脂肪囊内解剖途径在后腹腔镜肾上腺肿瘤切除术中的应用

目的 探讨脂肪囊内解剖途径在后腹腔镜肾上腺手术的临床应用价值.方法 2013年5月至2015年12月,采用后腹腔镜技术经脂肪囊内解剖途径血管区,行肾上腺及腺瘤切除术65例.男性35例,女性30例,年龄25～ 70岁.原发性醛固酮增多症15例,库兴综合征14例,嗜铬细胞瘤5例,副神经节瘤10例,髓脂瘤12例,其他单纯无功能皮质腺瘤9例;瘤体直径范围1.5 ～8.0 cm.这些病例手术均通过后腹腔镜经脂肪囊内途径完成.结果 本组65例手术均顺利完成.单侧手术时间25 ～ 150 min,术中估计出血量15 ～ 300 mL,术后住院时间3～8d.术后随访至今,未发现肿瘤复发.结论 依据脂肪囊内途径的解剖步骤,术中出血少,解剖层次清楚,较好避免术中腹膜损伤.脂肪囊内途径后腹腔镜手术是治疗肾上腺外科一个有益尝试.     

后腹腔镜治疗肾上腺嗜铬细胞瘤

目的 评价后腹腔镜肾上腺切除治疗嗜铬细胞瘤的临床价值.方法 对本院2000年2月～2008年12月25例后腹腔镜治疗肾上腺嗜铬细胞瘤的临床资料进行回顾性分析.左侧15例,右侧10例,肿瘤直径3.0 - 5.6 cm,平均4.2 cm.结果 除3例因出血和肿瘤粘连严重中转开放手术外,其余22例均成功切除肿瘤.手术时间67～210min,平均123min;手术出血量50～450mL,平均120mL;术中下腔静脉破裂2例,均在腹腔镜下完成修补;1例术后24小时死于继发出血.术后病理诊断24 例为良性肾上腺嗜铬细胞瘤,1例为低度恶性肾上腺嗜铬细胞瘤.术后住院时间8～20天,平均12天.随访5～36个月,平均12个月,除1 例需口服降压药外,其余血压恢复正常,24 小时尿VMA 检查正常,无远期并发症,未见肿瘤复发.结论 后腹腔镜肾上腺肿瘤切除术对最大径<6cm肾上腺嗜铬细胞瘤安全、有效、创伤少、出血少、恢复快.术前准备和术后处理在治疗嗜铬细胞瘤的过程中具有重要价值.     

不同手术方式治疗腮腺多形性腺瘤的临床分析

目的 比较两种不同手术方式治疗腮腺多形性腺瘤术后的并发症.方法 69例腮腺多形性腺瘤患者分为两组,一组采用传统的术式,即保留面神经,肿瘤及腮腺切除术;另一组采取功能性腮腺切除术,即肿瘤及腮腺部分切除术.通过3个月～8年的随访,观察术后味觉出汗综合征(Frey综合征)、涎瘘、面瘫、面部外形及复发等情况.结果 传统的术式组,面瘫、Frey综合征和面部外形明显不对称的发生率分别为26.47%、58.82%和17.64%;功能性腮腺切除术组的发生率分别为8.57%、25.71%和2.80%,三种并发症两组间比较有统计学差异(P＜0.05),后者术后并发症的发生率明显低于前者.结论 功能性腮腺切除术即肿瘤及腮腺部分切除术克服了传统腮腺手术的缺陷,值得临床推广.     

肾上腺转移癌28例临床诊治分析

目的:探讨肾上腺转移癌的临床特点和诊治方法。方法:回顾性分析我院1999年6月至2005年2月收治的28例肾上腺转移癌患者的原发疾病、临床表现、诊治及预后的临床资料。结果:28例肾上腺转移癌患者的原发肿瘤中肺癌12例(42.9%)、肾癌9例(32.1%)、乳腺癌4例(14.3%)、肝癌3例(10.7%)、结肠癌2例(7.1%)、胃癌和甲状腺癌各1例(各占3.4%)。5例临床表现为腰背部压迫感、胀痛,2例乏力、消瘦。手术切除肾上腺转移癌8例,介入动脉灌注化疗及栓塞治疗7例,化疗、放疗共10例,3例放弃治疗。随访22例,随访时间至2007年12月,平均随访时间3年;手术组术后平均生存15.7个月±5.1个月,非手术组平均数生存10.3个月±4.7个月(P(0.05)。结论:肾上腺是恶性肿瘤转移的好发部位之一,肺癌是最常见的原发肿瘤,肾上腺转移癌大多数无典型的临床症状,影像学检查在肾上腺转移癌的临床诊断具有重要作用,外科手术可能延长部分患者的生存期。     

小鼠细胞外基质与颗粒子宫腺细胞发育的关系

采用免疫组织化学ＬＳＡＢ法对妊娠小鼠胎盘进行研究，显示Ⅰ、Ⅳ、Ⅴ型胶原蛋白，纤维粘连蛋白及层粘连蛋白的分布及其在妊娠过程中的变动情况，从而了解细胞外基质与颗粒子宫腺细胞（ＧＭＧ细胞）的关系。结果表明，妊娠１６天左右大部分细胞外基质在子宫腺细胞区出现高峰，这一时期正是ＧＭＧ细胞数量最多而且分化最为成熟的时期。这一结果提示：细胞外基质与ＧＭＧ细胞增殖及分化等方面关系密切。     

Hyperosmotic secretion at low transport rates in the cat sweat gland

Summary The hypertonicity of the secretory fluid produced by the cat sweat gland is due to a potassium release mechanism which operates in series with an isosmotic NaCl transport process.The potassium excretion rate is not coupled with volume flow but is determined by the frequency of electrical stimulation.Evidence is presented for the presence of two potassium release mechanisms during the secretory process. A small potassium flux is due to cellular redistribution at the onset of stimulation potassium secretion perhaps originating from dark cells. The major potassium flux is related to the bicarbonate excertion rate.     

Genetically hypertensive rats: Relationship between the development of hypertension and the changes in norepinephrine turnover of peripheral and central adrenergic neurons

Summary In genetically hypertensive rats, the norepinephrine turnover of peripheral and central adrenergic neurons was determined either by the decline in endogenous norepinephrine after inhibition of tyrosine hydroxylase or by the decay in the specific activity of norepinephrine after labelling the stores by intravenous or intraventricular injection of³H-norepinephrine.In the periphery (heart and submaxillary gland), the norepinephrine turnover of genetically hypertensive rats was reduced in proportion to the rise in systolic blood pressure. In the hypothalamus, medulla-pons and the residual parts of the brain, the turnover was unchanged both in the prehypertensive and the hypertensive state. The results indicate that the central adrenergic neurons, involved in the control of blood pressure, may act independently from the activity of peripheral baroreceptors. The elevated blood pressure resulting from an enhanced peripheral vascular reactivity to the physiological neurotransmitter norepinephrine may induce a compensatory inhibition of the activity of the peripheral adrenergic neurons. In the genetically hypertensive rats, neither the peripheral nor the central adrenergic nervous system seems to play a primary role in the development of hypertension.     

Expression of integrin subunits correlates with differentiation of epithelial cell lineages in developing human gastric mucosa

Laminins may play important roles in gastric gland development due to the differential localization of their α chains in human fetal fundic (oxyntic) mucosa. To extend this hypothesis, the current investigation was undertaken to compare the anatomical and cellular distribution of epithelial integrin subunits with those of laminin α chains in the human stomach at different ages (8–22 weeks of gestation) using indirect immunofluorescence. In the body, fundus and antrum regions, the β1 and α6 subunits were associated with the entire epithelium at all developmental stages in the same way as laminin chains (α1/α5) detected with 4C7 monoclonal antibody. By contrast, the α3 and β4 subunits of α3β1 and α6β4 integrins together with the laminin α3-chain were concentrated in the surface and foveolus compartments composed of differentiating mucous cells. Most importantly, the α2 integrin subunit was expressed in a rather complex pattern: (1) it was located at the base and at cell-cell boundaries of surface/foveolar epithelium, (2) was specifically repressed in differentiating parietal cells, and (3) its expression increased in maturing glands, where it became concentrated at the basal pole of epithelial cells simultaneously exhibiting a strong reactivity for laminin-2 (α2-chain). Taken altogether, our observations provide new evidence for the implication of different laminins and their receptors in the development of all human gastric epithelial lineages, surface mucous cells or glandular cells. The coordinated expression of α2 and α3 integrin subunits as well as the cellular re-distribution of α2β1 integrin likely represent key events for the differentiation of glandular secretory cell types, especially maturing chief cells responsible for the synthesis/secretion of gastric digestive enzymes in fundic-type glands. Accepted: 26 March 2000     

小鼠咽鼓管及其腺体的解剖学研究

目的研究小鼠咽鼓管及其腺体的解剖结构,包括咽鼓管大体形态、黏膜上皮的移行及组成,腺体的分布、种类及组成。方法在解剖显微镜下分离出小鼠的咽鼓管及鼓室,常规石蜡包埋,5μm切片,苏木素-伊红(HE)和阿尔辛蓝-高碘酸Shiff(AB-PAS)染色,光学显微镜下观察。结果咽鼓管从鼓室向鼻咽部沿前内方向走行,平均长度约为1.53±0.08mm,宽度为0.22±0.03mm,高为1.14±0.08mm。小鼠咽鼓管可分为软骨部和膜部,软骨部主要被覆复层扁平上皮,膜部被覆多种上皮,其上份主要被覆复层扁平上皮,下份主要为假复层纤毛柱状上皮;咽鼓管腺体分布于咽鼓管的内侧壁和下壁,而外侧壁未发现有腺体分布。腺体可分浆液性、粘液性和混合性腺体,有导管开口于咽鼓管腔。结论咽鼓管黏膜上皮的结构及其腺体的位置分布提示咽鼓管黏膜及其腺体为一个有机的整体,对病原微生物进行有效的清除,共同维持着中耳腔的相对无菌环境。     

人下颌下腺干/祖细胞的分离及培养

近年来国内外学者研究证实了唾液腺组织中的确存在一类具有成体干细胞特性的唾液腺细胞,但是这类干细胞的研究多集中在动物的唾液腺,而人类唾液腺干细胞的生物学特征研究较少。 目的：体外分离、培养人唾液腺干/祖细胞,并观察其生物学特征。 方法：从流产胎儿下颌下腺中分离、单克隆培养获得人唾液腺干/祖细胞,应用免疫荧光染色方法检测上皮细胞标志CK19,Laminin的表达,流式细胞术检测CD29,CD90.1和 CD117的表达。绘制人唾液腺干/祖细胞生长曲线,评价体外增殖能力。 结果与结论：人唾液腺干/祖细胞胞浆表达上皮细胞标志CK19及Laminin;流式细胞术结果显示,CD90.1,CD29及CD117的表达率分别为99.69%,98.83%及67.27%;体外培养也表现出高增殖能力、克隆形成能力和较高的传代数等组织干细胞特性。提示人胎儿下颌下腺中能分离出具有组织干细胞特性的细胞。