食管胃结合部腺癌(AEG)是指肿瘤中心处于食管胃结合部(EGJ)上下50 mm范围以内并且侵犯EGJ的腺癌.根据Siewert分型分为:Ⅰ型,肿瘤中心位于EGJ上方10～50 mm,且肿瘤侵犯EGJ;Ⅱ型,肿瘤中心位于EGJ上方10 mm至下方20 mm,且肿瘤侵犯EGJ;Ⅲ型,肿瘤中心位于EGJ下方20～50mm,且肿瘤侵犯EGJ.

目的 探讨肿瘤体外药敏试验在进展期胃癌个体化新辅助化疗中的应用价值.方法 回顾性分析30例SOX方案新辅助化疗的进展期胃癌患者和30例肿瘤体外药敏试验指导新辅助化疗方案患者的临床资料.分析两组新辅助化疗次数、不良反应情况、影像学消退率、围术期各项指标及病理学缓解率的差异.结果 两组不良反应情况、术中清扫淋巴结个数及术后住院时间差异均无统计学意义(均P＞ 0.05);两组新辅助化疗次数、手术时间、术中出血量、影像学缓解率、手术根治率及肿瘤病理缓解率差异均有统计学意义(均P＜ 0.05).结论 肿瘤体外药敏试验在指导进展期胃癌新辅助化疗领域安全、有效,能减少新辅助化疗次数、缩小肿瘤体积、提高R0切除率、改善肿瘤病理学缓解有效率,具有一定的临床意义.

胃癌是常见的消化道恶性肿瘤之一.近年来胃癌在全球范围的发病率有所下降[1],但在我国依旧高发,发病率占到全球总发病率的42.6％[2].手术切除是目前公认有可能治愈胃癌的治疗方式[3].胃癌手术消化道重建的方式大致分为远端胃切除后的BillrothⅠ(毕-Ⅰ)式、Billroth Ⅱ(毕-Ⅱ)式、Roux-en-Y吻合和Uncut Roux-en-Y吻合;近端胃切除后的胃食管吻合;全胃切除后的Roux-en-Y吻合等.在经历了腹腔镜及机器人在手术方面的大力发展,胃癌手术也从传统的开放下进行演变为借助于腹腔镜、机器人进行.随着胃癌治疗水平的提高,患者术后生存时间得到明显改善,让患者得到更好的术后生活质量成为了手术吻合方式选择的重要考虑因素.

目的 探讨限制性液体复苏在创伤失血性休克救治中的应用价值.方法 选取2013年12月至2016年12月本院收治的110例创伤失血性休克患者为研究对象,根据不同液体复苏方案分为观察组与对照组.观察组62例实施限制性液体复苏,对照组48例实施常规液体复苏.观察两组患者存活率、并发症发生率、血气分析及凝血功能指标变化.结果 观察组与对照组存活率分别为90.32％、75.00％,观察组显著较高,差异有统计学意义(P＜0.05);观察组患者急性呼吸窘迫综合征(ARDS)、多器官功能障碍综合征(MODS)发生率分别为8.06％、6.45％,同对照组22.92％、18.75％比较,均明显较低,差异有统计学意义(P＜0.05);复苏前两组患者血气分析指标、凝血功能指标无显著差异(P＞0.05),复苏1小时后均有改变,观察组患者复苏1小时后血氧分压(PaO2)、氢离子浓度指数(pH值)显著高于对照组,二氧化碳分压(PaCO2)明显低于对照组,凝血酶原时间(PT)、凝血酶时间(TT)、活化部分凝血活酶时间(APTT)明显较对照组短,差异均有统计学意义(P＜0.05).结论 在失血性休克救治中,采用限制性液体复苏,可显著提高患者存活率,降低并发症发生风险,并能改善患者凝血功能及血气指标,值得推广.

目的 分析早期胃癌发生脉管癌栓的相关因素.方法 回顾性分析了2012年1月至2015年8月的161例早期胃癌患者的临床及病理资料.结果 161例早期胃癌患者中有19例存在脉管癌栓,脉管癌栓阳性率为11.80％(19/161).T1b早期患者脉管癌栓阳性率高于T1a患者,差异有统计学意义(P＜0 01);有淋巴结转移的早期胃癌患者脉管癌栓阳性率高于无淋巴结转移患者,差异有统计学意义(P＜0.01).logistic多因素回归分析显示肿瘤浸润深度(OR=6.691,P＜0.05,95％CI:1.436～31.170)和淋巴结转移(OR=3.138,P＜0.05,95％CI:1.293～7.615)均为早期胃癌发生脉管癌栓的独立影响因素.结论 早期胃癌患者发生脉管癌栓主要与肿瘤浸润深度和是否伴有淋巴结转移有密切关系.

Scinderin is a Ca-dependent filamentous actin (F-actin) severing and capping protein, which plays a key role in secretion. But few researches about biological effects of scinderin on human disease especially neoplasm are currently reported. In this study, we transfected the shRNA targeting scindern lentiviral vector into human gastric cancer cell line SGC-7901. The efficiency of transfection was observed under fluorescence microscope. Effects of gene silencing were confirmed by RT-qPCR and Western blot. The proliferation was analyzed by real-time cell analyzer (RTCA) and the cell cycle distribution was investigated by flow cytometer. The migration was analyzed by Transwell. Results showed that scinderin-shRNA was transfected into SGC-7901 successfully. After transfection, levels of scinderin mRNA and protein expression reduced significantly (P<0.01). The abilities of cell proliferation and migration decreased obviously (P<0.05), while cell cycle was arrested in the G2/M phase. Consequently, we can draw the conclusion that silencing scinderin can effectively restrain the proliferation and metastasis of human gastric cancer cell SGC-7901, which will be an experiment support for the possible regulation role of scinderin in gastric cancer evolvement.

腹腔镜辅助下胃癌根治术于1994 年由Kitano等[1]首次报道,近年来在各地逐步得到了开展.腹腔镜胃癌手术具有创伤小、术后疼痛轻、胃肠功能恢复快、住院时间短等优点己被学术界广泛认同[2-4].但目前对于腹腔镜胃癌根治术后患者机体的炎症应激反应的变化及血清白蛋白的变化仍缺乏研究.本研究通过比较开腹与腹腔镜辅助远端胃癌D2根治术后患者C反应蛋白(CRP)、血白细胞(WBC)、中性粒细胞(NE)、血清白蛋白(ALB)的变化,初步探讨腹腔镜手术对机体炎症指标及血清白蛋白的影响.

Objective To investigate the change of the cellmigration ability of breast cancer cells with acquired resistance to chemotherapy, and screen the related genes. Methods MCF- 7 cells were used as the parental cells, and human breast can-cer cellline MCF- 7/ADM were established with continuous low concentration of ADM. The chemotherapy resistance of MCF- 7 and MCF- 7/ADM cellwas detected by ATP- TCA drug sensitive test and xCELLIigence/RT- CES real- time cellelectronic analysis system. The cellmigration of MCF- 7 and MCF- 7/ADM cellwas detected by Transwel test and xCELLIigence/RT- CIM real- time cellelectronic analysis system. 4 times the difference of DNA copies of Genes in MCF- 7 and MCF- 7/ADM cellwere screeninged by comparative genomic chip. Results The drug resistant index of MCF- 7/ADM cellkept on 72.9 times over MCF- 7 cellafter cultured in the medium (without ADM) for 150 days. MCF- 7/ADM had no obvious cross- resistance to other chemotherapy drugs. The cellmigration of MCF- 7/ADM reduced significantly than that of MCF- 7 (P<0.05). The DNA copies of 12 genes of MCF- 7/ADM cellare 4 times more than that of MCF- 7, while the DNA copies of 6 genes of MCF- 7 cell are 4 times more than that of MCF- 7/ADM. Conclusion The migration ability of breast cancer cells was significantly reduced with acquired chemotherapy resistance,and the DNA copies of some genes are also obvious different.

肠外瘘是外科手术后一种严重的并发症,其病程较长,病死率高,文献统计占瘘总量的75%,病死率为5%~20%[1].临床上常采用紧急剖腹手术修补肠外瘘,但多因严重的腹腔感染、再瘘、营养不良及肠壁组织水肿而导致手术失败,病死率可达50%~70%.近年来引流加择期手术,应用生长抑素、生长激素,加之肠内外营养支持的进步,其治愈率大大增加,但昂贵的费用及漫长的病程仍然是眼下迫切需要解决的问题[2].我院自2002年1 月至2010 年12 月期间共收治11 例肠外瘘患者,在内镜下应用生物蛋白胶进行封堵治疗,获得满意疗效,现报道如下.

目的探讨改良甲状腺腺叶切除术预防甲状旁腺损伤的疗效。方法 137例患者以传统的手术步骤进行甲状腺腺叶切除(传统组),52例行改良甲状腺腺叶切除(改良组),观察比较两组术前2天、术后第1及3天血清甲状旁腺激素(PTH)浓度。结果两组术前血清PTH差异无统计学意义(>0.05),两组术后PTH均出现不同程度的下降,术后第1及3天差异均有统计学意义(均<0.05)。结论改良甲状腺腺叶切除术可以有效减少对甲状旁腺功能的损害。

Objective To explore a method to improve the nutritional state and immune function of patients after radical gastrectomy,and to decrease postoperative complication rate and accelerate recovery from operation.Methods In line with the concept of fast tract surgery (FTS),a new perioperative nutritional schedule was made for patients prior to radical gastrectomy,ehich included preoperative nutritional risk screen and prophylactic enteral nutrition,early postoperative light enteral nutrition,early ambulation and perioperative nursing care.Patients with gastric cancer were randomly assigned into fast track group or a simple control group.New perioperative schedule was executed in the patients of fast track group and traditional nutrition support in control group.After operation,serum albumen was measured to evaluate the patient's nutritional state and serum IgA to evaluate gastrointestinal immune function.In addition,the time to passage of flatus,postoperative recovery time and complication rate after operation were compared.Results Patiens in FTS group (n=35) showed higher serum albumin and serum IgA on d1 and d3 after operation than those in the control group (n=25) (P0.05-0.01).Patients in FTS group had earlier food intake because of earlier passage of flatus,compared to those in the control group.Conclusions Our study demonstrates that the nutritional and nursing concepts of FTS can be employed in the perioperative therapy of patients with gastric carcinama.Patients will benefit from less complications and early discharge from hospital,and with no increase of the operative risk.

目的观察手术前短期预防性肠内营养支持的疗效和可行性。方法实验组术前3d每天口服肠内营养混悬液(TPF)1000mL(4.19kJ/mL),术后观察肝功能、炎症反应、免疫球蛋白及体质量等指标的变化情况并与对照组比较。结果术后1周时两组体质量均较术前下降,实验组下降幅度较小,差异有显著性(<0.01)。术后第1天、第3天血清白蛋白水平实验组均较同期对照组高(<0.01)。实验组IgA水平术后第1天、第3天较同期对照组高(<0.01)。结论对经评估有营养不良风险的胃癌患者,术前短期肠内营养能改善其术后的营养状态,并能显著提高患者免疫功能。

腹腔镜下缝合是最难于掌握的腹腔镜基本操作技术之一.随着腹腔镜手术的广泛开展,腹腔镜下缝合技术成为限制手术时间的重要因素之一,同时也限制了很多初学者的腹腔镜操作学习进程.我们于2008年4月在开展腔镜下甲状腺切除手术的过程中,对2例患者在缝合颈白线时应用了一种新的腹腔镜下连续缝合结扎法,从而大大缩短了缝合时间,该方法简单,初学者易于掌握,介绍如下.

OBJECTIVE:To investigate the potential role of the preventive nutritional support in patients with nutritional risk defined by nutrition risk screening 2002(NRS 2002) before radical resection of gastric cancer.METHODS:Patients with gastric cancer were evaluated by NRS 2002 preoperatively. Elective patients with nutritional risk were randomly assigned into 3 d preventive enteral nutrition(EN) group versus control group. The preventive nutrition regimen was 1000 ml Nutrison Multi Fibre(4184 kJ/L). The changes in body weight lost, serum albumin, immunoglobulin were recorded postoperatively.RESULTS:One week after operation, the preventive EN group showed less decrease in body weight as compared to control group, which was statistically significant. The levels of serum albumin and IgA on day 1 and day 3 after operation in preventive EN group were significantly higher than those in control group.CONCLUSION:Before operation for gastric cancer, patients with nutritional risk defined by NRS 2002 may benefit from preventive enteral nutrition, which improves the patients' nutritional condition and enhances their immunologic function.

目的:探讨腔镜与传统甲状腺切除术对患者心理状况的影响及其原因。方法:将46例女性单侧甲状腺肿块依据患者意愿分成腔镜手术组及传统手术组,运用症状自评量表(SCL-90)评定患者手术后1个月内的心理状况,并分析手术并发症对术后心理状况的影响。结果:腔镜组患者SCL-90躯体化、人际关系、焦虑、抑郁4个因子评分明显小于传统手术组(P<0.05),腔镜组术后颈部不适及吞咽困难发生率明显小于传统手术组(P<0.05)。术后出现颈部不适或吞咽不适的患者中,躯体化、人际关系、抑郁、焦虑4项因子评分均明显高于无并发症的患者(P<0.05)。结论:腔镜下甲状腺切除术后并发症发生率低于传统甲状腺手术,术后患者的心理状况明显好于传统甲状腺手术。

目的探讨腔镜下甲状腺大部切除术治疗结节性甲状腺肿的临床疗效。方法回顾性分析30例经乳沟乳晕径路腔镜下行单侧甲状腺大部切除术治疗的甲状腺肿瘤患者的临床资料。结果30例患者手术均获得成功,无中转开放手术病例,无术后出血或呼吸困难患者。术后病理14例诊断为结节性甲状腺肿,余16例诊断为腺瘤样结节。均随访3～21个月,颈部无瘢痕,不影响美观,无严重并发症发生,未发现复发病例。结论腔镜下甲状腺大部切除术治疗结节性甲状腺肿是安全可行的,且不影响美观。

腹水是临床上常见症状之一,按病因可分为肿瘤性腹水、炎症性腹水、肝后性腹水、胰性腹水、肾性腹水等[1].大部分的腹水患者通过询问病史结合常规的腹水检验、腹水酶活性测定、肿瘤标记物、脱落细胞学检查以及CT、MRI等影像学检查明确诊断,但仍有小部分的腹水经过以上检查后仍不能明确诊断,最终需通过有创检查明确诊断.腹腔镜检查术是其中的重要手段之一,它具有确诊率高,创伤小,术后恢复快,并发症少的优点[2,3].本院自2000年1月来共收治因腹水入院并行腹腔镜检查术的疑难性腹水共36例,全部检查成功并有34例获得确诊,确诊率94.4%,无1例并发症.现报告如下.

目的比较气囊内充气法和注水法在中低位直肠癌MR I检查中对肿瘤细节结构的显示能力。方法应用自制改良后的三腔管,分别于气囊内充气和注水对57例中低位直肠癌进行MR I检查,对其中经手术证实的51例,分别观察两种方法对肿瘤部位、范围、大体类型、浸润深度等显示情况,并与术中所见及病理作对比回顾分析。结果57例患者均顺利插管,直肠中下段充分扩张,并获得良好的图像对比度。在T1W I中充气法和注水法对肿瘤细节结构的显示差异无显著性意义;在T2W I中注水法对肿瘤大体类型、范围和浸润深度的判断不及充气法,两者间差异具有显著统计学意义(P<0.01)。结论中低位直肠癌MR I检查宜应用气囊内充气法。

目的分析胃肠道间质瘤(gastro intestinal strom al tumors,G IST)的手术治疗效果及其影响复发和生存的因素。方法回顾1999年1月至2005年1月我院外科手术治疗的32例G IST患者的临床资料、病理诊断、免疫组织化学表达情况及手术过程并加以随访,分析手术治疗的效果及影响术后复发和生存率的因素。结果肿瘤直径<5 cm、≥5 cm、≥10 cm的复发率分别为0、20%、44.4%(P<0.05),全组中位生存时间为60.2个月,术后3年和5年生存率分别为70.6%和53.0%。肿瘤直径<5 cm患者的3年生存率显著高于≥5 cm者(P<0.05),复发组3年生存率显著低于未复发组(P<0.01),CD34阳性与阴性组患者的3年生存率差异无统计学意义(P>0.05)。结论G IST的预后与肿瘤大小、手术范围、手术的无瘤原则有密切关系。手术是G IST的首要治疗手段,可根据术中冷冻切片报告和肿瘤大小决定切除范围,免疫表型不能作为G IST的预后因素。

低位直肠癌术后局部复发是当今直肠癌治疗难点,是影响生存率的主要因素.近年对保肛条件讨论较多,但仍存在分歧.作者自2000年1月至2002年5月间对55例低位直肠癌行保肛手术患者的3～5年随访结果,总结低位直肠癌保肛指证,总结如下.