术前胆道引流对肝门部胆管癌手术并发症的影响

但不能降低术后并发症发生率和住院病死率.Bismuth-Corlette分型、是否合并肝切除是预测患者术后风险的重要因素.     

腹腔镜胆囊切除致胆道损伤26例分析

目的 探讨腹腔镜抻囊切除术(laparoscopic cholecystectomy,LC)致胆管损伤的原因、类型、临床表现、诊断及处理原则. 方法回顾性分析1997-2007年收治的26例LC致胆管损伤的临床资料.结果 胆管损伤Ⅰ型5例、Ⅱ型13例、Ⅲ型2例、Ⅳ型6例;3例术中发现胆管损伤并中转开腹,23例术后发现胆管损伤,其中13例为LC术后1周内发现,8例为术后20～60 d发现,2例在术后2年表现反复胆管炎发作的症状;24例接受介入治疗,其中5例获得治愈,19例在胆管炎和黄疸控制后获得手术;切除毁损胆管20例,行肝总管或左右肝管的胆肠吻合术.结论 胆道损伤是严重的LC术后并发症,应高度警惕.合理运用介入或手术的方法及时进行必要的胆管内支撑和通畅的胆汁外引流,应避免再次医源性损伤和修补术后胆道再狭窄.     

β-内酰胺类抗生素在胆汁中的浓度和药动学的实验研究

Objective To study the concentrations and pharmacokinetics of beta-lactams antibi-otics in rabbit bile and evaluate their microbicidal potential to present theoretical evidence and reference for choosing effective antibiotics for the prevention and therapy of hepatobiliary infection. Methods After anesthesia, the common bile duct of rabbits was isolated and cannulated with a silicone tube. The rabbits were administered intravenously with the equal-effect dose of beta-lactams antibiotics. Bile (1.5 ml) was collected at the time of 0. 25,0.5,0. 75,1,1.5,2,3,4,6,8 h after administration and as-sayed by HPLC. The bile drug concentration-time data were processed by software to figure out the pharmacokinetic parameters such as maximum concentration (Cmax), peak time (Tmax), half-life time (T1/2), clearance (CL) and apparent volume of distribution (VD). The bile antibiotics concen-tration contrasted to the minimum inhibitory concentration (MIC), and attained the bactericidal index (Cmax/MIC) and the time the drug concentration exceeded the MIC (TMIC) to evaluate microbicidal potential of the antibiotics in bile. Results The Cmax and T1/2 of each antibiotic were as follow: pip-eracillin (7950.16±3023.00)μg/ml and (1.97±1.23) h, ceftriaxone (1107.01±247.61)μg/ml and (3.14±0. 57)h,meropenem (31.97±12.44)μg/ml and (0. 36±0. 11)h. Piperacillin/tazobactam had the largest bactericidal index and the longest TMIC, and it can form 100 times of concentration than the MIC90 of the common pathogens in bile. Also its TMIC maintained 5～8 h. The bactericidal index and TMIC of ceftriaxone and meropenem were smaller as contrasted to the former. Conclusions The bile concentrations of three antibiotics all exceed their effective bactericidal concentrations. Piperacil-lin/tazobactam has the largest bactericidal index and the longest TMIC, so it can be of the first choice for the therapy in hepatobiliary infection.     

ABCG2蛋白在肝癌中表达的临床意义

Objective To investigate the expression and clinical significance of ABCG2 protein in hepato-cellular carcinoma (HCC). Methods Specimens of HCC were collected at The First Aifiliated Hospital of Sun Yat-sen University from January 2005 to December 2006. The expression of ABCG2 protein in 165 samples of HCC tissue, 25 samples of normal liver tissue and 40 samples of cirrhotic liver tissue was detected using immunohisto-chemistry. The correlation between the expression of ABCG2 protein and clinicopathological characters was then analyzed. Enumeration data, survival rate and the difference between groups were analyzed with a chi-square test, the Kaplan-Meier method and Log-rank test, respectively. Results ABCG2 protein expression was weakly posi-tive in all normal and cirrhotic liver tissues. In HCC tissues, the expression of ABCG2 protein was strongly positive in 66 cases and weakly positive in 99 cases. The expression of ABCG2 protein was related to tumor diameter, tumor number, adjacent organ invasion and TNM stages (χ2 =8. 130, 14. 279, 4. 820, 21. 179, P <0. 05). Kaplan-Meier survival analysis revealed that patients with strongly positive ABCG2 protein had a significantly lower 3-year overall survival (24. 1%) compared with those with weakly positive ABCG2 protein (39. 4%) (χ2 = 15.716, P<0.05). Conclusions The expression level of ABCG2 protein is related to tumor invasiveness, TNM stage and prognosis. ABCG2 has the potential to become a new target for HCC treatment.     

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食管静脉曲张破裂出血是门静脉高压症最严重的并发症和主要死亡原因。内科治疗仅部分病例可以暂时控制出血 ,外科施行分流、断流手术长期以来一直是主要的治疗手段 ,并发展出多种术式供临床医师选择。近年来 ,随着介入治疗技术的经颈静脉肝内门体静脉分流术 (ＴＩＰＳ)的迅速发展和肝移植效果的明显改善 ,分流、断流手术在门静脉高压症治疗中的重要地位正受到挑战。但到目前为止 ,分流和断流手术仍然在门静脉高压症外科治疗中具有重要的地位。到目前为止 ,无论分流还是断流手术尚无一种理想的术式既能有效地控制急性出血 ,降低病死率 ,又能…     

原发性肝癌肺转移手术治疗

原发性肝癌肺转移能成功手术切除者不多见,国内未见有专题报告。我们近30年来收治原发性肝癌肺转移并行手术治疗的共有4例,现报告如下。 例一:男,58岁,26年前因左外叶巨块型肝癌行左半肝手术切除,术后病理诊断:肝细胞癌。术后近5年胸部照片检查时发现左上肺一2 cm圆型病灶,作左上肺切除术,术后病理诊断肝细胞癌肺转移。肺手术后一年内先后2次再发现脑有单个转移性肿     

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目的 注意肝胆管结石合并胆管变异，提高肝内胆管结石的诊断治疗水平。方法 总结2001-2002年来手术治疗的5例肝胆管结石合并无肝右管或肝左管病例的诊断治疗过程和治疗方法。结果 5例病人都是手术中被发现肝胆管结石合并胆管变异，其中4例为无肝右管，1例为无肝左管，均行不同部位的肝切除和胆管空肠吻合，术后无残石，治疗效果良好。结论 对肝胆管结石需警惕合并胆管异常，治疗应争取切除结石并胆管异常的肝叶。     

术后应用肠外营养对肝细胞癌合并肝硬化病人的影响

目的探讨肝细胞癌合并肝硬化病人术后的营养支持。方法24例行根治性切除的肝癌病人随机分为PN组（n=12）和rhGH＋PN组（n=12）。术前、术后1d和术后6d测肝功能、血糖、AFP、血清前白蛋白、转铁蛋白及血清GH、IGF-1、IGFBP-3，用RT—PCR法检测肝组织（包括癌组织，癌旁组织和术后6d肝穿刺组织）ALBmRNA、IGF-1mRNA、IGFBP-3mRNA的表达，肝组织行Ki67免疫组织化染色。同时选12例因胆石症或肝血管瘤行手术的病人作为正常对照。结果肝细胞癌合并肝硬化病人血清前白蛋白，转铁蛋白低于正常对照组，血清GH水平高于正常对照组，而血清IGF-1、IGFBP-3水平低于正常对照组；术后6d，rhGH＋PN组血糖、血清前白蛋白、转铁蛋白、血清GH、IGF-1、IGFBP-3水平、肝ALBmRNA、IGF—1mRNA、IGFBP-3mRNA表达水平、肝Ki67指数均高于PN组。血清GH水平与血糖呈正相关，血清IGF1、IGFBP-3水平与血清AST、ALT、TBIL呈负相关，与血清ALB、前白蛋白，转铁蛋白呈正相关。结论rhGH＋PN有利于肝细胞癌合并肝硬化病人术后生长激素／胰岛素样生长因子-1轴的恢复，检测血清IGF-1、IGFBP-3水平有助于了解短期营养支持的效果和选择营养素。     

腺病毒载体介导的双自杀基因对人胆管癌细胞QBC939的体外杀伤实验

目的观察腺病毒介导的胞嘧啶脱氨酶/单纯疱疹病毒-1-胸苷激酶(CD/TK)双自杀基因对人胆管癌细胞 QBC939的体外杀伤作用。方法 CD/TK 克隆入穿梭载体成为 pAdtrack-CMV-CD/TK,与骨架载体 pAdeasy-1在细菌内同源重组为 pAd-CD/TK,经 PacⅠ酶切,293细胞包装、扩增、纯化后,体外转染人胆管癌细胞 QBC939,并给予前药5-FC 或 GCV,观察其体外杀伤效果。结果含 CD/TK 基因的重组腺病毒鉴定正确,扩增纯化后,病毒滴度为1×10~(11)颗粒/ml。重组腺病毒对 QBC939细胞在感染倍数(m.o.i)为100时的转染效率为90%,在 m.o.i50感染时,0.1mmool/L的5-FC 及10 μmol/L 的 GCV 对 QBC939细胞的杀伤率为80%,明显高于单用5-FC 与 GCV 的效应。结论双自杀基因以腺病毒为载体对人胆管癌细胞转染效率高,体外杀伤效应明显。腺病毒介导的双自杀基因治疗有望成为治疗胆管癌的有效方法。