PPIB蛋白对结肠癌成瘤的影响和低氧机制

目的:研究肽酰脯氨基顺反异构酶B(peptidyl-prolyl cis-trans isomerase,PPIB)蛋白对结肠癌细胞成瘤的影响,探讨结肠癌低氧发病的机制。方法:应用RNAi技术,构建下调PPIB蛋白表达的稳转结肠癌细胞株,移植到BALB/c裸鼠皮下,检测PPIB蛋白下调组与对照组的成瘤差异。TUNEL法检测两组移植瘤的细胞凋亡水平。低氧培养结肠癌细胞株,Western印迹法检测PPIB的表达水平与低氧诱导因子1α(hypoxia-inducible factor-1α,HIF-1α)的关系。结果:下调PPIB蛋白表达后,在裸鼠皮下成瘤的能力显著减弱。SW480-si PPIB下调组的移植瘤体积显著小于SW480-NC对照组(P<0.01)。TUNEL检测显示下调组的癌细胞凋亡比例显著高于对照组(P<0.001)。在低氧环境下培养后,结肠癌细胞的PPIB蛋白表达水平随着低氧条件下HIF-1α的上调而升高(P<0.05)。结论:PPIB蛋白在结肠癌中因为低氧环境而表达升高,且在升高后通过抑制癌细胞的凋亡而发挥促进结肠癌形成和进展的作用,是一个极具临床应用价值的防治结肠癌的分子靶点。     

腹腔镜远端胃癌根治术后并发症及预后危险因素分析

目的 :探讨腹腔镜辅助远端胃癌根治(LADG)术后并发症发生及远期预后的影响因素。方法 :收集2004年1月至2011年12月228例我科行LADG病人的临床病理资料,分析腹腔镜胃癌根治术后并发症发生及远期预后的影响因素。病人随访至2013年12月。结果:本研究33例发生术后并发症,发生率14.5%,主要为吻合口漏和狭窄、腹腔出血等。单因素分析表明:高龄(>70岁)、吻合方式和淋巴结转移为影响术后并发症发生的危险因素(P<0.05)。多因素分析表明:高龄以及毕Ⅱ式和Roux-en-Y吻合为影响术后并发症发生的独立因素(P     

腹腔镜腹股沟疝修补术与Lichtenstein术的对比研究

目的 评价腹腔镜腹股沟疝修补术(LIHR)的临床安全性和有效性.方法 对2003年1月至2006年1月所进行的251例LIHR和91例Lichtenstein术进行同期非随机对照研究,随访时间18~36个月.结果 LIHR和Lichtenstein的手术时间差异无统计学意义(P>0.05);两组的术后住院天数分别为(2.9±1.2)d和(3.2±1.1 d)d(P=0.107),恢复非限制性活动天数分别为(4.0±1.3)d和(4.2±2.0 d)d(P=0.167),差异无统计学意义;术后应用镇痛剂人数分别为0和2.2%;两组的术后复发率分别为0.68%和0.93%(P＝1.000);两组列前3位并发症均依次为血清肿、暂时性神经感觉异常和尿潴留,其中血清肿的发生率分别为5.5%和4.7%(P＝0.764),暂时性神经感觉异常的发生率分别为1.4%和1.9%(P＝0.659),尿潴留的发生率分别为2.4%和2.8%(P＝0.730),差异均无统计学意义.LIHR组的住院总费用(7058.4±1033.7)元高于Lichtenstein组(4012.6±312.8)元,差异有统计学意义(P=0.000). 结论 LIHR和Lichtenstein术都是安全有效的无张力修补方式,在临床上具有互补性,合理的选择术式可获得最佳的临床和卫生经济学效益.     

DETECTION DE LA MUTATION DU GENE HMLH1 DANS LE CANCER COLO-RECTAL PARELECTROPHORESE CAPILAILRE ASSOCIEE A LA FLUORESCENCE LASER-INDUITE

Objectif L'objectif de ce travail est d'etablir une methode d'analyse du polymorphisms de la conformation monochaine (PCMC) , capable de detecter la mutation ponctuelle du gene hMLHI dans le cancer colique en utilisant l'l ctrophor se capillaire associee a la fluorescence laser-induite (FLJ-EC). Methodes Les exons 12 du gene hMLHl du sang peripherique de 42 patients de cancer colo-rectal sporadique et 20 sujets sains temoins sont amplifies par la PCR. Le PCMC des produits du PCR est analyse par FLJ-EC. Les echantillons anor-maux ont ete confirmes par sequen age EC. Les effets de la concentration du milieu (LPA) , de la temperature de separationcet du voltage de separation sur le comportement de EC ont ete aussi studies. Resultats L'analyse de PCMC par la methode FLJ-EC a retrouve une mutation heterozygote chez 4 des 42 patients. La mutation ponctuelle de T1151A a ete objectivee par la sequen age EC de ces echantillons, aucune mutation n'a ete retrouvee chez les 20 sujets sains temoins. La separation des pics d'ADN monochainaux a ete facilitee par une legere augmentation de la concentration de LPA (4%-6% ) , une legere baisse de la temperature de separation (20℃) et une legere elevation du voltage de separation (9kV). Conclusion Une concentration adequate de LPA, une temperature de separation appropriee et un voltage de separation bien approprie ameliorent considerablement l'efficacite du FLJ-EC. L'application de cette methode pour detecter la mutation ponctuelle du gene hMLHl est d'une rapidite, d'une efficacite, et d'uneereproductivit consid rabies. Cette methode de realisation facile reste tres prometteur pour le depistage rapide et massive des mutations genetiques.     

腹腔镜胃局部切除术的临床应用

目的评价腹腔镜胃局部切除术的临床应用价值。方法回顾性分析23例腹腔镜胃局部切除手术患者的临床资料,包括肿瘤大小和位置、手术时间、术中失血量、术后排气时间、术后住院天数、手术并发症、术后病理结果及随访情况。结果23例患者的胃局部切除术均在腹腔镜下成功完成,无中转开腹手术。其中8例实施腹腔镜锲型胃局部切除术,15例实施腹腔镜经胃腔黏膜下病灶切除术。手术切除肿瘤直径(2.8±1.3)cm,手术时间(82.2±35.5)min,术中失血量(26.5±15.3)mL,手术切口长度(3.1±1.1)cm,术后恢复排气时间(2.1±0.9)d,术后住院天数(7.8±2.0)d。2例(8.7%)在接受腹腔镜经胃腔黏膜下病灶切除术后出现胃腔内渗血,经非手术治疗后痊愈。中位随访时间12个月(2～45个月),未发现肿瘤复发和戳口种植。结论腹腔镜胃局部切除术是治疗良性胃肿瘤安全、可行及微创的手术方法。     

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目的探讨腹腔镜下完整结肠系膜切除(complete mesocolic excision,CME)根治右半结肠癌的技术可行性。方法回顾性分析2010年3月至2011年9月上海交通大学医学院附属瑞金医院行腹腔镜CME术35例的临床病理数据及视频资料,分析其安全性与技术可行性;采用West分级系统评价手术质量;通过解剖学绘图描述腹腔镜CME的手术入路,解剖层次及技术要点。结果 (1)脏层筋膜呈"信封样"包绕整个结肠系膜,需超声刀锐性分离脏壁层筋膜,达到血管根部结扎与完整系膜切除。(2)中间入路以回结肠血管解剖投影为起步点,沿肠系膜上静脉为主线解剖血管,进入Told与肾前筋膜间的天然外科平面。(3)盲肠及升结肠癌,需清扫回结肠、右结肠及结肠中血管根部淋巴结;结肠肝曲癌,还需清扫No.6淋巴结及切除距肿瘤以远10～15cm胃大弯侧胃网膜。(4)35例均成功完成腹腔镜下CME;手术质量等级判定C级33例;中位清扫淋巴结数19(15～25)枚,Ⅲ期病人系膜根部淋巴结阳性25%;中位手术时间2.6(2～4)h,术中出血80(50～300)mL,术后排气时间2(1～4)d,住院时间12(6～20)d;术后发生肺部感染1例,出血1例,乳糜漏1例。结论 CME为基于胚胎解剖学与肿瘤外科学的新理念,有望成为规范化手术方式;中间入路腹腔镜下CME技术上可行,是否改善远期疗效有待对照研究证实。     

进展期直肠癌侧方淋巴结清扫对预后影响Meta分析

目的 评估侧方淋巴结清扫（LLND）对进展期低位直肠癌病人术后存活、复发及转移的影响。方法 检索Pubmed、EMbase、Cochrane library、中国学术期刊全文数据库等中英文数据库中的文献,纳入2000年1月至2018年6月与进展期低位直肠癌预后相关的临床对照研究,运用Stata/SE软件进行Meta分析,评估LLND对进展期低位直肠癌病人5年总存活率、5年无复发存活率、局部复发率、术后泌尿功能障碍发生率的影响。结果 纳入文献17篇共5631例病人。LLND组术后5年总存活率（HR=1.19,95%CI 0.98～1.43,P=0.902）、5年无复发存活率（HR=0.98,95%CI 0.82～1.17,P=0.794）、局部复发率（HR=0.93,95%CI 0.67～1.31,P=0.694）与非LLND组相比差异无统计学意义;LLND组术后泌尿功能障碍发生率高于非LLND组,差异有统计学意义（OR=4.08,95%CI 1.94～8.59,P<0.01）。结论 对于进展期低位直肠癌病人,LLND并不能改善术后生存等远期预后指标,但增加术后泌尿功能障碍发生率。     

大肠癌患者细胞因子水平与临床关系的研究

目的通过检测大肠癌患者细胞因子水平了解其是否存在Th1与Th2细胞因子的不平衡及肿瘤免疫缺陷,了解细胞因子与临床病理的关系.方法62例患者及15例正常志愿者参与本研究,分别抽取外周晨血测定IL-2、IL-6、IL-10、IL-12、TNF及测定NK、CD3+、CD4+、CD8+.结果IL-2、IL-12水平在肿瘤组显著下降,IL-12与Dukes分期相关.IL-6、IL-10在肿瘤组中显著升高(P＜0.05),DukesD期患者升高更显著,IL-10还与肿瘤大小和病理分期有关.肿瘤组NK活性、CD4+及CD4+/CD8+比例降低.结论大肠癌患者出现以Th1为主的细胞因子降低及Th2细胞因子的升高,肿瘤免疫缺陷.部分细胞因子代谢紊乱可能与大肠癌的不良预后有关.     

老年患者腹腔镜结直肠手术的安全性研究

Objective To compare the outcomes of laparoscopic colorectal surgery in elderly (≥ 70 years) and younger (< 70 years) patients, and to evaluate the safety of laparoscopic colorectal surgery in elderly. Methods From Aug. 2007 to Dec. 2007, 25 patients with colorectal cancer undergone laparoscopic colorectal surgery were studied prospectively. Ten patients aged 70 years or older (Elder Group), and 15 patients less than 70 years (Younger Group). The parameters of perioperative hemodynamics, blood chemistry, and intraabdominal organs perfusion were recorded periodically during operation and compared between the two groups. Results Elder group had a higher ASA degree (P<0.01). Mean age, height, weight, the classification of the disease, operative time, blood loss and complication were not significantly different between the two groups. The HCO3 value and PaCO2 value increased significantly intraoperatively, while the pH value decreased significantly. These parameters returned to basal line at the end of operation, with the decreased electrolytes, especially the kaliopenia and hypocalcemia. The CVP increased significantly at the beginning of operation and after fluid expansion, and decreased postoperatively. Gastric mucosal pH(pHi) decreased when the operation began. The partial pressure of gastric mucesa (PgCO2) increased significantly at the end of operation.Other parameters of hemodynamics including HR, CI, and SI were not significantly different during operation. The CVP of elder group was higher than that of younger group at 5 min after the beginning of the operation, while the MAP of elder group was lower than that of younger at 15 min after the end of the operation. Other parameters of hemodynamics including oxygenation, pedusion, and blood chemistry were not significantly different. Conclusions For laparoscopic colorectal surgery, no significant adverse response attributes to elderly patients. The compensation capacity of the elderly is lower. With the reasonable anesthesia administration, the adverse response can be controlled effectively.     

老年患者腹腔镜结直肠手术的安全性研究

Objective To compare the outcomes of laparoscopic colorectal surgery in elderly (≥ 70 years) and younger (< 70 years) patients, and to evaluate the safety of laparoscopic colorectal surgery in elderly. Methods From Aug. 2007 to Dec. 2007, 25 patients with colorectal cancer undergone laparoscopic colorectal surgery were studied prospectively. Ten patients aged 70 years or older (Elder Group), and 15 patients less than 70 years (Younger Group). The parameters of perioperative hemodynamics, blood chemistry, and intraabdominal organs perfusion were recorded periodically during operation and compared between the two groups. Results Elder group had a higher ASA degree (P<0.01). Mean age, height, weight, the classification of the disease, operative time, blood loss and complication were not significantly different between the two groups. The HCO3 value and PaCO2 value increased significantly intraoperatively, while the pH value decreased significantly. These parameters returned to basal line at the end of operation, with the decreased electrolytes, especially the kaliopenia and hypocalcemia. The CVP increased significantly at the beginning of operation and after fluid expansion, and decreased postoperatively. Gastric mucosal pH(pHi) decreased when the operation began. The partial pressure of gastric mucesa (PgCO2) increased significantly at the end of operation.Other parameters of hemodynamics including HR, CI, and SI were not significantly different during operation. The CVP of elder group was higher than that of younger group at 5 min after the beginning of the operation, while the MAP of elder group was lower than that of younger at 15 min after the end of the operation. Other parameters of hemodynamics including oxygenation, pedusion, and blood chemistry were not significantly different. Conclusions For laparoscopic colorectal surgery, no significant adverse response attributes to elderly patients. The compensation capacity of the elderly is lower. With the reasonable anesthesia administration, the adverse response can be controlled effectively.