超声引导射频消融联合^125I粒子植入治疗进展期胰腺癌

目的研究超声引导射频消融联合^125I粒子植入对进展期胰腺癌的治疗效果。方法对11例不能手术切除的胰腺癌患者实施术中超声引导射频消融联合^125I粒子植入治疗。结果术后1个月内11例患者均有不同程度的疼痛缓解,9例黄疸患者中黄疸指数下降,CA199与术前相比均有所减低,有2例患者术后发生胰瘘,均于1个月内治愈。术后超声和CT扫描检查提示肿瘤有较明显改变。随访期内死亡3例,1例死于心血管疾病,另2例死于肿瘤全身转移,6个月生存率72．7％。结论超声引导射频消融联合^125I粒子植入治疗进展期胰腺癌是较为有效和安全的方法之一。     

肝癌的冷冻治疗

冷冻疗法己成为治疗不能手术切除肝癌的重要手段。冷冻方法可选择手术中冷冻，切除或不切除肿瘤、腹腔镜下冷冻，或在超声、CT下，经皮冷冻。作为一局部治疗，冷冻具有超越其他治疗方法的若干优点：仅消融肝内肿瘤组织，而少伤及正常组织；由于大血管流动血流的温热作用，冷冻可安全地治疗临近大血管的肝肿瘤；冷冻比手术更适宜治疗肝多发性肿瘤。冷冻联合肝动脉化疗栓塞（TACE）、酒精注射或^125碘粒子植入，有相辅相成的作用。对于冷冻在肝癌治疗中应用，可归结如下：①〈5cm，尤其〈3cm的肝癌，数目不超过3个，可以手术中冷冻或经皮冷冻。②〉5cm的肝癌，先作TACE，再给予经皮冷冻。③〉5cm，边缘不整，预计冷冻不完全的肝癌，可予手术中或经皮冷冻，同时在冷冻区周边部注射酒精或植入^125碘粒子。     

超声内镜引导125I粒子组织间植入治疗晚期胰腺癌的疗效及粒子移位分析

目的分析胰腺癌超声内镜（EUS）引导下^125I粒子种植术治疗晚期胰腺癌的肿瘤变化及粒子移位，并评价其治疗效果。方法对17例不能手术切除的中晚期胰腺癌患者行EUS引导下放射性^125I粒子内照射治疗。所有患者治疗前均参照治疗设计系统估算期望植入粒子数量。治疗后每月复查，观察治疗前、后肿瘤变化及粒子移位、脱落等情况。结果17例患者均经EUS植入^125I粒子成功。治疗前肿瘤最大长径平均值为5．4cm（3．7～9．0cm），平均植入粒子数量为27颗，平均每次植入粒子中位数为14（7～24）颗，平均植入2次。平均单颗粒子的放射性活度为（0.689±0．016）mCi。治疗后平均随访4．8个月（2～14个月）。治疗后3个月评估疗效，部分缓解5例（29．4％），疾病稳定7例（41．2％），进展恶化5例（29．4％）。治疗后腹部平片示5例（29．4％）出现粒子丢失移位。1例脾区移位，1例肝脏移位，3例肠腔移位。治疗后粒子丢失4例。1例出现脾脏及左膈下囊肿。结论EUS引导下^125I粒子内照射治疗晚期胰腺癌，可使粒子照射区域内病灶明显萎缩。但需注意放射性粒子对周围脏器的损害及粒子脱落移位等并发症的发生。     

冷冻加放射性碘粒子植入治疗局部进展型胰腺癌

目的 探讨术中或经皮冷冻加125I粒子植入对局部进展型胰腺癌的治疗价值.方法 对38例经过综合评价被认为不能接受手术切除的局部进展型胰腺癌采用手术中或经皮冷冻加125I粒子植入方法进行治疗.125I粒子植入系在手术直视下或在超声或CT引导下经皮穿刺完成.8例患者人院前接受过4～6个周期化疗.治疗后3个月做CT评价肿瘤治疗反应.结果 11例患者接受术中冷冻,27例接受经皮冷冻,其中14例接受2次冷冻,3例接受3次冷冻.29例在冷冻的同时行肿瘤内125I粒子植入,9例在术后于超声或cT引导下行125I粒子植入.15例(其中13例伴胰周淋巴结或肝转移)患者行区域动脉化疗.CR、PR、SD和PD分别为9例、16例、10例和3例.20例(52.6%)患者出现上腹痛,16例(42.1%)血清淀粉酶升高,5例(13.2%)并发AP,其中1例为SAP,均经保守治疗痊愈.无治疗相关性死亡.随访5～37月,中位生存期12个月,6、12、24和36个月总生存率分别为94.7%、49.4%、21.8%和5.4%.接受化疗患者的6、12、24和36个月生存率分别为93.3%、26.6%、0和0,未接受化疗者生存率分别为95.6%、65,9%、19.8%和9.9%,两组相差显著(P＜0.01).生存期最长的2例分别为31和37个月,目前无任何复发证据.病死29例,12个月内共病死15例.结论 对大多数胰腺癌尤其不能手术切除患者,冷冻治疗有良好疗效,不良反应发生率较低.在冷冻同时或其后加用125I粒子植入,与冷冻治疗有相辅相成之效.     

内镜超声检查对胰腺癌可切除性的评估

目的：应用内镜超声检查术(EUS)对胰腺癌的可切除性进行前瞻性评估。方法：对初步诊断为胰腺癌的患者进行术前EUS，由2位内镜超声专家进行术前可切除性评估，以手术结果作为金标准进行对比，并与CT、MRI、B超诊断结果进行比较。结果：38例接受了手术治疗，其中10例术前EUS认为可切除，实际术中切除8例，EUS评估胰腺癌可切除性的准确度为80．0％；28例术前EUS评估为不可切除，实际手术无法切除27例，EUS评估不可切除准确度为96．4％。提示EUS术前评估结果与手术结果一致性较好。EUS诊断胰腺癌准确率为97．4％，CT为94．6％，MRI为89．5％．B超为73．7％。结论。应用EUS评估胰腺癌的可切除性是一种有效的方法。     

超声内镜引导下碘-125粒子种植治疗中晚期胰腺癌的近期疗效观察

胰腺癌发病率仅占所有肿瘤发病率的2％,但其每年死亡率却占到肿瘤死亡率的6％[ 2].在无法行根治性切除的患者中,平均生存期不到一年[1-2].除传统姑息手术治疗外,采用碘-125( 125Ⅰ)粒子的内照射治疗正用于临床晚期胰腺癌中.本研究回顾性分析胰腺癌瘤体内种植125Ⅰ粒子的疗效[3-5].     

超声引导射频消融联合^125Ⅰ粒子植入治疗进展期胰腺癌

对11例不能手术切除的胰腺癌患者实施术中超声引导射频消融联合^125Ⅰ粒子植入治疗，术后观察患者疼痛缓解情况、黄疸消退情况、CA199的变化、并发症的发生、影像学的变化及患者生存情况。结果术后1个月内11例患者均有不同程度的疼痛缓解，9例黄疸患者中黄疸指数下降，CA199与术前相比均有所减低，有2例患者术后发生胰瘘，均于1个月内治愈。术后超声和CT扫描检查提示肿瘤体积明显减小。认为射频消融联合^125Ⅰ粒子植入治疗进展期胰腺癌是较为有效和安全的方法之一。     

腹腔镜联合射频消融和125I粒子治疗肝转移癌

目的探讨腹腔镜切除并联合应用射频消融和^125I粒子植入治疗肝转移癌的临床价值。方法对62例术前经CT或MR确诊肝脏有转移灶的患者，行腹腔镜下肝转移瘤切除或射频消融，最后将^125粒子植入肝脏肿瘤部位。结果术中超声发现新病灶17个，所有患者均顺利行腹腔镜切除或射频消融及^125粒子植入。2例术后出现肝脓肿，1例术后发生腹腔少量出血，余无严重并发症。^125个转移病灶位于肝脏右后内叶或巨大仅行腹腔镜下射频消融及^125粒子植入，22例患者的38个边缘转移病灶行离体切除。随访12～25个月（平均22．3个月），有12例转移癌未见液化，行腹腔镜下二次射频及^125粒子植入。1年生存率为74．2％（46／62），2年生存率为59．7％（37／62）。结论腹腔镜切除并联合应用射频消融和^125粒子植入治疗肝转移癌具有微创、安全、有效，术后恢复快等优点。     

改善胰腺癌预后的探索

胰腺癌治疗极为困难。仅5％～15％的胰腺癌患者可做胰腺癌根治性切除，即使手术切除，5年生存率仍不超过20％，中位生存期仅12个月左右。对不能手术切除的胰腺癌治疗更为棘手，绝大多数在1年内死亡。近年来，为改善胰腺癌的预后，做了若干探索。     

冷冻联合125I粒子植入治疗局部进展性胰腺癌

目的 探讨冷冻联合125I粒子植入治疗局部进展性胰腺癌的价值.方法 49例无法手术切除的进展性胰腺癌患者,予以术中或经皮冷冻治疗;同时或术后植入125I粒子.部分患者术后接受腹腔动脉灌注化学治疗.对治疗效果、不良反应及患者存活期进行分析.结果 分别有13、36例患者行术中和经皮冷冻治疗.35例患者同时植入125I粒子,另14例则在冷冻术后实施.20例患者接受局部化学治疗.治疗3个月后,CT检查多数患者肿瘤不同程度坏死,其中完全缓解(CR)占20.4%、部分缓解(PR)38.8%、病情稳定(SD)30.6%、病情进展(PD)10.2%.主要不良反应包括上腹痛、血清淀粉酶升高;6例并发急性胰腺炎,其中1例属重症.经相关处理,均得到有效控制.无一例因治疗而死亡.随访中位时间18个月(5～40个月),中位存活期为16.21个月,有26例(53.1%)存活期≥12个月,8例存活期≥24个月.6、12,24和36个月时的平均存活率分别为94.1%、53.1%、22.8%和9.5%.最长的1例存活>46个月,无肿瘤复发征象.结论 冷冻治疗的创伤性小,且不良反应发生率低,可作为局部进展性胰腺癌患者的首选疗法.联合应用125I粒子植入能获得更佳效果.     

Pathogenesis of carcinoma of the papilla of Vater

Most adenomas and carcinomas of the small intestine and extrahepatic bile ducts arise in the region of the papilla of Vater. In familial adenomatous polyposis (FAP) it is the main location for carcinomas after proctocolectomy. In many cases symptoms due to stenosis lead to diagnosis at an early tumor stage. In about 80%, curative intended resection is possible. Operability is the most relevant prognostic factor. Most ampullary carcinomas resp. carcinomas of the papilla of Vater develop from adenomatous or flat dysplastic precursor lesions. They can be sited in the ampulloduodenal part of the papilla of Vater, which is lined by intestinal mucosa. They also can develop in deeper parts of the ampulla, which are lined by pancreaticobiliary duct mucosa. Intestinal-type adenocarcinoma and pancreaticobiliary-type adenocarcinoma represent the main histological types of ampullary carcinoma. Furthermore, there exist unusual types and undifferentiated carcinomas. Many carcinomas of intestinal type express the immunohistochemical marker profile of intestinal mucosa (keratin 7?, keratin 20+, MUC2+). Carcinomas of pancreaticobiliary type usually show the immunohistochemical profile of pancreaticobiliary duct mucosa (keratin 7+, keratin 20?, MUC2?). Even poorly differentiated carcinomas, as well as unusual histological types, may conserve the marker profile of the mucosa they developed from. These findings underline the concept of histogenetically different carcinomas of the papilla of Vater which develop either from intestinal- or from pancreaticobiliary-type mucosa of the papilla of Vater. Molecular alterations in ampullary carcinomas are similar to those of colorectal as well as pancreatic carcinomas, although they appear at different frequencies. In future studies, molecular alterations in ampullary carcinomas should be correlated closely with the different histologic tumor types. Consequently, the histologic classification should reflect the histogenesis of ampullary tumors from the two different types of papillary mucosa.     

Demonstration of the mechanism of action of biguanides

Summary Palmitic acid oxidation in rat diaphragm homogenate is depressed by biguanide concentrations that are still incapable of inhibiting oxidative phosphorylation. Glucose oxidation is not directly effected by the same biguanide concentrations: however, the inhibitory effect of palmitic acid on glucose oxidation is partly removed by biguanides. Inhibition of fatty acid oxidation, which accounts for most of the metabolic effects caused by these drugs, can be regarded as the fundamental mechanism of action of biguanides. There is some evidence suggesting that these drugs might interact with carnitine, thus preventing long-chain fatty acids from being transported across the mitochondrial membrane to the site of oxidation. Traduzione a cura degli AA.     

胰岛素瘤的解剖分布特点分析

目的胰岛素瘤是最常见的胰腺神经内分泌肿瘤，因其临床表现多样，导致诊断困难。影像学诊断尤其是超声内镜(EUS)在胰岛素瘤的诊断中起着重要作用，拥有较高的敏感性和特异性。本研究拟通过明确胰岛素瘤的解剖分布特点，以期有助于提高影像学的诊断准确率和降低漏诊率，尤其是在教育和培训实践中对于EUS的学习者更具有指导价值。 方法回顾性分析解放军总医院第一医学中心病案资料数据库1993年1月至2019年11月经外科手术、病理确诊为胰岛素瘤的患者的临床资料，检索方法采取搜索术后病理诊断为"胰岛素瘤"的病例，通过查阅病例的方法，提取出胰岛素瘤的大小和解剖分布等数据，进一步分析其特点。 结果共检索到确诊为胰岛素瘤的患者116例，其中，男45例、女71例，年龄13～76岁，平均年龄(44.4±14.85)岁。胰岛素瘤单发110例(94.8%)、多发6例(5.2%)。位置分布：头颈部46例(39.7%)，单发45例、多发1例；体尾部68例(58.6%)，单发65例、多发3例；全胰腺多发2例(1.7%)。病变大小特点：最大径0.4～3.4 cm，平均大小(1.53±0.58)cm。≤1 cm 29例、>1 cm而≤1.5 cm41例、>1.5 cm而≤2.0 cm28例，≤3 cm 15例，>3 cm 3例。年龄与肿瘤的大小相关，≤44岁患者肿瘤平均大小为(1.36±0.51)cm、>44岁患者肿瘤平均大小为(1.70±0.60)cm，P<0.05。头颈部的肿瘤大于体尾部的肿瘤，头颈部肿瘤平均大小(1.66±0.63)cm，体尾部(1.42±0.52)cm，P<0.05。 结论胰岛素瘤在胰腺体尾部较头颈部更好发；绝大多数单发，但可以全胰腺多发；多数小于1.5 cm，肿瘤的大小与患者年龄和肿瘤的解剖分布相关。     

氯硝柳胺悬浮剂的毒性评价

目的评价氯硝柳胺悬浮剂的毒性，为现场大规模应用灭螺提供依据。方法按照中华人民共和国国家标准GB 15670-1995《农药登记毒理学试验方法》和鱼类毒性试验方法进行。结果经口、经皮肤的LDso雌、雄性大鼠均>5 000 mg/kg，经呼吸道的LCso雌、雄性大鼠均>5 000mg/m3，该药经口、经皮肤、经呼吸道毒性均属微毒类药物；兔眼用药后，观察期内无不良反应，对眼无刺激性；皮肤用药后对皮肤无刺激性。与氯硝柳胺原药、氯硝柳胺乙醇胺盐原药和氯硝柳胺乙醇胺盐可湿性粉剂相比，氯硝柳胺悬浮剂对鱼急性毒性最低。结论氯硝柳胺悬浮剂属微毒类药物，对鱼的毒性低于其乙醇胺盐可湿性粉剂，适合于现场应用。     

Lack of correlation of degree of villous atrophy with severity of clinical presentation of coeliac disease

BACKGROUND AND AIM: Both the clinical presentation and the degree of mucosal damage in coeliac disease vary greatly. In view of conflicting information as to whether the mode of presentation correlates with the degree of villous atrophy, we reviewed a large cohort of patients with coeliac disease. PATIENTS AND METHODS: We correlated mode of presentation (classical, diarrhoea predominant or atypical/silent) with histology of duodenal biopsies and examined their trends over time. RESULTS: The cohort consisted of 499 adults, mean age 44.1 years, 68% females. The majority had silent coeliac disease (56%) and total villous atrophy (65%). There was no correlation of mode of presentation with the degree of villous atrophy (p=0.25). Sixty-eight percent of females and 58% of males had a severe villous atrophy (p=0.052). There was a significant trend over time for a greater proportion of patients presenting as atypical/silent coeliac disease and having partial villous atrophy, though the majority still had total villous atrophy. CONCLUSIONS: Among our patients the degree of villous atrophy in duodenal biopsies did not correlate with the mode of presentation, indicating that factors other than the degree of villous atrophy must account for diarrhoea in coeliac disease.     

血吸虫童虫生长发育及其机制的研究进展

血吸虫童虫是宿主免疫系统攻击的重要靶标,包括皮肤型、肺型和肝门型童虫。宿主分子对童虫生长发育具有重要作用。童虫生长发育机制包括免疫调节、信号转导、性别发育及凋亡等。肌动蛋白、组织蛋白酶、烯醇化酶和葡萄糖基转移酶等分子为血吸虫童虫生长发育的重要分子。本文对血吸虫童虫生长发育及其机制的研究进展做一综述。     

CagA-Hp抗体IgG与胃炎的组织学分析

研究幽门螺杆菌(Hp)感染与胃炎的关系。方法对204例慢性胃炎患者胃粘膜进行观察分析,并测定其中137例Hp阳性患者血清CagA-Hp抗体IgG水平,与组织学对照。结果慢性萎缩性胃炎伴肠上皮化生患者血清CagA抗体IgG明显高于对照组(P＜0.01);其他类型胃炎患者血清CagA抗体IgG水平无明显增高(P＞0.05)。结论CagA-Hp可能是导致慢性萎缩性胃炎伴肠上皮化生的因素之一,对这类患者应密切随访观察。     

慢阻肺急性加重期患者预后的影响因素分析

目的探讨慢性阻塞性肺病急性加重期(AECOPD)患者预后的相关危险因素。方法回顾性调查、收集58例AECOPD患者可能影响其预后的相关因素,并对其分别进行单因素分析。并进行Logistic多元逐步回归进行多因素分析,筛选影响AECOPD患者预后的独立危险因素。结果单因素分析后将结果 P0.1的因素纳入多因素Logistic回归,分析发现是否合并呼吸衰竭、气促程度、白细胞计数、APACHEⅡ、应用抗氧化剂、慢阻肺治疗依从性为影响AECOPD患者预后不佳的独立因素(P0.05)。结论根据AECOPD患者预后的独立危险因素,及早判断,选择合适的后续治疗方案,对提高其生存率及生存质量具有重要意义。     

124例耐多药结核分枝杆菌基因突变特征分析

目的对临床分离的耐多药结核分枝杆菌相关基因的突变特征进行分析。方法对124例耐多药结核分枝杆菌以及50株敏感株的耐药相关基因(包括异烟肼inh A、kat G、oxyR-ahp C间隔区以及利福平rpo B)进行序列测定,分析其基因突变情况。结果异烟肼耐药inh A基因突变率为14.5%;kat G基因突变率为70.2%(87/124),主要位于315位;oxyR-ahp C间隔区突变率为15.3%;inh A、kat G两种基因同时突变率75.0%,三种基因同时突变率为89.5%。利福平rpo B基因突变的检出率高达95.2%,突变主要发生在531、526、516位点。结论我省耐多药菌异烟肼耐药相关基因最常见突变为kat G 315、inh A C-T(-15)、axyR-ahp C间隔区(-10)C-T,利福平为rpo B531、526、516。结合MDR-TB耐药相关基因的特征分析,可以建立一种快速、准确、特异的适合于我省的检测结核菌耐多药性的新方法。     

Results of treatment of fistula-in-ano

To evaluate the application of Parks' classification in the management of patients with fistula-in-ano, a study was undertaken to assess the outcome of surgery, especially with respect to the recurrence rate and alteration of continence. A retrospective analysis of 160 consecutive patients who were classified at the time of operation was conducted. The distribution of fistulas was as follows: intersphincteric, 41.9 percent, transsphincteric, 52.1 percent, suprasphincteric, 1.3 percent, extrasphincteric, 0. A horseshoe extension occurred in 8.8 percent of the fistulas and 3.8 percent did not exactly conform to the classification as they were either complex or combinations of more than one type of fistula. The sole immediate postoperative complication was bleeding, which occurred one week postoperatively and ceased spontaneously (0.7 percent). Alteration in continence occurred in 6 percent of patients with 2.6 percent experiencing temporary incontinence to flatus, 1.3 percent to liquid stool, and 0.7 percent to solid stool. Permanent loss of control for flatus occurred in one patient (0.7 percent) and for liquid stool in one patient (0.7 percent). No patients suffered loss of control for solid stool. Recurrence developed in 6.3 percent of patients, all between five and 25 months postoperatively. Classifcation was found to be a useful guide in the operative management of patients with fistula-in-ano. Read at the joint meeting of the American Society of Colon and Rectal Surgeons with the Section of Colo-Proctology, Royal Society of Medicine, and the Section of Colonic and Rectal Surgery, Royal Australasian College of Surgeons, New Orleans, Louisiana, May 6 to 11, 1984.