肝细胞癌合并肝硬化患者肝脾联合切除术后免疫功能变化的研究

目的　探讨肝细胞癌合并肝硬化患者肝癌切除时联合脾切除术后免疫功能的变化。方法　将 16例肝癌合并肝硬化患者分成 2组 ,即肝癌切除联合脾切除组 ( 7例 )和单纯肝癌切除组 ( 9例 ) ,于术前、术后 2个月取外周血 7ml,采用流式细胞仪检测CD4、CD8、CD4 /CD8,ELISA法检测IL 2、IFN γ、IL 10。　结果　 2组患者术前CD4、CD8、CD4 /CD8、IL 2、IFN γ、IL 10水平差异无显著性 ;术后 2个月 ,切脾组CD4 ( 3 8 2 %± 3 7% )、CD4 /CD8( 1 7%± 0 3 % )高于保脾组CD4 ( 3 2 5 %± 4 0 % )、CD4 /CD8( 1 1%± 0 1% ) ,而CD8( 2 3 7%± 3 7% )低于保脾组CD8( 2 9 4 %± 4 0 % ) (P <0 0 5 ) ;切脾组IFN γ[( 10 4 4± 14 9)pg/ml]、IL 2 [( 98 6± 18 6)pg/ml]高于保脾组 [IFN γ( 70 5± 12 6)pg/ml、IL 2 ( 80 9± 13 5 )pg/ml],而IL 10 [( 5 5 5± 11 2 )pg/ml]低于保脾组 [IL 10 ( 89 4± 10 )pg/ml](P <0 0 5 )。　结论肝癌切除时联合脾切除不但没有降低机体T细胞亚群和Th细胞的平衡 ,反而促进其恢复平衡 ,并改善机体抗肿瘤免疫功能     

脾大部切除脾肺固定术治疗门脉高压症的评价

目的　探讨脾大部切除脾肺固定术治疗门脉高压症的效果 ,寻找门脉高压症外科治疗新方法。方法　自 1985～ 2 0 0 0年间应用脾大部切除将残脾与肺底固定术治疗门脉高压症患者 2 80例 ,通过X线、B型超声、锝扫描、血清Tuftsin检测、残脾病理检查 ,观察胸腔残脾形态及功能变化 ,采用血管造影、DSA等检测方法 ,了解脾肺间分流情况。结果　胸腔残脾均存活 ,功能正常。部分病人血清Tuftsin水平术前 (6 0 2± 16 4) μg/L ,术后为 (6 6 5± 144 ) μg/L。血管造影显示门肺形成分流通路。食管钡餐透视证实术后食管静脉曲张改善或消失 ,术后随访再出血率为 3% ,肝功能改善 ,腹水消失。无肝性脑病及OPSI发生。结论　保留脾极性脾大部切除术是门脉高压症巨脾保脾术最理想的术式。脾大部切除脾肺固定术可作为治疗门脉高压症的一种术式 ,认为门脉高压症的保脾术比外伤性保脾术更有临床价值     

肝癌合并肝硬化患者肝癌切除后机体免疫状态的变化

目的探讨肝癌合并肝硬化患者癌灶切除前后机体免疫状态的变化。方法以肝硬化患者为对照组 ,采用流式细胞技术 (FCM)及ELISA方法分析 18例中晚期肝癌合并肝硬化患者癌灶切除前后外周血T细胞亚群CD4、CD8、CD4 /CD8及Th1/Th2细胞因子IFN γ、IL2、IL10蛋白水平的变化。结果　肝癌切除术后CD4 (33± 3) %、CD4 /CD8(1 1± 0 1)、IL2 (71± 11)pg/ml、IFN γ(90± 15 )pg/ml回升 ,高于术前水平〔CD4 (2 9± 4 ) %、CD4 /CD8(0 9± 0 3)、IL2 (5 7± 15 )pg/ml、IFN γ(78± 13)pg/ml〕 ,但仍低于肝硬化组〔CD4 (37± 4 ) %、CD4 /CD8(1 3± 0 2 )、IL2 (82± 15 )pg/ml、IFN γ(10 4± 2 2 )pg/ml〕(P <0 0 1或P <0 0 5 ) ;CD8(32± 3) %、IL10 (70± 9)pg/ml下降 ,低于术前〔CD8(35± 6 ) %、IL10(81± 15 )pg/ml〕水平但高于肝硬化组〔CD8(2 9± 2 ) %、IL10 (6 1± 10 )pg/ml〕(P <0 0 5 )。结论　癌灶切除后 ,机体免疫功能有明显改善。但仍未恢复到肝硬化患者的水平。     

全脾切除术与部分脾切除术对门静脉高压症脾功能亢进患者免疫功能影响的比较

目的探讨全脾切除术与部分脾切除术对门静脉高压症脾功能亢进患者免疫功能影响。 方法采用随机分组的方法对2013年2月至2016年7月符合纳入标准的146名患者分为两组,全脾切除术组和部分脾切除术组。采用统计软件SPSS20.0进行分析,两组手术指标、免疫指标采用(均值±标准差)表示,独立t检验;两组计数资料的比较使用卡方检验。P<0.05为差异有统计学意义。 结果治疗前后比较,两组患者免疫球蛋白、T细胞亚群计数、炎症因子和细胞因子含量指标的差异均具有统计学意义(P<0.05),部分脾切除组患者IgG、IgA、IgM、CD8^＋均低于全脾切除组,而IL－1、IL－2、IL－6、TNF－α、TGF－β、CD4^＋和CD4^＋/CD8^＋高于全脾切除组。全脾切除组患者手术时间、失血量、胃肠道功能恢复时间指标均大于部分脾切除组,差异具有统计学意义(P<0.05)。 结论门静脉高压症脾功能亢进患者实施部分脾切除术效果更好,值得临床推广。     

腹腔镜巨脾切除术对患者术后免疫功能的影响

目的 观察腹腔镜巨脾切除术对患者免疫功能的影响.方法 将26例巨脾、脾功能亢进患者随机分为腹腔镜巨脾切除组(LS)12例和开腹脾切除组(OS)14例,比较两组病例术前、术后1、7 d外周血淋巴细胞亚群及免疫球蛋白变化.结果 腹腔镜组术后1、7 d的成熟T淋巴细胞(CD3)、辅助T淋巴细胞(CD4)、CD4与抑制淋巴细胞(CD8)的比值及免疫球蛋白IgG、IgA、IgM与术前比较差异无统计学意义(P>0.05).开腹组术后1、7 d的CD3、CD4、CD4/CD8及IgG与术前比较明显下降(P<0.05).结论 腹腔镜巨脾切除术较开放脾切除术对患者免疫抑制程度轻.     

新型肿瘤抗原gp96在肝癌小鼠体内的抗瘤效应

目的　观察从肿瘤细胞中提取的热休克蛋白gp96在小鼠体内的特异抗瘤效应。 方法　BALB/C小鼠肝脏成功接种肿瘤后 ,分成 4组。第Ⅰ组单纯切除肿瘤 ,不做免疫治疗 ;第Ⅱ组切除肿瘤 ,用gp96进行免疫治疗 ;第Ⅲ组不切除肿瘤 ,用 gp96进行免疫治疗 ;第Ⅳ组为对照组。第2 8天检测血清中白细胞介素 (IL) 10、干扰素 (IFN ) γ水平 ;CD4、CD8和IFN γ、IL 10双阳性细胞比例。用51Cr释放法测定各组小鼠脾细胞对亲本H2 2 肝癌细胞的杀伤活性。结果　第Ⅱ组血清IFN γ为 13 .3 3ng/L ,CD8+ IFNγ+ 和CD4+ IFNγ+ 细胞比例分别为 5 .79%和 2 .91% ,较其余组升高 (P <0 .0 1) ;血清IL 10为 5 .2 8ng/L ,CD8+ IL 10 + 和CD4+ IL 10 + 细胞比例分别为 4.5 4%和0 .75 % ,低于其他各组 (P <0 .0 1)。效靶比为 10 0∶1时 ,Ⅱ组小鼠脾细胞体外杀伤亲本H 2 2癌细胞的杀伤率为 3 9.3 % ,显著高于其他各组 (P <0 .0 5 )。结论　gp96可激发特异性细胞介导的免疫反应 ,改善抗肿瘤免疫反应。     

晚期血吸虫病巨脾切除对免疫功能的影响

目的 探讨晚期血吸虫病巨脾切除对免疫功能的影响。方法 对20例晚期血吸虫病巨脾病人切除前、术后两周、术后半年、术后一年分别抽取周围静脉血测IgG，IgA,IgM,C3,C4,TNF,sIL-2R,CD3^ ,CD4^ ,CD8^ ，用F检验作出显著性测定。结果 IgA,IgM,C3,C4,TNF,sIL-2R,CD8^ 切脾前后差异不显著（P＞0．05），IgG,CD3^ ,CD4^ ,CD4^ /CD8^ 切脾后升高，差异显著（P＜0．01－0．05）。结论 晚期血吸虫病巨脾切除后对体液免疫和细胞免疫均无不良影响，因而治疗性脾切除是合理的。     

脾切除对肝硬化门静脉高压脾功能亢进患者影响的研究进展

肝炎后肝硬化通常合并门静脉高压症,后者常致脾功能亢进(脾亢).对于同时伴有脾亢的患者,是否联合行脾脏切除,目前尚存在争议.持保脾观点的一方认为,脾切除后会降低免疫功能,增加感染机会和肝肿瘤的发生,同时会增加门静脉系统并发血栓的风险.而主张切脾的一方认为,联合脾切除作为外科治疗门脉高压症的主要方法之一,除了能降低门静脉压...     

手助腹腔镜脾切除与开腹脾切除对机体术后免疫功能影响的比较

目的研究手助腹腔镜脾切除术和开腹脾切除对机体免疫功能的影响,考察该术式的临床价值。方法16例肝硬化脾亢患者随机分为手助腹腔镜脾切除组和开腹脾切除组,比较两组病例术前、术后1d、3d、7d外周血淋巴细胞亚群的变化。结果开腹组术后1d、3d、7d的成熟淋巴细胞(CD3)、辅助淋巴细胞(CD4)及CD4与抑制性T淋巴细胞(CD8)的比值与术前相比明显下降(P<0.05或P<0.01)。而腹腔镜组术后1d、3d、7d的CD3、CD4、CD4/CD8与术前相比没有显著差异(P>0.05)。结论手助腹腔镜脾切除术结合了微创外科和传统开腹手术的优点,具有安全、创伤小、恢复快的特点,具有很好的临床应用价值和前景。     

探讨门脉高压及外伤性脾破裂行脾切除术后血小板升高及门静脉血栓形成情况

目的比较不同病因行脾切除术后血小板升高及门静脉系统血栓形成情况。方法回顾性统计2015年6月至2018年2月本院脾切除术患者64例,其中设定因门脉高压至脾大伴脾功能亢进行脾切除患者28例为门脉高压组,设定因外伤性脾破裂行脾切除患者36例为外伤组,分别统计并对比2组患者术前、术后第1、4、7天、第2、3、4周血小板计数及门静脉血栓形成情况。结果与外伤组相比,门脉高压组血小板升高幅度更为明显,差异具有统计学意义(P 0. 05),门静脉血栓形成率较高(P 0. 05)。结论与外伤性脾破裂相比,门脉高压所致脾大、脾功能亢进者,脾切除术后血小板升高更为明显,且升高幅度更大,更易形成门静脉血栓。     

急性胰腺炎细胞免疫功能测定

目的　探讨急性胰腺炎（ＡＰ） 病人的细胞免疫状态。方法　对３７ 例急性胰腺炎患者和１０ 例健康成人的Ｔ 淋巴细胞亚群,Ｃ 反应蛋白（ＣＲＰ） 进行测定分析。结果　Ｔ淋巴细胞亚群中ＣＤ４ 阳性细胞百分比和ＣＤ４／ＣＤ８ 比值在重症急性胰腺炎（ＳＡＰ） 患者中下降明显。结论　ＡＰ 患者特别是ＳＡＰ 患者存在细胞免疫功能损害,免疫调节治疗可能对ＳＡＰ 患者有一定的作用。邱新光, 男,３６ 岁, 医学博士, 河南医科大学附一院外科,４５００５２ 　河南省郑州市建设东路１ 号秦兆寅,纪宗正, 黎一鸣, 西安医科大学第二附属医院外科,７１０００４ 　陕西省西安市西五路３６ 号     

固定化脂肪酶Lipozyme TL IM催化菜籽油醇解反应合成生物柴油的工艺条件

脂肪酶Lipozyme TL IM在有机相体系中能有效催化菜籽油醇解反应生成生物柴油。作者研究了酶量、底物比率、反应时间、反应温度、转速、水分质量分数、有机溶剂对产物得率的影响。最佳工艺条件为：在正己烷的反应介质中,酶量50%,醇油摩尔比3∶1,反应温度50℃,转速150r/min,添加质量分数5%的水分,反应12 h后产物脂肪酸甲酯得率可达92.3%。     

Serial monitoring of immunological parameters following human hand transplant

BACKGROUND: Although early successes have been achieved in human hand transplant, the changes of immunological parameters in the recipients and their relations to clinical events were not yet known. METHODS: In two patients undergoing hand transplantation, we prospectively determined lymphocyte subsets using flow cytometry as well as the serum levels of interleukin (IL)-2, IL-10, tumor necrosis factor (TNF)-alpha, and interferon (IFN)-gamma using enzyme linked immunosorbent assays during the first 6 months after transplantation. RESULTS: The decreases in CD, CD, CD T cell, the activated T cell (CD/CD, CD/HLA-DR(+)) as well as IL-2, IFN-gamma and corresponding significant peak in IL-10 in human hand transplant during the first post-transplant week were observed. Then these parameters recovered to the pre-transplant level except for an even higher level of CD T cell. The low CD/CD ratio was been maintained constantly. After 7 wk, IL-2, IFN-gamma, and IL-10 decreased to be maintained at a low or undetectable level except for slight increase in IL-10 at post-transplant month 5. There are no significant variation in TNF-alpha early after transplant. After 3 months, IL-10 was not detected again. CONCLUSIONS: The immunosuppressive agents had significantly effects on the immunological status in human hand transplant recipients. These profiles of immunological parameters would be useful data for the future immunomonitoring in human hand transplant recipients.     

Methotrexate for the treatment of unruptured tubal pregnancy: a prospective nonrandomized study.

BACKGROUND AND OBJECTIVES: The aim of this study was to compare in a prospective nonrandomized study, the efficacy of 2 methods of administering methotrexate (MTX) in the treatment of ectopic pregnancy (EP): transvaginal injection under sonographic control or intramuscular injection (IM). METHODS: Patients with EP who met specific inclusion criteria for medical treatment were treated with MTX: 63 patients (group 1) were treated by IM and 47 patients (group 2) by transvaginal local injection. In group 1, 50 mg/m2 of MTX was injected intramuscularly; in group 2, transvaginal injection of 1 mg/kg of MTX was injected into the ectopic sac under sonographic control. When an additional dose of MTX was required, it was administrated IM at the dosage of 50 mg/m2 in both groups. RESULTS: The overall success rate, defined by a posttreatment normal hCG level (< 10 mUI/mL) was 71.4% in group 1 versus 91.5% in group 2 (P < 0.01); for patients with hCG levels < 2000 mUI/mL, 83% and 96%, respectively (not significant); for patients with hCG > or = 2000 mUI/mL, 37.5% and 86.4%, respectively (P < 0.01). CONCLUSION: In the medical treatment of EP, the efficacy of MTX is greater when administered by local transvaginal injection than by IM injection. We propose local treatment every time EP can be punctured, especially when hCG levels are > or = 2000 mUI/mL.     

胰岛素依赖型糖尿病患者胚胎胰腺组织脑内移植的远期疗效观察与免疫学研究

目的观察脑内胰腺组织移植治疗胰岛素依赖型糖尿病（ＩＤＤＭ）的远期疗效,并探讨其免疫学变化。方法应用短期培养的人胎胰腺组织脑内移植,共施行３０例,移植术后随访１～７年。结果移植后１年内有效２６例,无效４例;移植后２～３年随访２１例,有效１７例,失效４例;４～５年随访１８例,有效１５例,失效３例;移植后６～７年随访１５例,有效９例,失效６例。在移植有效的病例中,随访资料较完整者２３例,有效维持时间为（４．９±１．７）年,１１例完全或间断停用胰岛素治疗,停用时间达（３．１±１．９６）年,其中超过３年者６例。移植前胰岛细胞抗体（ＩＣＡ）阳性的６例,４例移植无效;移植无效或后期复发的患者,外周血Ｔ淋巴细胞亚群明显失衡。结论脑内胰腺组织移植治疗ＩＤＤＭ的远期效果显著;ＩＣＡ阳性者不宜行胰腺组织移植     

The diaphyseal aseptic tibial nonunions after failed previous treatment options managed with the reamed intramedullary locking nail

BackgroundThe nonunion of open and closed tibial shaft fractures continues to be a common complication of fractures. Tibial nonunions constitute the majority of long bone nonunions seen by orthopaedic surgeons. In this article, we present our approach to the surgical treatment of noninfected tibial shaft nonunions.MethodsBetween 2008 and 2014, 33 patients with aseptic diaphyseal tibial nonunion was treated by reamed intramedullary nailing and were retrospectively reviewed. The initial fracture management consisted of external fixation (27 patients), plate fixation (2 patients) and cast treatment (4 patients). All patients, preoperatively, were evaluated for the signs of the infection, by the same protocol. There were 13 hypertrophic, 16 oligotrophic (atrophic) and 4 defect nonunions registered in our material. The primary goal was to perform a closed intramedullary nailing on antegrade manner. An open procedure was only unavoidable when implants had to be removed or an osteotomy had to be performed to improve the alignment. Functional rehabilitation was encouraged with the assistance of a physiotherapist early postoperative. Patients were examined regularly during followed-up for a minimum of 12 months period for clinical and radiological signs of union, infection, malunion, malalignment, limb shortening, and implant failure.ResultsThe time that elapsed from injury to intramedullary nailing ranged from 9 months to 48 months (mean 17 months).Open intramedullary nailing was unavoidable in 25 cases (75,75%), while closed nailing was performed in 8 patients (24,25%). Osteotomy or resection of the fibula was performed in 78,8% of the cases. All patients were followed up in average period of 2 years postoperative (range 1–4 years), and 31(93,9%) patients achieved a solid union within the first 8 months. Mean union time was 5±0.8 months. Complications included 2 (6,06%) patients, one with deep infection and another case with absence of bone healing. Anatomical alignment has been achieved in the majority of patients, 28 patients (84,8%). The additionally autogenous bone chips were added in 4 patients (12,1%) where cortical defect was greater than 50% of the bone circumference.ConclusionIn conclusion, a reamed intramedullary nail provides optimal conditions for stable fixation, good rotational control, adequate alignment, early weight-bearing and a high union rate of tibial non-unions. Reaming of the medullary canal with preservation of periosteal sleeve create the "breeding ground" for sound healing of tibial shaft nonunions. Additionally cancellous bone grafting is recommended only in the case of defect nonunion.