En-bloc切除术治疗中低位骶骨肿瘤

中低位骶骨肿瘤通常指累及第3骶椎及以下的骶骨肿瘤,常累及多节段,周围组织侵袭较广,给外科治疗带来困难,术后易于局部复发.En-bloc切除可有效避免肿瘤残留及术中污染,从而降低局部复发率,是肿瘤切除的理想方式[1].我院自2001年1月至2008年8月采用En-b10c切除术治疗17例中低位骶骨肿瘤,现报告如下.     

颈椎孤立性浆细胞瘤的外科干预及放疗结果分析

目的 探讨颈椎孤立性浆细胞瘤的临床特点、治疗方法及结果.方法 回顾性分析我科1995年1月至2007年12月收治的23例颈椎孤立性浆细胞瘤患者的临床资料,其中男性16例,女性7例,年龄32～76岁,平均56岁.23例患者除2例仅行单纯放疗外,余21例均行手术治疗.依据脊柱肿瘤WBB分期,采取全椎体切除6例,附件切除4例,矢状切除3例,全椎节切除8例,手术病例采用前路、后路或前后联合入路.脊柱重建方式采取自体髂骨植骨和颈前路钛板、钛网骨水泥内固定或前后联合植骨融合内固定,术后均行辅助放疗.结果 23例患者获得随访,随访时间24.0～143.0个月,平均64.7个月.患者术后颈部疼痛症状明显好转,神经压迫症状消失或得到不同程度的改善,术后3个月患者神经功能Frankel分级平均有1～2个级别的改善.内固定位置及颈椎稳定性良好,无脊柱失稳现象,植骨融合率100%.随访期内有6例局部复发,且进展为多发性骨髓瘤(MM),死亡3例.2例未手术者分别于确诊后1年及1.5年进展为MM,转血液科进一步化疗.15例患者术后辅助放疗后一般情况良好,随访期内复查M蛋白、骨髓穿刺等检查均未见明显异常,单光子发射计算机断层扫描或PET-CT检查未发现其他部位骨骼有新发病灶.结论 颈椎孤立性浆细胞瘤临床较为少见,对于骨质破坏明显、椎节不稳或神经功能障碍者,首选手术治疗;术后辅助放疗能明显降低局部复发率及进展为MM的可能性,进展为MM者应根据相应化疗方案进行化疗,预后相对较差.     

经颌下入路切除枢椎肿瘤及前方内固定应用

目的 探讨经颌下胸锁乳突肌内侧缘入路切除枢椎肿瘤及前方内固定的应用.方法 2004年12月至2010年6月,采用经颌下胸锁乳突肌内侧缘入路联合后路行枢椎肿瘤切除前后内固定术治疗枢椎肿瘤17例,男11例,女6例;年龄23～77岁,平均49岁;C2 11例,C2.34例,C2-42例;8例累及椎体,9例累及椎体及附件.原发性肿瘤14例,其中骨巨细胞瘤4例,浆细胞瘤4例,脊索瘤2例,嗜酸性肉芽肿2例,血管外皮瘤、淋巴瘤各1例;转移性肿瘤3例.前路肿瘤切除后采用钛网植骨及钛板垂直放置螺钉固定、钛网植骨及钛板斜行放置螺钉固定、钛网修剪后植骨螺钉固定3种方式行上颈椎前路内固定,均一期联合后路肿瘤切除枕颈内固定.结果 术后患者局部疼痛缓解,神经症状减轻或消失.术后随访6个月至6年.1例采用钛网植骨及钛板垂直放置螺钉固定的患者术后1个月发生螺钉松动退出,经翻修后融合,余16例患者均获融合.1例患者于术后9个月死于脑梗死.2例脊索瘤患者分别于术后13和18个月局部复发,1例死于高位瘫痪、呼吸衰竭,1例带瘤生存.2例转移癌患者分别于术后12和18个月因全身多处转移、衰竭而死亡.结论 经颌下胸锁乳突肌内侧缘入路可获得枢椎肿瘤切除与重建的良好显露.应用颈椎内固定系统可实现枢椎肿瘤切除后上颈椎稳定的前方重建.

Abstract：

Objective To investigate procedure and therapeutic effect of resection and reconstruction for axis tumors through the sub mandible approach. Methods Between December 2004 to June 2010,17 patients with axis neoplasm underwent tumor resection and antero-posterior reconstruction through the combined the sub mandible-inner sternocleidomastoid muscle (SMIS) approach and posterior approach. Tumor lesions involved C2 in 11 cases, C2-3 in 4, C2-4 in 2. Eight cases involved vertebral body, and 9 involved both vertebral body and element. Fourteen primary lesions including 4 giant cell tumors, 4 plasmocytomas, 2 chordomas, 2 eosinophilic granulomas, 1 hemangiopericytomas and 1 lymphoma, and 3 metastatic lesions were involved in this study. Three types of reconstruction in upper cervical spine including titanium mesh plus vertically placed titanium plate, titanium mesh plus obliquely placed titanium plate and trimmed titanium mesh alone, were adopted after anterior tumor resection, and then posterior tumor resection and reconstruction were performed. Results All patients experienced pain relief and neurological improvement after surgery. Except for one incidence of screw pull-out which was corrected by a revision surgery, solid fusion was achieved in all patients. A follow-up period of 6 months to 6 years was available for this study. One patient died of cerebral infarction 9 months postoperative. Two patients with chordoma relapsed 13 months and18 months postoperative, respectively, of whom one died of high plegia and respiratory failure, and the other was alive with disease. Two patients with metastasis died of multiple remote metastases 12 months and 18 months postoperative, respectively. Conclusion Through the SMIS apporach, a satisfactory exposure can be obtained for axis tumor resection and reconstruction. Anterior reconstruction of upper cervical spine after tumor resection can be achieved with internal fixation system of cervical spine, which can improve intraopera-tive safety. The combined anterior reconstruction and posterior occipito-cervcial fixation can provide immediate stability, and benefit maintaining stability of upper cervical spine.     

缺血预处理对大鼠冷保存供肝细胞HMG-CoA还原酶活力的影响

目的 观察缺血预处理对大鼠冷保存供肝细胞HMG-CoA还原酶(HMGCR)活力的影响,探讨缺血预处理减轻大鼠供肝冷保存损伤的机制.方法 将25只大鼠随机分为对照组(C组)、冷保存组(Ⅰ组)、缺血预处理组(IP组)、阿托伐他汀30 μmol/L和100μmol/L处理组(A30组和A100组),每组5只.C组为正常大鼠肝脏,4℃UW液灌注;Ⅰ组为灌注后冷保存8 h;IP组先给予缺血预处理,灌注后冷保存8 h;A30组和A100组先给予缺血预处理,用终质量浓度为30μmol/L和100μmol/L的阿托伐他汀UW液灌注后再置入含30μmol/L和100μmol/L的阿托伐他汀UW液中4℃冷保存8 h.分别测定5组大鼠肝脏的HMGCR活力.结果 供肝经过8 h冷保存后(Ⅰ)HMGCR活性为(1872±157)nmol/(min·mg),与对照组(C)(3298±224)nmol/(min·mg)比较明显下降(P＜0.05),给予缺血预处理后再给予冷保存(IP),则HMGCR活性为(3746±231)nmol/(min·mg),明显升高(P＜0.05);给予缺血预处理同时给予HMGCR抑制剂阿托伐他汀则HMGCR活性则受到明显抑制,并随着阿托伐他汀浓度的增加而抑制效应更为明显,A30组、A100组HMGCR酶活力分别为(2010±193)nmol/(min·mg)、(1469±132)nmol/(min·mg),同IP组比较明显下降(P＜0.05).结论 缺血预处理可以明显提高HMGCR活力,而阿托伐他汀则可消除缺血预处理升高HMGCR活性的作用;缺血预处理升高HMGCR活力的机制是增加HMGCR蛋白的表达.

Abstract：

Objective To investigate the effects of ischemic preconditioning on the activity of 3-hydroxy-3-methylglutary coenzyme A reductase (HMGCR) of hepatocytes following cryopreservation in rats. Methods Twenty-five rats were randomly divided into five groups: control group ( C), cryopreservation group (Ⅰ), ischemic preconditioning group (IP), atorvastatin (30 γμmol/L) treatment group (A30) and atorvastatin (100 μmol/L) treatment group (A100). In control group, normal donor livers were flushed with 4 ℃ UW solution. In group I, donor livers were cryopreserved for 8 h after UWs flushing. In group IP, donor livers were subjected to ischemic preconditioning, and then flushed and cryopreserved in UWs. In group A30, donor livers were treated as in group I except that 30 μmol/L atorvastatin was added to the UWs. In group A100, donor lovers were treated as in group I with the exception that 100 μmol/L atorvastatin was added to the UWs. The activity of HMGCR was assessed. Results HMGCR activity in the donor cantly increased after ischemic preconditioning[(3746±231 ) nmol/(min-mg)]. The enhanced HMGCR activity induced by ischemic preconditioning was inhibited by atorvastatin in a concentration-dependent mantivity by up-regulating its protein expression and this effect can be abrogated by atorvastatin.     

人肺腺癌干细胞脊柱转移动物模型的建立和研究

目的 建立肺癌干细胞脊柱转移裸鼠模型并研究转移机制及特性.方法 雄性裸鼠共40只随机分成2组(A组和B组),每组各20只.均采用左心室注射法.A组使用浓度为107/mL的肺癌(A549)细胞悬液100 霯,B组使用浓度为104/mL的肺癌干细胞悬液50 霯.生物发光成像及X线检查肿瘤转移情况.动物出现死亡或接种后5周为...