胆囊切除术后问题的内镜诊断和治疗

目的 探讨内镜在胆囊切除术后问题病因诊断和治疗的应用价值。方法 对386例胆囊切除术后问题病人行逆行胆胰管造影（ERCP）检查明确病因后,对胆管结石者行括约肌切开术（EST）和乳头气囊扩张术（EPBD）后取石;对乳头炎性狭窄者行EST或EPBD治疗;对乳头旁憩室压迫乳头开口和Oddi括约肌功能紊乱（SOD）者行EPBD治疗;对乳头肿瘤和肝门胆管癌行胆管内支架（EMBE）;对化脓性胆管炎、继发性胆总管多发结石、结石难以一次取净及术后胆瘘、胆管中段狭窄者行ENBD。结果 371例（96.1％）ERCP成功。未发现异常30例。胆管结石243例,235例经1-3次内镜取石后取净。乳头炎性狭窄39例,经EST或EPBD治疗1次成功。乳头旁憩室压迫乳头开口9例,SOD 7例,行EPBD治疗1次成功。胆管中段狭窄16例,11例行ENBD成功。乳头肿瘤6例,肝门胆管狭窄5例,行内支架治疗后黄疸减退。胆囊切除术后胆瘘6例,行ENBD治疗成功,避免再次外科手术。胃十二指肠溃疡6例。胆囊管结石残留4例。总的并发症发生率5.7％。结论 ERCP能及早发现胆囊切除术后问题确切病因并给予相应内镜治疗。     

外生型肝癌细胞系的建立及生物学特性研究

目的：介绍外生型肝癌细胞系的建立及对其生物学特性进行研究,方法：将方法切除的肿瘤标本进行体外培养,观察肝癌细胞形态学改变,核型分析,增殖动力学,流式细胞计数,裸鼠成瘤情况及AFP测定。结果：外生型肝癌细胞系（EGHC－9901）无论形态学观察,还是功能学测定,均符合肝癌细胞的特征,染色体众数76－104条,并具有体外高分泌AFP功能,其特有表现为：呈克隆样生长,高密度时细胞呈重迭生长,肝癌细胞之间形成完整毛细胆管,内有明显微绒毛,细胞倍增时间较长,结论：EGHC－9901细胞系符合外生型肝癌细胞系的特征。     

不同途径应用单纯疱疹病毒胸苷激酶及丙氧鸟苷对裸鼠肝癌模型抑瘤效果的研究

目的　探讨腺病毒介导的单纯疱疹病毒胸苷激酶 (HSV tk)及丙氧鸟苷 (GCV)自杀基因系统通过不同途径应用时的抑瘤效果及粗略的量效关系。　方法　按瘤体内直接注射、尾静脉注射、腹腔内注射的不同途径分为 4组 ,尾静脉注射及腹腔内注射组组内按应用剂量不同各分为 3个亚组 ,分别注射重组腺病毒 (AdrAFPTK) 1× 10 9PFU、1× 10 10 PFU、1× 10 11PFU ,腹腔注射GCV10 0mg·kg-1·d-1后观察瘤体大小变化 ,用RT PCR方法检测瘤体中HSV tk基因片段。　结果　瘤体内直接注射及尾静脉注射 1× 10 11PFU组均观察到明显抑瘤作用 (t为 13 1,12 4,P <0 0 1)及HSV tk基因片段存在 ,尾静脉注射 1× 10 10 PFU组、1× 10 9PFU组及腹腔内注射各亚组均未观察到明显抑瘤作用 (t为 1 8、1 0、2 1、1 1、0 8,P >0 0 5 )及HSV tk基因片段存在。　结论　瘤体内直接注射及高剂量静脉注射途径应用腺病毒介导的HSV tk/GCV自杀基因系统均有明显抑瘤作用 ,其中静脉注射方法因方便实用及其对癌转移灶可能有的治疗作用将有希望成为一种有效治疗肿瘤的途径     

Repair effect of Schwann cells modified by microgene pSVPoMcat on injured spinal cord in rats

OBJECTIVE: To observe the repair effect of Schwann cells (SCs) modified by microgene pSVPoMcat on injured spinal cord in rats. METHODS: Semi-transection injury at the level of T(8) of spinal cord was made with cutting method on 120 Sprague Dawley (SD) rats. Then 40 rats implanted with SCs modified by microgene pSVPoMcat were taken as Group A, 40 rats implanted with simple SCs as Group B and the other 40 rats were taken as the control group (Group C). The functional recovery of the rats was observed through combined behavioral score (CBS) and cortical somatosensory evoked potential (CSEP), and the expression of the glial fibrillary acidic protein (GFAP) was measured with in situ hybridization and immunocytochemistry. At 3 months after operation, the rats were examined with magnetic resonance image (MRI), and the neurofilaments (NF) of the axons were stained with immunohistochemical method. RESULTS: GFAP expression in Group A was significantly lower than that of the other 2 groups. MRI showed that the spinal signals in the injured area recovered fundamentally in Group A, didn't recover in Group B and malacia focus was found in Group C, which was same as the results of NF staining. Wave amplitudes in incubation periods in Group A and Group B tended to recover. It recovered to the normal level in Group A, which was similar to the results of CBS. CONCLUSIONS: SCs modified by microgene pSVPoMcat can inhibit GFAP expression, improve the growth of the axons and the functional recovery of neurons after spinal cord injury.     

失效模式和效应分析在髋关节置换术后护理中的应用

目的探讨失效模式和效应分析(FMEA)在髋关节置换术后护理中的应用效果。方法将2009年1～6月收治的28例全髋关节置换术患者设为对照组,围手术期按骨科护理常规护理;2009年7～12月收治的30例髋关节置换术患者设为观察组,在围手术期除执行骨科护理常规外,还运用FMEA对髋关节置换术后可能发生脱位的失效模式进行前瞻性原因和操作流程分析、评估、计算,找出导致术后关节脱位的最高危因素及高危操作步骤,制定防范的优先行动计划和改进措施。结果观察组6个高危因子的危机值显著低于对照组(均P0.01);两组患者对防脱位相关知识掌握程度、住院时间、满意度比较,差异有统计学意义(P0.05,P0.01)。观察组住院期间人工关节未发生脱位,对照组发生脱位1例。结论应用FMEA对髋关节置换手术后患者进行评估、分析和采取相关措施,能有效防范风险,降低术后脱位的发生,提高护理质量,促进患者康复。     

微创技术在治疗急性胆源性胰腺炎中的应用

目的探讨微创技术在治疗急性胆源性胰腺炎(acute billiary pancreatitis,ABP)中的应用。方法回顾分析65例ABP病人的临床资料和腔镜联合微创治疗效果。结果单纯腹腔镜胆囊切除术(LC)30例,LC加十二指肠乳头切开(EST)引流20例,LC加腔镜下胆总管探查术(LCBDE)10例,5例传统开腹手术,均痊愈。结论采用三镜技术治疗ABP优势明显,占总病人数的92%,损伤小,痛苦少,不失为理想的治疗方法。     

Clinicopathologic Features of Gastric Carcinoma with Signet Ring Cell Histology

Background

Reports of clinicopathological features and prognosis in patients with signet ring cell carcinoma of the stomach (SRC) are conflicting. The aim was to describe the clinicopathological features and prognosis of patients with SRC in comparison with non-signet ring cell carcinoma of the stomach (NSRC).

Methods

In this retrospective study, we reviewed the records of 1,439 consecutive patients diagnosed with gastric carcinoma who were resected surgically from 1993 to 2003. Among them, 218 patients (15.1%) with SRC were compared with 1,221 patients with NSRC.

Results

There were significant differences in tumor size, tumor location, macroscopic type, depth on invasion, lymph node metastasis, lymphatic invasion, tumor stage, chemotherapy, and curability between the patients with SRC histology and NSRC. The overall 5-year survival of patients with SRC was 44.9% as compared with 36.0% for patients with NSRC (P?=?0.013). Multivariate analysis showed that lymph node metastasis and curative resection were significant factors affecting survival. A significant survival benefit for curative resection was observed, with a 5-year survival rate of 58.5% compared with non-curatively resected cases (8.4%).

Conclusions

When stage matched, SRC patients had a similar survival to NSRC patients. Curative resection is recommended to improve the prognosis of patients with SRC.     

前列腺癌内分泌治疗的合理选择

自从1941年首次报道以来，前列腺癌的内分泌治疗即在临床上得到广泛应用。经过长期的观察和研究，目前其适用范围已不仅仅局限于对晚期患者的缓解治疗，还包括对早期患者根治术前的新辅助治疗、术后的辅助治疗以及对治愈性治疗后生化复发患者的治疗等。内分泌治疗本身并无治愈效果，甚至其能否延长患者寿命也没有定论，因此对前列腺癌患者选择内分泌治疗时，必须权衡不同治疗方式的利弊，以及对患者生活质量可能造成的影响，方可作出合理决策。     

固载去甲万古霉素缓释微球补片对切口疝金黄色葡萄球菌感染的预防作用

目的补片修补切口疝术后可能发生感染,采用载药补片预防感染是解决方法之一。通过制备大鼠切口疝金黄色葡萄球菌感染模型,观察固载去甲万古霉素缓释微球聚丙烯补片修补切口疝术后对感染的预防作用。方法采用复乳溶剂挥发法制备去甲万古霉素缓释微球,并将其固载至聚丙烯补片(50 mg/片)。扫描电镜观察去甲万古霉素缓释微球形态,采用高效液相色谱法检测微球中去甲万古霉素含量以及补片中去甲万古霉素释放率。取健康10～11周龄雄性SD大鼠40只,体重200～250 g;制备切口疝金黄色葡萄球菌感染模型,分别植入固载去甲万古霉素缓释微球聚丙烯补片(实验组,n=20)和聚丙烯补片(对照组,n=20)。术后观察两组大鼠切口愈合情况,3周时处死大鼠取补片及周围组织进行组织学观察,并进行炎症程度分级。结果扫描电镜观察示去甲万古霉素缓释微球形态完整,表面平滑;微球粒径较均一,64%微球粒径位于60～100μm;去甲万古霉素载药量为19.79%。固载去甲万古霉素缓释微球聚丙烯补片表面均匀,载药量为(7.90±0.85)mg/cm2,去甲万古霉素体外释放达28 d以上,累计释放率达72.6%。两组大鼠术后均存活至实验完成。22只大鼠切口发生感染,其中实验组2只(10%),对照组20只(100%);两组感染率比较,差异有统计学意义(χ2=32.727 3,P=0.000 0)。实验组镜下见局部炎性反应不明显,炎症程度分级Ⅰ级16只,Ⅱ级4只;对照组补片有大量炎性细胞浸润,炎症程度分级Ⅱ级3只,Ⅲ级17只。两组炎症程度分级比较,差异有统计学意义(Z=32.314,P=0.000)。结论固载去甲万古霉素缓释微球聚丙烯补片对大鼠切口疝金黄色葡萄球菌污染具有抗感染作用。     

腕管综合征治疗研究进展

目的对腕管综合征(carpal tunnel syndrome,CTS)的治疗研究现状作一综述。方法查阅近年来国内外CTS治疗的相关文献,进行分析总结。结果腕夹板、类固醇适用于轻、中度CTS患者,近期效果显著;治疗后复发的CTS患者需采取手术治疗。主要术式为腕管松解术,包括腕管切开松解减压术(传统型和小切口型)、内镜下腕管松解减压术等。结论 CTS的最佳治疗方法尚无定论,部分学者推荐首选手术治疗。