影响功能性消化不良患者就医行为因素的调查与分析

目的:调查分析影响功能性消化不良(FD)患者就医行为的因素.方法:选取在5家医院门诊就诊的FD 200例,按照初诊医院分为基层医院组与三级医院组,进行罗马Ⅲ标准问卷调查并评分,对结果进行统计分析.结果:两组患者性别、年龄、职业、学历、消化不良症状的严重程度,差异均不显著(P>0.05);三级医院组消化不良症状的发作频率...     

218例巨大胆总管结石病人临床诊疗分析

Objective To investigate the clinical situation, laboratory examination, endoscopic therapy and complications in 218 patients with huge choledocholith. Methods A total of 218 patients with choledocholith were enrolled in the observational group (diameter≥2 cm), They were then sub-divided into the 1stone group, 2 stone group and >2 stone group according to the stone number. The other 231 patients with choledocholith were regarded as control group(diameter<2 cm). The history information, clinical situation, laboratory examination, endoscopic therapy and complications in all the patients were analyzed. Results The ratio of patients with history of biliary infection and choledocho-lithotomy was significantly higher in the observational group than in the control(26.6%, 35.6% ver-sus 15.2 %, 7.8 %). And the ratio of patients with history of acute pancreatitis was markedly lower in the former than in the latter group (9.6% vs 16.9%). In 2 stone group and >2 stone group, the inci-dence of abdominalgia and fever was higher than that in the control group significantly(88%, 94.2% vs 74.5% ,64%, 65.4% vs 41.6%). The incidence of jaundice and diarrhea was remarkably higher in >2 stone group than in the control group(78.8% vs 51.1% ,44.2% vs 26.8%). In 2-stone group and >2-stone group, the serum levels of TA, AKP, γ-GT were significantly increased as compared with the control group. Meanwhile, the serum levels of total bilirubin and direct bilirubin were markedly higher in >2 stone group than in the control group. After operation, the serum levels of total biliru-bin, direct bilirubin and AKP were reduced as compared with those before operation. The total and one-time success rate of endoscopic stone extraction was remarkably lower in 2 stone group and >2 stone group than in the control(88%, 79% vs 94% ,72%, 56% vs 82%). The mean duratgion of hos-pitalization was much higher than control group (13±4.6, 16±5.2 vs 10±3.8). In >2 stone group, the incidence of stone obstruction, papilla bleeding and arrhythmia was significantly increased as com-pared with the control group in the course of operation(21%, 33 %, 15 % vs 6.9 %, 19 %, 9 %). In 2 stone group and >2 stone group, the incidence of acute pancreatitis after operation was significantly higher than that in the control group(15%, 23% vs 7. 4%). The incidence of hyperamylasemia after op-eration was significantly higher than that in the control group in >2 stone group(17% vs 6%). Conclusion Repeated biliary infection and choledocholithotomy have close relation with huge choledocholith. Jaundice, diarrhea and lesion of liver function occur more easily in the patients with huge choledocholith, and the endo-scopic therapy is more difficult. Complications occur much easily during and after operation.     

细胞黏附分子L1基因沉默对胰腺癌细胞Capan-2神经侵袭能力的影响

目的 观察沉默细胞黏附分子L1基因(L1CAM)表达后对胰腺癌Capan-2细胞体外神经侵袭能力的影响.方法 应用慢病毒介导的L1CAM-shRNA干扰载体转染胰腺癌Capan-2细胞,以L1CAM-NC转染细胞为对照.分别将L1CAM-shRNA组及L1CAM-NC组细胞与大鼠背根神经节(DRG)、基质胶(matrigel)一起构成共培养神经侵袭模型,倒置显微镜下观察神经突及细胞生长情况并拍照,利用Image pro plus图像分析软件对照片进行分析.结果 共培养模型中,L1CAM-NC对照组细胞向DRG方向不断迁移增殖,包绕神经突起并沿之向DRG爬行,而L1CAM-shRNA组中并未观察到该现象.共培养第3天和第5天时,L1CAM-NC对照组细胞集落面积显著高于L1CAM-shRNA组(P＜0.01),但两组的神经突生长差异无统计学意义.结论 干扰L1CAM的表达可能通过抑制细胞集落形成及迁移爬行的方式抑制胰腺癌Capan-2细胞的神经侵袭作用.     

胰腺导管腺癌小鼠模型的研究进展

胰腺癌动物模型是胰腺癌实验研究中的重要组成部分,建立理想的胰腺癌动物模型将为研究者们探索胰腺癌发病机制提供有效工具,本文总结了近年来胰腺导管腺癌小鼠模型的建立方法,分析了不同模型的优缺点并作一展望.     

急性胰腺炎治疗研究进展——从外科手术到介入治疗

急性胰腺炎是常见的急腹症之一,其中胆管疾病和酒精中毒占急性胰腺炎住院患者病因的80％以上,药物、感染、内镜下逆行胰腺造影术、胰管结构异常等亦可引起急性胰腺炎的发生。近年来,急性胰腺炎的发病率有上升趋势,据统计,美国急性胰腺炎发病率从0．015％增至0．042％。急性胰腺炎病变轻重不等,轻者以胰腺水肿为主．具有自限性．通常在3～5d内恢复。重症急性胰腺炎（severeacutepancreatitis,SAP）是指并发器官衰竭和（或）局部并发症（如坏死、脓肿形成、假性囊肿）的急性胰腺炎,占所有病例的15％～20％。     

2.13胃腔内黏膜缝合术治疗胃食管反流病的临床研究

目的本文探讨胃腔内黏膜缝合术治疗胃食管反流病的临床应用效果. 方法32例入选患者均因反酸,烧心,上腹部饱胀不适等症状就诊,无胃部手术,无全身其他系统疾病.随机分为2组,手术组12例,行胃腔内黏膜缝合术;对照组20例,予以奥美拉唑,20mg,每日2次,治疗2周,后改为每日1次,再治疗4周.     

NI—Ti网状食管支架术后局部血流量变化分析

目的 研究实验犬食管支架术后0．5、24小时局部粘膜血流量的变化。方法 选择成年、健康犬12只,分别置入NI－Ti网状自扩张食管支架,采用多普勒血流仪检测支架术后0．5、24小时局部粘膜血流量的变化,与正常食管粘膜进行比较。结果 支架术后0．5、24小时食管局部粘膜血流量较正常食管均明显减少。结论 支架置入可导致食管局部粘膜血流量明显降低,从而促进粘膜的损害,说明支架对食管壁具有明显的损伤作用。     

Ni—Ti、317L合金在食管局部的致纤维化研究

为探讨新型支架材料Ni-Ti、317L合金在食管局部的致纤维化作用,按美国ASTM标准制备NiTi、317L合金的金属浸提液：“组织块培养法”原代培养食管壁疤痕的成纤维细胞（Fb),传代后以金属浸提液进行培养,分组后分别培养4、24、48、72h,MTT法检测不同培养时间后Fb增殖功能的变化;按美国ASTM标准进行Ni-Ti、317L合金试件的食管壁内包埋实验,即将金属试件经表面处理后直接置入食管壁粘膜层与肌层之间,术后2、12周取出包埋组织,分析试件周围组织的病理变化,并进行胶原纤维染色,观察纤维形成状况。结果显示,NiTi、317L金属浸提液可轻度抑制Fb的增殖功能,随培养时间延长抑制作用呈增强趋势,NiTi的作用略强于317L;包埋实验结果也完全符合美国ASTM标准的要求,随包埋时间延长试件表面的纤维膜逐渐变薄,纤维积聚呈减少趋势。这表明NiTi、317L合金在体液中的弥散成分不会激活Fb的增殖与分泌功能,两种合金置入食管内不致引起周围组织纤化维化。