创伤后肝细胞凋亡与坏死的检测及其意义

目的 探讨严重创伤后肝细胞凋亡及坏死在急性肝功能障碍发病机制中的作用。方法复制多发性骨折合并休克的大鼠创伤模型,采用 Annexin－V－Flous、碘化丙锭(propidium iodid,PI)双标法经流式细胞仪检测创伤后各时间点肝细胞凋亡与坏死的数量变化,结合光镜、电镜和电泳观察细胞凋亡与坏死,并与肝功能变化相比较。结果创伤后早期肝细胞即发生凋亡和坏死,坏死肝细胞的数量进行性升高,与肝功能变化显著呈正相关;凋亡肝细胞在创伤后3h达高峰,部分凋亡肝细胞发生继发性坏死,其数量与肝功能变化显著正相关。结论肝细胞坏死与凋亡是严重创伤后肝功能损害的重要原因,坏死肝细胞是肝功能损害的直接因素,凋亡肝细胞通过发生继发性坏死加重肝功能损害。     

抑肽酶预处理防护大鼠肝脏缺血再灌注损伤的实验研究

目的 探讨抑肽酶预处理对肝脏缺血再灌注损伤的防护作用。方法 SD大鼠80只，随机分为抑肽酶预处理和生理盐水预处理两组，观察肝脏缺血再灌注损伤引起及抑肽酶预处理的影响。结果 拟肽酶预处理组大鼠缺血再灌注损伤引起的血清谷丙转氨酶（ALT），谷草转氨酶（AST）活性及肝组织丙二醛（MDA）含量变化均显著低于生理盐水预处理组（P＜0．01）；肝细胞形态学异常改变也明显较生理盐水预处理组轻。结论 抑肽酶预处理对大鼠肝脏缺血再灌注损伤有明显的防治作用。     

模拟定位机引导下经皮穿刺集束巨能刀射频治疗肺癌的临床应用

为了探讨局部麻醉和模拟定位机引导在集束巨能刀治疗肺癌的射频治疗的适应证、治疗效果以及并发症的预防和处理，采用0．5％普鲁卡因局部浸润麻醉，模拟定位机引导下经皮穿刺集束巨能刀治疗肺癌46例。CT显示条索状瘢痕残余ll例，空洞形成或直径缩小32例，无变化1例，增大2例。治疗中患者均有不同程度的胸腔内热感及短时间内可以忍受的疼痛感。并发症包括气胸7例、皮下气肿5例、发热24例、咯血13例和慢性支气管炎急性发作4例。初步研究结果提示，集束巨能刀射频治疗周围型肺癌疗效满意，尤其适用于直径〈3cm的肿瘤。局部麻醉配合全身止痛药物应用可以很好地解决治疗中的疼痛问题，与全麻相比还具有省时省力、费用低的优势；对于周围型肺癌，模拟定位机引导经皮穿刺定位与CT引导相比，同样准确、安全，但操作更为方便。     

建立一种新的多药耐药的诱导方法

目的建立裸鼠原位肝癌耐药模型。方法培养肝癌细胞系HepG2,建立裸鼠的皮下肿瘤,形成“供瘤鼠”。开腹直视下将瘤块种植于裸鼠的肝包膜下建立原位肝癌模型,通过表阿霉素间歇腹腔化疗,建立裸鼠原位肝癌耐药模型。用体检、B超、CT、剖腹探查监测肝内瘤块生长情况。用逆转录聚和酶链反应(RT-PCR)和免疫组织化学方法检测肿瘤耐药基因mdrl-mRNA和p-gp蛋白的表达。结果(1)模型建立无手术死亡(0/25),种植成瘤率为88%(22/25),补种3例全部成功,耐药诱导成功率为80%(16/20);(2)诱导组mdrl-mRNA和P-gp蛋白的表达均明显高于对照组,分别约是对照组的23倍和13倍。结论成功地建立了与临床肝癌相似的裸鼠原位肝癌耐药模型,为进一步研究肝癌多药耐药基因的诊断和逆转提供了良好的动物平台。     

综合治疗晚期原发性肝癌72例疗效观察

目的 探讨腹腔化疗或联合其他方法综合治疗晚期原发性肝癌的治疗效果.方法 72例不能手术切除的、合并门静脉癌栓、腹腔内转移或淋巴结转移的晚期肝癌,采取腹腔化疗或者联合TACE等其他方法治疗.5-氟尿嘧啶(5-FU)0.5～0.75 g,腹腔内注入1/日,连用10～15天,总量5.0～12.5 g,最后一天腹腔内注入丝裂霉素(MMC)10 mg或卡铂100 mg.7例胆管细胞癌联合使用健择800～1000 mg.结果 全组平均生存时间13.97±6.27月.累积1年、2年生存率分别为59.7%和30.6%.肝功能Child A级平均生存时间15.91±5.49月,B级8.55±5.09月,有显著性差别.结论 腹腔化疗或联合其他综合治疗方法是肝癌并腹腔内转移的有效治疗方法,可延长部分晚期肝癌患者的生存时间,改善生活质量.     

组织特异性胞嘧啶脱氨酶和5-氟胞嘧啶热化疗对裸鼠结肠癌肝脏转移的影响

Objective To investigate the effects of tissue specific cytosine deaminase/5-fluorocytosine (CD/5-FC) thermotherapy on hepatic metastasis of colonic carcinoma in nude mice. Methods Forty-five nude mice were randomly divided into control group, 5-FC group and 5-FC thermotherapy group according to the random number table (15 mice in each group). Mice models of hepatic metastasis of colonic carcinoma were established by portal vein injection of LoVo/CEACD cells. The hepatic metastasis rate and number of metastatic nodules of the 3 groups were compared by ehi-square test and one-way ANOVA. The pathological changes in tumor tissues and apoptotic index of tumor cells were observed. The expression of the CD gene in tumor tissues was detected by fluorescent quantitative RT-PCR and Western blot. Results The number of metastatic nodules and liver metas-tasis rate were 4.6±1.3 and 100.0% in control group, 2.2±1.0 and 60.0% in 5-FC group, 0.5±0.8 and 13.3% in 5-FC thermotherapy group, with statistical difference among the 3 groups (F=25.898, χ2=5.208, 19.548, 5.168, P<0.05). The mean apoptotic indexes of tumor cells of the 3 groups were 4.6%, 9.9% and 17.4%, respectively. Vacuolar degeneration, cell necrosis, cytolysis and apoptotic bodies were mostly observed in the 5-FC thermotherapy group. The expression of CD gene in tumor tissue was detected in all the groups. Conclusion Tissue specific CD/5-FC thermotherapy has inhibitory effects on the hepatic metastasis of LoVo cells transfected with CD gene.     

High-Density Circumferential Pulmonary Vein Mapping with a 20-Pole Expandable Circular Mapping Catheter

The differentiation of pulmonary vein (PV) electrograms from atrial far-field signals during PV isolation (PVI) for atrial fibrillation (AF) may be difficult. In addition, owing to highly variable PV ostial sizes, current fixed-diameter circular PV mapping catheters may not yield optimal electrograms. We evaluated an expandable, circular 15–25 mm diameter, 20-pole mapping catheter for PV mapping during sustained AF in 25 patients. After selective PV angiography to define the ostial position and size, the catheter was introduced into each PV and withdrawn to the most stable proximal position, with optimal wall contact ensured by progressive loop expansion. At each PV ostium, electrograms recorded at high resolution (HR) were compared with those recorded at a resolution similar to that of a standard 10-pole Lasso catheter. After PVI performed during ongoing AF, the presence of residual far-field potentials (FFP) under both set-ups was compared. We mapped 97 PV, including 4 pairs with common ostia. In the HR recordings, the PV potentials had greater amplitude (0.5 ± 0.1 vs 0.3 ± 0.1 mV, P = 0.001) and fragmentation, whereas left atrial FFP were minimized. After successful isolation of all PV, FFP were observed in 33% of left superior and 28% of left inferior PV on the HR recordings, compared to 66% and 61%, respectively under normal resolution. Catheter stability and optimal wall contact, in combination with HR electrograms can optimize circumferential PV mapping during AF and improve the discrimination of FFP postablation.     

"Three-Grade Criteria" of Radical Resection for Primary Liver Cancer

OBJECTIVE The present study was designed to develop the "ThreeGrade Criteria" for radical resection of primary liver cancer (PLC) and to evaluate its clinical significance.METHODS Criteria for radical resection of PLC were summed up to 3 grades based on criterion development. Grade I: complete removal of all gross tumors with no residual tumor at the excision margin. Grade Ⅱ: on or the primary branches of the portal vein, the common hepatic duct or its dition to the above criteria, negative postoperative follow-up result including AFP dropping to a normal level (with positive AFP before surgery)within 2 months after operation, and no residual tumor upon diagnostic imaging.The clinical data from 354 patients with PLC who underwent hepatectomy were reviewed retrospectively. Based on the "Three-Grade Criteria" these patients were divided into 6 groups: Grade Ⅰ radical group,Grade Ⅰ palliative group, Grade Ⅱ radical group, Grade Ⅱ palliative group,Grade Ⅲ radical group, Grade Ⅲ palliative group. The survival rate of each group was calculated by the life-table method and the rates compared among the groups.RESULTS The survival rate of patients receiving radical treatment was better than those receiving palliative treatment (P＜0.01). Survival improved as more criteria were applied. The 5-year survival rate of the patients in Grade Ⅰ, Ⅱ and Ⅲ who underwent radical resection was 43.2%,51.2% and 64.4%, respectively (P＜0.01).CONCLUSION The "Three-Grade Criteria" may be applied for judging the curability of resection therapy for PLC. The stricter the criterion used,the better the survival would be. Adopting high-grade criteria to select cases and guide operations and strengthening postoperative follow-up would improve the results of hepatectomy for PLC.     

螺旋CT三期扫描对肝纤维化诊断价值研究

目的探讨螺旋CT三期扫描对肝纤维化的诊断价值。方法对66例经肝穿刺活检病理证实的慢性乙型肝炎肝纤维化患者组和42例正常对照组进行螺旋CT三期增强扫描。根据纤维化程度分期进行影像资料和相关指标的统计分析。结果肝左叶增大,肝表面形态及肝实质密度的改变,脾脏增大,门静脉增宽和侧枝循环的建立等影像学改变,随着肝纤维化严重程度的加重而有统计学差异。本研究显示57例肝纤维化患者螺旋CT三期扫描诊断肝纤维化52例,敏感性91.2%,特异性77.8%。各期肝纤维化分期准确28例,准确率49.1%;准确判断轻度纤维化(S1、S2)或重度纤维化(S3、S4)44例,准确率77.2%,诊断早期肝硬化16例,准确率84.2%。结论螺旋CT三期扫描能判断肝纤维化的程度,而且是动态观察肝纤维化的病程演进和临床随访的有效手段。