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1.
胆管癌发病和早期诊断相关基因的研究现状 总被引:4,自引:0,他引:4
胆管癌是起源于胆管上皮的恶性肿瘤。依其起源部位不同有肝内和肝外胆管癌之分。胆管癌被确诊时多为晚期,手术切除率低,预后差。如何早期诊断胆管癌,提高胆管癌患者生存率是当前研究的重点。随着分子生物学技术的发展,对胆管癌发病在基因水平的研究已有涉及。现有报道显示胆管癌相关基因包括抑癌基因、癌基因以及凋亡相关基因等。近年来,研究发现胆管癌发病与黏蛋白基因、三叶肽基因和同源异型盒基因的异常表达有关。本文就这些方面进展综述如下。 相似文献
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肝胆结石病是外科常见病之一 ,分为胆囊结石、胆总管结石、肝内胆管结石。肝胆结石病绝大多数需手术治疗 ,作为一种辅助治疗 ,中医中药也能发挥很重要作用 ,中医认为肝胆结石症的发生源于肝失疏泄 ,或脾虚失运导致胆汁淤滞 ,久则蕴热 ,湿热熏蒸而出现诸多临床症状。治疗则以舒肝健脾利胆清热为其原则。1 胆囊结石的中医中药治疗1 1 单纯胆绞痛型 :患者以右上腹绞痛为主 ,多较急剧 ,不发热 ,腹部无压痛和肌紧张。依据“急则治其标”的原则 ,此类病人的当务之急是缓解腹痛 ,常采用以下方法 :(1)禁食 2~ 3天 ,因为进食后会促使胆囊收缩 ,加… 相似文献
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Objective. To improve the localized diagnosis of insidious recurrent small intestinal hemorrhage. Methods. This retrospective analysis include 64 cases of such diseases, which were admitted from 1988 to 1998 toour hospital. Result. Ultrasonography, CT, small bowel pneumobariunlgraphy, diluted barium enema, isetopic examination, DSA and intraoperafive small-bowel endoscopy were used for diagnosis of hemonrrhagic site, and 37 cases got a defirfite location before operation, while 10 cases were confirmed the diagnosis during the operation. Forty-seven cases were treated surgically, while the other 17 cases had non-surgical treatment. Of the 47 cases,39 cases underwent partial en-terectomy, 5 cases had suture and ligature of vascular deformity, 2 cases had Whipple‘s operation, and one patient had ectomy of the end of ileum and right colon. Conclusion. DSA, Isotopic examination and intraoperafive enteroscopy are of considerable importance for the lo-cation judgement of recurrent small intestinal hemorrhage. 相似文献
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Objective. To improve the recognition of diagnosis and treatment of gallbladder cancer. Methods. Retrospective analysis of 52 cases of gallbladder carcinoma in our hospital from 1988 to 1998. Results. Preoperative diagnostic rate was 90.3%, of which 12 cases (23%) were early stage of carcinoma. The total operation resection rate was 55.8%, for which only 17.8% were advance stage of carcinoma. Conclution. The early diagnosis is the key factor of increasing treatment successful rate. The following are the symptoms that raise our special attention to carcinoma of gallbladder: ( 1 ) Age over 50 have recurrent eholecysfitis and with past history of gallstone; (2) Congenital malformation of bile duct; (3) Local thickening and irregularity of gallbladder,gall; (4) Polypoid lesion larger than lem inside gallbladder; (5) Atrophic gallbladder; (6) Intraluminal stone of gallbladder does not move when change in body position; (7) Regional lymph node enlargement. 相似文献
5.
目的研究去甲基化药物5-AZA对miR-34a和miR-34c在肝癌细胞中表达的影响及其抑制肝癌细胞糖酵解的分子机制。方法用real-time PCR法检测肝癌细胞系中miR-34a/c的表达以及糖酵解途径关键酶的表达;在肝癌细胞中过表达miR-34a、miR-34c或用5-AZA处理肝癌细胞,用乳酸检测试剂盒、葡萄糖检测试剂盒分析miR-34a/c及5-AZA对肝癌细胞BEL7402糖酵解的影响;设计拯救实验研究5-AZA、miR-34a/c与肝癌细胞糖酵解调控的关系。结果 5-AZA可以诱导BEL7402肝癌细胞内源性miR-34a、miR-34c的表达上调(P0.01);过表达miR-34a/c可以抑制糖酵解关键酶LDH-A的表达(P0.05);LDH-A是miR-34a/c的潜在靶基因;敲低miR-34a/c的表达可以降低5-AZA对肝癌细胞BEL7302糖酵解途径的抑制作用。结论 5-AZA通过诱导miR-34a/c表达上调,发挥抑制肝癌细胞代谢方式转换的功能。 相似文献
6.
目的 探讨壶腹肿瘤手术方式的合理选择.方法 回顾性分析北京协和医院1995年1月至2012年6月收治的238例壶腹肿瘤的临床病理资料.51例良性肿瘤患者中,行肿瘤局部切除术34例,胰十二指肠切除术17例;187例壶腹癌患者中,行壶腹局部切除术25例,胰十二指肠切除术162例.结果 无论是对于壶腹癌还是良性肿瘤,与胰十二指肠切除术相比,行局部切除术者手术时间更短、术中出血量更少、住院时间更短、术后并发症发生率更低(均P<0.05).壶腹部良性肿瘤行局部切除术组与行胰十二指肠切除术组的术后生存时间差异无统计学意义(P=0.071,x2=2.003).T1、T2期壶腹癌两种术式组术后生存时间差异也无统计学意义(P=0.054,x2=3.163);但T3、T4期胰十二指肠切除术组术后生存时间明显长于局部切除术组(P=0.041,x2=6.309).结论 壶腹肿瘤对手术治疗的反应相对良好.对于良性肿瘤及T1~2期壶腹癌,局部切除可达到根治目的;而对于T3~4期壶腹癌,则应行胰十二指肠切除术. 相似文献
7.
目的 探讨医源性胆管损伤导致远期胆管狭窄及闭锁并发症的治疗方法及要点.方法 回顾性分析2002年6月至2006年7月收治的5例因胆囊切除手术时胆管损伤导致胆管狭窄及闭锁远期并发症患者的临床资料.结果 5例医源性胆管损伤远期并发症包括:肝总管完全闭锁2例,肝门部胆管狭窄2例,胆肠吻合口狭窄1例.其中,2例为腹腔镜胆囊切除手术,3例为小切口胆囊切除术.损伤部位按Strasberg分型包括:E1型、E2型、E3型各1例、E5型2例.5例胆管损伤远期并发症患者,均于经皮肝胆管穿刺造影及引流减黄治疗后进行手术探查及胆道重建.手术方法包括肝门部肝管成型、肝管空肠Roux-en-Y吻合术3例,肝总管空肠Roux-en-Y吻合术2例,术后均恢复良好出院.5例患者均随访7年以上,未再发生梗阻性黄疸及胆道感染,目前仍在随访中.结论 对医源性胆管损伤导致胆管狭窄及胆管闭锁远期并发症患者,应先施行经皮肝胆管穿刺造影及引流治疗,待黄疸及炎症控制后二期手术行胆管空肠Roux-en-Y吻合.耐心细致解剖肝门、将损伤近端正常胆管组织与空肠吻合及保证吻合口足够大是手术治疗成功的要点. 相似文献
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Objective To discuss the diagnosis and treatment of congenital choledochal cyst (CCC).Methods The clinical data of 109 adult patients with congenital choledochal cyst admitted in Peking Union Medical College Hospita between 1984 and 2007 were retrospectively analyzed.The male: female ratio was 1 : 3.8.The mean age was 32.8 years.Seventy-eight of the patients belonged to Todani type Ⅰ, while twenty-six to type Ⅳ and five to type Ⅴ.There was no case of type Ⅱ or Ⅲ.Results Right upper abdominal pain or discomfort and recurrent cholangitis were the predominant presentations.Thirty patients had undergone previous surgical procedures while 26 procedures were done before 2000.B-US and MRCP were the primary methods for diagnosis after 2000.Ninety-four patients underwent complete excision of the extrahepatic cyst and hepaticojejunostomy.Four patients required the left lateral hepateetomy in addition.Four patients were testified malignant change by pathological examination.There were four pancreatic fistulas and two Subphrenic abscesses.There was no postoperative death.Forty-six patients were available for follow-up.The late complications in-eluded recurrent cholangitis, hepaticojejunostomy anastomosis stricture and intrahepatic biliary calcu-la.Conclusions Right upper abdominal pain or discomfort and recurrent cholangitis were the most common presentations in adult congenital choledochal cyst patients.B-US and MRCP should be the prefered imaging methods for diagnosis.Complete excision of the extrahepatic cyst and hepaticojeju-nostomy were ideal treatment. 相似文献