Critical Appraisal on the Role and Outcome of Emergency Colectomy for Uncomplicated Right-sided Colonic Diverticulitis

Background Emergency colectomy is well accepted for treating complicated right-sided colonic diverticulitis. However, the role of colectomy for uncomplicated diverticulitis is not well defined. The aim of this study was to evaluate the short-term and long-term surgical outcome of uncomplicated right-sided diverticulitis in our locality. Patients and Methods Retrospective chart review of patients operated for right-sided diverticulitis over a 20-year period was conducted. Recurrent attacks of right-sided diverticulitis, re-operation rate and re-hospitalisation rate were the long-term parameters of interest. An updated telephone interview was carried out for all surviving patients. Results Seventy-four patients (35 males and 39 females), median age 35.5 (range 16–70) years, were operated for uncomplicated diverticulitis. Thirty patients underwent colectomy, whereas the others underwent appendectomy with diverticulectomy (n = 8) or appendectomy alone (n = 36). All short-term parameters were less favourable for the colectomy group, including higher complication rate, slower return of gastrointestinal function, higher requirement of parenteral analgesic and longer hospital stay. Without colectomy, only 2 patients developed recurrent diverticulitis necessitating hospitalisation, both of whom resolved on conservative treatment. On the other hand, 1 patient required re-operation after colectomy because of intestinal obstruction. The overall re-hospitalisation rate was comparable between the colectomy and the non-colectomy group (16.7% vs. 13.6%). Conclusions Emergency colectomy can eradicate suspicious lesions and eliminate risk of recurrent diverticulitis but at the expense of higher morbidity rates. As the natural course of uncomplicated right-sided colonic diverticulitis is usually benign, conservative treatment with minimal surgery may be a better therapeutic option.     

溃疡性结肠炎的外科治疗指南

0引言此治疗指南是在Medline,PudMed以及循证医学Cochrane中心数据库中进行的一次回顾性资料的有组织查询分析．其中关键词包括溃疡性结肠炎、回肠肛管储袋式吻合、回肠造瘘术、结直肠肿物、外科手术、回肠直肠吻合术和一些相关的主题．循证医学水平和推荐等级见表1．     

克隆并应用计算机软件分析小鼠LASS1基因启动子区的特征

目的:克隆并应用计算机分析小鼠LASS1基因启动子,为进一步研究在细胞衰老过程中LAG1基因的转录调控奠定基础。方法:实验于2006-03/07在汕头大学医学院细胞衰老实验室完成。培养EC109细胞株,预测小鼠LASS1基因启动子所在区域,用PCR技术扩增启动子区序列,构建重组质粒pGEM-T-501、pGEM-T-181、pGEM-T-26,并转化JM109感受态菌,并分别克隆入荧光素酶报告基因载体pGL3-Basic及增强型绿色荧光蛋白报告基因载体pEGFP-1,酶切pGEM-T-501、181、26重组质粒及pGL3-Basic、pEGFP-1载体,制备插入片段和载体,构建重组表达质粒pGL3-501、pGL3-181和pGL3-26及pEGFP-501、pEGFP-181和pEGFP-26,转化JM109感受态菌。用脂质体介导的方法瞬时转染EC109细胞,测定荧光素酶表达活性及观察绿色荧光蛋白的表达情况。结果:①在预测启动子区构建了3种荧光素酶报告基因表达体系及3种增强型绿色荧光蛋白报告基因表达体系,分别为pGL3-501(-501bp～ 106bp)、pGL3-181(-181bp～ 106bp)、pGL3-26( 26～ 106)、pEGFP-501、pEGFP-181和pEGFP-26。②pGL3-501表达载体与pGL3-181表达载体荧光素酶表达活性相近,pGL3-26表达载体荧光素酶表达活性极低,与阴性对照活性相近, 26bp～ 106bp无启动子活性。绿色荧光蛋白的表达情况也类似,pEGFP-501和pEGFP-181有明显的绿色荧光蛋白表达,pEGFP-26和空载体pEGFP-1无表达活性。结论:-181bp～ 26bp区域含有小鼠LASS1基因转录所必需的基本启动子序列。其中2个SP1保守序列是小鼠LASS1基因启动子所必需的。     

筛选心肌缺血再灌注大鼠差异表达基因

目的：利用抑制性消减杂交技术，筛选出大鼠心肌缺血再灌注的差异表达基因，以期通过基因线索探讨其损伤机制。方法：实验于2006—03／10在中山大学中山医学院完成。①实验分组：Sprague-Dawley雄性大鼠40只，随机分为手术组，对照组，每组20只。②实验干预：手术组结扎左冠状动脉，心电图出现急性心肌梗死改变90min后，去除结扎线，再灌注60min，建立心肌缺血再灌注大鼠模型。对照组仅穿线不结扎，余同手术组。③取缺血区心肌，提取Total RNA，构建cDNA文库，利用抑制性消减杂交技术筛选差异表达基因，测序，登录Genbank寻找同源性基因。结果：共获得124个阳性结果，56个为高表达基因，68个为低表达基因，其中发现5个新的cDNA片段。其中能量代谢、物质运输、信号转导相关差异表达基因分别占所有差异表达基因的39．25％，15．89％，15．89％，并且主要变化为下调。结论：抑制性消减杂交技术是一种高效的筛选差异基因的方法。心肌缺血再灌注后基因变化涉及多种功能的基因，以能量代谢、物质运输、信号转导相关基因下调明显。