极限门静脉结扎后增生肝脏组织中NF-κB和IL-6表达变化的实验研究

目的:探讨核转录因子(Nuclear factor-kappa B,NF-κB)和白介素-6(Interleukin 6,IL-6)在90%极限门静脉分支结扎大鼠增生肝脏组织中的表达及其与肝再生的关系.方法:96只Sprague-Dawley(SD)雄性大鼠随机分成假手术对照组和门静脉结扎实验组.观察术后0.5、1、3、5、7、14、21和28 d保留侧肝脏重量变化,光学显微镜下观察保留侧肝细胞的形态变化,用免疫组化方法检测保留侧肝细胞的增殖细胞核抗原(Proliferating cell nuclear antigen,PCNA)及NF-κB和IL-6的表达,并进行统计分析.结果:①90%极限门静脉分支结扎后,结扎侧肝叶呈进行性萎缩变小,保留侧肝叶占总肝质重的比例与假手术对照组比较1-5 d升高,7 d达"平台期";②PCNA阳性细胞计数与假手术对照组比较,0.5-7 d表达增强(P<0.05),以后逐渐恢复正常;③保留侧肝叶NF-κB和IL-6的表达量与假手术对照组比较0.5-5 d表达增强,术后7-28 d差异无统计学意义(P>0.05);保留侧肝叶IL-6的表达量0.5d开始呈显著增加,并迅速达到高峰,随后1-5 d表达逐渐下降,但仍高于正常水平,术后7～28 d与对照组比较差异无统计学意义(P>0.05).④大鼠肝脏PCNA的表达在术后0.5、1、14、21、28 d组与肝内NF-KB表达呈正相关,在术后1、14、21 d组与肝内IL-6表达呈正相关,NF-K B的表达在术后1、7、21、28d组与肝脏IL-6表达呈正相关.结论:NF-κ B和IL-6蛋白在90%极限门静脉分支结扎后大鼠肝脏再生过程中发挥重要作用.     

Role of preoperative CT angiography with multimodality imaging reconstruction to perform laparoscopic Complete Mesocolic Excision (CME) and Central Vascular Ligation (CVL) in right-sided colon cancer: Is it really useful? A prospective clinical study

BackgroundThe concept of complete mesocolic excision (CME) and central vascular ligation (CVL) in right colonic resections appears to improve the oncological outcomes. The highest rate of complications reported in the literature in patients undergoing CME is related to difficult surgical manuevers and intraoperative bleeding due to the central vascular dissection.MethodsWe used preoperative findings obtained with the CT angiography, multiplanar reformation (MPR), maximum intesity projection (MIP) and 3D volume rendering (VR) technique to verify if this preoperative radiological assessment had significant benefits regarding the difficulty of dissection of the embryological planes, the identification of vascular structures and central lymph nodes with reduction in mean operative time, intraoperative complications and better short-term outcomes versus standard contrast enhanced CT scan. We also have administered a questionnaire to investigate the subjective responses on the degree of difficulty of the surgical procedure both by the surgical team expert in CME and by a group of young surgeons.ResultsStatistical analysis showed that overall operative time was significant shorter in patients underwent to radiological assessment (224,5 min; range 160–300 versus 252,6 min; range 200–340; p-value 0.023) with a significant lower rate of intraoperative complication (2.7% versus 4.2%; p-value 0.043). No differences were reported with respect to blood loss, conversion rate, anastomotic leakage or other surgical results. Analysis of the questionnaire underlined a progressive awareness of the correspondence between the radiological imaging and the surgical field.ConclusionThe possibility of identifying the characteristics and course of the vascular structures along the axis of the superior mesenteric vessels certainly increases the surgeon's knowledge of the operating field, making him more confident with surgical maneuvers and significantly reducing the duration of the operating time and intraoperative complications.     

不同方法治疗肛周巨大尖锐湿疣的疗效分析

目的:研究三种不同方法治疗肛周巨大尖锐湿疣的医学疗效,通过比较分析差异,找到其中更加高效的治疗方法。方法:选取90例2012年1月至2013年6月来我院进行治疗肛周巨大尖锐湿疣的患者,将其随机分成甲、乙、丙三组,每组各30例。甲组的患者使用疣体基底部缝扎手术切除,局部干扰素注入;乙组患者使用微波去除疣体之后,局部干扰素注入;丙组患者仅仅只是做疣体基底部缝扎手术切除,局部不做处理。详细记录三组治疗过程,痊愈时间以及复发情况等问题,对其进行详细的对比分析。结果:在整体的治疗过程中,乙组患者的出血量小于甲组和丙组,三者具有显著的差异,具有统计学意义(P0.05);三组患者创面愈合时间差异没有统计学意义(P0.05);治疗结束后,乙组患者的有效率要显著地高于甲组和丙组的患者,三者差异显著,具有统计学意义(P0.05)。结论:微波联合干扰素治疗肛周巨大尖锐湿疣,治疗过程出血量非常少,复发率较低,治疗费用较低,值得在临床上大力推广。     

尼龙圈结扎胃结肠壁全层安全性的初步实验研究

目的初步探讨尼龙圈结扎胃及结肠壁全层的安全性，为不断扩展的临床应用提供依据。方法成年狗4只，在纤维胃镜及开腹直视配合下应用尼龙圈结扎胃及结肠壁全层，术后3、7、10、17d分别行剖腹术观察结扎部位组织愈合情况。结果所有动物术后恢复良好，观察期间无感染及出血征象。剖腹检查未发现胃结肠穿孔，无局部脓肿形成。结扎部位可见溃疡样缺损。组织学检查可见胃结肠壁肌层断裂，肉芽组织连接胃结肠缺损部位，并逐渐转化为瘢痕组织。术后17d可见再生黏膜完全覆盖缺损表面。结论尼龙圈结扎胃结肠壁全层具有一定安全性，可进一步拓宽尼龙圈结扎在临床中的应用。     

食管静脉曲张内镜结扎术后近期再出血危险因素的探讨

目的 :探讨食管静脉曲张结扎术 (EVL)后早期再出血的危险因素及防范对策 ,旨在的提高EVL的成功率及效果。方法 :对 10 5例食管静脉曲张患者 ,进行了择期内镜下结扎治疗 179次 ,对其术后近期再出血患者进行了危险因素分析。结果 :并发近期再出血 15例 (14.3% ) ,分别发生于术后第 4～ 10d ,尤以术后第 7d为最高(40 .0 % )。经及时抢救治疗 ,9例出血停止 ,5例死亡 ,1例自动出院。结论 :术后 1周前后是再出血高危时期 ,饮食不当是主要诱因 ,胃食管返流是其危险因素之一 ,任何增加腹压的动作均可造成术后再出血。另外 ,亦与全身状况密切相关。本文就此提出了相应的防范对策