患者老年男性,因"右侧腹痛3 d"于2020年7月29日入院.3 d前出现右侧腹痛伴发热呕吐,门诊腹部CT发现阑尾增粗,周围脂肪间隙模糊;十二指肠降部肠壁可疑增厚.追问病史发现8年前有类似腹痛史,当时保守治疗.入院后查血常规:白细胞11.8×109/L,中性粒细胞比例87.8％,淋巴细胞8.2％;肿瘤标志物甲胎蛋白、癌胚抗原、CA19-9均正常.十二指肠镜发现降部约2.5 cm×3.0 cm充血隆起,质硬,中间凹陷.活检病理:黏膜慢性炎,局灶区呈腺瘤样增生,小灶腺上皮低级别上皮内瘤变.超声内镜提示降部黏膜隆起,外瘘? 病理:黏膜慢性炎伴局灶呈息肉样增生.8年前患者腹部CT发现急性化脓性阑尾炎,头端积脓.本次增强CT发现阑尾管壁增厚强化,周围脂肪间隙模糊,十二指肠降部肠壁增厚,增强后可见强化.初步诊断:慢性阑尾炎急性发作,阑尾十二指肠瘘? 十二指肠肿瘤? 完善术前准备后行腹腔镜探查,术中见阑尾根部位于距回盲部约2.5 cm处,体部经回盲部后方向上,头端紧邻十二指肠降部,并形成致密粘连(图1) ,沿阑尾浆膜层分离至十二指肠,证实为阑尾十二指肠外瘘,行阑尾切除术,同时切除瘘口及周围部分肠壁送术中冰冻,提示局灶腺上皮轻度非典型增生,未见明确恶性证据.术中与家属沟通后行十二指肠修补术.十二指肠降部肿物考虑系长期阑尾炎症刺激引起,多次病理均未发现恶性证据,因此术中并未切除整个肿物所在的肠壁,术后定期复查十二指肠镜.患者术后恢复良好,随访至今,未诉特殊不适.

目的 分析TAT-E4orf4融合蛋白对胃癌AGS细胞凋亡的影响及其作用机制.方法 PCR法构建pET28-his-TAT-E4orf4表达载体,经PCR酶切鉴定后,诱导表达.并分别用pET28、pET28-his-E4orf4和pET28-his-TAT-E4orf4处理胃癌AGS细胞,分别采用MTT法和Transwell小室检测TAT-E4orf4对胃癌细胞增殖和迁移的影响,以流式细胞仪检测刺激后胃癌细胞的凋亡,以Western blot检测半胱氨酸天冬氨酸蛋白酶(Caspases)和酪氨酸激酶(Src)信号轴上关键蛋白表达的变化.结果 PCR和Western blot实验结果证实成功构建pET28-TAT-E4orf4表达载体,MTT法显示pET28-his-E4orf4和pET28-his-TAT-E4orf4刺激后,胃癌AGS细胞增殖活性较空白对照组(1.01±0.12)分别下降至(0.69±0.44)和(0.41±0.06),且后者下降更为明显(P<0.05).与MTT实验结果趋势相似,Transwell实验的结果,pET28-his-TAT-E4orf4刺激后胃癌细胞迁移数目显著减少到(163.21±36.77)个,与Blank组(796.48±114.35)个、pET28组(803.71±127.39)个、pET28-his-E4orf4组(287.06±78.51)个比较,差异具有统计学意义(P均<0.05).流式细胞术检测结果显示,TAT-E4orf4融合蛋白干预后,AGS细胞凋亡率显著增加(33.40％),与Blank组(6.28％)、pET28组(8.40％)、pET28-his-E4orf4组(20.50％)比较,差异具有统计学意义(P<0.05).Western blot实验结果表明,Caspase-3和Caspase-9的表达水平无明显变化(P>0.05),而Src-ERK-AKT信号轴相关蛋白的表达在TAT-E4orf4融合蛋白干预后出现明显下调,差异具有统计学意义(P<0.05).结论 TAT-E4orf4融合蛋白能抑制胃癌细胞增殖和迁移,促进胃癌细胞凋亡,与Caspase途径无关,主要依赖对Src-ERK-AKT信号通路的调控.

目的 比较小切口辅助腹腔镜全直肠系膜切除术(TME)不同吻合方式的临床效果.方法 回顾性分析75例原发性直肠腺癌患者的临床资料,所有患者行耻骨上小切口辅助腹腔镜TME,乙状结肠与直肠吻合时采取单荷包双吻合器方式37例、双荷包单吻合器方式38例.比较两组患者临床指标、术后并发症情况、肿瘤根治性指标及预后情况.结果 与单荷包双吻合器组比较,双荷包单吻合器组患者住院时间更短,住院费用更低,差异均有统计学意义(均P<0.05);两组患者在手术时间、术中出血量、术后肠功能恢复时间、排尿及性功能障碍、排便功能异常等方面比较,差异均无统计学意义(均P>0.05).双荷包单吻合器组吻合口出血、吻合口漏、吻合口狭窄发生率均明显低于单荷包双吻合器组(均P<0.05);两组患者非计划二次手术比例比较,差异无统计学意义(P>0.05).两组患者清扫淋巴结数、肠管远端及近端切缘长度比较,差异均无统计学意义(均P>0.05).双荷包单吻合器组、单荷包双吻合器组患者3年总生存率分别为87.40％、81.10％,差异无统计学意义(P>0.05).结论 与单荷包双吻合器方式比较,小切口辅助腹腔镜TME中采取双荷包单吻合器方式的临床效果确切,能减少患者住院时间及治疗费用,降低术后吻合口相关并发症发生率.

目的 分析不同手术方式对结直肠癌腹膜转移患者预后的影响.方法 回顾性分析2010年5月-2014年6月在浙江省立同德医院行手术治疗的结直肠癌腹膜转移患者98例,根据手术方式的不同将其分为完全性切除组35例、不完全性切除组34例和减状手术组29例,分析3组患者的临床病理资料及术后生存情况,并采用Cox比例风险模型分析不同手术方式治疗结直肠癌患者的预后情况.结果 本研究98例患者均获得随访,随访率100％,随访时间为0.5～40.0个月,平均生存时间为(16.9±4.5)个月,1年、3年总生存率分别为40.8％ (40/98)和18.4％(18/98);完全性切除组平均生存时间为(28.6±6.2)个月,1年、3年总生存率分别为71.4％(25/35)和45.7％(16/35),不完全性切除组平均生存时间为(11.2±4.1)个月,1年、3年总生存率分别为26.5％ (9/34)和0,减状手术组平均生存时间为(10.9±3.2)个月,1年、3年总生存率分别为13.8％ (4/29)和0,完全性切除组患者的平均生存时间和1年、3年总生存率均明显高于不完全性切除组和减状手术组(P＜0.05),不完全性切除组患者的平均生存时间和1年、3年总生存率与减状手术组比较,差异无统计学意义(P＞0.05);Cox分析显示,分化程度、PCI、原发灶T分期和手术方式是影响结直肠癌腹膜转移患者预后的主要因素.结论 结直肠癌腹膜转移患者采取完全性切除手术预后效果较好,值得临床推广应用.

BackgroundXeroderma pigmentosum group G (XPG) plays an important role in maintaining the stability and integrity of genomic DNA. Previous studies demonstrate some XPG gene polymorphisms are associated with susceptibility to gastric cancer (GC).MethodsThe association between XPG rs2094258 polymorphism and GC risk was investigated first by a hospital‐based case‐control study involving 386 patients and 439 controls and then by a meta‐analysis. The polymorphism was genotyped by polymerase chain reaction‐restriction fragment length polymorphism (PCR‐RFLR).ResultsXeroderma pigmentosum group G rs2094258 polymorphism was associated with an increased risk of GC in a Chinese population. The meta‐analysis did not reveal any significant difference in the overall population. Subgroup analysis of geographic locations showed a significant association between the XPG gene rs2094258 polymorphism and GC risk in Southern China. Stratification analysis further indicated significant associations in hospital‐based studies and studies using PCR‐RFLR.ConclusionXeroderma pigmentosum group G gene rs2094258 polymorphism may be associated with an increased risk of GC in Southern China. Nevertheless, the findings of this meta‐analysis should be validated by well‐designed large‐scale case‐control studies among other ethnicities.

目的:探讨腹腔镜探查联合Lichtenstein或经腹腹膜前疝修补术(transabdominal preperitoneal,TAPP)治疗腹股沟嵌顿疝的手术方法,评估发生绞窄且行肠切除时放置合成补片的安全性.方法:回顾分析2013年9月至2015年12月因腹股沟嵌顿疝就诊且经手术治疗的71例患者的临床资料,其中35例腹腔镜探查后行Lichtenstein手术(Lichtenstein组),36例行TAPP(TAPP组).71例患者中60岁以上占64.8％,男性占78.9％,嵌顿时间平均(17.2±22.6)h;术后随访25～52个月,平均(39.1±8.3)个月.比较两组术后近远期并发症发生率及临床疗效.结果:7例因发生绞窄而行肠切除术.TAPP组住院时间、恢复日常活动时间与工作时间均优于Lichtenstein组,两组差异有统计学意义.两组并发症发生率差异无统计学意义.结论:在腹股沟嵌顿/绞窄疝的治疗中,如腹腔镜下探查判断肠管失活,先于镜下完成肠切除肠吻合术,联合Lichtenstein放置大孔聚丙烯补片是安全、有效的.

Objective To evaluate the adjuvant analgesia effect of the addition of dexamethasone to ropiva-caine in a transversus abdominis plane(TAP)block after inguinal herniorrhaphy. Methods 100 adult male pa-tients who underwent open tension-free inguinal herniorrhaphy from August 2015 to June 2017,randomized into two groups equally. TAP block with ropivacaine with additional dexamethasone was experiment group(group D) and with ropivacaine was control group(group C). Before the operation,all the patients were performed TAP block by the same group of surgeons. Celecoxib(200mg,Q12h,po)was prescribed to all patients in 48 hours after oper-ation. VAS and clinical symptoms were recorded. The sum and time of celecoxib consumption were also recorded af-ter 72 hours postoperatively. The surveys about the Carolinas comfort scale(CCS)of all the patients one week after operation were collected. Results The averaged pain score in 48 hours after operation has no statistical signifi-cance. The occurrence of postoperative nausea and vomiting of group D is lower than group C,neither of them were statistically significant. The averaged CCS of group D was lower than group C;the difference was significant. Con-clusions Compared to single usage of ropivacaine in the single-shot TAP as a preemptive analgesia method for in-guinal herniorrhaphy,adding dexamethasone to ropivacaine didn′t show significance in analgesic intensity after in-guinal herniorrhaphy,though the adjuvant usage of dexamethasone reduced the sum and duration of other analgesic medications and enhanced the comfort of the patients after mesh-used herniorrhaphy.

目的 分析术前纤维蛋白原(FIB)、D-二聚体(D-D)水平对胃肠道间质瘤(GIST)患者预后的预测价值.方法 选取2012年1月～2014年4月在我院诊治的80例GIST患者为研究对象,对所有患者行手术干预,术后随访3年,调查患者术后3年的一般资料及总生存率,并分析影响GIST患者预后的主要因素.结果 GIST患者术后三年的总生存率为75％,经单因素分析发现,患者的美国国立卫生院(NIH)危险分级、FIB水平、D-D水平及癌胚抗原(CEA)水平可显著影响患者预后(P＜0.05);经Cox回归分析发现,FIB及D-D水平是影响GIST患者预后的主要因素.结论 术前FIB及D-D水平对GIST患者的预后有较高预测价值.

Recent studies explored the association between insulin receptor substrate-2 (IRS-2) gene rs1805097 polymorphism and colorectal cancer (CRC) with contradictory findings. Therefore, we conducted a comprehensive meta-analysis by searching the databases of PubMed and Embase. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated by using fixed-effect or random-effect models. A total of 5 citations containing 6 case-control studies involving 4,333 cases and 5,333 controls were included. Our data indicated that IRS-2 rs1805097 polymorphism was associated with decreased risk of CRC. Stratification analysis of ethnicity found that rs1805097 polymorphism decreased the risk of CRC among Americans. Stratification analysis of cancer type suggested that this polymorphism decreased the risk of colon cancer. In summary, this meta-analysis indicates that IRS-2 gene rs1805097 polymorphism plays an important role in the pathogenesis of CRC.

Objective:To investigate the effect of curcumin on rat model of crush syndrome.Methods:The crush syndrome model was set up.Measure the levels of blood urea nitrogen,creatinine and potassium ion in rats with crush syndrome model under different doses (200 mg/kg and 100 mg/kg) in different extrusion time (6 h,12 h,24 h).Two characteristics of crush syndrome were observed:renal function injury and corresponding hyperkalemia.Result:The data of control group,extrusion group,curcumin general dose group (100 mg/kg) and curcumin high dose group (200 mg/kg) almost all showed a unified phenomenon in urea nitrogen,creatinine and potassium ion three projects.There were statistically significant differences in the data of the time attributes and there was statistical difference between any two data (P ＜0.05).The four groups also appeared significance in statistics (P ＜0.05).In the three items of urea nitrogen,creatinine and serum potassium,the curcumin dosage and different time points of the control group,the extrusion group,the curcumin group and the control group were significantly different (P ＜ 0.05).Spearman rank correlation analysis of the data of the curcumin general dose group (100 mg/kg) and the high dose group of curcumin (200 mg/kg) showed that in the longitudinal data of each time point of the three items was significant,P ＜ 0.05 and the r value was less than zero.Conclusion:Curcumin in the rat model of crush syndrome can effectively alleviate the damage of renal function.As a common and cheap traditional Chinese medicine in the treatment of crush syndrome,it is worth to a wider range of promotion.

Objective:To investigate the effect of Curcumin on renal injury and activation of JNK signaling pathway in rats of crush syndrome.Methods:Models with crush syndrome were built by heavy extrusion,experiment was divided into normal,model and Curcumin low,high dose groups,Curcumin was given to rats by intraperitoneal injection before modeling 2 hours.The pathological changes of crushed muscle and kidney were observed,serum BUN and SCr levels were determined after modeling 6,12,24 hours,c-jan protein expression in kidney tissue was determined by Western blot method.Results:The muscle and kidney injuries were obvious in modeling rats except normal group,those in Curcumin groups were slighter than those in model group.To compare with normal group,the serum BNU and SCr levels were significantly raised in modeling rats,p-JNK expression in renal tissue was enhanced significantly,these changes got worse with time;serum BNU and SCr levels of Curcumin groups were lower than those in model group,p-JNK expression in renal tissue was abated,the effects of high dose group were more significant (P ＜ 0.05).Conclusion:Curcumin can effectively reduce kidney injury in Crush syndrome rats,inhibit the activation of JNK signal pathway in renal tissue.

Objective To observe the antibiotic resistance of bacteria isolated from 269 cases of leg ulcers so as to provide the basis for the rational use of antibiotics.Methods The bacteria isolation and identification and drug-sensitive methods were used to analyze samples isolated from leg ulcer.Results A total of 389 strains of pathogens were isolated from 269 leg ulcers.Among the 389 strains,51.4% were Gram-positive bacteria,32.4% were Gram-negative bacteria,15.2% were anaerobes and 1.0% were fungi.Staphylococcus aureus were highly resistant to Penicillin G(91.3%),Erythromycin(70.4%) and Ampicillin/Sulbactam(66.1%).Vancomycin was effective against all Gram-positive bacteria,while Amikacin was the only effective agent against the Gram-negative bacteria.Conclusion Gram-positive bacteria are the predominant pathogens isolated from leg ulcers.The isolated pathogens are generally resistant to antibiotics commonly used in clinic.

术后早期炎性肠梗阻在临床较常见,是腹部手术、肛肠手术后较早出现的一种并发症[1].在腹部手术后,由于手术创伤、腹腔内炎症等因素引起肠壁水肿,甚至渗出,从而形成肠梗阻[2].对此,笔者近年来临床采用活血化瘀联合通腑泻下中药煎剂保留灌肠为主治疗48例.取得了明显效果,现报道如下. 1 一般资料 收集2010年5月～2012年5月于我院接受治疗的术后早期炎性肠梗阻患者96例,随机分为对照组和观察组各48例.其中观察组男28例,女20例;年龄16～68岁,平均年龄为37.37±8.16岁;根据手术后类型划分:阑尾手术25例,抚摸修补手术13例,胃肠道异物切除手术7例,粘连性肠梗阻手术3例.

目的:探讨可回收腔静脉滤器在置管溶栓治疗下肢深静脉血栓中的作用。方法:对接受可回收腔静脉滤器植入术的患者进行随访,根据是否进行置管溶栓治疗分为置管溶栓组28例和对照组63例,观察溶栓效果及两组滤器捕获率及滤器回收率有无差异。结果:置管溶栓组24例血栓溶解率超过50%;血栓捕获率及滤器回收率明显高于对照组(均P<0.05)。结论:置管溶栓过程中存在着较高的血栓脱落率,使用可回收腔静脉滤器是安全、有效的。

目的:观察下腔静脉滤器继发下腔静脉血栓的发病情况。方法:对接受下腔静脉滤器植入术的患者进行随访,根据植入滤器的类型分为永久型滤器组160例和临时型滤器组21例,对两组资料进行统计学分析,观察继发下腔静脉血栓的发生情况。结果:两组共继发下腔静脉血栓患者6例,给予及时治疗临床症状均得到缓解。结论:下腔静脉血栓是下腔静脉滤器植入后的常见并发症,其发生原因可能与血栓捕捉、血流动力学变化等因素有关。