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.     

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

目的 探讨术前口服葡萄糖水对肠道手术围手术期食管下段pH值、胰岛素抵抗及血浆蛋白的影响.方法 将2008年1-12月间择期行结直肠肿瘤根治手术的60例患者按随机数据表法随机分为糖水组、蒸馏水组及禁食组,每组20例 研究过程中有4例退出试验,最终3组患者分别为19例、19例和18例.糖水组术前晚口服12.5%的葡萄糖溶液800 ml,麻醉诱导前2 h再口服12.5%的葡萄糖溶液200 ml：蒸馏水组术前晚口服蒸馏水800 ml,麻醉诱导前2 h再口服蒸馏水200 ml 禁食组术前常规禁食8～12 h.手术采用静吸复合硬膜外麻醉维持,监测插管及拔管时食管下段pH值 术前及术后第1、3、7天测定白蛋白、转铁蛋白、前白蛋白以及血胰岛素、空腹血糖.结果 糖水组、蒸馏水组和禁食组患者围术期食管下段pH值分别为8.05±0.43、7.98±0.41和7.94±0.41,均未出现食管酸性反流（P＞0.05）.术后第1天糖水组血胰岛素水平为（16.32±16.11）μU/L,低于蒸馏水组的（30.65±41.74）μU/L和禁食组的（34.01±52.91）μU/L 胰岛素抵抗指标（log HOMA-IR）为0.491±0.345,低于蒸馏水组的0.589±0.565和禁食组的0.596±0.632 上述差异均有统计学意义（均P＜0.05）.术后第3天和第7天禁食组血转铁蛋白低于另外两组,术后第3天禁食组血白蛋白低于另外两组,差异均有统计学意义（均P＜0.05）.结论 禁水时间缩短至术前2 h并不增加麻醉诱导插管或拔管时食管反流的概率 术前口服葡萄糖水可减轻患者肠道手术后胰岛素抵抗及蛋白质分解.     

残胃癌的临床病理特点及淋巴转移规律分析

目的 探讨残胃癌临床病理特点和淋巴转移规律及其与原发性胃癌的差异.方法 比较1994年3月至2008年8月收治的56例残胃癌和1171例原发性胃癌临床病理与淋巴结转移情况,探讨残胃癌临床病理特点和淋巴转移规律.结果 本组残胃癌患者56例,占同期胃癌患者的4.6%.与原发性胃癌患者相比,残胃癌患者在发病年龄较高[(64.3±9.0)比(58.3±12.6)岁]、淋巴结阳性率较高(31.8%比25.5%)、Borrmann分型(较晚)及联合脏器切除率较高(57.1%比26.4%),差异均有统计学意义(X~2值为18.800、11.679、9.177、25.190;P均<0.05);与原发性胃癌行淋巴结廓清的病例相比,残胃癌No. 10、11组淋巴结转移阳性率较高(X~2值为5.558、6.099;P均<0.05);而原发性胃癌No.2、3、8组淋巴结转移率较高(X~2值为15.508、6.003、4.084;P均<0.05).残胃癌空肠系膜淋巴结转移率为24%(6/25),周围结缔组织浸润发生率高(8/56).结论 残胃癌患者具有与原发性胃癌不同的临床病理特征,淋巴结转移有一定规律可循;近端胃癌D2淋巴结廓清术和空肠系膜淋巴结清扫是残胃癌的标准手术,但应注意联合脏器切除.     

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.     

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。     

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