基于三维重建的腹腔镜下胃癌根治术临床效果

目的探讨三维重建模型在腹腔镜下胃癌根治术(LAG)中的临床效果。方法采用随机数字表法将2018年6月至2019年12月间行LAG的84例胃癌患者分为三维组(n=42)和CT组(n=42)。CT组使用CT图像进行术前规划和术中应用,三维组依据CT数据采用Mimics 17.0软件进行患者三维腹腔血管重建,利用三维模型进行术前规划和术中应用。采用SPSS18.0软件进行统计学分析。围术期相关指标等计量资料以(±s)表示,采用独立t检验;术后并发症等计数资料采用χ²检验分析;以P<0.05表示差异有统计学意义。结果与CT组相比,三维组可明显缩短腹腔镜下胃癌根治术的手术时间、平均住院时间,减少术中出血量及术中输血,增加术中清除淋巴结个数,差异均具统计学意义(P<0.05)。而两组术后首次排气时间、术后并发症发生率差异均无统计学意义(P>0.05)。结论三维腹腔血管重建技术应用于LAG术中准确评估患者腹腔血管的分型及变异情况,在术中提供重要决策作用,具有明显优势,值得临床推广。     

快速康复外科理念用于胃节段切除术治疗早期胃癌的临床评价

目的探讨快速康复外科理念(ERAS)用于胃节段切除术治疗早期胃癌的临床效果。方法回顾性队列分析2017年8月至2020年11月接受胃节段切除术的87例早期胃癌患者临床资料,根据围术期是否应用ERAS理念分为ERAS组(47例,应用ERAS理念)和传统组(40例,传统外科康复理念)。采用SPSS 23.0统计分析软件,术后恢复指标、营养状况、疼痛程度、QLQ-C30量表评分以(±s)表示,独立t检验;并发症用χ²检验。P<0.05为差异有统计学意义。结果ERAS组肠音恢复时间、肛门排气时间、首次排便时间、切口愈合时间、术后住院时间均比传统组短(P<0.05)。术后7 d ERAS组自评-主观全面评定量表(PG-SGA)总分、视觉模拟评分法(VAS)评分比传统组低(P<0.05)。术后12周ERAS组QLQ-C30量表各维度评分均比传统组高(P<0.05)。ERAS组术后并发症总发生率为12.8%比传统组30.0%低(P<0.05)。结论ERAS理念用于胃节段切除术治疗早期胃癌可加速术后恢复进程,缓解疼痛,改善术后营养状况及生存质量,临床应用价值高。     

保留幽门胃切除术后胃排空功能障碍的原因及防治

保留幽门胃切除术(PPG)治疗早期胃癌(EGC)通过减少胃切除的范围、保留幽门、保留迷走神经能够显著改善患者术后生活质量,降低术后倾倒综合征、胆汁返流及胆石症的发生率。腹腔镜辅助保留幽门胃切除术(LAPPG)将微创理念及功能保留结合,具有低侵袭性,最低限度的小肠麻痹,术后早期康复等优势。然而,无论PPG或LAPPG,术后早期胃排空功能障碍(GEF)的发生率较高,表现为食物长期存留于残胃之中,病人通常有饱腹感。本文综述近几年行PPG术后胃排空功能障碍的相关研究进展,为临床一线外科医生行PPG或LAPPG治疗EGC时防治GEF提供参考建议。     

γ干扰素cDNA在胃癌细胞中的表达研究

实验用构建的正向连入人ＩＦＮ－γｃＤＮＡ片段的重组表达载体ｐＭＡＭｎｅｏ－γ－ＩＦＮ，以Ｌｉｐｏ－ｆｅｃｔｉｎ介导法将重组载体转染入胃癌细胞７９０１中，挑选出Ｇ４１８抗性克隆，地塞米松诱导其分泌ＩＦｔＩ－γ经活性测定筛选出高分泌ＩＦＮ－γ的细胞株ＲＰＭ７９０１－７（１７２５ＩＵ／ｍｌ），Ｓｏｕｔｈｅｒｎｂｌｏｔ证实ＩＦＮ－γｃＤＮＡ确已导入该细胞株中。体外培养过程中，ＲｐＭ７９０１细胞与转染了对照质粒ｐＭＡＭｎｅｏ的细胞ｐＭ７９０１及野生型７９０１细胞在形态，生长能力等方面无明显差别，而经地塞米松诱导的ＲpＭ７９０１细胞则与之有显著差异。裸鼠体内接种显示，经诱导的ＲｐＭ７９０１细胞在致瘤性上显著低于野生型７９０１细胞及ｐＭ７９０１细胞。经基因转移后可高分泌ＩＦＮ－γ的肿瘤细胞为肿瘤的基因治疗提供了资料。     

Role of NO in vagally-mediated relaxations of guinea-pig stomach

Summary Vagal stimulation of the stomach induces a relaxation mediated via non-adrenergic, non-cholinergic (NANC) nerves. The neurotransmitter which is responsible for this relaxation is still unknown. To determine whether nitric oxide (NO) or a NO related substance mediates this relaxation, an intact guinea-pig stomach was mounted in an organ bath, with electrodes surrounding the vagal nerves.Electrical stimulation of the vagal nerves, in the presence of atropine, induced frequency dependent, tetrodotoxin-(TTX) sensitive relaxations of the stomach quantified as changes in volume. These relaxations were not affected by - or -adrenoceptor antagonists or guanethidine. Thus they were evoked by non-adrenergic, non-cholinergic (NANC) inhibitory nerves. The relaxant responses could be inhibited in a concentration-dependent manner by N^G-nitro-Irarginine (IrNNA) a substance that inhibits the formation of nitric oxide (NO). Addition of L-arginine, the substrate for NO-synthase, reversed the L-NNA-induced-inhibition of the relaxation.Addition of nitroglycerin (a NO-donor) to a nonstimulated stomach mimicked the relaxations observed after vagal stimulation in a concentration dependent manner. These relaxations were insensitive to TTX. Relaxation of the stomach by vagal stimulation was prevented by an inhibitor of soluble guanylate cyclase, methylene blue, further supporting our conclusions.These data indicate that NO or a substance releasing NO plays an important role in NANC-neurotransmission after vagal stimulation of the guinea-pig stomach.Correspondence to A. L. Meulemans at the above address     

The role of nitric oxide (NO) in 5-HT-induced relaxations of the guinea-pig stomach

Summary In a previous study we showed that the relaxations induced after vagal stimulation of the guinea-pig stomach are mediated via nitric oxide (NO) or a NO-related substance. Intra-arterial injection (i.a.) of 5-hydroxytryptamine (5-HT) also induced relaxations in the guinea-pig stomach. Since it has been shown that in the guinea-pig colon 5-HT-induced relaxations are mediated via NO the aim of this study was to establish whether NO is involved in the 5-HT-induced relaxations in the guinea-pig stomach. Intra-arterial injection of 5-HT induced dose-dependent relaxations of the stomach. Since atropine and - and -adrenoceptor blocking agents did not influence the relaxation and since tetrodotoxin (TTX) blocked the relaxations, this effect is mediated via NANC-neurons. Administration of a NO-synthase-inhibitor N^G-nitro-l-arginine (L-NNA) concentration-dependently reduced the 5-HT-induced relaxations. Haemoglobin (a NO-scavanger) did not affect the relaxations to 5-HT, while addition of methylene blue, an inhibitor of soluble guanylate cyclase, reduced the relaxations by 50%. Addition of an opioid receptor agonist (loperamide), a 5-HT₁ antagonist (methiothepin or metergoline) or a 5-HT₄ receptor agonist (cisapride) or-antagonist (tropisetron in micromolar concentrations) inhibited the 5-HT-induced relaxations. Neither the 5-HT₄ receptor agonist renzapride, nor the novel 5-HT₄ receptor antagonist SDZ 205-557, affected the relaxations to 5-HT. These data indicate that 5-HT-induced relaxations of the guinea-pig stomach are mediated via NANC-inhibitory nerves on which inhibitory opioid-receptors are present. The use of selective agonists and antagonists indicates that 5-HT does not act via 5-HT₂, 5-HT₃ or 5-HT₄ receptors. 5-HT may act via 5-HT₁ receptors but the subtype involved, if any, has not yet been identified. The inhibitory neurotransmitter which is involved is NO or a NO-related substance. Correspondence to A. L. Meulemans at the above address     

203例幽门螺杆菌相关性胃病的临床病理诊断分析

目的:探讨基层医院胃、十二指肠疾病幽门螺杆菌(HP)感染情况,检测方法及HP感染性胃病的临床病理形态特点。方法:采用北京同仁医院消化内科刘宾等提供的改良胃镜下HP感染的可视化诊断和Giemsa染色的HP形态学病理诊断方法,对203例上胃肠道疾病患者进行检测,并对其胃粘膜进行组织形态观察。结果:改良胃镜下HP的可视化诊断阳性率为96.55％,Giemsa染色病理诊断阳性率为95.07％,改良胃镜下HP感染的可视化诊断与病理诊断符合率为98.47％。HP感染胃粘膜有特征性组织形态改变。结论:改良胃镜下HP感染的可视化诊断及Giemsa染色HP形态学病理诊断相结合运用于胃、十二脂肠疾病的HP检测,适合普通基层医院采用。HP感染胃粘膜有特征性组织形态改变。     

一组癌基因扩增与胃癌生物学行为的相关分析

目的 :探讨癌基因HER2、mdm 2和C myc扩增与胃癌恶性程度、转移及预后的关系。 方法 :用差异竞争性多聚酶链反应检测胃癌原发灶、癌旁、转移淋巴结及远处脏器转移癌中HER2、mdm 2和C myc的基因变异。结果 :HER2扩增频率在近端胃癌组中明显高于远端胃癌组 (分别是 11/ 13和 5 / 19,P <0 .0 0 5 ) ,侵及浆膜组明显高于未侵及浆膜组 (12 / 18和 4/ 14,P <0 .0 5 )。mdm 2的扩增频率在转移淋巴结中高于胃原发癌 (12 / 2 1和 12 / 32 ,P>0 .0 5 ) ,在 3例淋巴结微转移灶中发现mdm 2扩增。C myc在胃癌原发灶及转移淋巴结中的扩增频率分别是6 / 32和 5 / 2 1,2例远处脏器转移癌中有扩增。结论 :HER2、mdm 2和C myc基因扩增与胃癌的快速生长有关 ,三者联合检测可能为判断胃癌恶性程度、转移及预后提供有价值的信息。     

雌素受体在胃癌细胞的表达和意义

目的 检测雌激素受体（ＥＲ）在胃癌的表达及其与胃癌生物学行为的关系。方法 应用免疫组化Ｓ－Ｐ法。结果 ＥＲ在慢浅表性胃炎、异型增生中表达均为阴性,在胃癌阳性率为４０％,三组 比较比较有显著性差异（Ｐ〈０．０５）。ＥＲ在进展期胃癌的阳性率显著高于早期胃癌（Ｐ〈０．０５）。胃癌有淋巴结转移组的阳性率显著高于无淋巴结转移组（Ｐ〈０．０５）。ＥＲ的表达在分化不良型胃癌高于分化型胃癌,但无统计学意义（Ｐ〉０     

胃癌相关抗原MG7-Ag模拟肽表位的筛选及测序分析

目的　从噬菌体呈现的随机肽库中筛选胃癌单克隆抗体MG7所识别的胃癌相关抗原的短肽模拟表位 ,为进一步研究胃癌相关抗原与单抗结合的结构基序奠定基础。方法　用胃癌单克隆抗体MG7对呈现于噬菌体衣壳蛋白pⅧ上的 2个九肽库分别进行亲和富集和免疫筛选 ;阳性克隆进一步用荧光标记和硝酸纤维素膜斑点印迹法证实其结合活性 ;经随机抽取部分阳性克隆进行DNA序列分析 ,推导出相应噬菌体呈现肽的氨基酸序列 ,通过序列比较分析相对保守的表位信息 ;运用HLA分子结合分析软件预测已测序短肽与HLA分子结合的可能性。结果　经反复多轮筛选和结合活性检测 ,从pⅧ和pⅧ cys 2个噬菌体肽库中分别得到了 12和 30个阳性克隆 ;通过对部分阳性克隆进行测序分析 ,推导相应的随机肽序列和序列比较分析 ,得到具有相对保守性的表位信息如PLX0 2 S、SAVR、XRMX、YARN等。经计算机预测分析 ,发现它们可与HLA多个分子结合。结论　PLX0 2 S、SAVR、XRMX、YARN等有可能为胃癌单克隆抗体MG7所识别的表位基序。