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21.
结直肠癌肝转移的外科手术治疗 总被引:1,自引:0,他引:1
目的评价手术治疗对结直肠癌肝转移病人生存率的影响。方法回顾分析2000年1月1日至2004年12月31日复旦大学附属中山医院收治的363例结直肠癌肝转移病人,其中91例为手术病例,评价手术治疗对生存率的影响。结果160例同时性肝转移病人中手术切除肝转移灶22例(13.8%),203例延时性肝转移病人中手术切除肝转移灶69例(34.0%),两者相比差异具有统计学意义(P〈0.000)。同时性肝转移组手术死亡率(4.5%,1/22)高于延时性肝转移组(2.8%,2/69),两者相比差异有统计学意义(P〈0.05)。以2005年6月31日为随访终点,91例病人随访率100%,手术病人中同时性肝转移组1、3、5年生存率和中位生存时间与延时性肝转移组相似(P〉0.05),但术后复发率较高(36.4%vs21.7%,P=0.03)。363例病人中有36例具有手术指征而未手术病例,其1、3、5年生存率分别为47.9%、5.34%和0,明显低于91例手术病例(80.5%、33.0%和22.7%),(P=0.0034)。应用COX比例风险模型,对所有91例手术病人影响生存的因素进行多因素风险分析,得出手术切缘达1cm(β=-0.8351,P=0.0363)和复发后再次手术(β=-0.9428,P=0.0411)是生存的保护性因素,而术后复发(β=0.6471,P=0.0226)是生存的危险因素。结论手术治疗是结直肠癌肝转移的首选治疗措施,可以明显提高病人的术后生存。 相似文献
22.
Fred Poordad Robert Gish Adil Wakil Richard Garcia-Kennedy Paul Martin Francis Y. Yao 《American journal of transplantation》2003,3(11):1413-1417
Non-alcoholic fatty liver disease (NAFLD) is an increasingly recognized clinico-pathologic entity typically associated with obesity, type II diabetes and hyperlipidemia. It has been noted to recur after orthotopic liver transplantation (OLT). We report four patients who developed de novo NAFLD within 3 months of OLT without the typical predisposing factors of diabetes mellitus or obesity. Three of the four patients underwent OLT for hepatitis C-related cirrhosis, and the other for alcoholic cirrhosis. Examination of the liver explants revealed no evidence of steatosis. No surreptitious alcohol use or a drug-induced process could be identified in these patients. Treatment of recurrent hepatitis C infection in one patient with interferon and ribavirin led to sustained suppression of the viral RNA to undetectable levels, but no improvement in histology or liver enzymes. All four patients had histologic evidence of preservation injury on the initial post-OLT biopsies, but the significance of this finding in relationship to the development of NAFLD is unknown. NAFLD can develop without any of the known predisposing conditions after transplantation, and this raises further questions about the pathogenesis of this condition . 相似文献
23.
33例肝占位性病变MRI误诊的分析 总被引:1,自引:0,他引:1
我院1988年以来4000余例腹部MRI中,发现肝占位性病变误诊33例。所用机型为美国Disonics公司0.5T超导MRI,自旋回波序列(SE序列)、常规T1加权(T1WI)、质子加权(PDWI)、T2加权(T2WI),覆盖全肝。其中,PHC误诊为MHC5例、MHC误诊为PHC6例、PHC误为HHE5例、MHC误诊为HHE2例、HHE误诊为PHC6例、肝硬化结节误诊为PHC2例、炎性假瘤误诊为PHC3例、肝结核误诊为PHC1例、HCY误诊为HHE3例。本文从病变的影像学特征和扫描技术方面详细探讨了误诊的原因和鉴别诊断要点。 相似文献
24.
Neural responses in the dorsal motor nucleus of the vagus (DMV) to topical administrations of sodium and portal infusions of hypertonic saline were investigated electrophysiologically by using multibarrel electrodes in anesthetized rats. Of 102 neurons that showed antidromic response to electrical stimulation of the ventral gastric vagus or the accessory celiac vagus, 51 neurons increased and 13 neurons decreased their discharge rates in response to the electrophoretic administration of sodium. The other 38 neurons did not respond to this stimulation. The portal infusion of hypertonic saline elicited neural responses of some DMV neurons whose axons are involved into either the ventral gastric or the accessory celiac vagus. Further, effects of the topical administration and the portal infusion of hypertonic saline were examined on 33 neurons. Typical response was characterized by an increase in discharge rate responding to both of the portal infusion and the topical administration. In conclusion, the DMV neurons receiving the afferent inputs from hepatoportal osmoreceptors may have an enteroceptor function detecting the change in osmotic pressure of their environment. 相似文献
25.
Partial splenic embolization for hypersplenism concomitant with or after arterial embolization of hepatocellular carcinoma in 30 patients 总被引:15,自引:0,他引:15
Ming-Jun Han Han-Guo Zhao Ke Ren Dong-Chun Zhao Ke Xu Xi-Tong Zhang 《Cardiovascular and interventional radiology》1997,20(2):125-127
Purpose To study the value of partial splenic embolization (PSE) for the treatment of hypersplenism in patients undergoing embolization
of hepatocellular carcinoma (HCC).
Methods Transcatheter hepatic arterial embolization (THAE) combined with PSE was performed in 30 patients with HCC complicating liver
cirrhosis, portal hypertension, and hypersplenism. Gelfoam sponge was used as the embolic material for PSE and limited to
100–150 pieces.
Results More than 50% of splenic parenchyma was infarcted in 27 patients. Leukopenia and thrombocytopenia were corrected by PSE in
25 of 27 patients with hypersplenism. In 26 patients with esophageal varices, including 5 patients with bleeding, no rebleeding
occurred during a 6–17 month follow-up. Hypersplenism was not corrected in 2 of 3 patients whose infarcted splenic parenchyma
was less than 50%. No splenic abscesses or other severe complications were observed. Of the 30 patients treated, 19 are still
alive after 1 year.
Conclusions THAE combined with PSE is a safe and effective measure for patients with HCC. 相似文献
26.
Naoki Sugawara Koji Arizono Toshiichi Kitajima Hideaki Inoue Yu-Rong Lai 《Archives of toxicology》1997,71(5):336-339
A new mutant, the Eisai hyperbilirubinemic (EHB) rat, shows no inherent expression of the canalicular isoform of the multidrug
resistance protein (cMrp) in the liver. It has defective biliary secretion of organic anions such as bilirubin glucuronides,
bromosulfophthalein (BSP), cysteinyl leukotrienes, glutathione (GSH) and bile acid sulfate and glucuronides. When rats were
injected intravenously with CdCl2, biliary excretion of Cd over 30 min was 0.28% and 0.004% of the total dose in Sprague-Dawley (SD) and EHB rats, respectively.
Six SD rats and five EHB rats were fed a diet containing Cd. Bile Cd was detected at the level of 2 ng/20 min in SD rats,
but not in EHB rats. There was no significant difference of hepatic Cd concentration between SD and EHB rats. Furthermore,
there were no significant differences of renal and intestinal Cd, and hepatic and renal metallothionein (MT) concentrations
between the SD and EHB groups. Biliary excretion of reduced-GSH for 20 min was 1.3 ± 0.3 mg and 3.6 ± 0.9 μg in SD and EHB
rats, respectively. Our results suggest that hepatobiliary excretion of exogenous Cd is mediated mainly via carrier transport,
including a cMrp or GSH carrier, but that the lack of the transport pathway does not contribute to abnormal accumulation of
Cd in the liver.
Received: 12 August 1996 / Accepted 7 November 1996 相似文献
27.
W. -A. Cappeller R. Knitza J. Briegel H. Forst H. Stiegler L. Sunder-Plassmann E. Pratschke 《Langenbeck's archives of surgery / Deutsche Gesellschaft fur Chirurgie》1992,377(2):100-103
Zusammenfassung Das HELLP-Syndrom (Hemolysis, Elevated Liver enzymes, Low Platelets) tritt als Komplikation einer Schwangerschaftspräeklampsie auf und kann zu ausgedehnten subkapsulären Leberhämatomen führen. Wegen der Rupturgefahr der Hämatome besteht eine lebensbedrohende Notfallsituation für Mutter und Ungeborenes. Anhand von 2 Fallbeispielen wird das interdisziplinäre Vorgehen diskutiert. Mit Diagnosestellung der subkapsulären Leberhämatome sollte die notfallmäßige Entbindung durch Sectio erfolgen. Dann kann die chirurgische Entscheidung für eine konservative, abwartende Therapie mit Intensivüberwachung oder für eine Notfalloperation im Falle einer Leberkapselruptur ohne vermeidbares Risiko getroffen werden.
Subcapsular liver hematoma with HELLP-syndrome — an interdisciplinary urgency
Summary The HELLP-syndrome (Hemolysis, Elevated Liver enzymes, Low Platelets), known as a complication during pregnancy, is associated with preeclampsia and may cause subcapsular liver hematomas. In case of hepatic rupture the lives of mother and unborn are threatened. Therefore, an interdisciplinary diagnostic and therapeutic approach is discussed and compared to two examples. The diagnosis of subcapsular liver hematoma must lead to urgent delivery through Cesarean section. Thereafter, the surgeon may decide between observation on an intensive care unit and urgent operation in case of hepatic rupture, without endangering the unborn.相似文献
28.
Jonathan Koea M.D. F.R.A.C.S. Graeme Taylor F.R.C.P.A. Mary Miller F.R.C.P.A. Michael Rodgers F.R. A.C. S. John McCall M.D. F.R.A.C.S. 《Journal of gastrointestinal surgery》2003,7(5):627-630
Solitary necrotic nodule of the liver is an unusual lesion that is often an incidental finding on abdominal imaging, intraoperative
examination, or post mortem. Most reported cases of solitary necrotic nodule have been in males, and over three quarters of
these lesions have occurred in the right lobe of the liver. Pathologically, solitary necrotic nodule is a benign lesion characterized
by a completely necrotic core that is often partly calcified, surrounded by a dense hyalinized fibrous capsule containing
elastin fibres. The ultrasound appearance of solitary necrotic nodule is usually of a “target” lesion with a hyperechoic center,
while on CT scan they appear as non-enhancing hypodense lesions that are typical of metastatic adenocarcinoma or peripheral
cholangiocarcinoma. The impression of malignancy is further enforced with the finding of necrotic cellular material on biopsy
and the macroscopically hard and “gritty” nature of the nodules. Currently, permanent histopathology of solitary necrotic
nodules is the only accurate method of diagnosis. However, solitary necrotic nodules are usually of a bilobed or lobulated
shape that is unusual for malignant liver lesions, and they often lie in close proximity to hepatic inflow structures. Solitary
necrotic nodule should be suspected in liver lesions with this configuration, location, and on a biopsy showing a large amount
of necrosis. 相似文献
29.
泡型肝包虫病的超声诊断再探讨-附100例分析 总被引:1,自引:1,他引:0
目的:探讨泡型肝包虫病的B超特征,提出分型依据。方法:综合分析100例经手术或穿刺病理证实的B超声像图表现,并结合部分经CT、MRI检查病例对比研究。结果:100例泡型肝包虫,B超主要表现为①肝内不规则强回声团块80例,其中团块内呈弥漫性粗颗粒状强回声类似"落雪状"改变25例,团块内合并坏死液化20例,团块内钙化25例,钙化和液化同时出现10例。②肝内呈结节状改变20例。结论:泡型肝包虫病表现有其特征性,团块内粗颗粒状强回声,不规则液化坏死,斑片状钙化,周边无低回声暗晕以及彩超团块内无血流信号是与肝癌等肿块鉴别的重要依据。 相似文献
30.
阿霉素磁性明胶微球的研究 总被引:2,自引:0,他引:2
报告了阿霉素磁性明胶微球(Adr-MG-ms)的制备与性质,研究了超细氧化铁粒子的合成和磁性明胶微球(MG-ms)在狗体内的栓塞效果。阿霉素磁性明胶微球由2%阿霉素(Adr)、68%明胶和30%的磁铁粒子组成,微球的平均粒径为22μm。在体外实验中,药物释放速度证明微球有缓释的性质。磁铁粒子的平均粒径约为10nm,磁性明胶微球与 ̄(99m)Tc标记磁性明胶微球通过导管分别输入狗的肝动脉内进行栓塞,照相和血管造影显示在未加外磁场时磁性明胶微球在左右肝叶分布几乎相等,而在1200高斯的外磁场作用下,靶部位肝左叶的微球分布是肝右叶的2.25倍,而甲状腺、脑、心脏的微球很微量,结果表明磁性明胶微球在外磁场作用下是一个很好的治疗肝癌的栓塞剂。 相似文献