目的 探讨胃腺癌淋巴转移过程中的细胞学特征及相关分子机制的改变.方法 收集2019年9-12月该院胃肠外科13例行胃癌根治术患者的胃癌组织及癌旁组织,利用单细胞RNA测序技术揭示标本中的细胞学特征及相关标记基因.利用实时定量PCR(RT-qPCR)检测主细胞3的标记基因XIST和窝状黏液细胞3标记基因CXCL5的表达水平.分析XIST、CXCL5在淋巴结转移阳性和阴性胃癌患者表达水平的差异.结果 主细胞3和窝状黏液细胞3在胃癌淋巴转移阳性的癌组织明显富集.主细胞3的标记基因XIST在淋巴转移阳性患者胃癌组织表达水平为(0.297±0.261),高于淋巴转移阴性患者胃癌组织的表达水平(0.025±0.023),差异有统计学意义(P＜0.05).窝状黏液细胞3的标记基因CXCL5在淋巴转移阳性患者胃癌组织表达水平为(0.036±0.019),高于其在淋巴转移阴性患者胃癌组织的表达水平(0.008±0.007),差异有统计学意义(P＜0.05).拟时序分析发现主细胞可能是胃癌发生的起源.结论 XIST、CXCL5可能是胃腺癌淋巴转移的潜在信号.

Objective:To investigate the clinical effect of total laparoscopic radical gastrectomy with different esophagogastrostomy.Methods:The clinical data of 126 patients with laparoscopic radical gastrectomy from January 2018 to June 2020 were analyzed retrospectively. According to the different methods of anastomosis，they were divided into overlap group，π Roux-en-Y group（π group）and Roux-en-y anastomosis group（regular group），42 cases in each group. SPSS 23.0 was used for data analysis. Perioperative indicators，nutritional indicators and other measurement data were expressed as（xˉ±s）. One-way ANOVA was performed for comparison between multiple groups. χ2 test was used for counting data such as complications，and P<0.05 indicated statistically significant differences.Results:Patients in π shape group were superior to Overlap group and routine group in terms of total operation time，anastomosis time，intraoperative blood loss，postoperative hospital stay and liquid diet time（P<0.05），and Overlap group was superior to routine group（P<0.05）. The incidence of postoperative complications in π shaped group was significantly lower than that in the other two groups（P<0.05）.Conclusion:π Roux-en-Y anastomosis is effective in operation time，anastomotic time and hospital stay. It is simple and safe，and the incidence of postoperative complications is low，which is conducive to the early recovery of patients，and is worth popularizing in clinical.

目的 探讨全腹腔镜下三角吻合联合经自然腔道取标本(NOSES)用于近端胃癌根治术的效果.方法 选取安徽医科大学第二附属医院2019年10月至2020年10月收治的62例近端胃癌患者,按照治疗方法的不同分为研究组与对照组,各31例.研究组行近端胃部分切除腹腔镜下三角吻合消化道重建联合NOSES治疗,对照组行食管残胃吻合术联合经腹部切口取标本治疗.比较两组的手术效果、手术前后炎症反应及免疫功能指标,以及并发症发生情况.结果 两组患者的性别、年龄、体质指数(BMI)、美国东部肿瘤协作组(ECOG)评分、肿瘤直径、美国麻醉医师协会(ASA)分级及病理分期比较差异无统计学意义(P>0.05).研究组的手术时间、吻合时间、淋巴结清扫数大于对照组,术中出血量、术后首次排气时间、流质饮食时间、术后下床时间小于对照组,差异有统计学意义(P<0.05),两组术后住院时间比较差异无统计学意义(P>0.05).两组手术前后炎症反应指标[白细胞计数(WBC)、C反应蛋白(CRP)]及免疫功能指标[CD3+、CD4+、CD8+、CD4+/CD8+]比较差异无统计学意义(P>0.05).两组术后并发症发生率比较差异无统计学意义(19.4％vs.25.8％,P>0.05).随访6个月,两组均无肿瘤复发、转移及死亡患者.结论 近端胃癌患者采用全腹腔镜下三角吻合消化道重建联合NOSES治疗比食管残胃吻合术联合经腹部切口取标本治疗的效果更优,术后恢复更快,安全可靠.

OBJECTIVE To investigate the effective surgical methods for parapharyngeal space tumors located in the medial part of the carotid artery.METHODS Clinical data and surgical processes of 12 cases with parapharyngeal space tumors located in the medial part of the carotid artery were summarized retrospectively.All tumors were removed through transcervical approach.For the tumor was situated upon the carotid bifuracation,the external carotid artery was cut in order to provide excellent exposure of the tumors.If the tumor was too big and can not be removed in bloc,the tumor can be removed piece by piece under the capsular membrane of the tumor.Also,endoscopic techniques would help a lot for the tumors involving the skull base.RESULTS All of the tumors of the 12 cases were removed completely without any complications,and the pathological report showed schwannoma in 8 cases,paraganglioma,lipoma,parotid mixed tumor and adenoid cystic carcinoma in one case respectively.CONCLUSION Based on the extent,location and the pathological type of the tumor in parapharyngeal space,proper method can be adopted to make the tumors exposed clearly and remove the tumors completely.

OBJECTIVETo discuss imaging characteristics of CT, MRI of tumors involving skull base in the parapharyngeal space,maximatily limit and improve the diagnosis rate of tumors involving skull base in the parapharyngeal space.METHODThirty-one patients with tumors involving skull base in the parapharyngeal space treated in our department were collected and reviewed. All the patients have pathological diagnosis and were examined by CT and/or MRI. To explore shape of tumor, its relation with surrounding structures, CT shows density size and the MRI signal directly through retrospective analysis of imaging characteristics of CT, MRI.RESULTIn all the 31 cases, 19 tumors were schwannoma, 8 tumors were mixed tumor of salivary gland, 2 tumors were carotid body tumor. 2 tumors were nasopharyngeal carcinoma involving skull base. Schwannomas and salivary gland mixed tumor can be expressed as round or oval with periphery smooth, and had intact capsule. The tumors had necrosis, sac variable area. Pleomorphic adenoma are all derived from deep parotid. Schwannoma had clear boundary with deep parotid. The effect of cavum nasopharyngeal and cavum oropharyngeal is relevant to tumor sizes and locations. Imaging characteristics of CT, MRI for carotid body tumor show soft tissue mass with attenuation similar to that of muscle. CT enhancement scan show intense enhancement. MRI show imaging of flowing empty vein. Imaging characteristics of MRI for nasopharyngeal carcinoma involving skull base in the parapharyngeal space show oval mass with low density signal, T1WI enhancement scan show necrosis, sac variable area.CONCLUSIONCT and MRI could provide the position, size, boundary of the tumor and its relationship with cervical blood vessels well, which were important to operation schemes. CT and MRI before operation are valuable to the treatment of PPS tumors.

目的:探讨鼻腔及鼻窦非霍奇金淋巴瘤(NHL)的CT特点,提高诊断准确性.方法:回顾性分析24例经病理证实的鼻腔及鼻窦NHL的CT表现.结果:24例中16例位于单侧,8例累及双侧.原发于鼻前庭2例、鼻腔6例、鼻窦9例、鼻腔鼻窦7例.病灶肿块表现15例,浸润表现9例.24例中22例病灶密度相对均匀,2病灶密度相对不均,增强后部分强化.原发于鼻腔的淋巴瘤1例见骨质破坏,原发于鼻窦和鼻腔鼻窦的有6例见骨质破坏；常累及邻近结构.结论:鼻腔鼻窦NHL的CT表现缺乏特征性征象,但有一些相对特异性征象有助于鼻腔鼻窦NHL的诊断.根据CT的相对特征性表现,结合临床,有助于及时诊断该类疾病.