liver metastasis from colorectal cancer. The survival rates at 1, 3 and 5 years were 69%, 21%, and 9% respectively. There was significant difference among the different liver metastasis group of H1, H2 and H3(X2=23.35, P<0.01). The survival rates of patients undergoing radical resection was higher than those undergoing palliative resection (PR)and by-pass operation or feeding neostomy(BP/ FN)(X2= 21.18,P<0.01). PR improved short-term prognosis but did not improve long-term survival compared with BP/FN group(P=0.13). Conclusion Colorectal cancer with synchronous liver metastases has poor clinic pathological characters. Different degree of liver metastasis result in different prognosis.Radical resection leads to a better prognosis. Palliative resection can improve short-term prognosis and life quality but can't improve long-term survival.     

核素心肌灌注显像与反向再分布

反向再分布(reverse redistribution)足指心肌灌注显像早期(静息或运动)灌注正常的部位,晚期显像则出现灌注异常,或者原来灌注异常的部位,晚期显像进一步恶化的现象.1979年,Tanasescu等首先报道了这一现象,以后的研究则进一步将前者称为A型,后者称为B型.多年以来,虽然研究对反向再分布进行了大量的研究,但其发生机制和临床意义至今尚无定论.     

抗噬菌体甲型副伤寒沙门菌突变菌的构建及其生物学特性

目的:采用同源重组基因敲除方法构建3株甲型副伤寒沙门菌(副甲)抗噬菌体突变菌,并研究其生物学特性。方法:通过PCR和融合PCR方法获得了2、3、5号同源臂片段,经酶切后与pYG4载体连接,构建pYG4-2、pYG4-3和pYG4-5同源重组质粒。经PCR测序鉴定正确后,与野生型副甲菌进行同源重组,获得2、3、5号3株抗噬菌体突变菌。将3株突变菌和野生型副甲菌经不同种类和浓度的抗生素、不同pH值和温度及不同浓度的盐离子处理后,测量菌株的A₅₉₅值,分析3株突变菌对抗生素、温度、pH值和盐离子的敏感性以及生长曲线。结果:PCR和融合PCR扩增出3个同源臂,构建的pYG4-2、pYG4-3和pYG4-5同源重组质粒经PCR测序表明构建成功;同源重组和抗噬菌体验证表明成功获得3株抗噬菌体突变菌。3株突变菌产生了卡那霉素抗性,且对链霉素表现出敏感性;2号菌表现出氨苄青霉素抗性,5号菌表现高温度耐受性;与野性型副甲菌比较,3株突变菌的生长曲线明显平缓,尤以2号突变菌最为突出。结论:成功构建抗噬菌体突变菌,并获得一些特殊的生物学特性。     

术后早期经口进食对结直肠癌术后体液免疫功能的影响

目的探讨术后12h内经口进食对结直肠癌患者术后临床结局及体液免疫的影响。方法前瞻性人组中山大学附属第一医院2008年5—12月间拟行限期根治性手术的70例结直肠癌患者,按随机数字表法分为早期进食组（术后12h内开始进食）和传统进食组（术后肛门排气后开始进食）,每组35例。比较两组患者术后临床指标及体液免疫指标。结果62例患者完成试验,其中早期进食组32例,传统进食组30例。早期进食组较传统进食组患者术后排气时间[（21）d比（4±2）d,P〈0．01]、排粪时间[（3．8±1．6）d比（6．4±2．5）d,P〈0．01]、半流饮食时间[（4±2）d比（8．2±2．2）d,P〈0．01]和术后住院时间[（6±1）d比（11．7±3．8）d,P〈0．01]均明显缩短。术后两组患者各项体液免疫指标均明显下降,之后逐渐回升,但早期进食组恢复速度快于传统饮食组,至术后第3天,早期进食组较传统进食组患者球蛋白[（24．1±2．4）g／L比（22．1±3．3）g／L,P〈0．05]、免疫球蛋白G[（10．8±2．4）g／L比（8．7±2．1）g／L,P〈0．01）和补体C4[（0．24±0．09）g／L比（0．17±0．05）g／L,P〈0．05]水平明显增高。结论术后12h内经口进食应用于限期结直肠癌手术患者安全有效,有助于加快术后肠道功能恢复,缩短术后住院时间,并促进术后体液免疫功能的恢复。     

微波血管腔内微创治疗下肢静脉曲张

目的：比较微波血管腔内微创治疗与传统手术治疗下肢静脉曲张的临床疗效与优缺点。方法：治疗组采用微波血管腔内凝固封闭大隐静脉结合属支曲张静脉穿刺凝固方法。对照组采用传统大隐静脉高位结扎加静脉剥脱手术方法。结果：治疗组在症状改善、患肢美观、手术时间、出血量、住院时间、术后并发症等方面优于对照组。结论：微波血管腔内微创治疗下肢浅静脉曲张，具有微创、患者痛苦小、恢复快、美观、疗效好、并发症少、手术操作简捷等优点。     

快速康复外科在结直肠癌择期手术中的应用效果

Objective To investigate the clinical application of fast track surgery in patients undergoing elective colorectal carcinoma surgery. Methods Seventy patients with colorectal carcinoma requiring colorectal resection were randomized into two groups: fast-track group (35 cases) and conventional care group (35 cases). Results Sixty-two patients finished the study, 32 cases in fast-track group and 30 cases in conventional care group. The median and average time to the first passage of flatus (2±1 vs. 4±2, P<0.01), the first passage of stool (3.8±1.6 vs. 6.4±2.5, P=0.0007), resumption of normal diet [(4±2) vs. (8.2±2.2), P<0.01] and the length of postoperative stay (6±1 days vs. 11.7±3.8 days, P<0.01) were much shorter in the fast-track group than in the conventional care group. The preoperative incidence of thirst (2/32 vs. 23/30, P<0.01), hunger (5/32 vs. 20/30, P<0.01) and postoperative infectious complications (2/32 vs. 8/30, P=0.04) were much lower in the fast-track group than in the conventional care group. Conclusion Fast track surgery in patients undergoing elective colorectal resection was safe and effective.     

浅析18F-FDG PET/CT肿瘤显像前应注意的几个问题

随着18F-FDG PET/CT显著的临床价值以及临床医生对18F-FDG PET/CT检查的认可,越来越多的肿瘤患者选择了18F-FDG PET/CT检查。为了尽可能使行18F-FDG PET/CT肿瘤显像的患者感到检查的舒适性和无创性,并最大限度获得准确和高质量的影像结果,本文就患者行18F-FDG PET/CT肿瘤显像前