急性胆管炎腹腔镜胆总管探查后一期缝合与T管引流的临床研究

目的 探讨急性胆管炎腹腔镜胆总管探查后一期缝合与T管引流两种手术方式的特点,评估其可行性与安全性.方法 回顾性分析首都医科大学宣武医院普外科2012年1月-2014年12月100例急性胆管炎患者行腹腔镜胆囊切除+胆总管探查术患者的临床资料,其中54例(54％)患者行一期缝合,46例(46％)患者行T管引流.结果 100例患者均成功行手术治疗,手术时间缝合组显著短于T管组(96.72 minvs123.00 min,P=0.001),术中出血量缝合组与T管组相比显著减少(27.13 mlvs38.48 ml,P=0.009).缝合组术后胃肠功能恢复时间(1.57 dvs2.33 d,P=0.003)与术后住院时间(6.19 dvs9.20d,P=0.000)均显著短于T管组.两组术后腹腔总引流量(309.22mlvs212.46ml,P=0.070),引流时间(3.96 dvs4.02 d,P=0.875),术后胆漏发病率(9.3％ vs0,P=0.060),出血率(5.1％vs2.2％,P=0.622)差异均无统计学意义.结论 急性胆管炎腹腔镜胆总管探查后一期缝合严格掌握适应证后,与T管引流相比,同样安全有效.     

胆胰管多点位引流的临床体会

目的：探讨内镜逆行胆胰管造影术（ERCP），同期置入多点位支架以姑息性解除胆胰管良恶性梗阻的可行性及疗效。方法：采用ERCP了解胆、胰管狭窄或梗阻的精确部位、范围、程度，并确定置入多点位支架。术后观察临床症状改善情况、血淀粉酶变化、黄疸消退情况、支架通畅时间及平均生存期。结果：75例病人中恶性梗阻病人多点位支架的平均通畅期为7个月，平均生存期10个月。全组未发生与操作有关的严重并发症及死亡。结论：在必要条件下，多点位支架引流对解除胆胰管良恶性梗阻比单根支架有更好的疗效、更少的术后胆管炎的发生率及黄疸消退时间。病人的支架通畅期及生存期均有所延长。     

Correlation of macrophage-mediated tumor-cell lysis with the production of macrophage cytolytic factor (CF). Preliminary characterization of a factor inhibiting CF production

Macrophage-mediated cytolysis of thymidine-prelabelled murine A9 fibrosarcoma cells was compared to the level of cytolytic factor (CF) present in the cultures by assaying supernatant aliquots on actinomycin (AcD)-treated A9 fibrosarcoma cells. A good correlation between the level of A9 killing and CF titer was observed when different concentrations of lipopolysaccharide (LPS) were added to various macrophage populations: murine peritoneal cells, short-term bone-marrow (BM)-derived macrophages and JBM phi macrophage lines. Optimal A9 killing and CF secretion, equivalent to the killing of about 1000 AcD-pretreated A9 cells by a single macrophage, were obtained following activation of JBM phi by LPS. CF production by BM-derived macrophages was enhanced in serum-free medium when compared to its release in the presence of fetal calf serum. The LPS-activated macrophages could be restimulated by the activating agent to produce CF following one week of propagation in the absence of LPS. On the other hand, CF activity was absent from the supernatants of activated macrophages co-cultured with normal embryonic fibroblasts, which are resistant to macrophage-mediated killing. This effect could be attributed to a factor, secreted by normal fibroblasts but not by A9 cells, which suppressed CF release from the activated macrophages. Our data strongly support earlier observations, suggesting that CF [which appears to resemble the tumor necrosis factor (TNF)] is responsible for LPS-induced macrophage-mediated tumor cell lysis. It is suggested that suppression of the latter process by the fibroblast-derived factor proceeds via inhibition of CF/TNF production from the macrophage.     

In vitro induction of tumor necrosis factor alpha, tumor cytolysis, and blast transformation by Spiroplasma membranes

Membranes of Spiroplasma sp. strain MQ-1 (hereafter referred to as MQ-1) were potent inducers of tumor necrosis factor alpha (TNF alpha) secretion and of blast transformation. Specific anti-recombinant murine TNF alpha antibodies markedly inhibited macrophage-mediated tumor cytolysis of A9 fibrosarcoma target cells following activation by MQ-1 membranes. Thus, TNF alpha plays a major role in mediation of tumor cytolysis induced by MQ-1 membranes, which is similar to its role in lipopolysaccharide (LPS)-induced tumor cytolysis. Two findings, however, suggested that the mechanism of macrophage activation by MQ-1 membranes differs from that by LPS: (a) macrophages, taken from C3H/HeJ mice showing a low responsiveness to LPS, were activated by MQ-1 membranes to enhanced TNF alpha secretion, resulting in a high-level tumor cytolysis compared with the negligible tumor cytolysis induced by LPS; and (b) MQ-1 membranes and LPS synergized to highly augment TNF alpha secretion by macrophages of C57BL/6 mice. MQ-1 membranes were capable of inducing blast transformation of murine lymphocytes as well. In addition, they activated human monocytes to secrete high levels of TNF alpha. Further studies need to be carried out using in vivo models to evaluate the therapeutic potential of MQ-1 membranes in the treatment of malignant diseases.     

血管性介入放射学的并发症

对1024例患者进行了血管内介入性诊断或治疗。除栓塞综合症和轻度暂时性骨髓抑制外，发生导管断裂，皮肤坏死、出血、胰腺异位栓塞，胃穿孔各1例；导管打结、离子型造影剂过敏各2例；血管痉挛与缺血，药物并发症各3例，文中对并发症的原因、处理及如何避免等问题作了讨论。     

紫外分光光度法测定消毒剂二氧化氯的含量

为检测含二氧化氯消毒剂中二氧化氯准确含量,采用紫外分光光度法测定消毒剂中二氧化氯。结果,二氧化氯在360um处有特征吸收峰,可作为定性依据;在430um处作定量分析,ClO~-、ClO_2~-、ClO_3~-不干扰测定;检出限为10mg/L,方法线性范围为10～250mg/L,线性相关系数r=0.9998;方法平均回收率为97.9％,相对标准偏差<10％;经对3个单位实际样品验证检测,所得结果一致。该方法操作简便,准确可靠,易于推广。     

乳腺癌耐药蛋白在非霍奇金淋巴瘤中的表达及意义

目的:探讨非霍奇金淋巴瘤(NHL)患者乳腺癌耐药蛋白(BCRP)的表达及临床意义。方法:采用RT-PCR法检测66例NHL患者新鲜淋巴组织标本BCRP及多药耐药基因(MDR1)的表达,并对所有患者进行随访。结果:66例NHL患者BCRP阳性率45.5%,MDR1阳性率59.1%;不同类型、不同临床分期BCRP阳性率不同;BCRP基因有无表达其缓解率、复发率、5年生存率不同;BCRP+MDR1+、BCRP+MDR1-、BCRP-MDR1+、BCRP-MDR1-4组化疗疗效不同(P<0.05)。结论:本组NHL患者BCRP及MDR1表达率高,是化疗敏感性差的重要原因。     

肝细胞癌多学科诊疗临床思维方法的PBL教学体会

根据肝癌多学科诊疗纵向与横向思维特点,在博士研究生临床思维方法的训练中,引入了PBL教学模式,并针对肝癌诊断和治疗分别设计了6项问题,结合病例分析训练临床思维能力。该项PBL教学以肝癌诊疗相关问题为中心,通过横向与纵向思维相结合,完成临床诊疗思维过程的培训,体现出了临床思维具有灵活性、综合性和流畅性的特点。     

针灸结合血府逐瘀汤治疗顽固性失眠20例

[目的]探讨顽固性失眠有效治疗途径。[方法]对20例患者采用针刺安神点及腹针并结合中药血府逐瘀汤加减治疗。[结果]在20例患者中,痊愈16例,好转3例,无效1例。总有效率95％。[结果]针灸结合血府逐瘀汤治疗疗效确切。     

活体右半肝移植中供肝肝中静脉取舍对供体安全的影响

目的:探讨依照剩余肝体积比(%RLV)、供肝受体体质量比(GRWR)和Ⅳ段静脉汇人情况来决定供肝切取时肝中静脉(MHV)的取舍对供体安全的影响.方法:43例供者拟行活体右半肝切取,当%RLV<35%且GRWR>1.0%时,入选B组;当%RLV≥35%且GRWR<1.0%时,入选A组;当%RLV≥35%且GRWR>1.0%时,如Ⅳ段静脉汇入肝左静脉为主入选A组,如Ⅳ段静脉汇入MHV为主入选B组.A组15例行带MHV的右半肝切取,B组28例行不带MHV的右半肝切取,分析比较2组供者术前和术中的一般情况以及术后血清丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、总胆红素(TBIL)、白蛋白(ALB)和剩余肝脏的再生情况.结果:2组供者除%RLV和GRWR外,其他一般状况差异无统计学意义,2组供体的术后ALT、AST、TBIL的最高值和ALB的最低值差异无统计学意义,2组状态与时间的交互效应差异均无统计学意义,2组所有供者均于术后2周痊愈出院,恢复正常生活.结论:依照以上预案来决定行是否带MHV右半肝切取,可以保障供体安全.