目的 探讨腹腔镜技术在普外科急腹症诊断及治疗中的应用价值.方法 收集2020 年3 月至2023 年3 月首都医科大学附属北京安贞医院收治的以急性腹痛为表现的 83 例急腹症患者的临床资料行回顾性分析.按照手术方法不同分为开腹组(41 例)和腹腔镜组(42 例),开腹组采用常规手术探查方法,腹腔镜组使用腹腔镜探查并根据情况行治疗.对比 2 组患者总体情况、手术及效果指标、临床转归.结果 2 组患者均得到了及时有效诊断和治疗.腹腔镜组手术时间、术中出血量及住院时间短于/少于开腹组[(75±18)min比(96±21)min、(30±12)ml比(60±18)ml、(5.6±2.4)d比(8.7±3.2)d],差异均有统计学意义(均P＜0.05).2 组拔除引流管时间、血常规指标恢复时间差异均无统计学意义(均 P＞0.05).所有患者术后腹痛症状消失或明显好转,无任何并发症,经常规治疗后所有患者顺利出院.结论 腹腔镜技术对于急腹症患者的诊断和治疗安全有效,并且手术时间、术中出血量及住院时间指标优于传统开腹手术.

目的 分析70岁及以上老年女性乳腺癌患者的临床特点及预后.方法 回顾性分析2006年6月至2016年7月首都医科大学附属北京安贞医院收治的238例70岁及以上老年女性乳腺癌患者的临床资料.记录患者的临床特征,对患者进行术后随访并记录预后情况.采用Kaplan-Meier生存曲线分析方法计算不同临床特征患者5年总生存率和5年无病生存率,分析影响患者生存率的危险因素.结果 238例患者中,214例(89.9％)患者以无痛性乳房肿块为主要就诊症状;202例(84.9％)为浸润性导管癌;63例(26.5％)肿瘤直径≤2 cm、149例(62.6％)肿瘤直径＞2 ～5 cm、26例(10.9％)肿瘤直径＞5 cm;56例(23.5％)淋巴结转移数量≥4个;85例(35.7％)肿瘤分期Ⅰ期、123例(51.7％)肿瘤分期Ⅱ期、30例(12.6％)肿瘤分期Ⅲ期;54例(22.7％)分子分型为Luminal A型、98例(41.2％)为Luminal B型/人表皮生长因子受体2(HER-2)阴性、26例(10.9％)为LuminalB型/HER-2阳性、19例(8.0％)为HER-2过表达型、41例(17.2％)为三阴性.截至2016年10月,226例得到随访,随访率为95.0％,随访时间85(65,89)个月,随访期间37例患者死亡.Kaplan-Meier生存曲线分析结果显示,患者5年总生存率为90.5％、5年无病生存率为84.2％.多因素Cox回归分析结果显示,淋巴结转移(相对危险度=1.549,95％置信区间:1.213～2.761,P=0.018)、分子分型(相对危险度=8.460,95％置信区间:1.437 ～8.462,P=0.006)是影响患者5年总生存率的独立危险因素,淋巴结转移(相对危险度=0.423,95％置信区间:0.146～1.924,P=0.002)是影响患者5年无病生存率的独立危险因素.结论 老年女性乳腺癌分子分型以Luminal A型及Luminal B型多见.淋巴结转移、分子分型是影响患者预后的独立危险因素.

目的 探讨伊立替康联合阿帕替尼辅助治疗对术后转移性胃癌患者的效果.方法 选取2016年1月至2021年1月在首都医科大学附属北京安贞医院接受治疗的术后转移性胃癌患者68例,按随机数字表法分为观察组与对照组,各34例.对照组给予伊立替康静脉滴注治疗;观察组在对照组基础上口服阿帕替尼辅助治疗.比较2组治疗后临床疗效,用药前后免疫功能指标CD3+、CD4+、CD8+水平及CD4+/CD8+比值,肿瘤标志物糖类抗原19-9(CA19-9)、CA125、神经元特异性烯醇化酶(NSE)水平,炎性因子白细胞介素10(IL-10)、IL-6、肿瘤坏死因子α(TNF-α)水平,生存质量评分和不良反应发生情况.结果 观察组总有效率明显高于对照组[85.3％(29/34)比61.8％(21/34)],差异有统计学意义(P=0.028).用药后观察组免疫功能指标CD3+、CD4+水平及CD4+/CD8+比值均高于对照组,CD8+水平低于对照组,肿瘤标志物CA19-9、CA125、NSE水平均明显低于对照组,炎性因子IL-10、IL-6、TNF-α水平均低于对照组,各维度生存质量评分均高于对照组,差异均有统计学意义(均P<0.05).2组不良反应发生率比较,差异无统计学意义(P=0.494).结论 术后转移性胃癌患者采取伊立替康联合阿帕替尼辅助治疗的效果较好,可增强患者免疫能力,促进肿瘤标志物改善,减轻炎性反应,并提升患者生存质量.

乳腺癌患者行乳腺切除术后的总体生存率与保乳手术后辅助放疗的总体生存率相似,术后辅助放疗可使乳腺癌患者总体生存率升高.影响乳腺癌术后放疗效果的主要因素有放疗方法、放疗体位、放疗呼吸方式、患者年龄、乳腺的体积及形态、肿瘤分期和分型等.本文对乳腺癌保乳手术后放疗的研究进展进行综述,分析影响放疗效果的因素.

目的 探讨乳腔镜保留乳头乳腺切除术治疗早期乳腺癌的临床效果.方法 选择首都医科大学附属北京安贞医院2013年2月至2015年2月收治的女性早期乳腺癌患者138例,根据患者意愿其中70例行乳腔镜保留乳头乳腺切除术(观察组),68例行传统改良根治术(对照组),比较2组患者的手术观察指标、住院时间、术后并发症发生率、术后6个月乳腺癌生存质量测评量表(FACT-B)评分以及5年内无复发生存率和总生存率.结果 2组患者均顺利完成手术,围术期均无死亡.观察组术中出血量少于对照组[(40 ±9)ml比(81±15)ml],住院时间短于对照组[(9.5±2.4)d比(12.5±3.1)d],手术时间长于对照组[(116±21) min比(90±18)min],术后并发症总发生率低于对照组[4.3％(3/70)比30.9％(21/68)],术后6个月生理状况、功能状况、社会及家庭状况、情感状况及附加状况评分均高于对照组(均P＜ 0.05),2组患者淋巴结清扫数和术后5年无复发生存率以及总生存率比较差异均无统计学意义(均P ＞0.05).结论 乳腔镜保留乳头乳腺切除术用于女性早期乳腺癌手术安全可行,与改良根治术相比能够减少术中出血量、缩短住院时间、降低并发症发生率、提高患者生活质量,且不降低无复发生存率和总生存率,但手术时间长于传统改良根治术,可通过增加术者手术操作熟练程度进一步改善.

Objective To analyze the safety and efficacy of laparoscopic radical resection of colorectal cancer for elderly patients over 70 years old. Methods From January 2014 to January 2017, a retrospective analysis of the patients with radical surgery for colorectal cancer in Department of General Surgery, Beijing Anzhen Hospital, Capital Medical University was performed.According to the patient′s age, the patients were divided into ≥70 years old group (68 cases) and<70 years old group (84 cases). The preoperative clinical data of the two groups were analyzed.The surgeons strictly followed the standard lymph node cleaning and the principle of no tumor for colorectal cancer radical operation.The surgical conditions, pathology, short-term efficacy and the follow-up conditions of the two groups were compared.Statistical analysis was performed using SPSS 20.0.The normal distribution of the data was expressed as Mean±SD, and the t-test was used for comparison between the group.The count data was compared using the χ2 test or the Fisher exact probability method. Results The operation was successfully completed in both groups.In the group of ≥70 years old, 2 cases were converted to open due to extensive adhesion of the abdominal cavity, no perioperative death.Compared with the 0.05). There was statistically significant difference in incidence of postoperative cardiovascular events between the groups (26.4% (18/68) vs.7.14%(6/84)χ2= 6.428, P=0.010) .However, there were no significant differences between the two groups in implications, rate of death and the time stayed in hospital.(P>0.05). Conclusion Laparoscopic radical resection for colorectal cancer patients over 70 years old is safe and feasible with strict indications and attention to perioperative management. Key words: Colorectal cancer; Laparoscopy; Elderly

目的:研究普外科合并静脉血栓栓塞症(VTE)患者,围术期抗凝治疗和临床管理的方案.方法:术前对患者进行VTE风险评估,选择围术期抗凝治疗方案,分析围术期不良事件(出血、血栓复发)发生情况并对不良事件相关因素进行研究.结果:149例入组患者分为四组,术前无抗凝14例、华法令抗凝无桥接组27例、华法令抗凝桥接组87例、新型口服抗凝药组21例.其中进行围术期抗凝者,下肢血栓多为中央型或混合型、同时存在深静脉血栓形成(DVT)及肺血栓栓塞症(PE)、合并恶性肿瘤、易栓症检测异常、VTE多为3个月之内、VTE多为中高风险、术前进行化疗并经外周静脉穿刺中心静脉置管(PICC)置管(P＜0.05).围术期桥接抗凝者血栓复发率(2.3％)明显低于无桥接组(9.7％)(P＜0.05).与血栓复发的相关因素为既往已有VTE复发(P＜0.001).围术期桥接抗凝者出血率(16.1％)与无桥接组(4.8％)无明显差异(P＞0.05).与出血相关的危险因素为年龄(P＜0.01),将年龄≥65岁的患者再进行出血相关因素分析,手术分级、桥接抗凝有统计学差异(P＜0.05).80岁以上低分子肝素0.6 mL/24 h或0.4 mL/12 h桥接抗凝患者无血栓复发及大出血.新型口服抗凝药组既无血栓复发也无出血病例.结论:对于普外科疾病合并VTE患者,中高复发风险、低出血风险患者选择低分子肝素桥接抗凝.既往有过反复VTE发作或停抗凝药后复发患者围术期血栓再复发的风险较大.高龄、手术规模较大、需要进行桥接抗凝者,则要警惕出血的风险.高龄患者小剂量抗凝加穿医用弹力袜、抬高患肢、早期离床活动,更为安全有效.新型口服抗凝药将可能成为有效、安全的首选抗凝方案.

Objective To analyze the clinical effects of 3D and 2D laparoscopic radical resection of colorectal cancer.Methods Totally 67 patients who had laparoscopic radical resection of colorectal cancer from June 2015 to October 2016 in Beijing Anzhen Hospital,Capital Medical University were reviewed;32 patients had 2D laparoscopic operation(2D laparoscopy group) and 35 patients had 3D laparoscopic operation(3D laparoscopy group).Surgical records,postoperative recovery and follow-up data were analyzed.Results All patients had successful laparoscopic operation with no perioperative death.Operation time and intraoperative blood loss in 3D laparoscopy group were significantly shorter/less than those in 2D laparoscopy group[(125 ± 23)min vs (166 ±28) min,(93 ± 28) ml vs (132 ± 29) ml] (P ＜ 0.05).Length of colorectal excision specimen,diameter of tumor,number of lymph nodes removed during operation,length between tumor and incisal edge had no significant differences between groups(P ＞0.05).Postoperative first exhaust time,complication rate,hospital stay time and hospital charges had no significant differences between groups (P ＞ 0.05).Tumor recurrence rate and metastasis rate during follow-up had no significant differences between groups(P ＞ 0.05).Conclusion Compared with 2D laparoscopy,3D laparoscopy assisted radical resection of colorectal cancer shows advantages of short operation time and few intraoperative bleeding.

Objective To study the effect of down-regulation of decoy receptor 3 (DcR3) on biological characteristics of hepatoma cell line HepG2.Methods DcR3 small interfering RNA (DcR3-siRNA)was transfected into HepG2 cells;6 cell groups(siRNA-1,siRNA-2,siRNA-3,siRNA-4,negative siRNA and non-siRNA transfection control group) were established for the next experiment.Proliferation ability of HepG2 cells was tested by Cell Counting Kit-8 method;motor ability was tested by scratch adhesion test;invasion and migration abilities were tested by Matrigel ad Transwell test.Results The expression of DcR3 in HepG2 cells with DcR3-siRNA (4 groups) was significantly lower than that in control group[(0.167 ± 0.007),(0.172 ± 0.010),(0.053 ± 0.016),(0.176 ± 0.010) vs (0.263 ± 0.019)] (P ＜ 0.05 or P ＜ 0.01).Proliferation of HepG2 cells was inhibited by down-regulation of DcR3 expression.After 24 h of transfection,the absorbance value in DcR3 siRNA HepG2 cells was significantly lower than that in blank control group and negative control group[(0.566 ±0.024) vs (0.621 ± 0.009),(0.613 ± 0.017)] (P ＜ 0.05).Invasion and migration abilities of HepG2 cells was inhibited by down-regulation of DcR3 expression.Conclusion Down-regulation of DcR3 has an inhibitive effect on proliferation,invasion and migration abilities of hepatoma HepG2 cells.

Lawsone (LS) a colored napthoquinone compound obtained from the plant Lawsonia inermis L. (Lythraceae) is known for its usefulness of being a precursor for synthesis of some anticancer compounds. Literatures support potent anticancer activity of napthoquinone derivatives in human colon cancer, present study evaluates the effect and mechanism of LS on chemical induced colon cancerous rats and human colon cancer DLD-1 cells, the study was supported by endoscopy, histological and immunohistochemistry analysis. KAD rats were subjected to colon cancer mediated by Azoxymethane (AOM) injections followed Dextran sodium sulfate (DSS) orally in drinking water. After endoscopic confirmation the rats were given LS (200mg/ml) orally for 8 weeks. Presence of aberrant foci, types of tumors and the proliferative effect on tumor lesions was studied by macroscopic, histological and immunohistochemical analysis. To establish the mechanism, human colon DLD-1 cancer cells were exposed to LS and its effect on proliferation were studied. LS reduced aberrant crypt without affecting tumor pathology. Histological study of colon suggested decrease in numbers of adenomas and lesions. Immunohistochemistry confirmed the antiproliferative activity in adenocarcinomas without affecting the cells of normal colon mucosa. Results on human DLD-1 cells showed LS delayed progression of cell cycle by decreasing expression of cyclin B1 as well as cdk1 by inactivating NF-κB without inducing apoptosis. The study concluded role of LS in suppressing cell proliferation of colon tumors. The suppressive activity on DLD-1 cells was not by apoptosis but by decreased NF-κB activity resulting in suppression of expression levels of cyclin B1 and cdk1.

Objective: MicroRNAs (miRNAs) are a class of small, non-coding RNA molecules that can regulate gene expression, thereby affecting crucial processes in cancer development. miRNAs offer great potential as biomarkers for cancer detection because of their remarkable stability in blood and their characteristic expression in different diseases. In the current study, we focused on Mir-382, one potential tumor-associated miRNA, investigated whether Mir-382 on serum could discriminate between breast cancer patients and healthy controls. Methods: We performed miRNA quantitation assay on serum from breast cancer patients, followed by construction of ROC (Receiver Operating Characteristic) curves to determine the sensitivity and specificity of the assay. A total of 164 breast cancer patients who underwent tumor resection were included in our follow-up study, meanwhile same number healthy subjects were also enrolled as control. Results: In this study, we aimed to investigate whether Mir-382 is associated with the TNM staging and prognosis of breast patients. We found that the Mir-382 expression was significantly lower in tumor tissues compared with that in normal tissue (P<0.05). Kaplan-Meier and analysis showed that the Mir-382 expression status is significantly associated with the survival duration (Log-rank test, P<0.001), and multivariate Cox regression revealed that patients with low Mir-382 expression were exposed to a 2.352 fold higher death risk (HR=2.352, 95% CI=1.379-4.012, P=0.002) compared with those with high Mir-382 expression. Expression of MiR-382 was also significantly correlated with TNM staging, especially for lymph node metastasis and distant metastasis. By in vitro study, exogenous expression Mir-382 could significantly inhibit the proliferation and migration of breast cancer cell MCF-7; on the other hand, knocking down Mir-382 could significantly reverse these biological characteristics. Conclusion: Our study thus demonstrates that Mir-382 expression in breast tissues is critically associated with the prognosis of patients, suggesting its potential clinical significance.

Objective To investigate the short-term outcomes and oncological safety of Abdominal Wall Lifting laparoscopy resection for colorectal cancer; to observe its effect on immune function.Methods Sixty-seven cases of colorectal were treated in our department,including 37 cases who received abdominal wall lifting laparoscopic surgery and 30 who received open surgery.The therapeutic efficacy,operation time,blood loss,the first exhaust time,the length of specimen and the total number of lymph nodes were compared.In addition the serum levels of IgA,IgM,IgG,C-reactive protein (CRP) in peripheral blood were assayed by ELISA,which might reflect the effects of different surgey on human immune function.Results There was no statistical difference between groups in terms of age,gender,location of tumor and TNM staging.The abdominal wall lifting laparoscopy and the open surgery,the operation time was (168 ±26)min,(166 ±31)min; the length of specimen was (21 ±2)cm,(22 ±3)cm; the total number of lymph nodes dissected was (15 ±4),(17 ± 6) ; there was no statistical difference in the abovementioned indexes(P ＞ 0.05).However the intra-operative blood loss was (194 ± 58) ml,(231 ± 68) ml and the first exhaust time after operation was (47 ±9)h,(64 ± 13)h,showing significant differences(P ＜0.05).In addition,the two groups of patients had no significant difference in IgA,IgG,IgM and CRP before operation.But 3 days [IgM (1.15 ± 0.48),(0.69 ± 0.15) ; CRP (39.4 ± 14.5),(58.8 ± 10.7) mg/L] and 5 days [IgM (1.68 ± 0.86),(1.12 ±0.48) ; CRP(19.5 ±10.6),(38.3 ± ll.0)mg/L] after operation the IgM and CRP had significant difference.Conclusions The two groups have no significant difference in the number of lymph nodes dissected,operation time and the length of specimen.However,in the aspect of blood loss,the first exhaust time,IgM and CRP that reflect the immune response.Furthermore,the abdominal wall lifting laparoscopy group is better than the open surgery group.

目的:通过分析两例老年阑尾炎病人术后并发急性肠系膜静脉血栓形成,探讨其病因及可能的预防措施。方法:今年诊治的两例急性化脓性阑尾炎患者,术后并发肠系膜静脉血栓形成,分析其发生特点。结果:两例均为老年、病情重、合并症多患者,诊断明确时均已经发生部分小肠坏死,行一期肠切除及吻合术,并抗凝治疗。结论:阑尾炎症严重的老年病人,围手术期应警惕腹腔内静脉血栓形成的危险。

1 临床资料 患者女,59岁,间断性右下腹痛半年余,可自行缓解,伴右下肢轻度水肿,无其他不适症状.体格检查:体温36.5℃,脉搏80次/min,呼吸19次/min,血压118/77 mm Hg(1 mm Hg=0.133 kPa),无浅表淋巴结肿大,腹部膨隆,可触及右中腹部实性包块,质韧,叩诊实音,肠鸣音3～5次/min.

目的 构建特异性的针对DCR3的siRNA,将其转染进入肝癌细胞系hepG2, 系统性的研究下调DCR3对HepG2的细胞系的影响，观察的指标包括增殖能力，运动能力，迁徙能力和侵润能力，同时构建肝癌原位动物模型，通过体内实验来研究下调DCR3对HepG2成瘤率的影响。旨在分析DCR3对肝癌细胞系生物学特性的影响。方法：培养肝癌细胞系HepG2，将特异性靶向DCR3的siRNA转染进入肝癌细胞系，通过CCK8实验来研究肿瘤细胞的增殖能力。通过划痕实验研究HepG2的运动能力，通过matrigel加transwell实验来研究肝癌细胞的侵袭和迁移能力，以期明确下调DCR3对HEPG2细胞生物学形状的影响。最后，通过建立裸鼠的原位移植肿瘤，分析DCR3的下调对体内裸鼠成瘤和转移的影响。结果：下调DCR3的表达显著的抑制了肝癌细胞HEPG2的增殖能力，降低了侵袭和转移的能力。体内裸鼠实验证实，下调DCR3的表达也显著降低了动物体内的成瘤率和转移的严重程度。结论：明确了DCR3同肝癌细胞系的发生和转移的关系，成功建立了与临床肝癌相似的裸鼠原位肝癌模型，为肝癌相关实验及治疗提供提供了良好的动物平台。