目的:探讨基质金属蛋白酶-2(MMP-2)、基质金属蛋白酶-9(MMP-9)、基质金属蛋白酶抑制剂-2(TIMP-2)、基质金属蛋白酶抑制剂-1(TIMP-1)在不同性质的大肠黏膜中的表达情况及MMP-2/TIMP-2、MMP-9/ TIMP-1与大肠腺瘤向大肠癌转变的相关性及临...目的:探讨基质金属蛋白酶-2(MMP-2)、基质金属蛋白酶-9(MMP-9)、基质金属蛋白酶抑制剂-2(TIMP-2)、基质金属蛋白酶抑制剂-1(TIMP-1)在不同性质的大肠黏膜中的表达情况及MMP-2/TIMP-2、MMP-9/ TIMP-1与大肠腺瘤向大肠癌转变的相关性及临床意义. 方法:用酶联免疫吸附试验(ELISA)的方法对MMP-2, MMP-9及其抑制剂TIMP-2、TIMP-1在大肠腺瘤轻、中、重度不典型增生以及大肠腺癌中进行定量检测. 结果:MMP-2在大肠腺瘤重度不典型增生与中含量明显高于轻、中度不典型增生及正常大肠黏膜(91.391±23.551 vs 19.461±8.836,42.313±14.094,27.330±8.405,P<0.05);MMP-9在正常肠黏膜中未见表达, 在大肠腺瘤轻中重度不典型增生及大肠癌中表达依次增强,两两间有显著性差异(11.260±4.104 vs 31.520±7,433 vs 57.803±19.060 vs 202.17±33.344,P<0.05); TIMP-2重度不典型增生组与正常大肠黏膜有显著性差异(136.279±19.539 vs 81.363±26.252,P<0.05); MMP-2/TIMP-2比率在腺瘤轻、中度不典型增生, 重度不典型增生及大肠腺癌中两两之间均有显著性差异(0.206±0.128 vs 0.360±0.129 vs 0.665±0.100 vs 1.136±0.300,P<0.05);TIMP-1在腺瘤轻中度不典型增生中表达与大肠腺癌中表达有显著性差异(227.413±208.497,654.854±339.005 vs 1136.271±607.029 P<0.05); MMP-9/TIMP-1比率在腺瘤轻中度不典型增生,重度不典型增生及大肠腺癌中两两之间均无显著性差异(P>0.05). 结论:MMP-2可能是大肠腺瘤向大肠腺癌转变过程中的早期事件.MMP-9可作为区别大肠肿瘤良恶性的一项重要指标.MMP-2/TIMP-2比率与大肠腺瘤恶变有相关性,而MMP-9/TIMP-1的比率与大肠腺瘤向大肠腺癌的转变无相关性.MMP-2、MMP-9的定量监测可以作为大肠腺瘤向大肠腺癌转变过程中重要的生物学指标.展开更多
PURPOSE: Up to 90 percent of patients with familial adenomatous polyposis develop adenomas in the upper gastrointestinal tract. Besides pancreaticoduodenectomy, which remains indicated in duodenal and ampullary can ce...PURPOSE: Up to 90 percent of patients with familial adenomatous polyposis develop adenomas in the upper gastrointestinal tract. Besides pancreaticoduodenectomy, which remains indicated in duodenal and ampullary can cer, less aggressive surgical procedure (such as ampullectomy) must be evaluated in selected patients with familial adenomatous polyposis patients presenting low-risk benign duodenal adenomas. METHODS: From 1995 to 2000, we performed a r etrospective, observational study, which included eight patients (5 females) wit h familial adenomatous polyposis underwent ampullectomy (with frozen sections) f or presumed benign polyposis lesions. Six patients had an ileal pouch-anal anas tomosis performed 2 to 27 years before ampullectomy. The remaining two patients had ampullectomy during the same operation than ileal pouch-anal anastomosis. R ESULTS: No patient died postoperatively. Mean hospital stay was 15 ±6.5 (range, 10-21) days. There was one major complication (pancreatic fistula), which was treated conservatively. Final pathologic examination of the specimens revealed t hat three patients had a severe dysplasia. Mean follow-up of the patients was 5 8 ±37 (range, 24-119) months. During endoscopic follow-up, although all the p atients underwent endoscopic resection of duodenal polyps, none presented recurr ence at the ampullectomy site. CONCLUSIONS: Ampullectomy could be safely propose d in selected familial adenomatous polyposis patients. Our low morbidity and the absence of recurrence after almost five years of follow-up suggests that such conservative treatment could be proposed before pancreaticoduodenectomy in patie nts with high-risk ampullary adenomas without invasive carcinoma.展开更多
文摘目的:探讨基质金属蛋白酶-2(MMP-2)、基质金属蛋白酶-9(MMP-9)、基质金属蛋白酶抑制剂-2(TIMP-2)、基质金属蛋白酶抑制剂-1(TIMP-1)在不同性质的大肠黏膜中的表达情况及MMP-2/TIMP-2、MMP-9/ TIMP-1与大肠腺瘤向大肠癌转变的相关性及临床意义. 方法:用酶联免疫吸附试验(ELISA)的方法对MMP-2, MMP-9及其抑制剂TIMP-2、TIMP-1在大肠腺瘤轻、中、重度不典型增生以及大肠腺癌中进行定量检测. 结果:MMP-2在大肠腺瘤重度不典型增生与中含量明显高于轻、中度不典型增生及正常大肠黏膜(91.391±23.551 vs 19.461±8.836,42.313±14.094,27.330±8.405,P<0.05);MMP-9在正常肠黏膜中未见表达, 在大肠腺瘤轻中重度不典型增生及大肠癌中表达依次增强,两两间有显著性差异(11.260±4.104 vs 31.520±7,433 vs 57.803±19.060 vs 202.17±33.344,P<0.05); TIMP-2重度不典型增生组与正常大肠黏膜有显著性差异(136.279±19.539 vs 81.363±26.252,P<0.05); MMP-2/TIMP-2比率在腺瘤轻、中度不典型增生, 重度不典型增生及大肠腺癌中两两之间均有显著性差异(0.206±0.128 vs 0.360±0.129 vs 0.665±0.100 vs 1.136±0.300,P<0.05);TIMP-1在腺瘤轻中度不典型增生中表达与大肠腺癌中表达有显著性差异(227.413±208.497,654.854±339.005 vs 1136.271±607.029 P<0.05); MMP-9/TIMP-1比率在腺瘤轻中度不典型增生,重度不典型增生及大肠腺癌中两两之间均无显著性差异(P>0.05). 结论:MMP-2可能是大肠腺瘤向大肠腺癌转变过程中的早期事件.MMP-9可作为区别大肠肿瘤良恶性的一项重要指标.MMP-2/TIMP-2比率与大肠腺瘤恶变有相关性,而MMP-9/TIMP-1的比率与大肠腺瘤向大肠腺癌的转变无相关性.MMP-2、MMP-9的定量监测可以作为大肠腺瘤向大肠腺癌转变过程中重要的生物学指标.
文摘PURPOSE: Up to 90 percent of patients with familial adenomatous polyposis develop adenomas in the upper gastrointestinal tract. Besides pancreaticoduodenectomy, which remains indicated in duodenal and ampullary can cer, less aggressive surgical procedure (such as ampullectomy) must be evaluated in selected patients with familial adenomatous polyposis patients presenting low-risk benign duodenal adenomas. METHODS: From 1995 to 2000, we performed a r etrospective, observational study, which included eight patients (5 females) wit h familial adenomatous polyposis underwent ampullectomy (with frozen sections) f or presumed benign polyposis lesions. Six patients had an ileal pouch-anal anas tomosis performed 2 to 27 years before ampullectomy. The remaining two patients had ampullectomy during the same operation than ileal pouch-anal anastomosis. R ESULTS: No patient died postoperatively. Mean hospital stay was 15 ±6.5 (range, 10-21) days. There was one major complication (pancreatic fistula), which was treated conservatively. Final pathologic examination of the specimens revealed t hat three patients had a severe dysplasia. Mean follow-up of the patients was 5 8 ±37 (range, 24-119) months. During endoscopic follow-up, although all the p atients underwent endoscopic resection of duodenal polyps, none presented recurr ence at the ampullectomy site. CONCLUSIONS: Ampullectomy could be safely propose d in selected familial adenomatous polyposis patients. Our low morbidity and the absence of recurrence after almost five years of follow-up suggests that such conservative treatment could be proposed before pancreaticoduodenectomy in patie nts with high-risk ampullary adenomas without invasive carcinoma.
