术中植入125Ⅰ粒子内放疗治疗脑胶质瘤长期疗效观察

目的 探讨术中植入125Ⅰ粒子内放疗治疗胶质瘤术后长期疗效.方法 将该院近几年胶质瘤患者分为:治疗组(手术切除加瘤巢内放疗组)和对照组(单纯手术切除组),观察2组肿瘤复发时间、生存时间、2年生存率和3年生存率.结果 2组复发时间及生存时间比较,治疗组肿瘤复发时间明显延长.治疗组较对照组2年生存率和3年生存率均明显提高.结论 术中植入125Ⅰ粒子内放疗治疗胶质瘤,长期疗效良好,是一种安全有效的治疗脑胶质瘤的方法.     

进展期胰腺癌临床化学治疗进展

胰腺癌发病率占人类全身肿瘤的1%～3%、消化道肿瘤的8%～10%。在美国,胰腺癌造成的死亡居肿瘤死亡原因的第5位;在我国其死亡率亦迅速增高,总体死亡率自20世纪90年代初的1.83%增至2000年的2.26%,近年仍呈上升趋势,占恶性肿瘤死因的第7～8位。胰腺癌的高死亡率与其高侵袭性的生物学特性及其对全身和局部治疗的低敏感性     

胃镜检出胃恶性病变3460例分析

目的:探索胃镜检出胃恶性病变患者的发病及胃镜、病理特点。方法:对我院1990～2009年胃镜诊断的3460例胃恶性病变患者按不同年龄分组进行胃镜及病理资料的回顾性分析、总结。结果:3460例胃恶性病变患者中,男性多于女性(2.26∶1),但年龄≤40岁组男女差别不大。50岁以上发病明显增高,特别是60～70岁发病率最高。胃窦部为胃癌的高发部位,年龄≤40岁组以胃体和胃窦为主,而60岁以上患者胃贲门食管连接部癌的发病率显著上升。年龄≤40岁组病理类型以分化差、恶性程度高的低分化腺癌和印戒细胞癌为主,随着年龄增长,病理类型逐渐趋向于以中分化管状腺癌、高分化管状腺癌为主。胃淋巴瘤多发于胃体、胃窦部,胃镜下表现以多发性溃疡病灶为主。结论:胃恶性病变的发病与年龄、性别密切相关,不同年龄组胃癌的发生部位、病理特点各不相同,应引起重视,同时应提高对青年人胃癌的认识,提倡和重视胃镜检查普及,做到早期发现、早期诊断、早期治疗。     

奥曲肽在内镜粘合剂D-TH治疗食管和胃静脉曲张中的应用

目的 探讨奥曲肽在内镜粘合剂Ｄ－ＴＨ治疗食管和胃静脉曲线中的作用。方法 粘合剂Ｄ－ＴＨ内镜注射治疗前５ｈ起静脉维持滴注奥曲肽０．０２５ｍｇ／ｈ,术前２０＇静脉注射冲击量奥曲肽０．１ｍｇ。内镜直观下注射Ｄ－ＴＨ液治疗肝硬化食管和胃静脉曲线及其出血。结果 Ｄ－ＴＨ治疗７例食管和胃硬化剂治疗均无针孔出知。结论 应用奥曲肽有助于食管和胃静脉曲张及其出血的内镜下Ｄ－ＴＨ硬化治疗,术后维持治疗可有效降低出血率     

进展期胃癌的新辅助化学治疗研究进展

据2012年Globocan~[1]报道,胃癌是全世界发病率第5位、致死率第3位的恶性肿瘤,我国属于胃癌的高发地区,胃癌一经发现多已处于进展期,5年生存率为20%~25%。手术是治疗胃癌的主要手段,随着对实体肿瘤综合治疗认识的加深,胃癌的综合治疗逐渐纳入化学治疗(化疗)、放射治     

两种负压创面治疗技术临床疗效比较

Objective To compare the differences of the clinical effects, side effects and treatment-related cost between two kinds of negative-pressure wound therapy (NPWT). Methods Forty-four inpa-tients with acute, subacute, and chronic wounds were divided into simplified NPWT group ( A group) and conventional NPWT group ( B group) according to the random number table. Wounds of patients in A group were treated with gauze + continuous suction with hospital central negative pressure ( -10.64 kPa) for 24 hs; wounds of patients in B group were treated with sponge + interrupted suction with a purpose-designed suction appliance ( -16.63 kPa) for 24 hs. Gross wound condition, treatment time, survival rates of skin graft and flap, changes of bacterial species on wound, treatment cost, and ratio of side effects between two groups were compared. Results There was no significant difference between A and B groups in respect of gross wound condition, treatment time [ A group (29 ± 12) d, B group (26 ± 13) d, P > 0. 05 ], changes of bacterial species, survival rates of skin graft [ A group (98 ± 4 ) % , B group ( 98 ± 4 ) % , P > 0. 05 ] and flap (A group 98% , B group 100% , P >0.05). Treatment cost of A group $ (374 ± 134) was obviously lower than that of B group $ (9825 ± 4956) ( P <0. 01 ), while more side effects were observed in A group (33.3%) than that in B group (5.0%) ( P < 0.05 ). Conclusions Both simplified NPWT and NPWT with purpose-designed appliance ean effectively improve wound healing. The simplified method may cause many side effects and has a potential risk of inciting nosocomial infection, but it can be conveniently employed with a low cost. In contrast, the cost of using purpose-designed appliance should be cut down to meet the aim of generalization.     

双气囊内镜与多层螺旋CT小肠造影在小肠克罗恩病诊断中的作用

Objective To investigate the value of double-balloon endoscopy (DBE) and multi-slice CT enteroclysis (MSCTE) in diagnosis of Crohn's disease (CD) in small intestine. Methods DBE and MSCTE were performed in 71 patients with suspected Crohn's disease in small intestine. The two methods were compared in terms of diagnosis, extents of disease, existance of complications and activity of the disease according to the pathologic findings and the outcome of follow-up. Results The diagnostic yields of DBE and MSCTE were comparable with no significant difference (χ2=2.29, P> 0.05). The positive and negative likelihood ratios were 22.5 and 0. 022 in DBE respectively, and were 1.6 and 0. 240 in MSCTE respectively. The results of DBE was consistent with MSCTE in diagnosis of mild bowel stenosis, but was inconsistent with MSCTE in diagnosis of moderate-severe bowel stenosis (χ2=11.298, P=0.001). The concordance of two methods in diagnosis of disease activity was 95.8%. Conclusions The first choice in diagnosis of small bowel CD is DBE. The combination of two methods will be helpful in diagnosis and evaluation of CD severity.     

大鼠烧伤和热压伤自身修复过程中miRNA⁃199a⁃5p的表达变化

目的：探讨大鼠烧伤和热压伤中变性真皮miRNA?199a?5p表达量随时间的变化情况。方法：用控温烫伤仪制作皮肤烧伤模型和热压伤模型,设置阴性对照组,用qRT?PCR检测不同的时间烫伤和热压伤部位变性真皮中的miRNA?199a?5p相对表达量。结果：各模型组变性真皮中miRNA?199a?5p相对表达量较正常组织中的相对表达量呈先下调后上调趋势,14 d时miRNA?199a?5p相对表达量上调具有显著差异（P＜0.05）。结论：miRNA?199a?5p表达和变性真皮的增殖和迁移调控相关,损伤早期表达量的下调,促进变性真皮恢复正常功能,表达量的上调则促进细胞增殖和迁移,为热压伤创面修复机制的探讨提供新思路。     

菱形皮瓣修复软组织缺损20例报告

目的:总结应用菱形皮瓣修复皮肤软组织缺损的临床经验?方法:2010年1月~2012年12月应用菱形皮瓣修复因色素痣?体表肿瘤等切除造成的面部和躯干皮肤软组织缺损病例20例,所有患者均采用术中快速冰冻切片监测标本的基底及切缘,供区直接拉拢缝合?结果:术后随访1个月~2年,皮瓣全部成活,瘢痕增生不明显,形态满意?结论:菱形皮瓣是修复一定范围内皮肤软组织缺损较为理想的方法,其设计合理,操作简便,效果满意,值得推广?     

内源性K-ras激活突变和Tp53失活突变共同作用产生干细胞胰腺癌

目的:探索胰腺癌干细胞的存在及其起源。方法:通过分析基因打靶小鼠胰腺腺管上皮异常增生(PanIN)及胰腺癌模型,对LSL-K-rasG12D与Pdx1-Cre产生的小鼠胰腺PanIN和LSL-K-rasG12D、LSL-Tp53R172H与Pdx1-Cre产生的小鼠原发浸润性胰腺癌及胰腺癌肝、肺、胸腺转移组织进行免疫组化分析,并分离、建立PanIN细胞系及胰腺癌和转移癌细胞系,鉴定其体外贴壁依赖性生长及在软琼脂半固体培养基中集落形成。结果:原发胰腺癌及其肝、肺、胸腺转移细胞Tp53和磷酸化-MAPK呈高表达,胰腺癌的肝、肺、胸腺转移灶显示了典型的胰腺腺体及腺管样结构特征;其细胞系在体外培养中快速增殖并在软琼脂中形成肉眼可见集落,提示胰腺癌中含有胰腺癌干细胞。令人感兴趣的是,PanIN的磷酸化-MAPK高表达,在体外培养中的增殖速度与原发及转移性胰腺癌相似,并且能在软琼脂中形成光学显微镜下所见的集落,随着培养时间的延长而集落增大,这不仅提示K-ras的激活突变是胰腺癌的早期分子遗传学改变事件,且提示PanIN细胞已在一定程度上具备了恶性转化的肿瘤行为。结论:本研究首次证实胰腺癌干细胞存在,并提出胰腺癌的发生演变假说:胰腺管上皮细胞—PanIN细胞—胰腺癌干细胞—浸润性和转移性胰腺癌。