胃间质瘤腹腔镜切除与开放手术疗效对比研究

目的：比较胃间质瘤（GST）腹腔镜切除和开放手术方法的效果及预后。方法回顾性分析2008年6月至2013年3月收治的胃间质瘤患者63例,其中37例采用腹腔镜切除（腹腔镜组）,26例为传统开放手术切除（开放组）,分析对比两组患者临床病理特征、手术情况及随访资料等。结果（1）腹腔镜组手术时间为（60.7±16.6）min,明显短于开放组的（127.7±31.3）min （t=11.023）;腹腔镜组的胃管拔出时间短于开放组[（2.6±0.7）d vs（5.6±1.1）d,t=13.231],术中出血量更少[（56.8±10.0）ml vs（104.4±21.2）ml,t=11.927],住院时间更短[（5.8±0.8）d vs（10.9±1.4）d, t=18.339],差异均有统计学意义（P〈0.01）。（2）腹腔镜组患者中位生存期为56.3个月,开放组中位生存期为48.6个月。Log-Rank检验显示组间差异有统计学意义（P〈0.05）;腹腔镜组患者无复发,开放组无复发生存率85.0%,组间差异有统计学意义（P=0.039）。结论相对于开放手术,腹腔镜胃间质瘤切除具有手术时间短、住院时间短、复发率低等优势。     

腹腔镜开窗引流术治疗单纯性肝囊肿的临床评价

目的:评价腹腔镜开窗引流术治疗单纯性肝囊肿的临床疗效。方法:回顾分析近5年为78例单纯性肝囊肿患者行腹腔镜开窗引流术的临床资料。其中单发囊肿41例,2枚及以上37例(96枚囊肿),共计137枚囊肿。肝后部(Ⅳa、Ⅵ、Ⅶ、Ⅷ)囊肿24枚,余113枚位于肝前部。23例囊肿最大直径<5 cm,作为腹腔镜胆囊切除等手术的附属手术行肝囊肿开窗引流术。结果:78例手术均获成功,无一例中转开腹,无手术并发症发生。手术时间平均(37.4±10.2)min,中位术中出血量10 ml(5~150 ml),术后平均住院(3.2±0.9)d。随访观察12个月,囊肿复发6例(其中3例复发囊肿位于肝后部),直径<5 cm,且无临床症状。结论:腹腔镜开窗引流术治疗单纯性肝囊肿疗效确切,患者创伤小,术后康复快,已成为治疗单纯性肝囊肿的首选方法。囊肿较小但合并胆囊结石等的患者,可适当扩大手术适应证。     

脊柱滑脱椎弓根钉术后早期神经根刺激症状产生的原因及预防

目的:分析脊柱滑脱椎弓根钉内固定术后早期神经根刺激症状产生的原因并探讨预防方法。方法:回顾性分析1999-2006年间采用后路复位椎弓根钉内固定术治疗脊柱滑脱,出现早期神经根刺激症状28例的临床资料。结果:总结出脊柱滑脱椎弓根钉内固定术后早期神经根刺激症状产生的7种原因。主要原因是椎弓根钉系统使用不当,缺乏手术经验和技巧。结论:总结出的原因基本上是医源性的。术中仔细操作、置钉准确、椎间隙撑开适度、适度复位及神经根管减压重建、术后早期脱水治疗是主要的预防策略。     

二至五叶汤治疗寻常痤疮116例

目的：观察二至五叶汤治疗寻常痤疮的疗效。方法：将231例患者随机分成2组,治疗组采用二至五叶汤,对照组在治疗组的基础上去女贞子、旱莲草,两组疗程均为3周,观察治疗前后临床症状变化情况。结果：治疗组治愈显效率74.14%,总有效率为88.79%,对照组治愈显效率46.09%,总有效率70.43%,两组治愈显效率差异有非常显著性（P〈0.01）,总有效率差异有显著性（P〈0.05）。结论：二至五叶汤治疗寻常痤疮疗效显著。     

胆管结石阻塞性黄疸患者术后应用自拟化湿柴平汤的疗效探析

目的：探析自拟化湿柴平汤治疗不同量化分型胆管结石阻塞性黄疸的临床疗效。方法随机抽取100例胆管结石阻塞性黄疸患者,中医分型中阳黄证60例,阴黄证40例;并将其分为阳黄治疗组(n=30)、阴黄治疗组(n=20),阳黄对照组(n=30)、阴黄对照组(n=20)4组,比较4组患者临床疗效、治疗前后肝功能指标(TBIL、DBIL、AST)情况。结果阳黄治疗组总有效率明显高于阳黄对照组(P<0.05)。阳黄治疗组、阴黄治疗组患者治疗后TBIL、DBIL、AST明显优于阳黄对照组、阴黄对照组(P<0.05)。结论自拟化湿柴平汤治疗胆管结石阻塞性黄疸疗效明确,特别是阳黄型黄疸,能明显恢复患者肝功能,减轻患者炎症反应。     

Spa-1和Ki-67在乳房外Paget病肿瘤组织中的表达

目的 探讨Spa-1在乳房外Paget病发生和转移中可能的作用.方法 取17例原位乳房外Paget病和12例侵袭性乳房外Paget病患者皮损及9例正常人皮肤组织,用免疫组化分别检测Spa-1和Ki-67的表达.结果 Spa-1在胞质中显色,Ki-67在胞核中显色.Spa-1和Ki-67仅少量表达于正常人皮肤基底层,在乳房外Paget病肿瘤组织中的表达明显高于正常人皮肤(P<0.01).Spa-1在侵袭性乳房外Paget病肿瘤组织中表达明显高于原位乳房外Paget病(P<0.01).乳房外Paget病肿瘤组织中Spa-1的表达与Ki-67的表达呈正相关.结论 Spa-1在乳房外Paget病的发生发展中可能起作用.

Abstract：

Objective To investigate the potential role of Spa-1 in the development and metastasis of EMPD.Methods Tissue specimens were resected from 17 patients with primary EMPD,12 patients with invasive EMPD and 9 normal human controls.Immunohistochemistry was performed to measure the expression of spa-1 and Ki-67.Results Positive staining was observed for Spa-1 in cytoplasm,and for Ki-67 in cell nuclei.Spa-1 and Ki-67 were weakly expressed in the basal layer of normal skin.The expression of Spa-1 and Ki-67 in EMPD tissue were statistically higher than those in the normal control tissue (both P<0.01).Increased expression of Spa-1 was noted in invasive EMPD tissue compared with in situ EMPD tissue.The expression of Spa-1 was positively correlated with that of Ki-67 in the tissue of EMPD.Conclusion Spa-1 may play a certain role in the initiation and progression of EMPD.     

从腹腔镜经腹腹膜前疝修补术向完全腹膜外疝修补术转变的注意事项

正临床上常用的成人腹腔镜腹股沟疝修补术有2种基本术式:腹腔镜经腹腹膜前疝修补术(laparoscopic trans-abdominal preperitoneal hernia repair,TAPP)和腹腔镜完全腹膜外疝修补术(laparoscopic totally extra-peritoneal,TEP)[1],其中TAPP在国内开展较多,而TEP虽然有手术时间短、住院时间短的优点,但由于不进入腹腔,在腹膜外操作,操作空间     

大鼠胰腺癌微环境诱导未成熟树突状细胞功能的变化

Objective To study the effect of pancreatic cancer microenvironment on maturation of dendritic cells ( DCs), and to investigate the mechanism by which tumors escape from immune recognition. Methods DCs were cultured with rmGM (40μg/L) ,rmIL-4 (40μg/L) ,and the supernatant of cell line AR42J cells was added on the day 6, then a large number of DCs was gained. DCs cultured and in-duced by routine methods were used as controls. The expression of surface molecules CD86, and CD80 in DCs was detected to observe whether this intervention could delay or block maturation of DCs and this effect could be reversed by stimulation with lipopolysaccharide (LPS). T cell stimulatory effects were also determined. Results Compared to normal DCs, CD86 and CD80 expression positive rate was significantly decreased in DCs induced by AR42J supernatant from (70.88±3.60)% to (7.15±0.71 )%. After stimulation with LPS, the expression of CD86, and CD80 in DCs was still low, suggesting the AR42J super-natant could block the maturation of DCs. The allostimulatory capacity of the immature DCs stimulated with the AR42J superoatant was significantly lower than that of the normal immature DCs. Conclusion The supernatant from pancreatic cancer ceils in rats could inhibit the maturation of DCs, which was not easily reversed.     

生脉胶囊治疗快速性心律失常45例

目的:观察生脉胶囊治疗快速性心律失常的疗效。方法:对入选的90例快速性心律失常患者随机分成两组,治疗组45例应用生脉胶囊3粒,3/日,对照组45例应用美托洛尔25mg,2/日。结果:治疗组主要症状的改善程度较好,中医证候疗效总有效率为91.1%,按心电图疗效统计总有效率为86.7%,与对照组相比,差异有显著意义。结论:生脉胶囊能有效缓解快速性心律失常患者的临床症状,改善心电图指标,且不良反应少。