脾切除联合生长抑素对85%大鼠肝切除模型早期肝衰竭的作用

目的探讨脾切除联合生长抑素在85%大鼠肝切除模型早期肝衰竭中的作用。方法将50只SD大鼠随机分为85%肝切除组、脾切除组、生长抑素组、脾切除联合生长抑素组和假手术组。生长抑素组和脾切除联合生长抑素组腹腔内注射生长抑素[84μg/(kg·d)]1 mL/100 g。术后观察各组大鼠血清丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)变化、门静脉压力变化及肝脏的组织病理学改变。另取40只SD大鼠,观察术后各组大鼠生存期的差异。结果各处理组的ALT、AST、门静脉压力分别较肝脏手术切除组明显降低(P<0.05);其中联合处理组较脾切除组和生长抑素组有所降低,但差异无统计学意义(P>0.05)。结论脾切除联合生长抑素可以减轻85%大鼠肝切除模型早期肝损害,其可能的机制是降低了门静脉灌流和压力,减轻肝脏损害。     

胆总管直径≤1cm的患者行腹腔镜胆总管探查一期缝合术中应用J形胆道支架的体会

目的:探讨在胆总管直径≤1 cm的患者行腹腔镜胆总管探查一期缝合术中应用J形胆道自脱落支架的价值。方法:回顾分析2015年1月至2017年1月收治的11例患者的临床资料,患者胆总管直径均不超过1 cm,行腹腔镜胆囊切除、胆总管探查一期缝合术。结果:手术均顺利完成,无中转开腹。1例患者胆道支架未自行脱落,经内镜取出,余均自行顺利排出。仅1例患者出现少量胆漏,经通畅引流后术后1周拔除引流管。术后随访6~18个月,患者均无胆道狭窄及结石复发。结论:对于胆总管扩张不明显的患者,腹腔镜胆囊切除、胆总管探查取石一期缝合术中置入胆道支架是安全、有效的。     

胰腺实性假乳头状瘤的临床特点及预后分析

Objective To study the clinicopathological and immunohistochemical features, histogenesis and biological behavior, clinical treatment and pronosis of solid pseudopapillary tumor of the pancreas ( SPT). Methods Routine HE and immunohistochemical (SP) stainings were used in the pathological examination of 18 cases of SPT. Their clinical data were retrospectively analyzed. All the 18 postoperative patients were followed-up for 3 months to 10 years with an average of 29.2 months.Results There were 16 females and 2 males, age ranging from 9 to 65 years with mean age of 25.3 years. Abdominal pain and palpable mass were among the major complains. Tumors were encapsulated and mixed with solid and cystic tissues. Histological features were pseudopapillary structure with a fibrovascular core. Immunhistologically, most tumors were positive for α-AT, α-ACT and Vim, with a high percentage of 94.4%. The eighteen cases were followed-up from 3 to 120 months. Five cases received reoperation after recurence, and 14 cases were alive. Maximum survival time was 121 months and the minimum survival time was 3 months, with a median survival time of 23.0 months. The 5-year survival rate was 72.2%. A Kaplan-Meier analysis revealed that patient's age,tumor size, pathologic features, metastasis were major prognostic factors for SPT. Conclusion SPT is a tumor of low-grade malignancy and may be derived from multipotent stem cells. SPT most frequently affects young female, and has distinct clinicopathologic manifestation with excellent prognosis after surgical treatment.     

肝脏血管平滑肌脂肪瘤的临床特点与诊治

目的 探讨肝脏血管平滑肌脂肪瘤(HAML)的临床特点,总结治疗过程中出现的问题,提高对HAML的诊断与治疗水平.方法 通过对9例经手术及病理证实HAML的诊断及治疗过程的回顾性分析,结合文献找出HAML所具有的共同点及特异性.结果 HAML多为女性,多无临床症状,在众多的辅助检查中,以CT及MRI对HAML的诊断价值最大;对HAML的手术治疗应注意操作,避免可能发生的并发症.结论 HAML作为肝脏罕见的良性肿瘤,只要掌握其特征,做出正确的诊断是完全可能的;一经诊断,应及时治疗.     

供者凋亡细胞静脉输注在异种肝移植中所产生体液免疫机理

目的以贵州香猪为供者、中国猕猴为受体的异种肝移植模型,采用静脉输注异种异基因骨髓及凋亡细胞的方法预处理受体,研究凋亡细胞对异种肝脏移植免疫排斥反应的影响,探讨异种肝脏移植免疫耐受的机制。方法受者猕猴随机分为A、B、C组,A组为阴性对照组,n=6;B组为实验对照组,n=28,在接受RIC之后,再接受供者贵州香猪的异种异基因骨髓(BM)静脉输注;C组为实验组,n=36,在接受RIC之后,再接受供者贵州香猪的BM和凋亡细胞同时静脉输注。观察各组受体的生存期,检测受体术后外周血中ALT、TB含量、Foxp3+CD4+CD25+调节性T细胞和T细胞亚群上GITR的表达,检测受体术后第14天移植肝的病理变化和术后第14天受体脾脏CTL杀伤活性。结果C组肝移植术后经历短暂排斥反应,最终可获免疫耐受并长期存活,其外周血中Foxp3+CD4+CD25+调节性T细胞表达比例在术后第14天渐恢复正常,受体外周血中CD3+CD4+T细胞上GITR表达降低,CD3+CD8+T细胞上GITR表达增加,提高CTL的杀伤活性;B组受体在术后第17~2 1天死亡,与A、C组相比,外周血血清中ALT、TB含量明显升高,而Foxp3+CD4+CD25+调节性T细胞比例明显降低。结论供者凋亡细胞静脉输注在异种肝移植中所产生体液免疫耐受的机理,可能是通过诱导受体外周血中CD3+CD4+T细胞上GITR表达降低,CD3+CD8+T细胞上GITR表达增加,提高CTL的杀伤活性来实现的。     

干细胞表面标志物CD90及端粒酶逆转录酶在原发性肝癌中的表达及临床意义

目的 检测CD90及端粒酶逆转录酶(hTERT)在原发性肝癌中的表达,研究其蛋白产物在原发性肝癌发生、发展过程中的表达特点及相互关系.方法 应用免疫组化S-P法检测36例原发性肝癌中CD90、hTERT的表达,并以同期20例正常肝组织作对照.结果 肝癌组织中CD90、hTERT基因蛋白产物阳性表达率(分别为63.9％和47.2％)显著高于良性对照组(CD90、hTERT均阴性);CD90、hTERT蛋白在UICC临床分期Ⅲ～Ⅳ期肝癌患者(分别为79.1％和62.5％)明显高于Ⅰ～Ⅱ期患者(分别为33.3％和16.6％);CD90、hTERT两者呈正相关;CD90、hTERT阳性患者生存率(术后中位生存时间分别为85 d和76 d)明显低于CD90、hTERT阴性患者(术后中位生存时间分别为505 d和463 d),log秩检验显示生存率差异均有统计学意义.结论 CD90可能与肝癌的发生、发展相关,有望成为判断患者预后的指标之一.     

胰腺实性假乳头状瘤的临床特点及预后分析

Objective To study the clinicopathological and immunohistochemical features, histogenesis and biological behavior, clinical treatment and pronosis of solid pseudopapillary tumor of the pancreas ( SPT). Methods Routine HE and immunohistochemical (SP) stainings were used in the pathological examination of 18 cases of SPT. Their clinical data were retrospectively analyzed. All the 18 postoperative patients were followed-up for 3 months to 10 years with an average of 29.2 months.Results There were 16 females and 2 males, age ranging from 9 to 65 years with mean age of 25.3 years. Abdominal pain and palpable mass were among the major complains. Tumors were encapsulated and mixed with solid and cystic tissues. Histological features were pseudopapillary structure with a fibrovascular core. Immunhistologically, most tumors were positive for α-AT, α-ACT and Vim, with a high percentage of 94.4%. The eighteen cases were followed-up from 3 to 120 months. Five cases received reoperation after recurence, and 14 cases were alive. Maximum survival time was 121 months and the minimum survival time was 3 months, with a median survival time of 23.0 months. The 5-year survival rate was 72.2%. A Kaplan-Meier analysis revealed that patient's age,tumor size, pathologic features, metastasis were major prognostic factors for SPT. Conclusion SPT is a tumor of low-grade malignancy and may be derived from multipotent stem cells. SPT most frequently affects young female, and has distinct clinicopathologic manifestation with excellent prognosis after surgical treatment.     

胆管结石病人施行腹腔镜胆总管探查术后直针法与弯针法缝合技术的效果比较

目的 比较腹腔镜胆总管探查术中直针法与弯针法两种缝合技术的效果。方法104例腹腔镜胆总管探查术患者的临床资料,按照术中采用的缝合技术将研究对象分为两组:直针法缝合组50例,弯针法缝合组54例,比较两组患者的手术进行时间、术中出血量、胆总管取石情况、术后肛门排气时间、术后下床活动时间、术后并发症发生情况、术后住院时间及住院费用等变量情况。结果两组患者均手术成功,无死亡病例,无中转开腹。直针法缝合组手术时间短于弯针法缝合组手术时间(6.1±1.4 min vs 12.4±2.3 min)(P<0.01);两组的胆总管取石数目、术后肛门排气时间、下床活动时间、发生胆漏数量、住院时间及住院费用差异无统计学意义(P>0.05)。结论直针法缝合技术比弯针法耗时短,具有明显优势。