胰腺假囊肿26例治疗体会

我科近10余年共收治胰腺假囊肿26例,疗效满意,现结合近年文献报告如下。1　临床资料1.1　一般资料　1987年～1998年收治胰腺假囊肿26例,其中男性17例,女9例;年龄17～60岁,平均38岁。病因:急性胰腺炎15例,胰腺外伤6例,不明原因5例。临床表现:腹痛19例,上腹部肿块16例,恶心、呕吐8例,黄疸1例。并发囊肿感染8例,囊肿破裂腹膜炎1例。Ｂ超和ＣＴ检查确诊率分别为92.3%和95.8%,ＣＴ或Ｂ超提示囊肿直径2.5ｃｍ～28.0ｃｍ,其中<6.0ｃｍ6例。肝胃型3例,胃后型18例,胃结肠型5例。囊肿穿刺液检查18例,囊液淀粉酶阳性15例,阳性率83.3%,癌胚抗原均<25μｇ…     

表达端粒酶逆转录酶siRNA的溶瘤腺病毒对裸鼠肾癌移植瘤的治疗作用

Objective To investigate the antitumor effect of oncolytic adenovirus armed with small interference RNA targeting hTERT gene for renal cancer therapy. Methods Nude mice were divid-ed randomly into 4 groups (8 mice/group),and were treated by intratumoral injections of ZD55-hTERT ( an oncolytic adenovirus armed with small interference RNA targeting hTERT gene) ,ZD55-EGFP ( an on-colytic adenovirus) and Ad-hTERT (replication-defective adenovirus armed with small interference RNA targeting hTERT gene) with three consecutive daily at 7 × 108 pfu/day or treated with PBS as a control. The expression of E1A and hTERT, and apoptosis of tumor xenografts were assessed by immunohistochemi-cal technique at the 7th day after injections. The tumor volume was measured at the 50th day after injec-tions. Results The tumor volume in ZD55-hTERT treatment group ( 124.1±27.5) was significantly less than that in ZD-EGFP (499.8±77.1 ) and Ad-hTERT ( 609.0±102.5 ) treatment groups. The E 1A pos-itive expression in ZD55-hTERT treatment group was significantly higher than that in Ad-hTERT treatment group. The hTERT positive expression in ZD55-hTERT treatment group was significantly lower than that in Ad-hTERT treatment group. ZD55-hTERT treatment of tumor xenografts resulted in an increased apoptotie cell death as compared with ZD55-EGFP and Ad-hTERT treatment. Conclusion The antitumor effect of ZD55-hTERT was more potent than oneolytie adenovirus ZD55-EGFP and Ad-hTERT.     

改良式Appleby手术治疗晚期胰体尾癌

目的: 介绍一种治疗胰体尾癌侵袭肝总动脉、脾动脉及腹腔干的改良式Appleby手术方法 。方法: 腹腔干自起始部接扎切断,将肿瘤及侵袭的动脉整块切除。术中注意保留网膜右和胃右动脉,以维持胃的血供。夹闭肝总动脉后,注意肝固有动脉的搏动情况 。结果: 术后,上腹部及腰背部疼痛消失,七个月后患者死于肝脏及肝门部转移,经影像学检查未见切除部位肿瘤复发 。结论: 该术式可提高胰体尾癌的手术切除率与根治程度,可改善病人术后的生存质量。     

表达端粒酶逆转录酶siRNA的溶瘤腺病毒对裸鼠肾癌移植瘤的治疗作用

Objective To investigate the antitumor effect of oncolytic adenovirus armed with small interference RNA targeting hTERT gene for renal cancer therapy. Methods Nude mice were divid-ed randomly into 4 groups (8 mice/group),and were treated by intratumoral injections of ZD55-hTERT ( an oncolytic adenovirus armed with small interference RNA targeting hTERT gene) ,ZD55-EGFP ( an on-colytic adenovirus) and Ad-hTERT (replication-defective adenovirus armed with small interference RNA targeting hTERT gene) with three consecutive daily at 7 × 108 pfu/day or treated with PBS as a control. The expression of E1A and hTERT, and apoptosis of tumor xenografts were assessed by immunohistochemi-cal technique at the 7th day after injections. The tumor volume was measured at the 50th day after injec-tions. Results The tumor volume in ZD55-hTERT treatment group ( 124.1±27.5) was significantly less than that in ZD-EGFP (499.8±77.1 ) and Ad-hTERT ( 609.0±102.5 ) treatment groups. The E 1A pos-itive expression in ZD55-hTERT treatment group was significantly higher than that in Ad-hTERT treatment group. The hTERT positive expression in ZD55-hTERT treatment group was significantly lower than that in Ad-hTERT treatment group. ZD55-hTERT treatment of tumor xenografts resulted in an increased apoptotie cell death as compared with ZD55-EGFP and Ad-hTERT treatment. Conclusion The antitumor effect of ZD55-hTERT was more potent than oneolytie adenovirus ZD55-EGFP and Ad-hTERT.     

缺血预处理对减体积肝移植大鼠缺血再灌注损伤的保护作用

目的探讨缺血预处理（IPC）对减体积肝移植大鼠缺血再灌注损伤的保护作用及其机制。方法将36只成年雄性SD大鼠行50%减体积肝移植,随机分为对照组（Control）组和IPC组,检测术后2、6、24 h血清丙氨酸转氨酶（ALT）水平变化。检测术后24 h肝组织形态学变化、丙二醛（MDA）和超氧化物歧化酶（SOD）含量;检测髓性过氧化物酶（MPO）活性以反映中性粒细胞浸润情况;ELISA法检测肝组织中肿瘤坏死因子α（TNF-α）水平。结果与Control组比较,IPC组术后6、24 h ALT水平显著下降（P〈0.01）;组织病理学显示,Control组肝细胞明显空泡样变性伴局部坏死,小叶结构破坏,门脉周围水肿、充血,炎症细胞浸润明显,而IPC组损伤减轻;与Control组比较,IPC组MDA水平显著下降而SOD含量则明显增加（P〈0.01）,肝组织中TNF-α和MPO亦显著降低（P〈0.01）。结论IPC明显减轻减体积肝移植术后再灌注损伤,其机制部分与增强抗氧化、抑制脂质过氧化、减轻炎症反应密切相关。     

甲状腺微小癌46例临床诊治分析

甲状腺微小癌(TMC)是指肿瘤最大直径≤10 mm的甲状腺癌.其起病隐匿,术前诊断率低,在临床上早期难以发现.2003年1月～2008年12月,我院共收治甲状腺癌304例,其中TMC 46例(占15.13% ),现回顾性分析如下.     

过氧化物酶体增殖物激活受体γ激动剂15-脱氧前列腺素J2对小移植肝再灌注损伤的保护作用

目的 探讨过氧化物酶体增殖物激活受体γ(PPARy)激动剂15-脱氧前列腺素J2(15d-PGJ2)对小移植肝大鼠再灌注损伤的保护作用及其机制.方法 将108只SD大鼠随机分为3组:(1)15d-PGJ2预处理组;(2)15d-PGJ2+GW9662组;(3)生理盐水对照组(NS组).检测术后6、24、72 h血清丙氨酸转氨酶(ALT)和天门冬氨酸氨基转移酶(AST)水平;检测术后24 h肝组织中丙二醛(MDA)和超氧化物歧化酶(SOD)含量;检测肝组织中髓性过氧化物酶(MPO)活性以反映中性粒细胞的浸润;酶联免疫吸附试验(ELISA)检测肝组织中肿瘤坏死因子(TNF)-α水平;观察术后24h光镜下肝组织病理学变化.结果 与NS组和15d-PGJ2+GW9662组比较,15d-PGJ2预处理组术后6、24、72 h血清ALT和AST水平明显降低(P＜O.01);术后24h SOD活性明显升高而MDA含量降低,差异有统计学意义(P＜0.01);肝组织中TNF-α含量及MPO活性亦明显降低,差异有统计学意义(P＜0.01);苏木素-伊红(HE)染色显示:NS组和15d-PGJ2+GW9662组术后24 h,表现为明显的肝细胞空泡变性,肝窦扩张,炎症细胞浸润;15d-PGJ2组较其他两组肝组织损伤轻微.结论 PPARγ激动剂15d-PGJ2对小移植肝术后再灌注损伤有明显的保护作用,其保护机制可能与提高机体抗氧化能力,抑制脂质过氧化及减轻炎症反应密切相关.

Abstract：

Objective To investigate the protective effect of peroxisome proliferator-activated receptor γ (PPARγ) agonist 15d-PGJ2 against reperfusion injury in small-for-size liver grafts and its probable mechanisms. Methods 108 adult male SD rats were randomly divided into three groups: ( 1 ) 15d-PGJ2 group; (2) 15d-PGJ2 + GW9662 group; (3) NS control group. Serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels at 6, 24 and 72 h after reperfusion and histopathological changes were analyzed, the contents of malondialdehyde (MDA) and superoxide dismutase (SOD) in liver grafts after 24 h were determined, myeloperoxidase (MPO) activity was examined to assay neutrophil infiltration into the grafts at 24 h after reperfusion, and transforming growth factor (TGF)-α levels at 24 h after reperfusion were measured by using enzyme-linked immunosorbent assay ( ELISA method). Results As compared with NS control group and 15d-PGJ2 + GW9662 group, serum AST and ALT levels were significantly reduced at 6, 24 and 72 h after reperfusion in 15d-PGJ2 group (P ＜0. 01 ). Histopathological analysis revealed apparent bulb-like degeneration, hepatic sinusoid dilation, and inflammatory cell infiltration in periportal area at 24 h in NS group and 15d-PGJ2 + GW9662 group after transplantation, while in the 15d-PGJ2 group, minimal damage was observed at 24 h after transplantation under the light microscopy, the contents of MDA were lower and SOD levels were higher than in other groups ( P ＜0. 01 ). As compared with NS group and 15d-PGJ2 + GW9662 group, TNF-α levels and MPO activity at 24 h after transplantation were also significantly decreased in 15d-PGJ2 group (P ＜ 0. 01 ). Conclusion PPARγagonist 15d-PGJ2 could ameliorate reperfusion injury in small-for-size liver grafts significantly, which was mediated in part by increasing antioxidant ability, inhibiting lipid peroxidation, and down-regulating inflammatory reaetion.     

大鼠30%小体积肝移植模型两种切肝方法的比较

目的探讨建立理想的成功率较高的大鼠30%小体积肝移植模型的可靠方法。方法采用改良＂二袖套法＂非动脉化法建立大鼠30%小体积肝移植模型。实验组分为两组：A组,右叶＋三角叶＋尾状叶做供肝的30%小体积肝移植组,共40例;B组,中叶做供肝的30%小体积肝移植组,共40例。观察两组术后并发症和术后3 d生存率。结果 A、B组切肝时间分别为（11±3）、（14±3）min,P〈0.01;术后发生肝后下腔静脉狭窄分别有2例、8例,P〈0.05;术后3 d生存率分别为53%（21/40）、40%（16/40）,P〉0.05;断面出血、胆漏和感染的发生率两组无明显差异。结论通过技术改良,可以以右叶＋三角叶＋尾状叶为供肝建立稳定的大鼠30%小体积肝移植模型。     

结直肠癌的基因治疗

结直肠癌是常见的消化道恶性肿瘤,目前治疗以外科手术为主,辅以放、化疗,术后5年生存率在50%左右。肿瘤基因治疗发展迅速,作为一种新的辅助治疗手段有重要意义。结直肠癌中研究比较多的是免疫基因治疗、自杀基因治疗、抑癌基因的应用等。基因疗法可以有效地杀伤肿瘤细胞,联合传统治疗方法可延长结直肠癌患者的生存时间,提高生活质量。     

循证护理在结肠造口早期并发症护理中的应用

目的探讨减少和护理结肠造口近期常见并发症的最佳途径。方法将80例患者根据时间分成两组，对照组40例按护理常规进行护理，观察组40例运用循证护理。比较两组效果。结果观察组的造口皮肤黏膜分离和粪性皮炎的发生率明显低于对照组，差异有统计学意义（P〈0．05）。结论循证护理减少了与护理密切相关的造口并发症，减轻了医生负担，密切了医护关系、护患关系。