【摘要】 目的 探讨急性假性结肠梗阻的临床诊断与治疗。方法 回顾性分析24例急性假性结肠梗阻患者的临床资料。结果 24例患者均有机械性肠梗阻的临床表现。12例经保守治疗治愈； 6例经结肠镜结合中西医药物治疗治愈； 6例行手术治疗，其中4例因误诊为器质性结肠梗阻而手术，2例死亡。结论 要提高对急性假性结肠梗阻的认识，多数急性假性结肠梗阻可通过非手术方法治愈，在采取积极保守治疗的同时，通过临床仔细分析可与器质性结肠梗阻相鉴别，要严密观察患者腹部体征，防止肠穿孔等并发症的发生。
ObjectiveTo explore the value of duodenum-preserving pancreatic head resection for benign lesions in pancreatic head. MethodsClinical data of 14 patients with benign lesions in pancreatic head who were underwent duodenum-preserving pancreatic head resection from Jan. 1995 to Dec. 2012 were retrospectively analyzed, to explore the value of the surgery. ResultsAll surgeries of the 14 patients were success. The operation time were 4.0-6.5 hours (5.2 hours on average), the intraoperative blood loss were 100-1 000 mL (450 mL on average). Postoperative complications happened in 3 patients (21.4%), including pancreatic fistula in 2 patients and biliary fistula in 1 patient, which were cured with non-surgical treatment. No deaths happened during surgery and hospitalization. Of the 14 patients, 13 patients were followed-up for 6 months to 2 years with no recurrence, diabetes, postoperative gastric emptying disorders, and other long-term complications happened. ConclusionDuodenum-preserving pancreatic head resection is the safe and effective treatment of benign lesions in the head of pancreas.
ObjectiveTo evaluate the clinical manifestation, diagnosis, and treatment of intrahepatic biliary cystadenoma (IBCA). MethodsThe clinical date of 12 patients with IBCA from January 2004 to December 2013 in our hospital were retrospectively analyzed. ResultsOf the total 10 patients were female and 2 were male. The average age was 49.0 years old (16-77 49.0 years old). The course of disease were 1 month-3years (average:7 months). The clinical symptoms were right upper abdominal fullness with a sense of pain in 6 patients, right upper abdominal mass in 1 case, jaundice in 1 case, and no symptoms in 4 cases. Enhanced CT examination showed that the tumor complete capsule and there were internal septations in 11 cases, the density of internal septations was different. There was mild enhancement of cyst wall and internal septations in 9 cases. All of 12 cases received surgical resection. Only 1 case showed recurrence in 2 years after operation, the remaining 11 patients had no recurrence. ConclusionsIBCA often occurs in middle-aged women. The main clinical symptoms are abdominal fullness with a sense of pain, right upper abdominal mass or jaundice. Enhanced CT is the main method of diagnosis before operation. Radical resection of IBCA is the best treatment, and can prevent recurrence effectively.
Objective To investigate the pathological features， diagnosis， treatment， and prognosis of multiple primary colorectal cancer （MPCC）. Methods Clinical data of 41 patients with MPCC treated in The Fourth Affiliated Hospital and The First Affiliated Hospital of China Medical University from Aug. 1993 to Mar. 2009 were retrospectively analyzed. Results Forty one patients with MPCC， including 29 patients with synchronous colorectal cancer （SCC） and 12 patients with metachronous colorectal cancer （MCC）， accounted for 1.8% （41/2 340） of colorectal cancer during the same period of time， and with adenomatous polyps in 19 cases and polyps canceration in 10 cases. Among 29 patients with SCC， 15 cases （51.7%） were diagnosed by preoperative fiberoptic colonoscopy， 9 cases （31.0%） were diagnosed by preoperative fiberoptic colonoscopy， abdomen CT， and barium enema， 5 cases （17.2%） were diagnosed by intraoperative exploration and intraoperative fiberoptic colonoscopy， respectively. All of the 12 patients with MCC were diagnosed by preoperative fiberoptic colonoscopy and abdomen CT. For 29 patients with SCC， tumor locations were from proximal appendix to distal rectum， but 12 patients with MCC were adverse. Sixty-five （77.4%） tumors were tubular or papillary adenocarcinoma， and 56 （66.7%） tumors were well and moderately differentiated adenocarcinoma. The TNM stage of most tumors （72） was stageⅡ or Ⅲ phase， account for 85.7%. Radical surgeries were performed in 37 patients and palliative surgeries in 4 patients， and there were no complications after operation. During the follow-up for 3-5 years （mear 3.6 years）， the overall survival rate of 3- and 5-year were 48.8% （20/41） and 34.1% （14/41）， respectively. In detail， 3-year survival rate of SCC group and MCC group were 48.3% （14/29） and 50.0% （6/12）， respectively；5-year survival rate were 31.0% （9/29） and 41.7% （5/12）， respectively. Conclusions Cause of MPCC has not been clear， but it has possible relationship with adenomatous polyps. Preoperative fiberoptic colonoscopy， abdomen CT， and barium enema are very important for patients with SCC， and intraoperative fiberoptic colonoscopy is also necessary. Patients with MCC should enhance postoperative follow-up with fiberoptic colonoscopy. Further more， radical resection should be performed as early as possible.
【 Abstract 】 Objective Overexpressions of epidermal growth factor (EGF) and EGF receptor have been associated with progression and invasive phenotype of pancreatic cancer. However, the underlying molecular mechanism by which EGF worked in pancreatic cancer cells has not been completely understood. In this study, effect of EGF on the invasion and metastasis of pancreatic cancer cells and its regulatory mechanism were investigated. Methods The effects of EGF on the proliferation, adhesion and invasion of pancreatic cancer cells were detected by WST-1 proliferation assay, adhesion assay and invasive assay, respectively. The activity and expression of MMP-2 and MMP-9 were examined by zymography, Western blot and RT-PCR, respectively. The activity of NF- κ B was examined by EMSA. Results EGF could significantly promote the invasiveness of pancreatic cancer cells but did not affect cell proliferation or adhesion. The expressions of NF- κ B and MMP-9 were significantly increased by EGF, but EGF did not affect the activity and expression of MMP-2. Furthermore, EGF stimulated the NF- κ B binding activity. Pretreatment with NF- κ B inhibitors, pyrrolidine dithiocarbamate (PDTC), could significantly inhibit the activity of NF- κ B induced by EGF. Meanwhile, the EGF-induced expression and activity of MMP-9, as well as cell invasiveness were also inhibited by NF- κ B inhibitor. Conclusion EGF could increase the expression and promote the invasiveness of MMP-9 via the activation of NF- κ B in pancreatic cancer cells, which implies that NF- κ B inhibitant, such as PDTC, may diminish the invasiveness of pancreatic cancer cells.
目的总结胰腺血管活性肠肽瘤（VIPoma）的临床特点并探讨其诊治方法。 方法回顾性分析1991年11月至2010年2月期间我院收治的3例VIPoma患者的临床资料。 结果3例均有周期性发作水样泻、低钾血症和低或无胃酸。有2例血浆血管活性肠肽值显著升高。B超及CT发现3例肿瘤均位于胰腺内，其中1例肝转移，1例怀疑肝转移。3例均行手术治疗。1例肿瘤位于胰头部行胰十二指肠切除术，随访3年无肿瘤复发；1例肿瘤位于胰头颈部及肝脏多发转移灶，行胰腺头颈部切除及肝脏转移结节摘除术，术后4个月腹泻症状复发，证实肝脏多发转移灶，又先后3次手术，于第1次手术后3.5年死于电解质紊乱；另1例术中发现肿瘤位于胰头部无法切除，肝脏多发转移灶，摘除1枚肝脏结节病理确认为转移癌，术后间断应用奥曲肽，术后2.5年仍在随访中。 结论VIPoma首选的治疗方法是手术切除肿瘤。恶性肿瘤即使无法根治手术，也应该姑息性切除和间断应用奥曲肽，以改善患者生活质量。
【Abstract】ObjectiveTo evaluate the relationships between the transporters BSEP， MRP2， MDR3 and cholesterol calculus formation. MethodsTwenty hepatic tissue specimens were taken from consented patients with cholesterol calculus during intraoperative liver biopsy, of which ten were taken from patients without cholesterol calculus. RNA of liver tissue from all the samples was extracted and ultraviolet spectrophotometry was used to measure the content and purity of it. The mRNA and protein expressions of BSEP, MRP2 and MDR3 were determined by reverse transcriptionpolymerase chain reaction (RTPCR) and Western blot analysis, respectively. ResultsRTPCR showed that the mRNA expressions of BSEP, MRP2 and MDR3 in liver were significantly lower in patients with cholesterol calculus （0.47±0.18, 1.12±0.39 and 1.02±0.24） than those in the liver of patients without calculus （0.90±0.42, 2.48±0.89 and 1.94±0.80）,P＜0.01. And Western blot also showed the protein expressions of these transporters were significantly lower in patients with cholesterol calculus （90.16±18.82, 45.43±22.77 and 61.08±14.77） than those in the liver of patients without calculus (186.17±4.34, 160.47±30.19 and 100.84±15.44). ConclusionThe decreased expression of BSEP, MRP2 and MDR3 may correlate with the formation of cholesterol calculus.