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肝囊性占位病变在临床比较常见。由于不同的囊性占位病变其治疗方法不同 ,因此鉴别诊断各种不同肝囊性占位病变非常重要。肝囊性占位病变一般可分为先天性和获得性两大类。前者包括孤立性非寄生虫性肝囊肿 (通常所称的肝囊肿 )、多囊肝、先天性肝纤维化 (肝纤维囊性变 )和Caroli病等 ;后者包括肿瘤性囊肿 (囊腺瘤或癌 ) ,感染性囊肿 (包括化脓性、阿米巴性和包虫性囊肿 )及损伤性囊肿等。大多数肝囊性占位病变初起时并无症状 (多在体检时发现 ) ,只有在肿块增大压迫邻近脏器或合并感染、出血等并发症时才出现症状。腹痛和腹部肿块是最常见…     

应用抑制性消减杂交筛选大鼠不同程度肝纤维化的上调基因

目的应用抑制消减杂交技术,筛选大鼠正常肝脏组织、轻度肝纤维化和重度肝纤维化组织中差异表达的上调基因。方法利用抑制消减杂交技术,构建大鼠轻度肝纤维化和重度肝纤维化2个差异cDNA文库,并挑选36条上调显著的基因进行测序鉴定。结果获得1152个克隆,其中有1036个含有插入片段。挑选32个克隆测序,与GenBank数据库进行初步比较,其中28条与已知基因的部分序列高度同源。结论应用抑制消减杂交技术成功构建了轻度肝纤维化和重度肝纤维化差异表达基因的cDNA削减文库,为进一步研究肝纤维化发生、发展和逆转的机制奠定了理论基础。     

组织转谷氨酰胺酶特异性抑制剂预防肝纤维化的实验研究

Objective To observe the effects of cystamine, a tissue transglutaminase (tTG) inhibitor, on the development of rat liver fibrosis induced by carbon tetrachloride. Methods One hundred male SD rats were randomly divided into control group (n=20), hepatic fibrosis group (n=40) and cystamine group (n=40) . Liver fibrosis model was induced by intraperitoneal injection of carbon tetrachloride. Cystamine (112 mg·kg-1·d-1) was administered by intraperitoneal injection 2 days before injection of carbon tetrachloride. The rats were sacrificed at weeks 4 and 8, and the liver tissues and serum specimens were obtained. The mRNA expression of tTG, smooth muscle-alpha (α-SMA), collagen-Ⅰ and tissue inhibitors of metalloproteinase-1 (TIMP-1) were detected by real time PCR. The protein expression of tTG and α-SMA, liver function and content of hydroxyproline in liver tissues were determined by Western blot. Histological changes of the liver was observed under microscope. The fibrosis conditions of rat liver in each group were evaluated according to the semi-quantita-tive scoring system. All the data were analyzed by one-way ANOVA. Results Eight weeks after the injection of carbon tetrachloride, obvious injury of the liver in liver fibrosis group was observed. The levels of alanine trans-aminase (ALT), total bile acid, total bilirubin, hydroxyproline, tTG, α-SMA, collagen-Ⅰ and TIMP-1 were (1313±157)U/L, (99.9±18.5)μmol/L, (10.9±1.6)μmoL/L, (55±12)μg/g, 145.6±51.2, 130.3±44.6, 211.3±75.1 and 162.4±53.5. After administration of cystamine, the levels of ALT, total bile acid, total bilirubin, hydroxyproline, tTG, α-SMA, collagen-Ⅰ and TIMP-1 were (378±87) U/L, (61.0±12.7) μmol/L, (9.8±1.7) μmol/L, (70±14 ) μg/g, 48.6±12.3, 40.7±12.3, 63.9±16.0, 59.2μ23.4. Conclusion Cystamine can alleviate the carbon tetrachloride-induced rat liver fibrosis by inhibiting the tTG pathway.     

加速康复外科在胃肠外科临床中的实践与思考

加速康复外科即通过优化围术期各项措施,减少重大手术患者并发症发生率,并且缩短其住院时间.其与胃肠外科相关的主要措施包括:术前营养支持、肠道准备、微创手术技术、腹腔引流管的放置、胃管的放置,术后活动及饮食恢复.在快速康复的实施过程中,应根据患者不同病情特点,针对性的采用加速康复的不同措施.临床医生也应正确把握手术适应证及手术方式的选择,保证手术的安全与质量,减少患者创伤,才能真正达到加快患者康复的最终目的.     

腹腔镜胃癌根治术后患者早期活动依从性提高的护理策略和效果

随着腹腔镜技术的快速发展，腹腔镜胃癌根治术术中出血少，手术创伤应激程度明显低于传统手术方式，并已被证实具有与开腹手术相似的近、远期疗效。快速康复外科（FTS）理念强调在术后鼓励患者早期下床活动，而传统的术后早期下床活动一般是患者在术后48～72h。有研究表明，患者术后早期活动，能刺激肠蠕动，避免肠粘连，改善呼吸功能，减少肺部并发症，促进血液循环，预防下肢静脉血栓的发生。为了提高患者术后早期活动的依从性，宁波市第一医院胃肠外科对腹腔镜胃癌根治术患者实施针对性术后活动护理干预，取得良好效果。现将结果报道如下。     

一例胃癌术后乳糜漏伴重度营养不足的循证病例报告

腹腔乳糜漏是胃癌术后的少见并发症,其危害在于高流量时可丢失大量的脂肪、蛋白质、水电解质和维生素（特别是脂溶性维生素）,迅速出现消瘦和严重的营养不足甚至恶病质而致死亡.因此临床上需足够重视并尽早诊断及治疗.本院成功诊治1例胃癌术后6周确诊腹腔乳糜漏合并重度营养不足及腹腔内感染患者,本研究在此基础上结合文献复习,对胃癌术后腹腔乳糜漏的临床诊断和治疗的证据进行回顾和总结。     

组织转谷氨酰胺酶特异性抑制剂预防肝纤维化的实验研究

Objective To observe the effects of cystamine, a tissue transglutaminase (tTG) inhibitor, on the development of rat liver fibrosis induced by carbon tetrachloride. Methods One hundred male SD rats were randomly divided into control group (n=20), hepatic fibrosis group (n=40) and cystamine group (n=40) . Liver fibrosis model was induced by intraperitoneal injection of carbon tetrachloride. Cystamine (112 mg·kg-1·d-1) was administered by intraperitoneal injection 2 days before injection of carbon tetrachloride. The rats were sacrificed at weeks 4 and 8, and the liver tissues and serum specimens were obtained. The mRNA expression of tTG, smooth muscle-alpha (α-SMA), collagen-Ⅰ and tissue inhibitors of metalloproteinase-1 (TIMP-1) were detected by real time PCR. The protein expression of tTG and α-SMA, liver function and content of hydroxyproline in liver tissues were determined by Western blot. Histological changes of the liver was observed under microscope. The fibrosis conditions of rat liver in each group were evaluated according to the semi-quantita-tive scoring system. All the data were analyzed by one-way ANOVA. Results Eight weeks after the injection of carbon tetrachloride, obvious injury of the liver in liver fibrosis group was observed. The levels of alanine trans-aminase (ALT), total bile acid, total bilirubin, hydroxyproline, tTG, α-SMA, collagen-Ⅰ and TIMP-1 were (1313±157)U/L, (99.9±18.5)μmol/L, (10.9±1.6)μmoL/L, (55±12)μg/g, 145.6±51.2, 130.3±44.6, 211.3±75.1 and 162.4±53.5. After administration of cystamine, the levels of ALT, total bile acid, total bilirubin, hydroxyproline, tTG, α-SMA, collagen-Ⅰ and TIMP-1 were (378±87) U/L, (61.0±12.7) μmol/L, (9.8±1.7) μmol/L, (70±14 ) μg/g, 48.6±12.3, 40.7±12.3, 63.9±16.0, 59.2μ23.4. Conclusion Cystamine can alleviate the carbon tetrachloride-induced rat liver fibrosis by inhibiting the tTG pathway.     

“改良”胰腺中段切除术1例报告

1临床资料患者,女,63岁,因"体检发现胰腺占位6天"于2009年4月1日入院。18年前因"肺结核、支气管扩张"在外院行左肺全切术。术前查体无特殊,腹部CT示:胰腺颈体2cm×1cm乏血供占位病变,术前实验室检查肿瘤标志物指标、肝肾功能、血常规、血糖等正常,糖耐量实验阳性。患者入院后     

Claudin在胃肠道肿瘤发生发展中的作用

Claudin是维持紧密连接结构和功能最重要的蛋白分子,在胃肠道肿瘤的发生发展及临床诊治中起着重要的作用.本文收集国内外近年来有关Claudin的分子结构及在胃肠道肿瘤发生发展中作用的最新文献并作综述.     

原发性巨大十二指肠空肠曲肿瘤4例报告

目的:总结和探讨原发性巨大十二指肠空肠曲肿瘤的诊治方法.方法:2007年11月至2009年9月共收治4例原发性巨大十二指肠空肠曲肿瘤患者,其中男性3例,女性1例,年龄35-45岁,以腹部包块为主要临床表现.结果:4例患者均成功实施了包括肿瘤在内的部分十二指肠和10cm-15cm近端空肠切除术及十二指肠空肠吻合术.其中3例为小肠间质瘤,1例为T细胞淋巴瘤.手术时间为240-480min,术中出血量600-5000ml,住院时间分别为17-58d.2例术后出现胃肠动力障碍,3例小肠间质瘤病人随访1-22个月均无瘤生存,而T细胞淋巴瘤病人于术后12个月复发死亡.结论:以腹部巨大包块为表现的病人应考虑到十二指肠空肠曲肿瘤的可能,积极探查和根治性切除是改善预后的唯一可靠手段.