肝静脉裂隙在肝脏外科中的应用

目的探讨肝静脉裂隙在肝脏外科的应用。方法30例背驮式肝移植，10例选择性肝静脉阻断切肝术，3例通过肝后隧道建立绕肝阻断带，行右肝叶切除术。结果三种术式都能通过肝静脉裂隙解剖出肝右静脉根部和左、中肝静脉共干，切断肝静脉或阻断肝静脉根部或建立肝后隧道，完成手术。结论肝静脉裂隙是肝静脉根部的重要解剖部位，要解剖出肝静脉根部、解剖肝静脉裂隙是必须的，也是可行、安全、可靠的。     

髋臼骨折术后下肢深静脉血栓形成的多因素分析

目的 分析影响髋臼骨折术后下肢深静脉血栓形成(DVT)的危险因素.方法 对102髋臼骨折术后DVT发生情况进行分析.术前及术后7～10d均用彩色多普勒检查双下肢深静脉血流通畅情况及DVT的发生,并对11项临床因素与人工关节置换术后DVT形成的相关性进行分析.结果 髋臼骨折术后发生DVT有18例,DVT发生率为17.65%(18/102).经Logistic多因素回归分析,与DVT相关的因素有6个,其中年龄、肥胖、静脉曲张及手术方式使术后发生DVT的风险分别增加到4.075、7.803、46.176和4.251倍(P＜0.05);硬膜外麻醉和踝泵练习使术后发生DVT的风险减少到0.121和0.114倍(P＜0.01).结论 年龄和肥胖是人工关节术后发生DVT的危险因素,而硬膜外麻醉和踝泵练习则是术后发生DVT的保护因素.髋臼骨折术后无症状DVT的大量存在,提示术后最好常规行双下肢彩色多普勒检查,一旦有DVT发生,及时治疗,防止发生致命性肺栓塞.     

Is Preservation of the Adrenal Vein Mandatory in Laparoscopic Adrenal-Sparing Surgery?

BACKGROUND AND OBJECTIVE: Adrenal tissue-sparing or partial adrenalectomy evolved initially for patients with bilateral synchronous adrenal surgical pathology to preserve vital adrenal volume. In the laparoscopic era, the exact criteria for performing such procedures laparoscopically have yet to be defined. Controversy exists regarding the importance of preserving the adrenal vein, main or accessory. The aim of this retrospective study was to present our short series of laparoscopic tissue-sparing adrenalectomies with vein preservation. Our main goal is not to support partial adrenalectomy as an alternative to total (this is already advocated by many surgeons) but to emphasize the vein-preserving technique. METHODS: Seven patients with peripherally located either aldosterone-producing adenomas (4 cases) or myelolipomas (4 cases) underwent laparoscopic lateral partial adrenalectomy. One patient harbored an aldosterone-producing adenoma and a myelolipoma as well. The main adrenal vein was identified and preserved in 6 patients and the accessory vein in one. RESULTS: No conversion to open adrenalectomy was necessary, and no perioperative morbidity or mortality occurred. Three adenoma patients are normotensive 44, 23, and 20 months postoperatively, while the fourth one's pressure is refractory. CONCLUSIONS: Surprisingly, total adrenalectomies preceded the partial ones, which is controversial compared with other procedures. Laparoscopic lateral partial adrenalectomy is a technically challenging tissue-sparing operation. Meticulous dissection allows preservation of the middle artery and main or accessory vein resulting in a functioning adrenal stump.     

Recurrence of left atrium-pulmonary vein conduction following successful disconnection in asymptomatic patients.

BACKGROUND: The clinical significance of conduction recurrences in isolated pulmonary veins of patients with atrial fibrillation is not established. METHODS: Twenty-two patients with paoxysmal atrial fibrillation underwent successful pulmonary vein isolation. Six months after the procedure, 14 patients were free of atrial fibrillation. Two of these patients were subjected to repeat mapping of the left superior pulmonary vein. RESULTS: There was recurrence of pulmonary vein to left atrium conduction despite complete lack of symptoms or evidence of recurrent atrial fibrillation. CONCLUSION: Successful pulmonary vein isolation with abolition of paroxysmal atrial fibrillation does not confer permanent disconnection of the pulmonary vein musculature from the left atrium.     

多层螺旋CT三维重建在左肾静脉压迫综合征中的临床应用

目的探讨多层螺旋CT(MSCT)三维重建在左肾静脉压迫综合征中的诊断价值。方法应用16层螺旋CT对11例左肾静脉压迫综合征病例进行泌尿系增强多期扫描,并获得各种后处理图像。结果11例左肾静脉压迫综合征病例均可见肠系膜上动脉(SMA)压迫左肾静脉(LRV)的征象。CT多平面重建(MPR)直观地显示了腹主动脉(AO)与SMA之间的夹角(α),最大为21.88,°最小为12.86°,平均为17.95°。CT横断位图像显示扩张的左肾静脉直径为12~15.3 mm,平均为13.26 mm;LRV受SMA压迫狭窄处直径为3.0~4.0 mm,平均为3.26 mm。左侧卵巢静脉或睾丸静脉直径为2.1~2.6 mm,平均为2.2 mm。5例增强扫描肾实质期(后期)显示双肾实质密度相差20 HU以上。结论MSCT在胡桃夹综合征诊断中具有明显的优势。     

门静脉动脉化对大鼠肝脏再生的影响

目的探讨门静脉动脉化重建肝血流后对肝脏再生的影响。方法建立门静脉动脉化重建肝脏血流加半肝切除(43%)的大鼠实验模型,分别在术后3 d和10 d取出肝脏烘干称重、光镜下计数进入有丝分裂期的肝细胞和分离肝细胞进行流式细胞仪分析,以观察肝脏再生的情况。结果实验组术后3 d和10 d测定的肝脏干重分别为(67.56±3.70)%(、78.76±5.68)%,与对照组(71.66±3.24)%(、82.38±4.86)%相比无显著性差异(P>0.05);进入有丝分裂期的肝细胞计数(708.4±68.21、239.6±24.50)与对照组(724.8±69.99、216.2±23.81)相比无显著性差异(P>0.05);流式细胞仪测得的进入G2和M期的肝细胞的DNA含量[(25.72±4.78)%、(15.60±2.52)%]与对照组[(28.78±3.37)%、(13.34±2.88)%]相比无显著性差异(P>0.05)。结论行门静脉动脉化重建肝血流不影响肝脏的再生。     

浆膜受侵的结直肠癌术后腹腔化疗联合静脉化疗的临床研究

Objective To compare the clinical efficacy of postoperative intraperitoneal chemotherapy combined with systemic chemotherapy to systemic chemotherapy alone for serosa-involved colorectal cancer. Methods According to the criteria of serosa-involving in colorectal cancer, 332 cases were divided into 2 groups prospectively without randomization. Study group (n=166) was treated with intraperitoneal chemotherapy combined with systemic chemotherapy, and control group (n=166) with systemic chemotherapy alone. Incidence of local recurrence, peritoneal metastasis, hepatic metastasis, other distant metastasis and 3-year, 5-year overall survival (OS) rate of two groups were compared. Results 3-year and 5-year OS rates of stage Ⅱ B in study group were similar to those in control group (χ2=0.612,P=0.434). The above rates of stage Ⅲ in study group were higher than those in control group (χ2=3.989,P=0.046). Either the study group or the control group, the 3-year and 5-year OS rates of patients undergone laparoscopic surgery or open surgery were similar (P=0.839, P=0.172). Incidences of local recurrence, peritoneal metastasis and hepatic metastasis in study group were 1.9%, 3.8% and 3.8% respetively, lower than those in control group (8.2%,9.5% and 10.1%,P<0.05). Distant metastasis rate in study group was similar to that in control group. In study group, intraperitoneal chemotherapy regimen with Oxaliplatin had lower rates of peritoneal metastasis and hepatic metastasis as compared to that with Cisplatin (0.9% vs 8.8% ,P=0.019), while the incidences of local recurrence and other distant metastasis were similar. Conclusions Postoperative intraperitoneal chemotherapy combined with systemic chemotherapy improves 3-year and 5-year overall survival rates in patients with stage Ⅲ serosa-involved colorectal cancer, and decreases local recurrence, peritoneal metastasis and liver metastasis rate, especially when intraperitoneal chemotherapy regimen contains Oxaliphtin. Comparing with open surgery, laparoscopic surgery dose not improve 3-year and S-year overall survival rates in patients receiving combined chemotherapy or systemic chemotherapy alone.     

尾状叶门静脉解剖结构研究

[目的 ]利用经动脉性门静脉造影CT(CTAP)重建门静脉及肝静脉三维结构 ,观察生理状态下的尾状叶门静脉的分支形式 .[方法 ]使用regiongrowing法重建门静脉及肝静脉的三维结构 ,把门静脉0 1次分支分出 ,分布于Spigel叶以及下腔静脉周围肝实质的门静脉支为尾状叶的门静脉 ,以左、中、右肝静脉为界 ,将下腔静脉周围分成左肝静脉的左侧部分、左肝静脉的右侧部分、右肝静脉的左侧部分及右肝静脉的右侧部分 ,观察尾状叶的门静脉在下腔静脉周围肝实质内的分支形式 .[结果 ]下腔静脉周边的尾状叶门静脉支为每例 2～ 5支 ,平均 4支 ;下腔静脉周围尾状叶门静脉支的出现率为左肝静脉的左侧部分为 10 0 % ,左肝静脉的右侧部分为 32 % ,右肝静脉的左侧部分为 80 % ,右肝静脉的右侧部分为2 7% .[结论 ]下腔静脉周围存在尾状叶 ,其门静脉支围绕着下腔静脉分布