布一加综合征的诊断和治疗(附48例报告)

目的：探讨布一加综合征的诊治经验。方法：回顾分析本院自1993年－2002年，采用超声介入及手术方法治疗48例布加综合征的疗法结果。超声引导下支架术治疗布一加综合征38例，其中内支架术联脾肾分流术治疗5例，支架术联合肠腔分流术治疗8例；腔房人工血管转流术治疗4例，肠腔转流术治疗2例，肠颈转流术治疗2例，经右心房联合破膜2例。结果：随访1个月－9年，平均4．68年，37例获显疗效，2例改善，6例行二次手术治疗，3例死亡。结论：应重视早期诊断和治疗。腔内超声介入方法治疗布一加综合征，简便、准确、安全、疗效肯定；联合分流术解除肝静脉梗阻，可获得满意疗效。     

微卫星改变与肺癌发生发展的关系

目的 :研究肺癌组织中第 3号染色体短臂 (3P)和第 9号染色体短臂 (9P)上微卫星标志物的改变与肺癌发生发展的关系。方法 :应用聚合酶链反应 (PCR)结合微卫星银染法检测 5 6例肺癌和 2 3例良性肺部病变 3P和 9P上的微卫星标志物的改变。结果 :5 6例肺癌组织标本中 3P上有微卫星改变 2 6例 ,检出率 46% ,9P上有微卫星改变的 2 3例 ,检出率为 41% ,5 6例肺癌组织中 ,3P和 9P上有微卫星改变的 3 9例 ,检出率 69 6% ,2 3例肺部良性疾病组织中均未出现微卫星标志物改变。肺癌组织标本中 3P上的微卫星改变与肺癌的分化程度有关 ,低分化肺癌的微卫星改变较高、中分化肺癌的微卫星改变明显增多 (P <0 .0 1)。而 9P上的微卫星改变与淋巴结转移有关 ,有淋巴结转移的肺癌组织标本上微卫星改变较不伴淋巴结转移的微卫星改变检出率明显增多 ,(P <0 .0 5 )。结论 :3P和 9P上的微卫星改变与肺癌发生、发展和转移密切相关 ,检测肺癌组织 3P和 9P上的微卫星改变对肺癌的早期诊断和判断有无淋巴结转移有一定的价值     

Granulocyte antibodies in leukaemic chronic lymphoproliferative disorders

The anti-granulocyte activity of serum from patients with B-cell chronic lymphocytic leukaemia (CLL) and other lymphoproliferative disorders was investigated. Granulocyte-binding IgG was measured in 34 patients with CLL, 13 patients with hairy cell leukaemia, one patient with prolymphocytic leukaemia, two patients with Sézary cell leukaemia, and seven patients with chronic T-cell lymphocytosis who had a predominance of circulating large granular lymphocytes. Anti-granulocyte activity was absent in CLL and its variants, but present in the majority of granulocytopenic patients with chronic T-cell lymphocytosis. In one of these patients, granulocytopenia was associated with complement-activating IgG granulocyte antibody. Thus, antibody-mediated granulocyte injury appears to be an unusual occurrence in chronic lymphocytic leukaemia, but is a frequent complication of chronic T-cell lymphocytosis.     

人肿瘤特异抗原MAGE-3基因疫苗的构建和表达

目的：克隆肿瘤特异性共享抗原mage-3基因，制备基于α－病毒复制酶的高效黑色素瘤特异性基因疫苗。方法：用RT-PCR方法从黑色素瘤细胞系LB373中制备mage-3基因，以含α－病毒复制酶的哺乳细胞高效表达质粒pSMART2a为载体，构建重组DNA疫苗。重组子用载体中的T7和T3启动子序列为测序引物进行自动测序。再将鉴定过的重组质粒用脂质体法转化293细胞，用免疫印迹法和免疫组化法鉴定转化细胞中mage-3蛋白的表达。结果：正确构建了mage-3/pSMART2a重组质粒，并且在转化此质粒的293细胞中检测出了mage-3蛋白的表达。结论：此重组mage-3/pSMART2a质粒可以作为肿瘤特异的DNA疫苗，可进行下一步的肿瘤动物模型的疫苗接种及相关免疫学效应研究。     

硬脑膜动静脉瘘65例

目的：对硬脑膜动静脉瘘临床诊断治疗特点进行探讨。方法：对60例患者行血管内栓塞治疗，5例行颈动脉压迫法治疗。其中13例1次栓塞，25 例行2次栓塞，17例行3次栓塞，5例行4次或多次栓塞，结果：治愈36例，好转25例，4例无效，无一例死亡，结论：硬脑膜动静脉瘘的临床表现和预后与其发病部位，静脉引流类型密切相关，颈动脉压迫法及选择性血管内栓塞是安全有效的治疗方法。     

荷包环扎式结直肠吻合保肛术治疗低位直肠癌*

目的 :评价荷包环扎式结直肠吻合保肛术治疗低位直肠癌的价值。方法 :对低位直肠癌采用荷包环扎结直肠吻合保肛术治疗 2 3例 (A组 ) ,采用Miles手术治疗 2 6例 (B组 )。结果 :A组术后 1、3年生存率分别为 10 0 % (2 3/ 2 3) ,95 7% (2 2 / 2 3) ,术后无局部复发病例 ;排便功能优 16例 (6 9 6 % ) ,良 7例 (30 4 % )。B组术后 1、3年生存率分别为 10 0 % (2 6 / 2 6 ) ,96 2 % (2 5 /2 6 ) ,术后局部复发率 3 8% (1/ 2 6 )。两组术后 1、3年生存率 ,局部复发率经统计检验 ,均无显著差异 (P值均 >0 0 5 )。术后并发症 :A组无吻合口瘘及吻合口狭窄发生 ,盆腔感染 1例。B组 :切口感染 1例 ,人工肛门狭窄 1例。结论 :采用螺纹支架管荷包环扎结直肠吻合保肛术治疗低位直肠癌既能达到根治目的 ,又有保留肛门的良好排便功能 ,且并发症少 ,操作简便易行 ,不用特殊器械 ,值得推广应用     

载瘤动脉闭塞术治疗颅内巨大动脉瘤的探讨

目的总结和探讨脑血管造影和载瘤动脉闭塞在治疗颅内巨大动脉瘤上的作用及特点。方法60例颅内巨大动脉瘤患者,根据其脑血管造影的特点采取血管内介入方法[可脱式球囊和(或)弹簧圈]闭塞载瘤动脉近端53例、闭塞载瘤动脉两端后孤立动脉瘤7例;其中23例闭塞前先行颅内-外血管搭桥术。结果出院时Rankin评分分级:单纯血管内介入治疗组37例中轻残3例,合并颅内-外血管搭桥术组23例中死亡1例、重残2例。1-6年的影像学随访动脉瘤无复发。结论血管内介入结合颅内-外血管搭桥术闭塞载瘤动脉是治疗颅内巨大动脉瘤的方法之一。     

Techniques for performing laparoscopic liver resection in various hepatic locations

Many studies have recently reported on laparoscopic liver resection, although its development has been slow compared to laparoscopy in other fields. The indications for the location of laparoscopic liver resection have previously been limited to easily accessible lesions. Performing laparoscopic liver resection in the posterior and superior parts of the liver has been considered difficult due to inadequate exposure, the poor operative field and the difficulty with parenchymal dissection. Flexible endoscopy, high definition imaging and various kinds of equipment for parenchymal transection have been introduced for clinical use. In addition, much experience with this procedure has been accumulated at many centers. Accordingly, there are an increasing number of reports on laparoscopic liver resection in difficult locations. At our institution, the location of the tumor is no longer a limitation to laparoscopic liver resection. However, for safer laparoscopic liver resection, the patient positioning and trocar placement should be individualized according to the tumor location. The type of resection also may depend on the remaining liver’s functional capacity. We describe here the technical considerations for performing laparoscopic liver resection, including the technical considerations for performing laparoscopic liver resection for lesions located in the postero-superior segments of the liver.     

乳腺良恶性病变的磁共振T2*W首过灌注成像与血管生成相关性研究

Objective： To study the diagnostic value of T2^＊-weighted first-pass perfusion imaging in breast tumors. Methods： We analyzed the magnetic resonance imaging （MRI） information along with the pathological and immunohistochemistry results. Magnetic resonance imaging was performed in 28 patients with breast tumor. The time to signal intensity curves were generated according to the T2^＊-weighted first-pass perfusion imaging. The curve＇s maximal signal intensity drop rate and maximal signal intensity decrease time were analyzed and compared with the pathological diagnoses after surgery. Results： Malignant breast lesions showed higher maximal signal intensity drop rate （44.69% ± 17.07 vs. 17.22% ±7.49, P 〈 0.001） than benign lesions, but there was no significant difference of maximal signal decrease time between those two lesions （23.94 s ± 4.92 vs. 20.02 s ± 6.83, P 〉 0.05）. Conclusion： The T2^＊-weighted first-pass perfusion imaging has enough sensitivity and specificity in breast tumor diagnosis.