门静脉激素疗法在改善肝切除术后肝功能的价值研究

目的　探讨门静脉激素疗法对肝切除术后肝功能改善的价值。方法　对照组 (n =70 )给予常规护肝处理。研究组 (n =70 )增加肝门阻断前及术后 1～ 3d经门静脉注射地塞米松治疗 ,两组于术前第 4天及术后第 4天分别测试口服葡萄糖耐量试验 (OGTT)及 15min血清吲哚氰绿潴留(retentionforindocyaninegreenat 15minutes ,R15ICG)。结果　对照组OGTT术前呈抛物线型 (P型 )4 4例中有 17例于术后变成线型 (L型 )。R15ICG由术前 2 3%± 5 %增加至术后的 2 7%± 8%。术后肝衰 2 0例 ,死亡 7例。研究组OGTT术前呈抛物线型 4 0例增加至术后的 6 1例 ,R15ICG由术前的 2 4 %± 7%下降至 14 %± 3% ,术后肝衰 5例 ,无死亡病例。两组术后的差异有显著性 (P <0 0 5 )。结论　门静脉激素疗法能显著改善术后肝功能及预防肝衰 ,OGTT及R15ICG能早期灵敏地反映肝储备功能     

Temporary vena cava filters in the prevention of pulmonary embolism during total hip arthroplasty

Thromboembolism constitutes one of the most dangerous complications during the immediate postoperative period of prosthetic surgery. Pharmacological prophylaxis and mechanical vascular compression are not always sufficient to protect from this surgical complication. In patients at greatest risk for thromboembolism, often with a positive history for pulmonary embolism, temporary vena cava filters may be used to reduce the incidence of vascular and pulmonary complications. However useful, these filters cannot be routinely used in orthopedic surgery. We present our results with the use of Filcard RFO2 vena cava filters in an open, randomized study of 30 patients. Received: 5 November 2001/Accepted: 30 November 2001     

Portal vascular anomalies in Down syndrome: spectrum of clinical presentation and management approach

Purpose

The occurrence of portal vascular anomalies in Down syndrome has been sporadically reported in the literature. These rare disorders have a wide spectrum of anatomical and clinical presentations. The aim of this communication was to describe the clinical course, imaging features, and management approaches in patients with this association.

Methods

We conducted a comprehensive search of the databases of the Vascular Anomalies Center and the Department of Radiology at Children's Hospital Boston for patients with Down syndrome and portal vascular anomalies. Medical records and imaging studies of varying modalities were reviewed.

Results

Three children with Down syndrome and portal anomalies (portosystemic shunt, simple arterioportal shunt, complex arterioportal shunt) were managed at our institution. The portosystemic shunt was clinically insignificant and resolved without any intervention. The simple arterioportal shunt was successfully treated with embolization. The complex arterioportal shunt was associated with major congenital cardiac defects and the child ultimately expired despite a decrease in the arterioportal shunting after embolization.

Conclusions

Three is a wide spectrum of clinical and anatomical features of portal vascular shunts in Down syndrome. The management approach should be tailored based on the severity of symptoms. Percutaneous embolization can offer a safe, effective, and minimally invasive alternative to the surgical approach in selective cases.     

合并右肝静脉根部损伤的中央型肝外伤救治体会

目的总结合并右肝静脉主干根部损伤的中央型肝外伤的救治体会。方法回顾性分析3例伴有右肝静脉主干根部损伤的中央型肝外伤患者的全部临床资料及随访资料。结果 3例患者的手术均获得成功;2例术后无并发症发生,1例术后先后并发脑水肿、成人呼吸窘迫综合征、心功能衰竭、肝肾功能损害及急性胰腺炎、肠麻痹、电解质紊乱;3例分别分别于术后17天、23天、37天康复出院;术后随访5年：3例全部恢复正常工作,其中2例右肝静脉主干修补者,1例血管通畅、肝功能完全正常,另1例血管轻度狭窄、肝功能轻度异常（此例同时合并有HBV感染）。结论伴有右肝静脉主干根部损伤的中央型肝外伤的救治仍较复杂和困难,具体手术处理措施应根据外伤类型、肝脏损伤范围及程度、右肝静脉损伤情况等因素综合决定,损伤的右肝静脉可予以修补,亦可予以缝扎。     

复发性下肢静脉曲张再手术原因分析

目的:探讨分析复发性下肢静脉曲张再手术的原因。方法:总结63例复发性下肢静脉曲张患者的临床资料,应用彩色多普勒和顺行静脉造影了解下肢深静脉和交通支瓣膜功能。结果:63例中52例为下肢深静脉瓣膜功能不全,11例为交通支瓣膜功能不全伴隐静脉主干及其部分属支残留。结论:有效修复深静脉瓣膜功能,结扎和离断相应属支及交通支,阻断静脉的反流,纠正3个静脉系统及溃疡周围的血液滞留,是防治下肢静脉曲张术后复发的主要措施。     

髂静脉受压综合征的腔内介入治疗

目的:探讨腔内介入治疗对髂静脉受压综合征的临床价值。方法:对78例髂静脉受压综合征患者进行以球囊扩张及支架置入为主的综合治疗,随访观察治疗效果。结果:术中术后无大出血、血栓形成、肺动脉栓塞及死亡病例,治疗效果良好。结论:腔内介入治疗是治疗髂静脉受压综合征的一种安全有效的治疗手段。     

贲门周围壁内外双重断流术治疗门脉高压症对肝脏血流及近远期功能的影响

目的：观察贲门周围壁内外双重断流术对门静脉高压症患者近远期肝功能的影响。方法：回顾性分析1989年1月—2008年1月我院367例行贲门周围壁内外双重断流术的门静脉高压症患者手术前后门静脉的血流变化,比较术前和术后1周和1、6、12个月谷丙转氨酶（ALT）、血清胆红素（TB）、血浆总蛋白（TP）、血浆白蛋白（ALB）等肝功能指标。结果：术前平均自由门静脉压为（36.2±4.2）cmH2O,术后为（31.4±3.3）cmH2O,差异有统计学意义（P〈0.05）。术后门静脉血流速度和血流量较术前显著降低,肝动脉血流速度和血流量较术前显著升高,差异均有统计学意义（P〈0.05）。术后1、3月肝功能各指标较术前无明显改变（P〉0.05）,术后6、12月肝功能各指标较术前明显改善（P〈0.05）。结论：贲门周围壁内外双重断流术能适度降低门静脉压力,同时强化肝动脉灌注,对维持门静脉高压症患者术后近期肝功能、改善术后远期肝功能具有重要作用。     

门静脉分支结扎后门静脉压力变化与肝再生的关系

目的 探讨90%门静脉分支结扎后大鼠门静脉压力变化与肝再生的关系.方法 45只雄性SD大鼠行90%门静脉分支结扎术,其中5只进行假手术作为对照.观察不同时相点门静脉压力和非结扎侧肝脏质量变化,光学显微镜下观察非结扎侧肝细胞的形态学变化,免疫组织化学方法检测未结扎侧肝细胞的增殖细胞核抗原(PCNA),TUNEL法检测未结扎侧肝细胞的凋亡情况,并进行定最分析.采用Pearson相关分析和t检验分析数据.结果 95%(38/40)的大鼠存活.结扎侧肝叶进行性萎缩,非结扎侧肝叶占全肝质量的比例随时问推移而增加,12 h内增加较缓慢,仅为10.75%;而1～5 d则增加速度明显加快,达到27.57%;7～28 d达到平台期,缓慢增加到32.37%.术前门静脉压力为(9.1±1.8)cm H_2O(1 cm H_2O=0.098 kPa);结扎后立即升高,12 h达到高峰(15.8±2.7)cm H_2O,与术前比较差异有统计学意义(t=6.847,P<0.05);1～28 d由(13.6±2.3)cm H_2O逐渐下降为(9.3±2.0)cm H_2O.术前大鼠PCNA阳性细胞计数为7%±3%,术后12 h至3 d由14%±5%上升至21%±6%,第5天达到高峰为26%±7%,与术前比较差异有统计学意义(t=9.129,P<0.05),随后逐渐恢复正常.TUNEL法检测结果显示,术前大鼠肝脏和术后各时相点大鼠未结扎侧肝脏仅见极少量凋亡细胞.大鼠门静脉压力与非结扎侧肝叶肝细胞PCNA的表达在术后1、3、5 d呈正相关(r=0.913,0.896,0.908,P<0.05),在术后14 d时相点呈负相关(r=-0.926,P<0.05).结论 大鼠90%门静脉分支结扎术后,引起未结扎侧肝细胞的活跃再生,再生后的肝脏可恢复原来的质量;肝再生以肝细胞增殖加速为主,而非肝细胞凋亡减少;门静脉压力变化在肝再生过程中可能发挥重要作用.     

联合门静脉切除重建的肝脏左三区切除治疗进展期肝门部胆管癌

The clinical value of applying portal vein resection and reconstruction in left trisectionectomy for treating advanced hilar cholangiocarcinoma is approved, while it is still a big challenge for clinicians. One female patient suffering from abdominal pain and jaundice received treatment in the General Hospital of PLA in July, 2009. She was prelimiarily diagnosed with Bismuth type Ⅲ a hilar cholangiocarcinoma. A tube was inserted in the left lateral inferior bile duct to carry out percutaneous transhepatic biliary drainage (PTBD). After the anatomic variation of the left bile duct was found, the diagnosis was revised as Bismuth type Ⅳ. A left trisectionectomy was proposed, and another PTBD tube was inserted in the right posterior bile duct.Combined portal vein resection and reconstruction and left trisectionectomy was successfully performed. The postoperation course was uneventful, except for the transient liver dysfunction and biliary-enteric anastomotic leakage.