肛周克罗恩病的诊断与治疗

1934年Bissell首先报道了同时有小肠局限性肠炎和肛周肉芽肿的病变。1938年Penner等描述了1例克罗恩病患者的肛瘘表现，包括无痛的肛裂、多发性肛瘘、脓肿、溃疡和皮赘，常伴有活动性肠道克罗恩病，亦可单独表现；其典型的特征是不断进展的肛周病变，不管是否得到足够的外科处理，状况仍可能愈来愈糟。     

重视"肛门及其周围疾病"的诊断

肛肠科诊治疾病谱范围,可大体上分为二个部分:肛门及其周围疾病和大肠疾病.     

结肠造口结肠癌原位移植模型的建立

Objective To establish a colorectal cancer colostomy orthotopic transplantation mice model. Methods A colostomy was preformed in BALB/C nu-nu nude mice. After two weeks, when the stoma healed, tumor tissues developed from Lovo cells were implanted into the submucosa of the stoma. When tumor grew up to 5 nun, fluorouracil(5-FU, 20 mg/kg) was administrated by intraperitoneal injection. Tumor developed at the colostomy was observed and its biological characteristics and behaviour were evaluated. Results Colostomy was performed in 10 mice and stoma healed at two weeks. Ten colostomies developed detectable tumor in two to three weeks. Three to five weeks later, the tumors grew up to 5 mm. Survival time of mice injected with 5-FU was (15.2±3.7) weeks (ranged: 11-21 weeks), and the survival time of the no-treantment group was (12.3±2.8)weeks (ranged:9-19 weeks). The difference was statistically significant (P=0.001). The rate of mesenteric metastasis was 1/5 and 2/5 in the treatment and no-treatment group respectively. Conclusion Colostomy orthotopic transplantation mice model is an ideal mice model with the advantages of having high success rate, visualization of implanted tumor in living animal, long survival time and significant tumor response to common chemotherapeutic agent.     

肛瘘挂线治疗

公元前五世纪，希波克拉底第一次描述了肛瘘的挂线疗法，其中的一些观念在当今处理复杂性肛瘘时依然适用。祖国医学挂线疗法同样历史悠久，明代《古今医统大全》（1556）即曾经记载：“上用草探一孔，引线系肠外，坠铅锤悬，取速效。药线日下，肠肌随长，僻处既补，水逐线流，未穿疮孔，鹅管内消。”古代挂线疗法是依靠重力将药线持续不断地收紧，     

痔诊断和治疗指南(2010修订版)

在美国,痔为临床常见疾病之一,患病人数已超过1000万.据统计,50岁以上的人群中,50％以上有此病史[1].不过,很多肛门、直肠疾病都被误诊为痔;因此,对于临床医师来说,对痔的诊断和治疗有清楚的认识是至关重要的.     

神经核蛋白γ（γ-syn）在直肠癌组织中表达的研究

目的研究直肠癌组织中γ-syn蛋白的表达情况。方法免疫组织化学法检测86例直肠癌组织γ-syn蛋白的表达。同时收集临床资料,包括年龄、性别、肿瘤距肛门距离、术前血清CEA水平、肿瘤分化程度、有无淋巴结转移。结果86例直肠癌组织中都有γ-syn蛋白的表达（86／86）。γ-syn蛋白的表达与患者性别、年龄、肿瘤距肛门距离、术前血清CEA水平之间无相关性;与直肠癌的组织分化程度、有无淋巴结转移无关。绪论直肠癌组织高表达γ-syn蛋白;γ-syn蛋白是直肠癌普遍存在表达的蛋白,可以作为直肠癌的生物标记。     

硝酸甘油软膏治疗肛裂的多中心随机对照研究

目的评价硝酸甘油软膏治疗肛裂的临床疗效和安全性。方法采用多中心、随机、双盲、安慰剂平行对照的临床试验方法,从7个临床中心入组240例慢性肛裂患者,按随机数字表法随机分为试验组（硝酸甘油软膏,120例）和对照组（凡士林软膏,120例）,疗程为8周。比较两组肛裂愈合率、肛裂疼痛强度VAS评分、肛管静息压的变化及不良反应事件发生率。结果共有221例（92．1％）完成了试验,其中试验组114例,对照组107例。治疗终点（56d）,试验组和对照组肛裂愈合率分别为78．9％（90／114）和29．0％（31／107）,排粪后肛裂疼痛VAS评分下降率分别为（94．8±15．7）％和（61．2±35．7）％,差异均有统计学意义（均P〈0．01）。试验组和对照组分别有12例和6例患者接受了肛门直肠测压,首次用药前后肛管静息压下降值试验组为（20．2±18．5）mmHg,对照组为（7．1±14．7）mmHg,但两组差异并无统计学意义（P=0．152）。试验组不良反应事件发生率明显高于对照组[42．1％（48／114）比913％（10／107）,P〈0．05],但不良反应事件主要为轻度的头痛、头胀,可自行缓解。结论硝酸甘油软膏可有效缓解肛裂疼痛,促进肛裂愈合,且使用安全、耐受性好。     

结肠慢传输型便秘及其合并出口梗阻型便秘的诊治

目的:探讨结肠慢传输型便秘(STC)及合并出口梗阻型便秘(OOC)的诊断和外科治疗。方法:对顽固性便秘的病人根据临床表现结直肠及盆底动力学等检查的结果进行分析诊断。对48例确诊为STC的病人采用结肠切除术治疗,对其中27例伴有OOC的病人于结肠切除术同期或前期采用相应的手术治疗。结果:病理检查:结肠壁内神经丛均有变性。56·3%(27/48)STC患者伴有OOC。术后随访1~5年手术有效率为93·8%。结论:STC的外科治疗应根据结肠慢传输的病变程度、分布范围及是否合并OOC选择适合的手术方案。     

下调AP-1基因表达在冬凌草甲素抑制结直肠癌中的作用

目的 探讨冬凌草甲素对结自肠癌的抑制作用及其机制.方法 以冬凌草甲素水溶液处理LoVo和SW480结直肠癌细胞株,噻唑蓝(MTT)比色法检测细胞增殖抑制率,以Illumina表达芯片检测LoVo细胞和SW480细胞基因表达的变化,对变异的基因进行定量逆转录-聚合酶链反应(RT-PCR)检测,建立结肠造口的结肠癌原位移植模型,以冬凌草甲素水溶液对动物模型进行腹腔注射,观察肿瘤的增殖并对上述发现的相关变化基因进行RT-PCR检测.结果 冬凌草甲素在25 mg/L剂量即对LoVo细胞和SW480细胞产生80%以上的抑制率,而且随药物剂量升高和时间延长,抑制率呈逐渐上升趋势;经冬凌草甲素处理后基因表达发现在LoVo结直肠癌中冬凌草甲素可以明显促进CKS2、SFN、SERTAD1、HERC5、RECQIA、GADD45AQ、bax、bxl-2等基因的表达,明显抑制了AP-1、NFkb和p38;而在SW480结直肠癌中冬凌草甲素可以促进ABCG1、ERCC1、HERC5、TERF2IP和TERF2IP等基因表达;与对照组比较,应用冬凌草甲素处理后的结肠癌结肠造口原位移植模型肿瘤生长速度明显低于对照组(P＜0.01),而SW480结直肠癌和LoVo结直肠癌在冬凌草甲素处理后肿瘤的生长速度差异无统计学意义(P＞0.05).在肿瘤模型中仅仅发现AP-1基因表达下调,其余的基因均无上调或下调,在4周时定量RT-PCR检测发现,不仅AP-1基因下调,而且核因子(NF)-κB和p38明显下调.结论 冬凌草甲素体外和体内研究都能明显抑制结直肠癌肿瘤的增殖,而且对2种肿瘤细胞株抑制率差异无统计学意义;在体外研究中发现冬凌草甲素可能抑制多种基因的信号转导途径,但是在在体研究中,只发现AP-1、NF-kB和P38下调,而且AP-1基因下调出现要早于其他2个基因,提示AP-1基因的下调可能是冬凌草甲素抑制结直肠癌的早期事件,AP-1抑制可能影响了NF-kB和MAKP途径基因表达从而发挥抑制肿瘤的作用.

Abstract：

Objective Oridonin is the active ingredient isolated from the Chinese herb Rabdosia rubescens. We used both in vivo and in vitro approaches to elucidate the underlying mechanism of the oridonin-mediated inhibition of colorectal cancer. Methods Two colorectal cell lines, LoVo and SW480,were treated with oridonin in solution. The effect of this treatment on inhibition of cell proliferation rate was determined by the methyl thiazol tetrazolium (MTT) method. The changes in gene expression that occurred in both cell lines in response to treatment with oridonin were determined via illumine expression sensor.Additionally, a colorectal cancer colostomy implantation model was established. Animals were injected intraperitoneally with an oridonin solution. Results Treatment of LoVo and SW480 cells with oridonin inhibited cell proliferation in a dose-dependent manner. The inhibition rate was increased with prolonged treatment. The growth rate of the colorectal cancer colostomy implantation model was significantly lower than control cells when treated with oridonin ( P ＜ 0. 01 ). However, oridonin treatment did not have a signiticant effect on tumor growth rate ( P ＞ 0. 05 ). In the tumor model, AP-1 was the only gene found to be downregulated after oridonin treatment by the gene expression sensor. After 4 weeks of treatment, AP-1,nuclear factor-κB (NF-κB) and p38 were all found to be downregulated. Conclusion Our study has confirmed the inhibitory effects of oridonin on colovectal cancer. These results indicate that the downregulation of AP-1 might be an initial response to treatment by oridonin. This regulation could, in turn, affect the expression of the NF-κB and MAPK pathways, thereby inhibiting tumor growth.     

应用荧光多重聚合酶链反应法检测结直肠癌微卫星不稳定

目的建立一种敏感、稳定、高通量的结直肠癌微卫星不稳定(MSI)检测技术。方法105例散发性结直肠癌患者取其新鲜癌组织及正常肠黏膜,DNA提取,荧光多重聚合酶链反应(PCR)扩增5个微卫星位点,应用GeneScan方法分析PCR产物。结果105例结直肠癌患者26例(24.7%)存在微卫星不稳定,其中MSI-H 14例(13.3%),MSI-L 12例(11.4%),MSS 79例(75.3%)。D5S346、BAT26、BAT25、D17S250、D2S123突变率分别为5.6%、8.6%、10.5%、8.6%、10.5%。结论应用荧光多重PCR可以高通量检测结直肠癌微卫星不稳定,敏感性高,结果可靠,适合临床应用。