人类前列腺癌裸鼠原位移植模型的建立

目的　建立人类前列腺癌裸鼠原位肿瘤模型,为前列腺癌的研究提供有用的工具。　6方法　将 2×106 PC 3细胞注射于 10只BALB/c裸小鼠背部靠近腋窝处。8周后,取出背部肿瘤,剪成小块,种植于 20只裸鼠前列腺背侧叶被膜下,缝合包埋固定。9~12周后处死裸鼠,对前列腺和相关器官进行检测,确定肿瘤生长和转移情况。　结果　18只 (90% )裸鼠前列腺生长出肿瘤, 17只肿瘤直径>1. 5cm。12只因梗阻出现膀胱扩张和肾积水, 10只出现腹膜后主动脉旁淋巴结转移, 4只出现肺转移, 1只肝转移,无骨转移。病理切片可见大部分腺体被肿瘤细胞破坏,细胞胞核浓染,呈多形性,可见异常分裂相;转移淋巴结的皮质和髓质被肿瘤细胞占据。　结论　外科原位移植技术建立的前列腺癌模型,较好地保留了肿瘤细胞的生物学习性,生长快,局部侵犯范围较广,有较高的淋巴转移和肺转移率,是较理想的前列腺癌异种移植模型。     

女性原位尿流改道的临床研究

目的　总结女性膀胱全切患者行原位尿流改道的临床疗效。　方法　回顾性分析1995年9月至2003年12月34例女性膀胱全切、原位尿流改道患者的临床资料。34例患者,年龄53~64岁,平均58岁。其中移行细胞癌30例,腺癌3例,鳞状上皮癌1例。原发肿瘤30例,复发肿瘤4例。34例患者均行膀胱全切,其中24例保留自主神经。所有患者均截取末段回肠,行回肠代膀胱。术后随访观察临床效果。　结果　34例手术时间平均360min(280~420min),输血量平均600ml(300~1000ml)。术后30例获随访,随访6~108个月,平均61个月。术后6个月昼夜控尿率分别为90% (27 /30)和86% (26 /30)。一次性排空膀胱23例, 2例排尿可控过度,需定时导尿,另5例需采用手压下腹部排空新膀胱。23例行尿动力检查结果显示:贮尿囊容量300~520ml,充盈期囊内压<23cmH2O(6~23cmH2O, 1cmH2O=0. 098kPa),最大尿道压35 ~70cmH2O,功能性尿道长2. 6~3. 5cm,剩余尿量0~38ml。IVU检查贮尿囊球形,无输尿管狭窄,轻度输尿管返流1例,肾盂输尿管轻度扩张1例。血电解质和肾功能正常.无肠膀胱或尿道残端复发者。　结论　女性膀胱癌患者行原位尿流改道可获得满意的临床效果,可作为该类患者的首选治疗方法。     

原位肠代膀胱术远期疗效评价(附266例报告)

目的 总结评价原位肠代膀胱术的远期临床效果。方法 对1991-2003年266例因膀胱癌行膀胱全切手术患者资料进行分析。Hautmann回肠原位代膀胱术206例，Reddy原位结肠代膀胱术60例。131例患者在原标准术式基础上作了手术技术改进。总结手术改进前后患者控尿率和并发症发生率等。结果 获完整随访患者225例。回肠代膀胱术改进前后男性平均随访时间62（44-146）个月和38（4-67）个月；结肠原位代膀胱手术改进前后患者平均随访时间为62（51-131）个月和34（5-67）个月。手术改进可提高男性术后夜间可控率（P〈0．05），女性改善不明显（P〉0．05），总的近期和远期并发症发生率为13．8％和19．6％。男性肿瘤尿道复发9例（4％），女性无复发。结论 原位尿流改道术的远期临床疗效满意，并发症发生率低。手术技术改进可提高男性患者的夜间控尿率。     

Use of the implantable cardioverter-defibrillator in long-term survivors of orthotopic heart transplantation

BACKGROUND: Orthotopic heart transplantation is considered an effective treatment for patients with refractory heart failure. The long-term survival of orthotopic heart transplantation recipients has increased over the last several decades, but many long-term survivors of orthotopic heart transplantation develop graft atherosclerosis and associated left ventricular dysfunction. The risk of sudden cardiac death in long-term survivors of orthotopic heart transplantation with these complications is believed to be high. There are no data on the usefulness of implantable cardioverter-defibrillators (ICDs) in this population; therefore, we report our early experience with ICD placement in such patients. OBJECTIVES: The purpose of this study was to examine the use of ICDs in adults who are long-term survivors of heart transplantation. METHODS: We retrospectively reviewed all adult patients who underwent orthotopic heart transplantation at Stanford University Hospital (Stanford, CA, USA) from 1980 to 2004. All patients who received an ICD after transplant were included in this study. We reviewed demographic data, medical history, ejection fraction, presence of graft atherosclerosis, indication for ICD placement, and any device therapy delivered. RESULTS: Of the 925 patients who had orthotopic heart transplantation during this time period, 493 patients were alive at the beginning of the year 2000. Of these patients, 10 ( approximately 2%) had subsequent placement of an ICD. All 10 patients were male. The average age at orthotopic heart transplantation was 37.8 years. The average age at ICD placement was 50.5 years. The average time from orthotopic heart transplantation to ICD placement was 14.6 years. The average ejection fraction at the time of implant was 46.5%. Five of the 10 patients had a low ejection fraction (within this subgroup, the average ejection fraction was 31%, range 15%-45%) and graft atherosclerosis. ICDs were placed because of symptomatic episodes of ventricular tachycardia (3 patients), low ejection fraction and severe graft atherosclerosis without symptoms (3 patients), and after thorough evaluation for otherwise unexplained syncope (4 patients). The average follow-up after device implantation was 13 months. Complications related to ICD placement were an infected ICD system requiring explant in one patient and a lead fracture in another patient. Three patients had subsequent appropriate shocks for ventricular arrhythmias, and one patient underwent a second orthotopic heart transplantation. One patient died of malignancy. CONCLUSION: Use of the ICD in long-term survivors of orthotopic heart transplantation should be considered in appropriately selected patients. Further data are needed regarding ICD use in this population.     

输尿管末端粘连:原位新膀胱术后上尿路积水原因之一

目的:总结原位新膀胱术后输尿管末端粘连致上尿路积水的诊断和处理经验。方法:2000年1月~2007年4月共施行全膀胱切除加原位新膀胱术250例,发现8例原位新膀胱术后患者上尿路积水是由输尿管末端互相粘连或与新膀胱壁粘连引起,在内镜下经尿道切断粘连带予以处理。结果:术后中位随访8个月(1~22个月),7例肾功能和积水程度明显改善,1例稳定,并在密切随访观察中。1例在积水缓解后7个月再次复发,发现输尿管肠吻合口狭窄,行开放手术作输尿管新膀胱再植,随访5个月,积水程度明显改善。结论:输尿管末端粘连是使用输尿管直接种植法的原位新膀胱术后上尿路积水的原因之一。膀胱镜检查既可明确诊断又能同时作粘连带切断而达到治疗的目的,因此,对原位新膀胱术后上尿路积水患者应常规作膀胱镜检查。     

原位肝移植患者术时止凝血变化的初步临床研究

研究原位肝移植术中的出血与全身止血凝血改变的关系。方法:本文对一例肝豆状核变性患者原位肝移植手术中凝血、抗凝及纤溶系统的功能进行了系统的观察。结果:发现在移植术中凝血抗凝系统的功能逐渐降低,在无肝期及重新灌注早期达最低点,随后逐渐恢复,而纤溶系统的功能随手术的进行而逐步增强,在无肝期及重新灌注期达最高峰。结论:原位肝移植术中的出血是综合因素引起的,手术各阶段的出凝血变化有其本身的特点。     

活体供肝原位部分肝移植一例报告

对１例晚期肝癌伴肝硬变的患者施行活体供肝部分肝原位移植术，供者为受者之妻。供肝切取时不阻断血流，沿正中裂偏左２ｃｍ处切取左半肝。受者的肝脏全部切除，供受体的肝左静脉行端端吻合，供肝门静脉左支与受者的门静脉主干行端端吻合，供肝左动脉与受者的肝固有动脉在显微镜下行端端吻合，胆道用５ｍｍ硅胶管插入左肝管后行外引流。供肝热缺血时间为０，冷缺血时间为２．５小时。术后用环孢素Ａ与小剂量激素进行免疫抑制。供者术后恢复良好。受者术后５小时即有胆汁分泌，１００～１５０ｍｌ／ｄ，术后第５天出现轻度黄疸，第９天出现腹膜炎体征，即行剖腹探查，供肝左内叶切面有局灶性坏死及胆漏，受者于术后第１２天因心率失常、心跳骤停而死亡。     

大鼠肝癌肝移植模型的建立

目的　建立肝癌肝移植动物模型并观察术后肝癌复发的生物学特点。方法　 130只近交系SD雄性大鼠 ,10 0ppm二乙基亚硝胺饲喂诱癌。共 98只大鼠据Kamada袖套技术行原位肝移植 ,术中根据肿瘤大小分为三组 :1组有明确肝癌结节但直径 <1 0cm (n =2 5 ) ,2组肝癌结节直径1 0～ 1 5cm(n =4 1) ,3组肝癌结节直径 >1 5cm(n =32 )。不行肝移植术的 10只大鼠作对照组。结果　三组大鼠肝移植术中死亡率 2 6 5 % (2 6 / 98) ,术后 30d累计死亡率 71 5 % (70 / 98)。术后存活 30d后计算平均生存期 ,1组 (81 3± 33 2 )d ,2组 (6 7 6± 2 4 9)d ,3组 (5 4 4± 2 4 9)d。对照组从诱癌开始 15 0d后计算 ,平均生存期为 (2 9 4± 12 9)d。术后肝癌复发率 35 7% (10 / 2 8) ,单纯移植肝内复发7 1% (2 / 2 8) ,肝和肺同时复发 10 7% (3/ 2 8) ,肝和腹腔同时复发 3 6 % (1/ 2 8) ,单纯腹腔肿瘤 7 1% (2 /2 8) ,单纯肺部肿瘤 7 1% (2 / 2 8)。结论　大鼠肝癌肝移植良好地模仿了临床过程 ,但诱癌大鼠体质差导致术中和术后短期死亡率高。大鼠术后长时间存活是观察到肿瘤复发的重要条件 ,肝癌复发的形式多样。该模型为肝癌肝移植术后抗复发和复发机制研究提供了极好的平台。     

裸鼠原位和异位脑肿瘤生物发光信号成像实验研究

目的应用生物发光成像技术,非侵入性地连续检测活体裸鼠原位和异位脑肿瘤发展演进过程。方法用SMPU-R-MND-luc载体转染人脑肿瘤U87MG细胞系,形成具有高荧光素酶活性的细胞克隆。在裸鼠脑内和胁腰部皮下植入持续表达荧光素酶的肿瘤细胞,建立原位和异位脑肿瘤模型,用影像学资料显示肿瘤部位。用光子发射定量分析动态监测肿瘤生长情况。结果成功地建立了表达荧光素酶活性的原位和异位脑肿瘤动物模型。采集反映肿瘤生长的生物发光信号,肿瘤细胞植入后不同时间点的发光信号值呈显著正相关,而且原位和异位脑肿瘤间存在明显差异。但生物发光脑肿瘤生物发光信号值在第4 d和第14 d时无显著差异。结论体内生物发光成像可以非侵入性地动态检测活体内脑肿瘤演进过程,为研究肿瘤发展机制及最佳治疗策略的选择提供了新的手段和工具。     

Kupffer cells participate in rejection following liver transplantation in the rat

Abstract Recognition of foreign antigens involves macrophages which release mediators such as immunoactive interleukins, and in the liver, the resident macrophages (Kupffer cells) are activated following transplantation. Therefore, we evaluated the hypothesis that Kupffer cells participate in the rejection reaction following transplantation. Orthotopic liver transplantation was performed between different syngenic rat strains. Livers from Lewis rats were stored in lactated Ringer's solution for 1 h to minimize cold ischemic injury and transplanted into PVG recipients. At 24 h postoperatively, transaminases (AST) were elevated to values around 2000 U/l, total bilirubin was increased to values around 20 μmol/l, and five of six rats died within 3 days. Macroscopic and histological examination showed large areas of necrosis without cellular infiltration, characteristic of rejection. When donor rats were treated with gadolinium chloride (GdCl₃, 10 mg/kg i.v. 24 h before storage of the liver) to inactivate the Kupffer cells, AST levels only rose to around 700 U/l, and the total bilirubin level was in the normal range (<4 μmol/l). Survival was improved significantly by GdCl₃, with five of seven rats surviving more than 1 month ( P < 0.05) and four of seven rats surviving for at least 100 days without immunosuppressive drug therapy. Rejection was not totally prevented, however, since the surviving rats had elevated AST and bilirubin levels, and cellular infiltration in portal areas along with proliferation of bile canaliculi was observed. These data are consistent with the hypothesis that Kupffer cells participate in mechanisms of early rejection following liver transplantation.