急性炎症期腹腔镜胆囊切除术的探讨

目的　探讨腹腔镜下切除急性炎症期胆囊的手术时机及可行性。方法　对 5 5例急性炎症期胆囊病人进行腹腔镜胆囊切除术的资料进行分析。结果　 5 5例患者除 1例中转开腹外 ,术中无伴胆管及肠管、血管损伤 ,术后无 1例发生胆漏、出血。结论　无并发症急性炎症期腹腔镜胆囊切除术是可行的 ,手术难度和效果与发病持续时间无明显关系。     

麻醉诱导前口服流质对结直肠癌患者胃液量及pH值的影响

目的 研究麻醉诱导前1.5-2 h饮250ml清流质对接受限期手术的结直肠癌患者麻醉诱导时残留胃渍量及胃渍pH值的影响.方法 入选2008年1月1日至2008年6月30日在我院接受限期手术的90例结直肠癌患者、所有患者均于术前晚午夜开始禁食并被随机分配到糖水组、纯水组或禁食组.术晨麻醉诱导前1.5-2 h,糖水组患者于5 min内饮完5%葡萄糖溶液250 ml,纯水组饮250 ml的纯水.全麻诱导并气管插管后马上置入多孔鼻胃管进行胃渍抽吸,对胃液进行计量及pH值测定.结果 三组患者在性別组成、年龄和体重指数方面差异无统计学意义.糖水组、纯水组和禁食组的各项试验指标分别为:残留胃渍量(19±14.4)m]、(15±13.4)ml和(16±10.3)m1;胃渍pH值1.64±0.166、2.02±1.265和2.18±1.420;残留胃渍量超过25 ml并且pH值小于2.5的比蜘12/30、7/30和5/30.三项指标在三组中的差异无统计学意义.结论 麻醉诱导前1.5-2 h饮250 ml清流质对接受限期手术的结直肠癌患者麻醉诱导时的残留胃液量及胃渍pH值无影响.     

快速康复外科在结直肠癌择期手术中的应用效果

Objective To investigate the clinical application of fast track surgery in patients undergoing elective colorectal carcinoma surgery. Methods Seventy patients with colorectal carcinoma requiring colorectal resection were randomized into two groups: fast-track group (35 cases) and conventional care group (35 cases). Results Sixty-two patients finished the study, 32 cases in fast-track group and 30 cases in conventional care group. The median and average time to the first passage of flatus (2±1 vs. 4±2, P<0.01), the first passage of stool (3.8±1.6 vs. 6.4±2.5, P=0.0007), resumption of normal diet [(4±2) vs. (8.2±2.2), P<0.01] and the length of postoperative stay (6±1 days vs. 11.7±3.8 days, P<0.01) were much shorter in the fast-track group than in the conventional care group. The preoperative incidence of thirst (2/32 vs. 23/30, P<0.01), hunger (5/32 vs. 20/30, P<0.01) and postoperative infectious complications (2/32 vs. 8/30, P=0.04) were much lower in the fast-track group than in the conventional care group. Conclusion Fast track surgery in patients undergoing elective colorectal resection was safe and effective.     

术前口服葡萄糖水对肠道手术围手术期胰岛素抵抗及血浆蛋白的影响

Objective To investigate the effects of oral intake of glucose solution before surgery on the pH at the lower esophagus,perioperative blood glucose level,and plasmic protein in patients undergoing radical resection for colorectal cancer.Methods Between January 2008 and December 2008,60 patients undergoing radical surgery for colorectal cancer were enrolled and randomized into three groups using the table of random digits.Four patients were withdrawn from the study.Patients in group A (n=19) were given 800 ml of 12.5% glucose solution for oral intake the night before surgery,and 200 ml two hours before surgery.Patients in group B (n=19) were given distilled water instead of glucose.Patients in group C (n=18) were asked to fast for 8-12 hours before operation.Combined general and epidural anesthesia was used.pH at the lower esophagus was monitored during intubation and extubation.Albumin,transferrin,prealbumin,insulin,and fasting blood glucose were measured before surgery and at postoperative day 1,3,and 7.Results pH at the lower esophagus was 8.05±0.43 in group A,7.98±0.41 in group B,and 7.94±0.41 in group C.There were no perioperative acid regurgitations (P＞0.05).Serum insulin in group A at postoperative day 1 was (16.32±16.11) μU/L,which was significantly lower than that in group B (30.65±41.74)μU/L and group C (34.01 ±52.91 ) μU/L.Log HOMA-IR in group A at postoperative day 1 was significantly lower than that in group B and group C (0.49±0.35 vs.0.59±0.56 and 0.60±0.63,P＜0.05).Transferrin in group C at postoperative day 3 and 7 was significantly lower than that in the other two groups,as was albumin at postoperative day 3(P＜0.05).Conclusion Oral liquid intake 2 hours before surgery is not associated with increased risk of regurgitation or aspiration during intubation and extubation,and may glucose solution intake reduce insulin resistance and protein degradation after colorectal surgery.     

大肠癌组织Twist和Survivin的表达与预后关系

<正>Twist作为一种肿瘤基因,通过在许多肿瘤细胞中的过度表达,在抗细胞凋亡、肿瘤的多药耐药性、上皮-间质转变(EMT)、血管的发生和肿瘤的侵袭方面起到了非常重要的作用。Survivin具有在正常分化组织中不表达而在各种肿瘤组织中高表达的特性,使其在肿瘤的早期诊断、治疗和评价预后方面具有独特的优势[2]。本研究应用免疫组织化学(SP)染色方法对66例大肠腺癌组织和10例大肠正常黏膜和中的     

siRNA特异性沉默hTERT基因对人结肠癌LoVo细胞生物学行为的影响

目的:探讨靶向端粒酶逆转录酶(hTERT)基因的siRNA抑制人结肠癌LoVo细胞生物学行为的影响和机制。方法:构建针对hTERT基因的siRNA(pU6-hTERT-siRNA),LipofectamineTM2000转染LoVo细胞,以同源性的pU6作阴性对照,以未转染的细胞作空白对照。MTT法检测细胞生长率。建立裸鼠结肠癌皮下移植瘤模型,瘤内注射法将pU6-hTERT-siRNAs、pU6转导,观察各组移植瘤生长情况。RT-PCR和荧光定量PCR检测细胞株和移植瘤细胞hTERTmRNA水平的变化。Western blotting检测hTERT蛋白水平的变化。结果:LoVo细胞转染pU6-hTERT-siRNA72 h后,细胞增殖抑制率达42.1%,显著高于阴性对照组(3.2%),P0.01。裸鼠皮下移植瘤转染pU6-hTERT-siRNA14 d后,种植瘤体积为(85.9±18.7)mm3,显著小于阴性对照组[(157.4±55.6)mm3]和空白对照组[(155.2±54.2)mm3],P0.01。荧光定量PCR和Western blotting结果显示转染pU6-hTERT-siRNA后,细胞株和移植瘤内的hTERT mRNA以及细胞株蛋白水平表达显著减少(P0.01),阴性对照和空白对照间无显著差异。结论:pU6-hTERT-siRNA在体内外能有效抑制结肠癌LoVo细胞中hTERT基因表达,对裸鼠皮下结肠癌细胞移植瘤有明显的抑制生长作用。     

直肠神经内分泌肿瘤内镜黏膜下剥离术

病例简介 57 岁男性, 体检发现直肠距齿状线1.5 cm 约1 cm 肿物,超声肠镜提示肿物来源于黏膜下层,考虑神经内分泌肿瘤可能性大.完善术前准备后予行内镜黏膜下剥离术,术后病理证实神经内分泌肿瘤G1 期.     

早期胃癌高迁移率族蛋白1表达与淋巴结微转移关系探讨

目的:研究早期胃癌组织中高迁移率族蛋白1(high mobility group box1,HMGB1)表达水平与淋巴结微转移的关系。方法:采用免疫组化方法检测早期胃癌组织中HMGB1的表达水平,并采用淋巴结组织HE染色和抗细胞角蛋白抗体CK20的检测判断淋巴结微转移,探讨HMGB1表达水平与淋巴结微转移的关系。结果:62例早期胃癌患者中总共有淋巴结1334个,11例患者62个淋巴结发现CK抗体阳性细胞,总淋巴结微转移率4.64(62/1334)。HMGB1在45.1%早期胃癌组织中表达,与肿瘤浸润深度呈正相关(P<0.05),随着分化程度降低而增强,有淋巴结转移组比无淋巴结微转移组中HMGB1表达明显增强。结论:胃癌组织HMGB1表达与胃癌分化程度、侵袭、转移和淋巴结微转移密切相关,HMGB1检测对判断预后和指导治疗有重要意义。