Protection of trocar sites from gallbladder cancer implantation by sodium hyaluronate shill carboxymethylcellulose–based bioresorbable membrane (Seprafilm) in a nurine model

Background: The risk of port site metastasis in laparoscopic surgery for cancer patients is a problem that has yet to be resolved. We examined the protective effect of a sodium hyaluronate–based bioresorbable membrane (Seprafilm) on tumor cell implantation at laparoscopic trocar sites. Methods: Four 2-mm trocar sites were created in nude mice, and the peritoneal wounds were covered with different-sized pieces of Seprafilm. The protective effect of Seprafilm on the implantation of GB-d1 (a human gallbladder cancer cell line) at the trocar sites was assessed after 7 days. In addition, the effects of sodium hyaluronate and Seprafilm on the growth and motility of GB-d1 were examined in vitro. Results: Seprafilm significantly decreased the incidence of implantation compared with the control group. Histologically, Seprafilm was observed on days 1 and 3, as a sheet of gel that covered the injured peritoneum and muscle layer. In an invasion assay using Seprafilm, no cells were found to infiltrate through the gel sheet. Conclusion: Seprafilm protects peritoneal wounds by physically covering the injured peritoneum. Therefore, if Seprafilm were attached to the injured peritoneum after laparoscopic surgery for cancer patients, it might reduce port site metastasis.     

Axillary lymph node metastasis following resection of abdominal wall laparoscopic port site recurrence of gallbladder cancer

Abdominal wall port site recurrence of gallbladder cancer is well described in the literature in patients that have undergone laparoscopic cholecystectomy with the incidental finding of a gallbladder cancer. The etiology and consequences of this type of metastatic recurrence are unclear. This report describes two cases with the unique sequelae of the interval development of nodal metastases to the axillary lymph nodes following resection of an abdominal wall laparoscopic port site recurrence of gallbladder cancer. The first case involves a patient who developed an isolated left axillary lymph node metastasis approximately 10 months after undergoing resection of a left-sided abdominal wall port site recurrence for a T2 gallbladder cancer. The original tumor had been found at laparoscopic cholecystectomy and definitively treated surgically approximately 3 years earlier. The second case involves a patient who developed isolated nodal metastases to the right axillary lymph nodes approximately 4 months after undergoing resection of right-sided abdominal wall port site recurrence, segment 4/5 hepatic resection, and portal lymphadenectomy for a T2 gallbladder cancer. This tumor had originally been found at laparoscopic cholecystectomy approximately 1 year earlier. These unique sequelae of the interval development of nodal metastases to the axillary lymph nodes demonstrated in both cases has not been previously reported.     

微创内镜保胆取息肉术与腹腔镜胆囊切除术治疗胆囊息肉的对比研究

目的：比较内镜微创保胆取息肉术与腹腔镜胆囊切除术治疗胆囊息肉的临床疗效。 方法：将2009年2月—2012年4月收治的196例符合条件的胆囊息肉患者,根据患者意愿分为内镜微创保胆取息肉术组（保胆组,103例）和腹腔镜胆囊切除术组（胆囊切除组,93例）,比较两组术中及术后的情况。 结果：两组在年龄、性别、合并症上差异均无统计学意义（均P>0.05）,具有可比性。保胆组 2例因术中取息肉后胆囊壁出血明显,改行胆囊切除术。与胆囊切除组比较,保胆组平均手术时间、术中出血量减少[（50.3±12.9）min vs.（61.2±16.7）min;（10.2±2.7）mL vs.（15.1±3.9）mL];术后疼痛、消化道不良反应发生率减少、首次排气时间缩短[16.83% vs. 32.26%;18.81% vs. 3.33%;（18.5±4.1）h vs.（26.2±5.3）h];远期并发症发生率减少（10.89% vs. 22.58%）（均P<0.05）。 结论：内镜微创保胆取息肉术较腹腔镜胆囊切除术痛苦轻、康复快、手术并发症少,对符合适应症的患者是一种安全、有效的术式。     

计算机导航辅助髋臼肿瘤精确切除与重建

目的 探索髋臼恶性肿瘤精确切除与重建的有效方法,评价其临床治疗效果.方法 利用图像融合、逆向工程、计算机辅助设计与制造等技术,建立髋臼恶性肿瘤精确切除与重建的治疗流程,完成术前规划并制备个体化定制髋臼假体,利用计算机导航系统辅助手术实施,实现肿瘤的精确切除及假体安装.自2010年12月至2012年5月,采用该流程治疗3例髋臼恶性肿瘤患者,软骨肉瘤2例、原始神经外胚层肿瘤1例,均累及骨盆Ⅱ+Ⅲ区.采用国际骨肿瘤协会(Musculoskeletal Tumor Society,MSTS)功能评分评价患肢功能,统计并发症发生情况.结果 3例患者均成功获得精确的肿瘤切除与髋臼重建.1例患者术后因搬动失误发生髋关节脱位,予以闭合复位;该例患者术后出现下肢深静脉血栓形成,对症治疗后治愈.术后3例患者均获得随访,随访时间10～21个月.至末次随访时3例患者均无瘤生存,未见感染、假体松动、螺钉断裂等并发症.MSTS评分为18～26分.结论 计算机导航辅助肿瘤切除和个体化定制髋臼假体重建能够满足髋臼肿瘤精确切除和重建的要求,肿瘤切除彻底、髋臼重建满意、并发症发生率低、近期效果良好,是外科治疗恶性髋臼肿瘤的一种有效方法,其远期疗效有待于进一步观察.     

新型胆囊镜的研发与应用

目的：为取石（息肉）保胆手术提供设备支持。 方法：2007年6月至2012年9月,结合胆囊的生理解剖、胆囊疾病的特点、人体工程学及工业设计于一体,研发出新型胆囊镜。 结果：在国家中医药管理局指定的两家医院进行了临床试验,完成取石（息肉）保胆手术120例,并申报国家专利102项,获得国家专利授权82项,获SFAD注册。 结论：研发的取石/息肉保胆手术专用的新型胆囊镜是安全、可靠、有效的取石（息肉）保胆手术器械,为胆囊病的研究提供了新的设备支持。     

胰腺浆液性囊腺瘤的诊断与治疗：附22 例报告

目的：总结胰腺浆液性囊腺瘤的诊断和治疗经验。 方法：回顾性分析2004年1月—2010年12月收治的22例胰腺浆液性囊腺瘤患者的临床资料。 结果：22例中男4例,女18例;年龄16~74（平均47.0）岁。患者多以腹痛腹胀等非特异性症状就诊,部分无症状。超声诊断灵敏度为86.3%（19/22）,CT诊断灵敏度为93.8%（15/16）,MRI诊断灵敏度为100%（12/12）。患者均接受手术治疗及病理检查证实,其中5例行胰十二指肠切除术,1例行保留十二指肠的胰头切除术,2例行胰腺中段切除术,3例行胰体尾切除术,5例行胰体尾及脾切除术,2例行腹腔镜下胰体尾及脾切除术,4例行胰腺肿瘤局部剜除术。全组无围手术期死亡,术后5例发生胰瘘,1例发生胰腺残端出血,1例发生胃排空延迟,均经保守治疗后好转出院。随访10个月至6年,均未发现肿瘤复发。 结论：胰腺浆液性囊腺瘤多见于中老年女性,超声、CT及MRI诊断价值高,手术是安全有效的治疗方法。     

腹腔镜与开腹D2远端胃切除术治疗胃癌的Meta分析

目的：评价腹腔镜辅助D2远端胃切除术治疗胃癌的价值。 方法：收集1995—2010年公开发表的实施D2淋巴清扫的腹腔镜辅助远端胃切除术和开腹远端胃切除术治疗胃癌的中文和英文文献,对两种术式的手术时间、出血量、清扫淋巴结数目、排气及进食时间、住院时间、并发症发生率、病死率和复发率共9个效应量进行Meta分析。 结果：筛选出符合纳入标准的8项研究（1 065例）。与开腹组比较,腹腔镜辅助组的出血量和并发症减少,胃肠功能恢复时间、进食时间和住院时间缩短,但手术时间延长（均P<0.05）。两组清扫淋巴结数目、病死率和复发率的差异无统计学意义（均P>0.05）。 结论：腹腔镜辅助远端胃D2根治术具有侵袭性小、并发症少、恢复快的优点,能够获得与开腹手术相当的根治效果和短期疗效。     

靶向CXCR1基因的shRNA真核表达质粒的构建及鉴定

目的：构建靶向化学趋化因子受体1（CXCR1）的短发夹小干扰RNA（shRNA）质粒表达载体。方法：针对人CXCR1基因的mRNA序列,按RNA干扰靶位点的设计原则,设计并构建靶向CXCR1基因的3个shRNA质粒表达载体和1个阴性对照质粒表达载体,经酶切和测序确认构建成功后,转染胃癌细胞MKN45,RT-PCR和Western blot检测CXCR1 mRNA和蛋白的表达。结果：经酶切和测序证实,3个靶向CXCR1基因的shRNA真核表达质粒均构建成功;与未转染和转染阴性对照质粒的MKN45细胞比较,转染3种shRNA质粒的MKN45细胞,CXCR1 mRNA和蛋白水平均明显下调（均P<0.05）。结论：靶向CXCR1基因的shRNA真核表达质粒的成功构建,为进一步研究CXCR1在胃癌中的功能和实验性靶向治疗提供了初步的基础。

     

巨大肝癌的综合外科治疗

目的　探讨巨大肝癌外科综合治疗的途径。　方法　对巨大肝癌依据肿瘤能否一期切除的原则 ,能一期切除者不行术前介入治疗 ,不能一期切除则介入治疗 ,肿瘤缩小后手术 ;术中充分游离肝脏 ,暴露肿瘤 ,尽可能减少肝门阻断时间 ,防止术中出血。术后抗炎、支持、保肝、防止应急性溃疡治疗 ,并预防性介入 2～ 3次。　结果　本组无手术死亡 ,一年生存率达90 %。　结论　对巨大肝癌行综合性外科治疗 ,是提高其治愈率、生存率的有效手段     

Utility of the tumor bed marker in patients with breast cancer receiving induction chemotherapy

Purpose: Induction or neoadjuvant chemotherapy is used in patients with locally advanced breast cancer to offer a higher rate of conservative surgery. The possibility of reduction in size, even in some cases complete clinical and mammographic regression, can make the localization of the tumor bed difficult at the time of surgery. The purpose of this study was to describe our experience about the utility of US-guided implantation of a metallic marker in patients with breast cancer before induction chemotherapy.Material and Methods: Forty-three patients with 44 masses were diagnosed with percutaneous biopsy of breast carcinoma. Before beginning of the induction chemotherapy all of them were referred for metallic marker placement. A metallic harpoon was placed under US guidance.Results: One patient died during the chemotherapy. Six underwent mastectomy, and 9 still had a palpable tumor at the time of surgery. In the remaining 27 patients (with 28 lesions) pre-operative wire localization of the tumor bed was carried out: in 11 cases the harpoon was necessary for the localization of the tumor bed, in 6 the harpoon was useful, and in 11 patients the localization of the tumor could have been done without the marker. No complications were observed and the marker remained stable in all patients.Conclusion: In patients who undergo induction chemotherapy, the placement of a metallic harpoon under US guidance is a safe, simple and inexpensive technique for localization of the tumor bed previous to conservative surgery.