逆行胰胆管造影术在肝胆外科的应用

<正> 临床应用纤维内窥镜作逆行胰胆管造影已有10余年历史。1968年Mc Cune首先报道成功。近年来,造影成功率已达到85—92%。目前已成为诊断肝、胆、胰疾患的重要手段之一。现将逆行胰胆管造影术在我院肝胆外科的应用情况报道如下: 临床资料1.病例分析:本组40例,男性23例,女性17例,年龄自22岁至63岁。40例均获得可靠诊断,具体诊断名称见表1。     

Analysis of serious complications of transcatheter arterial chemoembolization for the treatment of hepatocellular carcinoma

Objective： To analyze the inductive agents, post-surgical managements and precautions of the serious complications caused by transcatheter arterial chemoembolization （TACE） for the treatment of hepatocellular carcinoma. Methods： Clinical data of 2 375 cases of TACE for 832 patients with middlestage or advanced hepatocellular carcinoma from January 1994 to December 2002 were analyzed. Results： There were 7 cases of serious complications, one of which was liver carcinoma rupture and another was acute renal failure. Totally there were 4 cases of paraplegia and one case of conduit knotted. Conclusion： Deadly complications may happen after TACE and it needs close surveillance and management in time.     

高效毛细管电泳法测定利多卡因代谢产物单乙基甘氨酰二甲苯胺

目的 :建立一种测定利多卡因代谢产物单乙基甘氨酰二甲苯胺 (MEGX)含量的高效毛细管电泳法。方法 :用50mmol/L硼酸缓冲液 (pH =8.8)为电泳电解液 ,电压 1 2kV ,运行电流 1 8.8～ 2 3 .2 μA ,检测波长 2 1 4nm ,有效毛细管长度 50cm ,管径 50 μm ,氨茶碱为内标 ,展开 1 2min。 8只昆明种小白鼠腹腔注射 0 .2 %利多卡因 4 0mg/kg ,用本法测定其 5h尿液中MEGX累积排泄量。结果 :MEGX迁移时间 7.8min ,氨茶碱迁移时间 1 0 .7min。MEGX含量为 0 .0 62～1 .0mg/ml时 ,其浓度与色谱峰面积线性关系良好 ,r =0 .9991 ,日内、日间变异系数均小于 7.8% ,回收率为98.4 %～ 1 0 1 .6% ,常用 3 0种药物对其无干扰。 8只小鼠MEGX累积排泄量为 ( 2 95.2± 55.2 ) μg ,其中游离型MEGX为 4 4.7% ,结合型为 55.3 %。结论 :该方法简单、快速、灵敏 ,特异性和重现性良好 ,具有较强实用价值。     

Ⅰ型细胞间粘附分子mRNA表达与肝癌侵袭转移的关系

目的：研究Ⅰ型细胞间粘附分子（ＩＣＡＭ－１）ｍ ＲＮＡ 的表达与肝癌侵袭转移的关系。方法：采用原位分子杂交及Ｎｏｒｔｈ－ｅｒｎ ｂｌｏｔ方法检测３４例肝癌组织中ＩＣＡＭ－１ ｍ ＲＮＡ 的表达。结果：３４例肝癌中２４例包膜不完整、门静脉癌栓或形成转移灶,１０例肝癌包膜完整,３４例肝癌中２１例肝癌细胞ＩＣＡＭ－１ ｍ ＲＮＡ表达阳性。伴门静脉癌栓或形成转移的肝癌１８例中,１６例ＩＣＡＭ－１ｍ ＲＮＡ 表达（＋ ＋ ）～（＋ ＋ ＋ ）;６例包膜不完整的肝癌３例表达阳性,而１０例包膜完整的肝癌仅有２例表达阳性。门静脉癌栓及肝内转移灶ＩＣＡＭ－１ ｍ ＲＮＡ 表达强阳性。结论：肝癌细胞ＩＣＡＭ－１ ｍ ＲＮＡ 的表达与肝癌的侵袭转移相关。     

肝囊腺癌三例报道(附文献复习)

肝囊腺瘤较少见,而肝囊腺癌则更为罕见。复习文献记载到1984年肝囊腺癌不到20例。近10年来我科收治3例肝囊腺癌病例,结合文献复习,现报道如下。 例1 男,48岁,肝肿大5个月于1976年5月入院。体查:全身情况较好。肝下界在右锁中线肋下6cm,质中等硬,表面呈结节状,光滑,AFP(一)。诊断肝囊肿,于1976年6月3日在持续硬     

肝脏高分化脂肪肉瘤一例报告

肝脏高分化脂肪肉瘤是肝脏肿瘤中十分罕见的一种间叶性肿瘤。目前国内尚未见文献报道,现将我科1例报道如下: 患者,女性,46岁,1987年2月开始无明显诱因出现间歇性肝区隐痛,有时伴右腰背部疼痛,无恶心呕吐和右上腹剧痛及发热史。B超提示右后叶有-4.3cm×3.1cm大小的增强光团,疑为“血管     

Flt3配体修饰小鼠肝癌疫苗的制备及其体内抗肿瘤活性观察

目的:以小鼠Flt3配体(murine flt3 ligand, mFL)的重组腺病毒载体(AdmFL)体外感染小鼠肝癌细胞株Hepa1-6制备肝癌疫苗,并观察其体内抗肿瘤活性.方法:腺病毒载体体外感染Hepa1-6细胞,48 h后通过载体所携带的绿色荧光蛋白(GFP)的表达检测感染的效率;并用ELISA方法检测第0、2、4、6、8天培养上清中mFL的表达量;每天进行细胞计数(连续14 d),观察细胞的体外生长曲线;取5×106个修饰后的Hepa1-6细胞接种C57BL/6小鼠,4周后于原接种部位的对侧再接种2×106个野生型Hepa1-6或EL4细胞.结果:AdmFL能有效感染靶细胞Hepa1-6,培养上清中mFL表达量在第2天最高,达到(71.1±6.3) ng/ml,感染后Hepa1-6的体外生长未受到明显抑制;修饰后Hepa1-6细胞的体内成瘤性下降;4周后再接种Hepa1-6细胞,肿瘤生长速度明显降低;而再接种的EL4细胞呈渐进性生长,与对照组相比无显著差异.结论:腺病毒介导的Flt3配体基因修饰后的肝癌细胞的体内成瘤性下降,并能激发特异性免疫保护反应,是有效的肝癌疫苗.     

肝细胞癌合并门静脉癌栓多学科诊治创新体系建立及应用

门静脉癌栓是肝细胞癌发展到进展期最重要的标志之一，在初次就诊的肝细胞癌患者中门静脉癌栓的发生率高达44%~66.2%，在中晚期肝细胞癌患者中的这一比例更高（80%~90%）。肝细胞癌患者一旦发生门静脉癌栓，预后极差，自然生存时间仅为2.7~4个月。目前对于此类患者的治疗存在较大争议。欧美地区提倡索拉非尼是唯一的治疗方式；亚洲地区提倡多种治疗方式，包括手术治疗、经导管肝动脉化学栓塞治疗、放射治疗、系统化学治疗等。目前针对肝细胞癌合并门静脉癌栓的诊治尚未达成共识，本团队建立了肝细胞癌合并门静脉癌栓多学科诊治创新体系并对此展开了系统化的研究和应用。本文就肝细胞癌患者门静脉癌栓的发生机制、临床诊疗和多学科诊治创新体系的建立及应用展开讨论。     

Combined Therapy of Operation and Radiation in Primary Liver Cancer

Combined therapy of operation and radiation was carried out in 22patients with primary liver cancer in our hospital.All the patients weremales,ranging from 15-69 yr of age with an average of 44.5 yr.His-tological diagnosis was hepatocellular carcinoma in 21 cases andcholangioearcinoma 1 case.17(77.3％)patients were associated withliver cirrhosis,and 19(86.4％)patients had positive AFP bycounterimmunoelectrophoretic method.Clinically,6 patients were in stageⅠ,11 in stage Ⅱ and 5 in stage Ⅲ.Liver resection was performed on 17patients(5 local resections,5 right hemihepateetomies,2 left laterallobectomies,2 left hemihepatectomies,2 total right hepatectomies,and1 left medial Iobectomy)and palliative operation on the other 5 patients(4 hepatic artery ligations or operative embolizations and 1 hepaticartery infusion).For radiotherapy either local or perative whole-liverradiation with ~(60)Co was applied.Up to May 1983,19 patients who had been followed up had survivedfor more than 6 months.The survival rates at 1,2,3,4 years aftertreatment were 78.9％,66.7％,64.3％ and 44.4％ respectively with amedian survival duration of 36 months.Data have shown that the encou-raging results of this method are better than those of only liverresection or only radiotherapy at present.     

Preliminary Study of the Lectin Receptor Expression in Adenocarcinomas of the Gastrointestinal Tract

Ten cases of gastrointestinal adenocarcinomas were histochemically investigated fortheir lectin receptors by avidin—biotin-peroxidase complex(ABC)method.Results showed thatgastric adenocarcinomas expressed more types of lectin receptors than large boweladenocarcinomas.Positive rates of Glc/Man-and GlcNAc-specific lectin receptors in these tu-mors were kigher than those of Gal/GalNAc-and Fuc-specific lectin receptors.From the stom-ach to rectum,the spectrum of the lectin receptors in pericarcinomatous tissues graduallychanged from the gastric type to the rectal type.The expression of lectin receptors ingustrointestinal adenocarcinomas was obviously different Jrom that in their correspondingpericarcinomatous tissues.The increase and decrease of lectin receptor expression,theappearance and disappearance of some types of lectin receptors as well as the change of thereceptor distribution are indirectly regulated by cellular genome.