【摘要】 目的 探讨胰腺癌早期诊断的要点及误诊因素。 方法 回顾性分析2009年7月8日收治的1例以腹胀、呕吐为主要表现的胰腺癌患者。 结果 患者经及时剖腹探查确诊为胰腺癌并行手术切除。 结论 胰腺癌起病隐匿，其早期误诊率高，进行胰腺癌的早期诊断、避免误诊是提高预后的重点和难点。【Abstract】 Objective To explore the main points of early diagnosis of pancreatic cancer and its misdiagnosis factors. Methods The clinical data of one patient with pancreatic cancer on the 8th July, 2009 was retrospectively analyzed. The chief complaints included abdominal distension and vomiting. Results By exploratory surgery in time,the patient was diagnosed as pancreatic cancer and underwent the resection. Conclusion The onset of pancreatic cancer is very insidious,usually with a high misdiagnosis rate. How to make the right early diagnosis and to avoid misdiagnosis are the focal points of improving the prognosis.
ObjectiveTo investigate the levels of regulatory T cells (Treg) and FoxP3 gene in patients with gastric cancer before and after operation. MethodsTwenty patients with definite diagnosis of gastric cancer and 15 healthy volunteers were selected. The levels of Treg and T cell subsets in peripheral blood were determined by detecting of CD4 and CD25 with immunefluorescence stain and flow cytometry, the expressions of FoxP3 mRNA in these Treg were detected by RTPCR technique. The expression of FoxP3 protein in the gastric cancer tissue was measured by immunohistochemistry assay. ResultsThe percentage of Treg cells in total CD4+ T isolated from the patients with gastric cancer was higher than that of healthy volunteers 〔(19.39±5.58)% versus (9.91±3.23)%, Plt;0.01〕, and it markedly decreased after operation 〔（13.50±5.93）% versus (19.39±5.58)%, Plt;0.05〕. The FoxP3 mRNA expression in the patients with gastric cancer was also higher than that of healthy volunteers (0.86±0.03 versus 0.64±0.02, Plt;0.01), and decreased after operation (0.73±0.04 versus 0.86±0.03, Plt;0.05). The percentage of CD4+T cell in mononucleocytes of peripheral blood of patients with gastric cancer was significantly lower than that of healthy volunteers (Plt;0.01), but the difference was not significant between before and after operation. FoxP3 protein expressed in cytoplasm of 13 patients with gastric cancer, in which bly positive in 2 cases, middle positive in 6 cases, weakly positive in 5 cases. FoxP3 protein didn’t express in cytoplasm of 7 patients with gastric cancer. ConclusionsTreg may have a significant effect on the onset and development of gastric cancer through immunosuppressive effect. Tumor tissue is an important initiating agent on Treg proliferation.
ObjectiveTo explore the safety and effectiveness of endoscopic treatment for biliary tract complications after liver transplantation.MethodsPatients who underwent endoscopic treatment for biliary tract complications after liver transplantation from January 2009 to December 2018 in West China Hospital were enrolled. Characteristics of patients, types of biliary tract complications, effectiveness of endoscopic treatment and endoscopic related complications were collected and analyzed.ResultsAmong the 57 patients with biliary tract complications, 37 patients had biliary stricture alone, 4 patients had bile leak alone, 15 patients had biliary stricture plus biliary stones or sludge, and 1 patient had biliary stricture combined with biliary leakage. A total of 112 treatments of endoscopic retrograde cholangiopancreatography (ERCP) were performed, among which 100 treatments were accomplished successfully (89.3%), including the improvement of bile duct stenosis, the cure of bile leak and the successful removal of common bile duct stones. The number of total ERCP related complications was 15 (13.4%), among which post ERCP pancreatitis was the most common (9.8%).ConclusionEndoscopic therapy can be considered as an initial treatment for biliary tract complications after liver transplantation as its safety and effectiveness.
Objective To evaluate the therapeutic effects of endoscopic treatment on biliary tract complications after liver transplantation. Methods The clinical data of 55 patients with biliary tract complications after liver transplantation undergoing endoscopic treatment from January 2006 to June 2009 were analyzed retrospectively. Results Ninety-eight times of endoscopic treatment were performed in 55 patients. There were 11 cases of biliary fistula, 4 cases of bile duct stricture with biliary fistula, 21 cases of bile duct stricture, 12 cases of bile duct stricture with biliary sludge or stones, 3 cases of biliary sludge or stones, 2 cases of angular distortion of the bile duct and papilla duodeni stenosis in 2 cases. Different procedures including biliary tract dilation, endoscopic nasobiliary drainage, endoscopic sphincterotomy, stone extraction technique and biliary stent placement were performed in different biliary tract complications. The endoscopic treatments were successful in 46 cases (83.6%). The procedure related complications were found in 13 times (13.3%). Conclusion Endoscopy may serve as the primary modality for treating biliary tract complications after liver transplantation with safety and effectiveness.
ObjectiveTo investigate the etiology of pediatric pancreatitis and the effect of endoscopic retrograde cholangiopancreatography (ERCP) in it. MethodsPatients hospitalized for pancreatitis in West China Hospital of Sichuan University from Jan. 2008 to Jun. 2023 were included according to the inclusion and exclusion criteria. Totally, 241 cases (207 cases with acute pancreatitis and 34 with chronic pancreatitis) were included. Patients were divided into primary group (n=168) and recurrent group (n=73) according to their previous medical history. ResultsThe duration of hospitalization in the primary group was longer than that in the recurrent group [10.0 (7.0, 16.0) d vs. 7.5 (6.0, 11.8) d, P=0.012]. The proportion of acute pancreatitis in primary group (163/168, 97.0%) was higher than that in the recurrent group (44/73, 60.3%), P<0.001. There was no significant difference in the etiological component ratio between the primary and recurrent groups (χ2=7.504, P=0.347). However, in the primary group, the first etiology was biliary factors (38/163, 23.3%), and the second was biliary pancreatic anatomic abnormality (22/163, 13.5%). In the recurrence group, biliary pancreatic anatomic abnormality (13/44, 29.5%) was the first cause, and biliary factor (7/44, 15.9%) was the second cause. Among 207 cases with acute pancreatitis, there were 114 cases (55.1%) with clear etiology, including 45 cases (21.7%) of biliary factors, 35 cases (16.9%) of abnormal biliary pancreatic structure, 12 cases (5.8%) of traumatic factors, and 10 cases (4.8%) of drug-induced factors. In this study, 66 cases were treated with ERCP for pancreatitis, and a total of 103 ERCP operations were performed with cannulation success rate of 100%. Twenty-three cases (23/37, 62.2%) of acute pancreatitis resulted from biliary and biliary pancreatic structure abnormalities received ERCP. In biliary acute pancreatitis, the removal rate of choledocholithiasis in single ERCP operation was 80.0% (8/10). The clinical symptoms (abdominal pain, jaundice, and fever) of all cases were significantly improved after surgery, and no complications such as cholangitis, bleeding and perforation occurred. ConclusionsBiliary, congenital pancreatic anatomical abnormalities, drugs and trauma are the common causes of acute pancreatitis in children. ERCP is a safe and effective treatment for children with biliary pancreatitis, pancreatic anatomical abnormalities, and chronic pancreatitis.
ObjectiveTo compare the cost-effectiveness between endoscopic retrograde cholangio-pancreatography (ERCP) treatment and laparotomy treatment for simple common bile duct stone or common bile duct stone combined with gallbladder benign lesions. MethodsA total of 596 patients with common bile stone received ERCP (ERCP group) and 173 received open choledocholithotomy (surgical group) in our hospital between January 2009 and December 2012. Their clinical data were retrospectively analyzed. The curing rate, postoperative complications, hospital stay, preoperational preparation and total cost were compared between the two groups of patients. Meanwhile, for common bile stone combined with gallbladder benign lesion, 29 patients received ERCP combined with laparoscopic cholecystectomy (LC) (ERCP+LC group), 38 received pure laparoscopy treatment (laparoscopy group) and 129 received open choledocholithotomy combined with cholecystectomy (surgery group). ResultsFor simple common bile stone patients, no significant difference was found in cure rate and post-operative complication between endoscopic and surgical treatment groups (P>0.05). However, total hospitalization expenses[(13.1±6.3) thousand yuan, (20.6±7.5) thousand yuan)], hospital stay[(8.91±4.95), (12.14±5.15) days] and preoperative preparation time[(3.77±3.09), (5.13±3.99) days] were significantly different between the two groups (P<0.05). For patients with common bile stone combined with gallbladder benign lesion, no significant discrepancy was detected among the three groups in curing rate and post-operative complications (P>0.05). Significant differences were detected between ERCP+LC group and surgical group in terms of total hospitalization expense[(18.9±4.6) thousand yuan, (23.2±8.9) thousand yuan] hospital stay[(9.00±3.74), (12.47±4.50) days] and preoperative preparation time[(3.24±1.83), (5.15±2.98) days]. No significant difference was found in total hospitalization expense and hospital stay, while significant difference was detected in preoperative preparation time between ERCP+LC group and simple LC group. ConclusionFor patients with simple common bile stone, ERCP is equivalent to surgery in the curing rate, and has more advantages such as less cost, shorter length of hospital stay, and lower preoperative preparation time. For the treatment of common bile duct stone with gallbladder benign disease, ERCP combined with LC also has more advantages than traditional surgery.
ObjectiveTo evaluate the feasibility and efficiency of patient-controlled analgesia and sedation (PCAS) with propofol and remifentanil for colonoscopy in elderly patients. MethodsSixty elderly patients preparing for painless colonoscopy between May and September 2015 were randomly allocated into PCAS group and total intravenous anesthesia (TIVA) group with 30 patients in each. In the PCAS group, the mixture of remifentanil and propofol at 0.6 mL/(kg·h) was pumped continuously after an initial bolus of 0.05 mL/kg mixture. The examination began three minutes after the infusion was finished. Patients could press the self-control button. Each bolus delivered 1 mL and the lockout time was 1 minute. In the TIVA group, patients received fentanyl at 1 μg/kg and midazolam at 0.02 mg/kg intravenously, and accepted intravenous propofol at 0.8-1.0 mg/kg two minutes later. The examination began when the patients lost consciousness. ResultsA significant decline of mean arterial blood pressure was detected within each group after anesthesia (P < 0.05). The decrease of mean blood pressure in the TIVA group was more significant than that in the PCAS group (P < 0.05). The heart rate, pulse oxygen saturation and respiratory rate decreased significantly after anesthesia in both the two groups (P < 0.05), while end-tidal CO2 increased after anesthesia without any significant difference between the two groups (P > 0.05). The induction time, time to insert the colonoscope to ileocecus, and total examination time were not significantly different between the two groups (P > 0.05). As for the time from the end of examination to OAA/S score of 5 and to Aldrete score of 9, the PCAS group was significantly shorter than the TIVA group (P < 0.05). ConclusionPCAS with remifentanil and propofol can provide sufficient analgesia, better hemodynamic stability, lighter sedation, and faster recovery compared with TIVA.
Objective To explore the effects of celecoxib, a selective COX-2 inhibitor, on the expression of NHE1 and intracellular pH (pHi) of SGC-7901 human gastric carcinoma cells. Methods Human gastric carcinoma cell line SGC-7901 was used as research object. MTT method was used to detect the celecoxib's depressant effect on the proliferation of SGC-7901 cells after intervening with different concentrations of celecoxib (5, 12.5, 25, 50, 75, and 100 μmol/L) for different time. Western blot was applied to detect influence of different concentrations of celecoxib on NHE1 expression in SGC-7901 human gastric carcinoma cells. On this basis, pHi of SGC-7901 cells was tested by BCECF-AM immunofluorescence. Results Celecoxib could effectively inhibit the proliferation of SGC-7901 human gastric carcinoma cells. And within a certain concentration range, the inhibitory action on SGC-7901 cells increased with the increase of celecoxib concentration. It also increased with the extension of explosion time while at the same concentration (P<0.05). Different concentrations (except 5 μmol/L) of celecoxib could down-regulate the expression of NHE1 in SGC-7901 cells, which was concentration dependent (P<0.05). The pHi of SGC-7901 cells that were not intervened with celecoxib is alkaline. Compared the pHi of cells in control group, the pHi of SGC-7901 cells decreased significantly after intervening with different concentrations of celecoxib (except 5 μmol/L) for 24 h (P<0.05). And the decrease of pHi was also concentration dependent (P<0.05). Conclusion Celecoxib may inhibit the growth of SGC-7901 cells through down-regulating the expression of NHE1 and declining the pHi.