直肠后肿瘤65例临床诊治分析

目的 探讨直肠后肿瘤的诊断与治疗。方法 回顾性分析65例直肠后肿瘤患者的临床资料,直肠后肿瘤患者65例均行直肠指检、B超检查、CT或MRI检查作出诊断。65例患者均行手术切除,单纯经骶入路手术35例,单纯经腹入路手术17例,经腹经骶联合入路手术13例。结果 本组肿瘤完全切除有59例,部分切除6例,肿瘤切除率90.8%。术后直肠瘘1例,切口Ⅰ期愈合58例,术后切口感染3例,骶前脓肿3例。全组无围手术期死亡病例。65例中有56例获得随访6月~4年。3例术后复发,再手术后治愈。结论 合理的手术入路、方式是治疗直肠后肿瘤的关键,同时充分的术前准备、术后积极的辅助治疗以及多学科的通力合作也是需要重视的。     

肝移植术后血清降钙素原监测的临床意义

Objective To investigate the changes of procalcitonin (PCT) in patients after liver transplantation and explore their significance for diagnosis and differential diagnosis among bacterial infection, viral infection and acute rejection.Methods PCT was measured in serum of 25 liver trans-plant patients by immunofluorescence sandwich method and the patients were divided into the non-complication group, viral infection group, acute rejection group and bacterial infection group.Results The concentrations of PCT in the 1st, 2nd and 3rd day after transplantation were(24.50 ± 4.6)ng/ml, (21.40± 3.3)ng/ml and (12.25 ± 3.1)ng/ml, respectively and they presented a decreasing tendency.The concentrations of PCT in non-complication group, viral infection group and acute rejection group decreased gradually and were near the normal level of (0.51±0.11) ng/ml after 7～10 days.Moreo-ver, the concentrations of PCT in viral infection group and acute rejection group were (0.44 ± 0.16)ng/ml and(0.53±0.14)ng/ml when the patients were in fever.The concentration of PCT in the viral infection group were(15.70±5.1)ng/ml, which was significantly higher than that in other 3 groups (P<0.05) in the early days of fever.The statistical differences among the other three groups were not significant (P>0.05).Conclusion The concentration of PCT in serum is high in the 1st, 2nd and 3rd day then decreased gradually soon.The concentration of PCT is not high in viral infection or acute rejection while significantly high in bacterial infection, so it can be used to differentiate the bacterial infection from acute rejection and virus infection after liver transplantation.     

AFP/ANGIO/TK靶向性融合基因治疗人原发性肝癌的效果观察

目的：研究pcDNA3／AFP／angio／tk靶向性融合基因系统对人原发性肝癌皮下移植瘤的治疗效果。方法：建立人原发性肝癌裸小鼠皮下移植瘤模型。将荷瘤裸小鼠随机分为5组（每组6只）：肿瘤对照组；空质粒组；GCV组；pcDNA3／angio／tk组及pcDNA3／AFP／angio／tk组。瘤内分别注射不同的质粒，同时于裸鼠腹腔内注射GCV，在第二次瘤内给药后第2天及第三次瘤内给药后第15天，分别处死裸鼠进行检测（每次3只）病理学检查；原位末端标记（TUNEL）法检查细胞原位凋亡；透射电镜观察细胞超微结构变化。结果：病理学检查结果显示，prDNA3／AFP／angio／tk融合基因瘤内注射可明显抑制肿瘤生长。TUNEL法检测显示．pcDNA3／AFP／angio／tk组凋亡指数明显高于肿瘤对照组。透射电镜观察细胞超微结构变化，发现pcDNA3／AFP／angio／tk组有明显的细胞凋亡发生。结论：pcDNA3／AFP／angio／tk靶向性融合基因系统可显著抑制肿瘤的生长，而且作用效果优于pcDNA3／angio／tk融合基因系统（P〈0.05）。     

气血方、养阴方、健脾方联合化疗预防高危Ⅱ期及Ⅲ期结直肠癌术后复发转移多中心随机对照研究

目的:观察气血方、养阴方、健脾方对高危Ⅱ期及Ⅲ期结直肠癌术后患者复发转移的影响。方法:采用多中心随机对照方法,选择高危Ⅱ期及Ⅲ期结直肠癌术后患者303例按照2∶1的比例随机分为试验组202例及对照组101例,两组均接受4～9个周期奥沙利铂联合卡培他滨(CapeOx)方案辅助化疗,试验组根据证型加用气血方、养阴方、健脾方,观察两组1、2、5年无病生存率(DFS)、卡氏评分(KPS)、中医证候积分和不良反应。结果:最终纳入281例患者,随机分配至试验组190例,对照组91例。经过48个月的中位随访时间,试验组中74例(38.9%)出现复发,对照组中40例(44.0%)出现了复发,试验组1、2、5年DFS分别为94.2%(179/190)、84.2%(160/190)、61.1%(116/190),优于对照组的91.2%(83/91)、81.3%(74/91)、56.0%(51/91)。亚组分析中,试验组阴虚证患者干预后5年DFS差异有统计学意义(P=0.037)。两组不良反应总发生率差异无统计学意义,试验组的恶心/呕吐等消化道不良反应发生率显著低于对照组(P=0.014)。结论:气血方、养...     

肝移植术后血清降钙素原监测的临床意义

Objective To investigate the changes of procalcitonin (PCT) in patients after liver transplantation and explore their significance for diagnosis and differential diagnosis among bacterial infection, viral infection and acute rejection.Methods PCT was measured in serum of 25 liver trans-plant patients by immunofluorescence sandwich method and the patients were divided into the non-complication group, viral infection group, acute rejection group and bacterial infection group.Results The concentrations of PCT in the 1st, 2nd and 3rd day after transplantation were(24.50 ± 4.6)ng/ml, (21.40± 3.3)ng/ml and (12.25 ± 3.1)ng/ml, respectively and they presented a decreasing tendency.The concentrations of PCT in non-complication group, viral infection group and acute rejection group decreased gradually and were near the normal level of (0.51±0.11) ng/ml after 7～10 days.Moreo-ver, the concentrations of PCT in viral infection group and acute rejection group were (0.44 ± 0.16)ng/ml and(0.53±0.14)ng/ml when the patients were in fever.The concentration of PCT in the viral infection group were(15.70±5.1)ng/ml, which was significantly higher than that in other 3 groups (P<0.05) in the early days of fever.The statistical differences among the other three groups were not significant (P>0.05).Conclusion The concentration of PCT in serum is high in the 1st, 2nd and 3rd day then decreased gradually soon.The concentration of PCT is not high in viral infection or acute rejection while significantly high in bacterial infection, so it can be used to differentiate the bacterial infection from acute rejection and virus infection after liver transplantation.     

手助腹腔镜手术在结肠良性病变中的应用

手助腹腔镜手术(hand-assisted laparoscopic surgery,HALS)结合腹腔镜和传统开腹手术的特点,临床效果好[1].本中心于2009年8月至2010年4月,共实施此类手术18例,疗效满意,报道如下.临床资料1.一般资料:本组18例;其中结肠慢传输型便秘(slow transit constipation,STC)11例,均为女性,年龄25 ～56岁,平均(33.6±10.5)岁;病程2～20年,主要症状为便秘,排便间隔时间4～7d,均需药物辅助;家族性腺瘤性息肉病(familial adenomatous polyposis,FAP)6例,男2例,女4例;年龄13～61岁,平均(38.7±16.8)岁;主要症状为腹痛或腹部不适、血便、腹泻等;溃疡性结肠炎( ulcerative colitis,UC)1例,女,45岁,主要症状为腹泻及黏液血便.     

吲哚氰绿(ICG)排泄试验和MELD评分

目的探讨吲哚氰绿（ICG）排泄试验和MELD评分之间的关系。方法40例终末期肝病患者,根据Child-Pugh肝功能分级分为A、B、C三级;利用脉冲式色素浓度图象分析仪（DDG）行吲哚氰绿（ICG）排泄试验（血浆清除率（K）和15分钟滞留率（R15）,同时计算患者的终末期肝病模型（MELD）评分。结果随着肝功能分级的递增,K值下降,而R15和MELD评分则增加,各级之间相比差异有统计学意义;吲哚氰绿（ICG）排泄试验与MELD评分之间有显著的相关性,K值与MELD评分呈明显负相关（r=-0．901）;而R15与MELD评分则成明显正相关（r=0.864）。结论1.吲哚氰绿（ICG）排泄试验（K值、R15）是评价肝脏储备功能的良好指标,其K值、R15随着Child-Pugh肝功能分级的递增而变化;2．K值和R15与MELD评分关系密切,其中,K值的相关．性更为显著,提示K值有可能成为评估终末期肝病简便、准确的指标。     

自闭保护性回肠插管造口患者并发堵管性肠梗阻的危险因素研究

目的分析自闭保护性回肠插管造口患者发生堵管性肠梗阻的危险因素,为临床护理提供依据。方法采用病例对照研究设计,将2015年1月—2019年10月在浙江省某三级甲等医院行自闭保护性回肠插管造口术发生堵管性肠梗阻的45例患者作为病例组,从同一时期、同一科室、相同手术而未发生堵管性肠梗阻的324例中随机抽取180例(1∶4)作为对照组,比较两组的一般资料、体重指数、合并疾病、实验室相关指标、手术情况、回肠插管造口维护情况等,采用Logistic回归分析获取堵管性肠梗阻的危险因素。结果 Logistic回归分析显示,体重指数(OR=2.123)、术后腹腔感染(OR=11.119)、拔管时间(OR=0.193)、每周随访插管维护(OR=24.121)是自闭保护性回肠插管造口患者并发堵管性肠梗阻的独立危险因素。结论为预防堵管性肠梗阻的发生,临床需积极控制术后腹腔感染和尽早拔除插管,超重患者应重视回肠插管造口的冲洗,鼓励患者按计划随访。     

肝移植术后血清降钙素原监测的临床意义

Objective To investigate the changes of procalcitonin (PCT) in patients after liver transplantation and explore their significance for diagnosis and differential diagnosis among bacterial infection, viral infection and acute rejection.Methods PCT was measured in serum of 25 liver trans-plant patients by immunofluorescence sandwich method and the patients were divided into the non-complication group, viral infection group, acute rejection group and bacterial infection group.Results The concentrations of PCT in the 1st, 2nd and 3rd day after transplantation were(24.50 ± 4.6)ng/ml, (21.40± 3.3)ng/ml and (12.25 ± 3.1)ng/ml, respectively and they presented a decreasing tendency.The concentrations of PCT in non-complication group, viral infection group and acute rejection group decreased gradually and were near the normal level of (0.51±0.11) ng/ml after 7～10 days.Moreo-ver, the concentrations of PCT in viral infection group and acute rejection group were (0.44 ± 0.16)ng/ml and(0.53±0.14)ng/ml when the patients were in fever.The concentration of PCT in the viral infection group were(15.70±5.1)ng/ml, which was significantly higher than that in other 3 groups (P<0.05) in the early days of fever.The statistical differences among the other three groups were not significant (P>0.05).Conclusion The concentration of PCT in serum is high in the 1st, 2nd and 3rd day then decreased gradually soon.The concentration of PCT is not high in viral infection or acute rejection while significantly high in bacterial infection, so it can be used to differentiate the bacterial infection from acute rejection and virus infection after liver transplantation.