沉默Lin28b基因表达促进人结肠癌细胞奥沙利铂化疗敏感性

目的 探讨人结肠癌细胞中Lin28b基因表达及其与奥沙利铂化疗敏感性之间的关系.方法 构建干扰Lin28b的shRNA质粒(sh-Lin28b),并转染至结肠癌细胞(Cac02、SW480和HCT116细胞);逆转录-聚合酶链反应(RT-PCR)和Western blot法分别检测结肠癌细胞中Lin28b在mRNA和蛋白水平的表达;用细胞计数试剂盒(CCK-8)检测sh-Lin28b和奥沙利铂化疗协同作用,Transwell实验检测处理后的结肠癌细胞迁移能力.结果 RT-PCR和Western blot结果证实Cac02、HCT116及SW480结肠癌细胞中均有Lin28b基因表达,其中在SW480细胞中的蛋白表达量比在HCT116中高1.83倍.SW480和HCT116细胞中Lin28b的mRNA表达在50 nmol/L的sh-Lin28b作用下分别被下调36.4％和90.2％,在100 nmol/L的sh-Lin28b的条件下分别被下调61.8％和89.5％.CCK-8结果显示奥沙利铂处理48 h后,HCT116细胞的IC50值为(6.09±1.42) mg/L,SW480细胞升高34.3％,至(8.18 ±3.64) mg/L.sh-Lin28b联合奥沙利铂处理组比较于对照转染组(NC)抑制SW480和HCTll6细胞生存率分别为(55.10±0.78)％和(50.30±0.69)％.Transwell 实验结果显示SW480细胞的迁移能力在sh-Lin28b的作用下降低至(48.60±0.92)％.结论 沉默表达于结肠癌细胞的Lin28b,可显著抑制结肠癌细胞的迁移能力,并促进奥沙利铂的化疗敏感性.     

腹腔镜与同期开腹直肠癌根治术后肿瘤学结果对比研究

目的 评价腹腔镜和同期开腹直肠癌根治术在肿瘤学结果方面的差异.方法 分析南方医院2003年1月至2008年12月期间520例行直肠癌根治术的TNM Ⅰ～Ⅲ期病例的临床随访资料,其中腹腔镜组186例,开腹组334例,对2组术后复发、生存等肿瘤学结果进行比较.结果 腹腔镜组和开腹组基本临床病理特征及辅助治疗情况具有均衡可比性.2组平均随访30.3个月.腹腔镜组与开腹组比较,3年累积生存率为83%比80%,远处转移率为12.5%比15.6%,戳孔/切口癌转移率为0.6%比0,差异均无统计学意义(P>0.05);局部复发率为4.8%比10.7%,3年累积无病生存率为81%比68%,差异均具有统计学意义(P<0.05).生存分析显示,累积生存率2组差异无统计学意义(P=0.142),而累积无病生存率腹腔镜组则显著高于开腹组(P=0.010).Ⅰ或Ⅱ期病例中2组局部复发率、远处转移率、累积生存率及累积无病生存率的差异均无统计学意义(P>0.05);Ⅲ期病例远处转移率、累积生存率差异亦无统计学意义(P>0.05),但Ⅲ期病例腹腔镜组局部复发率显著低于开腹组(6.8%比17.7%,P=0.047),累积无病生存率则显著高于开腹组(P=0.045).结论 腹腔镜直肠癌根治术可以达到甚至优于同期开腹根治术的肿瘤学结果,提示针对直肠癌的腹腔镜外科前瞻性随机对照研究的可行性和必要性.     

LIN28B在结肠癌中的表达及其临床意义

目的探讨结肠癌组织中LIN28B的表达及其临床意义。方法选择美国Biomax的结肠癌及正常组织组合微阵列芯片及2003年1月至2004年12月南方医科大学南方医院的149例手术切除结肠癌石蜡标本作为研究对象。用免疫组化法检测组织芯片和石蜡切片中LIN28B蛋白表达并评分。采用χ2检验比较不同LIN28B表达水平和结肠癌病理性特点包括组织分级、恶性肿瘤(tumor,node,metastasis,TNM)分期及淋巴/远处转移之间的关系。结果 LIN28B在结肠癌组织中相比于正常结肠组织高表达,其高表达与肿瘤的低分化、TNMⅢ-Ⅳ期、结肠癌局部淋巴结转移及远处转移有关。多因素Logistic回归分析显示TNM分期是LIN28B高表达的独立危险因素。结论 LIN28B表达与结肠癌病理特征密切相关,有望作为判断结肠癌患者预后的指标。     

结直肠癌腹膜种植转移的危险因素分析

Objective To investigate risk factors associated with peritoneal metastasis in colorectal cancer. Methods Clinicopathological data of 873 patients with colorectal cancer treated at the Nanfang Hospital of Southern Medical University from January 2003 to December 2008 were retrospectively analyzed. The associations between peritoneal metastasis and cliniopathological factors were evaluated by univariate analysis including independent-samples t test and x2 test, and multivariable logistic regression analysis. Results Univariate analysis showed that age(P=0.032), tumor size(P=0.001 ),tumor differentiation (P=0.008), depth of bowel wall invasion ( P=0.000 ), lymph node metastasis ( P=0.000 ),serum carcinoembryonic antigen (CEA) level(P=0.003), and serum carbohydrate antigen 19-9(CA19-9)level (P=0.009) were associated with peritoneal metastasis. On multivariable logistic regression analysis,depth ofbowelwallinvasion, lymph node metastasis, serum CEA level and CA19-9 level remained as significant risk factors (all P＜0.05). Conclusion Depth of bowel wall invasion, lymph node metastasis,serum CEA level, and CA19-9 level are risk factors for peritoneal metastasis in colorectal cancer.     

腹腔镜结直肠癌手术应用及其评价

腹腔镜手术在结直肠癌外科有着重要的应用价值。最新的临床研究结果亦肯定了腹腔镜在结直肠外科治疗中的应用价值,显示了乐观的前景,但其临床应用仍需多中心前瞻性随机对照研究数据的支持。     

结直肠癌腹膜种植转移的危险因素分析

目的 探讨结直肠癌腹膜种植转移的危险因素.方法 回顾性分析2003年1月至2008年12月南方医院普通外科收治的873例结直肠癌患者的临床病理资料,研究结直肠癌腹膜种植转移与临床和病理因素的关系.结果 873例患者中,腹膜种植转移97例（11.1%）.单因素分析显示,患者的年龄（P=0.032）、肿瘤大小（P=0.001）、肿瘤分化程度（P=0.008）、肠壁浸润深度（P=0.000）、淋巴结转移（P=0.000）、术前CEA（P=0.003）和血清糖链抗原19-9（CA19-9）水平（P=0.009）与结直肠癌腹膜种植转移有关.Logistic多因素回归分析显示,肠壁浸润深度、淋巴结转移以及术前CEA和CA19-9水平与结直肠癌腹膜种植转移有关（均P＜0.05）.结论 肠壁浸润深度、淋巴结转移、术前CEA及CA19-9水平是影响结直肠癌腹膜种植转移的独立危险因素.     

腹腔镜手术治疗合并常见慢性病老年直肠癌患者的疗效评估

目的 探讨腹腔镜手术治疗合并常见慢性病的老年直肠癌患者的可行性、安全性及疗效.方法 回顾性总结2003年1月至2008年12月南方医科大学南方医院收治的192例合并常见慢性病的老年直肠癌患者的临床资料.192例患者分为腹腔镜组(91例)和开腹组(101例),比较两组患者的手术学指标、肿瘤学指标、预后指标.计量、计数资料分别采用t检验和x2检验,患者生存情况采用寿命表法和Kaplan-Meier法.结果 腹腔镜组和开腹组患者保肛率、手术时间、术后住院时间、术后主要并发症发生率分别为85.7%(78/91)、(194±61)min、(14±8)d、24.2%(22/91)和85.1%(86/101)、(187±58)min、(14±8)d、28.7%(29/101),其差异无统计学意义(x2=0.012,t=0.874,-0.265,x2=0.505,P＞0.05);术中出血量、术后肛门排气时间、进流质饮食时间和下床活动时间分别为(108±78)ml、(3±1)d、(4±2)d、(3±1)d和(270±600)ml、(4±1)d、(5±2)d、(5±1)d,其差异有统计学意义(t=-2.650,-4.545,-4.587,-13.310,P＜0.05).腹腔镜组和开腹组患者标本切除长度、淋巴结清扫数目分别为(18±5)cm、(9±7)枚和(18±5)cm、(9±8)枚,其差异无统计学意义(t=1.457,0.021,P＞0.05);而腹腔镜组肠管远切缘长度(3.8±1.5)cm显著长于开腹组的(3.1±1.5)cm(t=0.283,P＜0.05).腹腔镜组和开腹组患者3年累积生存率、总复发率、局部复发率、远处转移率分别为76%、12.1%(11/91)、2.2%(2/91)、9.9%(9/91)和82%、14.9%(15/101)、6.9%(7/101)、7.9%(8/101),其差异无统计学意义(U=2.600,x2=0.312,2.400,0.230,P＞0.05);生存分析显示,两组TNM Ⅰ、Ⅱ、Ⅲ期和Ⅰ～Ⅲ期患者累积生存率比较,差异无统计学意义(P＞0.05).结论 腹腔镜手术治疗合并常见慢性病的老年直肠癌患者是安全可行的,在术后恢复方面显示出明显的微创价值.

Abstract：

Objective To evaluate the feasibility, safety and clinical outcome of laparoscopic radical resection of rectal cancer in elderly patients with common chronic comorbidities. Methods The clinical data of 192 elderly patients with rectal cancer and common chronic comorbidities who were admitted to the Nanfang Hospital from January 2003 to December 2008 were retrospectively analyzed. All patients were divided into laparoscope group (n=91) and open group (n = 101). The operative procedures, clinicopathological data and outcomes of the two groups were collected and compared. All data were analyzed using the t test and chi-square test, and the survival of patients was analyzed using the life table and Kaplan-Meier curves. Results The sphincter preservation rate,operation time, postoperative length of hospital stay, morbidity rate were 85.7% (78/91), (194 ± 61) minutes,(14 ±8)days, 24.2% (22/91) in the laparoscope group, and they were 85.1% (86/101), (187 ±58) minutes,(14 ±8)days and 28.7% (29/101) in the open group, with no significant difference between the two groups (x2=0.012, t=0.874,-0.265, x2 =0. 505 , P ＞ 0. 05) . The intraoperative blood loss was (108 ±78)ml in the laparoscope group, which was significantly less than (270 ± 600) ml in the open group (t =-2. 650, P ＜0.05). The time to first flatus, time to liquid diet, time to out-of-bed activity were (3 ± 1) days, (4 ± 2) days and (3 ± 1)days, which were significantly shorter than (4 ± 1)days, (5 ± 2)days and (5 ± 1)days in the open group,respectively (t =-4. 545,-4. 587,-13. 310, P ＜ 0.05). The length of rectum resected and the number of lymph node dissected were (18 ± 5)cm and 9 ± 7 in the laparoscope group, and (18 ± 5)cm and 9 ± 8 in the open group, respectively, with no significant difference between the two groups (t = 1. 457, 0. 021, P ＞ 0.05), while the distance of distal resection margin to the tumors was (3.8 ± 1.5) cm, which was significantly longer than (3.1 ± 1.5) cm of the open group (t = 0. 283, P ＜ 0. 05). The 3-year cumulative survival rate, overall recurrence rate, local recurrence rate and distal metastasis rate in the laparoscope group were 76%, 12. 1% (11/91), 2.2% (2/91) and 9.9% (9/91), and they were 82%, 14.9% (15/101), 6.9% (7/101), 7.9% (8/101) in the open group, respectively, with no significant difference between the two groups (U=2. 600, x2 =0. 312, 2.400,0. 230, P ＞ 0.05). There were no significant difference in the cumulative survival rate between patients in TNM stage Ⅰ, Ⅱ and Ⅲ in the two groups (P ＞ 0.05). Conclusion Laparoscopic radical resection of rectal cancer is safe and feasible for elderly patients with common chronic comorbidities, and it has the advantages in quick recovery of patients after operaion.     

腹腔镜与同期开腹直肠癌切除术后长期肿瘤学结果的对比研究

摘要：目的比较腹腔镜及同期开腹直肠癌切除术术后的长期肿瘤学结果。方法回顾性分析南方医院自2003年1月~2008年
12月收治的514例病人的临床随访资料,对186例腹腔镜组和328例开腹组病人术后复发类型及长期生存结果进行了比较。结
果两组病人的中位随访时间为（48.54±28.76）月,两组间远处转移(3.9% vs 5.5%;P=0.284)、5年累积总生存率(69.5% vs 61.7%;
P=0.085)和5年无病生存率(67.7% vs 60.7%;P=0.110)的差异无统计学意义。IV期病例中腹腔镜组5年累计总生存率和5年无
进展生存率均高于开腹组（P<0.05）。结论腹腔镜直肠癌切除术可以获得不劣于开腹手术的长期肿瘤学结果。
     

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目的评价腹腔镜及开腹手术治疗浆膜浸润结直肠癌病人的预后。方法回顾性分析2003年6月至2007年6月南方医科大学附属南方医院收治的浆膜浸润结直肠癌病人的临床、病理资料及随访数据。对两组病人生存及复发情况进行比较。结果腹腔镜组和开腹组病人的基线数据及随访时间差异无统计学意义。腹腔镜组总死亡率为20.7%,开腹组为28.9%,两组之间差异无统计学意义(P=0.234);腹腔镜组肿瘤相关死亡率为17.2%,开腹组为26.8%,两组之间差异无统计学意义(P=0.105);腹腔镜组复发率为12.1%,开腹组为26.8%,差异有统计学意义(P=0.024)。生存分析显示腹腔镜组病人累积无复发率高于开腹组(P=0.035),两组病人累积总存活率(P=0.159)及肿瘤相关存活率(P=0.083)差异无统计学意义。结论对于浆膜侵润的结直肠癌,腹腔镜组病人复发率明显低于开腹组,因此可以获得部分优于开腹手术的结果。