ICGR15联合PT及标准残肝体积预测肝癌患者术后肝功能恢复

目的 探讨术前吲哚氰绿15分钟滞留率（indocyanine green retention rate at 15min,ICGR15）联合术前凝血酶原时间（prothrombin time,PT）及标准残肝体积（standard remnant liver volume,SRLV）对预测肝癌患者术后肝功能代偿的作用.方法 对64例因大肝癌行肝切除术的患者进行研究,根据术后患者肝功能代偿情况分组,对术前生化检查及一般情况进行差异性分析.结果 轻度肝功能代偿不全组（50例）、中重度肝功能代偿不全组（14例）之间ICGR15、PT、SRLV有统计学意义（P＜0.05）;Logistic回归分析得到回归方程为：PLFPI =0.186 × ICGR15 ＋0.849×PT-0.007×SRLV-9.617.经过ROC分析PLFPI预测术后肝功能重度代偿不全的临界值为-0.33,其灵敏度为100％,特异度为87.10％.结论 术前ICGR15联合术前PT及标准残肝体积能够较好地预测肝癌患者术后肝功能代偿情况;以PLFPI＜-33作为预防大肝癌肝切除术后重度肝功能代偿不全的术后肝功能综合预测指数界限是可行的.     

联合ICGR15与CT测量残肝体积在原发性肝癌病人的临床应用

目的探讨联合ICGR15与CT测量残肝体积在原发性肝癌病人的临床应用价值。方法研究对象为2014年9月至2017年6月在我院肝胆外科住院确诊为原发性肝癌并且进行手术治疗的48例病人。术前完成病人的生化、凝血功能检查、腹水B超,测定体表面积和肝体积,进行ICGR15检测,术后根据病人有否出现肝功能衰竭分为肝功能衰竭组(A组)9例,以及无肝功能衰竭组(B组)39例。对两组临床资料以及对三种评估方法进行比较。结果 48例病人肝癌术后出现肝功能衰竭9例,无肝功能衰竭39例,发生率为18.75%,两组病人的年龄、ALT、AST、TBIL、ALB、PT、术前Child-Pugh评分、手术时间、术中输血量等指标的差异均无统计学意义(P0.05);而术前ICGR15、SRLV、肝门阻断时间以及术中出血量等指标差异均有统计学意义(P0.05);ICGR15和残肝体积占比分别与Child-Pugh分级比较,差异有统计学意义(P0.05);ICGR15和残肝体积占比的比较,差异无统计学意义(P0.05)。结论 ICGR15与CT测量残肝体积可以作为评估原发性肝癌病人肝切除术后肝功能衰竭的准确指标,且联合应用两者可以互补优势。     

肝癌患者术后并发症的观察及护理

<正>肝切除术是肝癌的主要治疗手段之一,临床应用极为广泛,但术后并发症发生率较高,种类也较多。因此,总结并发症的观察及护理具有重要临床意义。2011-04-2012-12间,我科共行肝癌肝切除术200例,其中42例出现并发症,现将并发症的观察及护理进行回顾性分析。     

肝癌术后黄疸原因分析

目的　研究围手术期影响肝癌术后胆红素水平的相关因素以及相应的处理办法。方法　回顾分析 2 94例肝癌手术病例 (排除术前存在梗阻性黄疸者 ) ,找出影响术后胆红素的因素。对比术后胆红素≥ 5 1.3m mol/ L 与术后胆红素 <5 1.3mm ol/ L 两组病人在危险因素与近期疗效的差别。结果　术后胆红素与术前胆红素水平、肝硬化程度、手术持续时间和术中出血量明显相关。 4 8例观察组病人术前胆红素水平更高 (P<0 .0 0 1)、肝硬化较重 (P<0 .0 0 1)、手术持续时间长 (P<0 .0 0 1)、术中出血多 (P<0 .0 1)、住院时间长 (P<0 .0 1)、并发症和死亡率增高 (P<0 .0 0 1)。结论　 1围手术期胆红素水平在判断肝癌病人近期疗效中具有价值。 2手术应选择肝硬化程度轻或 /无 ,肝储备功能良好的病人、控制手术时间、减少术中出血量、及时处理术后胆道梗阻、加强围手术期治疗     

ICGR15在肝癌切除术前评估肝脏储备功能的作用

Objective To evaluate the role of ICGR15 in assessment of hepatic functional reserve before hepateetomy for hepatocellular carcinoma.Methods From August 2005 to October 2007, six-ty-six patients with hepatocellular carcinoma were treated in our hospital.The patients were random-ized into Child-Pugh grading group (32 cases) and ICGR15 detection group (34 cases).Preoperative preparation,operative procedures and postoperative management were the same in all the 66 patients.The morbidity and mortality were compared and the relationship between Child-Pugh grading and ICGR15 in assessment of hepatic functional reserve was determined.Results The incidence of hepatic failure after hepatectomy in ICGR15 detection group(23.50%) was significanly lower than that in Child-Pugh grading group(34.4%).ICGR15 (14.38 ±8.2)% in patients with tumor of Child-Pugh grading B was higher than ICGR15 (7.84 ± 4.8)% in those with tumor of Child-Pugh grading A.Conclusion ICGR15 valuecan be more sensitive in evaluating hepatic functional reserve than Child-Pugh grading, but some correlation can be observed between them.ICGR15 is useful in assessing the range of liver resection and prognosis before hepatectomy for hepatocellular carcinoma.     

ICGR15在肝癌切除术前评估肝脏储备功能的作用

目的 探讨快速肝储备功能检测系统(DDG)中ICGR15在肝癌切除术前评估肝储备功能的作用.方法 从2005年8月至2007年10月收治66例肝癌切除病人,随机将病人分为ChildPugh评分组和ICGR15组,比较两组术后肝功能不全发生率的变化和分析Child-Pugh评分与ICGR15的关系.结果 Child-Pugh评分组术后出现腹水11例,黄疸8例,肝性脑病5例,死亡2例,肝功能不全发生率为34.4%;ICGR15组术后出现腹水8例,黄疽4例,肝性脑病2例,死亡0例,肝功能不全发生率为23.5%;两组肝功能不全发生率相比有显著性差异(P<0.05);ICGR15组Child-PughB级病人ICGR15均值为(14.38±8.2)%,显著高于Chitd-Pugh A级病人(7.84±4.8)%(P<0.01).结论 Child-Pugh评分与ICGR15值有密切关系,但ICGR15较Child-Pugh评分能更准确,灵敏地评估肝脏储备功能,对决定肝癌切除范围和手术预后的评估有指导作用.     

ICGR15在肝癌切除术前评估肝脏储备功能的作用

Objective To evaluate the role of ICGR15 in assessment of hepatic functional reserve before hepateetomy for hepatocellular carcinoma.Methods From August 2005 to October 2007, six-ty-six patients with hepatocellular carcinoma were treated in our hospital.The patients were random-ized into Child-Pugh grading group (32 cases) and ICGR15 detection group (34 cases).Preoperative preparation,operative procedures and postoperative management were the same in all the 66 patients.The morbidity and mortality were compared and the relationship between Child-Pugh grading and ICGR15 in assessment of hepatic functional reserve was determined.Results The incidence of hepatic failure after hepatectomy in ICGR15 detection group(23.50%) was significanly lower than that in Child-Pugh grading group(34.4%).ICGR15 (14.38 ±8.2)% in patients with tumor of Child-Pugh grading B was higher than ICGR15 (7.84 ± 4.8)% in those with tumor of Child-Pugh grading A.Conclusion ICGR15 valuecan be more sensitive in evaluating hepatic functional reserve than Child-Pugh grading, but some correlation can be observed between them.ICGR15 is useful in assessing the range of liver resection and prognosis before hepatectomy for hepatocellular carcinoma.     

ICGR15在肝癌切除术前评估肝脏储备功能的作用

Objective To evaluate the role of ICGR15 in assessment of hepatic functional reserve before hepateetomy for hepatocellular carcinoma.Methods From August 2005 to October 2007, six-ty-six patients with hepatocellular carcinoma were treated in our hospital.The patients were random-ized into Child-Pugh grading group (32 cases) and ICGR15 detection group (34 cases).Preoperative preparation,operative procedures and postoperative management were the same in all the 66 patients.The morbidity and mortality were compared and the relationship between Child-Pugh grading and ICGR15 in assessment of hepatic functional reserve was determined.Results The incidence of hepatic failure after hepatectomy in ICGR15 detection group(23.50%) was significanly lower than that in Child-Pugh grading group(34.4%).ICGR15 (14.38 ±8.2)% in patients with tumor of Child-Pugh grading B was higher than ICGR15 (7.84 ± 4.8)% in those with tumor of Child-Pugh grading A.Conclusion ICGR15 valuecan be more sensitive in evaluating hepatic functional reserve than Child-Pugh grading, but some correlation can be observed between them.ICGR15 is useful in assessing the range of liver resection and prognosis before hepatectomy for hepatocellular carcinoma.     

ICGR15在肝癌切除术前评估肝脏储备功能的作用

Objective To evaluate the role of ICGR15 in assessment of hepatic functional reserve before hepateetomy for hepatocellular carcinoma.Methods From August 2005 to October 2007, six-ty-six patients with hepatocellular carcinoma were treated in our hospital.The patients were random-ized into Child-Pugh grading group (32 cases) and ICGR15 detection group (34 cases).Preoperative preparation,operative procedures and postoperative management were the same in all the 66 patients.The morbidity and mortality were compared and the relationship between Child-Pugh grading and ICGR15 in assessment of hepatic functional reserve was determined.Results The incidence of hepatic failure after hepatectomy in ICGR15 detection group(23.50%) was significanly lower than that in Child-Pugh grading group(34.4%).ICGR15 (14.38 ±8.2)% in patients with tumor of Child-Pugh grading B was higher than ICGR15 (7.84 ± 4.8)% in those with tumor of Child-Pugh grading A.Conclusion ICGR15 valuecan be more sensitive in evaluating hepatic functional reserve than Child-Pugh grading, but some correlation can be observed between them.ICGR15 is useful in assessing the range of liver resection and prognosis before hepatectomy for hepatocellular carcinoma.     

ICGR15在肝癌切除术前评估肝脏储备功能的作用

Objective To evaluate the role of ICGR15 in assessment of hepatic functional reserve before hepateetomy for hepatocellular carcinoma.Methods From August 2005 to October 2007, six-ty-six patients with hepatocellular carcinoma were treated in our hospital.The patients were random-ized into Child-Pugh grading group (32 cases) and ICGR15 detection group (34 cases).Preoperative preparation,operative procedures and postoperative management were the same in all the 66 patients.The morbidity and mortality were compared and the relationship between Child-Pugh grading and ICGR15 in assessment of hepatic functional reserve was determined.Results The incidence of hepatic failure after hepatectomy in ICGR15 detection group(23.50%) was significanly lower than that in Child-Pugh grading group(34.4%).ICGR15 (14.38 ±8.2)% in patients with tumor of Child-Pugh grading B was higher than ICGR15 (7.84 ± 4.8)% in those with tumor of Child-Pugh grading A.Conclusion ICGR15 valuecan be more sensitive in evaluating hepatic functional reserve than Child-Pugh grading, but some correlation can be observed between them.ICGR15 is useful in assessing the range of liver resection and prognosis before hepatectomy for hepatocellular carcinoma.     

Snail蛋白表达与肝细胞癌术后预后的相关性研究

目的研究Snail蛋白在肝细胞癌(HCC)中的表达及其与临床病理特征和术后预后的关系。方法应用免疫组织化学SP法,检测Snail蛋白在103例肝细胞癌及25例正常肝组织中的表达及其在细胞中的定位。结果Snail蛋白高度表达于肝癌组织的细胞核、细胞质,正常肝组织中表达较少甚至不表达,阳性率分别为51.5%和16%,两者差异有统计学意义(P0.05)。Snail在肝癌中的高表达与肝癌的pTNM分期、肿瘤有无包膜和微血管侵犯有关(P0.05)。结论HCC患者的术后的预后与Snail蛋白的表达有关,Snail蛋白有可能成为肝癌术后预测复发判断预后的生物学标志。     

肝细胞癌病人血清白细胞介素12水平变化及其临床意义

目的 探讨ＨＣＣ病人血清ＩＬ－１２水平变化及其临床意义，研究ＩＬ－１２在ＣＣ发生发展过程中的作用。方法 应用ＥＬＩＳ ＨＣ同人及３０例良性对照组血清ＩＬ－１２水平。结果 ＨＣＣ组血清ＩＬ－１２水平明显低于对照组，Ⅳ期ＨＣＣ病人血清ＩＬ－１２水平明显低于Ⅱ、Ⅲ期病人，肝功能，肿瘤直径，是否存在门静脉癌栓显著影响ＨＣＣ病人血清ＩＬ－１２水平，ＩＬ－１２水平与ＡＦＰ水平不相关。术后ＩＬ－１２水平先降低、     

手术前血清癌胚抗原与胃癌预后的关系

本文对病理组织学诊断为腺癌的９６例胃癌病人进行手术血清癌胚抗原（ＣＥＡ）测定，井与若干预后因素及生存率作们关分析和比较。结果显示：①胃癌患者血清ＣＥＡ增高时，肝转移率增高，但淋巴结转移率无明显增多；②ＣＥＡ水平虽与肿瘤分期不呈等级正相关，但Ⅰ、Ⅱ期与Ⅲ、Ⅳ期对照，ＣＥＡ水平差别有显著性（Ｐ＜０．０５）；③粘液腺癌病人ＣＥＡ阳性率较管状腺癌及印戒细胞癌病人高，但与肿瘤分化程度无明确关系；①当ＣＥＡ＞２０ｕｇ／Ｌ时，癌肿能作根治性手术切除的可能性减少，生存率明显降低。本研究结果提示，术前血清ＣＥＡ水平对判断胃癌预后有实用意义，术前检测ＣＥＡ对胃癌的治疗选择和制订手术方案有一定的参考价值。     

23例原发性肝癌自发性破裂大出血一期与二期肝切除术疗效比较

目的 探讨原发性肝癌自发性破裂(SRHCC)的一期与二期肝切除术疗效差异,找出合理手术时机和方法.方法 对1992年1月～2006年5月我们手术治疗过的23例SRHCC一期肝切除术(以下称A组)与二期肝切除术(以下称B组)的效果进行分析.结果 A组13例(56.5%),平均生存期22.6个月(3 d～90个月);B组10例(43.5%),平均生存期24.1个月(15天～85个月),P＞0.05.并发症(包括术后再出血、腹腔感染、胸腔积液、应激性溃疡、伤口感染、肝功能衰竭和围手术期死亡)A组也明显高于B组P＜0.05.结论 一期与二期肝切除术对SRHCC病人的平均生存期无显著影响,但二期肝切除术可明显降低术后并发症及死亡率,选择一期还是二期肝切除术应个体化.     

肝细胞肝癌术后隐匿性病灶的介入治疗

目的　探讨采用超选择性插管、小剂量、低流量持续动脉灌注栓塞化疗方法对肝细胞肝癌 (简称肝癌 )术后隐匿性病灶的治疗价值。方法　对 6 7例肝癌术后 4 0天～ 3个月内起开始作介入治疗的患者中 ,经肝脏数字减影血管造影 (DigitalSubtraction Angiography DSA)检查发现 13例患者肝内 14处隐匿性病灶。病灶直径 0 .4～ 0 .8cm,平均 0 .6 cm。 13例肝癌患者术后经 BUS、CT、MRI等检查均未发现病灶 ,甲胎蛋白 (AFP)检查 >4 0 0 μg/ m l2例 ,2 0 0～ 4 0 0 μg/ m l4例 ,80～ 2 0 0 μg/ ml2例。对 13例患者 14处病灶作 1～ 3次超选择性插管、小剂量、低流量持续动脉灌注栓塞化疗。结果　 13例患者介入治疗后 2周及 1个月后作肝脏 CT复查 ,见 14处病灶内碘油沉积良好 ,与 DSA检查所见病灶结果相同。经 1～ 3次介入治疗后病灶缩小稳定。原 11例 AFP阳性患者均降至正常。另 2例 AFP阴性患者仍为阴性。随访 2 5～ 5 1个月无一例肝内有新病灶发现。结论　肝癌术后隐匿性病灶的早发现、早治疗 ,对延长肝癌术后患者生存期有相当积极的作用。肝脏 DSA、碘化油 CT检查是发现隐匿性病灶的最敏感检测手段。超选择性插管、小剂量、低流量持续动脉灌注栓塞化疗是一种积极有效的治疗方法     

肝细胞癌多基因启动子甲基化与预后关系的研究

目的 了解肝细胞癌(hepatucellular carcinoma,HCC)中,DAPK、FHIT及SLIT2基因的甲基化状况与病人生存预后的关系.方法 应用甲基化特异性PCR(methylation- specific PCR,MSP)技术,检测50例HCC组织中上述基因启动子区域的甲基化状况,并分析每种基因甲基化...     

原发性肝癌肝切除病人肝储备功能的综合预测

目的 探讨多指标综合预测原发性肝癌肝切除病人的肝代偿功能的价值。方法将237例原发性肝癌肝切除术的病人按照术后肝功能恢复情况分为代偿良好（A）、代偿轻度不全（B）、代偿重度不全（C）三组,对照病人的术前常规肝功能、Child-pugh分级、OGTT曲线类型等因素进行综合分析。结果三组病人的年龄、术前常规肝功能ALT、AST、ALB无明显差异（P〉0．05）;A、B组病人的TBIL差异无统计学意义（P〉0．05）,但C组与A、B组之间差异有显著性意义（P〈0．05）。Child-Pugh肝功能分级的预测准确率为57．6％。OGTT P1型预测术后肝功能代偿良好的准确率为80％;OGTTP2型预测的肝功能代偿不良或重度不良的准确率为76．3％;OGTTL型预测肝功能重度不良的准确率为60．9％结论术前综合应用Child-pugh分级、TBIL和OGTT能较准确地预测原发性肝癌病人肝切除术后肝脏代偿能力。     

射频治疗原发性肝癌前后可溶性白细胞介素-2受体和肿瘤坏死因子的变化

目的　研究原发性肝癌患者集束电极射频治疗前后血清可溶性白细胞介素 - 2受体 (SIL - 2 R)和肿瘤坏死因子(TNF)水平的变化及其临床意义。方法　采用 EL ISA双抗体夹心法 ,检测 4 2例原发性肝癌 (HCC)患者集束电极射频治疗前后血清 SIL - 2 R和 TNF的表达水平的改变 ,并与健康对照组比较 ;分析 SIL - 2 R和 TNF与 AFP的相关性。结果　治疗前 HCC患者血清 SIL - 2 R和 TNF水平明显高于对照组 (P<0 .0 1) ;集束电极射频治疗后 1周 ,血清 SIL - 2 R和 TNF水平无明显变化(P>0 .0 5 ) ;治疗后 2周 ,血清 SIL - 2 R和 TNF水平降低 ,与治疗前比较差异有显著性 (P<0 .0 1) ,但仍高于对照组 (P<0 .0 1) ;血清 SIL - 2 R/ TNF水平与 AFP水平不相关。结论　原发性肝癌患者集束电极射频治疗后血清中 SIL - 2 R和 TNF水平下降 ,机体免疫功能增强 ;并可作为早期诊断、病情判断、复发检测的重要指标     

可切除大肝癌术前TACE对手术前后肝功能的影响

目的 探讨可切除大肝癌术前TACE对手术前后肝功能的影响。方法 分析2002年1月至2003年1月78例可切除大肝癌患者，其中31例术前行TACE，47例术前未经TACE(对照组)。分析两组术前肿瘤大小、肝功能指标变化、手术探查情况及手术相关因素、术后肝功能指标变化及并发症情况的差异。结果 TACE组术前7-球蛋白水平升高，术后前白蛋白水平下降，手术探查见肿瘤周围粘连明显增加，肝硬化加重，手术时间延长。两组间肝门阻断时间、术中平均出血量、术后并发症等指标无显著差异，TACE组TACE后平均肿瘤直径缩小并不显著。结论 大肝癌术前TACE使肝功能受损，增加手术难度及手术风险，并有可能耽误手术时机。