29例青年人食管贲门癌的临床分析

本文收集，整理了３５岁以下青年人食管贲门癌病例资料，资料分析并和文献中中老年病例比较表明，本组青年人食管贲门癌呈现发病率低、恶性程度高、病变进展快、转移发生早、手术切除率低、５年生存率低等特点，鉴于我国是食管癌高发区，针对上述特点，临床上提高认识，重视对青年患者的早期诊断和治疗是十分必要的。     

青年人贲门癌11例临床误诊分析

目的：探讨青年人贲门癌的临床特征及误诊原因。方法选择青年人贲门癌患者12例,对其中误诊的11例临床资料回顾性分析。结果青年人贲门癌的临床表现无特异性,极易误诊漏诊。最后诊断食管贲门癌1例,贲门癌4例,贲门胃底癌5例,食管贲门胃底癌1例,误诊为慢性胃炎4例,消化性溃疡1例,慢性胃炎和消化性溃疡合并上消化道出血各1例,慢性食管炎1例,食管痉挛1例,慢性肠炎1例,冠心病1例。结论青年人贲门癌少见,早期无特异症状,电子胃镜检查同时进行病理活检仍然是首选的检查方法,临床医师应提高诊断水平,全面分析,尽量提高早期诊断率。     

120例贲门癌临床病例分析

①目的比较伴有食管浸润和不伴有食管浸润的贲门癌在临床特点、手术治疗、病理特点和预后的差异,探讨影响生存的因素以指导临床工作。②方法回顾性分析我院普通外科和胸外科收治的贲门癌病例资料。比较两组病例的性别、年龄、确诊时间、症状、肿瘤Borrmann分型、术前肿瘤标记物、有无远处转移、手术方式、消化道重建方式、手术根治度、术后病理资料、生存率等之间的差异并进行统计学分析。③结果贲门癌浸润食管出现吞咽困难者多于贲门癌没有浸润食管者（P=0.020）,手术根治度-贲门癌没有浸润食管高于贲门癌浸润食管（P〈0.05）,肿瘤最大径-贲门癌没有浸润食管小于贲门癌浸润食管（P=0.008）,肿瘤浸润层次-贲门癌没有浸润食管超过贲门癌浸润食管（P〈0.05）,c-erbB-2的表达-贲门癌浸润食管多于贲门癌没有浸润食管（P=0.019）。5年生存率贲门癌浸润食管（35.82%）低于未浸润食管（61.89%）。④结论贲门癌是否浸润食管在症状、c-erbB-2的表达、肿瘤大小、浸润层次方面存在一定的差异,据此选择相应的淋巴结清扫范围有利于提高手术根治度。     

60例食管胃结合部腺癌临床病例分析

目的比较伴有食管下端癌和贲门癌在临床特点、手术治疗、病理特点和预后的异同,探讨影响生存的因素以指导临床工作。方法回顾性分析,巢湖市第二人民医院普外科、胸外科2005年1月～2010年12月间收治的食管胃结合部腺癌病例资料。对比两组病例的性别、年龄、确诊时间、症状、肿瘤Borrmann分型、术前肿瘤标记物、有无远处转移、手术方式、消化道重建方式、手术根治度、术后病理资料、生存率等之间的差异并进行统计学分析。结果食管下端癌出现吞咽困难者多于贲门癌(P=0.02),淋巴结清扫范围贲门癌大于食管下端癌(P=0.045),手术根治度-贲门癌高于食管下端癌(P=0.008),肿瘤最大径-贲门癌小于食管下端癌(P=0.008),肿瘤浸润层次-贲门癌超过食管下端癌(P=0.043),c-erbB-2的表达-食管下端癌多于贲门癌(P=0.019)。影响食管胃结合部腺癌病人预后的因素包括肿瘤病理分期、AEG分型和手术根治度,三者强度依次递减。结论食管胃结合部腺癌在症状、免疫组化、肿瘤大小、浸润层次方面存在一定的差异,据此选择相应的淋巴结清扫范围有利于提高手术根治度。食管胃结合部腺癌分型、手术根治度和术后病理分期是影响病人预后的因素。     

Analysis of 60 cases with adenocarcinoma in esophagogastric junction

目的 比较伴有食管下端癌和贲门癌在临床特点、手术治疗、病理特点和预后的异同,探讨影响生存的因素以指导临床工作.方法 回顾性分析,巢湖市第二人民医院普外科、胸外科2005年1月~2010年12月间收治的食管胃结合部腺癌病例资料.对比两组病例的性别、年龄、确诊时间、症状、肿瘤Borrmann分型、术前肿瘤标记物、有无远处转移、手术方式、消化道重建方式、手术根治度、术后病理资料、生存率等之间的差异并进行统计学分析.结果 食管下端癌出现吞咽困难者多于贲门癌(P=0.02),淋巴结清扫范围贲门癌大于食管下端癌(P=0.045),手术根治度-贲门癌高于食管下端癌(P=0.008),肿瘤最大径-贲门癌小于食管下端癌(P=0.008),肿瘤浸润层次-贲门癌超过食管下端癌(P=0.043),c-erbB-2的表达-食管下端癌多于贲门癌(P=0.019).影响食管胃结合部腺癌病人预后的因素包括肿瘤病理分期、AEG分型和手术根治度,三者强度依次递减.结论 食管胃结合部腺癌在症状、免疫组化、肿瘤大小、浸润层次方面存在一定的差异,据此选择相应的淋巴结清扫范围有利于提高手术根治度.食管胃结合部腺癌分型、手术根治度和术后病理分期是影响病人预后的因素.     

52 例食管、贲门癌术后医院感染因素分析

５２例食管、贲门癌术后医院感染因素分析徐锦玲石瑞华江苏省肿瘤医院２１０００９恶性肿瘤患者易发生医院感染。为探讨食管、贲门癌患者术后医院感染的情况，笔者对５２例食管、贲门癌患者手术期间发生的医院感染病例进行初步分析。１资料与方法查阅１９９３年１月～１９...     

食管贲门癌手术84例体会

食管贲门癌手术８４例体会洪孝飞姜洁吕政莉我院自１９８９年５月～１９９６年５月共施行食管贲门癌手术８４例，取得较好的临床疗效。现报道如下。１临床资料１．１一般资料本组病例男６３例，女２１例。年龄３８～６７岁，平均５２岁。贲门癌４９例，食管癌３５例。贲门...     

食管和贲门癌软组织块影术前判断的临床研究

食管，贲门部软组织块影是食管，贲门癌患者上消化道钡餐检查重要的Ｘ线征象之一。但实际工作中，钡餐Ｘ线摄片很难提供确切的诊断依据，针对临床上大都是晚期病例，手术切除率颅低的工作。作者有目的地对４５例食管，贲门癌的上消化道钡餐检查资料，结合手术所见，通过ＮＡＩ２００医用计算机系统对钡餐Ｘ线图片进行处理后，发现该医用图像系统能明显地优化图片质量，能清楚地显示肿瘤外浸所形成的软组织块影响，对肿瘤的范围，大小     

食管贲门癌术后吻合口瘘143例临床分析

为了观察食管贲门癌术后吻合口瘘的发生情况和寻求减少食管贲门癌术后吻合口瘘发生率、病死率的措施，１０年来１４３例食管贲门癌手术中，近５年由于加强围手术期治疗，严格选择病例和重视手术操作，对食管胸中段以上癌肿手术选择胸内整段食管切除，在颈部食管胃吻合，比较前５年手术病例，吻合口瘘发生率由１５．８％下降至４．５％，吻合口瘘的病死率亦有下降趋势。因此，加强围手术期治疗，重视手术操作，选择颈部吻合是减少食管     

食管贲门癌三种术式的临床体会

临床收治的食管癌和贲门癌多属中期，早期病例较少。传统手术损伤大出血多、术后并发症多、复发率高和远期疗效差。作者根据食管癌和贲门癌的生物特性、区域淋巴结转移特点和癌变部位，对病变切除后食管重建术制订了Ⅰ、Ⅱ、Ⅲ三种术式。术式Ⅰ适应证为胸上、中段癌。术式Ⅱ适应证为下段痛。术式Ⅲ适应证为贲门癌。实践证明可操作性好，实用性强，并发症少，复发率低。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Electro-Acupuncture Combined with the Trigger Point Needle-Embedding for Treatment of Primary Trigeminal Neuralgia in 31 Cases

In recent years, the author of this essay has applied electro-acupuncture combined with the trigger point needle-embedding for treatment of primary trigeminal neuralgia in 31 cases, yielding satis- factory results as reported in the following.     

Investigation of Matrix Metalloproteinase -1, 2 and tissue inhibitor of matrix metalloproteinases-1 in Endometriosis

Objective： To explore the role of matrix metalloproteinase-1,2 （MMP-1, MMP-2） and tissue inhibitor of matrix metalloproteinases-1 （TIMP-1） in endometriosis. Methods： The eutopic and ectopic endometria from 40 subjects suffering from endometriosis and regular.endometria from 40 subjects （excluding endometriosis） were collected and examined by in situ hybridization technology and western blot assay. Results： Both expressions of MMP-1 and -2 were stronger in ectopic endometrium and eutopic endometrium than in normal endometrium. On the contrary, the expression of TIMP-1 in ectopic endometrium and eutopic endometrium was lower. The differences were significant （P 〈 0.01 ）. Moreover, there was no relationship among the expressions of MMP-1, 2 and TIMP-1 in ectopic endometrium. Conclusion： The expressions of MMP-1, 2 and TIMP-1 lose balance and lack of periodic changes in ectopic endometrium , which explains the biological invasive behavior of endometriosis. It was suggested-that regulating the balance between the MMPs and TIMP-1 should be an ideal therapeutic target to endometriosis.     

Shi Da-zhuo (史大卓) —An outstanding cardiologist of integrative medicine

Prof. SHI Da-zhuo, Ph.D., male, was born on March 20, 1960. Prof. SHI entered the Ph.D. program in 1990 at the China Academy of Chinese Medical Sciences under the supervision of Prof. CHEN Ke-ji, majoring in the treatment of cardiovascular diseases. After receiving his Ph.D. degree in 1993, Prof. SHI started working at the Cardiovascular Center in Xiyuan Hospital affiliated to China Academy of Chinese Medical sciences.     

Persist in and Carry Forward the Integrative Medical Research——Speech at the 6th National General Congress of Chinese Association of Integrative Medicine by Academician CHEN Zhu,Minister of Ministry of Health

The 6th National General Congress of Chinese Association of Integrative Medicine （CALM） was convened at 19-20, April 2008 in Beijing. Academician CHEN Zhu, the minister of Ministry of Health indicated at the congress that the integration of Chinese and Western medicine is very well in keeping with the situation of our country and the general rule of development in medical science; and as a good integration of Chinese medicine and Western medicine, it is mutually beneficial and advantageous to both of them. Seeing the creativity shown in integrative medical investigation in theoretic and methodological sides, we should and must persist in and develop it.