【摘要】 目的 探討早期微創腹腔置管灌洗在重癥急性胰腺炎（severe acute pancreatitis，SAP）治療中，對減輕炎性反應的作用。 方法 選擇2007年1月-2009年6月收治的SAP患者56例，隨機分為早期微創腹腔置管灌洗組（灌洗組，n=28）和常規治療組（對照組，n=28）；兩組同時給予生長抑素，抑酸，抗感染，保持水、電解質及酸堿平衡等綜合治療，灌洗組在常規治療基礎上早期予以微創腹腔置管灌洗。檢測兩組治療前及治療后2、5、7 d C反應蛋白（C-reactrve protein，CRP）、血清腫瘤壞死因子α（tumor necrosis factor α，TNF-α）、 白細胞介素6（interleukin，IL-6）、IL-8水平。 結果 兩組治療前CRP、TNF-α、IL-6、IL-8水平差異無統計學意義（Pgt;0.05），治療后2、5、7 d比較差異有統計學意義（Plt;0.05）。 結論 早期微創腹腔置管灌洗操作簡便易行、創傷小、療效佳，對減輕SAP所致的全身炎性反應具有較好效果，是治療SAP有效方法之一。【Abstract】 Objective To explore the effect of the early minimally invasive peritoneal lavage in severe acute pancreatitis (SAP) from Januany 2007 to June 2009. Methods A total of 56 cases of SAP were randomly divided into early minimally invasive peritoneal lavage group (lavage group, n=28) and conventional treatment group (control group, n=28). The patients were given comprehensive treatment, including somatostatin, acid suppression, anti-infection, and maintaining water, electrolyte, and acid alkali balance.In lavage group, the patients were treated with early minimally invasive peritoneal lavage in addition.The levels of C reactive protein(CRP), serum tumor necrosis factor α (TNF-α), interleukin 6 (IL-6), and interleukin 8(IL-8)were detected before and 2, 5, 7 days after tretment. Results There was no significant difference in CRP, TNF-α, IL-6, or IL-8 before treament between the two groups (Pgt;0.05). There were significant differences in CRP, TNF-α, IL-6, and IL-8 after treatment between the two groups (Plt;0.05). Conclusion Early minimally invasive peritoneal lavage is a simple, minially invasive, and effective techinique in treating SAP.
【Abstract】Objective To investigate the expression of PCNA in gastric cancer and its relationship with telomerase activity of peritoneal washings and peritoneal dissemination, and to compare the efficacy of telomerase activity and cytology of peritoneal washings for prediction of peritoneal metastasis of gastric cancer. MethodsTelomeric repeated amplification protocol (TRAP)enzymelinked immunosorbent assay (ELISA) was performed to measure the telomerase activity of peritoneal washings collected from 60 patients with gastric cancer. Exfoliate cytologic analysis of the corresponding samples was used for comparison.Expression of PCNA was measured with immunohistochemical staining.Their relationship with clinicopathologic features were evaluated. ResultsThe positive rate of telomerase activity in peritoneal washing collected from patients with gastric cancer was 41.7%,which well related to serosal invasion, histology types, depth of infiltration and peritoneal metastasis of gastric cancer. The positive rate of telomerase activity increased with the increased depth of infiltration and serosal involvement areas (P＜0.05).The positive rate of exfoliative cytology was 25.0%, which was obviously high in the group with macroscopic peritoneal metastasis (the group of P1-3). The positive rate of exfoliative cytology also increased with the increased depth of infiltration and serosal involvement areas (P＜0.05). Although the positive rate of telomerase activity in peritoneal washing collected from patients with gastric cancer was not significantly higher than that of exfoliative cytology in general, it was significantly higher than that of exfoliative cytology in the group of pT4, P1-3 and undifferentiated type.The PCNA proliferation index (PI) of positive telomerase activity group was significantly higher than that of negative. The PCNA PI was significantly higher in the group of P1-3 and serosal invasion thanthat of P0 and without serosal invasion. ConclusionTo detect telomerase activity in peritoneal washings and to detect tumor cells by cytologic method are useful to predict subclinical metastasis to the peritoneum in patients with gastric cancer,but telomerase activity is more sensitive than the other one.Telomerase activity is well related to proliferating activity of gastric cancer,which was the very important reason of peritoneal metastasis and serosal invasion.