食管裂孔疝是常见病，会引起反酸烧心、反流性食管炎，甚至恶性呕吐、贫血及营养不良等并发症。腹腔镜食管裂孔疝修补术是治疗食管裂孔疝的有效方法。为了降低食管裂孔疝手术的复发率，通常采用补片来加强膈肌角和食管裂孔，但是，合成补片可能会造成炎症反应，导致术后食管狭窄，甚至侵蚀等严重并发症。本文报道1例合成补片修补食管裂孔疝术后的狭窄侵蚀病例，及其临床表现和治疗过程。

Objective:To explore the effect of protein kinase B (AKT) inhibitor SC66 on the proliferation of pancreatic cancer cells and related molecular mechanisms.Methods:The expression difference of AKT in pancreatic cancer and normal pancreatic tissues was analyzed by bioinformatics. The AKT-silencing cell line was constructed, and CCK8, Western blot and qPCR experiments were performed to detect the effect of AKT inhibitor SC66 on the proliferation of pancreatic cancer cells and the regulation and influence of related cell signal transduction pathways.Results:The expression of AKT in pancreatic cancer tissues was significantly increased. It promoted the proliferation of pancreatic cancer cells by regulating mTOR-related cell signaling pathways. SC66 inhibited the proliferation of pancreatic cancer cells by down-regulating AKT.Conclusion:SC66 can effectively inhibit the proliferation of pancreatic cancer cells and provide a new strategy for the treatment of pancreatic cancer.

目的:分析围手术期加速康复外科(ERAS)在全腹腔镜下改良三角吻合远端胃癌D2根治术中应用的可行性及对患者的应激、生命体征及细胞免疫的影响.方法:收集2017年2月-2019年2月在徐州市第一人民医院普外科行全腹腔镜下改良三角吻合远端胃癌D2根治术患者75例临床资料,随机分为2组:加速康复外科组(加速康复组,42例)和传统腹腔镜组(传统组,33例).对比研究两组患者的手术时间、术中出血量、术后下床活动时间、首次肛门排气时间、术后住院天数及患者术晨、术后24、48 h和72 h的应激指标(IL-6及CRP)、生命体征(心率和动脉压)和T淋巴细胞亚群[(CD3+和CD4+/CD8+)及NK]和并发症发生情况.结果:两组患者的性别、年龄及肿瘤分期等一般资料无统计学差异(P＞0.05);两组患者手术时间、术中出血量均无统计学差异(P＞0.05),与传统组比较,加速康复组的术后下床活动时间、术后首次肛门排气时间、住院天数均明显缩短(P＜0.05);两组患者术晨IL-6、CRP无统计学差异(P＞0.05);与传统组比,加速康复组术后24、48 h及72 h的IL-6、CRP均显著降低(P＜0.05);两组围术期的心率和动脉压、术晨免疫指标均无统计学差异(P＞0.05);与传统组比较,术后24、48 h及72 h加速康复组的CD3+、CD4+/CD8+均显著增高(P＜0.05),术后48 h及72 h加速康复组的NK均显著增高(P＜0.05).加速康复组发生呕吐、出血和疼痛分别为2例、1例和0例,并发症发生率为7.14％(3/42);传统组发生呕吐、出血和疼痛分别为4例、3例和3例,并发症发生率为30.21％(10/33),与传统组比,加速康复组发生并发症减少(P＜0.05).结论:加速康复外科理念应用于全腹腔镜改良三角吻合远端胃癌D2根治手术能减轻患者术后应激反应及细胞免疫,患者术后恢复更快.

目的 探讨直肠癌患者围手术期外周血循环肿瘤细胞(CTCs)的变化情况及其对患者预后的影响.方法 选择2015-09～2016-12广西壮族自治区人民医院胃肠外科收治的直肠癌患者30例,采用随机数字表法将其分为腹腔镜手术组和开腹手术组,每组15例.采用CanpatrolTM 2代技术对患者手术前后的外周血CTCs进行分型检测.术后随访22～33个月,分析两组患者手术前后的CTCs水平变化,术前各分型CTCs与疾病特征的关联性以及手术前后CTCs对患者预后的影响.结果 腹腔镜手术组术后总CTCs水平较术前显著降低(P<0.05).腹腔镜手术组术前混合型CTCs水平显著高于开腹手术组(P<0.05),但术后两组差异无统计学意义(P>0.05).两组手术前后间质型CTCs和上皮型CTCs水平比较差异均无统计学意义(P>0.05),且同组手术前后比较差异亦无统计学意义(P>0.05).间质型阴性组肿瘤直径≤3 cm的人数比例显著高于间质型阳性组(P<0.05).术前总CTCs、混合型CTCs、上皮型CTCs情况与患者年龄、性别、T分期、N分期及肿瘤直径的关联性不显著(P>0.05).3例术后CTCs阴性者在随访过程中均未发生死亡;27例术后CTCs阳性者在随访过程中出现死亡4例,术后CTCs阴性者的生存情况显著优于阳性者(log-rank检验:χ2=6.553,P=0.031).2例术前CTCs阴性者在随访过程中均未死亡,28例术前CTCs阳性者在随访过程中出现死亡4例,术前CTCs阴性者的生存情况显著优于阳性者(log-rank检验:χ2=5.245,P=0.027).结论 外周血CTCs可用于直肠癌患者预后评价,指导临床治疗.

目的 探讨加速康复外科(enhanced recovery after surgery,ERAS)指导下全腹腔镜远端胃癌D2根治术的临床效果.方法 远端胃癌病人75例,随机分为两组:A组42例,为加速康复外科组,B组33例为传统腹腔镜组.记录两组手术时间、术中出血量、首次肛门排气时间、术后首次下床活动时间、术后住院时间,采用视觉模拟评分法(visual analogue scale,VAS)对两组病人术后12小时、24小时、48小时和72小时时间点进行疼痛评估,术后24小时内采用语言描述评分(nau-sea verbal descriptive scale,NVDS)评估恶心、呕吐,采用腹胀评分评估腹胀,采用患者术后3天的日常生活能力量表(activity of daily living scale,ADL)评价病人生活能力,收集两组病人术后发生的出血、胃瘫、肠梗阻、吻合口或残端瘘.采用院内术后疼痛控制满意度、术后恶心、呕吐控制满意度、术后腹胀控制满意度及住院总体满意度调查表评价病人满意度.结果 两组病人手术时间、术中出血量比较,差异无统计学意义(P>0.05),与B组比较,A组的术后下床活动时间和术后首次肛门排气时间较早,住院时间明显减少,差异有统计学意义(P<0.05).A组术后不同时间点T12、T24、T48、T72 VAS均低于B组,差异有统计学意义(P<0.05).A组术后恶心、呕吐和腹胀均低于B组,ADL高于B组,差异有统计学意义(P<0.05).两组术后均无胃瘫、肠梗阻、吻合口或残端瘘等严重并发症的发生.A组术后疼痛、恶心、呕吐及腹胀控制满意度及住院总体满意度均高于B组,差异有统计学意义(P<0.05).结论 全腹腔镜远端胃癌根治术病人围手术期应用ERAS理念安全有效.

X-linked ubiquitin-specific peptidase 9 (USP9X) serves important roles in the development and progression of various human cancers. However, its role and molecular mechanism in liver cancer require further elucidation. In the present study, USP9X was found to be upregulated in liver cancer tissues. At the same time, overexpression of USP9X promoted the proliferation, invasiveness and migration of liver cancer cells, which were subsequently suppressed by USP9X silencing. On a molecular level, the results revealed that USP9X knockdown suppressed elements of the Janus kinase 2 (JAK2)/STAT3 signaling pathway, including JAK2, STAT3, matrix metalloproteinase-2 and c-Myc. By contrast, overexpression of USP9X had the opposite effect. In conclusion, the results of the present study suggest that USP9X is upregulated in patients with liver cancer, which may accelerate the proliferation, invasiveness and migration of liver cancer cells by regulating the JAK2/STAT3 signaling pathway.

目的 探讨外周血造血干细胞在体外转化为肝样干细胞的诱导条件.方法 选取自愿行造血干细胞移植符合入选标准患者,用血细胞分离机采集经粒细胞集落刺激因子(recombinant human granulocytecolony stimulating factor,G-CSF)+化疗药物动员后患者的外周血单个核细胞,通过流式细胞仪及免疫磁珠法筛选出CD34+的单个核细胞.将CD34+的单个核细胞分为对照组、肝细胞生长因子(hepatic growth factor,HGF)组、成纤维细胞生长因子4(fibroblast growth factor,FGF4)组、FGF4+ HGF组、HGF+ FGF4+巨噬细胞集落刺激因子(macrophage colony stimulating factor,MCSF)组.动态观察细胞形态学变化,15 d后免疫细胞化学检测Oct4、ALB、AFP、c-Kit、CK19及CD34在各组细胞中的表达.结果 HGF+ FGF4+ MCSF组:见大量类圆形细胞,贴壁生长,核仁明显,核质比例大,部分细胞串珠样生长;FGF4+ HGF组:见少量类圆形细胞,余细胞形变明显;对照组、HGF组、FGF4组:仅个别细胞呈类圆形,大部分死亡.HGF+ FGF4+ MCSF组:Oct4、c-Kit、CK19、CD34阳性表达,AFP弱阳性,ALB阴性;FGF4+ HGF组:细胞AFP、ALB阳性表达,CK19、CD34弱阳性表达,Oct4、c-Kit阴性;对照组、HGF组、FGF4组:检测指标均无表达.结论 经HGF、FGF4及MCSF联合诱导后的外周血CD34+单个核细胞更易转化为肝样干细胞.

Objective To investigate the expression of ETV1 protein in gastrointestinal stromal tumor (GIST) with different clinical pathologic factors and its prognostic significance in GIST.Methods One-hundred and fifteen cases of GIST patients, who were treated with surgical resection between January 2005 and December 2005 in the People's Hospital of Guangxi Zhuang Autonomous Region, were retrospectively analyzed.Using immunohistochemistry (IHC) combined with gene sequencing, ETV1, CD117, DOG-1, and CD34 protein expression were measured.Survival analysis was performed by survival curve.Univariate survival analysis and multivariate survival analysis were also performed.Results The ETV1, CD117, CD34 and DOG-1 positive rates were 92.2%, 89.6%, 92.2% and 84.2%, respectively;and there was no significant difference among their expression, nor significant correlation was revealed.ETV1 protein had higher expression (83.3%) in CD117 negative GIST than DOG-1 and CD34 proteins, but there was no significant difference (P>0.05).In Wild-type GIST, ETV1 was significantly higher expressed (66.7%) than DOG-1 and CD34 protein (P<0.05).There was significant difference in expression of ETV1 among different nuclear fission and NIH risk grades (P<0.05).For patients with radical resection, significant differences in the 3-year disease-free survival rate were revealed among different expression of ETV1 and NIH risk grades.Patients with positive ETV1 expression had significantly lower recurrence rate (14.1% vs.55.6%, P<0.05) and higher 3-year disease-free survival rate (80% vs.56%, P<0.05).Conclusion ETV1 protein has high expression rate in various GIST, providing good supplement in diagnosis of wild type GIST.For patients with radical resection, ETV1 promises to be a prognostic factor of 3-year disease-free survival.

目的 探讨胃肠间质瘤(GIST)患者的临床、病理特点,并分析预后影响因素.方法 对115例接受外科手术治疗的GIST患者的临床、病理资料进行回顾性分析.采用免疫组织化学法检测CD117、DOG-1及CD34蛋白的表达、基因测序法进行基因突变检测,并分析影响GIST预后的因素.结果 115例GIST患者中,病理类型以梭型细胞为主型95例(82.6％),上皮细胞为主型17例(14.8％),混合细胞型3例(2.6％).CD117、DOG-1、CD34蛋白阳性表达率分别为89.6％、92.2％、84.2％.CD117、DOG-1、CD34蛋白在不同性别、肿瘤大小、危险度分级、核分裂数及是否转移分组中阳性表达率比较,差异无统计学意义.103例CD117阳性表达患者的DOG-1、CD34阳性表达率明显高于12例CD117阴性患者(P ＜0.001).109例患者获得随访,1年、3年、5年总体生存率分别为90.1％、63.4％、48.6％,其中行根治切除患者1年、3年、5年总体生存率分别为100％、84.2％、70.3％.单因素分析结果显示:肿瘤大小、NIH危险度分级、是否转移、手术方式与患者生存有关(P＜0.05).多因素分析结果显示是否转移是影响患者术后生存时间的独立危险因素(P ＜0.001).结论 影响GIST预后的因素有肿瘤大小、NIH危险度分级、手术方式、转移情况,其中否转移是影响患者术后生存时间的独立危险因素.

目的 观察进展期胃癌根治术(毕Ⅱ式)对幽门螺旋杆菌(Hp)感染的影响及药物干预的临床效果.方法 103例可行根治性远端胃癌切除术的胃癌患者,采用胃镜活组织病理、13C尿素呼气试验(UBT)检测Hp感染,在进行胃癌根治手术(毕Ⅱ式)术后继续监测Hp感染状态,同时胃镜观察吻合口、残余胃组织,诊断是否存在吻合口炎、吻合口糜烂、吻合口溃疡、慢性胃炎及糜烂、胃黏膜肠化等病理改变,随访患者消化道症状.对术后4周仍存在Hp感染者60例随机分为两组,对照组30例给予临床观察,实验组30例给予根除Hp治疗;术后随访观察3年,术后每6个月随访胃镜、CT,记录消化道症状和胃镜结果,检查肿瘤是否复发转移.结果 该组胃癌患者术前Hp感染率为73.8％ (76/103),术后4周残胃Hp感染率58.3％ (60/103),术后6个月Hp持续感染率为41.7％ (43/103),术后6个月内残胃吻合口溃疡发生率为11.7％(12/103),吻合口炎发生率为80.0％ (82/103).其中,实验组(抗Hp治疗组)Hp根除率高于对照组(P＜0.05);实验组残胃炎发生率低于对照组(P＜0.05),实验组残胃癌复发率、吻合口溃疡发生率与对照组相比差异无统计学意义(P＞0.05);胃癌术后Hp持续阳性患者残胃癌发生率与Hp阴性患者相比有增加,但差异无统计学意义(P＞0.05).结论 进展期胃癌根治术后残胃Hp感染率下降,对于术后残胃Hp感染持续阳性者,抗Hp治疗可改善其症状,是否降低残胃复发率及残胃癌发生率,仍需扩大病例进行观察总结.