Objective To introduce the methods and the advancements of early diagnosis in primary carcinoma of gallbladder (PCG), and improve the early diagnostic rate of PCG. Methods Recent relevant literatures were reviewed. Results It was difficult in early diagnosis of PCG and with a poor prognosis. Comprehending case history and careful examination and being assisted by multiple imaging methods and molecular biology technology could markedly improve the early diagnostic rate. Conclusion Comprehending the progress will contribute a lot of improving the early diagnostic rate and selecting reasonable clinical methods to be used in early diagnosis of PCG.
目的 评价3DMax补片在腹腔镜下全腹膜外修补术(totally extraperitoneal,TEP)中修补腹股沟疝的价值。方法 回顾性分析我院2009年2～6月期间腹腔镜下应用3DMax补片对18例腹股沟疝患者行TEP的临床资料，分析其手术时间、住院时间、复发和并发症发生情况。结果 18 例患者中Ⅰ型疝3例，Ⅱ型疝4例，Ⅲ型疝9例，Ⅳ型疝2例； 斜疝11例，直疝6例，股疝1例。成功完成腹腔镜下TEP 17例。1例因疝内容物为末端回肠，与疝囊粘连并局部狭窄梗阻，中转开放手术切除部分回肠。手术时间40～95 min，平均65.4 min。术后均未使用镇痛剂，术后住院时间2～7 d，平均住院5.5 d。术后发生阴囊血清肿1例，经穿刺排液后愈合良好。随访1～6个月，无复发病例。结论 腹腔镜下TEP具有创伤小、恢复快、复发率低等优点，采用预先成型的3DMax 补片使手术操作更加简便。
ObjectiveTo summarize the surgical treatment and explore factors which influencing prognosis of hilar cholangiocarcinoma. MethodsClinical data of 189 cases of hilar cholangiocarcinoma who treated in our hospital from Jan. 2000 to Dec. 2010 and clinicopathological factors that might influence survival were analyzed retrospectively. A multivariate factor analysis was performed through Cox proportional hazard model. ResultsOf 189 cases, 62 cases received radical resection, 54 cases received palliative surgery, and 73 cases received non-resection surgery. Operative procedure (RR=0.165), differentiated degree (RR=2.692), lymph node metastasis (RR=3.014), neural infiltration (RR=2.857), and vascular infiltration (RR=2.365) were found to be the statistically significant factors that influenced survival by multivariate factor analysis through the Cox proportional hazard model. ConclusionsRadical resection is the best treatment for hilar cholangiocarcinoma. Skeletonized hepatoduodenal ligament, complete excision of infiltrated nerve and blood vessel are important influence factors to improve the prognosis of hilar cholangiocarcinoma.
【Abstract】Objective To investigate the diagnosis and treatment of primary small intestinal tumor (PSIT). MethodsEighty-eight cases of PSIT were analyzed in our hospital retrospectively. Results Thirty-six cases were diagnosed before operation, 52 cases were misdiagnosed and the percentage amounted to 59.1%. The major clinical manifestations of PSIT were abdominal pain (66 cases, 75.0%), obstruction (56 cases, 63.6%), abdominal mass (51 cases, 58.0%) and stool with blood (48 cases, 54.5%).The major pathological types of PSIT were adenocarcinoma (55.7%), sarcoma of smooth muscle (25.0%), lymphoma (13.6%), fatty sarcoma (5.7%). The tumors of 36 cases located in jejunum (40.9%), 34 cases in ileum (38.6%) and 18 cases in duodenum (20.5%).Conclusion It is difficult to diagnose PSIT before operation. The following advice could help to get a correct diagnosis: ① Surgeons should be alert when meeting a patient with the above symptoms, and then collect and analyze the clinical data comprehensively. ②Patients over 40 years with complaints of inexplicable abdominal pain, weight loss, anemia, dyspepsia and abdominal mass should be examined appropriately by gastrointestinal X-ray, gastrointestinal endoscopy, ultrasonography, CT and angiography of superior mesenteric artery. ③When the diagnosis can’t be confirmed, an exploratory operation should be performed immediately to avoid the delay of treatment. ④The treatment of PSIT includes radical resection of small intestine and chemotherapy according to the pathological results of tumor.
Objective To observe the expression of Ezrin protein in primary carcinoma of gallbladder tissue and the levels of CEA and CA19-9 in serum of patients with primary carcinoma of gallbladder, and to explore the relationship between the expressions of these measurements and clinicopathologic characteristics. Methods Immunohistochemistry was applied to analyze the expression of Ezrin protein in primary carcinoma of gallbladder and chronic cholecystitis tissue. The levels of CEA and CA19-9 in serum and clinicopathologic characteristics of all including patients were detected with clinical measurement. All data were analyzed statistically. Results ①The positive rates of Ezrin protein in primary carcinoma of gallbladder and chronic cholecystitis tissue were 66.7% （40/60） and 30.8%（4/13）, respectively (χ2=5.57, Plt;0.05). ②There was no difference between the expression of Ezrin protein in primary carcinoma of gallbladder tissue and age or gender (Pgt;0.05). However, difference was significant between the Ezrin expression and degree of difference, pNevin stages, pTNM stages, lymph node metastasis or distant metastasis (Plt;0.05). ③There were no differences between the positive rates of CEA and CA19-9 in primary carcinoma of gallbladder and age or gender (Pgt;0.05). However, differences were significant between the positive rates of CEA and CA19-9 and pNevin stages, pTNM stages, degree of difference, lymph node metastasis or distant metastasis (Plt;0.05). ④There was some relationship between the expression of Ezrin protein and the positive rate of CEA (rs=0.213, Plt;0.05), but not with the positive rate of CA19-9 (rs=0.081, Pgt;0.05). Conclusions The high expression of Ezrin protein may promote the invasion and metastasis in primary carcinoma of gallbladder. It could be possible to decide the outcome of primary carcinoma of gallbladder through the combined analysis on the expression of Ezrin protein and the serum levels of CEA and CA19-9.
Objective To obtain the polypeptides specifically binding to gastric cancer BGC823 cell from a Ph.D-12 TM phage display peptide library (PDPL), to search the markers of gastric cancer for early diagnosis and treatment. Methods The gastric cancer BGC823 cell was used as the antigen and the immortalized gastric epithelial GES cell was used as control for 3 rounds subtraction biopanning from PDPL at room temperature. The positive and specific binding clones were identified by cell enzyme-linked immunosorbent assay (ELISA) and immunochemistry staining. Those DNA sequences of identified clones were sequenced, polypeptides were marked by fluorescein FITC peptide tag, and polypeptides affinity and specificity of gastric cancer cells and tissues were identified. Results After 3 rounds of panning, 20 phage clones were identified by ELISA, one of which （GC-11） was specially binding to the BGC823. Cell and tissue immunofluorescence assay further presented a high affinity of fluorescein-labeled peptide FITC-GC-11 with BGC823 and gastric cancer tissue.Conclusion A peptide GC-11 which is specific binding to gastric cancer BGC823 cell and gastric cancer tissue has been selected from PDPL.
【Abstract】ObjectiveTo evaluate the advances in minimally invasive surgery treatment for hepatolithiasis. MethodsLiteratures about the advances in minimally invasive surgery treatment for hepatolithiasis were collected and reviewed. ResultsHepatectomy and bile duct exploration using laparoscopy can get better effect. Fibrocholedochoscopy play an important role in the course of operation and after operation for hepatolithiasis. ConclusionThe individualization treatment program should be used for hepatolithiasis. Association application of multipathway minimally invasive operation, such as laparoscopy, fibrocholedochoscopy and so on, can increase the cure rate of hepatolithiasis.