X线引导下经皮肝穿置管引流治疗肝脓肿49例分析

目的：：评价X线引导下经皮肝穿置管引流治疗肝脓肿的疗效及随访结果。方法：回顾性分析X线引导下经皮肝穿置管引流治疗的49例肝脓肿患者的临床资料。结果：29例为多房脓肿(部分液化),20例为单房脓肿(完全液化),所有患者均穿刺成功,无并发症发生。45例脓液细菌培养结果阳性(大肠杆菌35例,肺炎克雷伯杆菌10例), 4例阴性。术后引流管留置15~40天,经1~48个月随访发现脓肿灶于24个月后消失。结论：X线引导下经皮肝穿置管引流治疗肝脓肿操作简便安全,引流较彻底,术后随访疗效确切。     

介入性超声引导经皮穿刺置管持续引流治疗肝脓肿临床分析

目的探讨介入性超声引导经皮穿刺置管持续引流治疗肝脓肿的方法和疗效。方法本组41例肝脓肿病人均经临床、影像学（B超或CT）和细菌培养确诊,行介入性超声引导经皮穿刺置管持续引流治疗。脓肿位于肝左叶9例,肝右叶24例,肝2叶8例。31例为单个脓肿,10例为多发脓肿。结果36例1次置管引流成功,5例经2次穿刺置管引流成功,平均引流时间为（18．5±5．3）d。所有患者随访半年未见复发。2例患者出现穿刺脓液外漏经超声引导右膈下置管引流治愈。结论介入性超声引导经皮穿刺置管持续引流治疗肝脓肿是非常有效、安全的方法。     

彩色多普勒引导下经皮肝穿刺置管引流治疗细菌性肝脓肿

目的 探讨彩色多普勒引导下经皮肝穿刺置管引流治疗细菌性肝脓肿的临床应用价值.方法 对36例细菌性肝脓肿通过超声引导确定后进行穿刺抽脓后置管引流.结果 36例穿刺、置管全部获成功,术后无并发症.结论 彩色多普勒引导下肝脓肿穿刺置管引流术具有简便、安全、费用少,并发症低的优点,可用于治疗细菌性肝脓肿.     

超声引导下经皮肝穿刺置管引流治疗肝脓肿的临床应用

目的探讨超声引导下经皮肝穿刺置管引流治疗肝脓肿的临床应用价值。方法38例细菌性肝脓肿患者,采用普通B超探头体表十字方法定位,按Seldinger氏法经皮肝穿刺置管引流。结果超声诊断确诊率、抽脓成功率、治愈率均为100％(38／38)。其中1次穿刺置管引流成功率97．4％(37／38);无1例中转手术,出现并发症或死亡。结论超声引导下经皮肝穿刺置管引流治疗肝脓肿疗效显著,建议作为肝脓肿首选治疗手段。     

彩超引导下经皮肝穿刺置管引流治疗肝脓肿探讨

目的探讨彩色多普勒超声引导下经皮肝穿刺置管引流治疗肝脓肿的临床应用价值。方法采用回顾性分析的方法,对2007年7月-2011年5月期间收治的在彩色多普勒超声引导下经皮肝穿刺置管引流治疗的17例肝脓肿患者的临床资料进行总结分析。结果 17例肝脓肿患者均成功接受在彩色多普勒超声引导下经皮肝穿刺置管引流治疗。其中男性10例,女性7例。经引流及冲洗后所有患者均于24 h内体温下降至38℃以下,肝区疼痛得到明显缓解。穿刺成功率100%,总有效率100%。无1例出现大出血、局部感染、胆汁漏、气胸等并发症。结论彩色多普勒超声引导下经皮肝穿刺置管引流治疗肝脓肿的方法直接、安全、简便,成功率、有效率高,是目前治疗肝脓肿值得推广应用的好方法,具有良好发展前景。     

CT引导下经皮肝穿刺治疗细菌性肝脓肿患者的护理

目的:探讨在CT引导下经皮肝穿刺治疗细菌性肝脓肿患者的临床护理。方法:对肝脓肿患者23例行CT引导下经皮穿刺,脓腔直径<5cm行穿刺抽吸治疗,直径≥5cm行抽吸置管引流治疗,并做好术前、术中、术后护理,加强营养,预防并发症。结果:23例肝脓肿治愈率为100%。结论:CT引导下经皮穿刺抽吸和(或)置管引流冲洗治疗肝脓肿切实可行,具有创伤小、恢复快、疗效好、费用低的特点,加强临床护理是其疗效的重要保障。     

超声引导经皮肝穿刺引流治疗细菌性肝脓肿分析

目的总结超声引导经皮肝穿刺引流治疗细菌性肝脓肿的优点。方法对26例细菌性肝脓肿患者在超声定位引导下经皮肝穿刺,给予置管引流、局部抗生素冲洗、全身抗生素应用等综合治疗。结果肝穿刺引流、局部抗生素冲洗及全身抗生素治疗可提高治愈率。结论超声引导经皮肝穿刺引流治疗细菌性肝脓肿操作简单,避免了传统开腹手术带来的并发症,也降低了治疗费用。     

B超引导下穿刺置管引流治疗肝脓肿42例临床护理

目的:探讨在B超引导下经皮穿刺抽吸和(或)置管引流冲洗治疗肝脓肿的临床护理。方法:对肝脓肿患者42例51个病灶行B超引导下经皮穿刺,脓腔直径<5cm行穿刺抽吸治疗,直径≥5cm抽吸置管引流治疗,并做好术前、术中、术后护理,加强营养与护理,达到治疗目的,预防并发症。结果:42例肝脓肿治愈率为100%(51/51),未发生并发症。结论:B超介导下经皮穿刺抽吸和(或)置管引流冲洗治疗肝脓肿切实可行,具有微创、安全简便、经济的优点。     

超声引导下经皮穿刺置管引流在肝脓肿治疗中的应甩

目的 探讨超声引导下经皮穿刺置管引流在肝脓肿治疗中的效果。 方法 回顾性分析我科在2010 年1 月- 2012 年12月超声引导下经皮穿刺置管引流治疗肝脓肿患者110 例（156 个病灶） 治疗情况及并发症发生情况。 结果 110 例（156 个病灶）均穿刺置管成功,置管成功率100%。其中86 例在穿刺置管引流后临床症状及体征消失,超声检查肝内脓腔消失,血常规白细胞总数和中性粒细胞数正常,痊愈率达到78.2%（86/110）。本组并发症发生率为4.55%（5/110）。 结论 超声引导下经皮穿刺置管引流治疗肝脓肿临床疗效可靠、创伤小、并发症少、复发率低,具备较高临床推广价值。     

CT引导下经皮肝穿刺置管 引流治疗肝脓肿

目的 探讨CT引导下经皮穿刺置管引流治疗肝脓肿的临床效果.方法 对26例肝脓肿患者在CT引导下行穿刺置管引流术后,辅以适当的引流管冲洗和抗炎治疗.结果 26例患者均送细菌培养,阳性者23例;穿刺引流后,患者体温平均1.5 d恢复正常,白细胞数平均5.6 d内降至正常;平均留管时间为9 d;平均住院时间12 d;所有患者均痊愈出院,追踪观察3个月~8个月无复发病例.结论 CT引导下经皮穿刺置管引流术治疗肝脓肿操作简单,创伤小,恢复快,有良好的临床应用前景.     

探讨脂肪肝供肝在肝脏移植中的价值

目的探讨应用不同脂肪沉着程度供肝对肝移植患者预后的影响。方法选取64例进行肝移植术患者,依据供肝浸润程度,随机分为轻度脂肪肝组、中度脂肪肝组、重度脂肪肝组、无脂肪肝组共四组,每组各16例,比较四组患者肝功能(主要观察ALT、AST指标)、入住ICU的平均时间、1年移植物成活率、移植物原发无功发生率。结果轻度脂肪肝组入住ICU的平均时间、ALT和AST水平、移植物原发无功发生率与无脂肪肝组接近;中度脂肪肝组入住ICU平均时间、ALT和AST水平均较轻度组和无脂肪肝组明显增高,P0.05;重度脂肪肝组入住ICU平均时间、ALT和AST水平、移植物原发无功发生率明显较前三组为高,P0.05。结论轻、中度肝脏脂肪浸入可作为肝移植供肝,重度脂肪肝不能作为供肝的选择目标。     

Microenvironment of Liver Regeneration in Liver Cancer

The occurrence and development of liver cancer are essentially the most serious outcomes of uncontrolled liver regeneration. The progression of liver cancer is inevitably related to the abnormal microenvironment of liver regeneration. The deterioration observed in the microenvironment of liver regeneration is a necessary condition for the occurrence, development and metastasis of cancer. Therefore, the use of a technique to prevent and treat liver cancer via changes in the microenvironment of liver regeneration is a novel strategy. This strategy would be an effective way to delay, prevent or even reverse cancer occurrence, development and metastasis through an improvement in the liver regeneration microenvironment along with the integrated regulation of multiple components, targets, levels, channels and time sequences. In addition, the treatment of "tonifying Shen (Kidney) to regulate liver regeneration and repair by affecting stem cells and their microenvironment" can regulate "the dynamic imbalance between the normal liver regeneration and the abnormal liver regeneration"; this would improve the microenvironment of liver regeneration, which is also a mechanism by which liver cancer may be prevented or treated.     

Liver

<正>209293 Probing into indication of living-related Liver Transplantation for Wilson’s disease/Cheng Feng(Liver Transplant Center,1st Hosp Nanjing Med Univ,Key Lab Living Donor Liver Transplant,Minist Public Health,Nangjing 210029)…∥Chin J Surg.-2009,47(6).-437~440Objective To probe into indication of living-related liver transplantation(LRLT)for Wilson’s Disease.Methods From January 2001 to February 2007,thirty-seven living-related liver transplants were performed.A retrospective analysis was carried on outcome of those patients.The indications for LRLT were acute hepatic failure in 3 patients and chronic advanced liver disease in 32 patients including 13 patients with Wilsonian neurological manifestations.Two patients presented with severe Wilsoian neurological manifestations even though their liver functions were stable.According to the scoring system for evaluation of the neurological impairment in Wilsion disease based on neurological signs and functions(total score was 30),the pre-transplantation score of those patients with neurological manifestations was 15.9±4.3(n=15).Results Thirty-seven patients were followed up for 20-93 months.The survival rates of post-transplant patients and grafts at 1,3,and 5 year were 91.9%,83.8%,75.7%,and 86.5%,78.4%,75.7%,respectivly.Postoperative surgical complications occurred in 2 donors with bile leakage required drainage,in 2 recipients with hepatic thormbosis underwent retransplantation of cadeveric liver and in 1 recipient with hepatic stenosis required balloon dilatation.Neurological function was improved in all recipients and the score of posttransplantation at 6,12,18,24,and 30 months was 17.5±3.7(n=13);21.0±4.3(n=12);23.9±3.9(n=10);26.6±2.2(n=10)and 28.1±1.9(n=7)respectively.Conclusion Patients with acute hepatic failure or patients with severe liver disease unresponsive to chelation tratment should be treated with LRLT.Early transplantation in patients with an unsatisfactory response medical tratment may prevent irreversible neurologica     

Liver

<正>209461 Intraoperative ligation of recipient’s portasystemic shunt in liver transplantation/Chen Litian(,Organ Transplant Center,Tianjin 1st Centr Hosp Tianjin 300192)…∥Chin J Gen Surg.-2009,25(4).-489～491Objective To investigate the clinical significance of ligating the portasystemic shunt confirmed by preoperative CT evaluation during orthotopic liver transplantation.Methods From January 2007 to August 2008,35 patients in Tianjin First Central Hospital underwent preoperative three-dimensional CT scan,among them 23 patients had spontaneous major portasystemic shunts,the other 12 patients did not have portasystemic shunts.16 out of the 23 cases with significant shunts underwent shunt ligation based on portal blood flow volume measured by intraoperative portal vein flowmetry.The shunt of the other 7 patients were left untreated.Results The portal blood flow in the 12 patients without portasystemic shunt judged by preoperative CT scanning were(1 101±70)ml/min.The shunts in 7 patients with portal blood flow greater than 1 000 ml/min were not ligated,that of the 16 patients with portal blood flow volume lower than 1 000 ml/min were ligated.The portal blood flow volume in those 16 patients before and after ligating the shunt were(657±112)ml/min and(1 136±161)ml/min,respectively(P<0.05).Postoperatively 2 patients suffered from portal vein thrombosis,among them 1 patients suffered from intermittent disturbance of consciousness,2 patients died within 3 months,with one died of respiratory failure from pulmonary aspergillus infection,one died of hepatic failure in 2 months after operation because of graft dysfunction.The other 19 patients with normal blood flow and well-functioning graft were alive.Conclusion The ligation of portasytemic shunt is mandatory in patients when pretransplant CT evaluation showing a major porto-systemic shunts and portal blood flow volume was less than 1 000 ml/min.5 refs,2 figs.     

Liver

Alleviation of ischemia-reperfusion injury in rat liver donors by induction of exogenous hTERT gene;Effects of surgical technique on acute renal failure after orthotopic liver transplantation in patients with end-stage liver disease at high risk： a report of 90 eases;Timing for liver transplantation for chronic severe hepatitis;Analysis of bacterial variance and drug resistance after orthotopic liver transplantation;The influence of splenectomy on orthotopic liver transplantation and its management     

Liver

<正>209604 The suppressive effect of CD8+ CD28-regulatory T cells from spontaneous tolerance models on the acute rejection responses in rat liver transplantation/Chen Ning(陈宁,Dept Gastroenterol,Peking Univ Peop Hosp,Beijing 100044)…∥Chin J Organ Trans-plant. -2009,30(9). -524 ～526     

Liver

<正>209087 Clinical analysis of outcome of invasive fungal infection after kidney transplantation/Chen Guodong(陈国栋,Dept Transplant Surg,1st Hosp,Sun Yat sen Univ, Guangzhou 510080)…∥Chin J Organ Transplant. -2009, 30(10). -616～619 Objective To explore the outcome of invasive fungal infection in kidney transplantation and the influencing factors.     

Liver

Prevention and treatment of artery complication after liver transplantation by HBO , Clincal feature of cytomegabvirus pneumonia in orthtopic liver-transplantation and treatments, Risk factors of diabetes mellitus following orthotopic liver transplantation , Re-infection of hepatitis B virus after liver transplantation , Diagnosis and treatment of fungal infection after orthotopic liver transplantation , Two successful adult-to-adult living donor liver transplantation using dual grafts     

脂肪肝患者血清肝纤维化指标分析

目的探讨脂肪肝患者血清肝纤维化指标特点，寻找可能引起脂肪肝肝纤维化改变的相关因素。方法记录脂肪肝组和正常对照组临床资料与血清生化指标以及肝纤维化指标，分析各项指标的异常及脂肪肝组肝纤维化指标及其他指标的相关关系。结果脂肪肝组和正常对照组血清生化指标和肝纤维化指标之间的比较：脂肪肝患者组血清FPG、TG、Tc、ALT、HA、LN、PCⅢ、CIV、CG与对照组比较差异有统计学意义（P〈0．05）。血清肝纤维化指标HA与年龄（≥50岁）、酗酒、男性、CG增高、ALT增高、高血压病有线性回归关系；血清肝纤维化指标LN与酗酒、肥胖、糖尿病有线性回归关系；血清肝纤维化指标CIV与高脂血症，ALT增高有线性回归关系；血清肝纤维化指标PcⅢ与年龄（I〉50岁）、高脂血症、高血压病有线性回归关系。结论通过多元线性回归分析显示：男性，年龄≥50岁，酗酒，肥胖，伴发高血压病、高脂血症、糖尿病，出现CG增高，ALT增高，可能是促进脂肪肝发生肝纤维化的危险因素。     

化肝汤1号治疗酒精性肝纤维化症状及肝功能改变

目的观察活血化瘀、软坚散结药配伍治疗肝纤维化时对患者主、次症状改变及肝功能的影响。方法将确诊为酒精性肝纤维化患者90例,随机分为三组,治疗组采用自制方剂化肝汤1号(醋鳖甲、黄芩、柴胡、赤芍等),对照组1采用凯西莱治疗,对照组2采用化肝汤1号和凯西莱联合治疗,疗程3个月。观察三组患者治疗前后主、次症状改善情况,血清天冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、γ谷氨酰转肽酶(γ-GT)变化。结果三组治疗后的临床疗效比较差异无统计学意义(H=2.5897,P>0.05)。三组治疗后肝功能指标均有改善,与治疗前比较,差异有统计学意义(P<0.05)。结论化肝汤1号可有效地降低肝细胞的损害程度,促进受损细胞修复,从而改善肝功能。