目的 探討白試驗在肝切除手術中檢測漏膽的價值。方法 筆者所在醫院2008年1月至2013年1月期間在肝切除手術中采用白試驗聯合干紗布擦拭法檢測漏膽56例。即在肝切除手術操作末期，用干紗布擦拭法確認無漏膽后，經膽囊管或左右肝管插管注入5%無菌脂肪乳劑10～30mL，同時用手阻斷遠端膽總管。觀察肝切除手術創面的白色液體滲出情況，對滲出白色液體處予以間斷縫合。重復操作，至斷面無白色液體滲出為止。結果 56例患者經術中檢測，發現漏膽17例（漏膽檢出率為30.4%），每例發現漏膽1～6處（平均2.9處），術中均予以確切縫合以關閉漏膽處，且重復試驗操作，證實均再無漏膽。術后發生漏膽2例（3.6%），經相應治療后痊愈出院。全部患者出院后均隨訪3～6個月（平均3.8個月），無膈下積液或膈下感染病例發生。結論 術中白試驗能夠發現漏膽的精確部位，不會污染肝切除手術創面，并能夠無限次地重復試驗，值得臨床推廣。
Objective To assess the efficacy and safety of sevoflurane versus ketamine in the anesthesia of child short period surgery. Methods Such databases as EMbase, PubMed, The Cochrane Library, CNKI, VIP, CBMdisc, Ongoing Controlled Trial and Conference Articles were searched from their establishment to April 2011 to collect randomized controlled trials (RCTs) and the quasi-RCTs. The quality of those studies meeting the inclusive criteria was assessed, the data were extracted and the meta-analysis was conducted by using RevMan 5.1.1 software. Results Ten studies involving 600 participants were included. Seven studies showed that the intraoperative heart rate of the sevoflurane group was lower than that of the ketamine group (MD= –11.85, 95%CI –16.47 to –7.23, Plt;0.000 01). Nine studies showed that the revival time of the sevoflurane group was shorter than that of the ketamine group (MD= –29.05, 95%CI –37.98 to –20.12, Plt;0.000 01). Three studies showed that the anesthesia induction time of the sevoflurane group was shorter than that of the ketamine group (MD= –208.45, 95%CI –359.22 to –57.68, P=0.007). Six studies showed that the influence on mean arterial pressure (MAP) had no significante difference (MD= –4.86, 95%CI –10.02 to 0.29, P=0.06). Meanwhile, seven studies showed that the adverse events of the sevoflurane group were fewer than those of the ketamine group (Peto OR=0.29, 95%CI 0.20 to 0.40, Plt;0.000 01). Conclusion The results of this system review show that sevoflurane is more effective than ketamine with fewer adverse reactions, and it provides a new choice for clinical anesthesia for child short period surgery. However, ketamine is still the main drug in clinical anesthesia for the child short period surgery at present, so high quality studies are needed for further clinical researches.
ObjectiveTo explore the relationship between the expressions of fibronectin (FN) and phosphatase and tensin homology deleted on ehromosome ten (PTEN) in hepatocellular carcinoma (HCC) tissues and the clinical pathological features. MethodsThe expressions of FN and PTEN were detected by using Western blot and immunohistochemistry respectively in 83 HCC tissues and para-carcinoma tissues, 47 hepatic cirrhosis tissues and 11 normal hepatic tissues. The correlations between the expressions of FN and PTEN and the clinicopathologic features of HCC patients were analyzed. ResultsThe positive expression rate of FN protein in HCC tissues was significantly higher than those in para-carcinoma tissue, normal hepatic tissue, and liver cirrhosis tissues (P<0.05); meanwhile the expression of PTEN was opposite (P<0.05). The positive expression rate of FN protein in para-carcinoma tissues was also obviously higher than that liver cirrhosis tissues and normal hepatic tissues (P<0.05), meanwhile the expression of PTEN was opposite (P<0.05). The positive expression rate of FN protein was higher in HCC tissues with cancer embolus, lymphatic metastasis, positive AFP, and multiple tumor (P<0.05), but there were no statistically significant differences in FN protein expression, gender, age, HBsAg, degree of tumor differentiation, and size of tumor (P>0.05). The positive expression rate of PTEN was lower in HCC tissues with high-medium differentiation, cancer embolus, positive AFP, lymphatic metastasis, and tumor diameter ≥2 cm (P<0.05), there were no statistically significant differences in PTEN expression, gender, age, HBsAg, and the number of tumor (P>0.05). ConclusionsThe abnormal expressions of FN and PTEN in HCC tissues which may play a role in promoting or inhibiting occurrence, development, invasion, and metastasis of HCC. The abnormal expressions of both can be used as molecular biological markers for the malignant degree, invasion, and metastasis of HCC.