肝硬化门静脉高压症贲门周围血管断流术后近期及远期胃动力的临床研究

目的：探讨肝硬化门静脉高压症贲门周围血管离断术后按期及远期胃动力。方法:选择41例研究对象，均无糖尿病，分5组，分别为正常对照10例，手术对照组6例，术前组10例，术后近期8例（术后2周－6个月），术后远期7例（术后7个月以上）。各组病人行胃电图检查，胃排空时间测定及胃液pH值测定，术后近期组胃排空延迟并有症六者给吗丁啉10mg每日3次餐前30min及10mg睡前口服，1个月后重新行消化道症状评分。结果：术事两组胃电节律紊乱较正常均明显增大，术后两组胃电频率较正常无差异。术后近期组胃液pH值较正常明显升高，术后远期组胃液pH值较正常无差异。术后近期组胃半排空时间较正常明显延长者占80％，有症状者服胃动力药后消化道症状评分明显下降；术后近期组胃半排时间较正常缩短者占20％。断流术后远期组胃半排时间较正常无差异。结论：断流术后近期大多数病人胃排空延迟，胃动力药物可缓解症状。断流术后远期胃排空接近正常。断流术不必常规行幽门成形术。     

心脏停跳大鼠肝脏过氧化亚硝酸介导的细胞凋亡变化

目的 该实验旨在研究过氧化亚硝酸对心脏停跳大鼠肝细胞凋亡的影响.方法 切取雄性Wistar大鼠肝脏后,通过门静脉插管灌注60 ml 4℃HTK保存液,其中心脏搏动组为立即插管;心脏停跳组为60 min后插管;另外一组为心脏停跳但灌注液中含有7500 IU超氧化物歧化酶(SOD).(n均=6).然后所有的大鼠肝脏均在4℃HTK液中保存24 h后置于循环灌注系统中,用Kreb-Henseleit缓冲液常温再灌注45 min.结果 同心脏停跳组相比,心脏搏动和SOD组大鼠灌注液中转氨酶(GPT和GLDH)的含量明显减少(均P<0.05);门静脉压力明显降低(均P<0.01);胆汁分泌量明显增加(均P<0.01),一氧化氮含量明显降低(均P<0.05);细胞凋亡明显减少(均P<0.05);灌洗液中硝基酪氨酸明显减少(P<0.01和P<0.05)且硝基酪氨酸免疫组化染色明显减弱.结论 氧自由基的代谢产物--过氧化亚硝酸与心脏停跳大鼠肝脏细胞凋亡的发生相关.     

他克莫司胶囊和缓释胶囊预防肝移植急性排斥反应的效果和安全性

Objective To evaluate the efficacy and safety of tacrolimus exposure in stable liver transplant recipients converted from FK506 twice a day to Advagraf (tacrolimus extended-release capsules) once daily. Methods This was an open-label, random, control and multi-center study.Eligible patients were 19 to 70 years of age, 6 months post-transplant with stable renal and hepatic function and receiving stable doses of tacrolimus twice a day for 2 weeks prior to enrollment. There were 86 patients in the experimental group and the control group, separately. The average age of experimental group and control group was 46 ± 10 and 49 ± 9, respectively. Patients in experimental group received Advagraf, once daily, and the dose was adjusted according to the drug concentration,and the drug concentration was between 2 to 10 μg/L. The control group given tacrolimus, twice daily, and the drug concentration was between 2 to 10 μg/L. Results The incidence of acute rejection reaction was 1.20 % and 1.18 % respectively in experimental group and control group, and the 95 %confidence interval was -3.25% ～3.31 % and -3.26% ～ 3.34 %, individually. There was 1 case of acute rejection reaction in experimental group and control group, respectively. The patient and organ survival rate was 100%. Sixteen adverse events occurred in 15 patients (17.65 %) of the experimental group, and 10 adverse events occurred in 10 patients (11.63 %) of control group. Severe adverse events relating to the test drug in experimental group occurred in 4 patients (4. 71 %). and 2 patients (2. 33) in control group.Conclision Clinical trials indicated that Advagraf has efficacy and safety profiles similar to those of tacrolimus. The drug is safe and may improve patient compliance.     

心死亡供者器官获取伦理及肝移植临床应用

目前,心死亡供者(DCD)已成为国际上公认的供者三大来源之一,DCD的规范化应用可进一步扩大供者来源,增加移植手术例数,挽救更多濒危患者生命.不同国家对于DCD的监测等待时间、移植小组的介入时间、器官切取方案等有着不同的规定,这些DCD器官捐献的具体实施过程会直接影响其临床效果,因此临床上不仅需要在具体实施上,还要从供者选择、器官保存、移植物活力评估等方面展开综合的研究.本文主要探讨DCD器官捐献的主要工作流程、临床应用细则、医学及伦理学方面存在的问题等.     

肝脏移植治疗肝癌的研究进展

肝脏移植治疗肝癌的研究进展中国医科大学第一临床学院（１１０００１）刘浩刘永锋根据肝癌的生物学特性差异，临床上对肝癌的治疗方案也有所不同。对于肿瘤较小的原发性肝癌，可采用手术切除辅以联合放疗及化疗；对于肿瘤较大浸润范围较广的肝癌，如不能做局灶切除，考虑...     

他克莫司胶囊和缓释胶囊预防肝移植急性排斥反应的效果和安全性

Objective To evaluate the efficacy and safety of tacrolimus exposure in stable liver transplant recipients converted from FK506 twice a day to Advagraf (tacrolimus extended-release capsules) once daily. Methods This was an open-label, random, control and multi-center study.Eligible patients were 19 to 70 years of age, 6 months post-transplant with stable renal and hepatic function and receiving stable doses of tacrolimus twice a day for 2 weeks prior to enrollment. There were 86 patients in the experimental group and the control group, separately. The average age of experimental group and control group was 46 ± 10 and 49 ± 9, respectively. Patients in experimental group received Advagraf, once daily, and the dose was adjusted according to the drug concentration,and the drug concentration was between 2 to 10 μg/L. The control group given tacrolimus, twice daily, and the drug concentration was between 2 to 10 μg/L. Results The incidence of acute rejection reaction was 1.20 % and 1.18 % respectively in experimental group and control group, and the 95 %confidence interval was -3.25% ～3.31 % and -3.26% ～ 3.34 %, individually. There was 1 case of acute rejection reaction in experimental group and control group, respectively. The patient and organ survival rate was 100%. Sixteen adverse events occurred in 15 patients (17.65 %) of the experimental group, and 10 adverse events occurred in 10 patients (11.63 %) of control group. Severe adverse events relating to the test drug in experimental group occurred in 4 patients (4. 71 %). and 2 patients (2. 33) in control group.Conclision Clinical trials indicated that Advagraf has efficacy and safety profiles similar to those of tacrolimus. The drug is safe and may improve patient compliance.     

介入放射技术在肝移植术后肝动脉并发症中的应用

目的 探讨介入放射技术在肝移植术后肝动脉并发症诊治中的应用价值.方法 对13例肝移植术后出现肝动脉并发症患者进行介入治疗.对6例肝动脉狭窄(HAS)者采用PTA或支架植入治疗,3例肝动脉闭塞者先行动脉开通,再行PTA或支架治疗,3例肝动脉血栓形成(HAT)者行经导管溶栓治疗,1例胃十二指肠动脉盗血综合征(GSS)者行胃...     

人动脉的低温-深低温序贯保存

目的 通过观察低温及深低温保存后移植血管的细胞代谢活性及组织结构变化情况,探讨低温-深低温序贯保存人体血管的可行性与安全时限. 方法 取人的髂动脉和脾动脉,于4℃UW液中分别保存72 h、1周、2周、3周和4周,得到的血管一部分分别行氯化硝基四氮咗蓝(NBT)染色和HE染色.另一部分继续于-80 ℃下深低温冻存4周,复温后分别行NBT染色和HE染色,光镜及电镜下观察血管组织和细胞结构变化. 结果 冷保存2周时的血管NBT染色时间的差异无统计学意义(P＞0.05);冷保存后1周,冻存前后的染色时间的差异无统计学意义,冻存者的染色时间与新鲜血管比较,差异也无统计学意义(P＞0.05).随着4℃冷保存时间的延长,血管组织结构的破坏加重,当保存时间超过2周时.血管损伤更加明显及严重;4℃下保存越久的血管,再行-80℃冻存后其超微结构破坏越重,当4℃下保存时间超过1周时,血管损伤更加明显及严重. 结论 4℃UW液冷保存人体动脉的安全时限为2周;4℃UW液冷保存1周以内的血管再行-80℃深低温冻存,其细胞代谢活性与组织结构保持良好.     

他克莫司胶囊和缓释胶囊预防肝移植急性排斥反应的效果和安全性

Objective To evaluate the efficacy and safety of tacrolimus exposure in stable liver transplant recipients converted from FK506 twice a day to Advagraf (tacrolimus extended-release capsules) once daily. Methods This was an open-label, random, control and multi-center study.Eligible patients were 19 to 70 years of age, 6 months post-transplant with stable renal and hepatic function and receiving stable doses of tacrolimus twice a day for 2 weeks prior to enrollment. There were 86 patients in the experimental group and the control group, separately. The average age of experimental group and control group was 46 ± 10 and 49 ± 9, respectively. Patients in experimental group received Advagraf, once daily, and the dose was adjusted according to the drug concentration,and the drug concentration was between 2 to 10 μg/L. The control group given tacrolimus, twice daily, and the drug concentration was between 2 to 10 μg/L. Results The incidence of acute rejection reaction was 1.20 % and 1.18 % respectively in experimental group and control group, and the 95 %confidence interval was -3.25% ～3.31 % and -3.26% ～ 3.34 %, individually. There was 1 case of acute rejection reaction in experimental group and control group, respectively. The patient and organ survival rate was 100%. Sixteen adverse events occurred in 15 patients (17.65 %) of the experimental group, and 10 adverse events occurred in 10 patients (11.63 %) of control group. Severe adverse events relating to the test drug in experimental group occurred in 4 patients (4. 71 %). and 2 patients (2. 33) in control group.Conclision Clinical trials indicated that Advagraf has efficacy and safety profiles similar to those of tacrolimus. The drug is safe and may improve patient compliance.     

三针组穴和醋调吴茱萸敷贴涌泉穴治疗阴虚火旺型不寐临床观察

目的 :探讨三针组穴和醋调吴茱萸敷贴涌泉穴治疗阴虚火旺型不寐的临床疗效。方法 :75例阴虚火旺型不寐患者,随机分为针刺组、外敷组和对照组,每组25例。针刺组予三针组穴针刺治疗,外敷组予醋调吴茱萸敷贴涌泉穴,对照组予外敷夜交藤。观察3组患者治疗前后睡眠质量改善情况和临床综合疗效。结果 :针刺组总有效率为92%,外敷组为88%,对照组为32%;针刺组和外敷组与对照组疗效差异有统计学意义(P<0.05),针刺组与外敷组疗效无统计学意义(P>0.05)。针刺组和外敷组与对照组PSQI总分差异有统计学意义(P<0.05),针刺组与外敷组PSQI总分差异无统计学意义(P>0.05)。结论 :三针组穴可有效地治疗阴虚火旺型不寐,而醋调吴茱萸敷贴涌泉穴则是一种有效治疗阴虚火旺型不寐的外治法。