Objective To investigate the protective effects of antitumor necrosis factor-α antibody （TNF-αAb） on lung injury after cardiopulmonary bypass （CPB） and their mechanisms. Methods Forty healthy New Zealand white rabbits，weighting 2.0-2.5 kg，male or female，were randomly divided into 4 groups with 10 rabbits in each group. In groupⅠ，the rabbits received CPB and pulmonary arterial perfusion. In group Ⅱ，the rabbits received CPB and pulmonary arterial perfusion with TNF-αAb. In group Ⅲ，the rabbits received CPB only. In group Ⅳ，the rabbits only received sham surgery. Neutrophils count，TNF-α and malondialdehyde （MDA） concentrations of the blood samples from the left and right atrium as well as oxygenation index were examined before and after CPB in the 4 groups. Pathological and ultrastructural changes of the lung tissues were observed under light and electron microscopes. Lung water content，TNF-α mRNA and apoptoticindex of the lung tissues were measured at different time points. Results Compared with group Ⅳ，after CPB，the rabbitsin group Ⅰ to group Ⅲ showed significantly higher blood levels of neutrophils count，TNF-α and MDA（P＜0.05），higherTNF-α mRNA expression，apoptosis index and water content of the lung tissues （P＜0.05），and significantly lower oxyg-enation index （P＜0.05） as well as considerable pathomorphological changes in the lung tissues. Compared with group Ⅱ，after CPB，the rabbits in groups Ⅰ and Ⅲ had significantly higher blood concentrations of TNF-α （5 minutes after aortic declamping，220.43±16.44 pg/ml vs.185.27±11.78 pg/ml，P＜0.05；249.99±14.09 pg/ml vs.185.27±11.78 pg/ml，P＜0.05），significantly higher apoptosis index （at the time of CPB termination，60.7‰±13.09‰ vs. 37.9‰±7.78‰，P＜0.05；59.6‰±7.74‰ vs. 37.9‰±7.78‰，P＜0.05），significantly higher blood levels of neutrophils count and MDA （P＜0.05），significantly higher TNF-α mRNA expression and water content of the lung tissues （P＜0.05），and significantly loweroxygenation index （P＜0.05） as well as considerable pathomorphological changes in the lung tissues. Compared with groupⅠ，rabbits in group Ⅲ had significantly higher above parameters （P＜0.05） but lower oxygenation index （P＜0.05） only at 30 minutes after the start of CPB. Conclusion Pulmonary artery perfusion with TNF-αAb can significantly attenuate inflammatory lung injury and apoptosis of the lung tissues during CPB.
OBJECTIVE: Both primary and metastatic tumor of spine can influence spinal stability, spinal cord and nerves. The principles of dealing spinal tumor are resection of tumor decompression on spinal cord and reconstruction of spinal stability. METHODS: Since Aug. 1993 to Oct. 1996, 15 cases with spinal tumor were treated, including 4 primary spinal tumor and 11 metastatic tumor. Tumor foci were mainly in thoracic and lumbar spine. Graded by Frankel classification of spinal injuries, there were 1 case of grade A, 1 of grade B, 3 of grade C, 5 of grade D and 5 of grade E. Tumors of upper lumbar spine and thoracic spine were resected through anterior approach. Posterior approach also was adopted once posterior column was affected. Tumors of lower lumbar spine were resected by two-staged operation: firstly, operation through posterior approach to reconstruct spinal stability: secondly, operation through anterior approach. After resection of tumor, the spines were fixed by Kaneda instrument, Steffee plate or Kirschner pins. To fuse the spine, bone grafting was used in benign tumor and bone cement used in malignant tumor. RESULTS: Except one patient died from arrest of bone marrow, the others were followed up for 3 to 20 months. Postoperatively, 11 patients could sit up on one foot with the help of body supporter, and 9 patients could walk in two weeks under careful monitoring. There was no exacerbation of symptom and failure of fixation. The function of spinal cord was improved: 1 case from grade B to grade E, 1 from A to C, 2 from C to E and 4 from D to E. CONCLUSION: The spine can be reconstructed for weight bearing early by internal fixation. The symptom can be relieved and the nervous function can be improved by resection of tumor and decompression.
Objective To discuss the strategies for building the framework of team culture of multi-disciplinary team (MDT) for colorectal cancer. Methods By comprehending the traditional concept of volunteer and probing into the value of traditional team culture, combining the needs of MDT for colorectal cancer, build appropriate team culture and core idea of MDT for colorectal cancer. Results Confirm that building of volunteers groups and the volunteers culture is the core of the team culture of MDT for colorectal cancer. Analyze characters of volunteers groups and the operation strategies, and find the way of maintaining the volunteers culture. Conclusion With the development of volunteers groups and increased participants, the team culture of MDT for colorectal cancer will show more sociality and extent. And it is also the important idea and direction for development in future. As team culture, organization structure and personnel structure supplements each other, adjusting and perfecting the team culture in practice continually is a long-term work for MDT.
摘要:目的:探讨左半结肠癌合并肠梗阻Ⅰ期手术切除肠吻合的方法和注意事项。〖HTH〗方法:〖HTSS〗分析36例左半结肠癌合并肠梗阻患者Ⅰ期行手术切除肠吻合手术及术后恢复情况。结果:36例左半结肠癌并肠梗阻患者,Ⅰ期手术切除、肠吻合无一例吻合口瘘,术后恢复良好。〖HTH〗结论:〖HTSS〗只要围手术期、术中处理得当,左半结肠癌合并肠梗阻患者选择Ⅰ期手术切除肠吻合,可以减少患者痛苦、节约医疗费用,同时也是安全的。
63 normal human gallbladders (non-stone group) and 47 inflammed cholesterol stone gallbladders(stone group) were assayed for the amount of macrophages(ΜΦ),the levels of tumor necro-sis factor (TNF) and interleukin 1(1L-1).It was found that in stone group,the amount of ΜΦ was significantly higher than in non-stone group(ΜΦ4101.90±295.72 vs 572.13±30.07AU,Plt;0.01).The levels of TNF and 1L-1 released mainly from the MΦ in stone group were also significantly increased in comparison with those in non-stone group(TNF 18.12±2.03 vs 4.45±0.39ng/mg,Plt;0.001;1L-1 102.42±7.84 vs 66.75±9.50u/mg protein,Plt;0.05).These results suggest that the activited ΜΦ and increases of TNF,1L-1 may be closely related to the inflammatory reaction in gallbladders and the formation of cholesterol gallstones.
Objective To study the reparative and reconstructive for proximal humerus defect due to the excision of bone tumor with noninternal fixation non-vascularised fibular autografts. Methods From June 1991 toDecember 2003, 26 non-vascularised fibular grafts were used as substitutes for repair and reconstruction after resection for bone tumors on proximal humerus. Fifteen cases were given curettage and fibular supporting internal fixation, the other 11 cases were given tumor resection and joint reconstruction with proximal fibular graft. The age ranged from 6 to 41 years. Out of 26 patients, 5 had giant cell tumor, 9 had bone cysts, 8 had fibrous dysplasia and 4 had enchondroma. Results Twenty-six patients were followed up from 1 to 12 years (3.4 years on average). Local recurrence was found in 2 cases, and 1 of them died of lung metastasis. Both outlook and function of the reconstructed joints have good results in 15 proximal humeral joint surface reserved cases. Of them, 3 children gained normal shoulder function 3 weeks after operation. Part function were obtained in the other 11 fibular grafts substituted proximal humeral defect. Conclusion Non-vascularised fibular grafts is an appropriate treatment option for proximal humerus bone defect due to excision of bone tumor.
目的结合近期收治的1例肝脏血管周上皮样细胞肿瘤（perivascular epitheliod cell tumor，PEComa）的病例特点，总结该疾病的诊治体会。 方法回顾分析2013年9月笔者所在医院成功收治的1例肝脏原发PEComa的诊治过程，并结合既往文献报道，总结和复习该疾病的临床特点以及处理方法。 结果肝脏PEComa较为罕见，起病隐匿，症状缺乏特异性，临床诊断困难，多依赖病理学检查证实，手术切除是有效的治疗手段。 结论提高本病影像学特征的认识有助于术前肿瘤性质的判断，本病预后较好，但术后仍需要长期密切观察随访。
Objective To evaluate the safety and ascendancy of small caliber stapler application for anterior resection in ultra-low rectal cancer with anal sphincter preservation. Methods A retrospective analysis of the data of 60 cases of ultra-low rectal cancer treated by anterior resection with anal sphincter preservation by double stapling technique according to TME principle between June 2006 and June 2009 were undertaken. The 60 patients were divided into two groups, each group included 30 cases. One group adopted 33 mm stapler and another group adopted 29 mm stapler, and then the profiles of medi-operation, post-operation, and prognosis were assessed. Results Time of simple anastomose in operation was (9.0±3.3) min in 33 mm stapler group and (6.0±2.6) min in 29 mm stapler group, and there was significant difference between them (P=0.022 5). There were 6 cases needed to be restored because of lesion during operation or dys-anastomosis in 33 mm stapler group, while 2 cases in 29 mm stapler group, there was significant difference between them (P=0.030 1). No significant differences were observed between the two groups in terms of the time for operation, leakage, bleeding, stenosis, anastomotic recurrence, and fecal incontinence after operation or length of stay. Conclusion The application of 29 mm stapler not only can shorten time for anastomose and step down the degree of difficulty, but also dosen’t increase stenostomia and other complications.
ObjectiveTo summarize the application status and prospect of laparoscopic pancreaticoduodenectomy (LPD).MethodThe relevant literatures about studies of LPD at home and abroad were reviewed.ResultsLPD was a difficult operation, mainly suitable for pancreatic head and periampullary benign and malignant tumors. With the development of laparoscopic techniques in recent years, LPD combined the superior mesenteric vein and portal vein resection and reconstruction, or combined multi-visceral resection was feasible, but the survival benefit of LPD with arterial resection and reconstruction and extended lymph node dissection remained to be discussed. At present, there was no clear requirement on the way to reconstruct the pancreatic fluid outflow tract, but the pancreaticojejunostomy for digestive tract reconstruction was chose by the most surgeons. The most studies had confirmed that LPD was minimally invasive and had a short-term prognosis that was not inferior to that of open pancreaticoduodenectomy. However, the results of large sample analysis about long-term survival rate and oncology results were lacking, so it was difficult to judge the advantages and disadvantages of long-term prognosis of the two methods.ConclusionsLPD is a safe, feasible, reasonable, and effective surgical method. With improvement of laparoscopic technology, LPD is expected to become a standard operation method for treatment of pancreatic head cancer and periampullary carcinoma, and oncology benefits of LPD will be further confirmed in future by large-sample clinical randomized control trials and studies of long-term prognosis follow-up.
【摘要】目的 探讨低磁场MRI诊断胰腺癌的价值。方法 回顾性分析我院78例经手术和病理证实的胰腺癌的MRI表现。结果 肿瘤的低磁场MRI主要表现为胰腺出现局部软组织肿块或全部肿大，轮廓、信号异常，T1加权像呈等或低信号，信号不均匀，T2加权像信号不均匀增高； 肝内外胆管、胰管扩张，邻近组织及器官受累。结论 低磁场MRI能较好地显示胰腺癌的大小、形态和继发的胆、胰管梗阻、扩张以及肿瘤转移、侵袭范围，有利于肿瘤的诊断。