<正>乳腺癌是严重危害女性健康的恶性肿瘤[1],其发病率逐年递增,目前据相关资料报道已跃居为女性恶性肿瘤的首位[2],随着乳腺癌研究的深入,及临床发展的需要,作为临床前体内研究的基础,乳腺癌的动物模型对临床治疗起着至关重要的作用[3],现

<正>我院始建于1943年,是本市最早的公立医院,也是我市医疗卫生事业发展的摇篮,九十年代因特殊情况错过了三甲医院评审机会,是医院历史上的一大遗憾!经过70年的发展,已经成为一家以肿瘤防治为特色的大型综合医院。医院占地面积50671平方米,编制床位920张,拥有市肿瘤放射治疗中心、乳腺治疗中心、肿瘤研究所、法医鉴定中心,此外我院还是全国百万妇女乳癌普查工程定点医院。

目的:应用ISO 9000标准提高围手术期护理质量。方法:通过建立质量标准、工作流程,加强科室协调、监督检查等措施。结果:患者满意度提高。结论:此模式能够持续提高围手术期护理质量。

Objective To explore of clinical value of AFP-L3 in the diagnosis of patients with HCC.Methods The serum AFP-L3 levels in 137 patients with elevated AFP level were detected by ELISA.The patients were divided into HCC group and benign liver disease group.Results The serum levels of AFP-L3 in patients with HCC(109.04±62.51ng/mL) were significantly higher than those patients with benign liver diseases(25.96±49.43ng/mL,P0.001).The area under the ROC curve of AFP-L3 level in patients with HCC was 0.819.Taking AFP-L3 level ≥37.9ng/mL as diagnostic criteria,the sensitivity of AFP-L3 level in HCC diagnosis was 83.7%,and the specificity was 88.9%,with a total conformity rate of 85.4% compared to the confirmed clinical diagnosis.Conclusion The serum AFP-L3 levels might be a valuable biomarker in diagnosis and prediction of prognosis of HCC.The detection of AFP-L3 level by using ELISA is simple and cost-effective method.

Objective To study the relationship between fatty pancreas and insulin resistance(IR).Methods Multi-level spiral CT(MSCT) was employed to scan the upper abdomens of all research participants and their clinical data were retrospectively analyzed.Sixty patients with fatty pancreas were included in the study group,which was compared with the control group to observe the incidence of IR.Results Compared with the control group,the incidence of IR in the study group showed significant difference(P<0.01).Conclusion Patients with pancreatic fatty infiltration have obvious lipid metabolism disorders.The clinical manifestations of the fatty pancreas include pancreatic fatty infiltration,indicating the interactive relationship between the pancreatic fatty infiltration and IR.

[目的]探讨细胞凋亡抑制因子Clusterin在乳腺浸润性导管癌组织中的表达及其与临床病理因素的关系。[方法]应用免疫组化SP法检测70例乳腺浸润性导管癌、20例乳腺增生和10例乳腺癌旁组织标本中Clusterin的表达情况。[结果]Clusterin在乳腺癌旁正常组织、乳腺增生及乳腺浸润性导管癌组织中的阳性表达率分别为0、20.0%及71.4%,乳腺浸润性导管癌组织中的Clusterin表达水平明显高于乳腺增生及乳腺癌旁正常组织(P<0.05)。Clusterin蛋白在乳腺浸润性导管癌中的表达与临床分期、组织学分级及淋巴结转移情况有关(P<0.05),而与患者年龄、肿瘤大小无关(P>0.05)。在乳腺浸润性导管癌组织中Clusterin与ER、PR的表达呈负相关(P<0.05)。[结论]Clusterin可能在乳腺癌的发生发展中发挥重要促进作用,可望成为乳腺浸润性导管癌诊断中的标志物及新的治疗靶点。

目的探讨早期乳腺癌肿物切检术后前哨淋巴结活检(SLNB)的可行性、准确性及临床应用价值。方法采用锝-99m硫胶体(99mTc-SC)联合美蓝对26例T1～2N0M0乳腺癌患者进行SLNB,探讨联合示踪法SLNB在肿物切检术后早期乳腺癌中的临床应用价值。结果本组26例中共有9例SLN病理检测阳性并行腋窝淋巴结清扫(ALND),其中4例2种方法确定的前哨淋巴结不一致,1例术前显影失败,其余4例阳性及17例阴性病例两种方法确定的前哨淋巴结一致。联合示踪法灵敏度为88.9%,准确性为96.2%,假阴性率为11.1%,假阳性率为零。结论 99mTc-SC联合美蓝明显提高早期乳腺癌局部切检术后SLNB的成功率。

Objective:To study the effect of vascular endothelial growth factor(VEGF) in resisting infection of skin flap.Mtehods: Randomized flaps 6cm×4cm were created on the back of 60 Sprague-Dawley rats.The treatment group(n=30) received VEGF 1.0μg/flap during the operation.The control group(n=30) received equal quantity normal saline.After operation,Pseudomonas aeruginosa bacteria was inoculated immediately.Results: Immunohistochemical staining of basic fibroblast growth factor(bFGF): At the third postoperative day,there was a significant increase in bFGF expression in the middle part and the distal part of flap tissue in the VEGF treated group as compared to the corresponding portions in the control group(P0.01).Succinate dehydrogenase(SDH) level: At the forth postoperative day,the level of succinate dehydrogenase in the middle part and the distal part of flap tissue in the VEGF treated group were significantly increased(P0.01).Transmission electron microscopy(TEM) studies: the structures and functions of fibroblast and vascular endothelial cell in the VEGF treated group were better than those in the control group.Interleukin-1β expression in the control group flap significantly increased at the eleventh postoperative day compared with treatment group(P0.01).Vascular density in the treatment group significantly increased at the eleventh postoperative day compared with control group(P0.01).Conclusion: Vascular endothelial growth factor(VEGF) might improve the flap micro-circulation,accelerate the vascularization of the flap,protect flaps from ischemia and play an important role in improvement flap survival and resisting infection.

<正>陈光惠等研究表明,高血压模型中细胞增殖抑制基因(hyperplasic suppress gene,HSG)在增生活跃的血管平滑肌中呈低水平表达,而外源性给予HSG可明显地抑制血管平滑肌细胞的生长,同时证实HSG对多种肿瘤传代细胞系同样有明显的生长抑制和诱导凋亡的作用,提示HSG有可能成为新的抑癌基因。下面就HSG的结构、功能及其与高血压、肿瘤等疾病的关系作一综述。

我院2003年2月至2008年5月对雄激素非信赖性或去势治疗后肿瘤复发引起各种并发症的晚期前列腺癌患者采取外科手术治疗取得良好效果,报告如下.

目的探讨经尿道选择性绿激光汽化术治疗膀胱癌新技术的安全性和疗效。方法对84例经病理活检证实的表浅性膀胱癌患者,采用单盲随机的方试,分别运用经尿道选择性绿激光汽化和电切术2种方法进行治疗。并对术中出血、肿瘤复发情况、膀胱穿孔例数等指标进行比较。结果2种方法治愈率差异无统计学意义(P>0.05),但选择性绿激光汽化组术中出血远远低于电切组(P<0.01);且前者术后不需留置尿管、无需膀胱冲洗及无膀胱穿孔之忧。结论选择性绿激光治疗技术比电切治疗在术后恢复、减少术中术后并发症方面比电切更优越。

目的:烧伤康复期患者应用中草药浸浴观察微循环的变化,对烧伤后期康复治疗是一种有效的治疗方法和监测手段.方法:采用WX-753B型微循环显微镜及图像处理系统进行观测,应用法国产REF1254型自动调温浴缸.观测烧伤康复期患者应用中草药浸浴足甲襞微循环及未经中草药浸浴的烧伤康复期患者的足甲襞微循环.结果:未经中草药浸浴烧伤康复期患者的足甲襞微循环与经过中草药浸浴的烧伤康复期病人足甲襞微循环比较,最显著的变化:管襻畸形率高(P<0.01),汗腺导管增多(P<0.01),血管管襻周围渗出等.结论:严重烧伤经治疗伤面愈合,但是烧伤后微循环的紊乱长期存在,影响病人的康复.经中草药浸浴治疗可明显改善烧伤康复期患者的微循环,适合烧伤康复期病人的治疗.

气腹是施行腹腔镜手术的重要前提,目的在于为术者提供一个清晰的术野.CO2因不易燃爆,且在血液及组织中溶解度高,形成气栓的可能性小,是目前常用的充气气体.腹腔镜手术同开腹手术一样,在祛除病灶的同时,也给机体带来了创伤.腹腔镜手术给机体的创伤来源于:①腹腔内高压综合征;②CO2入血所致高碳酸血症;③手术结束时腹内压骤降引发类似缺血再灌注损伤.大量研究证实建立气腹时腹内压(intra-abdominal pressure,IAP)急性升高导致机体一系列病理生理变化,本文就腹腔镜手术时对机体应激反应的影响做一综述.

Objective To observe the effects of different CO_2 pneumoperitoneum pressure on duration of residual gas and shoulder pain following laparoscopic cholecystectomy (LC), and to identify factors which affect resolution time and shoulder pain. Methods Sixty-nine patients underwent LC from April 2002 to October 2002 were randomly divided into three groups with 23 patients in each group. The CO_2 pneumoperitoneum pressure was set at 10 mmHg in the Group A, 12 mmHg in the Group B, and 14 mmHg in the Group C. Serial chest X-ray examinations were taken until all residual gas was resolved. The X-ray results were analyzed by a consultant radiologist. The volume of residual gas bubble under each hemi-diaphragm 24 hours after operation was calculated by making of length of arc and height of the gas. The intensity of shoulder pain was recorded on a visual analogue score (VAS) at 1, 3, 6, 12, 24, 48, 72, 96, and 120h after operation. Results The pneumoperitoneum resolution time after LC was 1.8±1.1 d. There was no significant difference in the resolution time between male (1.8±1.1) and female patients (1.7±1.0) (H=0.013, P=0.911). There was no significant difference in the resolution time and the gas volume under the right hemi-diaphragm 24 hours after operation among the three groups (P>0.05). The stepwise regression analysis showed that the logarithm of the duration of residual gas had a parallel relationship with the gas volume under the hemi-diaphragm 24 hours after operation(r=0.616,P=0.006),a negative correlation with the duration of pneumoperitoneum (r=-0.228,P=0.014), and no correlation with patients’ age,body weight,height,operation time and gas volume consumed. Postoperatively, 26 patients reported postoperative shoulder pain. The shoulder pain VAS scores were significantly increased with the increasing of CO_2 pressure in the three groups (F=9.635, P=0.000). The shoulder pain VAS scores had a parallel relationship with the gas volume under the right hemi-diaphragm 24 hours after operation (r=0.333, P=0.005) and the duration of residual gas (r=0.296, P=0.014). Conclusions The CO_2 should be removed as thoroughly as possible at the end of operation to reduce the absorption of residual gas. The different CO_2 pressures of pneumoperitoneum have little effects on the volume of residual CO_2 24 hours after operation and the duration of residual gas. The shoulder pain following LC, will be aggravated with the increasing of pneumoperitoneum pressure. The over-stretching of the diaphragmatic fibers due to insufflation is the main cause of shoulder pain.

自1897年Schlatter首先施行全胃切除术成功后,直至1943年,世界文献共报道该手术303例,手术死亡率高达40%[1],以后手术死亡率逐年降低.近10年来,随着对胃癌生物学特性及其转移规律进行了深入的研究,多数学者主张对胃癌应扩大根治范围,认为全胃切除术为胃癌手术治疗的主要方法之一,其手术死亡率已下降至5%左右[2].我院2004年8月至2006年4月间共施行全胃切除治疗胃癌28例,现报告如下.

30岁以下青年乳腺癌往往病期晚,复发转移率高,预后很差[1].我院1990-1999年的10年间收治该年龄段患者73例,其中66例术后随访资料完整,死亡28例.本文对其死亡因素进行了分子生物学和临床指标的分析,报告如下.

Objective To investigate the feasibility of single-port gasless laparoscopy in animal models. Methods A novel shadowless cold light source was connected with a side-viewing camera and an abdominal wall lifting retractor.By using an electric knot-tying device and S-shaped or L-shaped surgical apparatuses,gasless abdominal operations were completed under direct vision combined with laparoscopic visualization.The operations included cholecystectomy and surgical operations of esophagus,stomach,and liver in rabbits(n=10),cholecystectomy and enteroanastomosis in dogs(n=4),and cholecystectomy in pigs(n=3).Results All the operations were completed smoothly.All the animals survived without biliary leakage.Tissues and blood vessels were ligated satisfactorily. Conclusions Single-port gasless laparoscopy in animal models is feasible,safe,and micro-invasive.It avoids complications related to pneumoperitoneum.