The Impact of Internal or External Transanastomotic Pancreatic Duct Stents Following Pancreaticojejunostomy. Which One Is Better? A Meta-analysis

Background

The use of pancreatic duct stent to improve postoperative outcomes of pancreatic anastomosis remains a matter of debate, and the value of stenting when performing anastomosis for normal pancreas (soft and duct less than 3 mm) needs further study. The aim of the present meta-analysis was to evaluate the perioperative outcomes of patients with stenting during pancreatic anastomosis and compare the effect of external stent with that of internal stent indirectly.

Methods

A systematic literature search (EMBASE, MEDLINE, PubMed, The Cochrane Library, and Web of Science) was performed to identify studies evaluating external stent or internal stent. Included literature was assessed and extracted by two independent reviewers. A meta-analysis including comparative studies providing data on patients with and without external stenting or internal stenting during pancreaticojejunostomy anastomosis was performed.

Results

Thirteen articles including 1,867 patients were identified for inclusion: five randomized controlled trials study and eight observational clinical studies. Meta-analyses revealed that use of external stent was associated with a significantly decreased risk for pancreatic fistula in total (odds ratio (OR) 0.47; 95 % confidence interval (CI) 0.31–0.71; P?=?0.0004; I ²?=?3 %), pancreatic fistula in normal pancreas(OR 0.5; 95 % CI 0.30–0.82; P?=?0.007; I ²?=?5 %), and overall morbidity(OR 0.64; 95 % CI 0.45–0.90; P?=?0.01; I ²?=?0 %); however, the meta-analysis showed that there were no significant differences between internal stenting and non-stenting groups as regards perioperative outcomes and that in fact it may increase pancreatic fistula rate in normal pancreas(OR 1.97; 95 % CI 1.05–3.69; P?=?0.03; I ²?=?0 %).

Conclusions

The results of this analysis demonstrate a trend toward reduced pancreatic fistula with the use of external pancreatic stents in pancreaticojejunostomy. An internal stent does not impact development of fistula and that in fact it was not useful in a soft pancreas. Our conclusion may be limited to stenting during the duct-to-mucosa pancreaticojejunostomy anastomosis, and the value of stenting during invagination anastomosis needs further study.     

腹腔镜胆囊切除术在急性胆囊炎中的应用

目的评价急性胆囊炎中应用腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)的方法和疗效. 方法回顾分析1998年8月～2003年8月LC治疗急性胆囊炎201例. 结果本组均于入院24 h内行LC.完成LC 192例(95.52%),中转开腹9例.手术时间40～150 min,平均85 min.随访2～12个月,无并发症. 结论急性胆囊炎中应用LC难度大、变异多,但只要严格掌握手术适应证和手术技巧,在基层医院开展LC是可行的.     

乳晕真皮内注射蓝色染料法前哨淋巴结活检的应用

目的 探讨使用乳晕真皮内注射蓝色染料法前哨淋巴结活检在早期乳腺癌治疗中的作用和价值。方法 回顾性分析25例早期乳腺癌患者应用乳晕真皮内注射蓝色染料法前哨淋巴结活检的临床结果。结果 25例患者中成功检测出前哨淋巴结者24例,检出率为96．0％。共检出前哨淋巴结62枚,平均每例2．5枚。病理结果中HE染色5例淋巴结有转移,免疫组化染色7例阳性。本组前哨淋巴结检出的灵敏度为87．5％;准确性96．0％;假阴性率12．5％;假阳性率0。结论 应用乳晕真皮内注射蓝色染料法前哨淋巴结活检在早期乳腺癌治疗中同样可以取得较高的检出率和准确性。     

可膨式金属胆道支架解除恶性胆管梗阻的临床应用及其疗效分析

目的 探讨可膨式金属胆道支架支解除恶性胆管梗阻的中远期疗效及初步分析影响疗效的因素,方法 １３４例各类恶性肿瘤导致胆管梗阻的患者接受金属支架放置术,其中内镜下经乳头放置１２８例,经皮经肝放置６例,随访引流效果并与同期９７例内镜下放置塑料支架的患者进行对比。结果 操作成功率９５．７％,并发症６．４％,黄疸消除率８５．６％,金属支架的平均通畅期为３００天,明显高于塑料支轲的８０天（Ｐ〈０．０１）;平均     

原发性甲状腺功能亢进症合并甲状腺癌的临床特点(附8例报告)

９７３～１９９２年作者所在医院共手术治疗原发性甲状腺功能亢进症３３３例，其中８例经病理检查证实合并甲状腺癌，占该组病例的２．４％（８／３３３）。在复习文献的基础上，作者着重讨论了该病的临床特点，漏诊原因及诊治问题。     

接纳承诺疗法对口腔癌复发患者癌症复发恐惧的影响

目的探讨接纳承诺疗法降低口腔癌复发患者癌症复发恐惧情绪的效果。方法将63例口腔癌复发患者按照住院时间分为对照组32例和干预组31例。对照组接受常规护理,干预组在对照组的基础上以接纳承诺疗法为理论基础,构建并给予口腔癌复发患者癌症复发恐惧的接纳承诺疗法干预方案。结果干预后,干预组恐惧疾病进展简化量表、接纳与行动问卷、焦虑自评量表得分显著低于对照组(均P0.01)。结论应用接纳承诺疗法干预方案有利于降低口腔癌复发患者癌症复发恐惧情绪。     

淫羊藿次苷Ⅱ对大鼠阴茎海绵体压力、平均动脉血压的影响及其作用机制的研究

目的 淫羊藿次苷Ⅱ是淫羊藿中提取分离的单体,为了解淫羊藿次苷Ⅱ对阴茎性功能障碍(ED)的疗效,通过体内试验观察其对阴茎海绵体压力和平均动脉血压的影响及作用机制.方法 麻醉下游离大鼠左侧颈总动脉和左侧阴茎海绵体,允别插管与电生理仪连接;游离左侧海绵体神经(CN),采用电生理仪刺激器连接双极电极刺激;检测不同浓度的淫羊藿次苷Ⅱ在刺激CN后对阴茎海绵体压力(ICP)和平均动脉血压(MAP)影响,淫羊藿苷、西地那非、罂粟碱作为对照组.同时观察可溶性环鸟苷酸(sGC)抑制剂H-[1,2,4]噁二唑[4,3.A]喹喔啉(ODQ)、一氧化氮合酶(NOS)抑制剂N~ω硝基-L-精氨酸(LNNA)及一氧化氮生成抑制剂亚甲蓝(methylene blue,MB)对淫羊藿次苷Ⅱ(10~(-4)mol/L)诱发ICP/MAP变化的影响.结果 4组药物均剂量依赖性显著提高ICP(P<0.01),淫羊藿次苷Ⅱ、淫羊藿苷和西地那非对MAP无显著影响(P>0.05),而罂粟碱浓度达10~(-4)mol/L后,即可显著降低MAP(P<0.01).在受试浓度下,LNNA、MB和ODQ可显著抑制淫羊藿次苷Ⅱ诱发的ICP变化(P<0.01),对两地那非诱发的ICP变化无影响(P>0.05).结论 淫羊藿次苷Ⅱ和淫羊藿苷呈剂量依赖性地提高大鼠阴茎勃起功能(ICP),淫羊藿次苷Ⅱ效价强度为淫羊藿苷的2.44倍,对平均动脉血压没有显著影响,其机制可能与增强阴茎海绵体NO-cGMP通路的活性有关.     

液氮冷冻建立犬股骨头缺血坏死模型的实验研究

[目的]为股骨头缺血性坏死的治疗研究建立动物模型.[方法]建立犬双侧股骨头骨缺血模型,并用液氮从缺损内将股骨头冷冻坏死,术后定期拍X线片,并取股骨头行组织切片了解股骨头坏死及修复情况.[结果]术后3d组织切片见股骨头坏死,术后3、6周见股骨头骨坏死和骨修复同时存在,术后12周X线片及大体标本观察见股骨头骨缺损仍然明显.[结论]液氮冷冻建立的犬股骨头缺血坏死可作为模拟临床手术刮除死骨、植骨治疗研究的动物模型.     

Significance of mismatch repair protein expression in the chemotherapeutic response of sporadic invasive ductal carcinoma of the breast

The mismatch repair (MMR) gene plays a key role in the correction of DNA damage, and the loss of MMR has been implicated in resistance to a variety of chemotherapeutic drugs. The purpose of this study was to assess whether the reduced expression of hMLH1 and/or hMSH2 affects the chemotherapeutic responsiveness of sporadic invasive ductal carcinoma of the breast. Immunohistochemical studies were performed on 71 histologic specimens of breast cancer taken from the patients treated with surgery and subsequent cyclophosphamide, methotrexate, and 5-fluorouracil (CMF) or cyclophosphamide, Adriamycin, and 5-fluorouracil (CAF) chemotherapy for stage II or III primary breast cancer. Single-strand conformational polymorphism polymerase chain reaction (PCR-SSCP) and sequencing were carried out in 16 patients. A combined immunoreactivity score (hMLH1-IS and hMSH2-IS) was calculated by multiplying the staining grade by the intensity score. Positive expression (>4) of hMLH1-IS and hMSH2-IS were 57.7% and 60.6%, respectively, and complete losses of hMLH1 and hMSH2 were observed in 4.2% of patients. Of the patients with advanced cancer with lymph node metastasis, those having a low hMLH1-IS had a significantly higher failure rate with the CMF regimen than those having a high hMLH1-IS (p = 0.03). No significant difference was noted in chemotherapeutic response according to hMLH1 and hMSH2 expression in the CAF group. Both hMLH1-IS (p = 0.03) and progesterone receptor (PR) status (p = 0.03) were well correlated with CMF chemotherapy response in breast cancers with lymph node metastasis. Our study shows that a lack of hMLH1 expression may play a role in drug resistance, especially in the CMF group, and immunohistochemical assay for MMR protein can be used as a convenient tool for evaluating chemotherapeutic response in patients with breast cancer.     

LY294002联合SN50对裸鼠胃癌模型肿瘤细胞生长和凋亡的影响

目的探讨磷脂酰肌醇3-激酶（P13K）抑制剂LY294002与NF—KBP65核转运抑制剂SN50联合应用对裸鼠荷人胃癌模型的影响。方法采用裸鼠皮下胃癌SGC7901细胞注射法建立移植瘤模型,将模型鼠分为对照组、LY294002干预组、SN50干预组、LY294002与SN50联合干预组,每组5只。干预处理10d后观察各组肿瘤大小并计算每组肿瘤抑制率。用免疫组织化学法检测Bcl-2、P53、Bax蛋白表达,并用透射电子显微镜从形态变化上观察各组肿瘤细胞凋亡情况。结果药物干预10d后,联合干预组裸鼠胃癌细胞生长抑制率为（49．2±2．5）％,明显高于LY294002干预组（29．4±1．5）％和SN50干预组（19．7±1．6）％,差异有统计学意义（P〈0．05）。此外,与LY294002干预组和SN50干预组相比,联合干预组Bcl-2表达下调和P53、Bax表达上调更为显著（P〈0．05）,胃癌细胞凋亡程度更为严重。结论LY294002与SN50联合应用可以显著抑制人胃癌SGC7901细胞裸鼠移植瘤的生长并促进胃癌细胞凋亡。