复合补片修补腹壁切口疝十例的临床分析

目的评价应用复合补片腹膜内置入修补腹壁切口疝的效果。方法2003年11月至2005年6月应用复合补片修补腹膜难以对合的腹壁切口疝10例，均采用腹膜内置入修补法。结果所有患者均顺利恢复，手术后早期未发生切口感染、皮下血肿和血清肿等并发症。10例患者术后均得到随访，随访6～24个月，平均18个月。随访期内未发现肠梗阻、窦道形成和肠瘘等远期并发症和切口疝复发，10例患者均局部感觉良好。结论应用复合补片腹膜内置入修补切口疝是一种安全、有效的方法。     

促甲状腺素抑制法与甲状腺全切术加双侧中央清扫在乳头状甲状腺癌中的治疗效果观察

目的 比较应用促甲状腺素抑制法和甲状腺全切除术联合双侧中央清扫在乳头状甲状腺癌治疗中的临床效果.方法 选择乳头状甲状腺癌患者30例,根据治疗方式分为观察组(甲状腺全切术联合双侧中央清扫)和对照组(甲状腺全切术加促甲状腺素抑制法)各15例,观察比较两组患者的临床治疗效果,并对两组患者进行6个月的随访,比较两组患者的复发情况及不良反应的发生情况.结果 两组患者临床疗效比较差异无统计学意义(P>0.05);观察组并发症发生率高于对照组;术后6个月随访发现,观察组患者复发率显著低于对照组患者(P<0.05).结论 甲状腺全切术加双侧中央清扫比促甲状腺素抑制法在治疗双侧乳头状甲状腺癌中具有更好的治疗效果.     

原位肝移植术后胆管并发症的预防与处理

目的 探讨原位肝移植术后胆管并发症的原因及防治。方法 2000年5月至2002年1月38例原位肝移植的临床资料进行回顾性研究。结果 本组38例病人术后共发生胆管并发症9例（9/38，24%）。其中单纯胆瘘4例，胆管空肠吻合口狭窄，肝内胆管结石，胆管狭窄合并胆泥形成，胆瘘继发胆管狭窄，胆管狭窄合并肝内胆汁瘤各1例。此9例中2例死于严重感染，7例痊愈。结论 原位肝移植术后胆管并发症病因复杂，后果严重。首先应该注重预防，并做到早期诊断。逆行性胰胆管造影术（endoscopic retrograde cholangiopanreatography,ERCP）和经皮经肝胆管造影术（percutaneous tran-shepatic cholangiography,PTC）等辅助性介入治疗手段应受到重视。     

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肝腺瘤是少见的肝脏良性肿瘤 ,至 1997年国外文献报道 30 0例 ,国内报道总计 42例。因本病症状无特异性 ,术前鉴别诊断时很难与肝脏恶性肿瘤相区别。为加强对该病的认识 ,现将本院收治的 4例报告如下。1　临床资料　　我院自 1990～ 1999年共诊治肝细胞腺瘤 4例。见表 1。2　讨论　　文献报告肝腺瘤几乎全部发生于女性 ,有报告 ,避孕药中所含的乙烯雌二醇甲酯与肝腺瘤的发病增多有关[1,2 ] 。但德国学者Ｈｅｉｎｅｍａｎｎ[9] 等经过 7年的多中心调查研究发现 ,长时间服用口服避孕药并未增加肝细胞腺瘤的发病率。本组中 2例女性均无长期口服…     

他克莫司对移植肝脏再灌注损伤的影响

目的 探讨他克莫司对移植肝脏再灌注损伤的影响.方法 建立大鼠肝移植模型,实验组(40只)和对照组(40只)分别注射他克莫司和生理盐水,检测再灌注24、48和96 h后TNF-α、IL-1、ALT、AST、LDH、内皮素(endothelin,ET)和丙二醛(malondialdehyde,MDA)水平,观察肝脏超微结构和细胞凋亡情况,RT-PCR法检测Fas、Bcl-2的mRNA水平.依据免疫抑制方案,将112例终末期肝硬化患者分为他克莫司组(63例)和环孢素A组(49例),比较临床肝移植使用环孢素A和他克莫司患者肝酶指标及急性排斥反应的发生.结果 实验组TNF-α、IL-1、ALT、AST、LDH、ET和MDA显著低于对照组(P＜0.05),肝脏超微结构受损和细胞凋亡较轻,Fas mRNA合成减少.患者使用他克莫司后急性排斥反应发生率较环孢素A低(x2=39.0,P＜0.05).结论 他克莫司可通过抑制细胞凋亡来减轻大鼠移植肝脏再灌注损伤,临床使用他克莫司能减少急性排斥反应的发生.     

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.     

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.     

肝移植术后并发移植后淋巴增生性疾病

1临床资料患者男,14岁.因原位肝移植术后1年、皮肤和巩膜黄染1周入院.患者于1年前因乙型病毒性肝炎后肝硬化失代偿,门静脉高压症于我院行原位背驮式肝移植术,术后恢复顺利.1年以来患者肝功能正常,他克莫司( FK506)血药浓度维持在6 ～ 10 μg/L,入院前每日服用FK506 2 mg.患者1周前无明显诱因出现皮肤和巩膜黄染,伴皮肤瘙痒,尿色加深,大便颜色变浅,为求进一步诊断和治疗遂来我院.发病以来患者精神、睡眠好,食欲稍差,体质量无明显变化.     

421例同种原位肝移植肝动脉重建体会

目的探讨肝移植手术过程中肝动脉重建的技术要点,分析肝移植术后肝动脉合并症发生的原因。方法回顾性总结2000年5月至2006年5月,6年间我院连续实施的同种原位肝移植421例患者的临床资料,分析肝移植手术过程中可能影响肝动脉重建的因素,以及术后肝动脉合并症发生的可能原因,总结术中肝动脉重建的技术要点。结果421例肝移植患者中共发生肝动脉相关合并症者14例,发生率为3.3%,肝移植术后血管合并症主要是动脉血栓形成及肝动脉狭窄。14例合并症患者中死亡9例,死亡率为64.3%。按合并症出现时间分类,早期动脉合并症8例,死亡6例,晚期动脉合并症6例,死亡3例。结论供肝动脉的完整性、供受体动脉的重建方法以及显微外科技术的应用是影响肝动脉重建结果的重要因素。     

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.