外伤性脾破裂非手术治疗的临床观察与护理

脾脏是腹部脏器中最容易受损的器官，外伤性脾破裂病人病情危重，通常采用手术治疗切除破裂的脾脏，但随着免疫学和临床医学的深入研究，对脾脏的功能有了更新的认识，使传统的治疗方法（脾切除术）受到冲击，保留脾脏越来越受到重视。我科2000年2月～2005年12月共收治外伤性脾破裂63例，其中24例采取了非手术治疗，20例保脾成功，现将护理体会总结如下：     

23例脾脏原发性恶性淋巴瘤临床分析

目的 提高临床对少见的脾原发性恶性淋巴瘤诊断和治疗的水平。方法 对1956年1月至1999年8月收治的23例脾原发性恶性淋巴瘤临床资料进行回顾性分析。结果 23例均行手术探查,22例获切除,术后均行COP或CHOP方案化疗。23例均为术后病理确诊,病理类型均为NHL,其中B细胞源性21例,T细胞源性2例。按Ahman脾恶性淋巴瘤临床分期,I期9例、Ⅱ期8例、Ⅲ期6例,5年生存率分别为50％、40％、16％。结论 脾恶性淋巴瘤的诊断主要依靠B超和CT,病期的早晚影响其预后,以手术为主的综合治疗是本病的主要治疗方法。     

Radical resection of gastric carcinoma with pancreas and spleen preservation a nd functional cleaning of lymph nodes

Objective To study the clinical value of radical resection of gastric carcinoma with pancreas and spleen preservation (PSP) and functional cleaning of lymph nodes (LNs) of the spleen hillus and along the splenic artery. Methods Pancreas and spleen involvement was retrospectively reviewed among 439 cases of resectable carcinoma of the gastric cardia,gastric corpus and total stomach. During gastric surgery, 2 ml of methylene blue was injected into the subserosal space of the gastric cardia or corpus to observe the spread of lymphatic flow in 54 cases of gastric carcinoma. The metastatic rate of LNs in splenic hillus and along the trunk of the splenic artery (No10, No11), postoperative complications and survival rates were investigated in 63 gastric carcinoma patients that had received gastrectomy with pancreas and spleen preservation (PSP). These were compared with the pancreas preservation (PP) group and pancreas and spleen combined resection (PSR) group. Results Among these 439 cases, only 25 cases were observed with direct invasion to the pancreas (5. 7%), and 10 cases with direct invasion to the spleen (2. 3%). After pathological examination of the pancreatic body and tail, we found 22 cases with pancreas and spleen combined resection, 4 cases (18. 2%, 4/22) with direct invasion of the capsule and 2 with invasion to the superficial parenchyma (9. 1%, 2/22), without metastasis to the lymph nodes within the pancreas and spleen. The metastatic rate of No10,No11 lymph nodes were 17. 5% (11/63) and 19. 1% (12/63) in the PSP group, 20. 8% (45/216) and 25%(54/216) in the PP group, and 20% (6/30) and 23. 3% (7/30) in the PSR group. There were no statistically significant differences (P>0. 05). Injection of methylene blue into the subserosal space of the stomach did not diffuse into the spleen or pancreatic parenchyma. Postoperative complications, diabetes and mortality in PSP (0%,0%,0%) were lower than in PP (4. 2%, 0. 9%, 0. 9%) or PSR (40%,10%,3. 3%). The 5-year survival rate (5-YSR) and 10-YSR in PSP (57. 5%, 52. 0%) were higher than in PSR (37. 5%,30. 0%). Those patients with stage Ⅱ and Ⅲa treated by PSP, improved markedly. Conclusions The surgical procedure of pancreas and spleen preservation for gastric cancer is a safe and organ function protected method. Postoperative complications were lower and survival rates were higher , the radicality was not reduced. These results indicate that PSP is preferred in patients with gastric carcinoma of stage Ⅱ or Ⅲa.     

复方中药制剂力平毒对吗啡依赖性小鼠的作用研究

通过力平毒对吗啡依赖小鼠戒断综合征的治疗观察,表明力平毒可明显抑制小鼠戒断跳跃反应,对吗啡依赖性小鼠胸腺及脾脏重量的下降有缓解的趋势     

灵芝孢籽粉对小白鼠脾脏、胸腺重量的影响

<正>用灵芝孢籽粉和贞芪扶正冲剂对小白鼠脾脏、胸腺的重量进行了比较试验,提示具有免疫功能的作用。 1 材料和试药 灵芝孢籽粉,由芜湖市药研所实验药厂提供。贞芪扶正冲剂,定西制药厂出品,批号:950428(以下称贞芪)。环磷酰胺,上海第十二制药厂出品,批号:950929(以下称CYA)。0.9％氯化钠溶液,蚌埠市第一制药厂出品(批号:950621,以下称NS)。昆明种小白鼠,体重20±2g,由皖南医学院动物供应科供应。     

小鼠脾脏淋巴细胞上存在μ阿片受体的证据

AIM: Using ohmefentanyl (Ohm), a high affinity mu opioid receptor agonist, to find whether mu opioid receptor exists on mouse spleen lymphocytes. METHODS: The proliferation rates of T-lymphocytes and B-lymphocytes were determined under various concentrations of Ohm with or without naloxone(Nal) in vitro. Binding characteristics of [3H] Ohm with mice spleen lymphocytes were studied by radioligand assays. ReSULTS: Ohm 0.1 pmol.L(-1)-1 nmol.L-1 enhanced Con A-induced spleen T-cell proliferation in vitro. Nal 50 mumol.L-1, which per se enhanced the T-cell proliferation, blocked the enhancing effects of Ohm. However, Ohm had no effect on B-cell proliferation. Furthermore, a satisfactory saturable, specific, and reversible binding was demonstrated with Kd of (6.9 +/- 0.6) nmol.L-1, Bmax of (74 +/- 6) fmol/10(7) cells. The binding of [3H] Ohm was blocked by unlabeled Ohm or Nal. CONCLUSION: Stimulating effects of Ohm on lymphocytes were mediated by opioid receptors. Mouse spleen lymphocytes present mu opioid receptors.     

保留脾脏的远端胰腺切除术的临床应用

国内常采用胰体尾切除＋脾切除治疗胰体尾部良性或低度恶性病变,但脾切除术后常导致局部感染、败血症及免疫功能低下。我们自１９９６年１月至１９９９年１月应用保留脾脏的远端胰腺切除术治疗６例胰腺良性疾病患者,取得较好的临床疗效,现报告如下。１　资料和方法１．１　一般资料　本组６例患者,男性４例,女性２例,年龄２６～７２岁,平均４５．２岁。其中慢性胰腺炎２例,胰岛细胞瘤２例,胰腺假性囊肿１例,胰腺囊腺瘤１例。所有诊断均经病理证实。１．２　手术方法　取左侧经腹直肌切口,切开胃结肠韧带,切断脾结肠韧带,显露胰…     

脾脏边缘带淋巴瘤

目的：结合文献讨论脾脏边缘带淋巴瘤的诊断标准。方法：回顾性分析一例脾脏边缘带淋巴瘤。结果;此例临床症状为牌中度肿大、贫血、体重减轻、发热等，伴有牌外转移（外周血及骨髓内见幼稚淋巴细胞）;组织学主要侵犯白髓的外套层和（或）边线带，红脸亦受累，病变区可见与正常边缘带细胞相似的肿瘤细胞;免疫学I，CA、L26、bcl-2、k、IgA阳性;MAC387、lysozyme散在阳性出UCHL-1、BerH2、EMA阴性。结论：该病是一种独特的外周B细胞淋巴瘤，应与毛细胞性白血病、牌外套层细胞淋巴瘤、脾脏绒毛状淋巴瘤和B粘膜相关淋巴瘤鉴别。     

消疣灵对小鼠免疫功能的影响

中药煎剂消疣灵由大青叶、板蓝根、黄芪、甘草、苦参、薏苡仁、生牡蛎、白花蛇舌草等组成。药理实验表明该方药能显著提高小鼠胸腺及脾脏重量、对小鼠腹腔巨噬细胞的吞噬功能有明显促进作用，增强正常小鼠外周血淋巴细胞ＡＮＡＥ阳性百分率，并明显对抗氢化可的松所致免疫抑制作用。提示消疣灵治疗尖锐湿疣的药理学基础与提高机体免疫功能有关。     

原发性脾脏占位性病变13例临床分析

目的 探讨原发性脾脏占位性病变的临床特点和诊治体会.方法 对13例原发性脾脏占位性病变的临床资料进行回顾性分析.结果 13例原发性脾脏占位性病变全部经脾切除手术和病理确诊,良性10例,恶性3例;术后均痊愈出院.结论 原发性脾脏占位性病变的定位诊断依靠影像学检查(B超、CT等),定性诊断需病理确诊,本病宜及早手术,脾切除是基本术式.