肝或肾移植术后受者再次行一期肝肾联合移植三例报告

目的 探讨肝或肾移植术后受者再次行一期肝肾联合移植的手术适应证、术后并发症及存活情况.方法 对2003年10月至2008年12月施行的3例肝或肾移植术后再次行一期肝肾联合移植的受者进行随访,并进行文献复习.对其围手术期死亡率、术后并发症及存活情况进行总结.结果 围手术期死亡率为33.3%(1/3).术后并发症:1例因腹腔出血术后第29天死于肺部感染、急性移植肾功能衰竭和多器官功能衰竭;3例患者均发生了肺部感染;无急性排斥反应发生.2例存活患者,从首次移植计算,已经分别存活56个月和228个月;从一期肝肾联合移植计算,已经分别存活40个月和48个月.结论 肝肾联合移植是治疗终末期肝肾疾病的有效方法.肝或肾移植术后受者再次行一期肝肾联合移植是可行的.     

外周血嗜酸性粒细胞水平与肝移植术后迟发性急性排斥反应的关系

目的评价外周血嗜酸性粒细胞诊断肝移植术后迟发性急性排斥反应(AR)的价值。方法回顾性分析中山大学附属第三医院37例肝移植术6个月后行肝穿刺活检患者的临床资料,根据病理确诊结果,比较迟发性AR组(AR组,24例次)和非迟发性AR组(非AR组,16例次)患者肝穿刺当日或前1d血常规中白细胞的分类,根据受试者工作特征(ROC)曲线确定嗜酸性粒细胞绝对值和比例的最佳截断值,分析其诊断迟发性AR的敏感度和特异度。结果AR组患者的外周血嗜酸性粒细胞比例显著高于非AR组。ROC曲线分析显示嗜酸性粒细胞绝对值和比例分别为0.145×109/L和0.023时约登指数最高(分别为0.333和0.625),ROC曲线下面积分别为0.746和0.813。分别以0.145×109/L和0.023作为嗜酸性粒细胞绝对值和比例升高的截断值,诊断AR的敏感度和特异度分别为0.46和0.88、0.75和0.88。当嗜酸性粒细胞绝对值≥0.285×109/L和比例≥0.03时,诊断AR的敏感度和特异度分别为0.25和1.0、0.50和1.0,所有嗜酸性粒细胞绝对值≥0.285×109/L者的细胞比例均≥0.03。结论肝移植术后6个月,延迟性AR患者的外周血嗜酸性粒细胞比例显著高于非延迟性AR患者,嗜酸性粒细胞比例≥0.03对诊断迟发性AR具有很高的临床价值。     

单中心11例肝内胆管细胞癌肝移植疗效分析

Objective To evaluate the effect of liver transplantation(LT)on the prognosis in patients with intrahepatic cholangiocarcinoma(ICC).Methods A retrospective analysis was performed on 11 consecutive patients with ICC who underwent LT between October 2003 and November 2008 at our institution.The overall and disease-free survival rates were calculated by the Kaplan-Mayer method.Results The median survival time Was 9.0 months(2.5-53 months).The 1-,2-,3-and 4-year disease-free survival rate and overall survival rate of all the patients were 51.9%、51.9%、51.9%、51.9%and 50.5%、50.5%、50.5%、50.5%,respectively.The perioperative mortality and the recurrence rate were 0 and 43.5%,respectively.The survival rate and disease-free survival time of patients with recurrence were 2.5-10 months(mean 7.5 months)and 1-8 months(mean 3.8 months).Conclusions The prognosis of LT for ICC is rather poor.ICC patients with lymph node metastasis.vascular or bile duct invasion is contraindicated for LT.     

一种人硫氧还蛋白基因修饰肝细胞的制备

[目的]制备出一种人硫氧还蛋白(hTrx)基因修饰的肝细胞.[方法]逆转录聚合酶链反应法扩增出hTrx cDNA,应用重组逆转录病毒制备hTrx基因修饰大鼠肝细胞.白蛋白免疫组化SABC法进行肝细胞活性鉴定,MTT比色试验进行抗氧化应激能力检测.[结果]克隆出hTrx开放阅读框cDNA并制备出重组逆转录病毒,感染真核细胞后可分泌融合表达的hTrx并具有生物学活性.制备出hTrx基因修饰大鼠肝细胞,免疫组化SABC法显示肝细胞功能正常,MTT比色法检测具有较强的抗氧化应激能力(P＜0.05),并可有效增殖.[结论]成功制备出一种具有较强抗氧化应激的hTrx基因修饰肝细胞.     

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目的　探讨动态检测急性胆管炎病人血清α GST对评估肝功能受损情况的临床意义。方法　 2 0 0 1～ 2 0 0 2年观察组为 32例急性胆管炎病人。对照组为 2 0位健康志愿者。α GST检测采用酶免疫测定法 (ELA)。谷丙转氨酶 (ALT)、谷草转氨酶 (AST)检测采用常规生化方法。结果　急性胆管炎病人血清中α GST在发病初期迅速升高 (P <0 0 5 ) ,并血清中所测α GST峰值变化于同期所测的ALT、AST值间比较明显提早 ,经治疗后α GST迅速下降 ,快于治疗后所测ALT、AST值的变化。结论　动态检测血清α GST浓度能更敏感的反映肝功能受损情况 ,对急性胆管炎病人的治疗有着重要的临床意义。     

西罗莫司对人肝癌裸鼠肝脏移植瘤生长的影响

Objective To study the effects of sirolimus (SRL) on the growth of transplanted human hepatocellular carcinoma (HCC) in nude mice. Methods HepG2 cells were Implanted into the liver of nude mice. The implanted mice were then treated with SRL and tacrolimus (FK506). The expression of vascular endothelial growth factor (VEGF) and proliferating cell nuclear antigen (PCNA) was detected by immunohistology, microvessel density (MVD) was counted by immunostaining with anti-CD34 antibody for endothelial cells. Tumor apoptosis was detected by terminal deoxynuclcotidyl transferase-mediated dUTP nick end-labeling (TUNEL) assay. Results The tumor weight was (352±38) mg, (683±53) mg and (675±45) mg in SRL, FKS06 and control group respectively. The tumor weight was significantly decreased in SRL group (P < 0.0 I), and there was no difference between FKS06 group and control group. The expression of VEGF and PCNA protein was remarkably down-regulated in SRL group compared to control group (P < 0.05), and it was not significantly different between FK506 group and control group (P > 0.05). Compared to the control group, MVD was significanly decreased in SRL group, and the apoptosis index of tumor cell was significantly higher in SRL group (P < 0.01). Conclusion SRL inhibits transplanted HCC tumor growth by reducing tumor angiogenesis, inhibiting tumor proliferation and inducing tumor apoptosis.     

雌激素受体在肝海绵状血管瘤中的表达及意义

采用免疫组化Ｓ－Ｐ法检测３０例肝海绵状血管瘤组织中雌激素受体的表达，并以ＣＨＬ瘤旁正常肝组织作对照。结果ＥＲ阳性表达于ＣＨＬ血窦内皮细胞胞浆中，阳性率为４３．３％，ＣＨＬ瘤旁正常肝组织中未见表达。提示肝海绵状血管瘤的生长与雌激素有关。雌激素可能其受体作用促进ＣＨＬ生长。     

一种人硫氧还蛋白基因修饰肝细胞的制备

 【目的】 制备出一种人硫氧还蛋白(hTrx)基因修饰的肝细胞&#65377; 【方法】 逆转录聚合酶链反应法扩增出hTrx cDNA,应用重组逆转录病毒制备hTrx基因修饰大鼠肝细胞&#65377;白蛋白免疫组化SABC法进行肝细胞活性鉴定,MTT比色试验进行抗氧化应激能力检测&#65377;【结果】 克隆出hTrx开放阅读框cDNA并制备出重组逆转录病毒,感染真核细胞后可分泌融合表达的hTrx并具有生物学活性&#65377;制备出hTrx基因修饰大鼠肝细胞,免疫组化SABC法显示肝细胞功能正常,MTT比色法检测具有较强的抗氧化应激能力(P < 0.05),并可有效增殖&#65377;【结论】 成功制备出一种具有较强抗氧化应激的hTrx基因修饰肝细胞&#65377;     

肝肺综合征患者肝移植预后的危险因素分析

.0%和83.3%.结论 肝移植是HPS的有效治疗方法.99Tcm-大聚合白蛋白肺分流率及术后机械通气时间是影响HPS肝移植患者术后生存的独立危险因素.     

移植肝脏病学:一门相对独立的新兴学科

1963年美国Starzl教授在科罗拉多大学完成世界首例人类同种异体原位肝移植（OLT）,从此开创了肝脏外科的新纪元。一些传统肝脏外科手术和内科治疗无法治愈的终末期肝病通过肝移植得以治愈。肝移植技术迅速发展,拯救了大量终末期肝病患者。