补中益气汤对兔结肠黏膜5-HT、CgA阳性细胞数的影响

目的：通过观察补中益气汤联合易蒙停对结肠黏膜5-羟色胺（5-HT）、嗜铬粒蛋白A（CgA）阳性细胞数的影响,探讨补中益气汤联合易蒙停治疗结肠切除术后排便障碍的作用机理。方法：切除青紫蓝兔结肠后,分别给予补中益气汤、易蒙停及两者联合治疗14d,处死后取吻合口处结肠。免疫组化法检测每组切除后正常结肠、吻合口处结肠黏膜中5-HT、CgA阳性细胞。结果：正常组、术后空白对照组、西药组、中药组、中西医药组5-HT阳性细胞数分别为10.40±2.22,26.27±2.35,18.20±2.71,15.93±2.46,14.33±2.87;CgA阳性细胞数分别为20.60±5.34,51.51±6.13,36.10±5.34,28.36±7.16,29.33±8.17。中药组与中西药组比较无差异（P〉0.05）,余各组间比较有差异（P〈0.01或P〈0.05）。结论：补中益气汤联合易蒙停致结肠切除后青紫蓝兔结肠黏膜5-HT、CgA阳性细胞数的减少,可能是其治疗结肠切除术后排便障碍的作用机制之一。     

参术生肌汤灌洗青紫兰兔直肠切除术后吻合口黏膜细胞中含b-FGF、CD68、VEGF者比对愈合的影响研究

目的:探讨参术生肌汤灌洗对青紫兰兔直肠吻合口需粘膜细胞中含碱性成纤维细胞生长因子(b-FGF)、CD68、血管内皮细胞生长因子(VEGF)者比对愈合的影响研究。方法:青紫兰兔30只,在距肛门约5 cm处作直肠吻合,然后随机分成两组。空白组给予常规治疗,实验组于术后第1日起给予参术生肌汤灌洗,每日2次,连续6 d。6 d后处死两组兔子,取含有吻合口的直肠约2 cm。免疫组化检测空白组、实验组吻合口需直肠黏膜细胞中含b-FGF、CD68、VEGF阳性者的比例,研究其对愈合的病理生理影响。结果:空白组、实验组b-FGF阳性细胞数分别为19.73±2.22,27.80±4.10;CD68阳性细胞数分别为19.87±2.20,13.73±2.71;VEGF阳性细胞数分别为18.20±2.81,24.27±2.25;两组间相比,均有明显差异(P0.01)。结论:参术生肌汤可促进直肠吻合口需的b-FGF、VEGF的增殖,同时减轻直肠术后吻合口区的炎症反应(CD68),有助于促进吻合口的愈合。     

慢传输型便秘结肠肌间丛NOS、SOM、5-HT免疫反应性变化

目的　探讨一氧化氮（ＮＯ） 、生长抑素（ＳＯＭ）及５羟色胺（５ＨＴ） 在慢传输型便秘（ＳＴＣ） 发病中的作用。方法　用免疫组织化学法结合计算机辅助的图像分析技术检测１５ 例ＳＴＣ 患者乙状结肠肌间丛一氧化氮合酶（ＮＯＳ） 、ＳＯＭ 及５ＨＴ的免疫反应性变化。结果　与对照组相比,ＳＴＣ 患者乙状结肠肌间丛ＮＯＳ、５ＨＴ免疫反应性增强（ Ｐ＜ ０－０１ ,Ｐ＜ ０－０５） ,而ＳＯＭ 无显著差别（ Ｐ＞ ０－０５）。结论　ＮＯＳ及５ＨＴ 免疫反应性增强是ＳＴＣ 患者结肠传输减慢的神经病理基础,ＳＯＭ 在ＳＴＣ结肠动力减弱中的作用不明显。     

IL-1α对体外培养兔椎间盘髓核组织PGE2、PGF1α及5-HT代谢的影响

目的 研究自细胞介素1α(IL-1α)对体外培养的兔椎间盘髓核组织前列腺素E2(PGE2)、前列腺素F1α(PGF1α)和5-羟色胺(5-HT)代谢的影响。方法 取日本大白兔，无菌手术摘取椎间盘髓核，制成匀浆后进行髓核组织的体外培养。实验组加入IL-1α，对照组空白，培养12、24、30、72h，分别测定各时段培养液中PGE2、PGF1α、5-HT的浓度。结果 各时段实验组和对照组的差异均有显著性，随着培养时间的延长，实验组培养液中PGE2、PGF1α、5-HT的含量均逐步增高，差异有显著性。结论 IL-1α刺激体外培养的兔椎间盘髓核细胞合成PGE2、PGF1α和5-HT，呈现明显的时间依赖性。     

痔上黏膜环形切除钉合术两种缝合方法对切除直肠黏膜宽度的影响

目的 初步探讨痔上黏膜环形切除钉合术(Procedure for Prolapse and Hemorrhoids,PPH)单荷包缝合、双荷包缝合以及调节两倚包间距离对切除直肠黏膜宽度的影响,为临床医师制订个体化治疗方案及更好地开展PPH术提供依据.方法 符合纳入标准的Ⅲ～Ⅳ期内痔28例,随机分为2组:单荷包缝合组15例,双荷包缝合组13例.分别对2组患者术中所切除直肠黏膜的宽度进行测量、记录.切除标本送病理检查,检查其是否带肌层.并对2组患者术后的临床疗效、并发症(出血、疼痛、尿潴留、急便感)进行统计学分析和比较.结果 2组间短期临床疗效、术后并发症(出血、疼痛、尿潴留)、切除组织是否带肌层的比较,差异均无统计学意义(P>0.05),但对2组间术中所切除黏膜环宽度进行比较发现双荷包缝合组所切除黏膜环的宽度明显大于单荷包缝合组,差异有统计学意义(P<0.01). 结论 单荷包缝合、双荷包缝合以及两荷包间距离可以控制PPH术切除黏膜环的宽度.     

全椎板切除对兔脊柱生长发育的影响

本试验切除幼兔和成兔多节段全椎板观察其脊柱畸形情况,实验分为两组,幼兔组(A组):10只,日龄40天,体重460g(400～550g);成兔组(B组):10只,月龄6个月,体重2kg(1.5～2.5kg)。结果表明多节段全椎板切除可造成幼兔比成兔更多更重的畸形,如后凸、侧凸、椎体楔形变、滑脱及广泛的椎管内粘连。     

不同功率的低强度激光对神经病理性疼痛大鼠痛阈及脊髓背角5-HT、GABA表达的影响

目的探讨低强度激光对神经病理性疼痛大鼠的镇痛作用、机制及最佳照射参数。方法56只雄性SD大鼠随机分为假手术组,模型组,10 nw和30 nw激光照射组四个组,模型组以及激光照射组制成坐骨神经缩窄性损伤模型。每组14只,分别于术前1 d、术后1 d、激光照射后3 d、12 d测定大鼠热水甩尾潜伏期(tail flick latency,TFL)。于激光照射后3 d、12 d各取7只采用免疫组化方法检测大鼠脊髓背角GABA、5-HT的表达。结果与假手术组比较,模型组以及激光照射组术后1 d大鼠痛阈降低(P0.05);与模型组比较,术后12 d,激光照射组TFL明显延长(P0.05),脊髓背角5-HT、GABA的表达显著增加(P0.05),30 nw优于10 nw(P0.05)。结论低强度激光能提高神经病理性疼痛大鼠的痛阈,激光治疗强度30nw优于10nw,其治疗机制可能与促进神经递质5-HT、GABA的表达有关。     

半夏泻心汤加减治疗肠易激综合征患者腹痛的疗效及对血清5-HT、VIP、SP水平的影响

目的：通过观察半夏泻心汤加减治疗肠易激综合征（IBS）患者腹痛的疗效,分析治疗前后血清5-羟色胺（5-HT）、血管活性肠肽（VIP）、P物质（SP）水平的变化,初步探讨其作用机制。方法：选取2020年10月至2021年10月于我院就诊且符合IBS诊断标准的80例患者,按随机数字表法分为观察组和对照组,每组40例,观察组予半夏泻心汤加减方口服治疗,对照组予马来酸曲美布汀片及双歧杆菌乳杆菌三联活菌片口服治疗,2组均治疗10d。比较2组患者治疗前后腹痛缓解情况及血清5-HT、VIP、SP水平的变化。结果：2组患者治疗第1、3、5、7、9天血清5-HT、VIP、SP水平及腹痛评分均逐渐下降。治疗后不同时间点组间比较：治疗第1、3天,2组患者血清5-HT、VIP、SP水平及腹痛评分比较差异无统计学意义（P>0.05）;治疗第5、7天,观察组患者血清5-HT、SP水平及腹痛评分明显低于对照组（P <0.05）,而血清VIP水平2组间无明显差异（P>0.05）;治疗第9天,观察组患者血清5-HT、VIP、SP水平及腹痛评分均明显低于对照组（P <0.05）。结论：半夏泻心汤加...     

冬虫夏草对5／6肾切除大鼠肾脏TGF-β1的影响

目的观察冬虫夏草对肾小球硬化大鼠转化生长因子-β1（TGF-β1）表达的影响，并探讨其作用机制。方法将36只正常Wistar大鼠随机分为对照组、模型组和冬虫夏草组。模型组和冬虫夏草组行5／6肾切除术制备进行性肾小球硬化模型。冬虫夏草组每天给予冬虫夏草（2．5g·kg^-1·d^-1）水提液灌胃，模型组和正常对照组每天给予等量的自来水灌胃。末次术后4周各组分别处死大鼠6只，术后9周处死剩余6只。测定血生化指标和尿蛋白排泄量，检测大鼠肾组织中TGF-β1 mRNA、TGF-β1的表达。结果①模型组术后4周24h尿蛋白定量增高，血浆白蛋白降低，胆固醇与低密度脂蛋白增高，TGF-β1及其mRNA的表达均增高。与模型组相比，冬虫夏草组尿蛋白排泄减少，血胆固醇降低，低密度脂蛋白降低，TGF-β1 mRNA的表达明显减少，TGF-β1的表达减弱。②术后9周，模型组肾脏病变进一步加重，血肌酐升高。与之相比，冬虫夏草组尿蛋白排泄减少、血白蛋白增高；血胆固醇降低、低密度脂蛋白降低、血肌酐降低；TGF-β1 mRNA的表达明显减少、TGF-β1的表达减弱。结论随着大鼠肾小球硬化程度的加重，TGF-β1的表达增加；冬虫夏草干预治疗后，TGF-β1的表达明显下调，提示TGF-β1参与了肾小球硬化的进展，冬虫夏草可以延缓肾小球的硬化。     

空、结肠黏膜细胞增殖过程中主要细胞周期蛋白表达规律的研究

目的研究正常空、结肠黏膜细胞增殖过程中的人类主要细胞周期蛋白Cyclins表达特征和变化规律。方法应用细胞免疫组织化学流式细胞术检测30例正常空、结肠黏膜不同层面、不同增殖阶段细胞主要细胞周期蛋白CyclinD1、E、A、B1及Ki-67的表达,以共聚焦显微镜观察证实检测结果。结果不同增殖阶段肠黏膜细胞Cyclins表达阳性率及相对表达水平不同,从底部→中间层→表层肠黏膜细胞增殖活性(以Ki-67为增殖指标)呈下降趋势,Cyclins(CyclinE、B1为主)表达阳性率及水平呈高→低→无的变化,差异有统计学意义(P<0.01);Cyclins表达与肠黏膜细胞增殖活性呈正相关(P<0.05);CyclinD1、A仅表达于底层增殖细胞,表层完全分化细胞不表达Cy-clins。结论正常空、结肠黏膜细胞增殖分化过程中Cyclins(以CyclinE、B1为主)呈高→低→无的规律性变化,参与细胞增殖的调控,其表达呈衰减变化与肠黏膜细胞有限增殖和定向分化有关。     

Laparoscopic Colectomy for Carcinoma of the Colon in Octogenarians

Background  

The incidence of colorectal cancer increases with age; most patients present with resectable disease. Since there is a high morbidity rate in the elderly, the laparoscopic approach, with its lower complication rate, appears to be the ideal choice for treatment of this patient group. In this retrospective study, we aimed to compare the short-term results of laparoscopic (LC) with open (OC) colectomies for carcinoma in patients 80 years of age or older.     

Laparoscopic Total Colectomy with Transvaginal Extraction of the Colon and Ileorectal Anastomosis

Background

The abdominal incision extraction site continues to be major source of morbidity after laparoscopic colectomy: mainly, incisional pain, wound infection, and incisional hernia. Also, in selected cases, it may delay initiating chemotherapy.

Methods

The video describes the technique of performing laparoscopic total colectomy, transvaginal removal of the entire colon, and intracorporeal ileorectal anastomosis in a 40-year-old woman with a sigmoid cancer and multiple endoscopically unresectable polyps throughout the colon. Computed tomography scan showed 2 liver lesions with carcinoembryonic antigen 138. Familial adenomatous polyposis gene analysis was negative. Six trocars (one 12 mm and five 5 mm) were used. The whole colon was removed through the transvaginal route. The anvil was introduced through the vagina, and circular stapled ileorectal anastomosis was done.

Results

There were no intraoperative complications. The operating time was 210 min. Blood loss was 20 mL. The patient was discharged home on postoperative day 2. Final pathology was T3N1bM1, and 2 of 23 lymph nodes were metastatic. All polyps were tubulovillous. She was commenced on chemotherapy 2 weeks after surgery. At 6-month follow-up, the patient was doing well, had no abdominal pain, and had no vaginal discharge or dyspareunia.

Conclusions

Natural orifice specimen extraction (NOSE) surgery can be added to the armamentarium of surgeons performing laparoscopic colon surgery. This technique may provide both an attractive way to reduce abdominal incision–related morbidity and a bridge to pure natural orifice transluminal endoscopic surgery (NOTES) colon surgery. Large-number patient data with long-term follow-up is needed.     

全腹腔镜及腹腔镜辅助结肠癌根治术25例报告

目的探讨腹腔镜结肠癌根治术的临床效果。方法对25例结肠癌实施腹腔镜结肠癌根治术，其中17例行腹腔镜辅助结肠癌根治术，8例行全腹腔镜结肠癌根治术。结果手术时间110—310min，平均195min。术中出血量100—350ml，平均180ml。术后胃肠功能恢复时间1—4d，平均1．7d。术后病理标本残端无肿瘤细胞残留、浸润。术后2例切口感染，无出血、吻合口瘘和狭窄。术后住院6—10d，平均7．5d。术后19例随访2—38个月，平均13个月，17例无肿瘤复发及切口种植，2例手术后12、14个月因广泛转移死亡。结论腹腔镜结肠癌根治具有微创、安全、术后恢复快、肿瘤根治彻底等优点，值得临床推广应用。     

A Hemophagocytic Syndrome-Like Condition After Emergency Colectomy for Perforated Colon Cancer: Report of a Case

Hemophagocytic syndrome is a rare but often fatal condition, and little is known about why this disorder can occur following surgery. We report herein the case of a patient successfully treated for a hemophagocytic syndrome-like condition that developed after emergency right hemicolectomy for a retroperitoneal abscess secondary to perforated colon cancer. The 62-year-old man initially presented after the sudden development of severe right back pain, and computerized tomography scans revealed a retroperitoneal abscess continuous with a tumor in the ascending colon. An emergency right hemicolectomy was subsequently performed. On postoperative day (POD) 2, his blood platelet count suddenly dropped to 1 × 10⁴/μl and histological examination of a bone marrow specimen taken on POD 5 showed abnormal histiocytes that had phagocytosed not only megakaryocytes, but also erythrocytes and leukocytes, and a normocellular marrow with a normal number of megakaryocytes. Hemophagocytic syndrome was suspected, and predonine was administered. The patient's condition improved remarkably and he was discharged on POD 51. Received: September 20, 2000 / Accepted: July 17, 2001     

Thirty-Day Outcomes in Patients Treated with En Bloc Colectomy and Pancreatectomy for Locally Advanced Carcinoma of the Colon

Objective  

The aim of this was to define 30-day outcomes of patients treated with colectomy and en bloc pancreatectomy for invasive colon cancer.     

Acute Diverticulitis of the Left Colon: Value of the Initial CT and Timing of Elective Colectomy

Computed Tomography is undeniably the most useful tool to confirm the suspected diagnosis of acute left-colonic diverticulitis and to objectively grade its severity into moderate diverticulitis (no signs of colonic perforation) and severe diverticulitis (signs of colonic perforation). Indeed, the severity of acute diverticulitis is statistically predictive of the risk both to need surgical treatment of the first episode of acute diverticulitis, and to follow a complicated evolution after successful conservative treatment of the acute phase. Consequently, CT brings a major contribution to define the place of surgery during the acute phase of diverticulitis, and, later on, inside the long-term evolution of the disease after initial successful conservative treatment. This paper was originally presented as part of the SSAT/AGA/ASGE State-of-the-Art Conference on Management Of Diverticular Disease at the SSAT 47th Annual Meeting, May 2006, in Los Angeles, California.     

直肠癌及其远端黏膜P53和CD34的表达及意义

目的 观察直肠癌组织及其远端黏膜组织中P53蛋白表达及微血管分布,并从分子病理学水平探讨直肠癌的安全远侧切缘.方法 对45例中低位直肠癌下缘进行标记,PET/CT检查并结合半定量免疫组织化学方法检测直肠癌及其远端黏膜组织中P53和CD34蛋白的表达.结果 直肠癌及其远端黏膜组织中均可见P53蛋白表达及微血管分布,直肠癌组织中P53蛋白表达及微血管密度(MVD)明显高于直肠癌远端黏膜组织(P<0.01).直肠癌远端黏膜组织中P53蛋白表达及MVD随着距离增大而减少,但有统计学意义的改变只在直肠癌远端1.5 cm内.正常直肠组织中仍有P53蛋白表达和微血管分布.除直肠癌组织及其远端0.5 cm段黏膜组织中MVD与肿瘤直径有关(P<0.05)外,直肠癌及其远端黏膜组织中P53蛋白表达及MVD分布与肿瘤直径、分期以及分化程度均无关.结论 从分子病理学角度说明2 cm的直肠癌远端长度是安全的远侧切缘.     

移位乙状结肠对阑尾切除手术的影响(附5例报告)

自1998年1月～2000年4月,于625例阑尾切除手术中发现伴有乙状结肠移位致右下腹的解剖变异共5例,占同期阑尾切除术的08%,现报道如下。1　临床资料11　一般资料本组共5例,男4例,女1例。年龄18～46岁。发病至手术时间1～3天。全组病例都具有转移性右下腹痛或右下腹痛病史。合并体温升高2例;合并胃肠道症状4例;既往有“阑尾炎”发作史者1例。结合体检右下腹麦氏点固定性压痛及反跳痛;血象及中性白细胞百分比均升高,术前均明确诊断“阑尾炎”。无肝、肾、心、肺功能障碍。12　手术方法及结果全组病例均先由工作2～4年的外科医师担任术者,由于对右…