目的:探讨以SVV作为监测指标的目标导向液体治疗在全麻复合硬膜外麻醉的老年患者结肠癌根治术中的指导作用。方法:择期行结肠癌手术的老年患者60例,ASAⅡ或Ⅲ级,在全麻复合硬膜外麻醉下,随机分为SVV组(S组)和CVP组(C组)。所有患者局麻...目的:探讨以SVV作为监测指标的目标导向液体治疗在全麻复合硬膜外麻醉的老年患者结肠癌根治术中的指导作用。方法:择期行结肠癌手术的老年患者60例,ASAⅡ或Ⅲ级,在全麻复合硬膜外麻醉下,随机分为SVV组(S组)和CVP组(C组)。所有患者局麻下行颈内静脉穿刺。S组连接Flotrac/Vigileo监测系统监测每搏变异度(SVV),将SVV≤13%,MAP≥65mmHg作为目标,行目标导向液体治疗;C组根据CVP及MAP行经典补液治疗。所有患者在麻醉诱导前(T0),手术开始后1h(T_1),2h(T_2)及手术结束时(T_3)记录血流动力学指标及血乳酸水平,记录术中出入量及去氧肾上腺素的应用、术后ICU停留时间和术后并发症等情况。结果:与C组相比,S组输注的液体总量明显减少[2114±503ml vs 2538±425ml,P<0.05],但是胶体液量增多(956±226ml vs 618±167ml,P<0.05),S组的血流动力学更稳定,各时点的血乳酸水平也较C组明显降低。S组的术后ICU停留时间明显缩短(4.2±1.3hvs 6.7±1.2h,P<0.05),恶心、呕吐发生率也明显降低(13.3%vs 20.0%,P<0.05)。结论:以SVV为监测指标的目标导向液体治疗(GDFT),用于全麻复合硬膜外麻醉的老年结肠癌根治术患者,可以满足其个体化的液体治疗,减少液体输注总量,提供更平稳的血流动力学,降低血乳酸水平,减少术后并发症的发生率。展开更多
结直肠癌是我国常见癌症之一。30年来,结直肠癌发病率年均上升3%~4%,但地区差异较大,如上海2012年发病率达56/10万。从全局看,我国结直肠癌发病仍暂处非高发水平。世界卫生组织国家癌症研究代表处（Internatinal Agency for Research on...结直肠癌是我国常见癌症之一。30年来,结直肠癌发病率年均上升3%~4%,但地区差异较大,如上海2012年发病率达56/10万。从全局看,我国结直肠癌发病仍暂处非高发水平。世界卫生组织国家癌症研究代表处（Internatinal Agency for Research on Cancer,IARC）发表的Globocan 2012估算中国大陆结直肠癌标化发病率为14.2/10万。展开更多
目的通过观察康莱特(K ang la ite,KLT)对大肠癌HT-29细胞株体外生长的抑制率、细胞周期及端粒酶活性影响,探讨其对大肠癌HT-29细胞株体外生长的抑制机制。方法(1)用M TT法检测康莱特在不同浓度及不同作用时间对大肠癌HT-29细胞株体外...目的通过观察康莱特(K ang la ite,KLT)对大肠癌HT-29细胞株体外生长的抑制率、细胞周期及端粒酶活性影响,探讨其对大肠癌HT-29细胞株体外生长的抑制机制。方法(1)用M TT法检测康莱特在不同浓度及不同作用时间对大肠癌HT-29细胞株体外生长的抑制率。(2)碘化丙啶(P I)染色后用流式细胞术检测康莱特作用前后HT-29细胞周期分布。(3)用TRAP-PCR-EL ISA法检测康莱特作用前后HT-29细胞的端粒酶活性。结果在40、80μl/m l康莱特作用下HT-29细胞体外增殖及端粒酶活性明显受抑制,G2+M期百分比明显增高。细胞生长抑制率在72小时时分别为9.5%与37.1%,在120小时时分别为25.5%与48.0%。端粒酶活性在72小时时分别为1.127±0.043与1.046±0.035;120小时时分别为1.075±0.047与1.008±0.057,均低于空白对照组(P<0.05)。G2+M期百分比72小时时分别为23.9%与45.2%,空白对照组为7.2%(P<0.05)。结论(1)康莱特使体外生长的大肠癌HT-29细胞株阻滞于细胞周期的G2+M时相。(2)康莱特抑制HT-29细胞株端粒酶活性。(3)抑制作用呈时间和剂量依赖性。展开更多
AIM: For many physicians who ordinarily treat patients with colonic diseases, colonoscopy is considered a prime study interest. Developments in colonoscopic equipment and methods have led to a large number of endoscop...AIM: For many physicians who ordinarily treat patients with colonic diseases, colonoscopy is considered a prime study interest. Developments in colonoscopic equipment and methods have led to a large number of endoscopic diagnoses and treatment for colorectal neoplasms. The purpose of this investigation is to evaluate the efficacy and outcomes of endoscopic treatment for colorectal neoplastic lesions.METHODS: From September 1999 to May 2003, 11 447 consecutive colonoscopic examinations in 9 864 patients were gathered; totaling 5 502 endoscopic treatments for colorectal neoplasms. Macroscopic characteristics of the neoplasms were classified into protruded (n = 3 953), sessile (n = 1 402), lateral spreading tumor (n = 139) and depressed lesions (n = 8). Snare polypectomy was conducted in 3 984 lesions, hot forcep removal in 1 368 lesions, and endoscopic mucosal resection in 150 lesions.RESULTS: Histological diagnoses were 4 596 neoplastic lesions (4 376 adenomas and 220 adenocarcinomas) and 906 non-neoplastic lesions (891 hyperplastic and 15 inflammatory polyps). For the adenocarcinoma group, 31 instances involved submucosal invasion or resection margin, who received further operations, while 13 surgical specimens discovered no residual tumors. Three perforations and 96 bleedings were found following endoscopic treatment. No procedure-related mortality was found and no recurrent malignancy was found after 1456 mo follow-up.CONCLUSION: To lower the incidence and mortality of colorectal cancer, endoscopic treatment for colorectalneoplasms is a simple and safe procedure.展开更多
AIM: To clarify whether subclassification of the type VI pit pattern on the basis of magnifying colonoscopy findings is useful in determining the type and depth of invasion of colorectal neoplasms.METHODS: We retrospe...AIM: To clarify whether subclassification of the type VI pit pattern on the basis of magnifying colonoscopy findings is useful in determining the type and depth of invasion of colorectal neoplasms.METHODS: We retrospectively analyzed 272 colorectal neoplasms (117 dysplasias and 155 submucosal invasive carcinomas; 228 patients) with a type V pit pattern [type VI, n = 202; type VN, n = 70 (Kudo and Tsuruta classification system)]. We divided lesions with a type VI pit pattern into two subclasses, mildly irregular lesions and severely irregular lesions, according to the prominent and detailed magnifying colonoscopy findings. We examined the relation between these two subclasses and histology/invasion depth.RESULTS: One hundred and four lesions (51.5%) were judged to be mildly irregular, and 98 lesions (48.5%) were judged to be severely irregular. Ninety-seven (93.3%) mildly irregular lesions showed dysplasias or submucosal invasion of less than 1000 μm (SM < 1000 μm). Fifty-five (56.1%) severely irregular lesions showed submucosal invasion equal to or deeper than 1000 μm (SM ≥ 1000 μm). Mild irregularity was found significantly more often in dysplasias or lesions with SM < 1000 μm than in lesions with SM ≥ 1000 μm (P < 0.01).CONCLUSION: Subclassification of the type VI pit pattern is useful for identifying dysplasias or lesions with SM < 1000 μm.展开更多
文摘目的:探讨以SVV作为监测指标的目标导向液体治疗在全麻复合硬膜外麻醉的老年患者结肠癌根治术中的指导作用。方法:择期行结肠癌手术的老年患者60例,ASAⅡ或Ⅲ级,在全麻复合硬膜外麻醉下,随机分为SVV组(S组)和CVP组(C组)。所有患者局麻下行颈内静脉穿刺。S组连接Flotrac/Vigileo监测系统监测每搏变异度(SVV),将SVV≤13%,MAP≥65mmHg作为目标,行目标导向液体治疗;C组根据CVP及MAP行经典补液治疗。所有患者在麻醉诱导前(T0),手术开始后1h(T_1),2h(T_2)及手术结束时(T_3)记录血流动力学指标及血乳酸水平,记录术中出入量及去氧肾上腺素的应用、术后ICU停留时间和术后并发症等情况。结果:与C组相比,S组输注的液体总量明显减少[2114±503ml vs 2538±425ml,P<0.05],但是胶体液量增多(956±226ml vs 618±167ml,P<0.05),S组的血流动力学更稳定,各时点的血乳酸水平也较C组明显降低。S组的术后ICU停留时间明显缩短(4.2±1.3hvs 6.7±1.2h,P<0.05),恶心、呕吐发生率也明显降低(13.3%vs 20.0%,P<0.05)。结论:以SVV为监测指标的目标导向液体治疗(GDFT),用于全麻复合硬膜外麻醉的老年结肠癌根治术患者,可以满足其个体化的液体治疗,减少液体输注总量,提供更平稳的血流动力学,降低血乳酸水平,减少术后并发症的发生率。
文摘结直肠癌是我国常见癌症之一。30年来,结直肠癌发病率年均上升3%~4%,但地区差异较大,如上海2012年发病率达56/10万。从全局看,我国结直肠癌发病仍暂处非高发水平。世界卫生组织国家癌症研究代表处（Internatinal Agency for Research on Cancer,IARC）发表的Globocan 2012估算中国大陆结直肠癌标化发病率为14.2/10万。
文摘目的通过观察康莱特(K ang la ite,KLT)对大肠癌HT-29细胞株体外生长的抑制率、细胞周期及端粒酶活性影响,探讨其对大肠癌HT-29细胞株体外生长的抑制机制。方法(1)用M TT法检测康莱特在不同浓度及不同作用时间对大肠癌HT-29细胞株体外生长的抑制率。(2)碘化丙啶(P I)染色后用流式细胞术检测康莱特作用前后HT-29细胞周期分布。(3)用TRAP-PCR-EL ISA法检测康莱特作用前后HT-29细胞的端粒酶活性。结果在40、80μl/m l康莱特作用下HT-29细胞体外增殖及端粒酶活性明显受抑制,G2+M期百分比明显增高。细胞生长抑制率在72小时时分别为9.5%与37.1%,在120小时时分别为25.5%与48.0%。端粒酶活性在72小时时分别为1.127±0.043与1.046±0.035;120小时时分别为1.075±0.047与1.008±0.057,均低于空白对照组(P<0.05)。G2+M期百分比72小时时分别为23.9%与45.2%,空白对照组为7.2%(P<0.05)。结论(1)康莱特使体外生长的大肠癌HT-29细胞株阻滞于细胞周期的G2+M时相。(2)康莱特抑制HT-29细胞株端粒酶活性。(3)抑制作用呈时间和剂量依赖性。
文摘AIM: For many physicians who ordinarily treat patients with colonic diseases, colonoscopy is considered a prime study interest. Developments in colonoscopic equipment and methods have led to a large number of endoscopic diagnoses and treatment for colorectal neoplasms. The purpose of this investigation is to evaluate the efficacy and outcomes of endoscopic treatment for colorectal neoplastic lesions.METHODS: From September 1999 to May 2003, 11 447 consecutive colonoscopic examinations in 9 864 patients were gathered; totaling 5 502 endoscopic treatments for colorectal neoplasms. Macroscopic characteristics of the neoplasms were classified into protruded (n = 3 953), sessile (n = 1 402), lateral spreading tumor (n = 139) and depressed lesions (n = 8). Snare polypectomy was conducted in 3 984 lesions, hot forcep removal in 1 368 lesions, and endoscopic mucosal resection in 150 lesions.RESULTS: Histological diagnoses were 4 596 neoplastic lesions (4 376 adenomas and 220 adenocarcinomas) and 906 non-neoplastic lesions (891 hyperplastic and 15 inflammatory polyps). For the adenocarcinoma group, 31 instances involved submucosal invasion or resection margin, who received further operations, while 13 surgical specimens discovered no residual tumors. Three perforations and 96 bleedings were found following endoscopic treatment. No procedure-related mortality was found and no recurrent malignancy was found after 1456 mo follow-up.CONCLUSION: To lower the incidence and mortality of colorectal cancer, endoscopic treatment for colorectalneoplasms is a simple and safe procedure.
基金a grant from the Japanese Society of Gastro-enterological Endoscopy, Chugoku Branch
文摘AIM: To clarify whether subclassification of the type VI pit pattern on the basis of magnifying colonoscopy findings is useful in determining the type and depth of invasion of colorectal neoplasms.METHODS: We retrospectively analyzed 272 colorectal neoplasms (117 dysplasias and 155 submucosal invasive carcinomas; 228 patients) with a type V pit pattern [type VI, n = 202; type VN, n = 70 (Kudo and Tsuruta classification system)]. We divided lesions with a type VI pit pattern into two subclasses, mildly irregular lesions and severely irregular lesions, according to the prominent and detailed magnifying colonoscopy findings. We examined the relation between these two subclasses and histology/invasion depth.RESULTS: One hundred and four lesions (51.5%) were judged to be mildly irregular, and 98 lesions (48.5%) were judged to be severely irregular. Ninety-seven (93.3%) mildly irregular lesions showed dysplasias or submucosal invasion of less than 1000 μm (SM < 1000 μm). Fifty-five (56.1%) severely irregular lesions showed submucosal invasion equal to or deeper than 1000 μm (SM ≥ 1000 μm). Mild irregularity was found significantly more often in dysplasias or lesions with SM < 1000 μm than in lesions with SM ≥ 1000 μm (P < 0.01).CONCLUSION: Subclassification of the type VI pit pattern is useful for identifying dysplasias or lesions with SM < 1000 μm.
