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??Modern concept of spleen preservation management ZHANG Mu, JIANG Hong-chi. Department of General Surgery, the First Affiliated Hospital, Harbin Medical University, Harbin 150001, China Corresponding author: JIANG Hong-chi, E-mail: jianghc@vip.163.com Abstract Since the 1960s, especially in the past 30 years, splenic surgery has developed rapidly because of the intensively study on the physiological function of spleen and the connection between spleen and many diseases. The concept of modern splenic surgery built by progressively accumulating of theory and practice, and formed the theory structure with a preliminary framework. The article retrospects the development and recognition changing of surgery treatment for the splenic trauma, and the consensus and development direction for the management of injuries to the spleen.     

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1 概述 液体治疗是麻醉手术期间维持手术病人生命体征稳定的重要措施.手术中病人需要补充正常的生理需要量以及麻醉和手术所导致的循环血容量改变和液体缺失,维持良好的组织灌注和内环境稳定,避免细胞代谢紊乱和器官功能损伤.     

��Upside-Down�� Augmentation Mastopexy

Background  

The author’s wide experience with postbariatric body contouring pushed him to find a technique suitable for correcting the two most common defects of the massive weight loss (MWL) breast: hypotrophy and ptosis. For these defects, a technique selection algorithm has been created. According to the algorithm, the “upside-down” technique was developed for those cases with a diagnosis of “minor ptosis” (<6 cm of vertical nipple–areolar complex correction).     

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戈谢病(Gaucher disease)是溶酶体贮积病(lysosomal storage disease,LSD)中最常见的一种,属于常染色体隐性遗传.1882年由法国人Gaucher首次报道.我院收治2例成人型戈谢病,现结合国内外文献,对其临床表现、诊断及治疗问题进行讨论.     

Bladder mass ��collagenoma��

Large bladder masses are typically found to be malignant in nature. We present a case of a large bladder neck mass as a result of previous imprecise collagen injection for urethral bulking. The patient was successfully treated as an outpatient with transurethral excision of the collagen mass combined with post-operative anticholinergic therapy.     

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治疗效果同治疗方式及理念的规范化密切相关,治疗的规范化带来了治疗效果和预后的改善。从全直肠系膜切除(TME)的理念提出和广泛应用,到肿瘤相关系膜切除(TSME)概念对TME进行完善和补充,直到近年完整结肠系膜切除(CME)理念的提出,胃肠外科医师对规范结直肠癌外科治疗的努力从未停止过。     

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目的 分析和总结残胃癌的外科诊断和治疗情况。方法 回顾分析了28例残胃癌发病率、临床表现及治疗情况。结果 首次胃切除以胃溃疡为主，占64.3%。首次手术B-Ⅱ式22例，占84.6%。确诊残胃癌距首次手术时间平均为28.3年。残胃癌发生在吻合口占50%，残胃小弯侧42.9%，贲门部7.1%。结论 胃良性病行手术治疗时以B-I式为首选；定期胃镜检查残胃癌高危人群，早期诊断、早期治疗是提高残胃癌预后的关键。     

EGF��EGFR��PCNA��������ٰ��ٴ�����ѧ������Ԥ��Ĺ�ϵ

目的　探讨EGF、EGFR和PCNA表达与胰腺癌临床病理学特征以及预后的关系。方法　用免疫组化法检测 70例胰腺癌和 8例正常胰腺组织EGF、EGFR与PCNA表达。结果　胰腺癌组织中EGF、EGFR表达阳性率分别为 47 1%和 6 1 4% ,PCNALI为 31 8%± 18 3% ,正常胰腺组织表达较弱。三者表达与胰腺癌分化程度有关(P <0 0 5或P <0 0 1) ,但与肿瘤大小、部位、淋巴结转移和临床分期无关。EGF阳性病例术后平均中位生存期与阴性病例无明显差别 (P >0 0 5 ) ,而EGFR阳性病例较阴性病例明显缩短 (P <0 0 1)。PCNALI与胰腺癌术后生存期呈明显负相关 (r=- 0 47,P <0 0 1) ,PCNALI≤ 33 2 %组术后生存期与 >33 2 %组相比具有明显差异 (P<0 0 5 )。结论　胰腺癌组织EGFR和PCNA检测对判定肿瘤恶性程度和估计预后具有一定临床意义。