目的 探讨在缺氧微环境下Pokemon对肝细胞癌血管形成的影响.方法 选取肝细胞癌细胞株HepG2和Huh7,采用短发夹RNA稳定转染并筛选稳定沉默Pokemon基因表达的肝细胞癌细胞株.通过RT-PCR验证沉默Pokemon之后血管形成相关基因的表达.在缺氧条件下通过Western blot法验证Pokemon基因沉默后缺氧诱导因子-1α(hypoxia inducible factor-1α,HIF-1α)表达的影响.结果 成功构建Pokemon干扰质粒.HepG2和Huh7细胞在Pokemon基因沉默后,血管形成相关基因促血管生成素2(angiopoietin-2,ANG2)、血管内皮生长因子A(vascular endothelial growth factor A,VEGFA)以及血管内皮生长因子受体2(vascular endothelial growth factor receptor 2,VEGFR2)的mRNA表达均受到抑制(均P<0.05).在缺氧条件下,HepG2和Huh7细胞在Pokemon基因沉默后HIF-1α蛋白表达均下调(均P<0.05).将HIF-1α质粒瞬转至Hela细胞36 h后,通过Western blot检测发现HIF-1α的表达增加(P<0.05),而Pokemon的表达变化差异没有统计学意义(P>0.05).结论 在缺氧微环境下Pokemon上调HIF-1α表达促进肝细胞癌血管形成,促进肝细胞癌的发生及发展.

目的 探讨血液滤过联合益生菌治疗重症急性胰腺炎(SAP)的临床效果.方法 选取2018年6月-2021年3月厦门新开元医院及厦门大学附属成功医院收治的78例SAP患者作为研究对象,按照随机数字表法分为对照组42例和联合组36例.对照组采用常规治疗及血液滤过,联合组在对照组基础上联合益生菌治疗,比较两组炎症因子(CRP、IL-10、TNF-α)、肠道黏膜损伤程度(内毒素、D-乳酸)、SAP并发症发生率、ICU住院时间及总住院时间.结果 联合组CRP、IL-10、TNF-α、内毒素及D-乳酸水平均低于对照组,差异有统计学意义(P<0.05);联合组SAP并发症发生率低于对照组,ICU住院时间及总住院时间短于对照组,差异有统计学意义(P<0.05).结论 血液滤过联合益生菌能改善SAP炎症反应及肠道损伤程度,降低并发症发生率,缩短住院时间,临床应用效果良好.

目的:研究临床在丙泊酚麻醉下透明帽辅助肠镜对肥大肛乳头切除的临床效果.方法:选取79例实施肛乳头肥大切除的患者作为研究对象,按照手术方法的不同,将79例患者分为两组,其中研究组42例患者实施透明帽辅助无痛肠镜下行肛乳头肥大切除,对照组37例患者采用肛门局部利多卡因胶浆涂抹,无透明帽辅助切除.对两组患者手术时间,切除肛乳头数目及大小,麻醉复苏后的疼痛情况,术后相关并发症的发生情况进行比较分析.结果:治疗后,研究组患者的效果更好.研究组的手术时间低于对照组(P<0.05),研究组患者的术后相关并发症发生率低于对照组且术后疼痛评分低于对照组患者(P<0.05).结论:透明帽辅助无痛肠镜下行肛乳头肥大切除的临床应用效果较好,可以明显缓解患者的症状,且手术时间短,疗效可靠,较为安全.

目的 探讨以腹水为主要表现的嗜酸细胞性胃肠炎(EG)的临床特征,为提高临床诊治提供指导.方法 回顾性选取2010年1月至2018年1月中国人民解放军第174医院及中国人民解放军第95医院消化科收治的48例以腹水为主要表现的EG患者的临床资料,分析其临床表现,实验室指标、影像、病理学特征,临床治疗方法和效果.结果 以腹水为主要表现EG患者多伴有以腹痛、腹胀等临床表现,外周血嗜酸性粒细胞(EOS)计数明显升高,腹水渗出液可见大量EOS,胃肠镜、CT可见胃肠病变处炎性改变,病理可见明显EOS浸润,EG患者对糖皮质激素治疗敏感,近期复发率低.结论 以腹水为主要表现的EG临床表现多样,无特异性,外周血和腹水EOS异常增高是以腹水为主要表现EG的诊断要点,治疗以糖皮质激素为主,预后较好.

目的:探讨非诺贝特联合血液滤过治疗高脂血症性胰腺炎患者的临床疗效。方法:选取2012年2月至2018年3月我院收治110例高脂血症性胰腺炎患者,研究分为常规治疗组43例,血液滤过组32例:在常规治疗基础上予血液滤过治疗;联合治疗组35例:常规治疗基础上血液滤过联合非诺贝特治疗。比较三组腹痛平均消失时间、平均住院时间、血C-反应蛋白（CRP）、甘油三酯（TG）、血清淀粉酶（AMP）水平变化情况。结果:联合治疗组患者治疗总有效率为88.57%（31/35）,显著高于血液滤过组84.38%（27/32）及常规治疗组72.09%（31/43）,差异有统计学意义（P＜0.05）;联合治疗组患者腹痛平均消失时间及平均住院时间分别为（4.3±1.2） d、（9.6±1.4） d,均明显短于血液滤过组（5.9±1.8） d、（11.3±1.8） d以及常规治疗组（6.8±1.1） d、（14.2±1.3） d,差异均有统计学意义（P＜0.05）;治疗5 d后联合治疗组患者的CRP、TG及AMP水平分别为（6.3±2.2） mg/L、（4.3±2.3） mmol/L、（421.3±97.2） U/L,均明显低于血液滤过组的（12.7±2.4） mg/L、（10.2±2.9） mmol/L、（475.8±83.5） U/L及常规治疗组的（16.2±1.6） mg/L、（14.9±2.4） mmol/L、（513.7±96.4） U/L,差异均有统计学意义（P＜0.05）。结论:在常规治疗基础上非诺贝特联合血液滤过治疗可提高高脂血症性胰腺炎临床效果,值得进一步推广应用。

Objective To study the function and mechanism of tumor suppressor gene PTEN in colorectal cancer. Methods Colon canc-er cells HT-29 cells were transfected with plasmid of each group,and the concentration of cell suspension in each group was adjusted to 5 ×104 cells/ml. Five groups of experimental group and control group were set up,including overexpression of empty vector group(transfected NC-oe), overexpression group(transfected PTEN-oe),interference empty vector group(transfected NC-sh),interference expression group(transfected PTEN-sh),and control group. qPCR to detect the contents of PTEN gene in samples of colon cancer cell line. The effect of PTEN on the prolif-eration of colon cancer cells was detected by MTT assay. Flow cytometry detection of PTEN on cell cycle and cell apoptosis in colon cance;PTEN recombinants were implanted in the subcutaneous tumor of the axillary posterior part of nude mice. The body weight and tumor size of nude mice were measured regularly after tumor formation. Results Compared with empty vector control group and blank control group,the expression level of PTEN mRNA in the overexpression group was increased and significantly decreased in the interference group. The cell proliferation rate was slowed down in the overexpression group and increased in the overexpression group. The number of cells in S phase was decreased in the overex-pression group and increased significantly in the interfering group. The apoptotic rate of the overexpression group was increased and decreased in the interfering group. The tumor growth was rapid and the nude mice were dead ahead of time in the interference group,the tumor growth was slow in the expression group. Conclusion PTEN gene can inhibit the proliferation and the DNA synthesis of the colorectal cancer cells,promote the apoptosis of colorectal cancer cells. Enhancement of the PTEN gene can provid a new way for the drug therapy of clinical injections of PTEN gene in tumors.

目的 分析胆汁淤积性肝病的临床特征,为临床加强该病的诊疗提供参考.方法 回顾性分析2015年1月-2017年12月收治于厦门大学附属成功医院并确诊为胆汁淤积性肝病的107例患者的临床资料.计量资料2组间比较采用t检验.结果 多数患者出现不同程度全身乏力、食欲不振、恶心、腹胀、皮肤瘙痒及黄疸等临床症状.按胆汁淤积部位分为肝内胆汁淤积64例(59.8％)和肝外胆管淤积43例(40.2％).按病因分为胆总管结石21例(19.6％),胆管寄生虫1例(0.9％),原发性硬化性胆管炎2例(1.9％),原发性胆汁性肝硬化3例(2.8％),肝癌8例(7.5％),胆管癌5例(4.7％),胰腺癌4例(3.7％),胰腺炎12例(11.2％),病毒性肝炎28例(26.2％),药物性肝损伤11例(10.3％),酒精性肝炎6例(5.6％),非酒精性脂肪性肝病4例(3.7％),自身免疫性肝炎2例(1.9％).合并基础病患者的肝功能(ALT、AST、GGT、ALP、胆汁酸和TBil)明显差于单纯性胆汁淤积性肝病患者(t值分别为-3.44,-2.99,-2.42,-4.39,-3.34,-2.49,P值均＜0.05).大多数患者经保肝、降酶、退黄等治疗后患者恢复良好.肿瘤患者预后不佳.结论 胆汁淤积性肝病病因众多,临床特征无特异性,应引起足够重视.

Objective To study the subcellular localization of PEG10 gene in colorectal cancer cells,and explore the role of PEG10 in the invasion and growth of colorectal cancer.Methods Subcellular localization of PEG10 protein was detected by laser scanning confocal microscopy imaging.PEG10-siRNA expression vector was constructed and stably transfected into SW620 cells.The expression of PEG10 gene was detected by Western-blot.The effect of PEG10 on the invasion and growth of SW620 cells was investigate with Transwell assay.Observing The tumor growth was observed when the SW620 cells after PEG10-siRNA was injected in C57BL/6 mice.Results Laser scanning confocal microscopy imaging showed that PEG10 was mainly located in the cytoplasm.The interference plasmid PEG10 was successfully constructed.Transwell cell experiments indicated that siPEG10 inhibited colorectal cancer cell SW620 invasion ability.In vivo,siPEG10 SW620 cells were injected into subcutaneous tumor inhibited colorectal cancer cells growth compared with the control group.Conclusion PEG10 can promoted the invasion and growth of colorectal cancer cell lines in vitro and in vivo.

目的 探讨胶囊内镜对回肠末端溃疡患者的诊断价值.方法 对34例回肠末端溃疡患者行胶囊内镜检查,回顾性分析其镜下表现.结果 34例患者肠道准备条件均比较满意,胶囊内镜排出时间约24～72 h;33例患者顺利完成检查,1例患者电池耗尽未进入结肠,共检出慢性非特异性炎症20例,克罗恩病11例,白塞氏病、嗜酸细胞性胃肠炎各l例.患者在整个检查中无不适反应. 结论 胶囊内镜对回肠末端溃疡患者具有较高的诊断价值,安全性高,不良反应少,易被患者接受,值得推广.

目的 探讨经电子肠镜联合X线监视金属支架置入治疗左半结直肠癌伴梗阻的临床疗效及操作技巧.方法 2014年5月至2017年12月经电子肠镜于X线下金属支架置入治疗的左半结直肠癌伴癌性梗阻患者28例,其中梗阻发生在直肠5例,14例梗阻位于乙状结肠,降结肠梗阻9例.记录支架置入成功率、梗阻缓解及并发症发生情况.结果 25例金属支架放置成功,成功率为89.3％.梗阻缓解情况:19例患者支架置入后当天症状缓解,5例支架置入后2～3d梗阻症状得到缓解或消除,1例支架置入术后症状无改善.25例支架置入成功者中,11例支架置入梗阻缓解后7～10 d行外科手术治疗,术后无吻合口瘘及腹腔感染发生;14例支架置入成功患者失去手术机会或心肺脑功能较差而未行手术治疗.并发症情况:全部患者金属支架置入术后未出现大出血或穿孔并发症,1例金属支架经肛门滑脱.结论 经电子肠镜联合X线监视金属支架置入治疗可有效缓解左半结直肠癌伴癌性梗阻患者症状,具有操作简单、易被患者接受等优点,可提高患者的生活质量.

Objective To investigate the expressions and clinical significance of ECHS1 and PKM2 proteins in cholangiocarcinoma.Methods The expressions of ECHS1 and PKM2 in cholangiocarcinoma tissues and paracancerous normal bile duct tissues were detected.The relationship of expressions of ECHS1 and PKM2 proteins with clinical pathology features and prognosis of cholangiocarcinoma were analyzed.Results The positive rates of ECHS1 and PKM2 proteins were significantly higher in cholangiocarcinoma than those in normal tissues (58.8% vs 17.9%, 64.7% vs 21.4%, P<0.05).The expressions of ECHS1 and PKM2 proteins in cholangiocarcinoma were not related with sex, age and tumor size (P>0.05).However, they were related with the differentiation grade, TNM stage and postoperative survival time (P<0.05).Conclusion Both ECHS1 and PKM2 poteins may play important roles in the occurrence and development of cholangiocarcinoma.

Objective To investigate the role of ECHS1 on the Warburg effect in cholangiocarcinoma and the growth of the human cholangiocarcinoma in transplanted nude mice.Methods The subjects were divided into the experi mental group and control group.ECHS1 gene was silenced in Experimental group.ECHS1 gene was normal in Control group.The effect of ECHS1 on the glucose metabolism of cholangiocarcinoma QBC939 cells was determined by using a microplate reader.The expression of PKM2 was detected in both experimental group and control group by western blot.Furthermore,we transfected ECHS1 siRNA to human cholangiocarcinoma cell line QBC939,established its subcutaneous transplantation tumor model in a nude mice and observed the effects of ECHS1 siRNA on growth of QBC939 cell in vivo.Results Microplate reader shows glucos uptaken was significantly lower than that in the control group (P＜0.05) (P＜ 0.05).Immunohistochemical results shown that interference ECHS1 can decrease PKM2 expression compared with cholangiocarcinoma QBC939 ceils in the control group (P＜0.05).Inhibit ECHS1 expression could decrease the nude mice subcutaneous tumor size (P＜0.05).Conclusion ECHS1 affects Warburg effect of cholangiocarcinoma QBC939 cells by regulating the expression of PKM2 protein and plays an important role in the growth of choriocarcinoma.inhibition of its expression by siRNA can reduce the growth of QBC939 cells in vivo.

Objective To investigate the expression of the phosphatase and tensin homolog (PTEN), vascular endo-thelial growth factor-A (VEGF-A) and microvessel density (MVD) in colorectal cancer tissues, and analyze the associa-tion with clinical pathology. Method Immunohistochemical SP method was applied to detect the expression of PTEN and VEGF-A in 50 samples of colorectal cancer and normal intestinal mucosa, while the endothelial cells were deter-mined by CD31 staining, and then the association between the indexes and clinicopathological parameters was investigat-ed. Result PTEN and VEGF-A protein expression and MVD value in colorectal cancer tissues were significantly differ-ent with those in normal adjacent tissues (P<0.05);and the expression of PTEN and VEGF-A, as well as the MVD were closely related with patients’age, depth of invasion, clinical stage, lymph node metastasis, and distant metastasis (P<0.05). Conclusion The expression of PTEN, VEGF-A and MVD is associated with the occurrence, development, inva-sion, and distant metastasis of colorectal cancer. The combined detection of PTEN and VEGF-A and MVD facilitates a precise evaluation of the invasion and metastasis of colorectal cancer, and is a practical adjuvant diagnostic instrument in assessing the clinical pathology of colorectal cancer.

目的 研究遗传印记基因PEG10在结肠癌、癌旁组织、正常结肠组织中的表达及意义.方法 收集中国人民解放军第一七四医院2015年1月-2015年9月40例结肠癌、癌旁组织,20例正常结肠组织标本,通过免疫组织化学及蛋白印迹法检测PEG10的细胞定位及其表达差异.结果 PEG10细胞主要分布于细胞质,在结肠癌中呈过表达,其表达明显高于癌旁组织、正常结肠组织,差异有统计学意义(P＜0.01).结论 PEG10可能参与结肠癌发生、发展,但其具体作用机制仍需进一步探讨.

目的 比较经口内镜下肌切开术(peroral esophageal myotomy,POEM)与腹腔镜Heller手术治疗贲门失驰缓症的临床疗效.方法 收集中国人民解放军第1 74医院2004年1月-2013年2月收治的贲门失弛缓症患者,根据手术方式,分为POME组和腹腔镜Heller手术组(腹腔镜组),比较两组治疗后临床症状缓解率、食管最大宽度下降幅度、并发症发生率及复发率.结果 共纳入60例贲门失驰缓症患者,POME组27例,腹腔镜组33例,术后随访1个月,两组症状均明显缓解,食管最大宽度下降幅度分别为(2.5±1.2)cm、(2.2±1.3) cm,两组相比,差异无统计学意义(P＞0.05).POEM组出现2例(7.4％)并发症,腹腔镜Heller手术组出现2例(6.1％)并发症,两组相比,差异无统计学意义(P＞005).随访1个月后POEM组出现2例(7.4％)胃食管反流病患者,随访1年2例(7.4％)复发,腹腔镜组术后未出现明显不适,两组术后并发症发生率和复发率相比,差异均无统计学意义(P＞0.05).结论 腹腔镜Heller手术与POME治疗贲门失弛缓症有效性及安全性相当.

Objective To evaluate the expressions of DPC4 in colorectal cancer and the relationship with the clinicopathologic fea-tures. Methods The expression of DPC4 was determined by the immunohistochemical method in total of 60 cases of colorectal cancer diagonosed by pathology. The correlation with clinicopathologic features was analyzed. Thirty cases of normal colorectal tissues were as the control. Results The expression ratio of DPC4 in colorectal cancer was 35. 5%,and the intense positive ratio was 6. 2%. The expression ratio of DPC4 in normal colorectal tissues was 100%,the intense positive ratio was 86. 9%. DPC4 expression in colorectal cancer was lower than that in normal colorectal tissues(P<0. 05). The expression of DPC4 in colorectal cancer was significantly related with differentiation,lymph node and Duke′s stage. Conclusion The expression of DPC4 in colorectal cancer is related to carcinogenesis and metastasis which can be used to determine the biological behavior and prognosis of colorectal cancer.

目的 探讨胃癌组织DPC4、PTEN蛋白表达与胃癌分化程度、淋巴结转移及临床分期的关系.方法 选取解放军174医院2013年5月-2014年8月胃癌标本60例,采用免疫组织化学方法检测DPC4、PTEN蛋白表达,并分析表达水平与临床病理参数之间的关系.结果 胃癌组织中DPC4、PTEN蛋白表达低于邻近正常胃黏膜组织(P＜0.05),且表达水平与癌细胞分化程度、淋巴结转移及临床分期密切相关;DPC4与PTEN的表达呈正相关(r=0.701).结论 胃癌发生、发展、浸润及转移与DPC4、PTEN蛋白表达关系密切.

目的：总结家族性结肠息肉病（ familial polyposis coli，FPC）的临床表现、病理及内镜下特征，探讨FPC的诊断和治疗。方法回顾性分析28例FPC患者的临床表现、病理及内镜检查等资料。结果28例患者中24例（85％）有家族史；临床表现以腹泻最为多见，占71％（20／28）；右半结肠及横结肠腺瘤性息肉分布密集，且腺瘤癌变15例，占60％。结论 FPC临床表现无特异性，主要依靠结肠镜下发现结肠内成百上千枚腺瘤性息肉进行早期诊断，便血或持续粪便隐血试验阳性为癌变的早期预警信号。开展患者家系调查，定期随访复查结肠镜对早期发现并诊治该病非常重要。

患者男，61岁，因“进食哽噎感1年余，加重伴呕吐半个月”入院。患者1年前无明显诱因出现进食哽噎，在当地医院行胃镜检查示全食管占位，活检病理示食管鳞状上皮增生、局部呈乳头状增生，之后未行进一步检查及治疗；本次入院前半个月，患者自觉进食哽噎感加重，伴呕吐，以进食时明显。入院后体检：体形消瘦，心、肺、腹部未见明显阳性体征。胃镜检查：食管腔内见巨大肿物，表面光滑；蒂部位于食管入口（图1A）；瘤体游离于食管腔内，向下延伸至胃底（图1B）；食管管腔狭窄，内镜尚可通过。纵隔 CT 平扫＋增强检查：第1胸椎体至第11胸椎全程食管管腔扩张，腔内见软组织块影，病灶内密度不均匀，边界清楚，增强后渐进性不均匀强化（图1C）。内镜超声提示：（肿物蒂部）起源于食管黏膜下层，内部呈混杂回声改变，其内可见管状结构，基底可见一囊性结构（图1D）。结合以上检查结果，诊断考虑为食管黏膜下肿物（平滑肌瘤？），拟行 ESD 切除治疗。术前完善血常规、凝血指标、肿瘤标记物、心电图、心脏彩超等检查，均未见内镜下治疗禁忌证。患者于入院后1周行 ESD 治疗，术中于肿物蒂部进行标记，黏膜下注射后从根部离断肿物，过程顺利，但因肿物体积巨大，无法直接经口取出，故予分块切除后取出（图2）。术后病理提示：食管黏膜下层至肌层间见边界不清的梭形细胞肿瘤（图3）；免疫组化提示：CD34、Bcl-2阳性（图4），Ki-67（阳性细胞数＜2％）；Melan-A、S-100、SMA、HMB45、CD117、CK、Dog-1阴性。最终诊断食管孤立性纤维性肿瘤。1周后复查胃镜，于食管入口处见 ESD 术后溃疡，食管中段可见电凝后炎症反应，食管管腔内未见肿物。

Solitary fibrous tumor is one of the most common soft tissue benign tumors that occur in adults, but it rarely occurs in the gastrointestinal tract and even more infrequently occurs in the esophagus. Only 4 cases of esophageal solitary fibrous tumors have been reported in PubMed using the search terms "solitary fibrous tumor" and "esophagus". These cases were all treated using surgical methods. Thus, we report a case of primary solitary fibrous tumor of the esophagus treated by endoscopic submucosal dissection. Endoscopic submucosal dissection was well tolerated in this patient, suggesting that it may be a therapeutic option for primary giant esophageal neoplasms.