西宁地区常温下肝门阻断切肝术的临床研究

目的研究西宁地区常温下肝切除术中阻断入肝血流方式、阻断时间对“安全切肝”,尤其是肝癌合并有乙肝、肝硬化者的临床意义。方法选择临床和病理确诊的肝脏肿瘤及肝包虫病人共10例行手术治疗。结果本组10例肝脏手术均获成功(1例术后7天因肝衰死亡),根据病例的不同情况采用了三种肝血流阻断方法。结论采取常温下阻断肝血流的方法,减少肝脏切除术中大出血,同时尽可能减少入肝血流阻断的时间以减少和避免术后发生衰竭,为“安全切肝”提供了有力的技术保障。     

肝良性病变手术切除术中出血情况分析

目的 探讨肝良性疾病肝切除术术中出血的控制情况.方法 回顾性总结空军总医院和解放军总医院1986-2010年955例连续性肝良性病变切除手术病例,对术中出血、输血情况,围术期情况及术后并发症等进行分析.结果 本组病例数最多的是肝血管瘤和肝内胆管结石,分别占所有良性疾病的44.3%(423例)和27.7%(265例).对...     

腹主动脉阻断术的临床应用研究

目的：探讨腹主动脉阻断技术的临床适用性。方法：通过20例腹主动脉阻断术的临床应用，对术中出血量进行评估。观察血压，心率及血氧饱和度（SaO2)变化情况，并行术后随访。结果：应用腹主动脉阻断术可使术中患者减少出血量500－1500ml，术中生命体征平衡，术后无并发症发生。结论：腹主动脉阻断术是一种预防骨盆及骶尾部手术中出血，且安全有效的方法。     

谷氨酰胺对入肝血流阻断后肠道损伤的影响及机制探讨

目的探讨谷氨酰胺（Gln）对入肝血流阻断后肠道损伤的影响及其机制。方法将雄性Wistar大鼠120只,随机分为3组：假手术组（1组）、对照组（2组）和实验组（3组）。每组40只。2组和3组采用Pringle＇s法进行入肝血流阻断,持续35分钟,在阻断前3组大鼠腹腔注射Gln（300mg／kg,用生理盐水稀释至4ml）,每天2次,连续5天。每组随机抽取10只大鼠分别于阻断前及再灌注后2、4、24小时,测定肠组织丙二醛（MDA）含量,检测血清肿瘤坏死因子-α（TNF-α）及门静脉内毒素水平。光镜观察并测定肠黏膜厚度、肠绒毛高度。采用逆转录聚合酶链反应（RT—PCR）法检测再灌注后24小时肠道高迁移率族蛋白B1（HMGB1）mRNA的表达。结果与1组相比,再灌注后2、3组MDA含量、TNF-α及内毒素水平增高（P〈0．05）,而肠黏膜厚度、肠绒毛高度下降（P〈0．05）。与2组相比,再灌注后3组MDA含量、TNF-α及内毒素水平降低（P〈0．05）,而肠黏膜厚度、肠绒毛高度明显增加（P〈0．05）。再灌注后24小时,与2组相比,1、3组HMGB1mRNA表达水平均明显降低（P〈0．05）。结论Gln能够抑制人肝血流阻断后内毒素移位、炎性因子释放及肠道HMGB1mRNA的表达,具有减轻肠道损伤的作用。     

常温下肝门入肝血流阻断后肠粘膜屏障损害实验研究

目的研究在常温下阻断肝门入肝血流,肠粘膜屏障结构和功能损害的动物模型及损伤机理。方法采用兔做计物模型,常温无菌条件下机械性阻断肝十二指肠韧带,造成凡肝血流阻断,肠道淤血,缺血、缺氧;观察血流阻断后15′,20′,30′,60′的门静脉血内毒素、细菌移位、肠粘膜的病理变化。结果(1)缺血、缺氧是肠粘膜屏障功能损害的直接因素。(2)肠粘膜屏障损害程度随血流阻断时问延长逐渐加重;发现实验组动物门静脉血内毒素值和细菌移位数明显高于对照组,病理改变更明显。结论肠道是体内最大的贮菌库,一旦肠粘膜屏障结构和功能损害将引起全身多器官多系统的损伤。加强对肠粘膜屏障损害的研究和保护对指导临床工作有益无弊。     

常温下肝门入肝血流阻断后肠粘膜屏障损害实验研究

目的 研究在常温下阻断肝门入脉血流,肠粘膜屏障结构和功能损害的动物模型及损伤机理。方法 采用兔做动物模型,常温无菌条件下机械性阻断肝十二指肠韧带,造成入肝血流阻断,肠道淤血,缺血、缺氧;观察血流阻断后15’,20’,30’,60’的门静脉血内毒素、细菌移位、肠粘膜的病理变化。结果(1)缺血、缺氧是肠粘膜屏障功能损害的直接因素。(2)肠粘膜屏障损害程度随血流阻断时间延长逐渐加重;发现实验组动物门静脉血内毒素值和细菌移位数明显高于对照组,病理改变更明显。结论 肠道是体内最大的贮菌库,一旦肠粘膜屏障结构和功能损害将引起全身多器官多系统的损伤。加强对肠粘膜屏障损害的研究和保护对指导临床工作有益无弊。     

剖宫产术中出血临床干预体会

目的探讨减少剖宫产术中出血量的干预措施。方法对585例剖宫产常规采取医学干预措施，减少术中出血进而预防剖宫产产后出血的发生。结果在585例剖宫产术中常规采取了预防措施，术后24小时平均出血量为420±100ml，出血量1000—2000ml者仅2例，产后出血发生率3．93％。结论剖宫产术中常规采取一些干预措施可减少术中出血量，有效预防剖宫产产后出血的发生，利于产妇术后的恢复。     

高原地区常温下肝门血流阻断对肝脏耐缺血安全时限的实验研究

肝癌的治疗目前仍以瘤块切除为主，但术中出血为常见并发症，常温下一次阻断入肝血流的安全时限为１５～２０分钟￣［１、２］，高原地区低氧环境下（氧分压１６．２ｋＰａ）一次性入肝血流阻断安全时限仍有一些争论，本文选用海拔２７００ｍ以上地区１３只健康狗的实验研究，结果Ａ、Ｂ两组为安全时限；Ｃ、Ｄ两组狗死亡率较高，生理变化较大，光镜和电镜报告肝细胞有明显损害。在平原地区临床报道在常温下一次性阻断肝血流达６５分钟而术后存活良好￣［４］。本实验在高原地区肝门阻断血流以２０分钟为安全时限，生理变化不大，肝细胞损害不明显，这个研究结果对高原地区肝叶切除一次性入肝血流的阻断提供了可靠的依据。     

胆道术后及肝癌破裂出血8例的栓塞治疗

我科于1990～1994年对5例肝癌破裂出血及3例胆道术后肝动脉破裂出血的患者急诊行肝动脉栓塞止血，取得良好效果。现报告如下。1＄麻田料本组8例均系男性，年龄38～56岁，平均47·5岁，其中5例为肝癌破裂出血，3例为肝内胆管结石手术取石后肝动脉破裂出血。8例均为大出血而行急诊栓塞治疗。2方法与步骤2．1术前准备会明部备皮；碘过敏试验；急查出、凝血时间及血小板。2．2操作步骤会阴部常规消毒铺巾，用1％普鲁卡因沿股动脉周围局部浸润麻醉，选择动脉穿刺针穿刺，穿刺点位于腹股沟韧带下1．scm，穿刺角度向头倒倾斜45”，血流呈鲜红色喷射…     

瑞马唑仑对颅脑介入手术患者血流动力学及术后康复影响

目的 探讨瑞马唑仑对颅脑介入手术患者血流动力学及术后康复的影响。方法 选取聊城市人民医院自2020年9月至2021年9月收治的75例接受颅脑介入手术的全身麻醉患者为研究对象。采用随机数字表法将患者分为A组、B组、C组,每组各25例。全身麻醉诱导时,A组患者静脉泵注瑞马唑仑0.2 mg/kg, B组静脉泵注瑞马唑仑0.3 mg/kg, C组静脉泵注丙泊酚2.0 mg/kg。分别于麻醉诱导前(T₁)、气管插管前(T₂)、插管后即刻(T₃)、拔管前(T₄)、拔管后5 min(T₅),记录并比较3组患者动脉血压(MAP)、脑电双频指数(BIS)、脉搏血氧饱和度(SpO₂)、心率(HR)。比较3组患者诱导后的观察指标,包括从诱导开始至BIS<60的时间、术后24 h手术恢复质量评分(QoR-15)、呛咳评分、镇静药物补救比例、低血压比例。结果 A组、B组T₂～T₅时的MAP、BIS均高于C组,差异均有统计学意义(P&...     

氨甲环酸对剖宫产术中术后出血及血液黏滞度的影响

目的评估术前静脉输注氨甲环酸对减少剖宫产术中术后失血的效果及对血液黏滞度的影响。方法选择本院拟行剖宫产的足月妊娠初产妇100例,随机分为 A 组（ n =50）和 B 组（ n =50）,在产妇进入手术室后,开始分别输入10 mg/kg的氨甲环酸或等剂量生理盐水,输液的时间超过10 min。输液完毕20 min后,实施相同标准的麻醉与手术。观察初产妇术中术后的基本情况以及血液学指标,包括术后24 h复查产妇的血液常规、凝血时间及围手术期催产素的使用总量,测定术后72 h内不同时间点的血液黏度。结果 A组在术中出血量、术后出血量、血色素下降以及催产素的使用总量上均明显低于B组（P<0.05）;两组的血液流变学指标在相同时点比较,差异无统计学意义（P>0.05）。结论剖宫产术前20 min给予10 mg/kg的氨甲环酸,可显著降低术中和术后早期失血量,并且不会带来血液黏滞度的升高。     

血小板及冷沉淀输注对创伤大出血患者凝血功能的影响

目的探讨血小板及冷沉淀输注对创伤大出血患者凝血功能的影响。方法以保定市第一中心医院西院2011年8月~2014年8月收治的131例行大量输血治疗的创伤大出血患者作为研究对象,在大量输血早期预防性输注血小板和(或)冷沉淀预防性输注。将仅输注血小板的患者设为血小板组;将仅输注冷沉淀的患者设为冷沉淀组;将联合输注血小板与冷沉淀者设为联合组。观察不同输注方法对3组患者输血前后凝血酶原时间(PT)、活化部分凝血酶原时间(APTT)、凝血酶时间(TT)、纤维蛋白原(FIB)、血小板(PLT)等的影响。结果联合组患者输注后PT、APTT、TT较输注前明显缩短(P0.05),FIB、PLT较输注前明显增加(P0.05);联合组与血小板组比较,PT、APTT、TT明显缩短,FIB明显增加,差异均有统计学意义(P0.05),联合组与冷沉淀组比较,PT、APTT、TT明显缩短,PLT明显增加,差异均有统计学意义(P0.05);3组在住院时间上无统计学差异;联合组生存率高于血小板组和冷沉淀组,但无统计学意义(χ2=1.09,P0.05和χ2=0.64,P0.05);3组入院后24h红细胞输注量无统计学差异;联合组血小板输注量少于血小板组(t=6.30,P0.05),冷沉淀输注量少于冷沉淀组(t=7.17,P0.05)。结论创伤大出血患者大量输血早期联合输注血小板与冷沉淀可明显提高患者凝血物质的含量,缩短凝血时间,比单独输注血小板或冷沉淀更有利于避免凝血功能紊乱,具有更显著的止血效果。     

淋巴结阳性的食管癌患者术后预防性放射治疗的回顾性研究

目的 回顾性分析淋巴结阳性的食管癌患者术后放射治疗的意义。方法 自1999年9月至2005年10月,选择260例代表不同淋巴结转移状态的食管癌根治性手术切除患者进行研究。其中, 单纯手术组(A组)130例,术后放疗组(B组)130例。根据淋巴结转移的个数分为3个亚组,A1组(无淋巴结转移)42例,A2组(淋巴结转移个数1~3枚)43例,A3组(淋巴结转移个数≥4枚)45例;B1组(无淋巴结转移)43例,B2组(淋巴结转移个数1~3枚)44例,B3组(淋巴结转移个数≥4枚)43例。结果 (1) A和B组的1、3、5年总生存率分别为71.5％、35.4％、20.0％和76.2％、48.5％、36.2％(χ²=7.822,P<0.05)。A1和B1组、A2和B2组及A3和B3组的1、3、5年生存率分别为83.3％、52.3％、38.1％和81.3％、58.1％、46.5％(χ²=0.283,P>0.05),69.8％、34.9％、18.6％和77.3％、47.7％、40.9％(χ²=4.188,P<0.05)及62.2％、20.0％、4.4％和69.8％、39.5％、20.9％(χ²=6.168,P<0.05);B2和B3组生存率分别为40.9％与20.9%(χ²=4.213,P<0.05)。(2)A1和B1组、A2和B2组及A3和B3组的5年累计淋巴结转移率分别为30.9％和11.6％(χ²=4.753,P<0.05),53.4％和22.7％(χ²=8.741,P<0.05)及 66.7％和30.2％(χ²=11.682,P<0.05)。(3)A1和B1组、A2和B2组及A3和B3组的5年血行转移率分别为11.9％和13.9％(χ²=0.079,P>0.05),20.9％和20.4％(χ²=0.003,P>0.05)及31.1％和25.6％(χ²=0.203,P>0.05)。结论 术后放疗可以提高淋巴结阳性患者的生存率,降低放疗部位的淋巴结转移率,血行转移随淋巴结转移数的增加而增加。     

Comparison of two different thermal techniques for the treatment of hepatocellular carcinoma

Purpose

To compare the safety and efficacy of radiofrequency ablation (RFA) and microwave ablation (MWA) in treating hepatocellular carcinoma (HCC) while conforming to the Milan criteria.

Materials and methods

The study was approved by the Institutional Review Board, and informed consent was waived due to the retrospective study design. One hundred ninety-eight patients met the inclusion criteria and were included in the study. Eighty-five patients with 98 lesions received RFA, and 113 patients with 131 lesions underwent MWA. Complete ablation rates, local recurrence rates, disease-free survival rates, cumulative survival rates, and major complications were compared between the two treatment groups.

Results

Complete ablation rates were 99.0% for RFA and 98.5% for MWA (P = 1.000). Local recurrence rates were 5.2% for RFA and 10.9% for MWA (P = 0.127). Disease-free survival rates at 1, 2, 3, and 4 years were 80.3%, 61.8%, 39.5%, and 19.0% in the RFA group and 75.0%, 59.4%, 32.1%, and 16.1% in the MWA group, respectively (P = 0.376). Cumulative survival rates at 1, 2, 3, and 4 years were 98.7%, 92.3%, 82.7%, and 77.8% in the RFA group and 98.0%, 90.7%, 77.6%, and 77.6% in the MWA group, respectively (P = 0.729). Major complication rates were 2.4% and 2.7% in the RFA group and the MWA group, respectively (P = 1.000). There were no patient deaths due to treatment.

Conclusion

RFA and MWA have the same clinical value in treating HCC conforming to the Milan criteria. RFA and MWA are both safe and effective techniques for HCC as clinical application.     

Scirrhous hepatocellular carcinoma: comparison with usual hepatocellular carcinoma based on CT-pathologic features and long-term results after curative resection

Objective

To compare the CT and pathologic features and the long-term results of scirrhous hepatocellular carcinoma (HCC) after a curative resection with those of usual HCC.

Methods

Twenty-one patients with a scirrhous HCC and 296 patients with a usual HCC underwent contrast-enhanced triple-phase helical CT examinations before and after the curative resection. The CT and pathological features of scirrhous HCC, along with the cumulative survival and recurrence rates after the curative resection using a Kaplan–Meier method were compared with those of a usual HCC.

Results

The common CT features of scirrhous HCC were an ill-defined tumor margin (76%), peripheral rim-like enhancement on arterial and portal phases (62%), presence of area of prolonged and delayed enhancement on equilibrium phase (95%), and hepatic surface retraction (59%) and the uncommon CT features were presence of washout area (19%) and tumor capsule enhancement (5%), which were significantly different from those of usual HCC (p < 0.05). Pathologically, the tumor capsule formation (29%) and tumor necrosis or hemorrhage (10%) were significantly less than those (81% and 43%, respectively) in usual HCC (p < 0.05), while portal or hepatic vein involvement (33%) was significantly more common than in usual HCC (9%) (p < 0.05). There were no statistically significant differences in the 5-year cumulative survival and recurrence rates between the two groups (p > 0.05).

Conclusion

Scirrhous HCC showed distinct CT and pathologic features from those of usual HCC. After the curative resection, the long-term results of scirrhous and usual HCCs were not significantly different.     

Gd-EOB-DTPA-enhanced magnetic resonance images of hepatocellular carcinoma: correlation with histological grading and portal blood flow

Objective:

To retrospectively investigate enhancement patterns of hepatocellular carcinoma (HCC) and dysplastic nodule (DN) in the hepatobiliary phase of gadolinium-ethoxybenzyl-diethylenetriamine (Gd-EOB-DTPA)-enhanced MRI in relation to histological grading and portal blood flow.

Methods:

Sixty-nine consecutive patients with 83 histologically proven HCCs and DNs were studied. To assess Gd-EOB-DTPA uptake, we calculated the EOB enhancement ratio, which is the ratio of the relative intensity of tumorous lesion to surrounding nontumorous area on hepatobiliary phase images (post-contrast EOB ratio) to that on unenhanced images (pre-contrast EOB ratio). Portal blood flow was evaluated by CT during arterial portography.

Results:

Post-contrast EOB ratios significantly decreased as the degree of differentiation declined in DNs (1.00?±?0.14) and well, moderately and poorly differentiated HCCs (0.79?±?0.19, 0.60?±?0.27, 0.49?±?0.10 respectively). Gd-EOB-DTPA uptake, assessed by EOB enhancement ratios, deceased slightly in DNs and still more in HCCs, while there was no statistical difference in the decrease between different histological grades of HCC. Reductions in portal blood flow were observed less frequently than decreases in Gd-EOB-DTPA uptake in DNs and well-differentiated HCCs.

Conclusions:

Reduced Gd-EOB-DTPA uptake might be an early event of hepatocarcinogenesis, preceding portal blood flow reduction. The hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI may help estimate histological grading, although difficulties exist in differentiating HCCs from DNs.     

HBV慢性感染相关的肝癌病人外周血树突状细胞亚群的特点及其意义

目的　探讨慢性HBV感染相关的肝癌病人外周血树突状细胞 (DC)亚群的特点和临床意义。方法　选择 2 6例慢性HBV感染相关的肝癌病人进行研究 ,2 3例慢性乙型肝炎病人和 2 0例健康人作为对照。流式细胞仪检测外周血DC亚群和淋巴细胞亚群。ELISA法检测外周血单个核细胞 (PBMC)经灭活 1型单纯疱疹病毒 (HSV 1)刺激后产生IFN α的能力。结果　与健康对照相比 ,慢性HBV感染相关的肝癌病人外周血DC1和DC2百分比和绝对细胞数降低 (P <0 0 5 ) ;DC1/DC2比率无显著差别 ;PBMC经灭活HSV 1刺激后产生IFN α的能力降低 (P <0 0 5 ) ;NK细胞绝对细胞数降低(P <0 0 5 )。结论　慢性HBV感染相关的肝癌病人外周血DC1和DC2数量减少、功能减低 ,且伴有NK细胞绝对数目的减少 ,这些可能是导致肝癌病人机体抗肿瘤免疫反应下降的重要原因。     

Portal hemodynamics in patients with hepatocellular carcinoma

The protal blood flow was assessed in 46 patients with hepatocellular carcinoma, 81 with cirrhosis, and 110 control subjects using an ultrasonic B-mode pulsed Doppler duplex system. The cross-sectional area of the portal vein was increased, and the velocity of portal blood flow was decreased in hepatocellular carcinoma and cirrhosis, whereas the blood flow volume was not significantly different. A significant decrease in portal blood flow was found in hepatocellular carcinoma only when at least three of the four major branches of the portal vein were occluded. The change in portal hemodynamics before and after transcatheter arterial embolization (TAE) was investigated. Immediately after TAE, neither portal venous pressure nor portal blood flow showed any constant trend. The portal blood flow reached a peak 1 week after TAE and then returned to its former value after 3-4 weeks, while all cases with poor prognoses showed a drop in portal blood flow after TAE.     

不同人格气质类型对老年患者术后谵妄的影响

目的 本研究探讨不同人格气质类型对老年患者术后谵妄的影响及探讨不同人格气质类型与外周血中炎性因子白细胞介素-6(interleukin-6,IL-6)、肿瘤坏死因子(tumor necrosis factor,TNF-α)、白细胞介素-1β(interleukin-1β,IL-1β)的变化是否有关联.方法 采用艾森克人...     

经阴分娩史对非插管静脉全麻下宫腔镜手术患者术中血流动力学及术后恢复情况的影响

目的 探讨经阴分娩史对非插管静脉全麻下宫腔镜手术麻醉术中血流动力学及术后恢复情况的影响。方法 检索解放军总医院第一医学中心麻醉临床信息系统,选取2008-08至2019-12在解放军第一医学中心498例行非插管静脉全麻下宫腔镜手术患者围手术期数据,将患者分为有经阴分娩史组(VD组)和无经阴分娩史组(NVD组),应用倾向性评分匹配(PSM),对两组患者的基线情况进行1∶1配对。对比麻醉前(T₁)、麻醉后1 min(T₂)、手术开始时(T₃)以及手术开始后5 min(T₄)的收缩压、舒张压、平均动脉压及心率变化情况;对比两组患者术后随访疼痛NRS评分及恶心呕吐等不适症状的发生率。结果 应用PSM后共354例(NVD组和VD组各177例)纳入分析。T₁与T₂时点两组患者收缩压、舒张压、心率变化未见明显差异;T₃与T₄时点NVD组较VD组收缩压、舒张压、平均动脉压、心率升高(P<0.01);两组SpO_2<...