合并 HBV 感染的肝门部胆管癌的临床特点

目的探讨合并 HBV 感染肝门部胆管癌的临床特点和远期疗效.方法收集81例肝门胆管癌患者的临床资料,对手术方式、围手术期并发症和远期疗效采用不同的统计学方法进行分析.结果肝门部胆管癌患者血清 HBsAg(+)率为23.5%.HBsAg(+)与(-)组肝门部胆管癌患者性别、年龄、Bismuth 分型、病理、AJCC 肿瘤分期、总胆红素、γ-GT 差别均无统计学意义(均 P >0.05),术前血清白蛋白、白球蛋白比、凝血酶原时间及手术方式两组间差异有统计学意义(均 P<0.05).HBsAg(+)组围手术期并发症发生率显著高于 HBsAg(-)组(P<0.01).HBsAg(+)组肝门部胆管癌术后1、2、3年生存率分别为42.1%、15.8%、2.8%,与 HBsAg(-)组(54.8%、14.5%、1.6%)比较差异无统计学意义(P=0.966).术前总胆红素量、凝血酶原时间及 AJCC 肿瘤分期和手术方式均是影响肝门部胆管癌预后的独立危险因素(均 P<0.05),HBsAg(+)还不能认为是影响肝门部胆管癌预后的独立危险因素(均 P >0.05).结论 HBV 感染是肝门部胆管癌的致病因素之一,合并 HBV 感染可能不是影响肝门部胆管癌预后的独立因素.     

老年人Ⅲ、Ⅳ型肝门部胆管癌12例的手术治疗

目的探讨老年人Ⅲ、Ⅳ型肝门部胆管癌的有效手术治疗方法。方法回顾总结12例老年人Ⅲ、Ⅳ型肝门部胆管癌采用距肿瘤边缘长约1cm处切断肝内胆管并切除距肿瘤边缘1cm肝组织的手术方法。结果全组患者无围术期死亡及术后胆瘘、吻合口瘘等严重并发症发生,术后1年和2年生存率分别为66.7%、41.7%。结论距肿瘤边缘长约1cm处切断肝内胆管并切除距肿瘤边缘1cm的肝组织的方法是老年人Ⅲ、Ⅳ型肝门部胆管癌的有效方法。     

肝门部胆管癌TVM分期与治疗方式探讨

目的 探讨肝门部胆管癌的ＴＶＭ分期与治疗方式。方法 肝门部胆管癌３８例，依据肿瘤对胆管肝门部血管侵犯程度及转移情况，试行ＴＶＭ分期；根据ＴＶＭ分期进行了手术方式选择并对３种术式进行比较。结果 依ＴＶＭ分期将肝门部胆管癌分为Ⅰ、Ⅱ、Ⅲ、Ⅳ期，其中 期以根治性切除为首选，Ⅲ期依不同情况选择根治性或姑息性切除，Ⅳ期则以胆道转流为首选。结论 通过对肝门部胆管癌ＴＶＭ分期的探讨，能较好反映本病的病程与治疗方     

肝门部胆管癌TVM分期与治疗方式探讨

目的探讨肝门部胆管癌的ＴＶＭ分期与治疗方式。方法肝门部胆管癌３８例,依据肿瘤对胆管肝门部血管侵犯程度及转移情况,试行ＴＶＭ分期;根据ＴＶＭ分期进行手术方式选择并对３种术式进行比较。结果依ＴＶＭ分期将肝门部胆管癌分为Ⅰ、Ⅱ、Ⅲ、Ⅳ期,其中Ⅰ、Ⅱ期以根治性切除为首选,Ⅲ期依不同情况选择根治性或姑息性切除,Ⅳ期则以胆道转流为首选。结论通过对肝门部胆管癌ＴＶＭ分期的探讨,能较好反映本病的病程与治疗方式之间的关系     

肝门部胆管癌中Shh和Ptch的表达与肿瘤侵袭性及根治术后复发的关系

目的研究Hedgehog信号通路核心蛋白Sonic hedgehog(Shh)和Patched(Ptch)在肝门部胆管癌中的表达及与肿瘤侵袭性和根治性切除术后肿瘤复发的关系,探讨其相关分子机制。方法采用免疫组织化学技术检测44例肝门部胆管癌、7例胆管炎性病变组织中Shh和Ptch的表达,分析Shh、Ptch与肝门部胆管癌临床病理特征及根治术后复发的关系。应用Kaplan-Meier法对肿瘤根治术后至肿瘤复发时间跨度进行单因素分析,并经Log-rank检验;选择可能对肝门部胆管癌患者预后产生影响的临床病理指标进行量化,依次引入COX风险比例模型进行多因素回归分析。结果肝门部胆管癌Shh和Ptch阳性表达强度明显高于胆管炎性病变组织;Shh和Ptch表达与肝门部胆管癌侵袭性呈正相关;Shh和Ptch表达与肝门部胆管癌根治术后早期复发呈正相关;单因素生存分析显示Shh和Ptch高表达组肝门部胆管癌患者根治术后复发时间更短(P<0.01);多因素回归分析显示Shh和Ptch表达是影响肝门部胆管癌患者根治术后复发的独立因素。结论 Shh和Ptch表达与肝门部胆管癌根治术后短期复发有关,Shh和Ptch可以作为预测胆管癌根治术后复发的独立影响因子。     

局部晚期肝门部胆管癌根治术后放射治疗的作用

肝门部胆管癌或称高位胆管癌是指发生于左右肝管及其汇合部的恶性肿瘤,占肝外胆管癌(extrahepatic bile ductcancer,EHBDC)的58%～75%[1];左右肝管汇合部的恶性肿瘤又称为Klastin瘤.目前手术切除仍是其根治的惟一方法.由于其发病隐匿,确诊时多为晚期,以及肝门部特殊的解剖关系,肝门部胆管癌的手术切除率及切净率均较低[2].近年来,扩大根治术提高了这一肿瘤的切除率,但术后复发率较高,这主要与术后肿瘤残留有关.因此,根治术后残留灶应是提高其治疗效果的关键.本文通过对Ⅳ期肝门部胆管癌根治术后有镜下残留47例患者加与不加放疗两组结果的对比分析,阐述根治术后瘤床放疗的作用.     

肝门部胆管癌52例外科治疗体会

目的:探讨肝门部胆管癌的治疗方法。方法:回顾性分析我院1996￣2004年间52例肝门部胆管癌的临床病例资料。结果:手术切除组、手术引流组、介入支架组及剖腹探查组的平均生存时间分别为19.08、6.6、4.3、1.2个月。围手术期死亡2例。结论:肝门部胆管癌肿瘤切除术疗效明显优于其他治疗方式,对此病患者应积极争取行根治性切除术。对不能切除病例积极行引流术治疗,以延长生命、提高生存质量。     

肝门部胆管癌诊治现状

肝门部胆管癌又称高位胆管癌 ,是指位于胆囊管开口以上的胆管癌。 195 4年由Browns行第一例手术 ,Klatskin于 196 5年首次全面总结了该病的临床、病理特点 ,故又称Klatskin瘤。其占肝外胆管癌的 5 0 %～ 75 %。由于肝门的解剖特殊性 ,肝门部胆管癌临床表现有其特殊之处 ,诊断和治疗较为困难 ,预后差。但近年来对其诊断和治疗的研究有了较大的进展 ,现简述如下。1　临床分型及分期1.1　分型　目前 ,国际上通常采用的是Bismuth CorletteⅠ～Ⅳ分型法。Ⅰ型 :肿瘤位于肝总管分叉以下 ,占 16 .3%。Ⅱ型 :肿瘤位于肝管分叉部 ,占2 2 .4 %。Ⅲa…     

肝门部胆管癌围手术期的观察及护理

目的探讨肝门部胆管癌围手术期的护理经验。方法对106例肝门部胆管癌患者围手术期护理方法进行总结。结果出现并发症共33例(31.13%),死亡8例,其他均治愈出院。结论术前完善各项术前准备,做好心理护理以及引流管护理;术后做好管道护理、并发症的观察及预防是肝门部胆管癌围手术期护理的要点。     

肝门部胆管癌的MRI诊断价值

目的 探讨肝门部胆管癌的MPd诊断价值。方法 对经手术病理证实的肝门部胆管癌16例，采用NR平扫、NRCP及Gd-DTPA动态增强扫描，分析其MRI表现及诊断价值。结果 16例肝门部胆管癌均表现为肝内胆管不同程度扩张，呈软藤样改变；14例MRI肝门区可见稍长T1、稍长T2的肿块影，2例未发现明确肿块；15例MRCP检查显示肝门区胆管狭窄、中断或腔内充盈缺损；14例增强扫描中9例行动态增强扫描及5例行常规增强扫描（相当于延迟期扫描），10例可见肿块延迟期缓慢持续强化，4例表现为管壁增厚强化，管腔狭窄；6例淋巴结肿大转移中3例也表现为延迟期缓慢持续强化。结论 MR平扫及增强扫描可显示肝门部胆管癌的特征性改变，联合应用MRCP有助于肝门部胆管癌的定位、定性诊断。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Electro-Acupuncture Combined with the Trigger Point Needle-Embedding for Treatment of Primary Trigeminal Neuralgia in 31 Cases

In recent years, the author of this essay has applied electro-acupuncture combined with the trigger point needle-embedding for treatment of primary trigeminal neuralgia in 31 cases, yielding satis- factory results as reported in the following.     

Investigation of Matrix Metalloproteinase -1, 2 and tissue inhibitor of matrix metalloproteinases-1 in Endometriosis

Objective： To explore the role of matrix metalloproteinase-1,2 （MMP-1, MMP-2） and tissue inhibitor of matrix metalloproteinases-1 （TIMP-1） in endometriosis. Methods： The eutopic and ectopic endometria from 40 subjects suffering from endometriosis and regular.endometria from 40 subjects （excluding endometriosis） were collected and examined by in situ hybridization technology and western blot assay. Results： Both expressions of MMP-1 and -2 were stronger in ectopic endometrium and eutopic endometrium than in normal endometrium. On the contrary, the expression of TIMP-1 in ectopic endometrium and eutopic endometrium was lower. The differences were significant （P 〈 0.01 ）. Moreover, there was no relationship among the expressions of MMP-1, 2 and TIMP-1 in ectopic endometrium. Conclusion： The expressions of MMP-1, 2 and TIMP-1 lose balance and lack of periodic changes in ectopic endometrium , which explains the biological invasive behavior of endometriosis. It was suggested-that regulating the balance between the MMPs and TIMP-1 should be an ideal therapeutic target to endometriosis.     

Shi Da-zhuo (史大卓) —An outstanding cardiologist of integrative medicine

Prof. SHI Da-zhuo, Ph.D., male, was born on March 20, 1960. Prof. SHI entered the Ph.D. program in 1990 at the China Academy of Chinese Medical Sciences under the supervision of Prof. CHEN Ke-ji, majoring in the treatment of cardiovascular diseases. After receiving his Ph.D. degree in 1993, Prof. SHI started working at the Cardiovascular Center in Xiyuan Hospital affiliated to China Academy of Chinese Medical sciences.     

Persist in and Carry Forward the Integrative Medical Research——Speech at the 6th National General Congress of Chinese Association of Integrative Medicine by Academician CHEN Zhu,Minister of Ministry of Health

The 6th National General Congress of Chinese Association of Integrative Medicine （CALM） was convened at 19-20, April 2008 in Beijing. Academician CHEN Zhu, the minister of Ministry of Health indicated at the congress that the integration of Chinese and Western medicine is very well in keeping with the situation of our country and the general rule of development in medical science; and as a good integration of Chinese medicine and Western medicine, it is mutually beneficial and advantageous to both of them. Seeing the creativity shown in integrative medical investigation in theoretic and methodological sides, we should and must persist in and develop it.