脾切除对肝纤维化大鼠肝脏PDGF-B表达及血清PDGF-BB水平的影响

目的 研究脾切除对肝纤维化大鼠肝脏PDGF-B表达和血清PDGF-BB水平的影响,探讨脾切除在肝纤维化治疗中的作用.方法 大鼠皮下注射CCl4,建立65只肝纤维化大鼠模型.于建模开始、肝纤维化期以及肝硬化期三组切除大鼠睥脏,并设立同期假手术组作为对照组.第一、二组及其对照组于建模后第10周,第三组及其对照组于建模后12周分别取大鼠肝脏和血液标本.用免疫组化SABC法测定肝脏PIGF-B的表达.HE染色检测肝纤维化,用双抗体夹心ELISA法测定血清PIGF-BB水平.结果 各切脾组PDGF-B阳性细胞A值(光密度值)明显低于其对照组;各切脾组血清PDGF-BB含量明显低于其对照组.根据HE染色,建模开始时切脾再行肝纤维化诱导,肝纤维化进程缓慢;建模第5周切脾后,肝脏病理状态比对照组明显缓解;肝硬化期切脾后,肝脏炎性改变和纤维化程度有一定减轻.结论 早期脾脏切除对实验性肝纤维化有一定延缓作用.脾切除后PDGF水平的下降可能是造成该延缓的机制之一.

Abstract：

Objective To explore the effects of splenectomy on hepatic fibrosis and on the expression of PDGF-B in the liver and PDGF-BB in the serum of rats with hepatic fibrosis. Methods By hypodermic injection CCl4, we established 65 rat models with hepatic fibrosis, splenectomies were performed in the three groups at different phases: before hypodermic injection CCl4 (A group), five weeks after hypodermic injection CCl4 (B group), and ten weeks hypodermic injection CCl4 (C group). The control groups were established at the same time, with samples of the livers and serum of the rats taken in different phases. The expressions of PDGF in the liver were detected by immunohistochemistry technique and the degree of hepatic fibrosis was detected by HE staining. The serum levels of PDGF-BB were analyzed by ELISA technique. Results Absorbance values of PDGF-B in the experimental group were significantly lower than the control groups (P＜0. 05). Serum levels of PDGF-BB of the rats after splenectomy were significantly lower than those in the control groups (P＜0.05). HE and Masson's staining showed that the progression of Hepatic fibrosis was slow in the A group. Hepatic pathologic state was significantly relieved in the B group and the inflammation and fibrosis was relieved in the C group. Conclusion Earlier period splenectomy could delay the proceeding of experimental hepatic fibrosis. After splenectomy the decline in the level of PDGF may be one of the mechanisms causing the delay.     

胆源性胰腺炎手术治疗体会

目的探讨胆源性胰腺炎手术治疗时机及方式的选择。方法回顾性分析2010年1月至2012年7月收治的96例胆源性胰腺炎患者的临床资料。结果 96例患者中治愈91例,术后患者临床症状、体征及实验室检查指标均明显缓解。因急性重症胰腺炎并发多器官功能衰竭死亡5例。结论急性非梗阻性胆源性胰腺炎早期应选择非手术治疗,待症状缓解后行延期手术治疗。对伴有胆管梗阻的急性重症胆源性胰腺炎患者宜采用早期外科手术治疗。     

肠系膜上静脉血栓形成的诊治分析

目的:探讨肠系膜上静脉血栓形成(SMVT)的诊断与治疗。方法:回顾分析2003～2007年间收治的8例SMVT患者临床资料,总结SMVT的临床特点、诊断和治疗。结果:手术治疗6例,保守治疗2例,无死亡病例。结论:SMVT的早期症状与体征不符,极易误诊,B超、CT及MRI是诊断SMVT的主要手段。早期诊断,及时手术治疗,术后抗凝是降低手术死亡率和复发的关键。     

急性出血性坏死性小肠炎的病因及诊疗方法探讨

目的:探讨急性出血性坏死性小肠炎(ANHE)的病因及诊疗方法。方法:回顾分析本院2002年4月～2007年5月收治的15例ANHE的临床资料,总结ANHE的临床特点、诊断和治疗。结果:15例ANHE患者手术治疗8例,保守治疗7例(死亡1例)。结论:ANHE误诊率高,腹腔穿刺,X线,B超是主要诊断方法。ANHE病因复杂,早期诊断,合理治疗才能降低本病病死率。     

3D腹腔镜下肝切除术在治疗肝脏肿瘤中的应用

目的:研究3D腹腔镜下肝切除术治疗肝脏肿瘤的应用优势。方法:回顾性分析2017年11月至2020年8月在湘雅常德医院行3D腹腔镜下肝切除术治疗的50例肝脏肿瘤患者的临床资料。分析患者术中出血量、手术时间与住院时间。结果:右半肝切除术、左半肝切除术、肝中叶切除术、肝Ⅴ段切除术及肝左外叶切除术的平均手术时间分别为(273±27)min、(123±9)min、(246±33)min、(96±18)min和(92±8)min;术中出血量分别为(285±97)ml、(134±28)ml、(252±36)ml、(108±25)ml和(107±36)ml;住院时间分别为(16±6)d、(12±1)d、(14±3)d、(11±2)d和(8±2)d。结论:3D腹腔镜下肝切除术治疗肝脏肿瘤具术中出血少、分离管道结构更清晰、并发症少、手术用时短、康复快等优势,值得在临床上推广应用。     

脾切除对肝纤维化大鼠肝脏PDGF-B表达及血清PDGF-BB水平的影响

Objective To explore the effects of splenectomy on hepatic fibrosis and on the expression of PDGF-B in the liver and PDGF-BB in the serum of rats with hepatic fibrosis. Methods By hypodermic injection CCl4, we established 65 rat models with hepatic fibrosis, splenectomies were performed in the three groups at different phases: before hypodermic injection CCl4 (A group), five weeks after hypodermic injection CCl4 (B group), and ten weeks hypodermic injection CCl4 (C group). The control groups were established at the same time, with samples of the livers and serum of the rats taken in different phases. The expressions of PDGF in the liver were detected by immunohistochemistry technique and the degree of hepatic fibrosis was detected by HE staining. The serum levels of PDGF-BB were analyzed by ELISA technique. Results Absorbance values of PDGF-B in the experimental group were significantly lower than the control groups (P＜0. 05). Serum levels of PDGF-BB of the rats after splenectomy were significantly lower than those in the control groups (P＜0.05). HE and Masson's staining showed that the progression of Hepatic fibrosis was slow in the A group. Hepatic pathologic state was significantly relieved in the B group and the inflammation and fibrosis was relieved in the C group. Conclusion Earlier period splenectomy could delay the proceeding of experimental hepatic fibrosis. After splenectomy the decline in the level of PDGF may be one of the mechanisms causing the delay.     

奥曲肽联合凝血酶治疗肝硬化合并上消化道出血的效果分析

目的探讨奥曲肽联合凝血酶治疗肝硬化合并上消化道出血的效果。方法92例肝硬化合并上消化道出血患者,随机分为对照组和观察组,每组46例。对照组使用奥曲肽治疗,观察组使用奥曲肽联合凝血酶治疗。对比两组的临床疗效、治疗指标、不良反应发生情况。结果观察组治疗总有效率为93.48%,高于对照组的73.91%,差异具有统计学意义(P<0.05)。观察组止血时间(1.14±0.15)d、住院时间(9.16±2.58)d短于对照组的(2.09±0.23)、(12.47±3.39)d,输血量(254.68±51.36)ml少于对照组的(445.72±55.93)ml,再出血率4.35%低于对照组的21.74%,差异具有统计学意义(P<0.05)。观察组不良反应发生率为8.70%(4/46),与对照组的10.87%(5/46)比较差异无统计学意义(P>0.05)。结论奥曲肽联合凝血酶治疗肝硬化合并上消化道出血的效果显著,止血速度快,效果好,再出血率低,且不良反应发生率低。     

人胚脑神经干细胞的分离、培养和鉴定

目的：探讨人胚脑神经干细胞的体外生长特性、分化情况和培养条件，为相关实验研究提供条件。方法：利用神经干细胞的条件培养基，对从9周和12周胚龄的自然流产胎儿分离的前脑、后脑进行神经干细胞培养，并比较其生长特性。以免疫荧光细胞化学技术检测神经上皮干细胞蛋白(Nestin)和分化后神经细胞抗原的表达。结果：两胚龄前、后脑组织中均分离出神经干细胞，他们均表达Nestin抗原阳性。血清诱导分化后，表达神经元、星型胶质细胞和少突胶质细胞的特异性抗原。9周胚龄的脑组织原代培养形成细胞克隆的比例高于12周胚龄的脑组织。在条件培养基存在的情况下，后脑组织分离的神经干细胞比前脑组织来源的更容易分化。结论：从人胚脑组织中的前、后脑中分离出神经干细胞，较小胚龄的脑组织原代培养时细胞克隆的形成比例较高，后脑组织分离的神经干细胞比前脑组织来源的更容易分化。     

声动力学治疗介导原卟啉Ⅸ抑制SW480荷瘤裸鼠肿瘤生长的效果观察

目的:观察声动力学治疗介导原卟啉Ⅸ抑制SW480荷瘤裸鼠肿瘤生长的效果。方法:将SW480荷瘤裸鼠随机分为4组:声动力学+原卟啉Ⅸ组,声动力学组,原卟啉Ⅸ组和对照组。观察并比较各组裸鼠肿瘤生长及抑制情况。结果:声动力学治疗介导原卟啉Ⅸ可抑制SW480荷瘤裸鼠肿瘤生长,和声动力学干预组、原卟啉Ⅸ组、对照组相比差异有统计学意义;和声动力学治疗组、原卟啉Ⅸ组比较,声动力学治疗介导原卟啉Ⅸ组肿瘤抑制率明显较高。结论:声动力学治疗介导原卟啉Ⅸ可明显抑制SW480荷瘤裸鼠肿瘤的的生长,其生物学效应及机制仍有待进一步深入研究。