食管胃分层吻合法的应用与实验观察

目的通过临床和动物实验观察食管胃分层吻合法的临床应用结果及吻合口愈合质量。方法采用食管胃分层吻合法施行食管癌、贲门癌手术1024例,同期用该手术方法做动物实验并观察吻合口情况。将24只犬采用抽签法分成两组,实验组:12只,采用食管胃分层吻合法;对照组:12只,采用传统吻合方法作为对照。分别在术后5d、8d、14d和42d测量两组大体标本的吻合口口径、瘢痕长度、瘢痕厚度,组织学观察炎性细胞数、成纤维细胞数和毛细血管数,并进行表皮生长因子(EGF)和转化生长因子β1(TGF-beta1)的免疫组织化学实验(LsAB法)。结果临床结果:术后分别随访至3个月,1024例患者术后无吻合口瘘发生,仅6例发生轻度狭窄,经扩张一次缓解。实验结果:实验组黏膜对合良好、吻合口柔软、瘢痕薄,术后早期炎性细胞数和成纤维细胞数增多(P<0.05),术后第42d炎性细胞数和成纤维细胞数减少(P<0.05);对照组吻合口瘢痕厚、黏膜对合不齐、常有肌层暴露,早期炎性细胞数和成纤维细胞数较少,而术后8～14d明显增加,一直持续到术后42d仍有增加的趋势。实验组细胞因子早期活跃,高表达,至术后42d时仅有少量表达;而对照组早期表达低,术后第8d明显增加,第42d仍有较高表达。结论食管胃分层吻合法患者吻合口愈合质量高、瘢痕小,其细胞增生和生长因子的表达有利于伤口正常愈合且达到了一期愈合的标准,值得临床推广应用。     

非小细胞肺癌患者手术前后血清中内皮抑素和VEGF水平变化及相关性研究

目的:探讨非小细胞肺癌(non-smallcell lung cancer,NSCLC)患者手术前后血清中内皮抑素(endostatin)和血管内皮生长因子(vasular endothelial growth factor,VEGF)水平的动态变化规律及两者水平变化的相关性。方法:用ELISA法检测46例NSCLC患者手术前后血清中endostatin和VEGF的水平。结果:1)NSCLC患者术后7d血清endostatin水平为(23·41±5·12)ng/mL,显著高于术前[(20·85±4·56)ng/mL]和术后1d[(18·89±4·67)ng/mL]血清endostatin水平,P值分别为0·011和0·000;术后7d血清VEGF水平为(3·75±0·71)ng/mL,显著高于术前[(1·72±0·46)ng/mL]和术后1d[(2·22±0·58)ng/mL]血清VEGF水平,P值均为0·000。2)NSCLC患者术前血清endostatin与VEGF水平呈非常显著负相关,r=-0·380,P=0·009。3)NSCLC患者术后7d血清endostatin水平与VEGF水平呈非常显著正相关,r=0·351,P=0·017。结论:NSCLC患者手术前、后血清endostatin和VEGF水平存在动态变化,且两者手术前后的水平变化有显著相关性,检测NSCLC患者手术前后血清中endostatin和VEGF水平可能是进一步预测肺癌恶性行为的有用指标。肿瘤防治杂志,2005,12(19):1441-1444     

Atrial fibrillation after surgery for esophageal carcinoma： Clinical and prognostic significance

AIM:To retrospectively evaluate the clinical relevance,perioperative risk factors,outcome of differentpharmacological prophylaxis,and short-term prognosticvalue of atrial fibrillation(AF)after surgery foresophageal carcinoma.METHODS:We retrospectively studied 63 patients withAF after surgery for esophageal carcinoma in comparisonwith 126 patients without AF after esophagectomyduring the same time.Postoperative AF incidence wasrelated to different clinical factors possibly involved in itsoccurrence and short-term survival.RESULTS:A strong relationship was observed betweenAF and postoperative hypoxia,history of chronicobstructive pulmonary disease(COPD),postoperativethoracic-gastric dilatation,age older than 65 years,malesex and history of cardiac disease.No difference wasobserved between the two groups with regard to short-term mortality and length of hospital stay.CONCLUSIONS:AF occurs more frequently afteresophagectomy in aged and male patients.Other factorscontributing to postoperative AF are history of COPD andcardiac disease,postoperative hypoxia and thoracic-gastric dilatation.     

Duration-dependent regulation of autophagy by isoflurane exposure in aged rats

Current evidence suggests a central role for autophagy in many inflammatory brain disorders, including Alzheimer's disease(AD). Furthermore, it is also well accepted that some inhalation anesthetics, such as isoflurane, may cause ADlike neuropathogenesis and resultant postoperative cognitive dysfunction, especially in the elderly population. However, the impact of inhalation anesthetics on autophagic components in the brain remains to be documented. Hence, our objective was to investigate the effects of different durations of isoflurane exposure on hippocampus-dependent learning and hippocampal autophagy in aged rats. Aged Sprague-Dawley rats(20 months old) were randomly exposed to 1.5% isoflurane or 100% oxygen for 1 or 4 h. Animals were then trained in the Morris water maze(4 trials/day for 5 consecutive days). Hippocampal phagophore formation markers, beclin 1 and protein microtubule-associated protein 1 light chain-3B(LC3B), as well as p62, an indicator of autophagic flux, were quantified by western blotting. There was no significant difference in the escape latencies and time spent in the target quadrant, as well as hippocampal expression of beclin 1, LC3 BII, and p62 at 24 h post-anesthesia between the1-h isoflurane-exposed rats and their controls(P 0.05). Four-hour exposure to isoflurane resulted in spatial learning and memory deficits, as evidenced by prolonged escape latencies on days 4 and 5 postanesthesia and less time spent in the target quadrant than sham-exposed animals(P 0.05). These events were accompanied by a decline in hippocampal expression of LC3B-I, LC3B-II, and beclin 1 24 h after isoflurane(P 0.01 and P 0.05). Nevertheless, no significant change in p62 expression was found. Further kinetics study of autophagic changes induced by 4 h of isoflurane showed a transient upregulation of LC3B-I, LC3B-II, and beclin 1 at the end of exposure and a subsequent striking decrease w ithin 12–24 h post-anesthesia(P 0.05). Hippocampal p62 p eaked at 6 h but subsequently resolved. These results from our pilot in vivo study support a durationdependent relationship between 1.5% isoflurane exposure, and s patial cognitive function as well as hippocampal phagophore formation.