慢性胃扭转的病因和治疗探讨

目的 探讨慢性胃扭转的病因和治疗效果,以便选择更适当的治疗方法。方法 回顾性分析我院30年来收治的慢性胃扭转27例,分析其临床表现、类型、合并症及其发病诱因,评价各种治疗方法的效果。结果 全组慢性胃扭转27例。其中器官轴扭转21例,系膜轴扭转2例,混合型扭转4例。存在明显诱因的有19例(70.4％)。手术治疗治愈13例,单纯非手术治疗治愈5例,症状好转出院7例,未愈2例。结论 慢性胃扭转是胃扭转的主要类型,常无特异临床表现,常存在诱因,钡餐造影是诊断本病的主要手段,外科手术是治愈本病的主要措施。     

Total gastrectomy in the treatment of advanced gastric cancer

To assess the role of total gastrectomy in the treatment of advanced gastric cancer, we reviewed the records of 27 patients who underwent the procedure from 1979 to 1988. Operative mortality was 4 percent (1 of 27), and postoperative morbidity occurred in 48 percent of the patients. Twenty-five of 26 patients were tolerating solid food at the time of discharge; 21 were able to maintain oral alimentation until just prior to their death. Median survival following the operation was 15 months (range: 2 to 110 months), with a 62 percent absolute 1-year survival rate and a 38 percent 2-year survival rate. On the basis of these results, we conclude that in patients with advanced gastric carcinoma, total gastrectomy with Roux-Y esophagojejunostomy can be performed with an acceptable morbidity and mortality, provides significant palliation by restoring the patient's ability to eat, and should be performed when technically feasible, even in the presence of gross residual disease.     

Perforated gastric ulcer--reappraisal of surgical options

BACKGROUND: The available operative procedures for perforated gastric ulcer are gastrectomy, ulcer excision and omental patch closure. This study analysed the outcome of these operative options in a single institution. PATIENTS AND METHODS: Seventy-two patients (mean age 43 years, 62 males) with perforated gastric ulcers were managed by laparotomy. There were 34 lesser curve (incisural) and 38 antral ulcers. RESULTS: Partial gastrectomy was performed in 27 patients, ulcer excision in 27 and simple patch closure in 18. Two ulcers were malignant. The mortality rate was 18% (26% for gastrectomy, 19% for ulcer excision and 5% for patch closure). Shock on admission (p = 0.006) and Candida (p = 0.020) in the histological specimen were predictive of poor outcome. Hospital stay was similar in the 3 groups. CONCLUSION: Omental patch closure and ulcer excision are as effective as gastrectomy in the management of perforated gastric ulcer and merit consideration as first-line therapy in technically applicable cases.     

Endo-organ full-thickness excision for gastric cancer: Report of a case

(Received for publication on June 8, 1998; accepted on May 27, 1999)     

胃癌病人血清CD27及其配体的检测

目的:检测胃癌病人血清CD27及其配体(CD27L)的含量,探讨其与胃癌临床及病理指标的关系。方法:应用ELISA方法测定42例胃癌病人血清中CD27和CD27L的含量,并与40例同期正常对照组的血清作对比。采用单因素方差分析和Spearman相关分析探讨CD27和CD27L的浓度与胃癌病理类型、病理分期及TNM分期的关系。结果:胃癌病人血清CD27和CD27L的表达显著低于正常对照组(P     

The clinical aspect of retained gastric antrum

Thirty symptomatic patients with retained gastric antrum proved pathologically and/or by isotopic visualization were studied and treated from 1968 to 1983. The latent periods from the antral exclusion to the occurrence of anastomotic ulcers after a subtotal gastrectomy with Billroth's type II reconstruction varied from a few days to 19 years, with an average of 2.8 years. Fasting serum gastrin levels were normal in 14 of 21 patients and were intermittently high in some patients. The basal to maximal acid-output ratio was greater than 0.6 in 69% of the patients; primary cimetidine treatment was effective in three of five patients. Thirty-five operations on 27 patients were divided into six groups; all of these 27 patients eventually underwent resection of retained gastric antrum. We concluded that resection remains the best treatment for anastomotic ulcer related to retained gastric antrum. Additional truncal vagotomy did not provide additional benefit to these patients. Furthermore, cimetidine can be useful to control the symptoms for preoperative preparation or definitive treatment in high-risk patients.     

P27kipl基因过度表达诱导人胃癌细胞系凋亡机制的研究

目的研究P27kipl基因转染对人胃癌细胞系BGC-823的诱导凋亡作用及其可能机制。方法构建含人P27kipl基因的逆转录病毒真核表达载体,将外源性P27kipl基因转染人胃癌细胞系BGC-823,应用Westernblot、流式细胞分析术(FCM)等方法,检测P27kipl蛋白在胃癌细胞内的表达、诱导凋亡作用及其对bcl-2基因表达的影响。结果外源性P27kipl蛋白在胃癌细胞中获稳定表达,胃癌细胞凋亡,bcl-2蛋白表达水平降低。结论P27kipl的过度表达可通过对bcl-2表达的调控显著促进胃癌细胞凋亡,提示P27kipl基因转染可成为胃癌的有效治疗方法。     

p27kip1基因逆转录病毒载体的构建及其对人胃癌细胞系生长抑制作用的研究

目的：研究逆转录病毒介导的p27^kip1基因过度表达对细胞周期和细胞增殖的影响。方法：构建含人p27^kip1基因的逆转录病毒真核表达载体，应用脂质体介导法，将外源性p27^kip1基因转染人胃癌细胞系BGC－823，应用Western blot,FCM等方法，检测p27^kip1蛋白在胃癌细胞内的表达及其对细菌胶殖的影响。结果：获得含人p27^kip1 cDNA的重组逆转录病毒载体，外源性野生型p27^kip1基因整合于胃癌细胞并获稳定表达，细胞生长速度受抑制，同时出现G1期阻滞。结论：构建的p27^kip1重组逆转录病毒能有效介导外源性p27^kip1在人胃癌细胞系中高表达，抑制细胞增殖，为进一步研究以p27^kip1为目的基因的肿瘤基因治疗奠定了基础。     

胃癌组织中p27基因甲基化改变及其与胃癌生物学特性的关系

目的 检测胃癌组织中p27基因的5'CpG岛甲基化状态,并探讨p27基因甲基化状态与胃癌生物学特性的关系。方法 利用甲基化特异性PCR测定49例胃癌组织,20例癌旁组织以及10例正常胃黏膜组织中p27基因的甲基化状态。结果 胃癌组p27基因甲基化率为49％,癌旁组p27基因甲基化率为25％,正常胃黏膜组p27基因甲基化率为0。胃癌组p27基因甲基化率明显高于正常胃黏膜组(P＜0.05);淋巴结转移组p27基因甲基化率为61％,显著高于无淋巴转移组的28％(P＜0.05)。P27基因甲基化率与患者年龄、性别、肿瘤组织大小、部位无关(P＞0.05)。结论 p27基因甲基化可能导致p27mRNA的失转录,并与胃癌的发生、转移相关。     

p27Kip1蛋白在胃腺癌中的表达及基与肿瘤细胞增殖的关系

目的 探讨细胞周期素依赖性激酶抑制蛋白27(p27kip1)在胃腺癌中的表达及其对肿瘤细胞增殖的影响和临床意义.方法 采用免疫组织化学SP法检测100例胃腺癌组织中p27kip1蛋白的表达,并与20例正常胃黏膜组织作对照,同时应用流式细胞仪对胃腺癌S期细胞比(SPF)进行检测.结果 正常胃黏膜组织中p27kip1蛋白高表达率明显高于胃腺癌组(X2=15.45,P＜0.01).在高/中分化组,黏膜层/黏膜下层组和无淋巴结转移的病例中,p27kip1蛋白高表达率分别为65.31%、80.00%、73.53%;SPF值分别为21.6±4.2、20.3±3.9、20.1±4.0.但随着胃癌分化程度的降低,侵及肌层/浆膜层或发生淋巴结转移,p27kip1蛋白高表达率明显降低(41.18%、48.24%、42.42%)(X2值分别为5.84、5.16、8.72,P＜0.05或P＜0.01);而SPF值明显升高(25.9±5.1、24:4±4.8、25.7±5.1)(t值分别为4.592、3.127、5.575,P均＜0.01).p27kip1蛋白高表达与SPF值呈显著负相关(t=3.478,P＜0.01).结论 p27kip1与胃腺癌发生发展密切相关.p27kip1蛋白表达降低和高的SPF值常提示胃腺癌的低分化、高侵袭转移能力,提示p27kip1和SPF值可作为临床判断胃腺癌预后的指标.     

PTEN蛋白和p27在胃癌中的表达和相关性研究

目的：研究胃癌中抑癌基因PTEN和p27的表达和丽者间的关系.方法：应用免疫组化方法检测36例胃癌组织、10例癌旁组织和8例正常胃组织中PTEN和p27蛋白的表达情况.结果：胃癌组织中PTEN和p27阳性表达率分别为61.1%（22/36）和63.9%（23/36）（P＞0.05）,均低于正常胃组织阳性率100%（P＜0.05）胃癌组织中PTEN和p27阳性表达存在正相关关系（r=0.3043 P＜0.05）,结论：PTEN和p27基因的异常改变参与胃粘膜细胞的恶性转化过程,PTEN和p27蛋白表达水平可作为评价胃癌病理生物学行为的客观指标之一.     

反义人端粒酶逆转录酶基因转染对人胃癌细胞系的影响

目的探讨反义人端粒酶(hTERT)基因治疗的可行性。方法构建hTERT基因的反义表达载体,经脂质体介导转染人未分化胃癌细胞系HGC-27,通过Southernblot检测外源反义基因的整合;RT-PCR及DNA测序法检测反义基因的转录;RT-PCR半定量方法检测被封闭目的基因mRNA的转录水平;TRAP及PCRELISA方法检测细胞的端粒酶活性;流式细胞仪检测细胞周期变化。结果外源反义hTERT基因已整合入细胞并获稳定转录,且能显著封闭目的基因转录的mRNA,并显著抑制HGC-27细胞的端粒酶活性,抑制HGC-27细胞的增殖并促进其凋亡。结论端粒酶反义hTERT基因可有效地应用于胃癌的基因治疗。     

Penetration of the gastric band through the gastric wall during pregnancy: A rare case report

Introduction and importanceObesity is a major health problem. Obese women have an increased risk of pregnancy-related complications. Weight loss before conception is associated with improved fertility rates and pregnancy outcomes. Bariatric surgery (BS), such as laparoscopic adjustable gastric banding (LAGB), was a popular option for obese women planning pregnancy. However, long-term follow-up studies indicate high rate of failure and reoperations.The work has been reported in line with the SCARE 2020 criteria.Case presentationWe present a case of a 41-years-old multigravida who was diagnosed with intragastric penetration of the gastric band on the 27th week. Diagnostic laparoscopy and intraoperative esophagogastroduodenoscopy were performed. Gastric band was not removed and no other surgical interventions were performed. The patient underwent a caesarean section on the 37th week, due to the remaining risk of repeated gastric-band-related complications.Clinical discussionThe management of pregnancy following LAGB has not been well defined yet. Gastric band erosion with intragastric band migration is considered to be one of the most worrisome of all LAGB-related complications.ConclusionInternational treatment consensus for pregnancy after BS is still missing. This case illustrates a need for practitioner to maintain a high index of suspicion of gastric-band-related complications during pregnancy.Gastric-band-related complications during pregnancy are rare with only limited number of published reports. To our knowledge, this is the first reported intragastric penetration of the gastric band in a pregnant woman, which was managed without gastric band removal during pregnancy and which had a good outcome for both, the patient and her baby.     

肿瘤坏死因子相关凋亡诱导配体通过促进死亡相关蛋白3表达抑制人胃癌细胞株的生长

目的：观察肿瘤坏死因子相关凋亡诱导配体（TRAIL）对人胃癌细胞株的生长抑制作用及其作用前、后人胃癌细胞株中死亡相关蛋白3（DAP3）表达情况，探讨DAP3在TRAIL抑制人胃癌细胞株生长中的作用。方法：选择不同浓度（0、50、100、200ng／m1）TRAIL作用于人胃癌细胞株BGC-823和HGC-2748h后，用酸性磷酸酶法测定各组细胞株生长抑制情况，确定TRAIL的有效浓度：取有效浓度的TRAIL处理人胃癌BGC-823和HGC-27细胞株48h后，分别用Westem印迹法和RT—PCR检测TRAIL对DAP3蛋白和DAP3mRNA表达的影响。结果：①酸性磷酸酶法测得100ng／mlTRAIL可有效抑制人胃癌细胞株BGC-823和HGC-27生长。②Western印迹法未能在人胃癌细胞株BGC-823和HGC-27中测得DAP3表达．而100ng／mlTRAIL处理后48h，在BGC-823和HGC-27中均可测得DAP3表达：同样．RT—PCR法测得100ng／mlTRAIL处理48h后．两株胃癌细胞株中DAP3mRNA表达显著升高。结论：TRAIL能有效抑制人胃癌细胞株BGC-823和HGC-27的生长．其机制与促进DAP3表达有关。     

Treatment of patients with gastric polyps

Examined were 104 patients after endoscopic removal of gastric polyps. In regular treatment of concomitant achylic gastritis, the activity of gastric juice normalized in 11 (17.4%) patients, the incidence of detection of alkaline phosphatase in it reduced 6-fold, thermostable fraction--27-fold, no polyp recurrences were revealed. Without treatment of gastritis, at control gastrofibroscopy, in 3 patients, the polyp recurrences were revealed, the indices of gastric secretion in 60% of the cases worsened.     

Effect of Roux-en-Y reconstruction on the gastric emptying of a solid meal

The gastric emptying of a solid meal was measured in 39 patients after Roux-en-Y reconstruction and compared with that in 27 patients after truncal vagotomy and pyloroplasty and that in 22 patients after Polya gastrectomy. There were no significant differences among the groups. It is concluded that despite the disruption of the normal motor pathway produced by the Roux-en-Y reconstruction it does not lead to clinically significant delay in gastric emptying.     

多层螺旋CT在晚期胃癌转化治疗后N分期及淋巴结转移判断中的临床应用分析

目的探讨多层螺旋CT(MSCT)检查在晚期胃癌转化治疗成功并行手术治疗患者的N分期和淋巴结转移判断中的应用价值。方法回顾性分析2017年7月至2019年7月期间青岛大学附属烟台毓璜顶医院收治的晚期胃癌转化治疗后成功行手术的患者27例,所有患者行SOX方案转化治疗,术前行MSCT增强扫描。以术后病理的N分期及淋巴结转移分组为金标准,判断MSCT增强扫描与其的一致性。结果以术后病理学检查结果为金标准,MSCT检查对1、3、5、6、7、8及16组淋巴结转移的评估准确率分别为77.78%(21/27)、81.48%(22/27)、85.19%(23/27)、88.89%(24/27)、85.19%(23/27)、74.07%(20/27)和96.30%(26/27);判断N分期的总准确率为62.96%(17/27),与病理N分期一致性的Kappa系数为0.419(P=0.003)。结论 MSCT检查对于转化治疗后晚期胃癌患者N分期的判断准确性较高,但一致性中等。此外,对于1、3、5、6、7、8及16组淋巴结转移的判断准确率也相对较高。     

外伤性胃穿孔30例诊断和外科治疗

目的 探讨外伤性胃穿孔的临床特点与诊治。方法 回顾性分析30例外伤性胃穿孔患者的临床资料,全部均行手术治疗,其中胃穿孔修补术28例,胃部分切除胃空肠吻合术2例。结果 治愈27例,死亡3例,病死率10％。结论 开放性损伤是外伤性胃穿孔常见的致伤原因,合并伤常见。手术是外伤性胃穿孔的主要治疗手段,以缝合修补为主。术中应注意胃贯穿性与后壁穿孔及其他脏器的合并伤的处理。     

Effect of cisapride on delayed gastric emptying in diabetic patients

Delayed gastric emptying is supposed to affect glycemic control in diabetic patients by relative over dosing of insulin to blood glucose level due to delayed absorption of nutrients. Therefore, treatment of delayed gastric emptying is important in diabetic patients. Cisapride, a potent gastrokinetic agents, has been reported to activate the motility from stomach to colon. We evaluated the effect of acute oral administration of cisapride in seven diabetic patients (aged 46-62) with delayed gastric emptying. All patients complicated with autonomic neuropathy. Ten mg of cisapride was administered orally 30 minutes before breakfast and lunch on the day of study. Gastric emptying study was done using 99mTc-tin colloid labeled omelet meal served with 2 slices of toast and 200 ml of milk. With cisapride, the retention rate at time of 150 minutes decreased from 76 +/- 10% to 47 +/- 13% (mean +/- SD) (p less than 0.001) and starting index shortened from 86 +/- 28 minutes to 38 +/- 27 minutes (p less than 0.05). Gastric emptying speed became faster from 0.31 +/- 0.16%/min to 0.43 +/- 0.12%/min (0.2 greater than p greater than 0.1). Blood glucose level before meal decreased from 117 +/- 27 mg/dl (mean +/- SE) to 74 +/- 7 mg/dl (n.s.), and difference between basal and maximal blood glucose level became larger from 46 +/- 27 mg/dl to 84 +/- 30 mg/dl (n.s.). We conclude that acute oral administration of cisapride has significant effect in improving delayed emptying of solid meal in diabetic patients.     

Surgical management of gastric ulcer

The charts of 139 patients operated on for benign gastric ulcer between 1976 and 1980 were reviewed. Indications for surgery included failure of medical management, bleeding, perforation and inability to differentiate benign from malignant disease. Surgical management included hemigastrectomy 29%, vagotomy with antrectomy 27%, vagotomy with pyloroplasty 13%, wedge resection 7% and highly selective vagotomy 4%. Eighty-four patients (60%) were available for a minimum 4-year follow-up. Recurrence rates were highest in those treated by highly selective vagotomy (33%) and wedge resection (30%). The overall death rate was 4.3%, and 70% of the patients were classified as Visick grades I or II (no or minimal symptoms). Of the 30 patients with acute perforation, 21 were treated by omental patching; 1 died and 3 had recurrent ulcer. Of six patients treated by vagotomy with antrectomy, there were no deaths and no recurrences. The authors conclude that lesser procedures are associated with an unacceptable recurrence rate and that gastric resection is the procedure of choice for both elective and emergency management of gastric ulcer.