术后后装放疗、吉西他滨化疗治疗原发性肝癌

目的:探讨术后后装放疗加吉西他滨全身化疗对原发性肝癌的治疗效果。方法:自1999年10月至2001年12月,将44例行肝癌切除术的原发性肝癌患者随机分为综合治疗组和对照组,每组22例。综合治疗组术中放置施源管3-6根,确定驻留点3-8个,术后3-10天行后装放疗,单次剂量10Gy,照射2-4次,总剂量20-40 Gy。放疗结束3周后,开始吉西他滨化疗,静滴1.4g每周1次,4周为1周期,每周期3次,共6个周期。对照组手术后不放、化疗。手术前后定期查血常规、肝功能、AFP、胸片、B超或CT。结果:综合治疗组后装放疗后AFP转阴率100%(17/17),对照组62.5%(10/16)(P<0.05);6月复发率0,低于对照组27.3%(6/22)(P<0.01);综合治疗组一年复发率18.2%(4/22)、转移率0和一年生存率100%(22/22),与对照组的45.5%(10/22)、13.6%(3/22)和77.3%(17/22)均有显著差异(P<0.05)。结论:术后后装放疗加吉西他滨全身化疗是提高原发性肝癌近期治疗效果,降低复发率和转移率的有效手段。     

Surgical treatment of malignant liver tumours

Surgical resection is the mainstay of treatment for malignant liver tumours and offers the only chance of cure. Advances in radiological imaging, surgical technique and peri-operative management have enabled liver resection to be performed safely. Partial hepatectomy is indicated for the treatment of hepatocellular carcinoma and hepatic metastases from colorectal cancer. In addition, it may be utilized for selected patients with liver metastases from other primary tumours. Total hepatectomy with transplantation may be of benefit in some patients with unresectable neuroendocrine metastases or small hepatocellular carcinomas. The role of cryosurgery has not been precisely defined, and it needs to be compared with other palliative therapies such as ethanol injection and hepatic artery embolization.     

不阻断入肝血流肝切除术

目的：探讨不阻断人肝血流肝切术手术的安全性及技巧。方法：分析不阻断人肝血流的肝切除术39例,其中男性31例,女性8例。术前肝功按Child分级：A级34例,B级5例。肿瘤直径3～15cm。手术方式：半肝切除术5例,中央型肝切除术9例,周边型肝切除术25例。主要用钳夹法和指折法相结合的方式断肝,必要时利用术中B超判断切除范围和肿瘤与肝内血管的关系一观察术后并发症发生率、术中输血量、手术时间等指标。结果：手术时间80～480分钟,术中输血量0～7600ml,术中平均输血量1120 980ml,术后并发症发生率17．9％(7／39),术后无肝衰发生。结论：本组资料显示应用不阻断人肝血流切肝可行、安全。     

快速康复模式在腹腔镜肝切除围手术期中的应用

目的 浅析快速康复模式(fast-track surgery,FTS)在腹腔镜肝切除围手术期中的应用.方法 选取2018年1月—2019年12月本院30例腹腔镜肝切除患者,采用随机数字表法分为两组,各15例.A组采取快速康复模式,B组采取传统处理策略.评价两组干预效果.结果 A组患者术中及术后指标值均优于B组,差异均有...     

医学图像三维可视化系统在精准肝切除中的应用价值

目的 探讨医学图像三维可视化系统(MI-3DVS)在精准肝切除中的指导作用.方法 2008年6月至2010年9月南方医科大学珠江医院利用自行研发的MI-3DVS在术前对45例肝癌患者肝脏的CT薄层图像数据进行三维重建.根据肝内门静脉和肝静脉走行划分肝段,确定肿瘤所在位置,测算切除的功能性肝脏体积并计算剩余肝脏体积百分比.术前评估可切除性,制订个体化的手术方案,然后进行仿真手术演练,指导临床手术.结果 45例肝癌患者根据肝内肝静脉和门静脉的走行分布分为7种类型:常见型21例,与Couinaud分段相同;未分型6例;肝右叶未分型11例;肝左叶未分型4例;肝右静脉型1例;肝中静脉双支型1例;右后下静脉型1例.39例患者行开腹肝癌切除术,平均剩余肝脏体积百分比为74%±17%,术后病理检查均为肝细胞癌;6例患者行TACE治疗.所有患者术后未发生急性肝功能衰竭、出血、胆汁漏等严重并发症.出院后随访6个月,患者无瘤或带瘤生存.结论 用MI-3DVS进行术前评估和指导临床手术,符合肝脏解剖与生理特点,对精准肝切除有重要的指导作用.

Abstract：

Objective To investigate the guiding significance of medical image three-dimensional visualization system (MI-3DVS) in precise hepatectomy. Methods The clinical data of 45 patients with hepatic neoplasms who were admitted to the Zhujiang Hospital from June 2008 to September 2010 were prospectively analyzed. The preoperative image data of the liver were three-dimensionally reconstructed by MI-3DVS. According to the distribution of the intrahepatic portal veins and hepatic veins, the liver was divided into different sections,and then tumors can be located within these hepatic segments. The volume percentage of residual liver and volume of liver resected were detected. Evaluation of surgical resectability and surgery simulation were done before operation. Results According to the distribution of the intrahepatic portal veins and hepatic veins, all patients were divided into seven types: 21 patients were with normal type which was the same as Couinaud type, six with nondivided type, 11 with non-divided right liver type, four with non-divided left liver type, one with right hepatic vein type, one with double middle hepatic vein type and one with right posterior vein type. Thirty-nine patients received open hepatectomy, and the volume percentage of the residual liver was 74% ± 17%. Postoperative pathological examination confirmed that all the 39 patients were with hepatocellular carcinoma. Six patients received transcatheter arterial chemoembolization. No severe complications such as acute hepatic failure, bleeding, bile leakage were detected. All patients were followed up for six months, and they survived with or without tumor. Conclusion MI-3DVS has guiding significance in preoperative assessment and perioperative guidance for precise hepatectomy.     

右美托咪定对肝大部分切除术后小鼠远期认知功能的影响

目的探讨右美托咪定对肝大部分切除术(PH)后小鼠远期认知功能的影响。方法成年雄性C57BL/6J小鼠40只,采用随机数字表法分为四组,每组10只:对照组(C组)、PH组、生理盐水组(NS组)和Dex组。PH术模型制备后2d,C组和PH组进行Morris水迷宫试验,4次/天,共4d;Dex组小鼠术毕苏醒即刻经腹腔注射Dex 25μg·kg-1·d-1,NS组给予等容量生理盐水,均连续30d后,Dex组和NS组进行Morris水迷宫试验,4次/天,共4d。检测四组小鼠海马组织湿/干重比(W/D)和总含水量(TWC);RT-PCR和Western blot分别检测海马组织caspase-12mRNA及蛋白表达水平;原位末端细胞凋亡检测法(TUNEL法)检测海马组织细胞凋亡指数(AI)。结果与第1天比较,C组、NS组和Dex组小鼠第3、4天逃避潜伏期及游泳距离均明显缩短(P0.05);与C组比较,PH组小鼠第3、4天逃避潜伏期及游泳距离均明显延长(P0.05),海马组织W/D、TWC及AI均明显升高(P0.05),海马组织caspase-12mRNA及蛋白表达水平均明显升高(P0.05)。与NS组比较,Dex组第3、4天小鼠逃避潜伏期及游泳距离均明显缩短(P0.05),海马组织W/D、TWC及AI均明显降低(P0.05),海马组织caspase-12mRNA及蛋白表达水平均明显降低(P0.05)。结论Dex可改善PH后小鼠远期认知功能,其机制可能与其抑制海马组织caspase-12介导的细胞凋亡有关。     

Effects of Ozone Oxidative Preconditioning on Liver Regeneration after Partial Hepatectomy in Rats

ABSTRACT

Aim: Similar protective effect of ischemic and ozone oxidative preconditioning (OzoneOP) in hepatic ischemia–reperfusion (I/R) injury was demonstrated, providing evidences that both preconditioning settings shared similar biochemical mechanisms of protection. We investigated the effects of OzoneOP on liver regeneration after 70% partial hepatectomy (PHx) in rats. Methods: Rats were divided into three groups: PHx, I/R + PHx, and OzoneOP + I/R + PHx groups. Ozone (intraperitoneal, 1.2 mg/kg) was given to rats subjected to I/R and 70% hepatectomy daily five times before operation. At 24 hr and 48 hr after resection, samples were collected for the measurement of serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), tumor necrosis factor alpha (TNF-α), and interleukin-6 (IL-6). Moreover, liver regeneration rate, proliferating cell nuclear antigen (PCNA) labeling index, mitotic index, and histopathological examination were evaluated. Results: OzoneOP reduced liver injury determined by liver histology and serum transaminases. There was a rise in serum TNF-α and IL-6 levels in the I/R + PHx group whereas OzoneOP significantly decreased the rise in the level of TNF-α but not IL-6 on the 24 hr and 48 hr of reperfusion. Moreover, liver regeneration in OzoneOP + PHx group, as assessed by the regenerated liver weight, mitotic, and PCNA-labeling index, was significantly improved when compared to I/R + PHx group. Conclusion: These results suggest that OzoneOP ameliorates the hepatic injury associated with I/R and has a stimulatory effect on liver cell regeneration that may make it valuable as a hepatoprotective modality.     

Aggressive surgical resection for hilar cholangiocarcinoma

BACKGROUND: Surgical treatment of hilar cholangiocarcinoma remains a great challenge to surgeons because of its low resectability, poor survival, and high operative mortality and morbidity. METHODS: The medical and pathological records of 36 patients with a preoperative diagnosis of 'resectable' hilar cholangiocarcinoma operated on by us between January 1998 and December 2002 were studied. The clinical presentations, operative records, and pathology results were retrospectively reviewed. RESULTS: Twenty-six patients (72%) underwent resection with curative intent. Apart from resection of the extrahepatic biliary tree and porta hepatis lymph node dissection, 85% received concomitant en-bloc liver resection and 4% received ex situ liver resection and auto-transplantation. The margin of resection was negative (R0 resection) in 73% of patients, and microscopically positive (R1 resection) in the remaining 27%. The 30-day hospital mortality was 7.6%. Of the patients, 42% had major postoperative complications. The median survival was 20 months, with the longest survival 75 months. The 1-, 3- and 5-year actuarial overall survival rate after resection with curative intent was 77%, 31%, and 12%, respectively. The 1-, 3-, and 5-year actuarial overall survival after R0 resection was 84%, 42%, and 16%, respectively. Tumour recurrence occurred in 58% of patients. CONCLUSIONS: Aggressive surgery increases the resectability of hilar cholangiocarcinoma. R0 resection provides the only chance of long-term survival of these patients.     

肝切除治疗肝胆管结石153例分析

目的探讨肝切除治疗肝胆管结石的疗效。方法回顾性分析2007年10月至2013年10月肝切除治疗肝胆管结石153例的临床资料,统计结石的分布、术式的选择、术后并发症情况及治疗效果。结果 153例中发生术后并发症45例(29.4%),无手术死亡病例,139例患者得到2个月至6年的随访,随访率90.8%,术后疗效优良率89.4%,残留结石率9.3%,结石复发率12.9%。结论肝切除是治疗肝胆管结石最有效的手段之一。