应用加速康复外科护理对腹腔镜胃癌根治术病人术后康复的影响

<正>腹腔镜技术既具有与剖腹手术相似的近期和远期疗效,又具有手术创伤小、术后恢复快的优势,目前已广泛应用于早期和进展期胃癌手术[1]。有研究表明,病人术后早期活动能刺激肠蠕动、避免肠粘连、改善呼吸功能、减少肺部并发症、促进血液循环和预防下肢静脉血栓的发生等多种优点[2-3]。加速康复外科(fast track surgery,FTS)是围手术期处理的一种全新理念,与传统护理理念不同,其强调和鼓     

快速康复外科在腹腔镜胃癌根治术围手术期中的应用

目的探讨快速康复外科（fast track surgery，FTS）在腹腔镜胃癌根治术中的应用价值。方法对60例择期行腹腔镜胃癌根治术的患者，随机分为快速康复外科理念指导下的围手术期处理组为观察组（30例）和传统的围手术期处理组为对照组（30例），比较两组术后临床观察指标的差异。结果观察组术后进食时间、排便排气时间、下床活动时间、住院天数明显缩短，差异有显著意义（P〈0.05）。结论快速康复外科理念在腹腔镜胃癌根治术患者中应用安全有效，促进了患者术后康复，缩短了术后住院时间，具有较高的临床应用价值。     

组织转谷氨酰胺酶特异性抑制剂预防肝纤维化的实验研究

Objective To observe the effects of cystamine, a tissue transglutaminase (tTG) inhibitor, on the development of rat liver fibrosis induced by carbon tetrachloride. Methods One hundred male SD rats were randomly divided into control group (n=20), hepatic fibrosis group (n=40) and cystamine group (n=40) . Liver fibrosis model was induced by intraperitoneal injection of carbon tetrachloride. Cystamine (112 mg·kg-1·d-1) was administered by intraperitoneal injection 2 days before injection of carbon tetrachloride. The rats were sacrificed at weeks 4 and 8, and the liver tissues and serum specimens were obtained. The mRNA expression of tTG, smooth muscle-alpha (α-SMA), collagen-Ⅰ and tissue inhibitors of metalloproteinase-1 (TIMP-1) were detected by real time PCR. The protein expression of tTG and α-SMA, liver function and content of hydroxyproline in liver tissues were determined by Western blot. Histological changes of the liver was observed under microscope. The fibrosis conditions of rat liver in each group were evaluated according to the semi-quantita-tive scoring system. All the data were analyzed by one-way ANOVA. Results Eight weeks after the injection of carbon tetrachloride, obvious injury of the liver in liver fibrosis group was observed. The levels of alanine trans-aminase (ALT), total bile acid, total bilirubin, hydroxyproline, tTG, α-SMA, collagen-Ⅰ and TIMP-1 were (1313±157)U/L, (99.9±18.5)μmol/L, (10.9±1.6)μmoL/L, (55±12)μg/g, 145.6±51.2, 130.3±44.6, 211.3±75.1 and 162.4±53.5. After administration of cystamine, the levels of ALT, total bile acid, total bilirubin, hydroxyproline, tTG, α-SMA, collagen-Ⅰ and TIMP-1 were (378±87) U/L, (61.0±12.7) μmol/L, (9.8±1.7) μmol/L, (70±14 ) μg/g, 48.6±12.3, 40.7±12.3, 63.9±16.0, 59.2μ23.4. Conclusion Cystamine can alleviate the carbon tetrachloride-induced rat liver fibrosis by inhibiting the tTG pathway.     

早期胆囊癌并不需要行根治性切除术

肿瘤的浸润深度是影响胆囊癌预后的最重要因素。对于侵及肌层的胆囊癌(pTlb)病人,有些研究者推荐行单纯胆囊切除术,有人则提倡行局部淋巴清扫的胆囊癌根治术。此研究回顾性地分析了经长期随访的25例pTlb病人,以确定pTlb是否为局部性疾病及评价胆囊癌根治性切除术的价值。     

原发性肝细胞肝癌胃转移一例

患者女,56岁.体检行胃镜检查时发现贲门至胃体小弯侧4 cm×3 cm凹陷性病灶,于2007年7月12日入院.胃镜取材病理检查:胃低分化腺癌.体查:一般情况良好,腹部检查示未见异常.辅助检查:甲胎蛋白(AFP)5.3μg/L,癌胚抗原(CEA)、糖链抗原19-9(CA19-9)和糖链抗原50(CA50)正常;肝功能止常;乙肝HBsAg阳性,丙肝标志物阴性.CT平扫显示胃贲门小弯侧胃壁不规则增厚,增强后有强化.腹膜后未见异常淋巴结影;肝脏形态正常,内见类圆形低密度灶.增强后边缘强化,脾脏大小正常,见图[1].术前诊断:胃癌肝转移.     

门静脉高压症鼠内脏和血管中环加氧酶的表达

目的研究门静脉高压症鼠血浆前列环素(PGI2)水平、血管和小肠中环加氧酶(COX)基因表达以及内脏血流动力学的变化,探讨PGI2、COXmRNA表达与门静脉高压症高血流动力学之间的关系。方法20只雄性SD大鼠随机分成肝内型门静脉高压症组(IHPH,n=7)、肝前型门静脉高压症组(PHPH,n=7)和假手术组(SO,n=6),同位素微球技术行内脏血流动力学研究,并采取股动脉血行血浆六-酮-前列腺素F1α(6-keto-PGF1α)浓度测定;RT-PCR法半定量测定血管和小肠标本中COXmRNA表达。结果IHPH、PHPH组均具有内脏血流量增加、内脏血管阻力降低等高血流动力学特征;IHPH、PHPH组血浆6-keto-PGF1α及胸主动脉、肠系膜上动脉和小肠COX-1mRNA的表达均显著高于SO组(P<0.05),且其浓度或表达情况均与内脏血流量(PVI)、内脏血管阻力(SVR)和门静脉压力(FPP)显著相关(P<0.05)。结论门静脉高压症时内脏、血管组织中COXmRNA表达和血浆6-keto-PGF1α浓度与内脏血流动力学变化显著相关。     

门静脉高压症血流动力学研究的意义

肝硬化门静脉高压症(PHT)时常伴有全身和内脏血流动力学异常，一般表现为病人全身血浆容量和心输出量增加，平均动脉压与周围血管总阻力下降，门静脉血流量(PVI)及门静脉压力(PVP)增加，侧支循环形成等，但每个病人可因病因和(或)病理生理的不同而有不同的血流动力学表现，特别是肝脏的血流动力学变化，因此其临床意义也极为重要。     

组织转谷氨酰胺酶特异性抑制剂预防肝纤维化的实验研究

Objective To observe the effects of cystamine, a tissue transglutaminase (tTG) inhibitor, on the development of rat liver fibrosis induced by carbon tetrachloride. Methods One hundred male SD rats were randomly divided into control group (n=20), hepatic fibrosis group (n=40) and cystamine group (n=40) . Liver fibrosis model was induced by intraperitoneal injection of carbon tetrachloride. Cystamine (112 mg·kg-1·d-1) was administered by intraperitoneal injection 2 days before injection of carbon tetrachloride. The rats were sacrificed at weeks 4 and 8, and the liver tissues and serum specimens were obtained. The mRNA expression of tTG, smooth muscle-alpha (α-SMA), collagen-Ⅰ and tissue inhibitors of metalloproteinase-1 (TIMP-1) were detected by real time PCR. The protein expression of tTG and α-SMA, liver function and content of hydroxyproline in liver tissues were determined by Western blot. Histological changes of the liver was observed under microscope. The fibrosis conditions of rat liver in each group were evaluated according to the semi-quantita-tive scoring system. All the data were analyzed by one-way ANOVA. Results Eight weeks after the injection of carbon tetrachloride, obvious injury of the liver in liver fibrosis group was observed. The levels of alanine trans-aminase (ALT), total bile acid, total bilirubin, hydroxyproline, tTG, α-SMA, collagen-Ⅰ and TIMP-1 were (1313±157)U/L, (99.9±18.5)μmol/L, (10.9±1.6)μmoL/L, (55±12)μg/g, 145.6±51.2, 130.3±44.6, 211.3±75.1 and 162.4±53.5. After administration of cystamine, the levels of ALT, total bile acid, total bilirubin, hydroxyproline, tTG, α-SMA, collagen-Ⅰ and TIMP-1 were (378±87) U/L, (61.0±12.7) μmol/L, (9.8±1.7) μmol/L, (70±14 ) μg/g, 48.6±12.3, 40.7±12.3, 63.9±16.0, 59.2μ23.4. Conclusion Cystamine can alleviate the carbon tetrachloride-induced rat liver fibrosis by inhibiting the tTG pathway.     

应用抑制消减杂交和cDNA表达谱芯片筛选肝星形细胞持续活化的相关基因

目的：利用抑制消减杂交（suppression subtractive hybridization,SSH）和cDNA表达谱芯片筛选早期活化的肝星状细胞与大鼠正常肝脏组织、轻度肝纤维化组织、重度肝纤维化组织中差异表达的基因.方法：从SSH构建的大鼠轻度和重度肝纤维化中两个差异cDNA文库中挑选1 000条上调显著的基因,与正常大鼠4 136条基因克隆制作成一张芯片,筛选持续期活化的肝星状细胞相关基因.结果：获得与HSC持续活化相关的上调基因633条,下调基因715条,其中血清和糖皮质激素调节蛋白激酶（SGK）在正常大鼠基因克隆和2、8周SSH上调差异基因中均呈上调信号.结论：联合应用SSH和cDNA表达谱芯片是筛选和鉴定不同样本中差异表达基因的快速、经济和有效方法;SGK可能作为多种细胞信号传导通路和细胞磷酸化级联反应的一个功能性交汇点,参与了肝星状细胞的早期活化和信号传导.     

门静脉高压症治疗的临床与基础研究现状

近年，肝移植在我国迅速发展，已逐渐成为治疗终末期肝病的常规手术。对肝硬化门静脉高压症（PHT）所致上消化道出血的手术方式的选择重新成为临床工作者关注的重点。行肝移植手术还是传统的PHT手术？在肝硬化PHT基础研究方面，过去主要是研究引起高动力循环的液递物质，而近5年来，人们更重视肝纤维化发展机制的研究，特别是在激活与抑制星状细胞的各种因子对肝纤维化形成过程的影响方面进行了较为深入的研究，试图延缓或逆转肝纤维化，从根本上治疗肝硬化PHT。本文复习国内外PHT临床与基础研究现状，并对一些PHT基础研究和临床诊治的热点问题进行探讨。