羟基积雪草苷对胶原关节炎大鼠肠道黏膜免疫的影响

目的:考察胶原关节炎大鼠肠道黏膜免疫的改变及羟基积雪草苷的调节作用。方法:在Wistar大鼠复制胶原关节炎模型,其后将大鼠分为正常对照组、模型组和羟基积雪草苷组,灌胃给药,连续21 d。ELISA法测定大鼠肠内容物中s Ig A含量及小肠组织中IFN-γ含量。流式细胞术检测小肠上皮内及固有层细胞中CD4+和CD8+T细胞的比例,计算CD4+/CD8+比值。实时定量PCR法检测小肠组织中CD80、CD86、IL-6、IL-12及Foxp3 mRNA的表达水平。结果:与正常对照组比较,模型组大鼠肠内容物中s Ig A含量及小肠组织中IFN-γ含量显著升高,小肠上皮内及固有层T细胞中CD4+/CD8+比值上升,小肠组织中CD80、CD86、IL-6和IL-12 mRNA表达显著上调,而Foxp3 mRNA的表达变化无统计学意义。羟基积雪草苷灌胃给药可降低模型大鼠肠内容物s Ig A和小肠组织IFN-γ含量、CD4+/CD8+比值及CD80、CD86、IL-6和IL-12 mRNA的表达,显著上调Foxp3 mRNA的表达。结论:关节炎状态下大鼠肠道黏膜免疫应答上调,抗原呈递细胞异常活化且免疫耐受状态遭到破坏,羟基积雪草苷可下调关节炎大鼠肠道黏膜免疫应答,促进肠道黏膜免疫耐受的形成和维持。     

CT presentations of colorectal cancer with chronic schistosomiasis: A comparative study with pathological findings

Objective

To clarify pathological basis of computed tomography (CT) presentations of colorectal cancer (CRC) with schistosomiasis for the purpose of improving the accuracy of CT diagnosis and differential diagnosis of the condition.

Materials and methods

130 patients (87 male and 43 female; age range 49–86 years, mean 71.1) were selected whose diagnoses were pathologically confirmed as CRC with schistosomiasis. All the patients underwent abdominal plain CT and contrast enhanced scanning. The location, morphology, size, calcification features and enhancement modalities (patterns) were evaluated and compared with the pathological findings by two radiologists in a blind way.

Results

CT showed that in 130 patients, the tumors occurred in the large intestine, among which 109 (83.9%) were solitary and 21 (16.1%) were multifocal. The intestinal wall was irregularly thickened in 123 patients, with soft tissue masses in 7 patients. Linear, spotty and small patchy calcifications were seen in 104 (80.0%) patients, with unclear margins in 96 patients. The tumors were markedly unevenly enhanced in 92 patients. Pathological examination revealed adenocarcinoma in 114 patients and in 104 patients, calcified Shistosoma japonicum (S. japonicum) ova inside the tumors, 15 patients were mucinous adenocarcinoma, and one patient was that of adenosquamous carcinoma.

Conclusion

Irregular thickening of the intestinal wall, soft tissue masses, multiple S. japonicum ova calcifications inside the tumor with obscured margins and multiple intestinal masses in some patients are important CT features of CRC with schistosomiasis.     

肠道血管畸形的多层螺旋CT血管成像诊断

目的探讨肠道血管畸形的多层螺旋CT血管成像(MSCTA)的表现。方法回顾性分析7例经手术证实的肠道血管畸形患者的CT表现。7例均行腹部平扫、动脉期、门静脉期和延迟期扫描,扫描范围从膈顶至耻骨联合。结果所有患者MSCTA像上均表现为局部血管丛增多、增粗、紊乱,粗细不等,其中2例增粗的血管局部呈"瘤"样改变,同时可见增粗的供血动脉及早显的引流静脉,1例见对比剂向肠腔内溢出,1例合并肠壁外血管畸形。结论肠道血管畸形的MSCTA诊断明确,具有简便、安全、无创、准确的特点,同时能发现肠壁及其他伴发病变,是肠道血管畸形有效的首选诊断方法。     

Comparative Study between Staplers and Conventional(Hand-Sewn) Anastomosis in Gastrointestinal Surgery

Conventional (hand-sewn) technique of intestinal anastomosis has been in vogue for decades. Staplers which were developed to simplify surgery began to have significant impact. To compare staplers versus conventional anastomosis with respect to certain intra operative and post operative parameters. Prospective study from November 2008 to October 2010 in Hyderabad at OSMANIA, GANDHI, MNJ CANCER hospitals. 120 patients were divided into three groups of 40 each, depending on the surgery like posterior gastrojejunostomy, distal gastrectomy and reconstruction (Billroth II) and colorectal anastomosis. Of these 40 patients, 20 were in hand-sewn group and the other 20 in stapler group. Unpaired ‘t’ test was used to find ‘p’ value . ‘p’ value less than 0.05 was considered statistically significant. Total operating time was shortened in stapler group. No significant difference was found in terms of restoration of intestinal function, post-operative hospital stay, post-operative complications like anastomotic leak. Staplers can expedite surgery. They have better access to difficult—to—reach areas. Thus staplers can be beneficial though one should not forget the art of conventional suturing.     

Intestinal Injury Secondary to an Umbilical Piercing

Background:

Body piercing has become increasingly popular throughout the world and may cause unanticipated complications during surgery.

Methods:

We describe the case of a 35-y-old woman with hepatocellular carcinoma who underwent a diagnostic laparoscopy for metastatic disease evaluation.

Results:

An early intestinal injury occurred upon abdominal entry and introduction of pneumoperitoneum. The injury was secondary to a single adhesion between the abdominal wall and small bowel caused by a previous umbilical piercing.

Conclusions:

Umbilical piercing can lead to unanticipated intraoperative complications even if it is removed prior to surgery. Surgeons performing laparoscopy should be aware of potential pitfalls associated with these art forms.     

传统胆肠吻合与保留Oddis括约肌的胆道重建对比分析研究

目的：比较胆肠吻合和保留Oddis括约肌的胆道重建两种手术方式的优劣。方法：比较行保留Oddis括约肌胆道重建患者和同期行胆肠吻合患者的治疗效果以及术后胆红素下降情况。结果：两种手术方式胆红素下降情差异无统计学意义（P〈0.05）,腹腔出血的发生率差异无统计学意义（P〉0.05）,胆汁漏、发热伴反流以及腹腔感染的发生率差异有统计学意义（P〈0.05）。术后再狭窄1年内无明显差别（P〉0.05）,2年后发生率有明显差别（P〈0.05）。结论：保留Oddis括约肌的胆道重建术后胆肠反流明显减低,但是增加了术后再狭窄的发生率,提倡个体化治疗。     

Intraluminal Polyethylene Glycol Stabilizes Tight Junctions and Improves Intestinal Preservation in the Rat

Rapidly progressing mucosal breakdown limits the intestinal preservation time below 10 h. Recent studies indicate that intraluminal solutions containing polyethylene glycol (PEG) alleviate preservation injury of intestines stored in UW‐Viaspan. We investigated whether a low‐sodium PEG solution is beneficial for intestines stored in histidine‐tryptophane‐ketoglutarate (HTK) preservation solution. Rat intestines used as control tissue (group 1) were perfused with HTK, groups 2 and 3 received either a customized PEG‐3350 (group 2) or an electrolyte solution (group 3) intraluminally before cold storage. Tissue injury, brush‐border maltase activity, zonula occludens‐1 (ZO‐1) and claudin‐3 expression in the tight junctions (TJ) were analyzed after 8, 14 and 20 h. We measured epithelial resistance and permeability (Ussing chamber) after 8 and 14 h. Group 2 had superior morphology while maltase activity was similar in all groups. TJ proteins rapidly decreased and decolocalized in groups 1 3; these negative events were delayed in group 2, where colocalization persisted for about 14 h. Intestines in group 2 had higher epithelial resistance and lower permeability than the other groups. These results suggest that a customized PEG solution intraluminally reduces the intestinal preservation injury by improving several major epithelial characteristics without negatively affecting the brush‐border enzymes or promoting edema.     

谷氨酰胺和ω—3多不饱和脂肪酸对大鼠肠道缺血再灌注损伤时肠道通透性和肺细胞凋亡的影响

目的研究大鼠肠道缺血再灌注损伤时,肠淋巴管结扎和不同肠内营养对肠道通透性、系统炎性反应和肺损伤的影响。方法SPF级雄性大鼠胃造瘘术后随机分为正常饮食组、普通肠内营养组、谷氨酰胺（Gin）肠内营养组、ω-3多不饱和脂肪酸（ω-3PUFA）肠内营养组和假手术组．前4组根据淋巴管是否结扎又各分为结扎和不结扎组．共9组．每组8只。所有肠内营养组均经胃造瘘给予等氮（1．8gN·kg-1·d-1）等热卡（1046kJ·kg-1·d-1）的营养支持,7d后除假手术组外其他8组实施肠道缺血60min,结扎组在缺血前同时进行淋巴管结扎：然后继续原营养再灌注3d。在胃造瘘术后第5、7和9天测定肠道通透性（尿中乳果糖／甘露醇浓度值．L／M）：术后第11天取血检测血清二胺氧化酶、内毒素、细胞因子及ALT、AST的水平：取小肠黏膜检测黏膜厚度和绒毛高度;取肺组织检测髓过氧化物酶（MPO）、NO和NO合酶（NOS）浓度及细胞凋亡指数。结果肠道缺血60min可引起肠道损伤;缺血后第1天,各组L／M均显著增加（P〈0．05）;缺血后第3天L／M明显下降（P〈0．05）,其中Gin肠内营养组和（ω-3PUFA肠内营养组已恢复至接近缺血前水平（P〉0．05）．且淋巴管结扎组L／M明显低于不结扎组（P〈0．05）。在肠道缺血再灌注损伤时．与普通肠内营养和正常饮食组比较,Gln肠内营养组和ω-3PUFA肠内营养组血清内毒素和细胞因子水平显著降低．小肠黏膜厚度和绒毛高度明显增高（P〈0．05）;且淋巴管结扎后效果更为明显（P〈0．05）。予以Gln或（ω-3PUFA肠内营养以及淋巴管结扎后,肺组织MPO、NO、NOS及细胞凋亡指数都有不同程度的下降（P〈0．05）。结论肠道缺血再灌注损伤引起的肺等远隔组织损伤及系统性炎性反应可能与肠淋巴液中的某些因子有关．阻断“肠-淋巴途径”和（或）补充Gln和ω-3PUFA的肠内营养可以降低缺血引起的肠道通透性增加．降低循环内毒素水平．增加肠黏膜的厚度．减轻系统炎性反应和肺组织损伤。     

围手术期不同处理因素对SD大鼠肠道菌群的影响

目的探讨围手术期不同处理因素对SD大鼠肠道菌群数量及比例的影响。方法根据围手术期不同处理因素,将SD大鼠48只分成对照组、抗生素组、肠道准备组、禁食组、抗生素-肠道准备组、抗生素-肠道准备一禁食组、肠道准备-手术处理-抗生素．术后早期进食组（术后早期进食组）及肠道准备-手术处理．抗生素一术后禁食组（术后禁食组）8组。每组6只．处死后取回盲部粪便．采用倍比稀释法分别涂在选择性培养基上,37℃恒温培育48h,对大肠杆菌、类杆菌、双歧杆菌和肠球菌计数。结果与对照组相比,抗生素组大鼠细菌总数、类杆菌、肠球菌和双歧杆菌计数均明显下降（P〈0．05）,而大肠杆菌水平上升（P〈0．05）,杆菌与球菌的比例（杆球比）升高（P〈O．05）：肠道准备组大鼠细菌总数、类杆菌、双歧杆菌和肠球菌计数均明显下降（P〈0．05）,而大肠杆菌无明显变化（P〉O．05）。杆球比下降（P〈0．05）;禁食组细菌总数、类杆菌、肠球菌和双歧杆菌计数均明显降低（P〈0．05）,大肠杆菌计数无明显改变（P〉0．05）,杆球比下降（P〈0．05）。术后早期进食组与术后禁食组相比,大肠杆菌、肠球菌及细菌总数明显升高（P〈0．05）,杆球比下降（P〈0．05）。结论抗生素、肠道准备及禁食均可影响SD大鼠肠道菌群数量和比例的改变,导致肠道菌群失调：术后早期进食对菌群失调有改善作用。     

胃癌患者术后早期肠内营养对临床结局的影响

目的观察术后早期肠内营养对胃癌患者临床结局的影响。方法将2010年7月至2011年5月间青岛大学医学院附属医院收治的60例胃癌患者按随机数字表法分为试验组和对照组．每组30例。试验组患者术后早期少量多次进水加肠内营养制剂,对照组患者术后采用传统围手术期治疗方案。比较两组患者临床结局、术后免疫功能及营养状况。结果试验组与对照组患者术后发热时间[（81．1±6．4）h比（87．3±8．0）h,P〈0．05]、排气时间[（79．9±9．5）h比（86．6±8．7）h,P〈0．05]和住院时间[（7．83±2．23）d比（9．57±1．96）d,P〈0．01]比较,差异均有统计学意义;治疗费用分别为（30．22±3．22）千元和（34．60±32．12）千元,差异亦有统计学意义（P〈0．01）;两组术后并发症发生率的差异无统计学意义[13．3％（4／30）比16．7％（5／30）,P〉0．05]。术后第3和第7天,试验组患者CD3＋、CD4＋、NK细胞、CD4／CD8、白蛋白和前白蛋白水平均明显高于对照组（均P〈0．05）,而CD8＋细胞显著下降．与对照组比较．差异亦有统计学意义（P〈0．05）。结论术后早期经口进食肠内营养制剂能够改善胃癌患者术后营养状况以及免疫功能,促进肠道功能早期恢复。