捆绑式胰肠吻合术在胰十二指肠切除术中的应用(附25例临床分析)

按照胰肠捆绑式吻合术进行胰肠吻合，游离胰腺断端3cm，胰管内置硅胶管。两者用可吸收线固定，空肠3cm处断端用电凝破坏其黏膜，胰断端套入空肠内3cm，空肠断端与胰包膜缝合，距空肠断面约1～2cm处利用可吸收线环绕空肠壁捆绑一道，使空肠壁与胰腺紧密相贴。探讨捆绑式胰肠吻合术在胰十二指肠切除术后预防胰肠吻合口瘘的临床价值。结果：25例患者均未出现胰瘘，无围手术期死亡，恢复顺利。提示：捆绑式胰肠吻合术操作简单、安全，是胰肠吻合理想的手术方式，值得推广。     

hNIS基因转染介导Hela细胞移植瘤放射性核素显像和治疗的实验研究

Objective To explore the feasibility of imaging and treatment of cervical cancer xenograft model using 131I mediated by hNIS gene transfection. Methods The cervical cancer xenograft models were established with Hela-NIS( +) cells and Hela cells, respectively. Five Hela-NIS( +) xenograft models and five Hela xenograft models were dynamically imaged at 0.5, 1, 2, 4, 8, 16 and 20 h postinjection of 131I(7.4 MBq). Five Hela-NIS( +) xenograft models were imaged at 0. 5,1,2,4,8,16, 20 and 25 h postinjection of 99TcmO4-(11.1 MBq). Twenty Hela-NIS( +) cervical cancer xenograft models were randomly divided into four groups: Three 131I treating groups and one control group. The therapeutic effects of 131I at threelevels (74,111,148 MBq) were investigated following intraperitoneal injection. Results Hela-NIS( +)human cervical cancer xenografts were established successfully in nude mice. The Hela-NIS( +) xenografts significantly accumulated radioactivity after intraperitoneal injection of 131I, and the radioactivity was persistently present until 20 h postinjection, but Hela xenografts had no radioactive accumulation. The T/B value of the Hela-NIS( +) xenografts reached 17.34 at 8 h postinjection. The imaging with 99TcmO4- showed that the radioactivity was persistently present in Hela-NIS( +) xenografts for almost 25 h. The Hela-NIS( +)xenografts shrinked after 131I treatment. The inhibition ratios of tumor growth in 111 MBq and 148 MBq groups were both significantly higher than that of 74 MBq group (t: 2.74-5.75, P ＜0.05). Conclusions Hela-NIS( +) cervical cancer xenografts in nude mice could persistently accumulate 131I and 99TcmO4- and could be treated successfully with 131 I. 131 I treatment mediated by hNIS gene transfection could be a promising cancer treatment method.     

自体脾移植术后T细胞亚群、sIL-2R、TNF变化研究

目的：探讨自体脾移植术对免疫学指标的影响。方法：将４０ 例外伤性脾破裂分为脾移植术和全脾切除术组,各２０ 例。对照组１０ 例。结果：术后１ 周,全脾切除术组和自体脾移植组,与对照组相比,ＣＤ＋３ 、ＣＤ＋４ 、ＣＤ＋８ 、ＣＤ＋４ ／ＣＤ＋８ 降低,ｓＩＬ－２Ｒ、ＴＮＦ皆升高（Ｐ＜ ０．０５）。术后３ 个月,自体脾移植组ＣＤ＋３ 、ＣＤ＋４ 、ＣＤ＋８ 、ＣＤ＋４ ／ＣＤ＋８升高,ｓＩＬ－２Ｒ、ＴＮＦ降低（Ｐ＞０．０５） 。而脾切除组,术后ＣＤ＋３ 、ＣＤ＋４ 、ＣＤ＋８ 、ＣＤ＋４ ／ＣＤ＋８ 持续下降,ｓＩＬ－ ２Ｒ、ＴＮＦ持续升高（ Ｐ＜ ０．０５）。结论：自体脾移植对维持机体的Ｔ细胞水平和增强机体的抗感染能力有益。     

急诊腹腔镜胆囊切除术中对Mirizzi综合征的治疗体会

Mirizzi综合征(MS)是胆囊颈或胆囊管的结石和炎症累及肝管引起阻黄,发热,胆绞痛的症候群,为少见并发症,术前诊断困难,处理较棘手,一直以来被视为腹腔镜胆囊切除术(LC)的禁忌证.随着腔镜技术的发展,部分可在腔镜下安全操作,现将我院2002年1月～2006年12月在急诊中遇到的12例病例报道如下.     

胃肠道间质瘤肝转移的射频消融治疗

胃肠道间质瘤(GIST)的肝转移发生率高,是影响治疗效果的重要因素.提高肝转移病灶治疗的有效率对提高患者的生存率,尤其至关重要.超声引导射频消融对GIST肝转移病灶的治疗,已成为临床非手术治疗领域中的重要手段.作者自2006年6月至2010年6月应用射频消融(radiofrequency ablation,RFA)技术治疗GIST肝转移患者25例,现报告如下.     

经肛门内镜显微手术治疗直肠肿瘤

目的探讨经肛门内镜显微手术（TEM）治疗直肠良、恶性肿瘤的手术方法和近期疗效。方法分析应用TEM治疗直肠良、恶性肿瘤12例（恶性3例,良性9例）的结果,从术中出血、术后疼痛、伤口感染等并发症,以及住院时间等评价其近期疗效。并从肿瘤切除到切缘缝合方法进行了相应的改进。结果3例直肠恶性肿瘤中2例侵及肌层,1例侵及全层,但标本切缘均为阴性。良性9例中,有3例伴有中、低级别上皮内瘤变。采用强生超声刀切除肿瘤、强生自动打结线盒缝合后,12例患者术中出血均〈5ml,除1例直肠中分化腺癌术后有少量出血外,余均未见术后便血,也无术后疼痛、大便失禁、伤口感染等并发症。住院时间平均4.6d。结论TEM是治疗直肠良、恶性肿瘤的安全术式,超声刀切除病灶、强生自动打结线盒缝合是有效的TEM手术技术。     

腹腔镜十二指肠溃疡穿孔修补术式的改进

腹腔镜下十二指肠溃疡穿孔修补术21例4例术中因穿孔处与大网膜紧密粘连而未行修补，仅腹腔冲洗治疗，无并发症。3例采用经穿孔处直接缝合修补，操作困难。14例采用在距穿孔左上方15mm的肠壁进针，穿过大网膜，将其覆盖在穿孔处后打结。易操作，无缝线切割或撕裂局部脆弱组织之嫌，并可减少缝线对清高的异物刺激，大网膜能迅速与穿孔粘连而修复穿孔，无并发症。     

腹腔镜疝修补术

自1999年Maurice Arregui首次采用腹腔镜行腹膜前修补法治疗腹股沟疝取得成功以后，腹腔镜用于治疗腹股沟疝取得了很大进展，随着操作技能的不断提高和配套器械的不断完善，其治疗作用及地位将得到进一步肯定。