腹膜转移瘤的影像学诊断

目的探讨腹膜转移瘤的影像学表现特点。方法回顾性分析经手术及穿刺活检证实的35例腹膜转移瘤的影像学表现,并与手术结果对照,35例做CT平扫及增强扫描,5例行MR I检查。结果(1)腹膜转移瘤常表现为大量腹水(22/35);(2)腹膜结节状增厚(23/35);(3)大网膜饼形增厚(16/35)和大网膜污垢样改变(12/35);(4)肠系膜污垢样改变(12/35)及结节状改变(9/35);(5)腹腔单发或多发囊性改变,有占位效应(4/35)。结论CT/MR I是发现腹膜转移灶的重要影像学方法。     

几丁糖预防腹膜粘连抑制胶原基因表达的实验研究

目的 :探讨几丁糖在胶原基因表达及预防大鼠腹膜粘连形成中的作用。方法 :制作大鼠回肠浆膜均一缺损的腹膜粘连模型 ,关腹前注入乳酸Ringer液或几丁糖 ,术后 14天进行粘连评分。采用半定量逆转录 -聚合酶链反应 (RT PCR)方法测定各粘连组织标本Ⅰ型胶原基因mRNA的表达 ;采用苦味酸天狼猩红染色 -偏振光法及计算机图像分析系统来观察和分析Ⅰ型和Ⅲ型胶原纤维在粘连组织中的分布及染色表达面积。结果 :与正常腹膜和乳酸Ringer’s液组相比 ,几丁糖组大鼠的粘连显著减轻 ,Ⅰ型胶原基因mRNA的表达减弱 ,Ⅰ型胶原形成减少 (P <0 .0 1) ,Ⅲ型胶原在各组间无差别 (P >0 .0 5 )。结论 :胶原基因的过度表达可能在粘连形成过程中有重要的作用 ,几丁糖能抑制Ⅰ型胶原基因的表达 ,减少Ⅰ型胶原的合成 ,从而减轻粘连的程度     

Culture of menstrual endometrium with peritoneal explants and mesothelial monolayers confirms attachment to intact mesothelial cells

BACKGROUND: To evaluate adhesion of menstrual endometrium (ME) to intact peritoneal mesothelium. METHODS: Explants of peritoneum were cultured for 1 h with ME (n = 6). Specimens were serially sectioned for haematoxylin and eosin stain and immunohistochemistry using an anti-cytokeratin antibody to label mesothelium. Confocal laser scanning microscopy (CLSM) was performed to identify an intact layer of mesothelial cells (MC) underlying sites of ME attachment. Also, ME and MC were labelled with Cell-Tracker dyes. ME was cultured with mesothelial monolayers for 1 h (n = 10). Cultures were examined with differential interference contrast and CLSM. Optical sections were taken and a three-dimensional model was constructed. RESULTS: In the peritoneal explants, ME adhered to intact mesothelium. There was no evidence of transmesothelial invasion. CLSM of sections of the explants demonstrated an intact monolayer of cytokeratin positive cells below the sites of ME implantation. Cytokeratin negative and positive ME cells adhered to mesothelial cells. Likewise, the ME attached to cultured mesothelium. Orthogonal sections and three-dimensional reconstruction confirmed an intact monolayer of mesothelium underlying ME attachment sites. CONCLUSIONS: This study confirms that ME adheres rapidly to intact peritoneal mesothelium. Further studies are needed that characterize the mechanisms of ME adhesion to, and migration through, mesothelial cells.     

Inhibition of chemokines prevents intraperitoneal adhesions in mice

BACKGROUND: The present study evaluates the efficacy of a broad-spectrumchemokine inhibitor, NR58-3.14.3, in the prevention of adhesionformation after i.p. surgery in mice. METHODS: A total of 110eight week old female Balb/c mice underwent laparotomy. Fortyanimals were randomly assigned to receive daily i.p. injectionsof either vehicle (control) or NR58-3.14.3. Time-course of adhesionformation was assessed. A titration of NR58-3.14.3 was conductedfor i.p. and s.c. administrations. The effectiveness of a singleintra-operative dose of NR58-3.14.3 was evaluated. Number, extent,location and type of adhesions were recorded. Immunohistochemistryof adhesions was done with leukocyte common antigen, CD45. RESULTS:Adhesion scores peaked on post-operative days 6–8. Onboth days 6 and 8, there were smaller adhesion size and lowercumulative adhesion scores in NR58-3.14.3-treated group. Moreover,on day 8, there were significantly fewer adhesions in NR58-3.14.3-treatedgroup compared to controls. The least effective dose for i.p.administration of NR58-3.14.3 was 0.45 mg/animal. Subcutaneousand single intra-operative i.p. administrations were also effectivein the prevention of i.p. adhesions. Although NR58-3.14.3 decreasedthe number of CD45⁺ inflammatory cells in the adhesions by 22.5%compared to control group, this was not significant. CONCLUSIONS:Our results show that this broad-spectrum chemokine inhibitorprevents post-operative adhesions in mice and may have a potentialclinical use.     

In-vitro adhesion of endometrium to autologous peritoneal membranes: effect of the cycle phase and the stage of endometriosis

BACKGROUND: Endometrium can adhere to autologous peritoneum. This study was undertaken to determine the effect of the menstrual cycle phase and the presence and stage of endometriosis on in-vitro adhesion of endometrium onto autologous peritoneum. METHODS: This was performed in an academic medical research centre. Sixty-seven subfertile women with a visually normal pelvis (n = 18) and with biopsy-proven endometriosis (n = 49) were included. Endometrial and peritoneal biopsies were obtained at laparoscopy during menstrual, follicular and luteal phase. Endometrium was cultured in vitro with autologous peritoneum, followed by fixation, paraffin embedding, serial sectioning, hematoxylin-eosin and immunohistochemical staining. Endometrial-peritoneal adhesion was evaluated using light microscopy. RESULTS: Endometrial-peritoneal adhesion was observed in approximately 80% of the adhesion assays and was not affected by the phase of the cycle, or by the presence and stage of endometriosis. The continuity of the mesothelial layer was disrupted at the attachment sites. Epithelialization was observed along the edges to integrate the endometrial implant. After adhesion, histological changes were observed within and below the implant. CONCLUSIONS: Endometrium obtained during menstrual, follicular or luteal phase appears to have a similar potential to implant in vitro on autologous peritoneum, and this adhesion process is not affected by the stage of endometriosis.     

不缝合腹膜剖宫产术式的临床观察

目的　探讨不缝合腹膜剖宫产术式的临床效果。方法　选取剖宫产不缝合腹膜 80例产妇作为观察组 ,与同期分娩按传统方法缝合腹膜产妇 80例作为对照组 ,观察两组术后病率、肠功能恢复及切口愈合情况。结果　观察组术后病 6例 ,对照组 15例 ,两组比较 ,差异有显著性 (P <0 0 5 ) ;观察组术后肛门排气时间为 2 0 5± 5 33h ,对照组为 36 6 7± 6 17h ,两组比较 ,差别有高度统计学意义 (P <0 0 1) ;腹部切口愈合两组无差异。结论　不缝合腹膜剖宫产术式安全、有效、并发症少 ,值得在临床上推广应用。     

大鼠膈腹膜间皮通透性的电镜观察

腹膜腔内注射兔血液和中墨汁后，用电镜观察了大鼠膈腹膜间皮对示踪剂血细胞和碳颗粒的通透笥。在膈膜隐窝区，示踪剂经三种途径通过膈腹膜间皮。（１）间皮孔的吸收作用。示踪剂由腹膜腔经间皮孔直接进入膈毛细淋巴管，或被成纤维细胞的突起包绕。（２）间皮细胞的吞噬作用。（３）示踪剂通过间皮细胞间裂隙或细胞间连接。     

大鼠膈腹膜间皮孔的电镜观察

用扫描电镜和透射电镜观察了正常大鼠膈腹膜间皮，并观察了腹膜腔内注射中国墨汁和兔血液后大鼠膈腹膜间皮的变化以及腹膜腔和间皮下毛细淋巴管的关系。     

腹膜淋巴孔研究的新进展

腹膜淋巴孔是腹膜下毛细淋巴管在腹膜间皮细胞间的开口。通过淋巴孔、腹膜腔与淋巴管系直接相通,它具有主动吸收功能,是腹膜腔内物质转归的最主要部位。淋巴孔与肝硬化腹水的转归、连续不卧床腹膜透析的失超滤、肿瘤细胞的转移和扩散等密切相关。淋巴孔还具有调控和免疫功能。ＮＯ对淋巴孔调控作用是目前研究的热点,它通过激活鸟苷酸环化酶途径,增加细胞内ｃＧＭＰ,降低Ｃａ＾２＋水平,使淋巴孔产生强烈的舒张,淋巴孔开放数目增多、孔径增大,淋巴引流作用增强。而中药通过提高内源性ＮＯ水平,也能对腹膜淋巴孔进行调控,以促腹水转归。