The effect of hepatic inflow occlusion on laparoscopic radiofrequency ablation using simulated tumors

BACKGROUND: The purpose of this study was to determine the effect of hepatic inflow occlusion (the Pringle maneuver) on laparoscopic radiofrequency (RF) ablation. METHODS: Using a previously validated agarose tissue-mimic model, 1-cm simulated hepatic tumors (three per animal) were laparoscopically ablated in five pigs with normal perfusion and then in five pigs with hepatic artery and portal vein occlusion. Energy was applied until tissue temperature reached 100 degrees C (warm-up) and thereafter for eight min. Specimens were examined immediately after treatment. RESULTS: Vascular occlusion was successful in all cases per color-flow Doppler ultrasound. Pringle time was 11.4 +/- 1.6 min. Warm-up time (2.7 +/- 1.4 vs 20.2 +/- 14.0 min) was significantly faster in the Pringle group. Ablation diameter (34.8 +/- 2.9 vs 24.7 +/- 3.1 mm), proportion of round/ovoid lesions (93% vs 20%), ablation symmetry (100% vs 40%), and margin distance (5.1 +/- 3.0 vs 1.1 +/- 1.2 mm) were significantly better for the Pringle group than the No Pringle group, respectively. CONCLUSION: Using a Pringle maneuver during laparoscopic RF ablation significantly enhances ablation geometry and results in larger margins.     

肝动脉球囊阻断下单次射频消融治疗中大肝癌的初步临床应用

目的探讨肝动脉球囊阻断下单次射频消融（BORFA）在治疗无法手术切除的中大肝癌中的临床疗效。方法对11例原发性肝癌患者（12个肿瘤结节,肿瘤直径4~8 cm）行BORFA治疗,术后监测和随访肝功能变化、并发症、局部复发和消融坏死范围。结果本组病例中每个肿瘤结节均行单次消融,消融平均时间为68±15 min;消融坏死范围长径为8.1±0.7 cm,短径为7.6±0.5 cm;肿瘤结节完全消融率为91.7%;局部复发率为9.1%;消融后未见严重并发症;肝功能指标在2周内均恢复术前水平。结论 BORFA技术应用于直径4~8 cm的中大肝癌初步疗效满意,有必要展开多中心大样本的临床研究进一步论证。     

血运障碍性肠梗阻的诊断与治疗

血运障碍性肠梗阻病情凶险,误诊率及病死率均较高。早期诊断,及时恢复受累肠管血运是改善其预后的关键因素。目前临床检查方法有多种,CT以其诊断率高达90%以及无创的优势而取代血管造影成为血运障碍性肠梗阻确定性诊断的首选方法。治疗方法的选择因病因不同而不同,动脉栓塞者多需手术治疗,静脉血栓形成者以抗凝治疗为主。     

Intracerebral vascular occlusion in familial erythrophagocytic lymphohistiocytosis: a case report of two siblings

Neuropathological findings in two siblings with familial erythrophagocytic lymphohistiocytosis (FEL) are reported. Case 1 showed the typical neuropathological findings of FEL with lymphohistiocytic infiltration of the leptomeninges and perivascular spaces. A characteristic erythrophagocytosis was detected in inguinal lymph nodes, lung and bone marrow. Case 2 revealed calcification and necrotic lesions in the brain. In the necrotic areas, parenchymal calcification, vascular medial calcification, and occlusion of many vessels due to subendothelial fibrosis were detected. The areas of necrosis correlated with the distribution of occluded vessels. These changes were most prominent in putamen, internal capsule, thalamus and dentate nucleus. Hypercytokinemia is suspected to be the underlying mechanism for the clinical and laboratory findings in patients with FEL, although the relationship to the vascular pathology is unclear.     

Arterial occlusion in systemic lupus erythematosus: a good prognostic sign?

Arterial occlusion with subsequent amputation of extremities is a rare manifestation of systemic lupus erythematosus (SLE). It may be caused by local arteritis and/or thrombosis. We describe the clinical and laboratory manifestations and treatment administered to six SLE patients who developed peripheral arterial necrosis necessitating amputation of extremities secondary to the arterial occlusion. All patients were female, with ages ranging from 16 to 65 years. Arterial occlusion took place in the initial months of disease (median: 7 months). Only one of five patients tested for antiphospholipid antibodies had these antibodies who also had vasculitis and thrombosis in a histopathological study. Most patients presented a very benign outcome after the amputation of extremities and stayed in remission for several years. The satisfactory outcome of most patients after the vascular phenomenon allows us to consider the possibility that such a complication could be, for unknown reasons, a marker for good prognosis in SLE or, alternatively, that the aggressive therapy administrated for patients with this complication at the beginning of the disease could recover the balance of the immune system, avoiding future relapses.     

三种肝血流阻断法对大鼠肝脏缺血再灌注后肝细胞凋亡的影响

目的探讨三种肝血流阻断法对大鼠肝缺血再灌注损伤后肝细胞凋亡的影响。方法将128只大鼠随机分为假手术组、Pringle法组、半肝阻断组和保留半肝动脉血供的入肝血流阻断组。分别于再灌注后1h、2h、6h和24h检测ALT和AST水平及肝细胞凋亡率,观察肝脏病理学及肝细胞超微结构改变。结果 Pringle法再灌注后各时间点ALT和肝细胞凋亡率显著高于半肝血流阻断组和保留半肝动脉血供的入肝血流阻断组;肝脏病理学包括肝细胞超微结构变化重于半肝血流阻断组和保留半肝动脉血供的入肝血流阻断组;再灌注后72h,Pringle法、半肝血流阻断和保留半肝动脉血供的入肝血流阻断组生存率分别为87.5%(7/8)、100%(8/8)和100%(8/8)。结论保留半肝动脉血供的入肝血流阻断法能够减少缺血再灌注后肝细胞凋亡,减轻肝脏缺血再灌注损伤。     

Meningioma and occlusive vasculopathy: coexisting complications of past extracranial radiation

We present two cases in which a meningioma and occlusion of the internal carotid artery with development of transdural collateral circulation coexisted following extracranial radiation in childhood.     

Hemihepatic versus total hepatic inflow occlusion during hepatectomy: a systematic review and meta-analysis

AIM:To evaluate the clinical outcomes of patients undergoing hepatectomy with hemihepatic vascular occlusion(HHO) compared with total hepatic inflow occlusion(THO).METHODS:Randomized controlled trials(RCTs) comparing hemihepatic vascular occlusion and total hepatic inflow occlusion were included by a systematic literature search.Two authors independently assessed the trials for inclusion and extracted the data.A metaanalysis was conducted to estimate blood loss,transfusion requirement,and liver injury based...     

The effect of acute and repeated ischemic preconditioning on recovery following exercise-induced muscle damage

ObjectivesThe aim of this investigation was to determine if acute or repeated applications of ischemic preconditioning (IPC) could enhance the recovery process, following exercise induced muscle damage (EIMD).DesignRandomized control trial.MethodsTwenty-three healthy males were familiarised with the muscle damaging protocol (five sets of 20 drop jumps from a 0.6 m box) and randomly allocated to one of three groups: SHAM (3 × 5 min at 20 mmHg), Acute IPC (3 × 5 min at 220 mmHg) and Repeated IPC (3 days x 3 × 5 min at 220 mmHg). The indices of muscle damage measured included creatine kinase concentration ([CK]), thigh swelling, delayed onset muscle soreness, counter movement jumps (CMJ) and maximal voluntary isometric contraction (MVIC).ResultsBoth acute and repeated IPC improved recovery in MVIC versus SHAM. Repeated IPC led to a faster MVIC recovery at 48 h (101.5%) relative to acute IPC (92.6%) and SHAM (84.4%) (P < 0.05). Less swelling was found for both acute and repeated IPC vs. SHAM (P < 0.05) but no group effects were found for CMJ, soreness or [CK] responses (P > 0.05).ConclusionTaken together, repeated IPC can enhance recovery time of MVIC more than an acute application, and both reduce swelling following EIMD, relative to a SHAM condition.     

个体化的“分步”血流阻断法在巨大肝癌切除术中的应用研究

目的 在复杂肝切除中,外科血管阻断控制出血与最小化缺血再灌注损伤之间存在矛盾.为更好寻求解决方案,该研究介绍一种新的个性化“分步”血流阻断法.方法 自2011年4月至2014年4月,对拟行手术治疗的巨大肝癌病人,按照“个性化阻断准备”、“分步阻断实施”进行肝切除血流控制.统计病人术中血流阻断时间、术中出血量、术后并发症等临床资料并与同类文献资料进行统计学比较.结果 154例病人中,依据术前评估分别对154、101、51例病人行第一肝门(PT),肝下下腔静脉(IIVC),肝上下腔静脉(SIVC)的个性化阻断准备.肝切除过程中,依据具体出血情况分别对116、73、21例病人实施PT,PT+ IIVC,PT+ IIVC+ SIVC阻断.PT、IIVC、SIVC平均阻断时间分别为(10.8±3.4)min、(8.1±2.6) in、(4.0±0.9)min.术中平均出血量为(352.2±162.9) ml,14例(9.1％)接受输血治疗.无病人出现严重并发症或死亡.与同类研究相比,该技术控制出血效果良好且缩短了肝脏热缺血时间.结论 个体化的“分步”血流阻断法能够安全、有效地满足巨大肝癌切除术中的出血控制.