术前纤维蛋白原水平对肝细胞癌微血管侵犯及预后的影响

目的 探讨术前血清纤维蛋白原（fibrinogen,FIB）水平与肝细胞癌（hepatocellular carcinoma,HCC）微血管侵犯（microvascular invasion,MVI）的关系及FIB对根治切除术后HCC预后的影响。方法回顾性分析福建医科大学孟超肝胆医院2015年1月至2019年4月行根治性肝切除手术的566例HCC患者的临床数据。通过绘制受试者工作特征曲线（receiver operating characteristic curve,ROC）分析FIB预测MVI的能力,并确定FIB预测MVI的最佳临界值;依据该临界值分为低FIB组和高FIB组,采用χ2 检验分析FIB与临床病理因素之间的关系;采用Kaplan-Meier法进行生存分析,采用Log-rank法进行差异性检验,单因素、多因素Cox回归分析法评价HCC预后的影响因素。结果 术前FIB预测MVI的最佳临界值为2.7 g/L。根据临界值分组,高FIB组（FIB＞2.7 g/L）MVI阳性率高于低FIB组（FIB≤2.7 g/L）[64.0%（183/283）vs 47.0%（133/283）,P＜0.01],高FIB组无复发生存率（recurrence-free survival,RFS）低于低FIB组（两组1、2、3年RFS分别为68.6%、47.0%、35.4%,以及71.5%、60.0%、48.3%,P＜0.05）,但两组总体生存率（overall survival,OS）差异无统计学意义（P=0.14）。单因素和多因素Cox回归分析显示FIB是HCC的RFS危险因素（HR=1.37,95%CI 1.07～1.75,P=0.011）,MVI是影响HCC者预后的独立危险因素（HR=6.65,95%CI 2.78～15.87,P＜0.001）。结论 本研究显示,术前纤维蛋白原水平与微血管侵犯呈正相关,与肝细胞癌根治性切除术后无复发生存率呈负相关。     

Functional anatomical hepatectomy guided by indocyanine green fluorescence imaging in patients with localized cholestasis: Report of four cases

BACKGROUNDLiver cancer is a malignant tumor with a high incidence. At present, the most effective treatment is laparoscopic hepatectomy (LH). Indocyanine green fluorescence imaging (ICG-FI) has become an important tool in LH, and the most common fluorescent types of tumors are total fluorescence, partial fluorescence, and rim fluorescence.CASE SUMMARYWe presented four cases of LH guided by ICG-FI in which we also observed the fourth special fluorescent type. When the tumor or intrahepatic stone compresses the adjacent bile duct to cause local cholestasis, the liver segment or subsegment with obstructed bile drainage will show strong fluorescence. Complete removal of the lesion together with the fluorescent liver parenchyma may help reduce the risk of tumor or stone recurrence.CONCLUSIONThis type of partial fluorescence can indicate local biliary compression, and the resection method is related to bile drainage, which may be called functional anatomical hepatectomy and ensures radical resection of the lesion.     

入肝血流阻断对正常大鼠部分肝切除术后肝再生的影响

目的 探讨人肝血流阻断对部分肝切除术后正常大鼠肝再生的影响。方法 健康雄性Ｗｉｓｔａｒ大鼠随机分为３组：ＰＴＣ组,肝门阻断１５ｍｉｎ切肝组;ＰＨ组,部分肝切除组;ＳＯ组,假手术组,测定术后肝脏重量的变化;用免疫组化法检测术后２４、４８、７２ｈ和７ｄ各时相点ＰＣＮＡ标记指数;观察各组术后血清前白蛋白（ＰＡ）的变化。结果 ＰＴＣ组较ＰＨ组术后肝再生率下降;ＰＣＮＡ标记指数降低,高峰延迟;ＰＡ水平恢复缓     

Changes of nitric oxide synthase activity and free methylarginines contents in regenerating rat liver after partial hepatectomy

In the present study, liver regeneration rate (%) was increased up to 70% 3 days after partial hepatectomy (PH). Nitric oxide synthase (NOS) activity in liver tissue as well as serum nitrite/nitrate content had no timed response, revealing no significant difference between shamoperated and partially hepatectomized rat liver. Contents of free methylarginines in liver tissue were increased biphasically in a time-dependent manner after PH. However, those in serum did not exhibit the same patterns as in liver. Taken together, the results suggest that N^G-monomethyl-L-arginine (MMA) and N^G, N^G-dimethylarginine (DMA) play a role in inhibiting nitric oxide (NO) synthesis in regenerating rat liver because the increase of their contents was synchronized with NOS expression.     

Pathophysiology of dogs after 84% hepatectomy with emphasis on prostaglandin metabolites and the effect of a thromboxane A2 synthesis inhibitor and a prostaglandin I2 analog

The pathophysiological conditions following 84% hepatectomy were examined in terms of the changes in thromboxane A₂ (TxA₂) and prostaglandin I₂ (PGI₂) in canine model. OKY-046, TxA₂ inhibitor, and OP-2507, a PGI₂ analog, were administered to evaluate the possibility of extending hepatic resection. The 2-week survival rate following 84% hepatectomy significantly improved after the administration of OKY-046 and OP-2507, from 12.5% to 58.3% and 75.0%, respectively. Furthermore, OP-2507 significantly improved impaired hepatocyte and sinusoidal endothelial cell function after 84% hepatectomy, resulting in a satisfactory recovery to the preoperative levels. Within 24 h after 84% hepatectomy, the plasma levels of thromboxane B₂ (TxB₂) increased significantly, and the 6-keto-prostaglandin F_l (6-KF) levels became slightly elevated. OKY-046 and OP-2507 decreased TxB₂ and increased 6-KF in the plasma, resulting in the maintenance of sufficient blood flow in the portal vein and hepatic tissue and the mitigation of microcirculatory disorders. Moreover, the cytoprotective effects of the two drugs inhibited functional impairment of the residual liver. In conclusion, abnormal prostaglandin metabolites were produced after 84% hepatectomy, being involved in residual liver disorders. However, the administration of either an inhibitor of TxA₂ synthesis or PGI₂ analog ameliorated the functional impairment of the residual liver, which suggests their potential value for extending the resectability of the liver from what is presently feasible.An abstract of this study was presented at the 92nd Annual Meeting of the Japan Surgical Society held in 1992.     

胃选择性迷走神经切断对大鼠肝再生的影响——肝细胞体积、数量和DNA含量的研究

探讨胃选择性迷走神经切断对大鼠再生肝细胞体积、数量和ＤＮＡ含量的影响。分别测定大鼠胃选择性迷走神经切断加肝叶大部分切除及肝叶大部分切除术后７ ｄ 再生肝ＤＮＡ含量、肝细胞数和体积。用多功能显微图像测量仪测定切片中肝细胞和肝细胞核面积及肝细胞核直径。按体视学方法测算整个肝脏的肝细胞数。用细胞分光光度技术测定切片中单个肝细胞ＤＮＡ 含量。结果表明, 胃选择性迷走神经切断加肝叶大部分切除组大鼠肝细胞ＤＮＡ含量、数量及体积均较单纯肝叶切除组增加 （Ｐ＜ ０．０５）。提示胃选择性迷走神经切断对大鼠肝再生过程有一定的促进作用。     

181例大面积烧伤患者心电图分析

对武汉市第三医院烧伤科１９９３年～１９９７年１８１例住院的大面积烧伤患者早期心电图结果进行回顾分析。心电图正常者５３例（２９．３％）,心电图异常者１２８例（７０．７％）,其中以窦性心动过速居多,占８７例（６７％）,心肌受损或ＳＴ－Ｔ异常改变６５例（５１％）。心电图异常者病死率（５３％）比心电图正常者病死率（１１％）显著增高,提示：大面积烧伤患者早期心电图异常改变、尤其是有心肌损害或ＳＴ－Ｔ异常改变患者预后较差     

应用CD3AK细胞预防肝癌术后复发的初步观察

目的 观察ＣＤ３ＡＫ细胞治疗对肝癌术后复发的影响。方法 ６２例肝癌切除术按序列单双数的原则分为两组,研究组３２例术后１周开始应用ＣＤ３ＡＫ细胞治疗,每隔２～３个月施行一疗程,共２～６个疗程;对照组３０例术后不用ＣＤ３ＡＫ细胞治疗,仅作一般护治疗。结果 ①研究组术后１年复发率６．３％（２／３２）明显低于对照组２６．７％（８／３０）（Ｐ〈０．０５）;②研究组和对照组术后４周免疫功能有明显差异（Ｐ〈０．     

The use of genetic instability as a clinical tool for cancer diagnosis

Human tumors exhibit two fundamentally important characteristics, extensive genetic alteration and clonality. Although it is still unclear to what extent tumors have an elevated mutational burden as compared with normal tissue, their clonality results in their ready detection. Thus, assaying tissues for clonal alterations at frequently mutated microsatellite loci represents a viable approach to cancer diagnosis. The most remarkable extension of this concept is that not only can cancer cells be detected in biological samples, but tumor DNA can also be directly detected in the serum or plasma of patients with some forms of cancer. This recent finding is currently being explored but may represent an important contribution to future diagnostic strategies.     

包括腔静脉旁部的肝右尾叶及全尾叶切除

目的 探讨并总结包括腔静脉旁部肝尾叶切除的方法和经验。方法 分别采用右后途径和左侧途径行右尾叶和全尾叶切除；前者附加部分右后叶切除，后者可为单独全尾叶切除或附加左外叶或左半肝切除。结果 成功施行包括腔静脉旁部的肝尾叶切除13例，其中右尾叶切除7例，全尾叶切除6例；全组无手术死亡，术中、术后均无严重病发症发生；术后平均失血量为896.15ml，平均肝门阻断时间为25.40min，术后平均住院12.38天。结论 虽然解剖关系复杂，切除包括腔静脉旁部的肝尾叶安全可行。