顺铂聚乳酸微球的药物释放特性及肝动脉栓塞研究

对顺铂聚乳酸微球进行了体外药物释放和家犬肝动脉栓塞研究。该微球粒径范围为50～200μm,平均粒径为115.76±35.94μm,顺铂含量为37.16%(W/W);体外药物释放机制符合Higuchi方程;肝动脉栓塞后8h,肝组织顺铂浓度高达21.55±12.18μg/g,明显高于肝动脉灌注顺铂组:3.16±0.09μg/g(P<0.05);肝动脉栓塞组的顺铂血浓峰值、各取血点浓度及曲线下面积AUC皆低于肝动脉灌注顺铂组。可望达到提高栓塞部位的药物疗效,降低全身毒副反应的作用。     

激活素A对人肝星状细胞系LI 90细胞增殖的影响

目的：检测激活素（ACT）A对肝星状细胞（HSC）系LI90细胞增殖的影响。方法：采用基因重组人ACT A（0．025－250ng/ml）、转化生长因子－β1（TGF－β1）、镦泡抑素（FS）处理体外培养的人HSC系LI90，采用四唑盐比色法（MTT法）检测其对细胞增殖的影响。结果：ACT A浓度在0.025-250ng/ml范围内，均可刺激LI90细胞增殖，0.025-25ng/ml浓度范围内的ACT A作用轻微，而250ng/ml的ACT A作用明显增强（P＜0．01）；相反，TGF－β1（2．5ng/ml）对LI90细胞增殖无明显影响；0．315ng/ml FS与浓度为0.25ng/ml的ACT A共同孵育可阻断ACT A促进LI90增殖的活性（P＜0．05），而0．315ng/ml FS单独作用对LI 90细胞生长明显影响。结论：ACT可促进HSC增殖，在肝纤维化发病机制中发挥重要作用。     

PGA指数和透明质酸在诊断慢性乙肝肝纤维化中的价值

目的：寻找一种简便实用的诊断慢性乙型肝炎纤维化的方法。方法：以78例经肝穿刺病理证实的慢性乙型肝炎为对象，测定并比较了由PT、GGT、ApoA1组成的PGA指数和HA、LN、PⅢP、C－IV与肝内纤维化程度(S)和炎症活动度（G）的关系。结果：（1）LN、PⅢP、C－IV在轻度慢性乙肝时无明显升高，在中度慢性乙肝时明显高于正常，但与轻度慢性乙肝无差异，而PGA指数和HA不仅在轻度慢性乙肝时显著升高，而且在轻中度间差异明显.因重度慢性乙肝和活动性肝硬化时，五项指标均显著增高。（2）在G2－4期，HA、LN、PⅢP、C－IV均明显高升，但在G1期，只有PGA指数高于正常，且各期间差异显著。（3）在S1－2期，只有PGA指数、HA、C－IV明显上升，但C－IV的上升幅度远低于PGA指数和HA。（4）加以PGA＞4．5或HA＞200μg／L作为判断临界值，则两者判断肝纤维化的敏感性均＞94％，精确性＞91％，特异性＞86％，如两者结合，则分别达到98．3％、95．2％和96．4％。结论：PGA指数和HA均是反映慢性乙型肝炎患者肝内纤维化程度的良好指标，两者联合检测则可达到最大的价值效益比。     

联合检测血清透明质酸、Ⅳ型胶原及层黏蛋白对肝纤维化的诊断价值

目的 :探讨血清透明质酸 (HA)、Ⅳ型胶原 (CIV)及层黏蛋白 (LN)联合检测对肝纤维化的诊断价值。方法 :采用酶联免疫法对健康人组 2 2例、急性肝炎组 10例、慢性肝炎组 10例、肝硬化组 2 5例及慢性重症肝炎组 10例 ,分别检测血清HA ,CIV及LN的水平 ;对肝硬化组三项指标分别检测和联合检测所得的敏感性、特异性及准确性进行比较。结果 :血清中HA ,CIV及LN的水平以肝硬化组和慢性重症肝炎组最高 ,均明显高于其它组 (P <0 0 1)。肝硬化组联合检测的敏感性高于单项检测的敏感性 ,但其特异性降低。结论 :联合检测HA ,CIV及LN可提高诊断肝纤维化敏感性 ,但特异性降低 ;其中HA +CIV的敏感性和特异性较高 ,为最优联合     

继发性肝癌的外科治疗

目的探讨继发性肝癌的手术适应证和方法。方法对52例继发性肝癌的临床病例资料进行回顾性分析。结果分别采用了左半肝切除、右半肝切除、左外叶切除、右前叶切除、右后叶切除和肝楔形切除术。术后1、3、5年的生存率分别为28.3%、19.4%和11.9%。结论对适合手术的继发性肝癌,行肝切除术可以获得满意的效果。     

Prior diabetes mellitus is associated with increased morbidity in cystic fibrosis patients undergoing bilateral lung transplantation: an ‘orphan’ area? A retrospective case–control study

Background: The aim of this study was to determine whether pre-existing diabetes mellitus increases the risk of rejection, infection and/or death in cystic fibrosis patients undergoing bilateral sequential single-lung transplantation.
Methods: A retrospective audit of 25 consecutive patients with cystic fibrosis who underwent bilateral sequential single-lung transplantation between 1 January 2003 and 31 December 2005 at a tertiary referral hospital was carried out.
Results: Although 32% patients had diabetes diagnosed before lung transplantation, 92% had random blood glucose levels ≥11.1 mmol/L requiring insulin during admission. Patients with pre-existing diabetes had increased infection-related (3.9 vs 1.2, P = 0.01) and putative rejection-related (1.4 vs 0.5, P = 0.04) hospital admissions post-transplantation compared with those without diabetes pre-transplant. During the period of observation, four of eight patients with a prior diagnosis of diabetes died compared with none of 17 patients without prior diabetes ( P = 0.0055).
Conclusion: Almost all cystic fibrosis patients develop hyperglycaemia after lung transplantation, but patients with prior diabetes have more complication-related admissions to hospital and a higher mortality rate.     

选择性肝血流阻断肝切除术的应用

目的探讨选择性肝血流阻断肝切除术的安全性和可行性。方法回顾性分析我院2002年3月至2006年10月行肝切除术65例,分为选择性肝血流阻断组（HVC,n=28）和第一肝门阻断组（Pringle,n=37）;比较两组病人术中出血量、手术时间、术后肝功能的恢复、术后两天的平均引流量以及术后并发症。结果两组病人术中出血量和手术时间均无显著性差异;HVC组术后3天和7天的血清谷丙转氨酶明显低于Pringle组,术后两天的平均引流量HVC组明显少于Pringle组;Pringle组有两例出现肝功能衰竭,其中1例死亡,HVC组没有肝功能衰竭及死亡病例。结论选择性肝血流阻断肝切除术安全、可行,较第一肝门阻断更有利于肝功能的恢复,减少肝功能衰竭的发生。     

Preoperative Chemotherapy for Colorectal Liver Metastases: Impact on Hepatic Histology and Postoperative Outcome

Some investigators have suggested that preoperative chemotherapy for hepatic colorectal metastases may cause hepatic injury and increase perioperative morbidity and mortality. The objective of the current study was to examine whether treatment with preoperative chemotherapy was associated with hepatic injury of the nontumorous liver and whether such injury, if present, was associated with increased morbidity or mortality after hepatic resection. Two-hundred and twelve eligible patients who underwent hepatic resection for colorectal liver metastases between January 1999 and December 2005 were identified. Data on demographics, clinicopathologic characteristics, and preoperative chemotherapy details were collected and analyzed. The majority of patients received preoperative chemotherapy (n = 153; 72.2%). Chemotherapy consisted of fluoropyrimidine-based regimens: 5-FU monotherapy, 31.6%; irinotecan, 25.9%; and oxaliplatin, 14.6%. Among those patients who received chemotherapy, the type of chemotherapy regimen predicted distinct patterns of liver injury. Oxaliplatin was associated with increased likelihood of grade 3 sinusoidal dilatation (p = 0.017). Steatosis >30% was associated with irinotecan (27.3%) compared with no chemotherapy, 5-FU monotherapy, and oxaliplatin (all p < 0.05). Irinotecan also was associated with steatohepatitis, as two of the three patients with steatohepatitis had received irinotecan preoperatively. Overall, the perioperative complication rate was similar between the no-chemotherapy group (30.5%) and the chemotherapy group (35.3%) (p = 0.79). Preoperative chemotherapy was also not associated with 60-day mortality. In patients with hepatic colorectal metastases, preoperative chemotherapy is associated with hepatic injury in about 20 to 30% of patients. Furthermore, the type of hepatic injury after preoperative chemotherapy was regimen-specific. Presented at the American Hepato-Pancreato-Biliary Association 2006 Annual Meeting, March 11, Miami, Florida.     

Outcome using hemihepatic vascular occlusion versus the pringle maneuver in resections limited to one hepatic section or less

Consensus is lacking concerning how to manage afferent vessels during hepatectomy, particularly as to the Pringle maneuver vs. selective hemihepatic clamping. Data for 81 hepatocellular carcinoma patients with chronic hepatitis or liver cirrhosis whose liver resection was limited to one section or less, including intraoperative data and postoperative liver function data, were analyzed retrospectively to compare two strategies. No significant differences of intraoperative data or postoperative clinical course were seen between the two groups, even in patients with chronic hepatitis or liver cirrhosis whose postoperative deterioration of liver function could be expected to be more than patients with a normal liver. The difference was evident only in serum alanine aminotransferase level on postoperative day 10 (mean ± SEM, 64.5±5.1 IU in the Pringle group vs. 51.6±4.4 IU in the selective clamping group; P<0.05). During liver resection limited to one section or less, even with underlying chronic hepatitis or cirrhosis, intermittent use of the Pringle maneuver preserved liver function to the same extent as selective clamping.     

螺旋CT三期扫描对肝纤维化诊断价值研究

目的探讨螺旋CT三期扫描对肝纤维化的诊断价值。方法对66例经肝穿刺活检病理证实的慢性乙型肝炎肝纤维化患者组和42例正常对照组进行螺旋CT三期增强扫描。根据纤维化程度分期进行影像资料和相关指标的统计分析。结果肝左叶增大,肝表面形态及肝实质密度的改变,脾脏增大,门静脉增宽和侧枝循环的建立等影像学改变,随着肝纤维化严重程度的加重而有统计学差异。本研究显示57例肝纤维化患者螺旋CT三期扫描诊断肝纤维化52例,敏感性91.2%,特异性77.8%。各期肝纤维化分期准确28例,准确率49.1%;准确判断轻度纤维化(S1、S2)或重度纤维化(S3、S4)44例,准确率77.2%,诊断早期肝硬化16例,准确率84.2%。结论螺旋CT三期扫描能判断肝纤维化的程度,而且是动态观察肝纤维化的病程演进和临床随访的有效手段。