腹腔镜辅助右半完整结肠系膜切除术(附视频)

德国的HOHEnbErgEr[1]在2009年提出了完整结肠系膜切除(COMPlETE MESOCOlIC EXCISIOn,CME)作为结肠癌规范化手术的新理念。该理念阐述的是直视下在结肠系膜脏壁两层筋膜间隙内锐性分离,以保证结肠及其系膜脏层的完整,并在系膜血管根部高位结扎,以此达到淋巴结的最大化清扫并减少肿瘤的局部复发和转移。对照HEAld提出的全直肠系膜切除术(TOTAl MESOrECTAl EXCISIOn,TME),发现CM

Do not forget the beginning mind, always have to Listen to—— Yi Zhongtian on medicine and humanities

医学本身蕴含着丰富的人文精神,人文关怀既表现为对患者生命、人格的尊重,也体现了医务人员的职业素质和人格力量。彰显医学的人文关怀,是以人为本的重要体现。医务人员应执守以人为本的“初心”,它不仅是对医生的要求,更是对整个医疗服务的期望。Medicine itself contains a wealth of humanistic spirit, humanistic care is not only the respect for the patient＇s life and personality, but also the reflex of professional quality and personality strength of medical staff. The highlight of the humanistic careis an important manifestation of people-oriented medicine. The medical staff should keep the very beginning mind of human-oriented, it is not only the request of the doctor, but also the expectation of the whole medical service

The identity and differences of right colon cancer surgery CME between China and German

德国HOHEnbErgEr先生提出的结肠癌完整系膜切除(COMPlETE MESOCOlIC EXCISIOn,CME)手术概念,已逐渐得到我国外科医生的认可和重视。但右半结肠癌完整系膜的上缘和内侧缘在哪里更符合CME要求呢？d3手术作为右半结肠CME手术的方法合理吗？是否有更符合CME理念的右半结肠癌根治手术方法呢？笔者将腹腔镜右半结肠CME手术方法与HOHEnbErgEr先生的CME进行对比阐述,以探讨右半结肠CME手术方法的合理性。The concept of complete mesocolic excision(CME)in colon cancer surgery proposed by professor Hohenberger from German,has been accepted and valued by Chinese surgeons.However,how to determine the upper edge and medial edge of the complete mesocolic excision for right colon cancer(RCME),and which will be more consistent with the requirements of CME? Whether the D3 surgery(Hemicolectomy with D3 lymph node dissection)is a reasonable surgical approach to RCME or not? Are there other surgical approaches to the right colon cancer radical surgery which are more in line with the concept of CME? By comparing the author's surgical approach to laparoscopic complete mesocolic excision for right colon cancer( L-RCME) with Mr.Hohenberger's surgical method in CME,we investigate the rationality of surgical approach to the complete mesocolic excision for right colon cancer

Effect and mechanism of TIPE3 interference plasmid on SW480 colorectal cancer growth

目的:通过TIPE3干扰质粒转染SW480结肠癌细胞,验证干扰TIPE3表达对SW480结肠癌细胞生长的影响并探讨相关机制。方法:构建TIPE3; -shRNA-pSIREN-RetroQ干扰质粒,通过脂质体转染法成功将干扰质粒导入SW480细胞,通过RT-PCR、Western; blot检测重组质粒的干扰效率。应用CCK-8方法检测SW480细胞生存率。AnnexinV-FITC/PI流式细胞法检测细胞凋亡。使用West; ern; blot检测细胞增殖、凋亡相关分子的表达情况。结果:成功设计、构建和筛选具有生物活性且干扰效率最佳的TIPE3-shRNA-pSIREN-Ret; roQ干扰质粒。CCK-8检测证实干扰SW480结肠癌细胞TIPE3表达可以抑制细胞生长。流式结果显示,TIPE3-shRNA3干扰组的凋亡率为; (27. 991. 087) %,显著高于正常细胞组(12. 102. 213) %及转染空载质粒组(11. 440. 277 0); %。证实了降低TIPE3表达可以增加SW480对aDR5ScFv所诱导的细胞凋亡敏感性。Western; blot结果显示干扰TIPE3表达可以活化caspase3蛋白,降低p-AKT、p-PDK1、PCNA等分子的表达。结论:干扰TIPE3的表达对; SW480结肠癌细胞具有促进凋亡,抑制增殖的作用。Objective: To study the effect of interference TIPE3 on the colon cancer; cell growth by transfecting SW480 colon cancer cells with the TIPE3; interference plasmid were detected. Methods: Transfecting the; constructed TIPE3-shRNA-pSIREN-RetroQ plasmid to SW480 cells. To; determine the highest interference efficiency plasmid, the mRNA and; protein levels of recombined plasmid were detected by RT-PCR and Western; blot separately and tested the cell proliferation with CCK8. Meanwhile,; apoptosis rate of SW480 cells was determined by flow cytometry assay; with AnnexinV-FITC/PI. To further determined the effects of recombined; plasmid on cell development, the level of protein involved in; proliferation and apoptosis were detected by Western blot. Results: The; most effecient interference plasmids were successfully constructed. We; found that the cell survival rate decreased when interference TIPE3 gene; expressing in colorectal cancer cells. Flow cytometry indicated that; interefering the expression of TIPE3 would increase the sensitivity of; SW480 cell to apoptosis induced by aDR5ScFv. The results of Western blot; showed that low expression of TIPE3 would activate caspase3 and; downregulate the expression of p-AKT,p-PDK1 and PCNA. Conclusion:; Interference TIPE3 could promote apoptosis and inhibit proliferation in; SW480 colon cancer cells.国家自然科学基金; 福建省属公益类科研院所基本科研专项项

右半结肠癌外科干淋巴结转移及微转移的临床研究

目的探讨右半结肠外科干淋巴结清除的临床意义。方法对进展期右半结肠癌32例患者行外科干淋巴结清扫,并将所得淋巴结行常规病理染色检测及癌胚抗原(CEA)、上皮抗原(EMA)免疫组织化学(免疫组化)微转移检测。结果常规病理外科干淋巴结转移率9.4%(3/32)。CEA、EMA表达阳性率分别为31.2%(10/32)及37.5%(12/32),CEA和EMA联合检测阳性率46.9%(15/32)。DukesB、C期结肠癌淋巴结微转移率分别为29.4%(5/17)及66.7%(10/15),两者比较差异有统计学意义(P<0.05)。结论对进展期右半结肠癌外科干淋巴结行CEA、EMA免疫组化微转移检测,有利于更精确地了解淋巴结转移范围

实时聚合酶链反应熔解曲线分析检测APC基因突变

目的建立一种准确、方便、价廉、适合临床的APC基因突变检测方法。方法采用SYBRGreenⅠ为实时聚合酶链反应(PCR)指示剂,首先从基因组DNA中扩增包含突变位点的靶基因(270bp),并通过熔解曲线分析确定产物;再以上述片段为模板扩增特定长度的小片段(40/35bp),以0.5℃/step的速率,获得从65℃到99℃的熔解曲线以检测APC_1309位5bp缺失突变。结果临床标本检测结果表明:18例结直肠肿瘤患者石蜡组织标本中检出APC_1309位5bp缺失突变7例,20例正常人外周血标本检测结果均为阴性。结论实时PCR熔解曲线法设计简单,操作简便,结果可靠,可望应用于临床APC基因突变检测,并可推荐用于其他基因突变的检测

Dieulafoy病的诊断与治疗(附9例病例分析)

目的　探讨Dieulafoy病的临床特点诊断及治疗方法。方法　回顾性分析9例Dieu lafoy病的临床表现、诊断、治疗方法。结果　均为上消化道大出血。胃镜确诊8例。手术确诊1例,胃镜下治愈7例。手术治愈2例。结论　提高对本病认识,急诊胃镜是首选诊断方法。内镜下止血为首选治疗方法,反复出血应及时转外科手术

Construction and identification of interference plasmid targeting on TNFAIP8

目的:构建并筛选出干扰效率最佳的TnfAIP8-SHrnA-P SIrEn-rETrO Q干扰质粒。方法:通过生物软件选择3个TnfAIP8基因干扰位点,构建干扰质粒并测序验证,将干扰质粒及对照质粒分别转染至A549细胞,通过rT-PCr、WESTErn blOT检测干扰效率。结果:经rT-PCr和WESTErn-blOT证实TnfAIP8-SHrnA-P SIrEn-rETrO Q干扰质粒能有效干扰并抑制细胞内TnfAIP8基因的表达,通过流式检测发现降低TnVAIP8表达可以提高细胞对A dr5SC fV诱导凋亡的敏感性。结论:成功构建和设计了对TnfAIP8基因具有显著干扰效率的干扰质粒,为进一步研究TnfAIP8基因的功能奠定了基础。Objective: To construct and screen the high efficiency interference plasmid of TFAIP8-shRNA-p SIRENRetro Q.Methods: Selected and synthesized three Target Sequence of TNFAIP8 shRNA1,TNFAIP8 shRNA2,TNFAIP8 shRNA3,and construct the TNFAIP8 interference plasmid.Transfection TNFAIP8-shRNA-p SIREN-Retro Q interference plasmid to A549 cells.Filter out the highest interference efficiency plasmid by detecting the mRNA and protein levels using RT-PCR and Western blot methods.Results: We successfully design and built three TNFAIP8-shRNA-p SIREN-Retro Q interference plasmids,and screen out the highest efficiency interference plasmid.Conclusion: Three interference plasmids targeting the TNFAIP8 gene have been constructed successfully and provide a useful tool for studying the function of TNFAIP8.国家自然科学基金项目(81272720); 福建省卫计委医学创新课题(2014-CXB-43); 厦门市科技计划项目(3502Z2083008)资

ERK干扰质粒的构建及对胃癌细胞株BGC823 DcR3表达的影响

目的探讨胃癌发展的分子机制,通过构建ERK1/2shRNA真核表达载体,体外研究其对人胃癌细胞株BGC823ERK1/2蛋白及DcR3表达水平的影响。方法应用PRNAT-U6.1/Neo载体构建ERK1/2基因shRNA重组质粒,经脂质体法导入BGC823细胞中,分别设置对照组、干扰组和U0126抑制剂组。Westernblot法检测转染后BGC823细胞及抑制剂使用后ERK1/2蛋白的表达变化,荧光显微镜检测质粒自带GFP基因的表达情况确认转染效率,ELISA法检测各组细胞上清中DcR3分泌蛋白的表达特点。结果成功构建ERK1/2基因shRNA重组质粒。证明了ERK1/2蛋白的表达与DcR3的分泌水平在BGC823细胞株中呈正相关。结论 ERK1/2干扰质粒明显降低BGC823细胞的ERK1/2蛋白表达水平,ERK信号通路对DcR3的分泌具有重要调控作用,为其下游调控机制的研究奠定了基础

The expression of TNFAIP8 in gastric cancer and its clinical significance

目的通过检测胃癌组织中肿瘤坏死因子α诱导蛋白8(TnfAIP8)的表达,探讨其与胃癌临床病理参数的关系及与胃癌发生发展的关系,揭示胃癌的发病机制。方法采用免疫组化SP法,检测50例胃癌以及50例正常胃粘膜中TnfAIP8的表达。结果 50例正常胃粘膜组织中TnfAIP8无表达,而在50例胃癌组织中TnfAIP8阳性表达13例,TnfAIP8阳性率为26%。低分化胃癌组TnfAIP8阳性表达率明显高于中分化腺癌组(P<0.05);Ⅲ期胃癌组TnfAIP8阳性表达率明显高于Ⅱ期胃癌组(P<0.05);有淋巴结转移组TnfAIP8阳性表达明显高于无淋巴结转移组;TnfAIP8在不同性别和年龄的胃癌组织中无差异。结论 TnfAIP8的表达与患者的性别和年龄无关,而与胃癌的组织学分级、胃癌的TnM分期和淋巴结转移有相关性。TnfAIP8在胃癌组织中表达率较正常胃粘膜升高,差异有统计学意义(P<0.05),提示TnfAIP8可能参与了胃癌的发生、发展。Tumor necrosis factor-α induced protein-8(TNFAIP8) is a recently discovered antiapoptotic molecule.Recent data have demonstrated that TNFAIP8 is involved in the regulation of apoptosis,cellular signaling cascade,tumor proliferation and invasion,as well as metastasis.In this study,we aimed to investigate the expression of TNFAIP8 in patients with gastric cancer and their relationships with clinicopathology.We detected the expression of TNFAIP8 in 50 cases of gastric cancer and 50 cases of normal gastric tissues with SP immunohistochemical.In gastric cancer,the expression of TNFAIP8 was located in cytoplasm and/or nucleolus of tumor cells;the expression of TNFAIP8 in patients with gastric cancer(26%) was higher than that in the normal gastric tissues(0%,P﹤0.05).And the expression of TNFAIP8 in poor differentiated adenocarcinoma of gastric was higher compared with that in well differentiated(P < 0.05),the same difference was fund between Ⅲ andⅡ stages of adenocarcinoma.However,the expression of TNFAIP8 was on significant difference among different person with different age and gender.The results suggest that the expression of TNFAIP8 is not related with patient gender or age,but related with the stage of disease.And the expression of TNFAIP8 may be involved in the generation and development of gastric cancer.福建省自然基金(2010D009