Gln与rhGh对肝硬化病人肠黏膜屏障的影响

目的观察Gln与rhGh各单独应用及联合应用对肝硬化病人小肠黏膜屏障形态学和功能学的影响。方法20个肝硬化病人随机分成四组,给予等氮等热量营养支持7d,Gln+rhGh组口服Gln[0.3g/(Kg·d)]和皮下注射rhGh(10U/d);Gln组口服Gln;rhGh组应用皮下注射rhGh;CONT对照组应用相应安慰剂。观察治疗前后患者小肠黏膜通透性和十二指肠黏膜绒毛高度和隐窝深度的变化,分别比较。结果Gln+rhGh组治疗后小肠黏膜通透性有显著性的降低(P<0.05),且显著低于其他三组(P<0.05);十二指肠黏膜绒毛高度和隐窝深度有显著性的增高(P<0.05),且显著高于其他三组(P<0.05)。结论Gln与rhGh联合应用能减低肠道黏膜的通透性和维持其形态学的完整。     

肾移植术后并发大腿感觉功能障碍(附28例报告)

目的 提高对肾移植术后并发大腿感觉功能障碍的认识水平。方法 对179例肾移植术后患者进行问诊和大腿皮肤针刺检查。结果 179例中发现28例存在手术侧大腿感觉功能障碍。其中78例移植肾动脉与髂内动脉吻合的患者中有11例，分别为大腿前面7例、外侧面2例、前面和外侧面2例：101例移植肾动脉与髂外动脉吻合的患者中有17例，分别为大腿前面13例、外侧面1例、前面和外侧面3例。除1例为持续性感觉功能障碍外，其余27例均在术后半年内自愈。结论 肾移植术后出现手术侧大腿皮肤感觉功能障碍是较常见的并发症。肾移植术前应告知患者可能出现这种并发症。     

术后镇痛泵加新斯的明对胃肠功能影响

目的探讨术后硬膜外持续镇痛泵中加入新斯的明对剖宫产术后胃肠功能的影响。方法选择行剖宫产产妇240例,根据麻醉医师分组的不同将产妇分为两组,观察组126例,术后持续镇痛泵中加入麻醉药和新斯的明1.0mg;对照组114例,镇痛泵中仅有麻醉药,两组麻醉药配伍相同。观察两组产妇术后麻醉镇痛效果、肛门排气时间及腹泻、腹胀、大便失禁、恶心、呕吐等并发症发生情况。结果观察组肛门排气时间为(26.92±10.98)h,对照组为(33.78±12.61)h,两组比较差别有高度显著性(P<0.01);镇痛效果:观察组优为93.55%,对照组优为93.75%,两组比较差别无显著性(P>0.05);观察组恶心、干呕发生率为6.35%,明显低于对照组的19.3%(P<0.05),无一例发生呕吐,对照组有两例发生呕吐,三例发生腹胀;两组均无腹泻及大便失禁发生。结论术后硬膜外持续镇痛泵中加入新斯的明能促进胃肠功能,减少胃肠道并发症,有望为术后胃肠道并发症的防治提供一条新途径。     

小肠粘膜下层的制备及细胞相容性的实验研究

目的了解猪小肠粘膜下层(SIS)的细胞相容性,探讨用SIS为生长载体复合骨髓基质干细胞(BMSCs)构筑组织工程骨的可能性。方法用物理和化学方法处理猪小肠粘膜下层,将兔骨髓基质干细胞与SIS进行体外复合培养,分别进行组织学、相差显微镜和扫描电镜观察。结果经物理和化学处理的SIS纯度高,孔隙多,胶原纤维未受损;BMSCs在SIS材料上生长、粘附、增殖,并能长入材料的孔隙内,分泌大量的细胞外基质成分。结论SIS的细胞相容性良好,不影响BMSCs的形态,对细胞生长和功能表达无抑制作用,可以用作骨组织工程的支架材料。     

Fecal stream is essential for adaptive induction of glucose-coupled sodium transport in the remnant ileum after total proctocolectomy

Our previous studies demonstrated that sodium glucose cotransporter 1 (SGLT-1) was induced in the remnant ileum of total colectomized rats via the action of factors other than hyperaldosteronism. The aim of the present study was to clarify whether fecal stream is required for the enhancement of SGLT-1-mediated sodium transport. Twenty-seven pairs of ileal tissues were obtained from the proximal and distal side, respectively, of loop ileostomy after total proctocolectomy. Mucosae were mounted in an Ussing chamber to evaluate glucose-coupled sodium transport. Levels of SGLT-1 mRNA in proximal and distal mucosae were compared by Northern blotting. Villous height and crypt depth were measured to test for correlations between mucosal structure and SGLT-1-mediated sodium transport or mRNA expression levels. Both glucose-coupled sodium transport and expression of SGLT-1 mRNA were significantly lower in distal mucosae relative to proximal mucosae. In distal mucosae, villous height, but not crypt depth, was significantly lower than in proximal mucosae, demonstrating a positive correlation between villous height and SGLT-1 function and expression. Comparative studies of proximal and distal mucosae demonstrated that in addition to hormonal changes, fecal stream is required for full induction of the sodium transport system (which includes SGLT-1-mediated transport) in the remnant ileum following total proctocolectomy. Presented in part at the Forty-Sixth Annual Meeting of The Society for Surgery of the Alimentary Tract, Chicago, Illinois, May 14–19, 2005 (poster presentation). This work was supported by Grants-in-Aid for Scientific Research 10557118 and 14657295 from the Ministry of Education, Science and Culture of Japan to K. Fukushima, and by Kanae Foundation to K. Fukushima.     

No difference in symptoms of irritable bowel syndrome between healthy subjects and patients with recurrent depression in remission

There is bidirectional comorbidity between anxiety/depression and irritable bowel syndrome (IBS). To investigate the prevalence of IBS symptoms, and factors associated with gastrointestinal symptoms in patients with recurrent depressive disorder. Patients (n = 95) with recurrent type of major depression according to DSM-IV criteria and sex- and age-matched controls (n = 190) were sent questionnaires investigating symptoms of IBS [Gastrointestinal Symptom Rating Scale (GSRS)-IBS] and symptoms of anxiety and depression [Hospital Anxiety and Depression Scale (HADS)]. Medical records were checked over a 10-year period for chronic somatic symptoms or diseases. Seventy-three patients with unipolar disorder (mean age 63.6 years SD 13.8; range 23-86 years) and 156 controls (mean age 59.2 years SD 11.6, range 21-85 years) responded. Patients with recurrent depression had higher GSRS-IBS scores and showed a strong correlation between symptoms of IBS and anxiety-depression (r(s) = 0.54; P < 0.001). IBS symptoms were also associated with multiple pain symptoms, higher health-seeking behaviour and selective-serotonin-reuptake inhibitor intake. However, patients with recurrent depression (n = 46) in remission (HADS-Depression score <8) did not have more symptoms of IBS than controls (GSRS-IBS median score 6.0 vs 6.5; P = 0.46). There is a strong association between symptoms of IBS and symptoms of anxiety and depression, whereas depressive patients in remission do not have more IBS symptoms than controls.     

胃肠道肿瘤术后复发与肠粘连引起的肠梗阻临床分析

目的：探讨胃肠道肿瘤复发和粘连性肠梗阻的临床区别和治疗特点。方法：回顾性复习了经手术治疗的86例胃肠道肿瘤术后出现肠梗阻的临床资料，并分析其在临床上区别和治疗特点。结果：86例中粘连性肠梗阻39例，肿瘤复发47例，在复发组胃癌术后复发最为多见(P＜0．05)，原发性肿瘤分化差的其复发引起肠道梗阻明显高于分化好引起的粘连性肠梗阻(P＜0．01)。症状上肿瘤复发组出现的恶心、呕吐及肛门停止排便排气低于粘连性肠梗阻(P＜0．01)。肿瘤复发的肠梗阻表现为不全性梗阻，口服泛影葡胺治疗多能缓解，但大部分患者部分症状仍存在，粘连性肠梗阻多为完全性肠梗阻(P＜0．005)，多需要手术。结论：低分化原发肿瘤、不全性肠梗阻、低发生率的恶心和呕吐及肛门停止排便排气的肠梗阻，多提示为肿瘤的复发，泛影葡胺治疗后梗阻缓解但仍有症状存在应首先考虑是肿瘤复发。     

肠道T细胞淋巴瘤临床分析

本文总结报告了3例肠道T细胞淋巴瘤(intestinal T-cell lymphoma，ITCL)的诊治资料，并结合文献复习，发现IT—CL多见于中年男性，以腹痛、血便、发热、体质量下降为主要症状，治疗效果差，预后不良。病理改变以肠道溃疡形成为特点，溃疡形态呈多形性、多灶性、不规则，镜下瘤细胞明显异型、弥漫性浸润，中至大细胞多见。肿瘤细胞呈T细胞表型。ITCL临床少见，缺乏特异性临床表现，极易误诊。故临床医师应重视对ITCL临床病理特征、免疫表型和基因型的研究，注意识别，促其早期诊治。     

胆囊结石与胆囊收缩素受体(CCK-A)和血管活性肠肽(VIP)的关系研究

目的探讨胆囊动力学异常在胆囊结石形成中的作用.方法随意选择胆囊结石患者35例,胆囊息肉样病变患者25例,正常对照30例.B超测空腹胆囊容积.放射免疫法测定血浆中血管活性肠肽(VIP)的浓度,逆转录-聚合酶链反应(rt-PCR)法测胆囊黏膜中胆囊收缩素(CCK-A)受体表达数目.结果①胆囊结石组胆囊空腹体积明显大于其它两组(F=3.45,P=0.039);②胆囊结石组胆囊收缩率明显低于其它两组 (F=5.747,P=0.005);③三组之间餐后VIP升高量无明显差异 (F=0.768,P=0.47);④胆囊结石组胆囊收缩素(CCK-A)受体表达明显低于胆囊息肉样病变组(t′=4.390,P=0.022),差异具有显著性.结论①胆囊结石组空腹胆囊体积增大与其胆囊结石形成有关; ②胆囊结石组胆囊收缩功能下降导致结石形成;③胆囊收缩素(CCK-A)受体表达低,使胆囊收缩功能减弱,促进胆囊结石的形成;④血管活性肠肽(VIP)与胆囊结石的形成无明显关系.