臨床肝移植始于1963年，1983年美國國家健康委員會對肝移植技術的接受和認可，為全球的肝移植發展注入了活力。目前全球有150余個移植中心，并每年以1萬余例的速度開展這項手術，總的手術次數已超過8萬例次，最長存活達30余年。與西方國家相比，我國肝移植工作起步晚，發展慢，并曾一度停滯了多年，這與當時的經濟狀況等因素有關。就早年不多的臨床肝移植而言，患者多于術后短期內死亡，這與手術技術的不成熟、有效免疫抑制劑的缺乏、術后管理經驗不足等有關。可喜的是，隨著近20年來與國外合作交流的增加，許多中青年學者學成后回國，為我國肝移植基礎與臨床工作的第二次發展奠定了基礎。我院肝移植開展于90年代初，近3年來發展迅速，目前已完成了102例。自20世紀90年代以來，肝臟移植在臨床上已日漸成為終末期肝病的治療方法之一，隨著外科技術和圍手術期管理水平的不斷提高，以及各種新型免疫抑制劑的不斷開發，肝移植的指征也從早期肝腫瘤擴大到良性終末期肝病，并已成功用于治療暴發性肝功能衰竭患者。目前，肝移植的手術死亡率在5%以下，1年生存率超過80%，5年生存率在75%左右，患者術后生活質量滿意。
Objective To introduce the mechanisms of graft injuries after small-for-size liver transplantation and protective measures. Methods Recently relevant literatures were reviewed and summarized. Results Portal hypertension after small-for-size liver transplantation induces mechanical injuries as well as hepatic sinusoidal microcirculation disturbance and cytokines release, which worsened the injuries. Decrease portal pressure by surgery or drug could improve grafts function. ConclusionComprehending the mechanisms of graft injuries will contribute a lot for the living donor liver transplantation.
Radioimmunoassay was performed to measure carcinoembryonic antigen (CEA) levels in gastric juice before and after operation in 51 gastric cancer patients (group Ⅰ)， 33 patients with gastric benign lesion (group Ⅱ) and 8 patients with malignant lesion in digestive system other than gastric cancer (group Ⅲ). The results showed that preoperative CEA levels of in group Ⅰ were the highest among three groups (Ｐ＜0.01), but no statistic difference was noted in group Ⅱ and group Ⅲ. In group Ⅰ and group Ⅱ, postoperative CEA levels were higer than the preoperative levels. The authors believe that preoperative CEA measurement of gstric juice is an accessory method in diagnosing gastric cancer, nevertheless, there is no diagnostic significence of postoperative measurement in patient undergone partial gastrectomy.
We have measured the serum levels of total cholic acid (TCA) in 103 samples of obstructive jaundiced patients (OB group) and 83 samples of gallbladder stone patients without jaundice (control group) by enzymeconjugated colorimetric analysis method. The results revealed that TCA level was higher in OB group than in control group (Plt;0. 001) and had postive correlation with total bilirubin, direct bilirubin and alanine aminotransferase in OB group (Plt;0.01 in all). The clinical value of TCA in obstructive jaundice in comparison with alkaline phosphatase is discussed.