深低温对第一肝门部影响的实验研究

目的：了解深低温对第一肝门部的影响。方法：１５只小猪，随机分为两组，用平底冷冻头对实验组第一肝门部进行３分钟的直接深低温冷冻；对照组：仅阻断肝门３分钟，术后通过血清学、病理学等方法了解肝脏改变。结果：动物肝门部的胆管系统在冷冻后出现严重损伤，表现为进行性、不可逆的胆管坏死、狭窄、胆瘘、化脓性胆管炎等并发症，肝动脉、门静脉的结构不受影响。结论：如对第一肝门部进行直接深低温冷冻，应注意避免损伤胆管系统     

阻断肝右静脉对肝硬化小猪肝脏血流动力学的影响

目的：探索肝硬化条件下合理的肝静脉阻断方式。方法：分别缝扎或间歇断肝硬化小猪各6头，动态观察肝脏组织病理学，肝功能，肝动脉造影，核素扫描和肝脏血流动力学的改变。结果：缝扎组早期肝损害明显，6周后恢复，早期肝右叶肿胀淤血，晚期有萎缩，左叶横径纵径增加；术后门静脉压力或高，门静脉血流减慢，流量减少，肝动脉血流加快，血流量增加，肝动脉－门静脉瘘，右肝门静脉分支与左肝静脉分支交通支形成。间歇阻断组肝损害较轻但持久，阻断期肝右叶肿胀，放松后改善，6周后左右略增大，右叶减小不明显，阻断期PVP，门静脉，肝动脉血流速度，血流量改变与结扎组相似，间歇期恢复；未见血管瘘形成。结论：肝硬化情况下缝扎RHV致肝右叶萎缩，左叶代偿增生较间歇阻断组明显；缝扎RHV致肝功能损害早期较明显，可自行恢复，间歇阻断致肝功能损害较轻但持久，缝扎RHV对肝脏血流动力学的影响较明显，肝内侧支循环较完善。     

肝硬化门脉高压患者入肝血流的超声评价

目的观测肝硬化门脉高压患者入肝血管(肝动脉、门静脉)血流动力学,探讨其与Child-Pugh肝功能分级、临床预后的关系.方法应用彩色多普勒超声分别检测35例正常健康人和37例肝硬化门脉高压患者的人肝血管的血流参数,分析肝硬化门脉高压入肝血管血流动力学参数与肝硬化分级关系.结果肝硬化门脉高压患者门静脉内径增宽,血流速度下降,充血指数增高,肝动脉血流阻力增高,与对照组有明显差异;肝硬化门脉高压患者Child-Pugh肝功能分级与门静脉内径无显著差异(P＞0.05),Child C级门静脉血流量显著减少,Child肝功能分级与门静脉的充血指数有关.结论测定入肝血管血流动力学参数有助于判断肝硬变门脉高压症的预后,为临床诊治提供依据.     

超声双多普勒同时检测肝硬化肝动脉及门静脉血流供应研究

目的：观察肝硬化患者肝动脉、门静脉血流动力学的变化，探寻与肝功能血液检测指标的相关性。方法：应用超声双多普勒先进测量技术同时对60例肝硬化患者的肝动脉、门静脉的血流速度进行检测，选择60例肝功能正常的健康人作为对照组，观察肝硬化患者与正常人血流变化情况。60例肝硬化患者均进行肝功能血液检测，探寻肝动脉阻力指数、以及肝动脉、门静脉血流速度与其相关性。结果：肝硬化患者较正常人肝动脉血流速度明显增高，阻力指数增加，但门静脉血流速度较正常人略有减低。当肝动脉阻力指数大于或等于0.7时，肝硬化患者肝功能血液检测指标丙氨酸基转移酶（ALT）、天门冬氨酸氨基转移酶（AST）、γ-谷氨酰转肽酶（GGT）至少有一项升高超出正常范围，呈正相关性。结论：肝硬化患者肝动脉与门静脉血流动力学变化与肝功能血液检测指标密切相关，有规律可寻，超声可以无创检测肝动脉与门静脉血流变化反应肝功能情况，为临床选择治疗方式及用药效果提供理论依据。     

冷冻损伤部分肝叶Glisson管道二级分支后,相应肝组织保留价值的实验研究

目的:了解深低温冷冻损伤部分肝叶Glisson氏管道系统后,相应肝组织有无保留价值。方法:14只小猪,随机分为2组,用冷冻头深低温冷冻实验组动物左肝外叶Glisson管道区域3min,对照组仅阻断肝门血流3min。分别在术后4、8周行肝组织活检,了解患肝病理改变,并对患肝组织进行糖原(PAS)、酸性磷酸酶(ACP)、琥珀酸脱氢酶(SDH)、葡萄糖-6-磷酸酶(G-6-Pase)染色,注射99mTC-植酸钠了解枯否细胞吞噬功能,并用彩超了解受冻肝叶管道情况。结果:动物可耐受上述冷冻,冷冻可造成受冻胆管壁的坏死,但肝动脉、门静脉分支的血流保持通畅,所属肝叶萎缩、纤维化;受冻管道所属肝叶的枯否细胞吞噬功能和肝细胞线粒体的功能明显减弱,但肝细胞的糖和蛋白质代谢功能变化不显著。结论:深低温冷冻损伤部分肝叶Glisson氏管道系统二级分支后,相应肝组织有一定的保留价值。     

大鼠Walker-256肝微小转移癌模型的CT灌注成像研究

目的通过多层螺旋CT灌注扫描研究肝脏微小转移癌大鼠的肝脏血流动力学变化。方法22只经脾脏注入Walker-256(细胞数量2×107)制备成肝脏微小转移癌的大鼠为实验组;10只大鼠经脾脏注入等量生理盐水为对照组。CT灌注扫描后用斜率法计算得到参数包括:肝动脉灌注量、门静脉灌注量、肝灌注指数、总肝灌注量。病理学检查HE染色证实转移癌的存在。结果19只大鼠发现的转移灶直径在0.5~6.6mm之间。肝脏微小转移癌的大鼠肝动脉的灌注量远远大于对照组(是对照组的2.25倍);而门静脉灌注量明显少于对照组(是对照组的76.6%)。总肝灌注量没有显著变化。结论大鼠微小肝转移癌表现为肝动脉灌注量的增加和门静脉灌注量的降低。CT灌注成像技术可以用来评价肝脏的血流动力学变化。     

肝纤维化门静脉压力改变与血管活性物质关系的实验研究

目的制作兔肝纤维化模型,观察血管活性物质与门静脉压力变化的关系.方法 40只家兔采用口服硫代乙酰胺方法造模,分别于造模8、12、16、20周时检测ET-1及NO浓度,超声观察胆囊壁及肝脏血流动力学指标,测量不同时期门静脉压力.分析血管活性物质与肝脏血流动力学指标及门静脉压力变化间的关系.结果胆囊壁增厚是肝纤维化阶段的二维超声表现;随着纤维化程度的加重,血清ET-1、NO浓度逐渐增加,且以ET-1/NO比值增加更为明显;门脉内压力、肠系膜上动脉、脾动脉搏动指数(PI)随纤维化程度逐渐增加,实验组与对照组间有显著差异(P<0.05),且与ET-1/NO值呈正相关(P<0.01).结论通过超声可无创检测肝脏血流动力学变化,帮助临床诊断肝纤维化及治疗效果的观察,具有积极的作用.     

门静脉高压症患者行脾切除及贲门周围血管离断术后肝脏血流动力学变化的超声观测

目的应用彩色多普勒超声研究门静脉高压症患者脾切除及贲门周围血管离断术后肝脏血流动力学的变化情况。方法彩色多普勒超声动态监测30例门静脉高压症患者术前1 d及术后第3、7、30天肝脏血流参数,包括门静脉内径、门静脉最大流速、门静脉血流量、肝固有动脉内径、肝固有动脉收缩期峰值流速和舒张末期流速、肝固有动脉阻力指数及肝固有动脉血流量;以上各参数均测量3次取其平均值,手术前后测量自由门静脉压力。结果所有患者门静脉内径术后第7天、第30天较术前均减小,门静脉最大流速术后第7天、第30天较术前均降低,门静脉流量术后第3天较术前减少,差异均有统计学意义(均P<0.05);术后肝固有动脉收缩期峰值流速、舒张末期流速及流量均较术前增加,术后阻力指数较术前降低,差异均有统计学意义(均P<0.05)。术前与术后各时间段肝固有动脉内径比较差异无统计学意义;术后自由门静脉压力较术前降低。结论彩色多普勒超声可监测门静脉高压症患者脾切除加断流术术后肝脏血流动力学变化,能够为临床疗效的判断提供可靠依据,具有重要的临床价值。     

慢性肝炎超声血流成像定量指标与肝功能损害程度的相关性研究

目的 探讨慢性肝炎门静脉及肝动脉血流动力学改变的超声测值与慢性肝功能损害程度的相关性.方法 将457例慢性肝炎患者肝功能异常分为轻度组、中度组和重度组,选取120例健康者为对照组;全部受检者均行门静脉、肝动脉超声检测和血清学、病毒标记物检测,209例患者经肝组织活检病理证实.将超声测值与血清学检测的肝损害程度分期对照分析.结果 对照组与轻度组,在门静脉内径、门静脉血流速度比较,无显著差异(P＞0.05);在肝动脉流速、阻力指数和收缩期峰值与舒张期峰值比值中存在显著差异(P＜0.05);对照组、轻度组与中度组、重度组在血流定量指标中存在显著差异(P＜0.05).结论 慢性肝炎患者门静脉流速、肝动脉流速及肝动脉阻力指数等能反映肝脏肝功能损害程度,从而对慢性肝病的临床治疗评价有一定的价值.     

门静脉部分动脉化的研究进展

门静脉部分动脉化在肝门部肿瘤切除、肝切除、肝移植等手术中减轻肝脏功能损害的作用已得到广泛研究 ,本文对其概况及研究进展进行了总结。1　门静脉部分动脉化概述门静脉部分动脉化法是为防止肝动脉阻断后的肝损害 ,而使动脉血流入门静脉的方法。此类方法是在维持门静脉原有静脉血流的同时灌注动脉血流 ,因此称为门静脉部分动脉化法。门静脉部分动脉化的方式 ,多采用肝动脉与门静脉直接吻合 ,亦有采用右肾动脉 ,胃十二指肠动脉与门静脉吻合或肠系膜动静脉侧侧吻合 ,肝总动脉与胃十二指肠静脉吻合等方法[1] 。而完全阻断了门静脉的血流 ,而…     

Histopathological studies on intrahepatic bile ducts in the vicinity of porta hepatis in biliary atresia.

Intrahepatic bile ducts in the vicinity of the porta hepatis were histologically investigated in 9 cases of biliary atresia and the pattern of bile duct was divided into two groups. In the first group, there were a few large bile ducts which had continuity to the extrahepatic bile duct. In the second group, many small bile ducts were histologically observed, but there was no large bile duct at the porta hepatis. This type of abnormal bile ducts was seen in the cases of obliteration of bile ducts at porta hepatis.     

门腔转流门脉重建对门脉血流动力学影响的实验研究

目的： 探讨门腔转流门脉重建对门脉血流动力学的影响。方法： 选健康小猪１６ 头, 实验组 １２ 只, 阻断门脉行门腔转流门脉重建。对照组４ 只, 仅阻断门脉。以彩色多普勒观察门静脉血流动力学变化, 同时解剖动物,测门静脉压。结果： 实验组术前与术后 ３０ 分钟、２ 周、４ 周、８ 周、１２ 周的门静脉压、平均流速、血流量无明显变化,术前与术后 １６ 周、２０ 周的门静脉压、平均流速、血流量则有显著变化。术前后各期门静脉内径无明显变化。结论：门脉重建时辅助门腔转流是必要的, 它不会影响重建后门脉血供。     

Endoscopic evaluation of the porta hepatis in patients with biliary atresia

Endoscopic inspection of the porta hepatis was undertaken through external enterostomy in nine postoperative patients with biliary atresia. The endoscopic appearance of bile flow in the porta hepatis was classified into three types. 1) Ductal type (D-type), which revealed good bile flow from distinct bile duct orifices (4 cases); 2) Oozing type (O-type), which showed adequate bile flow, but no definite bile duct (3 cases); and 3) Covered type (C-type), in which the porta hepatis was covered with bile "clots" and fibrous tissue (2 cases). The clinical course of the D-type was excellent with immediate disappearance of jaundice and relatively good liver function. In the case of the O-type, jaundice disappeared in 2 but persisted in one. Two patients with C-type died of hepatic failure or sepsis in the early postoperative period. In the D-type intrahepatic bile ducts were well visualized by cholangiography; however, those of the O-type were not so clear. Endoscopic inspection of the porta hepatis is very useful for evaluation of the postoperative state of bilioenteric fistulae in patients with biliary atresia.     

Emergency liver resection for combined biliary and vascular injury following laparoscopic cholecystectomy: case report and review of the literature

A 75-year-old woman suffering from symptomatic cholelithiasis was admitted to our hospital for elective laparoscopic cholecystectomy (LC). Intraoperatively, because of severe inflammation and dense adhesions in the region of the Calot triangle and bleeding arising from the porta hepatis which obscured the operating field, the method was converted to a conventional open approach. Copious hemostasis was achieved using sutures, clips and diathermy, and no bile duct or vascular injuries were recognized intraoperatively. Because of severe right upper quadrant abdominal pain and significant deterioration of the liver function tests (LFTs) on the first postoperative day, the patient underwent a Doppler ultrasound scan which showed absence of blood flow at the level of porta hepatis. Urgent relaparotomy revealed an ischemic liver on the right, a transected common bile duct at the level of its confluence, a divided and ligated right hepatic artery and thrombosed portal vein down to its confluence. Thrombectomy and reconstruction of the portal vein were performed to salvage the left hemiliver, and after restoration of blood flow to the left hemiliver, a right hemihepatectomy and a Roux-en-Y hepaticojejunostomy on the left were performed. Liver resection serves an important role in the case of parenchymal necrosis due to combined biliary, hepatic artery and portal vein injury following laparoscopic cholecystectomy and moreover, the operation can be safely performed in the acute setting.     

婴儿先天性肝门部囊性占位的超声鉴别

目的 探讨超声用于鉴别先天性囊肿型胆道闭锁和胆总管囊肿的应用价值。 方法 随机选取2016年6月~2017年6月我院收治的肝门区囊肿患儿31例,所有患儿均接受超声检查及手术治疗,依据手术结果将这些患儿分为囊肿型胆道闭锁组（n=15）和胆总管囊肿组（n=16）,对两组患儿的肝内胆管扩张、肝门部纤维块、胆囊内胆泥沉积、胆囊形态异常、胆囊收缩不良发生情况、肝动脉内径、胆囊大小、囊肿体积进行统计分析。 结果 囊肿型胆道闭锁组患儿的肝内胆管扩张、胆囊内胆泥沉积发生率0%、6.7%（1/15）均显著低于胆总管囊肿组75.0%（12/16）、50.0%（8/16）（P<0.05）,肝门部纤维块、胆囊形态异常、胆囊收缩不良发生率80.0%（12/15）、86.7%（13/15）、73.3%（11/15）均显著高于胆总管囊肿组0%、6.3%（1/16）、12.5%（2/16）（P<0.05）,肝动脉内径长于胆总管囊肿组（P<0.05）,囊肿体积小于胆总管囊肿组（P<0.05）,胆囊宽径短于胆总管囊肿组（P<0.05）,但两组患儿的胆囊长径之间的差异无统计学意义（P>0.05）。 结论 超声用于鉴别先天性囊肿型胆道闭锁和胆总管囊肿的应用价值高。       

胆管细胞癌的超声表现及与CECT、MRI、MRCP诊断价值的对比研究

目的 探讨胆管细胞癌(CCC)的二维超声、彩色多普勒及CEUS表现,比较超声、增强CT(CECT)、MRI、磁共振胰胆管成像(MRCP)对胆管细胞癌的诊断价值。方法 归纳57例CCC的二维超声和彩色多普勒血流的具体表现,并且对行CEUS检查的4例病灶造影剂灌注情况进行分析。比较普通超声、CECT、MRI、MRCP以及联合CEUS后超声对CCC的诊断价值。结果 57例病灶以肝门型居多,部分伴发肝内胆管扩张,少数可见肝门部或腹膜后淋巴结肿大。病灶多表现为血流不丰富的低回声,尤以肝门部和肝左叶者明显。肝门部病灶多伴发胆囊结石,肝右叶者多伴发肝内胆管结石,肝左叶者伴发胆囊和肝内胆管结石的比例各半。4例CEUS表现为动脉期高增强或等增强继而快速减退呈低增强并持续整个门脉期和延迟期。普通超声、CEUS、CECT、MRI及MRCP的诊断价值无统计学差异 (P>0.05)。结论 CCC的二维及彩色多普勒超声表现有一定规律可循,普通超声联合CEUS可降低漏、误诊率。     

Analysis of focal spared areas in fatty liver using color Doppler imaging and contrast-enhanced microvessel display sonography.

OBJECTIVE: The purpose of this study was to investigate whether focal fatty sparing (FFS) formation in the liver relates to aberrant blood flow. METHODS: Sixty-three FFSs of the liver in 52 patients were examined by color Doppler flow imaging and contrast-enhanced microvessel display sonography. The 63 FFSs included 16 FFSs in the porta hepatis, 14 FFSs around the gallbladder fossa, and 33 other FFSs. The control group included patients with a diagnosis of fatty liver but no FFSs or focal lesions near the porta hepatis. RESULTS: Fourteen of 16 FFSs in the porta hepatis showed venous blood toward those areas that were differentiated from the portal and hepatic veins. Focal fatty sparings in the hilus hepatis correlated with aberrant veins, having a statistical significance compared with the control group (P < .0001). Seven of 14 FFSs around the gallbladder fossa contained blood vessels, 5 of them veins and the remaining 2 arteries. Two FFSs were located around hemangiomas. Three FFSs were located around maldeveloped vessels. CONCLUSIONS: The blood supply to an FFS in the porta hepatis may be correlated with aberrant veins. Focal fatty sparings around the gallbladder fossa may be associated with aberrant blood flow.     

Sonographic diagnosis and follow-up of idiopathic hepatic artery aneurysm, an unusual cause of obstructive jaundice.

Hepatic artery aneurysms are rare. We report an idiopathic hepatic artery aneurysm causing obstructive jaundice in a case in which the common hepatic artery arose from the superior mesenteric artery. The diagnosis of hepatic artery aneurysm was suggested by gray-scale sonography, which showed that the common bile duct and intrahepatic biliary radicles were dilated with no obvious intraluminal abnormality and showed no evidence of a mass in the head of the pancreas. A papillotomy of the papilla duodeni major was performed to relieve the cholestasis. Repeat sonography 2 weeks later showed dilatation of the common bile duct and a cyst-like lesion at the porta hepatis impressing the anterior part of the common bile duct. Doppler sonography confirmed pulsatile flow within the cyst-like lesion. Helical CT showed a well-circumscribed lesion with a density similar to that of the abdominal aorta, and mesenteric angiography showed a 3-cm, smooth aneurysm arising from the common hepatic artery, which originated from the superior mesenteric artery. The aneurysm was successfully treated with transcatheter embolization.     

Interhepatic duct: A new biliary anomaly

True accessory bile ducts occur in only 1% of patients. An accessory bile duct connecting the right and left hepatic ducts at the porta hepatis is described. This anomaly has never been reported previously, and was clinically significant in the presence of partial obstruction of an anomalous right hepatic duct by stones. The embryologic origin of this duct, which we term an interhepatic duct, is uncertain.     

原位辅助性部分肝移植治疗门静脉高压症的实验研究

目的 在原位辅助性部分肝移植(APOLT)动物模型基础上，观察其对猪肝硬化门静脉高压症的初步治疗效果。方法 采用结扎胆总管的方法复制猪胆汁性肝硬化动物模型，6只健康良种幼猪作为供体组，6只肝硬化模型猪为受体组，肝移植采用APOLT术。术中观察血流动力学和生化指标；术前、术后当天及7d观察门静脉压力、血胆红素及肝功能，同时用彩色多普勒超声检查门静脉最大流速及流量。结果 胆总管结扎8周后见肝脏假小叶形成，小叶周围结缔组织增生明显，有胆栓及胆泥沉积，证实胆汁性肝硬化模型成功。6只猪APOLT术后5只存活。术后7d动物活杀病理检查见移植肝形态、色泽正常，各吻合口无扭曲、漏血和血栓形成；移植肝部分肝小叶结构紊乱，肝细胞萎缩或消失，肝小叶内大量淋巴细胞和浆细胞浸润，中央静脉周围肝小叶细胞浊肿，可见淋巴细胞浸润；受体肝无明显变性及坏死。术后7d存活猪经彩色多普勒超声检察发现，移植肝门静脉血流比宿主肝门静脉血流增多，回流通畅，移植肝功能良好。血总胆红素、丙氨酸转氨酶及天冬氨酸转氨酶等肝功能指标明显好转，术后7d门静脉压力与术前相比显著降低。结论 APOLT术对门静脉高压症有一定的治疗作用，是一种较有希望的治疗肝硬化门静脉高压的新方法。