左外叶肝内胆管结石的手术治疗体会

目的探讨左外叶肝内胆管结石手术治疗方法和长期愈后。方法回顾性分析1998年6月至2012年2月我院收治的左外叶肝内胆管结石32例的手术治疗情况。结果全组病例均行左外叶切除术,术后患者未见明显并发症,亦未见术后残留结石。结论左外叶肝内胆管结石,行左肝外叶切除,效果好,是减少术后胆管残留结石的最好术式。     

肝叶、肝段切除治疗肝内胆管结石46例体会

目的探讨肝叶、段切除术治疗肝内胆管结石的临床疗效。方法回顾性分析我院2000年1月至2011年8月行肝叶、段切除术的46例肝内胆管结石患者临床资料,手术方式分别为左肝外叶切除、左半肝切除、右肝前叶切除、右肝后叶切除、肝叶(段)切除术+胆管空肠Roux-en-Y吻合术。结果本组无手术死亡病例,术后发生并发症12例,分别为切口感染或裂开、胆漏、膈下脓肿、上消化道出血、肺部感染等,经保守治疗均治愈;术后残留结石率8.7%(4/46),随访期间复发3例,复发率为7.3%,再手术率13.0%(6/46)。结论选择合理的肝叶、段切除手术治疗肝内胆管结石可取得良好效果。     

手术治疗肝内胆管结石65例临床分析

目的：评价手术治疗肝内胆管结石的临床疗效。方法回顾分析我院2008年1月-2010年1月收治的65例肝内胆管结石患者的临床资料,术后并发症等。结果全部患者手术顺利,无1例手术中死亡,术后疗效评定优良率88.7%。术后并发症总共8例,其中胆瘘1例,肺不张肺部感染2例,右膈下感染1例,肝下腹腔感染1例,肝下腹腔感染1例,切口感染4例,结石残留7例,经对症治疗后全部好转。共随访59例,有3例术后复发,2例死亡。结论根据结石的分布或胆管狭窄,不同选择手术方式均可获得较好疗效,但以肝叶切除手术效果最好。     

部分肝切除术治疗肝内胆管结石45例疗效观察

目的探讨部分肝切除术在肝内胆管结石中的治疗效果。方法选择我院肝内胆管结石患者共45例,本组所选患者在手术前均行B超检查等相关影像学检查。在麻醉成功后实施肝叶切除术。结果本组患者均顺利完成手术,无手术死亡病例。术后实施胆道镜检查患者共43例,其中16例患者有结石残留,经胆道镜取石。术后1例患者出现胆漏并发症,1例患者出现胆道出血,2例患者发生膈下感染,上述术后并发症患者均给予保守治疗痊愈出院。患者术后住院期间,没有1例患者出现肝功能衰竭。结论部分肝叶切除术是治疗肝内胆管结石的有效手术措施,其术后残石率低且术后结石复发率低,效果显著,值得借鉴。     

肝内胆管结石37例外科治疗分析

目的 探讨不同类型的肝内胆管结石采取不同手术方式治疗的效果。方法 回顾分析1995年3月间我院收治并手术治疗的肝内胆管结石37例，其中合并肝胆管狭窄21例，占(56．75％)。分型：中央型结石19例，周围型结石3例，全程局限型结石12例手术，全程弥漫型结石3例。手术方式：肝叶段切除术13例，肝门胆管切开取石，高位胆管空肠吻合术14例，肝叶段切除，胆管空肠吻合术lO例。结果 30例获得5个月——6年的随访。全组优良34例(占91．89％)，差3例(占8．1％)。残余结石9例(占24．32％)，再手术3例(占8．1％)。结论 肝内胆管结石病情复杂，应根据不同类型结石采取不同的手术方式。盲目扩大肝叶段切除适应证并不能提高手术治疗效果，而增加并发症的发生。     

肝切除术联合术中胆管镜治疗肝内胆管结石的疗效观察

目的观察肝切除术联合术中胆管镜治疗肝内胆管结石的疗效。方法我院于2008年10月—2010年10月采用肝切除术联合术中胆管镜治疗肝内胆管结石。结果本组86例患者行相应的肝叶(段)切除和术中胆管镜取石,其中27例患者术后有残余结石,结石残余率为31.40%;术后胆管镜残余结石总取净率为81.48%(22/27),胆管镜取石后,3例患者出现2～4d发热,其余未出现并发症。86例患者总残石率为5.81%。本组中80例获得随访,随访时间6～72个月,随访率93.02%。其中优56例,占70.00%,良23例,占28.75%,差1例,占1.25%,优良率达98.75%。结论肝叶切除术是治疗肝内胆管结石的主要方法,具有疗效确切的优点,但是术中胆管镜检查可以发现术中遗留的肝内胆管结石,手术配合术中胆管境取石可以显著降低外科手术结石残余率。     

肝部分切除法治疗肝内胆管结石的疗效

目的：探索肝部分切除法治疗肝内胆管结石的临床疗效。方法：选择本院76例肝内胆管结石患者,实施肝部分切除术进行治疗。结果：76例患者均手术成功,无死亡病例,肝部分切除法治疗肝内胆管结石的成功率是100%,术后发生并发症7例,结石残留12例,术后随访3年,结石复发3例。结论：肝部分切除术作为治疗肝内胆管结石的一种手术方法,它不涉及肝门的大血管和胆管,只是将通向病变部位的血管分支和胆管切断、结扎。这种手术常用于病变较小而又不需要作肝叶或半肝切除者,手术操作简单,术后并发症少。     

肝内胆管结石手术治疗患者的观察与护理

目的探讨肝内胆管结石手术治疗患者的护理。方法通过对55例肝内胆管结石手术治疗患者进行临床分析，总结术后患者的护理问题、措施及效果。结果本组无手术死亡。护理措施落实，无护理并发症，护理满意度为97．5％。随访1．2～4．3年，术后残留结石4例，残石率7．27％；症状复发3例，复发率5．45％。结论加强护理能有效促进肝内胆管结石并狭窄手术治疗患者的康复。     

肝内胆管结石外科治疗132例临床分析

目的 探讨肝内胆管结石的临床特点及术式选择。方法 回顾性分析13年我院132例肝内胆管结石的临床资料。结果 全组病例根据手术探查的胆管狭窄部位及范围和结石状况，采用不同的手术方式，本组术后近期并发症28例，术后残留结石39例，占29．5％。结论 正确选择肝胆结石手术方式是减少术后残留结石的关键，左肝外侧叶切除，胆道镜的应用是减少术后胆管残留结石的主要手段。     

肝部分切除治疗肝内胆管结石的体会

目的 探讨肝部分切除治疗肝内胆管结石的效果。方法 回顾性分析５年对５６例肝病胆管结石行肝切除术的治疗情况。结果 左外叶切除４９例,左半肝功能３例,肝方叶１全中肝不规则切除３例,无手术死亡,术后并发症１０例（１７．９％）,其中切口感染５例（８．９％）,膈下感染２例（３．６％）,肺部感染、胆瘘、肝功能衰竭各１例（１．８％）。结石残留９例（１６．１％）,治疗效果优良率８４．６％。结论 肝部分切除术是治疗     

Methotrexate-induced apoptosis in hepatocytes after partial hepatectomy

To investigate apoptosis induced by methotrexate in hepatocytes in vivo, rats received a single injection of methotrexate immediately after partial hepatectomy and apoptosis was assessed by the terminal deoxynucleotidyl transferase-mediated nick end-labeling (TUNEL) and gel electrophoresis of DNA. Characteristic DNA fragmentation was obvious at 2 h and peaked at 4 h after partial hepatectomy with methotrexate injection. TUNEL-positive staining was observed in nuclei and nuclear fragments of hepatocytes in the methotrexate-injected liver (partial hepatectomy with methotrexate), with negligible background staining in the control (partial hepatectomy only) and in the methotrexate-injected normal (normal with methotrexate) rat liver. The involvement of the c-Jun N-terminal kinase (JNK) activator protein 1 (AP-1) pathway and p53 in apoptosis was also examined. The activity of JNK increased at 15 min and peaked at 1 h after partial hepatectomy. This increase was repressed by methotrexate injection. Western blot analysis showed that the levels of c-Fos and c-Jun protein expression, which increased at 1 h after partial hepatectomy, were also reduced by methotrexate. The levels of p53 protein were markedly increased after partial hepatectomy with methotrexate injection. The increase in p53 protein was followed by an up-regulation of p21(WAF1/CIP1) protein at 2 h after partial hepatectomy. These results suggested that the inhibition of the JNK-AP-1 pathway and concurrent up-regulation of p53 and p21(WAF1/CIP1) were involved in hepatocyte apoptosis induced by partial hepatectomy with methotrexate.     

Manganese-induced apoptosis in hepatocytes after partial hepatectomy

To investigate the apoptosis induced by manganese (Mn) in hepatocytes in vivo, rats received a single injection of manganese chloride immediately after partial hepatectomy. Characteristic DNA fragmentation was observed at 4 h after partial hepatectomy with Mn-injection. The activation of caspase-3 by Mn-injection was detected as early as 30 min and peaked at 1 h after partial hepatectomy. The activity of Jun N-terminal kinase (JNK) increased to a maximal level, which was about 10-fold the maximal level of the control, at 15 min after partial hepatectomy and this increase was maintained for 4 h in Mn-injected rats, while a transient increase was observed at 1 h in the control. No effect of the Mn-injection on the activation of p38 mitogen-activated protein kinase (MAPK) was observed. Western blot analysis revealed that the injection of Mn markedly increased c-Jun and phosphorylated c-Jun protein levels at 1 h after partial hepatectomy. An increase in p53 was also observed at 30 min after the Mn-injection and followed by the upregulation of p21(WAF1/CIP1) protein expression at 2 h after partial hepatectomy. These results suggested that the activation of JNK and the upregulation of c-Jun, p53 and p21(WAF1/CIP1) were involved in the apoptosis of hepatocytes induced by partial hepatectomy with manganese.     

乳腺癌肝转移的不同治疗方法比较

目的 比较手术治疗、全身化疗、全身化疗联合肝动脉化疗栓塞对乳腺癌肝转移的疗效.方法 回顾性分析1996年1月至2008年10月52例乳腺癌肝转移临床资料,根据治疗方法分为手术组(12例)和单纯全身化疗组(22例)和全身化疗联合肝动脉化疗栓塞组(18例),分析3组的疗效及预后,比较不同治疗方法的疗效.结果 52例乳腺癌术后肝转移患者,全组治疗有效27例(51.9%),手术组有效4例(33.3%),单纯全身化疗组有效11例(50.0%),全身化疗联合肝动脉化疗栓塞组有效12例(66.6%).1、2、3年生存率手术治疗组分别为25.0%(3例)、8.3%(11例)、0,单纯全身化疗组分别为31.8%(7例)、13.6%(3例)、9.1%(2例),全身化疗联合肝动脉化疗栓塞组分别为44.4%(8例)、33.3%(6例)、11.1%(2例),全身化疗联合肝动脉化疗栓塞组生存率明显优于手术治疗组和单纯全身化疗组(P<0.05).结论 采用全身化疗联合肝动脉化疗栓塞治疗乳腺癌术后肝转移疗效较好,值得临床进一步推广.

Abstract：

Objective To explore the efficacy of hepatectomy and chemotherapy and transcatheter arterial chemoembolization plus chemotherapy on breast cancer complicated with liver metastases. Methods Clinical features of 52 breast cancer patients with liver metastases from 1996 to 2008 were analyzed retrospectively. Fifty-two patients were divided into surgery group (group Ⅰ) , systemic chemotherapy group (group Ⅱ) and transcatheter arterial chemoembolization (TACE) plus chemotherapy group (group Ⅲ). The efficacies of different treatment approaches were compared. Results The total responsive rate was 51.9% for among all patients. TACE plus chemotherapy produced a significantly higher partial response rate 66. 6% in comparison with 50. 0% (11 cases) of systemic chemotherapy and 33.3% ( 4 cases ) of hepatectomy ( P < 0. 05 ). The median survival time was 16 months ( 2-50 months)and 1-year, 2-year, 3-year survival rate in three groups was 25.0% , 8. 3% , 0( group I ) , 31. 8% , 13.6%, 8.9%(group Ⅱ)and 44.4%, 33.3%, ll.l%(group Ⅲ), respectively. The survival time of group Ⅲ was the longest (P <0.05). Conclusion Chemotherapy plus TACE may be an effective and safe treatment for liver metastases after breast cancer.     

Roles of naofen, a novel WD-repeat-2 protein, in the CCl4-treated livers--a possible relationship to cell proliferation

Naofen (GenBank accession no. EF613262), a newly found intracellular protein in the WD-repeat-2 protein family, has been cloned as an anti-verotoxin II antibody immunoreactive substance, and the nucleotide- and amino acid-sequences have been clarified. The present study was undertaken to evaluate the roles of naofen especially in carbon tetrachloride (CCl4-induced cirrhosis model of rats, also in partial hepatectomy. Naofen mRNA expressions were observed from the early phases of cirrhosis development and during regenerative phases after partial hepatectomy, more remarkable in the former. Naofen immunoreactive fragments located in the vascular endothelial cells and peri-vascular spaces in normal livers especially in Glisson's areas, being strongly stained in the connective tissues 8 weeks after starting CCl4-injections, besides in the cytoplasm of hepatocytes in pseudo-lobules. In contrast, partial hepatectomy caused a small increase of naofen expressions in the whole hepatocytes, and significantly in the endothelial cells of portal veins and hepatic arterioles. Furthermore, in parallel to the degree of naofen mRNA and protein expressions, the rates of double-nuclei cells to total hepatocytes in the Glisson's areas increased in both cirrhosis and partial hepatectomy, suggesting a relationship between naofen expression and mitosis. In in-vitro studies with cell lines, vascular endothelial growth factor, a cell proliferation stimulant, increased the naofen mRNA expressions in HepG(2) cell lines, whereas paclitaxel, a cytotoxic anti-cancer drug, diminished them in NRK52E, both concentration-dependently. These results indicated that naofen immunoreactive fragments play an important role in the cell proliferation, relevant for analyzing the regenerative phases during cirrhosis developments and after partial hepatectomy.     

肝内胆管结石的手术治疗

目的研究肝内胆管结石的手术治疗方式及效果。方法回顾性分析近14年来手术治疗肝内胆管结石的临床表现、治疗方式及效果。结果362例中行肝部分切除162例,术后残石率16．7％,肝切除组与单纯取石组残石率差异显著,有统计学意义（P〈0．01）,围手术期并发症差异无统计学意义（P〉0．05）,效果优良率肝切除组优于单纯取石组,但差别无统计学意义（P〉0．05）。结论肝部分切除治疗肝内胆管结石效果优于单纯取石组,但切除范围应足够,同时矫正胆管狭窄,减少残余结石。     

Effect of tritoqualine on liver regeneration after partial hepatectomy in rats

Effect of tritoqualine (TRQ) on liver regeneration after partial hepatectomy in normal rats and chronically injured rats treated with carbon tetrachloride (CCl4) for 12 weeks were investigated by the measurement of serum and liver biochemical parameters concerning the hepatic function. The results are as follows: 1) In normal rats, the liver regeneration rate after partial hepatectomy was increased dose-dependently with the administration of TRQ for 7 days after the operation. TRQ improved BSP retention rate which was decreased after partial hepatectomy. In addition, protein synthetic activity in the liver microsomes prepared from TRQ-administered rats was higher than that prepared from control rats, and the contents of serum total protein, serum albumin and liver protein were also higher in TRQ-administered rats. 2) In the rats treated with CCl4 for 12 weeks, the liver regeneration rate after partial hepatectomy was increased dose-dependently with the administration of TRQ for 6 days. TRQ also improved the contents of serum total protein, serum albumin and liver protein. Though the amount of collagen in the liver chronically injured by CCl4 increased more than twice compared with that in the normal liver, the amount of collagen in the regenerating liver of CCl4-treated rats whose liver regeneration was accelerated by TRQ was not different from that in the normal liver. These results suggest that TRQ has the effect of improving the various hepatic functions through the activation of the protein synthesis in hepatocytes.     

Gender differences in the liver micronucleus test in rats with partial hepatectomy

The liver micronucleus test in rats with partial hepatectomy is a useful method to detect pro-clastogens such as diethylnitrosamine, the active metabolites of which do not reach the bone marrow due to their short lifespan. We have already reported that structural or numerical chromosome aberration inducers should be given before or after partial hepatectomy, respectively, to detect genotoxicity in the liver of rats. In the present study, we found that the percentage of binucleated cells in the liver from naive male rats is approximately 60% of that in female rats, which suggests a gender difference in the response to chromosome aberration inducers. Therefore, we investigated the responses to structural chromosome aberration inducers (diethylnitrosamine and 1,2-dimethylhydrazine) and numerical chromosome aberration inducers (colchicine and carbendazim) in male and female rats. The chemicals were given to 8-week-old male and female F344 rats a day before or after partial hepatectomy and hepatocytes were isolated 4 days after the partial hepatectomy. As the results, diethylnitrosamine and 1,2-dimethylhydrazine produced a significant increase in the frequency of micronucleated hepatocytes in both genders and the responses were comparable. In the case of colchicine and carbendazim, higher frequencies in the micronucleated hepatocytes were obtained in males than in females. Taken together, the response to chromosome aberration inducers in male rats was equal to or stronger than that in female rats. It seems that the use of only male rats in the liver micronucleus test is sufficient, unless existing data indicate a toxicologically meaningful gender difference in rats.     

Effect of the peroxisome proliferator ciprofibrate on hepatic DNA synthesis and hepatic composition following partial hepatectomy in rats

The peroxisome proliferator ciprofibrate was examined for its ability to alter liver regrowth following partial hepatectomy in rats. Ciprofibrate was fed to female Sprague-Dawley rats at concentrations of 0, 0.01% and 0.025% in the diet for 2 weeks. All rats were then subjected to partial hepatectomy and were killed at 0, 12, 24, 36, 48, 72, and 168 h afterwards. The increase in liver weight after partial hepatectomy occurred at a similar rate in control and ciprofibrate-fed rats, although liver weights were always higher in ciprofibrate-fed rats. The marked increase in DNA synthesis normally seen after partial hepatectomy, however, was partially inhibited in rats fed 0.025% ciprofibrate, as compared to control rats or rats fed 0.01% ciprofibrate. An increase in the ratio of protein to DNA in the liver was observed in rats fed either level of ciprofibrate. The marked increase in total lipid content normally seen after partial hepatectomy was inhibited by ciprofibrate treatment. Vitamin E levels were also reduced in ciprofibrate-fed rats. The activity of the peroxisomal enzyme fatty acyl CoA oxidase was increased in rats fed ciprofibrate at all time points, verifying the induction of peroxisomes by ciprofibrate. This study shows that the administration of 0.025% ciprofibrate before partial hepatectomy inhibits the peak of DNA synthesis normally seen shortly after partial hepatectomy but does not affect the regrowth of the liver. The regrowth of the liver in rats fed 0.025% ciprofibrate may be caused by cellular hypertrophy, as evidenced by the enhanced protein content of the liver.     

TGF-α在肝硬化大鼠部分肝切除后的表达研究

目的研究肝硬化大鼠肝脏部分切除后TGF-α在肝脏组织中的表达。方法选择成年雄性Wistar大鼠80只,随机分为两组,实验组中40只制作大鼠肝硬化模型,随后切除所有大鼠肝左叶及中叶。将实验组对照组大鼠随机分为8组,一组立即处死,算得肝切除比例。剩余7组大鼠分别于术后12h、24h、2d、4d、8d、14d、20d处死。免疫组织化学方法检测TGF-α在肝组织中的表达,两组对照比较。结果肝硬化造模成功,肝脏切除比例为(75.23±2.4)%。两组大鼠肝脏部分切除后TGF-α水平较术前高,肝硬化大鼠部分肝脏切除后不同时间肝中TGF-α较正常大鼠低。结论肝脏受损后能分泌出TGF-α进行肝细胞再生,在肝硬化肝脏中的表达较正常肝脏延迟,促进肝细胞再生能力也较在正常肝细胞中弱。     

Arsenite induces apoptosis in hepatocytes through an enhancement of the activation of Jun N-terminal kinase and p38 mitogen-activated protein kinase caused by partial hepatectomy

To investigate the effects of arsenite on cell proliferation and the signal transduction in hapatocytes in vivo, rats received a single injection of sodium arsenite immediately after partial hepatectomy. Characteristic DNA fragmentation was observed at 4h after the arsenite-injection in partially hepatectomized liver, while it was not detected either in the control (partial hepatectomy only) or arsenite-injected normal (without partial hepatectomy) liver. The effect of the arsenite-injection on the activation of extracellular signal-regulated kinase (ERK) was not observed in the normal or the partially hepatectomized liver. The activity of p38 mitogen-activated protein kinase (MAPK) markedly increased after 15min to 2h after the arsenite-injection in partially hepatectomized liver while no or a less increase was observed in the arsenite-injected normal or the control, respectively. The Jun N-terminal kinase (JNK) was activated to a maximal level, about six-fold the maximum of the control, at 15min after the injection with partial hepatectomy. The arsenite-injection markedly increased the phosphorylated forms of c-Jun and ATF-2 and the protein levels of c-Jun, p53 and p21(WAF1/CIP1) in the partially hepatectomized liver. These results suggested that arsenite induced apoptosis in the hepatocytes in vivo, through the enhancement of the activation of JNK and p38 MAPK caused by partial hepatectomy and the p53-dependent p21(WAF1/CIP1) protein expression.