新型双球囊导管在经皮选择性隔离肝脏灌注化疗中的应用

目的探讨自制双球囊导管在经皮选择性肝脏隔离灌注化疗(PSIHP)中的应用效果。方法实验猪12头,利用介入放射学方法进行双球囊导管选择性隔离肝脏灌注化疗结合血液灌流。化疗药物选用5-FU。比较灌注及未灌注区域肝细胞形态和凋亡指数。结果灌注区域肝细胞损伤明显,肝细胞凋亡指数(51.82%±5.34%)明显高于未灌注区域肝细胞凋亡指数(4.12%±0.84%)(P<0.01)。结论自制新型双球囊导管能有效隔离肝脏,对未灌注区域肝组织有良好的保护作用,是一种理想的隔离肝脏灌注化疗的球囊导管。     

介入性球囊导管技术在肝脏隔离灌注中应用的动物实验研究

肝脏隔离灌注 (ｉｓｏｌａｔｅｄｌｉｖｅｒｐｅｒｆｕｓｉｏｎ ,ＩＬＰ)是将肝脏所属主要血管游离阻断 ,并通过门静脉和(或 )肝动脉对肝脏进行隔离灌注。为了使技术简便易行 ,我们采用一种介入性球囊导管辅助隔离技术进行家猪的原位肝脏隔离灌注 ,现报告如下。1.材料与方法 :实验动物 :为健康家猪 12头 ,体重 2 3～ 35ｋｇ ,平均 2 8 9ｋｇ ,雌雄不限。主要试剂及仪器包括ＭｉｔｏｍｙｃｉｎＣ ,岛津ＬＧ 6Ａ型高效液相色谱等。随机分成 2组 ,Ａ组 (6只 ) :采用传统手术方法进行原位肝脏隔离灌注 ;Ｂ组 (6只 ) :采用球囊导管隔离技术进行灌…     

经皮选择性肝脏隔离灌注化疗肝细胞形态及凋亡研究

目的探讨经皮选择性肝脏隔离灌注化疗（PSIHP）的可行性及隔离效果。方法实验猪8头，利用介入放射学方法进行经皮选择性肝脏隔离灌注化疗结合血液灌流。化疗药物选用5-Fu。比较灌注及未灌注区域肝细胞形态和凋亡指数。结果灌注区域肝细胞损伤明显，肝细胞凋亡指数（52．83±5．12）明显高于未灌注区域肝细胞凋亡指数（3．52±0．96）（P〈0．01）。结论PSIHP是一种简单有效的肝脏隔离灌注化疗技术，隔离效果佳，对未灌注区域肝组织有良好的保护作用。     

原位肝脏隔离灌注行肝脏恶性肿瘤区域性化疗的实验研究进展(综述)

本文以肝脏隔离灌注行肝脏区域化疗的实验研究为重点,讨论动物模型的建立,灌注液成分与灌注途径及其实验研究的发展方向。     

肝癌区域性治疗的新突破——肝脏隔离灌注化疗

我国的肝癌患者约占全世界的 5 0 % ,其死亡率占恶生肿瘤死亡率的第二位。长期以来 ,手术切除一直是肝癌的首选治疗方法 ,但临床诊断明确的肝癌患者多数已属中晚期 ,可行手术切除者不足 2 0 %。近年来随着细胞生物学、影像学、介入放射学的发展 ,各种区域性化疗方法应运而生并迅速发展 ,为肝癌的开辟出新的领域。肝脏隔离灌注 (isolated liver perfusion IL P)化疗作为新近开展起来的技术为肝癌区域性化疗注入了新的活力。1　肝脏隔离灌注化疗的国内外研究进展要是通过阻断肝脏周围血管 ,将肝脏循环隔离于体循环之外 ,然后采用体外循环装…     

肝脏隔离灌注化疗治疗中晚期肝癌研究

实践证明 ,在肝癌的化疗中 ,局部化疗比全身化疗有效。肝脏隔离灌注(ｉｓｏｌａｔｅｄｈｅｐａｔｉｃｐｅｒｆｅｒｕｓｉｏｎ ,ＩＨＰ)治疗 ,作为一种局部化疗的手段 ,与其它局部治疗手段如化疗药物栓塞、冷冻治疗、酒精注射相比 ,具有可以治疗多发性肝癌、巨大肝癌 (直径大于 5ｃｍ) ,有效地降低体循环药物浓度等优点。一、方法原理ＩＨＰ原理是将肝脏的入肝血流和出肝血流通过体外转流装置和体循环隔离开来 ,从入肝血流处注入各种大剂量抗癌药物 (可达正常全身用量的 30～ 50倍 ) ,对肿瘤组织发挥作用。Ａｕｓｍａｎ和Ａｕｓｔ在 1 960年…     

肝脏隔离高温灌注化疗术的麻醉处理

肝癌是消化系统常见的恶性肿瘤 ,病人就诊时多不是早期 ,不足 30 %的病人能接受手术切除病变肝脏 ,临床治疗效果欠佳 ,寻求治疗肝癌新技术是国内外研究的热点。肝脏隔离灌注高浓度的抗肿瘤药加局部高温 (ｉｓｏｌａｔｅｄｈｙｐｅｒｔｈｅｒｍｉｃｌｉｖｅｒｐｅｒｆｕｓｉｏｎ ,ＩＨＬＰ)是治疗不可切除肝癌的新技术[1 ] ,ＩＨＬＰ手术期间需建立两条体外转流通路 ,对病人的生理干扰大 ,麻醉处理有其特殊性 ,现将我院开展一例ＩＨＬＰ手术的麻醉报告如下。临床资料病人男性 ,5 0岁 ,体重 6 0ｋｇ ,因右上腹胀痛伴纳差、乏力 1个月 ,以原发…     

区域隔离肝脏灌注的研究

本研究旨在探讨区域隔离肝脏灌注(RIHP)的可行性 ,并初步评价其隔离效果 ,化疗药物局部积聚效果及肝脏损害情况。一、材料与方法1.动物选择 :幼猪 2 1头 ,随机分为 3组 :经动脉组 (实验A组 ) 7头 ;经动脉和门静脉联合组 (实验B组 ) 7头 ;对照组(C组 ,经肝固有动脉灌注化疗组 ) 7头。3组动物的体重差异无显著性 (P >0 .0 5 )。2 .手术操作 :麻醉后上腹部屋顶形切口进腹 ;A组游离左肝动脉 ,近心端结扎 ,远心端插管 ;解剖出左肝静脉 ,远端阻断 ,近端插管。B组则在左肝动脉插管后 ,继续解剖游离出左门静脉 ,近端阻断 ,远端插管 ,左肝静脉处…     

经肝动脉区域肝脏隔离灌注的研究

目的　研究幼猪经肝动脉区域隔离肝灌注的效果。　方法　14只幼猪随机分为2组:对照组(7只):采用经肝动脉灌注;实验组( 7只):左肝动脉及左肝静脉插管,进行左肝区域隔离肝灌注。灌注液为氨甲喋呤溶液(1mg/kg), 灌注时间为60min。于灌注5、10、20、30、45、60min时分别抽取外周血、肝脏灌注区域血、肝脏未灌注区域血(实验组)测定血药浓度; 灌注后切取左肝及右肝组织进行病理检查。　结果　在所有时间点, 实验组肝脏灌注区域氨甲蝶呤的血药浓度明显高于非灌注区和外周血(P<0. 01), 60min时最高, 达( 40. 211±3. 756 )μg/ml, 而非灌注区和外周血中仅为(1. 584±0. 347)μg/ml和(0. 773±0. 096)μg/ml。实验组灌注区域血药浓度均高于对照组肝脏血药浓度(P<0. 01), 60min时分别达(40. 211±3. 756)μg/ml和(4. 498±1. 643)μg/ml。实验组灌注区浓度-时间曲线下面积为218. 295μg/ml,而在对照组肝脏仅为260. 860μg/ml。病理检查提示两组灌注肝脏均有肝细胞浊肿、气球样细胞,但实验组肝脏灌注区域肝细胞坏死率为85. 7% (6 /7),明显高于对照组28. 6% (2 /7)。实验组肝脏未灌注区域无明显病理损害。　结论　动物实验证实经肝动脉区域隔离肝灌注是一种灌注及隔离效果好、肝功能损害小的区域化疗方法。     

逆行隔离灌注化疗可减轻对大鼠肝脏的毒性及药物的泄漏

目的 采用大鼠肝脏隔离灌注模型探讨逆行隔离灌注(RIHP)较顺行隔离灌注(IHP)能否减少正常肝组织损伤及化疗药物外周泄漏率.方法 将90只体重300～350 g雄性SD大鼠随机分为A、B、C三组,每组30只:A组为空白对照组,经肝动脉及门静脉灌注乳酸林格液,以下腔静脉为灌注液流出道;B组行IHP,经肝动脉灌注含有350 mg/kg的氟尿嘧啶(5-Fu),门静脉灌注乳酸林格液,以下腔静脉为灌注液流出道;C组行RIHP,经肝动脉灌注含有350 mg/kg的氟尿嘧啶(5-Fu),经下腔静脉灌注乳酸林格液,以门静脉为灌注液流出道.术后1、3、5、7 d分别行血清ALT测定及肝组织病理学检查;高效液相色谱分析仪检测B、C组术中外周血药浓度.结果 三组术后3 d存活率分别为90.0%、86.7%和90.0%,三者差异无统计学意义.三组血清ALT均在术后第一天达到峰值,A组为(481.6±207.6)μmol/L;B组为(1641.6±658.0)μmol/L;C组为(913.0±353.5)μmol/L.B、C组均显著高于A组(P＜0.05);B组显著高于C组(P＜0.05).B组与C组术中外周血药浓度峰值分别为(131.2±29.4)μg/ml和(65.3±28.4)μg/ml.两组外周浓度有显著性差异(P＜0.05).A组术后肝脏病理改变较轻,术后7 d基本恢复正常;B组术后肝脏病理学改变相对严重,术后7 d局部仍可见坏死灶;C组术后肝脏病理改变后较A组严重,但较B组轻,术后7 d基本恢复正常.结论 RIHP较之IHP能够显著减轻化疗药物对正常肝组织的毒副作用和药物的外周泄漏,有望成为一种对肝癌更加有效安全的区域化疗方法.     

Construction and experimental application of a catheter for selective arterial kidney perfusion in situ

Summary In order to improve dog kidney perfusion in situ with a protective solution, a perfusion catheter was constructed which allowed continuous pressure measurement in the center of the catheter tip during perfusion. Using this catheter, the equilibration of the extracellular space with a protective solution (HTK solution) was found to be pressure dependent. Continuous pressure and resistance control is therefore a prerequisite for reliable organ protection.     

经皮选择性肝脏隔离灌注化疗的实验研究

目的探讨经皮选择性肝脏隔离灌注化疗的可行性及隔离效果。方法将12只猪随机分为两组:HAI组6头,进行常规经肝动脉灌注化疗;PSIHP组6头,利用介入放射学方法进行经皮选择性隔离肝脏灌注化疗结合血液灌流。化疗药物选用5-FU。分别检测肝静脉及外周血液中的血药浓度,并对肝组织行病理学检查。结果HAI组右肝静脉血和外周静脉血浓度峰值分别为(4082.530±415.213)mg/L,(1682.230±216.834)mg/L;PSIHP组右肝静脉血、外周静脉血血药浓度峰值分别为(5321.711±517.318)mg/L,(510.834±52.518)mg/L。两组间有显著性差异(P<0.01)。PSIHP组过滤后肝静脉血血药浓度峰值为(1192.063±114.864)mg/L,碳肾率过滤达到(77.6±0.9)%。PSIHP组灌注区域肝脏组织损害程度比HAI组大。结论PSIHP是一种简单有效的肝脏隔离灌注化疗技术,与常规经肝动脉灌注化疗相比,不仅可以增加局部血药浓度,更可以降低外周的血药浓度,降低毒副作用。     

腹腔镜下胆总管探查术中逐级导管扩张与球囊导管扩张治疗胆总管下段狭窄的对比研究

目的 分析比较腹腔镜下胆总管探查术中逐级导管扩张与球囊导管扩张治疗胆总管下段狭窄的安全性及有效性。方法 回顾性分析成都市第二人民医院2017年4月至2019年4月收治的胆总管结石合并胆总管下段狭窄患者56例,其中行逐级导管扩张术30例,行球囊导管扩张术26例。对比分析腹腔镜下胆总管探查中行逐级导管扩张术（以下简称逐级导管组）及球囊导管扩张术（以下简称球囊导管组）的临床治疗效果。结果 56例手术均成功,围手术期均无死亡或其他严重并发症发生。两组术后氨基转移酶（AST和ALT）、直接胆红素（DBIL）、手术时间、术中出血量、术后并发症等情况差异无统计学意义（P＞0.05）;两组在鼻胆管拔除时间、术后住院时间、术后血淀粉酶值、术后胃肠功能恢复时间方面存在差异,有统计学意义（P＜0.05）。结论 腹腔镜下胆总管探查术中逐级导管扩张或球囊导管扩张均可保护十二指肠乳头及Oddi括约肌的正常生理功能,安全有效地解除胆总管下段狭窄,术后并发症少、恢复快。     

ERCP with the double balloon enteroscope in patients with Roux-en-Y anastomosis

Background

Endoscopic retrograde cholangiopancreatography (ERCP) is technically more challenging in patients with postsurgical anatomy. We assessed the technical success of performing ERCP with the double balloon enteroscope (DBE) in patients with Roux-en-Y anastomosis.

Methods

This is a prospective evaluation of patients with Roux-en-Y anastomosis who underwent ERCP with the DBE. Diagnostic success was defined as successful duct cannulation or securing the diagnosis, and therapeutic success was defined as the ability to treat the underlying disorder. Complications of ERCP were defined according to standard criteria.

Results

ERCP using the DBE was performed on 17 occasions in 11 patients (10 men; mean age, 59.7 (range, 36–77) years) with Roux-en-Y anastomosis with or without hepaticojejunostomy. Indications for ERCP: biliary obstruction or cholestasis (n = 11). The overall diagnostic success was 82%, and the therapeutic success was 58%. Reasons for failed biliary cannulation included: inability to reach the proximal end of the afferent loop (n = 1), impossibility to advance the wire into the CDB despite adequate insertion of the biliary catheter into the distal CBD (n = 2), and inability to advance the stent over an adequately placed guidewire (n = 1). One major complication occurred (5.8%): perforation of the hepaticojejunostomy in a patient with recurrent choledocolithiasis, which was successfully resolved surgically.

Conclusions

ERCP using the DBE is feasible in patients with complex postsurgical anatomy, permitting diagnostic and therapeutic interventions in 82% and 58% of cases, respectively. Nevertheless, due to the complex anatomy, presence of adhesions, and looping of the usually long limbs complications can occur.     

肝段门静脉球囊导管阻断联合区域性肝动脉阻断在肝癌肝切除术的应用

目的 探讨肝段门静脉球囊导管阻断联合区域性肝动脉阻断下的肝切除术治疗肝细胞癌的临床应用效果。方法 2007年7月至2010年6月南昌大学第二附属医院对48例肝细胞癌病人行应用肝段门静脉球囊导管阻断联合区域性肝动脉阻断下的肝切除术（A组）,同时将应用常规肝切除术70例病人分为Pringle法阻断组（B组,n=36）和肝门区域性血管阻断组（C组,n=34）,比较三组的手术时间、术中出血量和术后肝功能指标。结果 三组病人均无手术死亡。A组手术时间较C组短,A组与B组比较差异无统计学意义;A组术中出血量少于C组,A组与B组比较差异无统计学意义;A组术后肝功能恢复较B组快,A组与C组比较差异无统计学意义。结论 肝段门静脉球囊导管阻断联合区域性肝动脉阻断下的肝切除术是安全有效的手术方式,对于有适应证的肝细胞癌病人,采用此术式可获得较好的疗效。     

The use of a balloon catheter to improve evaluation in anorectal manometry

The squeeze pressure in the anal canal reflects the contribution of the external anal sphincter and is normally assessed manometrically by asking patients to contract their anal muscles. However, this is an artificial situation as normally the external sphincter contracts to retain rectal content. Some patients with normal anal sphincter anatomy and innervation record low squeeze pressures suggesting that the concept of voluntary squeeze is foreign. The aim of this study was to examine whether squeezing to retain a balloon mimics the physiology of defaecation more accurately. Patients undergoing routine anorectal manometry testing had in addition the inflation of a balloon catheter to the volume of the first and sustained sensation to simulate a faecal bolus within the rectum. The patient was asked to retain it when the balloon was subjected to gentle traction, thus contracting their anal sphincter to prevent passage of the balloon. Squeeze pressure was measured in response to voluntary contraction, the pressure generated to retain the balloon, then voluntary contraction again. Eighteen women and 2 men were tested. The median maximal squeeze pressures with the routine assessment was 131.0 cmH2O. This increased to 210.0 cmH2O when the patients attempted to retain the balloon and fell to 165.4 cmH2O when patients were reassessed with voluntary squeeze postintervention. 15 of the patients improved their squeeze pressures with traction on the balloon. External anal sphincter contraction is difficult for some patients to perform on request. With traction on a balloon catheter anal squeeze pressures improved in most patients. This indicates that many patients perform maximal anal squeeze pressures better once that muscle group has been tested in a more normal physiological function. This simple technique could improve the accuracy of anorectal manometry results and evaluation in a larger population of symptomatic patients is warranted.     

Late‐onset venous outflow obstruction treated by placement of a Foley balloon catheter in living donor liver transplantation using a left lobe

Nomura R, Ishizaki Y, Sugo H, Yoshimoto J, Imamura, H, Kawasaki S. Late‐onset venous outflow obstruction treated by placement of a Foley balloon catheter in living donor liver transplantation using a left lobe.
Clin Transplant 2010: 24: 723–725. © 2010 John Wiley & Sons A/S. Abstract: A 60‐yr‐old man having hepatitis C virus‐associated liver cirrhosis and hepatocellular carcinoma underwent living donor liver transplantation using a left liver graft. On post‐operative day 20, the patient developed a large amount of ascites and hypovolemic shock because of decreased venous return. Emergency laparotomy revealed that fixation of the round ligament to the abdominal wall was loose, and free movement of the graft into the right subphrenic space had caused twisting the hepatic vein. After upward traction of the round ligament, two Foley balloon catheters were inserted into the right subphrenic space to maintain the graft in the midline portion. The catheters with the balloons were removed on day 30 after re‐operation. This method is easy, simple and inexpensive for the treatment of hepatic venous outflow block after partial liver transplantation.