肝胰十二指肠器官簇移植(附一例报道)

目的探讨肝胰十二指肠联合移植术治疗1例原发性肝癌合并胰头转移的疗效。方法2004年9月,对1例原发性肝癌合并胰头转移的患者行病肝、全胰腺十二指肠、远端胃及脾脏切除后,进行肝胰十二指肠原位器官簇移植。结果移植术后胰腺功能恢复正常,未应用胰岛素维持;术后1周肝功能恢复正常。患者目前已存活5个月,肝脏和胰腺功能均正常,未发生排斥反应,未见肿瘤复发迹象,一般情况好。结论肝胰十二指肠器官簇移植为上腹部晚期恶性肿瘤患者提供了延长生命的机会,同时更为晚期肝病伴有胰腺功能不良患者的彻底治愈探索出新的手术术式。     

RhoC基因在原发性肝癌中的表达及其意义

目的：探讨原发性肝癌组织及癌旁肝组织中RhoC mRNA的表达及其意义。方法：采用RT－PCR技术分析30例原发性肝癌病人的肝癌组织及癌旁肝组织中RhoC mRNA的表达。结果：肝癌组织中RhoC mRNA光密度相对值明显高于癌旁肝组织（P＜0．01）；有肝内转移灶者其癌组织中RhoC mRNA光密度相对值明显高于无肝内转移灶者（P＜0．05）。结论：RhoC mRNA的表达与原发性肝癌的转移程度可能有关，可望作为估计原发性肝癌转移的参考指标。     

原发性肝癌肝外转移癌六例再切除体会

目的探讨原发性肝癌肝外转移癌再切除的应用和价值。方法回顾性分析1986年至2008年我院27例原发性肝癌再切除中的6例肝外转移癌的临床治疗资料，其中肺部转移癌2例，腹腔转移癌4例。结果6例肝外转移癌切除均无手术死亡及术后并发症发生，术后中位生存期从再次切除算起4．6年。结论原发性肝癌肝外转移癌的高选择性再切除是安全有效的，可明显延长生存期。腹腔、肺部癌结节选择再切除或伽玛刀治疗，腹腔种植癌和浸润癌灶行切除术，可明显延长生存期，是进一步提高疗效的重要途径。     

原发性肝癌转移途径的解剖学基础

原发性肝癌（primary carcinoma of liver，PLC）是肝细胞和（或）肝内胆管上皮细胞发生的恶性肿瘤。PLC是我国常见的恶性肿瘤之一，男性占第3位，女性占第4位”，每年患病人数为11万-13万。肝癌以血行转移最常见，肝细胞癌侵犯肝血窦，在肝门静脉和肝静脉内形成癌栓，并向肝内和肝外转移。肺为肝外转移的主要器官，其他有肾上腺、骨、肾及脑等；其次为淋巴途径转移；种植性转移最少见。转移率与肿瘤大小、生长方式、机体免疫等因素有关。尸检肝癌转移率高达70％以上。PLC转移有其解剖学基础，本文从解剖学角度对PLC的转移途径做一综述。     

原发性肝癌合并肺转移的双重介入治疗的研究

目的探讨临床双重介入治疗原发性肝癌合并肺转移的临床效果。方法对40例晚期原发性肝癌合并肺转移的患者,采用经股动脉穿刺插管选择性经肝动脉分支和支气管动脉进行化疗栓塞术。结果原发性肝癌有效率为45%(18/40),肺转移灶有效率为40%(16/40)。原发性肝癌合并肺转移有效率为37.5%(15/40),半年和1年生存率分别为80%和37.5%。结论临床经肝动脉分支和支气管动脉双重联合介入治疗原发性肝癌合并肺转移是一种安全、有效的姑息性治疗方法。     

试论原发性肝癌复发转移的研究

自９０年代起，原发性肝癌（简称肝癌）已成为我国第二位癌症杀手。手术切除仍是各种治疗中疗效最好的，但无论是大肝癌切除，小肝癌切除，复发的再切除以及缩小后切除，切除后的复发转移是进一步提高疗效的障碍。肝癌根治性切除后５年复发率约６０％～７０％；小肝癌也达４０％～５０％。为此，肝癌切除后复发转移的预测与防治是２１世纪肝癌研究的一大课题。根据乙型肝炎病毒ＤＮＡ（ＨＢＶＤＮＡ）整合等研究，肝癌的肝内复发既有单中心发生，也有多中心发生。为此，肝内复发其本质不少是肝内转移，其核心是肝癌细胞的侵袭性。一、肝癌复…     

原发性肝细胞癌肝外转移与循环肿瘤细胞的关系

目的 研究原发性肝细胞癌肝外转移与外周血肝癌细胞的关系.方法 收集2005年10月至2006年12月收治的30例原发性肝细胞癌患者术前及手术结束时的外周血标本.并收集10名健康志愿者的外周血作为对照.采用免疫磁珠的方法,富集、分离肝癌患者术前、术后外周血中的癌细胞;随访观察术后患者肝外转移与外周血肝癌细胞的关系.结果 免疫磁珠技术可以富集分离到肝癌患者外周血中游离癌细胞,经甲胎蛋白免疫组化证实为肝细胞癌细胞.30例肝癌患者术前和术后外周血肝癌细胞阳性率分别是53.3%和83.3%,两者差异有统计学意义(P<0.05);术前外周血肝癌细胞阳性与肝外转移发生密切相关;外周血癌肝细胞浓度低于1×10~3个/L者未发现肝外转移.结论 原发性肝细胞癌患者肝外转移与术前外周血肝癌细胞阳性率及肝癌细胞浓度有关.     

Survivin在原发性肝细胞癌中的表达及其与侵袭、转移的关系

目的 研究Survivin基因在原发性肝细胞癌中的表达水平及其与肝癌侵袭转移的相关性.方法 收集4种肝细胞癌细胞株,35例原发性肝癌组织标本及相应的癌旁组织,以逆转录-聚合酶链反应(RT-PCR)检测Survivin mRNA转录情况;Western blot法检测Survivin蛋白表达.结果 在mRNA水平4株肝癌细胞株随侵袭转移能力升高Survivin表达依次升高(P＜0.01),HC-CLM6细胞株中Survivin表达水平最高.肝癌组织Survivin mRNA表达均为阳性,而癌旁组织内无一例阳性表达,Survivin mRNA的表达水平在肝内转移组(1.082±0.213)显著高于肝内无转移组(0.799±0.324,P＜0.05).Western blot的结果与RT-PCR结果一致,肝内转移组Survivin蛋白表达(0.892±0.198)显著高于肝内无转移组(0.342±0.237,P＜0.05).结论 Survivin在原发性肝细胞癌中表达,且与侵袭转移等肿瘤的恶性生物学行为有关,Survivin基因高表达可作为判断HCC侵袭性和进展的一个潜在重要指标.     

原发笥肝癌肝外复发转移的研究进展（文献综述）

原发性肝癌切除后肝外复发转移主要通过血液中癌细胞扩散，其临床表现多样。目前仍强调早期发现、早期综合治疗，包括再手术切除。由于大多数病人预后恶劣。且缺乏特效的治疗手段。因此，当前及今后研究的重点是肝外复发转移的监测和预防。     

肿瘤转移基因MTA 1在原发性肝癌中的表达及其临床意义

目的 了解肿瘤转移基因ＭＴＡ１在原发性肝癌转移复发中的作用。方法 利用反转录ＰＣＲ克隆出ＭＴＡ１编码区部分ｃＤＮＡ片段。对肝癌标本中ＭＴＡ１ｍＲＮＡ的表达情况进行原位杂交检测。结果 在伴有门静脉癌栓、肝内子灶、肝外转移、直径〉５ｃｍ,以及术后１年内死亡患者的肝癌中,ＭＴＡ１ｍＲＮＡ表达量显著增高（Ｐ〈０．０５）;而患者的性别、肝硬化情况及ＡＦＰ水平等与其表达水平无关。在部分侵袭性肝癌中,ＭＴＡ１ｍＲＮＡ阳性细胞集中分布于肿瘤边缘。结论 ＭＴＡ１基因表达量的增高与原发性肝癌的转移表型密切相关。可能在肝癌转移复发过程中具有重要作用。对肝癌的预后判断可能也具有一定意义。     

Perioperative and long-term morbidity and mortality after above-knee and below-knee amputations in diabetics and nondiabetics

We performed a retrospective review of a vascular surgery quality assurance database to evaluate the perioperative and long-term morbidity and mortality of above-knee amputations (AKA, n = 234) and below-knee amputations (BKA, n = 720) and to examine the effect of diabetes mellitus (DM) (181 of AKA and 606 of BKA patients). All patients in the database who had AKA or BKA from 1990 to May 2001 were included in the study. Perioperative 30-day cardiac morbidity and mortality and 3-yr and 10-yr mortality after AKA or BKA were assessed. The effect of DM on 30-day cardiac outcome was assessed by multivariate logistic regression and the effect on long-term survival was assessed by Cox regression analysis. The perioperative cardiac event rate (cardiac death or nonfatal myocardial infarction) was at least 6.8% after AKA and at most 3.6% after BKA. Median survival was significantly less after AKA (20 mo) than BKA (52 mo) (P < 0.001). DM was not a significant predictor of perioperative 30-day mortality (odds ratio, 0.76 [0.39-1.49]; P = 0.43) or 3-yr survival (Hazard ratio, 1.03 [0.86-1.24]; P = 0.72) but predicted 10-yr mortality (Hazard ratio, 1.34 [1.04-1.73]; P = 0.026). Significant predictors of the 30-day perioperative mortality were the site of amputation (odds ratio, 4.35 [2.56-7.14]; P < 0.001) and history of renal insufficiency (odds ratio, 2.15 [1.13-4.08]; P = 0.019). AKA should be triaged as a high-risk surgery while BKA is an intermediate-risk surgery. Long-term survival after AKA or BKA is poor, regardless of the presence of DM.     

Postoperative nausea and vomiting and opioid-induced nausea and vomiting: guidelines for prevention and treatment

Postoperative nausea and vomiting (PONV) causes patient discomfort, lowers patient satisfaction, and increases care requirements. Opioid-induced nausea and vomiting (OINV) may also occur if opioids are used to treat postoperative pain. These guidelines aim to provide recommendations for the prevention and treatment of both problems. A working group was established in accordance with the charter of the Sociedad Espa?ola de Anestesiología y Reanimación. The group undertook the critical appraisal of articles relevant to the management of PONV and OINV in adults and children early and late in the perioperative period. Discussions led to recommendations, summarized as follows: 1) Risk for PONV should be assessed in all patients undergoing surgery; 2 easy-to-use scales are useful for risk assessment: the Apfel scale for adults and the Eberhart scale for children. 2) Measures to reduce baseline risk should be used for adults at moderate or high risk and all children. 3) Pharmacologic prophylaxis with 1 drug is useful for patients at low risk (Apfel or Eberhart 1) who are to receive general anesthesia; patients with higher levels of risk should receive prophylaxis with 2 or more drugs and baseline risk should be reduced (multimodal approach). 4) Dexamethasone, droperidol, and ondansetron (or other setrons) have similar levels of efficacy; drug choice should be made based on individual patient factors. 5) The drug prescribed for treating PONV should preferably be different from the one used for prophylaxis; ondansetron is the most effective drug for treating PONV. 6) Risk for PONV should be assessed before discharge after outpatient surgery or on the ward for hospitalized patients; there is no evidence that late preventive strategies are effective. 7) The drug of choice for preventing OINV is droperidol.     

Body composition assessment and methodology in nonathletic and athletic adolescent and adult males and females

The purpose of this review is to outline methodology for assessing body composition utilizing anthropometric and densitometric techniques. The objective of body composition assessment is to measure body fat and lean body mass. The quantity of these components varies due to growth, physical activity, dietary regimens, and aging. Anthropometric techniques incorporate selected skinfolds, circumferences, skeletal widths, or other variables to estimate body composition within k2.0-4.0%. These techniques are adequate for field testing of groups or individuals, but are population specific. Densitometry measures body volume irrespective of physique, sex, or age. This laboratory technique estimates body composition within 1.0-2.0%, is more difficult to administer, but is not population specific. Some limitation exists with any present technique due to biological variability and incomplete research of reference body composition in children, females, and the aged. J Orthop Sports Phys Ther 1984;5(6):336-347.