术前局部注射

目的探讨术前应用免疫导向技术治疗胃癌的临床效果。方法以应用131I-3H11对16例胃癌病人术前行内镜下癌灶多点注射作为治疗组;选择6例胃癌病人采用FAM方案化疗作为对照组。并对术后标本进行观察。结果术后病理检查治疗组发现75.0%(12/16)出现癌细胞核固缩、碎裂、细胞浆凝固、细胞间质出现炎性细胞浸润;这些变化多以中度为主,重度及无变化较少;而对照组无明显变化。结论作为胃癌的综合治疗方法,术前胃癌局部注射     

胃癌术前选择性动脉导向化疗对组织和细胞结构的影响

目的 探讨应用免疫导向技术术前治疗胃癌的临床效果。方法 应用ADM-3H11对20例胃癌病人术前行选择性动脉导向化疗。选择6例胃癌病人局部灌注阿霉素(ADM)作为对照组，并对术后标本进行观察。结果 术后病理检查发现，在导向治疗组中有60．0％(12/20)病例出现癌细胞核固缩、碎裂、细胞浆凝固、细胞间质出现炎细胞浸润，这些变化以中度为主，重度及轻度变化较少。而对照组肿瘤细胞变化不明显。结论 作为胃癌的综合治疗方法，术前选择性动脉灌注ADM—3H11具有临床应用前景。     

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目的 研究^131I-3H11对裸鼠的胃癌腹膜亚临床种植灶形成的抑制作用。方法 裸鼠腹腔内接种胃癌细胞后分组，按不同时间分别腹腔内给予^131I-3H11,5-FU、顺铂、阿霉素、^131I-NMIgG和生理盐水。结果 RIT（导向治疗）组动物生存期延长，腹膜种植瘤的发生率低于非RIT组。结论 ^131I-3H11可有效地杀伤胃癌亚临床腹腔内病灶，起到了防治裸鼠胃癌腹膜种植瘤发生的作用，在临床应用时，术后24h开始腹腔局部应用较合理。     

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目的：比较肠外营养与肠内营养对胃癌病人术后细胞免疫功能的影响。方法：45例胃癌病人随机分为2组，其中肠外营养（PN）组23例，肠内营养9EN）组22例。术后第1天开始行肠外或肠内营养支持，时间1周，检测术前和术后第8天外周血T淋巴细胞亚群（CD3^ 、CD4^ 、CD8^ ）和NK细胞活性等细胞免疫指标。结果：PN组术后CD3^ 、CD4^ 水平和NK细胞活性明显下降，CD8^ 水平明显升高；而EN组术后CD3^ 、CD4^ 、CD8^ 水平和NK细胞活性与术前相比无显著性变化。结论：肠外营养对胃癌病人术后细胞免疫功能无明显改善作用，而肠内营养有明显的细胞免疫增强作用，可有效地纠正胃癌病人术后细胞免疫抑制状态。     

甲亢^131Ⅰ治疗前后骨密度测定的临床分析

目的 探讨甲亢患者^131Ⅰ治疗前及治疗后临床缓解持续时间的长短及其骨密度的变化情况。方法 70例甲亢患者于^131Ⅰ治疗前和其中37例于^131Ⅰ治疗后临床缓解小于6个月、9-12个月和大于18个月，分别用双能X线骨密度仪(DEXA)进行骨密度(BMD)测定，并分别与年龄匹配正常健康者95例进行对照分析。结果 (1)甲亢^131Ⅰ治疗前和治疗后临床缓解小于6个月、9-12个月的L2-4 BMD均明确低于正常对照组，差异有非常显著性，股骨上段各区(股骨颈、Ward’s区、大转子区)虽低于正常对照组，但差异无明显性；(2)^131Ⅰ治疗后临床缓解大于18个月的L2-4及股骨上段各区的BMD改善至接近正常人的水平，差异无显著性；(3)^131Ⅰ治疗后临床甲低组L2-4及股骨上段各区(尤其Ward’s区)的BMD均明显低于正常对照组，差异有非常显著性。结论 甲亢经^131Ⅰ治疗后临床缓解6-12个月骨矿含量改善不明显，至18个月逐渐增加接近正常对照组水平；^131Ⅰ治疗后临床甲低持续时间大于6个月者，同样会导致骨矿含量的降低。     

等容血液稀释自体输血对肿瘤病人围术期T淋巴细胞亚群、NK细胞影响的比较

目的：探讨异体输血和等容血液稀释自体输血对围术期T淋巴细胞亚群,NK细胞的变化。方法：选择直肠癌,结肠癌格或胃癌根治术病人30例,随机均分为2组。H组术中输异体全血400ml;A组于手术切皮前放血400ml,同时输入等量羟乙基淀粉。术中自体血回输给病人。分别于术前,输血前,术后第1d,第5d抽取静脉血,用流林细胞仪测定T细胞亚群和NK细胞的数量。结果：两组术后第1dCD3^ ,CD4^ ,CD4^ /CD8^ ,NK细胞较术前显著减少（P＜0．05或0．01）,异体输血组较自体输血组减少更明显（P＜0．05）。术后第5d异体输血组CD3^ ,CD4^ ,CD4^ /CD8^ ,NK细胞仍较术前显著减少,自体输血组基本恢复正常。结论：围术期输异体血严重抑制病人免疫,因液稀释自体输血免疫抑制轻微,且术后免疫功能很快恢复。     

免疫调节剂在外科感染及大手术中的作用机制探讨

目的 了解免疫调节剂胸腺肽α-1在外科感染及大手术中的作用机制。方法 分别选择60例外科感染病人和60例胰腺癌根治手术病人，分用药组和对照组。用药组病人在手术后使用胸腺肽α-1，对照组不使用免疫制剂。观察临床疗效、内毒素和细胞因子(IL-2、IL-6、IL-10和TNF-α)、T淋巴细胞亚群CD3^ 、CD4^ 、CD8^ 和NK细胞百分率的变化。结果 外科感染及胰腺癌病人无论用药组和对照组术后内毒素、IL-6和TNF-α均呈下降趋势，IL-2和IL-10呈上升趋势，但用药组大部指标在术后4d即达显著差异，术后7d变化趋势更为明显。外科感染及胰腺癌病人用药组术后CD4^ ／CD8^ 比值和CD4^ 百分率上升；同类病人术后用药组和对照组比较CD3^ 、CD4^ 百分率和CD4^ ／CD8^ 比值较高。用药组临床疗效略高于对照组。结论 胸腺肽α-1在外科感染及重大手术中可提高免疫功能，有利于病人恢复。     

胃癌患者围手术期CD4+CD25+调节性 T细胞的变化及其意义

目的:探讨胃癌患者围手术期CD4+CD25+调节性 T细胞的变化及其意义。方法:应用流式细胞仪检测52例胃癌患者（胃癌组）术前、术后7 d，术后1个月CD4+CD25+T细胞水平，并以24名健康者作为对照（对照组）。结果:胃癌组外周血CD4+CD25+ T细胞较对照组明显升高;胃癌组经根治或姑息术切除肿瘤1个月后，外周血CD4+CD25+ T细胞水平较术前及术后1周明显下降，而术后1周与术前比较无统计学差异。结论:胃癌组患者外周血CD4+CD25+ T细胞水平明显升高可能是机体免疫功能受抑制的重要机制。该指标可能成为胃癌免疫状态临床监测的指标。     

高龄胃癌病人的临床特点及外科处理

目的探讨高龄胃癌病人的临床特点,提高外科治疗水平。方法回顾性分析我院2001年10月至2003年10月间416例胃癌病人行标准胃癌根治术的临床资料。结果102例≥70岁胃癌病人中术前75例（73．5％）有并存病,术后并发症发生率27．5％,术后病死率5．9％;314例〈70岁胃癌病人术前53例（16．9％）有并存病,术后并发症发生率11．5％,术后病死率1．6％,两组比较差异有统计学意义（P〈0．05）;术前无并存病在≥70岁组与〈70岁组术后并发症发生率分别为11．1％和8．8％,病死率分别为0和0．03％,两组间的差异无统计学意义（P〉0．05）。结论高龄胃癌病人常合并心脏病、肺部疾病、糖尿病等疾病。加强围手术期处理仍可使高龄病人耐受标准胃癌根治术,降低病死率和并发症的发生率。     

CEA RT-PCR检测胃癌腹腔灌洗液游离癌细胞临床价值的初步观察

目的：初步观察癌胚抗原(CEA)逆转录．聚合酶链反应(RT-PCR)检测胃癌腹腔洗液中游离癌细胞的临床价值。方法：收集36例进展期胃癌和6例慢性胆囊结石病人腹腔灌洗液100ml，其中50ml行CEA RT-PCR，扩增CEA特异性片断；50ml行细胞学检查。胃癌细胞株MKN-45为阳性对照。结果：36例胃癌病人腹腔灌洗液中14例于131 bp处见CEA的特异性条带，阳性率为38．9％(14／36)；6例慢性胆囊结石病人腹腔灌洗液RT-PCR结果均为阴性；MKN-45在131bp处发现CEA的特异性条带。细胞病理学检查，36例胃癌病人中有6例腹腔灌洗液中发现有肿瘤细胞或核异形细胞，阳性率为16．6％(6／36)，且此6例RT-PCR结果均为阳性；8例RT-PCR结果阳性病人的细胞学检查为阴性。CEA RT-PCR的阳性率与肿瘤胃壁浸润深度、淋巴结转移数和胃癌分化程度明显相关。随访至今，36例进展期胃癌病人中CEA RT-PCR检查阴性的病人尚无一例腹腔内肿瘤复发，1例细胞学检查阴性而CEA RT-PCR阳性的病人术后4个月时出现腹腔内肿瘤复发。结论：腹腔灌洗液中胃癌细胞CEA mRNA的RT-PCR检测法敏感性较高．初步临床观察及随访显示该法有望作为诊断腹腔内游离癌细胞的有效辅助手段。     

131I-3H11经不同途径给药的药代动力学比较研究

目的 研究^131I-3H11不同给药途径的药代动力学。方法 将家兔分为3组。即耳静脉、门静脉和腹腔注射组,按4.44MBq/kg体重注射^131I-3H11,给药后固定时刻原则取下静脉血、门静脉血及腹腔液并检测其放射性药物的含量。结果 （1）耳静脉给药后,门静脉与外周静脉血内药物浓度没有明显差别;（2）门静脉给药30min后,门殂脉与外周血静脉血没有明显差别;（3）腹腔给药后,腹腔液中的药物浓度始终保持最高,其峰值浓度分别是外周静脉和门静脉血的37.2倍和5.4倍;门静脉血药物浓度次之,峰值浓度是外周静脉血的6.9倍,至24h仍达1.8倍。结论 ^131I-3H11腹腔给药具有高选择性区域导向治疗的药代动力学特点,腹腔液中高浓度的导向药物主要经门静脉吸收进入肝脏,保持了腹腔、门静脉和肝脏内持久恒定高浓度的导向治疗药物,有利于预防和治疗胃肠癌术后腹腔内复发和肝转移。     

99Tc-MDP联合钙剂、活性维生素D3治疗甲亢继发骨质疏松症的疗效评价

目的 评价99Tc-MDP治疗甲亢继发骨质疏松症的疗效。方法 将89例甲亢继发骨质疏松患者按治疗方法分为联合治疗组（A组 42例）和对照组（B组 47例）,两组均采用131I治疗甲亢,联合治疗组采用常规口服钙剂加活性维生素D3治疗,同时加用99Tc-MDP注射治疗,10d为1个疗程,连续3个疗程,每疗程之间间隔3~4w; 对照组常规口服钙剂加维生素D3治疗。分别观察 2 组治疗前及治疗后 3、6、12 个月骨密度( BMD) 、血清骨钙素( BGP) 、骨碱性磷酸酶( B-ALP) 以及甲状腺功能各项指标( FT3、FT4、TSH) 的变化。结果 （1）131I治疗6个月后联合治疗组BGP、B-ALP开始下降,治疗前后比较差异有统计学意义（P＜0.05）;（2）联合治疗组BMD值在治疗后 12 个月较治疗前增加,与对照组比较差异有统计学意义( P＜0. 05);(3)治疗3、6、12个月后两组间甲状腺功能指标变化无差异（P>0.05）;（4）联合治疗组与对照组总有效率分别为92.8%,76.6%,联合治疗组优于对照组,差异有统计学意义（P<0.05）。结论 99Tc-MDP与钙剂及活性维生素D3联用,对甲亢继发骨质疏松症有较好疗效,具有一定临床推广价值。     

The efficacy of recombinant interleukin 2 in local treatment of superficial bladder tumors

The present study was undertaken to assess the efficacy of recombinant Interleukin 2 (rIL-2: S-6820) in treatment of superficial bladder tumors. Three intratumor injections at a dose of 5 x 10(5) units/day via urethra, were performed every other day under endoscopic control in 12 patients with superficial bladder cancer. On the 15th day after completion of the series of injections, the tumor had disappeared in one patient and 50% regression over was observed in two other patients. Therefore, the response rate to the rIL-2 treatment in our study was 25.0%. Each tumor which responded to the therapy, was single, small and low grade. In the peripheral blood of the 12 patients, an increase in IL-2 receptor-positive lymphocytes and augmentation of natural killer activity were detected after the rIL-2 intratumor injection. There were no serious side effects except for moderate fever in our study.     

局部注射化疗药物和/或无水乙醇治疗原发性肝癌245例临床分析

目的　探讨原发性肝癌有效的非手术替代疗法。方法　对 192例因各种原因不能进行手术治疗的原发性肝癌 (PHC)患者给予化疗药物配合无水乙醇癌灶内局部注射 ,对 5 3例PHC患者采用癌灶内单纯无水乙醇注射的方法进行治疗。根据治疗前后肿瘤的消长、血AFP水平的变化以及存活期的长短等评估疗效。结果　经治疗后大部分患者出现癌灶缩小和 或减少 ,血AFP水平下降 ,生活质量和存活期明显改善。化疗药物配合无水乙醇局部注射的治疗效果显著优于单纯无水乙醇注射者。结论　无水乙醇配合化疗药物局部注射是原发性肝癌合理有效的非手术治疗方法     

原发性肝癌患者瘤内注射无水酒精及丝裂霉素后细胞免疫的动态变化

本文以自然杀伤细胞（ＮＫＣ）、白细胞介素－Ⅱ（ＩＬ－２）为观察指标，研究了１５例原发性癌（ＰＨＣＣ）患者行肝动脉结扎加肝癌瘤内注射无水酒精及丝裂霉素悬液后细胞免疫功能的动态变化，以肝癌切除术患者（ｎ＝１５）为对照。结果表明瘤内注射药物后１周，ＮＫＣ、ＩＬ－２活性继续下降，术后３周起恢复至术前水平，术后５周超过术前接近正常水平，和对照组变化一致，提示采用该法和手术切除一样可改善患者的细胞免疫功能。     

甲亢131I治疗前后骨密度测定的临床分析

目的 探讨甲亢患者131I治疗前及治疗后临床缓解持续时间的长短及其骨密度的变化情况。方法 70例甲亢患者于131I治疗前和其中37例于131I治疗后临床缓解小于6个月、9-12个月和大于18个月,分别用双能X线骨密度仪(DEXA)进行骨密度(BMD)测定,并分别与年龄匹配正常健康者95例进行对照分析。结果 (1)甲亢131I治疗前和治疗后临床缓解小于6个月、9-12个月的L2-4BMD均明确低于正常对照组,差异有非常显著性,股骨上段各区(股骨颈、Ward's区、大转子区)虽低于正常对照组,但差异无明显性;(2)131I治疗后临床缓解大于18个月的L2-4及股骨上段各区的BMD改善至接近正常人的水平,差异无显著性;(3)131I治疗后临床甲低组L2-4及股骨上段各区(尤其Ward's区)的BMD均明显低于正常对照组,差异有非常显著性。结论 甲亢经131I治疗后临床缓解6-12个月骨矿含量改善不明显,至18个月逐渐增加接近正常对照组水平;131I治疗后临床甲低持续时间大于6个月者,同样会导致骨矿含量的降低。     

The influence of Barrett's esophagus on the clinical signs and postoperative results of GERD

AIM OF THE STUDY: Was to estimate the influence of the Barrett's esophagus on the clinical signs and post-surgical results of the GERD. PATIENTS AND METHODS: Within 1998-2001 193 patients have been operated upon in our clinic due to GERD, 81 male and 112 female. Mean patient age was 55 years (from 16 to 84 years). All patients had complaints on heartburn and regurgitation. We assessed the severity of heartburn, regurgitation, dysphagia with the help of a special scale ranging from 1 (absence of symptoms) to 5 (most severe symptoms). All patients underwent gastric and esophageal radiological investigation with barium contrast as well as esophago-gastro-duodenoscopy (EGDS) with biopsy. In 190 cases esophageal hernia was found. The reflux-esophagitis was classified according to Savary-Miller after endoscopic examination. Esophagitis of degree I-III was diagnosed presurgically in 176 cases, Barrett's esophagus in 16 (9.1%) cases. In 13 cases we found a short metaplastic segment (< 3 cm), in 3 cases a long segment (> 3 cm). In 15 cases we found metaplasia without dysplasia, in 1 case low-grade dysplasia. In order to assess the presence of BM influence on presurgical clinical signs, the severity of esophagitis, and the regression rate of symptoms after surgery, we divided the patients into two groups and compared them: group I (with Barrett's metaplasia), and group II (without Barrett's metaplasia). All patients underwent laparoscopic Nissen or Toupet fondoplications. For group I patients we performed 14 Nissen and 2 Toupet procedures, in group II 148 Nissen and 29 Toupet interventions. The regression of clinical and endoscopic symptoms was assessed 6 months after surgery by re-questioning the patients and with the help of EGDS. In cases of Barrett's esophagus endoscopic biopsies from all 4 esophageal segments were performed. The patients of group I were followed-up by performing EGDS every 6 months. The mean follow-up period after surgery was 28 months. RESULTS: No statistically significant difference was found when comparing the groups for age (group I--59/SD 11, and group II--54/SD 13.2), gender, disease duration (group I--13.2/SD 13.7 years, group II--8.2/SD 10.5 years), radiologically determined hernial size or preoperative severity of esophagitis. The regression of the severity of heartburn and regurgitation was prominent in both groups with no significant difference between the groups. Dysphagia before and after surgery was comparable in both groups. Esophagitis confirmed by EGDS remained in 3 of 16 cases in group I and in 9 of 164 cases in group II. The metaplastic changes in group I were followed every 6 months for 16-36 months (mean 28 months). In 13 cases the metaplastic segment demonstrated no changes, it became shorter in 3 cases. We didn't observe any complete regression of metaplasia. In the case with preoperative low grade dysplasia, the length of the segment did not change, we observed neither histological progression or regression. CONCLUSIONS: Barrett's metaplasia had no influence on the regression of symptoms of GERD and esophagitis after antireflux surgery. No histological progression of Barrett's metaplasia has been observed after antireflux surgery. The EGDS follow-up should not be very frequent in cases of Barrett's esophagus without dysplasia and good postsurgical regression of symptoms.     

Collagen injection for treatment of urinary incontinence in children

PURPOSE: We assess the success rate of periurethral collagen injection in children with neurogenic bladder dysfunction secondary to myelomeningocele. MATERIALS AND METHODS: From 1992 to 1998, 15 male and 5 female patients with spina bifida (age 13.3 +/- 3.8 years) underwent endoscopic collagen injection for the treatment of urinary incontinence secondary to sphincter deficiency. Mean followup was 4.2 years. Pretreatment urodynamic study showed a stable compliant bladder with an average leak point pressure of 52 cm. H2O (range 23 to 100). Concurrent medical management included anticholinergics in 15 cases, agonists in 3, and clean intermittent catheterization in 16. Five patients had undergone previous ileocystoplasty. RESULTS: Collagen injections were given with the patient under general anesthesia. The number of injections was 1 in 5 cases, 2 in 11, 3 in 3, and 4 in 1. Average collagen volume injected per treatment was 6.6 cc (range 2 to 13). All patients were evaluated on a subjective continence scale of no change (wet), improved or completely dry at the time of assessment. Of the 20 patients, 16 had no change, 3 showed improvement and 1 was dry. Initial improvement in the first 2 months after injection deteriorated thereafter in 16 cases. CONCLUSIONS: The previously reported high success rate of collagen injection is not supported by this study. With long-term followup collagen injection is rarely effective for treating urinary incontinence in children with neurogenic sphincter deficiency.     

表皮生长因子防治急性胰腺炎大鼠肠粘膜屏障损害

目的 探讨表皮生长因子（ＥＧＦ）对急性胰腺炎（ＡＰ）大鼠肠粘膜屏障的保护作用。方法 ＳＤ大鼠３２只,建立ＡＰ模型后随机分为对照组（ｎ＝１６）和治疗组（ｎ＝１６）。对照组给予全肠外营养的支持;治疗组给予全肠外营养支持和ＥＧＦ皮下注射。于成模后１．５d 死,检测大鼠肠道通透性、空肠粘膜湿重、微绒毛高度和面积、双糖酶活性及髓 过氧化酶活性。结果 在成模后５d,治疗组动物空肠粘膜湿重、微绒毛高度及面积、双糖     

3D打印导航胆道内镜治疗胆石症

目的 探索3D打印导航胆道软、硬镜等内镜精准治疗胆石症的临床实践效果.方法 选择2018年5月至2019年7月间263例需内镜手术治疗的胆石症患者的临床资料进行回顾性分析,根据是否采用3D打印导航技术分为两组,观察组(n=131):进行薄层CT扫描和三维可视化重建、打印胆道数字模型,应用于术前手术评估、模拟,制订手术方...