运用腹腔镜技术根治性切除直肠恶性肿瘤的临床应用研究

目的探讨运用腹腔镜外科技术根治性切除直肠恶性肿瘤的可行性与临床意义。方法回顾性分析运用腹腔镜技术根治性切除57例直肠肿瘤的手术方式与临床资料,其中高位直肠癌8例,中位直肠癌19例,低位直肠癌21例,肛管癌9例。结果55例在全腹腔镜或其辅助下完成根治性切除术,2例中转开腹手术;手术时间平均(136±25)min,平均出血量(85±38)mL;术后无伤口感染、腹腔出血、吻合口漏、狭窄;术后病理组织学检查,肿瘤标本切除长度(26.35±13.26)cm,切除淋巴结数目(12.35±9.67)个;随访4￣36个月,2例术后14个月、18个月腹腔广泛转移死亡。结论运用腹腔镜外科技术根治性切除直肠癌具有创伤小、恢复快,且在理论和技术上是安全可行的,近期疗效可,值得推广。     

微创外科技术在胃肠外科中的应用及其局限性

微创外科（minimally invasive surgery，MIS）是近20年来高速发展起来的一门新兴学科。在这一进程中，发展最为迅猛、备受瞩目的当属微创外科在胃肠外科中的应用。     

FolFox-6化疗方案治疗结直肠癌疗效观察

目的探讨新辅助化疗FolFox-6方案治疗结直肠癌的疗效及其对术后并发症和预后的影响。方法筛选我院胃肠外科2005年10月-2008年10月结直肠癌合适病例60例,分为两组,治疗组（n=28）按FolFox-6方案术前化疗一次,14天后手术;术后再次按FolFox-6方案化疗,14天重复,共化疗4次。对照组（n=32）不做术前化疗,术后化疗与治疗组相同,采用WHO推荐的实体瘤近期疗效评价标准对治疗组行新辅助化疗后的疗效进行评估,采用WHO抗癌药物常见不良反应分级标准评价新辅助化疗后的不良反应,统计两组患者术后并发症,患者恢复情况,并对两组患者进行术后随访,评估预后情况。结果治疗组行新辅助化疗后有效率（RR）多在60％以上;新辅助化疗的不良反应均短暂且较轻;两组患者术后并发症发生率差异无统计学意义;治疗组局部复发率（13．04％）明显低于对照组（31．03％）;两组患者远期生存率分别为86．96％和82．76％,差异无统计学意义。结论新辅助化疗治疗结直肠癌可提高化疗疗效和降低局部复发率,但对远期生存获益的效果还有待进一步观察。     

微小RNA-100在胃癌患者血浆中的表达及临床意义

目的观察微小RNA-100(miR-100)在胃癌患者血浆中的表达情况,探讨其与临床病理特征之间的关系及临床意义。方法采用实时定量聚合酶链反应检测30例胃癌患者及30例正常成年人血浆中miR-100的表达情况,分析其与临床病理参数之间的相关性。结果胃癌患者血浆中的miR-100表达水平显著高于正常成年人(P<0.05);血浆miR-100表达水平与肿瘤分化程度有关(P<0.05),而与淋巴结转移、分期、性别、年龄无明显相关(P>0.05)。结论血浆miR-100作为新的生物学指标对于胃癌的诊断具有一定的价值。     

分泌型PTD4-Apoptin融合蛋白诱导HepG2细胞凋亡

目的研究分泌型的含蛋白质转导结构域的凋亡素(PTD4-Apoptin)融合基因经人脐静脉血管内皮细胞(HUVEC)表达和分泌后,对人肝癌HepG2细胞凋亡的影响,探讨其用于肝癌治疗的可能性。方法构建PTD4-Apop-tin融合基因的pSecTag2分泌型真核表达载体,并采用脂质体介导将其转染入HUVEC细胞,Western blot检测PTD4-Apoptin融合蛋白的表达及分泌,转染48h后收集培养上清作为条件培养液,用于HepG2、L02细胞培养,共培养24h后,采用Western blot检测细胞内和核内Apoptin的含量,流式细胞术检测细胞凋亡。结果瞬时转染pSecTag2-PTD4-Apoptin的HUVEC细胞可表达及分泌PTD4-Apoptin融合蛋白,其培养上清中的PTD4-Apoptin融合蛋白可有效进入HepG2和L02细胞,并可在HepG2细胞核内聚积,显著诱导HepG2细胞凋亡达47.4%(P<0.001),而对L02细胞无此效应。结论 HUVEC细胞表达分泌的PTD4-Apoptin融合蛋白可显著诱导邻近HepG2细胞凋亡,而对L02正常肝细胞无损伤。     

奥曲肽联合NSAIDs对结肠癌细胞生长的影响及作用机制

目的研究奥曲肽与非甾体类抗炎药物(NSAIDs)塞来昔布联合用药对人结肠癌细胞生长的影响及作用机制。方法 CCK-8法测定塞来昔布、奥曲肽单用及两者联合应用对人结肠癌细胞SW480增殖的影响;流式细胞技术检测细胞周期变化及细胞凋亡率的变化;Western blot检测未折叠蛋白反应(UPR)的标志分子BiP蛋白的表达。结果奥曲肽与塞来昔布联合应用与各自单用相比,细胞增殖减少,凋亡增加(P<0.05),各细胞时相的比例G2M期无明显变化(P>0.05),G0G1期增加(P<0.05),S期减少(P<0.05)。0、20、40、60、80μmol/L塞来昔布作用后细胞BiP表达量逐渐增加,80μmol/L塞来昔布与0、0.25、0.5、1、2mg/L奥曲肽作用后细胞BiP的表达量均减少。结论奥曲肽与塞来昔布联合应用能增强塞来昔布的抗肿瘤作用,其作用机制与奥曲肽抑制塞来昔布引起的UPR相关。     

Expressions of connexin and par-3 in the distal margin of rectal cancer after ultra-low anterior resection

This study examined the expression of connexin and protease-activated receptor 3 （par-3） in the distal resection margin of rectal cancer and the correlation of the expression of the two proteins with tumor relapse. A total of 40 patients with rectal cancer underwent ultra-low anterior resection with curved cutter stapler. The pathological specimens were divided into 3 groups in terms of sampling sites： tumor group, 2.0-cm group （in which the tissues were harvested 2.0 cm distal to the tumor tissues）, 3.0-cm group （in which the tissues were taken 3.0 cm away from the tumor tissues）. All the samples were pathologically observed and then measured for the expression of connexin and par-3 by employing immunohistochemistry and Western blotting. The operations in this series went uneventfully. No anastomotic stoma bleeding, stenosis and death occurred postoperatively. Histopathologically, in the tumor group, epithelial cells lost normal pattern of arrangement and polarity, and were loosely connected and even detached. In the 3.0-cm group, the epithelia had normal appearance, obvious cell polarity and essentially intact cell junction. Immunohistochemistry and Western blotting indicated that the 3.0-cm group had the strongest expression of connexin and par-3, and the expression in the 2.0-cm group and the tumor group was relatively weak. There existed significant difference in the expression of the two proteins among the three groups （P〈0.05 for all）. It was concluded that the down-regulated connexin and par-3 in the distal margin of rectal cancer tissues may indicate the progression of the disease and high likelihood of recurrence and metastasis. Although no tumor cells were found in the sections of the 2.0cm group, the decreased expression of connexin and par-3 may suggest the development of anaplasia and the increased odds of tumor relapse. Therefore, we are led to speculate that tumor resection only including 2.0 cm of unaffected rectum could not completely avoid the distant metastasis and local relapse.     

乳腺癌术后患者吡柔比星静滴时间与静脉炎的关系研究

目的探讨乳腺癌术后患者吡柔比星静脉滴注时间与静脉炎发生之间的关系。方法选择乳腺癌术后行TAC化疗方案的患者200例次,按入院顺序分为试验组与对照组,每组100例。试验组吡柔比星静滴时间为（110±10）min,对照组吡柔比星静滴时间为（150±15）min。结果试验组静脉炎的发生率明显低于对照组（P〈0.001）。结论吡柔比星静滴时间控制在（110±10）min可明显减少静脉炎的发生。     

腹腔镜辅助下全结直肠切除术治疗结直肠多发性疾病

目的:探讨腹腔镜辅助下全结直肠切除术治疗结直肠多发疾病的可行性与安全性。方法:回顾性分析11例在腹腔镜辅助下进行的全结肠切除术患者的临床资料,其中家族性腺瘤性息肉病(FAP)2例,息肉癌变2例,结直肠多发癌3例,慢性溃疡性结直肠炎2例,慢性顽固性便秘2例。结果:11例腹腔镜辅助下全结肠切除术均成功,手术时间约(348±47)m in,术中出血量约(187±68)m l,术后胃肠功能恢复时间(65±18)h,辅助切口3~5 cm,术后无腹腔出血、感染、吻合口瘘等并发症;随访6~24月,大便5~12次/d;无肿瘤复发、转移。结论:在熟练掌握腹腔镜操作技术和开腹大肠切除技巧的前提下,完成腹腔镜辅助下全结直肠切除术是安全可行的。     

Preoperative Neutrophil Lymphocyte Ratio and Platelet Lymphocyte Ratio Cannot Predict Lymph Node Metastasis and Prognosis in Patients with Early Gastric Cancer: a Single Institution Investigation in China

In the present study, we aimed at exploring the applied value of preoperative neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR) in the prediction of lymph node metastasis (LNM) and prognosis in patients with early gastric cancer (EGC). We retrospectively analyzed a total of248 consecutive patients who underwent curative gastrectomy to be identified T1 stage gastric adenocarcinoma between January 1, 2010 and May 1, 2016 in a single institution. According to median preoperative NLR and PLR value, we divided the patients into four groups: high NLR >1.73 and low NLR <1.73, high PLR >117.78 and low PLR <117.78. Furthermore, to evaluate the relationship between preoperative NLR and PLR values, we categorized patients according to cutoff preoperative NLR-PLR score of 2 [high NLR (>1.73) and high PLR (>117.78)], 1 [either high NLR or high PLR], and 0 [neither high NLR nor high PLR], Statistical analyses were conducted using SPSS 20.0 software. The results showed that the preoperative NLR or PLR values, lower or higher, could not predict the LNM in patients with EGC (both P=0.544>0.05). The invasive depth of tumor was significantly correlated with LNM of EGC (P0.001). Kaplan-Meier plots illustrated that preoperative NLR and PLR values were not associated with overall survival (OS) in patients with EGC. It was concluded that the preoperative NLR and PLR may be the predictors for LNM and prognosis in patients with advanced gastric cancer; nevertheless, they cannot predict LNM and prognosis in patients with EGC.