目的 對肝門膽管癌外科治療療效進行評價。 方法 回顧分析2007年3月－2012年3月收治的156例肝門膽管癌患者的臨床資料。按手術方式將患者分為手術切除組（n=45）、膽道引流組（n=78）和姑息治療組（n=33），并對住院期間并發癥發生率、病死率及生存時間等進行分析。 結果 156例患者根治性切率為23.1%不同治療方式住院期間病死率差異無統計學意義（P＜0.05）；手術治療組與姑息治療組并發癥發生率差異有統計學意義（P＜0.05）。手術切除組、膽道引流組、姑息治療組的1、3、5年累積生存率分別為64.4%、17.8%、0.0%；40.2%、12.6%、12.6%；17.7%、7.1%、0.0%，手術切除組生存情況明顯好于其他兩組（P＜0.05）。 結論 不建議所有患者術前均引流可減黃，且可以不過分強調R0切除。膽道引流可一定程度改善預后，但近遠期膽道感染相關并發癥發生率較高。
The interal changes of immunoglobulins in serum and bile among the rabbit models in partial biliary obstruction group (BO),partial biliary obstruction with infection group(BOI)and normal controls(Con)were studied. Concentrations of serum immunoglobulin A(IgA)in BO and BOI groups increase remarkably in all phases(Plt;0.001),Concentrations of serum IgG in both groups increase with the formation of gallstones. The IgG and IgA contents of bile samples in BO and BOI groups with negetive bacterial culture were much higher than that of the control group(Plt;0.05),but the Ig contents of bile with postive culture slightly lower than that of the control group.This experiment suggest in the formation of gallstones,the immunoglobulins of serum and bile had changed significantly.The Ig contents of bile have a relationship with the bacterial infection. Immunoglobulin A takes an important role in gallstone formation.
【Abstract】ObjectiveTo analyse the current situation and advance in perioperative therapy of liver transplantation for primary hepatocellular carcinoma(HCC).MethodsThe published papers on current situation and advance in the perioperative therapy of liver transplantation for HCC were reviewed.ResultsThe survival rate of liver transplantation for HCC in early stage has been the same as that for benign liver diseases up to now. However, it is still a difficult problem to improve the survival rate of liver transplantation for advanced HCC. The ideal perioperative therapies of liver transplantation for HCC should be helpful to suppress the growth of tumor while the HCC patients are waiting for donated livers, to diminish or eliminate the intraoperative spread or implantation of tumor cells and to repress the micrometastasis postoperatively. The current perioperative therapies of liver transplantation for HCC include hepatic arterial chemoembolization, systemic chemotherapy, radiotherapy, percutaneous ethanol injection into HCC and radiofrequency ablation etc. ConclusionThe perioperative assistant therapy of HCC can not only save time for patients before liver transplantation but also improve the survival rate after operation.
31 cases of iatrogenic cholangic injury reported. 28 cases followed from 9 months to 6 years. iatrogenic cholangic injury is not an uncommon occurence main cases are inregular procedures, and carelessness in this group, only 9 cases were found intraoperatively. The main manifestations after injury were aggravating jaundice and/or bilious peritonitis. Symptoms, signs, B-type ultrsound and sometimes ERCP were used for diagnosis. Once the injury ascertained ends are the best treatment, an alternative Roux-Y Cholangiojejunostomy was also commonly used. In this group, 4 cases received the first methos and all with good results; 23 patients treated by the second methos, 17 were uneventful, 4 experienced more or less abdomenal pain, 2 suffered difinite repeated cholangitis and another 1 died.
Controlling intraoperative bleeding is the core technology of liver surgery, and it is also an important way to improve the benefits of liver surgery and reduce the risk of surgery. In recent years, a number of methods to maintain low central venous pressure have been proposed, including inferior vena cava clamping, restricted fluid infusion, postural changes, intraoperative assisted ventilation, intraoperative hypovolemic venous incision, etc. In addition, more and more indicators used to guide intraoperative fluid input management to maintain low central venous pressure have been discovered, including global end-diastolic volume and stroke volume variability. Therefore, this article summarizes the relationship between low central venous pressure and surgical effect in liver surgery, and the ways to achieve low central venous pressure on the basis of previous research.
【摘要】 目的 探討外科手術治療原發性腹膜后腫瘤的方法和影響患者預后的因素。 方法 回顧分析2002年5月-2008年5月收治的70例原發性腹膜后腫瘤患者的臨床表現、影像學檢查、手術治療及隨訪情況。 結果 70例患者均進行了手術治療，其中良性腫瘤20例（28.57%），惡性腫瘤50例（72.43%），良惡之比為1∶2.5；完整切除腫瘤者58例（82.86%），腫瘤部分切除者7例（10%），腫瘤廣泛轉移行組織活檢者5例（7.14%），聯合器官切除者18例（25.71%）。術后隨訪1~5年惡性腫瘤患者45例，其中腫瘤完全切除組1、3、5年的生存率分別為91.67%、66.67%、22.22%，腫瘤部分切除組分別為66.67%、33.33%、0%。兩組比較差異有統計學（Plt;0.01）。研究發現腫瘤的大小、病理類型、是否完整切除是影響腫瘤局部復發、患者生存率的重要因素。 結論 早期診斷、充分的術前準備、腫瘤的全切除率能顯著改善患者術后遠期生存率。【Abstract】 Objective To investigate the surgical management for primary retroperitoneal tumors (PRT) and the factors influencing the prognosis after operation. Methods The clinical manifestation, image data, treatment and prognosis of 70 patients with primary retroperitoneal tumor from May 2002 to May 2008 were retrospectively analyzed. Results All of the patients with PRT had undergone the operations, in whom 20 (28.57%) had benign tumors and 50 (72.43%) had malignant tumors with a ratio of 1:2.5. Among these patients, 58 (82.86%) had complete resection, 7 (10%) had incomplete resection, five (7.14%) had surgical biopsies and 18 (25.71%) had combined resection of the organs. A total of 45 patients with malignant tumors were followed up for one month to five years. The one-, three-, and five-year survival rates of the patients in complete resection group was 91.67%, 66.67% and 22.22%, respectively; and was 66.67%, 33.33%, and 0%, respectively in incomplete resection group. The differences between the two groups were significant (Plt;0.001). The results showed that the completeness of tumor, sizes, and histological type were associated closely with local recurrence and prognosis. Conclusion Early diagnosis, sufficient preoperative preparation and complete tumor resection play important roles in reducing the recurrence and improving the long-term survival rate.