手术治疗腮腺良性肿瘤68例临床分析

目的探讨腮腺良性肿瘤切除的手术方式及其疗效。方法将68例腮腺良性肿瘤患者随机分为观察组和对照组各34例,观察组采用腮腺区域性切除术,对照组采用腮腺浅叶切除术。结果所有患者均顺利完成手术,观察组的手术时间少于对照组,术后并发症的发生率小于对照组,2组比较有显著性差异(P<0.01和P<0.05)。结论区域性切除术治疗腮腺小肿瘤的疗效比腮腺浅叶切除术好,值得临床推广。     

肝段叶切除联合手术治疗肝内胆管结石

目的探讨肝段叶切除联合手术治疗肝内胆管结石。方法对72位肝内胆管结石患者进行肝段叶切除方法治疗肝内胆管结石。左外叶或左半肝叶切除36例,右肝段切除7例,右半肝切除15例。其中24例行高位胆管切开整形及胆管空肠Roux-en-Y吻合32例;行肝断面扩张胆管、肝门胆管分别与空肠作双口吻合4例,T管引流20例和U管引流2例,手术后道镜取石12例。结果肝段叶切除+胆管空肠RouxenY吻合24例(33.3%),肝段叶切除+胆道探查14例(19.4%),肝段叶切除+胆肠吻合口切开探查7例(9.7%),肝段叶切除+胆道探查+右肝表面切开取石术5例(6.9%),术后胆道常规留置T管。其中肝段叶切除手术包括左外叶36例,左半肝21例,右前肝7例,右后叶2例,不规则左或右肝切除术5例。病人均治愈,无死亡。术后发生并发症例(13.9%),其中切口感染8例,切口裂开3例,均治愈。术后均经T管行胆道造影及胆道镜检,发现结石15例,残石率20.8%。72例肝段叶切除术中同时行胆管空肠吻合24例,肝断面扩张胆管、肝门胆管与空肠双口吻合6例,T管和U管引流分别为20例和14例。本组无手术死亡。72例随访1～10年,无复发病症,无再手术者。...     

结节性甲状腺肿术后复发再手术分析

目的探讨复发性结节性甲状腺肿再手术原因,手术方式和并发症的预防。方法回顾22例复发性结节性甲状腺肿再手术的临床资料进行回顾性分析。结果结节性甲状腺肿术后复发者多为首次手术挖地雷式单纯结节切除、腺瘤切除,腺叶部分切除。结论正确选择术式可降低结节性甲状腺肿术后复发率,掌握必要的手术技巧,精细操作,可减少和避免并发症的发生。     

甲状腺单发结节60例手术方式探析

目的探讨甲状腺单发结节的不同手术方式的临床效果。方法回顾性分析我院2004年至2008年收治的60例甲状腺单发结节患者的诊治情况。结果术前行查血T3、T4、TSH;甲状腺彩超、CT、放射性核素131Ⅰ扫描、颈部淋巴结活检、甲状腺肿物细针穿刺活检等,术中甲状腺冰冻切片病理检查5例,术后均做石蜡切片病理检查,病理诊断为甲状腺腺瘤10例,腺瘤囊性变7例,结节性甲状腺肿43例。患侧腺叶次全切除加峡部切除43例,患侧腺叶全切除加峡部切除9例,患侧腺叶全切除加峡部切除加对侧腺叶次全切除3例,单纯甲状腺结节摘除5例。结论根据甲状腺单发结节的大小、位置、病理性质等情况,选择合适手术方式进行治疗,对预防术后复发,避免遗漏恶性病灶,保证手术疗效至关重要。     

120例肝胆管结石再手术原因与治疗

目的探讨肝胆管结石再手术的原因与治疗。方法回顾性分析120例肝胆管结石患者的临床资料,其中肝内胆管结石48例,肝外胆管结石60例,肝内外胆管结石12例。手术行胆道探查取石T管引流60例,不规则肝叶切除24例,胆肠内引流36例,术中应用胆道镜48例,术后应用胆道镜72例。结果治愈108例,再次手术后经B超,胆道造影证实结石取净率90%。结论肝胆管结石再手术的主要原因为:胆管狭窄,结石残留,结石复发。再手术应严格遵循"清除结石,解除狭窄与梗阻,矫正畸形,切除病肝,通畅引流"其中"病肝切除,胆管狭窄处的切开整形,肝门大口径胆肠吻合"是提高手术治疗效果的关键。术中术后正确应用纤维胆道镜可降低残石率。     

30例右肺中叶病变的外科治疗分析

目的探讨右肺中叶病变的良、恶性鉴别诊断及外科治疗方法。方法对30例肺中叶病变行手术治疗。其中单纯中叶切除16例,中上叶切除3例,中下叶切除7例,右全肺切除2例,中叶楔形切除1例,剖胸探查活检1例。结果恶性肿瘤18例,良性病变12例。本组无手术死亡。术后并发切口感染2例,胸腔积液2例。结论中叶病变的诊断要将恶性肿瘤放在首要位置考虑。对诊断不明、内科治疗无效的中叶不张应尽早手术,手术难易程度及切除范围变化较大。     

鼻内翻性乳头状瘤的手术方式探讨

目的针对根治和微创如何选择术式,在一些研究的基础上结合临床分期对进一步优化手术方式做了一些临床探讨。方法参考Krouse的NIP临床分期标准对57例NIP进行分期,根据分期对2例(1期)进行单纯鼻内镜手术,53例(2～3期)采取鼻内镜联合上颌窦进路,2例(4期)采取鼻侧切开上颌骨部分切除手术。结果本组鼻内镜联合上颌窦进路配合术后治疗对Krouse三期以内肿瘤治疗的复发率为10.9%。结论鼻内镜联合上颌窦进路对Krouse三期以内肿瘤可以彻底切除、配合术后治疗控制了复发率,避免了面部切口以及术后舒适度明显改善。     

肝外胆管癌的诊断方法和外科治疗的临床效果

目的分析评价肝外胆管癌的诊断方法和外科治疗的临床效果。方法回顾性分析73例肝外胆管癌的病理特点,临床诊断及外科治疗方法。结果35例经手术及病理检查证实,其中腺癌占94.3%,腺鳞癌为5.7%。47例行手术治疗(64.4%),11例行PTCD或ERCD引流减黄,15例放弃治疗。手术切除22例(切除率46.8%),姑息性内外引流术25例,二者手术并发症率及死亡率为45.5%与40%和13.6%与8%,并均无统计学差异。手术切除术组中19例获得随访,手术切除组疗效优于其他治疗组(P<0.05),而手术引流及介入引流减黄治疗有明显地改善生活质量,延长生存期的作用。结论手术切除仍然是治疗肝外胆管癌最有效手段,部分患者可获得治愈性切除而长期生存。     

早期乳腺癌保留乳房治疗13年疗效观察

目的评价早期乳腺癌保留乳房治疗的远期疗效。方法57例乳腺癌病人年龄32～67岁,平均年龄46.3岁。选择指征:(1)肿瘤直径<3cm。(2)肿瘤距乳头>3cm。(3)单发肿瘤。(4)查体腋下无质硬淋巴结。按乳腺癌TNM分期为0期、I期、IIA期病人。手术方法是肿瘤扩大切除,将肿瘤连同周围2cm正常组织一并切除。根据切缘快速病理检查结果阴性保乳,反复阳性需改行改良根治术。本组病人部分I期、II期在术后行化疗、全部放疗及部分内分泌治疗。结果本组病例切缘均为阴性,腋下淋巴结无转移者46例,1～3枚淋巴结转移者11例,随访13年,局部复发率5.4%(2/57),总生存率91%(52/57)。美容效果满意率87.7%(50/57)。结论(1)保乳手术治疗早期乳腺癌与同期乳腺癌根治术有相同的生存率。(2)保留乳房外形提高病人生存质量。(3)术前严格掌握手术适应证,术后规范综合治疗是保乳手术获得良好疗效的保证。     

124例早期乳腺癌患者行保乳手术临床疗效分析

目的 观察早期乳腺癌保乳手术的治疗效果。方法 回顾分析2006年8月至2011年4月将I、II期乳腺癌患者共124例随机分为保乳手术组(治疗组60例)和改良根治术组(对照组64例)进行对比观察。采用肿瘤局部扩大切除或象限切除,以及腋淋巴结清扫,术后辅以放疗、化疗或内分泌治疗。残留腺体做阶梯状对缝,以保证乳晕部的隆起。结果 所有患者随访11～51个月,平均37个月。随访所有患者无死亡,无肿瘤局部复发,2例于术后43个月出现肺内转移,3年总存活率100%,局部复发率0%,无瘤生存率98.36%。12例皮肤有放疗后色素沉着,约占9.68%(6/62)。4例出现皮下积液。2组手术出血量、手术时间、住院时间比较差异有非常显著性。并发症发生率、生存率,比较差异无显著性。结论 保乳手术创伤小、并发症少、恢复快、形体改变小,疗效满意,病人心理状态良好,生存质量较高。     

Differential Expression of Peroxisomal Proteins in Distinct Types of Parotid Gland Tumors

Salivary gland cancers are rare but aggressive tumors that have poor prognosis and lack effective cure. Of those, parotid tumors constitute the majority. Functioning as metabolic machinery contributing to cellular redox balance, peroxisomes have emerged as crucial players in tumorigenesis. Studies on murine and human cells have examined the role of peroxisomes in carcinogenesis with conflicting results. These studies either examined the consequences of altered peroxisomal proliferators or compared their expression in healthy and neoplastic tissues. None, however, examined such differences exclusively in human parotid tissue or extended comparison to peroxisomal proteins and their associated gene expressions. Therefore, we examined differences in peroxisomal dynamics in parotid tumors of different morphologies. Using immunofluorescence and quantitative PCR, we compared the expression levels of key peroxisomal enzymes and proliferators in healthy and neoplastic parotid tissue samples. Three parotid tumor subtypes were examined: pleomorphic adenoma, mucoepidermoid carcinoma and acinic cell carcinoma. We observed higher expression of peroxisomal matrix proteins in neoplastic samples with exceptional down regulation of certain enzymes; however, the degree of expression varied between tumor subtypes. Our findings confirm previous experimental results on other organ tissues and suggest peroxisomes as possible therapeutic targets or markers in all or certain subtypes of parotid neoplasms.     

豚鼠对EB病毒的易感性分析

目的建立豚鼠感染EB病毒(Epstein-Barr virus,EBV)动物模型,分析EBV对豚鼠的易感性。方法将EBV经鼻腔和口腔感染豚鼠,建立感染EBV动物模型。提取分离的豚鼠淋巴细胞总RNA,巢式PCR法检测EBNA1及BcLF1基因mRNA的表达水平;ELISA法检测豚鼠血清中抗EBV IgG抗体水平的变化。取豚鼠肝脏、肺、脾脏、腮腺进行病理分析。结果10只模型组豚鼠中有6只检测到BcLF1基因mRNA的表达,其中有4只同时检测到了EBNA1和BcLF1基因mRNA的表达;经双酶切及测序鉴定,扩增的EBNA1及BcLF1基因大小与预期相符。10只豚鼠血清中VCA IgG和EBNA-IgG抗体水平均有所升高。模型组中有5只豚鼠的肝脏、肺、脾脏、腮腺的组织发生不同程度的病变。结论豚鼠可作为EBV感染动物模型的备选动物。     

显微手术切除听神经瘤32例

目的总结听神经瘤的显微手术操作技巧及分析面神经保留技术。方法回顾性分析研究2007年6月至2009年2月间显微手术治疗听神经瘤32例。结果肿瘤全切除30例(94%),近全切2例(6%),面神经解剖保留29例(91%),3例(9%)解剖未能保留面神经。结论显微手术治疗听神经瘤是安全和有效的方法,熟练的手术技巧是面神经保留的关键。     

不同代次F基因型SP-A株腮腺炎病毒在恒河猴体内的致病性

目的观察不同代次F基因型SP-A株腮腺炎病毒在恒河猴体内的致病性。方法选取腮腺炎病毒SP-A株在KMB17细胞上传至15、20、30代的活病毒作为实验组,在Vero细胞上传至第2代的病毒作为野毒株对照组,分别接种恒河猴腮腺。观察实验动物体温和临床体征。活体取双侧腮腺,进行组织病理检查,并检测腮腺炎病毒中和抗体。结果对照组动物出现了明显的体温升高,一般状况较差,注射后第5天出现腮腺肿大,组织病理检查表现为淋巴细胞大量浸润。而各实验组动物均未出现腮腺炎症状和明显的组织病理学变化。各组动物接种病毒后均能产生抗腮腺炎病毒的中和抗体,但对照组的中和抗体GMT水平均高于各实验组。结论腮腺炎病毒SP-A株传至第15代次,已无致腮腺炎发病能力,为开发F基因型腮腺炎病毒减毒活疫苗奠定了基础。     

Phospholipid profiles in the salivary glands of rats of different ages

It has been reported that diabetes and Sj?gren's syndrome patients exhibit variations in the amount of salivation and in the lipid components in saliva and salivary glands. We examined whether lipid compositions, especially phospholipid ones in the salivary glands of rats varied with aging. We analyzed phospholipid and fatty acid compositions in the salivary glands of young (5 to 6 weeks), adult (20 weeks), and old (50 weeks) rats and biochemical components in their blood. The aging (adult and old) rats had higher triacylglycerol, total lipid, total cholesterol and glucose contents in the plasma than the young one. The aging ones also had higher total lipid contents in the major salivary glands (parotid, submandibular and sublingual glands). They had higher wet weights of the major salivary glands and epididymal fat pads than the young ones, but had lower ratios of the major salivary glands to body weight. All of them had high phospholipid contents in the parotid and submandibular glands as compared to sublingual gland, but the aging ones had lower percentage of phospholipid contents of all salivary glands. Phosphatidylcholine and phosphatidylethanolamine were predominant among the phospholipids in the major salivary glands, and little difference was observed in phospholipid composition among the three groups. Palmitic and stearic acids (saturated acids), and linoleic, oleic and arachidonic acids (unsaturated acids) were major components of fatty acids of phospholipids in the major salivary glands. The aging ones had higher linoleic and lower arachidonic acid contents in the glands than the young one. In summary, the aging rats had higher total lipid contents than the young ones and had lower phospholipid contents of the major salivary glands. The n-6 fatty acid contents differed between aging and young ones. The results suggest that phospholipids in the major salivary glands change with the development of rat.     

No Major Role for Binding by Salivary Proteins as a Defense Against Dietary Tannins in Mediterranean Goats

We investigated whether Mediterranean goats use salivary tannin-binding proteins to cope with tannin-rich forages by determining the affinity of salivary or parotid gland proteins for tannic acid or quebracho tannin. Mixed saliva, sampled from the oral cavity, or parotid gland contents were compared to the intermediate affinity protein bovine serum albumin with a competitive binding assay. Goats that consume tannin-rich browse (Damascus) and goats that tend to avoid tannins (Mamber) were sequentially fed high (Pistacia lentiscus L.), low (vetch hay), or zero (wheat hay) tannin forages. Affinity of salivary proteins for tannins did not differ between goat breeds and did not respond to presence or absence of tannins in the diet. Proteins in mixed saliva had slightly higher affinity for tannins than those in parotid saliva, but neither source contained proteins with higher affinity for tannins than bovine serum albumin. Similarly, 3 months of browsing in a tannin-rich environment had little effect on the affinity of salivary proteins for tannin in adult goats of either breed. We sampled mixed saliva from young kids before they consumed forage and after 3 months of foraging in a tannin-rich environment. Before foraging, the saliva of Mamber kids had higher affinity for tannic acid (but not quebracho tannin) than the saliva of Damascus kids, but there was no difference after 3 months of exposure to tannin-rich browse, and the affinity of the proteins was always similar to the affinity of bovine serum albumin. Our results suggest there is not a major role for salivary tannin-binding proteins in goats. Different tendencies of goat breeds to consume tannin-rich browse does not appear be related to differences in salivary tannin-binding proteins.     

MicroRNA Expression Profiles in Superficial Esophageal Squamous Cell Carcinoma before Endoscopic Submucosal Dissection: A Pilot Study

Esophageal squamous cell carcinoma (ESCC) has a poor prognosis when diagnosed at an advanced stage, and early detection and treatment are essential to improve survival. However, intraobserver and interobserver variation make the diagnosis of superficial ESCC difficult, and suitable biomarkers are urgently needed. Here, we compared the microRNA (miRNA) expression profiles of superficial ESCC tissues and adjacent normal tissues obtained immediately before esophageal endoscopic submucosal dissection. We found that ESCC and normal tissues differed in their miRNA expression profiles. In particular, miR-21-5p and miR-146b-5p were significantly upregulated and miR-210-3p was significantly downregulated in tumor tissues compared with normal tissues. We also detected significant associations between miRNA expression and ESCC invasion depth and lymphovascular invasion. The same differential expression of miR-21-5p, miR-146b-5p, and miR-210-3p was detected in ESCC cell lines compared with normal esophageal epithelial cells in vitro. However, transfection of ESCC cells with miR-210-3p and miR-21-5p mimics or inhibitors had partial effects on cell proliferation and invasion in vitro. These results indicate that miRNA expression is significantly deregulated in superficial ESCC, and suggest that the potential contribution of differentially expressed miRNAs to the malignant phenotype should be further investigated.     

A Study on Modern High Effective Random Packings for Ethanol‐Water Rectification

Raschig Super‐Ring is a modern and high‐efficient packing used for intensification of absorption and distillation processes. The aim of this work is to characterize the efficiency of this packing applied to rectification of an important industrial system, ethanol‐water, and to compare its efficiency to that of some random packings of the third generation as well as to the structured packing, HOLPACK, which is used in the ethanol production industry. The experiments were carried out in a column installation, 0.213 m in diameter with a packing height of 2.8 m. The column is heated by a number of electrical heaters (total power 45 kW), which can be switched gradually. Operation at total and partial reflux is possible. Eight types of random packings were studied: five types of Raschig Super‐Ring, four metallic (with characteristic dimensions 0.5, 0.6, 0.7, and 1”) and one of plastic material 0.6”; two types of packing IMTP and one plastic Ralu Flow. Some experiments were conducted at total reflux operation at vapor velocity, 0.253–0.936 m/s, and liquid superficial velocity, 4.44 · 10^–4–1.63 · 10^–3 m³/(m²s). Experiments at partial reflux were carried out at constant liquid superficial velocity and changeable vapor velocity as well as at constant vapor velocity and changeable liquid velocity. The results are presented as height of transfer unit, HTU, and height equivalent to a theoretical plate, HETP, as a function of the velocity of phases.     

超声引导下麦默通旋切系统在乳腺微创外科中的应用

目的探讨超声引导下麦默通旋切系统在乳腺微创外科中的应用价值。方法2006年10月至2007年12月在超声引导下对96例患者142个乳腺病灶应用麦默通微创切除术,分析其在乳腺微创外科中的应用价值。结果术中超声检查证实肿块完整切除,乳房内血肿2例,局部皮下淤血3例。病理结果显示:浸润性导管癌3例(3.1%);乳腺导管内癌2例(2.0%),其余均为良性病变,乳腺纤维瘤40例,乳腺腺病45例,乳腺导管内乳头状瘤6例,病理诊断良性病变患者术后临床和超声检查随访均未发现肿块复发。结论超声引导下麦默通旋切系统对30mm以下乳腺病灶可进行微创完整切除并可获得明确的病理学诊断,具有穿刺准确、创伤小、操作简单、安全、并发症少等优点。     

Transient Activation of Hedgehog Signaling Inhibits Cellular Senescence and Inflammation in Radiated Swine Salivary Glands through Preserving Resident Macrophages

Salivary gland function is commonly and irreversibly damaged by radiation therapy for head and neck cancer. This damage greatly decreases the patient’s quality of life and is difficult to remedy. Previously, we found that the transient activation of Hedgehog signaling alleviated salivary hypofunction after radiation in both mouse and pig models through the inhibition of radiation-induced cellular senescence that is mediated by resident macrophages in mouse submandibular glands. Here we report that in swine parotid glands sharing many features with humans, the Hedgehog receptor PTCH1 is mainly expressed in macrophages, and levels of PTCH1 and multiple macrophage markers are significantly decreased by radiation but recovered by transient Hedgehog activation. These parotid macrophages mainly express the M2 macrophage marker ARG1, while radiation promotes expression of pro-inflammatory cytokine that is reversed by transient Hedgehog activation. Hedgehog activation likely preserves parotid macrophages after radiation through inhibition of P53 signaling and consequent cellular senescence. Consistently, VEGF, an essential anti-senescence cytokine downstream of Hedgehog signaling, is significantly decreased by radiation but recovered by transient Hedgehog activation. These findings indicate that in the clinically-relevant swine model, transient Hedgehog activation restores the function of irradiated salivary glands through the recovery of resident macrophages and the consequent inhibition of cellular senescence and inflammation.