腹腔镜胃上部癌根治术残胃空肠双通道重建

目的 探讨腹腔镜胃上部癌根治术残胃空肠双通道重建的价值.方法 对25例胃上部癌患者行腹腔镜近端胃大部根治性切除,保留远端残胃,行空肠残胃侧侧吻合、空肠空肠端侧吻合的双通道消化道罩=建术.结果 手术平均时间(240±35)min,切缘阴性,平均清扫淋巴结(22±5)枚,无吻合口漏及狭窄、梗阻等并发症.术后均行钡餐造影,显示大部分钡剂直接进入空肠,少部分经过残胃.十二指肠进入空肠,并在残胃中滞留30～60min,无钡剂反流入食管.随访4～18个月,患者无明显反流性食管炎表现,近期生活质量满意.结论 残胃空肠双通道重建术清扫、切除范围合理,残胃有一定储袋作用,能较好地预防反流性食管炎和倾倒综合征;保留了十二指肠径路,提高了患者生活质量,是胃上部癌根治术较理想的消化道重建方式.     

Effects of laparoscopy-assisted radical gastrectomy on the expression of intercellular adhesion molecule β1 and integrin 1 in peritoneal mesothelial cells and its significance

Objective To investigate the changes of the expression of intercellular adhesion molecule-1 (ICAM-1) and integrin β1 in peritoneal mesothelial cells during laparoscopy-assisted radical gastrectomy (LARG) and to explore the possible effects of LARG on the peritoneal metastasis. Methods From April to August 2008, LARG was performed for 26 patients with gastric cancer (laparoscopy group), while 20 cases underwent open radical gastrectomy (open group). Peritoneum of right upper belly was collected at 3 operation time points (the beginning, 2 hours, 4 hours). The expressions of ICAM-1 and integrin β1 in peritoneal mesothelial cells at 3 time points were detected by immunohistochemistry. Results With the operation prolonging, the expression of ICAM-1 and integrin β1 was increased gradually in both LARG and open groups. The expression of integrin β1 in two groups was obviously increased at 4-hour time point as compared to the beginning (P<0.05). Besides, there were no significant differences of these two adhesion molecules among the three operation time points between two groups (P>0.05). Conclusions Compared with open surgery, LARG is not associated with a greater effect on the expression of ICAM-1 and integrin β1 in peritoneal mesothelial cells, and may not promote peritoneal metastasis of gastric cancer through increasing the expression of adhesion molecule in peritoneal mesothelial cells.     

Effects of laparoscopy-assisted radical gastrectomy on the expression of intercellular adhesion molecule β1 and integrin 1 in peritoneal mesothelial cells and its significance

Objective To investigate the changes of the expression of intercellular adhesion molecule-1 (ICAM-1) and integrin β1 in peritoneal mesothelial cells during laparoscopy-assisted radical gastrectomy (LARG) and to explore the possible effects of LARG on the peritoneal metastasis. Methods From April to August 2008, LARG was performed for 26 patients with gastric cancer (laparoscopy group), while 20 cases underwent open radical gastrectomy (open group). Peritoneum of right upper belly was collected at 3 operation time points (the beginning, 2 hours, 4 hours). The expressions of ICAM-1 and integrin β1 in peritoneal mesothelial cells at 3 time points were detected by immunohistochemistry. Results With the operation prolonging, the expression of ICAM-1 and integrin β1 was increased gradually in both LARG and open groups. The expression of integrin β1 in two groups was obviously increased at 4-hour time point as compared to the beginning (P<0.05). Besides, there were no significant differences of these two adhesion molecules among the three operation time points between two groups (P>0.05). Conclusions Compared with open surgery, LARG is not associated with a greater effect on the expression of ICAM-1 and integrin β1 in peritoneal mesothelial cells, and may not promote peritoneal metastasis of gastric cancer through increasing the expression of adhesion molecule in peritoneal mesothelial cells.     

腹腔镜胃癌根治术对伴发慢性阻塞性肺病患者的影响

目的探讨腹腔镜胃癌根治术治疗伴发慢性阻塞性肺病（COPD）胃癌患者的可行性。方法回顾性分析第三军医大学西南医院2010年1月至2013年10月实施胃癌根治术的340例伴发COPD胃癌患者的临床资料,其中78例行开腹手术（开腹组）,262例行腹腔镜手术（腹腔镜组．腹内压维持在8～10mmHg）,比较两组术后肺部并发症的发生情况以及与术后肺部并发症发生的相关因素。结果腹腔镜组的手术时间[（220．4±19．1）rain]明显长于开腹组[（194．2±31．5）min,P=0．000],而术中失血量[（131．2±14．7）m1]明显小于开腹组[（246．7±49．0）ml,P=0．000]。腹腔镜组和开腹组患者术后肺部并发症发生率分别为5,3％（14／262）和15．4％（12／78）,差异有统计学意义（P=0．003）。多因素分析结果显示,COPD严重程度是术后出现肺部并发症的独立影响因素（P=0．031,HR=2．456,95％CI：1．306～1．789）,而采用腹腔镜手术还是开腹手术不是其独立影响因素（P=0．126）。结论应用较低腹内压的腹腔镜胃癌根治术治疗伴发轻、中度COPD的胃癌患者是安全可行的。     

Apigenin在肿瘤治疗中的进展

Apigenin是一种类黄酮化合物,化学名称为4,5,7-三羟基黄酮（4,5,7-trmydroxyflavone）,最初对Apigenin研究仅局限于抗炎、中枢神经镇静等方面,直到Wang等发现芹菜素能通过提高细胞内活性氧水平,改变线粒体跨膜电位促使细胞色素C释放到胞浆并激活capase-9的作用,进而导致细胞内caspase-3蛋白酶活化,引起细胞凋亡后,才开始关注其在抗肿瘤生长和转移方面的作用。     

腹腔镜下残胃癌及残胃复发癌的外科治疗

目的探讨残胃癌及残胃复发癌腹腔镜手术治疗的可行性。方法对4例残胃癌和4例残胃复发癌病人行腹腔镜手术切除，分析手术的方式、方法、难点及技术要领。结果在腹腔镜下完成根治性全胃切除6例，行姑息性全胃切除1例，中转开腹1例。腹腔镜手术平均用时（310±50）min，术中平均出血量（190±80）ml，清扫淋巴结平均数量（17．5±6）枚。术后胃肠恢复时间平均（3．5±1．5）d，进食时间平均（3．5±1．5）d，下床活动时间平均（4±1．5）d。无手术并发症。随访时间4～13个月，发生肝脏转移死亡1例，余7例病人仍生存。结论残胃癌和残胃复发癌在腹腔镜行手术切除技术上是可行的，创伤比开腹手术小，恢复快。     

腹腔镜胃癌手术对腹膜间皮细胞ICAM-1和整合素β1表达的影响及意义

目的研究腹腔镜胃癌根治术中腹膜间皮细胞ICAM-1和整合素β1表达的变化,探讨腹腔镜胃癌根治术对腹膜转移的可能影响。方法选择2008年4月至8月行腹腔镜胃癌根治术的26例（腹腔镜组）和同期行开腹胃癌根治术的20例（开腹组）患者,根据手术进程分3个时相（手术开始、手术2h及4h）取右上腹膜,采用免疫组织化学方法检测腹膜间皮细胞ICAM-1和整合素β1的表达。结果随手术时间的延长,腹腔镜组与开腹组腹膜间皮细胞ICAM-1和整合素β1的阳性表达均呈逐渐增强趋势。其中手术4h时两组整合素β1的阳性表达与本组手术开始时相比,差异有统计学意义（P〈0.05）。但两种黏附分子的阳性表达在3个手术时相中,两组间的差异均无统计学意义（P〉0.05）。结论与开腹手术相比,腹腔镜胃癌根治术没有增强腹膜间皮细胞ICAM-1和整合素β1的表达。腹腔镜胃癌手术可能并未通过改变腹膜间皮细胞黏附分子的表达而促进胃癌的腹膜转移。     

腹腔镜阑尾切除术学习曲线模式分析和临床意义

目的 探讨腹腔镜阑尾切除术手术时间变化模式和意义.方法 回顾性分析2007年1月至2010年3月第三军医大学西南医院连续施行105例腹腔镜阑尾切除术患者的临床资料,剔除5例中转开腹患者,最终分析100例患者的手术情况.统计不同手术者手术时间变化情况,总结学习曲线在腹腔镜阑尾切除术中的规律.结果 3名医生成功施行腹腔镜阑尾切除术100例,手术时间为30～217 min,平均手术时间为(87±36)min.所有患者未发生手术中意外伤害,出血量＜10 ml.每位医生手术时间按病例累积呈现持续振荡下降模式,简单正弦拟合两周期点平均为9.6例,可被作为学习曲线的初步终点.结论 腹腔镜阑尾切除术手术时间呈现特征性持续振荡下降模式,初步学习终点为9.6例.     

Effects of laparoscopy-assisted radical gastrectomy on the expression of intercellular adhesion molecule β1 and integrin 1 in peritoneal mesothelial cells and its significance

Objective To investigate the changes of the expression of intercellular adhesion molecule-1 (ICAM-1) and integrin β1 in peritoneal mesothelial cells during laparoscopy-assisted radical gastrectomy (LARG) and to explore the possible effects of LARG on the peritoneal metastasis. Methods From April to August 2008, LARG was performed for 26 patients with gastric cancer (laparoscopy group), while 20 cases underwent open radical gastrectomy (open group). Peritoneum of right upper belly was collected at 3 operation time points (the beginning, 2 hours, 4 hours). The expressions of ICAM-1 and integrin β1 in peritoneal mesothelial cells at 3 time points were detected by immunohistochemistry. Results With the operation prolonging, the expression of ICAM-1 and integrin β1 was increased gradually in both LARG and open groups. The expression of integrin β1 in two groups was obviously increased at 4-hour time point as compared to the beginning (P<0.05). Besides, there were no significant differences of these two adhesion molecules among the three operation time points between two groups (P>0.05). Conclusions Compared with open surgery, LARG is not associated with a greater effect on the expression of ICAM-1 and integrin β1 in peritoneal mesothelial cells, and may not promote peritoneal metastasis of gastric cancer through increasing the expression of adhesion molecule in peritoneal mesothelial cells.     

Effects of laparoscopy-assisted radical gastrectomy on the expression of intercellular adhesion molecule β1 and integrin 1 in peritoneal mesothelial cells and its significance

Objective To investigate the changes of the expression of intercellular adhesion molecule-1 (ICAM-1) and integrin β1 in peritoneal mesothelial cells during laparoscopy-assisted radical gastrectomy (LARG) and to explore the possible effects of LARG on the peritoneal metastasis. Methods From April to August 2008, LARG was performed for 26 patients with gastric cancer (laparoscopy group), while 20 cases underwent open radical gastrectomy (open group). Peritoneum of right upper belly was collected at 3 operation time points (the beginning, 2 hours, 4 hours). The expressions of ICAM-1 and integrin β1 in peritoneal mesothelial cells at 3 time points were detected by immunohistochemistry. Results With the operation prolonging, the expression of ICAM-1 and integrin β1 was increased gradually in both LARG and open groups. The expression of integrin β1 in two groups was obviously increased at 4-hour time point as compared to the beginning (P<0.05). Besides, there were no significant differences of these two adhesion molecules among the three operation time points between two groups (P>0.05). Conclusions Compared with open surgery, LARG is not associated with a greater effect on the expression of ICAM-1 and integrin β1 in peritoneal mesothelial cells, and may not promote peritoneal metastasis of gastric cancer through increasing the expression of adhesion molecule in peritoneal mesothelial cells.