联合肝脏分隔和门静脉结扎二步肝切除术治疗传统不可切除肝癌之进展

近年来,肝癌综合治疗进展显著,但手术切除仍为肝癌病人获得长期生存的主要治疗方式。随着肝脏外科的快速发展,肝脏解剖学的复杂性和手术操作已不再是肝脏手术的主要障碍,肝切除术后剩余肝脏体积不足成为肝脏手术的主要限制因素。临床上多数肝癌病人因此无法行一期根治性切除术,只能接受非手术治疗,长期预后较差。联合肝脏分隔和门静脉结扎二...     

腹腔镜根治性切除治疗肝门部胆管癌15例分析

目的 探讨腹腔镜根治性切除治疗肝门部胆管癌的可行性及安全性。方法 回顾性分析2013年5月至2018年5月在川北医学院附属医院行根治性手术治疗并经病理学检查证实的15例肝门部胆管癌病人的临床资料,分析术中及术后情况,并随访观察。结果 15例肝门部胆管癌病人中13例行完全腹腔镜手术,2例病人中转开放手术。手术时间为（404.3±62.8）min,术中出血（502.0±133.8）mL,术后住院时间为（9.6±2.7）d,术后首次排气时间为（3.2±0.8）d。术后淋巴结检出数目为（9.5±2.6）枚,1例发现N2淋巴结转移。术后发生胆漏1例,大量腹腔积液1例,切口脂肪液化1例,均经保守治疗后好转出院。所有病人均获得随访,截至2018年5月,随访时间为6～60个月,死亡4例。结论 通过术前充分评估及术中探查制定相应手术策略,并且在严格掌握手术适应证的前提下,由具备丰富腹腔镜手术经验的医生主持操作,腹腔镜技术应用于肝门部胆管癌病人相对安全、可行。     

Safety and efficacy of enhanced recovery after surgery (ERAS) programs in patients undergoing hepatectomy: A prospective randomized controlled trial

Background and aim

Enhanced recovery after surgery (ERAS) programs, following a variety of perioperative treatments with evidence‐based medical evidence, has indicated its validity to accelerate rehabilitation in a wide variety of surgical procedures. This randomized controlled trial (RCT) study was implemented to verify the safety and efficacy of the perioperative effects in patients undergoing hepatectomy with ERAS or with conventional surgery (CS).

Methods

From August 2016 to November 2017, according to the inclusion criteria, 160 patients with liver diseases were suitable for participating in this experiment. Patients before liver resection were randomized into ERAS group (n = 80) and CS group (n = 80), and then the outcome measures were compared between the two groups.

Results

Enhanced recovery after surgery group had significantly less complications than CS group (P = .009). Compared with CS group, patients in ERAS group had low peak of WBCs in postoperative day (POD1), ALT in POD1 and POD3 (P < .05), high value of ALB in POD3 and POD5 (P < .05), less pain and higher patient satisfaction (P < .001), earlier exhaust, oral feeding, ambulation and extubation time (P < .05),and also had less hospital stay and cost (P < .001). There were no significant differences in readmission rate (<30 days) between two groups (P = .772).

Conclusions

Enhanced recovery after surgery programs applied to patients undergoing hepatectomy can safely and effectively relieve stress response, reduce the incidence of complications, improve patient satisfaction, accelerate patient recovery, reduce financial burden, and bring economic benefits.

     

中西医结合治疗肝胆管结石

目的：中西医治疗肝胆管结石。方法：分析431例规则性肝切除与89例非规则性肝切除治疗肝胆管结石病在各个方面的差异,包括手术时间、住院时间、术中出血量、术后输血人数、术后并发症、结石清除率和随访情况以及30例中医药物治疗肝胆管结石等等。结果：规则性肝切除在术中出血量、术后输血人数、术后并发症、结石清除率以及随访情况等方面全部优于非规则性肝切除术。结论：规则性肝段切除治疗肝胆管结石病优于非规则性肝切除术。     

Impaired liver regeneration after partial hepatectomy in db/db mice

Fatty liver is the most common hepatic disorder in humans and supposed to be a cause of poor prognosis after liver transplantation and hepatic resection which could be resulted from impaired liver regeneration. This study was carried out to analyze the process of liver regeneration in db/db mice which show severe steatosis because of abnormal leptin receptor. We performed 70% partial hepatectomy (PH) on db/db mice and normal +m/+m mice, and then sacrificed the animals 1, 2, 3, 5, 7 and 10 days later. The liver samples were weighed and examined histologically or immunohistochemically. As a result, the liver mass restitution was significantly inhibited in db/db mice compared with +m/+m mice. The BrdU labelling index peaked at 2 days after PH in both strains, although the value was lower in db/db mice. After that, interestingly, it decreased to the control level at 5 days in +m/+m mice while the recovery was delayed in db/db mice. Similar sequence was also observed in the PCNA labelling index. In addition, the peak time of the mitosis index was 2 days and 5 days after PH in +m/+m mice and in db/db mice, respectively. Thus, although not significant, the proliferative response of hepatocytes to PH occurred somewhat more transient and sharply in +m/+m mice while it lasted somewhat longer in db/db mice. This suggests that db/db mice may be valuable as one of the animal models for the investigation of the effects of steatosis on the liver regeneration.     

大鼠肝再生中糖代谢相关基因的表达变化

目的了解糖类代谢相关基因在大鼠肝再生中的表达变化。方法本研究用搜集网站资料和查阅相关论文等方法获得糖类代谢相关基因,用大鼠基因组230 2.0芯片检测它们在大鼠再生肝中的表达情况,用比较手术组和假手术组中基因表达的差异性确定肝再生相关基因。结果初步证实上述基因中118个基因与肝再生相关。肝再生早期[部分肝切除(PH)后0.5~4h]、前期(PH后4~12h)、中期(PH后16~66h)和后期(PH后72~168h)等4个阶段起始表达的基因数为33、6、68和7;基因的总表达次数为68、44、210和83。表明肝再生相关基因主要在肝再生启动阶段起始表达,在不同阶段发挥作用。它们共上调205次,下调200次,分为12种表达方式,表明肝再生中糖代谢活动多样和复杂。其中,单糖和糖原代谢、糖蛋白和糖脂(主要为神经节苷脂)合成相关基因几乎在整个肝再生中表达增强,寡糖和糖胺聚糖合成及糖蛋白和糖脂分解相关基因表达下调。结论肝再生与糖代谢密切相关。