胃癌及胃癌前病变患者中医证型与病理及Hp感染的关系

目的研究胃癌及胃癌前病变患者中医分型与病理组织学及Ｈｐ感染的关系．方法选取资料完整的慢性胃病患者之病理及临床资料２０３例进行中医分型、Ｈｐ检测和ＰＣＮＡ染色，对胃癌前病变（ｎ＝１３４）胃癌（ｎ＝３３）及对照组（浅表性胃炎，ｎ＝３６）等各组进行比较分析．结果中医分型与病理改变有一定的相关性，在浅表性胃炎中以寒热夹杂型为主，胃癌及胃癌前病变中以脾胃虚寒为主，而寒热夹杂型较少，在胃癌及胃癌前病变患者中未发现Ｈｐ感染与中医分型有明显关系，胃癌及癌前病变组Ｈｐ感染率（６２４％，６６７％～７９８％）明显高于对照组（３４１％），且发病年龄Ｈｐ阳性者明显低于Ｈｐ阴性者（４９９％ｖｓ５６７，４６１～５３８ｖｓ５３８～６２０，Ｐ＜００５），ＰＣＮＡＬＩ随病变程度的加重而升高（γ＝０９５１，Ｐ＜００２５）．结论Ｈｐ感染与胃癌及胃癌前病变的发生有密切关系．ＰＣＮＡＬＩ是反应胃粘膜病变严重程度的较客观的定量指标     

幽门螺杆菌相关胃溃疡的细胞增殖与凋亡研究

目的观察Ｈｐ感染对胃溃疡（ＧＵ）患者胃粘膜上皮细胞增殖与凋亡的影响,进而对溃疡发生机制进行探讨．方法标本取自内镜下胃粘膜活检,细胞凋亡检测采用Ｔｕｎｅｌ方法,细胞增殖检测采用免疫组化ＬＳＡＢ方法测定增殖细胞核抗原（ＰＣＮＡ）．结果ＧＵＨｐ＋患者细胞凋亡指数（ＡＩ）明显高于Ｈｐ－患者（Ｐ＜００５）,但比较两者的增殖细胞指数（ＰＣＮＡＬＩ）,无显著性差异（Ｐ＞００５）;慢性浅表性胃炎Ｈｐ＋患者ＡＩ,ＰＣＮＡＬＩ明显高于Ｈｐ－患者（Ｐ＜００５）,ＧＵＨｐ＋患者的ＡＩ／ＰＣＮＡＬＩ比值为１５４１,明显高于其他各组（Ｐ＜００５）．结论Ｈｐ感染能诱导ＧＵ患者胃粘膜上皮细胞凋亡增加,出现细胞凋亡与细胞增殖平衡失调,促进溃疡形成     

幽门螺杆菌阳性胃粘膜病变AgNOR和rasp21的表达

目的研究幽门螺杆菌阳性（Ｈｐ＋）不同胃粘膜病变的ＡｇＮＯＲ数量及ｒａｓｐ２１阳性表达率，探讨其生物学行为及Ｈｐ在此过程中可能的作用．方法经内窥镜病理检查证实胃粘膜病变（慢性浅表性胃炎、慢性萎缩性胃炎、肠上皮化生、异型增生、胃癌）共计２７８例．通过Ｈｐ检测（ＣＬＯｔｅｓｔ结合ＷａｒｔｈｉｎＳｔａｒｙ染色）证实其中１４６例阳性，１３２例阴性．分别对其粘膜标本作了ＡｇＮＯＲ定量及ｒａｓｐ２１表达的研究，比较不同胃粘膜病变中Ｈｐ阳性和阴性组间ＡｇＮＯＲ数目和ｒａｓｐ２１阳性表达率．结果除慢性浅表性胃炎外各病变中Ｈｐ＋组的ＡｇＮＯＲ数量均显著高于Ｈｐ－组（Ｐ＜００５或Ｐ＜００１）；除慢性浅表性胃炎及慢性萎缩性胃炎外各病变中Ｈｐ＋组的ｒａｓｐ２１阳性表达率均显著高于Ｈｐ－组（Ｐ＜００５）．结论Ｈｐ＋胃粘膜病变具有更多的肿瘤生物学行为，该菌可能刺激胃上皮细胞的过度增殖而启动恶性变．     

幽门螺杆菌感染与胃粘膜增殖细胞核抗原表达的关系

目的探讨幽门螺杆菌（Ｈｐ）感染对胃粘膜细胞增殖活性的影响．方法采用免疫组化法，观察３４例Ｈｐ阳性的慢性胃病患者（男１９例，女１５例）胃窦粘膜增殖细胞核抗原标记指数（ＰＣＮＡＬＩ），同时以１２例Ｈｐ阴性的慢性胃病患者作对照，并对Ｈｐ阳性患者进行抗Ｈｐ治疗，４周后复查ＰＣＮＡＬＩ．结果Ｈｐ感染胃窦粘膜ＰＣＮＡＬＩ较无Ｈｐ感染显著增高（２９０２±１０２３比１４３１±６８７，Ｐ＜００１）；Ｈｐ根除（ｎ＝２４）后胃窦粘膜ＰＣＮＡＬＩ由２８１１±１１５降至１７６８±９６５（Ｐ＜００１），而Ｈｐ未根除（ｎ＝１０）时则无显著降低（２９１７±８１４→２４４２±７４４，Ｐ＞００５）．Ｈｐ感染时胃粘膜ＰＣＮＡＬＩ与炎症程度正相关（Ｐ＜００５），但与Ｈｐ菌量无相关（Ｐ＞００５）．结论Ｈｐ感染可增加胃粘膜细胞增殖活性，从而增加胃癌发生的危险性，根除Ｈｐ后可纠正这一变化，对预防胃癌发生可能有重要意义．     

胃粘膜肠化中幽门螺杆菌感染与PCNA,c-erbB-2的表达

目的研究肠化胃粘膜幽门螺杆菌（Ｈｐ）阳性率与ＰＣＮＡ,ｃｅｒｂＢ２表达率之间关系,以探讨Ｈｐ感染在胃肠化发生、发展中作用．方法经病理检查证实的慢性胃炎伴肠化１１６例,对照组非溃疡性消化不良．应用改良ＷａｒｔｈｉｎＳｔａｒｙ法检测Ｈｐ,免疫酶组化ＳＰ法检测ＰＣＮＡ,ｃｅｒｂＢ２的表达,比较Ｈｐ阳性组和阴性组间ＰＣＮＡ,ｃｅｒｂＢ２的阳性表达率．结果胃粘膜肠化者Ｈｐ感染率增高（５８６％ｖｓ１８８％,χ２＝１０７９,Ｐ＜００１）,肠化胃上皮内少见Ｈｐ粘附,Ｈｐ阳性组ＰＣＮＡ,ｃｅｒｂＢ２表达高于阴性组（４８／６８ｖｓ１２／４８,χ２＝９０５,Ｐ＜００５;３６／７４ｖｓ２／４２,χ２＝１３２８,Ｐ＜００１）．结论Ｈｐ感染促进胃粘膜肠化,并使肠化胃粘膜细胞增殖迅速而启动恶性变,故Ｈｐ感染可能促进胃癌的形成．     

胃Hp感染与癌前病变癌基因和抑癌基因表达的关系

目的研究Ｈｐ感染与胃癌及癌前病变中ｃｍｙｃ，ｐ２１，ｐ５３增殖细胞核抗原（ＰＣＮＡ）表达的相互关系，以探讨Ｈｐ可能的致癌机制．方法经内镜和病理诊断明确的病变者共１２０例，包括慢性浅表性胃炎（ＣＳＧ）、肠上皮化生、不典型增生、胃癌各３０例．以ＡＢＣ免疫组化法检测上述标本中ｃｍｙｃ，ｐ２１，ｐ５３，ＰＣＮＡ的表达，以改良Ｇｉｅｍｓａ法检测Ｈｐ．各组比较用χ２检验．结果肠型胃癌Ｈｐ阳性率为８３３％（２０／２４），弥漫型６例中Ｈｐ阳性１例．非贲门部胃癌阳性率为７３９％（１７／２３），贲门癌７例中阳性３例．胃癌Ｈｐ阳性率（６６７％）与ＣＳＧ（３３３％）比较差异非常显著（Ｐ＜００１）．各组Ｈｐ阳性的ｃｍｙｃ，ｐ２１，ｐ５３，ＰＣＮＡ与其Ｈｐ阴性者作相应比较均有显著或非常显著性差异（Ｐ＜００５～００１）．结论Ｈｐ感染与肠型胃癌的关系更密切，更容易发生于非贲门部．Ｈｐ感染可增加细胞的增殖活性，并通过使抑癌基因失活及癌基因激活而引起胃癌     

消化性溃疡及糜烂性胃炎患者前列腺素及血栓素与幽门螺杆菌的关系

目的探讨消化性溃疡及糜烂性胃炎与前列腺素、血栓素及幽门螺杆菌的关系．方法用放免技术，测定消化性溃疡（ｎ＝５３）、糜烂性胃炎（ｎ＝５５）患者及正常人（ｎ＝５４）血浆中前列腺素（６ｋｅｔｏＰＧＦ１α）、血栓素（ＴＸＢ２）的含量，并胃粘膜活检组织学查幽门螺杆菌（Ｈｅｌｉｃｏｂａｃｔｅｒｐｙｌｏｒｉ，Ｈｐ）．结果溃疡组及糜烂性胃炎组ＴＸＢ２含量及ＴＸＢ２／６ｋｅｔｏＰＧＦ１α的比值均明显高于对照组（Ｐ＜００１），两组的６ｋｅｔｏＰＧＦ１α的含量与对照组无差异（Ｐ＞００５）．两组患者中Ｈｐ（＋）与Ｈｐ（－）之间的６ｋｅｔｏＰＧＦ１α，ＴＸＢ２的含量及ＴＸＢ２／６ｋｅｔｏＰＧＦ１α的比值均无差异（Ｐ＞００５）．结论ＴＸＡ２与ＰＧＩ２失衡可能与溃疡的发病密切相关，而Ｈｐ的存在对前列腺素的含量无肯定作用     

幽门螺杆菌感染对胃上皮细胞增殖和凋亡的影响

目的为了探讨幽门螺杆菌感染对胃粘膜上皮细胞动力学的影响。方法应用免疫组织化学和切口末端标记法（ＴＵＮＥＬ），检测了１６例正常胃粘膜者和３１例幽门螺杆菌（Ｈｐ）相关慢性胃炎患者治疗前后胃粘膜上皮细胞增殖细胞核抗原（ＰＣＮＡ）标记指数（ＬＩ％）、细胞凋亡指数（ＡＩ）和表皮生长因子受体（ＥＧＦ－Ｒ）的表达。结果Ｈｐ阳性患者的ＰＣＮＡＬＩ％为１３．９４±１．６４，正常对照组为６．７１±０．９２，差异有非常显著性（Ｐ＜０．０１）；ＥＧＦ－Ｒ表达与ＰＣＮＡＬＩ％呈正相关（ｒ＝０．４４８７，Ｐ＜０．０１）：Ｈｐ阳性患者组的ＡＩ为７．１±１．６，正常对照组为１．３±０．６，差异有非常显著性（Ｐ＜０．０１）；抗Ｈｐ治疗后，２１例Ｈｐ根除者的ＰＣＮＡＬＩ％和细胞ＡＩ分别降至８．２１±１．３２和１．２±０．６，与治疗前相比差异有非常显著性（Ｐ＜０．０１），而１０例Ｈｐ持续阳性者则无明显降低（Ｐ＞０．０５）：ＰＣＮＡＬＩ％、ＥＧＦ－Ｒ表达及细胞ＡＩ与胃粘膜炎症程度无显著相关（Ｐ＞０．０５）。结论上述结果提示，Ｈｐ感Ｈ能引起胃粘膜上皮细胞过度增殖和凋亡。这为Ｈｐ感染胃癌发病中的作用机制提供了一些线索。     

北京儿童血清幽门螺杆菌抗体的检测价值

目的评价儿童血清ＨｐＡｂ检测的价值，过筛儿童Ｈｐ相关胃炎（ＨｐＧ）．方法健康组为随机抽样北京市１０７例健康儿童，症状组为有上消化道症状的儿童１２２例．采用ＥＬＩＳＡ法测定血清ＨｐＡｂ．对ＨｐＡｂ阳性儿童随机纤维内镜检查（ＧＦ）及ＨｐＵＴ检查．结果健康组ＨｐＡｂ阳性率为３８％（４／１０７），症状组ＨｐＡｂ阳性率为２７９％（３４／１２２），经统计学处理有显著性差异（χ２＝２３９８，Ｐ＜００１）．随机ＧＦ及ＨｐＵＴ检查阳性率９２９％，确诊为ＨｐＧ．结论Ｈｐ是儿童胃炎的主要致病因素．北京健康儿童ＨｐＡｂ阳性率近似西方发达国家．有上消化道症状儿童ＨｐＡｂ阳性率高于健康儿童．ＨｐＡｂ检测可以做为儿童ＨｐＧ筛查方法，对有Ｈｐ感染症状儿童可以做为诊断方法     

胃癌及癌前病变组织中c_erbB_2癌基因产物的表达

目的探讨ｃｅｒｂＢ２癌基因产物的表达与胃癌发生及胃癌生物学行为的关系．方法应用抗ｃｅｒｂＢ２癌基因蛋白（Ｐ１８５）的单克隆抗体，采用免疫组化ＡＢＣ方法对正常胃粘膜（ｎ＝９）、各级胃粘膜异型增生（轻度ｎ＝１０，中度ｎ＝６，重度ｎ＝７）、早期胃癌（ｎ＝１８）及进展期胃癌（ｎ＝３０）进行研究，并与胃癌类型、大小、有无淋巴结转移等作了比较分析．结果正常胃粘膜为阴性，仅在腺体颈部偶见Ｐ１８５蛋白的弱阳性表达．在异型增生病变中则有较高的表达率，并随异型增生程度的增加，表达率逐渐升高，轻、中、重度异型增生表达率分别为５０％，８３３％，８５７％．Ｐ１８５蛋白在早期及进展期胃癌中的表达率分别为２２２％和５６７％．重度异型增生表达率显著高于早期胃癌（Ｐ＜００５），进展期胃癌表达率显著高于早期胃癌（Ｐ＜００５），淋巴结转移组的表达率高于淋巴结未转移组（５９３％ｖｓ２３８％，Ｐ＜００５），但Ｐ１８５蛋白的表达与胃癌组织学类型及胃癌肿块大小无相关性（Ｐ＞００５）．结论ｃｅｒｂＢ２癌基因有可能参与正常胃粘膜的增殖、修复及癌变过程，Ｐ１８５蛋白阳性的肿瘤可能具有更强的浸润及转移能力．     

残胃癌25例诊治分析

目的:探讨残胃癌发生的可能因素及早期诊断。方法:对本院10年来25例残胃癌的临床资料进行回顾性分析。结果:B-Ⅱ式手术残胃癌的发生率比B-I式高出 5.22倍.与术后经过时间呈正相关。本组残胃癌发生时间平均为手术后15.1年。结论:择期手术尽量推迟至45岁以上。尽量避免行B-Ⅱ式手术。加强胃术后患者随访。     

老年患者胃黏膜病变与血清胃蛋白酶原变化

目的探讨老年胃疾病患者胃黏膜病理改变过程中，血清胃蛋白酶原（PG）Ⅰ、Ⅱ的变化规律。方法选择我院消化内镜中心行胃镜检查老年患者306例，按病理诊断标准分为4组：非萎缩性胃炎组（对照组）40例。慢性萎缩性胃炎组95例，消化性溃疡组105例，胃癌组66例。用免疫放射法（IEMA）测定患者血清PGⅠ及PGⅡ，并计算PGⅠ／PGⅡ的比值（PGR）。结果（1）正常对照组PGⅠ为（150．17±63．51）μg／L，PGR为10、44±3．42。（2）与对照组比较，慢性萎缩性胃炎患者血清PGI降低为（118．81±40．99）μg／L，PGR降低为7．11±2．99（P〈0.05）；（3）胃癌患者血清PGI降低为（95．39±22、80）μg／L，PGR降低为5．86±3．87（P〈0．01）；（4）消化性溃疡患者血清PGⅠ（175．29±33、69）μg／L及PGⅡ（21．81±8．91）μg／L升高（P〈0．05）。结论血清PGⅠ、PGⅡ含量的变化及PGR值对癌前状态和早期胃癌的诊断具有重要的临床意义，当血清PGⅠ及PGⅡ严重降低时，应及时进行胃镜检查，以明确诊断。     

Design and application of multifunctional stomach clamp

AIM Pylorus and pyloric vagus preserving gastrectomy (PPVPG) is an efficient operation mode for treatinggastric and duodenal ulcers. For its better application and popularization, we have designed andmanufactured a special multifunctional stomach clamp.METHODS The clamp has been designed carefully in view of the different sizes of the patients' stomachsand the different starting points of Latarjer nerves so as to facilitate the execution of the present operationmode, which requires the preservation of the vagus innervated pyloric region so as to make the remnantstomach maintain its normal physiological function and the vagus branches clinging antral seromuscular flapkept in proper size so that avoiding too much remaining antral mucosa is removed to cause greater difficultyin operation. With this in view, we observed and measured the distance between the Latarjer nerves distribution and the pyloric rings of 42 patients' stomachs in the course of operations. We bent an aluminumstring 3 mm thick for each stomach according to the size of antral seromuecular flap and chose an optimalcurvature from the 42 sizes for manufacturing the clamp. The clamp is made of 3 Cr13 stainless steel,consisting of three parts, the curved head, the fastening ring and the handle. The curved head is shapedalmost exactly like the remained antral seromuscular flap. The ring at its tip when in place fastens the twosides of the clamp so that the tissue of the stomach between will be clutched by an even force. On one sideare three cuts for moving the ring upwards, each cut representing 1 mm for fastening and adjustments can bemade in view of the thickness or thinness of the tissue. The handles bend backward for fighting shy of thecuts so as to facilitate the operation.RESULTS With the stomach disassociated in the light of PPVPG procedures, the clamp may easily beapplied from the upper part of the Latarjer nerves. The following merits can be noted. ① The curving line ofthe flap can be precisely cut. ②Before the antrum mucosa is stripped, the submucosal injection of hemostaticsalt solution can be confined without being expanded and the solution will separate muscular layer frommucous layer and helpful in stripping. ③The bleeding of the cuts on the antral seromuscular layer beingclamped and stopped. ④The antral seromuscular flap shaped by the clamp and facilitated to strip the antrummucosa beneath. ⑤The gastric juice can be prevented from flowing to the stripped region. All theseevidently facilitates the operation and shorten the time consumed. By the adjustment of its position in theoperation the clamp can be applied to stomachs in different size or with different starting points of Latarjernerves and even to those of experimental animal. Apart from applying to PPVPG, the clamp can be used forthe following operations: the Bancroft operation, with the curved part directing upwards; the resection ofgastric ulcer at the high portion of the stomach; the Billroth Ⅱ anastomosis. The clamp has proved in goodperformance for 122 cases of clinical treatment, worthy to be recommended to our colleagues.CONCLUSION The clamp can be used not only for this operation mode, but also for Bancroft operation,for the resection of gastric ulcer at the proximal end of the stomach and the Billroth Ⅱ anastomosis hencenamed the multifunctional stomach clamp.     

Gastric emptying measured by ultrasonography

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Case report of gastric syphilis in Korea: Clinical features,pathology, management,and prognosis

Rationale:Syphilis is a contagious infectious disease caused by Treponema pallidum. Gastric involvement of syphilis is rare and has nonspecific gastrointestinal symptoms and endoscopic findings. To date, 16 cases have been reported in Korea. Here, we report 2 additional cases of gastric syphilis in men in their 30 second.Patients concerns:Two 35- and 33-year-old men presented with epigastric pain.Diagnosis:The serum venereal disease research laboratory and fluorescent treponemal antibody absorption tests were positive. Esophagogastroduodenoscopy showed multiple variable-sized flat elevated lesions and geographic ulcers with whitish exudates in the antrum and body. Warthin–Starry silver staining of endoscopic biopsy specimens confirmed gastric syphilis.Interventions:The patients were treated with an intramuscular injection of 2.4 million units of benzathine penicillin once a week for 3 weeks.Outcomes:Clinical symptoms and gastric lesions were completely resolved.Lessons:First, gastric syphilis, despite its rarity and nonspecific symptoms and endoscopic findings, should be considered in a rare extracutaneous presentation of syphilis. Second, a high index of clinical suspicion and an accurate diagnosis based on a combination of clinical, radiological, endoscopic, serologic, and histopathologic findings provide an opportunity to identify and treat patients with gastric syphilis.     

老年人晚期贲门癌综合治疗疗效观察（附65岁以上老年患者38例分析）

目的对６５岁以上老年人晚期贲门癌３８例进行放疗加化疗综合治疗，探讨其疗效。方法患者均经病理或细胞学证实，均为Ⅲ、Ⅳ期病变，用６０Ｃｏ－γ线或直线加速器１０ｍＶＸ线前后野对穿照射，ＤＴ６５～７０Ｇｙ／６～７周放疗，同时加用ＵＭ（优福定及丝裂霉素）方案化疗。结果完全缓解１２例，占３１％；部分缓解２３例，占６１％；无缓解３例，占８％；总有效率９２％。１、２、３年生存率分别为４７％、３７％及１６％。结论对６５岁以上老年人不宜手术和失去手术机会的晚期贲门癌放疗加化疗的综合治疗是一种积极有效的治疗方法。     

Malignant Paraganglioma of the Stomach

Abstract: We report a case of malignant paraganglioma of the stomach. A gastric endoscopic examination on a 67-year-old female, performed for follow-up purposes, revealed an irregularly elevated lesion with a central ulcer on the lesser curvature of the lower body. The lesion showed characteristics of both an epithelial tumor and a submucosal tumor by endoscopy and radiography. The biopsy specimen suggested that the lesion was a malignant poorly differentiated tumor. On abdominal ultrasonography and computed tomography, several space occupying lesions were found in both lobes of the liver. Therefore, this case was diagnosed as having an advanced gastric cancer with liver metastases and underwent distal gastrectomy. Postoperatively, a final diagnosis of gastric paraganglioma was made by histological and immunohistochemical findings (positive for Grimelius, neuron specific enolase and other stains). These findings also revealed lymph node metastases. To date, only seven cases of gastric paraganglioma have been reported. Furthermore, two cases of malignant gastric paraganglioma have also been described in the literature. This is the first case of malignant gastric paraganglioma evaluated in detail by endoscopic and radiographic examinations.     

Outcomes of surgical treatment of intrathoracic stomach

The purpose of this study is to assess the long-term outcomes after surgical repair of intrathoracic stomach. Prospectively collected data was retrospectively reviewed. Patients underwent a phone questionnaire 1 year postoperatively to assess gastroesophageal reflux disease-related symptoms and surgical satisfaction. In addition, objective evaluation for integrity of hiatal hernia repair was undertaken either by esophagram or endoscopy. Any recurrence was considered a failure. Forty-one patients underwent surgical repair of a large paraesophageal hernia with intrathoracic stomach during the study period. Thirty-four patients underwent a laparoscopic repair, and seven patients underwent a transthoracic repair. An antireflux procedure was performed on 28 patients, and 13 patients had only hernia reduction and hiatal closure. In the laparoscopic group, two patients required conversion to open laparotomy, as one was unable to tolerate the pneumoperitoneum, and the other had mediastinal bleeding. Thirty-eight (93%) were available for 1-year follow-up. There were three (7.8%) recurrences, one requiring emergency transabdominal repair, and the other two being asymptomatic 1-cm recurrences. All patients report a high degree of satisfaction with surgery. There is a high incidence of short esophagus in patients with intrathoracic stomach. The surgical repair is safe and durable, with high patient satisfaction at 1-year follow-up.     

犬胃大部切除术后残胃粘膜癌变的形态学研究

目的探讨残胃粘膜癌前病变的发生发展过程及与残胃癌的关系方法当地雄性杂种犬16只，随机分为两组：手术组9只，施行BillrothⅡ式胃切除术；对照组7只，单纯剖腹术．两组大术后1mo始喂饲致癌剂MNNG加饱和氯化钠溶液，连续10mo.在实验周期的不同时相点，应用纤维内镜对残胃粘膜进行动态观察并活检．结果手术组浅表性炎、萎缩性炎和腺体增生不仅出现于手术后早期，而且出现于整个实验过程中．肠化和异型增生的发生率显著高于对照组（X2＝5．6，P＜0．05；X2＝7．14，P＜0.01），吻合口部显著高于残胃部（X2＝5．6，P＜0．05；X2＝7.14，P＜0．01）.结论Billroth胃切除术与残胃粘膜的病变有着直接的因果关系．残胃粘膜常见的腺体萎缩及增生性病变是发生癌前病变的重要基础，应成为临床防治的主要对象．