重症急性胰腺炎合并大出血的防治

目的 总结重症急性胰腺炎(SAP)合并大出血的防治经验.方法 回顾性分析华中科技大学附属协和医院胰腺外科中心1999年-2008年收治的790例SAP患者中并发大出血患者65例的临床资料,按防治出血方法的不同将其分为两阶段,对前后两阶段SAP合并大出血的发病率、死亡率进行比较.结果 1999年1月至2003年12月收治387例SAP患者,并发大出血44例,其中以消化道大出血为主12例、以腹腔内大出血为主32例,发病率11.37%(44/387),死亡19例,死亡率4.91%(19/387);2004年1月至2008年12月收治403例SAP患者,并发大出血21例,其中以消化道大出血为主8例、以腹腔内大出血为主13例,发病率5.21%(21/403),死亡5例,死亡率1.24%(5/403);两期出血发病率和出血所致死亡率的差异有统计学意义(P<0.01).结论 早期及时肠内营养和免疫治疗、有效腹腔引流及选择恰当手术时机和方式可能是降低SAP并发大出血的有效措施.     

缺氧微环境对胰腺癌细胞发生上皮向间叶转化的诱导作用

Objective To investigate whether hypoxic environment can promote the metastasis of pancreatic cancer cells by inducing epithelial to mesenchymal transition (EMT). Methods The Panc-1 cells were cultured in hypoxia environment. After cultured for indicated periods, the in vitro invasive ability of Pane-1 cells was compared with normoxia group using Transwell invasion assay. The epithelial marker E-cadherin and the mesenchymal marker vimentin were assayed by Western blot. The expression of Snail, a strong activator of EMT, was detected by real-time PCR. The HIF-1 α encoding cDNA was transiently trans-fected into the Pane-1 cells, and the E-cadherin and vimentin were analyzed. Results The number of cells invading to the lower side of the membrane under hypoxia was ( 121±5 ), whereas only ( 84±3 ) in no-morxia group ( P < 0.05 ). The relative expression of E-cadherin in normoxia, hyoxia groups at 12,24,48 hwas (0.59±0.04 vs 54.00±0.05,0.45±0.10,0.36±0.03 ), and that of vimentin was (0.36±0.05, 0.41±0.04,0.48±0.06,0.58±0.05 ) ( P < 0.05 ). The relative expression of Snail mRNA was in-creased in hypoxia environment, and the difference was significant after 72 h ( P < 0.05 ). Before and after HIF-1α cDNA was transfected into the Panc-1 cells, the relative expression of E-cadherin was 0.63± 0.05, and 0.47±0.07, and that of vimentin was 0.47±0.07, and 0.32±0.04 respectively ( P < 0.05 ). Conclusion Hypoxia microenvironment can activate HIF-1α and Snail to trigger EMT of pancreatic cancer cells.     

缺氧微环境对胰腺癌细胞发生上皮向间叶转化的诱导作用

Objective To investigate whether hypoxic environment can promote the metastasis of pancreatic cancer cells by inducing epithelial to mesenchymal transition (EMT). Methods The Panc-1 cells were cultured in hypoxia environment. After cultured for indicated periods, the in vitro invasive ability of Pane-1 cells was compared with normoxia group using Transwell invasion assay. The epithelial marker E-cadherin and the mesenchymal marker vimentin were assayed by Western blot. The expression of Snail, a strong activator of EMT, was detected by real-time PCR. The HIF-1 α encoding cDNA was transiently trans-fected into the Pane-1 cells, and the E-cadherin and vimentin were analyzed. Results The number of cells invading to the lower side of the membrane under hypoxia was ( 121±5 ), whereas only ( 84±3 ) in no-morxia group ( P < 0.05 ). The relative expression of E-cadherin in normoxia, hyoxia groups at 12,24,48 hwas (0.59±0.04 vs 54.00±0.05,0.45±0.10,0.36±0.03 ), and that of vimentin was (0.36±0.05, 0.41±0.04,0.48±0.06,0.58±0.05 ) ( P < 0.05 ). The relative expression of Snail mRNA was in-creased in hypoxia environment, and the difference was significant after 72 h ( P < 0.05 ). Before and after HIF-1α cDNA was transfected into the Panc-1 cells, the relative expression of E-cadherin was 0.63± 0.05, and 0.47±0.07, and that of vimentin was 0.47±0.07, and 0.32±0.04 respectively ( P < 0.05 ). Conclusion Hypoxia microenvironment can activate HIF-1α and Snail to trigger EMT of pancreatic cancer cells.     

胰腺囊性肿瘤的诊断与治疗——附41例报告

目的探讨胰腺囊性肿瘤的诊断和治疗。方法对本院1990年6月至2004年6月收治的41例胰腺囊性肿瘤患者的临床特点进行回顾性分析。结果胰腺囊性肿瘤好发于中青年女性，无急性胰腺炎，无上腹部手术及外伤史。临床表现以上腹部肿块和疼痛不适较为多见。影像学检查胰腺肿块为囊性，囊实性或不规则分叶状。肿瘤位于胰头部14例，胰体尾部27例。行不同术式的肿瘤切除35例，内引流3例，剖腹探查、肿瘤活检2例，1例拒绝于术治疗。有效随访34例，随访12个月～13年，22例囊腺瘤，17例仍生存；12例囊腺癌，生存时间〈12个月2例，12个月至2年4例，6例健在，其中5年以上3例，最长1例已生存7年。结论提高对胰腺囊性肿瘤的认识，减少误诊和积极的手术切除是改善其预后的主要措施。     

缺氧微环境对胰腺癌细胞发生上皮向间叶转化的诱导作用

Objective To investigate whether hypoxic environment can promote the metastasis of pancreatic cancer cells by inducing epithelial to mesenchymal transition (EMT). Methods The Panc-1 cells were cultured in hypoxia environment. After cultured for indicated periods, the in vitro invasive ability of Pane-1 cells was compared with normoxia group using Transwell invasion assay. The epithelial marker E-cadherin and the mesenchymal marker vimentin were assayed by Western blot. The expression of Snail, a strong activator of EMT, was detected by real-time PCR. The HIF-1 α encoding cDNA was transiently trans-fected into the Pane-1 cells, and the E-cadherin and vimentin were analyzed. Results The number of cells invading to the lower side of the membrane under hypoxia was ( 121±5 ), whereas only ( 84±3 ) in no-morxia group ( P < 0.05 ). The relative expression of E-cadherin in normoxia, hyoxia groups at 12,24,48 hwas (0.59±0.04 vs 54.00±0.05,0.45±0.10,0.36±0.03 ), and that of vimentin was (0.36±0.05, 0.41±0.04,0.48±0.06,0.58±0.05 ) ( P < 0.05 ). The relative expression of Snail mRNA was in-creased in hypoxia environment, and the difference was significant after 72 h ( P < 0.05 ). Before and after HIF-1α cDNA was transfected into the Panc-1 cells, the relative expression of E-cadherin was 0.63± 0.05, and 0.47±0.07, and that of vimentin was 0.47±0.07, and 0.32±0.04 respectively ( P < 0.05 ). Conclusion Hypoxia microenvironment can activate HIF-1α and Snail to trigger EMT of pancreatic cancer cells.     

MT2-MMP基因沉默对缺氧条件下培养的胰腺癌AsPC-1细胞增殖、凋亡及侵袭力的影响

目的 利用特异性siRNA沉默人胰腺癌AsPC-1细胞的膜型金属蛋白酶2（MT2-MMP）基因表达,观察其对缺氧条件下培养的细胞增殖、凋亡和侵袭力的影响.方法 采用脂质体转染法将插入MT2-MMP特异性siRNA的真核表达质粒转染至人胰腺癌AsPC-1细胞株（siRNA组）,以转染过表达MT2-MMP质粒（过表达组）或阴性对照质粒（空载体组）的AsPC-1作为对照.实时定量PCR法和蛋白质印迹法检测转染细胞的MT2-MMP mRNA和蛋白的表达.在缺氧条件（37℃、1％O2、5％ CO2、饱和湿度的三气培养箱）下培养后,应用CCK-8法检测转染细胞的增殖,流式细胞仪检测细胞的凋亡,Transwells小室检测细胞的侵袭能力.结果 成功获取MT2-MMP基因沉默的AsPC-1细胞株和过表达的细胞株.缺氧条件下培养24h后,空载体组、过表达组、siRNA组细胞增殖的吸光度值（A490值）分别为0.68±0.08、0.80 ±0.08、0.52±0.07;细胞凋亡率分别为（6.2±1.5）％、（2.8±1.1）％、（21.4±3.9）％;每个视野（200倍）的穿膜细胞数分别为（115.8 ±23.2）、（256.4±38.6）、（45.8±18.2）个.siRNA组较空载体组的细胞增殖显著被抑制,穿膜细胞数显著减少,而细胞凋亡率显著增加（P值均＜0.05）.过表达组较空载体组的细胞增殖显著增强,穿膜细胞数显著增加,而细胞凋亡率显著降低（P值均＜0.05）.结论 MT2-MMP基因沉默的AsPC-1细胞在缺氧条件下培养后细胞凋亡增加,增殖被抑制,侵袭力减弱.     

保留十二指肠胰头切除术后并发症的防治体会

目的 探讨保留十二指肠胰头切除术后并发症的防治措施.方法 回顾性分析2003-2008年期间武汉协和医院胰腺中心行保留十二指肠胰头切除术56例病人的临床诊疗经过.结果 术后发生并发症13例(23.2%),包括胰瘘7例(12.5%),十二指肠瘘2例(5.4%);胆瘘1例(2.8%);腹膜后积液和感染2例(5.4%);腹腔大出血1例(2.8%).消化道瘘经支持治疗和维持通畅引流等治疗而痊愈,腹膜后积液和感染病人在B超引导下置管引流治愈,腹腔大出血者急诊选择性腹腔动脉造影显示胃十二指肠动脉分支破裂出血,经明胶海绵和不锈钢圈栓塞后治愈.结论 胰瘘、十二指肠瘘、胆瘘、腹腔感染和出血等是DPPHR术后主要并发症,严格掌握手术适应证,术中仔细操作,尽量保留十二指肠的血液供应是减少DPPHR术后并发症和提高手术成功率的关键,一旦出现并发症应采用正确的治疗方法 .     

缺氧微环境对胰腺癌细胞发生上皮向间叶转化的诱导作用

Objective To investigate whether hypoxic environment can promote the metastasis of pancreatic cancer cells by inducing epithelial to mesenchymal transition (EMT). Methods The Panc-1 cells were cultured in hypoxia environment. After cultured for indicated periods, the in vitro invasive ability of Pane-1 cells was compared with normoxia group using Transwell invasion assay. The epithelial marker E-cadherin and the mesenchymal marker vimentin were assayed by Western blot. The expression of Snail, a strong activator of EMT, was detected by real-time PCR. The HIF-1 α encoding cDNA was transiently trans-fected into the Pane-1 cells, and the E-cadherin and vimentin were analyzed. Results The number of cells invading to the lower side of the membrane under hypoxia was ( 121±5 ), whereas only ( 84±3 ) in no-morxia group ( P < 0.05 ). The relative expression of E-cadherin in normoxia, hyoxia groups at 12,24,48 hwas (0.59±0.04 vs 54.00±0.05,0.45±0.10,0.36±0.03 ), and that of vimentin was (0.36±0.05, 0.41±0.04,0.48±0.06,0.58±0.05 ) ( P < 0.05 ). The relative expression of Snail mRNA was in-creased in hypoxia environment, and the difference was significant after 72 h ( P < 0.05 ). Before and after HIF-1α cDNA was transfected into the Panc-1 cells, the relative expression of E-cadherin was 0.63± 0.05, and 0.47±0.07, and that of vimentin was 0.47±0.07, and 0.32±0.04 respectively ( P < 0.05 ). Conclusion Hypoxia microenvironment can activate HIF-1α and Snail to trigger EMT of pancreatic cancer cells.     

缺氧微环境对胰腺癌细胞发生上皮向间叶转化的诱导作用

Objective To investigate whether hypoxic environment can promote the metastasis of pancreatic cancer cells by inducing epithelial to mesenchymal transition (EMT). Methods The Panc-1 cells were cultured in hypoxia environment. After cultured for indicated periods, the in vitro invasive ability of Pane-1 cells was compared with normoxia group using Transwell invasion assay. The epithelial marker E-cadherin and the mesenchymal marker vimentin were assayed by Western blot. The expression of Snail, a strong activator of EMT, was detected by real-time PCR. The HIF-1 α encoding cDNA was transiently trans-fected into the Pane-1 cells, and the E-cadherin and vimentin were analyzed. Results The number of cells invading to the lower side of the membrane under hypoxia was ( 121±5 ), whereas only ( 84±3 ) in no-morxia group ( P < 0.05 ). The relative expression of E-cadherin in normoxia, hyoxia groups at 12,24,48 hwas (0.59±0.04 vs 54.00±0.05,0.45±0.10,0.36±0.03 ), and that of vimentin was (0.36±0.05, 0.41±0.04,0.48±0.06,0.58±0.05 ) ( P < 0.05 ). The relative expression of Snail mRNA was in-creased in hypoxia environment, and the difference was significant after 72 h ( P < 0.05 ). Before and after HIF-1α cDNA was transfected into the Panc-1 cells, the relative expression of E-cadherin was 0.63± 0.05, and 0.47±0.07, and that of vimentin was 0.47±0.07, and 0.32±0.04 respectively ( P < 0.05 ). Conclusion Hypoxia microenvironment can activate HIF-1α and Snail to trigger EMT of pancreatic cancer cells.     

缺氧微环境对胰腺癌细胞发生上皮向间叶转化的诱导作用

目的 探讨胰腺癌细胞在缺氧微环境中通过发生上皮向间叶转化(EMT)从而获得侵袭性表型的可能机制.方法 在缺氧微环境下培养胰腺癌细胞Pane-1、Transwell侵袭小室对比检测细胞在缺氧微环境下侵袭能力的变化情况.Western blot、免疫荧光检测缺氧对Panc-1细胞上皮细胞标记分子E-cadherin、间叶细胞标记分子vimentin表达的影响;实时荧光定量聚合酶链反应(PCR)检测缺氧对EMT诱导因子Snail表达的影响.将编码HIF-1α cDNA的真核表达载体pCD-NA 3.1-HIF-1α瞬时转染Panc-1细胞,Western blot检测HIF-1α对E-cadherin、vimentin表达的影响.结果 常氧组细胞每高倍镜视野穿透数为(84±3)个,缺氧组为(121±5)个,差异有统计学意义(P<0.01).Panc-1细胞在常氧、缺氧12 h、缺氧24 h、缺氧48 h条件下E-cadherin蛋白的相对值分别为(0.59±0.04、54.00±0.05、0.45±0.10、0.36±0.03);vimentin蛋白的相对值分别为:(0.36±0.05、0.41±0.04、0.48±0.06、0.58±0.05),缺氧同常氧组比较差异有统计学意义(P<0.05).缺氧微环境下Panc-1细胞Snail mRNA的表达量升高,在缺氧第3天后差异具有统计学意义(P<0.05).Panc-1细胞转染HIF-1α前后,E-cadherin蛋白的相对值分别为0.63±0.05、0.47±0.07;Vvi-mentin蛋白的相对值分别为0.47±0.07、0.32±0.04,转染前后差异有统计学意义(P<0.05).结论 缺氧微环境可能通过活化HIF-lα、Snail等转录因子,促进胰腺癌细胞发生上皮向间叶转化,产生侵袭性表型.