精准肝切除术治疗复杂肝肿瘤的临床体会

目的总结精准肝切除术治疗复杂肝肿瘤的经验方法回顾分析昆明医科大学第二附属医院肝胆外科自2010年4月至2012年2月收治的9例复杂肝脏肿瘤患者并行精准肝切除术的临床资料结果 9例患者手术过程顺利,术后均未发生肝衰、肾衰、肝性脑病等情况;术后平均10 d肝功能恢复正常,平均住院时间20d.术后随访半年生存率100%.结论精准肝切除技术能直观显示肝脏血管及与肿瘤的关系,可提高复杂肝脏肿瘤切除的安全性.     

肝脏肿瘤行精准肝部分切除术的临床效果及经验总结

目的:探讨肝脏肿瘤施行精准肝部分切除术的临床效果、手术操作的技术关键、以及并发症的预防。方法:回顾分析行精准肝部分切除术40例患者的临床病历资料所有患者术前行B超、CT或MRI检查,明确肿瘤大小、位置,与第一肝门和第二肝门的关系。常规实验室检查血常规、肝功能和甲胎蛋白(AFP)。术中采用Pringle第一肝门阻断法,区域性肝门阻断法或不阻断肝门法等完整切除肝脏肿瘤。结果:成功完成精准肝部分切除术40例,无术后并发症,全组患者均痊愈出院。术后病理诊断肝细胞癌32例,肝血管瘤6例,肝脂肪肉瘤2例。随访1个月～3年,无肿瘤复发。结论:为肝脏恶性肿瘤患者施行精准肝部分切除术是安全可行的,该术式的适应证包括所有可切除的肝脏占位性病变,以肝脏恶性肿瘤多见。该术式具有创伤小、恢复快、并发症少等优点,是治疗肝脏肿瘤的安全有效的手术方式。     

邻近主肝静脉根部肝肿瘤的手术治疗

①目的 探讨邻近主肝静脉根部肝肿瘤切除的可能性。②方法 分析我院近3年经手术切除的累及主肝静脉根部肝肿瘤病人35例的临床资料。其中原发性肝癌22例，并发肝硬化12例；肝血管瘤11例；肝细胞局限性增生1例；肺癌肝转移1例。③结果 行左半肝切除 Ⅷ段切除术10例，左半肝切除术2例，Ⅷ段切除或部分切除术5例，肝Ⅶ段和Ⅷ段切除术10例，肝中叶切除术8例。9例肝中静脉主干结扎或切除，1例直接吻合，1例肝右静脉干因出血而切除，1例肝右静脉结扎。全肝血流阻断8例。术后出现中等量腹水2例和胸腔积液2例，胆汁漏1例，1例在术后3月死于肝功能衰竭。④结论 主肝静脉受累的肝脏肿瘤切除虽具有较大风险，但只要方法适宜手术仍然是安全和可行的。     

完全腹腔镜与开腹肝切除治疗肝肿瘤临床疗效比较

目的 观察完全腹腔镜肝切除与开腹肝切除治疗肝肿瘤的临床疗效.方法 回顾性分析2010年1月至2014年1月期间海南省人民医院肝胆外科62例行肝切除术的肝肿瘤患者的临床资料.结果 完全腹腔镜下肝切除术组30例,手术均获成功,包括肝血管瘤4例,肝炎性假瘤2例、局灶性增生1例,原发性肝癌23例;手术方式:肝左外叶切除(Ⅱ+Ⅲ段) 14例、左半肝切除(Ⅳa,Ⅳb段) 2例,Ⅴ~Ⅶ段部分肝切除14例.开腹肝切除术组32例,其中肝血管瘤6例,肝炎性假瘤1例、肝腺瘤1例,原发性肝癌24例;手术方式:左外叶切除(Ⅱ+Ⅲ段) 16例、左半肝切除(Ⅳa,Ⅳb段) 3例,Ⅴ~Ⅶ段部分肝切除13例.两种术式在肿瘤大小、部位、平均手术时间、术中出血量、术后引流量,术后并发症发生率等指标比较差异均无统计学意义(P>0.05),但腹腔镜组术后胃肠道恢复时间,术后住院时间等指标优于开腹手术组,差异均有统计学意义(P<0.05).结论 肝脏Ⅱ、Ⅲ、Ⅳb、V~Ⅶ的肿瘤行完全腹腔镜肝切除术是安全有效的,其具有术后恢复快、进食早、痛苦少、住院时间短等优点,近期疗效好.     

肝肿瘤术后并发肺栓塞的预防及护理

目的探讨肝肿瘤术后并发肺栓塞的预防和护理措施,总结医学经验,从而为临床提供借鉴意义。方法选取我院1998年6月-2012年6月收治的肝肿瘤术后并发肺栓塞患者3例（所有并发肺栓塞患者都自愿接受调查并服从所有准则）,收集并观察所有患者的术后肺栓塞的临床表现,根据临床表现和手术效果总结相应的预防和护理措施。然后收集所有患者的临床资料,并对其结果进行回顾性分析。结果肝肿瘤术后肺栓塞的发生时间在手术过后的3~6 h之间,患者会表现为呼吸存在困难、咳嗽、心慌、胸痛等;在这3例出现肺栓塞的患者中,经相关治疗和护理,有2例痊愈,1例救治无效死亡。结论对肝肿瘤术后肺栓塞患者进行积极的抗凝治疗,采取正确及时的护理措施,可以有效提高患者的生存质量,从而促进患者的恢复,有利于患者经过治疗达到更为满意的效果,值得临床推广应用。     

腹腔镜肝脏肿瘤切除的应用研究

目的 比较腹腔镜肝脏肿瘤切除术(LH)与开腹肝脏肿瘤切除术(OH)的疗效.方法 回顾性分析行肝脏肿瘤切除术93例临床患者资料,其中24例行LH(LH组).69例行OH(OH组),比较分析2组术中、术后情况,近期及远期疗效.结果 手术均顺利完成,2组患者在手术时间、术中出血量、切除肿瘤最大直径、肝功能恢复、肿瘤复发率、转移率及患者死亡率等指标的差异均无统计学意义(P＞0.05),LH组在术后住院天数、进食时间、引流管留置时间、镇痛药使用率、术后并发症方面优于OH组,其差异有统计学意义(P＜0.05);2组患者在术后第1、3、5天的ALT、AST、ALB、TBIL数值比较,其差异有统计学意义(P＜0.05);2组远期疗效差异无统计学意义(P＞0.05).结论 腹腔镜肝切除术近期疗效优于开腹组,其远期疗效与开腹组相当.     

肝脏少见良性肿瘤21例临床分析

目的探讨肝脏少见良性肿瘤的诊断和治疗。方法回顾性分析21例肝脏少见良性肿瘤的病例资料,其中肝脏炎性假瘤5例,肝脏局灶性增生结节4例,肝腺瘤和肝脏炎性肉芽肿各3例,肝脏血管平滑肌脂肪瘤和肝结核瘤各2例,肝间叶性错构瘤和肝平滑肌瘤各1例。结果术前影像学检查(B超、CT或MRI)总体良恶性鉴别诊断准确率为47.6%(10/21)。手术方式包括左肝外侧叶切除术2例,左半肝切除术2例,肿瘤局部切除术17例(其中2例合并胆囊切除,1例合并部分膈肌切除)。手术时间60～270(135±55)min。18例术中未输血,3例分别输血1 800、600、950mL。并发症发生率为4.8%(1/21),无再手术及手术死亡病例。术后住院时间5～26(10.3±4.4)d。术后平均随访13～95(42±23)个月,随访期内未见肿瘤复发。结论联合多种影像学检查可提高肝脏少见良性肿瘤的诊断率,但术前定性诊断较困难。对于多数有症状、怀疑恶变或有恶变风险的少见良性肿瘤,肝切除术是最有效的治疗方法。     

2例肝血管瘤术后并发肺栓塞的护理体会

目的:预防肝血管瘤并发肺栓塞的护理体会。方法:回顾2017年期间,我科肝血管瘤切除术后并发肺栓塞患者。结果:平均发病年龄50左右,2例均出现血氧饱和度下降,呼吸困难是急性肺栓塞最常见的临床症状,D2聚体检查阳性(有监测诊断的价值)CT及肺灌注扫描确诊。结论:肝血管瘤术后并发肺栓塞与长期卧床有主要因素,积极溶栓治疗,可显著改善预后,临床护理人员应引起高度重视。     

自体骨髓干细胞移植辅助肝三叶切除术治疗肝癌的临床研究

目的探讨术前自体骨髓干细胞移植在辅助肝癌肝三叶切除术中的应用。方法选取2005年4月～2010年12月我院肝癌患者行肝三叶切除的19例患者,其中8例在切除肿瘤后术中经肝固有动脉对残肝进行干细胞移植,另外11例行常规肝三叶切除,切除肿瘤后经肝固有动脉仅输入等量生理盐水。分析比较两组肝癌肝三叶切除术后切除率,术后并发症的发生率以及分别在术后第1、2、4周复查肝脏功能,观察肝功能实验室指标、住院时间等。结果干细胞移植辅助肝三叶切除术治疗组术后并发症明显低于对照组,住院时间治疗组为(13±5)d,而对照组为(16±3)d,实验组短于对照组。术后实验组和对照组均有一过性肝功能不全,主要表现为转氨酶升高、清蛋白降低及腹水形成。术后丙氨酸转氨酶、总胆红素、白蛋白和凝血酶原时间实验组优于对照组(P<0.01)。结论自体骨髓干细胞移植辅助肝三叶切除术治疗肝癌有利于患者术后恢复及减少肝功能衰竭等严重并发症。     

规则性肝切除与非规则性肝切除术后肝癌肝内复发情况比较

目的：对比规则性肝切除与非规则性肝切除术后肝癌肝内复发情况。方法选取我科2007-2012年行肝切除术治疗原发性肝癌的患者共120例,按照术式分为规则性肝切除组和非规则性肝切除组各60例。比较两组患者的一般手术情况、术后6个月肝功能和术后1年复发率、生存率。结果规则肝切除组的切除肿瘤直径、切除肝脏体积、术中出血量、输血量、切除肝段数目显著高于非规则肝切除组(P<0.01)。规则肝切除组术后6个月的血清白蛋白(ALB)显著高于非规则肝切除组,总胆红素(TBIL)、谷丙转氨酶(ALT)和直接胆红素(DBIL)显著低于非规则肝切除组(P<0.01)。规则肝切除组术后1年复发率显著低于非规则肝切除组,术后1年无瘤生存率和总生存率显著高于非规则肝切除组(P<0.05)。结论规则性肝切除虽然手术损伤较大,但切除肿瘤范围大,术后肝功能恢复好,复发率低,适合临床应用。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.