原位肝移植术后糖尿病高渗性昏迷一例

患者男性 ,40岁 ,无糖尿病史 ,因乙型肝炎后肝硬化并原发性肝癌于 2 0 0 0年 11月 6日行肝移植。术后第 9天确诊为继发性糖尿病 ,予胰岛素治疗 ,血糖维持在 130ｍｇ/Ｌ左右。2 0 0 0年 11月 30日出院。予达美康 80ｍｇ每日 2次 ,并制定饮食及运动方案 ,控制血糖 ;用ＦＫ5 0 6及泼尼松进行抗排斥治疗。出院后未及时复诊 ,于 2 0 0 0年 12月 15日因咽喉疼痛、进食困难而于当地医院输注未加胰岛素之葡萄糖液 ,病情无好转 ,出现疲倦、烦躁症状 ,于 2 0 0 0年 12月 19日转入我院。查体 :疲倦、神志清醒 ,皮肤干燥、无弹性 ,眼眶凹陷 ,口腔、咽喉…     

肝癌术后肝再生状态与肝癌复发关系的初步研究

目的:探讨肝癌肝切除术后再生激素的变化，以评估肝再生激素与肝癌复发之间的关系。方法:收集2年内确诊为原发性肝癌行手术治疗的患者129例的临床资料，将小肝癌及大肝癌术后复发患者分别分为术后1，6个月，1年复发组，并以肝癌TAE治疗患者40例作为对照组。分别于术前1d与术后1, 3, 7, 10, 14 d清晨抽取静脉血检测血清肝细胞生长因子(HGF)，观察其在手术前后HGF的变化。手术中切取癌及癌旁组织为标本分别采用半定量RT-PCR及Western Blot法检测HGF受体c-met的mRNA及蛋白表达，比较复发时间早晚与表达量的差别。将所得结果与病理检查发现的脉管癌栓发生率对照。结果:肝切除后，患者血清HGF水平升高，术后约10 d达高峰期，14 d 开始降低。大肝癌组的HGF升高水平明显高于小肝癌组(P<0.05)。大、小两肝癌组的c-met mRNA及蛋白的水平变化均显示肿瘤复发时间越早，c-met水平越高，脉管癌栓发生率越高。结论:肝癌患者肝部分切除术后血清HGF水平明显增高及肿瘤本身c-met 蛋白过度表达可能与术后早期复发有关。     

彩色多普勒血流显像观察活体肝移植血流动力学改变1例

患者男，26岁，因“暴发型乙型肝炎致肝功能衰竭肝昏迷”而入院行肝移植术。由于病情危急．采取活体肝移植术，供体是患者生父．受体接受了供体的右半肝。     

骨髓源性肝干细胞的筛选、扩增和分化

Objective To explore the feasibility of direct separation, selective proliferation and differentiation of BDLSC from hone marrow cells with culture systems containing cholestatic serum in vitro.Methods Whole bone marrow cells of rats cultured in routine medium were replaced with con-ditioning selection media containing eholestatic sera of different concentrations after they attached to the plates.The optimal concentration of cholestatic serum was determined according to the outcome of the selected cultures.Then the selected BDLSC were induced to proliferating culture system and dif-ferentiating culture system.Each passage of the proliferated stem cells was subjected to flow cytome-try for detection of stem cell markers.The morphology and phenotypie markers of BDLSC were char-acterized using immunohistochemistry, RT-PCR and electron microscopy.The metabolic functions of differentiated cells were also determined by glycogen staining and urea assay.Results The 50 ml/L eholestatie serum was the optimal concentration for the selection of BDLSC at which BDLSC could sur-vive while the other populations of the bone marrow cells could not.The purified BDLSC could prolif-erate for 6 passages and maintained stable markers in our proliferating system.When the culture sys-tem changed to differentiating system, hepatocyte-like colony-forming units (HCFU) were formed.HCFU expressed markers of embryonic hepatoeytes (AFP, albumin and cytokeratin 8/18), biliary cells (cytokeratin 19), hepatocyte functional proteins (transthyretin and eytoehrome P450-2b1), and hepatocyte nuclear factors (HNF-1α and HNF-3β).They also had glycogen storage and urea synthesis functions, two of the critical features of hepatocytes.Conclusion BDLSC can be selected directly from whole bone marrow cells and pure BDLSC can also proliferate for 6 passages.The differentiated cells have hepatocyte-like phenotype and function.BDLSC will he a new way to provide a readily avail-able alternate source of cells for clinical hepatocyte therapy.     

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暴发性肝功能衰竭(fulminant liver failure,FLF)起病急，病情凶险，短期内病死率达80％以上。我院通过人工肝支持和亲属右半肝活体肝移植救治暴发性肝功能衰竭1例。报告如下。     

肝脏血管周上皮样细胞肿瘤1例

1临床资料 患者,女,42岁,因发热半月于2012-04-16收入我科住院治疗。既往体健,否认家族有肿瘤疾病史,体温最高达39℃,伴乏力、全身肌肉酸痛,无咳嗽及咳痰,无胸闷及气促,无腹痛、腹胀,食欲尚可,无恶心及呕吐,大小便正常,体重无明显下降。查体：未见皮疹及焦痂,皮肤巩膜无黄染,心肺未见异常,腹软、无压痛及反跳痛、未及包块, Murphy氏征阴性,     

前白蛋白和视黄醇结合蛋白在肠外营养评估中的临床意义

研究前白蛋白和视黄醇结合蛋白在肠外营养评估中的临床意义。对 30例胃肠疾病病人在肠外营养支持前和一周后测定血浆中的前白蛋白、视黄醇结合蛋白、转铁蛋白、白蛋白 ,并进行统计学处理。结果 :血浆前白蛋白和视黄醇结合蛋白浓度在肠外营养支持治疗一周后明显增加 (P<0 .0 0 1) ,白蛋白水平稍下降 (P>0 .0 5 ) ,而转铁蛋白浓度没有改变 (P>0 .0 5 )。结论 :虽然前白蛋白和视黄醇结合蛋白易受应激及肝肾疾病的影响 ,但它们作为评估肠外营养疗效的指标却比其它常用的营养参数更加敏感。前白蛋白和视黄醇结合蛋白在肠外营养评估中的临床意…     

腹腔镜脾切除术初步体会

目的 探讨应用腹腔镜施行脾切除术的方法及效果。方法 应用腹腔镜施行脾切除术３例，分别为肝炎后肝硬化脾功能亢进、遗传性球形红细增多症及脾淋巴管瘤患者。结果 手术全部获得成功，平均手术时间为３．７ｈ（２．７～５ｈ），平均术中失血３２０ｍｌ（２００～４５０ｍｌ），均术后翌日恢复流质饮食，无术后并发症，平均术后住院７ｄ（５～１０ｄ）。结论 腹腔镜脾切除术具有手术创伤小、术后疼痛轻、恢复快、伤口美观等优点，     

原发性肝癌合并右心房癌栓行肝移植联合右心房切开取癌栓一例

我院于今年1月对一例原发性肝癌合并肝上下腔静脉癌栓并突入右心房病人实施原位肝移植联合体外循环常温心脏不停跳下右心房切开取癌栓术获得成功，病人至今已存活8个月，现报告如下。     

骨髓源性肝干细胞的筛选、扩增和分化

Objective To explore the feasibility of direct separation, selective proliferation and differentiation of BDLSC from hone marrow cells with culture systems containing cholestatic serum in vitro.Methods Whole bone marrow cells of rats cultured in routine medium were replaced with con-ditioning selection media containing eholestatic sera of different concentrations after they attached to the plates.The optimal concentration of cholestatic serum was determined according to the outcome of the selected cultures.Then the selected BDLSC were induced to proliferating culture system and dif-ferentiating culture system.Each passage of the proliferated stem cells was subjected to flow cytome-try for detection of stem cell markers.The morphology and phenotypie markers of BDLSC were char-acterized using immunohistochemistry, RT-PCR and electron microscopy.The metabolic functions of differentiated cells were also determined by glycogen staining and urea assay.Results The 50 ml/L eholestatie serum was the optimal concentration for the selection of BDLSC at which BDLSC could sur-vive while the other populations of the bone marrow cells could not.The purified BDLSC could prolif-erate for 6 passages and maintained stable markers in our proliferating system.When the culture sys-tem changed to differentiating system, hepatocyte-like colony-forming units (HCFU) were formed.HCFU expressed markers of embryonic hepatoeytes (AFP, albumin and cytokeratin 8/18), biliary cells (cytokeratin 19), hepatocyte functional proteins (transthyretin and eytoehrome P450-2b1), and hepatocyte nuclear factors (HNF-1α and HNF-3β).They also had glycogen storage and urea synthesis functions, two of the critical features of hepatocytes.Conclusion BDLSC can be selected directly from whole bone marrow cells and pure BDLSC can also proliferate for 6 passages.The differentiated cells have hepatocyte-like phenotype and function.BDLSC will he a new way to provide a readily avail-able alternate source of cells for clinical hepatocyte therapy.