白藜芦醇抑制胆囊癌细胞生长与诱导细胞凋亡的实验研究

目的:探讨白藜芦醇(Res)对胆囊癌细胞(GBC)和正常成纤维细胞(3T3)体外增殖的影响,进而观察Res对GBC和3T3细胞凋亡的影响.方法:MTT法测定肿瘤细胞生长抑制率;流式细胞术分析细胞周期,检测细胞凋亡;SABC法检测细胞bcl-2、c-myc、p53蛋白表达.结果:Res呈浓度依赖性抑制GBC细胞的生长与增殖(P＜0.01),抑制率最高可达54%.Res能明显诱导GBC细胞凋亡,凋亡率最高为30.52%;处理组较对照组G1期细胞由34.88%上升至55.47±3.95%,S期细胞减少8.41%～17.54%,呈明显的G0/G1期阻滞现象.GBC细胞的bcl-2、c-myc基因蛋白表达降低,而p53基因蛋白表达增强.结论:Res能通过诱导GBC细胞凋亡而抑制其生长与增殖,但对3T3细胞无此作用.     

手术对Ⅳ期胆囊癌预后的影响

目的分析不同手术方式对Ⅳ期胆囊癌预后的影响.方法对1997年6月～2001年5月间上海市172例Ⅳ期胆囊癌病例进行临床病理分析,并对获得随访的164例的预后与手术方式的关系进行探讨.数据分析采用Kaplan-Meier法.结果 172例中未手术者44例(25.6%),手术者128例(74.4%),其中包括单纯胆囊切除术45例(35.1%)、胆囊癌根治性切除术17例(13.3%)、胆囊癌扩大根治性切除术5例(3.9%)和剖腹探查术61例(47.7%).在行根治性切除者中,Ⅳa和Ⅳb期的1年生存率分别为69.2%和40.7%,明显好于胆囊未切除或单纯切除者,在Ⅳa和Ⅳb期中各有2例存活期超过5年.结论有选择地进行Ⅳ期胆囊癌病例根治性或扩大根治性手术,有助于改善预后.     

Atypical manifestation of a fistula between a hydatid cyst of a liver and a gallbladder: A case report

The hydatid cyst of the liver is the most common location of hydatid disease. Complications in this form are dominated by superinfection of the cyst and rupture into the bile ducts or the peritoneal cavity. We report the case of a 54-year-old female patient with a hydatid cyst of the liver complicated by a rupture in the gallbladder revealed by urinary symptoms.     

Acute appendicitis after colorectal endoscopic mucosal resection: a case report

Endoscopic mucosal resection (EMR) was originally described in 1973 and is currently a popular practice used in treating polyps, small adenomas, and early cancers. Although the safety of EMR has been proven in numerous studies, complications occur occasionally. We report a case in which the patient complained of severe upper abdominal pain and who was diagnosed with acute appendicitis after colorectal EMR. The patient recovered well after surgery. Cautious observation is necessary when resuming oral intake in patients who undergo colorectal EMR and who complain of postoperative abdominal pain. Observation is especially important for patients with a fecalith that may have originally existed in the appendix or in the colon near the appendix.     

保留胆囊对胆总管结石合并胆囊结石患者经内镜逆行胰胆管造影术后恢复的影响

目的探讨保留胆囊对胆总管结石合并胆囊结石患者经内镜逆行胰胆管造影术(ERCP)后恢复的影响。方法回顾性分析我院2016年1月至2019年1月收治的80例胆总管结石合并胆囊结石患者,所有患者均行ERCP术取石,依据胆囊是否切除分为胆囊保留组(37例)和胆囊切除组(43例),比较两组肠道恢复时间、住院时间、住院费用.、生活质量[体力状况评分(ZPS)、功能状态评分(KPS).]及胆道事件发生率。结果胆囊保留组肠.道恢复时间、住院时间、住院费用显著.少于胆囊切除组(P<005);胆囊保留组Z.PS评分显著低于胆囊切除组(P<0.05),KPS评分显著高于胆囊切除组(P<005);胆囊切除组胆道事件发生率为1395%,胆囊保留组胆道事件发生率为2162%,两组比较无显著差异(P>005)。结论保留胆囊能够缩短胆总管结石合并胆囊结石患者ERCP术后肠道恢复时间、住院时间,减少住院费用,促进术后恢复,提高生活质量,因此针对不存在胆囊切除绝对手术指征患者,推荐ERCP术取石后保留胆囊。     

柴胡桂枝干姜汤方证辨析

柴胡桂枝干姜汤方出自《伤寒论》＂,伤寒五六日,已发汗而复下之,胸胁满微结,小便不利,渴而不呕,但头汗出,往来寒热,心烦者,此为未解也,柴胡桂枝汤主之＂;方证定位于少阳病兼证,属经腑同病兼津伤阳损证,原文对太阴虚寒症状未作明示,但结合后世医家补充及临床验案,太阴虚寒为必有兼证。刘渡舟定位于胆火内郁兼太阴脾寒更贴近临床实际。方证应无表证,邪已传入少阳,水饮内停并非其兼证。因柴胡黄芩用量与小柴胡汤相同,故归于柴胡剂已达成共识,争论焦点在栝楼根、牡蛎及桂枝干姜的作用,详辨结构,乃小柴胡汤理中汤、栝楼牡蛎散合方之意。多数医者认同该方证病机为少阳枢机不利、胆火内郁,兼津伤阳损,广泛应用于消化系统疾病。刘渡舟主张使用本方,论病机为胆热脾寒,抓主证须重视口苦便溏;断病在少阳,以口苦为准,便溏之证是判断太阴病主要依据,对临床使用影响很大,多按此原则使用,疗效确切,极大地扩大了此方的使用范围。     

窒息新生儿胆囊排空功能的研究

观察窒息对新生儿胆囊排空功能的影响。方法用B超检测窒息新生儿107例及正常对照组 新生儿219例胆囊排空前后胆囊的长径、直径,计算出胆囊排空前后最大纵断面积近似值(长径×直径)的均 数、各指标胆囊排空前后差值及胆囊排空率;并用统计学方法比较以上各指标。结果窒息组的各差值及胆囊 排空率均小于正常对照组,而最大纵断面积近似值却大于正常对照组(P均＜0.01)。结论窒息可使新生儿 胆囊排空功能明显减弱,使新生儿胆囊扩张。     

150例胆囊结石胆胰合并症的诱发因素探讨

目的 探讨胆囊结石胆胰合并症的诱发因素.方法 2010年1月至2012年1月诊治的胆囊结石并发胆胰合并症患者150例进行临床资料调查,了解胆胰合并症诱发因素.结果 年龄＞50岁,病程＞10年,发病次数＞5次,结石直径＜1 cm、＞2 cm,胆囊管直径＞0.3 cm,伴发高脂血症等均为胆囊结石并发胆胰合并症高危因素,经统计学分析,对胆囊结石并发胆胰合并症各高危因素项进行比较差异有统计学意义(P<0.05).结论 胆囊结石是常见病、多发病,在我国胆囊结石患病率达10%以上,近年来随着人们生活方式和饮食结构变化,使得胆囊结石发病率呈逐年增高趋势,年龄>50岁、病程较长胆囊结石患者随着年龄增加,机体的调节能力、代偿能力和修复功能下降,长时间的结石与胆囊内进行局部刺激、发生慢性炎症,当机体受到外界环境和内环境变化时可以发生胆胰合并症.     

Role of adjuvant chemoradiotherapy and chemotherapy in patients with resected gallbladder carcinoma: a multi-institutional analysis (KROG 19-04)

Objective:The effectiveness of adjuvant treatments for resected gallbladder carcinoma (GBC) has remained unclear due to lack of randomized controlled trials; thus, the aim of present study was to evaluate the role of adjuvant treatments, including chemoradiotherapy (CRT) and/or chemotherapy (CTx), in patients with resected GBC.Methods:A total of 733 GBC patients who received curative-intent surgical resection were identified in a multi-institutional database. Of 733 patients, 372 (50.8%) did not receive adjuvant treatment, whereas 215 (29.3%) and 146 (19.9%) received adjuvant CTx and CRT, respectively. The locoregional recurrence-free survival (LRFS), recurrence-free survival (RFS), and overall survival (OS) of the adjuvant treatment groups were compared according to tumor stage (stage II vs. stage III–IV).Results:In stage II disease (n = 381), the 5-year LRFS, RFS, and OS were not significantly different among the no-adjuvant therapy, CTx, and CRT groups, and positive resection margin, presence of perineural invasion, and Nx classification were consistently associated with worse LRFS, RFS, and OS in the multivariate analysis (P < 0.05). For stage III–IV (n = 352), the CRT group had significantly higher 5-year LRFS, RFS, and OS than the no-adjuvant therapy and CTx groups (67.8%, 45.2%, and 56.9%; 37.9%, 28.8%, and 35.4%; and 45.0%, 30.0%, and 45.7%, respectively) (P < 0.05).Conclusions:CRT has value as adjuvant treatment for resected GBC with stage III–IV disease. Further study is needed for stage II disease with high-risk features.     

刘沈林教授中医治疗结肠息肉经验撷粹

随着内镜技术的发展,结肠息肉的诊断率越来越高,镜下切除术后易复发,而中医药治疗结肠息肉效果显著,文章意在总结刘沈林教授多年来临证中运用中医药治疗结肠息肉的经验,与读者共飨,并附医案1则以佐证.