开肺陷胸汤对大鼠胰源性肺损伤的防治效应

目的：在制备大鼠胰源性肺损伤动物模型基础上给予中药治疗，动态观察血氧分压及二氧化碳分压变化，并对肺脏进行病理学分析。方法：实验分为模型组及中药治疗组,72h后观察肺脏病理变化及不同时间血气分析。结果：治疗组肺脏病理改变明显减轻（P＜0．05）；治疗组72h血氧分压明显高于模型组（P＜0．01），血二氧化碳分压明显低于模型组（P＜0．01）。结论：在胰源性肺损伤发病过程中，血氧分压及二氧化碳分压的变化直接反应出肺损伤病理改变的严重程度，治疗组随着氧分压升高，二氧化碳分压降低，标志着肺脏病理改变明显减轻。     

A gastric duplication cyst with an aberrant pancreatic ductal system: report of a case

We report an extremely rare case of a gastric duplication cyst together with an aberrant pancreatic ductal system, which communicated with the stomach rather than the pancreatic ductal system with no evidence of pancreatitis. A 46-year-old woman developed severe abdominal pain after a 10-year history of occasional mild abdominal pain. Upper gastrointestinal barium radiography showed a rigidity of the stomach wall, and gastroscopy revealed a fistula orifice at a greater curvature of the gastric body. Subsequent endoscopic suction of mucous secretion from within the fistula provided immediate pain relief. Abdominal computed tomography and ultrasonography showed a cystic mass contiguous with the stomach wall. Surgical exploration revealed an uncommon anomaly of a gastric duplication cyst with the aberrant pancreatic lobe. The patient made an uneventful recovery and remains well 4 years after surgery. We also herein review ten other similar cases of this uncommon congenital anomaly reported in the literature. Received: August 20, 2001 / Accepted: January 8, 2002     

胃癌D2根治术后胰漏及其相关因素分析

目的 分析胃癌D2根治术后胰漏的发生率及其原因.方法 连续收集2009年7月1日至12月31日间经复旦大学附属中山医院胃癌专业组收治132例胃癌D2根治术患者的临床资料,测定术后第1、4、7天腹腔引流液及血清淀粉酶浓度,根据术后第1天的腹腔引流液淀粉酶值诊断胰漏.观察胰漏的发生率,并结合临床资料分析影响胰漏发生的因素.结果本组胰漏发生率为17.4%.胰漏的发生与患者年龄、性别、肿瘤部位、肿瘤分期、N分期、切除范围、引流液量及术后血清淀粉酶值无关.结论 胰漏在胃癌D2根治术后发生率较高,术中需常规预防性腹腔引流.     

Choice of surgical approach for ossification of the posterior longitudinal ligament in combination with cervical disc hernia

Ossification of the posterior longitudinal ligament (OPLL) is a common spinal disorder that presents with or without cervical myelopathy. Furthermore, there is evidence suggesting that OPLL often coexists with cervical disc hernia (CDH), and that the latter is the more important compression factor. To raise the awareness of CDH in OPLL for spinal surgeons, we performed a retrospective study on 142 patients with radiologically proven OPLL who had received surgery between January 2004 and January 2008 in our hospital. Plain radiograph, three-dimensional computed tomography construction (3D CT), and magnetic resonance imaging (MRI) of the cervical spine were all performed. Twenty-six patients with obvious CDH (15 of segmental-type, nine of mixed-type, two of continuous-type) were selected via clinical and radiographic features, and intraoperative findings. By MRI, the most commonly involved level was C5/6, followed by C3/4, C4/5, and C6/7. The areas of greatest spinal cord compression were at the disc levels because of herniated cervical discs. Eight patients were decompressed via anterior cervical discectomy and fusion (ACDF), 13 patients via anterior cervical corpectomy and fusion (ACCF), and five patients via ACDF combined with posterior laminectomy and fusion. The outcomes were all favorable. In conclusion, surgeons should consider the potential for CDH when performing spinal cord decompression and deciding the surgical approach in patients presenting with OPLL.     

胰腺癌的CT增强与病理分级、瘤体血管生成的相关性研究

目的探讨胰腺癌的胰实质期CT增强与病理分级、瘤体实质细胞处的微血管密度(microvessel den-sity,MVD)、血管内皮生长因子(vascular endothelial growth factor,VEGF)表达的相关性。方法选择经手术切除的胰腺癌患者30例,手术前均行CT增强扫描,观察胰腺癌胰实质期强化程度和形式;并对其手术标本行HE染色和免疫组化标记,对胰腺癌的CT强化状况、病理级别、瘤体实质细胞处的MVD和VEGF的表达行相关性分析。结果胰腺癌CT胰实质期瘤体强化程度、形式和其恶性度高低呈显著负相关(r=0.733,t=5.708,P0.001),和瘤体实质细胞处MVD计数显著负相关(r=0.778,t=6.551,P0.001);胰腺癌的病理分级和瘤体实质细胞处MVD计数正相关(r=0.437,t=7.574,P0.05),而与VEGF表达无关(r=-0.240,t=-1.306,P0.05)。VEGF阳性表达组MVD为57.7±11.1,VEGF阴性表达组MVD为44.6±12.2,两者差异有统计学意义(t=3.018,P0.05)。结论胰腺癌CT胰实质期增强程度高低能反映肿瘤的恶性程度及瘤体实质细胞处MVD计数。胰腺癌的恶性度高低、VEGF表达均与MVD计数密切相关。     

胰腺血供及其移植血管重建的研究

目的了解胰腺动脉及其变异情况,为胰腺移植动脉重建提供理论依据。方法回顾性分析中南大学湘雅二医院2000年1月至2006年2月300例胰腺动脉造影片,统计胰腺动脉的变异情况,并分析其结果。结果(1)300例造影中,仅1例能辨认胰十二指肠上动脉;胰十二指肠上前动脉及上后动脉的变异率分别为6.33%和5.06%。(2)胰十二指肠下动脉及其分支(胰十二指肠下前动脉、胰十二指肠下后动脉)的主要变异是发自第一空肠动脉,其发自第一空肠动脉的变异率分别是19.51%、17.54%及12.28%。(3)胰背动脉变异情况较为复杂,其变异率为23.61%。结论胰腺动脉走行复杂,在胰腺移植供胰的血管重建过程中,所重建的血管应既要能保证全胰十二指肠移植完整的血供又要能够减少术后血栓等外科并发症的发生。     

保留十二指肠胰头切除术的适应证及术式选择:附22例报告

目的探讨保留十二指肠胰头切除术（DPPHR）的适应证及具体术式的选择指征。方法回顾性分析我中心2001年1月至2006年1月实施的22例DPPHR术患者的临床资料,其中黏液性囊腺瘤8例,黏液性囊腺癌2例,实性-假乳头状瘤4例,神经内分泌肿瘤2例,慢性胰腺炎4例（伴胰头肿块2例,伴多发结石2例）,淋巴上皮囊肿1例,浆液性囊腺瘤1例。探讨DPPHR术式的适应证、手术方式的选择及术后并发症的防治。结果患者手术死亡0例,术后发生胰瘘3例,胆瘘1例,腹腔感染1例,十二指肠瘘2例。结论DPPHR术保留了胃、十二指肠及胆道的连续性,手术安全性好,降低了手术创伤和切除范围,可作为胰头颈部良性和低度恶性肿块局限性切除的术式。     

白藜芦醇对胰腺癌细胞的抑制作用

目的检测白藜芦醇(resveratrol,Res)体外单独及联合化疗药物对胰腺癌MIAPaCa-2细胞的抑制作用。方法在体外培养条件下观察Res,5-氟脲嘧啶(5-flurouracil,5-FU)和吉西他滨(Gemcitabine,Gem)分别对胰腺癌MIAPaCa-2细胞增殖的影响,然后根据以上抑制结果,选择对MIAPaCa-2细胞抑制率在15%～30%的5-FU或Gem药物浓度,再与不同浓度的Res联合用药。在联合药物处理MIAPaCa-2细胞48 h后,同样用噻唑蓝(methyl thia-zolyl tetrazolium,MTT)法检测联合用药,检测其对细胞增殖的抑制作用。结果Res,5-FU及Gem体外单独用药均能显著抑制MIAPaCa-2细胞的生长增殖,Res联合384.4μmol/L 5-FU或5.0μmol/L Gem后,对MIAPaCa-2细胞增殖的抑制作用显著提高,与单独用药组比较,差异有统计学意义(P<0.05)。结论体外Res能显著抑制人胰腺癌MIAPaCa-2细胞的增殖,Res联合5-FU或Gem能显著提高对MIAPaCa-2细胞增殖的抑制作用。     

腰椎术后脑脊液漏的处理

1993年7月～2007年5月,我科共行腰椎手术429例,其中18例术后发生脑脊液漏,发生率4．2％,经积极处理后均治愈。