肝胆外科进修医师带教体会

肝胆外科进修医师的教学属于继续教育的范畴。在教学工作中,采用"以人为本"的进修教学计划,进行医院优良传统教育,构建自主和谐的进修学习氛围,采用PBL教学方法,运用丰富生动的多媒体课件,适度增加手术和操作实践,达到了满意的教学效果。     

输注白蛋白在肝胆疾病术后的临床价值分析

目的:分析肝胆疾病术后患者输注白蛋白的临床价值。方法:使用前瞻性随机对照方法,将102例肝胆疾病术后早期的低白蛋白血症的患者随机分配到白蛋白组52例和生理盐水组50例,观察患者术后低白蛋白血症的发展、营养状态、术后液体平衡情况、术后并发症及住院天数。结果:不管有无输注白蛋白,肝胆疾病术后患者白蛋白水平均显著下降,两组的血浆白蛋白浓度下降幅度、营养指标、预后等均无显著性差异(P<0.05)。结论:对肝胆疾病术后早期低白蛋白血症,输注白蛋白并无临床价值。     

High-dose oral erythromycin decreased the incidence of parenteral nutrition-associated cholestasis in preterm infants

BACKGROUND & AIMS: Feeding intolerance because of functional gastrointestinal dysmotility and parenteral nutrition-associated cholestasis (PNAC) are common problems in preterm, very-low-birth-weight (VLBW) infants. This double-blind, randomized, placebo-controlled study aimed to assess the effectiveness of "high-dose" oral erythromycin as a prokinetic agent in decreasing the incidence of PNAC. Two secondary end points, including the time to achieve full enteral feeding and the duration of parenteral nutrition, were also evaluated. METHODS: Infants consecutively admitted to the neonatal unit were randomized to receive erythromycin (12.5 mg/kg/dose every 6 hours for 14 days) or an equivalent volume of normal saline (placebo) if they attained less than half the total daily fluid intake (<75 mL/kg/day) as milk feeds on day 14 of life. RESULTS: Of 182 VLBW infants enrolled, 91 received erythromycin. The incidence of PNAC was significantly lower in erythromycin-treated infants (18/91) compared with placebo infants (37/91; P = .003). Treated infants achieved full enteral nutrition significantly earlier (mean, 10.1; SE, 1.7 days; P < .001), and the duration of parenteral nutrition was also significantly decreased by 10 days (P < .001). Importantly, fewer infants receiving erythromycin had 2 or more episodes of septicemia (n = 4) compared with placebo patients (n = 13, P = .03). No serious adverse effect was associated with erythromycin treatment. CONCLUSIONS: High-dose oral erythromycin can be considered as a rescue measure for VLBW infants who fail to establish adequate enteral nutrition and in whom anatomically obstructive pathologies of the gastrointestinal tract have been excluded.     

玉米须在肝胆系统疾病的应用

玉米须(Corn Silkor Stigma Maydis)是一种物美价廉的药物,其"味甘、淡,性微温",玉米须含有多种有效化学成分,具有降糖、降压、降脂,抗菌,利胆、排石,止血,抗肿瘤,提高免疫力等药理作用,目前应用于临床治疗多种疾病。现仅就玉米须在肝胆疾病方面应用作综合讨论。     

Ascariasis as a cause of hepatic abscess: A report of 3 cases

We receive around 60 cases of hepatic abscess in a year. The commonest diagnosis reached at the time of discharge is amoebic liver abscess. The diagnosis of amoebic liver abscess is mostly presumptive and thus the patients are usually given a mixed treatment with injection ceftriaxone and tablet metronidazole. Here we report three cases of hepatic abscess diagnosed recently, where ascariasis was the probable etiology. Ascariasis may be a much commoner cause of hepatic abscesses in this region than we think.     

Comparative dosing and efficacy of sorafenib in hepatocellular cancer patients with varying liver dysfunction

Background

Sorafenib is the only FDA-approved systemic therapy for advanced hepatocellular carcinoma (HCC). In clinical practice, dose reductions are often required, although there are limited efficacy data related to dose modifications. Given the prevalence of HCC in South Texas, we assessed the efficacy and safety of sorafenib therapy in relation to dose and Child Pugh (CP) score.

Methods

A retrospective analysis was done of advanced HCC patients, starting sorafenib at 400 mg twice daily, or at physician discretion at 400 mg daily, with the goal of titrating to twice daily. Overall survival (OS) and progression-free survival (PFS) were assessed.

Results

Among 107 patients, median OS (mOS) was 10.2 months; median PFS (mPFS) was 5.2 months. mOS for sorafenib 400 mg/day was 6.6 vs. 800 mg/day was 12.8 months [hazard ratio (HR), 0.59; P=0.04]; mPFS was 3.5 vs. 5.9 months, respectively (HR, 0.66; P=0.07). For Child Pugh A class (CP-A) patients, mOS was 15.8 months for 400 mg/day vs. 12.8 months for 800 mg/day (HR, 1.48; P=0.35); mPFS was 9.0 vs. 5.9 months, respectively (HR, 1.23; P=0.56). For Child Pugh B class (CP-B) patients, mOS was 5.0 months for 400 mg/day vs. 11.2 months for 800 mg/day (HR, 0.33; P=0.002); mPFS was 2.1 vs. 5.6 months, respectively (HR, 0.41; P=0.006). No differences in adverse events (AEs) were observed in CP-A vs. CP-B.

Conclusions

Patients with CP-A or CP-B advanced HCC should be offered sorafenib at 400 mg twice daily with optimal management of AEs in order to improve survival.     

肝胆外科手术切口感染的多因素分析及治疗对策

目的 探讨肝胆外科手术后切口感染的多因素分析及治疗对策.方法 选择医院从2005年5月-2011年8月收治的554例肝胆外科手术患者,通过回顾性调查分析,分析发生手术切口感染的相关因素.结果 554例肝胆外科手术患学中,发生切口感染66例,感染率为11.9％;患者年龄、手术时间、手术切口类型对切口感染率存在差异;年龄＞60岁患者感染率显著高于＜60岁患者,说明老年患者术后切口感染率高;Ⅰ类切口感染率为6.2％,明显低于Ⅱ、Ⅲ类切口的16.0％、23.7％;并且手术时间越长,发生切口感染的概率越高;因而预防肝胆外科术后切口感染,应从患者自身因素及手术操作两方面进行.结论 外科医师一定要加强无菌观念,加强无菌环境及手卫生依从性、尽量缩短手术时间、完善感染管理制度、控制探视人员流量,以最大限度减少手术切口感染的发生率.     

In vivo and in vitro nuclear magnetic resonance spectroscopy as a tool for investigating hepatobiliary disease: a review of H and P MRS applications.

Nuclear magnetic resonance (NMR) spectroscopy is a non-invasive technique, which allows the study of cellular biochemistry and metabolism. It is a diverse research tool, widely used by biochemists to investigate pathophysiological processes in vitro and, more recently, by physicians to determine disease abnormalities in vivo. This article reviews the basics of the NMR phenomenon and summarises previous research on the hepatobiliary system using both laboratory-based and clinical methodologies. The role of proton and phosphorus-31 ((31)P) NMR spectroscopy in the study of malignant and non-malignant liver disease and studies of bile composition are discussed. In vivo techniques (magnetic resonance spectroscopy, MRS) can be performed as an adjunct to standard MR examination of the liver. Although still primarily a research tool, the in vivo technique provides non-invasive biochemical information on disease severity and holds promise in its use to gauge response to treatment regimens.