DCF方案一线治疗进展期胃癌的临床疗效观察

目的 观察DCF方案(多西他赛+顺铂+氟尿嘧啶)一线治疗进展期胃癌的临床疗效和不良反应.方法 收集我院2007年7月至2011年2月经病理和影像学确诊的61例进展期胃癌患者的临床资料进行回顾性分析.DCF方案:多西他赛75 mg/m2静脉滴注,第1天;氟尿嘧啶750 mg/m2持续静脉滴注24h,用化疗泵持续静脉滴注120 h(第1～5天);顺铂75 mg/m2第1天静脉滴注,所有患者至少用药3个周期.对近期客观疗效及不良反应进行评价.结果 治疗有效率为34.4％(21/61),疾病控制率为82.0％(50/61),中位无疾病进展时间为6.2个月,中位总生存期为10.1个月.中性粒细胞减少发生率为86.9％(53/61),其中Ⅲ～Ⅳ级为72.1％ (44/61),恶心呕吐发生率为80.3％(49/61),Ⅲ～Ⅳ级占18.0％(11/61).结论 DCF方案一线治疗进展期胃癌疗效较好,但骨髓抑制毒副作用较明显,可以作为一般状态较好的进展期胃癌患者有效化疗方案的选择.     

内镜窄带成像技术在胃癌诊断中的应用

目的 探讨内镜窄带成像技术(NBI)对胃癌病变范围的诊断价值.方法 25例胃癌患者依次在普通内镜、NBI模式下观察病变轮廓,评价两种检查方法图像的清晰度,并结合病理学检查进行分析.结果 25例患者中,早期胃癌5例,进展期胃癌20例,NBI对病变轮廓的显示明显优于普通内镜 (P<0.05).结论 NBI电子染色有助于提高胃癌检出率及判断癌病变范围的准确度.     

胃周血管的解剖学研究

目的通过对胃周围血管的解剖观测,探讨胃的血液供应情况、分布规律,为临床手术应用提供理论指导。方法取成人大体标本100具,乳胶灌注血管,解剖观察胃各部（胃底部、胃体部、贲门部、幽门部）的动脉分支、分布、管径粗细、血管吻合情况。结果胃的动脉均来源于腹腔干,主要分支有胃短动脉、胃网膜左动脉、胃网膜右动脉、胃左动脉、胃右动脉、胃后动脉。贲门部和胃底部主要为胃短动脉和胃网膜左动脉分布,胃体部胃小弯侧有胃左动脉和胃右动脉的分支分布,胃大弯侧有胃网膜左动脉和胃网膜右动脉的分支分布,幽门部主要有胃网膜右动脉的分支分布。胃的动脉除胃短动脉和胃后动脉数目不恒定外,胃网膜左动脉、胃网膜右动脉、胃左动脉和胃右动脉均为1条。结论进行胃部疾病手术治疗时,严格按照胃周围血管的分支、分布规律进行操作,可达到较为理想的效果。     

氨茶碱联合纳洛酮在早产儿原发性呼吸暂停治疗中的应用

目的 观察氨茶碱联合纳洛酮治疗早产儿原发性呼吸暂停的治疗效果.方法 原发性呼吸暂停早产儿87例随机分为两组,对照组42例应用氨茶碱治疗;治疗组45例应用氨茶碱联合纳洛酮治疗.比较总有效率及不良反应.结果 治疗组总有效率95.6%,对照组78.6%,差异有统计学意义(χ2=5.67,P<0.05),无不良反应.结论 氨茶碱联合纳洛酮治疗早产儿原发性呼吸暂停安全、有效.     

重组人粒细胞刺激因子灵活应用1例

化疗是治疗恶性肿瘤的主要手段之一。近年来,新的抗肿瘤药物不断问世,抗肿瘤疗效不断提高[1],在一定范围内,化疗效果常与给药剂量呈正相关,增加化疗药物的剂量经常是提高治疗效果的一个重要因素。但是,随着给药剂量的增加和给药时间的延长,不可避免地会造成骨髓抑制。     

56例胃癌前哨淋巴结转移的临床分析

目的:研究胃癌前哨淋巴结(SLN)的相关性因素及意义.方法:回顾性分析我院自2006年6月～2011年5月期间住院的胃癌患者56例,淋巴结划分为前哨淋巴结与非前哨淋巴结,与临床病理因素进行分析,探讨其发生的相关因素.结果:肿瘤的大小与分化程度与前哨淋巴结的检出相关,差异有统计学意义(P＜0.05).结论:胃癌前哨淋巴结有望成为指导胃癌根治术淋巴清扫范围的标尺.     

腹腔镜辅助下进展期胃癌根治术56例分析

目的探讨腹腔镜辅助下进展期胃癌根治术的可行性及疗效。方法对我院2009年12月～2011年5月收治的56例进展期胃癌于腹腔镜辅助下行根治术。结果 56例均顺利完成手术,无中转开腹病例。平均手术时间：根治性全胃切除术230 min,根治性近端胃大部切除术190 min,根治性远端胃大部切除术170 min;术中平均出血量：根治性全胃切除术130 ml,根治性近端胃大部切除术110 ml,根治性远端胃大部切除术120 ml。术后平均排气时间3.5 d,平均下床活动时间3.5 d。随访1～17个月,术后恢复良好,无近期并发症,无肿瘤的局部复发和Trocar种植转移。结论腹腔镜辅助下胃癌根治术治疗进展期胃癌疗效可靠,且具有良好的安全性。     

双色银染原位杂交与荧光原位杂交检测胃癌患者HER2基因状态

目的 比较双色银染原位杂交(DSISH)与荧光原位杂交(FISH)两种技术在胃癌HER2检测中的优缺点,评价DSISH用于胃癌患者HER2基因扩增状态检测的可行性.方法 收集2009年1月至3月在四川大学华西医院行根治性手术的原发性胃或胃食管交界处腺癌80例,行全自动免疫组织化学(IHC)染色检测HER2蛋白表达,所有标本行FISH和全自动DSISH检测HER2基因状态,比较不同检测方法之间的符合率.结果 DSISH和FISH初检均有5例失败,经重复检测后结果满意.IHC检测3+的13例中DSISH检测12例、FISH检测11例为HEB2基因扩增;IHC检测2+的6例中DSISH、FISH检测均有1例为基因扩增;IHC检测1+的18例中DSISH、FISH检测均有2例为基因扩增;IHC检测为0的43例中DSISH、FISH检测均无基因扩增.80例原位杂交病例中,仅1例检测结果不一致(DSISH有基因扩增而FISH无基因扩增),两种方法的总体符合率为98.8%(79/80,κ=0.958,P＜0.01).结论 DSISH技术用于胃癌HER2基因检测结果与FISH符合率高.DSISH与FISH检测各有优缺点,DSISH更具有可行性和实际应用价值.

Abstract：

Objective To investigate the advantages and disadvantages of dual-color silverenhanced in-situ hybridization(DSISH)and fluorescence in-situ hybridization(FISH)for determination of HER2 gene status in gastric carcinoma and to evaluate tlle feasibility of DSISH.Methods Eighty cases of primary gastric or gastroesophageal junction adenecarcinomag diagnosed and treated surgically from January to March.2009 at the West China Hospital were enrolled in the study.Automated immunohistochemistry (IHC)staining,FISH and automated DSISH were carried out to detect the HER2 status,respectively,and the concordance ofthe three techniques was then evaluated.Results DSISH and FISH failed initially,but repeated detection Was successful in 5 eases.Gene amplification was detected in 12/13 IHC 3+ cases in DSISH and in 11/13 IHC 3+ cases in FISH.In 6 IHC 2+cages, the amplification rate was both 1/6;in 18 IHC 1+cases.the amplifieation rate was both 2/18.No amplification Was observed in 43 IHC 0 cases.Only one of the 80 cases showed discrepancy.and tIlerefore the overall concordance between FISH and DSISH Wag 98.8%(κ=0.958,P＜0.01).Conclusions DSISH represents a novel approach for the determination of HER2 status in gastric carcinoma, and the overall concordance between DSISH and FISH is excellent.Despite their advantages and disadvantages.DSISH is more feasible and practical for routine application in surgical pathology.     

胃癌术前适形放疗的蛋白表达谱变化及意义

目的：探讨胃癌术前适形放疗作用后的蛋白表达谱变化及意义。方法：选择有病理诊断的胃癌患者,随机分组行单纯手术和适形放疗+手术,术后收集肿瘤组织标本。以固相pH梯度等电聚焦（IPG-IEF）为第一向、垂直平板十二烷基硫酸钠-聚丙烯酰胺凝胶电泳（SDS-PAGE）为第二向进行胃癌组织蛋白质分离;用图像分析软件PDQuest 8.0 分析电泳图谱,寻找有意义的差异蛋白点;运用MALDI-TOF质谱鉴定,并对其中差异显著蛋白采用Western blotting和RT-PCR进行鉴定,检测蛋白表达谱变化。结果：胃癌适形放疗组与对照组的蛋白表达谱明显不同,发现3个有意义的差异蛋白质点,适形放疗组肿瘤细胞血管内皮生长因子（VEGF）、c-erbB-2和表皮生长因子受体（EGFR）的表达降低,与对照组比较差异显著（P<0.01）。结论：胃癌术前适形放疗可以降低胃癌细胞相关表皮蛋白表达。这些蛋白可能成为胃癌治疗新的靶点。     

Neuroendocrine and mucinous differentiation in signet ring cell carcinoma of the stomach: evidence for a common cell of origin in composite tumors

Composite tumors are rare neoplasms containing a mixture of 2 different cellular components present in roughly equal proportions. It is hypothesized that composite tumors arise from a multipotential stem cell with subsequent bidirectional differentiation. We present an unusual composite tumor of the stomach composed equally of signet ring cell carcinoma and low-grade neuroendocrine carcinoma. Twenty-one additional patients with signet ring cell carcinomas of the stomach were studied to determine the prevalence of neuroendocrine differentiation by morphology and immunohistochemistry for synaptophysin and chromogranin A. Immunohistochemistry for mucins 5AC and 2 was performed to assess for divergent differentiation toward foveolar and intestinal mucin phenotypes, respectively, and to evaluate for any potential relationship with neuroendocrine differentiation. We found morphologic evidence of neuroendocrine carcinoma in 4 (19%) of 21 consecutive signet ring carcinomas. E-cadherin immunostaining was subsequently performed on these 4 tumors plus the index case. All 5 tumors demonstrated concordance between the signet ring and neuroendocrine components. There was no distinct relationship to mucin 5AC/mucin 2 profiles, with the exception that all 11 intramucosal signet ring cell carcinomas from 4 patients with germ line cadherin 1 gene mutations were composed exclusively of mucin 5AC+ signet ring cells that lacked intestinal mucin and neuroendocrine differentiation. The concordant E-cadherin status in the neuroendocrine and signet ring cell tumor components and the frequent admixture of mucin 5AC+ cells with foveolar differentiation and mucin 2+ cells with intestinal differentiation may support the hypothesis that composite tumors arise from a common stem cell with bilineage or multilineage differentiation.