结肠癌术中放置氟尿嘧啶缓释剂前后检测血T细胞和NK细胞的临床意义

目的探讨结肠癌患者术中放置氟尿嘧啶缓释剂前后外周血T细胞亚群和NK细胞的定量变化及其临床意义。方法将100例结肠癌进行手术的患者随机分为研究组和对照组各50例,研究组于手术中术野放入氟尿嘧啶缓释剂,对照组单纯手术。两组病人于术前、术后14天外周静脉血检测T细胞亚群和NK细胞活性。结果术前T细胞亚群和NK细胞两组之间差异无统计学意义（P〉0.05）,术后T细胞亚群和NK细胞研究组与对照组比较,除CD8＋外均明显降低（P〈0.05）,其他T细胞亚群和NK细胞仍无统计学意义（P〉0.05）。结论检测T细胞亚群和NK细胞可用于癌症患者的免疫监测,其中CD4＋/CD8＋的比值在一定程度上可以反映癌症患者负荷的情况。术中放置氟尿嘧啶缓释剂行术野缓释化疗对围手术期患者免疫功能无影响,为围手术期化疗提供理论依据。     

结肠癌并发急性肠梗阻的临床诊治探讨

目的：探讨结肠癌并发急性肠梗阻的临床诊治情况,以提高临床诊治水平.方法：回顾性分析我院46例结肠癌并发急性肠梗阻患者的临床病例资料.结果：本组资料无死亡病例.行Ⅰ期结肠切除吻合术35例,Ⅱ期吻合术5例,近端肠腔造瘘6例.术后并发症出现7例.感染患者经应用抗生素,换药等措施处理后治愈.结论：结肠癌并发急性肠梗阻应明确诊断,充分的术前准备,术中选择合理的手术方式,进行个体化治疗,术后应加强营养,注意抗感染等支持疗法,同时对于术后出现的并发症应及时处理.能够有效的提高结肠癌合并肠梗阻患者的诊疗水平.     

Clinicopathological risk factors of Stage II colon cancer: results of a prospective study

Aim Adjuvant 5‐fluorouracil based chemotherapy has demonstrated benefit in Stage III colon cancer but still remains controversial in Stage II. The aim of this study was to analyse the prognostic impact of clinicopathological factors that may help guide treatment decisions in Stage II colon cancer. Method Between 1996 and 2006 data from patients diagnosed with colorectal cancer at Hospital Universitari Bellvitge and its referral comprehensive cancer centre Institut Català d′Oncologia/L’Hospitalet were prospectively included in a database. We identified 432 patients with Stage II colon cancer operated on at Hospital Universitari Bellvitge. The 5‐year relapse‐free survival (RFS) and colon‐cancer‐specific survival (CCSS) were determined. Results The 5‐year RFS and CCSS were 83% and 88%, respectively. Lymphovascular or perineural invasion was associated with RFS [hazard ratio (HR) 1.84; 95% CI 1.01–3.35]. Gender (women, HR 0.48; 95% CI 0.23–1) and lymphovascular or perineural invasion (HR 3.51; 95% CI 1.86–6.64) together with pT4 (HR 2.79; 95% CI 1.44–5.41) influenced CCSS. In multivariate analysis pT4 and lymphovascular or perineural invasion remained significantly associated with CCSS. We performed a risk index with these factors with prognostic impact. Patients with pT4 tumours and lymphovascular or perineural invasion had a 5‐year CCSS of 61%vs the 93% (HR 5.87; 95 CI 2.46–13.97) of those without any of these factors. Conclusion pT4 and lymphatic, venous or perineural invasion are confirmed as significant prognostic factors in Stage II colon cancer and should be taken into account in the clinical validation process of new molecular prognostic factors.     

藤黄酸逆转人结肠癌细胞株SW480奥沙利铂耐药性的作用及机制研究

目的探讨藤黄酸对多药耐药人结肠癌细胞株SW480/L—OHP的耐药逆转及其对多药耐药基因（MDR1）和P-糖蛋白（P—gP）表达的影响。方法采用逐步增加药物浓度的方法建立奥沙利铂耐药结肠癌细胞株SW480/L—OHP。噻唑蓝（MTT）法测定SW480/L-OHP细胞株的耐药指数和藤黄酸在无细胞毒浓度下对结肠癌细胞耐受奥沙利铂的逆转作用,流式细胞术检测细胞凋亡、周期变化,RT—PCR检测各组细胞MDRlmRNA表达水平,Westernblot检测各组细胞P—gP蛋白的表达水平。结果藤黄酸对结肠癌SW480及SW480/LOHP细胞增殖均具有抑制作用,且呈量效关系。奥沙利铂与低毒剂量藤黄酸共同作用SW480/L-OHP细胞,其Ic50显著降低（P〈0．05）,耐药逆转倍数为3．72。与奥沙利铂单药组相比,加入低毒剂量藤黄酸后,细胞凋亡率明显增加,差异有统计学意义（P〈0．05）。藤黄酸作用后MDRlmRNA转录水平降低,同时下调了P—gp蛋白表达。结论藤黄酸部分逆转SW480/L—OHP细胞对奥沙利铂的耐药性,其机制与增加细胞内奥沙利铂的蓄积,抑制MDRl基因的表达及降低P—gp的表达有关。     

结肠癌SW480细胞FAP-1表达与奥沙利铂化疗耐药关系的研究

目的探讨结肠癌FAP-1表达与其对奥沙利铂化疗耐药间的关系。方法用奥沙利铂处理结肠癌SW480细胞,用MTT法评价其细胞增殖能力,以RT-PCR法评价FAP-1 mRNA表达水平。结果奥沙利铂化疗仅能一定程度上抑制结肠癌SW480的增殖,但随作用时间的延长,SW480细胞仍能继续增殖。经过奥沙利铂化疗FAP-1的表达上调。结论奥沙利铂化疗可引起FAP-1表达的上调,增强肿瘤细胞对抗Fas诱导的细胞凋亡。这可能与结肠癌对奥沙利铂化疗的耐药相关。     

手辅式腹腔镜右半结肠癌根治术在老年肥胖患者中的应用

目的评价手辅式腹腔镜右半结肠癌根治术在老年肥胖患者中的应用价值。方法回顾分析我院行手辅式腹腔镜右半结肠癌根治术的老年肥胖患者20例，以及同期开腹右半结肠癌根治术患者25例，并进行两组比较。结果两组均无手术死亡病例，均行一期吻合；手辅式腹腔镜组术中出血量少、术后体温恢复快、排气早、术后住院时间短、与开腹组相比差异有显著性意义（P〈0．01）；手辅式腹腔镜组手术时间与开腹组差异无显著性意义；手辅式腹腔镜组手术切除标本长度、清扫淋巴结总数及术后并发症与开腹组比较均无显著性差异。结论手辅式腹腔镜右半结肠癌根治术应用于老年肥胖患者，具侵袭性小、操作安全可行、术后恢复快等优点，是一种较为理想的微创手术方式。     

人结肠癌细胞中组蛋白乙酰化对细胞周期调节基因表达的影响

目的 研究组蛋白乙酰化对Colo-320和SW1116人结肠癌细胞系p21^WAF1和p16^INKRA基因表达的影响。方法 培养人结肠癌细胞系SW1116和Colo-320,分别以去甲基化制剂5-氮脱氧胞苷(5-aza-dC)和／或组蛋白脱乙酰化酶(HDAC)抑制剂曲古抑菌素(TSA)及丁酸钠(NaBu)干预细胞。运用流式细胞术检测细胞周期变化;以定量逆转录-聚合酶链反应(RT-PCR)法研究控制细胞周期的基因p21^WAF1和p16^INKRA的表达;染色质免疫沉淀技术分析基因相关染色质乙酰化组蛋白的水平。结果 TSA或NaBu使人结肠癌细胞阻滞于G1期,而5-aza-dC并不能改变细胞周期。正常情况下,SW1116和Colo-320细胞中均有较弱的p16^INKRA表达;两种结肠癌细胞系p21^WAF1表达缺如。5-aza-dC干预后,p16^INKRA表达增强,相反p21^WAF1仍无明显表达。当该两个细胞系经TSA或NaBu处理后,p21^WAF1转录水平明显上调,并诱导p21^WAF1基因相关染色质乙酰化组蛋白H3和H4的积聚。结论 两种人结肠癌细胞系中,HDAC抑制剂通过选择性增加p21^WAF1基因相关染色质乙酰化水平,上调p21^WAF1基因的转录,并相应地导致结肠癌细胞生长停滞;而p16^INKRA基因表达主要受甲基化调节。     

结肠镜检查在大肠癌诊断中的应用研究

目的探讨结肠镜检查在大肠癌诊断中的应用价值。方法回顾性分析经结肠镜及活检病理诊断为大肠癌患者328例患者的临床资料,对其临床表现、年龄、部位、病理类型等进行分析。结果患者多表现为便血、腹痛、大便性状改变和腹部包块等;男女平均发病年龄差异无统计学意义(P0.05),各年龄段中以40岁以后检出率逐渐增多,60~69岁及70~79岁为高检出率年龄段;直肠是大肠癌最多发部位;结肠镜下表现为隆起型225例(68.6%)、溃疡型71例(21.6%)、浸润型32例(9.8%);病理类型以管状腺癌最多。结论结肠镜可以直观地观察到结直肠黏膜的病变状况,结合活检病理诊断,有助于确定肿瘤的类型、分期,对确诊并制定治疗方案有重要参考价值。     

错配修复基因在右半结肠癌的表达对病理特征的影响

目的:研究散发性结肠癌错配修复基因MLH1、MSH2、MSH6和PMS2在右半结肠癌的蛋白质表达缺失情况,进一步分析错配修复基因的表达缺失与右半结肠癌病理特征的相关性。方法:收集2015年1月至2020年8月期间,在我院就诊的206例结肠癌病人手术切除组织标本及病历资料,左半结肠癌116例,右半结肠癌90例。应用免疫组织化学检测MLH1、MSH2、MSH6和PMS2基因的蛋白质表达情况,分析错配修复基因的蛋白质表达缺失与结肠癌病理特征的相关性。结果:错配修复基因在右半结肠癌的蛋白质表达缺失率高于左半结肠癌。右半结肠癌错配修复基因的蛋白质表达缺失与肿瘤分化程度、肿瘤神经浸润显著相关(P<0.05)。结论:散发性结肠癌中右半结肠癌病人错配修复基因的蛋白质表达缺失比例高于左半结肠癌。错配修复基因的蛋白质表达缺失右半结肠癌病人分化程度低,不易发生神经浸润。     

Surgical Technique and Survival in Patients Having a Curative Resection for Colon Cancer

PURPOSE: This study was performed to determine whether the adoption of a standardized technique for resection of colon cancer, based on mobilization along anatomic planes, resulted in improved survival after adjustment for other known prognostic factors. METHODS: Patients undergoing a potentially curative, elective colonic resection at Concord Hospital from 1971 to 1995 were included. None received adjuvant therapy. Data were recorded prospectively. Overall survival and colon-cancer–specific survival were examined by the Kaplan-Meier method and proportional-hazards regression in relation to patient and tumor characteristics and the introduction of a standardized surgical technique in 1980. RESULTS: Overall five-year survival rose from 48.1 percent before 1980 to 63.7 percent after 1980 (P < 0.0001); cancer-specific survival rose from 66.4 percent to 76.6 percent (P = 0.002). Factors that did not change significantly before and after 1980 were patient age and gender, tumor site, stage, grade, serosal surface involvement, and apical node metastases. The proportion of tumors 5 cm in diameter decreased after 1980 (61.9 to 49.2 percent, P = 0.001) but survival was unrelated to size. Venous invasion rose after 1980 (9 to 15.8 percent, P = 0.014). Multiple regression with adjustment for age, stage, grade, venous invasion, serosal surface involvement, and apical node metastases showed significantly shorter overall survival before the introduction of the standardized technique (hazard ratio, 1.5; 95 percent confidence interval, 1.2–1.8) and significantly shorter colon-cancer–specific survival (hazard ratio, 1.7; 95 percent confidence interval, 1.3–2.2). The proportion of patients having a noncurative operation because of residual tumor in a line of resection (excluded from the survival analyses) fell from 10.6 percent (confidence interval, 7–15.3 percent) before 1980 to 3.2 percent (confidence interval, 2–4.9 percent) after 1980. CONCLUSION: As in rectal cancer surgery, mobilization of the colon along anatomic planes is an important principle that influences outcome and needs to be emphasized.