经肝动脉灌注平阳霉素碘油乳剂对兔正常肝脏组织的影响

目的：探讨平阳霉素碘油乳剂（PLE）经肝动脉灌注对兔正常肝脏组织的影响。方法：14只4～5个月龄日本大耳白兔，体重（2.5±0.2）kg，按注入生理盐水或PLE的量分为假手术组、实验A组（低剂量组）和实验B组（高剂量组）。各组兔均开腹穿刺肝动脉，按分组剂量注入PLE。术后1，2，4，6周取病理切片，HE染色，光镜下观察肝脏组织学改变;免疫组织化学（免疫组化）染色标记血小板衍化生长因子B链（PDGF-B），并行图象分析。结果：A组HE染色肝细胞呈一过性水样变，变性在2周时最重，至6周已明显减轻。B组HE染色2周时肝细胞明显水样变，4周时可见汇管区纤维组织增生，6周时部分肝组织出现明显假小叶结构。免疫组化染色显示，PDGF-B在肝细胞胞膜及纤维间隔中有明显表达。结论：经肝动脉灌注PLE可导致正常肝脏组织产生不同程度的肝纤维化;PDGF-B参与了肝纤维化的病理过程。     

医用胶原蛋白海绵治疗重度肝破裂的临床研究

目的：探讨医用胶原蛋白海绵对重度肝破裂创面的治疗作用。方法：将重度肝破裂患者以入院先后为序，随机分成治疗组（68例）和对照组（64例）。治疗组和对照组分别用医用胶原蛋白海绵片和明胶海绵片对肝创面进行止血和填塞。结果：治疗组的止血时间为(19.65±1.28)min，术中出血量为(301.57±56.18)mL均少于对照组［分别为(34.3±1.2)min及(642.3±61.8)mL］(均P<0.05)。治疗组术后腹腔引流量为(380.45±12.34)mL,并发胆瘘(1.5%)及再出血(3.0%)均少于对照组［分别为(693.2±219.4)mL,6.3%及9.5%］(均P<0.05);治疗组术后住院时间(24.01±4.89)d短于对照组(35.8±5.9)d(P<0.05)。术后CT复查显示治疗组创面肝组织修复时间(30.30+6.42)d短于对照组(62.1±7.2)d(P<0.05)。结论：胶原蛋白海绵对肝创面止血效力强于明胶海绵，与创面的黏附力强，术后并发症少，恢复快，是一种治疗肝破裂的有效、安全而可靠的生物材料。     

Bcl-2反义寡核苷酸对VP-16抑制人胆管癌细胞株增殖和诱导凋亡的影响

目的:探讨bcl-2 反义寡核苷酸（ASODN）对VP-16抑制人胆管癌QBC939细胞生长和诱导细胞凋亡的影响。方法:合成特异性靶向Bcl-2 ASODN，并将其转染QBC939细胞;四甲基噻唑蓝（MTT）试验检测Bcl-2 ASODN对VP-16抑制QBC939细胞增殖的影响;流式细胞术观察Bcl-2 ASODN对VP-16诱导QBC939细胞凋亡的影响。结果:ASODN组细胞的存活率显著低于无义寡核苷酸（NSODN）组(P＜0.05);ASODN+VP-16组细胞存活率显著低于ASODN组及VP-16组(P＜0.05);ASODN组、ASODN+VP-16组和VP-16组细胞凋亡率显著高于对照组和NSODN组（P＜0.05);ASODN+VP-16组细胞凋亡率显著高于ASODN组及VP-16组(P＜0.05)。结论:Bcl-2 ASODN对VP-16抑制人胆管癌QBC939细胞生长和诱导细胞凋亡有促进作用。     

小鼠全肝缺血再灌注时肺泡巨噬细胞TLR2的激活与肺损伤的机制

目的：探讨肺泡巨噬细胞Toll样受体2（TLR2）的激活机制及其在肝脏缺血再灌注（HIR）中肺损伤的意义。方法：用野生型小鼠C3h/Heouj和TLR4缺失小鼠C3h/Hej建立HIR动物模型。于再灌注1，6，12h后经支气管肺泡灌洗液获取肺泡巨噬细胞，采用荧光定量PCR方法检测TLR2/4mRNA的表达。同时检测支气管肺泡灌洗液中内毒素及肿瘤坏死因子（TNF）的水平，肺组织湿干重比值，肺组织髓过氧化物酶的浓度，并进行肺组织学评分。结果：C3h/Heouj组HIR缺血再灌后各时点肺泡巨噬细胞TLR2/4mRNA表达升高，TLR2mRNA表达持续升高，TLR4mRNA6h达到最高值。同时C3h/Heouj组HIR后支气管肺泡灌洗液中TNF水平明显升高，肺损伤加重，肺组织湿干重比值持续升高，肺组织髓过氧化物酶持续增加(P<0.05)。C3h/Hej组HIR后TLR2mRNA表达仅轻度升高，且支气管肺泡灌洗液中TNF水平低于C3h/Heouj组(P<0.05)，肺损伤轻于C3h/Heouj组(P<0.05)。结论：HIR可致肺泡巨噬细胞表面TLR4的激活，可上调TLR2的表达，从而可加重HIR时的肺损伤。     

腹腔镜联合纤维胆道镜行胆总管切开取石30例临床观察

目的:探讨电视腹腔镜胆总管切开纤维胆道镜取石在胆囊良性疾病合并胆管总管结石治疗中的应用效果。方法:总结分析30例胆囊良性疾病合并胆总管结石行腹腔镜胆囊切除+胆总管切开纤维胆道镜取石T 形管引流治疗的临床资料。结果:28例治愈，残留结石2例（经T管再次纤维胆道镜取尽治愈）。平均住院天数9 d。结论:腹腔镜联合纤维胆道镜行胆囊切除+胆总管切开取石 T 管引流术治疗胆囊良性疾病合并胆总管结石是安全、有效的。     

胆内瘘:附32例漏诊分析

目的:探讨胆内瘘术前漏诊的原因及减少漏诊的方法。方法:回顾性分析32例胆内瘘漏诊患者的临床资料,平均年龄52.1(25~72)岁,患者分别行B超,T管造影,消化道钡餐,胃镜,胆道镜,ERCP,PTC检查,所有患者均行手术治疗。结果:32例均为术前漏诊者,占同期收治的44例胆内瘘的72.73%。32例均术中确诊。结论:胆内瘘术前漏诊率高,应提高对该病的警惕性;注意寻找该病的特征性表现;尤其当B超发现有胆道积气时,应行进一步检查 如内镜和造影检查,这是提高术前诊断的重要方法。     

医源性血管损伤的救治:附24例报告

目的：总结医源性血管损伤的防治经验。方法：对3年来救治的24例各种医源性血管损伤的临床资料进行回顾性分析。结果：24例中肠系膜上动脉、静脉损伤7例，门静脉损伤3例，颈动脉损伤4例，髂、股动脉损伤6例，其他为腘动脉、腋动脉、肾动脉、胃左动脉等损伤。治疗方法：血管修补6例，血管吻合5例，血管置换2例，血管结扎3例，介入下带膜支架型人工血管封堵2例，其他为取栓、溶栓、填塞等处理。24例中22例成功治愈，1例术后24h大出血死亡，1例术后5d死亡。结论：医源性血管损伤只要高度重视，辨明解剖、充分准确、仔细操作是可以预防和减少的。一旦发生医源性血管损伤要查找原因，针对情况选择不同的处理方式，若缺乏有效的处理技术应及时求援或转院治疗。     

原位肝移植中受体血管异常时的肝动脉重建

摘要：目的 探讨原位肝移植中动脉异位重建的方法及效果。 方法 回顾性分析我院10年来的440例肝移植中36例因受体血管异常而行异位重建的方法及术后处理措施等。 结果 36例中行供肝动脉与受体肾下腹主动脉吻合20例，与肾上腹主动脉吻合10例，与胃左动脉吻合4例，与脾动脉吻合2例。5例围手术期死亡，但吻合口通畅，31例存活3个月至4年无血管相关并发症，仅1例术后2个月因胆道缺血坏死行再次肝移植。 结论 肝移植时受体肝动脉有病变或异常改变时，应将受体肾下或肾上腹主动脉、脾动脉、胃左动脉与供肝动脉进行异位重建，可取得满意效果。     

In sight on multiple morphological abno rmalities of sperm flagella in male infertility:what is new?

The syndrome of multiple morphological abnormalities of the sperm flagella(MMAF)is a specific kind of asthenoteratozoospermia with a mosaic of flagellar morphological abnormalities(absent,short,bent,coiled,and irregular flagella).MMAF was proposed in 2014 and has attracted increasing attention;however,it has not been clearly understood.In this review,we elucidate the definition of MMAF from a systematical view,the difference between MMAF and other conditions with asthenoteratozoospermia or asthenozoospermia(such as primary mitochondrial sheath defects and primary ciliary dyskinesia),the knowledge regarding its etiological mechanism and related genetic findings,and the clinical significance of MMAF for intracytoplasmic sperm injection and genetic coun sell ng.This review provides the basic kno wledge for MMAF and puts forward some suggestions for further investigations.     

CD44V6,c-Met在原发性肝癌中的表达及其临床意义

摘要：目的:探讨黏附分子CD44V6与原癌基因c-Met共同在原发性肝癌中的表达、相关性及其与临床病理指标、复发、预后之间的关系。方法:采用免疫组织化学方法检测50例肝癌组织及46例癌旁组织中CD44V6,c-Met的表达情况，并分析肝癌细胞中CD44V6,c-Met的表达与临床资料的关系。结果:(1)CD44V6在肝癌组织中的阳性表达率为30.0%，CD44V6表达与静脉侵犯明显有关(P<0.05)。(2)c-Met阳性表达率为52.0%，c-Met表达与Edmondson分级明显有关(P<0.05)。(3) CD44V6与c-Met表达呈有关(P<0.05)。(4)CD44V6,c-Met阳性表达患者较CD44V6,c-Met阴性表达患者术后2年内的复发率明显升高（P<0.05）；CD44V6,c-Met阳性表达组术后生存率均明显低于阴性表达组（P<0.01）。结论:CD44V6,c-Met在肝癌的发生、发展有重要作用。     

辅助性肝移植治疗大鼠急性肝功能衰竭的实验研究

目的探讨辅助性肝移植对急性肝功能衰竭（简称肝衰）的治疗作用。方法在３０只肝功能衰竭大鼠模型上,于原残肝下移植同系异体６２％部分肝脏,手术成功２８例。观察了肝衰组和移植组大鼠存活、血液生化、９９ｍＴｃＨＩＤＡ肝显像、残肝和移植肝组织细胞形态改变。结果肝衰组（１５只）和移植组（２８只）大鼠４８小时存活率分别为０％和７１．４％。移植术后１４天残肝细胞明显增生,肝功能基本恢复正常,辅助肝开始萎缩,术后３０天辅助肝完全纤维化。结论辅助性部分肝脏异位移植可为衰竭之残肝提供暂时性功能支持。原残肝细胞再生,功能恢复过程中辅助肝逐渐萎缩、废用     

原发性肝癌与非肝癌病人行肝移植治疗的比较研究

目的：探讨我国目前肝癌与非肝癌病人行肝移植治疗的风险及长期生存效果。方法：回顾性总结21例晚期肝癌病人行肝移植手术治疗风险及长期生存情况，并与同期所行另外19例非肝癌病人的肝移植进行比较。结果：晚期肝癌病人的手术前凝血状态好于因其它非肝癌原因而接受肝移植的病人，与此相应的手术中出血量、需要输血量、术中输液总量均少于非肝癌病人，手术中因出血而导致的低血压时间短，手术后较恢复顺利，围手术期病死率低。虽然肿瘤复发所致的远期死亡率明显高于非肝癌病人，但是，总生存率与非肝癌病人无明显区别，部分病人可长期无瘤生存。结论：现阶段肝移植仍是失去根治性切除机会的肝癌病人的有效治疗手段，术后部分病人有无瘤长期生存的可能性。     

How to estimate the size of the donor liver

Abstract  Of readily available methods to estimate the donor liver size, measurement of the body circumference at the xiphoid level (xiphoid measure) appeared to be the most accurate in the present prospective study of 60 donors and 57 recipients ( r = 0.64, P = 0.0001). The estimated liver volume could be calculated using the equation: bloodless liver volume (1) = 1.44 x xiphoid measure (m). The difference between donor and recipient xiphoid measures was significantly higher in slowly recovering patients than in those recovering uneventfully (7 ± 7 cm vs. - 5 ± 8 cm, P < 0.001). The bloodless donor liver volume measured by water displacement averaged 1249 k 230 ml and had increased by 3 weeks post-transplant by 64 ± 28 % as determined using computed tomography. The volume of the liver graft seemed to adapt to the recipient as it correlated positively with body weight ( r = 0.64, P < 0.01) and negatively with the age of the recipient (r = - 0.42, P < 0.01). The liver graft volume seemed to increase less markedly in patients with a slow recovery than in those with an uncomplicated recovery (37 %±15 % vs. 68 %± 24 %, P< 0.001). We conclude that a simple measurement of the body circumference at the xiphoid level can be used to estimate the donor liver volume. A gross mismatch of this parameter between the donor and the recipient seems to increase the risk of graft dysfunction. We also found that the change in the liver graft volume is influenced by the recipient's age and body weight.     

术前肝脏储备功能评估方法的研究进展

肝切除术是肝脏外科疾病,尤其是肝细胞癌的重要治疗手段。在我国,绝大多数肝癌患者合并有肝硬化等肝实质的广泛性损害,肝脏储备功能有不同程度的降低。肝切除术后肝功能不全甚至肝衰竭成为患者围手术期死亡及影响患者术后长期生存的重要原因。因此,术前精确评估肝脏储备功能十分重要。近年来评估肝脏储备功能的方法越来越多,但是临床上仍然缺少一种公认的、能全面评估肝脏储备功能的方法。通过综述目前临床常用的术前肝脏储备功能的评估方法,总结分析了其中几种重要方法的价值和不足,并对术前肝脏储备功能评估方法的发展进行展望。     

同种异体原位肝移植10例报告

目的 探讨原位肝移植的适应证、手术技术及手术期期处理特点。方法 对１例肝尾叶癌，２例先天性弥漫性肝内胆管囊性扩张症及７例晚期肝硬变进行了原位肝移植，对其中１便１１岁女孩进行了减体积肝移植（ＲＳＬＴ）。供肝均取２０－４０岁脑死亡的健康人。８例供、受者ＡＢＯ血型相同，２例供者为Ｏ型，受者为Ａ型。供肝采用单独肝脏切取法，以ＵＷ液进行门静脉和腹主动脉灌注。病肝采用经典式原位肝移植切肝法，在生物泵转流下切除     

原发性肝癌肝移植11例临床资料小结

目的探讨肝移植在原发性肝癌治疗中的意义。方法回顾分析2004年3月-2006年7月11例肝癌肝移植的临床资料。结果11例手术全部成功,围手术期无死亡。随访时间最长40个月,最短12个月,其中1例因乙肝复发,爆发性肝功能衰竭、肝肾综合症,于术后16个月死亡。1例在术后2个月因肺部巨细胞病毒感染,呼吸衰竭死亡。其余健康成活,1-3个月复查一次,无肿瘤复发,肝脏功能正常,α-FP<8ng/ml,HBV-DNA<103拷贝/毫升。结论肝移植治疗原发性肝癌仍要严格控制适应症;早期预防感染和长期治疗乙肝也是提高成功率的一个重要环节。     

Liver failure after major hepatic resection

Introduction  The consequence of excessive liver resection is the inexorable development of progressive liver failure characterised by the typical stigmata associated with this condition, including worsening coagulopathy, hyperbilirubinaemia and encephalopathy. The focus of this review will be to investigate factors contributing to hepatocyte loss and impaired regeneration. Methods  A literature search was undertaken of Pubmed and related search engines, examining for articles relating to hepatic failure following major hepatectomy. Results  In spite of improvements in adjuvant chemotherapy and increasing surgical confidence and expertise, the parameters determining how much liver can be resected have remained largely unchanged. A number of preoperative, intraoperative and post-operative factors all contribute to the likelihood of liver failure after surgery. Conclusions  Given the magnitude of the surgery, mortality and morbidity rates are extremely good. Careful patient selection and preservation of an obligate volume of remnant liver is essential. Modifiable causes of hepatic failure include avoidance of sepsis, drainage of cholestasis with restoration of enteric bile salts and judicious use of portal triad inflow occlusion intra-operatively. Avoidance of post-operative sepsis is most likely to be achieved by patient selection, meticulous intra-operative technique and post-operative care. Modulation of portal vein pressures post-operatively may further help reduce the risk of liver failure.     

Liver transplantation for small HCC in cirrhosis

Segmental liver resection is generally considered the treatment of choice for small HCC in cirrhotic livers. Although in selected patients with small encapsulated nodules and low alpha-fetoprotein levels long-term survival can be expected after resection [4], Western experience is still limited, and follow-up studies too short so that the data presently available cannot be considered satisfactory [3]. The true value of alcoholization as a possible alternative therapy in these patients is still to be ascertained. When using these treatment modalities, the major problem is the high tumour recurrence within the liver [1, 6]. Three main reasons could explain these clinical observations:

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劈离式肝移植术后移植肝再生的研究

目的研究劈离式肝移植术后移植肝组织的再生规律。方法通过CT检查计算劈离式肝移植术后4例受体在不同时间点的肝体积变化,并检查患者移植术后肝功能。结果受体1术后4个月、1年时肝体积分别是标准体积的114%、97%,肝体积再生率为-11·0%、-24·3%;受体2术后4个月、1年肝体积分别是标准体积的96%、100%,肝体积再生率为24·4%、30·0%。受体3术后2个月肝体积是标准体积的86%,肝体积再生率为12·0%;受体4术后2个月肝体积是标准体积的90%,肝体积再生率为20·0%。4例受体术后肝功能均恢复正常。结论劈离式肝移植供肝有较强的再生能力,能满足受体的代谢需要。     

Protective Effects of Ambroxol in Hypothermic Liver Preservation: A Transplant Study

The bronchosecretolytic agent ambroxol added to histidine-tryptophan-ketoglutarate (HTK) solution has recently been shown to protect cold stored rat hepatocytes. The aim of the present study was to confirm these observations in a rat liver transplantation model. Before orthotopic liver transplantation, donor livers from 30 syngeneic Wistar rats were assigned to three groups (n = 10): (A) in situ flush (ISF) and ½-h cold storage (CS) with HTK solution, (B) ISF and 3-h CS with HTK, and (C) ISF and 3-h CS with HTK + 10^-3