间歇性肿瘤细胞减灭术治疗晚期卵巢上皮性癌治疗中的疗效探讨

目的:探讨间歇性肿瘤减灭术在晚期卵巢上皮性癌治疗中的临床价值。方法:将我院收治的68例卵巢上皮性癌患者随机分为观察组和对照组,观察组采用间歇性肿瘤减灭术治疗,对照组采用辅助化疗治疗,对比两组患者的治疗前后的临床特征及术后生存状况。结果:观察组的手术时间、住院时间、术中出血量明显优于对照组,术后3年生存率和5年生存率明显高于对照组。结论:间歇性肿瘤细胞减灭术提高卵巢上皮性癌的治疗效果,延长患者生命,具有较高的临床应用价值。     

航空生理环境对肝胆系统功能影响的研究进展

随着高性能战机的装备使用,飞行人员所处的航空生理环境也发生相应的变化。肝胆系统的解剖生理特点决定了其容易受到低压、低氧、加速度飞行等航空生理环境的影响。近年来国内外对航空生理环境影响飞行人员肝胆系统生理功能,进而导致肝胆系统相关疾病的机制研究已取得一定进展。本文就此作一综述。     

胆道造影在胆管黏液性囊腺瘤诊断中的作用

目的 探讨经皮肝穿刺胆道造影(percutaneous transhepatic cholangiography,PTC)在胆管黏液性囊腺瘤(hepatobiliary mucinous cystadenoma)诊断中的作用,提高本病的诊断水平. 方法 总结2004-01 ～2014-06收治的10例病理诊断为肝内胆管黏液性囊腺瘤的临床表现、影像学和PTC特点,回顾性分析PTC在胆管黏液性囊腺瘤诊断中的作用. 结果 10例肝脏囊腺瘤患者中MRI或CT见肝内部分胆管和胆总管扩张,无明显占位;6例行PTC显示胆总管不显影或显影不全,经抽吸出胶冻状物质后胆总管显影. 结论 肝胆管黏液性囊腺瘤PTC表现有特殊性,具有较高的诊断价值.     

Which is the best MRI marker of malignancy for atypical cirrhotic nodules: Hypointensity in hepatobiliary phase alone or combined with other features? Classification after Gd‐EOB‐DTPA administration

Purpose:

To investigate whether the malignancy of atypical nodules in cirrhosis can be identified at gadoxetic‐acid‐disodium(Gd‐EOB‐DTPA)‐MRI by their hypointensity in the hepatobiliary(HB)‐phase alone or combined with any other MR imaging features.

Materials and Methods:

One hundred eleven atypical nodules detected in 77 consecutive Gd‐EOB‐DTPA‐MRIs were divided, based on arterial‐phase behavior, into: Class I, isovascular (n = 82), and Class II, hypervascular without portal/delayed washout (n = 29). The two classes were further grouped based on HB‐phase intensity (A/B/C hypo/iso/hyperintensity). Portal/venous/equilibrium‐phase behavior and T2w features were also collected. Histology was the gold standard. Per‐nodule sensitivity, specificity, negative and positive predictive values (NPV/PPV), and diagnostic accuracy were calculated for HB‐phase hypointensity alone, and combined with vascular patterns and T2w hyperintensity.

Results:

Histology detected 60 benign and 51 malignant/premalignant nodules [10 overt hepatocellular carcinomas (HCCs) and 41 high‐grade dysplastic nodules (HGDN)/early HCC]. Class IA contained 31 (94%) malignancies, IB one (3%), and IC only benign lesions. Class IIA had 100% malignancies, IIB three (37.5%) and IIC only two (28.5%). HB‐phase hypointensity alone (Classes I–IIA) had 88% sensitivity, 91% NPV, and 93% diagnostic accuracy, superior (P < 0.05, P < 0.006, and P < 0.05, respectively) to any other MR imaging feature alone or combined.

Conclusion:

In atypical cirrhotic nodules, HB‐phase hypointensity by itself is the strongest marker of malignancy. J. Magn. Reson. Imaging 2012;36:648–657. © 2012 Wiley Periodicals, Inc.     

Gadoxetic acid-enhanced T1-weighted MR cholangiography in primary sclerosing cholangitis

Purpose:

To investigate the value of gadoxetic acid‐enhanced three‐dimensional T1‐weighted MR cholangiography (T1w‐MRC) in comparison to three‐dimensional T2‐weighted MR cholangiopancreaticography (T2w‐MRCP) in patients with primary sclerosing cholangitis (PSC).

Materials and Methods:

Thirty‐four MR exams in 29 patients (46.0 ± 16.1 years; 19 men, 10 women) scanned within a 14‐month period were retrospectively included. Two abdominal radiologists independently evaluated image quality regarding image contrast, image quality degradation due to artifacts, and visualization quality of ducts. The order of biliary tree branches that were visualized and reader preference toward each method were recorded. Helpfulness of T1w‐MRC was scored in consensus. Confirmatory endoscopic retrograde cholangiopancreaticography (ERCP) performed within 3 months of the MR examination was available in 8 patients.

Results:

Image quality of T1w‐MRC and T2w‐MRCP was graded good to excellent in all cases. There were advantages for both T1w‐MRC (functional information, less degradation due to artifacts) and T2w‐MRCP (higher order of visualized branches, better branch depiction). Both readers showed preference for T2w‐MRCP; however, both readers found gadoxetic acid–enhanced T1w‐MRC helpful in the majority of cases.

Conclusion:

Gadoxetic acid‐enhanced T1w‐MRC is complementary to, but should not replace, T2w‐MRCP. T1w‐MRC is a useful adjunct to T2w‐MRCP for morphologic evaluation and provides additional diagnostic information. J. Magn. Reson. Imaging 2012;36:632–640. © 2012 Wiley Periodicals, Inc.     

Short rigid scope and stereo-scope designed specifically for open abdominal navigation surgery: clinical application for hepatobiliary and pancreatic surgery

Background

We have reported the utility of an image display system using augmented reality (AR) technology in hepatobiliary surgery under laparotomy. Among several procedures, we herein report a system using a novel short rigid scope and stereo-scope, both designed specifically for open abdominal navigation surgery, and their clinical application for hepatobiliary and pancreatic surgery.

Methods

The 3D reconstructed images were obtained from preoperative computed tomography data. In our specialized operating room, after paired-point matching registration, the reconstructed images are overlaid onto the operative field images captured by the short rigid scopes. The scopes, which are compact and sterilizable, can be used in the operative field. The stereo-scope provides depth information. Eight patients underwent operations using this system, including hepatectomy in two, distal pancreatectomy in three, and pancreaticoduodenectomy in three patients. The stereo-scope was used in five patients.

Results

All eight operations were performed safely using the novel short rigid scopes, and stereo images were acquired in all five patients for whom the stereo-scope was used. The scopes were user friendly, and the intraoperative time requirement for our system was reduced compared with the conventional method.

Conclusions

The novel short rigid scope and stereo-scope seem to be suitable for clinical use in open abdominal navigation surgery. In hepatobiliary and pancreatic surgery, our novel system may improve the safety, accuracy and efficiency of operations.     

The Patterns of Glycine and Taurine Conjugates of Bile Acids in Serum in Hepatobiliary Disease

Fasting serum concentrations of glycine and taurine conjugates of cholic, chenodeoxycholic, and deoxycholic acid were measured with a high-pressure liquid chromatography-enzymatic assay in patients with hepatobiliary disease. The total glycine to taurine ratio was significantly lower in extrahepatic cholestasis (median 1.1) than in cirrhosis (median, 2.0) and controls (median, 1.7). In patients with cirrhosis the ratio was significantly correlated with the S-bilirubins, P-coagulation factors (II + VII + X), and S-total conjugated bile acids. Because of large overlaps of the ratio between the groups the glycine to taurine ratio is of hardly any diagnostic value. The ratio of cholic acid conjugates to chenodeoxycholic acid conjugates was over 1.5 in 10 of 12 cholestasis patients and below this value in all but 1 patient with cirrhosis; the separation of the groups was not improved by splitting the ratio in glycine and taurine conjugates. This study does not suggest that separate determination of glycine and taurine conjugates of bile acids in serum adds diagnostic information in hepatobiliary disease.     

肝胆恶性肿瘤患者胆道混合菌感染与单一菌感染对患者造成损失的差异分析

目的 对比肝胆恶性肿瘤患者胆道混合菌感染与单一菌感染对患者造成的损失的差异.方法 选取天津医科大学肿瘤医院2017年1月—2019年12月诊断为肝胆恶性肿瘤且发生胆道感染的患者,按胆汁培养病原菌种数分为混合菌感染组和单一菌感染组,收集病例相关信息,采用倾向性得分匹配法(PSM)对两组患者进行1:1配对,配对成功后,采用...     

龙胆泻肝汤对四氯化碳肝损伤大鼠肝脏转运功能的影响

目的:研究龙胆泻肝汤对四氯化碳(CC l4)所致急性肝损伤大鼠的靛氰绿(ICG)肝清除率的影响。方法:将32只大鼠随机分为空白对照组、模型组和龙胆泻肝汤高、低剂量组,每组8只。用CC l4制作大鼠急性肝损伤模型,测定下列变化:(1)大鼠血清天冬氨酸转氨酶(ALT)、丙氨酸转氨酶(AST);(2)肝脏形态学的改变;(3)肝血流量和靛氰绿肝清除率的改变;观察龙胆泻肝汤对CC l4大鼠急性肝损伤的影响。结果:龙胆泻肝汤能明显抑制CC l4所致大鼠血清中ALT及AST含量的升高(P<0.05或P<0.01),改善肝脏组织病理,对抗CC l4所致肝血流量和肝清除率下降(P<0.05)。结论:龙胆泻肝汤可保护肝脏,对抗CC l4所致肝清除率和肝血流量下降。