Muscle-sparing切口在胸部手术中的应用

目的探讨胸部Muscle-sparing切口在临床中的应用价值。方法采用Muscle-sparing切口开胸手术56例,其中周围型肺癌行肺叶切除术39例,随机抽取同期39例肺癌患者及其他病变行后外侧切口开胸手术病例共计56例作为对照组;对两组病例术后切口疼痛、术侧肩关节功能等指标进行分析。术后肩关节功能的评估采用Constant评分法;术后切口疼痛的评估采用Prince-Henry评分法。结果治疗组术后3天、1周、4周切口疼痛程度明显低于对照组;术侧肩关节功能明显优于对照组。治疗组无围术期死亡,术后无皮下积液、切口血肿发生。结论有选择地应用Muscle-sparing切口,可以在保证手术质量和的安全性的前提下,减轻术后切口疼痛,减少术后肩关节功能障碍。

改良Muscle-Sparing剖胸切口在治疗周围型肺部肿块中的应用

目的：探讨改良 Muscle-Sparing(MS)切口在治疗周围型肺部肿块中的应用价值。方法：自2001年4月～2004年5月，应用此切 口治疗周围型肺部肿块共62例，另选择同期月常规切口行肺部手术者62例为对照(SP)，对两组病例的开关胸时间、手术时间、术野 面积等进行分析。结果：全组病例均无大出血、肺不张、肺部感染、胸腔感染或呼吸衰竭等严重并发症。平均开胸时间：改良 MS 组11 min，SP 组13 min；平均关胸时间：改良 MS 组14 min，SP 组22 man；施行肺叶切除术时，改良 MS 组术中操作时间平均为142min，长于 SP 组；改良 MS 组术后引流量平均为550ml，少于 SP 组；改良 MS 组术后住院时间平均为7． 8 d，短于 SP 组。结论：只要注意病例的 选择，对肺楔形切除术和中、下肺叶切除术，改良 Muscle-sparing 切口是一种安全可行的方法，具有美观、术后恢复快的优点。

3种Muscle-Sparing剖胸切口临床应用的比较

目的:Muscle-Sparing(MS)剖胸切口是当今流行的一种微创剖胸切口,有多种不同的操作方法,通过对传统MS切口、改良MS切口和听诊三角MS切口3种不同剖胸方法的比较,探讨其各自的临床适用范围。方法:1999年12月—2006年6月,应用上述3种MS剖胸切口共完成各种胸部手术327例,包括周围型肺癌191例,肺转移性肿瘤39例,肺部良性肿瘤64例,纵隔肿瘤10例,自发性气胸16例,食管平滑肌瘤7例。结果:全组无手术死亡病例,无术中、术后严重并发症。术后发生长时间漏气21例,伤口血肿7例。传统的MS切口开胸时间最短(平均10.5 min),术野面积最大(平均148cm^2),但从创伤和美观的角度来看不及另两种切口。改良的MS切口完整地保留了胸壁肌群,但为显露前锯肌后缘需大范围游离皮瓣及背阔肌,术中上胸部骨性胸廓显露较差,进胸时间最长(平均18.1 min),术野显露不及传统的MS切口。听诊三角MS切口则利用斜方肌与背阔肌、前锯肌之间的间隙进胸,其术野面积最小(平均87 cm^2)。结论:3种不同的MS切口均适用于肺楔形切除、肺大疱切除、胸膜固定等简单手术。其中传统MS切口术野显露最佳,可应用于上叶切除、全肺切除、食管平滑肌瘤摘除、纵隔肿瘤切除等相对复杂的手术。对于原发性肺癌,该切口可适用于大部分临床分期为Ⅰa至Ⅱb的病例以及部分Ⅲa期病例。改良的MS切口对于肺叶切除则限于下叶和中叶,对于原发性肺癌的治疗一般应限于临床分期为Ⅰ期的病例以及部分Ⅱ期病例。听诊三角MS切口因术野较小,即便行肺楔形切除术,也应选择病变位于切口附近的病例,对于原发性肺癌仅限于少数临床分期为Ⅰ期的病例,还适用于简单的后上纵隔肿瘤切除术。只要掌握各种切口特点,合理选择病例并恰当使用一次性手术器械,MS剖胸切口是一种安全可行的微创剖胸切口。

胸腔镜与Muscle-Sparing开胸肺叶切除术的临床比较

目的比较胸腔镜与Muscle-Sparing开胸肺叶切除术的临床结果。方法56例行肺叶切除术的患者,分为胸腔镜辅助肋间切口(VAMT)肺叶切除术(VAMT组)20例和微创Muscle-sparing开胸(MST)肺叶切除术(MST组)36例,比较两组的临床结果。结果两组均无围术期死亡;两组围术期并发症、住院时间的差异均无显著性(P值均>0．05)。MST组手术时间(90 min)明显短于VAMT组(150 min,P<0．01)。结论VAMT和MST下行肺叶切除术均安全、可行,但前者适合于较早期的肺癌患者,后者几乎可应用于所有有手术指征的肺癌患者。

Muscle-sparing切口与后外侧切口在开胸手术中的比较

目的:通过比较Muscle-sparing切口开胸(MST)与后外侧切口开胸(PT)在开胸术后疼痛评分、切口并发症、手术前后FEV1及MVV测定,了解两种开胸手术方式对患者的影响。方法:选取60例需接受开胸手术患者,依据临床资料将患者随机分成MST组和PT组,每组各30例,比较两组术后患者疼痛评分、切口并发症及手术前后肺功能之间的差异。结果:两组患者术前在营养情况、肺功能情况的比较差异无显著性,MST组未发生术后切口并发症,PT组术后出现4例切口并发症;MST组在术后疼痛评分及切口并发症发生率明显低于PT组;MST组FEV1及MVV在手术前后的差异不明显(P>0.05);PT组FEV1及MVV在手术前后差异具有显著性(P<0.05)。结论:MST组术后疼痛评分及切口并发症发生几率均明显低于PT组。MST组相对于PT组而言,对开胸患者肺功能影响较小。

腋下Muscle-sparing剖胸切口在临床中的应用

目的 :探讨腋下Muscle-Sparing剖胸切口在临床中的应用及其优、缺点。方法 :对 35例行Muscle-Sparing剖胸术病例进行回顾性分析。结果 :Muscle -Sparing剖胸切口手术时显露较差 ,操作较困难 ,但术后肺功能影响小 ,疼痛轻 ,胸壁肌肉保留完整 ,伤侧上肢、肩关节活动受限轻、恢复快。结论 :对适当病例Muscle

胸腔镜、胸腔镜辅助腋下Muscle-sparing切口常规开胸治疗老年自发性气胸的分析

目的:比较胸腔镜、胸腔镜辅助腋下Muscl e-spari ng切口、常规开胸治疗老年自发性气胸的疗效,为选择不同手术方法提供相关理论依据。方法:选择60例老年自发性气胸患者分别采用胸腔镜手术、胸腔镜辅助腋下Muscl e-spari ng切口手术、常规开胸手术治疗,比较3组治疗效果及并发症的发生率。结果:3组均无死亡病例,均治愈,胸腔镜手术组、胸腔镜辅助腋下Muscl e-spari ng切口手术组、常规开胸手术组在胸管引流时间、术后疼痛时间、住院时间、住院费用等差异有统计学意义(P<0.05)。结论:胸腔镜手术适合伴有其他疾病的老年自发性气胸患者,对于经济条件差、心肺功能差不适合常规开胸患者可采用胸腔镜辅助腋下Muscl e-spari ng切口手术。

Radionuclide Colloid ^(32)P Used for the Treatment of Stage II Lung Cancer by Video Enhanced Minimal Access Muscle Sparing Thoracotomy

Objective: To study the feasibility of radionuclide colloid 32P used for the treatment of stage II lung cancer by video enhanced minimal access muscle sparing thoracotomy (VEMAST). Methods: Video assisted thoracoscopic surgery (VATS) was carried out under general anesthesia. A double lumen endobronchial tube was intubated into trachea. One lung ventilation of the healthy side was done during operation. An incision of 8–10 cm long was made along the 4th or 5th intercostals. The lobectomy could be performed under VATS. Radionuclide colloid 32P was injected locally into the area where surgical cleaning of lymph node around was considered to be unsatisfactory or desection of the tumor was not completed. Results: The operation with VEMAST was successful in 29 patients. A conventional lobectomy by thoracotomy had to be done due to unusual bleeding from the pulmonary artery involved during VEMAST in one case and the procedure was interrupted because the pulmonary artery cloud not be separated from the tumor in another patient. There was no dead case or the patient who had any severe complication or adverse response to the radiant. Conclusion: Radionuclide therapy was performed to the treatment of stage II lung cancer with VEMAST in case that surgical resection was considered not to be satisfactory. Minithoractomy assisted with VATS lobectomy and radionuclide colloid 32P therapy is a safe and e?ective technique for some selected stage II lung cancer.

Muscle spare开胸术在胸部手术中特殊情况下的应用

目的:探讨Muscle spare切口在胸部手术中特殊情况下的应用。方法:对2011-01～2011-12收治必须或最适宜进行muscle spare开胸术患者的临床资料进行回顾总结。结果:6例术中顺利,出院后随访2月无并发症发生。结论:Muscle spare切口对术后引流量减少,平均住院日缩短,对肺功能较差的患者和老年患者具有更为重要的临床价值。

Glycosylation-independent binding to extracellular domains 11-13 of mannose-6-phosphate/insulin-like growth factor-2 receptor mediates the effects of soluble CREG on the phenotypic proliferation of vascular smooth muscle cells

Background The present study aimed to investigate the detailed mode and specific sites for their binding as well as the functional relevance of this binding in the phenotypic proliferation of vascular smooth muscle cells(SMCs). Methods CREG knocked-down SMCs were employed to evaluate the biological activity of wtCREG and mCREG.Expressions of SMC differentiation markers SM myosin heavy chain(SM-MHC),SM-actin,heavy caldesmon and myocardin were determined by Western blotting using specific antibodies. Cellular growth of SMCs was assessed by bromide dewuridine (BrdU) incorporation and cell cycle analysis on fluorescence-activated cell sorting(FACS).A solid-phase binding assay was used to study the binding of CREG to extracellular domains of M6P/IGF2R.The cellular co-localization of the two recombinant CREGs with M6P/IGF2R was detected on SMC surface by immunoprecipitation and immunofluorescence analysis.Results The molecular weight of wtCREG was around 30 kD while that of the mCREG was～25 kD.Treatment of wtCREG with PNGase F reduced its molecular weight from～30 kD to～25 kD,whereas PNGase F treatment had no effect on the molecular weight of mCREG.Both wtCREG and mCREG proteins enhanced SMC differentiation,inhibited BrdU incorporation,and arrested cell cycle progression when added to the culture medium.In CREG knocked-down SMCs,the amount of CREG detected by immunoblotting in M6P/IGF2R immunoprecipitates was significantly reduced when compared to normal cells.Both recombinant CREGs co-immunoprecipitated with M6P/IGF2R, although slightly reduced amount of the mutant CREG was detected in M6P/IGF2R immunoprecipitates.Immunostaining revealed that His-tagged CREGs co-localized with IGF2R on the cell surface in a glycosylation-independent manner.In vitro binding assay showed that CREGs bound to M6P/ IGF2R extracellular domains 7-10 and 11-13 in a glycosylation -dependent and -independent manner,respectively.Further blocking experiments using soluble M6P/IGF2R fragments and M6P/IGF2R neutralizing antibody indicated that the biological activities of recombinant CREGs in SMC growth and the up-regulation of SMC differentiation markers were all abolished by treatment with the M6P/IGF2R neutralizing antibody. However,although the growth inhibitory effect of wtCREG was nearly abolished by D7-10 or D11-13,the effect of mCREG was only reversed by Dll-13,indicating that the binding to domains 11-13 is required for CREG to modulate the proliferation of SMCs.Conclusions These data suggest that solubleCREG proteins can exert their biological function via binding to the extracellular domains 7-10 and 11-13 of cell surface M6P/IGF2R in both a glycosylation-dependent and -independent manner.

The role of mitochondria in redox signaling of muscle homeostasis

In the past,contraction-induced production of reactive oxygen species(ROS)has been implicated in oxidative stress to skeletal muscle.As research advances,clear evidence has revealed a more complete role of ROS under both physiologic and pathologic conditions.Central to the role of ROS is the redox signaling pathways that control exercise-induced major physiologic and cellular responses and adaptations,such as mitochondrial biogenesis,mitophagy,mitochondrial morphologic dynamics,antioxidant defense,and inflammation.The current review focuses on how muscle contraction and immobilization may activate or inhibit redox signalings and their impact on muscle mitochondrial homeostasis and physiologic implications.

Role of the Notch Signaling Pathway in Fibrosis of Denervated Skeletal Muscle

In order to investigate the role of the Notch signaling pathway in skeletal muscle fibrosis after nerve injury, 60 Sprague-Dawley rats were selected and divided randomly into a control and two experimental groups. Group A served as controls without any treatment. Rats in groups B were injected intraperitoneally with 0.2 mL PBS and those in group C were injected intraperitoneally with 0.2 mL PBS+100 ymol/L, 0.2 mL N-[N-(3,5-difluorophenacetyl)-l-alanyl]- S-phenylglycine t-butyl ester (DAPT, a gamma-secretase inhibitor that suppresses Notch signaling) respectively, on postoperative days 1, 3, 7, 10, and 14 in a model of denervation-induced skeletal muscle fibrosis by right sciatic nerve transection. Five rats from each group were euthanized on postoperative days 1, 7, 14, and 28 to collect the right gastrocnemii, and hematoxylin and eosin (HE) staining, immunohistochemistry test, real-time PCR, and Western blotting were performed to assess connective tissue hyperplasia and fibroblast density as well as expression of Notch 1, Jagged 1, and Notch downstream molecules Hes 1 and collagen I (COL I) on day 28. There was no significant difference in HE-stained fibroblast density between group B and C on postoperative day 1. However, fibroblast density was significantly higher in group B than in group C on postoperative days 7, 14, and 28. Notch 1, Jagged 1, Hes 1, and COL I proteins in the gastrocnemius were expressed at very low levels in group A but at high levels in group B. Expression levels of these proteins were significantly lower in group C than in group B (P<0.05), but they were higher in group C than in group A (P<0.05) on postoperative day 28. We are led to conclude that locking the Notch signaling pathway inhibits fibrosis progression of denervated skeletal muscle. Thus, it may be a new approach for treatment of fibrosis of denervated skeletal muscle.

Angiotensin-（1-7）： new perspectives in atherosclerosis treatment

Angiotensin （Ang）-（1-7） is recognized as a new bioactive peptide in renin-angiotensin system （RAS）. Ang-（1-7） is a counter-regulatory mediator of Ang-II which appears to be protective against cardiovascular disease. Recent studies have found that Ang-（1-7） played an important role in reducing smooth muscle cell proliferation and migration, improving endothelial function and regulating lipid metabolism, leading to inhibition of atherosclerotic lesions and increase of plaque stability. Although clinical application of Ang-（1-7） is restricted due to its pharmacokinetic properties, identification of stabilized compounds, including more stable analogues and specific delivery compounds, has enabled clinical application of Ang-（1-7）. In this review, we discussed recent findings concerning the biological role of Ang-（1-7） and related mechanism during atherosclerosis development. In addition, we highlighted the perspective to develop therapeutic strategies using Ang-（1-7） to treat atherosclerosis.

针刀疏筋解结术对类风湿关节炎家兔滑膜炎症的影响及作用机制研究

目的观察针刀疏筋解结术对类风湿关节炎(RA)模型家兔膝关节滑膜组织NF-κB/Bcl-2通路活性及肿瘤坏死因子-α(TNF-α)、白细胞介素(IL)-1β、IL-6、Bax、caspase-3表达的影响,探讨其抑制RA滑膜炎症的作用机制。方法24只新西兰白兔随机分为正常组、模型组、药物组和针刀组,每组6只,除正常组外,其余组采用卵蛋白+弗氏完全佐剂膝关节腔注射复制RA模型,分别予相应干预,连续18 d。测定家兔膝关节痛阈、膝关节周径,超声观察关节腔积液、滑膜厚度及内部血流信号,HE染色观察膝关节滑膜组织形态,TUNEL染色观察滑膜组织成纤维样滑膜细胞(FLS)凋亡情况,免疫组化检测滑膜组织TNF-α、IL-1β、IL-6表达,RT-PCR检测滑膜组织核因子(NF)-κBp65、Bcl-2mRNA表达,Westernblot检测滑膜组织NF-κBp65、p-NF-κBp65、Bcl-2、Bax、caspase-3蛋白表达。结果与正常组比较,模型组家兔膝关节痛阈降低、膝关节周径增加,超声评分和滑膜组织病理评分增加;滑膜组织FLS凋亡率降低,TNF-α、IL-1β、IL-6表达升高,NF-κBp65、Bcl-2 mRNA和蛋白及p-NF-κBp65蛋白表达升高,Bax、caspase-3蛋白表达降低,差异均有统计学意义(P<0.05)。与模型组比较,药物组和针刀组家兔膝关节痛阈增加、膝关节周径减小,超声评分和滑膜组织病理评分减少;滑膜组织FLS凋亡率升高,TNF-α、IL-1β、IL-6表达降低,NF-κBp65、Bcl-2m RNA和蛋白及p-NF-κBp65蛋白表达降低,Bax、caspase-3蛋白表达升高,差异均有统计学意义(P<0.05)。结论针刀疏筋解结术可能通过降低滑膜组织NF-κB/Bcl-2通路活性,促进FLS凋亡,减少TNF-α、IL-1β、IL-6产生,抑制RA滑膜炎症,减轻膝关节肿胀、提升痛阈。

Vasorelaxant effect of 3,4-dihydro-2-(4-morpholinylmethy)-1(2H)-naphthalenone on the vascular smooth muscle of rabbits

The purpose of this study was to examine the relaxation effect of CY on the vascular smooth muscle （VSM） from rabbits. Experiments were carried out on isolated thoracic aorta of rabbits. CY （3 x 103 mM- 3 mM） could relax the VSM preparations pre-contracted by adrenaline （AD）, noradrenaline （NE）, high-K^＋ solution or BaCl2 with respective EC50 values of （0.3 1±0.11） mM, 0.19±0.03 mM, 0.20±0.04 mM and 0.25±0.04 mM. Moreover, CY （10-2 mM, 0.1 mM and 1 mM） inhibited norepinephrine （NE）, CaCl2 and KCl-induced vasoconstriction in a concentration dependent manner. The phasic contraction produced by NE was concentration dependently attenuated with CY （10^-2 mM, 0.1 mM and 1 mM） in calcium-free medium, similar to that caused by verapamil. The present findings suggest that CY relaxed thoracic aortic rings by blocking voltage-dependent Ca^2＋ channels. The inhibition of intracellular Ca^2＋ release may be one of the main vasorelaxant mechanisms of CY.

微创肌肉非损伤性开胸术治疗支气管肺癌的中期随访

背景与目的：肺癌的外科治疗已发生了巨大的变化。微创肌肉非损伤性开胸术对肺叶切除手术是安全、切实可行的，现已成为国外治疗肺癌的主要手段。但目前国内尚未见关于其与预后的相关报道。本研究主要探讨微创肌肉非损伤性手术（Muscle—Sparing）治疗支气管肺癌的手术安全性、彻底性及临床有效性。方法：2001年至今随访超过1年的150例行Muscle—Sparing手术的支气管肺癌病例，其中男性113例，女性37例，平均年龄64．61岁。病理类型：鳞癌63例，腺癌66例，小细胞癌9例，腺鳞癌6例，大细胞癌3例，粘液表皮样癌1例，肉瘤样癌1例，神经内分泌癌1例。病理分期：ⅠA期18例，ⅠB期54例，ⅡA期4例，ⅡB期17例，ⅢA期46例，ⅢB期7例，Ⅳ期4例。手术方式：右侧肺叶切除者76例，右全肺切除者10例，左侧肺叶切除者52例，左全肺切除者12例。术中行肺门及纵隔淋巴结清扫，平均清扫淋巴结6．6组（包括第2组至第11组）。这150例患者随访了12～58个月，平均随访18．6个月。结果：术后支气管切缘阳性者12例，手术后需输血者5例，有4例患者出现乳糜胸，3例发生皮下积液。围术期死亡率为1．3％。术后1年总的生存率为78％，术后3年总的生存率为62％。结论：微创肌肉非损伤性开胸术与传统的胸部后外侧切口开胸手术比较，具有一定优势。微创肌肉非损伤性开胸术操作简单，手术视野充分，几乎可以完成所有的肺癌切除手术，可以作为肺癌手术的常规术式。而且微创肌肉非损伤性开胸术的中期随访结果是令人满意的。

微创肌肉非损伤性开胸治疗肺癌的探讨

目的 探索肌肉非损伤性开胸术作为肺癌手术的常规切口。方法 自 2 0 0 1年 3月至 2 0 0 3年 4月连续对 93例临床上怀疑或确诊为肺癌的患者 ,应用肌肉非损伤性开胸方法作为胸部手术的常规切口。共行肺切除术 89例 ,右上肺叶切除 2 2例 (其中袖式切除 2例 ) ,右中下肺叶切除 11例 (其中心包内处理肺静脉 2例 ) ,右中叶切除 3例 ,右下肺叶切除 12例 ,右全肺切除 3例 (其中心包内处理肺动脉 1例 ) ,左上肺叶切除 11例 (其中加胸壁大块切除 1例 ) ,左下肺叶切除 12例 (其中加胸壁大块切除 1例 ) ,左全肺切除 6例 (其中心包内处理肺动脉 1例 ) ,楔形切除 9例。术前确诊为肺癌和术中冰冻病理证实为肺癌及高度怀疑为肺癌的 ,均行肺门、隆突及纵隔淋巴结清扫。结果 这种切口基本可以满足这些手术的需要 ,无围手术期死亡 ,未出现严重并发症。结论 肌肉非损伤性开胸术操作简便 ,并不会因为手术中暴露不足而影响手术的彻底性 。

胸部小切口与胸腔镜治疗孤立性肺结节对比研究

目的:探讨治疗各类孤立性肺结节(SPN)患者的最佳微创手术方式。方法:156例SPN患者被分为胸部小切口(MST)组89例和胸腔镜(VATS)组67例行手术,再根据病检和最后术式分为良性MST组、良性VATS组、恶性MST组、恶性VATS组。比较良性MST组和良性VATS组、恶性MST组和恶性VATS组之间在手术时间、出血量、术后住院时间、并发症发生率、住院费用、恶性患者淋巴结清扫数方面的差异。结果:原VATS组有7例中转为MST,中转率为10.44%。最后分为良性MST组25例、良性VATS组14例、恶性MST组71例、恶性VATS组46例。良、恶性MST组的手术时间和住院费用低于VATS组(P<0.05),余差异无统计学意义(P>0.05)。结论:在治疗SPN时,MST和VATS一样具有出血量少,恢复快,并发症少的优点。因此,对于VATS容易定位、既往无胸部疾病史且经济能承受的SPN患者,推荐VATS诊治,反之,MST为首选。

微创肌肉非损伤性开胸术治疗贲门肿瘤

目的 探讨微创肌肉非损伤性开胸行贲门肿瘤手术的可行性。 方法 采用经左胸第 7肋间微创肌肉非损伤性开胸行贲门肿瘤手术 2 5例。 结果 2 0例贲门腺癌 ,4例鳞癌 ,行近端胃大部和食管下段切除 ,残胃 -食管胸内吻合术。 1例贲门部增生型息肉 ,行胃底切开 ,肿瘤摘除术。全组患者无围术期严重并发症 ,无手术死亡。 结论 微创肌肉非损伤性开胸术操作简单 ,暴露充分 ,对相对早期的贲门癌是一种可选择的手术方法。