肝移植术后肝动脉栓塞的防治

目的 探讨肝移植术后肝动脉栓塞的预防和治疗。方法 于１９９６年５月至１９９９年５月成功地进行了５例同种异原位肝移植术,２例存在供肝动脉变异,经整形后成功地进行了吻合;术后采用肠溶阿司匹林,潘生丁和低分子右旋糖酐联合抗凝治疗。结果 无一例肝动脉栓塞发生;除第１例肝炎后肝硬化病人于术后７个月死于急性肝坏合并急性出血坏死性胰腺炎外,其余４例健康存活３６,３２,１８和２个月。结论 妥善的血管吻合和合理的术     

经导管肝动脉化疗栓塞术(TACE)后胆道缺血性损伤及其防治

经导管肝动脉化疗栓塞术(transcatheter arterial chemoembolization，TACE)已被公认为中晚期肝癌的首选治疗方法，疗效是肯定的。近年来报道TACE已被应用于肝癌切除术后预防肿瘤复发的后续治疗，甚至经肝动脉栓塞(hepatic arterial embolization，HAE)治疗肝海绵状血管瘤。尽管普遍注意到TACE所造成的发热、     

肝动脉栓塞治疗原发性肝癌术后血清AFP变化规律的初步探讨

肝动脉栓塞治疗原发性肝癌术后血清ＡＦＰ变化规律的初步探讨张少宏张军曙王军华向军章全主见１９９１年１１月～１９９７年５月，我们对３７例不能手术切除的原发性肝癌（以下称肝癌）行了术中肝动脉结扎置管栓塞术（ＨＡＥ），并动态观察其血清甲胎蛋白（ＡＦＰ）、谷丙...     

肝内外胆管结石胆道镜取石后胆道大出血选择性肝动脉栓塞一例

病人，男，69岁。因反复右上腹疼痛高热黄疸30余年，加重5d入院。30年前行胆囊造瘘，5年前行胆囊切除胆道探查时损伤回肠行肠造瘘，随后行肠造瘘闭合术，又因切口感染切口疝行疝修补术，入院前四次手术均为外院所做。入院检查：体温38℃，脉搏80次／min，呼吸15／min，BP14／10kPa，巩膜、皮肤黄染，右上腹压痛。B超及MRCP；胆囊结石，胆总管结石，肝内胆管结石。入院后第3天行手术，由于肝     

肝血管瘤的肝动脉栓塞治疗(附12例报告)

目的：分析比较肝血管瘤不同栓塞剂的栓塞治疗结果，寻找更为理想、合理的方法。方法：对12肝血管瘤16例次经皮穿刺超选择性肝动脉插管行栓塞治疗，其中单纯碘化油栓塞2例次，碘化油 明胶海绵颗粒栓塞6例次，碘化油 聚乙烯醇（PVA）微球栓塞5例次，碘化油 平阳霉素栓塞3例次。随访10-32个月。结果：全部病例均取得较肯定的疗效，无并发症发生。碘化油 平阳霉素和碘化油 PVA微球两种方法疗效稳定，复发率低，优于前两种方法。结论：肝动脉栓塞治疗肝血管瘤疗效肯定，几种栓塞剂中，碘化油 平阳霉素及碘化油 PVA微球最佳。     

原发性肝癌经肝动脉化疗栓塞后并发胆管损伤的诊治

经肝动脉化疗栓塞（ＴＡＣＥ）已被广泛用于肝癌的治疗并取得了令人鼓舞的疗效,目前已被公认为是不能手术切除肝癌的首选治疗方法。近年来有关ＴＡＣＥ并发症的报道经常见到,人们已熟悉常见并发症的诊治,由于国内外对ＴＡＣＥ后胆道损伤报道相对较少［１～３］,所以并...     

选择性肝动脉栓塞治疗胆道术后胆道大出血

胆道出血或称血胆症（hemobilia）在临床上虽不很常见，但由于其常有周期性的特点，且处理比较棘手，常带来高并发病率和高病死率[1，2]。近年来，由于诊断技术上的进步，治疗效果有明显改善[3]。我院近3年共收治胆道术后胆道大出血3例，其中2例行选择性肝动脉栓塞治疗。现报告如下：1临床资料1．1简要病史病例1，男，47岁。间断性右上腹痛3年，症状加重伴黄疽3天，在外院诊断为急性化脓性胆管炎，急诊行胆囊切除、总胆管探查和胆肠吻合术。术后第4天无明显诱因便血、量不详，休克2次。给予输血800ml、抗感染、止血等治疗好转出院。但术后35…     

超选择性肝动脉插管栓塞术治疗胆道出血

胆道出血是胆道感染、肝胆系统外伤、肝动脉瘤、血管瘤和医源性损伤等疾病引起的一种严重并发症。患者往往一般情况较差，虽作了及时的外科手术处理，但再出血率及死亡率仍然很高。自Walter1976年首次成功应用肝动脉栓塞治疗肝活检引起的胆道出血以来，随着介入性放射学的迅速发展，通过选择性、超选择性肝动脉栓塞（HePatlcarteryemboligaton，HAE）来治疗胆道出血已在国内、外逐渐被人们所采用。肝脏的动脉供血除肝动脉外，从肝周各韧带有26条侧支动脉入肝，与肝动脉形成广泛交通。有人发现在结扎肝固有动脉后，部分病例其肝端仍有明显…     

肝移植术后肝动脉栓塞的防治

目的 探讨肝移植术后肝动脉栓塞(HAT)的防治.方法 回顾性分析2004年4月～2006年10月期间130例肝移植术中动脉重建的经验,以及并发HAT后采取溶栓及动脉架桥的疗效.结果 130例中仅有4例发生HAT,其中2例溶栓成功,2例溶栓失败后即行肝动脉架桥术并取得成功.结论 肝移植术中进行肝动脉吻合时,选择适合的吻合位置及恰当的吻合方式能够有效预防HAT的发生;一旦出现HAT时,早期的治疗措施需合理选择.     

Percutaneous transhepatic portal embolization for persistent bile leakage after hepatic resection: Report of a case

Bile leakage is a relatively common complication after hepatic resection. We report a case of intractable bile leakage after hepatectomy, which was successfully treated by percutaneous transhepatic portal embolization (PTPE). A 58-year-old Japanese man underwent anterior resection of the rectum followed by central bisegmentectomy of the liver (S4 + S5 + S8) for rectal cancer with liver metastasis. Bile leakage from the cut surface of the posterior segment developed on postoperative day 2. Conservative management with simple drainage and ethanol injections into the fistula proved ineffective. Thus, we performed PTPE in the posterior portal branch to eliminate the production of bile from the posterior segment and to block the enterohepatic circulation to that segment. His post-treatment course was uneventful and the bile leakage resolved immediately.     

选择性肝动脉栓塞治疗肝血管瘤

目的探讨肝动脉栓塞治疗肝血管瘤选择性的效果。方法对35例肝血管瘤患者使用平阳霉素碘油乳剂行选择性肝动脉栓塞治疗,观察血管瘤大小的变化、临床症状的改善情况。结果对35例肝血管瘤患者成功实施了栓塞治疗。随访3个月~2年,术后病灶不同的程度的缩小,并随时间的增加,呈现进行性的缩小,术后3~6个月、6个月~1年、1年~2年病灶平均缩小率为55.4%、78.2%、81.0%。治疗前的临床症状得到均获得好转或消失。结论选择性肝动脉栓塞是一种安全、有效、创伤小、并发症少的治疗肝血管瘤的方法。     

Cholangiojejunal fistula caused by bile duct stricture after intraoperative injury to the common hepatic artery

A 68-year-old man, admitted for the treatment of recurrent cholangitis after a pancreatoduodenectomy (PD) performed 3 years previously was diagnosed as having multiple hepaticolithiasis. On laparotomy, the hepatic artery was not recognized. The anastomosed common hepatic duct was obstructed, and a fistula had been formed between the right hepatic duct and the Roux limb of the jejunum. Lithotripsy was performed from this fistula and it was reanastomosed. Angiography was performed postoperatively and it revealed common hepatic artery injury, most likely to have occurred during the previous PD. The patient's postoperative course was uneventful and he has been asymptomatic for 8 months after the operation, indicating that reanastomosis of the fistula can be an effective method. The stricture of the anastomosis was suspected to be mainly due to cholangial ischemia, because no episode of anastomotic leak or retrograde biliary infection had occurred during the PD perioperative period. There are several reports of late stricture of anastomosis 5 or more years after cholangiojejunostomy. This patient, therefore, requires further long-term follow up. Received: August 16, 2001 / Accepted: November 16, 2001     

膈下动脉供血在肝癌介入性栓塞治疗中的价值

目的　探讨膈下动脉对肝癌的供血及其介入性栓塞在肝癌治疗中的价值。　方法　原发性肝癌 35例 ,其中一例为肝癌并发胆道大出血。全部行肝动脉及膈下动脉造影 ,对肝动脉及有参与肝癌供血的膈下动脉分别进行化疗性栓塞治疗 ,胆道出血病例加用明胶海绵和弹簧圈栓塞。　结果　 35例中有 2 1例膈下动脉供血 ,主要为侵犯肝包膜的弥漫型肝癌和巨块型肝癌 ,供血的范围从 2 0 %～ 70 %。治疗后肿瘤缩小 4 0 %～ 5 0 % 14例 ,10 %～ 30 % 18例 ,无变化 3例 ,胆道出血停止。　结论　在肝癌的侧支供血中 ,膈下动脉是主要侧支动脉 ,行肝癌介入治疗需与肝动脉同时进行栓塞     

Prophylactic embolization of hepatic artery pseudoaneurysm after blunt abdominal trauma in a child

We describe a 10-year-old boy who developed a pseudoaneurysm in the territory of the left hepatic artery after blunt trauma to the abdomen, which was prophylactically embolized. He was discharged early and was able to return to activities of daily life. In view of the potentially fatal complication of severe hemorrhage from a missed hepatic pseudoaneurysm rupture, recognition and early embolization of a traumatic pseudoaneurysm of hepatic artery are recommended. This decreases morbidity, mortality, and length of hospital stay and allows for early mobilization especially in children who are difficult to restrain in bed.     

应用左肝胆管径路治疗肝内外胆管结石

目的探讨经左肝胆管径路治疗肝内外胆管结石的临床价值。方法回顾性分析我院近10年来应用左肝胆管径路治疗肝内外胆管结石56例的临床资料。结果经剑突下小切口左肝管径路取石26例,结石一次性取净率为84.6%;经左肝外叶断面径路取石30例,结石一次性取净率为93.3%。全组病例术后临床症状消失,黄疸消退。结论经左肝胆管入镜治疗合并左肝胆管结石的肝内外胆管结石安全、有效,特别是对于肝门部严重粘连的病人。     

Laparoscopic debridement of hepatic necrosis after hepatic artery chemoembolization.

BACKGROUND AND OBJECTIVES: Hepatic artery chemoembolization (HACE) used to treat neuroendocrine tumors metastatic to the liver has shown both survival benefit and improvement in symptoms. The development of hepatic necrosis after HACE is rare, but the consequences can be devastating. We report the first case of laparoscopic management of extensive hepatic necrosis occurring after HACE. CASE REPORT: A 58-year-old man with neuroendocrine tumor metastatic to the liver underwent HACE in addition to medical management. He had undergone previous biliary stenting for biliary obstruction. After HACE was performed via the right hepatic artery, the patient developed sepsis due to right hepatic lobe infarction. Percutaneous drainage and antibiotics were attempted for 2 months, but hepatic debridement was ultimately required due to repeated drain malfunction and septic complications. Laparoscopic necrosectomy was performed with ease and with little blood loss. The patient quickly recovered without any further infectious complications. CONCLUSION: Infected hepatic necrosis resulting from HACE that fails percutaneous management can be successfully managed with laparoscopic necrosectomy. This report adds to the growing evidence that minimally invasive techniques can be used to manage complicated hepatic conditions.     

肝移植术后肝动脉狭窄的防治策略

目的 探讨肝移植术后不同肝动脉狭窄类型治疗时机的选择和疗效.方法 2003年10月至2007年5月,本院共有21例肝移植病人术后发生肝动脉狭窄,其中19例接受肝动脉支架放置术,2例定期随访观察;同时监测介入治疗前后肝功能、肝动脉通畅程度变化及病人临床转归等情况.结果 肝移植术后肝动脉狭窄发生率为3.43%(21/613),诊断中位时间146 d.6例早期肝动脉狭窄病人均接受介入治疗,其中病死2例,存活4例病人中有2例再移植.15例晚期肝动脉狭窄病人中,13例接受介入治疗,其中病死4例,再移植2例,7例存活但肝功能反复出现异常.另外2例在肝门及肝内分支形成良好的侧支循环,肝功能维持稳定.结论 移植术后应根据肝动脉狭窄类型、胆道缺血损伤程度以及有无良好侧支循环代偿等综合因素采取个体化治疗策略.     

去胆管及去门静脉肝叶肝细胞功能分化的研究

目的 观察胆管结扎及门静脉结扎后肝细胞形态及功能分化现象,探讨去胆管及去门静脉肝叶的保留价值.方法 应用氰基丙烯酸酯对仅保留两个肝叶的大鼠行一叶胆道栓塞并结扎,另一肝叶行门静脉结扎,进行分肝静脉血化验检查、组织病理及超微结构观察.结果 去胆管肝叶形态及糖原染色变化不大,分肝静脉血白蛋白(30.9±1.8)g/L与对照组(31.9±2.0)g/,L比较差异无统计学意义(P>0.05).去门脉肝叶萎缩明显,但血胆红素指标维持正常,与未处理对照组比较[(7.7±3.2)比(8.7±2.3)μmol/L]差异无统计学意义(P>0.05).结论 去胆管肝叶在观察期内无明显萎缩,仍保留有蛋白质合成分泌等功能;去门脉肝叶肝细胞能够承担胆汁代谢功能.     

腹腔镜下中下段胆管癌根治术中联合肝动脉切除重建的疗效与安全性：附3例报告（附视频）

背景与目的：中下段胆管癌临床上主要以下段胆管癌多见,下段胆管癌一般采用胰十二指肠切除术,中段胆管癌可以采用胰十二指肠切除术或胆管癌根治、胆肠吻合术。中下段胆管癌因胆管紧邻肝动脉和门静脉,因此更容易发生门静脉侵犯,因肝动脉有动脉外鞘,因此肝动脉受侵犯相对较少,但一旦侵犯,因为涉及肝动脉切除吻合重建,具有较高技术难度,常需联合肝动脉切除重建才能实现R0切除。目前肝动脉切除重建在临床逐渐成熟,但腹腔镜下完成肝动脉切除重建经验缺乏,需要进一步积累。因此,本研究对3例完成腹腔镜下联合肝动脉切除重建的胆管癌患者的临床资料进行回顾性分析并评估短期结果,以期为临床实践提供初步经验。方法：回顾性分析2021年11月—2022年11月中国人民解放军陆军军医大学第二附属医院肝胆外科的3例行联合肝动脉切除重建的中下段胆管癌根治术患者的临床资料。结果：3例患者中女性1例,男性2例,年龄分别为61、65、69岁;病例1为胆管中段癌,因肿瘤侵犯右肝动脉和门静脉,且胆管下端切缘阴性,行联合右肝动脉切除重建、门静脉切除重建、胆管癌切除、胆肠吻合术、肝门部胆管整形术、淋巴结清扫术;病例2为胆管下段癌,因肿瘤侵犯替代右肝动...