早期肠内营养在肝胆外科术后患者胃肠功能恢复中的价值

目的研究早期肠内营养在肝胆外科术后患者胃肠功能恢复中的价值。方法本次研究对象为2019年6月—2020年5月在本院接受手术治疗的肝胆外科患者,按照随机数字表法将107例患者进行分组,对照组52例予以常规肠内营养支持,观察组55例实施早期肠内营养支持。将两组的营养相关指标、胃肠功能恢复情况、住院时间进行比对,评估临床疗效。结果治疗后,观察组患者的血清白蛋白(albumin,ALB)、前白蛋白(prealbumin,PAB)、预后营养指数(prognostic nutritional index,PNI)均高于对照组,差异具有统计学意义(P<0.05);观察组患者的胃肠功能恢复时间、住院时间均短于对照组,治疗总有效率高于对照组,差异具有统计学意义(P<0.05)。结论对肝胆外科术后患者实施早期肠内营养支持有助于其营养状况的改善,可促进胃肠功能恢复,疗效显著。     

Biomarker-Driven and Molecular Targeted Therapies for Hepatobiliary Cancers

The recent accumulation of molecular profiling data for primary hepatobiliary malignancies, including hepatocellular carcinoma and biliary tract cancers, has led to a proliferation of promising therapeutic investigations in recent years. Treatment with pathway-specific targeted inhibitors and immunotherapeutic agents have demonstrated promising early clinical results. Key molecular alterations in common hepatobiliary cancers and ongoing interventional clinical trials of molecularly targeted systemic agents focusing on hepatocellular carcinoma and biliary tract cancer are reviewed.     

肝胆系统疾病患者胆汁病原菌分布与临床特征

目的了解肝胆系统疾病患者胆汁分离病原菌情况及临床特征。方法采用回顾性研究方法,收集和分析某院肝胆疾病患者胆汁标本细菌培养结果及相关临床资料。结果共收集肝胆系统疾病患者胆汁标本406份,培养阳性率为64.53%,262份阳性标本中分离单一病原菌的占62.21%(163份),2种病原菌的占32.83%(86份),3种病原菌的占4.96%(13份)。分离病原菌374株,其中革兰阴性菌242株(64.71%),革兰阳性菌131株(35.02%),真菌1株(0.27%)。肝硬化、既往有肝胆手术史、患胆道结石者胆汁分离病原菌阳性率均高于对照组(均P0.05),胆道系统不同部位结石患者的胆汁病原菌分离阳性率有差异;而不同年龄、性别、以及是否患肝胆肿瘤各组比较,差异均无统计学意义(均P0.05)。胆道系统有无结石、既往有无手术史患者胆汁分离病原菌种类构成比较,差异无统计学意义(均P0.05);而肝硬化患者与无肝硬化患者胆汁分离病原菌种类构成比较,差异有统计学意义(χ~2=14.058,P=0.001)。结论肝胆系统疾病患者胆汁分离菌以肠杆菌科细菌及肠球菌属细菌单一感染为主,肝胆系统结石患者、既往肝胆手术患者及肝硬化患者胆汁分离病原菌阳性率较高。     

Development and validation of a symptom index for advanced hepatobiliary and pancreatic cancers

BACKGROUND:

The 45‐item Functional Assessment of Cancer Therapy–Hepatobiliary (FACT‐Hep) questionnaire assesses health‐related quality of life in patients with liver, bile duct, and pancreatic cancers. Although the FACT‐Hep was initially derived from patient input, this study's researchers sought to verify adequate coverage of items by soliciting open‐ended input from patients with advanced disease.

METHODS:

As part of a larger study in collaboration with the National Comprehensive Cancer Network (NCCN), 50 people (60% male, 80% caucasian, average age 60.4 years) with stage 3 or 4 hepatobiliary or pancreatic cancer were recruited. Participants generated and ranked up to 10 important symptoms and concerns that physicians should monitor when assessing the value of chemotherapy. Patients were also able to provide open‐ended, qualitative information that was evaluated systematically. Ten expert physicians also provided input on priority symptoms.

RESULTS:

The resulting 18‐item NCCN‐FACT Hepatobiliary‐Pancreatic Symptom Index (NFHSI‐18) demonstrated high internal consistency (α = .89) and moderate to strong correlations with measures of physical well‐being (ρ = .76), emotional well‐being (ρ = 0.52), and functional well‐being (ρ = 0.57). Scores on the NFHSI‐18 were also highly correlated with the original hepatobiliary scale of the FACT‐Hep (ρ = .82; all P < .001). Compared with patients with better performance status, patients with poor performance status had worse NFHSI‐18 symptom scores, F(3,47) = 9.74; P = .0003.

CONCLUSIONS:

The NFHSI–18 assesses symptoms of importance to patients with hepatobiliary and pancreatic cancers and demonstrates promising measurement properties. The scale is a good candidate for brief symptom assessment in clinical trials. Cancer 2012. © 2012 American Cancer Society.     

回顾性评估钆塞酸二钠增强MRI和磁共振弥散加权成像检测小肝细胞癌的准确性

目的:比较钆塞酸二钠(Gd-EOB-DTPA)增强MRI和磁共振弥散加权成像(DWI)检测小肝细胞癌(sHCC,直径≤2 cm)的准确性。方法:回顾性评估84例接受3T MRI腹部检查的肝细胞癌患者,根据检查方式分为A组(Gd-EOB-DTPA对比增强)和B组(DWI),由两名对本研究不知情的造影专家分别独立解读图像、进行赋值并比较。采用受试者工作特征曲线(ROC)评估两组分析方法对sHCC诊断的准确性和灵敏度。结果:在102个病灶中,A组有6个病灶、B组有17个病灶未被检测到。A组中两个观察者的ROC曲线下面积(AUS)均显著高于B组(P<0.05)。观察者对两组成像评价的一致性极好。A组中两个观察者的灵敏度和阳性预测值均显著高于B组(P<0.05)。结论:Gd-EOB-DTPA增强MRI在检测sHCC方面比DWI更准确。     

肝切除术式合理决策要点

切除病变肝组织是肝胆疾病有效的治疗手段，合理肝切除方案需要在彻底切除病灶、确保手术安全和病人最优预后等关键性治疗目标间取得平衡。肝胆恶性肿瘤肝切除术的决策要点在于合理的肝切除范围、肿瘤切缘以及对肝脏储备功能的准确评估。研究结果表明，肿瘤生物学异质性、肝段间血管交通支或流域重合的存在、肿瘤微环境新生血管等多个因素的影响可能会弱化肝细胞癌实施解剖性肝切除的治疗效应，而手术宽切缘是肝细胞癌预后获益的独立显著性因素；淋巴结转移是肿块型肝内胆管癌决策合理切缘的重要考量因素；除肿瘤累及右肝门者，扩大肝切除范围对pT2期及以上的胆囊癌并无生存优势；R1-vas切缘对肝细胞癌和结直肠癌肝转移以及肝门部胆管癌侵及肝动脉的治疗价值，值得更多探索性研究。基于保留更多功能性肝实质的理念，联合肝静脉主干切除的限制性肝切除对生长于第二肝门、肝静脉主干受侵的肝细胞癌，以及围肝门切除对于Bismuth-Corlette Ⅲ~Ⅳ型肝门部胆管癌，具有临床价值。     

肝胆系统PET/MR成像检查规范专家共识

目前国内外尚缺乏关于肝胆系统一体化PET/MR标准化检查规范的探讨，无法满足日益增长的临床需求。国内相关专家结合国内外临床指南、专家共识和参考文献，以及在临床实践中获得的临床扫描经验，针对联影一体化PET/MR系统特点，对肝胆系统PET/MR检查的扫描方案进行了优化、细分及规范化，对临床适应证、扫描方案及图像质量控制等内容达成专家共识，以期规范一体化肝胆系统PET/MR检查方案，更好地为临床提供精确影像学证据。     

Micrometastases from HBP malignancies and metastatic cancer

Despite advances in early diagnosis and surgical treatment, the prognosis for patients with primary malignant tumors of the hepatobiliary tract and pancreas has not changed markedly over the last decades. Early metastatic relapse after complete resection indicates the presence of disseminated tumor cells undetectable by current tumor staging methods. Sensitive immunohistocytochemical and nucleic acid‐based assays have been developed to detect single tumor cells present in lymph nodes, bone marrow, or blood. Standardization of the current occult tumor cell detection protocols are needed before “micrometastatic” tumor staging can be used in clinical practice. We present an overview of recent studies on the frequency and prognostic value of occult disseminated tumor cells in the lymph nodes, bone marrow, and blood of patients with hepatopancreatobiliary malignancies and metastatic colorectal cancer identified by immunohistocytochemistry or nucleic acid‐based assays.