AIM: To investigate the splenic hilar vascular anatomy and the influence of splenic artery(Sp A) type in laparoscopic total gastrectomy with spleen-preserving splenic lymphadenectomy(LTGSPL).METHODS:The clinical anato...AIM: To investigate the splenic hilar vascular anatomy and the influence of splenic artery(Sp A) type in laparoscopic total gastrectomy with spleen-preserving splenic lymphadenectomy(LTGSPL).METHODS:The clinical anatomy data of 317 patients with upper- or middle-third gastric cancer who underwent LTGSPL in our hospital from January 2011 to December 2013 were collected. The patients were divided into two groups(concentrated group vs distributed group) according to the distance between the splenic artery's furcation and the splenic hilar region. Then, the anatomical layout, clinicopathologic characteristics, intraoperative variables, and postoperative variables were compared between the two groups.RESULTS: There were 205 patients with a concentrated type(64.7%) and 112 patients with a distributed type(35.3%) Sp A. There were 22 patients(6.9%) with a single branch of the splenic lobar vessels, 250(78.9%) with 2 branches, 43(13.6%) with 3 branches, and 2 patients(0.6%) with multiple branches. Eighty sevenpatients(27.4%) had type?Ⅰ?splenic artery trunk, 211(66.6%) had type Ⅱ, 13(4.1%) had type Ⅲ, and 6(1.9%) had type Ⅳ. The mean splenic hilar lymphadenectomy time(23.15 ± 8.02 vs 26.21 ± 8.84 min; P = 0.002), mean blood loss resulting from splenic hilar lymphadenectomy(14.78 ± 11.09 vs 17.37 ± 10.62 m L; P = 0.044), and number of vascular clamps used at the splenic hilum(9.64 ± 2.88 vs 10.40 ± 3.57; P = 0.040) were significantly lower in the concentrated group than in the distributed group. However, the mean total surgical time, mean total blood loss, and the mean number of harvested splenic hilar lymph nodes were similar in both groups(P > 0.05 for each comparison). There were also no significant differences in clinicopathological and postoperative characteristics between the groups(P > 0.05).CONCLUSION: It is of value for surgeons to know the splenic hilar vascular anatomy when performing LTGSPL. Patients with concentrated type Sp A may be optimal patients for training new surgeons.展开更多
Castleman's disease(CD) is a rare lymphoproliferative disorder of unknown etiology.Clinically,it occurs as a localized(unicentric) disease or as a systemic(multicentric) disease.Unicentric Castleman's disease(...Castleman's disease(CD) is a rare lymphoproliferative disorder of unknown etiology.Clinically,it occurs as a localized(unicentric) disease or as a systemic(multicentric) disease.Unicentric Castleman's disease(UCD) presents as a solitary mass and primarily affects the mediastinal,retroperitoneal,and cervical lymph nodes.In contrast to multicentric CD,which involves peripheral lymphadenopathy and numerous systemic symptoms,UCD is not typically associated withgeneralized symptoms.Three main distinct histologic variants are recognized:hyaline-vascular type,plasma cell type,and mixed type.Extranodal CD is rare.Specifically,UCD exclusively in the spleen is extremely rare,with only 2 cases described in the literature to date.Here,we describe an asymptomatic 75-yearold man with a 5.7 cm × 4.5 cm sized heterogenous enhanced mass located in the spleen.He underwent surgical resection for diagnosis and treatment.A pathologic examination indicated the hyaline-vascular type of CD.In this patient,the preoperative diagnosis was difficult to determine,and therefore,invasive procedures were required.展开更多
Littoral cell angiomas(LCA) of the spleen are vascular tumors of unknown etiology arising from the littoral cells of the splenic red pulp sinuses. Usually a benign and incidental finding,LCA have been repeatedly repor...Littoral cell angiomas(LCA) of the spleen are vascular tumors of unknown etiology arising from the littoral cells of the splenic red pulp sinuses. Usually a benign and incidental finding,LCA have been repeatedly reported in association with a variety of visceral malignancies and hold the potential for dissemination per se. We encountered a case of a 30 year old female who was diagnosed with solid pseudopapillary tumor of the head and distal pancreas by fine needle aspiration cytology. A distal pancreatectomy with splenectomy was performed in addition to a pylorus-preserving Whipple's procedure and cholecystectomy. Histopathological examination confirmed solid pseudopapillary tumor of the pancreasand showed multiple well-circumscribed anastomosing vascular channels in the spleen. The diagnosis of LCA of the spleen was confirmed by immunohistochemistry that revealed co-expression of endothelial cell marker,CD31 and CD34,along with histiocytic marker,CD68 by the vascular lining cells. LCA has been previously reported in association with colorectal and pancreatic adenocarcinoma,malignant lymphoma,myelodysplasia and autoimmune disorders. We report the first case of LCA associated with solid pseudopapillary tumor of the pancreas.展开更多
Formation of new blood vessels is paramount for tumour growth and metastatic dissemination and vascular endothelial growth factor (VEGF) is one of the key regulators of this process. The purpose of this study was to e...Formation of new blood vessels is paramount for tumour growth and metastatic dissemination and vascular endothelial growth factor (VEGF) is one of the key regulators of this process. The purpose of this study was to evaluate the immunohistochemical expression of VEGF in 23 splenic hemangiosarcomas and 7 splenic hemangiomas in dogs. Blood tests performed previous to splenectomy were analysed for correlation with tumour VEGF expression. Results showed significantly higher VEGF expression in hemangiosarcomas than hemangiomas and lower hematocrit values and red cell count in dogs affected with malignant neoplasia (P < 0.05). These findings suggest the presence of high VEGF levels may be related to the malignant vascular proliferation seen in hemangiosarcomas.展开更多
[目的]探讨健脾固肾化瘀方联合氯沙坦钾片治疗脾肾两虚夹瘀型糖尿病肾脏病(DKD)的临床疗效以及其对患者血清基质金属蛋白酶-9(MMP-9)、单核细胞趋化因子-1(MCP-1)和血管内皮生长因子(VEGF)水平的影响。[方法]选择沧州中西医结合医院2019...[目的]探讨健脾固肾化瘀方联合氯沙坦钾片治疗脾肾两虚夹瘀型糖尿病肾脏病(DKD)的临床疗效以及其对患者血清基质金属蛋白酶-9(MMP-9)、单核细胞趋化因子-1(MCP-1)和血管内皮生长因子(VEGF)水平的影响。[方法]选择沧州中西医结合医院2019年1月—2021年5月纳入80例脾肾两虚夹瘀型DKD患者作为研究对象,采用随机数字表法分成观察组与对照组各40例。观察组给予健脾固肾化瘀方联合氯沙坦钾片治疗,对照组单用氯沙坦钾片治疗,连续治疗12周后观察两组临床疗效。治疗前后检测受试者血糖[空腹血糖(FPG)、餐后2 h血糖(2 h PG)和糖化血红蛋白(HbA1c)]、血脂[总胆固醇(TC)、三酰甘油(TG)和低密度脂蛋白胆固醇(LDL-C)]及肾功能指标[尿微量白蛋白/尿肌酐比值(UACR)、肌酐(SCr)和尿素氮(BUN)]。选用酶联免疫吸附法测定血清MMP-9、MCP-1和VEGF水平。并统计两组不良反应情况。[结果]观察组总有效率为92.50%(37/40),较对照组72.50%(29/40)有所提高(P<0.05)。两组治疗后FPG、2 h PG和HbA1c均较治疗前降低(P<0.05),且均以观察组的改善更显著(P<0.01)。两组治疗后血清TC、TG和LDL-C浓度均较治疗前下降(P<0.05),且均以观察组的改善更显著(P<0.01)。两组治疗后UAER和血清SCr、BUN水平均较治疗前降低(P<0.05),且均以观察组的改善更显著(P<0.01)。两组治疗后血清MMP-9水平均较治疗前升高(P<0.05),血清MCP-1、VEGF浓度均较治疗前下降(P<0.05);且治疗后,观察组对血清MMP-9水平的升高作用及对血清MCP-1、VEGF水平的降低作用较对照组更显著(P<0.01)。所有患者均无明显不良反应发生。[结论]应用健脾固肾化瘀方联合氯沙坦钾片治疗脾肾两虚夹瘀型DKD能安全有效地上调患者MMP-9表达水平,下调MCP-1、VEGF表达水平,改善肾功能,整体疗效确切。展开更多
目的:探讨补气健脾化痰法对2型糖尿病患者中医证候积分与血管内皮功能的影响。方法:将2019年9月-2021年9月北京中医药大学房山医院月华分院收治的148例2型糖尿病患者随机分成对照组和观察组,对照组74例给予二甲双胍+格列美脲治疗,观察...目的:探讨补气健脾化痰法对2型糖尿病患者中医证候积分与血管内皮功能的影响。方法:将2019年9月-2021年9月北京中医药大学房山医院月华分院收治的148例2型糖尿病患者随机分成对照组和观察组,对照组74例给予二甲双胍+格列美脲治疗,观察组74例给予二甲双胍+格列美脲+补气健脾化痰法治疗,两组均治疗3个月。观察两组的中医证候积分、血糖水平[空腹血糖(Glucose,GLU)、餐后2 h血糖(2 h Postprandial Blood Glucose,2 h PBG)、糖化血红蛋白(Glycosylated Hemoglobin,HbA1c)]、血管内皮功能指标[内皮素-1(Endothelin-1,ET-1)、一氧化氮(Nitric Oxide,NO)、血管性假血友病因子(von Willebrand Factor,vWF)、血栓调节蛋白(Thrombomodulin,TM)]、临床疗效以及不良反应(恶心、呕吐、头晕、嗜睡)。结果:两组治疗后的口渴喜饮、气短寡言、少食易饥、疲乏无力的评分均降低(P<0.05),且观察组治疗后口渴喜饮、气短寡言、少食易饥、疲乏无力的评分低于对照组(P<0.05);两组治疗后的GLU、2 h PBG、HbA1c均降低(P<0.05),且观察组治疗后的GLU、2 h PBG、HbA1c低于对照组(P<0.05);两组治疗后的ET-1、vWF、TM均降低(P<0.05),NO均升高(P<0.05),且观察组治疗后的ET-1、vWF、TM低于对照组(P<0.05),NO高于对照组(P<0.05);观察组总有效率为95.95%(71/74),高于对照组的81.08%(60/74)(P<0.05);观察组不良反应发生率为9.46%(7/74),与对照组的10.81%(8/74)相近(P>0.05)。结论:补气健脾化痰法对2型糖尿病患者的治疗效果较好,可降低中医证候积分,减轻患者症状,且能改善血糖水平与血管内皮功能指标,总有效率高,不良反应少,有效性与安全性兼备,可推广。展开更多
目的 探讨益气温阳补肾方加减治疗老年高血压脾肾阳虚证的临床效果。方法 选取2021年12月—2022年11月期间青岛市中医医院收治的脾肾阳虚证老年高血压患者98例,采用随机数字表法分为对照组和试验组,每组各49例。对照组给予常规西药降压...目的 探讨益气温阳补肾方加减治疗老年高血压脾肾阳虚证的临床效果。方法 选取2021年12月—2022年11月期间青岛市中医医院收治的脾肾阳虚证老年高血压患者98例,采用随机数字表法分为对照组和试验组,每组各49例。对照组给予常规西药降压治疗,试验组在对照组基础上联合益气温阳补肾方加减治疗,两组患者均治疗4周。观察比较两组患者临床疗效、治疗安全性,治疗前后中医证候积分、血压[收缩压(Systolic blood pressure,SBP)、舒张压(Diastolic blood pressure,DBP)、脉压(Pulse pressure,PP)、24 h SBP、24 h DBP]水平、血管内皮功能指标[内皮素-1(Endothelin-1,ET-1)、一氧化氮(Nitric oxide,NO)、血栓素A2(Thrombin A2,TXA_(2))]水平。结果 (1)临床疗效:治疗后试验组总有效率95.92%(47/49)明显高于对照组81.25%(39/48),差异有统计学意义(P<0.05)。(2)中医证候积分:治疗后两组患者中医证候各项症状积分均较治疗前降低,差异有统计学意义(P<0.05);且试验组中医证候各项症状积分均明显低于对照组,差异有统计学意义(P<0.05)。(3)血压监测水平:治疗后两组患者SBP、DBP、PP、24 h SBP、24 h DBP水平均较治疗前降低,差异有统计学意义(P<0.05);且试验组SBP、DBP、PP、24 h SBP、24 h DBP水平均明显低于对照组,差异有统计学意义(P<0.05)。(4)血管内皮功能水平:治疗后两组患者血清ET-1、TXA_(2)均较治疗前降低,NO较治疗前升高,差异有统计学意义(P<0.05);且试验组ET-1、TXA_(2)均明显低于对照组,NO明显高于对照组,差异有统计学意义(P<0.05)。(5)安全性:治疗期间,两组患者均未发生严重或影响治疗的不良反应,仅对照组出现1例轻度潮红,未给予干预自行缓解。结论 益气温阳补肾方加减治疗老年高血压脾肾阳虚证效果显著,安全性高,有利于控制患者血压水平,且可能与调节血管内皮功能有关。展开更多
基金Supported by National Key Clinical Specialty Discipline Construction Program of China,No.[2012]649Key Project of Science and Technology Plan of Fujian Province,China,No.2014Y0025
文摘AIM: To investigate the splenic hilar vascular anatomy and the influence of splenic artery(Sp A) type in laparoscopic total gastrectomy with spleen-preserving splenic lymphadenectomy(LTGSPL).METHODS:The clinical anatomy data of 317 patients with upper- or middle-third gastric cancer who underwent LTGSPL in our hospital from January 2011 to December 2013 were collected. The patients were divided into two groups(concentrated group vs distributed group) according to the distance between the splenic artery's furcation and the splenic hilar region. Then, the anatomical layout, clinicopathologic characteristics, intraoperative variables, and postoperative variables were compared between the two groups.RESULTS: There were 205 patients with a concentrated type(64.7%) and 112 patients with a distributed type(35.3%) Sp A. There were 22 patients(6.9%) with a single branch of the splenic lobar vessels, 250(78.9%) with 2 branches, 43(13.6%) with 3 branches, and 2 patients(0.6%) with multiple branches. Eighty sevenpatients(27.4%) had type?Ⅰ?splenic artery trunk, 211(66.6%) had type Ⅱ, 13(4.1%) had type Ⅲ, and 6(1.9%) had type Ⅳ. The mean splenic hilar lymphadenectomy time(23.15 ± 8.02 vs 26.21 ± 8.84 min; P = 0.002), mean blood loss resulting from splenic hilar lymphadenectomy(14.78 ± 11.09 vs 17.37 ± 10.62 m L; P = 0.044), and number of vascular clamps used at the splenic hilum(9.64 ± 2.88 vs 10.40 ± 3.57; P = 0.040) were significantly lower in the concentrated group than in the distributed group. However, the mean total surgical time, mean total blood loss, and the mean number of harvested splenic hilar lymph nodes were similar in both groups(P > 0.05 for each comparison). There were also no significant differences in clinicopathological and postoperative characteristics between the groups(P > 0.05).CONCLUSION: It is of value for surgeons to know the splenic hilar vascular anatomy when performing LTGSPL. Patients with concentrated type Sp A may be optimal patients for training new surgeons.
基金Supported by Research fund from Chosun University,2013
文摘Castleman's disease(CD) is a rare lymphoproliferative disorder of unknown etiology.Clinically,it occurs as a localized(unicentric) disease or as a systemic(multicentric) disease.Unicentric Castleman's disease(UCD) presents as a solitary mass and primarily affects the mediastinal,retroperitoneal,and cervical lymph nodes.In contrast to multicentric CD,which involves peripheral lymphadenopathy and numerous systemic symptoms,UCD is not typically associated withgeneralized symptoms.Three main distinct histologic variants are recognized:hyaline-vascular type,plasma cell type,and mixed type.Extranodal CD is rare.Specifically,UCD exclusively in the spleen is extremely rare,with only 2 cases described in the literature to date.Here,we describe an asymptomatic 75-yearold man with a 5.7 cm × 4.5 cm sized heterogenous enhanced mass located in the spleen.He underwent surgical resection for diagnosis and treatment.A pathologic examination indicated the hyaline-vascular type of CD.In this patient,the preoperative diagnosis was difficult to determine,and therefore,invasive procedures were required.
文摘Littoral cell angiomas(LCA) of the spleen are vascular tumors of unknown etiology arising from the littoral cells of the splenic red pulp sinuses. Usually a benign and incidental finding,LCA have been repeatedly reported in association with a variety of visceral malignancies and hold the potential for dissemination per se. We encountered a case of a 30 year old female who was diagnosed with solid pseudopapillary tumor of the head and distal pancreas by fine needle aspiration cytology. A distal pancreatectomy with splenectomy was performed in addition to a pylorus-preserving Whipple's procedure and cholecystectomy. Histopathological examination confirmed solid pseudopapillary tumor of the pancreasand showed multiple well-circumscribed anastomosing vascular channels in the spleen. The diagnosis of LCA of the spleen was confirmed by immunohistochemistry that revealed co-expression of endothelial cell marker,CD31 and CD34,along with histiocytic marker,CD68 by the vascular lining cells. LCA has been previously reported in association with colorectal and pancreatic adenocarcinoma,malignant lymphoma,myelodysplasia and autoimmune disorders. We report the first case of LCA associated with solid pseudopapillary tumor of the pancreas.
文摘Formation of new blood vessels is paramount for tumour growth and metastatic dissemination and vascular endothelial growth factor (VEGF) is one of the key regulators of this process. The purpose of this study was to evaluate the immunohistochemical expression of VEGF in 23 splenic hemangiosarcomas and 7 splenic hemangiomas in dogs. Blood tests performed previous to splenectomy were analysed for correlation with tumour VEGF expression. Results showed significantly higher VEGF expression in hemangiosarcomas than hemangiomas and lower hematocrit values and red cell count in dogs affected with malignant neoplasia (P < 0.05). These findings suggest the presence of high VEGF levels may be related to the malignant vascular proliferation seen in hemangiosarcomas.
文摘[目的]探讨健脾固肾化瘀方联合氯沙坦钾片治疗脾肾两虚夹瘀型糖尿病肾脏病(DKD)的临床疗效以及其对患者血清基质金属蛋白酶-9(MMP-9)、单核细胞趋化因子-1(MCP-1)和血管内皮生长因子(VEGF)水平的影响。[方法]选择沧州中西医结合医院2019年1月—2021年5月纳入80例脾肾两虚夹瘀型DKD患者作为研究对象,采用随机数字表法分成观察组与对照组各40例。观察组给予健脾固肾化瘀方联合氯沙坦钾片治疗,对照组单用氯沙坦钾片治疗,连续治疗12周后观察两组临床疗效。治疗前后检测受试者血糖[空腹血糖(FPG)、餐后2 h血糖(2 h PG)和糖化血红蛋白(HbA1c)]、血脂[总胆固醇(TC)、三酰甘油(TG)和低密度脂蛋白胆固醇(LDL-C)]及肾功能指标[尿微量白蛋白/尿肌酐比值(UACR)、肌酐(SCr)和尿素氮(BUN)]。选用酶联免疫吸附法测定血清MMP-9、MCP-1和VEGF水平。并统计两组不良反应情况。[结果]观察组总有效率为92.50%(37/40),较对照组72.50%(29/40)有所提高(P<0.05)。两组治疗后FPG、2 h PG和HbA1c均较治疗前降低(P<0.05),且均以观察组的改善更显著(P<0.01)。两组治疗后血清TC、TG和LDL-C浓度均较治疗前下降(P<0.05),且均以观察组的改善更显著(P<0.01)。两组治疗后UAER和血清SCr、BUN水平均较治疗前降低(P<0.05),且均以观察组的改善更显著(P<0.01)。两组治疗后血清MMP-9水平均较治疗前升高(P<0.05),血清MCP-1、VEGF浓度均较治疗前下降(P<0.05);且治疗后,观察组对血清MMP-9水平的升高作用及对血清MCP-1、VEGF水平的降低作用较对照组更显著(P<0.01)。所有患者均无明显不良反应发生。[结论]应用健脾固肾化瘀方联合氯沙坦钾片治疗脾肾两虚夹瘀型DKD能安全有效地上调患者MMP-9表达水平,下调MCP-1、VEGF表达水平,改善肾功能,整体疗效确切。
文摘目的:探讨补气健脾化痰法对2型糖尿病患者中医证候积分与血管内皮功能的影响。方法:将2019年9月-2021年9月北京中医药大学房山医院月华分院收治的148例2型糖尿病患者随机分成对照组和观察组,对照组74例给予二甲双胍+格列美脲治疗,观察组74例给予二甲双胍+格列美脲+补气健脾化痰法治疗,两组均治疗3个月。观察两组的中医证候积分、血糖水平[空腹血糖(Glucose,GLU)、餐后2 h血糖(2 h Postprandial Blood Glucose,2 h PBG)、糖化血红蛋白(Glycosylated Hemoglobin,HbA1c)]、血管内皮功能指标[内皮素-1(Endothelin-1,ET-1)、一氧化氮(Nitric Oxide,NO)、血管性假血友病因子(von Willebrand Factor,vWF)、血栓调节蛋白(Thrombomodulin,TM)]、临床疗效以及不良反应(恶心、呕吐、头晕、嗜睡)。结果:两组治疗后的口渴喜饮、气短寡言、少食易饥、疲乏无力的评分均降低(P<0.05),且观察组治疗后口渴喜饮、气短寡言、少食易饥、疲乏无力的评分低于对照组(P<0.05);两组治疗后的GLU、2 h PBG、HbA1c均降低(P<0.05),且观察组治疗后的GLU、2 h PBG、HbA1c低于对照组(P<0.05);两组治疗后的ET-1、vWF、TM均降低(P<0.05),NO均升高(P<0.05),且观察组治疗后的ET-1、vWF、TM低于对照组(P<0.05),NO高于对照组(P<0.05);观察组总有效率为95.95%(71/74),高于对照组的81.08%(60/74)(P<0.05);观察组不良反应发生率为9.46%(7/74),与对照组的10.81%(8/74)相近(P>0.05)。结论:补气健脾化痰法对2型糖尿病患者的治疗效果较好,可降低中医证候积分,减轻患者症状,且能改善血糖水平与血管内皮功能指标,总有效率高,不良反应少,有效性与安全性兼备,可推广。
文摘目的 探讨益气温阳补肾方加减治疗老年高血压脾肾阳虚证的临床效果。方法 选取2021年12月—2022年11月期间青岛市中医医院收治的脾肾阳虚证老年高血压患者98例,采用随机数字表法分为对照组和试验组,每组各49例。对照组给予常规西药降压治疗,试验组在对照组基础上联合益气温阳补肾方加减治疗,两组患者均治疗4周。观察比较两组患者临床疗效、治疗安全性,治疗前后中医证候积分、血压[收缩压(Systolic blood pressure,SBP)、舒张压(Diastolic blood pressure,DBP)、脉压(Pulse pressure,PP)、24 h SBP、24 h DBP]水平、血管内皮功能指标[内皮素-1(Endothelin-1,ET-1)、一氧化氮(Nitric oxide,NO)、血栓素A2(Thrombin A2,TXA_(2))]水平。结果 (1)临床疗效:治疗后试验组总有效率95.92%(47/49)明显高于对照组81.25%(39/48),差异有统计学意义(P<0.05)。(2)中医证候积分:治疗后两组患者中医证候各项症状积分均较治疗前降低,差异有统计学意义(P<0.05);且试验组中医证候各项症状积分均明显低于对照组,差异有统计学意义(P<0.05)。(3)血压监测水平:治疗后两组患者SBP、DBP、PP、24 h SBP、24 h DBP水平均较治疗前降低,差异有统计学意义(P<0.05);且试验组SBP、DBP、PP、24 h SBP、24 h DBP水平均明显低于对照组,差异有统计学意义(P<0.05)。(4)血管内皮功能水平:治疗后两组患者血清ET-1、TXA_(2)均较治疗前降低,NO较治疗前升高,差异有统计学意义(P<0.05);且试验组ET-1、TXA_(2)均明显低于对照组,NO明显高于对照组,差异有统计学意义(P<0.05)。(5)安全性:治疗期间,两组患者均未发生严重或影响治疗的不良反应,仅对照组出现1例轻度潮红,未给予干预自行缓解。结论 益气温阳补肾方加减治疗老年高血压脾肾阳虚证效果显著,安全性高,有利于控制患者血压水平,且可能与调节血管内皮功能有关。
