皮肤扩张术在整形外科的临床应用

对25例病人进行了皮肤软组织扩张术,扩张器容量为50～600ml。术后7～10天开始注水,注水总量超过扩张器容量的15%～20%,维持1～4周后行第二次手术,术中再即时扩张30分钟。除1例扩张器外露失败外,其余均获满意效果。讨论了手术注意事项。     

E-钙粘素在扩张皮肤组织中的表达

目的:研究E-钙粘素在扩张皮肤组织中的表达。方法:利用免疫组织化学技术S-ABC法,对人扩张皮肤和正常皮肤E-钙粘素的分布和表达进行测定,并对结果进行图像分析。结果:扩张皮肤和正常皮肤表皮基底层均有E-钙粘素的表达和分布,但扩张皮肤中的E-钙粘素的分布和表达较明显,染色较深且密,部分阳性细胞呈多层排列;对正常皮肤和扩张皮肤的相对灰度值和阳性细胞密度的图像分析,进一步证实了上述观察结果。结论:扩张皮肤表皮细胞E-钙粘素表达增加,推测E-钙粘素可能在扩张皮肤细胞增殖过程中发挥一定的作用。在扩张刺激的作用下,表皮细胞内的E-钙粘素被大量表达,推测钙粘素可以增加细胞间粘附,并把机械信号传递给细胞内,激活下游分子,进而引起细胞的增殖,最终实现皮肤的扩张。     

快速组织扩张术在皮肤软组织缺损修复中的应用

目的 探讨采用皮肤快速扩张术修复创伤性皮肤软组织缺损的方法和效果.方法 选择19例外伤性皮肤软组织缺损患者,共19个创面,择期埋置37个皮肤扩张器并进行快速扩张.术后第5天开始,隔日注水扩张1次,每次注水至有局部有轻度胀感.完成扩张后制作皮瓣,修复外伤性皮肤缺损创面,分Ⅲ期手术完成.结果 37个扩张器全部完成注水扩张过程,注水扩张时间为46～63 d.有5个扩张区出现并发症,但均得到控制.19个缺损创面均得到完整修复.6个月后随防1 2例,皮瓣色泽和质地与受区皮肤接近,外观良好,局部无臃肿.结论 快速皮肤扩张术是修复某些特殊部位创伤性皮肤缺损的可行有效方法,可获得功能和美学双重修复的满意结果.     

胶原蛋白海绵在皮肤扩张术中的应用

目的：观察胶原蛋白海绵在皮肤扩张术中的临床应用效果。方法：选择40例（个）皮肤扩张器埋置和50例（个）皮肤扩张器取出及15例自身对照的病例组,应用胶原蛋白海绵术中贴敷于渗血创面,术后观察其吸收、止血效果。结果：术中渗血于2～10min内停止,病例组中无血肿发生,术后引流量明显减少,伤口愈合时间缩短。结论：在皮肤扩张术中胶原蛋白海绵是一种良好的生物止血材料。     

Maspin蛋白和诱导型一氧化氮合酶（iNOS）在膀胱癌中的表达及意义

目的研究诱导型一氧化氮合酶（iNOS）蛋白和maspin蛋白在尿路上皮癌中的表达及其意义。方法采用免疫组织学SP法检测54例尿路上皮癌和18例正常膀胱组织中以上两种蛋白的表达。结果两种蛋白在膀胱尿路上皮癌中的表达与在正常膀胱黏膜中表达比较,均有显著性意义（均P〈0.01）。iNOS蛋白表达与maspin蛋白表达间存在负相关（r=-0.992,P〈0.05）,但与TCCs分级无关。maspin表达与浸润性膀胱尿路上皮癌呈负相关性。结论 iNOS的高表达和maspin蛋白低表达是膀胱癌预后不良的指征。     

iNOS及eNOS mRNA表达在急性坏死性胰腺炎肺损伤中的作用

目的通过观察急性坏死性胰腺炎(acute necrotizing pancreatitis,ANP)大鼠肺组织中诱导型一氧化氮合酶(inducible nitric oxide synthase,i NOS)mRNA和内皮型一氧化氮合酶(endothelial nitric oxide synthase,eNOS)mRNA的表达,探讨内源性NOS在ANP肺损伤中的作用。方法 40只Wistar大鼠随机分为ANP组(n=30)和假手术组(SO组,n=10),采用5%牛磺胆酸钠逆行胆胰管注射法建立大鼠ANP模型。光镜下观察ANP造模后3 h、6 h及12 h时大鼠肺组织病理变化,并应用RT-PCR法检测相应时相肺组织中i NOS及eNOS mRNA的表达水平。结果随着病程延长,ANP组肺组织可见不同程度的充血、水肿、炎性细胞浸润、出血、坏死等病理损害,各时间点其肺损伤评分均明显高于SO组(P0.05),且呈逐渐升高趋势(P0.05)。ANP组3 h、6 h及12 hi NOS和eNOS mRNA的表达水平较SO组均有明显升高(P0.05)。结论肺组织中i NOS及eNOS mRNA的过度表达可能是大鼠ANP肺损伤发生的重要原因之一,这为采用抑制i NOS及eNOS mRNA的表达减轻ANP肺损伤的治疗手段提供了理论依据。     

72小时快速皮肤软组织扩张术在面部整形中的临床应用

皮肤软组织扩张是修复软组织缺损的常用手段。采用一种有别于２周左右的习用快速扩张和５周以上的常规扩张的速扩张术，将扩张时间缩短至７２小时左右。在面部整形中，成功地运用了７例，取得了令人满意的效果。讨论了手术方法，注意事项，并从临床的角度将７２小时快速扩张与习用快速扩张，常规扩张及术中即刻扩张进行了对比分析。     

皮肤扩张术在整形相科的临床应用

对２５例病人进行了皮肤软组织扩张术，扩张器容量为５０－６００ｍｌ。术后７－１０天开始注水，注水总量超过扩张器容量的１５％－２０％，维持１－４周后行第二次手术，术中再即时扩张３０分钟。除１例器外露失败外，其余均获满意效果。讨论了手术注意事项。     

VEGF-C在肝癌组织的表达及意义△

目的通过检测血管内皮生长因子-C(VEGF-C)及其受体Flt-4在肝癌组织中的表达,分析它们与肝癌脉管形成及临床病理特征之间的关系,以了解VEGF-C在肝癌进程中的作用。方法采用免疫组化染色法检测62例肝细胞肝癌(HCC)组织及15例正常肝组织中VEGF-C和Flt-4的表达,并计算以CD34为标记的微血管密度(MVD)和以Flt-4为标记的淋巴管密度(LVD),分析它们相互之间及各自与HCC临床病理特征之间的关系。结果 HCC组织中VEGF-C及Flt-4的阳性表达率均明显高于正常肝组织(P0.05,P0.01)。HCC组织中VEGF-C的表达与有无门静脉癌栓、肿瘤组织学分化程度、术后复发及转移有关(P0.05,P0.01);Flt-4的表达与肿瘤组织学分化程度及术后复发有关(P0.05,P0.01);MVD与肿瘤大小、TNM临床分期、肿瘤组织学分化程度、有无门静脉癌栓、术后复发和转移有关(P0.05,P0.01);LVD与肿瘤组织学分化程度、术后复发和转移有关(P0.05,P0.01)。HCC组织中VEGF-C和Flt-4的表达及MVD和LVD这四者之间均两两呈正相关(P0.01)。结论 VEGF-C和Flt-4在肝癌组织中高表达并与术后复发有关,且与MVD及LVD呈正相关,提示VEGF-C/Flt-4通路可能通过促进肝癌血管和淋巴管的生成从而影响肝癌的进展及预后。     

CD34在IgA肾病肾小管间质病变中的表达及意义

目的:研究白细胞分化抗原CD34在IgA肾病肾小管间质病变中的表达变化,探讨其在IgA肾病进展过程中的作用.方法:应用免疫组织化学双标记技术检测不同小管间质病变程度的IgA肾病患者肾组织内CD34和α-平滑肌激动蛋白(α-SMA)的表达.肾小管间质病变分级采用Katafuchi积分.详细收集每例患者肾活检时的24 h尿蛋白定量(TUPr)及内生肌酐清除率(Ccr),并与免疫病理结果进行相关分析.结果:无小管间质病变组未见CD34的表达,α-SMA仅表达于间质的动脉壁;轻度小管间质病变组CD34和α-SMA表达散在,主要见于小管间质受损部位;中、重度病变组较轻度病变组CD34和α-SMA的表达显著增加(P＜0.05);小管间质内CD34的表达与α-SMA的表达及TUPr、Ccr具有显著相关性(P＜0.05).结论:随小管间质病变进展而出现的CD34表达增多可能在IgA肾病中发挥重要作用.     

食管鳞癌组织中固生蛋白与CD34表达的研究

目的 探讨固生蛋白(tenascin,IN)和CD34在食管鳞癌组织中的表达及其与临床病理因素的关系.方法 选取食管鳞癌组织91份及正常食管组织47份石蜡标本,应用免疫组织化学检测TN和CD34(用微血管密度值表示,microvessel denaity,MVD)的表达.结果 (1)在食管癌组织中TN表达强度显著高于正常食管组织(t=12.331,P＜0.01);(2)浸润肌层、外膜组、有淋巴结转移组和TNM分期Ⅱ、Ⅲ期组的TN表达强度肿瘤长度≥3 cm组明显高于肿瘤长度＜3vm组(F=12.373,P＜0.01)、浸润黏膜组(F=11.039,P＜0.01)、无淋巴转移组(F=6.882,P=0.01)和TNM分期I期组(F=5.060,P=0.003);(3)食管癌组织中MVD值明显高于正常食管组织(t=6.023,P＜0.01);(4)有淋巴结转移组和TNM分期Ⅱ、Ⅲ期组的MVD值肿瘤长度≥3cm组明显高于肿瘤长度＜3cm组(F=9.033,P＜0.01)、无淋巴转移组(F=12.429,P＜0.01)和TNM分期I期组(F=5.717,P＜0.01);(5)食管鳞癌组织中TN和NVD表达呈正相关(P=0.001).结论 TN蛋白的高表达可能是食管鳞癌发生的一种生物学标志,且与MVD存在协同作用.联合检测这两种指标对判断食管鳞癌恶性程度、淋巴转移具有重要价值.     

乒乓球拍样皮瓣成活过程中基质细胞衍生因子-1、CD34的表达

Objective To detect the expression of stromal cell-derived factor 1 (SDF-1), CD34 in the PingPong Racket flap during the survival process, and investigate the role of SDF-1 in flap neovascularization. Methods The PingPong Racket flap animal model was established. The morphology and survival of the flap were observed. The expression of SDF-1 and CD34 in the distal flap was detected by using immunohistochemistry and enzyme-linked immunosorbent assay at 0, 3, 5, 7, and 14 days after operation respectively. Results (1) In the same group of flaps, with prolongation of time, the expression of SDF-1 and CD34 was increased. The expression of SDF-1 reached the peak at the 5th day (group A; 124. 80 ±4.05, B: 137.85±3.03, C: 166.53±2.98, D: 72. 80 ±2.63, E: 62.79±2.20), and that of CD34 reached the peak at the 7th day (group A: 16. 76 ±0.62, B: 17. 60 ±0.72, C: 18.48 ±0.55, D: 12.70 ±0. 60, E: 11. 51 ±0. 70) ; (2) In the different groups of flaps, when the flap area was increased, the expression of SDF-1 and CD34 was increased, and at the area of 5 cm ×5 cm, the flaps had partial necrosis. Conclusion There was a positive relationship between SDF-1 and CD34 in the survival process of the flap.     

乒乓球拍样皮瓣成活过程中基质细胞衍生因子-1、CD34的表达

Objective To detect the expression of stromal cell-derived factor 1 (SDF-1), CD34 in the PingPong Racket flap during the survival process, and investigate the role of SDF-1 in flap neovascularization. Methods The PingPong Racket flap animal model was established. The morphology and survival of the flap were observed. The expression of SDF-1 and CD34 in the distal flap was detected by using immunohistochemistry and enzyme-linked immunosorbent assay at 0, 3, 5, 7, and 14 days after operation respectively. Results (1) In the same group of flaps, with prolongation of time, the expression of SDF-1 and CD34 was increased. The expression of SDF-1 reached the peak at the 5th day (group A; 124. 80 ±4.05, B: 137.85±3.03, C: 166.53±2.98, D: 72. 80 ±2.63, E: 62.79±2.20), and that of CD34 reached the peak at the 7th day (group A: 16. 76 ±0.62, B: 17. 60 ±0.72, C: 18.48 ±0.55, D: 12.70 ±0. 60, E: 11. 51 ±0. 70) ; (2) In the different groups of flaps, when the flap area was increased, the expression of SDF-1 and CD34 was increased, and at the area of 5 cm ×5 cm, the flaps had partial necrosis. Conclusion There was a positive relationship between SDF-1 and CD34 in the survival process of the flap.     

乒乓球拍样皮瓣成活过程中基质细胞衍生因子-1、CD34的表达

目的 检测基质细胞衍生因子-1(SDF-1)、CDM在乒乓球拍样皮瓣组织不同时间、不同面积的表达,观察SDF-1在皮瓣组织血管新生中的作用.方法 制作乒乓球拍样皮瓣动物模型.对皮瓣进行大体观察、皮瓣成活情况、免疫组织化学及酶联免疫吸附试验(ELISA)技术检测皮瓣远端组织在术后0、3、5、7、14 d时SDF-1、CD34的表达.结果 (1)同一组狭长窄蒂皮瓣,随着时间推移,SDF-1、CD34的表达也随之增加,SDF-1在第5天达到最高值(A组124.80±4.05,B组137.85±3.03,C组166.53±2.98,D组72.80±2.63,E组62.79±2.20),CD34在第7天达到最高值(A组16.76±0.62,B组17.60±0.72,C组18.48±0.55,D组12.70±0.60,E组11.51±0.70),随后逐渐下降.(2)不同组狭长窄蒂皮瓣,随着皮瓣面积的增大,SDF-1、CD34的表达也随之增加,当皮瓣面积达5 cm×5 cm时,各项指标不再增加,皮瓣远端部分坏死.结论 在皮瓣成活过程中SDF-1和CD34的表达呈正相关.

Abstract：

Objective To detect the expression of stromal cell-derived factor 1 (SDF-1), CD34 in the PingPong Racket flap during the survival process, and investigate the role of SDF-1 in flap neovascularization. Methods The PingPong Racket flap animal model was established. The morphology and survival of the flap were observed. The expression of SDF-1 and CD34 in the distal flap was detected by using immunohistochemistry and enzyme-linked immunosorbent assay at 0, 3, 5, 7, and 14 days after operation respectively. Results (1) In the same group of flaps, with prolongation of time, the expression of SDF-1 and CD34 was increased. The expression of SDF-1 reached the peak at the 5th day (group A; 124. 80 ±4.05, B: 137.85±3.03, C: 166.53±2.98, D: 72. 80 ±2.63, E: 62.79±2.20), and that of CD34 reached the peak at the 7th day (group A: 16. 76 ±0.62, B: 17. 60 ±0.72, C: 18.48 ±0.55, D: 12.70 ±0. 60, E: 11. 51 ±0. 70) ; (2) In the different groups of flaps, when the flap area was increased, the expression of SDF-1 and CD34 was increased, and at the area of 5 cm ×5 cm, the flaps had partial necrosis. Conclusion There was a positive relationship between SDF-1 and CD34 in the survival process of the flap.     

CD8+T细胞在胃癌组织中的表达及其临床意义

目的 观察胃癌组织中浸润性淋巴细胞CD8+T的表达及临床作用.方法 应用免疫组织化学染色检测102例胃癌患者手术标本中浸润淋巴细胞CD8+T的表达.结果 在胃癌、胃炎及胃息肉组织中均可见浸润淋巴细胞CD8+T的表达,但胃癌组浸润淋巴细胞CD8+T的表达[(29.53±14.71)个/HPF]明显高于慢性胃炎组[(19.54±8.10)个/HPF]和胃息肉组[(14.26±6.83)个/HPF],差异有统计学意义(P＜0.05).CD8+T细胞的表达与胃癌患者的性别、年龄、肿瘤部位、肿瘤大小、淋巴结转移、复发、病理分级和TNM分期无明显相关(P＞0.05);但与组织学类型和浸润深度有关,其中分化型胃癌患者CD8+T细胞的表达[(33.9±18.4)个/HPF]高于低分化型患者的表达[(27.6±12.0)个/HPF],差异有统计学意义(t=2.04,P＜0.05);未侵入肌层组的CD8+T细胞表达[(38.8±13.8)个/HPF]明显高于侵入肌层组[(27.7±14.1)个/HPF],差异有统计学意义(t=2.45,P＜0.05).与CD8+T细胞低表达组比较,CD8+T细胞高表达组胃癌患者中位生存时间延长5个月,但差异无统计学意义(χ2=1.0274,P＞0.05).多因素COX模型分析显示,与浸润淋巴细胞CD8+T低表达组比较,高表达组有降低胃癌死亡风险的趋势(RR=0.82,95%CI=0.41～1.65).结论 浸润性淋巴细胞CD8+T的表达与胃癌的预后有关.

Abstract：

Objective To study the expression and clinical significance of infiltrating lymphocytes CD8 + T in gastric carcinoma tissues.Methods The expression of infiltrating lymphocytes CD8 + T in 102surgically resected specimens of gastric cancer tissues was detected by using immunohistochemistry.Results CD8+ T cells were expressed both in gastric carcinoma,gastritis and gastric polyp tissues,but the number of CD8 + T cells in gastric carcinoma tissues [(29.53 ± 14.71 )/high powered field (HPF)]wassignificantly greater than in gastritis tissues [( 19.54 ±8.10)/HPF]and polyp tissues [( 14.26 ±6.83)/HPF](P ＜0.05).No correlation was found between CD8 + T lymphocyte count and gender,age,tumor location,tumor size,lymph node metastasis,tumor relapse,pathological grade or TNM stage ( P ＞ 0.05 ).However,there was a statistically significant correlation between the number of CD8 + T cells and the histological type,invasive depth.The CD8 + T cell count was obviously higher in the differentiated group [(33.9 ± 18.4)/HPF]than in the undifferentiated group [(27.6 ± 12.0)/HPF]( t = 2.04,P＜0.05 ).And the number of CD8 + T cells was greater in the non-invasive group [(38.8 ± 13.8)/HPF]than in the invasive group [(27.7 ± 14.1 )/HPF]( t = 2.45,P＜0.05 ).The median survival time of gastric cancer patients with high expression of CD8 + T cells was 5 months longer than in those with low expression,but there was no significant difference.Multi-factor COX model analysis demonstrated that the risk of death in gastric cancer patients was lower in the CD8 + T cells high expression group than in the low expression group ( RR = 0.82,95%,CI = 0.41-1.65 ).Conclusion Detection of infiltrating lymphocytes CD8 + T expression in gastric carcinoma tissues will be beneficial to the judgment of the prognosis.     

内皮抑素、bFGF及CD34在胆囊癌中的表达及其意义

目的 探讨内皮抑素及碱性成纤维细胞生长因子(bFGF)在胆囊癌发生、发展中的作用,为胆囊癌的生物学治疗探索理论依据.方法 运用免疫组化SP法检测内皮抑素、bFGF及CD34在61例胆囊癌组织和10例正常胆囊组织中的表达,并通过CD34的表达计算微血管密度(MVD),分析它们与胆囊癌临床病理特征的关系.结果 内皮抑素在正常胆囊组织及胆囊癌组织中的表达阳性率分别为40.00%(4/10)及77.05%(47/61),差异有统计学意义(P<0.05);胆囊癌组织中,内皮抑素的表达强度与其临床分期及淋巴结转移有关(P<0.05),与患者性别及年龄、肿瘤部位和大小及组织学分级无关(P>0.05).bFGF在正常胆囊组织和胆囊癌组织中的表达阳性率分别为20.00%(2/10)及67.21%(41/61),差异有统计学意义(P<0.05);胆囊癌组织中,bFGF的表达强度与其临床分期及淋巴结转移有关(P<0.05),与患者性别及年龄、肿瘤部位和大小及组织学分级无关(P>0.05).胆囊癌组织中MVD为(76.66±20.15)个/HP,明显高于正常胆囊组织的(29.53±5.03)个/HP(P<0.01).胆囊癌组织中,临床分期Ⅲ～Ⅴ期的MVD为(80.53±17.98)个/HP,明显高于Ⅰ+Ⅱ期的(46.79±5.38)个/HP(P<0.01);有淋巴结转移者的MVD为(94.60±7.28)个/HP,明显高于无淋巴结转移者的(58.12±9.24)个/HP(P<0.01);MVD在组织学分级G1[(60.59±14.71)个/HP3、G2[(83.08±15.30)个/HP3及G3E(96.53±6.92)个/HP]者间的差异均有统计学意义(P<0.01);MVD与患者性别及年龄、肿瘤部位及大小无关(P>0.05).胆囊癌组织中内皮抑素的表达与MVD有关(P<0.01),bFGF的表达亦与MVD有关(P<0.01).结论 内皮抑素、bFGF及CD34在胆囊癌的发生、发展过程中起不同程度的作用.它们的检测可给胆囊癌的早期诊断、恶性程度的判定和进一步治疗提供有效的依据.     

老年大肠癌中CD34、CerbB-2、Ki-67的表达及其临床意义

目的 探讨CD34、CerbB-2、Ki-67在老年大肠癌患者肿瘤组织中的表达及其临床意义.方法 将791例大肠癌病例分为老年组和中青年组(对照组),进行CD34、CerbB-2、Ki-67免疫组化染色,同时按pTNM标准分期.结果在老年组中CD34、CerbB-2、Ki-67的阳性表达率分别为68.4%、56.5%、70.3%,三者在两组间表达差异均有统计学意义(P<0.05);在老年组中CD34与CerbB-2的表达呈明显的正相关(r=0.130,P=0.012),CerbB-2与Ki-67的表达亦呈明显的正相关(r=0.133,P=0.011).结论 中青年大肠癌和老年大肠癌有不同的临床特点及生物学特征.老年结肠癌患者中,CD34、CerbB-2、Ki-67的表达与疾病的侵袭转移和预后密切相关.CD34、CerbB-2、Ki-67可作为判断老年大肠癌恶性程度、侵袭转移及预后的指标.