经腹腔镜射频消融术治疗肝细胞癌的临床观察

目的探讨经腹腔镜射频消融术治疗肝细胞癌的临床效果。方法12例共18个肝癌病灶经腹腔镜行射频消融治疗,病灶平均直径3．2cm。术后复查超声造影,观察治疗效果。结果12例均顺利完成手术,单个病灶射频消融时间平均为8．6min。术后均未出现腹腔出血、胆囊损伤、胆漏、胃肠道损伤、膈肌损伤及肝功能衰竭等严重并发症。术后超声造影复查病灶完全坏死率达83．3％,残留病灶均再次B型超声引导下经皮射频消融治疗。随访6～32个月（平均16个月）,2例发现肝内新病灶,3例消融部位复发,均采用B型超声引导下经皮射频消融进行治疗。结论经腹腔镜射频消融治疗肝细胞癌安全可行,减少并发症的发生,扩大了治疗的适应证。但应选择肿瘤位于肝脏表面、肝左外叶的病例进行治疗。     

术中射频消融、125I放射性粒子植人联合区域性灌注化疗治疗中晚期胰腺癌

目的探讨术中射频消融、125I放射性粒子植入联合区域性灌注化疗治疗中晚期胰腺癌的疗效。方法回顾性分析2004年1月～2008年12月我院收治的34例中晚期胰腺癌患者的临床资料,分为2组,实验组16例采用术中射频消融、125I放射性粒子植入联合区域性灌注化疗治疗,对照组18例采用单纯区域性灌注化疗,对比2组患者治疗后疗效、疼痛缓解程度、生存期、不良反应及CA19-9变化。结果实验组治疗有效率（81．25％）高于对照组（27．78％）;实验组治疗后CA19-9低于治疗前及对照组;实验组9、12个月生存率及中位生存期高于对照组;实验组比对照组能够明显改善患者的疼痛症状。结论术中射频消融、125I放射性粒子植入联合区域性灌注化疗治疗中晚期胰腺癌可获得较好的疗效。     

腹腔镜胆囊切除术导致胆管损伤的外科治疗

目的 探讨腹腔镜胆囊切除术(LC)所致胆管损伤的外科治疗方法及疗效.方法 回顾性分析1992年1月～2005年12月间我院收治的LC导致胆管损伤的37例病人的临床资料,并结合随访结果进行分析总结.结果 37例病人中15例胆管损伤在我院发生,22例为外院发生.胆管修补(或端端吻合)+T管支撑引流术5例(13.5%),胆管空肠Roux-en-Y吻合术29例(78.4%),经B超引导腹腔穿刺置管引流1例(2.7%),长期保留LC术中所置腹腔引流管2例(5.4%).术后无死亡病例,10例(27%)病人出现至少一个手术后并发症,其中包括切口感染5例(16.2%),吻合口狭窄3例(8.1%),腹腔脓肿5例(16.2%),手术后均经气囊扩张或经皮穿刺置管引流后好转,没有病人需要冉次手术治疗,远期随访有效率为100%.结论 胆管损伤是腹腔镜胆囊切除术中常见的严重并发症,采用恰当的外科治疗方法町获得较好的疗效.     

射频消融术治疗肝血管瘤

目的 探讨开腹射频消融治疗肝血管瘤的临床疗效.方法 对12例13个肝血管瘤开腹后采用输出功率为150 W的射频发生仪行射频消融治疗,血管瘤平均直径6.2(4.6～8.2)cm,射频消融时间5～28 min,平均16.5min.术后复查超声造影.结果 12例患者均顺利完成治疗,术中、术后无大出血、胆漏、膈肌损伤、肝功能衰竭等严重并发症.术后3个月患者复查超声造影13个病灶血流完全消失.随访11例,随访期5～26个月,疗效满意.结论 开腹射频消融治疗较大肝血管瘤足一种安全、有效的治疗方法.     

ICGR15在肝癌切除术前评估肝脏储备功能的作用

Objective To evaluate the role of ICGR15 in assessment of hepatic functional reserve before hepateetomy for hepatocellular carcinoma.Methods From August 2005 to October 2007, six-ty-six patients with hepatocellular carcinoma were treated in our hospital.The patients were random-ized into Child-Pugh grading group (32 cases) and ICGR15 detection group (34 cases).Preoperative preparation,operative procedures and postoperative management were the same in all the 66 patients.The morbidity and mortality were compared and the relationship between Child-Pugh grading and ICGR15 in assessment of hepatic functional reserve was determined.Results The incidence of hepatic failure after hepatectomy in ICGR15 detection group(23.50%) was significanly lower than that in Child-Pugh grading group(34.4%).ICGR15 (14.38 ±8.2)% in patients with tumor of Child-Pugh grading B was higher than ICGR15 (7.84 ± 4.8)% in those with tumor of Child-Pugh grading A.Conclusion ICGR15 valuecan be more sensitive in evaluating hepatic functional reserve than Child-Pugh grading, but some correlation can be observed between them.ICGR15 is useful in assessing the range of liver resection and prognosis before hepatectomy for hepatocellular carcinoma.     

ICGR15在肝癌切除术前评估肝脏储备功能的作用

Objective To evaluate the role of ICGR15 in assessment of hepatic functional reserve before hepateetomy for hepatocellular carcinoma.Methods From August 2005 to October 2007, six-ty-six patients with hepatocellular carcinoma were treated in our hospital.The patients were random-ized into Child-Pugh grading group (32 cases) and ICGR15 detection group (34 cases).Preoperative preparation,operative procedures and postoperative management were the same in all the 66 patients.The morbidity and mortality were compared and the relationship between Child-Pugh grading and ICGR15 in assessment of hepatic functional reserve was determined.Results The incidence of hepatic failure after hepatectomy in ICGR15 detection group(23.50%) was significanly lower than that in Child-Pugh grading group(34.4%).ICGR15 (14.38 ±8.2)% in patients with tumor of Child-Pugh grading B was higher than ICGR15 (7.84 ± 4.8)% in those with tumor of Child-Pugh grading A.Conclusion ICGR15 valuecan be more sensitive in evaluating hepatic functional reserve than Child-Pugh grading, but some correlation can be observed between them.ICGR15 is useful in assessing the range of liver resection and prognosis before hepatectomy for hepatocellular carcinoma.     

腹腔镜可调节性胃束带术治疗病态肥胖症的近期疗效

目的 了解腹腔镜可调节性胃束带术(laparoscopic adjustable gastric banding,LAGB)治疗病态肥胖症及伴发病的近期疗效. 方法 2006年10月至2007年12月,对50例病态肥胖症患者(其中伴发2型糖尿病11例、高血压3例、血脂异常15例、脂肪肝28例、睡眠呼吸暂停综合征1例和胆囊结石2例)行LAGB治疗,术后随访6～18个月,平均11.2个月,观察减重效果、伴发病变化及并发症发生情况.结果 术后9个月、12个月和18个月平均体质量指数由术前(39±6)ks/m2分别降至(31±4)kg/m2、(28±7)kg/m2和(27±7)kg/m2(P＜0.05);术后平均超重体重减重百分比分别为30%±11%、42%±13%和45%±13%;术后12个月和18个月超重体重减重百分比＞50%的人数分别达到20%和44%,66%～100%的患者术后12个月和18个月其肥胖相关伴发疾病得到完全缓解或好转.术后发生并发症4例,其中3例经保守治疗、1例经再次手术治疗痊愈.结论 LAGB是一种安全、有效和可行的治疗肥胖症及其相关伴发疾病的方法.     

ICGR15在肝癌切除术前评估肝脏储备功能的作用

Objective To evaluate the role of ICGR15 in assessment of hepatic functional reserve before hepateetomy for hepatocellular carcinoma.Methods From August 2005 to October 2007, six-ty-six patients with hepatocellular carcinoma were treated in our hospital.The patients were random-ized into Child-Pugh grading group (32 cases) and ICGR15 detection group (34 cases).Preoperative preparation,operative procedures and postoperative management were the same in all the 66 patients.The morbidity and mortality were compared and the relationship between Child-Pugh grading and ICGR15 in assessment of hepatic functional reserve was determined.Results The incidence of hepatic failure after hepatectomy in ICGR15 detection group(23.50%) was significanly lower than that in Child-Pugh grading group(34.4%).ICGR15 (14.38 ±8.2)% in patients with tumor of Child-Pugh grading B was higher than ICGR15 (7.84 ± 4.8)% in those with tumor of Child-Pugh grading A.Conclusion ICGR15 valuecan be more sensitive in evaluating hepatic functional reserve than Child-Pugh grading, but some correlation can be observed between them.ICGR15 is useful in assessing the range of liver resection and prognosis before hepatectomy for hepatocellular carcinoma.     

急性重症胆管炎大鼠肝组织高迁移率族蛋白-1对肿瘤坏死因子-表达的影响

目的 探讨急性重症胆管炎(ACST)大鼠肝组织高迁移率族蛋白1(HMG-1)改变及其对肿瘤坏死因子(TNF-α)表达的调节作用.方法 通过制作ACST大鼠模型,正丁酸钠干预,不同时相点检测肝组织HMG-1及TNF-α表达,同时观察肝功能及结构改变.结果 AGST组12～24 h肝组织HMG-1和TNF-a mRNA表达均显著增强(P＜0.05或0.01).正丁酸钠处理可显著抑制ACST后12～24 h肝组织HMG-1 mRNA表达(P＜0.01),并明显下调肝组织TNF-α mRNA表达及TNF-α水平(P＜0.05或0.01),同时血清谷丙转氨酶(ALT)水平显著降低(P＜0.05或0.01),肝脏的病理形态得到明显改善.结论 ACST大鼠肝组织HMG-1表达可促进局部TNF-α的合成与释放,从而诱导ACST大鼠急性肝功能损害.     

经皮胆囊碎石术后结石复发危险因素分析

目的探讨经皮胆囊碎石术(PCCL)后结石复发危险因素。方法随访1990年12月至1992年8月在我院行PCCL病人500例,了解胆囊结石复发情况及危险因素。结果成功随访384例,随访率76.8%,术后胆囊结石1年复发率为9.6%,每年递增约5%~10%,5年后达到高峰并趋于平稳。胆囊结石复发与病人年龄、性别及伴有糖尿病、冠心病无明显关系,而与病人胆囊结石家族遗传史、术前胆囊功能、壁厚、结石单发或多发、术后油腻饮食及伴有肝脏疾病有明显关系(P<0.05或P<0.01)。结论PCCL术前合理掌握适应证,避免结石复发危险因素可大大降低结石复发率,此术式仍不失为一种具有临床价值的治疗方法。