【摘要】 目的 探索顯微眼內窺鏡在后段眼內異物取出及玻璃體切除術中的應用。 方法 將2005年7月-2006年3月38例眼內異物患者分為試驗組（15例）及對照組（23例）。試驗組采用顯微眼內窺鏡下完成對外傷性視網膜玻璃體病變等的處理及眼內異物的取出；對照組采用顯微鏡直視下行常規玻璃體切割及眼內異物取出術。 結果 試驗組術后角膜透明度及眼壓恢復、視力提高及視網膜復位等情況均優于對照組；異物取出情況、手術時間和并發癥兩組無差異。 結論 在觀察困難或異物處于極周邊時應用顯微眼內窺鏡，能夠在手術中直接取出眼內各個部位異物，及時發現視網膜裂孔并同時行抗青光眼手術，減少對角膜材料的依賴和對角膜的損傷，為及時、準確和安全地手術提供了條件。【Abstract】 Objective To investigate the application of the intraocular micro-endoscope in extracting intraocular foreign bodies (IOFB) and vitrectomy. Methods A total of 38 patients with IOFB from July 2005 to March 2006 were divided into a trial group (15 patients) and control group (23 patients). The treatment for traumatic retinal vitreous lesions and extraction of IOFB were performed under the intraocular micro-endoscope in the trial group; while the conventional vitrectomy and IOFB extraction were performed under the microscope in the control group. Results The degree of corneal recovery, improvement of intraocular pressure, visual acuity, and retinal reattachment were better in the trial group than that in the control group. There was no difference in removal of IOFB, surgical time and complications between the two groups. Conclusion In patients with intraocular foreign bodies and cloudy cornea or other conditions that made the observation difficult, intraocular micro-endoscope is a useful convenience without relying on donated cornea. The practice made the judge of size, location and the distance more and more accurate through the monitor.
Objective
To explore the risk factors of postoperative portal vein system thrombus (PVST) after laparoscopic splenectomy in treatment of portal hypertension and hypersplenism.
Methods
Clinical data of 76 patients with portal hypertension and hypersplenism who underwent laparoscopic splenectomy in the Sichuan Provincial People’s Hospital from January 2012 to January 2017 were analyzed.
Results
There were 31 patients suffered from PVST (PVST group), and other 45 patients enrolled in non-PVST group.There were significant differences on age, diameter of splenic vein, diameter of portal vein, blood flow velocity of portal vein, level of D-dimer, and platelet count between the PVST group and the non-PVST group (P<0.05), but there were no significant difference on gender, Child-Pugh classification, etiology of cirrhosis, operation time, intraoperative blood loss, postoperative complications, and prothrombin time between the two groups (P>0.05). Multivariate logistic regression analysis showed that, patients with age >50 years (RR=1.31, P=0.02), splenic vein diameter >12 mm ( RR=1.29, P<0.01), portal vein diameter >13 mm (RR=1.55, P=0.01), blood flow velocity of portal vein <18 cm/s ( RR=1.47, P<0.01), increases level of D-dimer (RR=2.89, P=0.03), and elevated platelet count (RR=1.82 P=0.02) had higher risk of postoperative PVST than those patients with age ≤50 years, splenic vein diameter ≤12 mm, portal vein diameter ≤13 mm, blood flow velocity of portal vein ≥18 cm/s, normal level of D-dimer and platelet count.
Conclusion
For patients with portal hypertension and hypersplenism who underwent laparoscopic splenectomy, we should pay more attention to the risk factor, such as D-dimer and so on, to avoid the occurrence of postoperative PVST.
Objective
Hepatitis B virus X (HBx) protein is involved in the initiation and progression of hepatocellular carcinoma (HCC) by regulating the host protein-coding genes. Herein, we want to explore whether HBx protein can alter the expression of microRNAs (miRNAs) to promote proliferation and transformation in malignant hepatocytesin vitro.
Methods
MiRNA microarray and quantitative reverse-transcription polymerase chain reactions (qRT-PCRs) were performed to identify miRNAs that were differentially regulated by HBx protein in HCC cells. Protein and mRNA expression analyses, cell cycle and apoptosis analyses, and luciferase reporter assays were performed to delineate the consequences of miR-16 family repression in HepG2 cells.
Results
HBx protein induced widespread deregulation of miRNAs in HepG2 cells, and the downregulation of the miR-16 family was reproducible in HepG2, SK-HEP-1, and Huh7 cells. CCND1, a target gene of the miR-16 family, was derepressed by HBx protein in HepG2 cells. C-myc mediated the HBx-induced repression of miR-15a/16 in HepG2 cells. Ectopically expressed miR-15a/16 suppressed the proliferation, clonogenicity, and anchorage-independent growth of HBx-expressing HepG2 cells by arresting them in the G1 phase and inducing apoptosis, whereas reduced expression of miR-16 accelerated the growth and cell-cycle progression of HepG2 cells.
Conclusions
HBx protein altered thein vitro expression of miRNAs in host malignant hepatocytes, particularly downregulating the miR-16 family. Repression of miR-15a/16 is c-myc mediated and is required for the HBx-induced transformation of HepG2 cellsin vitro. Therefore, miR-16 family may serve as a therapeutic target for hepatitis B virus (HBV)-associated HCC.
Objective To explore the measures for early diagnosis and treatment of iatrogenic injury in the distal part of common bile duct. Methods The clinical data of 20 patients with iatrogenic injury in the distal part of common bile duct treated in our hospital from 1990 to 2008 were analyzed retrospectively. Results The injuries of 15 cases were found during the operation: 11 cases were treated with 3-stoma (bile duct, pancreas, duodenum)+Oddi sphinctreoplasty (OSP), 1 case with OSP+choledochojejunostomy, 2 cases with the perforated common bile duct suture repair+T tube drainage, 1 case with T tube drainage; All of them were cured after surgery. The other 5 cases were not found during the primary operation, 2 cases in which were cured with several operations, the other 3 were dead from infectious shock. Conclusions Early diagnosis and treatment of iatrogenic injury in the distal part of common bite duct can obtain perfect effects. Different procedures should be performed according to different degrees of the injury. The perfect preoperative imaging examination and intraoperative choledochoscopy before bile duct exploration may reduce the occurrence of the injury.
