腹腔镜在先天性胆管扩张症中的应用

目的：总结腹腔镜手术诊治先天性胆管扩张症（congenital biliary dilatation,CBD）的经验,评价腹腔镜肝外扩张胆管切除、肝管空肠吻合术的可行性及安全性。方法：回顾2002~2010年腹腔镜手术治疗106例CBD患者的临床资料,分析其手术技术、围手术期并发症及随访情况。结果：62例胆总管呈囊状扩张、44例呈梭形扩张。其中,83例行术中胆道造影,77例显示胰胆管合流异常。103例成功完成腹腔镜手术,3例中转开腹,其中1例囊肿巨大,1例Ⅲ型囊肿损伤十二指肠,1例合并炎性血管瘤出血。24例伴有肝内胆管局限性扩张（IV-A型）同时行肝门胆管狭窄段切开或切除扩大成形术。手术时间平均（214.9±58.3）min,术后平均住院（7.7±2.3）d。围手术期发生并发症8例,1例术中门静脉损伤,5例暂时性胆漏,1例胆支空肠袢扭转,1例应激性溃疡。随访6个月~8年,1例发生肝门吻合口狭窄行二次手术解除,1例术后切口疝经手术修复,2例肠梗阻经保守治疗后缓解。余者恢复良好。结论：腹腔镜术中胆胰管造影可确定CBD类型及胆胰管合流情况,腹腔镜提供的视野放大效果有助于根除病变、避免损伤胆胰管连接部和矫治肝门胆管狭窄,腹腔镜手术可安全地施行并取得满意效果。     

腹膜后恶性蝾螈瘤2例报告

目的：总结恶性蝾螈瘤（malignant triton tumor,MTT）的临床及病理特点、诊治方法及预后。方法：回顾性分析2例腹膜后MTT患者的临床资料,均为女性,分别为8个月及44个月大婴幼儿。均因体检发现腹部肿物入院。下腹部均可触及质韧肿物,表面光滑,活动度可,无压痛。B超、CT、MRI等影像学检杏见中下腹或腹盆腔区有大小约14cm×12cm×9cm和15cm×13cm×10cm肿块,增强CT示肿物呈不均匀强化。2例患者均行肿瘤根治性切除术。结果：镜下见肿瘤由梭形细胞及多角形细胞组成,可见病理性核分裂,伴有横纹肌分化。免疫组织化学染色示NSE＋,Vimentin＋,Desmin＋,S-100＋。诊断为腹膜后MTT。1例患者随访3个月,术后2个月复发转移,近期肿物有所增长。另1例随访5个月,目前情况良好。结论：腹膜后MTT是一种罕见、高度恶性的肿瘤,确诊需依赖病理检查和免疫组织化学检测。本病以手术根治治疗为主,术后易复发和转移,预后差。     

前列腺黏液腺癌2例报告及文献复习

目的：探讨前列腺黏液腺癌的病理和诊疗特点。方法：回顾性分析我院1995年1月～2011年3月收治的2例前列腺黏液腺癌患者的临床资料,并结合文献复习,分析其特点。结果：2例患者年龄分别为73和84岁,因不同程度的排尿困难入院。1例误诊为前列腺增生,行经尿道前列腺电切术;另1例直肠指检、B超、CT、MRI及PSA检查均提示为前列腺癌,行穿刺活检后确诊,根据患者全身状况行硬膜外麻醉下经尿道前列腺电切术,以改善排尿症状,术后病理检查回报为前列腺黏液腺癌,免疫组织化学检查有较特异性表现。术后给予抗雄激素治疗等。结论：前列腺黏液腺癌在前列腺癌中罕见,没有特征性的临床表现,确诊主要依靠病理和免疫组织化学检查;治疗方法可采用根治性前列腺切除术。     

超声联合CT引导下经皮冷冻治疗胰腺癌85例

目的评估超声和CT引导经皮冷冻治疗胰腺癌的安全性及可行性。方法回顾性分析2008年11月至2010年5月在我院接受超声联合CT引导下经皮冷冻治疗的胰腺癌患者85例的临床资料,其中不可切除胰腺癌67例,拒绝手术治疗的可切除性胰腺癌患者18例,共计86个瘤灶接受121次经皮冷冻治疗。依据肿瘤的大小、形状及位置,分别选用1～8根探针。胰头癌采用经腹穿刺,胰体尾癌经腹或经背穿刺的方法。采用两个冷冻一复温循环,冷冻温度为（-160±10）℃,复温温度（25±5）℃,均持续5～10min。于冷冻前后检查CT,评估状态（kamofsky performance status,KPS）评分,观察冷冻治疗后并发症及术后住院时间。结果全组121例次经皮冷冻治疗均顺利完成,无一例死亡。出院时KPS较治疗前提高（P〈0．叭）。冷冻后1～3个月肿瘤平均直径明显缩小[（4．7±0．3）VS．（4．1±0．4）,P〈0．01],所有瘤灶冷冻区活性消失。平均住院时间为（8．0±0．6）d。结论超声联合CT引导经皮冷冻治疗胰腺癌安全可行,具有微创、准确、适形等特点,为临床胰腺癌治疗提供了新的技术手段。     

腹腔镜食道裂孔疝修补联合胆囊切除术的临床应用探讨

目的探讨腹腔镜下食道裂孔疝修补联合胆囊切除手术的临床应用。方法回顾性分析24例腹腔镜食道裂孔疝修补联合胆囊切除术患者的临床资料。结果 24例均获成功,无并发症发生及中转开腹,术后4～7d痊愈出院。结论腹腔镜下食道裂孔疝修补联合胆囊切除术能安全有效的处理腹部多发病变,在掌握好手术适应证的条件下是安全可行的。     

外敷氨基胍霜剂对糖尿病大鼠皮肤组织的影响

目的 观察外敷氨基胍霜剂对糖尿病大鼠皮肤组织晚期糖基化终末产物(AGE)形成、KC细胞增殖及氧化应激的影响.方法 将硬脂酸、液状石蜡、凡士林、羊毛脂、肉豆蔻酸异丙酯、甘油、50 g/L尼泊金醇、盐酸氨基胍等试剂按一定比例混合制成氨基胍霜剂,以不含有氨基胍的霜剂为基质.取健康大鼠背部皮肤,分别用5、10 g/L氨基胍霜剂和5 g/L氨基胍+10g/L氮酮霜剂处理,于用药后2、4、7、10、12、24 h测定药物透皮效果.将30只SD大鼠按随机数字表法分为正常对照组6只、糖尿病组8只、氨基胍治疗组8只、基质治疗组8只.后3组大鼠腹腔注射链脲佐菌素65 mg/kg,诱导糖尿病模型;对照组大鼠注射0.05 mmol/L柠檬酸缓冲液.注射1周后,正常对照组与糖尿病组大鼠不行任何治疗,氨基胍治疗组与基质治疗组大鼠背部分别连续外用10 g/L氨基胍霜剂与基质治疗4周.取各组皮肤组织,胶原提取液荧光强度检测法测定AGE含量,流式细胞仪分析表皮KC周期,检测氧化应激相关指标超氧化物歧化酶(SOD)、丙二醛、总抗氧化能力、髓过氧化物酶(MPO)含量.对实验数据行t检验.结果 10 g/L氨基胍霜剂透皮效果优于5g/L氨基胍和5 g/L氨基胍+10 g/L氮酮的霜剂.1只基质治疗组大鼠未诱导成功.建模后4周,糖尿病组与氨基胍治疗组大鼠分别死亡4只和1只.糖尿病组大鼠皮肤组织AGE含量为每毫克羟脯氨酸(OHP)中(36.8±2.6)U,明显高于正常对照组的每毫克OHP中(24.6±2.7)U(t=7.2,P＜0.01);氨基胍治疗组AGE含量为每毫克OHP中(28.6±3.7)U,明显低于糖尿病组(t=-3.9,P＜0.05);基质治疗组AGE含量[每毫克OHP中(32.2±5.2)U]与糖尿病组相近(t=1.6,P＞0.05).糖尿病组大鼠S期KC比例为(5.3±0.6)%,低于正常对照组的(7.6±0.9)%(t=4.50,P＜0.01);氨基胍治疗组大鼠S期和G2/M期KC比例均明显高于糖尿病组(t值分别为6.80、3.17,P值均小于0.01);基质治疗组大鼠S期KC比例[(9.2±1.5)%]显著高于糖尿病组(t=4.90,P＜0.01).糖尿病组大鼠皮肤组织氧化应激指标含量均高于正常对照组,其中SOD和MPO差异有统计学意义(t值分别为4.4、3.7,P值均小于0.05);氨基胍治疗组各氧化应激指标含量均较糖尿病组降低,其中SOD含量显著低于糖尿病组(t=-1.4,P＜0.05);基质治疗组MDA、MPO含量显著低于糖尿病组(t值分别为2.6、2.9,P值均小于0.05).结论 外用氨基胍霜剂可以在一定程度上阻碍糖尿病大鼠皮肤组织中AGE的形成,改善表皮KC细胞增殖能力,适当降低皮肤组织氧化应激状态;单用霜剂基质也可适当降低皮肤组织氧化应激状态.

Abstract：

Objective To investigate the effects of aminoguanidine cream on the proliferation of keratinocytes (KC), content of advanced glycosylation end products (AGE) and oxidative stress in skin tissue of rats with diabetes. Methods Stearic acid, liquid paraffin, vaseline, lanolin, isopropyl myristate fat,glycerol, 50 g/L alcohol paraben, aminoguanidine hydrochloride etc. were mixed in certain proportion to make aminoguanidine cream, and cream without aminoguanidine was used as matrix. The dorsal skin of normal rats were harvested and treated by aminoguanidine cream with dose of 5, 10 g/L, or 5 g/L together with 10 g/L azone. The transdermal effect was respectively measured at post treatment hour 2, 4, 7, 10, 12,24. Thirty SD rats were divided into normal control(NC, n = 6) , diabetes(D, n = 8) , aminoguanidine cream-interfered(AI, n = 8), matrix cream-interfered groups(MI, n = 8) according to the random number table. Diabetes was reproduced by intraperitoneal injection of STZ (65 mg/kg) in rats of D, AI, and MI groups, and rats in NC group were injected with 0. 05 mmol/L citrate buffer as control. One week later, dorsal skin of rats in AI and MI groups were respectively treated with 10 g/L aminoguanidine cream and matrix cream by external use for 4 weeks. AGE content was determined with fluorescence detection from skin collagen extract. KC cell cycle was detected by flow cytometry. Skin tissue specimens were obtained for determination of levels of superoxide dismutase (SOD), malondialdehyde (MDA), myeloperoxidase (MPO), and total antioxidant capacity. Data were processed with t test. Results Transdermal effect of aminoguanidine cream with dose of 10 g/L was better than that with 5 g/L or 5 g/L + 10 g/L azone cream. One rat was not induced successfully in MI group. Four weeks after model reproduction, 4 rats died in D group and 1 rat died in AI group. The AGE content in D group was obviously higher than that in NC group [(36.8 ± 2.6),(24. 6 ±2.7) U per milligram hydroxyproline, respectively, t = 7.2, P ＜0. 01], and that in AI group [(28.6 ±3.7) U per milligram hydroxyproline] was also lower as compared with that in D group(t = -3.9,P ＜ 0.05). There was no significant difference in AGE content between MI [( 32.2 ± 5.2) U per milligram hydroxyproline] and D groups(t = 1.6, P ＞ 0. 05). The percentage of KC in S phase was obviously lower in D group than in NC group [(5.3 ±0.6)%, (7.6±0.9)%, respectively, t =4.50, P ＜0. 01], while that in MI group [(9. 2 ± 1.5) %] was higher as compared with that in D group(t = 4.90, P ＜ 0. 01). It was more higher in AI group than in D group on KC percentage in S and G2/M phase (with t value respectively 6.80, 3.17, P values all below 0. 01). The oxidative stress indexes of skin tissue in D group were all higher than those in NC group, in which levels of MPO and SOD showed statistical difference(with t value respectively 4.4, 3.7, P values all below 0. 05). The oxidative stress indexes were all lower in AI group than in D group, especially in SOD level(t = -1.4, P ＜0. 05). Levels of MAD, MPO in MI group were significantly lower than those in D group(with t value respectively 2.6, 2.9, P values all below 0. 05).Conclusions Aminoguanidine cream can promote KC proliferation and appropriately reduce oxidative stress through inhibiting AGE formation to a certain extent in skin tissue of rats with diabetes. Signal use of matrix cream can also reduce oxidative stress in skin tissue of rats with diabetes.     

Bryan人工颈椎间盘置换术的中期随访结果分析

目的 观察Bryan人工颈椎间盘置换术后临床和影像学结果以及相邻节段退变的情况.方法 回顾性分析术后随访时间超过2年的26例单节段置换患者的临床资料,临床效果采用JOA和Odom评分进行评定.采用x线片观察手术节段活动度和椎旁骨化.采用X线片和MRI观察对比相邻节段退变情况.术前X线片示置换节段的活动度为2°～12°,平均为6.9°.结果 (1)临床结果:18例脊髓型颈椎病患者随访时JOA评分平均16分,平均改善率84%,8例神经根型颈椎病患者随访时临床症状全部消失.Odom分级:优秀15例,良好7例,一般4例.(2)X线片:术后置换节段的活动度为1°～14°,平均7.8°;7例出现假体周围异位骨化,仅1例假体运动消失,其余6例平均活动度为5.3°.相邻节段椎间隙高度术后无明显变化.(3)MRI T2加权像:根据Pfirrmann椎间盘退变分级方法,相邻节段椎间盘的分级术后无明显加重表现;相邻节段黄韧带肥厚对椎管的侵占率术后无明显加重;但是上下相邻椎间盘侵占率均略有增加.结论 Bryan人工颈椎间盘置换术保留了置换节段的运动性,避免了相邻节段的加速退变,2年以上随访效果优良.     

整合素ανβ6与肿瘤关系的研究进展

整合素ανβ6是由α、β亚单位以非共价键结合组成的跨膜异二聚体,只表达于恶性上皮性肿瘤组织而健康组织及良性肿瘤组织无表达.目前研究发现,整合素ανβ6参与多种信号传导通路,在多种肿瘤的发生发展、侵袭转移过程中发挥重要作用.对整合素ανβ6的深入研究为恶性肿瘤的诊治提供一条新的思路.     

闭合复位穿针内固定治疗肱骨近端骨折

目的探讨采用闭合复位经皮穿针内固定治疗肱骨近端骨折的疗效。方法肱骨近端骨折患者32例，均在C臂X光机透视下行闭合复位、经皮克氏针内固定治疗。结果32例均获随访，平均8（3～15）个月，骨折均愈合。克氏针松动9例，脱出3例，针孔感染4例。无神经损伤、骨髓炎、肱骨头坏死等并发症。疗效按Neer肩关节功能评分：优19例，良7例，可5例，差1例，优良率81．2％。结论闭合复位经皮穿针内固定具有操作简单、创伤小、利于骨折愈合等优点，是治疗肱骨近端骨折的有效方法之一。     

产后小鼠子宫内膜边缘群干/祖细胞的分离纯化

目的分离和纯化小鼠子宫内膜边缘群(side population,SP)干/祖细胞,为进一步探讨产后子宫修复的细胞机制奠定基础。方法分别采用酶消化和机械分离结合法与机械研磨分离的方法,原代分离小鼠子宫内膜上皮细胞与基质细胞,通过Hoechst33342-SP法(对照加入维拉帕米),使用流式细胞仪检测子宫内膜SP细胞。结果未孕小鼠子宫内膜上皮与基质中均无明确SP干/祖细胞,产后哺乳期后的小鼠子宫内膜基质中含有SP干/祖细胞达(3.44±1.59)%。结论本研究初步检测到小鼠产后子宫内膜中含有SP干/祖细胞。产后更多SP细胞的出现可能与修复损伤的子宫内膜有关。这群SP细胞是子宫原位干细胞还是有其他来源,如何参与子宫内膜的修复,其分子机制如何,尚待进一步研究。