肝硬变门脉高压症血流动力学评估中MRA的临床应用

目的探讨磁共振血管成像(MRA)在门静脉高压症血流动力学研究中的应用价值。方法对38例肝硬变门静脉高压症病人和12例非肝硬变对照组病人进行MRA检查，检测门静脉系统解剖形态成像和血流量变化，分别与间接门静脉造影(IPVG)和多普勒超声(DUS)的结果进行比较。结果MRA成像结果优于IPVG，能很好显示门静脉系统各属支，对流速、流量的测定与DUS有良好相关性。结论MRA能较好显示门静脉系统解剖影像，并可测得其流速、流量，应成为门静脉高压症患者血流动力学研究的首选方法。     

CO2气腹环境对胃癌细胞黏附与侵袭转移的影响

Objective To investigate the influence of CO2 pneumoperitoneum on the adhesive and invasive ability of gastric cancer cells based on the expression of adhesive and invasive molecules. Methods With an artificial CO2 pneumoperitoneum model in vitro, human gastric cancer cells MKN-45, SGC-7901 and MKN-28 were exposed to 3 different CO2 gradients: 9 mm Hg, 15 mm Hg and control group (0 mm Hg). The expression of E-cadherin, ICAM-1, MMP-2 and VEGF-A were measured at 2 and 4 hours exposure by using RT-PCR, CytoMatrixTM kit and ECMatrixTM kit. The pretreated gastric cancer cells were injected into abdominal cavity of nude mice(2×106 cells per mouse). Five mice in each group were sacrificed 4 weeks later to record the number of tumor nodules in abdominal cavity. The remaining mice were kept for observation of survival time. Results The expression of E-cadherin (MKN-45: from 2.26 to 2.19, SGC-7901 :from 2.16 to 2.09、MKN-28 :from 2.06 to 1.99), ICAM-1 (MKN-45 : from 2.20 to 2.28、SGC-7901: from 2.10 to 2.18、MKN-28: from 2.00 to 2.08), MMP-2 (MKN-45:from 2.05 to 2.13、SGC-7901: from 1.95 to 2.03、MKN-28: from 1.85 to 1.93) and VEGF-A(MKN-45 : from 2.10 to 2.16、SGC-7901 :from 2.00 to 2.06、MKN-28: from 1.90 to 1.96) didn't change significantly with increasing pressure and time (P>0.05). The expression of adhesive and invasive molecules didn't change significantly between the experimental groups and the control group. There was no statistical significance of tumor metastasis in abdominal cavity of nude mice(MKN-45:from 22 to 23、SGC-7901 :from 20 to 22、MKN-28:from 21 to 22) and survival time(MKN-45 :from 23 to 21、SGC-7901 :from 22 to 21、MKN-28 :from 22 to 21) among all the groups. Conclusion Under low pressure and short time of CO2 exposure, the adhesive and invasive capacity of gastric cancer cells did not change significantly hence did not increase the possibility of neoplasm metastasis.     

急性肠系膜静脉血栓形成的诊治体会

目的探讨肠系膜静脉血栓形成(Mesenteric venous thrombosis)的诊断及治疗。方法分析7例急性肠系膜静脉血栓形成的临床表现、实验室及影像学检查和术中所见、病理等。结果7例患者均急诊行剖腹探查，术中发现肠系膜静脉部分栓塞，均行部分小肠切除术。结论肠系膜静脉血栓形成的早期诊断较为困难，CT与血管造影较为敏感。对高度怀疑本病或有腹膜炎体征者，应立即剖腹探查，切除坏死肠管。     

CO2气腹环境对胃癌细胞黏附与侵袭转移的影响

Objective To investigate the influence of CO2 pneumoperitoneum on the adhesive and invasive ability of gastric cancer cells based on the expression of adhesive and invasive molecules. Methods With an artificial CO2 pneumoperitoneum model in vitro, human gastric cancer cells MKN-45, SGC-7901 and MKN-28 were exposed to 3 different CO2 gradients: 9 mm Hg, 15 mm Hg and control group (0 mm Hg). The expression of E-cadherin, ICAM-1, MMP-2 and VEGF-A were measured at 2 and 4 hours exposure by using RT-PCR, CytoMatrixTM kit and ECMatrixTM kit. The pretreated gastric cancer cells were injected into abdominal cavity of nude mice(2×106 cells per mouse). Five mice in each group were sacrificed 4 weeks later to record the number of tumor nodules in abdominal cavity. The remaining mice were kept for observation of survival time. Results The expression of E-cadherin (MKN-45: from 2.26 to 2.19, SGC-7901 :from 2.16 to 2.09、MKN-28 :from 2.06 to 1.99), ICAM-1 (MKN-45 : from 2.20 to 2.28、SGC-7901: from 2.10 to 2.18、MKN-28: from 2.00 to 2.08), MMP-2 (MKN-45:from 2.05 to 2.13、SGC-7901: from 1.95 to 2.03、MKN-28: from 1.85 to 1.93) and VEGF-A(MKN-45 : from 2.10 to 2.16、SGC-7901 :from 2.00 to 2.06、MKN-28: from 1.90 to 1.96) didn't change significantly with increasing pressure and time (P>0.05). The expression of adhesive and invasive molecules didn't change significantly between the experimental groups and the control group. There was no statistical significance of tumor metastasis in abdominal cavity of nude mice(MKN-45:from 22 to 23、SGC-7901 :from 20 to 22、MKN-28:from 21 to 22) and survival time(MKN-45 :from 23 to 21、SGC-7901 :from 22 to 21、MKN-28 :from 22 to 21) among all the groups. Conclusion Under low pressure and short time of CO2 exposure, the adhesive and invasive capacity of gastric cancer cells did not change significantly hence did not increase the possibility of neoplasm metastasis.     

从瘀毒角度运用治未病思想防治肺结节

肺结节是指肺内出现的不规则病灶,影像学表现为高密度阴影。基于中医学对瘀、毒的认识,以 及肺结节的临床表现,对肺结节的防治进行探讨,分析认为瘀、毒既可以是肺结节的病理产物,也可以是致病 因素,且贯穿疾病的始终。肺结节疾病发展可分为三个阶段,第一阶段是邪犯肺脏,积聚成瘀;第二阶段是邪 毒炽盛,痹阻肺络;第三阶段是正气亏虚,瘀毒搏结。因部分肺结节可发展为早期肺癌病变,鉴于疾病转归的 特殊性,提出运用中医治未病思想防治肺结节,可根据瘀、毒作用的强弱、时间节点及位置,结合肺结节证候 演变的全过程,抓住存在的时间节点,判定结节的性质,确立治则治法,针对性控制病情,防止传变。     

铁皮石斛试管苗壮苗培养基的研究

目的:研究铁皮石斛试管苗生产中,壮苗阶段的适宜培养基。方法:对基本培养基、天然提取物、香蕉提取物浓度和激素种类的选择进行了研究。结果:基本培养基以B₅或1/2MS为好;天然提取物应选用香蕉水提物,香蕉水提物浓度为10%;植物激素是2mg/L的NAA较好。结论:以上培养基组成是铁皮石斛试管苗壮苗的适宜培养基。     

脑梗死患者凝血功能的分析

目的分析脑梗死患者凝血图及血小板数目、体积变化情况，探讨脑梗死发生发展的理论依据。方法对80例发病时间在6～24h内的脑梗死患者测定其血小板数目（PLT）、平均血小板体积（MPV）及凝血图，并与正常人比较。结果脑梗死患者的血浆纤维蛋白原含量（FIB）及平均血小板体积（MPV）均显著高于正常人。结论平均血小板体积（MPV）和血浆纤维蛋白原含量（FIB）的异常与脑梗死的发生发展密切相关。     

紫杉醇脂质体联合大剂量5-FU持续静脉滴注治疗进展期胃癌的临床疗效

目的评估紫杉醇脂质体联合大剂量5-氟尿嘧啶（5-Fu）持续静脉滴注治疗进展期胃癌的疗效和不良反应。方法选择我院普外科2009年5月至2012年8月期间收治的63例进展期胃癌患者,给予紫杉醇脂质体联合大剂量（2．5g／m^2）5-FU持续静脉滴注治疗。依据RECIST标准进行疗效评价,并观察该化疗方案的不良反应。结果无一例患者因严重化疗毒性反应不能耐受而终止治疗。63例患者中达到完全缓解5例（7．94％）,部分缓解31例（49．2％）,总体有效率为57．1％（36／63）。血液学毒性反应中Ⅲ／Ⅳ级白细胞减少、中性粒细胞减少分别为8例（12．7％）和10例（15．9％）,没有发生Ⅲ／Ⅳ级的贫血或血小板减少。非血液学毒性反应相对较轻,基本为Ⅰ／Ⅱ级反应。结论紫杉醇脂质体具有安全性高、耐受性好、靶向性高和长时疗效的特点。紫杉醇脂质体联合大剂量5-FU持续静脉滴注治疗进展期胃癌临床疗效确切、不良反应较轻、患者耐受性好。     

APPLICATION OF MAGNETIC RESONANCE ANGIOGRAPHY IN PORTAL HYPERTENSIVE SURGERY

Objective To compare magnetic resonance angiography （MRA） with traditional angiography and doppler ultrasonography （DUS） in the assessment of portal venous anatomy and its hemodynamics. Methods Three dimensional dynamic contrast-enhanced （ 3 D-DCE） MRA and two dimensional phase-contrast （2D-PC） MR were used for the study of portal venous system in the patients with portal hypertension and those without liver cirrhosis. The comparison of the portal blood flow （PBF） measured with 2D-PC MR and DUS was made. Results The portal vein, splenic vein, superior mesenteric vein, cephalic collateral veins and anastomotic stoma of surgical shunting were clearly displayed in 3D-DCE MRA. There was no significant difference between PBF measured with 2D-PC MR and DUS. Conclusion The results of present study indicate that the anatomical imaging of the portal venous system can be dearly revealed in MRA and the PBF can be accurately measured with 2D-PC MR. It is believed that MRA is a useful tool in the management of the patients with portal hypertension.     

老年人急性肠系膜缺血2例报告

急性肠系膜缺血是全部或部分肠道血流量不足引起的临床综合征，其临床表现由缺血性损伤的程度和受损肠道的部位及其长度决定。由于其症状和体征变化较大，且老年人反应较迟钝，早期诊断较为困难，且本病在手术时机和方法的选择、围手术期的处理及预防复发等方面仍存在一定争议。我科2002年上半年收治2例老年急性肠系膜缺血病例，现将诊治经过报告如下。