ENDOSCOPIC PANCREATIC STENTING IN CHRONIC PANCREATITIS WITH DUCTAL DILATION PROXIMAL TO A STRICTURE: A SAFE and EFFECTIVE PROTOCOL

After removal of intraductal stones, a 10‐Fr or 7‐Fr pancreatic stent was placed in 16 patients with upstream ductal dilation proximal to a stricture of the main pancreatic duct. Stents were removed after a mean duration of 52.5 days. Nine patients underwent repeated stenting. About one year after removal of the initial stent, when the remaining upstream ductal dilation was found on follow‐up pancreatograms, the next stent was replaced. Repeated stenting improved outflow of pancreatic juice more effectively than one‐time stenting. Correlation between long‐term pain relief without recurrence of intraductal stones and reduction of duct diameter was also shown. Stent occlusion was observed in 14 of 30 stents. Stent occlusion was frequently associated with recurrence of pancreatitis and intraductal stones, and was also associated with morphologic changes in the pancreatic ductal system. Although there were no significant differences between stent patency of the initial stents and that of the next stents, stent patency of 10‐Fr stents was superior to that of 7‐Fr stents. 10‐Fr stents should be removed within 8 weeks and 7‐Fr stents should be removed within 4 weeks for the prevention of stent occlusion. Repeated stenting with short‐term stenting is therefore considered a safe and effective protocol of endoscopic pancreatic stenting.     

凋亡抑制因子Livin在膀胱移形细胞癌中的表达

目的检测抗凋亡（IAP）家族中Livin基因在膀胱移形细胞癌（BTCC）组织及癌旁组织的表达，探讨Livin的表达在膀胱癌发生发展中的意义。方法采用免疫组织化学和实时荧光定量逆转录．荧光定量聚合酶链反应（RT-QPCR）方法对30例膀胱癌患者中Livin基因在癌组织和癌旁组织中的表达进行检测。结果免疫染色标本中，在癌旁组织和膀胱癌组织中Livin的阳性表达率分别为0．60％。Livin在膀胱癌组织中的-△△CT值是癌旁组织的8．0454（7．4264—8．6644）倍，与分级和分期没有相关性。结论Livin基因在癌旁组织中有少量表达，而在BTCC组织中的表达量远远高于癌旁组织。     

丝裂霉素C与C2-神经酰胺联合应用治疗膀胱癌

目的 观察丝裂霉素C（MMC）与C2-神经酰胺（C2-cer）联合应用对人膀胱癌细胞的作用效果，并探讨其机制。方法 不同浓度MMC与C2-cer单独及联合作用于人膀胱癌BIU-87细胞后，应用噻唑蓝（MTT）比色法检测细胞生长抑制率，计算合用指数（CI），流式细胞仪（FCM）检测BIU-87细胞凋亡率，吖啶橙（AO）荧光染色观察凋亡形态学变化，Western blot检测细胞色素C在细胞内分布变化，并检测Caspase-3活性改变。结果 单独应用时MMC与C2-cer的中效浓度分别是159和28μmol／L，联合用药时下降为55和11μmol／L，CI=0．74。MMC与C2-cer单独及联合应用均可导致BIU-87细胞出现凋亡的形态学变化。两种药物联合应用时的凋亡率高于各自单用（P＜0．05）。线粒体细胞色素C含量在MMC与C2-cer单独及联合应用时均较对照组减少，联合用药时减少最为明显，细胞质内细胞色素C含量在联合用药时增加也最为明显（P＜0．05）。Caspase-3活性在MMC与C2-cer单独及联合应用时均较对照组升高，联合用药时升高最为明显（P＜0．05）。结论 MMC与C2-cer联合应用可以通过共同诱导细胞凋亡，协同抑制膀胱癌细胞生长。线粒体细胞色素C释放和Caspase-3活性变化可能发挥重要作用。     

尿动力学检查对膀胱颈硬化症逼尿肌功能评价的研究

目的：探讨如何准确评价膀胱颈硬化症逼尿肌功能。方法：对78例膀胱颈硬化症患者进行了尿动力学检查。结果：单纯性逼尿肌收缩力增高者39例，术后疗效不佳的发生率为0；逼尿肌不稳定者31例，术后疗效不佳的发生率为46%；逼尿肌收缩无力者8例，术后疗效不佳的发生率为100%。结论：应用尿动力学检查来评价膀胱颈硬化症逼尿肌功能，对合理选择病倒，指导临床治疗，提高疗效有重要的价值。     

改良W形回肠代膀胱术的疗效观察(附36例报告)

目的 :探讨改良W形回肠代膀胱术的疗效。方法 :对 36例膀胱肿瘤患者行根治性膀胱切除、W形回肠代膀胱术 ,并对术式进行改进。结果 :36例手术时间平均 4 .2h。术后 31例随访 4～ 19个月 ,平均 10 .6个月 ,无严重并发症 ,均无瘤生存。患者一般于术后 3周自主可控性排尿 ,日间尿控率为 10 0 % ,术后 3、6、12个月夜间尿失禁发生率分别为 2 2 .5 %、11.1%及 6 .2 %。术后 6个月尿动力学检查膀胱容量 (36 0± 30 )ml,最大尿流率 (13.6± 2 .6 )ml/s,剩余尿量 (11.5± 5 .8)ml,充盈期膀胱压力明显低于尿道闭合压。新膀胱造影发现新膀胱呈球形 ,完全位于盆腔 ,未见输尿管反流。B超及IVU检查发现原上尿路积水 4例均明显减轻 ,其余未发现输尿管狭窄和上尿路积水征象。无高氯性酸中毒 ,肾功能正常。结论 :改良W形回肠代膀胱术手术时间短 ,操作简单 ,创伤轻 ,并发症少 ;新膀胱容量大 ,内压低 ,顺应性好 ,功能接近于正常膀胱 ,保持原位排尿 ,明显提高了患者术后生活质量 ,值得临床推广应用。     

膀胱癌中环氧化酶-2的表达与临床病理的关系(英文)

目的　探讨环氧化酶 - 2 (COX - 2 )表达与膀胱癌生物学行为的关系及其意义。方法　采用免疫组化SABC法检测 5 4例膀胱癌、2 9例癌旁组织和 10例正常膀胱粘膜中的COX - 2表达 ,结合临床病理资料进行分析。结果　COX - 2在不同膀胱组织中的表达差异有显著性 (P <0 .0 5 ) ,即膀胱癌组织 >癌旁组织 >正常膀胱粘膜。COX - 2表达随膀胱癌病理级和临床分期的增加而增加 (P <0 .0 5、P <0 .0 1) ,且癌组织中COX - 2表达与淋巴转移有关 (P <0 .0 5 )。结论　COX - 2表达与膀胱癌病理分级、临床分期、淋巴转移有关 ,提示它可能在胱癌的发生、发展中扮演重要角色 ,通过抑制COX - 2活性可能为膀胱癌的防治提供新途径。     

Laparoscopic choledochotomy with primary closure

Background: Thirty-three patients were candidates for laparoscopic choledochotomy. The indications for this operation are described. Methods: The procedure was completed 32 times (97%). We had 29 successful common bile duct (CBD) clearances, three negative explorations, and one failed clearance which needed to be converted to laparotomy. All the completed procedures ended with primary closure of the main duct. Median duration of surgery was 180 min (range 100–300), including three associated laparoscopic procedures. Results: There were three postoperative complications (9.4%), none major. Average postoperative hospital stay was 7.1 days (range 4–14). In May–June 1995 we controlled 31 out of the 32 consecutive patients (one patient was lost to follow-up) who had a successful laparoscopic choledochotomy from October 1991 to December 1994. Median follow-up was 22 months (range 5–44). Besides clinical control, 23 patients also had ultrasound (US) controls and 24 had blood tests. Eleven had intravenous cholangiotomography. Two patients died 11 and 22 months after the operation for unrelated causes and without biliary symptoms. Two patients had umbilical hernias. One had a small residual asymptomatic stone, which was removed endoscopically. None had signs of postoperative CBD stricture. At US, CBD was ≤7 mm in 15 patients, 8–10 mm in four patients, and 10–12 mm in three patients. The last group had preoperative CBD dilation, too. We could compare preoperative and postoperative CBD diameters in 22 patients: 11 had no change; in nine it decreased; and two had a slight increase (8–10 mm). Conclusions: We conclude that laparoscopic choledochotomy with primary closure is a very good operation: It has a high success rate and low morbidity. Mortality is nil so far. Medium-term results are very positive: We had no CBD stricture and only one case of asymptomatic residual stone, which could have been avoided. Our results suggest that intraductal biliary drainage is useless, and its specific complications are well known. Received: 20 October 1995/Accepted: 28 February 1996     

Transurethral resection of a bladder tumor in pregnancy: A report of 2 cases

Carcinoma of the urinary bladder presenting during pregnancy is rare. We report two such cases presenting with gross hematuria, both of which were managed by transurethral electroresection of the tumor; there was no adverse effect on the pregnancies. Transurethral resection thus appears to be the procedure of choice in the management of this condition, and carries minimal morbidity even when performed during pregnancy. EDITORIAL COMMENT: As these authors point out, bladder tumors are rare in pregnancy and frequently present as gross hematuria that is mistaken for vaginal bleeding due to the pregnancy. Ultrasound is very helpful in distinguishing the causes of bleeding, and will show the bladder filled with clots and frequently the tumor as well. Standard transurethral resection is effective when performed during pregnancy, bearing in mind the need to heed to the anesthetic risks inherent in any operative procedure during pregnancy.     

HyTK基因转移联合丙氧鸟苷对人膀胱癌细胞株EJ体外杀伤作用

为探索ＨｙＴＫ基因转移对人膀胱癌的治疗作用，采用单纯疱疹病毒胸苷激酶（ＨＳＶＴＫ）基因转移联合丙氧鸟苷（Ｇａｎｃｉｃｌｏｖｉｒ，ＧＣＶ）对通过逆转录病毒载体转导了ＨｙＴＫ基因的人膀胱癌细胞株ＥＪ细胞（ＥＪ／ＴＫ）进行体外杀伤。对分别培养及混合培养的ＥＪ细胞及ＥＪ／ＴＫ细胞，用不同浓度ＧＣＶ进行处理，然后观察细胞形态改变及测定活细胞数量。结果：在ＧＣＶ作用下，ＥＪ细胞形态及数量与对照组无明显变化；而ＥＪ／ＴＫ细胞受到ＧＣＶ明显杀伤，细胞形态破坏，细胞数量明显减少，含１０％ＥＪ／ＴＫ的混合培养细胞就可观察到很明显的杀伤作用。表明：转导ＨｙＴＫ基因的ＥＪ细胞获得了对ＧＣＶ的敏感性，并存在很强的“旁观者效应”。提示ＨｙＴＫ基因转移联合ＧＣＶ可能适用于人膀胱癌治疗。     

A stratified intraoperative surgical strategy is mandatory during laparoscopic common bile duct exploration for common bile duct stones

Background: Open exploration and endoscopic sphincterotomy (ES) remain the preferred treatment of common bile duct stones (CBDS). The recent spread of laparoscopy has worsened the dilemna of choosing between surgical and endoscopic treatment of CBDS. The aim of this study was to critically evaluate the results of our preliminary experience with laparoscopic common bile duct exploration (CBDE) for CBDS. Methods: Ninety-two consecutive patients were prospectively submitted to laparoscopic CBDE. Surgical strategy included an initial transcystic approach or laparoscopic choledochotomy. Failure of stone clearance was managed by conversion to open CBDE or by postoperative ES. Electrohydraulic lithotripsy and papillary balloon dilatation were selectively used. Stone clearance was assessed by choledochoscopy and control cholangiography. Results: The overall laparoscopic stone clearance in this series was 84% (transcystic route 63% and choledochotomy 93%). Conversion to laparotomy was mandatory in 12% of the patients because of incomplete stone clearance and in 5% because of intraoperative complications. Postoperative ES was required in 4% of the patients, giving an overall surgical success rate of 96%. When indicated (small and limited number of stones located below the cysticocholedochal junction, with a dilated and patent cystic duct) the transcystic route had the lower success rate, the higher complication rate, and the shorter operative time and postoperative hospital stay. When indicated (accessible and dilated common bile duct over 7 mm), laparoscopic choledochotomy had the higher success rate, the lower complication rate, the longer operative time, and the longer postoperative hospital stay, which is related to associated external biliary drainage. The hospital mortality included two high-risk patients (2%) and the complications rate was 15%. Conclusions: Laparoscopic CBDE is safe in selected patients. A stratified intraoperative surgical strategy is mandatory in deciding between a transcystic route and choledochotomy with specific indications for each approach. When feasible, laparoscopic choledochotomy is more efficient and safe than the transcystic route, but it is associated with a longer postoperative hospital stay, which is due to external biliary drainage. Received: 7 May 1996/Accepted: 19 November 1996