原发性肝癌发生与ras基因突变的关系

目的 探讨H-ras、K-ras、N-ras基因突变与原发性肝癌发生发展的关系.方法 采用HotStarTaq聚合酶链反应(PCR)检测32例原发性肝癌组织中H-ras、K-ras、N-ras基因的表达并采用PCR直接测序分析H-ras、K-ras、N-ras基因突变x2检验检测H-ras突变与临床病理的关系.结果 在32例原发性肝癌组织中均可检测到H-ras、K-ras、N-ras基因的表达,32例原发性肝癌标本PCR结果经测序后,17例标本发现H-ras基因发生突变(17/32,53.1％),14例40密码子中A突变成G,3例62密码子中G突变成A.K-ras、N-ras基因未发生突变,H-ras突变与肿瘤转移有关.结论 H-ras基因异常表达与肝癌相关,可能导致了原发性肝癌的发生.     

白细胞介素-2在胆囊胆固醇结石形成中的作用

①目的　探讨胆囊胆汁和胆囊组织中白细胞介素 2在胆囊胆固醇结石形成中的作用。②方法　采用放射免疫分析 (RIA)方法分别测定了 56例胆囊胆固醇结石及 1 6例非胆囊结石病人胆囊组织和胆汁中白细胞介素 2的含量。③结果　胆囊胆固醇结石组胆囊组织和胆囊胆汁中白细胞介素 2含量与对照组比较有显著性差异(F =6 .0 4、3 .84,q =3 .1 4～ 4 .78,P <0 .0 5、0 .0 1 ) ,且胆囊胆固醇结石组胆囊组织中白细胞介素 2含量与胆囊胆汁中的白细胞介素 2含量呈显著正相关关系 (r=0 .66 ,P <0 .0 0 1 )。多发结石组胆囊胆汁及胆囊组织中白细胞介素 2含量与单发结石组比较无显著性差异 (q =0 .74、0 .1 6 ,P >0 .0 5)。④结论　胆囊组织及胆囊胆汁中白细胞介素 2与胆囊胆固醇结石的形成密切相关 ,并在胆囊胆固醇结石的形成过程中起重要作用     

改良APACHE-Ⅱ评分对结直肠癌并急性肠梗阻患者术后并发症的预测价值

目的 探讨改良急性生理和慢性健康状态评价系统Ⅱ（APACHE-Ⅱ）对结直肠癌并急性肠梗阻患者术后并发症的预测价值.方法 回顾性分析92例结直肠癌并急性肠梗阻患者术后并发症情况,对传统APACHE-Ⅱ评分和改良APACHE-Ⅱ评分系统（将慢性健康指标中的严重器官功能不全或免疫损害改为梗阻时间和梗阻程度,并以此两项作为肠梗阻侵袭度）预测术后并发症的敏感度、特异度、准确性及约登指数进行比较,并通过绘制受试者工作特征曲线（ROC）来计算曲线下面积（AUC）.结果 92例患者术后有25例出现并发症（包括3例围手术期死亡病例）,并发症组APACHE-Ⅱ评分（13.72±4.24）、改良APACHE-Ⅱ评分（19.28±4.92）及肠梗阻侵袭度评分（5.56±2.20）均显著高于无并发症组（10.58±3.44、14.69±3.73和4.10±1.52,均P＜0.01）.改良APACHE-Ⅱ评分取最佳截点（20分）,其预测术后并发症的敏感度、特异度、准确性、约登指数及AUC分别为0.640、0.940、0.859、0.580和0.839,均高于传统APACHE-Ⅱ评分（以14分为最佳截点）,其上述指标分别为0.560、0.896、0.804、0.456和0.784.结论 将APACHE-Ⅱ评分系统增加肠梗阻侵袭度这一指标后,能更好地预测结直肠癌并急性肠梗阻患者的术后并发症.     

阔韧带裂孔疝一例报告

女患，32岁。因阵发性腹痛伴呕吐2天，于1995年6月5日入院。7年前曾有剖腹产史。患者2天前晨起跑步中突感下腹部疼痛，初为阵发性，后渐呈持续性疼痛，伴有恶心呕吐，为胃容物，不发热，无阴道流血，但感腹胀。妇科检查在子宫左侧似可扪及一包块，边界不清。疑诊卵巢囊肿蒂扭转     

老年结直肠癌合并急性肠梗阻：附116报告

目的探讨老年结直肠癌合并急性肠梗阻的处理原则和方法。方法回顾性分析5年间收治的116例老年(≥60岁)结直肠癌并发急性肠梗阻患者的临床资料。全组右半结肠癌并梗阻39例,左半结肠癌并梗阻64例,直肠癌并梗阻13例。采用右半结肠一期切除吻合治疗39例,左半结肠一期切除吻合62例,Hartmann手术9例,Dixon手术4例,肿瘤近端肠管造瘘2例。结果术后出现并发症17例(14.7%)21例次,包括切口感染14例次,腹腔感染5例次和吻合口瘘2例次,死亡1例(0.9%)。115例(99.1%)痊愈出院。结论一定条件下,一期切除吻合治疗结直肠癌并发急性肠梗阻,是方便可行而安全有效的方法。     

IGF-Ⅰ在大鼠肝肌纤维母细胞增殖中的作用研究

目的 研究胰岛素样生长因子-Ⅰ（IGF-在）在大鼠肝肌纤维母细胞（MF）增殖中的作用。方法 培养1到4代的MF（P1-4）用于研究。用Northern blot RNA印迹杂交法测定IGF-ⅠmRNA的表达。5-溴-2-脱氧尿嘧啶核苷（BrdU）核素掺入法分析DNA合成。结果 P1-4 MF表达了IGF-Ⅰ特有的mRNA的转录产物,IGF-Ⅰ和较少量的胰岛素能增加MF的DNA合成。IGF-Ⅰ与IGFBP-2或-3重组体同时作用能抑制IGF-Ⅰ刺激MF中DNA的合成。但是用IGFBP-2或-3对MF做预孵育后则进一步增强了IGF-Ⅰ刺激MF中DNA的合成。结论 IGF-Ⅰ在MF增殖的调节中起了重要的作用,可能与急性和慢性肝损伤过程中发生的肝纤维化过程有密切的关系。     

法呢基转移酶在原发性肝癌中的表达

Background  Primary liver cancer (PLC) is a common malignant tumor. Over the past decade, although farnesyltransferase (FTase) has emerged as a significant target for anticancer therapies and has become a hotspot of cancer research, its exact mechanism of action remains unknown. The aim of this study was to investigate the expression of FTase in PLC and its role in the development of PLC.

Methods  Expression of FTase was detected by real-time fluorescent quantitative-polymerase chain reaction (FQ-PCR) in cancer and surrounding normal tissues from 32 patients with PLC.

Results  Expression of FTase mRNA in PLC was significantly higher than that in normal hepatic tissues (P <0.001). Overexpression of FTase was as high as 87.5%. The positive rate for FTase mRNA in the high tendency to metastatic recurrence group was obviously higher than that in the low tendency to metastatic recurrence group (P=0.02). The positive rate for FTase mRNA in patients with metastatic recurrence during postoperative follow-up was also significantly higher than that in those without metastatic recurrence (P=0.01).

Conclusions  The level of FTase mRNA expression in cancer tissues is much higher than in normal tissues. FTase may play an important role in the genesis and development of PLC and may be one of the reliable markers for the metastatic activity gained by liver tumor cells. FTase could be used clinically in predicting metastatic recurrence of PLC.     

探讨器械吻合联合全直肠系膜切除对低位直肠癌保肛手术的可行性

目的　探讨低位直肠癌根治中直肠系膜全切除后 ,利用器械吻合技术行保肛手术的可行性。方法　回顾性分析 3a间实施保肛的低位直肠癌根治术 93例的临床资料 ,特别是术后直肠感觉及肛门功能恢复的情况。结果　所有患者下切缘无癌浸润。术后 2a内局部复发率为 5 .3 % (5 / 93 )。93 .5 % (87/ 93 )患者术后直肠感觉及肛门功能恢复较满意。结论　利用器械吻合技术行低位直肠癌保肛手术能提高术后生活质量。只要掌握好选择手术适应证及做到根治性切除 ,保肛手术是安全、可行的。     

Value of modified APACHE Ⅱ score in predicting postoperative complications in patients with acute obstructing colorectal carcinoma

Objective To evaluate the value of modified acute physiologic and chronic health score (APACHE Ⅱ score) in predicting postoperative complications in patients with acute obstructing colorectal carcinoma. Methods Postoperative complications in 92 patients with acute obstructing colorectal carcinoma were evaluated by APACHE Ⅱ score and modified APACHE Ⅱ score (severe organ dysfunction and immune damage in chronic health indicators were replaced by the duration and degree of obstruction, which were considered as the severity of intestinal obstruction). The sensitivity,specificity, and Youden index were compared with regard to complication prediction. Receiver operating characteristic curves were plotted to calculate area under the curve (AUC). Results Twnenty-five patients developed postoperative complications including 3 deaths. The APACHE-Ⅱ score (13.72±4.24), modified APACHE Ⅱ score (19.28±4.92), intestinal obstruction severity score (5.56±2.20) were significantly higher in patients with complications than those in patients without complications (10.58±3.44,14.69±3.73,4.10±1.52,al1 P＜0.01). The sensitivity, specificity, accuracy, Youden index, and AUC were 0.640, 0.940, 0.859, 0.580, and 0.839 for the modified APACHE-Ⅱ score with 20 being the optimal cut-off point, respectively, and were 0.560, 0.896, 0.804, 0.456, and 0.784 for APACHE- Ⅱ ( 14 was the optimal cut-off point), respectively. Conclusion The modified APACHE- Ⅱ score system with the intestinal obstruction severity score is a better prediction method for the occurrence of postoperative complications in patients with acute obstructing colorectal carcinoma.