白介素-17A和白介素-18在慢性功能性便秘患者结肠黏膜内的表达及意义

目的 探讨白介素（IL）-17A和IL-18在慢性功能性便秘患者结肠黏膜内表达情况,分析这两种白介素在慢性功能性便秘发病机制中的作用。方法 选择2 0 1 8年10月至2 0 1 9年6月在河南科技大学第一附属医院消化内镜中心进行肠镜检查的32例慢性功能性便秘患者作为试验组,并选取同期30例健康体检者作为对照组;两组研究对象在结肠镜检查过程中取乙状结肠黏膜活检,进行HE染色观察组织形态学、实时定量聚合酶链式反应（PCR）检测IL-17A和IL-18 mRNA表达情况,并应用酶联免疫吸附测定（ELISA）方法测定IL-17A和IL-18蛋白水平,比较这两种炎症因子mRNA和蛋白在两组结肠黏膜的表达差异。结果 试验组与对照组结肠黏膜组织形态学均无异常改变,试验组患者结肠黏膜内未发现慢性炎症细胞（如淋巴细胞、浆细胞等）浸润增加。试验组结肠黏膜组织中IL-17A mRNA、IL-17A蛋白表达水平高于对照组,差异有统计学意义（P<0.05）;而IL-18 mRNA和蛋白表达两组间比较,差异无统计学意义（P>0.05）。结论 IL-17A在慢性功能性便秘结肠黏膜组织中表达升高,IL-17A可能参与功能性便秘的发病机制或病理过程。     

170例腹腔镜辅助阴式子宫切除术

目的：探讨应用腹腔镜扩大阴式子宫切除术的应用范围及减少并发症。方法：回顾性分析1998年6月－2001年11月行腹腔镜辅助阴式子宫切除术170例临床资料。结果：手术均顺利完成，无中转开腹。手术时间50min-240min，平均80min。平均出血量50ml。术中发生膀胱损伤1例，术后深静脉血栓形成1例，术后病率1例，无其它并发症发生。结论：在腹腔镜辅助下，扩大阴式子宫切除术的应用范围可行。     

小剂量多巴胺对烫伤大鼠休克期肠粘膜的保护作用

目的　观察小剂量多巴胺对严重烫伤大鼠休克期肠粘膜机械屏障的保护作用。方法　大鼠预置心导管 ,30 %Ⅲ度烫伤后静脉复苏。观察大鼠常规治疗 (对照组 )和小剂量多巴胺 (3μg·kg-1·min-1)持续给药后 ,血清中二胺氧化酶 (DAO)、丙二醛 (MDA)及乳酸水平的变化 ,对肠道的病理学改变进行评分。　结果　多巴胺治疗组大鼠休克期一般情况明显好于对照组 ,小剂量多巴胺能显著降低严重烫伤大鼠血清中的乳酸、MDA、DAO水平 ,以伤后 3～ 12h明显 ;多巴胺治疗组大鼠回肠病理学评分明显优于对照组。　结论　小剂量多巴胺对严重烫伤大鼠休克期肠粘膜机械屏障有明显的保护作用。     

舌黏膜尿道成形治疗尿道狭窄的初步报告

目的:探讨舌黏膜补片法尿道成形治疗尿道狭窄的疗效。方法:采用舌黏膜尿道成形治疗尿道狭窄14例。尿道狭窄段3.5~14cm,平均6.2cm;术前耻骨上膀胱造瘘8例,余6例排尿均较为困难,最大尿流率2.5~5.5ml/s,平均3.8ml/s。结果:术后随访2~8个月,1例因伤口感染致尿道皮肤瘘,余患者均排尿通畅,最大尿流率增至22~51ml/s,平均29.6ml/s。结论:舌黏膜具有取材方便、对患者创伤小、抗感染力强等特点,是一种较好的尿道替代物,尤其适合尿道狭窄段<6cm的患者。     

双联PPH治疗直肠前突合并直肠黏膜内脱垂的围手术期护理

本文总结了双联PPH治疗直肠前突合并直肠黏膜内脱垂所致便秘患者的围手术期护理经验。术前做好患者的心理护理、肠道准备和特殊检查;术中做好体位护理及术中配合;术后做好心理护理,加强饮食护理、排便指导、并发症的观察及护理;做好出院指导。结果76例患者均顺利完成手术,治愈出院。无术后大出血、肛周脓肿、直肠阴道瘘、大便失禁等并发症。结果表明,加强围手术期护理是保证手术成功的重要措施。     

后型尿道下裂二期膀胱黏膜半管状重建尿道术的临床研究

目的探讨采用二期膀胱黏膜半管状重建尿道术治疗后型尿道下裂的临床研究。方法81例后型尿道下裂病例采用二期手术：一期手术将阴茎海绵体完全伸直,阴茎包皮内板和背侧皮肤预置于阴茎腹侧;二期手术采用半管状阴茎阴囊皮肤＋半管状膀胱黏膜成形尿道术。结果81例后型尿道下裂患者矫形后形态几乎接近正常。手术成功率为86．4％（70／81）,尿瘘发生率为13．6％（11／81）,8例（9．9％,8／81）发生尿道狭窄,经尿道扩张治疗后痊愈。结论二期膀胱黏膜半管状重建尿道术治疗后型尿道下裂的手术成功率较高,值得临床推荐。     

水通道蛋白3、4、8在大鼠慢传输型便秘模型结肠黏膜中的表达

目的探讨水通道蛋白（AQP）3、4、8在大鼠慢传输型便秘（STC）模型中的表达情况。方法利用复方地芬诺酯灌胃的方法建立大鼠STC模型,采用RT—PCR方法测定STC组（16只）及对照组大鼠（16只）升、降结肠黏膜的AQP3、4、8mRNA表达情况。结果STC组与对照组升结肠、降结肠AQP3平均相对表达量分别为0．344和0．602（P〈0．05）、0．419和0．509（P〉0．05）：STC组和对照组升结肠、降结肠AQP4平均相对表达量分别为0．764和0．759（P〉0．05）、0．776和0．736（P〉0．05）;AQP8在实验组和对照组升降结肠中未见明显表达。结论AQP3在STC大鼠的升结肠黏膜中表达下调,对水吸收起调节作用：AQP4和AQP8的表达无明显变化。     

双歧三联活菌对体外循环心脏直视手术患者肠黏膜屏障功能的影响

目的 探讨双歧三联活菌对体外循环心脏直视手术患者肠黏膜屏障功能的影响.方法 择期拟行体外循环下瓣膜置换术患者40例,年龄30～64岁,体重40～80 Kg,ASA分级Ⅱ或Ⅲ级,采用随机数字表法,将患者随机分为对照组(C组)和双歧三联活菌组(Y组),每组20例.Y组于术前7d开始,每日口服双歧三联活菌制剂(每片含活菌数0.5×107 CFU)4片,每日3次,连服7 d.分别于体外循环前(T1)、主动脉开放10 min(T2)、停体外循环即刻(T3)、术后2、6和18 h(T4～6)时采集中心静脉血样5 ml,采用紫外分光光度法测定血浆二胺氧化酶(DAO)活性和D-乳酸浓度,酶联免疫吸附法测定血浆IL-6和IL-10的浓度.结果 与T1时比较,两组其余时点血浆DAO活性和D-乳酸IL-6和IL-10浓度均升高(P＜0.05);与C组比较,Y组T2～5时血浆DAO活性和D-乳酸浓度降低,T4,5时血浆IL-6和IL-10浓度降低(P＜0.05).结论 双歧三联活菌可在一定程度上抑制炎性反应,改善体外循环心脏直视手术患者的肠黏膜屏障功能.

Abstract：

Objective To investigate the effects of probiotics on the plasma diamine oxidase (DAO) activity and D-lactate, IL-6 and IL-10 levels in patients undergoing open heart surgery under cardiopulmonary bypass (CPB) , trying to elucidate the mechanism of protective effect of probiotics against CPB- induced injury to intestinal mucosal barrier. Methods Forty ASA Ⅱ - Ⅲ patients of both sexes aged 30-64 yr weighing 40-80 kg undergoing open heart operation under CPB were randomized into 2 groups ( n = 20 each) : control group (group C) and probiotics group (group Y) . Group Y received Jinshuangqi (Bifid Triple Viable containing bifido-bacterium, lacto-bacillus, streptococcus thermophiles) 4 pills 3 times a day for 7 days before operation. Venous blood samples were taken from CVP line before operation (T1 ), at 10 min after aortic unclamping (T2 ) and at the end of CPB (T3 ) and at 2, 6, 18 h (T4,5,6) after operation for determination of plasma DAO activity and D-lactate, IL-6 and IL-10 levels.Results Plasma DAO activity, D-lactate, IL-6 and IL-10 levels were significantly increased after CPB was started at T2-6 as compared with the baseline values at T1 in both groups. Plasma DAO activity and D-lactate level were significantly lower at T2-5 , the plasma IL-6 level was significantly lower and plasma IL-10 level higher at T4,5 in group Y than in group C. Conclusion Probiotics can protect intestinal mucosal barrier in patients undergoing open heart surgery under CPB and attenuate inflammatory response.     

捆绑式胰管对黏膜吻合术

目的 研究一种与捆绑式胰肠吻合术和捆绑式胰胃吻合术互补的术式--捆绑式胰管对黏膜吻合术的可行性.方法 (1)动物实验:对6只成年新西兰兔行胃肠造瘘术,两个造瘘口分别用导尿管、硅胶管、输液器管作为支撑管连接,导管两端分别置入胃腔与肠腔内,造瘘口荷包缝合,胃壁与肠壁浆膜层拉拢缝合周定.观察胃肠造瘘口处渗漏及愈合情况,显微镜下观察胃黏膜与空肠黏膜愈合情况.(2)临床实践:对7例患者施行捆绑式胰管对黏膜吻合术.手术方法包括:胰端的准备、肠侧的准备、胰断端与空肠对合固定的准备、吻合的实施、最后施行胰断端与空肠的对合固定.术后定期检测腹腔内引流管和血淀粉酶以及各种并发症的情况.胰漏按来源不同分为胰腺实质漏(胰创面漏)和吻合口漏两种.结果 动物实验结果显示愈合良好.临床全部病例均未出现吻合口漏,但有2例腹腔内引流液淀粉酶出现一过性增高,引流量均未超过50 ml/d,未影响患者康复,属于胰腺实质漏(胰腺创面漏).结论 捆绑式胰管对黏膜吻合术是一种简单安全的吻合方法,给外科医生提供了一种新的选择,以便在面对不同的患者时,能够灵活采用不同的方法去取得最理想的治疗效果.

Abstract：

Objective To study the feasibility of binding pancreatic duct to mucosa anastomosis (BDM)-a complementary procedure to both binding pancreaticojejunostomy and binding pancreaticogastrostomy. Methods (1) Animal experimental study: gastrostomy and jejunostomy were performed on six adult New Zealand rabbits. The gastrostomy and jejunostomy shared a same stent (rubber urethral catheter, silicone tube or plastic infusion tube). Both ends of the stent were placed in gastric and enteric cavity. Purse-string suture was performed around the stent before the jejunum and the stomach were brought together for fixation by few stitches. And to observe whether the purse-string suture around a plastic tube,rubber tube or silicon tube inserted into jejunum and/or stomach can prevent leaking out of the jejunal or gastric content to cause peritonitis. (2)Clinically 7 patients were performed with BDM anastomosis. The procedure was consisted of five steps: preparation of the pancreatic stump; preparation of the jejunum;preparation of the fixing sutures between the pancreatic stump and the jejunum; implementation of the anastomosis; lastly, fixation of the jejunum beside the pancreas stump. Post-operative periodic examination of the blood amylase and the amylase in the abdominal drainage. Pancreatic fistula was classified in to two categories: parenchymal fistula (pancreatic cut surface fistula) and anastomotic leakage. Results Animal experiment did not show any leakage around the plastic tube or silicon tube inserted into jejunum and(or) stomach. There was no anastomotic leak in all the patients. There was transient increase of amylase in two cases, but the volume of drainage did not exceed 50 ml/d and the recovery of the patients was not affected.Conclusions BDM is a simple, safe and easy procedure to perform. It provides to the surgeons with a new option in different situations to achieve the most ideal surgical result.     

重视食管癌围手术期肠道黏膜屏障的保护

肠黏膜不仅担负着消化吸收、机体与外界进行物质交流的重要生理功能．而且是人体最大的免疫器官与黏膜屏障（肠屏障）。这一屏障的损害与许多疾病、尤其是术后并发症相关。食管癌围手术期的许多因素影响着肠屏障功能的完整．其中以低灌注与禁食水的损害最甚。了解肠屏障包括其机械、生物与免疫屏障的机制．了解益生菌的重要生理功能及早期肠内营养对肠屏障的保护作用．是食管癌手术快速康复的重要组成部分。