Objective To explore the effects of ulinastatin (UTI) on renal apoptosis and expression of bcl-2 in rats with severe acute pancreatitis (SAP). Methods Sixty rats weighing 250-300 g were randomized divided into 3 groups: pseudo-operation group (SO group, n=20), SAP group (n=20) and UTI treated group (UTI group, n=20). The model of SAP was established by retrograde injection of 5% sodium taurocholate solution into the biliopancreatic duct in the rats. Serum Cr and BUN were determined. The left kidneys were resected for light and electronic microscopic study. Renal cell apoptosis was determined by TUNEL. Expression of bcl-2 was detected by immunohistochemical staining of SABC. Results Serum Cr, BUN, renal cell apoptotic index and bcl-2 expression were markedly increased in SAP group compared with SO group （P＜0.05， P＜0.01）, Renal tissue injuries were aggravated in SAP group under light and electronic microscopic study as well. In UTI group, serum Cr, BUN and renal cell apoptotic index were decreased significantly while the expression of bcl-2 increased remarkably and renal tissue injuries relieved compared with SAP group （P＜0.05）. Positive correlations were found between the renal cell apoptotic index and BUN as well as Cr (r=0.807, P＜0.05; r=0.812, P＜0.05). Conclusion The protective effect of UTI on SAP renal injury is probably through increasing bcl-2 expression and decreasing apoptosis.
ObjectiveTo introduce the experience in diagnosing and treating cholecystoenteric fistula (CEF) during laparoscopic cholecystectomy (LC). MethodsFive cases with CEF in a series of 4 200 LC cases were reviewed.All of the five patients were proved to have CEF during operations.There were four cholecystoduodenal fistulas and one cholecystocolic fistula. One case with cholecystoduodenal fistula was treated by a suturing of the fistula under laparoscopy; 1 case was closed with titaniun and 2 cases were converted to laparotomy and fistulectomy.The patient with cholecystocolic fistula clips was treated by a suturing of the fistula under laparoscopy. ResultsAll the patients had got good recovery without complications.Conclusion CEF is a rare complication of cholelithiasis.If the diagnosis is made before operation, open operation might be a better choice.But if the diagnosis was made during the LC operation, suture closure or clip closure or stapler closure of CEF under laparoscope might be chosen for an experienced surgeon.
（承2008年第4期）2腹腔镜结直肠癌的手术适应证、禁忌证及手术的基本原则2.1适应证腹腔镜结直肠癌手术适应证与开腹手术大致相同，亦分姑息性手术与根治性手术。对晚期伴有广泛转移的结直肠癌病例行姑息性手术，包括腹腔镜肠造瘘、肠道转流及节段性结直肠切除术。根治性手术适用于结直肠任何一段的癌肿，其切除范围应包括癌肿所在肠襻、系膜及其区域淋巴结； 各根治术式的要求详见各节。主要术式包括： 腹腔镜右半结肠切除术、 腹腔镜左半结肠切除术、腹腔镜次全和全结肠切除术、腹腔镜TME直肠前切除术、腹腔镜TME腹会阴直肠切除术。 ......
Objective To summarize the current research advances of colorectal signet-ring cell carcinoma (SRCC). Methods In this paper, the related literatures of colorectal SRCC in recent years were collected and reviewed. Results Colorectal SRCC was a pathological subtype of colorectal adenocarcinoma, with extremely low incidence but high malignancy and poor prognosis. At present, its molecular mechanism was still not very clear and the clinicopathological manifestations were not specific. Surgical treatment was the major treatmen. Conclusions Although we already have a certain degree of understanding about colorectal SRCC, due to the limitations in the results of some related researches because of the small sample size or the single-center study, we still need more researches to improve the cognition of colorectal SRCC.
ObjectiveTo summarize advances in immunotherapy for gastric cancer.MethodThe relevant literatures about immunotherapy for gastric cancer in recent years were reviewed.ResultsRecently, the immunotherapy for the tumors mainly included the immune checkpoint blocking, tumor vaccine, and adoptive immunotherapy. There were many studies on the immune checkpoint blocking, mainly targeting the antibodies of programmed death receptor 1 (PD-1) and cytotoxic T-lymphocyte associated antigen 4 (CTLA-4). A series of studies had shown that the pembrolizumab was effective in the patients with advanced gastric cancer who expressed PD-1 ligand positive. The nivolumab had become the first immune checkpoint inhibitor approved for the treatment of advanced gastric cancer in Asia, and the patients with mismatch repair defects could benefit more from the PD-1 treatment. Although the CTLA-4 targeted immune checkpoint blocking therapy had been reported, some studies had found that the patients with advanced gastric cancer didn’t benefit from the treatment of CTLA-4 monoclonal antibody ipilimumab. The tumor vaccine therapy in the gastric cancer had been reported. Due to the high heterogeneity of tumor cells in the gastric cancer, the tumor vaccine efficacy of autoantibody was not stable, based on the high- throughput sequencing of neoantigens identification and screening process was complex, the vaccine preparation needed the longer period, how to individualized screening the neoantigen, and the selection of antigens that could effectively activate the T cells to recognize and kill the tumor cells still needed to be overcame.ConclusionsTumor immunotherapy has received worldwide attention. Anti-PD-1 and its ligand as representative immune checkpoint statin therapy in treatment of advanced gastric cancer has showed great potential, but at present there are still many problems need to be solved, such as number of applicable patients of immunotherapy is small, curative effect of immune checkpoint inhibitor screening index also is not clear, tumor vaccine and adoptive cell therapy are promising but there is lack of evidence from clinical research data, combined use of existing treatments and immunotherapy on curative effect still needs more clinical trials to explore.