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Chinese Medical Journal 2018年第4期131卷 413-419页

作者： Jian Zhao Gang Wang Zhi-Wei Jiang Chuan-Wei Jiang Jiang liu Can-Can Xia jie-shou li Research Institute of General Surgery Jinling Hospital Medical School of Nanjing University Nanjing Jiangsu 210002 China

Background： Most studies on enhanced recovery after surgery （ERAS） for gastric cancer exclude patients who received neoadjuvant chemotherapy. Here, we aimed to evaluate whether patients who received neoadjuvant chemotherapy can be enrolled into the ERAS program for locally advanced gastric cancer. Methods： From April 2015 to July 2017, 114 patients who received neoadjuvant chemotherapy for locally advanced gastric cancer were randomized into ERAS and standard care （SC） groups. Postoperative length of stay, complications, bowel function, and nutritional status were recorded. Results： The postoperative length of stay of the ERAS group was shorter compared with that of the SC group （5.9 ± 5.6 vs. 8.1 ± 5.3 days, P=0.037）.The postoperative complication rate was 9.3% in the ERAS group and 11.5% in the SC group（P=0.700）.The time to first flatus （2.7 ± 2.0 vs. 4.5 ± 4.6 days, P = 0.010） and time to a semi-liquid diet （3.2 ± 2.1 vs. 6.3 ± 4.9 days, P 〈 0.001） in the ERAS group were shorter compared with those in the SC group. On the 10thday after surgery, the values of weight, total protein, albumin, and prealbumin of the ERAS group were lower compared with those of the SC group. Conclusions： Patients who received neoadjuvant chemotherapy could be enrolled into ERAS programs for locally advanced gastric cancer. The nutritional status of these patients was not adversely affected.

关键词： Advanced Gastric Cancer Enhanced Recovery after Surgery Gastrectomy Length of Stay Neoadjuvant Chemotherapy

Non-composite combined liver and intestinal allotransplantation

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Hepatobiliary & Pancreatic Diseases International 2006年第4期5卷 613-616页

作者： Ning li, You-Sheng li, Yuan-Xin li, Wei-Ming Zhu, Xiao-Dong Ni, liang Zhu, Bin Cao, Wei-Su li, Kai Luo and jie-shou li Research Institute of General Surgery, Jinling Hospital, Nanjing 210002, China Research Institute of General Surgery Jinling Hospital Nanjing 210002 China. liningrigs@***

BACKGROUND: Patients with short bowel syndrome may require combined liver and intestinal transplantation due to total parenteral nutrition(TPN)-related liver damage. We report combined liver and intestinal allotransplantation as a non-composite technique in a patient in China. METHODS: During the operation, a 380 cm long intestine was transplanted with systemic drainage and aortic inflow, while the liver graft was placed in a piggyback fashion. Warm ischemic time of the donor graft was 2 minutes and 30 seconds, and cold ischemic time for intestinal and the liver graft was 6 hours and 40 minutes and 8 hours and 7 minutes, respectively. Immunosuppressants used after operation included tacrolimus, methylprednisolone, mycophenolate mofetil and Zenapax. RESULTS: The recipient recovered with no evidence of rejection and was kept well on tube feeding. Eventually, he died of massive hemorrhage of the thoracic cavity on day 210 after transplantation. CONCLUSION: The non-composite combined liver and intestinal allotransplantation is superior to composite technique in adult patients, particularly those who have had abdominal infection or repeated abdominal operations.

关键词： transplantation intestinal transplantation liver transplantation combined liver and intestinal transplantation

Mechanism of reduction of albumin expression induced by lipopolysaccharide in rat hepatocytes

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中华医学杂志(英文版) 2005年第20期000卷 25-32页

作者： WANG Xin-ying, li Wei-qin, LU Jun, li Ning and li jie-shou Research Institute of General Surgery, Jinling Hospital, Nanjing 210002, China Department of Orthopaedics, Zhongda Hospital, Nanjing 210009, China Research Institute of General Surgery Jinling Hospital Nanjing 210002 China Department of Orthopaedics Zhongda Hospital Nanjing 210009 China

Background The severity of hypoalbuminemia has been sho wn to be related to morbidity and mortality in some critical illnesses, illustra ting the need for better understanding of molecular mechanism of hypoalbuminemia . lipopolysaccharide (LPS) is a key mediator inducing hypoalbuminemia in sepsis and septic shock. The present study was designed to identify if the reduction of albumin expression is directly induced by LPS and modulated by activated extr acellular signal-regulated protein kinase (ERK) and p38 mitogen-activated prot ein kinase (MAPK) in rat hepatocytes. Methods Primary rat hepatocytes were divided into five groups. In two of them, hepatocytes were treated with normal saline or 1 μg/ml LPS, th en albumin mRNA expression was observed at 0, 2, 8, 12 and 24 hours after treatm ent. In another group, hepatocytes were pretreated with 100, 40 or 20 μmol/L o f cycloheximide (CHX, an inhibitor of protein synthesis) for 30 minutes followed by 1 μg/ml LPS for 24 hours. Then the RNA was extracted from the cells for RT -PCR to detect the expression of albumin. The other two groups were administer ed 1 μmol/L, 10 μmol/L and 50 μmol/L of SB203580 (p38 MAPK inhibitor) or PD98 059 (ERK inhibitor) 30 minutes prior to 1 μg/ml LPS treatment. After 24 hours of LPS treatment, the supernatant was collected and assayed for albumin concentr ations. Data were analyzed by one-way analysis of variance, followed by the Ne wman-Keul test; a Pline. The reductio n did not occur until 24 hours after LPS treatment, and albumin mRNA decreased b y 30% approximately compared to the control group at 24 hours (0.587 vs 0.832, P=0.007). CHX could inhibit the decline of albumin mRNA induced by LPS an d the effect was correlated with the dose of CHX. The ERK inhibitor PD98059 cau sed a significant increase in LPS-induced albumin production

关键词： lipopolysaccharide · hepatocytes · albumin · hypoalbuminemia · signal transduction

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急性腹腔间室综合征及其护理

中华护理杂志 2007年第3期42卷 209-211页

作者：黎介寿南京军区南京总医院全军普通外科研究所南京市210002

论述了急性腹腔间室综合征(ACS)的形成原因、发病率、病理生理改变、临床表现及其预防、治疗与护理要点。对于各种原因导致急性腹内压增高的病人,强调早期、动态监测腹内压,采取各种措施降低腹内压,维持循环、呼吸等系统和肾脏的功能,... 详细信息

论述了急性腹腔间室综合征(ACS)的形成原因、发病率、病理生理改变、临床表现及其预防、治疗与护理要点。对于各种原因导致急性腹内压增高的病人,强调早期、动态监测腹内压,采取各种措施降低腹内压,维持循环、呼吸等系统和肾脏的功能,防止发生下肢静脉受阻、全身炎症过度性反应、多器官功能障碍综合征(MODS)和脓毒血症;当腹内压>25mmHg时,应考虑实施剖腹手术敞开腹腔,以迅速降低腹内压。

关键词：腹腔间室综合征腹内压护理

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医学博士后的跨学科研究

医学研究生学报 2017年第1期30卷 1-4页

作者：黎介寿南京大学医学院附属金陵医院(南京军区南京总医院)全军普通外科研究所南京210002

跨学科研究是近年来科研方式讨论的热点之一。近年来,一大批使用跨学科方法或从事跨学科研究与合作的科学家陆续获得诺贝尔奖,再次证明了跨学科研究的重要性。就其深刻性而言,医学领域的跨学科研究本身也体现了当代医学科学探索的一种... 详细信息

跨学科研究是近年来科研方式讨论的热点之一。近年来,一大批使用跨学科方法或从事跨学科研究与合作的科学家陆续获得诺贝尔奖,再次证明了跨学科研究的重要性。就其深刻性而言,医学领域的跨学科研究本身也体现了当代医学科学探索的一种新范型。将跨学科研究应用到对医学博士后培养工作中,目的在于培养一批既是优秀临床医师又懂得实验研究的医学创新型的"两栖专家"。随着现今医学的发展与当前实际工作的情况来看,单独一个学科的发展是远远不够的。文中将从跨学科人才培养思路的由来,外科学与解剖学、信息学、影像学等其他学科间的密切关系等方面说明,医学的进步需要各科之间相互协作,并利用各自领域所长共同开展医学博士后的跨学科研究。

关键词：博士后跨学科 3D成像加速康复外科肠屏障

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发展我军重症医学,提高新时期战伤救治水平

解放军医学杂志 2017年第2期42卷 91-94页

作者：李维勤黎介寿解放军南京总医院普外ICU

重症医学是20世纪后期发展起来的新兴学科,从其发展至今,积累了丰富的理论和实践经验,并独具特色,成为临床医学领域中最活跃的学科。我军的重症医学在严重创伤、脓毒症、热射病、多脏器衰竭和重症急性胰腺炎等疾病的救治和研究方面取得... 详细信息

重症医学是20世纪后期发展起来的新兴学科,从其发展至今,积累了丰富的理论和实践经验,并独具特色,成为临床医学领域中最活跃的学科。我军的重症医学在严重创伤、脓毒症、热射病、多脏器衰竭和重症急性胰腺炎等疾病的救治和研究方面取得了重要成果,在危重患者的器官功能维护、持续血液滤过、营养支持等技术方面处于国内领先地位,在医院危重患者的抢救、卫勤保障、灾难救援等活动中发挥着重要作用。目前战伤救护体系与重症医学的关系越来越密切,同时新时期战争形态的变化也给战伤救治提出了新的课题,结合未来信息化联合作战条件下的战伤特点,发展我军重症医学,提高新时期战伤救治水平,可为重症医学未来的工作指明方向。

关键词：重症医学战伤救治卫勤保障损伤控制

Clinical effects of continuous high volume hemofiltration on severe acute pancreatitis complicated with multiple organ dysfunction syndrome

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World Journal of Gastroenterology 2003年第9期9卷 2096-2099页

作者： Hao Wang Wei Zhou Wei-Qin li Ning li jie-shou li Department of Surgery,School of Medicine,Nanjing University,Nanjing 210002,Jiangsu Province,China Department of Surgery School of Medicine Nanjing University Nanjing 210002 Jiangsu Province China. wanghao_nju@***

AIM: To investigate the efficiency of continuous high volume hemofiltration (HVHF) in the treatment of severe acute pancreatitis (SAP) complicated with multiple organ dysfunction syndrome (MODS).METHODS: A total of 28 SAP patients with an average of 14.36±3.96 APACHE Ⅱ score were involved. Diagnostic criteria for SAP standardized by the Chinese Medical Association and diagnostic criteria for MODS standardized by American College of Chest Physicians (ACCP) and Society of Critical Care Medicine (SCCM) were applied for inclusion. HVHF was started 6.0±6.1 (1-30) days after onset of the disease and sustained for at least 72 hours, AN69 hemofilter (1.2 m2)was changed every 24 hours. The ultrafiltration rate during HVHF was 4 000 mi/h, blood flow rate was 250-300 mi/min,and the substitute fluid was infused with pre-dilution. Low molecular weight heparin was used for ***: HVHF was well tolerated in all the patients, and lasted for 4.04±3.99 (3-24) days. 20 of the patients survived,6 patients died and 2 of the patients quited for financial *** ICU mortality was 21.4%. Body temperature, heart rate and breath rate decreased significantly after *** Ⅱ score was 14.4±3.9 before HVHF, and 9.9±4.3after HVHF, which decreased significantly (P＜0.01). Partial pressure of oxygen in arterial blood before HVHF was 68.5±19.5 mmHg, and increased significantly after HVHF,which was 91.9±25 mmHg (P＜0.01). During HVHF the hemodynamics was stable, and serum potassium, sodium,chlorine, glucose and pH were at normal ***: HVHF is technically possible in SAP patients complicated with MODS. It does not appear to have detrimental effects and may have beneficial *** HVHF, which seldom disturbs the hemodynamics and causes few side-effects, is expected to become a beneficial adjunct therapy for SAP complicated with MODS.

关键词：急性胰腺炎多器官功能衰竭综合征并发症血液滤过治疗

Intestinal permeability in patients after surgical trauma and effect of enteral nutrition versus parenteral nutrition

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World Journal of Gastroenterology 2003年第8期9卷 1878-1880页

作者： Xiao-Hua Jiang Ning li jie-shou li, Research Institute of General Surgery, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, China Xiao-Hua Jiang Ning Li Jie-Shou Li Research Institute of General Surgery Medical School of Nanjing University Nanjing 210002 Jiangsu Province China

AIM: To study the intestinal permeability (IP) following stress of abdominal operation and the different effects on IP of enteral nutrition (EN) and parenteral nutrition (PN).METHODS: Forty patients undergoing abdominal surgery were randomized into EN group and PN group. Each group received nutritional support of the same nitrogen and calorie from postoperative day (POD) 3 to POD 11. On the day before operation (POD-1), POD 7 and POD 12, 10 g of lactulose and 5 g of mannitol were given orally, and urine was collected for 6 hours. Urine excretion ratios of lactulose and mannitol (L/M) were ***: L/M ratios of EN group on POD-1, POD 7 and POD 12 were 0.026±0.017, 0.059±0.026, 0.027±0.017,respectively, and those of PN group were 0.025±0.013,0.080±0.032, 0.047±0.021, respectively. Patients of both groups had elevated L/M ratios on POD 7 vs. POD-1. However the ratio returned toward control level in EN group by POD *** contrast, PN group still had elevated L/M ratios on POD ***: L/M ratio increases for a period of time after surgical trauma and the loss of gut mucosal integrity can be reversed by substitution of enteral nutrition.

关键词：手术后肠内营养肠内营养肠渗透性

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复杂腹腔感染的外科升阶梯治疗

中国实用外科杂志 2019年第6期39卷 542-544,551页

作者：李幼生黎介寿上海交通大学医学院附属第九人民医院普外科上海200011 中国人民解放军东部战区总医院全军普通外科研究所江苏南京210002

复杂腹腔感染(cIAIs)的病死率居高不下,侵袭性开放手术并不能改善cIAIs的预后。随着微创手术和损伤控制外科(DCS)理念的推广,学界提出了外科升阶梯治疗的理念,以期尽可能以最小的手术创伤达到最佳的治疗效果。外科升阶梯治疗包括:微创引... 详细信息

复杂腹腔感染(cIAIs)的病死率居高不下,侵袭性开放手术并不能改善cIAIs的预后。随着微创手术和损伤控制外科(DCS)理念的推广,学界提出了外科升阶梯治疗的理念,以期尽可能以最小的手术创伤达到最佳的治疗效果。外科升阶梯治疗包括:微创引流(经皮穿刺引流、内镜下引流),微创手术(微创手术引流、肠造口)和开放手术(按需再开腹、计划性再开腹、腹腔开放),这些治疗方法对病人的创伤应激依次增大,术后的恢复时间不断延长,手术并发症发生率也逐渐增高。由于计划性再开腹手术在cIAIs治疗中的应用愈来愈多,腹腔填塞与开放的使用也不断增多,应重视腹腔开放并发症的预防与治疗,包括肠空气瘘、腹壁缺损等。在临床实际应用中,cIAIs的升阶梯治疗并非一成不变,需要依据病人的实际情况选择合适的治疗方案。同时,良好的复苏、抗生素的合理选择以及营养支持对cIAIs的外科治疗效果也至关重要。

关键词：复杂腹腔感染升阶梯治疗微创引流微创手术开放手术腹腔开放

静脉成形术和经颈静脉肝内门体静脉分流术治疗肝静脉型巴德-吉亚利综合征回顾性分析

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中华外科杂志 2013年第2期51卷 131-134页

作者：吴性江南京军区南京总医院全军普通外科研究所南京210002

【目的】分析肝静脉闭塞型巴德-吉亚利综合征（BCS）的治疗方法。【方法】回顾性分析1995年5月至2012年2月收治的50例肝静脉型BCS患者的临床资料。男性23例，女性27例｜平均年龄（39±11）岁，肝功能Child-Pugh评分（9.6±2.6）分。肝... 详细信息

【目的】分析肝静脉闭塞型巴德-吉亚利综合征（BCS）的治疗方法。【方法】回顾性分析1995年5月至2012年2月收治的50例肝静脉型BCS患者的临床资料。男性23例，女性27例｜平均年龄（39±11）岁，肝功能Child-Pugh评分（9.6±2.6）分。肝静脉近段闭塞12例，肝静脉闭塞合并下腔静脉狭窄6例，全肝静脉闭塞19例，肝小静脉闭塞13例。急性3例，亚急性或慢性47例。患者主要表现为食管静脉曲张破裂出血和顽固性腹水，采用多普勒超声、CT血管造影或磁共振血管造影、上消化道钡餐、血管造影明确诊断。治疗方法包括：肝静脉成形术12例，肝静脉成形加下腔静脉成形术6例，经颈静脉肝内门体静脉分流术（TIPS）13例，改良TIPS 19例。【结果】所有患者均成功完成手术。TIPS或改良TIPS术后，门静脉压力由（41±10）cmH2O（1 cmH2O=0.098 kPa）下降至（27±6）cmH2O（t=20.20，P=0.001），门静脉血流速度由（14±10）cm/s增至（52±14）cm/s（t=15.02，P=0.001）。患者出血控制，腹水渐消退，肝功能明显好转。住院期间因肝功能不全死亡1例，肝门分流道急性阻塞1例。术后随访12～204个月，平均随访时间（82±46）个月，分流道狭窄行扩张内支撑2例，肝静脉狭窄再扩张2例。【结论】肝静脉成形术和TIPS是治疗肝静脉型BGS的有效方法。

关键词：肝静脉血栓形成门体分流术经颈静脉肝内