动静脉结合的新辅助化疗治疗56例进展期胃癌的回顾性分析

Background  Pre-operative chemotherapy has gained widespread interest while treating advanced gastric cancer in eastern countries. However, there is currently no established standard regimen for gastric cancer. The aim of this research was to explore the value of preoperative chemotherapy with a combination of intravenous and intra-arterial intensified chemotherapy in advanced gastric cancer.

Methods  A total of 56 histologically proven gastric cancer patients, who were considered to be stage II or higher with metastatic lymph nodes and with or without distant metastasis (T_2–4, N_1–3, and M_0–1), were treated with a neoadjuvant chemotherapy. Patients received a combination of intravenous 5-Fu (370 mg/m²) and leucovorin (200 mg/m²) on days 1–5, and intra-arterial etoposide (80 mg/m²) and cisplatin (80 mg/m²) on days 6 and 20. After two cycles of preoperative chemotherapy, patients with resectable tumors underwent laparotomy.

Results  All patients finished two cycles of chemotherapy. The overall response rate was 78.57% (44 cases), of which 7.14% (four cases) clinical complete response. Forty-six patients underwent resection, including 21 initially unresectable diseases. R0 resection rate for prechemotherapy resectable and unresectable diseases was 96.15% (25/26 cases) and 66.67% (20/30 cases), respectively. Pathological complete response was observed in 8.70% of patients. Toxicity was moderate and there were no chemotherapy-related deaths. With a median follow-up of 31 months (range 6–76 months), the 5-year survival rate for the whole group and patients with initially resectable tumors were 21.8% and 42.3%, respectively. The median survival for initially resectable and unresectable patients were 41 months (95%CI, 31.006–50.994) and 18 months (95%CI, 13.399–22.601; P <0.01), respectively.

Conclusion  Preliminary results proved that the combined intensive chemotherapy was a safe and promising regimen for pre-operative treatment of advanced gastric cancer.

     

原发性神经外胚层瘤

原发性神经外胚层瘤（periphral primitive neuroectodermal tumor，PNET），由Arthur于1918年首次报道，是一种发生于除中枢神经系统及交感神经系统外的PNET，该肿瘤是一恶性小园细胞肿瘤，好发于青少年的深部软组织或骨组织。原发于肠系膜的PNET十分罕见，迄今国内外文献尚未见报道。我们报道2例原发于腹腔内肠系膜的PNET。     

肝细胞生长因子改善移植小肠的粘膜屏障功能

目的 :了解肝细胞生长因子 (HGF)对改善移植小肠粘膜屏障功能的作用。　方法 :以Wistar大鼠为供体 ,SD大鼠为受体 ,行异位全小肠移植 ,并以环孢素A(CsA) 6mg/(kg·d)肌注 ,抑制排斥反应 ;肝细胞生长因子组(HGF组 )用微量输液泵持续均匀输入HGF 15 0 μg/(kg·d) ;对照组输入等量等渗盐水。于第 7天以乳果糖及甘露醇对移植小肠进行灌注 ,第 8天采集移植肠系膜淋巴结及门静脉血行细菌培养。　结果 :对照组尿液中乳果糖含量 (0 .0 931± 0 .0 0 85vs 0 .0 15 0± 0 .0 0 2 0 ,P =0 .0 0 0 1)及乳果糖 /甘露醇比率 (0 .132± 0 .0 2 1vs0 .0 2 0± 0 .0 0 5 ,P=0 .0 0 0 1)明显高于正常标准。HGF组乳果糖含量 (0 .0 396± 0 .0 0 90vs 0 .0 15 0± 0 .0 0 2 0 ,P =0 .0 0 2 3)及乳果糖 /甘露醇比率 (0 .0 5 6± 0 .0 13vs 0 .0 2 0± 0 .0 0 5 ,P =0 .0 0 17)也较正常标准增加 ,且两项指标均显著低于对照组(P <0 .0 5 )。HGF组移植肠系膜淋巴结细菌培养阳性率为 10 % ,对照组为 6 0 % ,明显高于HGF组 (P =0 .0 2 8)。HGF组与对照组门静脉血培养细菌阳性率无显著差异。　结论 :HGF能够降低同种移植小肠粘膜的通透性及细菌移位率 ,改善肠粘膜屏障功能。     

腹腔感染后抗氧化能力对血浆维生素A、E、C水平的影响

目的：观察腹腔感染后抗氧化能力对血浆维生素A、E、C水平的影响。方法：采用盲肠结扎加穿孔（CLP）模型，观察腹腔感染后丙二醛（MDA）、还原型谷胱甘肽（GSH）对血浆维生素A、E、C水平的影响。结果：CLP后血浆维生素A、C、E、GSH均明显下降，而血浆MDA显著升高，并发现血浆GSH与维生素A的变化有显著相关性，而血浆MDA与维生素C、E的变化也有显著相关性。结论：腹腔感染后由于机体抗氧化能力的下降而导致维生素A、C、E的大量消耗，可能是造成维生素A、E、C缺乏的重要原因。     

肝细胞生长因子对移植小肠通透性及细菌易位的作用

目的探讨肝细胞生长因子（hepatocyte growth factor,HGF）对移植小肠通透性及细菌易位的作用。方法以Wistar大鼠20只为受体,SD大鼠20只为供体行异位全小肠移植,并以环孢素A（6mg/kg.d）肌注抑制排斥反应。HGF组（n=10）用微量输液泵持续均匀输入HGF（150μg/kg.d）,对照组（n=10）输入等量生理盐水,随机选取同批正常Wistar大鼠作为正常基准（n=10）。第7天两组实验动物均分别以乳果糖/甘露醇液2ml（含乳果糖100mg、甘露醇50mg）行移植小肠灌注,采集24h尿液检测乳果糖、甘露醇含量及乳果糖/甘露醇比值;第8天采集移植小肠肠系膜淋巴结及门静脉血行细菌培养,小肠组织学观察。结果对照组尿液中乳果糖含量为0.0931%±0.0085%,乳果糖/甘露醇比值为0.132±0.021,与正常基准0.0150%±0.0020%和0.020±0.005比较,差异均有统计学意义（P〈0.05）;HGF组乳果糖含量为0.0396%±0.0090%,乳果糖/甘露醇比值为0.056±0.013,与正常基准比较差异均有统计学意义（P〈0.05）,且低于对照组（P〈0.05）。HGF组移植小肠肠系膜淋巴结细菌阳性率为10%,对照组为60%,差异有统计学意义（P〈0.05）。HGF组门静脉血细菌阳性率为10%,对照组为20%,差异无统计学意义（P〉0.05）。两组移植小肠组织学观察仅见少量炎性细胞浸润。结论HGF能够降低同种移植小肠的通透性及细菌易位率,改善小肠黏膜屏障功能。     

生长激素、纤维蛋白胶促进腹腔感染大鼠肠吻合口愈合的动态研究

目的:观察生长激素(GH)和纤维蛋白胶(FG)促进腹腔感染大鼠小肠吻合口愈合的作用.方法:雄性Wistar大鼠腹腔感染24 h后行肠切除、肠吻合术,肠吻合予以6/0无损伤丝线缝合4针,将210只大鼠随机分为三组:对照组:肠切除后行肠吻合术;FG组:肠吻合术后吻合口涂抹FG;FG/GH组:肠吻合术后吻合口涂抹FG,同时应用GH至术后14天.观察肠吻合口愈合率、破裂压力、抗张力强度、羟脯氨酸含量及组织学.结果:FG组肠吻合口抗张力强度手术12 h后明显增加,维持至术后第5天,第5天后肠吻合口愈合不良.FG/GH组肠吻合口破裂压力和抗张力强度手术第5天后明显增加,至术后第10天达峰值.结论:FG能短暂维护肠吻合口愈合,GH对肠吻合愈合持续时间较长,但起作用较晚,二者联合应用具有相互重叠、协同作用.     

加速康复外科理念下腹腔镜造口还纳术（附2例报告）

目的：探讨在加速康复外科理念下腹腔镜造口还纳术的安全性及可行性。方法：回顾分析行腹腔镜造口还纳术2例患者的临床资料,观察手术时间、出血量、术中术后并发症、是否中转开腹、术后住院时间等。结果：2例手术均获成功,无中转开腹。手术时间分别为90min和120min,出血量均小于30ml,切口一期愈合,无吻合口漏等相关并发症。术后分别住院3d、4d。结论：加速康复外科理念下腹腔镜技术用于肠道的造口还纳手术是安全、可行的,且疗效显著。     

肠外营养支持在腹部手术后乳糜腹水治疗中的应用

目的：研究肠外营养支持在治疗腹部手术后乳糜腹水中的作用。方法;对１例胃癌行根治性胃大部切除术后发生乳糜腹水的病人应用经外周静脉的营养支持３周,通过腹腔持续引流观察腹水引流量的变化,并观察病人体重及一般营养状况的变化。结果：肠外营养过程中每天腹水产生和流出量逐渐减少。体重在营养支持开始和结束时无明显变化,血清白蛋白水平在第１周下降,后逐步升高,在营养支持结束时明显超过营养支持开始时。结论：腹部手术后