阻断与不阻断入肝血流切除肝癌

目的探讨不阻断入肝血流肝切术手术的安全性及技巧,以及对残肝功能的影响和术后并发症的影响。方法利用病例对照研究,比较阻断与不阻断入肝血流切除肝癌,观察术后并发症发生率、术中输血量等指标。结果甲组(阻断入肝血流)n=59,乙组(不阻断入肝血流)n=42。甲组和乙组术中估计失血量分别为892ml±843ml、914ml±894ml。甲组和乙组术后ALT恢复正常时间分别为17±6天,12±4天,P<0.05。甲组和乙组术后Tbil恢复正常时间分别为18±7天,13±5天,P<0.05。甲组和乙组术后并发症发生率分别为41.3%与12.5%,P<0.05。结论本组资料显示应用不阻断入肝血流切肝可行、安全。     

原发性肝癌破裂大出血的外科治疗

目的　探讨原发性肝癌破裂大出血外科治疗的疗效。方法　自 1985年 1月至 2 0 0 1年 12月收治肝癌自发性破裂大出血共 68例 ,其中 3 1例经急诊手术。手术方式 :左半肝切除 5例 ,右叶局切 4例 ,尾状叶局切 1例 ,肝右动脉结扎栓塞 5例 ,肝固有动脉结扎纱布条填塞 3例 ,局部填塞止血 2例。结果　手术组中位生存期 2 2 3± 3 5个月 ,平均生存期 2 3 2个月 ;保守治疗组中位生存期 4 0± 1 9个月 ,平均生存期 4 5个月。P值 <0 0 1。结论　对于肝癌破裂大出血者 ,如符合手术指征 ,应尽可能及时手术治疗。     

人IL-2、sIL-2R、IL-8酶联免疫测定在癌症标本检测中的应用

本文采用酶联免疫法测定癌症病人血浆IL-2、sIL-2R、IL-8含量的变化,探讨与肿瘤的发生机制,疗效观察及愈后估计.本研究发现,良性垂体瘤组IL-2(12.75±4.40 pg/ml)、sIL-2R(92±46.92 pg/ml)、IL-8(36.38±3.06 pg/ml)与正常对照组IL-2(15.00±4.20 pg/ml)、sIL-2R(70±45.01 pg/ml)、IL-8(30.02±4.60 pg/ml)相比,未见明显改变(P>0.05).而胶质瘤、胃癌、肺癌组病例IL-2、sIL-2R含量有明显改变(P<0.05),肺癌组病例IL-8含量明显增高(P<0.05).胃癌组手术前IL-2(8.18±3.21 pg/ml)、sIL-2R(178.36±50.21 pg/ml)与癌肿全切后IL-2(17.34±5.10 pg/ml)、sIL-2R(128.31±     

肝细胞癌中mdm2基因表达与p53基因失活有关

mdm2基因与p53基因间存在相互调节网络,可望成为基因治疗的靶基因,本文应用反转录PCR反应、PCR联合限制性内切酶反应方法,研究了42例癌组织和25例癌周肝组织中mdm2基因表达与p53基因第七外显子第249密码子突变的相互关系.结果提示mdm2基因表达值(均数±标准误)在p53基因未突变肝癌组(62.1%±8.4%)高于p53基因突变肝癌组(38.5±4.8%,P<0.5),也高于癌周肝组织(p53基因无突变)(26.2%±5.1%,P<0.01),而在p53基因突变组(38.5±4.8%)与癌周肝(26.2%±5.1%,P>0.05)间无明显差别.病灶多发肝癌与病灶单发肝癌相比,mdm2基因表达值(均数±标准误)在病灶多发组(68.9%±10.1%)明显高于病灶单发组(42.6±4.2%,<0.05),而p53基因第249密码子突变率则明显差别(40%对44%,P<0.05).     

甲状腺微小癌的外科手术治疗研究

目的 比较甲状腺微小癌全切术与传统手术的疗效.方法 比较82例经甲状腺全切术治疗的甲状腺微小癌患者(观察组)与82例经传统手术治疗的甲状腺微小癌患者(对照组)的疗效、手术指标(手术时间、出血量、切口长度、住院时间)、术后并发症发生情况和术后1年复发率、颈部淋巴结转移率、远处转移率.结果观察组患者治疗的总有效率为95.12%(39/41),高于对照组的78.05%(32/41),差异有统计学意义(P﹤0.05).观察组患者的手术时间、出血量、切口长度和住院时间分别为(41.5±11.4)min、(42.5±12.8)ml、(5.2±1.0)cm、(4.4± 1.2)d,均低于对照组的(68.7±14.6)min、(83.6±10.6)ml、(6.2±1.4)cm、(6.3±1.4)d,差异均有统计学意义(P﹤0.05).治疗后观察组患者的并发症发生率为7.32%(3/41),低于对照组的29.27%(12/41),差异有统计学意义(P﹤0.05).术后1年观察组患者的复发率、颈部淋巴结转移率和远处转移率分别为4.88%(2/41)、4.88%(2/41)、7.32%(3/41),均低于对照组的19.51%(8/41)、21.95%(9/41)、26.83%(11/41),差异均有统计学意义(P﹤0.05).结论 甲状腺全切术治疗甲状腺微小癌的疗效明显,对患者造成的创伤较小;同时可以明显减少术后并发症、复发率和转移率,有利于患者早日康复,值得临床推广应用.     

胆囊切除在肝癌术后肝动脉栓塞化疗中的临床意义

目的　讨论胆囊切除在肝癌术后经皮肝动脉栓塞化疗中的临床意义。方法　A组 2 0例在初次肝癌切除术中同时切除胆囊 ,B组 5 7例仅作肝癌切除术。比较两组术后经皮肝动脉栓塞化疗术后的副作用。结果　介入术后栓塞综合征 ,两组发生例数分别为发热 ( 7/38)、右上腹痛 ( 2 /19)、腹胀 ( 0 /9)、恶心呕吐 ( 5 /2 6 )、纳差 ( 4 /31)。结论　肝癌切除术中同时切除胆囊 ,有利于降低术后肝动脉栓塞化疗中介入栓塞综合征的发生率 ,减轻其副作用。     

肝癌破裂出血急诊治疗策略

目的讨论研究原发性肝细胞肝癌(简称肝癌)破裂出血急诊治疗的策略.方法回顾分析18例肝癌破裂出血急诊治疗经验.治疗方法包括手术切除肿瘤,术中腹腔温热化疗(IPHC)和术后经肝动脉介入栓塞化疗(TACE);姑息治疗方法为术中结扎肝动脉、缝扎或纱布填塞压迫止血.全组随访2年.结果急诊肿瘤切除10例,止血后延期再手术切除肿瘤1例,手术切除率61.11%,姑息性治疗7例.切除组手术死亡率、1年和2年生存率分别为9.09%、81.82%和36.36%;而姑息治疗组分别为28.57%、14.29%和0%(P＜0.05).切除组随访2年,腹腔种植转移率为9.09%,肝内复发率36.36%.结论(1)肝癌破裂出血急诊治疗中肿瘤切除预后优于姑息治疗;(2)本组肝癌破裂出血腹腔种植转移发生率低于10%,腹腔种植转移倾向不应作为放弃手术切除肿瘤的依据;(3)术中减少肿瘤挤压、腹腔温热化疗和术后TACE可降低肝癌复发及转移发生率;(4)专业肝脏外科医生参与手术有助提高临床疗效.     

血清VEGF在肝癌栓塞化疗时的变化对疗效影响的研究

目的 :探讨血清VEGF对肝癌栓塞化疗疗效的影响。方法 :分析 30例肝细胞肝癌患者的血管造影 ,并采用ELISA检测 2 0例TACE前后患者血清VEGF的变化。结果 :1 3例肿瘤富血管患者血清VEGF水平高于 1 7例肿瘤乏血管患者 (8 80± 3 2 3ng/mlvs 5 70± 2 .68ng/ml,P <0 0 5) ;患者肝动脉栓塞治疗前后血清VEGF分别为 7 41± 3 56ng/ml,8 72± 3 79ng/ml,P <0 0 5。有 1 6例患者血清VEGF水平在肝动脉栓塞治疗后升高 ,其中 1 2例在第二次血管造影时发现新生肿瘤血管 ,他们的血清VEGF水平显著升高达 1 0 84± 2 70ng/ml。血清VEGF浓度升高的患者介入的临床疗效较差。结论 :肝癌TACE后若肿瘤细胞表达VEGF增强 ,其预后差 ,血清VEGF是影响肝癌栓塞化疗效果的因素之一     

分层钳夹法肝切除术(附42例报告)

减少肝切除术中创面出血而又不致残肝功能严重受损是手术成功的关键。我科近年来采用不阻断入肝血流、分层钳夹控制切肝时创面出血 4 2例 ,与肝门阻断指折法切肝组 35例比较 ,效果良好 ,报告如下。1　材料与方法1 1　一般资料本组男 2 8例 ,女 14例 ,平均年龄 50岁。其中原发性肝癌 34例 ,复发性肝癌 1例 ,肝转移癌 7例。1 2　肝切除类型试验组 :非规则右半肝切除 8例 ,非规则左半肝切除 2 4例 ,肝部分切除 10例。对照组 :非规则右半肝切除 7例 ,非规则左半肝切除 2 0例 ,肝部分切除 8例。1 3　手术方法1 3 1　分层钳夹切 (断 )肝法 (试验组…     

氨基酸肠外营养支持对肺癌化疗患者血清褪黑素和色氨酸水平的影响

目的探讨氨基酸肠外营养支持对中晚期非小细胞肺癌(NSCLC)化疗患者血清中褪黑素(MT)和色氨酸(Try)水平的影响。方法将72例不能手术的中晚期NSCLC患者分为3组,统一采用NP方案(顺铂+去甲长春花碱)进行3个周期的化疗,A组和B组患者在化疗的同时分别给予250和500ml/d的9-复合氨基酸(9AA)营养支持,C组仅行化疗。测定3组患者治疗前后血清MT和Try的浓度。结果治疗后中午12∶00时,A、B和C组患者血清MT分别为(3．3±2．7)、(5．4±5．2)和(3．0±3．1)pg/ml,夜间0∶00时分别为(30．1±4．9)、(30．7±9．5)和(17．1±6．5)pg/ml。治疗后中午12∶00时,A、B和C组患者血清Try分别为(31．3±16．6)、(38．3±17．3)和(20．7±12．5) pg/ml,夜间0∶00时分别为(15．4±5．4)、(18．6±7．6)和(12．2±9．9)pg/ml。A、B组血清MT和Try浓度高于C组(P＜0．05),且500ml/d氨基酸营养支持的B组高于250ml/d氨基酸营养支持的A组(P＜0．05)。结论氨基酸肠外营养支持有利于纠正化疗后中晚期NSCLC患者血清MT和Try水平的低下,且500ml/d的氨基酸肠外营养支持效果较为显著。     

拉米夫定在肝癌合并乙型肝炎术后治疗中的应用

目的 探讨拉米夫定在原发性肝癌合并乙型肝炎治疗中的作用。方法 选取2002年1月至2006年5月我院58例原发性肝癌合并乙型肝炎患者,随机分为两组：对照组27例,行单纯肿瘤切除术;治疗组31例：肿瘤切除术联合拉米夫定治疗。观察比较两组间术后肝功能、乙型肝炎病毒复制相关指标、肝癌术后复发率和生存率。结果 6月后对照组血清天门冬胺酸转胺酶水平明显高于治疗组。术后2、3年,肝功能Child pugh积分治疗组明显小于对照组(7.4±1.7 vs. 8.9±1.8,7. 8±1.5 vs. 10.2±2.2,P<0.05)。治疗组术后6、12月HBV DNA转阴率分别为90.3%、100%,明显高于对照组0%和3.7%(P<0.01),且乙肝e抗原转阴率亦好于对照组。两组术后1、2年复发率和生存率间差异均无统计学意义,但术后3年复发率治疗组明显低于对照组(45.2% vs. 59.3%,P<0.05),而术后3年生存率高于对照组(77.4% vs. 54.8%,P<0.05)。结论 拉米夫定可有效控制原发性肝癌合并乙型肝炎术后体内病毒复制,保护术后肝功能,降低术后复发,改善肝癌患者愈后。     

Impact of monopolar radiofrequency coagulation on intraoperative blood loss during liver resection: a prospective randomised controlled trial

Purpose: To evaluate the impact of using monopolar thermal coagulation based on radiofrequency (RF) currents on intraoperative blood loss during liver resection.

Materials and methods: A prospective randomised controlled trial was planned. Patients undergoing hepatectomy were randomised into two groups. In the control group (n?=?10), hemostasis was obtained with a combination of stitches, vessel-sealing bipolar RF systems, sutures or clips. In the monopolar radiofrequency coagulation (MRFC) group (n?=?18), hemostasis was mainly obtained using an internally cooled monopolar RF electrode.

Results: No differences in demographic or clinical characteristics were found between groups. Mean blood loss during liver resection in the control group was more than twice that of the MRFC group (556?±?471?ml vs. 225?±?313?ml, p?=?.02). The adjusted mean bleeding/transection area was also significantly higher in the control group (7.0?±?3.3?ml/cm² vs. 2.8?±?4.0?ml/cm², p?=?.006). No significant differences were observed in the rate of complications between the groups.

Conclusions: The findings suggest that the monopolar electrocoagulation created with an internally cooled RF electrode considerably reduces intraoperative blood loss during liver resection.     

羟基喜树碱联合低分子肝素钠对肿瘤生长转移抑制的研究

 目的　研究羟基喜树碱（HCPT）联合低分子肝素钠对裸小鼠肝细胞癌生长转移的抑制作用。方法 建立人肝癌裸鼠转移模型。将造模成功的40只模型鼠随机分成4组，即对照组、HCPT组、低分子肝素钠组、联合组（HCPT、低分子肝素钠）。分别观察肿瘤大小、抑瘤率，测血清甲胎蛋白（AFP）、肿瘤微血管密度（MVD）、血小板内皮细胞黏附分子-1（CD31）。结果　对照组、HCPT组、低分子肝素钠组、联合组的肿瘤体积分别为（25 260±12 976）mm3、（5773±2498）mm3、（5911±3093）mm3和（1596±1207）mm3；抑瘤率分别为0、76.6 %、79.8 %和94.1 %；MVD分别为21.1±6.5、17.2±3.1、7.1±2.3和4.8±1.8；CD31分别为31.7±6.1、26.2±5.2、20.9±4.7和19.5±2.4；AFP分别为（121.9±31.4）ng／ml、（56.2±37.9）ng／ml、（75.6±28.7）ng／ml和（20.7±12.9）ng／ml；肝癌转移率分别为80 %、70 %、20 %和10 %；肺转移率分别为70 %、60 %、20 %和10 %；腹壁转移率分别为90 %、60 %、30 %和30 %；腹腔积液形成率分别为20 %、10 %、0和0。HCPT组、低分子肝素钠组、联合组分别与对照组比，对肝癌生长的抑制作用差异有统计学意义（F＝9.074，P＜0.01）。HCPT联合低分子肝素钠对肝癌的生长和转移有良好的抑制作用，与对照组及HCPT组比较差异有统计学意义（F＝24.837，P＜0.01）。结论　HCPT联合低分子肝素钠对肿瘤的生长与转移有良好的抑制作用。     

精准外科时代3D可视化技术在肝癌切除术中的应用价值

目的探讨精准外科时代3D可视化技术在肝癌切除术中的应用价值。方法采用随机数字表法将100例原发性肝癌患者分为3D组和常规组,每组50例,3D组患者实施3D可视化技术辅助肝癌切除术,常规组患者实施常规肝癌切除术。比较两组患者的手术情况、肝功能指标[丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)水平]、肝功能损伤程度、术后并发症发生情况、术后1年生存及复发情况。结果3D组患者的术中出血量明显少于常规组,肝门阻断时间和手术时间均明显短于常规组,差异均有统计学意义(P﹤0.01)。两组患者的实际切除肝体积比较,差异无统计学意义(P﹥0.05)。术后第1天、第3天、第5天,3D组患者的ALT和AST水平均低于常规组,差异均有统计学意义(P﹤0.05)。3D组患者的肝功能损伤程度明显小于常规组,差异有统计学意义(P﹤0.01)。3D组患者的术后并发症总发生率为18.0%(9/50),明显低于常规组的56.0%(28/50),差异有统计学意义(P﹤0.01)。3D组患者的1年生存率高于常规组,1年复发率低于常规组,差异均有统计学意义(P﹤0.05)。结论精准外科时代3D可视化技术应用于肝癌切除术中能够有效减轻患者肝组织的损伤程度,减少术后并发症,延长患者的生存时间,具有良好的应用价值。     

Effects of doxorubicin on cancer cells after two-thirds hepatectomy in rats

A rat model of liver metastases generated by intraportal injection of syngeneic tumor cells after two-thirds hepatectomy was used to determine the optimal regional chemotherapeutic modality for early hepatic metastases. WKA rats had viable tumor cells injected directly into the portal vein after two-thirds hepatectomy. Ten rats were used as a control; the remaining groups were given doxorubicin (4/3 mg/kg) injected directly into the hepatic artery at 24 hr, 72 hr, and 7 days (after liver regeneration) postoperatively. The mean survival period in each group was 21.0, 20.0, 20.5, and 20.7 days, respectively, compared with those treated with doxorubicin (4 mg/kg) injection at 24 hr, 72 hr, and 7 days postoperatively, with a mean survival period in each group of 20.0, 21.6, and 25.6 days, respectively. When a comparison was made with regard to the doses of doxorubicin administered, statistically significant differences in survival rates were recognized between the rats that had doxorubicin (4 mg/kg) injection 7 days postoperatively and the others (P < 0.01). Based on these findings, we believe that appropriate adjuvant chemotherapy should be given after the liver regeneration phase. © 1995 Wiley-Liss, Inc.     

Pure laparoscopic versus open major hepatectomy for hepatocellular carcinoma with liver F4 cirrhosis without routine Pringle maneuver – A propensity analysis in a single center

Background/Aim: Laparoscopic hepatectomy has been gaining popularity but its evidence in major hepatectomy for cirrhotic liver is lacking. We studied the long-term outcomes of the pure laparoscopic approach versus the open approach in major hepatectomy without Pringle maneuver in patients with hepatocellular carcinoma (HCC) and cirrhosis using the propensity score analysis.MethodsWe reviewed patients diagnosed with HCC and cirrhosis who underwent major hepatectomy as primary treatment. The outcomes of patients who received the laparoscopic approach were compared with those of propensity-case-matched patients (ratio, 4:1) who received the open approach. The matching was made on the following factors: tumor size, tumor number, age, sex, hepatitis serology, HCC staging, comorbidity, and liver function.ResultsTwenty-four patients underwent pure laparoscopic major hepatectomy for HCC with cirrhosis. Ninety-six patients who underwent open major hepatectomy were matched by propensity scores. The laparoscopic group had less median blood loss (300 ml vs 645 ml, p = 0.001), shorter median hospital stay (6 days vs 10 days, p = 0.002), and lower rates of overall complication (12.5% vs 39.6%, p = 0.012), pulmonary complication (4.2% vs 25%, p = 0.049) and pleural effusion (p = 0.026). The 1-year, 3-year and 5-year overall survival rates in the laparoscopic group vs the open group were 95.2%, 89.6% and 89.6% vs 87.5%, 72.0% and 62.8% (p = 0.211). Correspondingly, the disease-free survival rates were 77.1%, 71.2% and 71.2% vs 75.8%, 52.7% and 45.5% (p = 0.422).ConclusionsThe two groups had similar long-term survival. The laparoscopic group had favorable short-term outcomes. Laparoscopic major hepatectomy without routine Pringle maneuver for HCC with cirrhosis is a safe treatment option at specialized centers.     

Neoadjuvant therapy of bevacizumab in combination with oxaliplatin and capecitabine (XELOX) for patients with metastatic colorectal cancer with unresectable liver metastases: a phase II,open‐label,single‐arm,noncomparative trial

1 Aim

This phase II, open‐label study evaluated the efficacy and safety of neoadjuvant therapy with bevacizumab plus XELOX (capecitabine and oxaliplatin) for untreated metastatic colorectal cancer with unresectable liver metastases and assessed conversion of unresectable to resectable metastases after neoadjuvant treatment.

2 Methods

Patients received bevacizumab 5 mg/kg and oxaliplatin 85 mg/m² on day 1, and capecitabine 1000 mg/m² twice daily on days 1–5 followed by 2 days of rest in a 14‐day cycle for 12 cycles; bevacizumab was excluded in cycles 6 and 7. Patients were later divided into resected and unresected groups, depending upon whether they underwent curative resection after chemotherapy. Efficacy and safety were evaluated.

3 Results

Of 45 patients enrolled, 17.8% completed the study. The resection rate of liver metastases after neoadjuvant therapy was 42.2%. The median time to disease progression was 10.1 and 8.7 months in the resected and unresected groups, respectively (P = 0.1341). Response rate was significantly higher in the resected (47.4%) versus the unresected group (34.6%; P = 0.0010), and seven patients achieved complete response (resected group). Overall, 94.3% of adverse events were of mild or moderate severity, and grade ≥3 adverse events occurred in 4.3% and 7.3% of patients in the resected and unresected groups, respectively. The most common adverse events in both groups were palmar‐plantar erythrodysesthesia syndrome, decreased appetite, thrombocytopenia, peripheral neuropathy, fatigue, diarrhea, vomiting, proteinuria and nausea.

4 Conclusion

Neoadjuvant therapy with bevacizumab plus XELOX was well tolerated and effective in previously untreated metastatic colorectal cancer patients with initially unresectable liver metastases.     

Adriamycin Thermotherapy through the Hepatic Artery Using VX2 Carcinoma in Rabbit liver as a Model

OBJECTIVE It has been reported that heating can enhance sensitivity of rabbit VX2 cells to adriamycin and increase the intracellular concentration of adriamycin. This study was designed to evaluate the anti-tumor effect of interventional hyperthermia and interventional thermochemotherapy on VX2 carcinoma in rabbit liver. METHODS VX2 carcinoma cells were surgically implanted into the right liver lobe of 60 male New Zealand white rabbits, which were randomly divided into 4 groups (15 per group). The 4 groups (designated as 1, 2, 3, 4 respectively) were injected with 10 ml of the following via the hepatic artery: physiological saline (37℃); adriamycin (37℃); physiological saline (60℃); adriamycin (60℃). One week later, the tumor volume, serum level of aspartate transaminase (AST) and the survival of the rabbits bearing VX2 were observed and compared among the different treated groups. RESULTS The tumor growth rate in group 4 (ADM 60℃) (0.53±0.21)% was significantly lower than that in group 1 (3.48±1.17)%, in group 2 (1.09±0.26)% and group 3 (3.32±1.28)% (P<0.05, P<0.05, P<0.01, respectively). The days of survival days for group 4 (87.0±2.0) were significantly more than that in group 1 (40.0±3.0). Group 4 showed a significantly higher increase in serum AST compared to group 1 (P<0.05), but without significant differences compared to the other groups (P>0.05). CONCLUSION Adriamycin treatment at 60℃ significantly deceased the tumor growth, prolonged the survival period and resulted in reversible liver damage.     

维拉帕米联合5-氟脲嘧啶腹腔内化疗对荷肝癌大鼠的抗肿瘤作用

Objective To study the antineoplastic effect of the calcium channel blocker verapamil and 5-fluorouracil intraperitoneal chemotherapy on hepatocarcinoma-bearing rats, and examine the action between calcium channel blockers and cytotoxic drugs. Methods We adopted the method of subcapsular implantation of carcinoma tissues of walker-256 in the left liver lobe as a model of liver carcinoma-bearing rats. All experimental animals were divided into four groups. On the sixth day post implantation, in group A (control group) 6 ml of saline was injected intraperitoneally once a day for 3 days. In group B (single chemotherapy group) 6 ml, of 5-Fu 75 mg/kg was injected intraperitoneally once a day for 3 days. In group C (combination of treatment group) both 5-Fu (75 mg/kg) and verapamil (25 mg/kg) were administered simultaneously as in A and B. In group D (simple verapamil group) only 6 ml of verapamil (25 mg/kg) was administered as above. Results Compared with groups A, B and D, The volume of cancer and the contents of liver cancer DNA and protein were significantly reduced. The rates of inhibiting cancer (89.9% in group C and 35.4% in group B) were significantly increased in group C. Group C had significantly long survival time compared to groups A, B and D (P<0.05). By light microscopy, a number of focal necroses were found in cancer tissue in group C. Conclusion Calcium channel blockers can enhance the antineoplastic effect of 5-Fu intraperitoneal chemotherapy to liver cancer: The use of verapamil can not increase the toxicity of 5-Fu.