NevinⅤ期胆囊癌的诊断和治疗

Diagnosis and treatment of Nevin Stage Ⅴ gallbladder cancer.

目的 总结NevinⅤ期胆囊癌的诊断和治疗经验。方法 对手术和病理确诊的NevinⅤ期胆囊癌 74例资料进行回顾性分析。结果 电脑彩超正确率达 75 0 % (2 1/2 8) ,CT结合增强扫描正确率达 82 1% (32 /39)。NevinⅤ期行根治性或扩大根治性胆囊癌切除术 2 3例 ,平均生存期为 1年 3个月 ;11例NevinⅤ期行姑息性胆囊切除 ,平均生存 5个月 ;NevinⅤ期仅能行剖腹探查和活检术、对症治疗 38例、腹腔镜探查和活检 2例 ,平均生存期仅 2个月。结论 对无手术禁忌证的病人应积极行手术探查、腹腔镜探查和活检。病变范围较广泛者可行肿瘤化疗药敏试验、区域动脉灌注化疗、记忆合金胆道内支架应用等综合措施 ,可延长病人的生存期。

Objective To summarize the experience of diagnosis and different surgical management for Nevin StageⅤ gallbladder cancer.Methods The present study was an retrospective analysis of 74 patients who were operated in our hospital and suffered from Nevin StageⅤ gallbladder cancer proved histopathologically. Results The diagnostic accuracy of color Doppla ultrasound was 75 0%(21/28), abdominal enhanced CT, 82 1%(32/39). 23 patients with Nevin StageⅤ disease received radical or extended radical cholecystectomy, the mean survival time was 1 year and 3 months; 11 patients with Nevin StageⅤ disease without a complete resection had a mean survival of 6 months; 38 patients with Nevin StageⅤ diesase had a mean survival of 2 months after palliative bypass procedure or biopsy. Conclusion A exploratory operation by laparoscope is useful in the diagnosis of advanced gallbladder cancer. According to local situation of gallbladder cancer and general body state, different management are employed in treatment so that the effect may be improved.椋簦椋螅ǎ希粒? ａｎｄ ｔｈｅ ｐｒｏｌｉｆｅｒａｔｉｏｎ ａｎｄ ａｐｏｐｔｏｓｉｓ ｏｆ ｃｈｏｎｄｒｏｃｙｔｅｓ．Ｍｅｔｈｏｄｓ The anterior,posterior Cruciate Ligaments and medial menisci of the left knee in 36 adult New Zealand rabbits were sectioned to produce models of OA;the animals were then randomly divided into test group and control group.HHD 1 tab per day were given to the animals in the test group for 13 weeks after surgery.16th,20th,and 24th weeks after operation,the animals were sacraficed respectively and specimens were procured from the medial femoral condylar and the medial plateau of tibia for light microscopic,transmission electron microscopic and scanning electron microscopic study.Immunohistochemical method and in situ end labbelling method were used to detect the proliferation and apoptosis of chondrocytes in articular cartilage. Results The degenerative changes of cartilage in test group had no significant difference from control’s,the apoptosis index and proliferative index of chondrocytes were less than control’s (P<0 05) at 24 weeks postoperation.Conclusion The study indicated that HHD can decrease the apoptosis of chondrocytes in the late stage of OA and keep the balance of proliferation and apoptosis of OA chondrocytes. Key Words Osteochonritis Cartilage,articular Cells in the treatment of osteoarthritis(OA) and the proliferation and apoptosis of chondrocytes.[HT5”H]Methods [HT5”SS]The anterior,posterior Cruciate Ligaments and medial menisci of the left knee in 36 adult New Zealand rabbits were sectioned to produce models of OA;the animals were then randomly divided into test group and control group.HHD 1 tab per day were given to the animals in the test group for 13 weeks after surgery.16th,20th,and 24th weeks after operation,the animals were sacraficed respectively and specimens were procured from the medial femoral condylar and the medial plateau of tibia for light microscopic,transmission electron microscopic and scanning electron microscopic study.Immunohistochemical method and in situ end labbelling method were used to detect the proliferation and apoptosis of chondrocytes in articular cartilage. [HT5”H]Results [HT5”SS]The degenerative changes of cartilage in test group had no significant difference from control’s,the apoptosis index and proliferative index of chondrocytes were less than control’s (P<0 05) at 24 weeks postoperation.[HT5”H]Conclusion [HT5”SS]The study indicated that HHD can decrease the apoptosis of chondrocytes in the late stage of OA and keep the balance of proliferation and apoptosis of OA chondrocytes. [WT5”HZ] Key Words Osteochonritis Cartilage,articular C