Objective To study ultrastructure and clinical significance of gastrin secretory granule in colorectal carcinoma cells. Methods The gastrin expression in colorectal carcinoma tissue and blood of 10 cases was examined by using radioimmunity analysis and immunohistochemistry. The ultrastructure of gastrin secretory granule of 10 cases, the positive of gastrin immunohistochemistry of colorectal carcinoma were examined by using immunoelectron microscopic technique. Results The gastrin concentration of the colorectal cancer group 〔（130.75 ±21.34） pg/ml〕 was significantly higher than that of control group 〔（95.63± 12.26） pg/ml〕，Plt;0.05. In 10 specimens of colorectal cancer, 5 cases were gastrin immunohistochemistry positive (+++), 4 moderate positive (++) and 1 weak positive (+). Cells in colorectal cancer were polyshaped, with unusual nucleoli different in size, concentrating on the edge, the cytoplasm mitochondrion was plentiful with vacuolates, and more secretion granules could be seen, 400-1500 nm in diameter with a clear border of membrane. There were two types of granular appearance: type A was largest in bulk size, low electrodensity was welldistributed, granular core appeared loose; type B was smaller in bulk size, high electrodensity was welldistributed, nucleus was usually compact.protein A gold (pAg) positive granules were located partially in secreting granules. pAg positive granules in highly differentiated cancer were mainly located in secreting granules of type A. pAg positive granules in low differentiated cancer were mainly located in secreting granules of type B. A part of cancer cell membrane, and inside and outside of microvillus membrane, adhering to pAg granules in line could be seen. Conclusion The colorectal carcinoma cells may synthesize and secrete gastrin themselves, which may be the mechanism of high gastrin levels in colorectal cancer. The use of gastrin antagonist and receptor antagonist may treat the patents with colorectal carcinoma.
目的探讨经腹正中线入路2孔法腹腔镜胆囊切除术的可行性。 方法对笔者所在医院2009年5月至2013年3月期间收治的220例胆囊结石、胆囊炎患者行经腹正中线入路2孔法腹腔镜胆囊切除术，观察其手术时间、术后疼痛、并发症发生情况及恢复时间。 结果220例中成功施行经腹正中线入路2孔法腹腔镜胆囊切除术215例，成功率为97.73%，手术时间30～110 min，平均45 min。另5例因炎症严重、操作困难而改为3孔法完成腹腔镜胆囊切除术，并行腹腔引流。本组患者无中转开腹者，术后均未用镇痛剂，也无并发症发生；术后住院时间3～5 d，平均4 d。 结论经腹正中线入路2孔法腹腔镜胆囊切除术，具有切口更少、创伤更小、疼痛轻、康复快、美容效果更好、不增加设备投入等优点。
Objective To investigate the clinical applications of plasma shock wave lithotripsy （PSWL） in the treatment of calculi via choledochoscope. Methods Between 2004 and 2009, 56 huge residual calculi (54 cases) were underwent PSWL via choledochoscope treatment in our hospital. Calculi size: diameter ≤10 mm in 9 calculi, 10 mm lt;diameter ≤15 mm in 24 calculi, 15 mm lt;diameter ≤20 mm in 17 calculi, and diameter gt; 20 mm in 6 calculi. Twenty four cases of these 54 patients had bile duct stricture. Procedure: Firstly found the calculus, and then the lithotriptor wire was introduced to the place 0.5-1.0 mm far away from the calculus surface through choledochoscope channel, and powered on, fired, destructed. Results Forty-eight cases of 54 patients were cured by PSWL with 1 times, 2 cases with 2 times, 2 cases with 3 times, and 2 cases with 4 times. Shock 4-300 times were exported per PSWL, with an average of 65 times. Crushing each stone needed shock for 4-680 times, with an average of 77 times. The calculi were ruptured in different degrees by PSWL, of which 20 cases were completely ruptured. All calculi were completely extracted. Except one case with bile duct stricture was found a small amount of bile duct bleeding during operation, all other patients had no operation complications. Conclusion PSWL technique plays an important role in lithotripsy. It is easy to deal with intrahepatic impacted calculi by PSWL, especially the pigment stones with rough surface.