Inguinal hernia repair in Hospital Authority hospitals: The role of laparoscopic hernioplasty

Objective: Two major changes have occurred in inguinal hernia repair during the last two decades: (i) the use of tension‐free mesh repair; and (ii) the application of laparoscopic technique for repair. The aims of the present study were to study: (i) how inguinal hernia repair was carried out; and (ii) the outcome of inguinal hernia repair in Hospital Authority (HA) hospitals. Methodology: This was a retrospective analysis on 8311 elective inguinal hernia repairs performed in 16 HA hospitals from January 2001 to December 2003. The mean age was 63.9 ± 14.2 years, and the male to female ratio was 22.0 : 1.0. Among these, 869 (10.5%) repairs were performed with the laparoscopic approach and 7442 (89.5%) repairs with the open approach. The proportion of laparoscopic hernia repair increased from 8.7% to 12.6%. Results: For open repair, 39% of cases were carried out with regional anaesthesia, 32% with general anaesthesia and 29% with local anaesthesia (LA). Furthermore, mesh repair was used in 88% of the patients. For laparosocpic repair, 98.4% of cases were carried out under general anaesthesia, and all patients had mesh repair using the totally extraperitoneal approach. A significantly higher proportion of bilateral repair and recurrent hernia repair was performed with the laparoscopic approach (P = 0.000). For primary unilateral repair, there was no significant difference in the postoperative length of stay (LOS) and the total LOS between the laparoscopic and the open surgery groups. No difference in LOS was found in recurrent hernia repair between the two groups. With respect to bilateral repair, both the preoperative LOS (P = 0.036) and total LOS (P = 0.039) were shorter in the laparoscopic group. Furthermore, a significantly higher proportion of day‐surgery patients was observed in the laparoscopic group than the open surgery group (21.3%vs 16.9%, P = 0.001). Nevertheless, when only the results of 2003 were analyzed, the postoperative LOS (P = 0.000) and total LOS (P = 0.000) were significantly shorter in the laparoscopic group than the open surgery group. The LOS parameters were significantly shorter in the open surgery LA subgroup compared with the non‐LA subgroup (P = 0.000), and they were not different from those in the laparoscopic group. Conclusions: The open mesh repair is the predominant approach for inguinal hernia repair in HA hospitals. The originally described local anaesthetic approach was under utilized, although it resulted in good outcome. The use of laparoscopic hernia repair is increasing and a learning curve was recently observed with improved outcome.     

80岁以上高龄结直肠癌患者接受腹腔镜辅助根治手术的围手术期安全性观察

目的:通过比较高龄结直肠癌患者接受腹腔镜辅助根治性手术与传统开腹根治性手术的围手术期情况,了解腹腔镜辅助结直肠癌根治手术对高龄结直肠癌患者的治疗安全性。方法:2006年1月至2008年6月,69例大于等于80岁的结直肠癌患者接受限期性根治手术,其中26例接受腹腔镜辅助结直肠癌根治术(腹腔镜组),男13例,女13例,平均(83.91±3.02)岁(80～90岁);43例接受传统开腹结直肠癌根治术(开腹组),男29例,女14例,平均(83.70±3.43)岁(80～91岁)。回顾性分析比较两组患者的术前评估(ASA评分)、术前合并症情况、手术病理分级(Dukes分期)、术中及术后血气分析变化、术后胃肠道功能恢复时间、住院天数及并发症等围手术期情况。结果:手术前,两组间的ASA评分无显著差异(Ⅰ级5:8,Ⅱ级19:32,Ⅲ级2:3,P>0.05),伴随的合并症发生率无显著差异(19/26,73.1%vs.26/43,60.5%,P>0.05)。腹腔镜组术中未出现高碳酸血症。术后24h与72h出现血气分析异常,分别为5人及2人,与开腹组的18人和7人相比,有显著性差异(P<0.05);腹腔镜组恢复排气时间显著短于开腹组[(2.27±0.46)dvs.(3.68±0.58)d](P<0.05);术后住院天数显著低于开腹组[(14.55±7.21)dvs.(22.16±18.99)d](P<0.05);术后并发症发生率显著低于开腹组(6/26,23.1%vs.18/43,41.9%,P<0.05);两组手术死亡率方面无显著差异,其中腹腔镜组死亡率3.85%,开腹组手术死亡率4.65%(P>0.05)。结论:80岁以上高龄结直肠癌患者选择腹腔镜辅助根治术比传统开腹手术具有术后康复快、并发症少等优势,同时腹腔镜手术不会增加术后死亡率。因此,腹腔镜辅助结直肠癌根治术对于高龄结直肠癌患者具有良好的手术安全性。     

多西他赛联合表柔比星、环磷酰胺和氟尿嘧啶治疗局部晚期乳腺癌

目的:观察多西他赛联合表柔比星、环磷酰胺、氟尿嘧啶(DECF方案)新辅助化疗治疗局部晚期乳腺癌 (locally advanced breast cancer,LABC)疗效及毒副反应.方法:2005年8月-2007年9月收治的26例LABC患者,均为女性.中位年龄46岁(30～72岁), Ⅲa期16例,Ⅲb期10例,化疗剂量为多西他赛80 mg/m2、表柔比星60 mg/m2、环磷酰胺500 mg/m2和氟尿嘧啶500 mg/m2静脉滴入, 每3周为1个周期, 2个周期后评价疗效,并决定是否继续1～2个周期DECF方案后再接受手术或放疗.化疗后48 h预防性应用细胞集落刺激因子(G-CSF).结果:26例患者接受2～4个周期DECF方案的新辅助化疗.治疗后完全缓解5例,部分缓解15例,稳定4例,进展2例,有效率76.9%(20/26),病理完全缓解率、临床完全缓解率和临床部分缓解率分别为11.5%、19.2%和57.7%,本组的手术切除率为96%.主要毒副反应为白细胞减少,Ⅲ～Ⅳ度白细胞减少的发生率分别占总周期数的12.5%和15.0%,其他不良反应为轻、中度的脱发、恶心或呕吐、肌肉关节酸痛、体液潴留、疲乏、腹痛等.结论:DECF方案是LABC的一种安全有效的新辅助化疗方案.     

中低位直肠癌经腹肛门切除套入式肠直肠黏膜吻合保肛术169例临床研究

目的探讨套入式结肠直肠黏膜吻合术治疗中低位直肠癌保留肛门括约肌功能的安全性和可行性。方法对中低位直肠癌经腹肛门根治性切除行套入式结肠直肠黏膜吻合术治疗的169例临床资料进行分析。169例中男107例,女62例。年龄21～99岁,平均为54.2岁。肿瘤下缘距齿状线5～9cm。病理诊断直肠腺癌163例,其中高分化者70例,中分化者81例,低分化者6例,黏液腺癌6例。腺瘤癌变6例。Dukes分期:A期61例,B期101例,C期7例。结果术后发生吻合口瘘5例(2.9%),狭窄3例(1.7%),术后早期排便次数可达6～12次/d,术后12～18周时排便功能基本恢复正常。169例术后随访率为91%,中位随访时间5.8年。局部复发率为5.8%,肝转移率为13.7%。术后总体5年生存率为66.9%,中位生存时间69(6～132)个月。结论套入式结肠直肠黏膜吻合保肛术式能达到直肠癌根治性切除,且可保留肛门正常的排便控制功能。     

新生大鼠胰腺nestin阳性细胞的体外分离、培养和分化的研究

目的探索新生大鼠胰腺nestin阳性细胞体外分离、培养并使之形成类胰岛样细胞团的方法。方法应用胶原酶消化新生大鼠胰腺,将消化的组织碎片培养形成类胰岛样细胞团后传代。免疫荧光细胞化学法检测贴壁细胞胰岛素、胰高血糖素及nestin的表达。RT-PCR检测培养1周的贴壁细胞nestin及细胞角蛋白(CK19)的表达。结果在pH 7．6条件下培养24-36 h有部分细胞贴壁生长,改用pH 7．4无血清RPMI 1640培养液培养18-24 d可形成类胰岛样细胞团,传代后可有单层细胞生长。培养24～36 h的贴壁细胞nestin呈阳性,但胰岛素、胰高血糖素阴性,形成的类胰岛样细胞团传代后24 h胰岛素、胰高血糖素呈阳性。培养1周的单层细胞经RT-PCR扩增获得nestin 片段,但未获得CK19相应的片段。结论类胰岛样细胞团传代培养后可表达胰岛素、胰高血糖素; 胰腺nestin阳性细胞具有胰岛干细胞的特点。     

Changes of occludin expression in intestinal mucosa after burn in rats

In severely burned rats, hyperemia, edema and other pathological injuries occur in the intestinal mucosa. Ultramicroscopically, the microvilli, tight junction and organelles are disrupted. Occludin is a functional component of tight junctions. The purpose of the present study is to investigate changes of occludin expression, and to further elucidate the relationship between occludin expression and ultrastructure damage. The fluorescence intensity of occludin was detected in intestinal wall by the method of immunofluorescence histochemistry and confocal laser scanning microscopy (CLSM). Expression of occludin and its mRNA were determined by western blotting and RT-PCR, respectively. Changes of intestinal mucosa ultrastructure were observed by TEM. The results showed that fluorescence intensity of occludin at 3PBH was enhanced, higher than that of the control group, being 80.77+/-8.38 and 72.86+/-4.74, respectively, and reached a peak at 12PBH (116.14+/-6.89). The expression levels of occludin at 3PBH and 6PBH were 1.21+/-0.02 and 1.53+/-0.14 times that of the control group, respectively, and there were significant differences (P<0.01) between 3PBH group and 6PBH group and control group. The levels of occludin mRNA were also enhanced. At 12PBH, the level reached a peak (P<0.01), being 2.00+/-0.24 times that of the control group. Coincidently, the structure of the tight junction between epithelial cells was disrupted on a large scale under TEM. We speculate that up-regulation of epithelial occludin may play a role in enhancing paracellular permeability and be related to the damage to the tight junction.     

ZIC1基因转染联合姜黄素对人乳腺癌细胞生物学行为的影响

［摘要］目的: 探讨ZIC1基因转染联合姜黄素对人乳腺癌MDA-MB-231细胞生物学行为的影响。方法: 将慢病毒载体pLV Zic1 PGK Puro稳定转染人乳腺癌MDA-MB-231细胞,通过蛋白质印迹法检测转染后MDA-MB-231细胞ZIC1蛋白的表达水平。通过MTT法检测抑制率在50％左右的姜黄素浓度,并作为后续实验的标准加药浓度。以ZIC1空载不加姜黄素为对照组,空载加姜黄素、转染不加姜黄素及转染加姜黄素为实验组,以MTT法检测ZIC1、姜黄素及ZIC1联合姜黄素对MDA-MB-231细胞黏附的影响;用划痕实验检测各组细胞的迁移能力;用流式细胞术检测各组细胞的凋亡率。结果： 乳腺癌细胞转染ZIC1质粒后,ZIC1蛋白呈阳性表达,而转染空载体细胞中ZIC1蛋白表达阴性。细胞增殖抑制率在50％左右的姜黄素浓度为5 mg/L,以此作为标准加药浓度。与对照组比较,转染组、姜黄素组及转染联合姜黄素组乳腺癌MDA-MB-231细胞增殖受到明显抑制,凋亡率明显增高(均P＜0.05)。其中,ZIC1转染联合姜黄素对细胞增殖的抑制及凋亡诱导作用更明显(P＜0.05)。结论： ZIC1基因与姜黄素对乳腺癌的抑制存在协同作用。     

腰椎骶化者腰椎生理曲度差异及临床意义

目的比较分析Ⅱ、Ⅲ、Ⅳ型腰椎骶化者与无腰椎骶化者的腰椎生理曲度差异,并探讨其临床意义。方法从南昌大学第一附属医院影像科随机选取腰椎骶化患者216例及对照组(无腰椎骶化者)1412例。腰椎骶化患者根据Castellvi分型方法分为Ⅱ、Ⅲ及Ⅳ型。比较腰椎骶化患者与对照组间、男女间腰骶角(Ferguson法,F)、腰骶角(Wiltse法,LSA)、腰骶角(Grogkopff法,G)和腰椎前突指数的差异性。结果腰椎骶化患者与对照组腰骶角(F)、腰骶角(G)和腰椎前突指数比较差异有统计学意义(P<0.001);对照组腰骶角(F)、腰骶角(G)和腰椎前突指数男性与女性比较差异有统计学意义(P<0.05);腰椎骶化患者腰骶角(F)和腰椎前突指数男性与女性比较差异有统计学意义(P<0.05)。Ⅱ型和Ⅲ型间腰骶角(F)、腰骶角(G)和腰椎前突指数比较差异有统计学意义(P<0.05);Ⅱ型和Ⅳ型间腰骶角(G)比较差异有统计学意义(P<0.05)。结论腰椎骶化者腰椎生理曲度发生改变,且男女之间腰椎生理曲度存在差异。更多还原     

低剂量氯氟氰菊酯对斑马鱼胚胎运动行为的影响

目的：研究低剂量氯氟氰菊酯对斑马鱼胚胎运动行为的影响。方法：用0、10、20、40、80、100 µg/L的氯氟氰菊酯对斑马鱼胚胎进行处理,进行畸形表型及浓度效应分析。研究0、2.5、5、10 µg/L的低剂量氯氟氰菊酯对斑马鱼胚胎自主运动、接触反应、自由泳动等运动行为的影响。结果：氯氟氰菊酯暴毒斑马鱼胚胎的主要畸形表型为心包囊肿大、脊柱和尾部弯曲、卵黄囊肿大等。与对照组比,20 µg/L及以上浓度暴露下斑马鱼胚胎的畸形率显著提高（P＜0.05）,而10 µg/L氯氟氰菊酯对斑马鱼胚胎无明显致畸效应。氯氟氰菊酯在胚胎受精后120 h（120 hpf）的半数致畸浓度（EC50）为38.61 µg/L。运动行为检测结果显示,2.5 µg/L暴露下斑马鱼胚胎的自主运动频率在19、21和22 hpf时显著升高（P＜0.05）,10 µg/L氯氟氰菊酯暴露下胚胎的自主运动频率在20和21 hpf时显著下降（P＜0.05）,且峰值由21 hpf延迟到22 hpf;5、10 µg/L组胚胎在27和48 hpf时对接触反应的运动距离呈显著下降（P＜0.05）;10 µg/L氯氟氰菊酯显著降低了仔鱼的自由泳动速度（P＜0.01）。结论：氯氟氰菊酯对斑马鱼胚胎有严重的致畸效应,且呈现剂量依赖性。对斑马鱼胚胎无明显致畸效应的低剂量氯氟氰菊酯即可显著影响其自主运动、接触反应、自由泳动等发育早期的运动行为。     

稳定的大鼠大脑中动脉栓塞脑梗死模型的建立

目的 探讨使用激光多普勒血流监测技术制作稳定的大鼠脑梗死模型（middle cerebral artery occlusion, MCAO）的可行性。方法 16只SD雄性大鼠随机分成2组：实验组和对照组各8只。实验组将模型制作过程中脑血流下降至基础值的30%判定为模型制作成功;对照组不监测脑血流,将尼龙栓线插入深度为1.8 cm判定为模型制作成功。模型前和模型后24 h分别行神经损伤严重程度评分（modified neurological severity scores, mNSS）;模型后24 h处死大鼠行2,3,5-三苯氯化四氮唑（TTC）染色并计算脑梗死体积。结果 实验组8只大鼠模型后24 h均出现典型偏瘫症状,mNSS评分稳定在10分～13分,梗死体积稳定性和均一性好,为37.5?.9%。对照组8只大鼠mNSS评分稳定性较差,其中5只大鼠的mNSS评分为10分～13分,5只大鼠的脑梗死灶和实验组相似,但有3只大鼠的脑梗死体积明显小于实验组（P < 0.05）。实验组的模型成功率为100%,对照组的模型成功率为62.5%（P < 0.05）。结论 激光多普勒血流监测技术可以显著提高大鼠MCAO模型的成功率、稳定性和均一性。