Objective To investigate the effect of implanting uncovered self-expandable metal stent for treatment of distal malignant biliary obstruction through endoscope. Methods The effect of therapy about implanting uncovered self-expandable metal stents to 16 patients who had unsectable malignant tumors companing with obstructive jaundice through endoscope was reviewed. Results Fifteen of the studied patients were implanted uncovered self-expandable metal stents successfully (94%), for their internal drainage were patent. At the seventh and fourteenth day after implantation, liver function and B-ultrasound were rechecked. Compared to the data before operation, total bilirubin, direct bilirubin and transaminase declined respectively (P＜0.01). And the diameter of the total biliary duct became shorter (P＜0.01). Six of them returned to the normal level in three weeks. Early adverse events (in seven days) included mild acute pancreatitis (one case) and acute cholangitis (one case). Mean survival and patency of drainage were 186.93 days (54 to 426 days) and 156 days (51 to 426 days) respectively. All of them, 3 cases occured obstruction of stents (20%). Conclusion Implantation of uncovered selfexpandable metal stent through endoscope is an ideal therapy for distal malignant biliary obstruction.
Objective To find out some ideal reconstructions after total gastrectomy in experimental study of rat. Methods Sixty male Sprague-Dawley rats were randomly and averagely divided into 6 groups: Roux-en-Y group (RY group), proximate jejunal pouch group (PJP group), distal jejunal pouch group (DJP group), two jejunal pouchs group (TJP group), duodenumjejunal pouch interposition group (DJPI group) and laparotomy group (L group). Body weight of rats, intestinal transit distance, adaptive changes in esophagojejunostomic mucosa and morphology changes of intestine after operation were observed and compared. Results At 2 weeks after operation, body weight in each group were significantly lower than that before operation （P＜0.05）. At 4 weeks postoperatively, body weight in PJP group, TJP group and DJPI group were significantly higher than that in RY group respectively （P＜0.05）, as well as at 8 weeks. Intestinal transit distance in PJP group was shorter than that in RY group （P＜0.05）. With regard to intestinal mucosa, TJP group and DJPI group were significantly different with RY group （P＜0.05）. Interestingly, there was no difference in each group as to refluxing esophagitis （P＞0.05）. Conclusion Proximate and two jejunal pouchs Roux-en-Y esophagojejunostomy seem to be ideal procedures for digestive tract reconstruction after total gastrectomy. The jejunal pouch interposition procedure seems to be same effective to PJP and TJP, but there is no preponderance over the former.
【Abstract】ObjectiveTo evaluate the therapeutic benefits of three styles of hernioplasties such as the traditional hernioplasty, the mesh only hernioplasty and the plug amp; mesh hernioplasty. MethodsThe traditional hernioplasty in 534 cases(583 sides), the mesh only hernioplasty in 57 cases(60 sides) and the plug amp; mesh hernioplasty in 51 cases(54 sides) were performed. The comparing studies on the operative time, the postoperative complications, the recurrent rate and so on were analyzed. ResultsThe average operative time of the traditional styles group was (34.26±4.56) min, which was significantly shorter than the mesh only group 〔(40.35±6.24) min, P＜0.05〕 and the plug amp; mesh group 〔(49.12±8.69) min, P＜0.01〕 respectively. This significant difference between the mesh only group and the plug amp; mesh group was also identified (P＜0.05). Postoperative complications in the traditional styles group, the mesh only group and the plug amp; mesh group were 1.12%, 1.75% and zero,respectively (Pgt;0.05). Recurrent rate in the traditional styles group was 5.99%(32/534), which was significantly higher than that of the mesh only and the plug amp; mesh group (no recurrence). The average hospitalizing time in the traditional styles group, the mesh only group and the plug amp; mesh group was (7.11±3.06) days，（5.38±2.53） days and （6.19±3.61） days, respectively, in which there was no significant difference among groups. The activityrecovering time in the traditional styles group was (16.98±4.35) days, which was significantly longer than （7.26±2.46） days in the mesh only group and （8.02±3.35） days in the plug amp; mesh group. Conclusion The mesh only hernioplasty or the plug amp; mesh hernioplasty have a lower recurrent rate comparing with that in the traditional hernioplasty, which should be much more popularly applied in the treatment of inguinal hernia.
目的 通过检测脑胶质瘤患者血清中胰岛素生长因子-1（IGF-1）和胶质纤维酸性蛋白（GFAP）的表达，探讨其与胶质瘤分级及预后评估的关系。 方法 2010年12月－2011年11月，采用双抗体一步夹心法分别测定A、B两组共40例不同级别脑胶质瘤患者术前、术后血清中IGF-1和GFAP浓度。 结果 高级别胶质瘤患者组血清中IGF-1浓度显著高于低级别胶质瘤组（P=0.009 0）；血清GFAP浓度显著低于低级别胶质瘤组（P＜0.000 1）。经手术治疗后且疗效评价为有效的胶质瘤患者，其血清中IGF-1、GFAP浓度较术前水平显著下降（P＜0.001 0）。结论 IGF-1、GFAP是两种较好的脑胶质瘤血清标志物，在其分级及预后评估中具有重要的临床应用价值。
Objective To investigate the clinical meanings of lymphangiogenesis, lymph vessel invasion (LVI) and lymph node (LN) micrometastasis in gastric cancer. Methods The expression of D2-40 in 68 patients with gastric cancer of primary lesion and the expressions of CK20 and (or) CKpan in 791 lymph nodes from 51 cases which were detected by immunohistochemical staining were analyzed, as well as their clinicopathologic profiles. The relationship of lymph vessel density (LVD), LVI and LN micrometastasis with LN metastasis and other clinicopathologic parameters was analyzed respectively. Results Positive rate of LVI with HE (LVI-HE) and D2-40 (LVI-IM) staining was respectively 66.2%(45/68) and 76.5%(52/68), P=0.118. The positive rate of LVI-IM was related to deeper tumor invasion (P=0.044), later stage of TNM (P=0.003) and LN metastasis (P=0.000). Average LVD of 68 cases was (18.19±7.44)/HP. The increment of LVD was significantly associated with LVI-HE positive status （P=0.040）, LVI-IM positive status （P=0.001）, venous invasion （P=0.037）, later stage of TNM （P=0.020） and LN metastasis （P=0.001）. The survival rate of the group sharing ≥15/HP of LVD was significantly lower than that in the group sharing ≤14/HP of LVD in early period of follow-up （P=0.032）. The incidence of nodal involvement in 51 patients was increased from 74.5%(38/51) by HE staining to 88.2%(45/51) by CK (CK20 or CKpan) immunostaining. The detection rate of metastasized LN was increased from 32.0%（253/791） by HE staining to 41.5%（328/791） by CK immunostaining (Plt;0.001). The significant difference of LN micrometastasis detection rate between CK20 (8.7%) and CKpan (12.3%) was also identified (P=0.003). The increased number of LN micrometastasis was related to larger diameter of tumor (P=0.001), higher LVI-HE positive rate (P=0.040), deeper invasion of tumor (P=0.018) and later stage of TNM (P=0.012). Both LN stage and TNM stage were changed according to the detection of LN micrometastasis: Seven patients of N0 should be recognized as N1 (N0→N1)， 6 as N1→N2, 1 as N2→N3. Four patients of stage Ⅰb should be recognized as stage Ⅱ (Ⅰb→Ⅱ)， 4 as Ⅱ→Ⅲa， 3 as Ⅲa→Ⅲb， 1 as Ⅲb→Ⅳ. Conclusion Detection of D2-40 and CK in diagnosis of LVI and LN micrometastasis is better than HE staining. The combined detection of CK20 and CKpan may be much easier to find out the LN with micrometastasis. Later stage of TNM the tumor is, more frequently the LN micrometastasis happens. The relationships of LVI-IM, LVD and LN micrometastasis with LN metastasis in gastric cancer has been demonstrated. Patients with higher LVD share a lower survival rate in early period of follow-up.
Objective To investigate the expression of transcription factor e2f-1 in the different development stages of gastric cancer, the relationships between clinicopathologic characteristics and e2f-1 expression status, as well as its influences on the prognosis. Methods The operative samples from primary lesion of 121 patients who underwent radical resection for gastric cancer were detected by SABC immunohistochemical staining. The relationships of e2f-1 expression with clinicopathologic characteristics and with the prognosis were observed by univariate, multivariate and relative analyses. Results The total positive expression rate of e2f-1 in all patients was 38.8% （47/121）. With the advancement of gastric cancer, the level of e2f-1 expression in TNMⅠ-Ⅳ stage was gradually decreased (r=－0.320， Plt;0.05)： Ⅰa stage with 62.5% （10/16）， Ⅰb with 47.1% （8/17）， Ⅱwith 55.0% （11/20）， Ⅲa with 40.0% （8/20）， Ⅲb with 27.3% （6/22）， Ⅳ with 15.4% （4/26）. The expression of e2f-1 was significantly negative correlated with tumor diameter, depth of infiltration, lymph node metastasis ratio, and N stage （Plt;0.05）. The multivariate analysis revealed that either histology type, or survival time was respectively an independent factor for e2f-1 expression （Plt;0.05）. Log-Rank test showed the relative factors to survival included N stage, tumor diameter, tumor position, lymph node metastasis ratio, depth of infiltration, and TNM stage （Plt;0.05）. Cox survival analysis found that both of later N stage and e2f-1 higher expression were independent prognostic factors （Plt;0.05）. The higher e2f-1 expression was related to a poor survival in TNM stageⅠand Ⅱ patients （r=－0.304, Plt;0.05）, the prognosis of patients with e2f-1 positive expression was worse than that of patients with negative expression （χ2=13.437， Plt;0.05）, and there was no statistic relationship between the expression of e2f-1 and prognosis in stage Ⅲ and Ⅳ patients （Pgt;0.05）. Conclusions e2f-1, as a useful marker, seems to be an indication for the malignant behavior in relatively earlier gastric cancer, in which the e2f-1 positive expression shares a significantly poor survival. And the lower expression of e2f-1 has been identified in later advanced gastric cancer, the more malignances in advanced gastric cancer might associate with a lower expression of e2f-1.