Laparoscopic versus open surgery in the treatment of hepatic hemangioma: A meta-analysis

Background:The aim of this study was to systematically evaluate and compare the effectiveness and safety of laparoscopic versus open resection (LR vs OR) in the treatment of hepatic hemangioma.Methods:We searched PubMed, the Cochrane Library, Web of Science, Medline, EMBASE, and the Chinese Biomedicine Database from January 2000 to April 2020 for studies comparing the outcomes of laparoscopic versus open surgery in hepatic hemangioma treatment.Results:Based on the preset criteria, 12 randomized clinical trials (RCTs) and 12 observational clinical studies (OCSs) were selected for analysis. Our results showed that laparoscopic surgery was more effective than open surgery in terms of reducing operation time, intraoperative blood loss, postoperative exhaust time, postoperative complications, postoperative bile leak, postoperative intra-abdominal infection, postoperative alanine aminotransferase (ALT) and aspartate aminotransferase (AST) values, postoperative visual analog scale (VAS) scores, and hospitalize length. No significant differences were found between the 2 groups in hepatectomy time, hospitalized cost, intra-abdominal hemorrhage, and the postoperative recurrence of hemangioma.Conclusion:While similar therapeutic effect was achieved by the compared herein surgical methods, the findings of our analysis revealed that laparoscopic surgery is superior over open surgery in terms of less trauma, faster recovery, less postoperative pain, shorter hospitalize length, and reduced postoperative complications. Therefore, laparoscopic resection of hepatic hemangioma is a safe, effective, and feasible surgical method that is worth considering in clinical applications.     

l-Ornithine-l-aspartate in the management of hepatic encephalopathy: A meta-analysis

Background and Aim:  Hepatic encephalopathy continues to be a major clinical problem and the current decade has not witnessed major therapeutic breakthroughs in this area. l -ornithine- l -aspartate (LOLA) is not frequently used as there are still some reservations about its benefits. The present study aimed to assess the effectiveness and safety of LOLA in the management of hepatic encephalopathy.
Methods:  We used the method recommended by the Cochrane Collaboration to perform a meta-analysis of randomized controlled trials of LOLA therapy for hepatic encephalopathy including three randomized controlled trials.
Results:  Three randomized trials randomizing 212 patients were included. LOLA versus placebo had a significant effect on improvement of hepatic encephalopathy (relative risk 1.89; 95% CI 1.32 to 2.71; P  = 0.0005). This comparison showed no statistical heterogeneity ( P  = 0.85 and χ² = 0.09). Subgroup analysis showed that LOLA could be effective versus placebo in trials with grade I or II overt hepatic encephalopathy patients (relative risk 1.87; 95% CI 1.30 to 2.68; P  = 0.0007) and had no significant effect in trials with subclinical hepatic encephalopathy patients (relative risk 1.69; 95% CI 0.72 to 3.94; P  = 0.23). Adverse effects were observed in only three patients treated with LOLA in one report.
Conclusions:  LOLA benefited patients with overt hepatic encephalopathy (I or II), whereas these data do not support the use of LOLA for patients with subclinical hepatic encephalopathy.     

Compound Biejia-Ruangan tablet as an adjunctive therapy to entecavir for chronic hepatitis B complicated with hepatic fibrosis: A systematic review and meta-analysis of randomized controlled trials

Background:The compound Biejia-Ruangan tablet (CBRT), as an adjunctive therapy to entecavir, is a potential treatment for hepatic fibrosis (HF) in patients with chronic hepatitis B (HBV). However, the present study yielded inconsistent results. In this systematic review and meta-analysis, we comprehensively investigated the efficacy and safety of CBRT as an adjunctive modality to entecavir for the treatment of HBV infection complicated with HF.Methods:We searched the Cochrane Library, PubMed, Embase, CNKI, VIP, CBM, and Wangfang databases through April 1, 2022, for randomized controlled trials (RCTs) assessing the effect and safety of CBRT as an adjunctive modality to entecavir for HBV complicated with HF. The primary outcomes were biochemical parameters of serum hyaluronic acid, laminin (LN), pretype-III collagen (PC-III), and type IV collagen (IV-C). The secondary outcomes were liver function indices of serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), and total bilirubin (TBiL) levels, total effect rate, and occurrence rate of adverse events. Two researchers independently conducted study selection, data extraction, and quality assessment. Statistical analysis was performed using the RevMan 5.3 software.Results:Eight RCTs involving 747 patients were included. Compared with entecavir monotherapy, CBRT as an adjunctive therapy to entecavir exerted more encouraging effect in serum levels of hyaluronic acid (mean difference [MD] = –28.15; 95% confidence interval [CI]: –43.82 to –12.47; P < .001), LN (MD = –29.46; 95% CI: –50.69 to –8.23; P < .001), PC-III (MD = –11.83; 95% CI: –19.43 to –4.23; P < .001), and IV-C (MD = –19.62; 95% CI: –29.76 to –9.49; P < .001); levels of serum ALT (MD = –16.83; 95% CI: –26.30 to –7.36; P < .001), AST (MD = –20.52; 95% CI: –33.11 to –7.93; P < .001), and TBiL (MD = –7.54; 95% CI: –11.58 to –3.49; P < .001); and total effect rate (odds ratio = 3.53; 95% CI: 1.71–7.29; P < .001). Meta-analysis results also showed that CBRT as an adjunctive therapy to entecavir had a lower occurrence rate of adverse events (odds ratio = 0.54; 95% CI: 0.22–1.34; P < .001) than entecavir alone.Conclusion:The results of this study showed that CBRT as an adjunctive modality to entecavir may benefit HBV patients complicated with HF. High-quality RCTs are needed to confirm the current findings in the future.     

Significance of septal fibrosis for disturbance of hepatic circulation

Abstract: To examine the significance of fibrous septa of the liver for hepatic circulatory disturbance, haemodynamic changes were investigated in rats with septal fibrosis induced with horse serum injections. The fibrotic liver showed thin fibrous bands originating in the vicinity of the peripheral branches of the hepatic vein connected with each other and partly with the portal triads, without conspicuous periportal, pericentral or perisinusoidal fibrosis. There was no evidence of hepatic cell enlargement, disarrangement of hepatic cell plates or narrowing of the sinusoids in the fibrotic livers. Portal vascular resistance, bile production and hepatic oxygen consumption, which were measured by an isolated liver perfusion method, were much the same in the normal and the fibrotic livers. Moreover, there was no significant difference in in vivo blood pressures of the portal vein, the terminal portal venule, the terminal hepatic venule and the inferior vena cava between the normal and the fibrotic rats. These data suggest that septal fibrosis in itself does not disturb hepatic circulation.     

微生态制剂治疗肝性脑病的荟萃分析

[目的]评价微生态制剂治疗肝性脑病的疗效和安全性。[方法]采用计算机检索方式,检索Medline、PubMed、Embase、中国生物医学文献数据库、维普中文科技期刊全文数据库和中国期刊全文数据库,纳入微生态制剂治疗肝性脑病的随机对照试验(RCT),采用Revman 5.2软件对资料进行系统分析。[结果]共纳入7篇RCT,包括604例患者。分析显示:微生态制剂能有效提高患者的临床缓解率,明显降低血氨水平,改善数字连接试验(NCT-A),与乳果糖制剂相比两者效果相似,而明显优于安慰剂/空白对照组,且总体不良反应少。[结论]现有的临床证据表明,微生态制剂对于治疗肝性脑病疗效肯定,可以作为临床治疗的一种选择。     

威灵仙对实验性肝纤维化的干预作用

[目的]通过比较肝纤维化模型组、威灵仙组、虎杖组、丹参组、易善复组及正常对照组大鼠肝脏的肝纤维化分期,探讨威灵仙在肝纤维化中的干预作用和意义.[方法]成年雄性SD大鼠120只,随机分为模型组、威灵仙组、虎杖组、丹参组、易善复组和正常对照组共6组,每组20只.通过四氯化碳诱导制备肝纤维化大鼠模型,同时分别用威灵仙、虎杖、丹参及易善复治疗,设立正常对照组,10周后光镜观察肝脏组织学改变,进行肝纤维化分期,使用统计学方法进行分析.[结果]造模结果：10周末随机抽取模型组大鼠2只,经病理检查证实肝纤维化模型造模成功.各组肝纤维化分期：模型组（3.22±0.65）,正常对照组0,威灵仙组（1.20±0.62）,虎杖组（1.32±0.48）,丹参组（1.30±0.57）,易善复组（1.45±0.69）.模型组、威灵仙组、虎杖组、丹参组和易善复组肝纤维化分期均明显高于正常对照组,差异均有统计学意义（P＜0.01）;威灵仙组、虎杖组、丹参组和易善复组肝纤维化分期均明显低于模型组,差异均有统计学意义（P＜0.01）,而威灵仙组、虎杖组、丹参组和易善复组之间肝纤维化分期比较差异无统计学意义（P＞0.05）.[结论]威灵仙能有效干预实验性肝纤维化,且与虎杖、丹参、易善复无明显差异,可为临床上中医药和中西医结合治疗肝纤维化提供新思路和重要理论依据.     

复方鳖甲软肝片抑制大鼠酒精性肝纤维化的实验研究

目的探讨复方鳖甲软肝片对实验性大鼠酒精性肝纤维化的抑制作用机制。方法40只Wistar雄性大鼠随机分为正常组、模型组、中药组和西药组。模型组、中药组、西药组以“酒精-吡唑-玉米油”混合液灌胃并饲以高脂饮食,正常组每天用生理盐水灌胃,并以普通饲料喂养。16周后中药（复方鳖甲软肝片）组和西药（复方牛胎肝提取物片）组开始药物治疗。给药4周后检测血生化、肝组织病理学变化、肝组织中TGF—B1蛋白表达变化。结果酒精性肝纤维化模型大鼠肝功能显著异常,肝纤维化明显。经4周治疗,与模型组比较,中药组及西药组血清中ALT、AST、HA含量显著下降（P〈0．01）。光镜观察结果显示,中药组和西药组大鼠肝血窦周围胶原明显减少,相邻血窦间的纤维联络基本消失。免疫组化染色结果显示,中药组大鼠肝组织中TGF—β1蛋白含量显著下降。结论复方鳖甲软肝片通过下调TGF—β1表达抑制胶原纤维的产生,阻止纤维化的发展,从而有效阻止和逆转酒精性肝纤维化的进程。     

激动素抗大鼠肝纤维化的实验研究

目的:研究激动素对实验性肝纤维化的影响,探讨作用机制。方法:用CCl4诱导形成大鼠肝纤维化模型,使用0.1%激动素溶液0.5ml.100g-1.d-1,背部皮下注射,治疗12周,设正常对照组和模型组。血清ALT用全自动生化分析仪检测,血清透明质酸(HA)、层黏连蛋白(LN)、Ⅲ型前胶原(PCⅢ)和Ⅳ型胶原(CⅣ)含量用RIA方法检测。肝组织学检查:采用苏木精-伊红染色观察肝组织炎症和纤维化程度。结果:激动素组ALT水平与模型组ALT水平分别为(57.40±17.49)U/L和(84.70±31.85)U/L,两组比较差异有显著性意义(P<0.05)。激动素组LN和CⅣ含量分别为(29.25±6.67)ng/ml和(14.84±5.84)ng/ml,较模型组(37.18±10.06)ng/ml、(35.69±30.84)ng/ml明显降低(P<0.05);激动素组HA和PCⅢ含量分别为(136.25±76.83)ng/ml和(11.43±3.67)ng/ml,较模型组(168.55±56.19)ng/ml、(14.64±8.00)ng/ml有不同程度降低,但无统计学意义。组织学检测结果表明,模型组肝脏炎症和纤维化程度明显高于激动素组。结论:激动素对实验性大鼠肝纤维化具有抑制作用。     

肝纤维化大鼠血清有机膦酸酯酶的变化

目的:探讨肝纤维化大鼠血清有机磷酸酯酶的变化。方法:用四氯化碳诱导大鼠产生肝纤维化,分别于第4,8,12,14周用荧光分光法测定血清有机膦酸酯酶(PE)水平,并与血清PCⅢ,HA进行比较。结果:于实验第4,8,12,14周,大鼠血清PE水平分别为168.6±40.0,212.9±32.1,271.5±40.6与243.1±83.1IU/L,均明显高于正常大鼠(91.0±25.0IU/L)。与血清PCⅢ及HA呈显著正相关。结论:肝纤维化时血清PE明显升高,且与肝纤维化程度呈正相关,可作为肝纤维化诊断的血清学指标之一。     

Role of hepatic vitamin A and lipocyte distribution in experimental hepatic fibrosis

ABSTRACT— Lipocytes are the major site of hepatic vitamin A storage, and they have been demonstrated to lose their vitamin A content in the process of hepatic fibrosis. To investigate the relationship between hepatic vitamin A content and the degree of hepatic fibrosis, we measured levels of retinyl palmitate and retinol in the CCl₄-induced fibrotic liver using high-performance liquid chromatography. We estimated hepatic collagen content using a spectrophotometric analysis with sirius red, and also by measuring hydroxyproline levels. Lipocytes were detected by an immunoperoxidase method with anti-desmin antibody, and were counted morphometrically through a Texture Analyzing System. A significant negative correlation was observed between the level of retinyl palmitate and collagen content (r = –0.64) as well as the hydroxyproline level (r = –0.69) in the CCl₄-induced fibrotic liver. In the process of fibrosis, hepatic retinol levels were elevated in association with a decrease in retinyl palmitate. In particular in the early stage of fibrosis, lipocytes increased remarkably in number in fibrotic areas in spite of a decrease in total hepatic vitamin A. The present study suggests that an increase in hepatic retinol as well as a decrease in retinyl palmitate may facilitate the process of hepatic fibrosis produced by lipocytes.     

人参皂苷Rbl抗肝纤维化的实验研究

目的：观察三七总苷单体成分人参皂苷Rbl对实验性肝纤维化的作用。方法：用50%四氯化碳造成大鼠肝纤维化模型,共35天,同时给予三七总皂苷单体成分人参皂苷Rbl治疗,于第5周（实验结束）时检测肝功能、血清Ⅲ型前胶原（PCⅢ）、透明质酸（HA）、层黏连蛋白（LN）,同时分离肝组织,光镜观察肝组织病理变化。结果：三七总皂苷能改善肝纤维化大鼠的肝功能,降低血清PCⅢ、HA、LN含量,明显减轻肝组织胶原的沉积,改善肝纤维化程度;而人参皂苷Rbl不能改善肝纤维化程度。结论：人参皂苷Rbl不具有抗肝纤维化的作用,人参皂苷Rbl不是三七总苷抗肝纤维化的有效成分。     

Congenital hepatic fibrosis in Indian children

BACKGROUND: Congenital hepatic fibrosis (CHF) is an uncommon cause of portal hypertension in children. So far, there is no report of this from the subcontinent. We have studied the clinical spectrum of CHF in North Indian children. METHODS: Fifteen children were diagnosed with CHF on the basis of their liver histology over a period of 6.5 years. Their clinical details were recorded. Oesophagogastroduodenoscopy and abdominal ultrasonography were performed in all cases. All siblings were examined clinically; and ultrasonography, endoscopy and liver biopsy were performed if there was firm hepatomegaly. Children with variceal bleeding were managed by endoscopic sclerotherapy. The median age of these children was 8 years with a male to female ratio of 1.5:1. RESULTS: Only one sibling (of 33) was diagnosed as having CHF. The predominant presentations were variceal bleeding in six, abdominal distension in seven and incidental detection of organomegaly in two. Hepatomegaly was present in all patients and splenomegaly in all but one. Liver function and renal function tests were normal in all children, except for a raised serum alkaline phosphatase in six. Two children had associated renal cysts, two had choledochal cysts, one each had Caroli's disease and biliary atresia and two children had portal vein thrombosis. Variceal obliteration was achieved in five children after an average 4.8 sclerotherapy sessions and one required a mesocaval shunt. On follow up (median 41 months, range 1-80 months) all are doing well. CONCLUSIONS: Congenital hepatic fibrosis is mainly sporadic in India and associated renal lesions are uncommon. Endoscopic sclerotherapy is effective in controlling variceal bleed and the prognosis is universally good in the absence of renal diseases.     

肝纤维化血清学无创检测研究进展

肝纤维化指肝脏细胞外基质弥漫性的过度沉积,是机体对于肝实质损伤的一种修复反应及许多慢性肝病共同的病理过程,也是各种慢性肝病向肝硬化发展的重要步骤.迄今为止,临床尚缺乏特异性有效逆转或阻止肝纤维化进展的药物,尽早对肝纤维化进行诊断具有重要意义.目前肝纤维化的诊断主要靠组织病理学、血清学标志物及影像学手段.肝活检被认为是肝...     

蝎仙口服液治疗慢性肝病肝纤维化的临床研究

目的：观察自制中药蝎仙口服液对慢性肝病肝纤维化的临床疗效。方法：60例慢性肝病肝纤维化患者随机分为两组：治疗组30例给予蝎仙口服液口服，对照组30例则予安慰剂生理盐水口服，两组均常规使用肝太乐、肌苷、VitC、VitBco片口服；治疗前后检测患者血清透明质酸（HA）、层粘蛋白（LN）、Ⅳ型胶原（Ⅳ-C）水平，观察主要症状和体征，肝功能指标及肝脏B超声像图情况。结果：治疗组治疗前后HA、LN和Ⅳ-C的水平比较差异有显著性意义（P〈0．01）。两组间在脾脏回缩、ALT、Alb、GGT及HA、LN和Ⅳ-C方面比较差异有显著性意义（P〈0．01）。结论：蝎仙口服液对慢性肝病肝纤维化患者有较好的抗肝纤维化作用。     

慢性乙型肝炎血浆内毒素与肝纤维化指标及肝脏病理的关系

探讨慢性乙型肝炎血浆内毒素水平与肝纤维化指标及肝脏病理的关系 ,住院的 75例慢性乙型肝炎患者采用基质显色法检测血浆内毒素 (ET)水平 ,同时用放射免疫法测定血清肝纤维化指标 :HA、LN、PC—Ⅲ和Ⅳ—C ,以同期健康体检正常者 15例作对照。并对其中 2 0例患者行肝组织活检。结果显示 :慢性乙型肝炎患者血浆内毒素水平与肝纤维化指标呈正相关 ;活检病例病理分级、分期与血清肝纤化指标及内毒素水平存在相关性。血清肝纤维化指标与内毒素水平可作为肝脏病理损害的判断指标之一 ;内毒素血症在肝纤维化发生发展中起重要作用     

血瘀型肝纤维化大鼠模型的建立与评价

目的：复制血瘀型肝纤维化大鼠病证结合动物模型。方法：采用复合多因素的造模方法，在DMN（二甲基亚硝胺）制作大鼠肝纤维化模型的同时，多次静脉培予去甲肾上腺素和小牛血清白蛋白综合追模，对模型大鼠进行血瘀证的体征观察，采用多部位微循环显微镜行肠系膜微循环检测，并进行肝脏病理组织学观察。结果：模型（血瘀组）大鼠出现明显的血瘀表现，血瘀证候积分明显高于DMN组；血瘀组大鼠肠系膜微血管均出现典型微循环障碍。肠系膜血管管径血瘀组较DMN组增粗显著（P〈0．01）；血瘀组红细胞聚集明显。血囊流态以粒流或粒缓流为主。肝脏病理显示血瘀组纤维化改变程度较DMN组更严重，部分肝窦中可见明显扩张瘀血。结论：病证结合动物模型既具备肝纤维化的病理特征。又符合中医血瘀证的证候表现。     

螺内酯防治实验性大鼠肝纤维化作用研究

探讨螺内酯对肝纤维化的防治作用。雄性SD大鼠46只,随机分成对照组(6只);模型组(30只),复合因素制成肝纤维化模型;螺内酯预防组(10只),造模方法同模型组,螺内酯每天100mg·11ml灌胃。于第8W末,将模型组(16只)再随机分为A组(肝硬化组)8只,用等量自来水灌胃;B组(螺内酯治疗组)8只,螺内酯灌胃8w。分别观察肝内纤维组织变化。显示螺内酯预防组肝脏I、Ⅲ型胶原、纤维连接蛋白、层粘蛋白增生明显减低(PO.05)。