妊娠期直肠癌

本文报道13例妊娠期直肠癌,患者多见于青壮年,易被误诊.病理特点以粘液腺癌、印戒细胞和低分化腺癌等高恶性度癌所占比例较大,病情发展快,易发生扩散.一经确诊,应立即终止妊娠,及早手术,其方法同非妊娠病例.卵巢转移常是手术治疗失败的原因,术中应考虑卵巢活检冰冻切片或预防性切除.     

P16蛋白在大肠癌中的表达与预后的关系

目的探讨P16蛋白在大肠癌中表达及预后的关系。方法应用SP免疫组织化学法检测了P16蛋白在89例大肠癌组织中的表达。结果P16蛋白表达缺失45例,缺失率为50.6%,P16蛋白随着Duke分期级别升高,缺失率越来越高,且差异有统计学意义;有淋巴结转移组P16的缺失率比无淋巴结转移组高;P16的缺失表达与大肠癌患者的生存时间有关(P<0.05);P16缺失表达的患者预后较差。结论P16表达与Duke分期、淋巴结转移和患者生存时间有关。P16基因表达可能为影响患者预后的一个重要因素。     

四引物扩增受阻突变体系聚合酶链反应在SNP基因分型中的研究

目的 探讨四引物扩增受阻突变体系聚合酶链反应(tetra-primer amplification refractory mutation system-potymerase chain reaction,tetra-primer ARMS-PCR)在SNP基因分型中的应用. 方法 利用人EXO1基因第10外显子CA9T单核苷酸多态性为研究对象,以tetra-primer ARMS-PCR的原理设计四种引物进行扩增,从而对Mg2 浓度、dN浓度、Taq酶用量及内外引物浓度比例4个因素进行优化. 结果 当反应体系的退火温度为51℃,Mg2 浓度、dNTP浓度分别为2.0 nanol/L、0.1 mmol/L,Taq酶用量为0.5 U,内/外引物浓度为1/0.2μmol/L时,tetra-primer ARMS-PCR应用于该SNP位点的基因分型结果最佳. 结论 四引物扩增受阻突变体系聚合酶链反应是SNP基因分型的一种可行方法,但在应用时需对反应条件进行必要的优化.     

Cox模型在结肠癌远期生存中的应用

应用Ｃｏｘ回归模型分析方法，对１２１例结肠癌患者进行了生存影响因素分析。结果显示，单因素分析有５个因素有显著性意义。多因素分析癌转移、组织学类型和病程进入多因素回归模型，其相对危险度（ＲＲ）分别为２．５２、２．１２和０．７９。     

直肠癌低位前切除术后肛肠动力学对肛门功能的影响

目的探讨直肠癌低位前切除(low anterior resection,LAR)术后肛肠动力学与肛门功能发生改变的内在相关性,揭示影响肛门功能的肛肠动力学指标。方法简单随机选择LAR患者40例,应用肛肠测压仪,于术后1个月测定肛管直肠静息压、肛管最大收缩压、直肠最大耐受容量、直肠顺应性和直肠肛门抑制反射;术后1个月肛门功能采用徐忠法评价方法和评价标准进行评估;然后,将测压指标和肛门功能的相关关系进行分析,得出LAR术后影响肛门功能的动力学指标。结果肛管直肠静息压、直肠最大耐受容量、直肠顺应性与肛门功能呈显著性正相关;肛管最大收缩压、直肠肛门抑制反射与肛门功能无相关性。结论肛肠动力学与肛门功能存在内在相关性,肛管静息压、直肠最大耐受容量、直肠顺应性是反映肛门功能的主要参数。     

直肠癌低位前切除术后肛肠动力学对肛门功能的影响

目的 探讨直肠癌低位前切除（low anteriorresection，LAR）术后肛肠动力学与肛门功能发生改变的内在相关性，揭示影响肛门功能的肛肠动力学指标。方法简单随机选择LAR患者40例，应用肛肠测压仪，于术后1个月测定肛管直肠静息压、肛管最大收缩压、直肠最大耐受容量、直肠顺应性和直肠肛门抑制反射；术后1个月肛门功能采用徐忠法评价方法和评价标准进行评估；然后，将测压指标和肛门功能的相关关系进行分析，得出LAR术后影响肛门功能的动力学指标。结果肛管直肠静息压、直肠最大耐受容量、直肠顺应性与肛门功能呈显著性正相关；肛管最大收缩压、直肠肛门抑制反射与肛门功能无相关性。结论肛肠动力学与肛门功能存在内在相关性，肛管静息压、直肠最大耐受容量、直肠顺应性是反映肛门功能的主要参数。     

肝叶切除术的体会

<正> 我科自1980～1984年收治各种肝病患者46例,其中24例行肝叶切除术。兹将我们的治疗体会报告如下: 临床资料本组男17例,女7例;年龄:31～61岁,平均38岁;病程:1个月～1年。肝区疼痛8例,上腹部异常肿块16例。术前诊断:临床期肝癌22例,其中单纯型16例,硬化型8例;肝包囊虫病和血管瘤     

复方嗜酸乳杆菌联合曲美布汀治疗腹泻型肠易激综合征临床疗效分析

目的探讨复方嗜酸乳杆菌联合曲美布汀治疗腹泻型肠易激综合征的临床疗效及不良反应。方法128例腹泻型肠易激综合征患者随机分成复方嗜酸乳杆菌联合曲美布汀组（A组,44例）、复方嗜酸乳杆菌组（B组,42例）和曲美布汀组（c组,42例）,A组给予复方嗜酸乳杆菌,1g／次,3次／d,餐后口服;曲美布汀,100mg／次,3O：／a;B组给予复方嗜酸乳杆菌,1g／次,3次／d,餐后口服;12组给予曲美布汀口服,100mg／次,3Oz／d;4周为1个疗程。观察比较三组治疗前、治疗临床疗效及不良反应发生情况。结果治疗4周后,A组总有效率93．2％明显高于B组的71．4％和C组的78．6％（）（2=4．87、4．01,均P〈0．05）,C组和B组间差异无统计学意义（P〉0．05）,三组均未见明显不良反应。结论复方嗜酸乳杆菌联合曲美布汀治疗腹泻型肠易激综合征临床疗效较好,值得临床推广应用。     

加替沙星与左氧氟沙星治疗急性下呼吸道感染的疗效观察

目的：探讨加替沙星与左氧氟沙星治疗急性下呼吸道感染的临床效果。方法：将在我院治疗的下呼吸道感染患者64例随机分为观察组和对照组,对照组给予左氧氟沙星治疗,观察组给予加替沙星治疗。结果：治疗后两组患者咳嗽咳痰、发热、胸痛及胸片阴影人数均较治疗前明显减少（P〈0.05）。治疗后观察组患者咳嗽咳痰、发热、胸痛及胸片阴影改善情况与对照组比较差异无统计学意义（P〉0.05）。观察组细菌清除率为96.88%,对照组为90.63%,两组比较差异无统计学意义（P〉0.05）。观察组治愈率为90.63%,对照组为68.75%,两组比较差异具有统计学意义（P〈0.05）。两组患者均未见明显的药物不良反应。结论：加替沙星在治疗下呼吸道感染中治愈率较左氧氟沙星更高,副作用少,值得应用。     

FOLFOX-6与肝动脉灌注化疗对结直肠癌肝转移治疗效果的比较

Objective To compare the efficacy and side effects between systemic chemotherapy and hepatic arterial infusion by combination of oxaliplatin and 5-fluorouracil (FOLFOX-6) with 5-fluorouracil in the patients who have developed hepatic metastasis after colorectal cancer operation. The factors that would affect the prognosis without operational treatment were also analyzed. Methods 46patients who had signed the informed consents were allocated into two groups: the group with general chemotherapy (Trial Group includes 26 cases) and the one with hepatic arterial infusion chemotherapy (Control Group includes 20 cases). The total effective rate, the prognosis, the cytoxicitic side effects,quality of life, the total survival rate and the responses were the main parameters determined. Kaplan-Meier was used to analyze Mono-factor to the prognostic responses and the Cox mode was used to analyze poly-factor to the prognostic responses. Results The overall survival rate was significantly higher by using systemic treatment versus HAI(median, 15. 0 v 11.2 months;P＜0.05). The difference in overall responsive rate (CR+PR) between the two groups was statistically significant (50% v 10%;P=0. 011). No significant difference was found in PS scale during the treatment. (P=0. 126). Except for myelosuppression and abdominal pain, no significant difference was found in the other side effects. Univariate analysis revealed that the invasive lesions to serosa, the distribution of liver metastases, the size and number of liver metastases, primary carcinoma involving lymph nodes and the treatment were correlated with prognoses. Cox regression analysis showed that the larger diameter of liver metastases, the number of liver lesions, primary carcinomas involved in serosal layer and the treatment modules were independent prognostic factors. Conclusions The oxaliplatin-based FOLFOX-6 chemotherapy regiment has a better responsive rate and survival rate than the traditional infusion with 5-fluorouracil to the main hepatic artery for interventional therapy. The diameter of the hepatic metastasis larger than 5em, multiple hepatic metastasis and the primary lesions penetrating serosal layer suggest the poor prognosis. The oxaliplatin-based systematic chemotherapy has a better prognosis. Therefore,it is worth carrying on further study on modification of traditional hepatic arterial infusion and on evaluation of therapy by combination of the hepatic arterial infusion with the systematic chemotherapy.