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胆肠吻合术 (choledochojejunostomy ,CJ)是治疗胆道疾病常用的手术方式 ,自 1888年Riedel成功施行第 1例胆总管十二指肠侧侧吻合术以来 ,至今已有 10 0多年历史。CJ包括Oddi括约肌切开成形术、胆总管十二指肠吻合术、肝外 (肝门 )胆管间置空肠十二指肠吻合术和胆管空肠Roux-en -Y吻合术。使用最广泛的是胆总管十二指肠吻合术和胆管空肠Roux -en -Y吻合术。CJ常用于修复胆道损伤、肝外胆管病变切除后及治疗胆道结石的胆道重建 ,在2 0世纪 90年代以前曾风靡一时 ,几乎成为胆道外科的常规手术和标志性手术。然而 ,经过多年大量的临床病例…     

奥曲肽上调Smad4表达抑制肝癌细胞生长

目的观察奥曲肽（octreotide，OCT）对Bel7402人肝癌细胞内Smad4调节及其对肝癌细胞的抑制作用。方法以MTr法测量OCT对Bel7402细胞增殖的影响，光镜下观察细胞形态的变化。以细胞迁移实验和粘附实验观察细胞侵袭和粘附能力的影响。以流式细胞仪检测细胞周期和Smad4蛋白的变化。以裸鼠人肝癌种植模型，观察OCT对种植瘤生长的影响，以免疫组化观察种植瘤内Smad4蛋白的表达。以半定量RT—PCR观察体内外Smad4mRNA的表达。结果OCT处理的Bel7402细胞增殖能力和细胞形态无明显改变，细胞的侵袭和粘附能力明显下降，细胞生长静止期（G0／G1）的比例显著增加（48．0％±3．2％vs57．7％±0．9％），OCT明显抑制裸鼠人肝癌种植瘤的生长，抑瘤率达到67．9％。体外OCT流式细胞仪检测治疗组种植瘤内Smad4蛋白（6．36±1．22）的表达显著高于对照组（3．22±1．20）。体内外Smad4 mRNA的表达，治疗组（0．701±0．035，1．091±0．131）也明显高于对照组（O．531±O．073，0．634±0．222）。结论OCT能显著抑制体内外肝癌细胞的生长，上调肝癌细胞内Smad4的表达可能是其抑瘤的重要机制。     

对胆肠吻合术的再认识

胆肠吻合术是治疗胆道外科疾病、重建胆汁引流的重要方法,是胆道外科最常应用的手术方法之一.在多年的临床实践中,胆肠吻合的术式不断改进,在不同的历史时期均有其代表性术式.     

HBx在乙型肝炎病毒相关性肝癌形成与发展中的分子机理

目的 了解HBx基因在乙肝病毒相关性肝癌形成与发展中的分子机理。方法 综合国外近5年的文献进行分析。结果 HBx具有促进细胞恶性转化、抑制受损DNA的修复、反式激活、抑制wtp53功能和抑制细胞凋亡等生物学功能。HBx可能通过直接致癌作用、抑制DNA的修复、抑制wtp53、干扰Fas/CD95系统和抑制Caspase-3活性等分子机理,诱发肝癌形成和促进肝癌发展。结论 HBx及其编码的蛋白HBxAg具有广泛的生物学功能,从多方面、多途径促进肝癌的形成和发展。     

左半肝切除与肝左外叶切除治疗左侧肝内结石的效果比较

目的比较左半肝切除与肝左外叶切除治疗左侧肝内结石的效果。方法回顾性分析我科近14年来手术切除的结石局限在左侧肝内的肝内结石患者96例,其中左外叶切除61例,为左外叶切除组,左半肝切除35例,为左半肝切除组。比较两组的术后残石率、手术并发症和远期效果。结果左外叶切除组术后结石残余率为13．1％,明显高于左半肝切除组(0％), P=0．025(Fisher exact test)。左外叶切除组术中出血量(P=0．005)和手术时间(P=0．017)均明显低于左半肝切除组,左外叶切除组的平均住院时间短于左半肝切除组,但无统计学差异(P=0．057)。左外叶切除组和左半肝切除组术后总的并发症发生率分别为19．7％和31．4％,P=0．220。左半肝切除组的远期优良率显著高于左外叶切除组(78．8％vs 96．8％,P=0．027)。结论左半肝切除治疗左侧肝内结石的短期和远期效果明显优于肝左外叶切除,对于局限在左侧肝内的胆管结石,应行左半肝切除。     

前入路右半肝切除术与传统右半肝切除术治疗大肝癌的对比观察

Objective To compare the outcomes between anterior versus conventional approach right hepatectomy for large hepatocellutar carcinoma(HCC).Methods A total of 188 consecutive patients with large HCC(≥5 cm)undergoing right hepatectomy were reviewed retrospectively.Among them,92patients received anterior approach right hepatectomy(anterior group)while the other conventional right hepatectomy(conventional group).Their clinicopathologic data and survivals were compared.Results There were five surgical deaths(2.7%),two in the anterior group and three in the conventional group.The biochemical and tumor pathological data(except for tumor size) of these two groups were comparable.The mean intranperative blood loss,the number of patients with massive hemorrhage(＞3000ml)and the volume of blood transfusion of the anterior group were markedly less than those of conventional group.The 1-,3-year disease-free survival rates of the anterior group were significantly better than those of the conventional group anterior group were also markedly higher than those of conventional group.The Cox regression model indicated that tumor size[P=0.014,odd ratio(OD):1.074] and surgical procedure(P:0.009,OD=0.468) were independent risk factors correlated with disease-free survival.And the surgical procedure(P=0.003,OD=0.369) was the only independent risk factor for postoperative cumulative survival.Conclusion Anterior approach right hepatectomy can significantly decrease intraoperative blood loss.The postoperative survivals of large HCC patients are significantly improved by anterior approach right hepatectomy.     

改良胆肠袢式吻合术的疗效分析

Objective To evaluate the long-term efficacy of modified loop choledochojejunostomy (MLC). Methods The clinical data of 259 patients who had underwent choledochojejunostomy in First Affiliated Hospital of Sun Yat-Sen University from January 2000 to December 2006 were retrospectively analyzed. Of all the patients, 130 underwent MLC (MLC group) and 129 underwent Roux-en-Y choledochojejunostemy (RYC, RYC group). The changes in incidence of cholangitis and liver function between the 2 groups were compared. All the data were analyzed by t test, chi-square test or Fisher exact probability. Results The levels of alaninetransa-minase and alkaline phosphomonoesterase were (63±42) U/L and (147±147) U/L in MLC group, and (84±52)U/L and (256±201)U/L in RYC group, with statistical difference between the 2 groups (t=1.634, 1.655, P>0.05). The level of gamma-glutamyl transferase in MLC group was (116±91)U/L, which was signifieandy lower than (169±96)U/L in RYC group (t=2.461, P<0.05). Three patients (2.3%) in MLC group and 9 (7.0%) in RYC group suffered from acute cholangitis after operation, with no statistical difference in the incidence between the 2 groups (P>0.05). Of the 12 patients with acute cholangids, 1 in MLC group and 7 in RYC group were hospitalized, with statistical difference between the 2 groups (P<0.05). Conclusions The incidence of acute cholangitis in patients who underwent MLC is comparable to that of RYC. However, the procedure of MLC is simpler than RYC, and patients have milder symptom and lesser frequency of reflux cholangitis onset after MLC.     

沉默乙型肝炎病毒编码X蛋白基因表达增强索拉非尼促人肝癌细胞株PLC的凋亡

目的 探讨沉默乙型肝炎病毒编码X蛋白(HBx)基因后对索拉非尼促人肝癌细胞株PLC凋亡的影响及其机制.方法 应用小干扰RNA(siRNA)方法沉默HBx基因,应用实时定量聚合酶链反应(Real-time PCR)检测HBx mRNA表达水平,流式细胞技术检测细胞凋亡,Real-time PCR基因芯片检测HBx-siRNA转染后索拉非尼作用肝癌敏感细胞株PLC丝裂原活化蛋白激酶(MAPK)信号通路基因的表达.结果 HBx特异的siRNA作用后,HBx mRNA表达水平为0.61,与其他对照组比较显著下调(P＜0.05).索拉非尼作用HBx-siRNA干扰后PLC细胞株凋亡表达率为43％,显著高于其他对照组(P＜0.05).索拉非尼作用PLC细胞后,与对照组比较,实验组MAPK信号通路中有13个差异表达基因,其中＞2.0倍的有2个,≤0.5倍的有11个.用siRNA干扰去除HBx基因的影响,经索拉非尼作用PLC细胞后,与对照组比较,实验组MAPK信号通路中有37个差异表达基因,其中＞2.0倍的有1个,≤0.5倍的36个.结论 沉默HBx基因增强了索拉非尼促人肝癌细胞株PLC的凋亡作用,可能是沉默HBx基因表达后,扩大和增强了索拉非尼对MAPK信号通路基因的抑制作用.     

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胆肠吻合术(choledochojejunostomy，CJ)是治疗胆石症的重要的手术方式之一。自1888年Riedel成功施行第一例胆总管十二指肠侧侧吻合术以来，至今已有100多年历史。随后CJ发展了多种术式，主要包括Oddi括约肌切开成形术、胆总管十二指肠吻合术、肝外/肝门胆管间置空肠十二指肠吻合术、胆管空肠Roux-en-Y吻合术和在Roux-en-Y吻合基础上发展的抗反流术式。