酒精性肝硬化的研究进展

酒精性肝硬化（AC）是长期和过量饮酒导致的一种不可逆的慢性肝脏疾病,是酒精性肝病（ALD）的终末阶段。近年来我国的ALD发病率呈逐年上升趋势,进展为AC的患者也逐年增多,ALD及AC的相关研究受到广泛关注。就AC的发病机制及治疗进展作一综述。     

异物致胃肠穿孔三例临床分析

回顾分析2008年8月至2011年4月我院收治的3例异物致胃肠穿孔病例，总结其临床及影像表现。3例中男性2例、女性1例，全部经手术证实，均以不明原因腹痛入院，术前CT可见穿透胃肠壁的高密度异物影。     

经股动静脉置管犬体外膜肺氧合模型的建立

目的探讨在犬体外膜肺氧合（ECMO）实验模型中快速建立血管通路的最佳血管插管技术,以及半切开直视下切口内穿刺置管术的效果。 方法选用Beagle犬20只,经右颈内静脉放置中心静脉管、桡动脉放置动脉测压管连接心电监护仪。采用半切开直视下切口内置管术行ECMO股动静脉插管。记录该置管方法的成功率、置管时间、出血量、术后出血并发症。 结果半切开直视下穿刺置管成功率95%,平均置管手术时间为（41±18）min,平均出血量（16±8）ml,术后切口部位出血发生率15%。 结论建立实验动物犬体外膜肺氧合模型时,采用股动静脉半切开直视下切口内穿刺置管术能快速有效地建立体外循环通路。     

羟基红花黄色素A对四氯化碳急性肝损伤的保护作用

目的探讨羟基红花黄色素A(HSYA)对四氯化碳(CCl4)急性肝损伤的保护作用。方法将60只昆明种小鼠随机分为正常对照组和CCl4损伤组、HSYA保护组(2、4、8、16?mg/kg组),每组各10只。CCl4腹腔注射建立小鼠急性肝损伤模型。观察肝组织病理学改变;测定血清丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)的活性,肝组织匀浆谷胱甘肽(GSH)、超氧化物歧化酶(SOD)、丙二醛(MDA)、肿瘤坏死因子 α(TNF α)的含量及肝细胞色素P450 2E1(Cytochrome P450 2E1,CYP2E1)蛋白的表达。结果与CCl4损伤组比较,HSYA保护组肝组织病理改变明显减轻;血清ALT、AST活性明显降低(P<0.05); 肝组织匀浆中GSH、SOD含量明显升高(P<0.05);MDA、TNF α含量明显降低(P<0.05);CYP2E1蛋白表达量增加。综合各指标表明,以8?mg/kg保护组效果最佳。结论HSYA对CCl4急性肝损伤有明显保护作用,其机制可能与抑制脂质过氧化,清除自由基,降低TNF α水平有关。     

Pathological characteristics of liver allografts from donation after brain death followed by cardiac death in pigs

Donation after brain death followed by circulatory death （DBCD） is a unique practice in China. The aim of this study was to define the pathologic characteristics of DBCD liver allografts in a porcine model. Fifteen male pigs （25-30 kg） were allocated randomly into donation after brain death （DBD）, donation after circulatory death （DCD） and DBCD groups. Brain death was induced by aug- menting intracranial pressure. Circulatory death was induced by withdrawal of life support in DBCD group and by venous injection of 40 mL 10% potassium chloride in DCD group. The donor livers were perfused in situ and kept in cold storage for 4 h. Liver tissue and common bile duct samples were col- lected for hematoxylin and eosin staining, TUNEL testing and electron microscopic examination. Spot necrosis was found in hepatic parenchyma of DBD and DBCD groups, while a large area of necrosis was shown in DCD group. The apoptosis rate of hepatocytes in DBD [（0.56±0.30）%] and DBCD [（0.50 ±0.11）%] groups was much lower than that in DCD group [（3.78±0.33）%] （P〈0.05）. And there was no significant difference between DBD group and DBCD group （P〉0.05））. The structures of bile duct were intact in both DBD and DBCD groups, while the biliary epithelium was totally damaged in DCD group. Under electron microscope, the DBD hepatocytes were characterized by intact cell membrane, well-organized endoplasmic reticulum, mild mitochondria edema and abundant glycogens. Broken cell membrane, mild inflammatory cell infiltration and sinusoidal epithelium edema, as well as reduced glycogen volume, were found in the DBCD hepatocytes. The DCD hepatocytes had more profound cell organelle injury and much less glycogen storage. In conclusion, the preservation injury of DBCD liver allografts is much less severe than that of un-controlled DCD, but more severe than that of DBD liver allografts under electron microscope, which might reflect post-transplant liver function to some extent.     

手助腹腔镜下直肠癌低位和超低位前切除术

目的总结手辅助腹腔镜（HALS）下低位和超低位直肠癌保肛手术的经验和近期疗效。方法回顾性分析2010年1月至2011年1月间在中山大学附属第一医院胃肠外科接受HALS下直肠前切除术的49例低位直肠癌患者的临床资料。结果49例直肠癌患者肿瘤近端切缘（14．3±6．9）cm,远切缘（4-3±1．9）cm,手术时间（128．3±70．9）min,术后肉眼评估全直肠系膜切除完整者42例。接近完整者为7例;环周切缘大于或等于2mm者为42例,小于2mm者为7例：获得R0切除者46例,R,切除者3例。淋巴结受检总数（16．2±9．2）枚／例,转移淋巴结（1．12±2．19）枚／例。术后病理示TNMI期12例,ⅡA期18例,ⅡB期1例,ⅢA期2例．HIB期8例,1IC期5例,Ⅳ期3例。术后住院时间（6．3±3．9）d,未见吻合口瘘、肠梗阻、腹、盆腔及吻合口出血,术后切口感染2例。结论HALS下直肠癌低位和超低位前切除术安全、可行,近期效果良好。     

合并乙肝肝硬化的肝上皮样血管内皮瘤1例报道并文献复习

目的 分析1例术前诊断为肝癌同时合并乙肝肝硬化的肝上皮样血管内皮瘤患者的临床特点及影像学特征,从而提高对此病的认识,减少误诊,进一步指导临床诊疗。方法 收集并分析1例术前诊断为肝癌同时合并乙肝肝硬化的肝上皮样血管内皮瘤患者的临床资料,检索相关病例报道并进行文献复习。结果 患者,51岁,男性,因“体检中发现肝脏孤立占位性病变3 d余”入院,查体未见特殊异常。肿瘤标志物未见明显异常。肝脏MRI:平扫不具有特征性,扩散加权成像(DWI)和表观扩散系数(ADC)提示病变边缘部分弥散受限,中央区弥散不受限,提示合并坏死;增强扫描与CT类似,也是呈周边不均匀强化,并有向内填充的趋势,延迟期开始廓清。术后病理证实为肝上皮样血管内皮瘤。结论 在临床诊疗过程中,遇到肝脏实性占位性病变、影像学没有典型肝细胞癌、胆管细胞癌及肝血管瘤等常见病表现时,尤其是影像学提示典型的“包膜回缩征”“靶征”或“棒棒糖征”时,应考虑到本病可能。