3D腹腔镜单吻合器法经肛门取出标本在超低位直肠癌保肛手术中的运用

目的研究单吻合器法经肛门取出标本在超低位直肠癌保肛手术的临床疗效。方法回顾性分析2016年1月—2018年1月同济大学附属东方医院胃肠肛肠外科行腹腔镜直肠前切除术的112例超低位直肠癌患者临床资料。其中单吻合器法经肛门取标本手术83例,双吻合器法小切口手术29例,对比两组患者在手术时间、出血量、住院时间、初次造口排便时间、淋巴结检出数、下切缘长度、术后吻合口瘘发生率、肛门Wexner失禁评分以及1年无病生存率(disease-free survival, DFS)等方面的差异。结果全部112例手术顺利完成,两组患者在手术时间、出血量、淋巴结检出数、肛门Wexner失禁评分及1年DFS等方面差异无统计学意义( P >0.05);单吻合器组住院天数少于双吻合器组,分别为(7.9±3.5) d和(10.2±2.5) d,差异有统计学意义( P <0.01);两组初次造口排气时间分别为(13.7±6.0) h和(44.6±5.2) h,差异有统计学意义( P <0.01);两组肿瘤下切缘长度分别为(1.8±0.3) cm和(1.6±0.2) cm,差异有统计学意义( P <0.01);吻合口瘘发生率分别为2/83和4/29,差异有统计学意义( P <0.01)。结论与传统双吻合器法相比,单吻合器法经肛门取出标本进行超低位直肠癌保肛安全可行,可缩短住院时间、促进术后恢复。

Reactive oxygen species are involved in cell death in wheat roots against powdery mildew

Inoculation of wheat(Triticum aestivum L.)leaves with wheat powdery mildew fungus(Blumeria graminis f.sp.tritici)induces the cell death in adventitious roots.Reactive oxygen species(ROS)play a key role in respond to biotic stress in plants.To study the involvement of ROS and the degree of cell death in the wheat roots following inoculation,ROS levels and microstructure of root cells were analyzed in two wheat cultivars that are susceptible(Huamai 8)and resistant(Shenmai 8)to powdery mildew fungus.At 18 d after powdery mildew fungus inoculation,only Huamai 8 displayed the leaf lesions,while root cell death occurred in both varieties.Huamai 8 had a high level of ROS accumulation,which is associated with increased root cell degradation,while in Shenmai 8,there was little ROS accumulation correlating with slight root cell degradation.The molecular study about the expression levels of ROS scavenging genes(MnSOD and CAT)in wheat roots showed that these genes expression decreased after the leaves of wheat was inoculated.The difference between Huamai 8 and Shenmai 8 on subcellular localization of H2 O2 and O2^–·was corresponded with the different down-regulation of the genes encoding for superoxide dismutase and catalase in two wheat cultivars.These results suggested that ROS were involved in the process by which powdery mildew fungus induced cell death in wheat roots.