全腔镜治疗食管癌临床分析

目的：探讨胸腔镜联合腹腔镜下食管癌切除临床应用价值。方法回顾性分析中国医科大学附属盛京医院胸外科收治的50例食管癌患者的临床资料。根据治疗方法不同,分为研究组(A组,n=25)和对照组(B组,n=25)。 A组采用全胸腔镜、腹腔镜下食管癌根治方案;B组采用传统开胸手术方案。对比两组患者手术时间、失血量、清扫淋巴结数、术后住院天数、围术期并发症发生例数等临床数据。结果与B组比较,A组手术时间缩短、术中出血较少、住院时间明显缩短、肺部感染率降低,差异均有统计学意义(P<0．05);两组患者在清扫淋巴结数、再次开胸止血、吻合口瘘等并发症发生率方面,差异无统计学意义(P>0．05)。结论对食管癌患者给予全胸腔镜、腹腔镜下食管癌根治术,疗效确切,可有效缩短治疗疗程,对降低术后肺部感染风险,值得临床推广。     

食管嗜酸性炎性假瘤误诊1例

1病历摘要 男，55岁。胸闷气短1a，进食哽咽感1个月余，无胸痛，恶心呕吐，声音嘶哑及胸背部疼痛。无阳性体征。胃镜示距门齿33-39cm达贲门处，食管右侧壁可见长约10cm隆起肿物，黏膜表面糜烂，活检为BRETTET食管炎。     

风险管理用于自发性气胸手术治疗患者的效果

目的 探讨风险管理应用于自发性气胸手术治疗患者中的临床效果.方法 120例采用手术治疗的自发性气胸患者分为观察组和对照组,对照组采用胸外科常规护理,观察组在对照组的基础上加强风险管理,比较两组患者的治疗效果及护理效果.结果 观察组的术后咳痰(≤1d)、术后下床时间(≤1 d)、胸管留置时间及住院时间分别为85.0％、95.0％、(1.8±0.3)d、(8.1±1.7)d,显著优于对照组的20.0％、75.0％、(3.8±1.4)d、(10.2±3.1)d(x2=11.37、4.27,=3.65、3.87,均P＜0.05).观察组的护理质量评分、患者的满意度、护理事故及并发症发生分别为(97.7±5.2)分、100.0％、0、3.3％,显著优于对照组的(84.5±4.6)分、83.3％、8.3％、15.0％(t=5.68,x2=4.25、4.54、4.89,均P＜0.05).结论 风险管理能够最大限度的控制各种不全性因素,提高护理质量,确保患者的住院安全.     

改良的Heller手术附加贲门瓣成形和大网膜覆盖治疗贲门失弛缓的临床研究

目的 评价在改良的Heller肌层切开的手术基础上附加贲门瓣成形和带蒂的大网膜覆盖等措施治疗贲门失弛缓症的临床效果.方法 全部病例行常规改良的Heller手术后,游离部分胃底制成贲门瓣,向上包绕覆盖食管下段,与切开之食管肌层缝合固定.再游离带蒂的大网膜覆盖裸露的食管黏膜.结果 本组115例病人,围手术期无死亡,术中发生食管黏膜穿孔12例,术后无食管瘘发生.经过1～27年的随访,评价优者73例,良好36例,失败的6例,优良率94.8%,失败率5.2%.失败的病人均有较重的反流性食管炎和吞咽困难,经保守治疗有不同程度缓解;再次严重吞咽困难的行狭窄段切除治疗1例.结论 贲门瓣成形和带蒂的大网膜覆盖能有效地减少改良的Heller手术后再次狭窄和反流性食管炎的发生率,对提高贲门失弛缓病人的长期生活质量有一定效果.     

肺组织瓣包埋金属支架重建气管、食管的动物实验研究

目的 用犬的自体肺组织瓣包埋金属支架重建气管、食管,探索应用肺组织瓣重建气管、食管的可行性.方法 24只杂种犬,分别制成气管、食管缺损模型,用自体肺组织瓣内衬金属支架分别修补.定期处死实验犬,行大体观察、组织学观察和影像学检查.结果 18只实验犬存活超过2周以上.肺组织瓣与气管、食管紧密结合,未发生缺血坏死,术后12周被走行一致的胶原纤维替代.肺组织瓣表面有新生上皮爬行,且爬行较快.结论 自体肺组织瓣与气管、食管上皮细胞有较好的相容性,能为气管、食管上皮的爬行提供良好的载体.

Abstract：

Objective To study the feasibility of applying autogenous pulmonary tissue flap with alloy stent to correct the defects of trachea and esophagus. Methods Twenty-four dogs were divided into tracheal and esophageal groups. Bronchus was ligated to prepare a pulmonary flap. And a defect of 3 -4 cm long and 1/2-2/3 perimeter was made in tracheal or esophageal wall. Pulmonary arteries and veins were protected. Then the pulmonary gas was emitted to create a pulmonary tissue flap. The defect was repaired with a pulmonary flap with a self-expanded stent inside. The gross appearance, histological appearance, CT and barium X-ray films were observed at Weeks 2, 4, 6 and 8 post-operation. Results Eighteen experimental dogs survived over 2 weeks. Anatomotic leak was the main cause of death. Two dogs died of perforation of ulcer in esophageal group. Reliable cicatrisation was observed between the pulmonary tissue flap and damage area. A quick growth of new tracheal and esophageal epithelium was observed from periphery area to central area. During the first 2 weeks, a little epithelization was observed at free edge of anastomosis equivalent to 1 - 2 layers of new epithelial cells. At weeks 4-6 post-operation, the internal surface of defect was covered with 3 - 5 layers of epithelial cells. At Weeks 8-10 post-operation, the luminal surface was covered with 6 - 8 layers of stratified epithelial cells. More ulcers could be observed on the surface of pulmonary tissue flap in esophageal group. In pulmonary flap, massive fibrous tissue proliferated and fibroblasts were active, but no necrosis occurred. CT and barium X-ray showed no obstruction in anastomotic stoma. Conclusion With an excellent compatibility with epithelial cells of trachea and esophagus, the autogenous pulmonary tissue flap can support the mucosal crawl in the defect of trachea and esophagus. When combined with alloy stent, it may be a choice procedure for reconstructing the defect of trachea and esophagus.     

骨髓间充质干细胞移植促进移植气管上皮再生

目的 探讨经静脉移植的骨髓间充质干细胞(BMSCs)对深低温处理的同种异体气管移植后的存活和上皮再生作用.方法 用深低温冻储2周和6周的大鼠气管进行同种异体气管移植后,将PKH-26标记后的3～5代BMSCs经鼠尾静脉移植入受体内,通过观察局部PKH-26荧光检测和供体气管的组织学、上皮爬行和再生情况,评价BMSC对移植气管的新生上皮再生作用.结果 骨髓间充质干细胞移植并深低温冻储后的移植气管结构完整,组织学检查管腔内为假复层纤毛柱状上皮所覆盖,软骨无变性坏死;术后均能长期存活.PKH-26;标记的BMSCs在受损气管组织定植后呈现红色荧光.结论 BMSCs可迁移并修复受损组织,并通过促进移植气管上皮再生,从而促进气管的损伤恢复.

Abstract：

Objective To investigate the role of BMSCg on enhancing the implant survival and bacheal epithelium regeneration. Methods After transplanted with cryopreserved 2 weeks and 6 weeks allocraft, PHK-26 labeled 3-5 passage BMSCs were injected into the recipient rats via tail vein. Rats in the control groups were injected with the same amount of PBS.We observed the histology of the transplanted trachea including epithelium growth and regeneration, and the PKH-26 fluorescence levels at the para-anastomotic trachea to evaluate the role of BMSC transplantation on the epithelium regeneration. Results Rats from BMSCs injection group survived a long period. Histological observation showed that the tracheal lumen was covered by psudo-striated ciliated columnar epithelium. The cartilage structure was intact. There are no signs of denaturation and necrosis. In the PBS injection group, epithelium regeneration is better in PBS-6-week group than PBS-2-week group. The longest survival time in PBS-6-week group was 32 days, whereas it was 10 days in PBS-2-week group. In BMSCs injection group, rats in BMSC-6-week groups survived longer than 8-week group(12 rats were terminated at 1 week, 4 weeks and 8weeks as planned). There was one rat who survived and were terminated at the designated 8 weeks time point (there were 8regenerated epithelium was similar in the two BMSC transplanted groups. PKH-26 labeled BMSCs migrated to the implant site and showed red fluorescence, with most red fluorescence shown at the anastomotic part. Conclusion BMSCs can migrate to the impaired tissue to repair it. BMSCs may exert their reparation function via enhancing epithelium regeneration.     

低浓度表柔比星对肺腺癌A549细胞增殖及调控的影响

目的:探讨低浓度表柔比星对肺腺癌A549细胞增殖及调控的影响。方法:应用Western-blot及RT-PCR方法检测低浓度表柔比星处理后的肺腺癌A549细胞中caspases-3、p21、RARα、nm23、bcl-2、cy-clinD3表达的变化,及MTT法检测细胞的增殖抑制情况。结果:低浓度表柔比星处理后的肺腺癌A549细胞中caspases-3、p21、RARα、nm23表达增强,bcl-2、cyclinD3表达减弱,细胞出现明显的增殖抑制。结论:低浓度表柔比星能够使肺腺癌A549细胞增殖、周期调控等方面发生变化,使肿瘤细胞总体上向良性转化。     

AKAP7γ在小鼠卵母细胞减数分裂过程中的表达

 目的 研究小鼠卵母细胞减数分裂过程中AKAP7γ的表达情况。 方法 收集生发泡（GV）期及第2次减数分裂中期（MII期）小鼠卵母细胞,Western blot方法检测AKAP7γ 蛋白的表达及修饰情况。 结果 在小鼠卵母细胞减数分裂过程中,AKAP7γ在GV及MII期均有表达,且在MII期卵母细胞中,AKAP7γ电泳迁移率变慢,应用冈田酸及碱性磷酸酶（ALP）分别处理GV 及MII 期卵母细胞,AKAP7γ电泳迁移率差异消失。结论 随减数分裂进程,在MII期小鼠卵母细胞中,AKAP7γ发生磷酸化修饰,提示AKAP7γ不仅作为A型激酶锚定蛋白发挥支架蛋白的作用,其本身也可作为其他激酶的底物和效应分子。     

siRNA沉默K-C1协同转运子1基因的表达对肺腺癌细胞顺铂敏感性的影响

%0 Journal Article %A 徐然;赵俊刚;石文君; 目的：探讨降低K-Cl协同转运子1（KCC1）基因在肺腺癌A549细胞中的表达及对化疗药物顺铂（DDP）敏感性的影响。方法：设计并合成KCC1特异性siRNA,转染A549细胞;RT-PCR检测RNA干扰后KCC1基因的表达改变;应用DDP处理后,MTT法测定细胞毒性指数,流式细胞仪检测细胞凋亡情况。结果：siRNA-KCC1能够抑制KCC1基因在A549细胞中的表达;而KCC1表达降低后,A549细胞的凋亡明显升高（P〈0.05）,增殖能力明显下降（P〈0.05）。结论：KCC1基因表达降低能够抑制A549细胞的增殖并促进细胞凋亡,并能够在一定程度上增强A549细胞对化疗药物DDP的敏感性。