结石性胆囊炎合并肝功能损害600例分析

<正> 结石性胆囊炎常合并有肝功能损害,判断肝功能损害的性质程度,对胆结石的治疗,病情的转归有重要的临床意义。现随机抽取我院1996年到1999年间收治的结石性胆囊炎患者中合并肝功能损害600例分析如下。 临床资料 1 一般资料 本组患者男性398例,女性202例。年龄28～76岁,平均46岁,病程3天到22年,平均2.4年。反复右上腹疼痛发作者520例,食欲减退、乏力、腹胀、恶心等消化道症状者176例,有肝掌、蜘蛛痣等慢性肝病表现者38例,过去有肝炎病史者48例。 2 实验室检查 取患者清晨时空腹静脉血检测各项肝功能指标:T-Bil(总胆红素)、D-Bil(直接胆红素)、ALT(丙氨酸转氨酶)、AST(天冬氨酸氨基转移酶)、ALP(碱性磷酸酶)、GGT(丙谷氨酰转肽酶)、ALB(血浆白蛋白)等。以T-Bil>     

血清胆固醇及肝功能指标对胆结石诊断的意义研究

目的 探讨血清中胆固醇含量及肝功能指标与胆结石发病的相关性及对病情的预示意义。方法 采用生化检测仪对128例胆结石患者和86例健康人进行血清胆固醇(TC)及肝功能指标的检测;通过ROC曲线分析各指标鉴别胆结石患者和健康对照者的特异性和灵敏度,并利用尤登指数计算诊断分界值。结果 胆结石患者的TC及谷丙转氨酶(ALT)、谷草转氨酶(AST)、碱性磷酸酶(ALP)、总胆红素(TB)和间接胆红素(IB)的含量均高于对照组,且差异具有统计学意义(P0.05)。TC、ALT、AST、ALP、TB和IB在胆结石患者和健康对照者之间的诊断临界值分别为:TC4.36 mmol/L、ALT40.20 U/L、AST38.53 U/L、ALP142.66 U/L、TB10.68μmol/L、IB6.39μmol/L。结论 TC和ALT、AST、ALP、TB、IB与胆结石有相关性,可以作为早期胆结石诊断的辅助参考指标。     

术前肝功能评估指标的临床应用及研究进展

目的 了解术前肝功能评估方法的临床应用情况及最新进展.方法 对有关术前肝功能评估指标研究的相关文献进行综述并分析.结果 血清学指标可多方面反映肝功能;吲哚菁绿清除试验、Child-Pugh和MELD评分系统可以提高评估肝储备功能的准确性;影像学检查及人工智能(影像组学和深度学习)有助于诊断肝纤维化程度和精准测量功能性肝...     

肝硬化合并胆石症的手术治疗

目的: 探讨肝硬化合并胆石症患者的手术风险及预后 。方法: 对我院1994~2000年间收治的42例肝硬化合并胆石症患者的临床资料进行回顾分析 。结果: 42例肝硬化合并胆石症患者中,肝功能ChildA级19例,ChildB级18例,ChildC级5例。急诊手术15例,择期手术27例。术中出血量1000ml以上13例。术后出现并发症22例,其中ChildA级6例(占31.6%),B级12例(占66.7%),C级4例(占80.0%)。治愈29例,死亡6例,术后胆道残余结石7例 。结论: Child分级适用于肝硬化患者胆道手术风险的评估。术中出血和术后肝功能衰竭是影响预后的主要因素。     

肝硬化合并胆石症的外科治疗

肝硬化合并胆石症在临床上并不少见,手术中易出血,术后并发症多。现对我院1995年以来收治的25例肝硬化合并胆石症病人(占同期总的胆道结石病人1．82％)的临床资料进行回顾性分析,报告如下。 1 临床资料 1．1 一般资料本组25例中,男16例,女9例。年龄41-77岁,     

严重多发伤致肝功能损害临床分析

近年来．随着严重多发伤抢救成功率的提高．伤后出现肝功能损害的病人也逐年增多。肝功能损害会严重影响病人预后。故将本院自2002年以来收治的严重多发伤病人298例分析报告如下。     

血清前白蛋白检测评价肝功能损害的临床应用

目的 探讨血清前白蛋白浓度测定在临床肝功能损害评价中的价值.方法 分析80例接受脾切除+贲门周围血管离断术的肝硬化患者术前血清前白蛋白(PA)水平、终末期肝病模型(MELD)与术后出现肝功能衰竭的关系.结果 术后出现肝功能衰竭的患者术前的PA值为(79.8±28.5)mg/L,较术后未出现肝功能衰竭情况患者的术前PA值(149.6±31.5)mg/L明显降低(P＜0.01).单独使用MELD评分≥9分和PA值＜100mg/L来判断肝硬化门脉高压患者术后是否出现肝功能衰竭的敏感性分别为71.4%和69.6%,使用MELD评分联合PA值来判断术后是否出现肝功能衰竭的敏感性为82.4%,明显高于单独使用MELD和PA值(P＜0.01).单独使用MELD评分≥9分、PA值＜100 mg/L和MELD评分联合PA值三种方法对术后肝功能衰竭情况评价的特异性都较强,分别为93%、91.5%和90.5%,但三种方法之间的差异无统计学意义(P＞0.05).结论 前白蛋白可反映乙肝后肝硬化门脉高压患者的肝功能损害程度.术前MELD评分联合PA值评估术后是否出现肝功能衰竭情况有良好的敏感性及特异性,可应用于临床.

Abstract：

Objective To investigate the clinical use of serum prealbumin (PA) in evaluating liver function damage. Methods Preoperative PA and the model for end-stage liver disease (MELD) score were retrospectively analyzed in 80 patients with liver cirrhosis and portal hypertension undergoing splenectomy and devascularization around the cardia. The correlation of preoperative PA level and MELD score with postoperative hepatic failure was also analyzed. Results The mean serum value of PA in the patients with hepatic failure was (79. 8 ± 28.5 ) mg/L, and that in thouse without hepatic failure was ( 149. 6 ±31.5 ) mg/L ( P ＜ 0. 01 ). The sensitivity of using MELD score ≥9 to evaluate postoperative hepatic failure was 71.4%, that of PA ＜ 100 mg/L was 69. 6%, and that of MELD score ≥9 combined with PA ＜ 100mg/L was 82. 4% respectively (P ＜0. 01 ). The specificity of the three methods was 93%, 91.5% and 90. 5% respectively, with the difference being not significant (P ＞ 0. 05). Conclusion The serum level of PA could reflect the liver function damage sensitively and exactly. Preoperative MELD score combined with serum PA has good sensitivity and specificity in predicting postoperative hepatic failure and could be used clinically.     

肾移植术后肝功能损害的预防及护理

肾移植术后肝功能损害的预防及护理西安医科大学第一临床医学院王金侠，阮玮，辛爱莉，何术琴据国内文献报道，肾移植术后肝功能损害平均发生率为２４％［１］。我院１９８７年４月至１９９３年４月对２４４例肾移植病人进行积极的预防及护理，取得了较好的效果，现报告如...     

大鼠辅助肝移植对肝损害的支持作用肝功能及血氨基酸变化

我们选用Ｗｉｓｔａｒ大白鼠，首先制成Ｄ－氨基半乳糖诱发的肝损害，然后行门腔分流术导致不可逆性肝损害模型与行辅助肝移植进行比较，结果显示，随术后时间延长，尽管移植组也表现为体重下降，低蛋白血症，但仍较分流组维持了较高的白球比值和较高的尿素氮水平；血氨基酸分析结果表明，分流组支链氨基酸有减少趋势，芳香族氨基酸明显升高，其比值（ＢＣＡＡ／ＡＡＡ）显著下降，而移植组ＢＣＡＡ和ＡＡＡ以及ＢＣＡＡ／ＡＡＡ均与正常组无差异。提示辅助肝对肝损害机体具有一定程度的支持作用，在一定程度上可以纠正肝损害引起的氨基酸代谢紊乱。     

射频治疗肝癌对患者肝功能的影响

目的:探讨肝癌射频治疗对肝功能的影响.方法:32例经皮肝癌射频治疗患者,分为小肝癌组(<3 cm)、大肝癌组(3~10 cm)和巨大肝癌组(>10 cm).对所有患者分别于术前及术后3 d进行血肝功能指标检测.结果:肝癌射频治疗对肝功能的影响与肿瘤大小、是原发性还是转移性有关.肿瘤越大,射频治疗对肝功能的影响越大,表现为巨大肝癌组大于大肝癌组,后者大于小肝癌组;射频治疗对原发性肝癌患者肝功能的影响大于转移性肝癌患者.结论:肝癌射频治疗前患者肝功能最好,处于Child-Pugh A级或B级.对于肿瘤直径大于10 cm的巨大肝癌患者,为防止术后肝功能衰竭,可对患者行分次治疗.     

Changes in liver function after hepatic dearterialization in man

With the object of palliation of hepatic malignancy, hepatic artery ligation was performed in seven patients; six with metastatic liver tumor and the one with primary liver cancer. The proper hepatic artery was ligated in five patients and the right hepatic artery in one. In another patient with metastatic leiomyosarcoma, the right and left hepatic arteries were ligated in two stages. In all patients varying degrees of clevated serum bilirubin and increased activities of serum GOT, GPT and LDH were seen in the first postoperative week which returned to preoperative levels within one to two weeks. No significant rise was found in the activities of serum alkaline phosphatase and leucine aminopeptidase, but in three patients an elevation of alkaline phosphatase was seen at a rather later period after the ligation. Serum albumin, total cholesterol, A/G ratio and cholinesterase showed gradual decreases attaining to the lowest level one to two weeks after the operation and returned to the preoperative values within three weeks. In two patients, abnormal preoperative LDH isoenzyme patterns returned to normal on the 14th postoperative day as well as total LDH activities. This study supports the view that man can tolerate an almost complete dearterialization of the liver without fatal sequela.     

Assessment of liver function for successful hepatectomy in patients with hepatocellular carcinoma with impaired hepatic function

Background/Purpose  This study aimed to construct a formula for assessing liver function in order to prevent post-hepatectomy liver failure. Methods  A formula was constructed by analyzing data from 28 patients with hepatocellular carcinoma (HCC) with liver cirrhosis operated on between 1981 and 1984. Next, we evaluated the validity of this formula in 207 hepatectomy patients operated on from 1985 to 1999. For 145 hepatectomy patients operated on from 2000 to 2006, this formula was calculated before surgery in order to assess their risk of hepatectomy. Results  The formula for liver functional evaluation, constructed from preoperative hepatic function parameters, was: liver failure score = 164.8 − 0.58 × Alb − 1.07 × HPT + 0.062 × GOT − 685 × K. ICG − 3.57 × OGTT. LI + 0.074 × RW, where Alb is albumin (g/dl); HPT, hepaplastin test (%); GOT, glutamate oxaloacetate transaminase (U/l); K. ICG, K value of indocyanine green clearance test; OGTT. LI, 60-min/120-min glucose level in 75-g oral glucose tolerance test. linearity index of OGTT; and RW, weight of resected liver (g). We decided that a score below 25 would be safe for hepatectomy. Conclusions  The mortality rate decreased from 3.9% in 1985–1999 to 1.3% in 2000–2006. This finding allows us to conclude that the formula is valid for assessing the risk of post-hepatectomy liver failure.     

104例EB病毒感染肝功能损害患者的临床特点及预后分析

目的：回顾性观察单纯性EB病毒（EBV）感染引起肝功能损伤患者的临床特点、肝功能变化及预后。方法回顾性分析本院2004年8月至2012年8月诊治的104例EB病毒感染所致肝损害患者。根据流行病学史、病毒学、血清学和肝脏影像学检查等,所有患者均排除了其他原因引起的肝功能损伤,观察患者肝脏生化指标、凝血机制、血液常规和腹部超声等,了解患者的临床特点以及预后。结果本研究104例患者中,男性54例,女性50例,平均年龄37.33岁;平均发病天数为17.51 d,最早的发病后2 d即出现转氨酶增高,患者丙氨酸氨基转移酶（ALT）和天门冬氨酸氨基转移酶（AST）水平均升高,分别为正常值的19倍和11倍;γ-谷氨酰转移酶（γ-GT）增高至正常值的3.5倍,碱性磷酸酶（ALP）有不同程度的升高。血总胆红素（TBil）异常者70例（67.3%）,最高达426.5μmol/L。TBil与GGT、ALP水平均呈正相关关系（r =0.374、P＜0.001,r =0.328,P=0.001）;ALP和GGT呈正相关关系（r =0.525、P＜0.001）。4例患者凝血酶原时间活动度（PTA）低于40%,3例患者行人工肝血浆置换治疗。7例患者发展为慢性肝炎,最长时间维持2年1个月。所有患者预后良好,肝功能均恢复正常。无死亡病例,无1例发展为肝硬化。结论 EBV感染所致肝能损伤为自限性肝炎,可引起胆汁淤积,少数可发展为慢性肝炎及肝功能衰竭。     

Remnant liver function during surgery for extensive hepatic resection

True functional reserve of remnant liver should be determined at the same condition that contemplated hepatectomy has been performed, and this condition can be achieved before resection by temporary lamping of the inflow vessels of hepatic lobes to be removed. Using indocyanine green (ICG), the remnant liver function (RLF) was evaluated whether or not the method can be a useful indicator for or against hepatomy. In the study of healthy dogs, the RLF proved to be a reliable indicator to prospect hepatic failure which may occur after extensive resection of the liver. Then, the method was employed in nine patients who underwent 40 to 70 per cent hepatectomy. The results indicated that the RLF with ICG during surgery, if performed under stable hemodynamics, is a beneficial tool to decide the resectability in equivocal cases.     

Improved liver function due to decompression of the hepatic veins after extended left hepatectomy

Extended left hepatectomy was performed on a patient with hepatocellular carcinoma in the median segment of the liver. The impaired hepatic venous outflow demonstrated by preoperative duplex Doppler ultrasonography improved after surgery due to decompression of the hepatic veins, and liver function improved. A certain volume of hepatic venous outflow may be necessary to maintain liver function and allow compensatory hypertrophy after partial hepatectomy.     

Protection of the liver during hepatic surgery

Very few areas in medicine have seen as many controversies as the evaluation and treatment of patients with liver diseases. Many novel therapies, often marketed before conclusive demonstration of their efficacy, have been developed to enable selective destruction of liver tumors to minimize the risk of liver failure associated with major surgery. Whether these techniques are effective and result in lesser complications often remains speculative. Persisting challenges in selecting the optimal therapy are the evaluation of the risk of surgery in patients with normal or diseased liver and the preparation for surgery. A panel of hepato-biliary surgeons experienced in the management of complex cases convened at the annual meeting of the American Hepato-Pancreato-Biliary Association in Boston, MA, to address the rapidly evolving field of protective strategies for hepatic surgery.     

原发性肝癌术后肝功能变化临床分析

目的探讨原发性肝癌病人手术前后肝功能变化规律。方法回顾性分析1990—2005年收治的142倒原发性肝癌，按术前肝功能Child分级分为2组。ChildA级102例（A组），ChildB级40例（B组）。分析比较两组病人手术前、后的主要肝功能指标变化。结果原发性肝癌病人丙氨酸转氨酶（ALT）、天冬氨酸转氨酶（AST）和血清胆红素于手术后均升高，术后3d迭较高水平，后呈现逐渐下降的趋势。A、B两组在升高幅度及下降趋势上差异有显著性，肝功能ChildA级病人2周后上述指标恢复到术前水平。结论原发性肝癌病人手术前、后的主要肝功能指标变化与术前肝功能Child分级密切相关。     

Lobular damage caused by cellular and humoral immunity in liver allograft rejection

BACKGROUNDS: Diagnosis of acute liver allograft rejection (ALAR) is usually performed by the estimation of changes in portal areas. In this study, changes in the hepatic lobules were investigated retrospectively by immunohistochemistry, and compared with changes in the portal areas. Humoral immunity in ALAR was also studied by C4d-staining. MATERIALS AND METHODS: In total, 35 biopsy specimens from 20 patients who had undergone living-related liver transplantation were included. Specimens had been graded as mild, moderate-to-severe acute rejection based on the Banff Schema. Changes in hepatic lobules were investigated by hematoxylin-eosin (H & E) staining, an immunohistochemical study using anti-CD3 (T cells), anti-GMP-17 (cytotoxic cells), anti-CD68 (macrophages) and C4d, and the terminal deoxynucleotidyl transferase (TdT)-mediated dUTP-biotin nick end-labeling (TUNEL) method. RESULTS: Changes in hepatic lobules consisted of the infiltration of mononuclear cells, swelling and necrosis of hepatocytes, and hemorrhages. The degree of these changes increased with the severity of ALAR. Immunohistochemical analysis revealed that infiltrating cells included CD3+ T cells, GMP-17+ cytotoxic cells and CD68+ macrophages. The number of infiltrating cells increased with the severity of the ALAR. The TUNEL assay demonstrated apoptotic cells in ALAR and the number of apoptotic cells increased with the severity of the ALAR. In moderate-to-severe rejection, C4d depositions were observed in the hepatic sinusoids as well as the portal veins and hepatic arteries. CONCLUSIONS: Changes in the hepatic lobules were observed in ALAR and the severity increased with the severity of ALAR. Apoptosis was involved in the mechanism of cell death and humoral immunity plays a role in the mechanism of ALAR.     

运用去唾液酸糖蛋白受体定量评估肝脏储备功能体系的建立

目的 肝脏去唾液酸糖蛋白受体(ASGPR)指标结合吲哚氰绿储留率(ICGR_(15))建立综合评估肝脏储备功能的体系。方法 测定不同比例肝脏切除大鼠模型肝脏ASGPR的HH_(15)、LHL_(15)和MRI结合ICGR_(15),建立一个综合定量评估肝脏储备功能的评分体系。结果 在正常肝脏容量丢失15％时,HH_(15)、LHL_(15)、MRI、ICGR_(15)等均不能显著反映出肝脏储备功能的变化,而涵盖上述指标的综合评估体系Y值(肝脏功能残余量)则能显著反映肝脏储备功能的变化。结论 涵盖HH_(15)、LHL_(15)、MRI及ICGR_(15)等指标的回归方程Y=2.56+33.188×MRI-44.844×HH_(15)+24.032×LHL_(15)-34.915×ICGR_(15)中的Y值是评估肝脏储备功能的敏感指标,能够对四氯化碳肝硬化大鼠模型的肝脏储备功能作出准确可靠的定量评估。