医源性胆管损伤21例治疗体会

目的总结医源性胆管损伤的原因、预防及处理经验。方法对21例医源性胆管损伤的临床资料进行回顾性分析。结果本组21例病例中,痊愈出院17例（81%）,死亡1例（4.8%）,死亡原因为胆汁性腹膜炎导致的感染中毒性休克。3例术后晚期胆管狭窄患者,经单纯的ERCP扩张并置支架内引流,效果不佳,自动放弃手术治疗。术后存活的17例患者中,术后1年有3例出现胆管炎反复发作,影像学证实为胆管再狭窄,经再次手术后痊愈。结论提高对医源性胆管损伤的认识和术中细致的解剖是预防的关键。胆管空肠吻合术是医源性胆管损伤或损伤性胆管狭窄的修复重建的主要手段。     

氟尿嘧啶植入剂在Ⅲ期胃癌患者根治术中的应用

目的探讨氟尿嘧啶植入剂在Ⅲ期胃癌患者根治术中应用的临床疗效。方法分析中山市人民医院1999年1月至2002年12月收治的200例Ⅲ期胃癌根治术患者（120例患者术中使用氟尿嘧啶植入剂）的一般情况及生存情况，观察氟尿嘧啶植入剂在胃癌患者根治术中应用的临床疗效。结果两组在体重（P=0．041）、血红蛋白（P=0．024）、血小板（P=0．017）及肿瘤标志物CEA（P=0．001）、CA199（P=0．003）之间差异有统计学意义。治疗组恶心、呕吐的发生率（28％）高于对照组（17％，P=0．006）；两组骨髓抑制（P=0．81）、腹泻（P=0．72）、肝功能损害（P=0．97）及肾功能损害（P=0．20）的发生率差异无统计学意义。5年累积生存率治疗组（45％）高于对照组（15％，P=0．002）。结论胃癌根治术中应用氟尿嘧啶植入剂可显著提高患者的临床疗效。     

Expression and significance of β-catenin and peroxisome proliferator-activated receptor-γ in hepatocellular carcinoma

Objective To investigate the expression and significance of β-catenin and peroxisome prolifera-tot-activated receptor-γ,(PPARγ) in bepatocellular carcinoma. Methods Tissue microarrays were established to detect β-catenin and PPARγ expression in 49 cases of hepatocellular carcinoma,49 cases of adjacent nontumoral liv-er tissue and 6 cases of normal liver tissue. The relationships between PPARγ and β-catenin as well as between PPARγ and clinicopathological parameters were observed. Results The aberrant expression rate of β-catenin was 69.39%,48.98 % and 0 respectively (P=0.001). The positive expression rate of PPARγ was 51.02%,30.61% and 0 respectively (P=0.016). Clinicopathological analysis revealed that the increase of PPARγ expression was not associated with age,tumor size,serum alpha fetoprotein (AFP) levels,tumor embolus of portal vein or inferior vena cava,and HBsAg infection(χ2=0.214,3.201,0.046,3.201,P>0.05 for each),but correlated with differentiation grades(χ2=4.693,P<0.05). Aberrant expression of β-catenin was associated with PPARγ expression(χ2= 5.130,P<0.05). Conclusion Aberrant expression of β-catenin may involve in the liver carcinogenesis. The high expression of PPARγ in hepatocellular carcinoma is significantly correlated with the clinicopathological characteris-tics. Detection of PPARγ is valuable for diagnosing hepatocellular carcinoma,and evaluating malignancy extent and prognosis.     

腹腔镜超低位直肠癌经括约肌间切除术后肛门控便机制变化的研究

目的探讨腹腔镜超低位直肠癌经括约肌间切除（ISR）术后肛门控便机制变化的规律。 方法选择2014年6月至2016年6月间29例腹腔镜超低位直肠癌ISR术患者为治疗组,分别于术后1、3、6、12个月时进行肛门失禁Wexner评分,与肛管测压、代直肠静息容量测定相结合以评估患者的排便功能,同时设立健康成人对照组,进行统计学分析。 结果肛门失禁Wexner评分显示,治疗组术后1、3、6、12个月均与对照组差异有统计学意义（P<0.01）,治疗组内术后3、6、12个月均与上一个检测时间点差异有统计学意义（F=182.4,P<0.001）。患者肛管压力测定显示,治疗组术后1、3、6个月的最大静息压、最大收缩压均明显低于对照组（P<0.05）,治疗组内术后3、6、12个月的最大静息压均与上一个检测时间点差异有统计学意义（F=25.029,P<0.05）。代直肠静息容量测定显示,治疗组所有检测时间点的静息向量容积、收缩向量容积均明显低于对照组（均P<0.001）,治疗组内术后3、6、12个月均与上一个检测时间点差异有统计学意义（F=4 640.715、3 421.403,均P<0.001）。 结论低位直肠癌经括约肌间切除术的患者肛门控便功能是一个逐渐恢复的过程,术后12个月左右达到或接近正常水平。     

Expression and significance of β-catenin and peroxisome proliferator-activated receptor-γ in hepatocellular carcinoma

Objective To investigate the expression and significance of β-catenin and peroxisome prolifera-tot-activated receptor-γ,(PPARγ) in bepatocellular carcinoma. Methods Tissue microarrays were established to detect β-catenin and PPARγ expression in 49 cases of hepatocellular carcinoma,49 cases of adjacent nontumoral liv-er tissue and 6 cases of normal liver tissue. The relationships between PPARγ and β-catenin as well as between PPARγ and clinicopathological parameters were observed. Results The aberrant expression rate of β-catenin was 69.39%,48.98 % and 0 respectively (P=0.001). The positive expression rate of PPARγ was 51.02%,30.61% and 0 respectively (P=0.016). Clinicopathological analysis revealed that the increase of PPARγ expression was not associated with age,tumor size,serum alpha fetoprotein (AFP) levels,tumor embolus of portal vein or inferior vena cava,and HBsAg infection(χ2=0.214,3.201,0.046,3.201,P>0.05 for each),but correlated with differentiation grades(χ2=4.693,P<0.05). Aberrant expression of β-catenin was associated with PPARγ expression(χ2= 5.130,P<0.05). Conclusion Aberrant expression of β-catenin may involve in the liver carcinogenesis. The high expression of PPARγ in hepatocellular carcinoma is significantly correlated with the clinicopathological characteris-tics. Detection of PPARγ is valuable for diagnosing hepatocellular carcinoma,and evaluating malignancy extent and prognosis.     

Expression and significance of β-catenin and peroxisome proliferator-activated receptor-γ in hepatocellular carcinoma

Objective To investigate the expression and significance of β-catenin and peroxisome prolifera-tot-activated receptor-γ,(PPARγ) in bepatocellular carcinoma. Methods Tissue microarrays were established to detect β-catenin and PPARγ expression in 49 cases of hepatocellular carcinoma,49 cases of adjacent nontumoral liv-er tissue and 6 cases of normal liver tissue. The relationships between PPARγ and β-catenin as well as between PPARγ and clinicopathological parameters were observed. Results The aberrant expression rate of β-catenin was 69.39%,48.98 % and 0 respectively (P=0.001). The positive expression rate of PPARγ was 51.02%,30.61% and 0 respectively (P=0.016). Clinicopathological analysis revealed that the increase of PPARγ expression was not associated with age,tumor size,serum alpha fetoprotein (AFP) levels,tumor embolus of portal vein or inferior vena cava,and HBsAg infection(χ2=0.214,3.201,0.046,3.201,P>0.05 for each),but correlated with differentiation grades(χ2=4.693,P<0.05). Aberrant expression of β-catenin was associated with PPARγ expression(χ2= 5.130,P<0.05). Conclusion Aberrant expression of β-catenin may involve in the liver carcinogenesis. The high expression of PPARγ in hepatocellular carcinoma is significantly correlated with the clinicopathological characteris-tics. Detection of PPARγ is valuable for diagnosing hepatocellular carcinoma,and evaluating malignancy extent and prognosis.     

Expression and significance of β-catenin and peroxisome proliferator-activated receptor-γ in hepatocellular carcinoma

Objective To investigate the expression and significance of β-catenin and peroxisome prolifera-tot-activated receptor-γ,(PPARγ) in bepatocellular carcinoma. Methods Tissue microarrays were established to detect β-catenin and PPARγ expression in 49 cases of hepatocellular carcinoma,49 cases of adjacent nontumoral liv-er tissue and 6 cases of normal liver tissue. The relationships between PPARγ and β-catenin as well as between PPARγ and clinicopathological parameters were observed. Results The aberrant expression rate of β-catenin was 69.39%,48.98 % and 0 respectively (P=0.001). The positive expression rate of PPARγ was 51.02%,30.61% and 0 respectively (P=0.016). Clinicopathological analysis revealed that the increase of PPARγ expression was not associated with age,tumor size,serum alpha fetoprotein (AFP) levels,tumor embolus of portal vein or inferior vena cava,and HBsAg infection(χ2=0.214,3.201,0.046,3.201,P>0.05 for each),but correlated with differentiation grades(χ2=4.693,P<0.05). Aberrant expression of β-catenin was associated with PPARγ expression(χ2= 5.130,P<0.05). Conclusion Aberrant expression of β-catenin may involve in the liver carcinogenesis. The high expression of PPARγ in hepatocellular carcinoma is significantly correlated with the clinicopathological characteris-tics. Detection of PPARγ is valuable for diagnosing hepatocellular carcinoma,and evaluating malignancy extent and prognosis.     

高迁移率族蛋白HMGA1在肝细胞癌及胆管细胞癌中的表达差异及临床意义

目的：探讨高迁移率族蛋白A1（HMGA1）在肝细胞癌（HCC）、肝内胆管细胞癌（IHC）中的表达差异和临床意义。 方法：采用免疫组化SABC法对60例HCC、42例胆管细胞癌及10例正常肝脏组织标本中HMGA1的表达情况进行检测,并分析其与临床病理特点之间的关系。 结果：HMG组A1在10例正常肝脏组织中无一例表达,在HCC组中表达率为3.3％（2/60）,在IHC组中表达率为66.7％（28/42）。IHC组与HCC组中HMGA1表达差异有统计学意义（P = 0.000）;IHC组HMGA1与p53的表达呈正相关（r = 0.673,P＜0.05）;1年内死亡患者的HMGA1表达水平（80.0％）较1年内存活患者的（33.3％）高,差异有统计学意义（P 〈 0.05）。 结论：HMGA1可作为鉴别肝细胞癌与肝内胆管细胞癌的一个潜在指标。HMGA1在肝内胆管细胞癌的生成中可能发挥了重要作用,HMGA1在肝内胆管细胞癌的高表达提示预后不良。     

连续64例胰十二指肠切除无胰漏并发症的临床经验

目的探讨预防胰十二指肠切除术后并发症的临床经验。方法回顾性总结胰十二指肠切除术64例的临床资料。结果全组无胰漏发生,术后并发伤口感染3例,胃排空障碍1例,肺部感染1例,胃肠出血1例,腹腔脓肿1例,胆瘘1例。并发症发生率为12.5%(8/64)。结论胰管内支撑引流、精细的胰肠吻合和有效的围手术期治疗是预防Whipple术后胰漏的关键。     

肝癌术后黄疸原因分析

目的　研究围手术期影响肝癌术后胆红素水平的相关因素以及相应的处理办法。方法　回顾分析 2 94例肝癌手术病例 (排除术前存在梗阻性黄疸者 ) ,找出影响术后胆红素的因素。对比术后胆红素≥ 5 1.3m mol/ L 与术后胆红素 <5 1.3mm ol/ L 两组病人在危险因素与近期疗效的差别。结果　术后胆红素与术前胆红素水平、肝硬化程度、手术持续时间和术中出血量明显相关。 4 8例观察组病人术前胆红素水平更高 (P<0 .0 0 1)、肝硬化较重 (P<0 .0 0 1)、手术持续时间长 (P<0 .0 0 1)、术中出血多 (P<0 .0 1)、住院时间长 (P<0 .0 1)、并发症和死亡率增高 (P<0 .0 0 1)。结论　 1围手术期胆红素水平在判断肝癌病人近期疗效中具有价值。 2手术应选择肝硬化程度轻或 /无 ,肝储备功能良好的病人、控制手术时间、减少术中出血量、及时处理术后胆道梗阻、加强围手术期治疗