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<正>虚拟肝是利用外科学、临床解剖学、现代影像学、计算机图形学、图像处理和虚拟现实技术进行多学科交叉研究,研发出计算机软件系统,利用病 相似文献
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目的 评估体外肝切除自体肝移植在巨大肝癌患者复杂肝切除中的临床价值.方法 回顾性分析2008年1月至2010年5月首都医科大学附属北京朝阳医院收治的4例巨大原发性肝癌患者的临床资料.肿瘤最大直径10 ~ 18 cm,病灶不同程度地累及了第一、二、三肝门.患者难以耐受常规肝切除,均行体外肝切除自体肝移植.结果 4例患者顺利完成手术,手术时间690 ~840 min,无肝期250~300 min,术中出血量400~1400 ml,术中无肝期未行门、腔静脉转流术.4例患者在体外肝切除后行下腔静脉或肝静脉及门静脉修复成型,均应用成型异体血管来延长剩余肝脏肝上腔静脉以利于腔静脉吻合及第一肝门的重建.本组患者1例术后肝功能正常,1例出现腹腔出血再次手术止血,1例发生肝功能不全,1例出现肝肾功能不全于术后5d放弃治疗而死亡.3例术后生存的患者术后1~2个月间剩余肝脏均发生不同程度的代偿增生.术后生存的3例患者中2例分别于术后8、9个月发现肺部多发转移瘤,分别于术后13个月及15个月死亡.随访截至2012年4月,1例患者无瘤生存37个月.结论 体外肝切除自体肝移植为复杂肝切除的巨大肝癌患者提供了技术上的可行性,术后肝功能代偿不全及近期肿瘤的复发是限制该手术发展的主要问题. 相似文献
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【摘要】 目的〓探究不规则肝切除术和规则肝切除术在巨大肝癌手术切除中的临床应用及比较。方法〓本研究回顾性分析2006年6月至2014年6月罗定市人民医院收治的原发性肝癌肝切除手术患者,对已实施的不规则性肝切除术与规则性肝切除术两组病例进行比较。包括两组手术的围手术期各个指标及术中、术后各个指标进行比较。结果〓规则肝切除组中的手术时间、术中出血、输血浆、输红细胞量、住院时间及并发症发生率均明显地高于不规则肝切除组的情况,差异有统计学意义(P<0.05),而肿瘤能完整切除的最大直径显著小于不规则肝切除(P<0.05);二者在死亡率的比较上无明显差异,无统计学意义(P>0.05)。结论〓与规则肝切除相较,不规则肝切除在腹部手术史引起严重腹腔内组织粘连、肝功能分级较差、肿瘤数目较多及小肝癌中均体现了明显的优势。而对于肿瘤体积较大的肝癌患者,规则肝切除则更为有效。 相似文献
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Significant progress has been made in the assessment of liver dysfunction by application of non-invasive physical and biochemical test procedures. However, liver biopsy remains an important tool for diagnosis, evaluation and prognosis of chronic liver diseases and hepatic neoplasms. Liver biopsy results are most useful when the biopsy is performed for well-defined indications following a complete work-up of the patient. In case of lesions highly suspicious for hepatocellular carcinoma, a biopsy should be performed in case surgical (curative) treatment is no option. Thus for the planning of a surgical intervention, biopsy of the tumor is not necessary. In case of concomitant liver cirrhosis, a biopsy taken from the non-neoplastic (cirrhotic) liver may help to assess the functional capacity or to clarify the etiology. Metastases of the liver with unknown primary tumor should be biopsied to obtain information of the primary tumor and the potential for cytostatic therapy. In case of hemangioma or focal nodular hyperplasia, diagnosed and confirmed by radiology or ultrasound, biopsy is usually not necessary. Concern has been expressed about seeding of the needle tract with malignant cells. Indeed, such instances have been recorded with various carcinomas, but they remain rare events and are seldom of clinical importance. With the use of needles with diameter < 1.3 mm to minimise also the risk of bleeding, the procedure is simple, safe and painless. 相似文献
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目的探讨供肝脂肪浸润程度与肝脏移植病人预后的关系。方法天津市第一中心医院2002年1~12月间供体采用UW液灌注的首次肝脏移植病人71例,根据供肝脂肪浸润程度分为四组,比较各组问术后谷丙转氨酶(ALT)、谷草转氨酶(AST)水平、ICU时间及1年移植物存活率等各项指标。结果轻度脂肪肝组与无脂肪肝组的术后ALT、AST、ICU时间、1年移植物存活率均无显著性差异,中度脂肪肝组的术后ALT、AST、ICU时间均高于轻度及无脂肪肝组,但1年移植物存活率一致,三组均无移植物原发无功(PNF)发生。重度脂肪肝组只有2例,故未作统计学分析,其中1例发生PNF,于术后第2天行再次移植手术。结论轻、中度脂肪肝均可应用于l临床肝移植,对病人预后无影响;重度脂肪肝PNF发生率较高,不宜应用。 相似文献
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目的探讨腹腔镜下解剖性肝叶切除术治疗肝良恶性病变的安全性、可行性.方法对2005年1月至2010年2月在我院行腹腔镜下解剖性肝部分切除术的67例患者进行可行性及疗效分析,并对其临床效果进行观察.结果67例完全腹腔镜下解剖性肝叶切除术均获得成功,平均手术时间(50.6±16.2)min;术中平均出血量(220.8±76.5)ml.术中无需阻断肝门血流,术后无并发症发生.术后48 h均能下床活动,术后1~3 d即能进食.术后住院5~7 d,平均(6.6±1.1)d;总住院费用(30767.4±150.1)元.结论对位于肝左叶、右肝表面、肝右叶下段的良恶性病灶,行腹腔镜下解剖性肝叶切除术是安全和可行的,且具有创伤小恢复快的特点,值得临床推广应用. 相似文献
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Karakayali H Ekici Y Ozcay F Bilezikci B Arslan G Haberal M 《Transplantation proceedings》2007,39(4):1157-1160
The only proven therapy for patients unlikely to recover from acute liver failure (ALF) is liver transplantation. Correct diagnosis of these individuals and rapid referral to a transplant center are crucial. We evaluated 12 pediatric patients with ALF who underwent liver transplantation (LT) at our institution during a 3-year period. The reasons for transplantation were hepatitis A (3 patients); non-A, non-E hepatitis (3); autoimmune hepatitis (1); fulminant Wilson's disease (3); Amanita phalloides (mushroom) poisoning (1); and hepatitis B and toxic hepatitis with leflunomide treatment (1). Seven of the participants were female and five were male (mean age, 9.1 +/- 4.2 years). Three received right liver-lobe grafts, one received a whole liver graft, and the remainder received left or left-lateral liver lobe grafts. All patients recovered from hepatic coma the second postoperative day. Two patients died at postoperative days 57 and 71 due to adult respiratory distress syndrome and sepsis with multiorgan failure, respectively. One patient required retransplantation because of chronic rejection 7 months after the initial transplantation. That patient died 10 days after retransplantation because of sepsis. Nine patients were healthy at follow-up (range, 2-46 months). LT is the only treatment option for ALF in patients in countries with low organ-donation rates. In this scenario, donor preparation in a limited time frame is difficult. We have been able to decrease the duration of donor preparation to approximately 4 hours (including biopsy of the donated liver tissue). 相似文献
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目的 探讨肝移植治疗多囊肝病中的效果和经验.方法 回顾分析我中心2000年1月至2008年12月9例多囊肝行肝移植的病例,对患者术前MELD评分、肝肾功能,术中输血、失血,手术时间、无肝期以及术后并发症、存活时间等方面进行总结.结果 9例患者术前MELD平均(16±9)分,5例同时患有多囊肾,除1例出现肝硬化外其他8例无明显肝功能损害但因明显的压迫症状而严重影响生活质量,3例有肾功能异常需要透析.术中平均输血(1800±1600)ml,失血(3500±2600)ml,平均手术时间(7.2±1.5)h,无肝期(52.7±15.4)min.术后3例分别因腹腔出血、急性排斥反应及循环衰竭导致多器官衰竭而早期死亡;6例患者均存活1年以上,现最长存活时间8年.本组1年和2年存活率分别为77.8%和66.7%.结论 肝移植是治疗多囊肝疾病的有效方法,比较其他的肝移植受者手术时间长,失血量较大,手术难度较高,但预后良好. 相似文献
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Schilsky ML 《Transplantation proceedings》2011,43(3):879-883
Survival of patients presenting with acute liver failure (ALF) has improved over the past decades due to earlier disease recognition, advances in supportive measures, intensive care, and liver transplantation. Liver assist devices may have a role in future care of patients with ALF, bridging them to recovery or to transplantation. A multidisciplinary team approach to the care of patients with ALF is critical for achieving good patient outcomes. 相似文献
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Soliman T Langer F Puhalla H Pokorny H Grunberger T Berlakovich GA Langle F Muhlbacher F Steininger R 《Transplantation》2000,69(10):2079-2084
BACKGROUND: A 35-year period of clinical development resulted in orthotopic liver transplantation (OLT) becoming a standardized surgical procedure. Despite this progress, the rate of technical complications is still high. Although the main problem in most analyses is vascular or bile duct failure, we observed a remarkable number of parenchymal liver injuries that led to intraoperative problems. Our aim, therefore, is to present an overall report on the incidence, treatment, and clinical course of parenchymal liver injuries in OLT. METHODS: Five hundred seventy-two consecutive OLT procedures performed between 1988 and 1998 were analyzed in a retrospective study. Parenchymal liver injury was diagnosed by means of examination of the surgical reports. Donor- and recipient-related data followed the medical report. The lesions were classified according to the Organ Injury Scale. RESULTS: Parenchymal liver injury was diagnosed in 23 patients (4%). The lesions were classified as grade Ia (13.1%), grade Ib (13.1%), grade IIb (52.1%), grade IIIa (17.1%), and grade IIIb (4.3%). In 19 patients (82.6%), the lesion was detected during OLT, and in four patients (17.4%), during relaparotomy. The latter group showed significantly higher-grade injuries. Treatment was suture or fibringlue alone, 17.4%; fibringlue and hemostyptics, 26.1%, mesh wrapping 30.4%, and mesh packing 26.1%. Seven patients (30.4%) underwent relaparotomy. Further active bleeding was not found in any of them. Statistical analysis found a correlation between injury grade and relaparotomy rate. No patients died as a result of parenchymal liver injury. CONCLUSIONS: Parenchymal liver injuries can be treated well, with no adverse effect on patient or graft survival. An early decision concerning the surgical procedure for controlling hemorrhage is required. A basically aggressive therapeutic approach might avoid further complications relating to reperfusion edema. 相似文献
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Laparoscopic liver resection of benign liver tumors 总被引:8,自引:0,他引:8
B. Descottes D. Glineur F. Lachachi D. Valleix J. Paineau A. Hamy M. Morino H. Bismuth D. Castaing E. Savier P. Honore O. Detry M. Legrand J.S. Azagra M. Goergen M. Ceuterick J. Marescaux D. Mutter B. Hemptinne R. Troisi J. Weerts B. Dallemagne C. Jehaes M. Gelin V. Donckier R. Aerts B. Topal C. Bertrand B. Mansvelt L. Krunckelsven D. Herman M. Kint E. Totte R. Schockmel J.F. Gigot 《Surgical endoscopy》2003,17(4):668-668
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Jan Best Paul Manka Wing-Kin Syn Laurent Dollé Leo A. van Grunsven Ali Canbay 《肝胆外科与营养》2015,4(1):48-58
During massive liver injury and hepatocyte loss, the intrinsic regenerative capacity of the liver by replication of resident hepatocytes is overwhelmed. Treatment of this condition depends on the cause of liver injury, though in many cases liver transplantation (LT) remains the only curative option. LT for end stage chronic and acute liver diseases is hampered by shortage of donor organs and requires immunosuppression. Hepatocyte transplantation is limited by yet unresolved technical difficulties. Since currently no treatment is available to facilitate liver regeneration directly, therapies involving the use of resident liver stem or progenitor cells (LPCs) or non-liver stem cells are coming to fore. LPCs are quiescent in the healthy liver, but may be activated under conditions where the regenerative capacity of mature hepatocytes is severely impaired. Non-liver stem cells include embryonic stem cells (ES cells) and mesenchymal stem cells (MSCs). In the first section, we aim to provide an overview of the role of putative cytokines, growth factors, mitogens and hormones in regulating LPC response and briefly discuss the prognostic value of the LPC response in clinical practice. In the latter section, we will highlight the role of other (non-liver) stem cells in transplantation and discuss advantages and disadvantages of ES cells, induced pluripotent stem cells (iPS), as well as MSCs. 相似文献
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Laparoscopic liver resection of benign liver tumors 总被引:27,自引:10,他引:17
Descottes B Glineur D Lachachi F Valleix D Paineau J Hamy A Morino M Bismuth H Castaing D Savier E Honore P Detry O Legrand M Azagra JS Goergen M Ceuterick M Marescaux J Mutter D de Hemptinne B Troisi R Weerts J Dallemagne B Jehaes C Gelin M Donckier V Aerts R Topal B Bertrand C Mansvelt B Van Krunckelsven L Herman D Kint M Totte E Schockmel R Gigot JF 《Surgical endoscopy》2003,17(1):23-30
Objective: The objective of this study was to assess the feasibility, safety, and outcome of laparoscopic liver resection
for benign liver tumors in a multicenter setting. Background: Despite restrictive, tailored indications for resection in benign
liver tumors, an increasing number of articles have been published concerning laparoscopic liver resection of these tumors.
Methods: A retrospective study was performed in 18 surgical centres in Europe regarding their experience with laparoscopic
resection of benign liver tumors. Detailed standardized questionnaires were used that focused on patient's characteristics,
clinical data, type and characteristics of the tumor, technical details of the operation, and early and late clinical outcome.
Results: From March 1992 to September 2000, 87 patients suffering from benign liver tumor were included in this study: 48
patients with focal nodular hyperplasia (55%), 17 patients with liver cell adenoma (21%), 13 patients with hemangioma (15%),
3 patients with hamartoma (3%), 3 patients with hydatid liver cysts (3%), 2 patients with adult polycystic liver disease (APLD)
(2%), and 1 patient with liver cystadenoma (1%). The mean size of the tumor was 6 cm, and 95% of the tumors were located in
the left liver lobe or in the anterior segments of the right liver. Liver procedures included 38 wedge resections, 25 segmentectomies,
21 bisegmentectomies (including 20 left lateral segmentectomies), and 3 major hepatectomies. There were 9 conversions to an
open approach (10%) due to bleeding in 45% of the patients. Five patients (6%) received autologous blood transfusion. There
was no postoperative mortality, and the postoperative complication rate was low (5%). The mean postoperative hospital stay
was 5 days (range, 2–13 days). At a mean follow-up of 13 months (median, 10 months; range, 2–58 months), all patients are
alive without disease recurrence, except for the 2 patients with APLD. Conclusions: Laparoscopic resection of benign liver
tumors is feasible and safe for selected patients with small tumors located in the left lateral segments or in the anterior
segments of the right liver. Despite the use of a laparoscopic approach, selective indications for resection of benign liver
tumors should remain unchanged. When performed by expert liver and laparoscopic surgeons in selected patients and tumors,
laparoscopic resection of benign liver tumor is a promising technique. 相似文献
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Living-donor liver transplantation for polycystic liver disease 总被引:1,自引:0,他引:1
Ueda M Egawa H Oike F Taira K Uryuhara K Fujimoto Y Kozaki K Tanaka K 《Transplantation》2004,77(3):480-481
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右半肝活体肝移植验证标准肝体积公式 总被引:1,自引:0,他引:1
目的 分析216例活体肝移植患者的临床资料,探讨适合中国成人活体肝移植肝体积评估标准.方法 华西医院移植中心2001年7月至今共实施216例活体肝移植,选取符合标准的成人间活体右半肝(不含肝中静脉)179例肝移植供体,将供体的术中实测右半肝体积与CT测量右半肝体积以及各公式计算的标准右半肝体积进行比较,评估哪种公式更适合中国成人.结果 CT测量右半肝体积大于实际右半肝体积(P<0.01).德国Heinemann、美国Yoshizumi、日本Urata、美国Vauthey、韩国Lee公式计算的右半肝体积结果显著大于实际肝脏体积(P<0.01).香港Sheung Tat 公式计算的右半肝体积结果小于实际肝脏体积,差异有统计学意义(P<0.05).华西Lünan-yan公式计算的右半肝体积结果与实际肝脏体积比较差异无统计学意义(P>0.05).结论 华西Lünan-yan 标准肝体积公式适合中国成人活体肝移植标准肝体积评估. 相似文献