[目的]观察吡柔比星和内皮抑素(Endostatin,ES)对乳腺癌细胞的影响.[方法]将人乳腺癌MCF-7细胞株分为对照组;不同浓度的吡柔比星组;ES组以及不同浓度吡柔比星+ES组.用MTT法测定不同浓度吡柔比星及ES作用于MCF-7细胞72 h后的增殖活性并进行比较.[结果]吡柔比星单独应用时,平均制率(IR)随着吡柔比星浓度的增加依次增加,作用72 h时,各浓度组均对增殖活性均有抑制作用(P＜0.05);ES单独应用时,作用72 h时对增殖活性具有抑制作用(P＜0.05),吡柔比星与ES联合应用时,平均IR亦随着其中吡柔比星浓度的增加依次增加,作用72 h后,3种浓度的吡柔比星与ES联合应用,均具有协同作用(P＜0.05).[结论]ES与吡柔比星两者联用在抑制肿瘤生成方面具有协同作用.

[Objective]To explore the inhibitory effect of endostatin (ES) combined with pirarubicin(THP) on tumor growth and neoangiogenesis in human breast cancer xenografts in nude mice .[Methods]Nude mice models of breast cancer were established .Forty nude mice models were randomly divided into 4 groups with 10 mice in each group .The control group(group A) was given subcutaneous injection of 1 × 106/0 .1mL normal human fibroblasts into the back of contralateral tumor .Group B(group ES) was given subcutaneous injection of 1 × 106/0 .1mL human fibroblast transfected with ES .Group C(pirarubicin group) was given injection of 5mg/kg THP by caudal vein once a week for 4 weeks .Group D(ES+ THP group) was given subcutaneous in-jection of 1 × 106/0 .1mL human fibroblasts into the back of contralateral tumor and injection of 5mg/kg T HP by caudal vein once a week for 4 weeks .ELISA was used to detect serum vascular endothelial growth factor (VEGF) .Pathological section of tumor tissue was used to observe microvessel density (MVD) .[Results]Tumor inhibition rate(TIR) of group B ,C and D were 61 .96% ,27 .33% and 75 .16% ,respectively .The TIR of group D was obviously higher than that of other two groups .Compared with other groups ,VEGF and MVD of group D were obviously decreased ,and there was significantly difference( P<0 .05) .[Conclusion]ES combined with THP can obviously inhibit tumor growth and neoangiogenesis of human breast cancer xeno-grafts in nude mice ,and has synergetic effect .

[目的]总结电子胸腔镜在外科胸腔积液诊疗中的应用体会.[方法]回顾性分析20例胸腔积液患者电子胸腔镜检查结果及检查方法.[结果]该组20例经胸腔镜和胸膜活检确诊19例,确诊率为95％.[结论]可弯曲电子胸腔镜检查操作简单、安全,在外科胸腔积液的诊断中具有重要价值.

[目的]对比开胸手术与胸腔镜下手术(VATS)治疗原发性自发性气胸(PSP)患者术后生活质量.[方法]选取2005～2008年本院行手术治疗的PSP患者共100名.将患者分为两组,其中行传统开胸手术治疗53例(A组),行胸腔镜手术者47例(B组).观察比较两组患者手术情况及患者术后生活质量.[结果]两组病人均无死亡病例,但A组术后镇痛治疗时间较B组长(P＜0.05).A组病人术后一个月疼痛发生率明显高于B组(P＜0.05),且两组比较差异均具有显著性.术后三年,认为自己完全康复的B组病人共占97%,明显高于A组,且两组比较差异具有显著性.17.78%的A组病人需到医院就医止痛治疗.[结论]胸腔镜手术对于PSP治疗较传统开胸手术具有相对的优势,值得临床推广.

目的 探讨老年贲门癌手术入路的选择.方法 对270例分为经胸、经腹手术治疗的贲门癌年龄大于65岁的老年患者的资料进行回顾性分析.结果 经腹组较经胸组术前存在更显著的高危因素(P<0.01),但两组术后心肺功能不全发生率、手术切除率、吻合口瘘发生率,吻合口狭窄、手术时间、清扫腹腔淋巴结转移率与经胸组比较差异均无统计学意义.经腹入路切缘癌残留、清扫胸腔内淋巴结、术后疼痛与经胸组比较有统计学意义.结论 老年贲门癌手术应选择以经胸微创手术切除为主的手术入路,针对个别情况可选择经腹入路.

目的:通过Meta分析明确食管癌术前辅助化疗的价值.方法:用RevMan 5.0.2软件来完成Meta分析.结果:共有16项研究,2594例患者纳入本分析,接受术前辅助化疗组与手术组1年生存率无统计学意义(RR=1.02;95％CI:0.95～1.10);5年生存率有统计学意义(RR=1.31;95％CI:1.13～1.51;P=0.0003)；手术死亡率无统计学意义(RR=0.89;95％CI:0.64～1.23).结论:食管癌术前辅助化疗不增加手术风险,有利于提高食管癌患者5年生存率.

Objective To investigate the feasibility and superiority of video-assisted minithoracotomy surgery (VAMT) in treatment of adolescent patients with primary spontaneous pneumothorax. Methods The clinical data of 103 adolescent patients with spontaneous pneumothorax were analyzed retrospectively. VAMTS was performed in 56 cases and video-assisted thoracoseopic surgery(VATS) was performed in 47 cases. complications Statistical analysis were undergoing in middle-operation, post-operation and ambi-operation in the two groups were analyzed. Results No statistically significant difference were found in blood loss ,operating time,pain grade, out-of-bed activity time, antibiotics use time,chest drainage time,hospital day pulmonary infection between the two groups( all P ＞0.05 ). The cost of hospitalization was lower in VAMTS group compare to VATS group ( P ＜ 0.05). Conclusion VAMT in treatment of adolescent patients with primary spontaneous pneumothorax had the advantage of simple performance, reliable effectiveness, practical,lower cost of hospitalization fee.

[目的]探讨采用上腹、右胸联合切口根治性切除中段食管癌的临床效果.[方法]2005年8月至2009年12月间本院收治中段食管癌(肿瘤上缘距门齿约24～27 cm)患者156例,按手术路径分为两组:右胸组采用上腹、右胸联合切口进行食道癌根治手术,左胸组采用经左胸路径切口进行食道癌根治手术.观察比较两组手术切除率、术后吻合口漏、吻合口狭窄、切缘阳性率等情况.[结果]右胸组患者术后吻合口漏发生率、切缘阳性率均较经左胸组患者低,且差异有统计学意义(P<0.05).[结论]选择经上腹、右胸二切口根治性手术治疗中段食管癌,特别对病变侵及主动脉弓及气管隆凸者,可以减少并发症及提高根治效果.

OBJECTIVE:To explore the association between COX-2 expression in human esophageal cancer and its clinicopathologic characteristics of esophageal cancer.METHODS:Published studies were searched in the CBMdisc(1978-2011),CNKI(1979-2010),VIP(1989-2010) database,CMA Digital Periodicals(1998-2010),other relevant journals were manually searched to identify all the related case-control studies in mainland China.The quality of the included studies was assessed.Cochrane Collaboration's Software Revman 5.0.2 was utilized to test the heterogeneity,the overall effect and the publication bias of the combined studies as well.RESULTS:Seven studies were included.For the positive rate of COX-2 expression,significant difference was tested between esophageal cancer and normal esophageal tissues[OR=31.44,95%CI(10.47,94.38)].In addition,cell differentiation G1+G2 vs.cell differentiation G3 revealed significant difference[OR=3.60,95%CI(1.63,7.99)].However,there was not any significant difference shown in terms of gender,age,depth of invasion,lymph node metastasis,of which the overall effect were 1.56(0.61,3.98),0.59(0.27, 1.30)、1.21(0.49,2.98),1.47(0.38,5.64),respectively.CONCLUSION:According to the currently available national evidence,higher COX-2 expression may be associated with esophageal cancer and cell differentiation.

目的 观察多巴酚丁胺与洋地黄治疗充血性心力衰竭的疗效.方法 将病人随机分成多巴酚丁胺组和洋地黄组各50例,前组用多巴酚丁胺2.5 μg/(kg·min)连续静滴48小时,每周1次,共8周,辅以利尿剂治疗.洋地黄组每天口服地高辛0.125～0.250 mg,急性发作辅以西地兰0.2～0.8 mg/d静脉注射,辅以利尿剂,共8周,用彩色多普勒超声心动图测定心功能参数.结果 多巴酚丁胺组总有效率84%,洋地黄组总有效率64%,差异显著,P值＜0.05,彩色多普勒超声心动图测定治疗前后心功能参数有显著性差异,心搏量(SV)P值＜0.05,心排量(CO)、心脏指数(CI)、射血分数(EF)、左室短轴缩短率(FS),P值均＜0.01.结论 多巴酚丁胺与洋地黄治疗心力衰竭都有明显疗效,无毒副作用,不失为一种可选择的治疗方法。

目的 评价外科手术治疗先天性多囊肺的临床效果.方法 回顾性分析68例先天性多囊肺患者的临床资料.结果 29例(42.6%)行肺叶切除,25例(36.8%)行全肺切除,术中发现隔离肺3例,术后病理证实伴发腺癌1例,鳞癌1例.本组无手术死亡,长期随访均无严重并发症和复发,患者生活质量明显改善.结论 先天性多囊肺一经诊断应尽早择期行病肺切除术,肺部感染反复发作、病史长者手术较困难,并有恶变倾向,应注意定期随访.

[Objective]To evaluate the clinical effect of three different analgesic methods on complications following thoracotomy in aged patients.[Methods]One hundred and six patients (male 79, female 27)underwent thoracotomy were randomly assigned to 3 groups.group Ⅰ:epidural analgesia(n=36); group Ⅱ: intravenous analgesia (n=33); group Ⅲ: muscular injection analgesia(n=37). Main complications of cardio-pulmonary system and side effects were compared.[Results]In epidural analgesia group, the scores of analgesic scale was significantly superior to the two other groups, and complications including arrhythmia, hypertension, angina, atelectasis, lung infection, hypoxemia were fewer.[Conclusion]Epidural analgesia lessens the complications of cardio-pulmonary system obviously, it is a good method of easing pain for aged patients after thoracic surgery.

目的研究经腹治疗老年贲门癌的优点和指征.方法对1994至2004年72例经腹治疗的贲门癌进行回顾性分析.结果术后心肺并发症发生率低4.2%(3/72),食管切端癌残留率为2.8%(2/72),无口瘘发生吻合.术后1年、3年、5年生存率分别为80.60%、44.78%、22.39%.结论经腹径路治疗老年贲门癌具有创伤小、术后恢复快等优点,是一种理想、安全的方式.

目的总结创伤性湿肺的诊断及治疗经验.方法对112例创伤性湿肺的资料进行回顾性分析.结果绝大部分病例均治愈出院.结论创伤性湿肺是一种常见的、严重的胸部损伤,只要及早作出诊断,及时治疗,治疗效果满意.

由于内镜技术的进步,结合超声装置的小探头超声内镜MPS(Miniprobe Endosonography)开辟了消化系统疾病研究的新领域.它既有内镜直观,可行活检进行病理诊断的优点,又具备超声影像术检测深部病变及范围的功能,故在欧美、日本等国得到广泛应用.由于仪器价格昂贵、成本较高,我国目前应用不多.本院自1996年10月起使用日本富士能小探头超声内镜诊断上消化道疾病40例,现结合文献对其性能、操作技术及临床价值进行探讨.

目的:探讨微探头超声内镜(MPS)对食管癌的诊断价值.方法:食管癌病人30例,MPS检查作术前TN分期,并与手术后病理结果对照.结果:27例手术病人中,MPS对1例局限于粘膜层及2例局限于粘膜下层的早期癌均作出准确判断,对于进展期癌,癌肿浸润深度诊断准确率为81.5%,食管邻近的纵隔淋巴结转移判断敏感性为88.9%,特异性为77.8%.结论:MPS能对早期食管癌作出准确诊断,对于进展期癌能较准确地进行术前分期,可作为手术可切除性预测和预后估计的重要依据.

应用微型探头超声内镜(MPS)对30例癌病人进行检查,结果显示:MPS能对局限于粘膜层抑或粘膜下层的早期癌做出准确诊断.对于进展期癌,癌肿浸润深度诊断准确率为81.5%,食管邻近的纵隔淋巴结转移判断的敏感性为88.9%,特异性为77.8%,并能准确诊断有无胸主动脉等纵隔重要脏器受累,可成为手术可切除预测和预后估计的重要检查方法.