影响胆囊癌手术疗效的因素

我院于1980．1～1996．3月，手术治疗胆囊癌65例，利用Cox模型分析影响手术疗效的因素，现将主要情况报告如下。     

肝硬化大鼠肝癌细胞原位种植瘤模型的建立

目的： 探讨硬化肝脏促进CBRH-7919大鼠肝癌细胞原位种植瘤形成的可能及其机制。方法：30只Wistar大鼠随机分成A、B 2组，即正常肝脏组和硬化肝脏组。肝硬化大鼠通过口服二乙基亚硝胺 (DENA) 溶液诱导。在2组大鼠肝脏上原位种植CBRH7919的种植瘤，观察肝癌原位种植瘤形成率和病理情况。在种植肿瘤的同时切取小部分肝脏，免疫组化的方法检测转化生长因子β1(TGF-β1)、磷酸化Smad2、Smad4和Smad7蛋白的表达，半定量RT-PCR检测Smad4 mRNA的表达。结果：CBRH-7919细胞在硬化肝脏上原位种植的成功率为53.3％（8/15），呈现类似人类肝细胞癌的病理特点，而正常肝脏的原位种植成功率为0％。正常肝脏内TGF-β1和Smad4极少表达，但有较多磷酸化Smad2的表达，也可见Smad7的少量表达；而硬化肝脏内TGF-β1、Smad4和Smad7的表达明显增多，而磷酸化Smad2的表达较正常显著减少。结论：肝硬化可以促进大鼠肝癌原位种植瘤的生长，提高模型制作的成功率，其机制可能与硬化肝脏内磷酸化Smad2表达的减少，而TGF-β1、Smad4和Smad7表达的增加有关。     

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.     

Hepadif对肝切除术后肝功能的保护作用

肝切除术是治疗原发性肝癌和肝内结石最有效的方法，但由于大部分原发性肝癌和肝内结石病人都合并不同程度的肝硬化或肝功能损害，肝切除手术将加重对肝脏的打击，甚至导致肝功能衰竭。如何增强术前肝储备功能及术后肝功能的保护是保证手术顺利进行和改善病人预后的重要措...     

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.     

276例胰腺癌临床预后因素分析

目的 探讨影响胰腺癌预后的因素.方法 回顾性分析1995年9月至2005年8月收治的276例胰腺癌患者的临床资料,采用Cox比例风险模型分析可能影响胰头癌、胰体尾癌预后的独立因素,用Kaplan-Meier方法描述不同位置胰腺癌的中位生存时间,并进行Log-rank和Breslow检验.结果 Cox比例风险模型发现包块直径、肠系膜上血管浸润情况和治疗方式是胰头癌预后的独立影响因素;年龄、淋巴结肿大和治疗方式是胰体尾癌预后的独立影响因素.根治术后胰头癌和胰体尾癌患者的中位生存时间分别为460 d和480 d,显著高于姑息治疗或放弃治疗患者的240 d和200 d.在肿瘤位置对生存时间的影响中,全胰癌患者总体中位生存时间为117 d,明显低于胰头癌的330 d和胰体尾癌的300 d.结论 根治性手术是目前改善胰腺癌预后最好的方法.包块直径＞4 cm、肠系膜上血管浸润的胰头癌预后较差;年龄≤60岁和淋巴结肿大的胰体尾癌预后较差.胰头癌与胰体尾癌的预后相近,全胰癌是胰腺癌中极为晚期的状态,预后极差.     

肝细胞癌肝切除术患者术中大出血的术前危险因素探究

目的探讨肝细胞癌肝切除术中发生大出血的术前危险因素,并针对危险因素提出术中护理对策。方法将肝细胞癌行肝切除术患者1 051例,根据术中出血量分为术中大出血组(n=170)和非大出血组(n=881)。对两组变量进行单因素分析和多因素Logistic回归分析。结果 Logistic多元回归分析发现术前血小板100×10~9/L(OR=1.731)、肿瘤直径5.0 cm(OR=2.454)、合并门静脉血栓(OR=1.492)和大块肝切除术(OR=1.577)是肝细胞癌肝切除术患者术中大出血的术前危险因素(P0.05,P0.01)。大出血组术中输注红细胞悬液、新鲜冰冻血浆、晶体的量显著高于非大出血组,手术结束时的体温显著低于非大出血组,手术时间显著长于非大出血组(均P0.01)。结论护理人员需充分了解肝细胞癌肝切除术患者术中大出血的术前危险因素,加强相应的术前、术中护理干预,减少术中出血。     

阻塞性黄疸病人围手术期肝肾功能保护的临床研究

目的　研究天普洛安对阻塞性黄疸病人围手术期的肝肾功能的保护作用。方法　以我科连续收治的需手术治疗的阻塞性黄疸病人 4 2例为研究对象 ,2 4例为试验组 ,18例为对照组 ,试验组立即给予天普洛安静脉点滴 ,疗程为 5d ,对照组仅予以常规治疗。结果　术后 15d 2 4h尿量 (mg/kg) ,试验组病人明显多于对照组 ,其中以术后第 3天最为明显 ,差别有显著性 (P =0 0 14 ) ;术后第 5天试验组血清肌酐水平为 6 3± 18μmol/L ,对照组为 79± 2 7μmol/L ,差别有统计学意义 (P =0 0 2 8) ;两组术后AST、γ GT及总胆红素无明显差异 ,但试验组的各检验值恢复速度更快。结论　天普洛安对阻塞性黄疸病人围手术期的肝肾功能有保护作用。     

实验性大鼠肝脏癌变过程中生长抑素受体2表达的意义

目的：研究生长抑素受体2（SSTR2）在肝癌癌变过程中的表达和分布，探讨SSTR2在肝癌发生过程的作用。方法：二乙基亚硝胺溶液(DENA)诱发SD大鼠发生肝癌，RT-PCR和免疫组化检测肝硬化肝组织、肝癌中SSTR2的mRNA和蛋白表达，比较不同时期肝组织中SSTR2-mRNA和蛋白的表达。结果：DENA诱癌8周后，可见肝癌形成。诱癌8周时，癌旁肝组织SSTR2-mRNA明显高于正常肝脏（1.794±0.212 vs 0.950±0.138,P<0.05），随着诱癌时间的延长，SSTR2-mRNA的表达逐渐增强，到16周时到最高（2.053±0.169），随后逐步下降（22周时低至1.468±0.107），而肝癌组织SSTR2-mRNA表达只为1.219±0.249。免疫组化检测SSTR2蛋白表达发现，SSTR2主要位于胞浆和细胞膜，SSTR2蛋白表达的变化与SSTR2-mRNA的变化一致。结论：SSTR2在实验性肝硬化早期表达逐步升高，随着肝硬化的加重和肝细胞癌变的发生，SSTR2表达逐渐下降。SSTR2表达下降可能与肝细胞癌发生、发展密切相关。     

胆囊癌扩大根治术及其并发症的预防

胆囊癌是肝外胆道常见的恶性肿瘤，具有高度恶性生物学行为，大部分患者就诊时已为中晚期，手术切除率低，预后差。近年来随着胆囊癌的扩大根治术的开展，其治疗结果令人鼓舞，逐步改变人们对胆囊癌的看法。本文着重论述胆囊癌扩大根治术及其并发症的防治。