目的 提高对幼年性息肉致小肠套叠的诊治水平。方法 按检索策略，检索PubMed、中国生物医学文献数据库（CBM）、中文科技期刊全文数据库（CSJD）、中国期刊全文数据库（CJFD）及CNKI数字图书馆的相关文献，并结合笔者所在医院于2011年收治的1例幼年性息肉致小肠套叠病例资料，对该病进行一系统的描述。结果 共检出相关文献65篇，按纳入及排除标准，最后纳入6篇文献。共7例患者，临床表现为腹痛、呕吐5例，便血2例，贫血3例；经超声检查诊断4例；全组均行小肠切除肠吻合术，其中1例为腹腔镜辅助手术；有1例患者共实施了3次手术，最后死于恶液质，其余患者恢复较好。结论 幼年性息肉致小肠套叠为临床罕见疾病，超声检查仍为首选诊断方法；提高医师对该病的认识，术中彻底探查肠道，必要时术中行快速冰冻切片病理学检查，有望减少息肉遗留，改善患者的预后。
Objective To analyze the effect of meglumine diatrizoate on diagnosing and treating adhesiveness small intestinal obstruction. Methods The clinic data of 484 cases of adhesiveness small intestinal obstruction were analyzed retrospectively. Those patients were treated with radiography with 76% of meglumine diatrizoate by orally or injected. Results After taking meglumine diatrizoate, 362 patients were cured, and the other 122 cases were diagnosed clearly and treated with surgery. Conclusions Meglumine diatrizoate can be used to diagnose adhesiveness small intestinal obstruction and confirm where the obstruction is. It can be the routine treatment for adhesiveness small intestinal obstruction and can be used repeatedly. It also can provide evidence to surgical treatment and guide to make the surgical project.
Objective To investigate the inhibitory effect and its mechanisms of TLSFJM (JM acute T leukemia cell line derived suppressor factor) on allograf t rejection of small bowel t ransplantation in rat , and to compare the effect s and complications of TLSFJM with those of FK506. Methods One hundred male Brown Norway (BN) rats and 100 Lewis(L EW) rat s were t reated as donors and recipient s of small bowel t ransplantation , respectively. Then they were divided into five groups according to the dose of administ ration of TLSFJM and/ or FK506 : small bowel transplantation group (SBT group) ; large dose of FK506 〔0. 5 mg/ ( kg ·d) 〕group ; small dose of FK506 〔0. 25 mg/ (kg ·d) 〕group ; TLSFJM 〔10 U/ ( kg ·d) 〕group ; TL SFJM 〔10 U/ ( kg ·d) 〕associated with small dose of FK506 〔0. 25 mg/ (kg ·d) 〕group. FK506 and TLSFJM were administered through int ramuscular or int raperitoneal injection , respectively. Survival time , body weight , hepatic and renal function and histopathology of recipient s in each group were observed. Results TLSFJM took no damage effect on the recipient s’renal and hepatic functions 7 days after administ ration. When TLSFJM was administ rated associated with small dose of FK506 in small bowel transplantation , it could not only effectively suppress rejection reaction , extend recipient’s survival time , but also decreased the dosage of FK506 and prevented the side effect s. But TLSFJM may not be used as immunosuppressive agent alone for the prevention and treatment of rejection in rat small bowel t ransplantation because the rejection still existed. Conclusion As an effective immunosuppression agent , TLSFJM associated with small dose of FK506 can prolong the survival time of both recipients and graf ting small bowel , relieve intensity of rejection , and prevent the side effect s when high dosage FK506 is administ rated. TLSFJM may be used as a high-efficiency , low-toxicity immunosuppresive agent in small bowel transplantation.
目的 探讨腹腔镜对小肠大出血的诊断和治疗。方法 对15例怀疑小肠大出血的患者进行腹腔镜探查。结果 探查阳性率100%，其中小肠肿瘤7例，小肠憩室5例，小肠憩室并套叠1例，小肠血管畸形2例，均在腹腔镜辅助下行小肠部分切除或憩室切除术。结论 腹腔镜对小肠出血的诊断尤其是治疗方面有较高的价值。
【摘要】目的 探讨腹腔镜辅助下小肠切除术的治疗价值。 方法 回顾性分析我院2001年7月至2004年9月期间实施腹腔镜辅助下小肠切除术10例患者的临床资料。 结果 除1例中转开腹外，余 9例均实施腹腔镜辅助下小肠切除。平均手术时间(70.2±18.3) min （60～120 min），术中平均出血量(30.3±12.6) ml （15～50 ml），平均住院时间(6.5±1.6) d （5～8 d）。所有患者均在术后24 h开始下床活动，48 h内恢复胃肠功能。术后无一例使用止痛剂。全组手术无病灶遗漏,无并发症和手术死亡发生。 结论 腹腔镜辅助下小肠切除术安全、经济并具有良好的治疗效果。
【Abstract】Objective To investigate the value of laparoscopy in the diagnosis and treatment of small bowel diseases.Methods Data of thirtythree cases of small bowel diseases receiving laparoscopy in this hospital from May 2000 to February 2004 were analyzed retrospectively. Results All cases underwent laparoscopy successfully and no complication was observed. The mean operative time was 65 min.The mean intraoperative blood loss was 30 ml. Postoperative pain was mild. Flatus and feces were passed about 32 hours after treatment and the mean postoperative hospital stay was 7 days. The pathologic examination showed: 18 benign and 6 lowgrade malignant stromal tumors, 5 Meckel’s diverticula and 4 NonHodgkin’s lymphomas. No recurrence occurred in 33 cases during the followup for 10 to 36 months.Conclusion Laparoscopy is a very useful and minimally invasive technique in the diagnosis and treatment of small bowel diseases. It is simple, safe, effective and worthy of be clinically applied.
【Abstract】ObjectiveTo explore the effects of p38 mitogenactivated protein kinase (MAPK) on apoptosis of small intestinal epithelial cells after transplantation in rats. MethodsSmall intestinal transplantation was performed in SD and Wistar rats. The recipients were divided into three groups: isograft group (Wistar→Wistar group), allograft group (SD→Wistar group) and allograft+cyclosporine A group (SD→Wistar+CsA group). The grafts were harvested on day 1, 3, 5 and 7 after operation. All graft samples were subjected to histological examination. The apoptosis of graft epithelial cells was detected by TUNEL method. p38 MAPK was measured by Westernblotting method and serum TNFα was determined by ELISA. ResultsMild, moderate and severe rejection reaction occurred in the SD→Wistar group, it was showed that the number of apoptotic cells increased with the severity of the rejection reaction by TUNEL. In SD→Wistar group, the numbers of apoptotic cells were significantly higher than those of the other two groups （P＜0.01）. The severity of rejection reaction in SD→Wistar+CsA group was less than that of SD→Wistar group and the number of apoptotic cells increased with the severity of the rejection reaction (P＜0.01). The level of serum TNFα varied with the apoptotic degree of small intestinal epithelial cells in SD→Wistar group and SD→Wistar+CsA group （P＜0.01）. The expression of p38 MAPK increased with the number of the apoptotic cells in SD→Wistar group and SD→Wistar+CsA group （P＜0.01）, but there was no evident change in Wistar→Wistar group （Pgt;0.05）. The expression of p38 MAPK and the level of serum TNFα were positively correlated with apoptosis in small intestinal rejection after transplantation （r=0.875， P＜0.01； r=0.837， P＜0.01）. p38 MAPK and TNFα were also positively correlated （r=0.826，P＜0.01）. ConclusionApoptosis plays an important role in small intestinal rejection. p38 MAPK is involved in apoptosis and is an important regulator in signal pathway of cell apoptosis.
Objective To review the CT appearances and important differential diagnoses of various primary and secondary mesenteric neoplasms. Methods By describing the mesenteric anatiomy and major routes for the dissemination of metastatic mesenteric tumors, the article presents both the common and rare types of various primary and secondary mesenteric neoplasms, and addresses the characteristic CT appearances and important aspects of the differential diagnosis. Results CT study, especially the multislice spiral CT (MSCT), along with the clinical history and other related information, can nicely depict various mesenteric tumors and well differentiate them from infectious, inflammatory or vascular processes affecting the mesentery. Conclusion CT is the imaging method of choice for the evaluation of tumors of small bowel mesentery.
【Abstract】Objective To investigate the diagnosis and treatment of primary small intestinal tumor (PSIT). MethodsEighty-eight cases of PSIT were analyzed in our hospital retrospectively. Results Thirty-six cases were diagnosed before operation, 52 cases were misdiagnosed and the percentage amounted to 59.1%. The major clinical manifestations of PSIT were abdominal pain (66 cases, 75.0%), obstruction (56 cases, 63.6%), abdominal mass (51 cases, 58.0%) and stool with blood (48 cases, 54.5%).The major pathological types of PSIT were adenocarcinoma (55.7%), sarcoma of smooth muscle (25.0%), lymphoma (13.6%), fatty sarcoma (5.7%). The tumors of 36 cases located in jejunum (40.9%), 34 cases in ileum (38.6%) and 18 cases in duodenum (20.5%).Conclusion It is difficult to diagnose PSIT before operation. The following advice could help to get a correct diagnosis: ① Surgeons should be alert when meeting a patient with the above symptoms, and then collect and analyze the clinical data comprehensively. ②Patients over 40 years with complaints of inexplicable abdominal pain, weight loss, anemia, dyspepsia and abdominal mass should be examined appropriately by gastrointestinal X-ray, gastrointestinal endoscopy, ultrasonography, CT and angiography of superior mesenteric artery. ③When the diagnosis can’t be confirmed, an exploratory operation should be performed immediately to avoid the delay of treatment. ④The treatment of PSIT includes radical resection of small intestine and chemotherapy according to the pathological results of tumor.