SIRS评分诊断对多脏器功能障碍的早期预警意义初探

本文试图通过对全身性炎症反应综合征(SIRS)的评分诊断的初步分析,来揭示其对多脏器功能障碍(MODS)的预警作用。1 临床资料1.1 一般资料收集本院1997年5月～1998年8月间本院脑血管科、ICU 室重症病人78例,其中男56例,女22例,年龄35岁～77岁,平均62.8岁±5岁。脑出血44例,重症感     

肺转移瘤的手术治疗

目的：探讨肺转移瘤外科治疗适应证、手术方式以及疗效。方法回顾性分析28例经手术治疗肺转移瘤患者的临床资料。结果术后随访5年,术后1、3、5年生存率分别为75.0%、57.1%、42.9%,中位生存期为35.3个月;肺转移瘤完全切除患者24例,5年生存率为45.8%(11/24),不完全切除患者4例,5年生存率为25%(1/4);术后病理结果证实有淋巴结转移17例和无淋巴结转移11例,5年生存率分别为29.4%(5/17)和63.6%(7/11)。结论对肺转移瘤进行早期的完全性切除是延长患者生命的关键,原发性肿瘤性质及纵隔淋巴结的转移状况是影响手术方式和预后效果的重要因素。     

完全机器人腹腔镜腹膜后入路活体供肾切取术的临床应用

目的探讨机器人腹腔镜腹膜后入路活体供肾切取的手术技术及安全性,总结临床经验。方法分析该院2017年1月所实施的3例机器人活体供肾切取术,供受体均为母子关系,供体年龄47~49岁,受体年龄23~29岁,其中取左肾2例,右肾1例,术前供体各项检查及伦理审批完全符合捐献条件,术前血管成像未发现血管变异,1例术中发现一支副肾动脉。结果 3例患者顺利完成供肾切取术,未行中转开放。术后未发生手术相关并发症,手术时间分别为115.0、120.0和140.0 min;术中出血量50、85及110 ml;热缺血时间2.0~4.0 min;3例患者均在术后第3天拨除引流管,术后第5天出院。移植肾均在血流开放后2.0 min内泌尿,术后1周内移植肾功能均恢复正常。结论采用经腹膜后入路行机器人活体供肾切取术是安全有效的,供体术后恢复快,对供肾也无不利影响,但高昂的手术费用制约了其广泛的临床应用。     

全胸腔镜肺叶切除术中转开胸手术指征的探讨

目的为了更好地把握全胸腔镜肺叶切除术中转开胸的时机,探讨全胸腔镜肺叶切除中各种原因中转开胸的手术指征。方法2006年9月至2009年2月共施行全胸腔镜肺叶切除术172例,男88例,女84例;平均年龄58.9岁。术后病理:原发性肺癌133例,肺转移癌或其他恶性肿瘤7例,良性疾病32例。病变位于右肺上叶46例,右肺中叶23例,右肺下叶31例,左肺上叶36例,左肺下叶36例。手术均通过3个切口完成,肺叶解剖性切除和系统性淋巴结清扫的操作顺序与常规开胸手术基本相同。如镜下操作遇纵隔淋巴结粘连或转移、出血等特殊情况,则延长操作口至12～15cm,转为开胸手术。按肿瘤最大径分为最大径≥5cm组和最大径≤3cm组;再按是否中转开胸将患者分为中转开胸组和未开胸组,分别比较两组患者的临床资料。结果全部患者手术顺利,无严重并发症及围手术期死亡发生。全组手术时间185min,术中出血213ml。中转开胸13例,中转开胸率7.6%。其中淋巴结干扰9例,出血4例。开胸后完成肺叶切除12例,全肺切除1例。其中肿瘤最大径≥5cm组16例,手术时间187min,出血203.8ml;最大径≤3cm组98例,手术时间202min,出血231.3ml,两组数据比较差异无统计学意义。中转开胸组13例,平均年龄68.7岁,实体瘤最大径23.8mm;未开胸组159例,平均59.3岁,实体瘤最大径27.8mm,两组年龄差异有统计学意义(P=0.016),而实体瘤最大径差异无统计学意义(P=0.404)。结论淋巴结干扰和出血是主要的中转开胸的原因,肿瘤大小、叶间裂分化情况及胸腔粘连不是常见的中转开胸的原因。     

Injury of ~(125)Ⅰ seeds implants to trachea and esophagus of rabbits

Objective To evaluate the impact of 1125 seeds para-tracheal braehytherapy on regional tissue injury in rab-bit models. Methods 42 rabbits were randomized into 7 groups. Group 1 to 6 belong to study groups (in which 1,4,5 and 6 belong to "dose gradient" subgroup, while 2,3 and 4 to "chronologic" subgroup) , while the last group acts as negative con-trol. The activity of seeds in study group were 0.3 mCi in group 1, 0.5 mCi in group 2 to 5, 0.7 mCi in group 5, and 0.9mCi in group 6. False seeds (0 mCi) were used for the negative control. 4 seeds with equal dosage were implanted between trachea and esophagus in each rabbit under general anesthesia. Seeds arrangement was made according to Paris principle. For the tissue injury evaluation, group 2 was sacrificed by the end of first month post-operatively, group 3 at the end of the second month, and group 4 end of the third month. The rest of rabbits were also sacrificed at the end of the third month. Pieces of adjacent e-sophagus and trachea were sampled from each rabbit. Tissue injury features such as inflammation, edema, congestion or fibrosis as evaluated histologically. Results All rabbits were healthy during study period except 5. Histological analysis revealed that trachea samples from all groups had lymphocytas and plasma cells infiltration as signs of chronic inflammation, hut fibrosis was nut clearly visible. There were no differences between study and control groups with respect to inflammation, edema and con-gestion scores. But in groups which received the highest doses of radiation or sacrificed at 60 d showed more eosinophil infiltra-tion and epithelum degeneration, and statistical significance was reached between these groups and control. Esophageal samples had less histological changes compared with trachea. Conclusion Para-tracheal implantation of ~(125)Ⅰ seeds with therapeutic or higher dosage only induce minor and reversible damage to the regional tissue. This implies that ~(125)Ⅰ implants adjacent to trachea or esophagus are clinically safe.     

Risk factors for occult nodal metastasis in patients with stage ⅠA peripheral non-small cell lung cancer

Objective To study the risk factors of mediastinal lymph node metastasis in patients with ≤3 cm peripheral non-small cell lung cancer.Methods From January 2000 to December 2010,a total of 281 patients with NSCLC[152 men and 129 women,aged ( 60.31±12.13) years;≤ 3 cm in diameter]underwent lobectomy or partial resection with systematic mediastinal lymphadenectomy in hospital .Clinical data included age,gender,symptoms,history and quantity of smoking history,history of tumor,family history of tumor,site,diameter,calcification,speculation,border,lobulation,traction of pleural,vascular convergence sign,cavity were collected compaired and analyzed.Single and multi-variate analysis was performed to determine the independent risk of occult N2 nodal involvement.Results Logistic regression analysis show seven clinical characteristics (fleshless( OR:22.262),history of tumor(OR:5.485),diameter( 0R:3.788),density( OR;5.850),traction of pleural (OR:1.371),border ( OR:8.259) and cavity (OR:7.124) were risk factors.Conclusion Fleshless,history of tumor,diameter,density,traction of pleural and the border and cavity were independent predictors of malignancy in patients with ≤3 cm peripheral non-small cell lung cancer.     

纵隔畸胎瘤伴胸膜及支气管瘘误诊肺包虫病1例

病人男,55岁.内蒙古籍.反复咳嗽、咳痰20年,加重伴发热40天.咳痰约150～300 ml/天,黄色稀胶冻样,有明显腥臭味.无咯血及胸痛胸部X线片示左肺巨大囊肿性占位性病变,中心液化坏死(图1).胸部CT示左肺上叶囊性占位性病变(图2、3).诊断:左肺包虫病.     

K-Ras突变对表皮生长因子受体抑制剂敏感细胞株的影响

目的 观察K-Ras突变对于携带表皮生长因子受体(EGFR)突变细胞的EGFR抑制剂敏感性的影响.方法 构建K-Ras突变真核表达质粒,采用脂质体转染技术转染肺癌细胞HCC827(EGFR突变,K-Ras野生)和H292(EGFR、K-Ras均野生),噻唑蓝(MTT)比色法测定转染K-Pas突变质粒和空白质粒后各细胞对EGFR抑制剂的半数抑制浓度(IC_(50)).结果 真核表达质粒构建成功.细胞HCC827未转染K-ras突变质粒对吉非替尼(Iressa)的IC_(50)为0.007,转染后对Iressa的IC_(50)为12.3,差异有统计学意义(P<0.01).细胞H292未转染K-ras突变质粒对Iressa的IC_(50)为0.04,转染后对Iressa的IC_(50)为12.0,差异有统计学意义(P<0.01).细胞A549(K-Ras突变)对Iressa的IC_(50)为12.8,与转染K-ras突变质粒的细胞HCC827及H292比较,差异无统计学意义(P>0.05).结论 野生型或突变型EGFR出现K-Ras突变均可引起吉非替尼耐药,其程度与K-Ras突变的细胞株相当.     

CO2气体灌注内镜甲状腺手术的研究

目的 观察内镜甲状腺手术CO2充气对机体病理生理的影响,探讨CO2充气内镜甲状腺手术临床应用的可行性.方法 通过动物颈部灌注CO2气体压力及其内镜甲状腺切除术实验,检测动物在术前、术中30、60 min和手术结束各时段心率(HR)、呼吸频率(BR)、PH、PaO2、PaCO2和BE.依据CO2气体灌注内镜甲状腺手术的基础,分析经前胸壁入路内镜甲状腺切除术31例临床资料.结果 应用6mmHg CO2(1 mmHg=0.133 kPa)充气压力建立操作空间,实验动物的BR、HR、PH、PaO2、PaCO2和BE在手术过程中无明显变化.应用12 mmHg CO2充气压力建立操作空间,实验动物的BR、HR、PH、PaO2、PaCO2和BE变化差异均有统计学意义(P<0.01).临床31例患者均顺利完成手术,其中行甲状腺部分切除加例,甲状腺次全切11例.平均手术时间113 min,平均术中出血量6 ml,术后平均引流时间2.83 d,术后平均住院时间4 d.术后无喉上、喉返神经损伤及甲状旁腺损伤,无高碳酸血症出现.所有病例随访1～10个月均无不适.结论 严格掌握手术适应证及禁忌证,掌握其并发症的特点和防治措施,完善相应的围手术期处置,临床上将CO2气体灌注压力控制在4～6 mmHg,进行内镜甲状腺切除术安全可行,具有良好的微创、美观效果.     

丹参酮ⅡA对人肝癌细胞HepG2生长的抑制及诱导凋亡的研究

目的研究丹参酮ⅡA对人肝癌细胞HepG2生长的抑制作用及诱导其凋亡的作用,探讨丹参酮ⅡA抑制肿瘤的作用机制。方法将丹参酮ⅡA配制成0．5μg／L、1．0μg／L、2．0μg／L、5．0μg／L、10．0μg／L的浓度,0μg／L为阴性对照。将肝细胞在不同浓度的丹参酮ⅡA中培养24h、48h、72h,采用MrITI’法检测丹参酮ⅡA对肝癌细胞HepG2的抑制情况,流式细胞仪检测细胞的周期和凋亡情况。结果相同的浓度．随着时间延长,吸光度逐渐下降,而同一时间,随着浓度的增加,吸光度也逐渐下降。相同浓度,随着时间的延长．丹参酮ⅡA对肝癌细胞HepG2生长的抑制率逐渐增加,相同时间,随着浓度的增加,丹参酮ⅡA对肝癌细胞HepG2生长的抑制率也逐渐增加。随着丹参酮ⅡA浓度的增加,G0／G1的比例逐渐升高（2．0μg／mL、5．0μg／mL、10．0μg／mL）,与对照组比较差异有统计学意义（P〈0．05）。随着丹参酮ⅡA浓度的增加,细胞凋亡率逐渐升高．与对照组比较差异有统计学意义（P〈0．05）。结论丹参酮ⅡA对肝癌细胞HepG2的生长具有抑制作用,且具有时间和浓度依赖性,对凋亡的诱导作用具有浓度依赖性。