回肠浆肌层补片膀胱扩大术治疗反射亢进型神经原性尿失禁的疗效随访

背景神经原性尿失禁手术治疗方法多样,疗效不一,探讨手术治疗神经原性尿失禁的效果,以求证其有效性.目的评价去粘膜回肠浆肌层补片膀胱扩大术治疗反射亢进型神经原性尿失禁疗效,为改良手术提出建议.设计以患者为研究对象的回顾性病例分析.单位一所大学医院的小儿外科.对象对郑州大学第一附属医院小儿外科自1998-04/2004-01手术治疗的68例神经原性尿失禁患者进行随访,所有患者术前均确诊为神经原性尿失禁,随访资料完整者共38例.方法对38例反射亢进型神经原性膀胱患者随访4～69个月,平均17.2个月.患者年龄4～17岁,38例患者行去粘膜回肠浆肌层补片膀胱扩大术,34例盆底肌松弛者同时行双侧髂腰肌盆底加强术.主要观察指标观察手术前后症状、膀胱顺应性、最大膀胱容量和相对安全膀胱容量.结果30例(79%)尿失禁症状改善(控尿时间＞1 h);尿动力学检查示所有行回肠去浆肌层膀胱扩大术患者术后均为腹压排尿,尿流动力学检查均未发现在排尿期有主动的逼尿肌收缩;术后顺应性增加(27.43±24.78)mL/kPa(P＜0.01),最大膀胱容量较术前增加(122.18±79.99)mL(P＜0.01),相对安全膀胱容量较术前增加(98.63±86.78)mL(P＜0.01).未发现有上尿路功能受损加重情况.结论去粘膜回肠浆肌层补片膀胱扩大术可保护上尿路功能,是有效治疗神经原性膀胱的一种方法.     

血清蛋白质标记物在神经母细胞瘤中的诊断意义

目的 寻找特异的蛋白质标记物,探讨神经母细胞瘤血清蛋白质标记物的检测及初步诊断模型的构建和临床应用.方法 收集血清样本87例,其中47例为神经母细胞瘤患儿,30例为其它恶性实体肿瘤患儿,10例为健康儿童;用ZUCI-Protein Chip Data Analyze System分析软件进行数据处理;经留一法交叉验证,...     

经肛门手术根治小儿先天性巨结肠

目的对经肛门先天性巨结肠根治术的方法、疗效、适应症和随访结果加以总结。方法采用经肛门直肠肌鞘内病变结肠切除。保留直肠肌鞘3-4cm，沿结肠壁处理肠系膜血管，结肠拖出并在齿状线加以吻合。结果手术时间平均60min。均于术后24h内进食，平均住院日6d，随访2月，2年，患儿排便情况1-5次／d，无大便失禁和肛门狭窄。结论本术式简单、有效，并发症少。近期疗效良好。     

新生儿肝炎综合征外科治疗的分析

目的对内科保守治疗效果差的8例新生儿肝炎综合征患儿进行手术治疗。方法接受手术日龄为45~75d,术中7例确诊为肝外胆道闭锁,行肝门肠吻合术（kasai手术）1例患儿术中确诊为胆汁浓缩综合征,给予胆道冲洗。结果经随访8例患儿短期疗效满意,黄疸消退,血清胆红素明显下降,大便颜色正常,3例曾出现术后胆管炎,经抗炎及抗感染治疗后好转。结论对内科治疗效果不佳、各项检查提示胆道闭锁的患儿早期应进行手术治疗,kasai手术是治疗胆道闭锁的有效术式。长期疗效尚需进一步观察。     

儿童肾母细胞瘤HMGB1、RAGE及VEGF的表达及意义

目的 探讨高迁移率族蛋白-1(HMGB1)、晚期糖基化终末产物受体(RAGE)和血管内皮生长因子(VEGF)在小儿肾母细胞瘤组织中的表达及其在肿瘤血管浸润、淋巴结转移中的意义.方法 收集郑州大学第一附属医院2003年1月至2010年1月小儿外科手术切除经病理证实为肾母细胞瘤的石蜡标本50例、15例同期相应瘤旁组织和7例正常肾组织标本.应用免疫组织化学SP染色辅以计算机图像分析系统分析结果的方法,研究HMGB1、RAGE及VEGF在各组标本中的表达及意义.结果 HMGB1、RAGE在肾母细胞瘤组织中的表达(144.46±13.55、138.18±12.26)与两者在瘤旁组织和正常肾组织中表达(107.47±5.27、103.91±4.29;100.98±4.82、100.82±3.32)相比差异均有统计学意义(P＜0.05),HMGB1在瘤旁与正常肾之间表达差异有统计学意义(P＜0.05).VEGF在瘤体组与瘤旁组中(147.57±13.77,140.28±7.85)和在正常肾组织组中的表达(106.38±1.92)相比差异显著(P＜0.05).三者在临床分期Ⅲ～Ⅳ期和预后不良组织型组及淋巴结转移组的肾母细胞瘤组织中的表达(148.69±12.17、147.73±6.71、163.14±7.50;157.88±4.44、155.29±3.97、169.17±4.42;152.11±7.36、151.56±5.46、163.83±7.20)显著高于临床分期Ⅰ～Ⅱ期和预后良好组织型及无淋巴结转移组(P＜0.05)(139.23±5.83、133.30±11.23、140.85±8.87;139.52±5.22、135.39±9.71、143.94±10.39;138.61±5.59、133.00±8.75、141.18±8.95).相关分析显示肾母细胞瘤组织中HMGB1与RAGE、VEGF的表达均成正相关(r=0.424,P=0.002;r=0.453,P=0.001),RAGE与VEGF之间无明显相关(r=0.237,P=0.101).结论 HMGB1、RAGE和VEGF的高表达与肾母细胞瘤的临床分期、病理类型、淋巴结转移有关,参与了肿瘤血管浸润及淋巴结转移,HMGB1/RAGE可能是促进肾母细胞瘤转移的一条信号通路,给我们靶向治疗肾母细胞瘤提供了新的思路.

Abstract：

Objective This study aim to assess the expressions of high mobility group box chromosomal proteinl ( HMGB1) and receptor foradvanced glycation end products (RAGE) and vascular endothelial growth factor (VEGF) in Wilms'tumor and their clinical significance both in the tumor blood vessel infiltrates and in the lymph node metastasis. Methods Fifty cases of Wilms'tumor samples, which had been confirmed by pathology, were collected from The First Affiliated Hospitals of Zhengzhou University from january 2003 to january 2010. And 15 cases were taken from the adjacent kidney tissues at the same time. Other 7 cases were normal kidney tissues. The expression of HMGB1, RAGE and VEGF were detected by the Immunohistochemical SP staining in each group of specimens. The expression intensity was analyzed by computer image processing and their significance in each group of specimens were studied. Results The expressions of HMGB1 and RAGE in the Wilms'tumor tissues (144. 46 ± 13. 55、138.18 ±12. 26) were compared with those in the adjacent kidney tissues and in the normal kidney tissues( 107. 47 ± 5. 27、103. 91 ± 4. 29; 100. 98 ± 4. 82、 100. 82 ± 3. 32). The expressions of HMGB1 in the adjacent kidney tissues and in the normal kidney showed significant differences. There was a significant differences between the Wilms' tumor group and the adjacent kidney tissues or in the normal kidney tissues ( F ＜ 0.05 ). The expressions of VEGF proteins in Wilms'tumor tissues and in the adjacent kidney tissuess(147. 57 ± 13. 77,140. 28 ± 7. 85) comoared to those in the normal kidnev tissues(106. 38 ± 1. 92)were remarkably different(P＜0. 05). The expressions of HMGB1 ,RAGE and VEGF proteins in Wilms' tumor tissues of stage Ⅲ-Ⅳ and high risk histopathology and lymph node metastasis group (148. 69 ± 12.17、147. 73 ± 6. 71、163.14 ± 7. 50; 157. 88 ± 4. 44、155. 29 ± 3. 97、169. 17±4.42;152. 11 ± 7. 36、151. 56 ± 5. 46、163. 83 ± 7. 20)were significantly higher than those of stage Ⅰ-Ⅱ and low risk histopathology and no lymph node metastasis group(P＜0. 05) (139. 23 ± 5. 83、133. 30 ± 11. 23、140. 85 ± 8. 87; 139. 52 ± 5. 22、135. 39 ± 9. 71、143. 94 ± 10. 39; 138. 61 ± 5. 59、133. 00 ±8. 75、141.18 ± 8. 95). There was a positive correlation between the expressions of HMGB1 with RAGE and VEGF(r = 0. 424, P = 0. 002; r = 0. 453, P = 0. 001), but the correlation between the RAGE and VEGF is not clear (r = 0. 237, P = 0. 101). Conclusions There was a high expression of HMGB1 ,RAGE and VEGF in the Wilms'tumor tissues and they are partly related to the clinical stages and pathological type and lymph node metastasis of Wilms'tumor. They perhaps participated in the tumor blood vessel infiltration and the lymph node metastasis and the pathway of HMGB1/RAGE is perhaps the main mechanism correlated with the metastasis of Wilms'tumor.