目的 研究灵芝乙醇提取物是否通过脾酪氨酸激酶(Syk)影响胰腺癌细胞SW1990的增殖、迁移和侵袭.方法 胰腺癌细胞SW1990给予25、50、100μg/ml剂量的灵芝乙醇提取物,采用噻唑蓝(MTT)比色法检测细胞存活,平板克隆测定细胞克隆形成,Transwell小室法评估细胞迁移和侵袭,免疫印迹实验(western blot)分析细胞核相关抗原Ki67(Ki67)、上皮型钙黏附蛋白(E-cadherin)、神经型钙黏附蛋白(N-cadherin)及Syk表达.在SW1990细胞中转染pcDNA3.1-Syk,或转染pcDNA3.1-Syk并给予100μg/ml浓度的灵芝乙醇提取物,利用上述方法考察细胞的增殖、迁移和侵袭变化.结果 低、中、高剂量的灵芝乙醇提取物明显降低细胞存活率、克隆形成数、迁移细胞数、侵袭细胞数、Ki67、N-cadherin蛋白表达水平,并显著提高E-cadherin、Syk蛋白表达水平,均呈剂量依赖性(P<0.05).Syk过表达明显减少细胞的细胞存活率、克隆形成率、迁移细胞数、侵袭细胞数、Ki67、N-cadherin蛋白表达水平,显著增加E-cadherin蛋白表达水平(P<0.05).Syk过表达后,灵芝乙醇提取物对SW1990细胞存活、克隆形成、迁移、侵袭、Ki67、N-cadherin蛋白表达的抑制作用和其对细胞E-cadherin蛋白表达的促进作用被增强.结论 灵芝乙醇提取物通过上调Syk,抑制胰腺癌细胞SW1990的增殖、迁移和侵袭能力.

目的 探讨水飞蓟素(SM)对缺氧条件下人肝癌HepG-2细胞中缺氧诱导因子-1α(HIF-1α)和多耐药基因1(MDR1)表达的影响.法不同浓度的SM(0、10、20、40mg/L)与浓度梯度的化疗药物(多柔比星、索拉菲尼、顺铂)处理HepG-2细胞后应用四甲基偶氮唑蓝比色法(MTT)检测不同浓度SM对HepG-2细胞化疗药物敏感性的影响;在缺氧条件下,分别用0、10、20、40 mg/L的SM处理HepG-2细胞8 h后,应用RT-PCR检测不同浓度SM对HepG-2细胞的HIF-1 α及MDR1 mRNA表达水平的影响,利用蛋白质印迹法检测不同浓度SM对HepG-2细胞的HIF-1α及P-糖蛋白(P-Gp)蛋白表达水平的影响.结果 随着SM浓度的增加,HepG-2细胞对化疗药物多柔比星、索拉菲尼和顺铂的敏感性逐渐增强;与对照组相比,10、20、40 mg/L SM处理的HIF-1α mRNA表达量差异无统计学意义(P＞0.05),而MDR1 mRNA表达量呈浓度依赖性降低(P＜0.05),10、20、40 mg/L SM处理的HIF-1 α与P-Gp蛋白表达水平呈浓度依赖性降低(P＜0.05).结论 SM可能通过在转录后水平抑制HepG-2细胞HIF-1α的蛋白表达而降低MDR1的mRNA与蛋白表达,从而降低肝癌细胞的耐药性.

目的 比较腹腔镜与开腹胰十二指肠切除术的临床疗效.方法 回顾性分析南充市中心医院2014年6月至2019年8月期间完成的104例胰十二指肠切除术患者资料,其中包含胰头癌47例,十二指肠乳头癌31例,胆管下段癌26例,根据已行的手术方式分为腹腔镜胰十二指肠切除组(A组,n=40)和开腹胰十二指肠切除组(B组,n=64).比较两组的手术时间、术中出血量、平均排气时间、术后下床活动时间、住院时间及术后并发症发生情况.结果 两组手术时间和术中出血量无统计学差异(P>0.05),平均排气时间、术后下床活动时间及住院时间A组小于B组(P<0.05).其中A组术后发生胰瘘5例,胆漏4例,腹腔内出血1例,胃瘫综合征3例;B组术后发生胰瘘9例,胆漏5例,腹腔内出血1例,胃瘫综合征4例,余无明显严重并发症发生;两组术后总并发症发生率无明显差异(P>0.05).结论 腹腔镜和开腹胰十二指肠切除术均安全有效,但腹腔镜胰十二指肠切除术后恢复优于开腹胰十二指肠切除术.

目的 探讨可切除原发性肝癌破裂出血行急诊肝切除与经导管动脉化疗栓塞术(transcatheter arterial chemoembolization,TACE)后二期肝切除的疗效及预后.方法 回顾性分析南充市中心医院2010年1月至2016年1月期间收治的可切除原发性肝癌破裂出血患者共42例,其中行急诊(入院24～48 h)肝切除术24例,行TACE后二期(TACE后1～2周)手术18例,比较2组患者的术中出血量和输血量、围术期死亡率、术后肝功能不全的发生率、术后1年肝癌复发或腹腔转移率以及术后1年及3年生存率.结果 行急诊肝切除术患者和TACE后二期手术患者的术前一般资料比较差异无统计学意义(P＞0.050).行急诊肝切除术患者的术中出血量和输血量均明显多于TACE后二期手术患者(P=0.028、P=0.017),二者间的围术期死亡率(P=0A89)、肝功能不全发生率(P=1.000)、1和3年生存率(P=0.650、P=0.463)及1年复发率(P=0.601)比较差异均无统计学意义,均未发现腹腔种植转移.结论 对于可切除原发性肝癌破裂出血行急诊肝切除与TACE后二期肝切除均安全有效,应根据患者的具体情况选择合适的治疗方案.

目的 探讨肿瘤相关钙信号转导蛋白2(Trop-2)基因对肝癌发生发展的影响及作用机制.方法 收集10例肝癌患者的肝癌组织标本和癌旁正常组织标本,免疫组织化学染色法和实时荧光定量聚合酶链反应(qRT-PCR)法分别检测不同组织中Trop-2蛋白和mRNA的表达情况;流式细胞术和蛋白质印迹法(Western blot)检测HepG2、HCCLM3、HL-7702细胞中Trop-2蛋白的表达情况;Western blot法检测不同组织和转染后HepG2细胞中Trop-2、蛋白激酶C-α(PKC-α)、磷酸化蛋白激酶C-α(p-PKC-α)和核因子-κB(NF-κB)的表达情况;CCK-8法检测转染后HepG2细胞的增殖率.结果 肝癌组织中p-PKC-α、NF-κB、Trop-2蛋白及Trop-2 mRNA的相对表达量均明显高于癌旁正常组织(P﹤0.01);HCCLM3细胞和HepG2细胞中Trop-2蛋白的相对表达量均明显高于HL-7702细胞(P﹤0.01);Trop-2 siRNA组HepG2细胞中Trop-2、p-PKC-α、PKC-α和NF-κB蛋白的相对表达量均低于空白对照组和阴性对照组(P﹤0.05);Trop-2 siRNA组HepG2细胞的增殖率低于阴性对照组(P﹤0.05).结论 Trop-2基因在肝癌组织和肝癌细胞株中均有较高水平的表达,提示其可能是肝癌潜在的治疗靶点.

目的 探讨miRNA-23靶向gremlin1调节肝癌细胞的生物学功能.方法 将人肝癌细胞株HSMMC-7721分为高表达组、抑制组和对照组,高表达组转染miRNA-23mimics,抑制组转染miRNA-23inhibitor,对照组不进行转染.MTT实验检测细胞增殖,流式细胞仪实验检测细胞周期,Transwell小室实验检测细胞侵袭,Western blot检测gremlin1表达.结果 高表达组的miRNA-23相对表达量显著高于抑制组和对照组(P<0.05),抑制组和对照组比较差异无统计学意义(P>0.05).与抑制组和对照组相比,高表达组的细胞增殖率显著降低,S期与G2/M期比例显著增加,GO/G1期比例显著减少,细胞侵袭数显著减少,差异均有统计学意义(P<0.05).与抑制组和对照组相比,高表达组的gremlin1蛋白相对表达量显著下降(P<0.05).结论 miRNA-23高表达能抑制gremlin1的表达,调节肝癌细胞周期,抑制肝癌细胞增殖与侵袭,可为防治肝癌提供新的思路和治疗靶点.

目的 探讨水飞蓟素(SM)对人肝癌细胞系MHCC97侵袭和转移能力的影响及可能涉及的分子机制.方法 MTT法检测细胞增殖;Transwell、划痕实验和细胞-基质黏附实验分别检测细胞侵袭、迁移及黏附能力;RT-PCR和Western blot检测MMP-9、VEGF、E-cadherin、integrinβ1和Akt mRNA及蛋白的表达.结果 和对照组相比,水飞蓟素抑制细胞增殖(P<0.05),显著降低细胞侵袭、迁移和黏附能力(P<0.05).水飞蓟素处理组MMP-9、VEGF、integrinβ1和Akt的mRNA及蛋白表达量降低(P<0.05),而E-cadherin的mRNA及蛋白表达量增高(P<0.05).结论 水飞蓟素可抑制MHCC97细胞增殖,并且降低细胞侵袭、迁移和黏附能力.

Objectives Overexpression of human trophoblast cell surface antigen 2 (Trop2) has been observed in many cancers; however, its roles in proliferation, apoptosis, migration, and invasion of hepatocellular carcinoma (HCC) remain unclear. Thus, this study aimed to characterize the function of Trop2 in HCC. Methods Trop2 protein expression was detected by immunohistochemistry in HCC tissues. Cell proliferation, apoptosis, and invasion were respectively measured by CCK-8, flow cytometry, Transwell, and wound healing assays. Expression levels of epithelial–mesenchymal transition-related proteins and Trop2 protein in HCC cell lines were detected by western blotting after silencing of the TROP2 gene. Results Trop2 protein was highly expressed in HCC tissues and HCC cell lines. Trop2 mRNA and protein expression levels decreased in HepG2 and HCCLM3 cells after transfection with Trop2 siRNA. Silencing of the TROP2 gene in HepG2 and HCCLM3 cells strongly inhibited cell proliferation and migration, while enhancing cell apoptosis. Investigation of the molecular mechanism revealed that silencing of the TROP2 gene suppressed epithelial–mesenchymal transition of HepG2 and HCCLM3 cells. Conclusions The results of the present study may improve understanding of the role of Trop2 in regulation of cell proliferation and invasion, and may aid in development of novel therapy for HCC.

Objective To investigate comprehensive treatment on gastroparesis syndrome after pancreato-duodenectomy. Methods A total of 108 patients with pancreatoduodenectomy between Jan. 2011 and Jan. 2016 in Nanchong Central Hospital were analyzed retrospectively. Among them 43 cases had occured gastric paralysis syndrome which confirmed by the clinical manifestation, the general influence of the upper gastrointestinal tract radiography and gastroscopy. According to the classification of International Study Group of Pancreatic Surgery, 35 cases in Grade A and 8 cases in Grade B. Comprehensive treatment included routine treatment, continuous gastrointestinal decompression, enteral nutrition support in the jejunum nutrition tube, improving gastric motility, the traditional Chinese medicine and acupuncture were given, and the clinical effect in all patients were observed. Results The recovery time of gastric motility were 2 to 4 weeks after operation, 35 cases (Grade A) recovered within 2 weeks, 6 cases (Grade B) recovered within 3 weeks, 2 case (Grade B) recovered within 4 weeks, and the average course of disease was 13.5 d. All patients were cured and no reoperation and serious complications hap-pened such as pancreatic fistula and anastomotic leakage. The outpatient follow-up were made for 3~6 months and no recurrence of gastroparesis was found. Conclusion Comprehensive treatment is safe and effective to treat gastroparesis syndrome after pancreatoduodenectomy.

目的:探究改良法经皮经肝胆道镜治疗肝胆管结石应用价值及技术要点.方法:选取南充市中心医院肝胆外科2014年4月~2016年2月肝胆管结石患者63例,依据建档顺序分组,对照组31例予以传统开腹手术治疗,研究组32例予以改良法经皮经肝胆道镜治疗,观察记录2组手术情况,并统计对比2组预后情况.结果:研究组术中失血量、手术用时、术后住院用时、术后肠胃功能恢复时间均少于对照组,差异有统计学意义(P<0.05);研究组并发症发生率12.50%(4/32)、切口感染率0.00%(0/32)、结石残留率3.13%(1/32)、结石复发率9.38%(3/32)、胆管炎复发率6.25%(2/32)均低于对照组[并发症发生率35.48%(11/31)、切口感染率22.58%(7/31)、结石残留率25.81%(8/31)、结石复发率32.26%(10/31)、胆管炎复发率29.03%(9/31)],差异具有统计学意义(P<0.05).结论:予以改良法经皮经肝胆道镜治疗肝胆管结石效果显著,可明显改善患者预后.

慢性胰腺炎是胰腺组织的慢性炎症性和纤维化病变,主要表现为胰腺不可逆转的形态学改变和内、外分泌功能的永久持续丢失以及顽固性疼痛.发病机制不完全清楚,临床表现多样.主要治疗方法是缓解疼痛和提高生活质量,手术治疗是关键环节.理想的手术方案不仅需要缓解疼痛、引流胰管、治疗邻近器官梗阻性并发症,还需要最大可能保存胰腺的内、外分泌功能,保证生活质量和预防复发.手术方法主要包括引流胰管类、切除部分胰腺组织类、以及引流+切除联合三大类手术,其中保留十二指肠的胰头切除术逐渐成为治疗慢性胰腺炎的标准术式.本文就慢性胰腺炎的外科治疗策略作一评述.

Objective To determine the effect of omental flap wrapping of pancreaticoduodenectomy on postoperative pancreatic fistula and intra-abdominal bleeding in patients undergoing pancreaticiduodenectomy through meta-analysis of published studies.Methods Articles about whether omental flap wrapping could prevent postoperative pancreatic fistula and intra-abdominal bleeding were searched in databases of MEDLINE,PUBMED and EMBASE.14 English article were found and according to including and excluding criteria,4 eligible articles with a total of 2971 patients were selected.Random effects model was used to analyze odds ratios and 95％ confidence intervals (CIs).Results 1129 patients were in omental wrapping group,and 1842 patients in nonomental wrapping group.Omental roll-up during pancreaticoduodenectomy could not prevent postoperative pancreatic fistula (OR =0.81,95 ％ CI 0.40～1.63,P＞0.05) or postoperative abdominal bleeding (OR=0.67,95％ CI 0.28～1.59,P＞0.05).The sensitivity analysis showed the pancreatic fistula rate was lower in the nonomental roll-up group than that in the omental roll-up group (OR=1.24,95％ CI 1.03～1.50,P＜0.05).Conclusions Omental wrapping can not decrease the risk of pancreatic fistula and abdominal bleeding after pancreaticoduodenectomy.Further randomized controlled trials are needed to identify the effect of omental wrapping technique for pancreaticoduodenectomy.

BACKGROUND/AIMS:To systematically determine the effect of omental flap in pancreaticoduodenectomy against postoperative complication through metaanalysis of published studies.METHODOLOGY:Thorough literature search in Ovid-MEDLINE and EMBASE databases was conducted to identify studies whether the use of Omental Flap to prevent postoperative complications. Review of 14 article candidates, identified 4 eligible articles with a total of 2971 patients for meta-analysis. Dichotomous data regarding distinction between omental roll-up and nonmental roll-up were pooled using random effects model to obtain the diagnostic odds ratios and their 95% confidence intervals (CIs).RESULTS:1129 patients in omental roll-up group, 1842 patients in nonomental group. Omental roll-up during pancreaticoduodenectomy could not prevent postoperative pancreatic fistula (OR=0.81, 95%CI 0.40-1.63, P=0.56). it also could not prevent postoperative intra-abdominal bleeding (OR=0.67, 95%CI 0.28-1.59, P=0.37). We use the sensitivity analysis which found The pancreatic fistula was lower in the nonomental roll-up group than in the omental roll-up group (OR=1.24, 95%CI 1.03-1.50, P=0.02).CONCLUSIONS:The use of omental roll-up could not decrease the risk of pancreatic fistula after pancreaticoduodenectomy. Further randomized controlled trials are needed to identify the effect of omental roll-up technique for pancreaticoduodenectomy.

目的 探讨精准肝切除在肝门胆管癌根治术中的临床应用.方法 回顾性分析我院肝胆外科2012年9月至2015年3月采用精准肝切除行肝门胆管癌根治本(R0根治)的肝门部胆管癌患者15例.术前根据CT/CTA、MRI/MRCP等影像学资料进行Bismuth-Corlette分型及改良T分期制定周密的手术方案,术中采用精准肝切除技术行半肝+尾叶切除,完整切除胆管肿瘤,肝十二指肠韧带骨骼化,残肝胆管(整形)胆肠吻合内引流,在彻底清除病灶的同时,最大程度的保留剩余肝脏体积,术后给予个体化精细的处理.结果 15例患者中Bismuth分型Ⅱ型3例,Ⅲa型4例,Ⅲb型7例,Ⅳ型1例.改良T分期T1 10例,T2 5例.对15例患者以精准肝切除技术进行肝门胆管癌根治术(R0根治)均获得成功,平均手术时间(350±486)min,术中出血量为(350～700)ml,2例患者出现胆瘘,均通过腹腔引流治愈;4例患者出现肺部感染,均通过抗感染治疗痊愈;2例患者出现切口感染,加强换药后痊愈;住院时间12-18天,术后1周复查胆红素水平下降至术前1半以下;无肝衰竭发生;15例患者痊愈出院.结论 通过精密的术前评估,术中采用精准肝切除技术进行肝门胆管癌根治术具有出血少、住院时间短、肝功能恢复快的优点,还能最大的程度的保留剩余肝脏体积和减少术后并发症的发生,值得应用和推广.

目的 观察抗病毒治疗对乙肝病毒(HBV)感染的肝细胞癌患者根治性手术预后的影响.方法 回顾性分析2008年8月至2012年6月期间笔者所在医院科室行肝癌根治性切除术50例患者的临床资料,50例患者HBV-DNA血清浓度大于3 log10 copies/mL纳入本次研究,其中21例患者未行抗病毒治疗(未治疗组),29例患者行核苷酸类似物抗病毒治疗(抗病毒治疗组).结果 抗病毒治疗组患者肝癌根治性切除术后1、3及5年累积无瘤生存率分别为72.4％、58.6％和31.0％,未治疗组患者肝癌根治性切除术后1、3及5年累积无瘤生存率分别为61.9％、38.1％和14.3％;抗病毒治疗组患者肝癌根治性切除术后1、3及5年累积总生存率分别为86.2％、68.9％和55.2％,未治疗组患者肝癌根治性切除术后1、3及5年累积总生存率分别为71.4％、47.6％和28.6％.抗病毒治疗组患者术后的累积无瘤生存率和总生存率均明显高于未治疗组(P＜0.05).单因素分析结果显示:肿瘤数目、抗病毒治疗和TNM分期是影响患者无瘤生存率的危险因素;肿瘤直径、肿瘤数目、抗病毒治疗和TNM分期是影响总生存率的危险因素.多因素分析结果显示:肿瘤数目及TNM分期是影响无瘤生存率的独立危险因素(OR: 2.95,95％ CI: 1.502 ～ 6.114,P＜0.05;OR: 4.12,95％ CI: 1.972～68.960,P＜0.05);抗病毒治疗及TNM分期是影响患者总生存时间的独立危险因素(OR: 3.86,95％ CI: 1.745～7.028,P＜0.05;OR: 5.17,95％ CI: 2.356～11.479,P＜0.05).结论 使用核苷酸类似物抗病毒治疗可改善乙肝肝癌切除术后患者的预后.

Objective To analyze the outcome of clamp-crush technique versus radiofrequency-assisted liver resection for hepatocellular carcinoma.Methods105 patients with hepatocellular carcinoma (HCC) who underwent liver resection were divided into Clamp-crush group (CC group) and radiofrequency-assisted group (RF group) from January 2010 to June 2014. The transaction and operation time, hepatic ischemic time, total blood loss, blood loss during transaction, operative time, postoperative hospital stay, complications, disease-free and overall survival rate between the two groups were compared.Results The RF group had less transaction time, hepatic ischemic time, total blood loss, blood loss during transaction compared to the CC group. The total operative time, disease free survival and overall survival were comparable between these two groups (P>0.05).Conclusion Radiofrequency- assisted liver resection is feasible for hepatocellular carcinoma.

目的 探讨射频消融(RFA)在外伤性脾破裂保脾手术中的临床疗效.方法 回顾性分析肝胆外科2010年4月～2014年7月收治的外伤性脾破裂患者45例,根据中华医学会外科学分会脾脏学组脾损伤分级,其中行脾切除18例(Ⅳ级),单纯性射频消融5例(Ⅰ级)、射频消融下脾部分切除22例(Ⅱ～Ⅲ级),术后1月随访患者复查B超、血小板、免疫球蛋白、补体C3、补体C4等指标.结果 所有保脾患者手术均获得成功,平均手术时间为(120±48) min,术中出血量为50～200ml,术后均未出现脾脏再出血,住院时间12～20天,无严重并发症发生,术后1月复查B超来出现脾梗死、脾脓肿,血小板、免疫球蛋白及补体C3、C4等指标均在正常范围.结论 外伤性脾破裂患者可根据脾脏损伤分级选择合理的手术方式,对于Ⅰ～Ⅲ级患者采用射频消融进行保脾手术是一种简单、安全、可靠、有效的方法.

Objective:To study the related factors of laparoscopic cholecystectomy conversion to open operation and its preventive measures investigation. Methods:Patients received laparoscopic cholecystectomy in our hospital were enrolled, situation of convertion to open operation were observated, related factors of conversion to open operation were investigated and preventive measures were explored. Results:(1) The incidence of convertion to open operation in patients with different age, upper abdominal operation history, gallbladder wall thickness, anxiety, cholecystitis were different (P<0.05); (2) old age, upper abdominal operation history, gallbladder wall thickness, anxiety and acute cholecystitis were risk factors of laparoscopic cholecystectomy conversion to open operation. Conclusion:Laparoscopic cholecystectomy conversion to open operation is affected by many factors, patients with old age, upper abdominal operation history, gallbladder wall thickness, anxiety and acute cholecystitis should be paid more attention and given preventive interventions.

目的:探讨精准肝脏切除术在结直肠癌肝转移中的治疗效果.方法:回顾分析我院2007年6月至2013年5月结直肠癌肝转移的肝脏切除病例,23例行精准肝切除,31例采用传统Pringle法肝门阻断的肝切除术,在手术时间、术中出血、术后肝功能恢复、住院时间等多方面做对比.结果:精准肝切除组与Pringle法肝切除组比较,手术时间延长,[(325.3 ±41.8)vs(264±31.1)]min,P＜0.05;术中出血量减少[(357±91.4)vs(577±75.2)] mL,P＜0.05;术后肝脏功能恢复加快,ALT:[(343.5±114.4)vs(704.3±142.8)]U/L、AST:[(430.7±140.0)vs(704.3±142.8)]U/L、TBIL:[(35.5±12.1) vs(62.8±18.1)]μmol/L,P均＜0.05;住院时间缩短[(17.6±3.2)vs(25.8±2.1)]d,P＜0.05.结论:精准肝切除术相比传统肝脏切除术,术中出血少,肝脏功能恢复快,住院时间短.

目的:探讨精准胰腺外科理论和操作技术在胰腺肿瘤性疾病切除中的应用及其价值.方法:回顾分析我院2011年1月至2013年6月期间行精准胰腺肿瘤切除术的病例资料,包括胰十二指肠切除术56例,胰体尾切除术32例.术前根据CT、MRI/MRCP、CTA(CT血管造影)等影像学资料制定周密的手术计划,术中根据精准外科原则切除肿瘤,规范化淋巴结清扫,在彻底清除病灶的同时,最大程度保留正常器官功能,术后给予个体化精细的处理.结果:全部88例病人手术顺利,术中失血平均210 mL,术后仅1例死于肺部感染、呼吸衰竭,死亡率仅1.14％,术后胰瘘发生11例,根据国际胰瘘小组定义及标准,其中A级9例,未给予任何干预自愈,B级胰瘘2例,均通过B超引导下穿刺引流治愈,无C级致命性胰瘘.平均住院时间9.7d.结论:精准外科理论及技术在胰腺肿瘤性疾病根治术中优势明显,在最大程度保留器官功能的同时,可以带来很低的围手术期并发症发生率,住院时间也较短,是现代胰腺外科的发展方向和必然趋势.