直肠腔内超声在直肠癌术前环周切缘评估中的作用

  目的  评估直肠腔内超声(endorectal ultrasound, ERUS)诊断直肠癌环周切缘(circumferential resection margin, CRM)的可行性和准确性  目的  回顾性分析2010年5月至2013年12月在北京协和医院行术前ERUS评估的直肠癌患者120例。纳入患者仅采用直肠全系膜切除术切除肿瘤, 未采用术前新辅助放化疗治疗。患者行术前ERUS检查时测量CRM, 即肿瘤的最外缘与直肠系膜筋膜的最短距离。以病理结果为金标准, 比较不同CRM诊断标准下ERUS的诊断价值。分析ERUS对不同位置、距肛缘距离、分期的CRM诊断准确性差异  结果  ERUS可以显示直肠系膜筋膜114例, 显示率为95%。采用不同探头频率, 直肠系膜筋膜显示的差异存在统计学意义(P=0.034)。以CRM ≤ 2 mm为标准时, ERUS诊断CRM的敏感性、准确性、阴性预测值最高, 分别为100%、98.2%、100%。ERUS对不同位置、距肛缘距离、病理分期病灶的诊断准确性差异不具有统计学意义(P>0.05)  结论  ERUS可以准确诊断直肠癌环周切缘, 同时具有较高的阴性预测值, 可为判断预后及制定临床治疗方案提供可靠依据。     

直肠癌术前螺旋CT分期的应用价值研究

目的:评价多层螺旋CT(MSCT)在直肠癌术前分期的准确性及应用价值.方法:对49例经肠镜病理证实的直肠癌患者,进行术前MSCT平扫及动态增强扫描,参考TNM分期方法进行MSCT分期,并与术后病理分期对照分析比较其敏感性等指标.结果:正常直肠壁的CT值为30～50Hu,直肠壁分层显示不明显,原发癌灶显示良好,其CT值较正常直肠壁低,T分期总敏感性为66.56%,T3、T4敏感性大于T1、T2,达90%以上,假阴性率小于10%;淋巴结的CT值为15～30 Hu,增强后可提高10～20 Hu,N分期的总敏感率为86.7%,对紧靠癌肿旁的淋巴结、非连续性转移、直肠系膜中的小结节敏感性低;对肝脏、阴道壁、膀胱壁、卵巢中的转移灶较敏感,对小肠、结肠及其系膜上、腹壁上的小转移灶敏感性低.结论:MSCT对T3、T4期癌原发灶显示良好,这正符合新辅助性化疗术前分期的要求,是非常实用的检查方法,应作为直肠癌术前影像学分期的常规评估手段;通过对淋巴结的大小、密度、形态及增强情况可大致判定其转移性;但对于小肠、结肠及其系膜中、腹壁上的微小转移敏感性低,分辨病变的性质有一定困难,尚需结合其他方法进行综合判定.     

MRI在直肠癌TME术前评价中的价值

目的:本研究通过回顾性分析直肠癌侵犯直肠系膜的MRI表现,以进一步明确MRI对TME的术前评估价值。材料与方法:48例中低位直肠癌患者中,经手术证实36例癌肿不同程度侵犯直肠系膜。该36例患者中,男26例,女10例,年龄35-77岁,平均年龄58岁。结果:本组经手术证实的36例中低位直肠癌均有不同程度侵犯直肠系膜,即肿物侵犯范围超出直肠纤维膜向肠腔外生长侵犯。其中8例直肠系膜筋膜(盆腔脏层筋膜)受累,MR表现为直肠系膜筋膜局限性增厚8例;边界不规则不光滑6例;病灶呈不均匀长T1、稍长T2信号6例;呈长T1等T2信号2例。该8例患者中,癌肿或转移性淋巴结与直肠系膜筋膜之间距离分别为≤1mm者3例;1-2mm之间4例;3mm者1例。无直肠系膜筋膜受累的28例患者中,癌肿或转移性淋巴结与直肠系膜筋膜之间距离为5-20mm。结论:MRI检查在TME手术前评估中具有较大的价值。     

64排螺旋CT评价肠系膜上动脉腹主动脉夹角与肠系膜上动脉压迫性病变及腹部脂肪分布相关性

目的 评估肠系膜上动脉夹角和腹部脂肪分布及肠系膜上动脉压迫性病变的相关性.方法 使用64排螺旋CT回顾性观察19例肠系膜上动脉压迫性病变患者及238例正常检查者肠系膜上动脉和腹主动脉之间夹角的大小以及腹部脂肪体积百分率,并计算出正常人肠系膜上动脉和腹主动脉之间夹角的参考范围以及腹部脂肪体积百分率的范围.结果 19例肠系膜上动脉压迫性病变患者肠系膜上动脉和腹主动脉之间夹角为15.74°±4.93°,腹部脂肪百分率为（22.79±8.30）％;238例正常检查者肠系膜上动脉和腹主动脉之间夹角为48.79°±25.85°,腹部脂肪百分率为（32.58±9.85）％.两组有显著差异（P＜0.0001）.结论 64排多层螺旋CT清楚显示肠系膜上动脉和腹主动脉之间夹角,该夹角＜25°时易发生肠系膜上动脉压迫性病变,该夹角的大小与腹部脂肪体积百分率呈正相关.     

直肠癌直肠系膜全切除术及其临床应用价值

进修医生 直肠癌直肠系膜全切除术的理论和概念是怎样发展起来的呢? 教授 按照传统解剖学教科书描述,直肠是没有肠系膜的。解剖学上的肠系膜是指由浆膜(腹膜)包裹的支配该肠段的脂肪、血管组织、神经、淋巴组织等组成,直肠未被腹膜完全包裹,为腹膜外位器官,没有肠系膜,但并不代表该肠段无脂肪、血管、淋巴管、神经。实际上腹膜     

从膜解剖浅谈腹腔镜直肠癌全系膜切除的新认识

直肠癌是我国常见恶性肿瘤之一,它以起病隐匿、死亡率高为特点,在我国直肠癌发生率高于结肠癌,且以青年、低位多见,严重危害国民健康。近年来直肠癌发病率有增高的趋势[1]。尽管近些年放化疗等一系列治疗方法的在不断发展,目前手术治疗仍是治疗结直肠癌的首选方法[2]。全直肠系膜切除(total mesorectum excision,TME)最早由英国学者Heald于1982年提出,将直肠深筋膜包裹的直肠、直肠系膜及直肠周围脂肪组织、神经血管和淋巴结视为一个解剖单位。直肠癌手术时力求以此解剖单位行完整切除[3]。     

经直肠超声术前评估直肠癌累及直肠系膜筋膜

目的 探讨经直肠超声（ERUS）术前评估直肠癌累及直肠系膜筋膜（MRF）的价值。方法 44例直肠癌患者术前均接受ERUS检查,其中18例接受新辅助放化疗,26例未接受;所有患者于接受ERUS检查后1周内行全直肠系膜切除手术（TME）。以术后病理诊断环周切缘（CRM）的结果为金标准,判断ERUS术前评估直肠癌累及MRF的诊断效能。结果 44例患者中,术后病理诊断T1期2例,T2期17例,T3期25例;CRM阳性2例,CRM阴性42例。低位直肠癌16例,中位直肠癌28例。肿瘤位于前壁和前侧壁26例,后壁和后侧壁13例,累及肠壁全周5例。ERUS对术前接受和未接受新辅助放化疗的患者诊断准确率分别为83.33%（15/18）和92.31%（24/26）;肿物位于前壁和前侧壁时,诊断准确率为80.77%（21/26）,而肿物位于后壁和后侧壁时为100%（13/13）;对于低位和中位直肠癌,诊断准确率分别为75.00%（12/16）和96.43%（27/28）;总准确率为88.64%（39/44）。结论 ERUS是术前评估直肠癌是否累及MRF的有效辅助检查方法。     

直肠系膜的解剖结构和临床病理学研究进展

近年来 ,直肠癌的外科治疗从临床实践到基础理论都出现强劲发展势头 ,传统Miles手术正逐渐被兴起的低位和超低位吻合取代 ,距肛缘 5～ 6cm以上的下段直肠癌可获保肛根治性切除[1 ] 。这得益于 1 982年Heald等[2 ] 提出的TME或直肠周围系膜全切除术(completecircumferentialmesorectalexcision ,CCME)的概念 ,该术式能使术后局部复发率由原来的 30 %降低至 3 6～ 6 % [3,1 5] 。许多学者对直肠系膜进行了大量的基础和临床研究 ,极大地促进了TME这一新技术的发展。本文就直肠系膜的解剖和临床病理学方面的研究进展作一简要综述。1　直肠…     

低位直肠癌经肛尾介入直肠系膜内注射5-氟尿嘧啶缓释剂的新辅助化疗实验研究

目的 研究体外经肛尾介入骶前间隙进针,直肠系膜内注射5-氟尿嘧啶（5-Fu）缓释剂对直肠癌肿瘤细胞的诱导凋亡作用.方法 建立人直肠癌裸鼠原位种植模型,将荷瘤鼠27只随机分为A、B、C3组.移植后第35天,A组给予直肠系膜内注射5-Fu缓释剂5μl,1 mg/kg;B组给予直肠系膜内注射生理盐水5μl;C组经腹腔注射5-Fu缓释剂,1 mg/kg.化疗48 h后处死裸鼠,测定肿瘤细胞凋亡系数（AI）.结果 A组肿瘤细胞的AI为（9.09±2.86）％、明显高于B组[（1.07±0.43）％]和C组[（4.06±1.00）％],差异有统计学意义（P ＜0.001）;A、B组直肠系膜未见出血、细胞溶解、坏死.结论 直肠系膜内注射5-Fu缓释剂对肿瘤细胞有明显的诱导凋亡作用.该途径方便、安全、实用、易推广.     

多排螺旋CT肠系膜混浊征对回盲部病变的诊断价值

目的探讨MDCT肠系膜混浊征(MM)对回盲部病变的诊断价值。方法回顾性分析60例经病理证实的回盲部病变的MDCT表现。结果 18例恶性肿瘤中,11例(11/18,61.11%)可见MM;42例炎性病变中,36例(36/42,85.71%)可见MM。炎性病变较恶性肿瘤更易出现MM、脂肪缆绳征、逗号征及梳子征。恶性肿瘤较炎性病变更易出现系膜血管受累、系膜结节、腹腔积液及系膜根部淋巴结肿大。结论 MM能提示回盲部病变的性质,结合其他CT异常征象及临床病史有利于明确诊断。     

Antimicrobial tolerance in group C and group G streptococci

The in-vitro activity of various antimicrobial agents against 61 clinical isolates (35 group G streptococci and 26 group C streptococci) was studied. Penicillin, cephalothin and vancomycin were the most active agents with MIC90 values of 0.03, 0.06 and 0.12 mg/l respectively. Tolerance, defined as an MIC to MBC ratio of 32 or greater, was observed in six isolates (four group G--11.4% and two group C-7.7%). Two isolates were tolerant to penicillin alone and one each to cephalothin, vancomycin, latamoxef (moxalactam) and cefotaxime. No cross-tolerance was observed. The addition of gentamicin to the beta-lactam agents and of gentamicin or rifampicin to vancomycin resulted in bactericidal activity. None of the combinations were antagonistic. Our results demonstrate that various bactericidal antimicrobial combinations are available for therapy against tolerant organisms.     

Bacterial communication and group behavior

The existence of species-specific and interspecies bacterial cell-cell communication and group organization was only recently accepted. Researchers are now realizing that the ability of these microbial teams to communicate and form structures, known as biofilms, at key times during the establishment of infection significantly increases their ability to evade both host defenses and antibiotics. This Perspective series discusses the known signaling mechanisms, the roles they play in both chronic Gram-positive and Gram-negative infections, and promising therapeutic avenues of investigation.     

Transfusion to blood group A and O patients of group B RBCs that have been enzymatically converted to group O

BACKGROUND: The transfusion of ABO-incompatible RBCs is the leading cause of fatal transfusion reactions. Group O RBCs, lacking terminal immunodominant A and B sugars to which humans are immunized, are safe for transfusion to persons of any ABO blood group. With the use of a recombinant alpha-galactosidase to remove terminal galactose from group B RBCs, the safety and efficacy of enzyme-converted group-B-to-group-O (ECO) RBC components were studied in transfusion-dependent patients. STUDY DESIGN AND METHODS: Twenty-four patients (blood groups A and O) were randomly assigned to receive transfusion(s) of either ECO or control group O RBCs. If a second transfusion was given, the other blood component was administered. RESULTS: Twenty-one patients were given ECO RBCs; 18 also underwent control transfusions. One patient received only a small aliquot for RBC survival studies, instead of a full-unit transfusion, because his serum was incompatible with ECO RBCs. No adverse events occurred. Both ECO and control transfusions resulted in appropriate Hb increments and comparable (51)Cr-labeled RBC survival studies. One patient developed a transient, weak-positive DAT, without hemolysis. Two weeks after transfusion, 5 of 19 evaluable ECO RBC recipients had increases in anti-B titers. CONCLUSION: ECO RBCs were comparable to group O cells for safety and efficacy in this study. The clinical significance of the increase in anti-B and of occasional serologic incompatibilities with ECO RBCs is unclear. If strategies can be developed to remove A epitopes, enzymatic conversion could be used to create a universal (group O) donor blood supply.     

The harvard group scale of hypnotic susceptibility and related instruments: Individual and group administrations

The purported relationship between hypnotizability and speed of information transfer from iconic to short-term memory was studied in a comparison of 12 low and 12 high hypnotizable Ss. As in Ingram, Saccuzzo, McNeill, and McDonald (1979), high hypnotizable Ss showed less interference from a visual mask in the report of a briefly presented item than did low hypnotizable Ss when the mask delays were predictable. When the delay of the mask could not be anticipated, however, differences between high and low hypnotizable Ss disappeared. It is suggested that differences in information processing related to hypnotizability may be due to differences in strategy, skills, or other factors, rather than underlying information processing speed.