腹腔镜下保留肥大肝尾状叶的次全肝切除术治疗肝胆管结石病1例

患者男, 63岁, 因反复右上腹痛伴寒战、发热20余年, 加重1个月入院, 既往30余年前于外院行开腹阑尾切除术。体格检查:右上腹轻度压痛、反跳痛, 肝区叩击痛明显。实验室检查:WBC:5.86×109/L, 总胆红素15.3 μmol/L, AST:33.47 U/L, ALT:15.2 U/L, ALB:45.3 g/L。CT示肝脏比例失调, 左、右叶萎缩, 尾叶肥大, 肝内胆管扩张, 胆管可见多发结石, 胆源性肝硬化;MRCP示肝内胆管可见多发结节状充盈缺损, 肝内外胆管扩张显著, 胰管扩张(图1)。术前评估:患者Child-Pugh A级, 肝脏储备功能良好(术前吲哚菁绿15 min滞留率为5.3%), CT三维重建计算全肝体积1 331 cm3, 肝尾状叶体积837cm3。标准化肝脏体积(standard liver volume, SLV)采用Urata公式计算:SLV(ml)=706.2×体表面积(m2)+2.4, 计算标准肝体积为1 117 cm3, 剩余肝脏体积占标准肝脏体积的74.9%。依据术前评估, 患者可安全进行手术。行腹腔镜下单独保留肥大肝尾状叶的次全肝切除+...     

环氧合酶-2、第10号染色体同源缺失性磷酸酶-张力蛋白基因在肝胆管结石合并胆管癌组织中的表达及意义

目的 探讨环氧合酶-2(COX-2)、第10号染色体同源缺失性磷酸酶-张力蛋白基因(phosphatase and tensin homolog deleted on chromosome ten,PTEN)在肝胆管结石合并胆管癌(hepatobiliary calculus with cholangiocarcinoma,HCWC)中的表达及其意义,研究COX-2、PTEN与HCWC发生、发展的关系,为HCWC的临床防治提供依据.方法 研究分三组:正常胆管组(肝血管瘤或肝外伤切除标本)10例(A组),肝内结石所在胆管组30例(B组),HCWC组37例(C组).应用免疫组织化学SP法,通用二步法检测各组COX-2、PTEN的表达情况,并对检测结果进行分析.结果 COX-2在A、B、C三组中的表达阳性率分别为10.0%、33.3%和70.3%,癌组织中的表达阳性率明显高于对照组胆管组织(P＜0.01).PTEN在A、B和C三组中的表达阳性率分别为90.0%、80.0%和35.1%,癌组织中的表达阳性率明显低于对照组胆管组织(P＜0.01).在COX-2阳性表达的HCWC组织中,PTEN有较低表达.Kendall相关分析表明HCWC组织中COX-2与PTEN表达呈显著负相关(r=-0.323,P＜0.05).结论 COX-2高表达可能与HCWC形成有关.在HCWC中,COX-2和PTEN表达呈负相关.COX-2高表达、PTEN低表达可能提示HCWC更易发生淋巴转移或肝外转移.

Abstract：

Objective To explore the expressions of cyclooxygenase-2 (COX-2), phosphatase and tensin homolog deleted on chromosome ten (PTEN) in hepatobiliary calculus associated with cholangiocarcinoma (HCWC) and their clinical significance. The relationship between the expressions of COX-2, PTEN and the onset and progression of HCWC was investigated to form an experimental base for the prevention and treatment of HCWC. Methods Thirty seven patients with tumor tissues of HCWC (group C), thirty patients with tissues of bile duct surrounding intrahepatic calculus (group B), and ten patients with normal tissues of bile duct from operations of hemangiomas of liver or liver trauma as the control (group A) were sampled and collected. A two-step immunohistochemistry (SP method) was employed to detect and statistically analyze the expressions of COX-2 and PTEN in each of the 3 groups. Results In groups A, B, C, the positive rate of the expression of COX-2 was 10%,33.3%, and 70.3%, respectively. The positive rates of expression of COX-2 in the carcinoma tissues of HCWC was significantly higher compared with the control group (P＜0. 01). In groups A, B, C the positive rates of the expression of PTEN was 90. 0%, 80. 0%, and 35.0%, respectively. The positive rate of expression of PTEN in the carcinoma tissues of HCWC was significantly lower than the control group (P＜0. 01). The expression of COX-2 was followed by a low expression of PTEN in the tissues of HCWC. Kendall's related analysis showed a strong negative correlation between the expression of COX-2 and PTEN in HCWC (r=-0. 323, P＜0. 05). Conclusions A high expression of COX-2 was related to HCWC. There was a negative correlation between the expressions of COX-2 and PTEN in HCWC. A high expression of COX-2 and a low expression of PTEN suggested a high chance of HCWC in extrahepatic or lymphatic metastasis.     

肝胆管结石并左肝肥大右肝萎缩的分型与手术治疗

目的总结肝胆管结石并左肝肥大、右肝萎缩的分型和手术治疗经验。方法对320例肝胆管结石并左肝肥大、右肝萎缩患者在分型基础上实施手术,其中Ⅰ型98例,Ⅱ型128例,Ⅲ型13例,Ⅳ型55例,Ⅴ型25例,Ⅵ型1例。结果无术后死亡病例,主要并发症为腹水13例,切口脂肪液化18例,应激性溃疡8例,均经保守治疗获得治愈。269例获随访,平均3.15年（3月～13年）,优124例,良104例,差41例,优良率为84.8%。结论根据肝胆管结石并左肝肥大、右肝萎缩的分型,采取相应恰当的手术治疗,可获较好效果。     

R-chop方案成功治疗原发性胰腺弥漫大B细胞型淋巴瘤1例

患者男,55岁,因全身皮肤、巩膜黄染1月余入院。查体：腹部平软,左上腹轻度压痛、反跳痛,可触及肿块,体重近期减少4 kg。实验室检查：Hb 134 g/L,白细胞5.23×10 9/L,总胆红素282.7 μmol/L,肿瘤标志物正常。超声：肝内外胆管、主胰管扩张,胰头部低回声肿块。胸部CT未见异常.腹部CT...     

1800名中学生艾滋病知识、态度及行为的调查

艾滋病是一种死亡率很高的传染病 ,其广泛流行已成为全球瞩目的公共卫生问题和社会问题。青少年是预防艾滋病的重要主力军 ,是开展艾滋病健康教育的重要对象。为了解青少年对艾滋病的知识 (Ｋ)、态度 (Ａ)及行为 (Ｐ) ,我们对本市 180 0名中学生进行调查 ,现将结果分析如下。1　对象和方法从市区 15～ 17岁的中学生中抽取 180 0名为调查对象 ,采用封闭问卷式调查研究方法 ,用自行设计的ＫＡＰ量表进行调查。调查问卷采用匿名自填式问卷 ,现场收集调查表后输入微机进行分析处理。2　结果2 .1　一般特征　在 180 0份调查问卷中 ,男性 981人 ,…     

选择性COX-2抑制剂抑制结肠癌细胞生长作用的研究

近年来,流行病学、动物实验和临床研究发现非甾体消炎药（NSAIDs）能显著降低各种肿瘤发生的风险,可能与诱导肿瘤细胞的凋亡、抑制细胞的增殖、减少肿瘤血管的生成有关.本研究旨在观察选择性COX-2抑制剂尼美舒利对结肠癌细胞系HT-29的增殖、端粒酶活性的影响,以探讨其抗肿瘤作用的分子机制.     

医源性总胆管远段损伤的术中诊治与预防

目的 探讨医源性总胆管远段损伤的术中诊治及预防.方法 回顾性复习1990年2月至2005年2月湖南省人民医院收治的22例医源性总胆管远段损伤的病例.结果 取石钳入腹膜腔(95.5%),注水试验阳性(100%).长臂T管支撑总胆管是有效的手段.全组18例获得随访,平均20.8个月,效果满意.结论 术中胆扩裸露征、注水试验是总胆管远段损伤的有效诊断手段.遵循浅、通、撑、抑四字外科原则,可获满意效果.满意的术野显露是有效的预防措施.

Abstract：

Objective To review the diagnosis and causes of iatrogenic injury to the distal choledochus at operation. Method The case notes of the patients with bile duct injuries that were treated in my Department from 1990.2-2005.2 were reviewed. Results To detect distal bile duct injuries, a sound in the bile duct had an accuracy rate of 95 % while injection of water into the bile duct to detect leakage had an accuracy rate of 100%. Using a long arm T tube in the common bile duct was an effective method to treat the injury. In 18 patients with an average follow-up time of 20. 8 months, the results were satisfactory. Conclusions Injecting water into the bile duct to diagnose distal common bile duct injury at operation was an effective way to detect distal bile duct injury. Adequate exposure of the opeative field is the best method to prevent bile duct injury.     

胰源性门脉高压症11例的诊断与治疗

目的 探讨胰源性门脉高压症的诊断与治疗。方法 回顾性分析该科3年11例胰源性门脉高压症的临床诊疗过程、结果及随诊。结果 11例患者中,慢性胰腺炎引起4例,胰腺假性囊肿6例,胰腺体尾部肿瘤1例。均有脾肿大,胃镜示胃底(或伴食管)静脉曲张,肝功能基本正常。行单纯脾切除9例,脾及胰体尾切除1例,脾切除、胆囊切除加结肠切除1例。除肿瘤患者外余预后良好。结论 良性病变所致的胰源性门脉高压症能取得良好的根治效果。