微波切肝的临床观察—附48例对照分析

作者应用ＧＸ－Ⅰ型微波手术机行肝叶切除４８例，其中胆石症２８例，原发肝癌２０例，并选用同期４８例常规手术刀切肝作为对照组，作者就其术中出血，输血，手术时间及术后并发症进行了讨论。显示微波切肝组术中失血和平均输血均明显少于常规手术组（Ｐ＜０．０１），手术时间短，但术后并发症明显高于对照组。本文提示，微波切肝术后并发症有待进一步研究。     

RESULTS OF HEPATECTOMY FOR HUGE PRIMARY LIVER CANCER

ＲＥＳＵＬＴＳＯＦＨＥＰＡＴＥＣＴＯＭＹＦＯＲＨＵＧＥＰＲＩＭＡＲＹＬＩＶＥＲＣＡＮＣＥＲＬｉＧｕｏｈｕｉ；李国辉；ＬｉＪｉｎｑｉｎｇ；李锦清；ＺｈａｎｇＹａｑｉ；张亚奇；ＣｕｉＳｈｕｚｈｏｎｇ；崔书钟；ＹｕａｎＹｕｎｆｅｉ；元云飞（ＴｕｍｏｒＨｏｓ...     

单核巨噬细胞系统在肝切除后余肝损伤中作用的实验研究

以大鼠肝部分切除为实验对象，观察单核巨噬细胞系统吞噬与分泌功能改变，并探讨其在余肝损伤中的作用。结果表明：肝切除后随着肝脏枯否细胞清除功能的下降，以肺泡巨噬细胞为代表的肝外单核巨噬细胞相应激活，并且血清肿瘤坏死因子活性与余肝损伤程度呈线性正相关。提示肝切除后肝损伤机制可能在于肝切除后肝清除功能下降，肠源内毒素溢入体循环，并激活肝外单核巨噬细胞释放肿瘤坏因子等因素，从而介导肝损伤。     

Carcinosarcoma of the liver with an osteosarcomatous component

We report a case of hepatocellular carcinoma associated with mesenchymal differentiation, which was identified as a true carcinosarcoma based on thorough pathologic examination. A 48-year-old man presented with a giant mass in the lateral segment of the liver. It was resected by lateral segmentectomy combined with total gastrectomy. Microscopically, the tumor consisted of hepatocellular carcinoma, osteosarcoma, and undifferentiated sarcomatous components. The undifferentiated sarcomatous components were positive for cytokeratin, whereas the osteosarcomatous components were negative for cytokeratin and positive for S100. To our knowledge, this is only the second known case in which mesenchymal differentiation was immunohistochemically demonstrated in liver carcinosarcoma. Received: May 21, 1998 / Accepted: October 28, 1998     

精准肝切除在肝内胆管结石手术治疗中的应用

目的:探讨肝内胆管结石患者行精准肝切除术治疗的临床效果。方法:选取2010年3月—2014年12月收治的107例肝内胆管结石患者,随机分为观察组(54例行精准肝切除术)与对照组(53例非规则性肝切除术),比较两组患者的相关临床指标。结果:与对照组比较,观察组手术时间延长(242.3 min vs.203.4 min),术中出血量(361.3 m L vs.518.6 m L)、手术当日引流量(131.7 m L vs.208.6 m L)、术后住院时间(18.1 d vs.20.9 d)、住院费用(2.2万元vs.2.9万元)均减少;术后3、7 d转氨酶峰值降低;总并发症发生率(5.56%vs.18.87%)与结石复发率(7.41%vs.20.75%)降低,差异均有统计学意义(均P0.05)。结论:肝内胆管结石患者施行精准肝切除术,有利于减轻手术创伤,减少术后并发症,降低结石复发率。     

胆道梗阻大鼠肝切除术后胆汁内引流和外引流对肝功能及肝再生的影响

目的:比较胆汁内引流和外引流对胆道梗阻大鼠肝切除术后肝功能及肝再生的影响。方法:将SD大鼠随机分为胆汁内引流组(ID组)、胆汁外引流组(ED组)、对照组,ID组和ED组均行胆总管结扎,对照组行假手术,各组均于术后72 h行部分(70%)肝切除,ID组和ED组同时分别行胆汁内引流与胆汁外引流。分别在肝切除术后0、1、2、3、7 d收集大鼠血清与残余肝组织,检测肝功能指标、肝组织有丝分裂细胞数以及增殖细胞核抗原(PCNA)的表达,并计算各组肝切除术后7 d残肝质量/体质量比值。结果:与对照组比较,ID组和ED组肝切除术后各时间点,血清总胆红素(TBIL)与谷草转氨酶(AST)均明显升高,而白蛋白(ALB)水平明显降低(均P0.05);ID组与ED组间比较,除TBIL水平无统计学差异外(均P0.05),其他两项指标ID组均优于ED组(均P0.05)。与对照组比较,ID组和ED组核分裂细胞数在肝切除术后大多数时间点均明显降低(均P0.05),但ID组核分裂细胞数多于ED组,在肝切除术后2、3 d差异有统计学意义(均P0.05)。肝切除术后,ID组和ED组肝组织PCNA表达量升高的速度与幅度均低于对照组(均P0.05),ID组升高的程度与衰退的速度大于ED组(均P0.05)。与对照组比较,ID组和ED组在肝切除术后7 d的残肝质量/体质量比值均降低(均P0.05),ID组的残肝质量/体重比值明显高于ED组(P0.05)。结论:胆道梗阻的大鼠部分肝切除术后,胆汁内引流可以改善术后肝功能,促进残余肝脏再生。     

腹腔镜肝肿瘤切除术临床观察

目的 探讨腹腔镜肝肿瘤切除术治疗肝肿瘤的有效性和安全性.方法 回顾性分析2013年1月—2015年1月收治的肝肿瘤55例.将采用腹腔镜手术的28例作为观察组,行开腹肝切除术的27例作为对照组.观察两组手术情况,包括手术时间、术中出血量、腹腔引流时间和住院时间,并对两组术前1d和术后1、3d肝功能和凝血指标进行比较.统计两组并发症、复发转移发生情况和1年生存情况.结果 观察组术中出血量少于对照组,腹腔引流时间和术后住院时间均短于对照组(P<0.05).两组手术时间比较差异无统计学意义(P>0.05).两组术后1 d和3 d丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、总胆红素(TBIL)高于术前1 d(P<0.05).术后1 d和3 d观察组ALT、AST低于对照组(P<0.05).两组并发症、术后复发转移发生率及生存率比较差异均无统计学意义(P>0.05).结论 与开腹肝切除术相比,腹腔镜肝切除术创伤小,有利于肝功能的早期恢复,未增加并发症及术后转移复发风险,可以用于肝肿瘤切除.     

Associating liver partition and portal vein ligation for staged hepatectomy:From technical evolution to oncological benefit

Associating liver partition and portal vein ligation for staged hepatectomy(ALPPS) is a novel approach in liver surgery that allows for extensive resection of liver parenchyma by inducing a rapid hypertrophy of the future remnant liver. However,recent reports indicate that not all patients eligible for ALPPS will benefit from this procedure. Therefore,careful patient selection will be necessary to fully exploit possible benefits of ALPPS. Here,we provide a comprehensive overview of the technical evolution of ALPPS with a special emphasis on safety and oncologic efficacy. Furthermore,we review the contemporary literature regarding indication and benefits,but also limitations of ALPPS.     

Hepatectomy for Metabolic Associated Fatty Liver Disease (MAFLD) related HCC: Propensity case-matched analysis with viral- and alcohol-related HCC

Background and aimsWe investigated the clinical impact of the newly defined metabolic-associated fatty liver disease (MAFLD) in patients undergoing hepatectomy for HCC (MAFLD-HCC) comparing the characteristics and outcomes of patients with MAFLD-HCC to viral- and alcoholic-related HCC (HCV-HCC, HBV-HCC, A-HCC).MethodsA retrospective analysis of patients included in the He.RC.O.Le.S. Group registry was performed. The characteristics, short- and long-term outcomes of 1315 patients included were compared according to the study group before and after an exact propensity score match (PSM).ResultsAmong the whole study population, 264 (20.1%) had MAFLD-HCC, 205 (15.6%) had HBV-HCC, 671 (51.0%) had HCV-HCC and 175 (13.3%) had A-HCC. MAFLD-HCC patients had higher BMI (p < 0.001), Charlson Comorbidities Index (p < 0.001), size of tumour (p < 0.001), and presence of cirrhosis (p < 0.001). After PSM, the 90-day mortality and severe morbidity rates were 5.9% and 7.1% in MAFLD-HCC, 2.3% and 7.1% in HBV-HCC, 3.5% and 11.7% in HCV-HCC, and 1.2% and 8.2% in A-HCC (p = 0.061 and p = 0.447, respectively). The 5-year OS and RFS rates were 54.4% and 37.1% in MAFLD-HCC, 64.9% and 32.2% in HBV-HCC, 53.4% and 24.7% in HCV-HCC and 62.0% and 37.8% in A-HCC (p = 0.345 and p = 0.389, respectively). Cirrhosis, multiple tumours, size and satellitosis seems to be the independent predictors of OS.ConclusionHepatectomy for MAFLD-HCC seems to have a higher but acceptable operative risk. However, long-term outcomes seems to be related to clinical and pathological factors rather than aetiological risk factors.