谷胱苷肽硫转移酶M1、T1基因缺失及烟酒嗜好与广西壮族人胃癌易感性的关系

胃癌是中国广西最常见的恶性肿瘤之一,其病死率居广西居民恶性肿瘤死因的第2位[1]。大量的研究表明,胃癌的发生是遗传因素和环境因素相互作用的结果。近年来,毒物代谢酶系的遗传多态性与胃癌易感性关系的研究逐渐受到重视。谷胱苷肽硫转移酶M1(glutathione S-transferase M1,GS     

TIAP和PICC在肿瘤患者化疗和营养支持治疗中的并发症比较和临床意义

临床化疗中使用经外周静脉(peripherally inserted central catheters,PICC)置管,目前还有前胸部完全植人式输液港(totally implantable access port,TIAP)的置管方式.我们通过分析481例恶性肿瘤化疗患者经锁骨下静脉穿刺的TIAP和经外周静脉的PICC两种不同途径中心静脉置管(centra venous catheterization,CVC),比较2组患者的并发症情况.     

甲状腺切除术中喉返神经解剖与未解剖对其损伤的比较研究

目的 比较甲状腺切除术中解剖和未解剖喉返神经（RLN）预防其损伤的发生率.方法 回顾性分析甲状腺切除术中RLN解剖（472例,639侧次）与未解剖（232例,296侧次）临床资料,比较两者间并发RLN损伤几率.结果 解剖组：RLN暂时损伤为1.49%（7/472）,无永久性损伤,暂时性甲状旁腺功能低下为1.69%（8/472）.未解剖组：暂时损伤为6.03%（14/232）,永久性损伤2.16%（5/232）.术中RLN解剖与未解剖比较,手术时间和RLN永久性损伤差异有统计学意义（P＜0.01）.结论 甲状腺切除术中RLN解剖与未解剖相比前者虽然增加手术时间,但对预防或避免医源性RLN损伤有重要意义.     

全胃切除术后恢复十二指肠路径P型和功能性空肠间置代胃消化道重建术对患者远期营养状况的影响

目的比较全胃切除术后P型空肠间置代胃和功能性空肠间置代胃（FJI)两种恢复食物经十二指肠路径的消化道重建方式对患者远期营养状况和生活质量的影响。方法 2003年1月至2011年6月,50例胃癌患者在东华医院行全胃切除术,其中27例行P型空肠间置代胃消化道重建术,23例行FJI消化道重建术。术后第1天至第7天予以全肠外营养支持。观察患者围术期并发症情况。术后6个月和12个月分别监测两组患者体重、血清总蛋白、血清白蛋白、血红蛋白和反流性食管炎发生情况,计算营养评定指数（NAI）。结果 50例患者均未发生严重手术并发症,无围术期及化疗相关死亡。术后6个月P型组和FJI组的体重减轻量［（3.67±0.91)kg比(3.44±0.52)kg,P=0.28］、血清总蛋白［（52.62±1.67)g/L比(53.22±1.24)g/L,,P=0.16］、血清白蛋白［（31.26±1.29)g/L比(30.70±2.41)g/L,P=0.32］、血红蛋白［（118.01±5.96)g/L比(117.83±6.72)g/L,P=0.92］、NAI(P=0.39)和反流性食管炎发生率（11.1%比13.0%,P=1.00）差异无统计学意义。术后12个月两组的体重减轻量［（2.71±0.45)kg比(2.74±0.42)kg,P=0.77］、血清总蛋白［（53.93±1.66)g/L比(53.34±1.84)g/L,P=0.24］、血清白蛋白［（32.60±1.42)g/L比(30.76±2.10)g/L,P=0.23］、血红蛋白［（124.18±6.56)g/L比(119.99±6.13)g/L,P=0.16］、NAI(P=0.43)和反流性食管炎发生率（7.4%比8.7%,P=1.00）差异无统计学意义。结论 全胃切除术后P型和FJI这两种消化道重建方式对患者术后远期营养状况和生活质量的影响无差异。     

改良近端胃癌根治术在改善术后反流性食管炎中的应用

目的:探讨通过一种改良的近端胃癌根治术,能在达到良好根治效果的同时,降低术后反流性食管炎的发生,以改善患者的生活质量。方法:选取东莞市东华医院2016年7月至2017年12月收治的行改良近端胃癌根治性切除病例设为观察组(n=30),同时纳入基本资料与观察组相匹配的行常规近端胃癌根治性切除病例设为对照组(n=30)。比较两组术后返流性食管炎发生率、早期并发症发生率、术后1年生存率;术后1年的体质量指数(BMI)、血红蛋白、白蛋白、维生素B12(VitB12)及铁蛋白水平。结果:观察组患者反流性食管炎发生率6.7%,低于对照组26.7%,组间比较,差异具有统计学意义(P 0.05)。观察组患者术后并发症发生率10.0%,对照组为16.6%,组间比较,差异无统计学意义(P 0.05)。术后两组患者BMI、血红蛋白、白蛋白、VitB12及铁蛋白营养状况,组间比较,差异无统计学意义(P 0.05)。在治疗后两组患者均存活。结论:与传统近端胃癌根治术比较,改良的近端胃癌根治术可有效减少术后反流性食管炎的发生,且不会增加患者营养不良及死亡的发生率,是一种安全有效的手术方式。     

保留空肠黏膜与胰肠直接套入在胰肠吻合术的临床研究

Objective To investigate the pancreaticoenterostomy technique using end to end anastomosis of remianing pancreas and jejunum with jejunum mucus preserved. Methods 28 cases underwent pancreatectomy were observed and analyzed from May 2005 to August 2009. There were 26 cases underwent duodenopancreatectomy and 2 cases underwent the pancreatectomy of pancreas body and tail. All cases used the end to end pancreaticoenterostomy, remnant pancreas was directly anastomosed with jejunum without destroy of jejunal mucosa. During the operation, 2.0 cm～2.5 cm long remnant of pancreas was pulled into jejunum without mucosa destroyed. Then, the cut end of the jejunum was fixed on the pancreatic remnant correspondingly by interrupted suture. Finally, a 7-silk suture was used to bind the jejunum and the pancreatic remnant together 1 cm away from the cut surface of the pancreatic remnant. Results 1 case underwent operated again due to bleeding of the pancreatic remnant. 28 patients recovered and discharged from hospital without having the complication of pancreatic fistula. Conclusions Because of the complicated suturation methods, the conventional pancreaticoenterostomy consumes more time. But it still has rather high incidence of pancreatic fistula.The new pancreaticoenterostomy which we used can shorten the operating time and integrity and binding stomas. It is effective to lower the incidence of pancreatic fistula.     

全胃切除术后3种不同空肠构建贮存袋与保持十二指肠连续性消化道重建患者生活质量的比较

Objective To compare the short-term quality of life after total gastrectomy in patients with gastric cancer with three recontructive methods of stamoch storage function. Methods Totally 62 cases underwent jejunal interposition afar total gastrectomy from March 2000 to December 2007. Patients were divided into three groups according to the procedures: functional jejunal interposition (FJI-type) group ( n = 23 ), modified jejunal interposition ( Ⅲ -type) group ( n = 20), and P-type jejunal interposition (P-type) group (n = 19). In each group,the patients' general conditions, the nutritional status at month 3 and 12, and gastrointestinal symptoms were evaluated. Results The durations of procedures were significantly different among three groups (P ＜0. 01 ). The intraoperative bleeding volume, postoperative complications, and food intake of each meal at month 3 were not significantly different ( P ＞ 0. 05 ). Compared with the data at month 3, the levels of hemoglobin and serum calcium at month 12 were significantly higher in all three groups (P ＜ 0. 01 ). Compared to the level at month 3, the level of serum albumin at month 12 significantly increased in FJI-type group (P ＜ 0. 05 ) but showed not significant difference in Ⅲ-type group and P-type group ( P ＞ 0. 05 ). The incidence of reflux esophagitis in three groups and the comparative parameters among the three groups at month 12 were not significantly different ( P ＞ 0. 05 ). Conclusions The jejunal interpositions after total gastrectomy will not increase the complexity and risk of the surgical procedure. In fact, they can reduce the reflux esophagitis and improve quality of life by keeping the storage function and restoring food passage through the duodenum. FJI-type is simpler than the other two types, and P-type is preferred for operations that need to open the pectoral cavity.     

全胃切除术后3种不同空肠构建贮存袋与保持十二指肠连续性消化道重建患者生活质量的比较

目的对胃癌全胃切除术后3种不同空肠构建贮存袋与保持十二指肠连续性的消化道重建方式患者术后短期生活质量进行比较。方法自2000年3月至2007月12月对62例施行胃癌全胃切除术患者采用3种不同的空肠构建贮存袋消化道重建,其中功能性空肠间置代胃（FJI）型23例、袢式空肠代胃改良m（BraunⅢ）型20例、空肠代胃P型19例,记录患者一般情况及术后3和12个月的营养状况及胃肠道症状评分等。结果P型与FJI及Ⅲ型手术持续时间差异具有统计学意义（P〈0．01）;3种术式术中出血量、术后并发症和术后3个月每餐进食量差异无统计学意义（P〉0．05）;术后12个月与术后3个月比较,3组患者每餐进食量均有上升,差异具有统计学意义（P〈0．01）,FJI型、Ⅲ型和P型3组的血红蛋白及血清钙明显升高,前后对比差异具有统计学意义（P〈0．01）。3组血清白蛋白比较,FJI型术后12个月高于术后3个月,差异具有统计学意义（P〈0．05）;Ⅲ型和P型术后12个月有高于术后3个月的趋势,但差异无统计学意义（P〉0．05）;3组返流性食管炎的发生率及术后12个月3组各指标比较差异均无统计学意义（P〉0．05）。结论全胃切除术后采用空肠构建贮存袋和保持十二指肠连续性消化道重建并未增加手术复杂性或风险性,由于构建贮存袋与恢复食糜经十二指肠的生理通道,对提高患者的生活质量和降低返流性食管炎并发症有重要意义。FJI型手术方式较Ⅲ型和P型简单,当需要经胸联合切除食管中、下段切除时应选择P型。     

肝后下腔静脉间隙和肝外血管在半肝切除术中的临床解剖及应用研究

目的探讨肝后下腔静脉(RHIVC)前间隙和肝外进、出肝血管在半肝切除术中的临床解剖学意义。方法对21例通过RHIVC前间隙解剖与选择肿瘤侧半肝进、出血管解剖阻断技术(slective hepatic vascul exclusi,SHVE)和22例Pringle阻断法的半肝切除术,同时对半肝切除一侧RHIVC的肝短静脉(shorthepatic veins SHVs)数目和分布情况进行分析。结果在SHVE组患者解剖RHIVC前间隙和将肿瘤侧肝动脉、肝门静脉、肝静脉解剖分离予以结扎或置阻断带过程顺利,无发生RHIVC或肝静脉损伤。在本组43例半肝切除术中,SHVs数量3～4支44.2%,6～8支55.8%,其中SHVs位于RHIVC前壁中轴线占11.6%。结论由于RHIVC前间隙无/或潜在少,且细小的SHVs,通过RHIVC前间隙解剖与SHVE技术,对于巨大肝肿瘤的半肝切除术具有重要的临床实用意义。     

完全植入式输液港在肿瘤患者化疗中的临床应用

进展期乳腺癌和消化道肿瘤患者在术前或术后除需要间断、数周期甚至需要长期化疗外,中心静脉置管(CVC)方式已经成为最佳途径.本试验自2007年3月至2011年12月对164例乳腺癌、胃肠道肿瘤和其他肿瘤化疗患者行锁骨下静脉穿刺的CVC完全植入式输液港(TIAP),探讨化疗患者选择CVC置管的最佳途径.报告如下.