肝癌术后局部化疗对复发的影响

目的 :探讨肝动脉留置化疗泵进行局部化疗对肝癌复发的临床作用。方法 :把 76例无手术禁忌症的肝癌病人依有无进行局部化疗分成A、B两组 ,按肝癌的临床分期方法 ,对两组进行统计分析 ,发现两组的期别构成比差异无显著性 (P >0 .0 5 )。A组行肝癌切除 +肝动脉放置化疗泵 ,B组仅将肝癌切除。术后两组均随访 ,复查肝功能、AFP、行B超、MRI等 ,A组给予全身化疗 +局部化疗 ;B组仅用全身化疗。结果 :A组的 1、2年复发率为 2 8.5 %、6 1.2 %,B组为 4 2 .3%、72 .8%;A组 1、2年的生存率为 88.3%、4 7.8%,B组为 71.4 %、31.7%(P <0 .0 5 )。结论 :肝癌术中放置肝动脉化疗泵能降低复发率 ,提高生存率。     

肝移植治疗巨块型肝癌术后肺部感染的防治

目的分析我院今年6例肝移植术后肺部感染的高危因素,探讨其防治策略和临床效果。方法对6例巨块型肝癌患者,在肝移植术后发生肺部感染的临床资料进行回顾性分析。结果6例患者术后有5例发生肺部感染。其中1例并发呼吸衰竭死亡。结论肝移植患者于由术后免疫抑制剂的应用、营养状况差,气管插管时间过长等因素,造成免疫力低下,感染的危险性增加而引起肺部感染。使用有效的抗生素,吸痰时无菌操作和通畅呼吸道引流是防治肺部感染的重要措施。     

胆管囊肿的诊治分析(附41例报告)

目的：探讨胆管囊肿的诊断及治疗方法。方法：回顾性分析41例先天性胆管囊肿的临床资料。结果：临床表现为腹痛32例（78．0％），黄疸18例（43．9％），腹部包块14例（34．1％），发热，寒颤6例（14．6％），出现胆管囊肿三联征6例（14．6％），30例行B超检查，26例见胆管扩张；18例行CT检查，15例发现胆管扩张；10例行MR检查，9例有胆管扩扩长。37例患者施行手术治疗，27例行胆管空肠吻合（23例行Roux-en-Y吻合），3例行单纯胆管十二指肠吻合，3例行外引流术，2例行肝叶（段）部分切除，2例行单纯囊肿切除，胆管重建。结论：伴腹痛，肿块，黄疽，胆管囊肿，三联征者不多见。I型在临床上多见，B超，CT和MR有重要诊断价值。能代替有创检查如PTC或ERCP。目前最佳手术方法为囊肿切除，胆管空肠吻合术。     

氟比洛芬酯用于腹部手术后镇痛的临床观察

目的评价氟比洛芬酯注射液用于腹部手术术后镇痛的安全性和有效性。方法将45例行开腹胆囊切除术的患者随机分成3组,A组注射氟比洛芬酯注射液,B组按需求肌注度冷丁2mg/kg,C组采用硬膜外患者自控镇痛。术后2、4、12、24h进行模糊视觉疼痛评分(VAS)法评分,监测患者的心率、呼吸、血压及脉搏氧饱和度,并记录副反应。结果A组无1例加用度冷丁,A组和C组术后2、12和24h的VAS分值均明显低于B组(p<0.05)。3组恶心呕吐的发生率无显著性差异(p>0.05)。结论氟比洛芬酯注射液用于腹部手术术后镇痛,持续、有效、经济,使用方便,不良反应少。     

腹腔镜肝癌切除术的临床应用价值

目的探讨腹腔镜肝癌切除术的临床应用价值。方法将近期手术切除的30例原发性肝癌随机分为两组:腹腔镜肝癌切除术组(Ⅰ组)14例,开放式肝癌切除术组(Ⅱ组)16例,对其治疗及效果进行统计分析。结果Ⅰ组与Ⅱ组的手术时间、术中出血量、住院时间、肝功能影响分别为4.06h及3.40h,137.86ml及233.13ml,8.36d及10.50d,48.71U/L及119.94U/L(P均<0.01);近期并发症发生率分别为0及25.0%(P<0.05)。结论腹腔镜肝癌切除术具有微创、效果好等优势,有较高的临床应用价值。     

终末期肝病模型评分在原发性肝癌合并肝硬化脾功能亢进外科治疗中的作用

目的 探讨终末期肝病模型(MELD)评分评估肝储备功能在原发性肝癌合并肝硬化脾功能亢进中确定手术适应证的应用价值.方法 对2001年1月至2007年1月间行肝癌切除联合脾切除(联合术)治疗的40例原发性肝癌合并肝硬化脾功能亢进患者的临床资料进行回顾性分析.通过MELD评分与Child-Pugh分级比较,结合临床资料及术后并发症分析,确定这一方法在评估肝储备功能中的作用.结果 同一Child-Pugh分级的患者MELD评分结果并不一致,在各级别间有交错现象.术后发生肝功能衰竭组(6例)的MELD评分均值为(24.6±6.6).未发生肝功能衰竭组(34例)的MELD评分均值为(16.3±8.5),差异有统计学意义(P<0.05).根据MELD评分分为A组16例(MELD评分<10),B组17例(MELD评分10-20),C组7例(MELD评分>20).A组术后肝功能衰竭发生率为0,B组为11.8%(2/17),C组为57.1%(4/7),差异有统计学意义(P<0.05).根据Child-Pugh分级分为Ⅰ级26例,Ⅱ级14例.Ⅰ级术后肝功能衰竭发生率为15.4%(4/26),Ⅱ级为14.3%(2/14),差异无统计学意义(P>0.05).结论 MELD评分能够较为客观地反映肝储备功能,对外科术式的选择、手术时机的确定有一定的参考作用.     

体外不同比例再生肝细胞与结肠癌细胞的共培养

Objective To investigate the proliferation potential of colon cancer cells co-cultured with different proportions regenerating hepatocytes and role of the cell growth factors related to liver regeneration in vitro.Methods Active regenerating hepatocytes were obtained by collagenase perfusion in situ of rats models underwent 70% liver resection after 24 hours.Co-cultures with different proportions of hepatocytes to human colon cell line SW480 were performed respectively.The proportion of hepatocytes to human colon cell line SW480 Was 10:1 in group A,1:1 in group B.There was only human colon cell line SW480 in group C(control group).Proliferation capacity was assessed with the percentage by 3H-thy incorporation.Concentration of epidermal growth factor(EGF),insulin-like growth factor-1(IGF-1)and hepatocyte growth factor(HGF)was analyzed by ELISA.Results There was no significant difference among the 3 groups in 3H-thy incorporation percentage,and concentration of EGF,IGF-land HGF after 24 hours' culture(P>0.05).3H-thy incorporation percentage(15.9±1.4,13.2±1.5),and concerntration of EGF [(722.9±55.4)ng/L,(498.2+41.5)ng/L]and IGF-1[(755.2±35.7)ng/L,(538.1±37.5)ng/L]in Group A and B were higher than that in group C after 72 hours(P<0.05).Especially the indexes above in group A were higher than that in group B(P<0.05).there was no significant difference in concerntration of HGF among the 3 groups after 72 hours(P>O.05).Conclusions These results imply that the regenerating hepatocytes contribute to the hyperproliferative state of co-culturing colon cancer cells.The mechanism maybe have relationship with EGF and IGF-1 high expression in colon cancer cells caused by growth signals coming from hepatocytes.     

体外不同比例再生肝细胞与结肠癌细胞的共培养

Objective To investigate the proliferation potential of colon cancer cells co-cultured with different proportions regenerating hepatocytes and role of the cell growth factors related to liver regeneration in vitro.Methods Active regenerating hepatocytes were obtained by collagenase perfusion in situ of rats models underwent 70% liver resection after 24 hours.Co-cultures with different proportions of hepatocytes to human colon cell line SW480 were performed respectively.The proportion of hepatocytes to human colon cell line SW480 Was 10:1 in group A,1:1 in group B.There was only human colon cell line SW480 in group C(control group).Proliferation capacity was assessed with the percentage by 3H-thy incorporation.Concentration of epidermal growth factor(EGF),insulin-like growth factor-1(IGF-1)and hepatocyte growth factor(HGF)was analyzed by ELISA.Results There was no significant difference among the 3 groups in 3H-thy incorporation percentage,and concentration of EGF,IGF-land HGF after 24 hours' culture(P>0.05).3H-thy incorporation percentage(15.9±1.4,13.2±1.5),and concerntration of EGF [(722.9±55.4)ng/L,(498.2+41.5)ng/L]and IGF-1[(755.2±35.7)ng/L,(538.1±37.5)ng/L]in Group A and B were higher than that in group C after 72 hours(P<0.05).Especially the indexes above in group A were higher than that in group B(P<0.05).there was no significant difference in concerntration of HGF among the 3 groups after 72 hours(P>O.05).Conclusions These results imply that the regenerating hepatocytes contribute to the hyperproliferative state of co-culturing colon cancer cells.The mechanism maybe have relationship with EGF and IGF-1 high expression in colon cancer cells caused by growth signals coming from hepatocytes.     

24例胃大部切除术中损伤邻近器官的原因及对策

目的：分析胃大部切除术中邻近器官损伤的原因,提出防范措施和处理方法。方法：回顾分析24例胃大部切除术中邻近器官损伤的病例。结果：发现损伤的发生与溃疡病变严重、局部变形粘连解剖关系改变以及术操作不够规范、细致有关。结论：应重视胃大部切除术的基本要求和基本操作训练,熟悉解剖,从而避免或减少胃大部切除术中医源性损伤的发生。     

肝移植术后合并精神状态异常1例

患者,女,３２岁。临床诊断为晚期肝硬化（丙肝）,门静脉高压,脾功能亢进,脾动脉栓塞术后,移植术前精神状况良好,三代无家族精神病史于２００１年３月接受了原位全肝移植术,手术时间１０ｈ,术中出血１２００ ｍｌ。术后常规抗排斥、抗感染、抗凝血三联治疗。术后的丙氨酸转氨酶（ＡＬＴ）和直接胆红素（ＤＢＩＬ）在第６天又复持续性升高,伴胆汁明显减少和肝区隐痛不适,诊断为急性排斥反应,给予激素冲击治疗后进行性下降,第１０天起渐伴兴奋多语、夜间失眠等精神症状,给予催眠等药物治疗未见改善。于术后第１７天出现了明显的…