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胃大部切除术后近期再生手术53例临床分析

Analysis of Diagnosis and Treatment of Primary Hyperparathyroidism

目的　探讨原发性甲状旁腺功能亢进症(PHPT)的诊治经验。 方法　回顾性分析我院近15年间18例手术治疗的PHPT患者的临床资料。结果　初诊病例术前核素99Tcm-sestamibi扫描和B超检查阳性定位诊断率分别为100%（9/9）和88%（15/17）。18例均经手术治疗，其中1例为再手术病例。术后病理诊断甲状旁腺腺瘤13例，其中1例为双腺瘤； 甲状旁腺增生4例； 甲状旁腺腺癌1例。首次手术治愈率为88%（15/17）。2例甲状旁腺增生病例未治愈。再手术1例因损伤了单侧喉返神经致术后声音嘶哑。结论　术前核素99Tcm-sestamibi扫描和B超检查对制定手术方案有重要意义，大多数PHPT病例适合行单侧颈部探查术。甲状旁腺增生病例的手术治愈率低。

The Growth Inhibition Effect of Antibody Against Vascular Endothelial Growth Factor on Experimental Hepatocellular Carcinoma in vivo

Objective To investigate whether the growth of the human experimental hepatocellular carcinoma (HCC) can be suppressed by the antibody against vascular endothelial growth factor (VEGF). MethodsThe monoclonal antiVEGF antibody was injected to nude mice nearby the xenograft tumour foculs of the human SMMC7721 HCC. The changes of the tumour size were measured at different times. The intratumoural microvessels were showed by immunohistochemical staining of CD31 antigen; the apoptotic cells in the tumour tissues were detected in situ by terminal deoxynucleotidyl transferasemediated dUTPbiotin nick end labeling (TUNEL) assay. ResultsIn the first and second week after finishing the injection procedure, the tumour sizes were compared as the length (mm) multiplying width (mm) between the two groups, the tumour sizes as the test group vs the control group were (26.46±19.81) mm2 vs (105.77±17.40) mm2 (P＜0.001) and (45.20±23.02) mm2 vs (150.77±77.41) mm2 (P＜0.05), respectively. After 2 weeks the intratumoural microvessel density (iMVD) and the apoptotic index (AI) were compared between two groups with iMVD being (2 311±120)/mm2 vs (3 900±328)/mm2(P＜0.001 ) and AI being (15.31% vs 6.83%), P＜0.005. Conclusion The antiVEGF antibody can suppress the xenograft tumour growth of the human SMMC7721 HCC by antiangiogenesis.In fact, its antitumour effect is produced by elevating the incidence of apoptosis in tumour tissues.

ULTRASOUND GUIDED CORE-NEEDLE BIOPSY OF NONPALPABLE BREAST LESIONS

目的 评价B超引导下核心针活检术（CNB）对不可触及的乳腺病变（NPBL）的诊断价值。方法 采用18G Tru-cut针结合活检枪对88例患者的96个NPBL行B超引导下CNB，并与切除活检病理结果比较。结果 NPBL大小4～23mm（平均13.1mm）。在CNB中，86个为良性，2个为可疑恶性，6个为恶性，2个取材不良。在切除活检中9个为恶性，87个为良性。CNB可疑恶变的2个NPBL均为恶性，1个恶性NPBL误诊为乳腺腺病，取材不良的2个NPBL均为良性。本组NPBL中恶性病变占9.38%（9/96），B超引导下CNB对NPBL的良恶性诊断正确率为98.94%（93/94），诊断乳腺癌的敏感性为88.89%（8/9），特异性为100%（8/8），良性病变的病理诊断符合率为97.70%（85/87），取材不良为2.08%（2/96）。结论 B超引导下CNB对NPBL的诊断具有较高的敏感性和特异性，结果准确可靠。

A Comparative Study on Sensitivity of HE,IHC and RTPCR in Detection of Breast Cancer Metastases in Axillary Lymph Nodes

【Abstract】Objective To compare the sensitivity of HE,immunohistochemistry (IHC) and RT-PCR in detection of breast cancer metastases in axillary lymph nodes.MethodsTwenty female patients with newly diagnosed and clinically nodenegative breast cancers underwent modified radical mastectomy, including a complete axillary lymph node dissection. The ages of the patients ranged from 31 years to 65 years, and the diagnosis of breast cancer was approved by pathological finding. Two hundred and thirty-nine axillary lymph nodes were found in these 20 patients. Metastases in axillary lymph nodes were explored by HE， cytokeratin 19 IHC and RT-PCR for cytokeratin 19 respectively. ResultsSeven(2.9%) lymph nodes were found to have metastatic cancers by HE in 3 patients,all nodes were found in level Ⅰ. Metastatic cancers were found in 13(5.4%) nodes by IHC in 7 patients,11 nodes in level Ⅰ and 2 nodes in level Ⅱ; and 52(21.8%) nodes were found to contain tumor cells by RT-PCR in 14 patients,30 nodes in level Ⅰ and 22 nodes in level Ⅱ. All of 7 histologically(HE) positive nodes were found to contain tumor cells by IHC and RT-PCR. Among 232 histologically(HE) negative nodes,6(2.6%) nodes were found to contain tumor cells by IHC,and 45(19.4%) nodes were found to contain tumor cells by RT-PCR, all 6 IHC positive nodes showed the expected 460-base pair products on gel electrophoresis (P＜0.05).ConclusionThis study suggests that IHC and RT-PCR are more sensitive methods for the detection of micrometastases of breast cancer in lymph nodes than HE is,and RT-PCR is even better than IHC; the micrometastases of breast cancer in axillary lymph nodes could be detected accurately through these techniques.

Effect of Tumor Necrosis Factoralpha Genetransduced Tumor Vaccine in Mice Liver Cancer Implanted Tumors

;ObjectiveUsing human tumor necrosis factoralpha (TNFα) genetransduced human liver cancer cell BEL7404 as tumor vaccine, to study the effect of immune rejection to mice liver cancer implanted tumors. MethodsMice were divided into five groups, and were inoculated with TNFα genetransduced BEL7404 cells which irradiated with 60Co (BEL7404TNFCo group), TNFα genetransduced BEL7404 cells (BEL7404TNF group), BEL7404 cells (BEL7404 group), BEL7404 cell irradiated with 60Co (BEL7404Co group) respectively. Normal saline was injected in control group. Then mice liver cancer H22 cells were implanted to each group, the growth of mice liver cancer implanted tumors was observed. The apoptosis index of implanted tumors was detected by TUNEL method.ResultsCompared to BEL7404 group,BEL7404Co group and control group, the tumor vaccine which did not transduce with TNFα gene and the control group, the tumorigenesis rate of liver cancer implanted tumors was reduced, the growth of implanted tumors was inhibited and the apoptosis of implanted tumors was increased in BEL7404TNFCo group,P＜0.01.There was no difference between BEL7404TNFCo group and BEL7404TNF group,Pgt;0.05. ConclusionHuman tumor necrosis factoralpha genetransduced human liver cancer cell can be used as tumor vaccine, it has quite b effect of immune rejection to mice liver cancer implanted tumors.

Application of RouxenY Gastrojejunostomy after Proximal Gastrectomy

ObjectiveTo prospectively study the effect of preventing postoperative reflux esophagitis with esophagogastrostomy and RouxenY gastrojejunostomy after proximal subtotal gastrectomy.MethodsTwentysix cases of carcinoma of the gastric fundus and cardia were allocated randomly to 2 groups (the control group with 12 cases and the experimental group with 14 cases) according to odd or even number of the admission number.After proximal subtotal gastrectomy and esophagogastrostomy, the control group underwent pyloroplasty while the experimental group with pyloruspreserving RouxenY gastrojejunostomy.The inflammatory reaction of the tissue obtained at the esophagogastric junction using a fiber gastroscope was observed after half year of postoperative followup in the two groups.An examination of gastric emptying of a radionuclidelabeled test meal were performed.According to the Visick score of followup data,the effects of operation were evaluated.The 5year survival rate was also evaluated.ResultsThe postoperative gastrointestinal symptoms in the experimental group were slighter than those in the control group.The examination of gastric emptying of a radionuclidelabeled test meal showed that the gastric emptying time of a half dose,gastric remains rates of radionuclide after 10 min and 60 min in the experimental group were similar to those in the control healthy people group.But in the control group,the gastric emptying time of a half dose delayed,and the gastric remains rate of radionuclide after 10 min and 60 min were higher than the other groups.The biopsy study of the esophagogastric junction showed that the inflammatory reaction in the experimental group was slighter than that in the control group.There was no significant difference between the two groups in the survival rate.ConclusionFor patients with carcinoma of the gastric fundus and cardia, after proximal subtotal gastrectomy and esophagogastrostomy,compared with pyloroplasty,pyloruspreserving RouxenY gastrojejunostomy can decrease the reflux esophagitis,and relieve the postoperative gastrointestinal symptoms.