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。
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 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.
目的 探讨术中应用缓释5-氟尿嘧啶在结直肠癌治疗中的价值及安全性。方法 回顾性分析173例结直肠癌患者术中应用缓释5-氟尿嘧啶后的疗效和不良反应。结果 171例患者顺利出院，1例患者死于严重骨髓抑制，1例死于真菌败血症； 无出血、吻合口漏、肠穿孔、肠梗阻等严重并发症发生。155例患者获6个月至3年的随访，随访期间死亡23例，发生局部复发5例，肝脏等远处转移3例。结论 结直肠癌术中使用缓释5-氟尿嘧啶是安全、有效的。
Objective To investigate the infection rate and observe the healing courses of the incision after gastrointestinal surgery which was managed by positioning extraperitoneal U-type latex drainage strip. Methods Two hundred patients after abdominal operation were divided into drainage group (n=97) and control group (n=103). Drainage group were treated with positioning extraperitoneal U-type latex drainage strip, while control group were treated with no latex drainage strip. The infection rate of incision, the mean time in hospital and mean time of incision healing were observed. Results The infection rate of drainage group was significantly lower than that of control group 〔7.22% (7/97) vs. 18.45% (19/103), P=0.024〕. The mean time in hospital and the mean time of incision healing in drainage group were significantly shorter than those in control group 〔(8.86±1.48) d vs. (14.12±2.63) d， P=0.000； (8.24±1.02) d vs. (12.32±3.47) d， P=0.000〕. Conclusion The infection rate and the healing course of incision of gastrointestinal surgery could be improved by positioning extraperitoneal U-type latex drainage strip.
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.
ObjectiveTo explore the early diagnosis and treatment of acute non-tumor perforation of the back wall of ascending colon. MethodsWe retrospectively analyzed the clinical data of 17 patients with acute non-tumor perforation of the back wall of ascending colon treated between July 2007 and April 2014 in our hospital. Among them, 8 patients who underwent perforation repair combined with abdominal cavity drainage were regarded as the experimental group, and the other 9 patients who underwent operation of right hemicolectomy (or ascending colon resection) were designated as the control group. Clinical indexes and biochemical indexes of both the two groups were compared and analyzed. ResultsAll patients were cured. The operation time[(74.20±12.45), (120.23±15.20) minutes; t=-3.224, P<0.001], the intraoperative blood loss[(40.24±12.20), (80.69±18.98) mL; t=-4.114, P<0.001], the postoperative anal exhaust[(75.62±6.56), (84.54±7.82) hours; t=1.108, P=0.037], the medical expenses[(18.2±5.7) thousand yuan, (26.5±8.3) thousand yuan; t=-5.556, P<0.001], and the hypersensitive C-reaction protein on the third day after operation[(89.45±8.98), (99.85±10.78) mg/L; t=-3.004, P=0.029] in the experimental group and the control group all had significant differences. There was no significant difference between the two groups in the hospital stay time[(9.80±3.16), (9.81±3.20) days; t=1.501, P=0.080]. There was one case of incision infection in the experimental group and one case of fat liquefaction of incision in the control group, and both of them were cured after treatment. ConclusionThe early abdominal sign of perforation of the back wall of ascending colon is not obvious, which can easily lead to misdiagnosis as acute appendicitis. Early diagnosis mainly depends on the clinical symptom, vital sign, blood routine examination and CT examination. Among them, CT findings of gaseous sign behind peritoneum is a definite diagnosis, and operation should be arranged as early as possible. Perforation repair combined with abdominal cavity drainage is preferred due to its advantages of being simple, saving time, less bleeding and lighter traumatic reaction.
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.