近年来，胰腺癌的治疗并未取得良好的收效，全基因组测序及诊断的微解剖技术使我们发现胰腺癌的分子分型的多样性，诊疗策略均无法套用其他肿瘤的模式，但可以肯定的是由于胰腺癌肿瘤组织和间质的部分独立性发展及相互联系制约，使得肿瘤相关的微血管以及肿瘤微环境亦有其独特性，肿瘤微环境更像是一个微生态，干预微血管的生理可以使肿瘤、微环境的特性发生改变，机械性的过渡干预或者不适时的干预则会干扰了机体自身对肿瘤的免疫。目前针对胰腺癌微血管的生理特性的认识较前有所提高，但其对肿瘤发生、发展及转移的影响机制仍需要进一步研究。

回顾分析2013年1月至2014年1月青海省人民医院普外科行体外肝切除加自体肝移植治疗4例终末期肝泡型包虫病患者资料。4例患者顺利完成手术，无肝期190～250 min，体外病灶切除及自体门静脉重建肝静脉流出道耗时120～150 min。其中1例术后出现多脏器功能衰竭于术后第4天死亡，其余3例随访情况良好。

目的 研究分析微创内镜保胆取息肉术治疗胆囊息肉的临床疗效、并发症及远期预后,为胆囊息肉临床有效治疗提供科学指导.方法 回顾性分析2012年6月至2015年6月诊治的125例胆囊息肉患者临床资料,随机将其分为两组.对照组55例行腹腔镜胆囊切除术治疗,研究组70例行微创内镜保胆取息肉术.对比两组患者围术期指标、并发症、胆囊壁厚度与胆囊收缩功能改善以及远期预后效果.结果 研究组手术时间、肠功能恢复时间、肛门排气时间、住院时间依次为(50.01±ll.84)min、(21.23±3.14)h、(17.62±4.25)h、(4.15±1.25)d均短于对照组(62.12±3.14) min、(42.26±4.25)h、(27.55±5.14)h、(9.82±3.25)d,出血量(11.25±2.47) ml、术后VAS评分(2.67±1.25)分均少于对照组(17.26±3.02)ml、(7.56±1.81)分(P＜0.01);两组术后胆囊壁厚度、胆囊收缩功能均改善,且研究组改善优于对照组(P＜0.01);研究组息肉复发7.14％低于对照组25.45％.结论 微创内镜保胆取息肉术治疗胆囊息肉效果显著,未发生胆瘘、出血等严重并发症,且可改善患者胆囊收缩功能,降低息肉复发率,具有临床推广价值.

Objective To investigate the extent of pancreatic and liver function damage of acute necrotizing pancreatitis (ANP) rats under altitude hypoxia environment,and to provide a reference for better diagnosis and treatment of severe acute pancreatitis (SAP) in the plateau region.Methods Ninety-six specific pathogen free (SPF) Wistar male rats were involved in 1 500 meters,3 300 meters and 4 300 meters altitude.The model of ANP was established by using pancreatic capsule injection of sodium taurocholate (NaTc).In the sham operation group,the rats' belly was opened and closed after only flipping its pancreas several times.Rats in sham group were sacrificed at 6 h,and ANP group were sacrificed at 6,12,24 h after modeling.Serum amylase activity was measured,and pancreas and liver tissue were harvested for pathological examination and score.Results Serum amylase activity in sham operation group rats was not remarkably changed,and pathological changes of pancreas and liver were not obvious.At same altitude,serum amylase activity,pancreas and liver pathology score of ANP rats at each time point were significantly higher than those in the sham operation group;and serum amylase activity,pancreas and liver pathology scores of ANP 12,24 h group rats were significantly higher than those of ANP 6h group;and the difference was statistically significant (P ＜ 0.05).At 3 300 meters,4 300 meters altitude,the pancreas and liver pathology scores of ANP rats at each time point were significantly higher than those at 1 500 meters altitude,and the differences were statistically significant (P ＜ 0.05),but the difference in serum amylase activity was not statistically significant.Conclusions With the increase of altitude,pancreatic and liver pathological damage of ANP rats shows continuing aggravation.

Objective To detect the expression levels of Caspase-3 and Survivin in rats with acute pancreatitis,and to explore their correlation with pancreatic tissue damage.Methods Sixty SPF male Wistar rats were randomly divided into four groups:sham-operation group ( n =15),6 hours after pancreatitis group (6h group, n =15),12 hours after pancreatitis group (12h group, n =15),24 hours after pancreatitis group (24h group, n =15).The animal models with pancreatitis were induced by injection of 5% Na-Tc under capsula pancreatis.The activity of serum amylase,pathological injury of pancreas, expression levels of Caspase-3 and Survivin were detected for all the groups.Results There were significant differences in the activity of serum amylase, pathological injury of pancreas and the expression levels of Caspase-3 and Survivin among sham-operation group,6h group,12h group,24h group with each other ( P <0.05).There were close correlations among Caspase-3,Survivin, serum amylase and pathological injury scoring.Conclusion The process of acute pancreatitis is accompanied with the expression disorder of Caspase-3 and Survivin, furthermore, which is closely correlated to pancreas injury.

Objective To explore the expression of matrix metalloproteinase-11 (MMP-11) gene in gastric cancer and its correlation with transcription factor Sp1.Methods The expressions of the MMP-11 and Sp1 in level of RNA and protein in 11 specimens from the gastric cancer patients s were detected by RT-PCR,differential PCR and Western-blot,respectively.Results Electrophoresis illustration showed MMP-11 mRNA expression had significant differences in eight pairs of gastric cancer tissues and normal tissues,including 7 pairs of over expressed in gastric cancer tissues and low or no expression in normal tissues,and 1 pair of low expression in cancer tissues but high in normal tissues.The relative molecular weight of Sp1 protein was mainly 95×103 in cancer tissue and 106×103 in normal tissues.Activated MMP-11 protein mainly was over expressed in gastric cancer tissues,and low or no expression in normal tissues,but degradable MMP-1 1 protein was not observed.The enzyme prototype of and activated type of MMP-11 protein were also associated with Sp1 protein.Conclusions The MMP-11 mRNA expression in gastric tissue is higher than that in the adjacent tissues.Sp1 protein and MMP-11 protein are expressed in gastric cancer,but are low or no expression in normal tissue.There is relationship between Spl and MMP-11.

通过搜集国内外关于此病的诊断、治疗的发展过程的相关文章,结合国内外相关资料及各类治疗指南,并结合笔者临床经验,从该病的发展,对本病的逐渐认识及研究进程来进一步阐述急性梗阻性化脓性胆管炎的诊治及治疗现状.

Wnt信号通路在生物个体发育过程中发挥着重要作用.分泌型卷曲相关蛋白5(SFRP5)在细胞外竞争性地与细胞膜表面Fz受体结合抑制经典以及非经典Wnt信号通路的激活,从而对Wnt信号通路的状态产生重要影响.研究发现,SFRP5是一种脂肪细胞因子,可通过调节Wnt信号通路的状态影响生物体内代谢过程,调节能量的摄入和消耗以及调节糖代谢、脂代谢,在代谢性疾病的发病过程中发挥重要作用.

目的:总结DNA甲基化和E-cadherin基因甲基化与胃癌关系的研究现状.方法:应用PubMed及万方数据知识服务平台检索系统,以“胃癌、DNA甲基化、E-钙黏蛋白基因和CpG岛”等为关键词,检索1979-01-2013-05的相关文献,共检索到英文文献2 093篇,中文文献672篇.纳入标准:1)关键词包括胃癌及DNA甲基化;2)文中包括E-钙黏蛋白基因启动子区CpG岛甲基化.剔除标准:1)非E-钙黏蛋白基因启动子区CpG岛的甲基化;2)关键词有E-钙黏蛋白但文中无甲基化描述.符合纳入标准的中文文献56篇,英文文献43篇,根据剔除标准剔除中文文献46篇,英文文献23篇,最后纳入分析30篇文献.结果:DNA甲基化在基因表达、调控过程中发挥重要作用,其功能紊乱在恶性肿瘤形成过程中具有重要作用,与胃癌的发生密切相关.E-cadherin基因能抑制肿瘤细胞的浸润和转移,E-cadherin基因启动子区CpG岛甲基化是胃肠道肿瘤E-cadherin基因失活的主要原因,可引起E-cadherin表达下降或缺失,与胃癌的发生、浸润、转移和预后密切相关.结论:DNA甲基化和E-cadherin基因甲基化与胃癌的形成、浸润和转移等关系密切,但其要成为胃癌防治的靶点仍需进一步研究.

切口感染率是衡量医院治疗水平的重要标志之一.腹部Ⅲ类切口感染是腹部手术后常见并发症,与多种因素密切相关,其防治工作已成为外科临床工作中一项重要任务.我们发现在手术过程中采取一些简单易行的措施可有效控制和降低切口的感染率,报道如下.

青海省是肝包虫病的高发地区,其中泡型肝包虫病的发病更位居全国首位.终末期泡型肝包虫病的治疗极为困难,常规手术无法达到根治的目的.体外肝切除结合自体肝移植不失为治疗该病的一种理想选择.我院于2013年5月22日,对1例常规肝切除方法无法治疗的终末期泡型肝包虫病患者,实施了体外肝切除+自体肝移植术,效果满意.现报告如下。

淋巴结转移、腹膜转移是胃癌转移最常见形式.是影响胃癌预后及治疗策略的重要因素.本综述阐述目前与胃癌转移相关的分子标志物的研究进展.为胃癌的早期诊断与治疗提供新思路.

Objective To observed the expression of serum TNF-α and IL-10 in rats with severe acute pancreatitis (SAP) at different altitudes,and to explore the relationships between TNF-α and IL-10,the pathological changes of the pancreas,and the experimental basis for clinical diagnosis and treatment of SAP.Methods 72 specific pathogen free (SPF) Wistar male rats were divided randomly into three groups:1 500 meters altitude (group L),3 300 meters altitude (group M),and 4 300 meters altitude (group H).These three groups were then each divided randomly into four subgroups:control (group n),6 hours after pancreatitis (group p 6 h),12 hours after pancreatitis (group p 12 h),and 24 hours after pancreatitis (group p 24 h).Pancreatitis was induced by intraductal administration of 5％ sodium taurocholate hydrate (NaTc).The rats were killed at 6,12,and 24 hours after NaTc injection in groups p.The group n rats were killed after 6 hours of pancreas observation.Blood samples and pancreatic tissues were collected post mortem and enzyme-linked immunosorbent assay (ELISA) measured serum TNF-α and IL-10.Results Compared with the control (group n),histopathological scores,IL-10,and TNF-α in the same altitude had a significant difference (P ＜ 0.05) in group p at each time point.In the same altitude of group p,histopathological scores and IL-10 were increased with time elapsed (P ＜ 0.05),while TNF-α was decreased with time elapsed (P ＜ 0.05).There was a significant difference between group Mp and Lp in histopathological scores,IL-10,and TNF-α (P ＜ 0.05),and the same result between group Hp and Lp (P ＜ 0.05),but there was no significant difference between group Hp and Mp (P ＜ 0.05).Meanwhile,IL-10 had a positive relationship with histopathological score,but TNF-α had a negative relationship with histopathological score.Conclusions The level of TNF-α increased with increasing altitude but significantly reduced with elapsed time.The level of IL-10 increased with both increasing altitude elapsed time.These results suggested that TNF-o and IL-10 might play a important role at different times in severe acute pancreatitis.

OBJECTIVE:To explore the blood oxygen saturation and heart rate changes of the Antarctic explorers.METHODS:During August 2010 to April 2011, the changes in blood oxygen saturation, heart rate and plateau reaction of 16 Antarctic expedition team in different plateau environments (Tibetan plateau versus Antarctic plateau) were monitored with the noninvasive pulse oximeter MD300-C. The extent of acute mountain sickness was determined according to the Lake Louise Consensus acute mountain reaction symptom scores and judgment method.RESULTS:The changes of blood oxygen saturation, heart rate at different altitudes of 110, 3650, 4300 m (96.8% ± 1.2%,89.1% ± 1.2%, 86.1% ± 2.0%, (75.0 ± 5.4) times/min, (104.0 ± 4.3) times/min, (113.0 ± 5.2) times/min,F = 214.155, 240.088,both P < 0.05). With rising latitude and elevation gradient in Antarctic plateau, the changes of blood oxygen saturation, heart rate at different altitudes of 2000, 2500, 3000, 3500 and 4087 m(91.9% ± 1.3%,90.5% ± 1.3%,87.6% ± 1.4%,85.0% ± 1.8%,81.5% ± 2.2%, (85.9 ± 3.2) times/min, (90.6 ± 2.8) times/min, (97.8 ± 4.1) times/min, (102.0 ± 3.4) times/min, (106.3 ± 3.9) times/min, F = 105.418, 90.174, both P < 0.05). Levels of blood oxygen saturation and heart rate were both correlated with the risk of altitude sickness (r = -0.446 and 0.565, both P < 0.05).CONCLUSIONS:As the increases of altitude, there are significant changes in oxygen saturation, heart rate of the Antarctic explorers. And with the increases of altitude, the risk of altitude sickness gradually increases.

<正>闭合性腹部损伤(blunt abdominal injury,BAI)是普外科常见的急诊之一,随着工、农业和交通运输业的高速发展,BAI的发生率也随之升高,损伤的程度有加重的趋势。BAI病情复杂、变化快,因其往往是多脏器损伤,且具有隐蔽性,加上感染等因素,容易出现多器官功能衰竭而危及生命,如诊治不及

Objective To study the diagnosis and surgical principle for pancreatic injury.Methods The clinical data of 39 cases with pancreatic injury in our hospital from Feb 2002 to Oct 2012 were analyzed retrospectively.Lucas classification of 4 grading was used to evaluate the extent of pancreatic injuries.Results The patients with pancreatic injuries were diagnozed all by operation.Eleven cases(28.2%) were pancreatic injuries only and 28 cases(71.8%) combined with other organ injuries.Totally 31 cases were cured.The mortality(8 cases) was 20.5% of which 3 case died postoperative early with multible organ injuries and 5 cases postoperative late by multible organ dysfunction syndrome due to severe pancreatic necrosis,pancreatic leakage and pancreatic infection.Four cases with Ⅳ degree of pancreatic injuries were cured by damage control procedure firstly and definitive operation subsequently.Conclusions MRCP is suitable for the diagnosis of pancreatic duct injury.The identification and location of main pancreatic duct injury is the key to successful treatment.Damage control surgery should be performed for severe pancreatic injury.

Classical methods of digestive tract reconstruction after pancreaticoduodenectomy for pancreatic carcinoma have such side effects as damage to the normal physiological function and an higher incidence of complications. Researchers have have modified procedures for alimentary reconstruction and produced controversial results. Perfect reconstruction after pancreaticoduodenectomy must maintain the physiological function of the patient and a low morbidity. Every reconstruction has the advantages and disadvantages,and is indicated for different situations. Decision should be made for each patient according to tumor location,their condition and skills of surgeons. This article summarizes the clinical experiences in the reconstruction of the digestive tract after pancreaticoduodenectomy for pancreatic carcinoma.

Objective To investigate the alterations of blood coagulation and fibrinolysis system in murine experimental severe acute pancreatitis (SAP) at different altitudes.Methods 72 Wistar male rats were divided into three groups randomly (n =24 in each group):4300 metres' altitude(group H),3300metres' altitude group(group M) and 1500 metres' altitude group(group L).Each group was further divided into four subgroups (n =6 in each subgroup):normal group (group N),6 hour after SAP model establishment group(group p6 h),12 hour after SAP model group(group p12 h),24 hour after SAP model group(group p24 h).Retrograde pancreatic duct injection of 5％ sodium taurocholate (NaTc) method was used to establish SAP animal model.The levels of amylase (AMY),D-dimer,prothrombin time (PT),activated partial thromboplastin time (APTT),fibrinogen (FIB) and the contents of antithrombin Ⅲ (AT-Ⅲ) in serum were measured.Pancreatic tissues were sampled and studied by hematoxylin-eosin(HE) staining.Results (1)Compared to group N,the pancreas pathology score,AMY,Fib and D-dimer in serum increased significantly (P ＜ 0.05) and PT,APTT and AT-Ⅲ lowered significantly (P ＜ 0.05) at each time point in group P in the same altitude.In group P,the contents of Fib and D-dimer and pathological score gradually increased with time (P ＜ 0.05),AT-Ⅲ activitise gradually decreased with time (P ＜ 0.05) ; there was a significant difference (P ＜ 0.05) when Fib,D-dimer,AT-Ⅲ was compared among three altitude's group P.(2) There was a significant difference (P ＜ 0.05) between histological scores,PT and APTT in group Hp and group Lp,and the same result (P ＜ 0.05) between group Mp and group Lp.There was no significant difference between group Hp and group Mp (P ＞ 0.05).(3) There was a positive correlation between histological scores and Fib,D-dimer (P ＜ 0.05) in group P in the same altitude ; AT-Ⅲ and histological scores,Fib,D-dimer (P ＜ 0.05) have a negative correlation in group P in the same altitude.Conclusions More severe damage of pancreatic tissues and disorders of coagulation and fibrinolysis system were observed in rats with severe acute pancmatitis at high altitudes.Changes in blood coagulation and fibrinolysis system may be involved in the severity of acute pancreatitis.

<正>慢性胰腺炎(chronic pancreatitis,CP)是指由不同病因引起的胰腺实质弥漫性或局限性病理改变,临床上可表现为持续性腹痛,进行性的内、外分泌功能减退。影像学检查可发现胰管狭窄、扩张、胰管结石、胰腺钙化、胰腺假性囊肿、胰腺包块等。治疗目的主要是缓解疼痛,解除胆胰管梗阻,清除结石,切除肿大的胰腺包块,延缓病程,补充胰腺内、

Objective To discuss the selection of surgical procedure, the curative effect and the safety of resection for hepatic hemangioma. Methods Clinical data of 96 patients with pathologically confirmed hepatic hemangioma who received resection in the People's Hospital of Qinghai Province from January 2000 to December 2011, were analyzed retrospectively. There were 34 males and 62 females with the age of 28 to 67 years old and the median age of 47 years old. There were 69 patients with single lesion and 27 patients with multiple lesions. The informed consents of all patients were obtained and the ethical committee approval was received. The patients received resection of hepatic hemangioma, or segmental hepatectomy, lobectomy, hemihepatectomy and hepatic hemangioma ligation. The procedure, intraoperative bleeding, postoperative complications and recurrence were observed. Patients were followed up after being discharged from hospital and liver ultrasonography was applied to check whether there was hemangioma recurrence. Results All the patients underwent operation successfully without perioperative death. Of the 96 patients, 68 patients received resection of hepatic hemangioma, 3 patients underwent right hemihepatectomy, 1 patient underwent left hemihepatectomy, 5 patients underwent hepatic caudate labectomy, and 19 patients underwent segmental hepatectomy; 27 patients with multiple lesions underwent resection of major lesions firstly and then the smaller lesions were ligated. The median of intraoperative bleeding was 630(60-5700)ml. Pleural effusion was observed in 9 patients, bile leakage in 3 cases, subphrenic hydrops in 2 cases and incision infection in 1 case. All the patients were cured by conservative treatment. Sixty-nine patients were followed up for 1-3 years and no hemangioma recurrence was found. Conclusions Surgical resection is a safe and effective treatment for hepatic hemangioma, in which hemangioma resection is the most common approach. Liver hemangioma ligation is usually performed to deal with the smaller lesions in patients after the major lesions are resected. Key words: Hemangioma, cavernous; Liver neoplasms; Hepatectomy; Suture techniques