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原发性肝癌是我国常见的恶性肿瘤 ,与乙型病毒性肝炎肝硬化关系密切。 80 %的肝癌病人同时合并肝硬化 ,2 0 %～ 2 8%的肝癌病人合并有不同程度的门静脉高压症。原发性肝癌的门静脉高压症较之单纯肝硬化诱发的门静脉高压症而言 ,影响因素更多 ,除肝硬化外尚有 :(1)门静脉癌栓形成 ,尤其是门静脉主干的癌栓 ,使门静脉回流受阻 ;(2 )瘤内动 门静脉瘘 ,高压动脉血注入门静脉导致其压力增高 ;(3)肿瘤团块压迫门静脉 ;(4)反复的ＴＡＥ治疗一定程度上促进肝硬化进展 ,引起或加重门静脉高压。在合并以上因素时 ,肝癌病人的门静脉高压症可出现严重的…     

肝癌合并门静脉高压症联合手术41例临床分析

肝癌合并门静脉高压症的病人，以往得到手术治疗的机会极少，预后极差。随着肝癌早期诊断、早期治疗、二步切除，以及外科多模式综合治疗的迅速发展，对肝癌合并门静脉高压症的病人，在肝癌切除的同时，酌情联合手术，既治疗了肝癌同时又治疗了门静脉高压症。我科对41例肝癌合并门静脉高压症施行联合手术，取得较满意的效果，现分析如下。     

原发性肝癌合并门静脉高压症的手术选择

目的探讨原发性肝癌合并门静脉高压症的手术方法及疗效。方法回顾分析我科1995年10月至2002年10月手术治疗原发性肝癌合并门静脉高压症84例。结果手术并发症和手术死亡率分别是15．5％和3．6％。术后1，3，5，7年生存率分别是82．9％，44．6％，37．2％，8．3％。结论个体化原则是提高原发性肝癌合并门静脉高压症治疗效果的关键。     

贲门周围血管离断术前后肝硬化病人肝脏血流灌注的改变

目的：利用肝脏阻抗血流图探讨肝硬化门静脉高压症病人的肝脏血流灌注改变和贲门周围血管离断术对肝脏血流灌注的影响。方法：选取22例肝硬化门静脉高压症病人，分别在术前1周、术后2周检测肝血流阻抗改变，同时用Doppler检测门静脉血流动力学变化。结果：阻抗血流图表明，和对照XEG相比，门静脉高压症病人的肝动脉、门静脉向肝血流灌注明显下降，总肝灌注量降低；门静脉高压症病人术后门静脉向肝灌注增加，肝动态的向肝灌注无显著改变。Doppler测定表明门静脉高压症病人的门静脉直径增加，血流量增加，但血流速度无显著差别；术后门静脉血流动力学与术前无差别。结论：肝硬化病人肝动脉、门静脉向肝有效血流灌注都降低，肝脏总血流量下降；贲门周围血管离断术增加大部分病人的门静脉向肝血流灌注，但对肝动脉的向肝灌注无显著影响；肝脏阻抗血流图作为反映肝脏动态血流灌注的无创性检查，对于评价肝硬化病人的肝脏血流及评价手术对肝脏血流动力学的影响有一定的价值。     

肝癌合并门静脉高压的治疗中应该注意的几个问题

原发性肝癌多在肝炎后肝硬化的基础上发生，因此肝癌合并门静脉高压在临床上并不少见。肝癌合并门静脉高压时往往会出现食管静脉曲张、上消化道溃疡、凝血功能障碍等合并症，对这类病人的治疗较不合并门静脉高压的肝癌要困难得多，病人在术后极易发生肝功能衰竭，上消化道出血等严重并发症，甚至危及生命。因此，在治疗肝癌的同时能否处理好同时并存的门静脉高压症直接关系到肝癌病人的预后。随着肝癌综合治疗的逐步完善和开展，针对肝癌合并门静脉高压治疗的报道也逐渐增     

原发性肝癌合并门静脉高压症的诊疗现状

原发性肝癌合并门静脉高压的处理仍然是一个我们经常遇到的临床难题。综合文献报道约有85％的原发性肝癌病人伴有不同程度的肝硬化，其中合并食管胃底静脉曲张的发生率为27％～35．7％．更有15％～28％肝癌病人因食管静脉曲张破裂出血死亡，占肝癌直接死亡原因的第2位。因此，在治疗肝癌的同时能否有效地处理门静脉高压症的问题直接关系到肝癌病人的预后。随着肝癌综合治疗的发展，肝癌的总体疗效得以逐步提高，但肝癌合并门静脉高压及其并发症的防治仍旧是影响肝癌远期疗效的重要因素之一．     

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据统计约有 80 %的原发性肝癌病人伴有不同程度的肝硬变 ,因此肝癌合并门静脉高压症在临床上并不少见[1] 。文献报道 ,肝癌病人合并食管胃底静脉曲张的发生率约为2 7%～ 35 7% ,约有 15 %～ 2 8%肝癌病人死于食管静脉曲张破裂出血 ,占肝癌直接死亡原因的第 2位。因此 ,在治疗肝癌的同时能否有效地处理门静脉高压症的问题直接关系到肝癌病人的预后。随着肝癌早诊、早治、二期切除以及外科综合治疗的发展 ,肝癌的总体疗效逐步提高 ,对肝癌合并门静脉高压症及其并发症的防治已引起外科医生的重视。1　发病机制肝癌合并门静脉高压与一般门静脉…     

肝癌合并门静脉高压症的外科治疗

原发性肝癌是临床上最常见的恶性肿瘤之一,我国原发性肝癌80%发生在肝炎后肝硬化基础上,其中约30%临床合并显著的门静脉高压症。肝癌与门静脉高压症可相互影响。一方面,门静脉高压症的出现提示肝脏代偿功能已有明显损害;另一方面肝癌的出现,尤其是合并门静脉癌栓或动静脉瘘肝癌,会进一步加重门静脉高压。对于这类病人的手术治疗非常困难,术后易发生肝功能衰竭、上消化     

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尽管诊断技术的进步 ,小肝癌或可切除肝癌病人能够得到及时的诊断 ,但对于合并严重肝硬化或门静脉高压症病人 ,由于手术存在较大的风险 ,术后并发症多 ,以及预后差等原因 ,目前处理意见尚不一致。国内已报道的合并门静脉高压症原发性肝癌病人中半数以上选择了非手术治疗 ,即使在手术治疗的病人中 ,癌肿的切除率也不超过30 % [1,2 ] 。我们在肝脏外科的实践中也体会到应该重视对合并门静脉高压症肝癌病人的治疗 ,可以根据发生门静脉高压症的不同原因、肝脏的储备功能情况、癌肿的大小和部位等来选择治疗方法。1　肝癌合并门静脉高压症的机制…     

原发性肝癌合并严重肝硬化门静脉高压症的外科治疗选择

目的探讨原发性肝癌合并严重肝硬化门静脉高压症的外科治疗方法及疗效。方法回顾性分析我院1998年1月至2006年8月手术治疗的肝癌合并严重肝硬化门静脉高压症161例，其中行脾切除＋贲门周围血管离断术联合肝癌局部根治性切除70例，脾切除＋贲门周围血管离断术联合术中射频消融治疗68例，肝移植23例。结果肝癌切除组、术中射频治疗组和肝移植组术后5年生存率分别为34．3％、39．7％和82．6％，并发症发生率分别为20．0％、4，4％和8．7％，无围手术期死亡。结论对于可切除的原发性肝癌合并严重肝硬化门静脉高压症的患者，在加强围手术期处理的同时根据病情合理选择外科治疗方法，可以有效地治疗肝癌和门静脉高压症，提高患者的生存质量及延长生存期。     

Rules for allocation of livers for transplantation

Previous rules of allocation of livers for transplantation were based mainly on local priorities, with final management left to the local team. This created substantial regional disparities. A prospective survey of waiting list deaths and dropouts due to aggravation of liver disease (2003-2005) validated the MELD (Model for End-stage Liver Disease) score on French data. A new allocation score (Liver Score) for liver transplants, based on specific variables for each liver disease, was introduced in March 2007. An initial evaluation, based on the first 5 months of practice, clearly shows that the Liver Score reduces the rates of deaths, dropouts, and futile transplantations; it also accelerates access to transplantation for the sickest patients. Several points remain unresolved: both the MELD and Liver scores may be improved. The variability of the MELD score related to different laboratory assay methods requires harmonization between laboratories.     

Survey of arrangements for anaesthesia for interventional neuroradiology for aneurysmal subarachnoid haemorrhage

The management of patients with subarachnoid haemorrhage following rupture of an intracranial aneurysm is changing. The recent introduction of endovascular occlusion of the aneurysm using detachable coils offers an alternative to craniotomy and clipping of the aneurysm for the prevention of recurrent aneurysmal haemorrhage. The aim of this survey was to evaluate the current provision of peri-operative care for patients with an aneurysmal subarachnoid haemorrhage in the United Kingdom and Republic of Ireland. A survey was conducted of the 34 neuroscience centres which provide an adult neurosurgery service in the United Kingdom and Republic of Ireland. Most centres reported an increasing role for coiling, and a decreasing role for clipping in the management of aneurysmal subarachnoid haemorrhage. The provision of peri-operative care for patients undergoing interventional neuroradiology procedures varied greatly between centres. Neurovascular services in the UK are being reorganised and adequate staff and facilities should be available for the peri-operative care of patients undergoing interventional neuroradiology procedures.     

Risk factors for osteoporosis for residents of Kiwa

We evaluated 207 individuals (49 men and 158 women) living in a small town in central Japan to identify the risk factors for, and the etiology of, osteoporosis. Female sex, advanced age, short stature, low body weight, and deficiencies in calcium and protein intake were associated with an increased risk of osteoporosis. Nutrition appeared to be strongly related to a decrease in bone mass, because subjects who lived solitary lives were more likely to have decreased bone mass and bone mass was similar between husbands and wives.     

Criteria for selection of patients for bariatric surgery

Because of the high prevalence of co-morbid conditions and poor life expectancy a Body Mass Index (BMI) of 40 kg/m(2) or more is an indication for surgery in a fully informed, consenting adult in optimal medical condition to tolerate general anaesthesia. Patients with BMI of 35-40 kg/m(2) and the existence of one or more serious obesity-related conditions ameliorated by weight loss, such as hypertension, pulmonary insufficiency, non-insulin-dependent diabetes mellitus etc., are also candidates for surgical treatment. The bariatric surgeon should use these international criteria as guidelines only, not strict rules. Attempts on the part of internists and more frequently insurance carriers to require documented failure of previous non-operative treatment is not meaningful.