目的 探讨手助腹腔镜胰十二指肠切除术的技术路线。方法 笔者所在科室于2011年10月17日完成1例手助腹腔镜胰十二指肠切除术。术中采用术者双侧站位、左右侧对称戳孔的策略，站立于患者右侧，游离胃网膜左血管和胃左血管，包括清扫No.7、No.8和No.9淋巴结；站立于患者左侧，游离十二指肠环和清扫下腔静脉旁淋巴结。经手助切口直视下完成消化道重建。结果 上腹部正中手术切口长7cm；手术时间为420min；术中出血量约600ml。术后病理报告：送检胃、十二指肠和胰腺标本，十二指肠球部低级别神经内分泌癌，浸润至深肌层，胃及胰腺未受累；两端切缘未见癌细胞，肝十二指肠韧带淋巴结未见癌转移（0/2）；慢性胆囊炎。手术后患者生命体征平稳，术后第5天肛门排气，第7天排便。术后发生腹腔积液并感染，经保守治疗治愈。术后28d出院。结论 术者双侧站位、左右对称戳孔是手助腹腔镜胰十二指肠切除术的新模式，安全、可行、微创，值得进一步探索。
Objective To evaluate the effect of ultrasound guided percutaneous drainage on acute perforation of gastroduodenal ulcer in elderly patients. Methods The clinical features, treatments, and the curative effects of 86 elderly cases (≥65 years) of acute perforation of gastroduodenal ulcer in our hospital between January 2004 and October 2009 were retrospectively analyzed. Twenty-one cases were treated by ultrasound guided percutaneous drainage (drainage group), and 65 cases were treated by exploring operation (operation group). Results Drainage group was cured and had no complications. In 15 patients which accepted recheck one month after drainage, gastroscope showed the ulcer healed in 12 cases， and improved in 3 cases. In operation group, 63 cases were cured and 2 cases died. Compared with the drainage group, there was no significant difference in cure rate (Pgt;0.05). However, 11 patients had operative complications in operation group, which was significantly more than that in the drainage group （Plt;0.05）. In 45 patients which accepted recheck one month after operation, gastroscope showed the ulcer healed in 38 cases， and improved in 7 cases. Conclusion For elderly patients with acute perforation of gastroduodenal ulcer， if the patients do not fit for exploring operation， ultrasound guided percutaneous drainage is proved to be a simple, safe, and effective means.
ObjectiveTo evaluate the curative effect of laparoscopic assisted and open D2 radical resection in treatment of advanced gastric cancer. MethodsThe clinical data of 76 cases performed by laparoscopic assisted D2 radical resection (laparoscopic group) and 104 cases performed by open operation (open group) from October 2010 to October 2012 in our center were retrospective analized.Operation related index, postoperative recovery, and extent of radical resection of tumor of 2 groups were compared. ResultsThe operative time of the laparoscopic group[(192.5±14.8) min]was longer than that open group[(171.5±16.5) min, P < 0.05].But the blood loss, postoperative drainage, length of incision, and hospital stay of the laparoscopic group were significantly less or shorter than those of open group (P < 0.05).There were no significant difference in postoperative complications and extent of radical resection of tumor between the 2 groups (P > 0.05).There were no residual tumor in distal margin and operatiive death case in both 2 groups. ConclusionComparing with open operation, the laparoscopic assisted surgery for advanced gastric cancer could achieve the same clinical outcomes, and obvious advantage of minimal invasion.
Objective To detect the anti-colon cancer ability of whole cell lysates pulsed dendritic cell (DC) which acts as an adjuvant. Methods Whole cell lysates of LoVo cells were extracted with freeze thawing method, then the monocyte-derived DC were pulsed with this cellular antigen. Subsequently, the capability of antigen pulsed DC to promote T lymphocytes proliferation and the ability of T lymphocytes to kill LoVo cells were detected by 3H-TdR incorporation and lactate dehydrogenase release methods, respectively. Results The whole cell lysates of LoVo cells pulsed DC significantly stimulated T cells proliferation, and the cytotoxicity abilities of primed T cells to kill LoVo cells were also enhanced. Conclusion Tumor cell lysates which act as the cellular antigen to pulse DC can improve the efficacy of anti-cancer immune response， which provides us an experimental evidence for cancer immunotherapy.
Objective To construct AWP1 (associated with protein kinase C related kinase 1) recombinant adenovirus as the tool of transferring the gene and investigate its expression and localization in human vascular endothelial cell ECV304. Methods Cloned AWP1 cDNA was inserted into the multiply clone sites (MCS) of plasmid pcDNA3 for adding flag tag, and the flag-AWP1 gene was subcloned into shuttle vector pAdTrack-CMV. After identified with restrictional enzymes, plasmid pAdTrack-flag-AWP1 was linearized by digestion with restriction endonuclease PmeⅠ, and subsequently cotransformed into E.coli BJ5183 cells with adenoviral backbone plasmid pAdEasy-1 to make homologous recombination. After linearized by PacⅠ, the homologous recombinant adenovirus plasmid transfected into 293 cells with Lipofectamine to pack recombinant adenovirus. After PCR assay of recombinant adenovirus granules, recombinant adenoviruses infected 293 cells repeatedly for obtaining the high-level adenoviruses solution. And then, the recombinant adenoviruses infected human ECV304 cells for observing the expression and localization of AWP1 under laser scanning confocal microscope (LSCM). Results PCR assay showed that recombinant adenovirus Ad-flag-AWP1 was obtained successfully; and ECV304 cells were infected high-efficiently by the homologous recombinant virus. Then, it was observed that flag-AWP1 protein expressed in ECV304 cells and distributed in the leading edges of the cell membrane. Conclusion The vectors of flag-AWP1 recombinant adenovirus are constructed, and the localization of AWP1 protein in ECV304 cells might show that AWP1 may be a potential role on the cell signal transduction.
【摘要】 目的 研究腹腔镜行进展期胃癌根治术较传统开腹手术在围手术期临床和生化指标的变化，进一步探讨其临床应用的优越性。 方法 采用统一入组标准、同期临床对比研究方法，对2010年1-12月腹腔镜手术组和开腹手术组完成的112例进展期胃癌根治术患者在围手术期临床指标和生化指标的比较分析，其中腹腔镜手术组59例，开腹手术组53例。 结果 腹腔镜组手术切口长度为（5.77±0.74） cm，开腹手术组为（12.05±1.30） cm，组间差异有统计学意义（t=-30.921，P=0.000）；腹腔镜组术中失血量为（107.20±27.23） mL，开腹手术组为（168.87±96.76） mL，组间差异有统计学意义（t=-4.483，P=0.000）；腹腔镜组术后住院时间为（7.19±0.97） d，开腹手术组为（8.32±1.16） d，组间差异有统计学意义（t=-5.634，P=0.000）；腹腔镜组手术时间为（202.12±15.71） min，开腹手术组为（196.32±16.73） min，组间差异无统计学意义（t=1.891，P=0.061）；腹腔镜组清扫淋巴结枚数（14.15±4.51）枚，开腹手术组（15.25±5.17）枚，组间差异无统计学意义（t=0.736，P=0.471）；腹腔镜组肠功能恢复时间为（57.88±9.70） h，开腹手术组为（59.16±10.82） h，组间差异无统计学意义（t=-0.655，P=0.514）。两组前白蛋白和血红蛋白水平差异无统计学意义（Pgt;0.05）。 结论 进展期胃癌行腹腔镜手术与传统开腹手术比较，并不加重患者创伤反应，也不增加手术并发症，具有手术切口小、术中出血少、术后恢复快等优点。【Abstract】 Objective To evaluate the differences between laparoscopy and open surgery for treating advanced gastric cancer in peri-operative clinical and biochemical indexes, in order to investigate the superiority of laparoscopy in treating the disease. Methods The same including standards and double-blind randomized control study were carried out to compare the peri-operative clinical and biochemical indexes of 112 patients who underwent radical treatment for advanced gastric cancer from January to December 2010. Among them, 59 patients were included in the laparoscopic group, and 53 in the traditional open operation group. Results Compared with the open surgery group, the incision length [(5.77±0.74) cm vs. (12.05±1.30) cm; t=-30.921, P=0.000], intraoperational blood loss [(107.20±27.23) mL vs. (168.87±96.76) mL; t=-4.483, P=0.000] and hospital stay time [(7.19±0.97) days vs. (8.32±1.16) days; t=-5.634, P=0.000] were significantly shorter or lower in the laparoscopic group. However, the operation time [(202.12±15.71) minutes vs. (196.32±16.73) minutes; t=1.891, P=0.061], number of lymph nodes removed (14.15±4.51 vs. 15.25±5.17; t=0.736, P=0.471), and intestinal functioning time [(57.88±9.70) hours vs. (59.16±10.82) hours; t=-0.655, P=0.514] were not significantly different between the two groups. There was no significant difference between the two groups in the level of prealbumin and hemoglobin. Conclusion Compared with the traditional open operation, laparoscopic surgery for gastric cancer has obvious advantages including smaller incision, lower blood loss during the operation, and fast recovery, without aggravating patients′ traumatic response or increasing the incidence of operational complications.
Objective To evaluate the significance of serum colon cancer-specific antigen-2 （CCSA-2） in diagnosisof colorectal cancer （CRC）. Methods By using ELISA method， the serum CCSA-2 was measured from 105 patients with 5 kinds of diseases， including CRC， gastric cancer， inguinal hernia， acute appendicitis， and breast cancer， who weretreated in our hospital from Jul. to Dec. in 2008， and 20 health donors were enrolled in addition. The blood samples were collected on 3 days before surgery， but blood samples from patients with acute appendicitis were collected before emergencysurgery， blood samples of health donors were collected on 1 day before ELISA test. Results The level of serum CCSA-2 in CRC patients was （99.27±6.25） μg/L， which was significantly higher than those of other patients and health individuals〔（53.58±2.73） μg/L， t=48.29， P=0.000〕. Serum CCSA-2 at a cutoff of 73.96μg/L had a sensitivity of 100% （95% CI：100%-100%） and a specificity of 100% （95% CI：100%-100%） in separating CRC populations from all other indivi-duals by using receiver operator characteristic curve （ROC） analysis. As compared with carcinoembryonic antigen （CEA） and CA19-9， the serum CCSA-2 assay （at a cutoff of 73.96μg/L） was significantly more sensitive than CEA and CA19-9 assay in CRC detection （P＜0.01）. Serum CCSA-2 was not related with patients’ gender （P=0.81）， age （P=0.59）， TNM stage （P=0.85）， Dukes stage （P=0.63）， nuclear grade （P=0.44）， as well as expressions of multidrug resistance associated protein （P=0.33）， P-glycoprotein （P=0.72）， and topoisomeraseⅡ（P=0.95）， but higher in patients with colon cancer than those of patients with rectal cancer （P=0.02）. Conclusion Serum CCSA-2 may be a useful biomarker in diagnosis of CRC， and it may be only related to tumorigenesis， but is irrelated to tumor progression and chemotherapy.
Objective To explore the applying value of laparoscopic partial gastrectomy for gastric stromal tumors. Methods The clinical data of 22 patients with gastric stromal tumors between July 2007 and December 2009 in this hospital were analyzed retrospectively. And the laparoscopic resection was performed in all the patients. Results The laparoscopic resections were performed successfully in all the patients, and the tumors were completely resected. The length of operative incision on abdominal wall was 4－6 cm with average 5.3 cm. The mean operation time was 70 min. Postoperative recovery was smooth, no procedure related complications happened. The mean hospital stay was 7.2 d. Specimens of 20 cases were with CD117 (+), and 15 with CD34 (+) by immunohistochemistry. No recurrence or metastasis happened with average follow-up of 13 months (2－23 months). Conclusion Laparoscopic partial gastrectomy for gastric stromal tumors could be performed safely, postoperative recovery quickly and effectively with the advantage of minimal invasiveness.