中药精准煮散饮片

本文从饮片形制入手,在总结煮散饮片历史变迁的基础上,结合现代质量控制技术和物流管理理念,提出精准煮散饮片概念及其科学内涵。本文探讨了中药煮散的历史沿革及剂量、粉碎粒度等相关问题,提出了精准煮散饮片的质量控制技术体系、规范化生产流程、自动化应用系统和质量溯源系统。精准煮散饮片是对传统中药饮片剂型的继承与创新,可最大限度的利用好现有资源;对中药饮片进行质量均一化处理,使之实现生产和配给的标准化、自动化,从而提高中医临床疗效的稳定性和临床评价的可靠性,从供给侧推动中医药产业链条的整体升级,对中医药行业的可持续发展具有重要意义。     

原发性肝癌手术切除患者预后危险因素分析

目的：分析影响原发性肝癌患者手术切除后总体生存率和元瘤生存率的危险因素。方法：回顾性分析186例手术切除的肝癌患者临床和病理资料,Kaplan-Meier法和logrank检验进行单因素分析,应用Cox比例风险模型进行多因素分析。结果：影响思者总体预后的独立危险因素包括AFP水平、有无包膜、TNM分期、肿瘤分布、血管侵犯和围手术期输血;影响患者无瘤生存的独立危险因素包括性别、AFP水平、有无包膜、TNM分期、肿痛数目、肿瘤分布和围手术期输血。结论：肝癌手术切除患者预后与肿瘤进展程度以及围手术期大量输血有关。术前积极改善患者凝血功能,术中有效控制出血,减少输血对于改善患者预后可能有积极的作用．     

N -甲基- D -天冬氨酸受体在肝细胞癌中表达与临床病理、预后的关系

 【目的】通过探讨N -甲基- D -天冬氨酸受体（NMDAR1）蛋白在肝细胞癌组织及其相应癌旁组织中的表达,分析其与肝癌患者临床病理因素及预后的关系。 【方法】采用免疫组织化学方法,检测135例肝细胞癌组织及其相应癌旁组织中NMDAR1蛋白的表达,通过统计分析其与临床病理因素和预后的关系。 【结果】在135例肝癌组织中NMDAR1阳性表达的有107例（79.3%）,且明显高于相应癌旁组织;相关性分析结果显示,NMDAR1在肝癌中高表达与肿瘤大小、肿瘤分化程度、肿瘤包膜、卫星结节和血管侵犯相关 (P < 0.05)。NMDAR1蛋白阳性表达的患者无复发生存期(P < 0.05)与总生存期(P < 0.001)明显较短。Cox多因素分析结果揭示,NMDAR1表达水平是肝癌患者术后无复发生存期与总生存期的独立危险因素之一 (P < 0.05),且具有重要的预后预测价值。 【结论】 NMDAR1蛋白在肝细胞癌组织中表达增加,且与肿瘤分化程度和侵袭转移相关;NMDAR1可作为预测肝癌患者预后的独立分子标志物。     

肝癌术后早期下床活动方案的构建及应用

目的制订肝癌术后早期下床活动方案,探讨实施效果。方法按照入院时间将93例肝癌行肝切除术患者分为对照组45例和观察组48例。对照组实施术后常规活动护理;观察组实施早期下床活动循证实践方案,通过检索数据库获取最佳证据及整合证据,制定肝癌术后早期下床活动实践方案及流程。结果观察组术后24 h内下床活动率、首次下床时间及术后活动量指标显著优于对照组,术后排气排便时间、胃管留置时间显著短于对照组,术后24 h疼痛评分、疼痛控制满意度显著优于对照组(P0.05,P0.01);两组早期活动不良事件发生率比较,差异无统计学意义(P0.05)。结论肝癌术后早期下床活动最佳实践方案的实施,可加快肝癌患者术后康复,促进患者安全(并不增加患者安全事件)。     

Major Hepatectomy Induces Phenotypic Changes in Circulating Dendritic Cells and Monocytes

Introduction  Patients undergoing major hepatectomy are at increased risk for post-operative morbidity and mortality, and changes in the phenotype of effector cells may predispose these patients to infectious sequelae. Methods  To better understand post-hepatectomy immune responses, peripheral blood from 15 hepatectomy patients was drawn immediately before and after liver resection and on post-operative days 1, 3, and 5. Circulating monocytes and dendritic cells were analyzed by flow cytometry for quantity, phenotype, activation status, human leukocyte antigen DR (HLA-DR) expression, and toll-like receptor-2 and -4 expression. Results  Major hepatectomy increased the numbers of activated CD16^bright blood monocytes and the percentage of activated dendritic cells, although monocyte HLA-DR expression was reduced. These results may represent both dysfunctional antigen presentation and pending anergy, as well as cellular priming of immune effector cells. Better understanding of the alterations in innate immunity induced by hepatectomy may identify strategies to reduce infectious outcomes.     

Recent advances in the treatment of hilar cholangiocarcinoma: portal vein embolization

The clinical application of portal vein embolization (PVE) has contributed to improving the postoperative outcome of hilar cholangiocarcinoma. The enlarged nonembolized lobe after PVE protects the patient from postoperative hepatic failure, due to the increased functional reserve, and shortens the hospital stay. Although numerous reports have shown beneficial effects of PVE on postoperative outcome after extended hepatectomy, no randomized controlled study has been performed so far. It is urgent to establish a “gold standard” of PVE, because the indications, approach to the portal vein, types of embolic materials, and methods used to evaluate the function of the future liver remnant are variable among institutions. The indications and procedures of PVE for hilar cholangiocarcinoma may be different from those for hepatocellular carcinoma or colorectal metastasis, because, in many patients with hilar cholangiocarcinoma, biliary cancer is associated with biliary obstruction and cholangitis. This review article summarizes the contribution of PVE to the outcome of postoperative management in patients with hilar cholangiocarcinoma needing extended hepatectomy. We also describe our PVE procedure, which has been established from our experience of more than 240 cases of biliary cancer. Furthermore, the drawbacks of PVE, which may reduce the pool of candidates for surgery, are also discussed.     

[35S]methionine interaction with rat liver tRNA and effect of chemical carcinogens

The interaction of [³⁵S]methionine with hepatic tRNA in normal, carcinogen-treated, and partially hepatectomized rats was studied. tRNA was preferentially labeled following [³⁵S]methionine (1.6 mCi, 25 mg/kg body wt) administration by intraperitoneal injection. The extent of [³⁵S]methionine-tRNA interaction was impaired by partial hepatectomy and by conditions having a carcinogenic potential.Presented at the Proceedings of the International Meetings on Normal and Neoplastic Growth in Hepatology, Bari, Italy, June 1989.Supported by CNR, Progetti Finalizzati Chimica Fine ed Oncologia     

人血白蛋白在原发性肝癌肝切除术后的应用分析

目的 对东方肝胆外科医院原发性肝癌行肝切除术后使用人血白蛋白的情况进行合理性评价。 方法 回顾分析2012年6月至2013年6月期间150例原发性肝癌患者行肝切除术后应用人血白蛋白治疗的临床资料,比较患者术后应用人血白蛋白前后临床指标、生化指标,及人血白蛋白用药剂量相关因素分析,评价该院人血白蛋白的用药合理性。 结果 在统计的150份病历中,白蛋白总用量11 212.5 g(897瓶),总金额527 744元,占药品总费用的近20%,占住院总费用的近10%。患者在术后使用人血白蛋白后肝功能异常指标阳性率降低(P<0.05),人血白蛋白的使用剂量与患者用药前肝功能的Child-Pugh评分存在正相关(P<0.05)。 结论 该院原发性肝癌肝切除术后使用人血白蛋白较为合理,可达到预期的治疗效果。     

Comparative analysis of vascular bulldog clamps used in laparoscopic liver resection

To compare the clinical effect of Bulldog clamps with traditional Pringle for vascular occlusion during laparoscopic hepatectomy.One hundred ten patients were retrospectively investigated in this research from December 2014 to January 2019 in the second hospital of Anhui Medical University, who underwent laparoscopic liver resection using Bulldog (modified group, n = 54) and cotton tourniquet (traditional group, n = 56) for blocking the liver inflow-blood. Intraoperative blood loss, duration of the operation time, clamping time, postoperative outcomes were analyzed.All the operations were accomplished successfully without conversion to laparotomy, perioperative period clinical date was calculated. Intraoperative operative time, blood loss and resection sections had no statistical significance, but the clamping time (36.2 ± 5.6 vs 277.3 ± 88.4 s, P < .001) was significantly shorter in the bulldog group. Albumin, alanine aminotransferase, aspartate aminotransferase and serum total bilirubin had no statistical differences in postoperative day (POD) 1and 3, but POD 5 alanine aminotransferase (71.0 ± 46.8vs 105.8 ± 61.7IU/L P = .018) and aspartate aminotransferase (72.8 ± 39.7 vs 100.2 ± 16.7 IU/L P = .028). The postoperative hospital stays (7.02 ± 1.56 vs 8.50 ± 2.35 days P = .026) in bulldog group were lower than cotton group and differences had statistical significance. The C-reactive protein levels were significantly higher in the traditional group than in the modified group on POD 3 (46.3 ± 19.2 vs 57.7 ± 23.9 mg/L P = .019), and POD5 (13.3 ± 4.2 vs 17.5 ± 7.3 mg/L P = .001). There were 8 postoperative complications occurred in cotton group, while there was 5 in Bulldog group, all patients with complications were discharged after adequate drainage and symptomatic treatment.Bulldog is an effectively performed approach for vascular occlusion during laparoscopic hepatectomy than traditional Pringle maneuver.