96例术中经胆囊管胆道造影分析

在胆囊结石行胆囊切除时,术中经胆囊管胆道造影的重要价值已被外科医师所重视。我们自1979年以来术中经胆囊管胆道造影96例。现就术中胆道造影的意义和价值讨论如下。临床资料1.本组96例,男49例,女37例。年龄20～77岁。经胆囊管胆道造影显示满意的84例;显影不满意的12例,主要因体位不正确,摄片时移动以及气体注入胆道或充盈不好所致。2.结果:96例中术前34例有黄疸病史者经胆囊管胆道造影仅4例有异常发现,占11%(4/34)。余30例为阴性,因而未作胆道探查。96例中有56例具备传统认为胆总管探查指征者术中胆道造影仅8     

CLDN在结直肠癌组织中的表达及研究进展

Claudin(CLDN)是维持紧密连接结构和功能最重要的蛋白分子,在胃肠道肿瘤的发生发展及临床诊治中起着重要的作用.全文收集国内外近年来有关CLDN在大肠癌发生发展中作用的最新文献并作一综述.     

FasL基因表达对缺氧状态下直肠癌细胞增殖凋亡的影响

Objective To elucidate the effect of FasL gene expression on the proliferation and apoptosis of hypoxic rectal carcinoma cells. Methods The normoxic expression level of FasL in HR-8348 subtype cells (HR-8348B, HR-8348L, HR-8348F and HR-8348As) with different invasive power were verified by Western blot. Hypoxia models for HR-8348B, HR-8348L, HR-8348F and HR-8348As were constructed with chemical modeling, then the FasL levels in all groups at 12 h after hypoxia were quantitated by Western blot. Distribution of different cell life cycles was determined with flow cytometry. Cell reproductive activities were detected with MTT method, and cell apoptesis was assessed with TUNEL. Results FasL protein was pigmentized at the position of 40 000 by Western blot, and the expression level of FasL was significantly higher in HR-8348F cells than those in HR-8348B, HR-8348L and HR-8348As cells(F=361.149, P<0.01) in normoxia. At 12 h after hypoxia, the FasL level was also significantly higher in HR-8348F cells than those in other groups (F=278.766, P<0.01), but was not markedly different as compared to themselves in normoxia (t=1.762, P>0.05). The proliferation index was significantly higher in HR-8348F (60.43±3.72) than those in HR-8348B (40.01±3.30), HR-8348L (41.30±4.06) and HR-8348As cells (35.87±4.39), respectively (F=39.477, P<0.01). However, both inhibition rate of proliferation and apoptotic index were remarkably lower in HR-8348F (17.30±1.98 and 13.10±1.04) than those in HR-834B (33.70±4.33 and 21.60±1.31), HR-8348L (34.20±3.92 and 20.10±1.15), and HR-8348As (38.00±4.55 and 23.90±1.23), respectively (F=28.811 and 76.462, respectively, P<0.01). Conclusion The expression enhancement of intracellular FasL in rectal carcinoma in hypoxia can lead to accelerated proliferation and reduced apeptosis of cells, which will promote tumor cells to adapt microenvironmental hypoxia.     

T3期中低位直肠癌同步放化疗后行保肛手术的临床研究

目的观察术前同步放化疗对T3期中低位直肠癌保肛手术的临床效果。方法分析65例T3期中低位直肠癌临床资料。术前同步放化疗采用常规分割放疗联合化疗方法,放射总剂量为50Gy,每次2 Gy,每周5次。放疗第一周和第五周进行全身化疗,应用5-氟脲嘧啶联合甲酰四氢亚叶酸,每日静脉滴注一次,连续5 d。放化疗结束后4~6周行TME切除加保肛手术。结果65例T3期中低位直肠癌经术前同步放化疗后,27例采用前切除吻合器吻合法,38例采用套入式结肠直肠黏膜吻合术。术前同步放化疗后,有53例（53/65,81.5%）直肠病灶有不同程度缩小。12例（12/65,18.5%）病灶大小无显著变化,同步放化疗前后病灶缩小者所占比例与病灶无变化者有显著性差异（χ2=51.7231,P〈0.01）。65例无手术死亡。术后发生吻合口漏2例（2/65,3.1%）,切口感染1例（1/65,1.5%）。随访时间平均为32个月。局部复发3例（3/65,4.6%）,肺转移1例（1/65,1.5%）,肝转移3例（3/65,4.6%）。3年无病生存率为72.7%。结论对T3期中低位直肠癌行术前同步放化疗可降低保肛术后局部复发率,有助于提高患者术后无病生存率.     

结直肠癌患者血清中组织因子含量与临床意义的研究

目的:探讨结直肠癌患者血清中组织因子(TF)含量及其在临床诊断和预后中的意义.方法:应用ELISA方法检测105例正常人(对照组)、100例结直肠癌患者(结直肠癌组)术前血清中TF浓度.同时检测100例结直肠癌患者血清肿瘤标志物CEA、CA242、CA19-9含量;44例结直肠癌患者手术后获得随访,比较TF阴性与阳性获随访者的生存率.结果:结直肠癌组血清TF水平[(1.35±1.14)U/L]明显高于对照组[(0.17±0.15)U/L],与年龄、组织学分级无关(P>0.05),与淋巴结转移及术后复发、转移有相关性(P<0.05),在Dukes分期中,D期TF水平明显高于其他3期(P<0.05);TF敏感性(64%)优于肿瘤标志物CEA、CA242、CA199(P<0.01).44例获随访者中血清TF阳性结肠癌患者生存率明显低于阴性者.结论:TF在结直肠癌患者血清中呈高表达.可能是对结直肠癌诊断和评估预后的一个有价值指标.     

腹膜后罕见巨大脂肪肉瘤一例

患者女性，37岁，身高157crfl，体质量72kg。因发现腹部肿物6年余，迅速增大1年于2008年3月入院。入院查体：一般状况差，恶病质貌，血压130／80mmHg，心率74次／min，双下肢轻度水肿。     

大肠癌Nm23—H1和p53基因杂合性缺失及其相关性研究

目的了解ｎｍ２３－Ｈ１和ｐ５３基因杂合性缺失与大肠癌临床关系以及二者的相关性。方法应用Ｓｏｕｔｈｅｒｎ印迹杂交检测了大肠癌ｎｍ２３－Ｈ１和ｐ５３杂合性缺失情况。结果本组病例ｎｍ２３－Ｈ１和ｐ５３杂合性缺失率分别为２５％和４５．８％,ｎｍ２３－Ｈ１杂合性缺失与大肠癌Ｄｕｋｅｓ分期及远处转移相关;ｐ５３杂合性缺失与大肠癌远处转移相关。两基因杂合性缺失在大肠癌中呈明显正相关。结论ｎｍ２３－Ｈ１和ｐ５３基因杂合性缺失均可能参与大肠癌恶性进展及转移过程的调节,并相互协同促进。     

扩大壁细胞迷走神经切断术治疗十二指肠溃疡并发症150例的远期效果

目的 探讨扩大壁细胞逃走神经切断术(EPCV)的远期临床效果。方法 自1979年始应用EPCV治疗十二指肠溃疡病并发穿孔、出血和狭窄150例,其中穿孔103例,出血12例,狭窄35例。结果 全组131例获得随访,总的溃疡复发率为2．3％,复发狭窄率为29％,再出血率为0。VisickⅠ级为832％,Ⅱ级为10．6％,Ⅲ级为3．1％。Ⅳ级为3．1％;Ⅰ级和Ⅱ级共占93.8％。结论 作认为EPCV术后远期患无论是消化吸收功能和营养状态,还是恢复劳动能力和生活质量都较高,进一步证实该手术设计的合理性和可行性。     

与癌症相关的腹泻及其护理对策

与癌症相关的腹泻是近年来才被认识的新课题。了解与癌症相关腹泻的病因与机制、分型、评估指标、治疗方法及护理措施,能使腹泻病人得到正确合理的治疗。     

肝移植术后直肠癌患者行根治性切除保肛术一例报告

患者男,47岁,因大便习惯伴性状改变1月于2007年月8日入院,曾于2005年6月16日因重症肝炎行经典原位肝移植术.术后常规服用免疫抑制剂,普乐可复和骁悉胶囊,一年后普乐可复维持在血药浓度5 ng/ml左右.术后肝脏功能一直正常,但血糖较高,一直皮下注射胰岛素维持血糖至今.既往直系及三代以内旁系亲属无癌症患者.