Substrate of complex fractionated atrial electrograms: evidence by pathologic analysis

Background  Ablation of complex fractionated atrial electrograms (CFAE) is an important adjunctive therapy in atrial fibrillation (AF). The present study was to elucidate the substrate underlying CFAE.

Methods  Nine adult mongrel dogs were involved in the present study. AF was induced through rapid atrial pacing with vagosympathetic nerve stimulation. CFAE was recorded during AF. Ablation was performed at CFAE sites. Based on the location of the ablation scar, the atrial specimens were divided into CFAE and non-CFAE sites. Serial sections of the atrium were stained respectively with hematoxylin-eosin (HE) and the general neural marker protein gene product 9.5 (PGP9.5). We compared the characteristics of the myocardium and the ganglionated plexus (GPs) distribution between the CFAE and non-CFAE sites.

Results  The myocardium of non-CFAE sites was well-organized with little intercellular substance. However, the myocardium in the CFAE site was disorganized with more interstitial tissue ((61.7±24.3)% vs. (34.1±9.2)%, P <0.01). GPs in the CFAE site were more abundant than in non-CFAE sites ((34.45±37.46) bundles/cm² vs. (6.73± 8.22) bundles/cm², P <0.01).

Conclusion  The heterogeneity of the myocardium and GPs distribution may account for the substrate of CFAE and serve as a potential target of ablation.

     

Acute responses to inhalation of Iloprost in patients with pulmonary hypertension

Background  Iloprost has been used to test acute pulmonary vasoreactivity in idiopathic pulmonary arterial hypertension (PAH). We aimed to investigate the acute hemodynamic and oxygenation responses and tolerability to 20 µg aerosolized Iloprost in Chinese patients with pulmonary hypertension.

Methods  Between March 2005 and May 2010, 212 pulmonary hypertension patients inhaled a single dose of 20 µg Iloprost over 10–15 minutes for vasoreactivity testing. The acute hemodynamic and oxygenation responses and adverse events were recorded.

Results  Iloprost decreased total pulmonary resistance ((1747±918) dyn×s×cm^-5 vs. (1581±937) dyn×s×cm^-5, P <0.001), increased stroke volume ((45.0±22.1) ml vs. (47.0±24.2) ml, P=0.002), and cardiac output ((3.7±1.7) L/ml vs. (3.9±1.9) L/min, P=0.009). Heart rate and systemic vascular resistance remained stable during inhalation. However, systemic arterial blood oxygen saturation fell slightly ((91.0±6.8)% vs. (90.3±6.7)%, P=0.002). Pulmonary and systemic arterial blood pressures declined within 1–3 minutes after inhalation initiation and reached their lowest levels within 10–15 minutes. Idiopathic PAH responded more favorably than pulmonary hypertension due to other causes (P £0.001) and patients with less severe pulmonary hypertension have better responses to Iloprost. No adverse events requiring medical care or leading to termination of inhalation occurred.

Conclusions  Inhalation of 20 µg Iloprost showed potent and selective pulmonary hemodynamic effects and was well tolerated in the Chinese pulmonary hypertension patients. Patients with idiopathic PAH and less severe pulmonary hypertension responded more favorably to inhalation of Iloprost.

     

Interleukin-18 and -12 synergistically enhance cytotoxic functions of tumor-infiltrating lymphocytes

Background  The role of tumor-infiltrating lymphocytes (TILs) in the immunopathogenesis of individual cancer is not clear and is a challenge for anti-tumor immunotherapy. This study aimed to investigate the effects of interleukin (IL)-18 and -12 on cytotoxic functions of TILs.

Methods  TILs from postoperative gastric cancer patients were costimulated with IL-18 and IL-12. SGC-7901 tumor cells were pre-incubated with TILs and subcutaneously injected into BALB/C SCID mice. The function of TILs was evaluated by measuring tumor sizes in tumor-bearing mice, T helper (Th)1 (tumor necrosis factor (TNF)-α, interferon (IFN)-γ) and Th2 cytokine levels (IL-10 and IL-4) in serum and cytotoxicity of mouse natural killer (NK) and CD8⁺ T cells.

Results  IL-18 and IL-12 synergistically inhibited the growth of SGC-7901 cells in vivo and significantly extended the survival rate of SGC-7901-bearing mice (66.7% vs. 13.7%, P <0.01). Moreover, TILs could promote the secretion of TNF-α and IFN-γ ((130.34±7.65) vs. (210.63±12.31) pg/ml, P <0.01; (14.23±1.97) vs. (30.52±2.12) pg/ml, P <0.01), and downregulate IL-10 and IL-4 secretion ((103.72±11.21) vs. (61.36±5.41) pg/ml, P=0.021; (49.36±4.67) vs. (28.48±3.86) pg/ml, P=0.024).

Conclusion  IL-18 and IL-12 can synergistically enhance cytotoxic functions of TILs from human gastric cancer.

     

Ultrasonic destruction of albumin microbubbles enhances gene transfection and expression in cardiac myocytes

Background  It has been proven that ultrasonic destruction of microbubbles can enhance gene transfection efficiency into the noncardiac cells, but there are few reports about cardiac myocytes. Moreover, the exact mechanisms are not yet clear; whether the characteristic of microbubbles can affect the gene transfection efficiency or not is still controversial. This study was designed to investigate whether the ultrasound destruction of gene-loaded microbubbles could enhance the plasmids carried reporter gene transfection in primary cultured myocardial cell, and evaluate the effects of microbubbles characteristics on the transgene expression in cardiac myocytes.

Methods  The β-galactosidase plasmids attached to the two types of microbubbles, air-contained sonicated dextrose albumin (ASDA) and perfluoropropane-exposed sonicated dextrose albumin (PESDA) were prepared. The gene transfection into cardiac myocytes was performed in vitro by naked plasmids, ultrasound exposure, ultrasonic destruction of gene-loaded microbubbles and calcium phosphate precipitation, and then the gene expression and cell viability were analyzed.

Results The ultrasonic destruction of gene-loaded microbubbles enhanced gene expression in cardiac myocytes compared with naked plasmid transfection ((51.95±2.41) U/g or (29.28±3.65) U/g vs. (0.84±0.21) U/g, P <0.01), and ultrasonic destruction PESDA resulted in more significant gene expression than ASDA ((51.95±2.41) U/g vs. (29.28±3.65) U/g, P <0.05). Ultrasonic destruction of microbubbles during calcium phosphate precipitation gene transfection enhanced β-galactosidase activity nearly 8-fold compared with calcium phosphate precipitation gene transfection alone ((111.35±11.21) U/g protein vs. (14.13±2.58) U/g protein, P <0.01). Even 6 hours after calcium phosphate precipitation gene transfection, ultrasound-mediated microbubbles destruction resulted in more intense gene expression ((35.63±7.65) U/g vs. (14.13±2.58) U/g, P <0.05 ) .

Conclusions  Ultrasonic destruction of microbubbles might be a promising method for the delivery of non-viral DNA into cardiac myocytes, and the gene tranfection is related to the characteristics of microbubbles.

     

Expression of interleukin-2 in Candidal balanoposthitis and its clinical significance

Background  Candidal balanoposthitis (CB) is a common male genital infection. Autoimmune mechanisms may play an important role in the pathogenesis of CB. Interleukin-2 (IL-2) is an important molecule in cell-mediated immunity.

Methods  One hundred and one patients were diagnosed with CB using mycology culture in the dermatology and urology clinics in our hospital. Ninety-four healthy males were randomly selected as controls. We studied serum levels of IL-2 of patients with CB using ELISA and analyzed the correlations between serum IL-2 and clinical data.

Results  Serum IL-2 concentrations in CB patients were significantly lower than that in the control group ((7.80±4.78) vs. (15.44±7.90) ng/L; t=2.27, P <0.05). The incidence of CB in the low-level group was significantly higher than that in the high-level group (70% (71/101) vs. 36% (30/84), P <0.05). Low levels of serum IL-2, comorbidity with other sexually transmitted diseases (STDs), and sexual partners with vulvovaginal candidiasis (VVC) increased the risk of CB.

Conclusion  The pathogenesis of CB is a complex procedure that includes internal autoimmune factors.

     

Protective effect of low potassium dextran solution on acute kidney injury following acute lung injury induced by oleic acid in piglets

Background  Low potassium dextran (LPD) solution can attenuate acute lung injury (ALI). However, LPD solution for treating acute kidney injury secondary to ALI has not been reported. The present study was performed to examine the renoprotective effect of LPD solution in ALI induced by oleic acid (OA) in piglets.

Methods  Twelve animals that suffered an ALI induced by administration of OA into the right atrium were divided into two groups: the placebo group (n=6) pretreated with normal saline and the LPD group (n=6), pretreated with LPD solution. LPD solution was injected intravenously at a dose of 12.5 ml/kg via the auricular vein 1 hour before OA injection.

Results  All animals survived the experiments with mild histopathological injury to the kidney. There were no significant differences in mean arterial pressure (MAP), creatinin and renal damage scores between the two groups. Compared with the placebo group, the LPD group had better gas exchange parameters at most of the observation points ((347.0±12.6) mmHg vs. (284.3±11.3) mmHg at 6 hours after ALI, P <0.01). After 6 hours of treatment with OA, the plasma concentrations of NGAL and interleukin (IL)-6 in both groups increased dramatically compared to baseline ((6.0±0.6) and (2.50±0.08) folds in placebo group; and (2.5±0.5) and (1.40±0.05) folds in LPD group), but the change of both parameters in the LPD group was significantly lower (P <0.01) than in the placebo group. And 6 hours after ALI the kidney tissue concentration of IL-6 in the LPD group ((165.7 ± 22.5) pg∙ml^-1∙g^-1 protein) was significantly lower (P <0.01) than that in placebo group ((67.2± 25.3) pg∙ml^-1∙g^-1 protein).

Conclusion  These findings suggest that pretreatment with LPD solution via systemic administration might attenuate acute kidney injury and the cytokine response of IL-6 in the ALI piglet model induced by OA injection.

     

Co-transplantation of neural stem cells and Schwann cells within poly (L-lactic-co-glycolic acid) scaffolds facilitates axonal regeneration in hemisected rat spinal cord

Background  Various tissue engineering strategies have been developed to facilitate axonal regeneration after spinal cord injury. This study aimed to investigate whether neural stem cells (NSCs) could survive in poly(L-lactic-co-glycolic acid) (PLGA) scaffolds and, when cografted with Schwann cells (SCs), could be induced to differentiate towards neurons which form synaptic connection and eventually facilitate axonal regeneration and myelination and motor function.

Methods  NSCs and SCs which were seeded within the directional PLGA scaffolds were implanted in hemisected adult rat spinal cord. Control rats were similarly injured and implanted of scaffolds with or without NSCs. Survival, migration, differentiation, synaptic formation of NSCs, axonal regeneration and myelination and motor function were analyzed. Student’s t test was used to determine differences in surviving percentage of NSCs. One-way analysis of variance (ANOVA) was used to determine the differences in the number of axons myelinated in the scaffolds, the mean latency and amplitude of cortical motor evoked potentials (CMEPs) and Basso, Beattie & Bresnahan locomotor rating scale (BBB) score. The χ² test was used to determine the differences in recovery percentage of CMEPs.

Results  NSCs survived, but the majority migrated into adjacent host cord and died mostly. Survival rate of NSCs with SCs was higher than that of NSCs without SCs ((1.7831±0.0402)% vs. (1.4911±0.0313)%, P <0.001). Cografted with SCs, NSCs were induced to differentiate towards neurons and might form synaptic connection. The mean number of myelinated axons in PLGA+NSCs+SCs group was more than that in PLGA+NSCs group and in PLGA group ((110.25±30.46) vs. (18.25±3.30) and (11.25±5.54), P <0.01). The percentage of CMEPs recovery in PLGA+NSCs+SCs group was higher than in the other groups (84.8% vs. 50.0% and 37.5%, P <0.05). The amplitude of CMEPs in PLGA+NSCs+SCs group was higher than in the other groups ((1452.63±331.70) µV vs. (428.84±193.01) µV and (117.33±14.40) µV, P <0.05). Ipsilateral retransection resulted in disappearance again and functional loss of CMEPs for a few days. But contralateral retransection completely damaged the bilateral motor function.

Conclusions  NSCs can survive in PLGA scaffolds, and SCs promote NSCs to survive and differentiate towards neurons in vivo which even might form synaptic connection. The scaffolds seeded with cells facilitate axonal regeneration and myelination and motor function recovery. But regenerating axons have limited contribution to motor function recovery.

 

     

Ibutilide decreases defibrillation threshold by the reduction of activation pattern complexity during ventricular fibrillation in canine hearts

Background  Ibutilide has been commonly used for pharmacologic cardioversion of atrial fibrillation and flutter in clinical settings. The objective of this study was to investigate the effects of ibutilide on the defibrillation threshold (DFT), restitution properties, dispersion of refractoriness and activation patterns during ventricular fibrillation (VF).

Methods  Ibutilide was administrated intravenously in six open-chest beagles. Before and after the drug administration, 20-second episodes of VF were electrically induced and recorded with a 10×10 unipolar electrode plaque sutured on the lateral epicardium of the left ventricle. DFT and VF activation patterns, including type of epicardial activation maps, VF cycle length (VF-CL), conduction velocity, wavelength (WL) and reentry incidence, were measured. Restitution properties and dispersion of refractoriness were estimated from activation recovery intervals (ARI) during pacing.

Results  Compared to baseline, ibutilide markedly decreased the DFT by 31% ((491±14) V vs. (337±59) V, P <0.01). The drug significantly reduced the maximal slope of the restitution curve (1.34±0.08 vs. 0.76±0.06, P <0.01) and its epicardial dispersion (0.36±0.09 vs. 0.21±0.06, coefficient of variation, P=0.03). The dispersion of refractoriness was enhanced at the pacing cycle length of 300 ms to 160 ms by ibutilide. The drug significantly increased the VF-CL ((96±19) ms vs. (112±20) ms, P <0.01) and the WL ((41±9) mm vs. (52±14) mm, P=0.02) during VF, and reduced the reentry incidence by 25% (0.08±0.02 vs. 0.06±0.02, P <0.01). In the epicardial activation maps, ibutilide significantly reduced the percentage of more complex activation maps during VF.

Conclusions  Intravenous ibutilide significantly decreased the DFT. It might be due to reduction of activation pattern complexity during VF.

     

Ibutilide decreases defibrillation threshold by the reduction of activation pattern complexity during ventricular fibrillation in canine hearts

Background  Ibutilide has been commonly used for pharmacologic cardioversion of atrial fibrillation and flutter in clinical settings The objective of this study was to investigate the effects of ibutilide on the defibrillation threshold (DFT), restitution properties, dispersion of refractoriness and activation patterns during ventricular fibrillation (VF).

Methods  Ibutilide was administrated intravenously in six open-chest beagles. Before and after the drug administration, 20-second episodes of VF were electrically induced and recorded with a 10×10 unipolar electrode plaque sutured on the lateral epicardium of the left ventricle. DFT and VF activation patterns, including type of epicardial activation maps, VF cycle length (VF-CL), conduction velocity, wavelength (WL) and reentry incidence, were measured. Restitution properties and dispersion of refractoriness were estimated from activation recovery intervals (ARI) during pacing.

Results  Compared to baseline, ibutilide markedly decreased the DFT by 31% ((491±14) V vs. (337±59) V, P<0.01). The drug significantly reduced the maximal slope of the restitution curve (1.34±0.08 vs. 0.76±0.06, P<0.01) and its epicardial dispersion (0.36±0.09 vs. 0.21±0.06, coefficient of variation, P=0.03). The dispersion of refractoriness was enhanced at the pacing cycle length of 300 ms to 160 ms by ibutilide. The drug significantly increased the VF-CL ((96±19) ms vs. (112±20) ms, P<0.01) and the WL ((41±9) mm vs. (52±14) mm, P=0.02) during VF, and reduced the reentry incidence by 25% (0.08±0.02 vs. 0.06±0.02, P<0.01). In the epicardial activation maps, ibutilide significantly reduced the percentage of more complex activation maps during VF.

Conclusions  Intravenous ibutilide significantly decreased the DFT. It might be due to reduction of activation pattern complexity during VF.

     

Clipping the extremity of ureter prior to nephroureterectomy is effective in preventing subsequent bladder recurrence after upper urinary tract urothelial carcinoma

Background  Bladder recurrent disease is still a challenge in the treatment of upper tract urothelial carcinoma (UTUC). This controlled study aims to investigate the efficacy of early clipping of the distal ureter prior to nephroureterectomy (NU) to prevent bladder recurrence after UTUC.

Methods  Patients with clinical diagnosis of UTUC were subjected to open trans-peritoneal NU and were randomly divided into two groups. One group received modified NU: clipping the distal ureter prior to NU; while the other group underwent traditional standard NU. Subsequent bladder recurrence was the primary endpoint.

Results  From January 2007 to December 2009, 85 eligible cases were enrolled in this study. Modified NU and standard NU were performed on 42 and 43 patients, respectively. Operation time ((215.73±21.26) minutes vs. (220.19±15.35) minutes), blood loss ((105.15±11.32) ml vs. (110.12±9.07) ml), transfusion event (11.20% vs. 9.78%), and the in-patient time (10.0 days vs 9.5 days) were not significant between the two groups. After a median follow-up of 28 months (5–60), six (14.3%) cases who received modified NU had bladder recurrence, which was significantly lower compared with 15 (34.9%) patients from the group that underwent standard NU (P=0.026). In univariate and multivariate analysis, tumor grade (HR 4.33, 95%CI 2.66–6.30, P=0.01) and operation type (HR 2.35, 95%CI 1.53–3.48, P=0.041) were independent risk factors for subsequent bladder recurrence after UTUC.

Conclusions  Clipping the distal ureter at the beginning of NU significantly reduces bladder recurrence after UTUC. It is reasonable to conclude that clipping the distal portion of ureter trans-peritoneal is an effective surgical procedure for the treatment of UTUC.

     

胰腺局部精准切除术治疗胰腺良性肿瘤的临床体会

目的 评价胰腺局部精准切除术(尽可能保留有功能的胰腺组织)的临床可行性、安全性和疗效.方法 分析2007年1月以来本科开展的17例次胰腺局部精准切除术的临床资料.结果 保脾胰体尾切除术11例,中段胰腺切除术5例,保留十二指肠的胰头切除术1例,术后均康复出院.平均手术时间(3.0±0.78) h,术中平均出血量(258.8±86.65) ml,全组病例术中均未输血.保脾组中2例快速病理示恶性肿瘤后即刻加行脾切除术,1例术后胰尾小囊肿;中段胰组中1例术后脾静脉迟发性破裂出血再手术切除脾脏;保留十二指肠胰头切除病例术后短期小流量胰瘘.全组术后血小板计数为(273.1±43.76)×109 L-1,术后平均住院时间为(15.8±7.07) d,术后随访4～48个月,病理提示良性肿瘤者均未见复发及转移.结论 胰腺局部精确切除术治疗胰腺良性肿瘤疗效确切,并可达到最小创伤、最大脏器保有和最佳康复的效果.     

保留脾脏和脾血管的胰体尾切除术15例临床分析

目的总结保留脾脏和脾血管的胰体尾切除术在胰体尾部病变中的应用体会。方法回顾性分析我院2000年至2009年行保留脾脏和脾血管的胰体尾切除术15例患者的临床资料。其中,良性肿瘤7例,恶性肿瘤2例,胰体尾损伤6例。结果本组15例均成功保留脾血管和脾脏,术后胰瘘1例,经保守治疗痊愈。根治性切除胰腺体尾癌2例,生存时间分别为48个月和53个月。结论保留脾血管和脾脏的胰体尾切除术是治疗胰体尾部病变的理想术式。     

Laparoscopic splenectomy: color Doppler flow imaging for preoperative evaluation

Background Laparoscopic splenectomy （LS） is currently the standard approach for resection of a normal-sized spleen. However, this method becomes technical challenge in cases of splenomegaly due to intraoperative hemorrhage. A complete understanding of the splenic vessel anatomy is important to facilitate the difficult laparoscopic procedure. In this retrospective study, we examined the role of color Doppler flow imaging （CDFI） in splenic vessel anatomy and evaluated its value for LS.
Methods Forty-eight patients who underwent splenectomy for various hematologic and autoimmune disorders from May 2004 to December 2007 were enrolled in this study. Twenty-three patients underwent preoperative CDFI examination that included examination of the anatomic type of splenic pedicle, the adjacent relationship between the splenic vessel and pancreas, and spleen size （CDFI group）. In the remaining 25 patients, ultrasonic inspections of the splenic vessel were not performed （non-CDFI group）. Laparoscopic splenectomies in the CDFI group were performed in accordance with the information provided by the preoperative CDFI in each patient. In the non-CDFI group, LS was performed according to the conventional method. In the CDFI group, the constituent ratios of the above-mentioned parameters by CDFI were compared with those recorded during LS using the chi square test. The effectiveness of the technique on surgery in both groups was compared with an independent sample Student＇s ttest.
Results All laparoscopic splenectomies in both groups were performed successfully. However, 2 cases in the non-CDFI group were converted to LS with the assistance of micro-incision because the branches of the splenic vein were inadvertently torn. Two anatomic types of splenic pedicle and four different adjacent relationships between the splenic vessel and pancreas were detected by CDFI. About 80% of spleens fit the criteria of megalosplenia. There were no statistically significant differences between the constituent ratios of the parameters by CDFI and those by intraoperative telerecording in the CDFI group （χ^2=0.383, 1.072, 0.119, P=0.536, 0.784, 0.730）. However, statistically significant differences were observed in the operative time （（158.70±42.51） minutes vs （200.65±47.89） minutes, P=0.003）, intraoperative blood loss （（55.87±17.36） ml vs （101.83±62.21） ml, P=0.001）, and recovery time of gastrointestinal function （（24.39±8.88） hours vs （30.60±9.45） hours, P=0.024） between the groups. Conclusions The individual operative route and schedule can be successfully determined on the basis of various kinds of reproducible anatomic frameworks of the spleen provided by preoperative CDFI. This technique facilitates the surgical procedure, shortens the operative time, reduces intraoperative blood loss and decreases the risk of LS in splenomegaly cases.     

Hand-assisted laparoscopic splenectomy for splenomegaly: a comparative study with conventional laparoscopic splenectomy

Background Laparoscopic splenectomy (LS) has been considered as the standard approach to remove a normal-sized spleen, but it is facing technical challenges when applied to splenomegaly. Hand-assisted laparoscopic technique was designed to facilitate the performance of difficult laparoscopic procedure. This study was aimed to evaluate the efficacy and superiority of hand-assisted laparoscopic splenectomy (HALS) for splenomegaly.Methods From November 1994 to January 2006, 36 patients with splenomegaly (final spleen weight &gt;700 g) were treated with laparoscopic operations for splenectomy in our hospital. Conventional LS was performed in 16 patients (7 men and 9 women, group 1) and HALS in the other 20 patients (12 men and 8 women, group 2). The patients’ features, intraoperative details and the postoperative outcomes in the both groups were compared.Results The both groups were comparable in the terms of patient’s age ((38±12) years vs (43±14)years, P&gt;0.05), the greatest splenic diameter ((24±5)cm vs (27±7)cm, P&gt;0.05), preoperative platelet count ((118±94)×10(9)/L vs (97±81)×10(9)/L, P&gt;0.05) and diagnosis. Compared with LS group, operation time ((195±71) minutes vs (141±64) minutes, P&lt;0.05) was shorter, intraoperative blood loss ((138±80)ml vs (86±45)ml, P&lt;0.05) and conversion rate (4/16 vs 0/20, P&lt;0.05) were lower, but hospital stay ((5.3±3.8) days vs (7.4±1.6) days, P&lt;0.05) was longer in HALS group. There was no significant difference in the aspects of intraoperative and postoperative complication rate (2/16 vs 0/20, P&gt;0.05) or recovery time of gastrointestinal function ((16.3±11.6) hours vs (18.7±8.1)hours, P&gt;0.05) between the two groups.Conclusions In the cases of splenomegaly, HALS significantly facilitates the surgical procedure and reduces the operational risk, while maintaining the advantages of conventional LS. HALS is more feasible and more effective than conventional LS for the removal of splenomegaly.     

Laparoscopy-assisted D2 radical distal gastrectomy for advanced gastric cancer: initial experience

Background Laparoscopy-assisted radical gastrectomy is gaining acceptance for treating early gastric cancer. However, few reports concerning the effectiveness of laparoscopy-assisted D2 radical distal gastrectomy （LADG） for advanced gastric cancer or data comparing the results obtained after open distal gastrectomy （ODG） are yet available. The aim of this study was to evaluate the method, feasibility and clinical result of LADG for advanced gastric cancer. Methods A retrospective study was performed comparing LADG and ODG for advanced gastric cancer. Seventy-eight patients who underwent LADG were compared with 90 patients who underwent ODG in terms of pathologic findings, operative outcome, and complications. Results There was no conversion to open surgery in the LADG group and no postoperative mortality of any patients. There were no significant differences between LADG and ODG in operative time （（245±35） vs （220±620） minutes）, complication rate （7.7% vs 10.0%）, and number of lymph nodes （23.5±6.0 vs 21.0±7.5）, while the blood loss was less after LADG （（110±25） vs （196±30） ml, P 〈0.05）. The time to postoperative flatus and postoperative hospital stay were shorter after LADG （（73.0±8.5） vs （102.0±10.5） hours, and （8.6±1.2） vs （12.1 ±2.5） days, P 〈0.05, respectively）. Conclusion LADG for advanced gastric cancer is feasible, safe, and minimally invasive.     

腹腔镜远端胰腺切除术与开腹远端胰腺切除术对比分析

目的 对比分析腹腔镜远端胰腺切除术( LDP)与开腹远端胰腺切除术(ODP)术中及术后资料,探讨LDP的可行性、安全性及与临床疗效.方法 回顾性分析2011年5月至2012年2月68例远端胰腺切除术患者的临床资料,其中LDP组16例,ODP组52例,比较两组基线情况、术中及术后情况.结果 两组均无死亡病例.LDP组与ODP组患者性别比例、年龄、体质量指数、肿瘤直径及住院总费用差异均无统计学意义.LDP组与ODP组手术切口长度分别为(3.50±1.34) cm和(17.94±2.12) cm,手术时间分别为(145.63±56.80) min和(87.21±32.06) min,两组切口长度、手术时间差异有统计学意义(P＜0.001).LDP组与ODP组术后住院时间分别为(5.06±1.24)d和(8.06±2.53)d,术后卧床时间分别为(1.31±0.68)d和(2.94±0.80)d,术后禁食时间分别为(1.31±0.57)d和(2.86±1.34)d,两组术后住院时间、卧床时间、禁食时间差异均有统计学意义(P＜0.001).两组术中失血量分别为(318.75±227.21) ml和(306.35±378.36) ml,差异无统计学意义(P=0.898).LDP组术后并发胰漏4例(25.00％),腹腔积液1例(6.25％);ODP组术后并发胰漏12例(23.08％),腹腔积液3例(5.77％),其中有1例同时发生胰漏和腹腔积液;两组间胰漏及腹腔积液发生率差异均无统计学意义.LDP组术后疼痛指数多分布于1～2级,而ODP组多分布于2～3级,两组差异有统计学意义(P＜0.001).结论 LDP用于治疗胰腺体尾部良性或交界性疾病是安全可行的,与常规开腹手术相比,LDP具有创伤轻、痛苦小、恢复快等优势,且并未增加总住院费用.     

腹腔镜胰体尾切除术与开腹胰体尾切除术临床疗效对比

目的随着设备的改进和技术的成熟,腹腔镜技术逐步应用到胰腺外科手术。文中对比分析腹腔镜胰体尾切除(laparoscopic distal pancreatectomy,LDP)与开腹胰体尾切除(open distal pancreatectomy,ODP)临床疗效,探讨LDP的优缺点。方法 2010年2月至2011年9月共行LDP13例,同期所行ODP15例,比较2组手术及术后恢复情况。结果 2组病例手术时间、术中出血量、住院费用及术后排气、进食、住院时间差异有显著性统计学意义(P<0.05)。2组病例保脾率、术后发生胰瘘率差异无统计学意义(P>0.05)。ODP组术后有2例发生切口感染,LDP组未出现切口感染。结论 LDP安全、可行,短期临床疗效优于ODP。     

脾动脉优先阻断在Kimura法腹腔镜保留脾脏胰腺体尾部切除术中的应用

  目的  通过总结Kimura法腹腔镜保留脾脏胰腺体尾部切除术（laparoscopic spleen-preserving distal pancreatectomy, Lap-SPDP）中应用优先阻断和未阻断脾动脉的手术经验,探讨脾动脉优先阻断Kimura法Lap-SPDP术的安全性和可行性,特别是此方法在控制术中出血和成功保留脾脏方面的优势。  方法  在2011年2月至2019年5月期间,连续纳入54例经B超或CT检查提示“胰腺体尾部良性或低度恶性占位性病变”的患者行Kimura法Lap-SPDP术。2015年以前的患者纳入未阻断组（n=25,未阻断脾动脉）,2015年以后的患者纳入阻断组（n=29,行脾动脉优先阻断）。未阻断组横断胰腺颈部后脾动脉只做常规牵引带牵引,保留脾动脉供血,完成胰腺体尾部切除;阻断组在横断胰腺颈部后予bulldog钳在脾动脉根部暂时阻断脾动脉,在脾动脉无供血状态下切除胰腺体尾部。回顾性收集两组患者资料,将两组患者按肿瘤直径>3 cm和≤3 cm分层进行比较,并详细描述阻断脾动脉Kimura法的手术技巧。  结果  分层前,未阻断组与阻断组间比较,年龄差异有统计学意义（P=0.033）,而体质量指数差异无统计学意义（P=0.069）。两组的肿瘤的中位直径分别为2.5 cm和4.0 cm,差异无统计学意义（P=0.065）。两组的保留脾脏成功率分别为93.1%和92%,但差异无统计学意义（P=1.000）。未阻断组的住院时间稍长于阻断组（P=0.020）。与未阻断组相比较,阻断组的中位手术时间（165 min vs. 235 min）和中位术中出血量（100 mL vs. 200 mL）均减少,差异有统计学意义（P<0.05）。按肿瘤直径分层后,肿瘤直径>3 cm者阻断组(25%)和未阻断组(14.3%)各有2例保留脾脏失败,但两组间比较差异无统计学意义（P=0.602）。而在肿瘤直径≤3 cm时两组保留脾脏率均达到了100%。肿瘤直径>3 cm时,阻断组比未阻断组手术用时少（P=0.005）。无论是在>3 cm组还是在≤3 cm组,阻断组均较未阻断组出血量少（P均<0.05）。阻断组无中转开腹和术中或术后需输血者。分层后两组间住院时间均无差异（P均>0.05）。中位随访时间13.5（3～96）个月。随访期间,无围手术期死亡、疾病复发、门静脉或脾静脉血栓发生,无胃底静脉曲张或上消化道出血。  结论  脾动脉优先阻断的Kimura法Lap-SPDP术安全、可行,该法在获得较高的保留脾脏成功率的同时,缩短了手术时间,减少了术中出血量,值得推广。     

保留脾脏和脾血管的胰体尾切除手术

目的探讨胰腺体尾部肿瘤进行保留脾脏和脾血管的胰体尾切除手术的可行性与安全性。方法对2003年12月至2005年1月收治的4例胰腺体尾部实性假乳头状肿瘤患者,采用了保留脾脏与脾血管的方法进行胰腺远端的切除。在肿瘤的右侧横断胰腺,显露脾动静脉,自胰腺的体部向脾脏方向分离脾动静脉血管与胰腺。不需离断脾动静脉和胃短血管,不需游离脾脏。结果4例患者均成功完成保留脾脏和脾血管的胰体尾切除手术。全部病例的平均手术时间为208min±52min;手术中的平均出血为475ml±96ml;手术均未需要输血;手术后平均住院时间为18d±13d。手术后1例患者出现胰瘘,经保守治疗治愈。无其他合并症。随访无复发与转移。结论保留脾脏和脾血管的胰腺远端切除是安全可行的,对于胰腺良性与交界性肿瘤的切除是最佳的选择。     

Solitary pulmonary nodules: comparison of multi-slice computed tomography perfusion study with vascular endothelial growth factor and microvessel density

Background The solitary pulmonary nodule （SPN） is one of the most common findings on chest radiographs. The objectives of clinical practice are to differentiate malignant nodules from benign nodules in the least invasive way and to make a specific diagnosis. This study was aimed to evaluate the correlation between perfusion imaging features and microvessel density （MVD） and vascular endothelial growth factors （VEGF） in SPNs using multi-slice computed tomography （MSCT）; and to provide the theoretical basis for SPN blood flow pattern and blood flow quantitative features. Also, the study called for the discussion of the method＇s clinical application value in the differential diagnosis of benign and malignant SPNs.Methods Sixty-eight patients with SPN underwent multi-location dynamic contrast enhanced （nonionic contrast material was administrated via the antecubital vein at a rate of 4 ml/s） MSCT. Precontrast and postcontrast attenuations on every scan was studied. Perfusion, peak height, and the ratio of the peak height of the SPN to that of the aorta were analyzed. Perfusion was calculated using the maximum gradient of the time-density curves （TDC） and the peak height of the aorta. The quantitative parameters （perfusion, peak height, ratio of peak height of the SPN to that of the aorta） of the blood flow pattern were compared with MVD and the VEGF expression of immunohistochemistry. Results The perfusion peak heights of malignant （（96.15±11.55） HU） and inflammatory （（101.15±8.41） HU） SPNs were significantly higher than those of benign （（47.24±9.15） HU） SPNs （P 〈0.05, P 〈0.05）. Ratios of SPN-to-aorta of malignant and inflammatory SPNs were significantly higher than those of benign SPNs （P 〈0.05, P 〈0.05）. No significant differences were found between the peak height and SPN-to-aorta ratio of malignant SPNs and inflammatory SPNs （P 〉0.05, P 〉0.05）. The precontrast densities of inflammatory SPNs were lower than those of malignant SPNs （P 〈0.05）. Perfusion values of malignant and inflammatory SPNs were significantly higher than those of the benign SPNs （P 〈0.05, P 〈0.05）. The VEGF positive expressions appeared in 32 patients with malignant SPNs and 2 patients with benign SPNs, and the average value of the MVD was higher in patients with malignant SPNs （36.88±6.76） than in patients with either benign （4.51±0.60） or inflammatory （26.11±5.43） SPNs （P 〈0.05, P 〈0.05）. There were statistically significant correlations between the CT perfusion feature and the MVD. The highest correlation was between the peak height of SPN and the MVD （r=0.657, P 〈0.05）.Conclusions Tumor microvessel density and VEGF expression facilitate the exploration of the pathophysiological basis of CT perfusion in SPNs. Multi-slice CT perfusion has shown strong positive correlations with angiogenesis in SPNs.