目的 总结腹部手术后胃瘫综合征（PGS）的病因、诊断及治疗方法。方法回顾性分析我院2003年1月至2009年3月期间行腹部手术后发生胃瘫的30例患者的临床资料。结果 PGS发生于术后5～10 d，通过临床表现、上消化道造影及胃镜检查明确诊断。全组均经营养支持、药物治疗等保守治疗后治愈，治愈时间14～62 d，平均25 d。结论 PGS是由多种因素导致的,上消化道造影及胃镜检查是诊断PGS的可靠方法,保守治疗为其主要治疗手段，应尽量避免再次手术。
Objective To summarize risk factors of pancreatic fistula after pancreaticoduodenectomy and to investigate clinical application of pancreatic fistula risk prediction system. Method The literatures of the risk factors and risk prediction of pancreatic fistula after the pancreaticoduodenectomy were collected to make a review. Results There were many risk factors for pancreatic fistula after pancreatoduodenectomy, including the patient’s own factors (gender, age, underlying diseases, etc.), disease related factors (pancreatic texture, diameter of pancreatic duct, pathological type, etc.), and surgical related factors (operation time, intraoperative blood loss, anastomosis, pancreatic duct drainage, etc.). The fistula risk prediction system after the pancreatoduodenectomy had a better forecast accuracy. Conclusions Occurrence of pancreatic fistula after pancreaticoduodenectomy is related to softness of pancreas and small diameter of pancreatic duct. Pancreatic fistula risk prediction system is helpful for prevention of pancreatic fistula after pancreaticoduodenectomy.
ObjectiveTo summarize the experience of diagnosis and treatment of pancreatic cystic neoplasms (PCN).MethodThe general information, imaging findings, preoperative blood biochemical indexes, tumor markers, operation related data, postoperative complications, and pathological results of patients with PCN confirmed by pathological examination in Affiliated Hospital of Xuzhou Medical University from January 1, 2014 to December 31, 2019 were retrospectively analyzed.ResultsAmong the 158 patients who underwent surgical resection, the male to female ratio was 1∶1.6, and the median age was 56.2 years (range 26 to 82 years). Serous cystadenoma (SCN) was the most common, accounting for 34.2% (n=54), followed by mucinous cystadenoma (MCN) and intraductal papillary mucinous neoplasm (IPMN), accounting for 26.6% (n=42) and 20.2% (n=32). The proportion of solid pseudopapillary tumor (SPT) was the smallest, which was 19.0% (n=30). The PCN malignant rate was 19.0% (n=30), with the highest malignant rate being IPMN (43.8%, n=14), and the lowest being SCN (3.7%, n=2). Patients with PCN malignant group had significantly higher serum CA19-9, CEA, CA125, and neutrophil/lymphocyte ratio (NLR) than those in the benign group（all P<0.05）. The preoperative diagnosis of PCN was ambiguous, and the rate of misdiagnosis was high. The correct diagnosis rate of accurate preoperative specific classification was only 31.6% (n=50), and the lowest SCN (14.8%, n=8). High CA19-9, high NLR value, tumor location in the head/neck of pancreas and enhanced solid component were independent predictors of malignant PCN (P<0.05).ConclusionImproving the preoperative diagnosis ability of PCN and accurately determining the PCN classification before operation are helpful for the standardized treatment of PCN.
ObjectiveTo analyze the clinical effective of differentiated thyroid cancer and approach the correct treatment methods for it. MethodThe clinical and postoperative follow-up data of 137 patients with differentiated thy-roid cancer treated in this hospital from 2002 to 2012 were analyzed retrospectively. ResultsOne hundred and thirty-seven patients accepted individualization surgery, conventionalⅥregion lymph node dissection, and postoperative com-prehensive therapy.The rate of lymph node metastasis was 53.28%(73/137).Ⅵregion lymph node was confirmed to be positive by pathology which performedⅡ+Ⅲ+Ⅳregion lymph node dissection, the rate of lymph node metastasis was 41.10%(30/73).Multivariate analysis showed that penetrate capsule, pathologic type, and TNM stage were the independent risk factors for lymph nodes metastasis (P < 0.05).No death occurred perioperative period.The temporary hoarseness was found in 4 cases (2.92%), short-term hypocalcemia in 11 cases (8.03%).During postoperative average 6.5 years of follow-up, there were 5 cases (3.65%) of local recurrence, 11 cases (8.03%) of cervical lymph node meta-stasis, 3 cases (2.19%) of distant metastasis including 1 case of bone metastasis and 2 cases of pulmonary metastasis, and 16 cases (11.68%) of reoperation. ConclusionIndividualized surgical options, conventionalⅥregion lymph node dissection, and close follow-up management could reduce the postoperative complications and guarantee the treatment effect of differentiated thyroid cancer.
目的总结胰腺浆液性囊腺瘤的临床特点、诊治及预后情况。 方法对我院2003年6月至2013年6月期间收治的19例胰腺浆液性囊腺瘤患者的临床资料进行回顾性分析。 结果胰腺浆液性囊腺瘤好发于中老年女性（本组男女比例为1:3.75，发病平均年龄56.7岁）。患者首发症状：腹部疼痛不适12例，发现腹部包块2例，无特殊症状因体检发现5例。肿瘤部位：胰头及胰颈部8例，胰体部6例，胰尾部5例。肿瘤平均直径5.4 cm。CT及MRI术前诊断率分别为60.0%（9/15）、80.0%（8/10）。19例患者均成功手术并行病理检查，其中浆液性微囊性腺瘤15例，浆液性寡囊性腺瘤4例。有4例患者术后出现胰漏，其中1例合并腹腔感染，经内科治疗后痊愈。术后随访4～124个月，平均55个月，未见肿瘤复发。 结论胰腺浆液性囊腺瘤的临床表现无特异性，CT及MRI术前诊断价值较高。手术为最有效的治疗方法，预后良好。
ObjectiveTo investigate the expression of ubiquitin-specific protease 9X (USP9X) in pancreatic cancer, and to evaluate the correlation of USP9X with the survival of patients with pancreatic cancer. MethodThe expression of USP9X was detected in 55 pieces of surgically resected primary pancreatic cancer tissues and adjacent nontumorous pancreatic tissues by streptavidin-perosidase immunohistochemical method. ResultsThe rate of USP9X high expression in the 55 pieces of the primary pancreatic cancer tissues was 58.2% (32/55), which in the adjacent nontumorous pancreatic tissues was zero. The expression of USP9X was not correlated with the gender, age, tumor position, or tumor size (P > 0.05), while which was significantly correlated with the differentiation degree, lymph node metastasis, or TNM stage (P < 0.05). By using Cox proportional hazard model, the multivariable analysis revealed that the differentiation degree, lymph node metastasis, and USP9X expression were the independent risk factors. Survival of the patient with USP9X high expression was significantly shorter than that with USP9X low expression (P < 0.05), and there was the same result in the patients with stageⅡ, with lymph node negative, or intermediate differentiation degree (P < 0.05). ConclusionThe results indicate that USP9X might play an important role in the pathogenesis and prognosis of pancreatic cancer.
ObjectiveTo observe expre with ssions of insulin receptor substrate 1(IRS-1) and ubiquitin-protein in skeletal muscle of non-obese rats with type 2 diabetes mellitus following gastric bypass operation (GBP), and to investigate possible mechanism of GBP in improving insulin resistance. MethodsMale GK rats were randomly divided into diabetic operation group (DO group), diabetic sham operation group (DSO group), and diabetic control group (DC group), 8 rats in each group; besides 8 male Wistar rats were served as normal control group (NC group). Fasting body weight (FBW), fasting plasma glucose (FPG), and fasting insulin (FINS) were measured respectively before operation and on week 1, 2, 4 and 8 after operation. Homeostasis model-insulin resistant (HOMA-IR) index was calculated respectively before operation and on week 8 after operation. The expressions of IRS-1 protein and ubiquitin-protein in skeletal muscle were detected by using Western blot method on week 8 after operation. Results① Compared with the preoperative levels, the FBWs on week 1, 2, and 4 after operation markedly decreased (P < 0.05), but it recovered to the preoperative level on week 8 after operation (P > 0.05) in the DO group; which in the DSO group decreased on week 1 after operation (P < 0.05) and then increased on week 4 after operation (P < 0.05); which in the DC group or the NC group increased continuously and had a significant difference on week 8 after operation (P < 0.05).② The FPGs in the DO, DSO and DC groups were significantly higher than those of the NC group before operation (P < 0.05), which in the DO group decreased from (9.10±0.98) mmoL/L before operation to (5.70±0.91) mmol/L on week 8 after operation (P < 0.05) and were significantly lower than those of the DSO group or the DC group on week 2, 4, and 8 after operation (P < 0.05); which in the DC group, DSO group and NC group had no obviously changes between before and after operations (P > 0.05). ③ The FINS had no significant differences among these four groups before operation (P > 0.05), which in the DO group obviously increased[(9.64±1.59) mU/L] on week 2 after operation (P < 0.05) and then obviously decreased[(6.58±1.05) mU/L] on week 8 after operation (P < 0.05) and significantly lower than those of the DSO group or the DC group on week 8 after operation (P < 0.05), while which had no significant difference between before and after operations in the DSO group, the DC group, or the NC group (P > 0.05). ④ The HOMA-IR index in the DO, DSO or DC group was significantly higher than that of the NC group before operation (P < 0.05), which in the DO group markedly decreased from 3.18±0.50 before operation to 1.96±0.63 on week 8 after operation (P < 0.05) and significantly lower than that of the DSO group or the DC group on week 8 after operation (P < 0.05), while which had no significant difference between before and after operations in the DSO group, the DC group, or the NC group (P > 0.05). ⑤ The expression of IRS-1 protein in the DO group was significantly higher than that in the DSO group (P < 0.05) or the DC group (P < 0.05) on week 8 after operation. While there was no significant difference between the DSO and the DC group after operation (P > 0.05). ⑥ Compared with the NC group, the expression of ubiquitin-protein was significantly increased in the DO group, the DSO group, or the DC group (P < 0.05). Compared with the DSO group or the DC group, the expression of ubiquitin-protein was significantly decreased in the DO group on week 8 after operation (P < 0.05), especially it was most obvious near the molecular weight of 180×103. While there was no significant difference between the DSO group and the DC group after operation (P > 0.05). ConclusionsExpression of IRS-1 protein in skeletal muscle insulin signaling pathway in type 2 diabetes mellitus rats following GBP is increased, it might be associated with decreasing ubiquitin-protein level in skeletal muscle, thus reduces the IRS-1 ubiquitin-degradation, increase insulin sensitivity, and improve insulin resistance of skeletal muscle.
ObjectiveTo investigate the expressions of glucose transporter-4 (GLUT-4) and secreted protein acidic and rich in cysteine (SPARC) in adipose tissue of Goto-Kakizaki (GK)/Wister rats after gastric bypass operation (GBP), and to explore the possible mechanism of GBP improving insulin resistance.MethodsHealthy male GK rats were randomly divided into diabetic operation group (DO group, underwent GBP), diabetic sham operation group (DS group, underwent sham-operation), and diabetic control group (DC group, received no-treatment), Wister rats were set as normal control group (NC group, received no-treatment). The weight, fasting blood glucose (FPG), fasting serum insulin (Fins), and HbA1c were measured before operation and at the 1st, 2nd, 4th, and 8th week after operation. Quantitative insulin sensitivity check index (QUICKI) was measured in before operation and at the 8th week after operation, and the expressions of GLUT-4 and SPARC protein in adipose tissues were measured by Western Blot method at the 8th week after operative too.Results① Weight: the weight of the DO group was lower than preoperative at the 2nd and 4th week after GBP (P<0.05), but increased to the normal level at the 8th week after GBP (P>0.05). The weight of the DO group was lower than those of the DS group, DC group, and NC group at the same time point of 2nd, 4th, and 8th week (P<0.05). ② FPG: the FPG level of the DO group was lower than preoperative at the 2nd, 4th, and 8th week after GBP (P<0.05), and lower than those of the DS group and the DC group from 2nd to 8th week after GBP (P<0.05). The FPG level between the DS group and the DC group had no statistical significance (P>0.05). ③ Fins: the Fins level of the DO group was higher than preoperative at the 2nd week after GBP (P<0.05), and decreased gradually at 4th and 8th week but not significantly differed from the NC group at the same time point. At the 2nd week after GBP, the Fins level of the DO group was higher than those of the DS group and the DC group (P<0.05), but there was no statistical significance between the DS group and the DC group (P>0.05). ④ HbA1c: the HbA1c level of the DO group started to decrease but there was no statistical significance between preoperative and all time after GBP (P>0.05). There was no statistical significance among the 4 groups at the 8th week after GBP (P>0.05). ⑤ QUICKI: at the 8th week, the QUICKI value of the DO group was higher than preoperative (P<0.05), and at the same time, the QUICKI value of the DO group and the NC group were higher than those of the DS group and the DC group (P<0.05), but there was no statistical significance between the DO group and the NC group (P>0.05), as well as the DS group and the DC group (P>0.05). ⑥ GLUT-4 protein and SPARC protein: the expression of GLUT-4 protein of the DO group was dramatically higher than those of the DC, DS, and NC group (P<0.05), and the expression of SPARC protein of the DO group was dramatically lower than those of the DC, DS, and NC group (P<0.05) at the 8th week. But the expressions of GLUT-4 and SPARC protein had no statistical significance among the DS, DC, and NC group at the 8th week after GBP (P>0.05).ConclusionGBP may improve and increase the sensitivity of insulin resistance by regulating the expressions of GLUT-4 and SPARC protein in adipose tissue of GK rats.