乳腺部患者手术创面冲洗液细胞学检查的价值

目的 观察乳腺癌患者手术创面脱落癌细胞与临床病理分期的关系,为术中采用杀来脱落癌细胞的措施提供依据。方法 对２６２例乳腺癌患者手术创面冲洗液进行细胞学检查,并将结果与临床病理分期做对比分析。结果 本组虱脱落癌细胞阳性者６３例,占２４％。Ⅰ、Ⅱ、Ⅲ、Ⅳ期乳腺癌患者脱落癌细胞检出率分别为５．３％、２７．１％、７９．３％１００％。Ｔ１、Ｔ２和Ｔ３以上者,脱落癌细胞检出纺分别为６．１％、１８．９％、５６１     

腰椎间盘退变动物模型的建立

目的　建立腰椎间盘退变的动物模型并行组织学和MRI观察。　方法　健康成年恒河猴 8只 ,手术组 6只 ,在其腰4 ,5、腰5,6、腰6,7椎间盘分别作一 5mm× 3mm切口 ,分别于术前及术后 1、4、8、13、2 0周对手术椎间盘行MRI观察 ;8只恒河猴分别于术前 (对照组 )及术后 4、8、2 0周随机取 2只处死后行椎间盘组织学观察。　结果　正常成年恒河猴腰椎间盘组织学结构特点与人类相似 ;手术椎间盘高信号区域面积的百分比于术后 8、13、2 0周显著减少 (P <0 0 5 ) ;术后 4周椎间盘切口外被纤维组织覆盖 ,术后 8周 ,切口外层纤维样愈合 ,其内无愈合迹象 ,术后 2 0周 ,切口向椎间盘内延伸 ,部分髓核出现纤维化。　结论　恒河猴是一种生理特性与人类相接近的动物 ,以其为对象应用纤维环切开法可以获得可靠的腰椎间盘退变动物模型 ;通过测量MRI轴位T2加权像椎间盘高信号区域面积百分比的方法可于早期无损伤地发现椎间盘退变。     

Treatment of urinary calculi with ureteroscopy and Swiss lithoclast pneumatic lithotripter: report of 150 cases

PURPOSE: To present our clinic experience with the Swiss Lithoclast pneumatic lithotripter in the endoscopic management of urinary calculi. PATIENTS AND METHODS: From August 1994 to December 1997, 145 patients with ureteral calculi and 5 patients with urethral calculi were treated with the Swiss Lithoclast. RESULTS: In the ureteral stone group, ureteroscopic addressing of the stones was successful in 133 patients. In 27 patients, the stones were partially fragmented and remained in situ or were pushed back to the calices. They were subsequently treated successfully with SWL. Stones were fragmented in a single session in 101 cases. Complications associated with the procedure included five perforations and four urinary tract infections. All of the five urethral stone patients were treated successfully with pneumatic lithotripsy. The overall successful fragmentation rate thus was 70.7% (106 of 150) and 88.7% (133 of 150) in combination with adjuvant SWL. CONCLUSIONS: We have found Swiss Lithoclast pneumatic lithotripsy to be a safe, effective, and economical treatment method for urinary calculi. If combined with other modalities such as SWL, this treatment will be even more effective.     

化学诱导大鼠多发肾囊肿伴肾肿瘤及肾组织DNA损伤的表达

目的 观察化学药物大鼠多发肾囊肿伴肾肿瘤模型的诱发情况和ＤＮＡ损伤标记物８－羟基脱氧鸟苷（８－ＯＨｄＧ）在其肾组织的表达。方法 用２－氨基４,５－二苯噻唑（ＤＰＴ）和Ｎ－亚硝基吗啉（ＮＮＭ）诱发和人类获得性肾囊肿（ＡＣＤＫ）伴肾癌相似的大鼠动物模型,并用免疫组化方法（ＬＳＡＢ法）检查８－ＯＨｄＧ在大鼠肾组织的表达。结果在本实验中,ＮＮＭ组３／１０的大鼠诱发肾肿瘤出现,在ＤＰＴ／ＮＮＭ组的９只大鼠均     

125I标记抗胃癌单克隆抗体3H11在胃癌放射免疫导向手术中的应用

目的　探讨12 5I标记抗胃癌单克隆抗体MAb 3H11在胃癌放射免疫导向手术 (RIGS)中的应用价值。　方法　胃癌患者 35例 ,在胃镜直视下将12 5I标记的MAb 3H11注射于癌周围粘膜下 ,4～ 11d后手术 ;术中使用手持式γ探测仪对靶部位 (T)及对照本底 (NT)进行放射性计数 ,T/NT比值≥ 3 5为判别胃癌及癌浸润胃壁的标准 ,T/NT≥ 3 0为判定转移淋巴结的标准 ;对RIGS阳性、而术后常规病理检查阴性的 19组淋巴结 ,采用免疫组织化学方法检测微转移癌。　结果　本组病例中 ,33例RIGS获得成功 ,RIGS判别切缘癌浸润的总特异性和准确率分别为 98 5 %和 97 0 % ;注射标记抗体后 6～ 8d手术的患者 (n =2 5 ) ,RIGS判别区域淋巴结转移的敏感度、特异性及准确率分别为 83 6 %、95 0 %和 91 3% ;免疫组织化学染色从 10组 (5 2 6 % )RIGS阳性 ;而术后常规病理检查阴性的淋巴结中检出胃癌微转移灶。　结论　应用12 5I标记抗胃癌单克隆抗体MAb 3H11进行胃癌RIGS ,可有效判别胃癌浸润范围及区域淋巴结转移程度。     

胸肩峰皮瓣微循环监测及临床应用

目的　监测胸肩峰皮瓣微循环血流动态变化及其规律 ,为选择最佳断蒂时间提供可靠客观量化指标。　方法　应用激光多普勒血流计 (LDF)对 12例胸肩峰皮瓣转移面中点于术后 2～ 7天逐日进行微循环监测 ,皮瓣移植后第 4天起记录皮瓣蒂部阻断前、后LDF的PU(灌注单位 )值变化情况。　结果　胸肩峰皮瓣微循环血流变化可分为 2期 ,即术后前 4天的骤升期PU值分别为 3 5±1 3、4 5± 1 7、6 7± 2 9;术后 4～ 7天的平台期PU值分别为 7 4± 2 0、7 6± 2 3、7 3± 1 6。本组断蒂时间为术后 6～ 8天。　结论　胸肩峰皮瓣在转移修复面部缺损时 ,其微循环血流变化在平台期后期时 ,当阻断皮瓣蒂部后其PU值恢复到或超过阻断前水平的 5 0 %时进行断蒂 ,皮瓣全部成活。     

肝硬化门静脉高压症患者肝脏组织α1紧上腺素受体亚型的mRNA表达

目的 探讨肝硬化门静脉高压症患者肝脏组织α１肾上腺素受体亚型ｍＲＮＡ的表达。方法 应用半定量逆转录聚合酶链反应检测了１２例乙型肝炎后肝硬化门静脉高压症患者和１５例无高血压,无肝脏疾患的胆石症或胃肠道肿瘤患者肝脏组织α１肾上腺素受体亚型ｍＲＮＡ的表达。在同一体系中同时逆转录并扩增α１肾上腺素受体亚型特异性片段和内参ＧＡＰＤＨ片段,以二者的积分密度比值作为该受体亚型的ｍＲＮＡ相对表达量。结果 肝脏组织     

Klatskin tumors and Klatskin mimicking lesions of the biliary tree.

AIM: We report on the preoperative capability of imaging modalities and clinical assessment to differentiate between Klatskin tumors and Klatskin mimicking lesions of the biliary tree. Adenocarcinomas of the hepatic ducts (Klatskin tumors) mimic benign fibrosing cholangitis. Extensive resections carry a substantial risk but offer the only chance for cure in patients with a Klatskin tumor. METHODS: Thirty-three consecutive patients who underwent resection for suspicion of a malignant tumor of the hepatic hilum were reviewed. All patients underwent preoperative ultrasonography, computed tomography, ERCP and angiography. The patients were divided into a group of true Klatskin tumors and a group of benign Klatskin mimicking lesions. RESULTS: Twenty-seven of the resected specimens were malignant tumors, and six lesions showed only fibrosing cholangitis. Preoperative clinical presentation and imaging modalities were very similar between Klatskin tumors and fibrosing cholangitis. CONCLUSIONS: Management of obstruction of the liver hilum is dictated by the suspicion of malignancy. Complete removal of the tumor remains the therapeutic aim but clinical presentation and imaging modalities cannot help to differentiate between Klatskin tumors and Klatskin mimicking lesions prior to surgery.