肝尾状叶损伤外科诊治分析

目的分析肝尾状叶损伤的原因及治疗效果,探讨其治疗方法。方法回顾性分析近10年来作者治疗的肝损伤病例482例,其中肝尾状叶损伤者17例,分别从其解剖特点、损伤机制、诊断和治疗等方面进行分析。结果本组17例均给予手术治疗,其中13例治愈,治愈率76.5%。死亡4例,死亡率23.5%(4/17)。死亡4例均有严重的合并伤,分别死于颅脑损伤、失血性休克、多器官功能衰竭等。结论肝尾状叶损伤术目前确诊困难多数在术中发现,术中仔细探查避免漏诊。肝尾状叶损伤应及时选择适宜的手术治疗。     

Scanning electron microscopic examinations of microvascular casts of the rat liver and bile duct

Microvascular features of normal rat livers and bile duct system were examined with the vascular casts using methacrylated resin. Portal vein branches not only showed regular tapered down bifurcations but also had many side branches, some of which were directly connected with sinusoids. Terminations of hepatic arterial branches were divided into three types: 1) Many branches pouring into peribiliary capillary plexus (PBP), 2) branches directly pouring into periportal sinusoids and/or peripheral portal vein branches via arterio-portal anastomoses, and 3) anastomoses with periportal vascular plexus. PBP was composed of rich vascular networks. In large portal tracts, the plexus showed two layers, that is, the inner layer made up of a close network of capillary vessels and the outer layer consisting of a loose network of arteries and veins, while the PBP in the small portal tracts was composed of only a single layer of loose capillary network. Transitional features of these two patterns were found in the medium-sized portal tracts. PBP was supplied by afferent vessels from the interlobular hepatic artery as described above, and were directly connected with interlobular branches of the portal vein (internal root). The extrahepatic bile duct revealed a much richer vasculature than the intrahepatic bile duct. Both arterial and venous branches were ramified at almost right angle from a pair of arteries and veins running parallel with the bile duct. Occasional strictures, which might have been sphincter portions of the media, were noted at the branching sites of the artery.(ABSTRACT TRUNCATED AT 250 WORDS)     

肝后下腔静脉前间隙的临床解剖学研究

目的：探讨肝后下腔静脉前间隙的解剖基础及其临床应用价值。方法：在安徽医科大学解剖教研室选取的甲醛溶液固定的成人肝脏19例,标本的腔静脉系统用乳胶灌注。以尾状叶静脉与肝中静脉右缘的连线为下腔静脉前间隙的左侧界线;以肝右后下静脉与肝右静脉左缘的连线为下腔静脉的右侧边界。打开下腔静脉,数显卡尺测量下腔静脉前间隙内的直径超过1mm肝短静脉。结果：下腔静脉前间隙的左、右边界分别为尾状叶静脉与肝中静脉右缘的连线,肝右后下静脉与肝右静脉左缘的连线;19例标本中14例出现肝右后下静脉、肝右后中静脉或二者同时存在,在所有的标本中都存在Spiegel叶静脉;在下腔静脉前间隙内,有少量细小的肝短静脉。结论：肝后下腔静脉前间隙有其解剖学基础,在肝脏外科中具有重要的意义。     

肝动脉变异的解剖学及DSA对比研究

目的探讨肝动脉解剖变异的种类及分型,为临床肝介入提供解剖学资料。方法通过对30例成人尸体肝动脉的解剖观察,以及200例门诊及住院肝介入诊疗患者的肝动脉数字减影血管造影图像的观察,并对两组的资料进行统计学处理。结果尸体解剖组：30例锯剖标本中,典型分布的肝动脉占17例,占56．7％。变异的肝动脉13例,占43．3％,其中男10例,女3例。数字减影血管造影组：200例数字减影血管造影图像中发现典型分布的肝动脉的有127例,占63．5％;有肝动脉变异的有73例,占36．5％,其中男64例,女9例。结论通过分析肝动脉变异的来源,将肝动脉的来源分为四型：腹腔干供血型、胃左动脉供血型、肠系膜上动脉供血型和其他动脉供血型。     

Morphological consideration of the bronchial arteries and its interventional angiography

The authors dissected the bronchial arteries macroscopically in 40 human adults. (1) Two right and two left bronchial arteries were most commonly observed in 19 cases (48%). (2) Besides the intercostobronchial artery, one more right bronchial artery was mainly distributed to the lower lobe of the right lung. (3) Relationship between the intrapulmonary distribution of each bronchial artery and the lobe of the lung was not definite. Technological considerations of the BAG were presented from the results of this study.     

Transcatheter arterial embolization for cystic hepatic metastases from leiomyosarcoma of gastrointestinal tract

Transcatheter arterial embolization was performed in three patients with cystic hepatic metastases from leiomyosarcoma of gastrointestinal tract. In one patient who had been alive and examined by CT scanning for more than 3 years, it was considered as valid for evaluating efficacy of TAE that the size reduction of cystic lesions followed the reduction of mural nodules and smoothing of marginal irregularity.     

Emergency hepatic arterial embolization in the management of hemobilia

We present 5 patients with hemobilia treated successfully by emergency transcatheter hepatic artery embolization (TAE). All patients had severe associated illnesses and were very poor candidates for operative treatment. In 3 patients, hemorrhage was completely controlled by TAE using sponge alone, however in 2 patients with hepatic artery pseudoaneurysm, additional TAE using coil was necessary for hemostasis. No major complication was encountered after TAE. Since angiography can offer both diagnostic and therapeutic benefits, we feel that angiography should be considered for exact localization of hemobilia and possible transcatheter therapeutic embolization for control.     

Clinical usefulness of half-dose gadolinium-enhanced MR angiography of portal venous system (MR portography)--combined use with conventional dynamic MR imaging

The clinical usefulness of half-dose Gadolinium-enhanced MR portography combined with the conventional full-dose dynamic MR imaging was evaluated on normal volunteers and patients. Half-dose MR portography was performed immediately following conventional full-dose Gd-enhanced dynamic MR imaging. The visualization of the extrahepatic portal system was either good or excellent in most cases excluding the splenic vein which was poor in 20.7%. That of the right and left main portal branches was also excellent. As for segmental branches, the visualization was poor of the left lobe. The comparison with digital subtraction angiography showed that the visualization of the right and left main portal branches was mostly equal. That of the splenic vein alone was worse on MR portography. We conclude that half-dose Gadolinium-enhanced MR portography is useful for the overall assessment of the portal venous system and can be added to the conventional dynamic MR imaging.     

尾叶肝癌手术切除的临床应用

目的 总结尾叶肝癌手术切除的可行性及经验.方法 对2003年10月至2007年10月手术切除的7例尾叶肝癌患者的Il缶床资料进行回顾性分析.结果 7例尾叶肝癌均经手术成功切除,3例分别于术后12、18、23个月死亡,4例术后分别10、11、17、24个月仍健在.结论 尾叶肝癌手术难度高,风险大,但手术切除仍是最理想的治疗方法,不能轻易放弃,应积极治疗、慎重对待,合理的手术及术后的综合治疗是尾叶肝癌治疗取得远期疗效的关键.     

Pulmonary embolization-induced thymus hyperplasia in rabbits

The effects of pulmonary embolization on the thymus glands of rabbits were studied morphologically, morphometrically and immunohistochemically. Pulmonary embolization was induced by an intravenous injection of 0.4 ml of Sephadex bead suspension (particle size; 150 to 300 microns, about 2,000 per ml). Both mean weight and volume of the thymus of rabbits killed at 2 weeks after embolization, were about 1.5 times more than those in control animals treated with physiologic saline. Histological examinations showed enlargement of the cortex and medulla of the thymus, and the embolized Sephadex beads in the branches of pulmonary arteries of the lung. The area ratios of medulla/cortex, in the embolization group and in control, were not significantly different. The cells with immunohistochemically positive staining of anti-nuclear antigen of monoclonal antibody of Ki-67, were found in both portions of the medulla and cortex. These data suggest that pulmonary embolization in the rabbit induces true thymic hyperplasia. An intravenous injection of India ink into the right highest intercostal artery revealed the distribution of bronchial arteries, which send the branches to the right lobe of the thymus. In 2 out of 4 animals killed 2 weeks after pulmonary embolization, the left lobe of the thymus as well as the right were stained with the injected ink. As it is known that pulmonary vascular obstruction caused a marked increase in the bronchial blood flow, these data suggest that the thymus blood supply from the bronchial arteries increases in the conditions of pulmonary embolization, which might contribute to thymus hyperplasia.     

78例短暂性脑缺血患者数字减影全脑血管造影结果分析

目的通过全脑数字减影血管造影（DSA）检查,分析短暂性脑缺血性（TIA）与供血脑动脉病变的关系,探讨TIA的发病机制。方法对临床表现为TIA的90例患者行全脑血管造影,并对患者的DSA资料进行分析,计算颅内-外动脉狭窄率,并对患者的颅内外动脉狭窄或闭塞情况进行比较。结果 90例TIA患者中有78例患者有不同程度的颅内外动脉狭窄,颅内外共198支动脉狭窄或闭塞,总异常率为86.67%（78/90）,其中颅内动脉狭窄或闭塞共145支,占73.23%（145/198）,颅外动脉狭窄共53支,占26.77%（53/198）,颅内-外多发病变11例,共累及54支颅内外血管。结论颅内-外动脉狭窄是发生TIA的重要因素,DSA检查有助于明确VB-TIA病因,对治疗具有指导意义。     

Risk factors for intractable pleural effusion after liver resection

BACKGROUND: Although intractable pleural effusion is a well-known complication after liver resection, risk factors for this condition have not been established. METHODS: Records of 254 patients who underwent liver resection for hepatocellular carcinoma between January 1994 and December 2002 were reviewed. Postoperative pleural effusion that required thoracentesis or continuous drainage with or without pleurodesis was defined as intractable. Variables evaluated as risk factors included demographic factors, presence of cirrhosis, routine preoperative laboratory data, serum concentration of type IV collagen 7S domain (7S collagen), Child-Pugh class, preoperative interventions, including transcatheter arterial embolization (TAE), operative procedure, intraoperative blood loss, histology of noncancerous hepatic parenchyma, and major postoperative complications. RESULTS: Postoperative intractable pleural effusion developed in 15 (5.9%) patients. Serum concentration of 7S collagen, preoperative transcatheter arterial embolization (TAE), and liver resection that included segments 7 and/or 8 were independent risk factors on multivariate analysis. In patients with high concentration of 7S collagen (> or = 8.0 ng/mL), the incidence of the complication was significantly lower in patients who had not undergone TAE than in those who had undergone TAE. CONCLUSION: An increase in serum 7S collagen concentration (> or = 8.0 ng/mL) and preoperative TAE are independent and preoperative risk factors for the development of intractable pleural effusion after liver resection for HCC. Preoperative TAE should be avoided when possible in patients whose serum 7S collagen concentration is > or = 8.0 ng/mL.     

Transcatheter arterial embolization of hemangiomas in the perioral region

This paper presents four cases with successful transcatheter arterial embolization (TAE) for oral and perioral hemangiomas. Four TAEs were performed without major complications and the tumors disappeared in one case and decreased in size in the other 3 cases.     

3．0T磁共振LAVA序列技术对肺血管成像的研究

目的：探讨3．0T磁共振LAVA序列对肺部血管成像的可行性。材料和方法：GE 3．0T HD MR对怀疑胸部病变行MRI检查的患者59例，行横断位T1WI（FSE，TR／TE 833ms／13．4ms）和T2WI（抑脂SSFSE，TR／TE2000ms／98．7ms）常规扫描，继之采用冠状位LAVA序列（TR／TE2．3／1．1msec，flip angle 120，FOV=35×35cm层厚1．4mm）行肺动脉期、肺静脉期、主动脉期扫描。ADW4．3工作站上以MIP方法进行重建，得到肺血管图像。由2名有经验的胸部放射科医生对肺动脉各分支、肺静脉属支、支气管动脉显示程度以及肺动脉和肺实质的信噪比分析。结果：肺动脉3级分支显示率98％，4级分支显示率为90％，5级分支显示率为51％。肺静脉3级属支显示率98％，4级属支显示率为91％，5级属支显示率为58％。左右支气管动脉纵隔内段的显示率分别为78％和86％。结论：在3．0TMR LAVA技术可清楚显示肺部各级血管走行，并能提供高质量的肺血管形态细节。     

Diagnosis of the pelvic fracture which requires TAE on plain pelvic radiograph

We reviewed the initial emergency-room plain pelvic radiographs of 75 patients with pelvic fracture. In thirty-six patients transcatheter arterial embolization (TAE) was performed for retroperitoneal hemorrhage associated with pelvic fracture (TAE group) and in 39 patients (non-shock group) TAE was not required. In TAE group, fractures involving iliosacral region and pubic symphysis were more dominant than in non-shock group. Specific soft tissue abnormal shadow of TAE group was not present. It may be impossible to determine the necessity of TAE in pelvic fracture on the basis of plain pelvic radiograph.     

Contrast-enhanced MR angiography of the epigastric and hepatic regions: visibility in three-dimensional reconstructions

PURPOSE: We applied the Maximum Intensity Projection method (MIP method), volume rendering method (VR method) and Shading process in reconstruction of arteries, portal veins and hepatic veins using Contrast-enhanced MR Angiography (MRA) in the epigastric region and examined its usefulness. In addition, the visibility of tumor vessels in the liver was evaluated using original images. SUBJECTS AND METHODS: The subjects were 85 patients. Abdominal dynamic imaging was performed using the efgre3d sequence. We reconstructed MRA for stereoscopic images using the MIP, VR, or VR + Shading process method and evaluated the visibility rates and score of each artery, portal vein and hepatic vein. The visibility of tumor vessels in the liver was also evaluated from original images obtained using MRA. RESULTS: In the arterial phase, the VR method and shading process yielded greater visibility than the MIP method. The average score was highest in the shading process followed by the VR method, and then the MIP method. In the portal phase, there was little difference in visibility among the reconstruction methods. The average score with the MIP method was slightly, but not significantly, higher than with the VR method and Shading process. For the hepatic veins, visibility rates of each three-dimensional reconstruction image were markedly lower than in original images. Tumor vessels were visualized over 85% using MRA. CONCLUSION: The VR method and Shading process were useful for evaluation of arteries. The MIP method was useful for evaluation of the portal vein. Original images were useful for evaluation of the hepatic veins. Contrast-enhanced MRA of the epigastric and hepatic regions was clinically quite useful in that it permitted evaluation of all vessels including arteries, portal vein and other veins throughout the liver as well as evaluation of tumor vessels.     

The difficulty of distinguishing retroperitoneal schwannoma from liver tumor in the caudate lobe

A 68-year-old woman was admitted to our hospital for the evaluation of an abdominal tumor. Both ultrasonography and computerized tomography revealed a mass at the caudate lobe of the liver. However, it was difficult to distinguish the mass from a liver tumor in the caudate lobe. The laboratory data showed only a slight elevation of the serum gamma-GTP level and ICG retention. The abdominal arteriography revealed a vascular tumor located in the retroperitoneal space, which was receiving its blood supply from the right inferior phrenic artery. When a laparotomy was performed, a yellowish solid mass (8 X 6 X 4.5 cm) was found behind the lateral segment of the left liver lobe. Histological examination showed interlacing bands of uniform spindle cells of which elongated nuclei were arranged in a palisading pattern. The tumor was diagnosed as schwannoma. Literatures on retroperitoneal schwannoma are reviewed, as this tumor is relatively rare.     

A case of hepatoma suspected pulmonary emboli following transcatheter arterial embolization

A case with hepatoma who was suspected to have pulmonary emboli after transcatheter arterial embolization (TAE) was reported. The pulmonary emboli occurred approximately 20 days after TAE. The cause was thought to be due to necrotic tumor emboli from the known tumor thrombus in the hepatic vein and inferior vena cava.     

Differential regulation of igf1 and igf1r mRNA levels in the two hepatic lobes following intrauterine growth restriction and its treatment with intra-amniotic insulin-like growth factor-1 in ovine fetuses

Intrauterine growth restriction (IUGR) has life-long health implications, yet there is no effective prenatal treatment. Daily intra-amniotic administration of insulin-like growth factor (IGF)-1 to IUGR fetal sheep improves fetal gut maturation but suppresses hepatic igf1 gene expression. Fetal hepatic blood supply is regulated, in part, by shunting of oxygen- and nutrient-rich umbilical venous blood through the ductus venosus, with the left hepatic lobe predominantly supplied by umbilical venous blood and the right hepatic lobe predominantly supplied by the portal circulation. We hypothesised that: (1) once-weekly intra-amniotic IGF-1 treatment of IUGR would be effective in promoting gut maturation; and (2) IUGR and its treatment with intra-amniotic IGF-1 would differentially affect igf1 and igf1r mRNA expression in the two hepatic lobes. IUGR fetuses received 360 μg IGF-1 or saline intra-amniotically once weekly from 110 until 131 days gestation. Treatment of IUGR fetuses with IGF-1 reversed impaired gut growth. In unembolised, untreated control fetuses, igf1 mRNA levels were 19% lower in the right hepatic lobe than in the left; in IUGR fetuses, igf1 and igf1r mRNA levels were sixfold higher in the right lobe. IGF-1 treatment reduced igf1 and igf1r mRNA levels in both lobes compared with IUGR fetuses. Thus, weekly intra-amniotic IGF-1 treatment, a clinically feasible approach, reverses the impaired gut development seen in IUGR. Furthermore, igf1 and igf1r mRNA levels are differentially expressed in the two hepatic lobes and relative expression in the two lobes is altered by both IUGR and intra-amniotic IGF-1 treatment.