肝移植治疗乙型肝炎、肝硬化并发肝癌的分析

 目的　研究乙型肝炎、肝硬化并发肝癌行肝移植手术时机的选择及术后免疫抑制剂的应用。方法　对9例患者施行肝移植,其中4例为经典式原位肝移植,5例为背驮式原位肝移植,术后应用免疫抑制剂甲基泼尼松龙、他克莫司及吗替麦考酚酯（商品名：骁悉）,同时采用抗乙型肝炎免疫球蛋白及拉米夫定预防乙肝病毒复发。结果　9例肝癌肝移植手术均获成功,2例术前情况差的患者术后死于多器官衰竭,1例死于急性排斥反应,余6例全部生存至今。结论　乙型肝炎、肝硬化并发肝癌最有效的治疗方法之一是肝移植,手术在肝癌转移前进行疗效较好,术后应用免疫抑制剂甲基泼尼松龙、他克莫司及吗替麦考酚酯可以有效控制免疫排斥的发生。     

肝移植治疗乙型肝炎、肝硬化并发肝癌的分析

目的 研究乙型肝炎、肝硬化并发肝癌行肝移植手术时机的选择及术后免疫抑制剂的应用.方法 对9例患者施行肝移植,其中4例为经典式原位肝移植,5例为背驮式原位肝移植,术后应用免疫抑制剂甲基泼尼松龙、他克莫司及吗替麦考酚酯(商品名:骁悉),同时采用抗乙型肝炎免疫球蛋白及拉米夫定预防乙肝病毒复发.结果 9例肝癌肝移植手术均获成功,2例术前情况差的患者术后死于多器官衰竭,1例死于急性排斥反应,余6例全部生存至今.结论 乙型肝炎、肝硬化并发肝癌最有效的治疗方法之一是肝移植,手术在肝癌转移前进行疗效较好,术后应用免疫抑制剂甲基泼尼松龙、他克莫司及吗替麦考酚酯可以有效控制免疫排斥的发生.     

肝移植治疗乙型肝炎、肝硬化并发肝癌的分析

目的 研究乙型肝炎、肝硬化并发肝癌行肝移植手术时机的选择及术后免疫抑制剂的应用.方法 对9例患者施行肝移植,其中4例为经典式原位肝移植,5例为背驮式原位肝移植,术后应用免疫抑制剂甲基泼尼松龙、他克莫司及吗替麦考酚酯(商品名:骁悉),同时采用抗乙型肝炎免疫球蛋白及拉米夫定预防乙肝病毒复发.结果 9例肝癌肝移植手术均获成功,2例术前情况差的患者术后死于多器官衰竭,1例死于急性排斥反应,余6例全部生存至今.结论 乙型肝炎、肝硬化并发肝癌最有效的治疗方法之一是肝移植,手术在肝癌转移前进行疗效较好,术后应用免疫抑制剂甲基泼尼松龙、他克莫司及吗替麦考酚酯可以有效控制免疫排斥的发生.     

肝移植在结直肠癌肝转移中的价值

结直肠癌是全球范围内发病率和死亡率均高的恶性肿瘤之一,早期容易发生转移,而肝脏恰是结直肠癌远处转移的最常见器官.随着肝移植技术的发展与进步,不可切除性结直肠癌肝转移患者获得了长期生存的新机遇.近年来,挪威奥斯陆大学医院在肝移植治疗不可切除性结直肠癌肝转移的领域中取得了一系列巨大突破,引起了世界各地学者的广泛关注.随后,...     

经肝动脉栓塞治疗肝海绵状血管瘤（附26例）

目的：观察经肝动脉栓塞治疗肝海绵状血管瘤的临床疗效和安全性。方法：对26例肝海绵状血管瘤经股动脉或左锁骨下动脉入路插管,超选择至肿瘤供血动脉,采用平阳霉素与无水乙醇或碘化油、明胶海绵进行栓塞治疗,1年内随访疗效及不良反应。结果：26例患者介入治疗成功率100％,肿瘤完全消失者6例,瘤体缩小〉50％者17例,瘤体缩小不足50％者2例,瘤体无变化者1例,无瘤体进展者;总有效率为95．1％;所有患者未出现严重并发症。结论：经肝动脉栓塞治疗肝海绵状血管瘤是一种安全、简便、有效的方法。     

The expression of ETAR in liver cirrhosis and liver cancer

Background: To investigate the expression of endothelin receptors in liver diseases and discuss its role in the process of liver cirrhosis and liver cancer.

Research design and methods: We examined the expressions of ETAR, ETBR and α-SMA in tissue samples using western blotting analysis. Furthermore, immunofluorescence was used to locate ETAR expression in hepatic stellate cells (HSCs) and hepatic sinusoidal endothelial cells (HSECs), we calculated the percentage of positive cells and then analyzed its relation with clinical indexes.

Results: According to the western blotting analysis, the expression of ETAR was high in hepatic hemangioma and liver cancer tissues and ETBR was highly expressed in cirrhosis tissues. The immunofluorescence results demonstrated that the expression of ETAR was elevated in hepatic hemangioma and liver cancer tissues. Moreover, ETAR expression was found in both HSCs and HSECs. Finally, the statistical analysis revealed that the number of positive ETAR cells was correlated with the clinical index platelets (PLT), alanine transaminase (ALT) and diameter of portal vein.

Conclusion: Endothelin receptors express differently in liver cirrhosis and liver cancer tissues and play a role in hepatic diseases by affecting HSCs and HSECs.     

A breakthrough in liver regeneration for treatment of liver cancer

The liver is the largest solid organ, and it is involved in mul-tiple biological processes, including energy metabolism, pro-tein synthesis, and detoxification1...     

经肝动脉栓塞治疗肝海绵状血管瘤(附26例)

目的:观察经肝动脉栓塞治疗肝海绵状血管瘤的临床疗效和安全性.方法:对26例肝海绵状血管瘤经股动脉或左锁骨下动脉入路插管,超选择至肿瘤供血动脉,采用平阳霉素与无水乙醇或碘化油、明胶海绵进行栓塞治疗,1年内随访疗效及不良反应.结果:26例患者介入治疗成功率100%,肿瘤完全消失者6例,瘤体缩小＞50%者17例,瘤体缩小不足50%者2例,瘤体无变化者 1例,无瘤体进展者;总有效率为95.1%;所有患者未出现严重并发症.结论:经肝动脉栓塞治疗肝海绵状血管瘤是一种安全、简便、有效的方法.     

肝移植在小肝癌治疗中的地位

探讨肝脏移植在小肝癌治疗中的地位,认为小肝癌肝移植病例选择应符合①合并肝硬化的小肝癌,单个肿瘤病灶直径≤5.0cm,或2～3个肿瘤病灶,其直径之和≤5.0cm;②门静脉、肝静脉主干无癌栓;③无肝外转移病灶;④临床判断为不能切除的小肝癌.小肝癌肝移植术后1年生存率80%～88%,5年生存率60%～74%,在术后无瘤生存、远期生存及生活质量方面优于肝癌肝切除术.供肝等待期采取适当辅助治疗抑制肿瘤进展是提高疗效的关键.     

The role of liver sinusoidal endothelial cells in cancer liver metastasis

Liver sinusoidal endothelial cells (LSECs) are the gatekeeper cells in the liver, contributing critical roles in liver physiological and pathological changes. Factors such as dietary macronutrients, toxins, and aging impact LSEC fenestration. Defenestration of LSECs changes their phenotype and function. Under liver injury, capillarized LSECs promote hepatic stellate cells (HSCs) activation and fibrogenesis, while decapillarized LSECs protect the activation of HSCs and liver injury. The expression of chemokines, such as CXCL9 and CXCL16, changes and impacts the infiltration of immune cells in the liver during disease progression, including hepatocellular carcinoma (HCC). As the largest solid organ, liver is one of the most favorable organs into where tumor cells metastasize. The increased interaction and adhesion of circulating tumor cells (CTCs) with LSECs in the local microenvironment and LSEC-induced tolerance of immunity promote cancer liver metastasis. Several strategies can be applied to target LSEC to modulate their function to prevent cancer liver metastasis, including gut microbiota modulation, microRNA therapy, and medical treatment. Delivery of different treatment agents with nanoparticles may promote precise target treatment. Overall, targeting LSECs is a potential strategy for treatment of early liver diseases and prevention of cancer liver metastasis.     

Effect of preoperative chemotherapy on liver resection for colorectal liver metastases

Aim

To compare the effects of preoperative chemotherapy on liver parenchyma morphology, as well as morbidity and mortality after liver resection for colorectal liver metastases.

Methods

Prospectively collected data on 173 patients undergoing liver resection for CLM between 1/2003 and 9/2005 was analysed in three groups: A: preoperative oxaliplatin (Ox, n = 70); B: other chemotherapeutic agents (OC, n = 60); and C: surgery alone without chemotherapy (SA, n = 43). Blood transfusion, hospital stay, operative procedure, peak postoperative bilirubin levels, complications and histopathology of the resected liver were compared.

Results

Intra-operative blood transfusion requirement (34%) and biliary complications (16%) was higher in patients receiving oxaliplatin-based chemotherapy (p = 0.01 and p = 0.06, respectively). Oxaliplatin-based chemotherapy was also associated with sinusoidal dilatation of mild grade in 52.8% vs. 26.6% and 23.3% patients (p = 0.007 and p = 0.004) in other groups, respectively. Steatosis was similarly distributed across the study group. Postoperative mortality was 2, 1 and 4 patients, respectively (p = ns).

Conclusion

Oxaliplatin-based preoperative chemotherapy is associated with vascular alterations in the liver parenchyma without significantly increasing the risk of steatosis, or postoperative morbidity and mortality.     

Myelolipoma of the liver

A case of hepatic myelolipoma is described, including the angiographic and computed tomographic appearance. Only three such cases have been reported previously.