125I粒子植入术病人实施阶段性健康教育的效果评价

目的 使125I粒子植入术病人系统了解疾病相关知识,积极配合治疗护理,提高治疗效果和生存质量.方法 采用随机分组的方法,将58例125I粒子植入术病人分为实验组和对照组,每组29例,对照组按常规进行健康教育,实验组实施阶段性健康教育,并采用自行设计的问卷调查病人对健康教育内容知晓情况和病人满意度.结果 2组病人对健康教育内容的知晓率和对护理工作满意度的差异具有统计学意义(P＜0.05).结论 根据病人的情况实施阶段性健康教育能帮助病人掌握疾病相关知识,促进病人依从治疗方案,提高护理工作满意度.     

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.     

急性重症胆管炎高迁移率族蛋白-1、TNF-α的mRNA表达及血必净的调节作用

目的 观察大鼠肝组织急性重症胆管炎（ACST）高迁移率族蛋白-1（HMG-1）、TNF-α的mRNA表达变化，以及应用血必净的调节作用。方法 通过制作大鼠ACST模型，应用血必净治疗．不同时相点检测肝组织HMG-1及TNF-α的mRNA表达，同时观察肝功能及结构改变。结果 ACST 12～24h肝组织HMG-1和TNF-α的mRNA表达均显著增强（P〈0．05或P〈0．01）。血必净治疗可显著抑制ACST肝组织HMG-1mRNA表达（P〈0．01），并明显下调肝组织TNF-α mRNA表达（P〈0．05或P〈0．01），同时血清谷丙转氨酶（ALT）水平显著降低（P〈0．05或P〈0．01）．肝脏的病理形态得到明显改善。结论 ACST肝组织HMG-1高表达可促进局部TNF-α的合成与释放，从而诱导ACGT的急性肝功能损害。血必净具有显著的免疫调节作用，从而减轻肝功能损害。     

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。     

Mirizzi综合征与腹腔镜胆囊切除术中的胆管损伤

Mirizzi综合征是一种较少见的慢性胆囊炎、胆石症的并发症。此病于1948年由Mirizzi所命名。由于此种综合征在术前不易确诊，故此在腹腔镜胆囊切除术(LC)已广泛开展的今天，它是导致胆管损伤的主要原因之一。我们总结我院1992年1月至2002年7月期间收治的Mirizzi综合征病人14例，分析引起胆管损伤的情况，以期达到吸取教     

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.     

LC术中中转HLC取代开腹手术的探讨

目的：探讨腹腔镜胆囊切除术(LC)术中中转手助腹腔镜胆囊切除术(HLC)以取代开腹手术的可行性。方法：为LC术中遇有“主动中转开腹指征”(胆囊周围粘连严重，Calot三角区解剖不清)的5例患者中转HLC，即向右侧绕脐将原脐下缘的1．0cm观察孔延长至6．5cm，作一绕脐正中或“Ω”形小切口，术者将左手伸入腹腔，于脐右侧8cm处另作-0．1cm观察孔，实施HLC。结果：5例中转HLC均获成功，除胆囊结石伴胆囊积脓1例术后平均每天引出50ml(20～100ml)胆汁性渗液，3d后治愈外，其余无手术并发症，均痊愈出院。与中转开腹比较，术后疼痛轻，恢复快，瘢痕小。结论：LC术中遇有“主动中转开腹指征”时，中转HLC取代中转开腹手术，安全可行。并能达到微创美观手术效果。     

猪肝脏扩大切除术后残留小肝脏行门静脉分流术的效果

进行了肝扩大切除术后，术后肝功能衰竭常常难以避免。肝衰竭的发生可能与扩大肝切除后的门静脉高压有关。本研究通过对猪肝脏扩大切除术后行门静脉分流术，了解是否可避免门静脉高压导致肝窦状隙微循环损伤的影响。将14头猪分成两组，一组为肝扩大切除术（残余肝脏体积约为原肝脏大小的17％）；一组肝扩大切除术＋门静脉分流术。分流术采用门静脉与下腔静脉的侧侧吻合。结果显示，肝扩大切除术组所有实验猪在术后3d内死于肝衰竭；     

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。     

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.