低能量电凝处理多发胸膜下肺大疱在自发性气胸术中的应用

目的 探讨在自发性气胸手术治疗过程中以低能量电凝处理多发胸膜下肺大疱的可行性、疗效及其技术要点.方法 2004年3月～2010年8月,共计77例次自发性气胸患者在术中接受多发胸膜下肺大疱的低能量电凝处理,回顾性分析所有患者的临床资料.所有患者因自发性气胸接受电视辅助胸腔镜手术(VATS)患侧胸腔探查,术中肺尖部明显的成簇状分布的薄壁肺大疱予以楔形切除,而分布于其余肺组织表面的多发的胸膜下肺大疱则以10～15kJ的低能量电凝烧灼凝固处理;烧灼程度以整个肺大疱萎陷,肺大疱表面及周围约0.5～1.0 cm范围内的脏层胸膜及肺组织皱缩凝固变白而又不伴有脏层胸膜破损为最佳.术后待肺组织无漏气、复张良好,脏壁层胸膜完全贴合48 h后拔除胸腔引流管.结果 该组患者平均住院时间11.2 d;平均手术时间为121.8min;术中平均出血量40mL;术后平均闭式引流时间5.9 d;以漏气时间大于1周作为持续漏气标准,术后无患者出现持续漏气;全组患者未出现其他明显围手术期并发症;所有患者随访至2010年10月,平均随访时间26个月;除3例患者因出现对侧自发性气胸而再次于该科行胸腔镜手术治疗,余患者无复发.结论 如能充分掌握术中技术及术后康复要点,在自发性气胸术中以低能量电凝处理多发散在胸膜下肺大疱,方法简便、可靠,疗效满意.     

肺癌相关基因SLC35F2 RNA干扰重组慢病毒载体的构建和鉴定

目的 针对肺癌相关基因SLC35F2构建RNA干扰(RNAi)重组慢病毒质粒并进行慢病毒包装,建立SLC35F2表达稳定抑制的H1299肺癌细胞株,并探讨SLC35F2基因的功能.方法 应用pGCSIL-PUR慢病毒载体构建针对SLC35F2的ShRNA载体,转染包装293T细胞,收集病毒上清转染肺癌细胞株H1299,经嘌呤霉素(puromycin)筛选并扩大培养得到稳定克隆;实时荧光定量聚合酶链反应(Real-time PCR)和Western blot检测癌细胞内SLC35F2的表达;CCK-8比色法检测细胞增殖;Annexin V-FITC/PI双染法检测细胞凋亡.结果 成功构建SLC35F2-ShRNA慢病毒载体(SLC-siRNA)及SLC35F2表达稳定抑制的肺癌细胞株,经过检测证实SLC-siRNA慢病毒载体对SLC35F2的抑制效率达81.8%;CCK-8检测显示SLC-siRNA稳定转染的H1299细胞株生长抑制率达16.3%,稳定转染株凋亡细胞百分比较阴性对照组明显升高(14.88%比3.16%,P＜0.05).结论 慢病毒载体介导的靶向SLC35F2的RNAi可有效抑制SLC35F2表达,降低肺癌细胞的增殖能力,增加其凋亡比例.

Abstract：

Objective To investigate the possibility of SLC35F2 inhibition by lentiviral vector-mediated RNA interference (RNAi) and the influence on cell proliferation and apoptosis in lung cancer cell line,and to set up a lung cancer cell line in which SLC35F2 is stably suppressed.Methods The lentiviral vector of siRNA targeted against SLC35F2 (SLC-siRNA) was constructed and transfected into the packaging cells 293T,and the viral supernatant was collected to transfect H1299 cells.After selection by puromycin and culture expansion,the stable cell clones were attained.Quantitative real-time fluorescent polymerase chain reaction (PCR) and Western blotting were used to detect the expression of SLC35F2.The effect of SLC35F2 silencing by RNAi on cell proliferation was quantified by CCK-8 assay.Annexin V-FITC/PI staining was employed to examine the apoptosis.Results Lentiviral vector SLC35F2-shRNA was constructed successfully.As compared with control group,the SLC35F2 expression was decreased to 81.8% in RNA and protein levels.CCK-8 revealed that the inhibition rate of H1299 cells transfected with SLC35F2 was 16.3%,and the apoptosis rate was significantly increased as compared with negative control group ( 14.88% vs 3.16% ,P ＜0.05 ).Conclusion Lentiviral vector-mediated RNA interference targeting against SLC35F2 can effectively inhibit SLC35F2 expression and cell proliferation.The lung cell line in which SLC35F2 gene was stably suppressed was successfully established.     

胺碘酮控制预激综合征儿童的持续快速心律失常

儿童预激综合征常伴有快速室上性心律失常。这些心律失常历时短暂,通常对惯用药物反应良好,但有些病例应用惯用药物治疗无效,心律失常持续发作,可伴随心血管损害,甚至循环衰竭。晚近发现成人预激综合征伴反复心律失常时采用胺碘酮能取得良好效果,但儿童病例报道不多。本文报道用胺碘酮治疗预激综合征儿童的持续室上性心律失常。方法:10例预激综合征儿童,胺碘酮开始治疗时的年龄为3个月～15岁(平均8岁10个月),6例女性,4例男性,3例伴有先天性心脏畸形。所有病     

食管及食管胃多原发性恶性肿瘤11例报告

多原发性恶性肿瘤 (ｍｕｌｔｉｐｌｅｐｒｉｍａｒｙｃａｎｃｉｎｏｍａ ,ＭＰＣ)是指在同一患者同时或先后发生两种以上互不相连的原发性恶性肿瘤。 1984年 8月～ 1998年 12月 ,我院诊治食管及食管胃ＭＰＣ 11例。报告如下。1　资料与方法1.1　临床资料　男 9例 ,女 2例 ;年龄 3 4～ 70岁 ,平均 5 2岁。11例均经手术、病理证实 ,其中食管ＭＰＣ 4例 ,食管贲门ＭＰＣ3例 ,食管胃ＰＭＣ 4例。 5例术前确诊 ,4例术中发现 ,2例病理诊断。1.2　手术方式　经左胸食管部分切除 ,胃代食管 ,弓上吻合3例。经右胸三切口 ,胃代食管 4例。经左胸食管部…     

胸腔镜胸腺扩大切除术治疗重症肌无力的疗效观察及影响因素分析

目的对胸腔镜胸腺扩大切除术治疗重症肌无力(myasthenia gravis,MG)的疗效进行总结,分析影响MG手术疗效的因素。方法回顾性研究我院2000年6月～2009年10月47例MG接受胸腔镜手术的临床资料,采用单因素分析和logistic回归模型对患者性别、年龄、病程、MGFA分型、胸腺病理类型等可能影响因素进行分析。结果 45例完成随访,随访16～111个月,平均51个月。根据MGFA提出的治疗后状况分类:完全稳定缓解占64.4%(29/45),药物缓解占17.8%(8/45),微小症状表现占8.9%(4/45),恶化占2.2%(1/45),复发占4.4%(2/45),死亡占2.2%(1/45)。年龄(β=0.059,P=0.027,OR=1.060,95%CI为1.007～1.117)和胸腺病理类型(β=1.558,P=0.025,OR=4.750,95%CI为1.214～18.584)是影响手术疗效的因素。结论 MG行电视胸腔镜下胸腺扩大切除术疗效满意,年龄和胸腺病理类型是手术疗效的影响因素。     

肺癌相关基因LSCC-3对肺癌细胞形态特征和生物学活性的作用

目的 观察肺癌相关基因LSCC-3的表达对肺腺癌细胞PAa形态学特征及生物学活性的作用.方法 构建含有LSCC-3基因全长开放阅读框架(ORF)片段之真核表达载体并转染肺癌PAa细胞;显微镜及倒置荧光显微镜下观察LSCC-3基因的表达及其对于肺癌PAa细胞的形态学特征的影响;采用四甲基氮唑盐(MTT)比色法研究LSCC-3基因的转染对于肺癌PAa细胞生物学活性的作用.结果 以pLPS-LSCC-3-3'EGFP真核表达载体成功转染肺癌PAa细胞,显微镜下观察显示细胞质内有大量LSCC-3基因表达的肺癌PAa细胞出现了细胞脱水、核膜皱缩,核小体形成乃至细胞结构破坏等典型的细胞凋亡、破坏迹象.转染LSCC-3基因后第1～5d肺癌PAa细胞的增殖活性(以A490值表示)较对照组细胞受到明显抑制,始终维持在较低水平(0.1157、0.1257、0.1297、0.134、0.145 Vs.0.1165、0.1300、0.1677、0.1935、0.2058);而细胞凋亡率则明显增加,尤其是转染后前3d,实验组细胞的凋亡率几乎呈线性增长,与对照组细胞间差异有统计学意义(0、12.1%、33.2%、37.8%、38.7% Vs 0、9.1%、13.7%、10.3%、13.1%;P<0.01). 结论 LSCC-3基因的表达在体外可以明显地促进肺癌细胞的凋亡,从而抑制肺癌细胞的增殖,其或许可被应用于肺癌的基因或生物治疗.     

胸膜下胸壁肿瘤的胸腔镜诊断和治疗

胸膜面的胸壁肿瘤,临床少见.2003年9月至2008年6月,我们完成18例胸膜下胸壁肿瘤的胸腔镜诊断和治疗,疗效满意,现总结报道如下.     

肺癌相关基因LSCC-3真核表达载体的构建及其表达

目的构建含有肺癌相关基因LSCC-3全长ORF片段的真核表达载体,并验证其在细胞内的表达。方法PCR方法获取LSCC-3基因全长ORF片段,构建含有上述片段的真核表达载体（含3’端绿色荧光蛋白尾）并验证、纯化;将该真核表达载体转染人肺腺癌PAa细胞系,在倒置荧光显微镜下对LSCC-3基因的表达进行观察和验证。结果成功将LSCC-3基因全长ORF片段装入真核表达载体pLPS-3’EGFP（pLPS-LSCC-3-3’EGFP）并转染人肺腺癌PAa细胞系,在倒置荧光显微镜下观察到了核外细胞浆内LSCC-3基因蛋白表达产物的存在。结论成功构建了LSCC-3真核表达载体pLPS-LSCC-3-3’EGFP,该载体可在肺癌细胞胞浆内顺利表达。     

胰十二指肠切除术后住院时间影响因素分析-回顾性研究

Background. Postoperative hospital stay after pancreaticoduodenectomy (PD) was relatively longer than other gastrointestinal operations, The aim of current study was to investigate the risk factors of postoperative hospital stay after PD. Methods. Patients who were performed PD in Cancer Hospital Chinese Academy of Medical Sciences (CHCAMS) between December 2008 and November 2012 were selected for the retrospective study. The clinical and pathological data was collected and analyzed. The primary outcome was postoperative hospital stay. Normal discharge or recovery was defined as postoperative hospital stay no more than 10 days, otherwise it was defined as delayed discharge or recovery (including hospital death). Results. Finally, 152 patients were enrolled in present study. Postoperative hospital stay was 19.7±7.7 (7-57 d). 67 of 152 patients were normal discharge, and 85 of 152 patients were delayed discharge. The overall morbidity of complications was 62.5% (95/152), and the mortality rate was 3.29% (5/152). Multiple factors analysis showed that complication morbidity (adjusted OR=10.40, 95%CI=3.58-30.22), age (adjusted OR=4.09, 95%CI=1.16-14.39), BMI (body mass index) (adjusted OR=4.40, 95%CI=1.19-16.23), surgical procedure (adjusted OR=26.14, 95%CI=4.94-153.19), blood transfusion (adjusted OR=7.68, 95%CI=2.09-28.27) and fluid input (adjusted OR=3.47, 95%CI=1.24-11.57) were significantly associated with delayed discharge. Conclusions. Postoperative complications affects the postoperative hospital discharge. Furthermore, age, BMI, transfused red blood, surgical procedure and input might prolong LOS (length of hospital stay). Studies with more patients were needed in future.