胃癌根治术血管鞘内、外淋巴结清扫临床结果比较分析

目的 比较血管鞘内、外淋巴结清扫对胃癌患者临床结局的影响.方法 回顾性分析1994年6月至2005年4月外科治疗的759例胃癌患者的临床资料,其中根治性切除627例,并分别采取血管鞘内淋巴结清扫(VLND组,215例)和血管鞘外淋巴结清扫(NVLND组,412例).分析比较两组不同的淋巴结清扫方法的手术时间、术中失血量、外科并发症等资料,并比较分析两组术后生存率差异.结果 根治性切除手术后5年和10年生存率比较:VLND组分别为55.4%和51.2%,NVLND组分别为39.1%和36.8%,两组差异均有统计学意义(P<0.05).VLND组中N0～N2、T2～T4、Ib～Ⅳ期胃癌患者术后5、10年累积生存率均显著高于NVLND组.而术中输血量、手术时间、手术并发症、术后并发症两组差异无统计学意义.结论 对于进展期胃癌患者,血管鞘内淋巴结清扫可提高术后生存率,不增加手术时间和术后并发症,是安全的淋巴结清扫技术.     

动静脉结合给药的FLEEOX方案对以淋巴结转移为主晚期胃癌的新辅助化疗

动静脉结合给药的FLEEOX新辅助化疗对于以淋巴结转移为主的晚期胃癌具有较好的疗效,动静脉不同的给药途径是提高胃癌新辅助化疗疗效的一种办法.     

联合脾切除治疗进展期胃上部癌的预后分析

目的 探讨联合脾切除对进展期胃上部癌患者预后的影响.方法 1980年1月至2003年6月对237例进展期胃上部癌患者施行了胃癌D2根治术联合脾切除,其中N0.10淋巴结转移患者75例,No.10淋巴结无转移患者162例.对影响患者的预后因素进行单因素及多因素分析;对影响患者预后的独立因素进行分层分析.结果 237例患者中No.10淋巴结转移和无转移患者术后5年生存率分别为27.7%和35.4%,二者差异有统计学意义(P<0.05).单因素分析显示,淋巴结转移、浸润深度、大体分型、胃切除方式和No.10淋巴结转移是影响患者预后的相关因素;其中浸润深度、胃切除方式和No.10淋巴结转移是影响患者预后的独立因素.分层分析显示,T3期No.10淋巴结转移和无转移患者术后5年生存率分别为34.5%和39.7%,二者差异无统计学意义(P>0.05);全胃切除No.10淋巴结转移和无转移患者术后5年生存率分别为31.2%和36.7%,二者差异无统计学意义(P>0.05).结论 对于T3期胃上部癌No.10淋巴结转移的患者,施行全胃联合脾切除能够提高患者远期疗效.     

Re-exposure to endotoxin induces differential cytokine gene expression in the rat hypothalamus and spleen

This study was designed to investigate whether the pattern of hypothalamic and splenic cytokine expression induced by peripheral administration of a bacterial lipopolysaccharide (LPS) is affected by prior exposure to LPS derived from another bacterial strain. Injection of LPS from Salmonella enteritidis (LPS₂) alone resulted in increased hypothalamic gene expression of IL-1β, IL-6, TNFα, IL-1ra and IL-10. However, pre-exposure to LPS derived from Escherichia coli (LPS₁) 3 weeks before, significantly attenuated hypothalamic IL-1ra, IL-6 and IL-10 expression. IL-1β expression also tended to be lower. This pattern contrasted with the robust cytokine expression in the spleen of LPS₂-treated rats previously exposed to LPS₁, since pre-treatment with endotoxin resulted in a significantly greater response of IL-1β and IL-1ra to LPS₂. Expression of TNFα and IL-10 also tended to be higher. Pre-treatment with LPS₁ did not significantly affect the marked increase in corticosterone and adrenaline blood levels induced by LPS₂. Thus, while endotoxin pre-exposure seemed not to induce a “tolerant” state in the periphery as judged by the immune and endocrine parameters evaluated upon re-stimulation, expression of four of the six cytokines measured was decreased in the hypothalamus. This is the first demonstration that endotoxin priming can differentially affect cytokine expression in the central nervous system and peripheral tissues when a host is confronted with a second, acute, pro-inflammatory stimulus. These results may provide new evidence for the involvement of cytokine pathways in the central nervous system in modulating peripheral inflammation and mediating cognitive and behavioural alterations during inflammatory diseases.     

高龄胃癌病人的临床特点及外科处理

目的探讨高龄胃癌病人的临床特点,提高外科治疗水平。方法回顾性分析我院2001年10月至2003年10月间416例胃癌病人行标准胃癌根治术的临床资料。结果102例≥70岁胃癌病人中术前75例（73．5％）有并存病,术后并发症发生率27．5％,术后病死率5．9％;314例〈70岁胃癌病人术前53例（16．9％）有并存病,术后并发症发生率11．5％,术后病死率1．6％,两组比较差异有统计学意义（P〈0．05）;术前无并存病在≥70岁组与〈70岁组术后并发症发生率分别为11．1％和8．8％,病死率分别为0和0．03％,两组间的差异无统计学意义（P〉0．05）。结论高龄胃癌病人常合并心脏病、肺部疾病、糖尿病等疾病。加强围手术期处理仍可使高龄病人耐受标准胃癌根治术,降低病死率和并发症的发生率。     

全胃切除术后膳食营养调查初探

目的调查全胃切除术后病人膳食营养情况。方法测定91例全胃切除病人术前以及术后3个月、6个月、1年的身高、体重、血清白蛋白和血红蛋白,计算出体质指数,采用24h回顾法调查同时期膳食情况。结果术后6个月前病人营养素及能量摄入不足,术后1年营养素及能量摄入基本与健康人相同,主要营养指标也得到恢复。结论全胃切除术后合理的膳食能够满足机体需要。     

经腹经后纵隔贲门癌根治术

目的 探讨经腹经后纵隔进行贲门癌根治的可行性和安全性.方法 对26例贲门癌侵及食管下段的患者进行经腹经后纵隔贲门癌根治术,其中根治性近端胃食管切除9例,根治性全胃食管切除17例.结果 本组26例均成功完成经腹经后纵隔贲门癌根治术.平均手术时间:全胃切除(189±39)min,近端胃切除(153±35)min;平均手术出血量:全胃切除(200±80)ml,近端胃切除(168±76)ml;平均清扫淋巴结数:腹腔淋巴结(23.3±7.3)枚/例,食管旁淋巴结(4.1±2.0)枚/例.术后无吻合口出血、吻合口瘘、吻合口狭窄发生,4例患者出现肺部感染,经治疗好转,所有患者恢复良好.术后随访5～51个月,4例出现肝转移,2例发生肺转移,其中1例死亡,其余患者情况良好,无吻合口癌复发.结论 经腹经后纵隔贲门癌根治术安全、可行,适用于膈肌没有受侵犯、食管受侵小于5 cm的胃上都癌.     

脾动脉缩窄对门静脉高压大鼠脾脏iNOS表达及Th1/Th2平衡的影响

Objective To investigate the effect and the potential mechanism of splenic artery coarctation on the expression of iNOS and Th1/Th2 cytokines in spleen of cirrhotic rats with portal hypertension (PHT). Methods Cirrhotic rats were randomized into 3 groups (n= 10):sham operation group (SOG), splenic artery coarctation group (SAC) and splenic artery ligation group (SAL). Ten normal rats treated with sham operation were employed to serve as normal control group (NCG). Immunohistochemial staining was used to observe iNOS. RT-PCR was used to detect IFN-γ and IL-4mRNA. The Pearson's correlation analysis was used to investigate the relationship between iNOS and IFN-γ or IL-4. Results The expression of iNOS was increased significantly in spleen of cirrhotic rats as compared with NCG(P＜0. 01). It was decreased after SAC and SAL compared with SOG (P＜0. 01). The expression of IFN-γmRNA and IFN-γ/IL-4 of SOG were decreased but IL-4mRNA increased significantly than that of NCG(P＜0.01). IFN-γmRNA was increased after SAC compared with SOG (P＜0.05). IL-4mRNA was decreased and IFN-γ/IL-4 increased after SAC and SAL compared with SOG (P＜0. 05). The expression of iNOS was negatively correlated with the expression of IFN-γmRNA(r=-0.672, P＜ 0.01 ) and positively correlated with the expression of IL-4 mRNA (r=0.634,P＜0. 01). Conclusion The expression of iNOS is decreased and IFN-γ/IL-4 increased after SAC in spleen of cirrhotic rats with PHT and it may improve Th1/Th2 polarization by reducing the expression of iNOS.     

Relationship between HMGB1 content and MHC-Ⅱ expression in circulating monocytes and spleen of mice challenged with zymosan

Objective: To observe the regularity of change in high mobility group protein box 1 (HMGB1) content in serum and spleen of mice with multiple organ dysfunction syndrome (MODS), to analyze the correlation between HMGB1 content and major histocompatibility complex (MHC)-Ⅱ-I-Ab expression on monocytes in blood and spleen, and to explore the effect of HMGB1 on immune function of circulating monocytes and splenocytes. Methods: One hundred 8-week-old male 57BL/6 mice were randomly divided into normal group and experimental group subdivided into 8 subgroups: 3, 8, 12 hours, 1, 2, 3, 5-7 days and 10-12 days post zymosan injection (PZI). MODS model was replicated by injecting zymosan into the peritoneal cavity. At each time point, blood and spleen were collected to detect HMGB1 content and the rate of I-Ab positive monocytes. Results: In normal and PZI 3-hour, 8-hour mice, serum HMGB1 was not detected, but it significantly increased at PZI 12 hours. In spleen of normal mice, there was low level of HMGB1 expression. In zymosan-treated mice, HMGB1 started to rise in spleen at PZI 3 hours. Subsequently, HMGB1 content in both serum and spleen significantly increased, and it reached the peak level in 1-2 days, decreased in 5 days, and then increased in 10-12 days. The number of I-Ab positive monocytes in circulating blood and spleen decreased at 1-2 days (t=9.589, 4.432, P<0.01) and 10-12 days following the challenge, forming a two trough like decrease, just corresponding with two-peak increase of HMGB1. However, at 3 hours after zyrnosan challenge, I-Ab expression on circulating monocytes was downregulated (t=5.977, P<0.01), while that in spleen upregulated (t=4.814, P<0.01). Conclusion: In mice with MODS, up-regulated HMGB1 expression can regulate I-Ab expression on monocytes to depress their ability of presenting antigen, which results in immune disturbance contributing development of MODS.     

A Case of Gastritis Associated with Gastric Capillariasis

This report is about the case of gastritis associated with capillariasis. The patient was a 52-yr-old Korean woman who occasionally ate raw fish and chicken. She complained of mild abdominal pain and nausea, but not diarrhea. An endoscopic examination revealed an exudative flat erosive change on the gastric mucosa of the antrum. She was microscopically diagnosed as chronic gastritis with numerous eosinophil infiltrations. The sectioned worms and eggs in mucosa were morphologically regarded as belonging to the genus Capillaria. This is the first case of gastric capillariasis reported in the Republic of Korea.