左半结肠癌急性梗阻一期切除吻合的安全保证——彻底快速而无污染的肠减压术(英文)

目的研究一种彻底快速而毫不污染手术野的术中肠减压方法,以便提高手术的安全性。方法游离系膜后,钳夹下将拟切除肠段的下端先切断,将其近侧断端置入并固定于粘附在手术床边的塑料袋中;松开肠钳,肠内容物自由流入袋内;双手交替推挤膨胀的肠段,由近而远,由小肠向大肠,直至大、小肠的内容物彻底排空。钳夹下切断上端,移除切下的肠段和充满粪便的塑料袋。结果使用本法行肠减压术,一期切除急性梗阻的左结肠癌31例,均未发生吻合口漏,创口一期愈合。另有6例肝段切除同时切除未作肠道准备的结肠癌亦取得同样结果。同法亦用于各种急性小肠梗阻,均未造成腹腔污染。结论本法可推荐为术中肠减压的首选方法。     

胆囊良,恶性病变的癌基因产物研究

目的：从分子生物学角度探讨胆囊良病变的潜能以及胆囊癌与多基因改变的关系。方法：应用免疫组化技术，５８例胆囊良、恶性病变的ＥＧＦＲ、Ｐ５３、ｂｃｌ－２的表达。结果：全部病例均呈ｂｃｌ－２阴性表达；ＥＧＦＲ和Ｐ５３在单纯增生病变、腺瘤、腺癌中的表达率分别是０％、２８％、６２．５％和０％、４２．８％、４３．８％，差异增有显著意义（Ｐ〈０．０１）；ＥＧＦＲ阳性表达与腺癌的分级、转移有关（Ｐ〈０．０５，Ｐ＝     

新型提神醒脑药物莫达非尼的合成

以二苯甲基氯和巯基乙酸乙酯为起始原料,经醚化,氨解,氧化三步反应得到新型提神醒脑药物莫达非尼（１）,总收率：４１％,实验结果表明：该方法具有合成路线短,反应条件温和,产物易纯化,收率高等优点,完全适合工业化生产。     

Vimentin significantly promoted gallbladder carcinoma metastasis

Background  The precise molecular mechanisms underlying the gallbladder carcinoma (GBC) metastasis has not been fully elucidated.

Methods  In the present study, metastasis-associated proteins were identified by comparative proteomic analysis. The functional study of the candidate protein vimentin was further investigated. First, a pair of higher and lower metastatic sublines (termed GBC-SD/M3 and GBC-SD, respectively), originated from the same parental cell line, was screened by spontaneous tumorigenicity and metastasis in vivo in animal study and further characterized by metastatic phenotypes analysis in vitro. Subsequently, a proteomic approach comprised two-dimensional gel electrophoresis analysis and mass spectroscopy was used to identify and compare the protein expression patterns between higher metastatic GBC-SD/M3 and lower metastatic GBC-SD cell lines. Then twenty-six proteins were identified.

Results  Among the 26 proteins identified, fourteen proteins were up-regulated and 12 proteins were down-regulated in GBC-SD/M3. Vimentin was identified and found to be overexpressed in GBC-SD/M3 as compared with GBC-SD. This result was further confirmed by quantitative PCR and Western blotting analysis. Furthermore, the cell migration and invasion potency of GBC-SD/M3 in vitro was remarkably suppressed after small interference RNA-mediated knockdown of vimentin. Moreover, immunoblot and immunohistochemical analysis on 12 human GBC specimens showed consistently increased vimentin expression in metastases compared with primary tumors.

Conclusion  Tumor vimentin level may reflect the pathological progression in some GBC and may be a useful marker for predicting tumor metastasis and a therapeutic target for the treatment of GBC patients with metastases.

     

胆囊结石病人Apo B基因Xba I多态性及其与血脂的关系

研究胆囊结石病人Apo B基因中Xba I位点的多态性及其与血脂的关系。方法:对190例胆囊结石病人组和442例正常人对照组,采用PCR-RFLP法分析Xba I多态性的基因型,测定血脂。结果:胆石组的X~( /-)基因型频率显著高于对照组(男性:16.7％比8.0％,P=0.01;女性:26.7％比7.7％,P<0.001;总体:20.6％比7.9％,P<0.001)。胆石组的X~ 等位基因频率显著高于对照组(男性:8.33％比4.01％,P<0.05;女性:14.47％比3.85％,P<0.001;总体:10.79％比3.96％,P<0.001)。胆石组携带X~ 等位基因者的血清总胆固醇(4.85±0.75mmol/L比4.54±0.89mmol/L,P<0.05)和低密度脂蛋白胆固醇(2.74±0.58mmol/L比2.49±0.69mmol/L,P<0.05)均高于不携带X~ 等位基因者,对照组携带X~ 等位基因者的血脂也有类似的增高趋势。结论:Apo B的X~ 等位基因有增高血清胆固醇和低密度脂蛋白胆固醇的特点,可能是胆固醇结石形成的易感基因。     

左半结肠癌急性梗阻一期切除吻合的安全保证

Objective: Thorough, prompt enteral decompression technique without contamination was developed to ensure safety for emergent colon resection and primary anastomosis. Methods: After isolating the mesentery, the to be resected colon segment was cut at its lower end, then the proximal cut end was put into a plastic bag which was adhered to one side of the operating table. After releasing the clamp, the content could flow into this bag. The operator could squeeze the bowel with two hands by turns, from proximal to farness, and from small bowel to large bowel, until the entire bowel content was fully discharged. Then the upper end of this to be resected colon segment was cut, and was removed together with the plastic bag. Results: 31 cases of left colon cancer with acute obstruction were decompressed with this technique. They all recovered smoothly, without anastomosis fistula. Another 6 cases of hepatic segmentectomy with incidental colonectomy were decompressed with this technique and had the same results. This technique was also used in different kinds of acute small intestinal obstruction and gained satisfactory results. Conclusion: This technique could be considered as the preferable choice for intraoperative enteral decompression.     

促神经生长因子生长剂Neotrofin的合成

对氨基苯甲酸乙酯用丙烯酰氯酰化，在碱催化下对腺嘌呤9-位N进行烷基化，随后经重氮化、水解得促神经生长因子生长剂Neotrofin，总收率为55％。     

结石性急性胆管炎不同治疗方式的疗效评估

急性胆管炎是外科的常见病,特别是重症胆管炎来势凶猛,变化快,若处理不当,预后较差。胆管炎中以胆总管结石原因为主。作者单位根据电脑数据库收集了自2002年11月至2007年3月的符合急性胆管炎为主要诊断的病例,全部由胆总管结石为病因,共135例,回顾性分析了采用不同治疗方式对结果的影响,分析如下。     

内皮素在大鼠梗阻性黄疸肝脏损伤中的作用

目的：观察大鼠胆管梗阻后内皮素在肝组织及血液中的分泌状况及甘胆酸的变化，探讨内皮素与甘胆酸之间的关系，方法：用放射免疫法观察大鼠胆管梗阻后5、10、15、20、25天时血及肝组织中内皮素含量，组织病理切片观察肝脏的病理改变。结果与结论：内皮素含量随梗阻性黄疸后时间延长而递增，与甘胆酸升高水平呈正相关(P<0．01)，说明内皮素可能是参与梗阻性黄疸致肝脏损伤的重要因素之一。     

人肾母细胞瘤裸小鼠肾原位移植模型的建立和生物学特性的研究

目的 建立人肾母细胞瘤的裸小鼠肾原位移植模型。方法 直接将未经处理的患儿肾母细胞瘤组织块接种在裸小鼠肾包膜下作原代以及系列传代移植；原、2、3、4代接种裸小鼠数目分别为2、5、5、18只，每代间隔时间均为8周。原、2、3代裸小鼠分别于接种8周后全部处死，4代裸小鼠从接种后3周至8周，每周处死3只至全部，取出移植瘤进行称重，以反映肿瘤生长动力学。采用流式细胞仪检测原代和系列传代肿瘤样本中细胞周期/凋亡分布以及倍体数。光学显微镜下观察肿瘤标本形态学以及角质蛋白18和结蛋白的免疫组化染色特征，聚合酶链反应扩增基因组微卫星序列D14S68、D18S69and D20S199，以确定其人源性。结果 人肾母细胞瘤在原代裸小鼠中形成肾原位移植瘤，随后系列传四代，共30只裸小鼠，其中27只在肾原位可以检测到移植瘤生长；移植瘤生长曲线符合指数模型，其倍体数、细胞周期分布在各代之间相似。所有移植瘤都保留了最初的组织形态学和免疫组化染色特征。而且，移植瘤基因组微卫量DNA序列与人肾母细胞瘤完全一致。结论 该异种原位移植瘤模型，准确地重现所移植的人肾母细胞瘤的形态和恶性生物学特点，具有重要的基础和临床研究应用价值。