B超引导下硬化剂注射治疗肝囊肿

本文报道了19例共34个肝囊肿应用B超引导装置硬化剂（无水乙醇或四环素注射液）注射治疗的效果。结果表明：单纯性囊肿治愈率89.5%，有效率100%，囊肿越小，效果越好，治愈时间越短，多囊肝治疗也取得了满意的效果，一次穿刺成功率100%，本法简单，易行，无严重并发症，是非手术治疗肝囊肿的首选方法，值得临床推广应用。     

超声引导下两种硬化剂药物治疗单纯性肝囊肿的疗效及并发症观察研究

背景近年来,超声介入技术发展迅速,超声引导下注射硬化剂治疗单纯性肝囊肿具有创伤小、并发症少、操作简便、疗效显著等优点,越来越受到临床重视,并成为单纯性肝囊肿的首选治疗手段.而其临床治疗效果与所使用的硬化剂种类密切相关.目的探讨超声引导下注射不同药物治疗单纯性肝囊肿的效果及其临床应用价值.方法回顾性分析我院收治的126例单纯性肝囊肿患者(共126个单纯性肝囊肿)的临床资料,按硬化剂药物不同分为聚桂醇组(63例,超声引导下注射聚桂醇治疗)和高渗葡萄糖组(63例,超声引导下注射高渗葡萄糖治疗),比较两组术中、术后1 mo的并发症情况以及术后3 mo的临床疗效.结果聚桂醇组治疗总有效率(98.41%)明显高于高渗葡萄糖组(73.02%),差异有统计学意义(P<0.05);聚桂醇组术后并发症总发生率(7.94%)明显低于高渗葡萄糖组(22.22%),差异有统计学意义(P<0.05).结论超声引导下注射硬化剂治疗单纯性肝囊肿疗效确切,而注射聚桂醇的疗效及安全性优于高渗葡萄糖,值得临床推广应用.     

25例肝包虫囊肿破入胆道的诊治体会

目的探讨肝包虫囊肿破入胆道的诊断及治疗方式。方法回顾分析我院2001年～2011年行手术治疗的25例肝包虫囊肿破入胆道患者的临床表现、实验室检验、影像学检查、手术方式及治疗效果。结果超声、CT、磁共振胰胆管成像(MRCP)及内镜逆行胰胆管造影(ERCP)对于肝包虫囊肿破入胆道均具有良好的诊断价值,其中ERCP诊断价值最高,确诊率可达100%。25例患者中22例手术方式为胆囊切除、胆总管探查、T管引流+肝包虫残腔引流,其余3例行胆囊切除、胆总管探查、T管引流+肝包虫病灶根治性切除。所有患者均痊愈出院。结论超声因普及易行,应作为诊断肝包虫囊肿破入胆道的首选辅助检查,MRCP检查具有诊断准确率高和无创等优点,ERCP则对肝包虫囊肿破入胆道诊断率最高。胆囊切除、胆总管探查、T管引流+肝包虫残腔引流应作为肝包虫囊肿破入胆道首选手术方式,对于部分复杂病例可行胆囊切除、胆总管探查、T管引流+肝包虫病灶根治性切除,效果良好。     

开放式全囊壁剥离术治疗单纯性巨大肝囊肿

为了寻找一种根治效果与安全性俱佳的单纯性巨大肝囊肿的手术治疗方法,作者自行设计了开放式全囊壁剥离术。此术可在不阻断肝门血流的情况下将囊肿壁完全剥离切除。从根本上杜绝了手术后肝囊肿复发或残余囊壁癌变的可能性,且易于操作,安全性好。认为可以作为治疗单纯性巨大肝囊肿的首选方式。     

CT导向下囊内注射无水乙醇治疗肝囊肿效果观察

目的评价CT导向下经皮穿刺注射无水乙醇治疗肝囊肿的临床应用价值。方法 19例23个肝囊肿,其中单纯性肝囊肿15例,多发性肝囊肿4例。在CT导向下行穿刺无水乙醇硬化治疗,分析其并发症,并追踪观察其疗效。结果 19例中23个囊肿顺利完成穿刺硬化治疗,无并发症发生。对23个囊肿术后追踪观察6～12个月,CT复查囊腔缩小50%以上2例,70%以上9例,囊腔闭合无复发8例。结论 CT导向下经囊内注射无水乙醇治疗是一种安全有效的治疗方法。     

经腹腔镜手术治疗腹腔实质脏器囊肿93例疗效观察

采用腹腔镜行囊肿切开或切除后引流治疗肝囊肿78例、脾囊肿11例、胰腺囊肿4例。结果成功完成手术90例,中转开放手术3例。手术时间40～280 min,平均78.5 min;出血5～30ml,平均15 ml;术后住院时间3～7d,平均4.2 d。无腹腔感染、胆漏、胰漏和出血等术后并发症。术后随访1～13个月,无复发。认为腹腔镜手术治疗肝囊肿、脾囊肿和胰腺囊肿效果满意、创伤小、瘢痕小,患者痛苦轻、恢复快、住院时间短,是治疗肝、脾、胰腺囊肿的较好方法。     

腹腔镜下肝囊肿开窗术与超声引导下穿刺介入治疗单纯性肝囊肿患者疗效对比研究*

目的 探讨超声引导下穿刺介入治疗与腹腔镜下肝囊肿开窗术治疗单纯性肝囊肿（SHC）患者的疗效。方法 2015年6月~2018年3月我院介入超声科和普外科治疗的94例SHC患者被随机分成对照组和观察组,每组47例,分别采取腹腔镜下肝囊肿开窗术和超声引导下穿刺介入治疗。结果 术后1个月,两组总有效率均为100%;观察组血清丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST）和总胆红素（TBIL）水平分别为（28.4±4.3） U/L、（28.5±2.3） U/L和（18.5±2.4） mmol/L,与对照组的（31.7±4.7） U/L、（31.3±2.4） U/L和（19.9±3.5）mmol/L比,无显著性差异（P<0.05）;术后,观察组患者发热、腹胀腹痛和呕吐发生率分别为14.9%、19.2%和25.5%,显著低于对照组的29.8%、42.6%和48.9%（P<0.05）。结论 在超声引导下穿刺介入治疗SHC患者,总有效率与腹腔镜下肝囊肿开窗术治疗相当,但创伤小,并发症发生率较低,值得在临床上推广使用。     

无水酒精局部注射治疗非寄生虫性肝囊肿

自从B超应用于临床以来,非寄生虫性肝囊肿(以下称肝囊肿)的发现率逐日增多。既往对肝囊肿的治疗主要依靠手术治疗。我院在用无水酒精局部注射治疗肝癌的基础上,于1988年以来用无水酒精局部注射治疗肝囊肿37例。收到良好的效果。临床资料一.病例选择:B超或CT确诊为肝囊肿。 1.囊腔直径≥4cm,患者有上腹胀或上腹不适。 2.囊腔直径≥8cm无症状者,为防止囊肿破裂引起不良后果。 3.囊腔于短期内进行性增大者。二.一般资料:男17例,女20例。年龄22～62岁(平均53岁)。最大囊腔18×12cm。发现时间平均53.2天。     

207例肝囊肿的临床分析

目的加强对肝囊肿的认识,为今后临床诊疗工作提供参考。方法回顾性分析由于各种病因在仁济医院住院,有肝囊肿资料的病例共207例,总结其临床特性和诊疗情况。结果男女之比1.5∶1。平均年龄(62.90±12.42)岁,41~80岁最多见,占89.3%。单发87例(42.0%),其中肝囊腺瘤1例;多发114例(55.1%);多囊6例(2.9%),多囊肝患者中伴多囊肾3例(50%)。肝囊肿位于左肝31例(15.0%),右肝96例(46.4%),左右肝均有80例(38.6%)。囊肿最大直径范围0.4~21.0cm,平均4.5cm。Logistic回归单因素及多因素分析影响临床表现的因素均为肝囊肿直径大小(P<0.05)。B超为诊断首选,但6.3%的患者B超未能诊断,进一步行CT或(和)MRI检查后诊断。B超引导下经皮肝囊肿穿刺抽液者33例(15.9%),外科治疗者22例(10.6%),未行创伤性治疗者152例(73.4%)。结论本组肝囊肿患者临床情况与已报道的文献相符。B超诊断价值高于CT、MRI,列为首选,但仍有6.3%患者需要进一步行CT或MRI检查后方可诊断。26.5%的肝囊肿需要抽液或手术治疗。     

肝囊肿与胆囊息肉发病的相关性分析

[目的]探讨肝囊肿与胆囊息肉发病的相关性。[方法]2 627例患者进行肝、胆、肾B超检查证实为肝囊肿161例,胆囊息肉63例,分别对其发病率、发病与性别的关系,进行统计学分析。[结果]肝囊肿检出率为6.1%,发病的性别差异有统计学意义（P〈0.01）;胆囊息肉检出率为2.4%,并存肝囊肿组与不并存肝囊肿组之间差异有统计学意义（P〈0.01）,但性别之间差异无统计学意义（P〉0.05）。[结论]肝囊肿发病以男性常见;肝囊肿并存胆囊息肉发病较多见,因此推测它们的发病机制可能存在某些关系;肝囊肿并存胆囊息肉的发病与性别无明显关系。     

Sclerotherapy of simple hepatic cysts by repeated aspiration and alcohol instillation

Background/aims: The efficacy and safety of traditional alcohol sclerotherapy procedures are controversial in the management of large simple hepatic cysts. In this study, we aimed to develop and evaluate a novel alcohol sclerotherapy procedure, termed repeated aspiration and alcohol instillation sclerotherapy, for the treatment of simple hepatic cysts. Materials and Methods: A prospective, double-blind, randomized study was performed. Sixty-seven patients with large simple hepatic cysts were randomized into two groups to receive either single-session alcohol retention sclerotherapy (alcohol was instilled into the cyst cavity, kept for 20 minutes and aspirated) or repeated aspiration and alcohol instillation sclerotherapy (instillation of 30-70 ml of alcohol and immediate aspiration with repetition 3 to 6 times until the estimated alcohol concentration exceeded 80%). The cyst volume reduction was calculated to compare the efficacy of the two procedures. We evaluated the safety of the procedure by monitoring side effects and assaying blood alcohol concentrations at 0, 0.5, 1, 2 and 3 hours after sclerotherapy. Results: The cyst volume reduction in patients undergoing repeated aspiration and alcohol instillation sclerotherapy was significantly higher than that in those receiving alcoholretention sclerotherapy. The concentration of alcohol in the last aspirated cyst fluid was correlated with the mean volume reduction in patients undergoing repeated aspiration and alcohol instillation sclerotherapy but not in the alcohol-retention group. Only minor side effects occurred in both groups. Although elevated blood alcohol concentration was noted in all patients, it declined to normal levels within 2-3 hours after treatment. There were no significant differences in blood alcohol concentration between the two groups. Conclusions: Repeated aspiration and alcohol instillation sclerotherapy is superior to single-session alcohol-retention sclerotherapy in the management of large simple hepatic cysts.     

超声引导下穿刺抽液联合聚桂醇置换冲洗硬化治疗巨大肝囊肿患者疗效研究*

目的 探讨在超声引导下穿刺抽液联合聚桂醇置换冲洗硬化治疗巨大肝囊肿患者的疗效。方法 2018年1月～2020年12月我院诊治的巨大单纯性肝囊肿患者73例,随机分为对照组36例和观察组37例,两组均采用在超声引导下穿刺抽液,在对照组注射无水乙醇硬化治疗,在观察组注射聚桂醇置换冲洗硬化治疗。随访6个月。采用化学发光法检测血清C反应蛋白(CRP)和血清淀粉样蛋白A(SAA)水平,采用磁微粒化学发光法检测血清皮质醇(Cor)水平。结果 在术后6个月复查,观察组临床总有效率为97.3%,显著高于对照组的80.6%(P＜0.05);治疗前后,两组血清肝功能指标无显著性差异(P＞0.05);在术后1周,观察组血清CRP、Cor和SAA水平分别为(15.7±3.6)mg/L、(283.6±10.3)nmol/L和(13.5±2.4)ng/mL,显著低于对照组【分别为(21.1±4.5)mg/L、(312.3±10.7)nmol/L和(19.8±3.7)ng/mL,P＜0.05】。结论 在超声引导下穿刺抽液联合聚桂醇置换冲洗硬化治疗巨大肝囊肿有良好的临床治疗效果,且对肝功能的影响小。     

超声引导下经皮穿刺置管引流联合聚桂醇泡沫硬化治疗单纯性肝囊肿患者疗效研究*

目的 观察在超声引导下经皮穿刺置管引流联合聚桂醇泡沫硬化治疗单纯性肝囊肿(SHC)患者的疗效。方法 将112例SHC患者随机分为观察组56例和对照组56例,采用超声引导下经皮穿刺置管引流,分别注射聚桂醇泡沫硬化或聚桂醇硬化治疗。采用化学发光法检测血清C反应蛋白(CRP)水平,采用磁微粒化学发光法检测血清皮质醇(Cor)水平。结果 在术后半年随访,观察组总有效率为100.0%,与对照组的92.9%比,无统计学差异(P＞0.05);观察组不良反应发生率为5.4%,显著低于对照组的19.6%(P<0.05);术后1 w,两组血清总胆红素、丙氨酸氨基转移酶、天冬氨酸氨基转移酶、碱性磷酸酶、胆碱酯酶、C反应蛋白、皮质醇和血糖水平变化无显著性差异(P>0.05)。结论 在超声引导下经皮穿刺置管引流联合聚桂醇注射硬化治疗单纯性肝囊肿患者疗效肯定,采取聚桂醇泡沫注射可能能减少并发症的发生。     

单纯性肝囊肿酒精硬化治疗的进展

单纯性肝囊肿酒精硬化治疗已有22年的历史,目前已成为治疗单纯性肝囊肿的一线方案,然而,至今国内外一直没有肝囊肿治疗标准方案(Guideline),致使不同医疗机构囊肿治愈率明显不同,目前有必要规范囊肿治疗方案,提高囊肿治愈率.规范方案目前存在的主要问题包括囊肿酒精硬化治疗方法的选择、治愈囊肿的最低有效酒精浓度、最大酒精用量及安全性等.     

Results of percutaneous sclerotherapy and surgical treatment in patients with symptomatic simple liver cysts and polycystic liver disease

AIM: To evaluate the results of the treatment of simple liver cysts (solitary and multiple) and polycystic liver disease (PLD) using percutaneous sclerotherapy and/or surgical procedures in a single tertiary referral centre. METHODS: Retrospective analysis of 54 patients referred for evaluation and possible treatment of simple liver cysts (solitary and multiple) and PLD, from January 1997 to July 2006. RESULTS: Simple liver cysts were treated in 41 pts (76/) with a mean size of 12.6 cm. The most common reason for referral was abdominal pain or discomfort (85/). Percutaneous sclerotherapy was performed as initial treatment in 30 pts, showing cyst recurrence in 6 pts (20/). Surgical treatment was initially performed in 11 pts with cyst recurrence in 3 pts (27/). PLD was treated in 13 pts (24/) with a mean size of the dominant cyst of 13 cm. Percutaneous sclerotherapy for PLD was performed in 9 pts with recurrence in 7 pts (77.8/). Surgical treatment for PLD was undertaken in 4 pts (30.8/) with recurrence in all. Eventually, 2 pts with PLD in the presence of polycystic kidney disease underwent liver-and kidney transplantation because of deterioration of liver and kidney function. CONCLUSION: The majority of patients with simple liver cysts and PLD are referred for progressive abdominal pain. As initial treatment, percutaneous sclerotherapy is appropriate. Surgical deroofing is indicated in caseof cyst recurrence after percutaneous sclerotherapy. However, the results of percutaneous sclerotherapy and surgical treatment for PLD are disappointing. Partial liver resection is indicated when there is suspicion of a pre-malignant lesion.     

Significances of serum level and immunohistochemical stain of CA19-9 in simple hepatic cysts and intrahepatic biliary cystic neoplasms]

BACKGROUND/AIMS: In spite of various diagnostic modalities, biliary cystic neoplasms (biliary cystadenoma and cystadenocarcinoma) remain to be difficult to diagnose preoperatively. Recently, there are some reports that elevated CA19-9 level in serum and/or cystic fluid could be a useful finding in the differential diagnosis of biliary cystic neoplasm. This study aimed to evaluate the expression of CA19-9 and to elucidate its significances in intrahepatic biliary cystic neoplasms and simple hepatic cysts. METHODS: In 8 patients with biliary cystic neoplasms and 6 simple hepatic cysts, symptoms, radiologic and laboratory findings were reviewed retrospectively. In 5 biliary cystic neoplasms (4 biliary cystadenomas, 1 biliary cystadenocarcinoma) and 5 simple hepatic cysts, immunohistochemical stainings for CA19-9 were performed with formalin-fixed, paraffin-embedded tissues. RESULTS: In 8 biliary cystic neoplasms, two cases were suspected as biliary cystadenoma preoperatively and 6 cases could not be distinguished from simple cysts or cholangiocarcinoma preoperatively. In 6 simple hepatic cysts, 3 cases were diagnosed preoperatively and 3 cases could not be distinguished from biliary cystadenoma or pancreatic pseudocyst preoperatively. Expression of CA19-9 in simple hepatic cysts and biliary cystic neoplasms were 80% in both groups. Expression of CA19-9 is not related to the elevated level of CA19-9 in serum. CONCLUSIONS: Our data suggests that the elevated level of CA19-9 in serum may not be helpful in the preoprative diagnosis of biliary cystic neoplasm.     

超声引导下穿刺硬化治疗肝肾囊肿患者临床疗效研究*

目的 探讨超声引导下穿刺硬化治疗肝肾囊肿患者的临床疗效。方法 2019年1月～2020年12月我院收治的肝肾囊肿患者72例,其中36例在超声引导下穿刺注射无水乙醇治疗,另36例注射聚桂醇治疗。比较两组临床疗效、囊肿体积缩小率和不良反应发生率。结果 在术后6个月超声复查,聚桂醇治疗组囊肿消失或明显缩小发生率为94.4%,与无水乙醇治疗组的91.7%比,无显著性差异(P>0.05);在术后1 m、3 m和6 m,聚桂醇治疗组囊肿体积缩小率分别为(67.5±8.1)%、(81.6±5.5)%和(95.2±4.9)%,显著高于乙醇治疗组【分别为(53.9±6.4)%、(73.2±4.7)%和(85.6±3.5)%,P＜0.05】;聚桂醇治疗组术后发热、醉酒样反应和恶性呕吐等不良反应发生率为8.3%,显著低于无水乙醇治疗组的27.8%(P＜0.05)。结论 在超声引导下穿刺注射聚桂醇或无水乙醇硬化治疗肝肾囊肿患者疗效较好,但注射聚桂醇可提高囊肿体积缩小率,减少不良反应的发生。     

Endoscopic sclerotherapy of esophageal varices. Long-term follow-up, recurrence, and survival

One hundred thirty-three patients (34.5% Child's C class) with at least one severe variceal hemorrhage and treated with repeated endoscopic sclerotherapy had a follow-up of 1-6 years (mean 20 months). The risk of rebleeding decreased significantly from 2 months after onset of sclerotherapy. Sixty-four patients (or 48%) rebled, within 2 months in 45 (70%). The incidence of rebleeding correlated with Child's category and with the size of the varices. The 2-month mortality rate was 28.6%; two-thirds died of severe rebleeding. Thirteen patients underwent emergency surgery for bleeding uncontrolled by sclerotherapy; nine of them died. Of the 120 treated only by sclerotherapy 93% ultimately died, 90% from variceal rebleeding. Mortality related to the liver disease was thus determined by rebleeding mainly within 2 months and by hepatic failure but not by etiology of the disease or number of previous hemorrhages. The more pronounced mortality in Child C versus B or A patients is thus due to early rebleeding and to more pronounced liver insufficiency in the early and later period. Varices could not be eradicated within 1 year by sclerotherapy in 9 patients; 68 of the 72 patients alive had total eradication, but recurrence of varices was observed in 19 (or 28%) within 1 year, independent of the etiology and severity of liver disease and varices. Only four patients rebled within 1 year, with no mortality. After 1-4 years, another five recurrences were noted, with two nonfatal bleeding episodes. This study argues for continuation of sclerotherapy until total eradication of varices as well as for regular follow-up to avoid recurrences.(ABSTRACT TRUNCATED AT 250 WORDS)     

Congenital hepatic fibrosis in Indian children

BACKGROUND: Congenital hepatic fibrosis (CHF) is an uncommon cause of portal hypertension in children. So far, there is no report of this from the subcontinent. We have studied the clinical spectrum of CHF in North Indian children. METHODS: Fifteen children were diagnosed with CHF on the basis of their liver histology over a period of 6.5 years. Their clinical details were recorded. Oesophagogastroduodenoscopy and abdominal ultrasonography were performed in all cases. All siblings were examined clinically; and ultrasonography, endoscopy and liver biopsy were performed if there was firm hepatomegaly. Children with variceal bleeding were managed by endoscopic sclerotherapy. The median age of these children was 8 years with a male to female ratio of 1.5:1. RESULTS: Only one sibling (of 33) was diagnosed as having CHF. The predominant presentations were variceal bleeding in six, abdominal distension in seven and incidental detection of organomegaly in two. Hepatomegaly was present in all patients and splenomegaly in all but one. Liver function and renal function tests were normal in all children, except for a raised serum alkaline phosphatase in six. Two children had associated renal cysts, two had choledochal cysts, one each had Caroli's disease and biliary atresia and two children had portal vein thrombosis. Variceal obliteration was achieved in five children after an average 4.8 sclerotherapy sessions and one required a mesocaval shunt. On follow up (median 41 months, range 1-80 months) all are doing well. CONCLUSIONS: Congenital hepatic fibrosis is mainly sporadic in India and associated renal lesions are uncommon. Endoscopic sclerotherapy is effective in controlling variceal bleed and the prognosis is universally good in the absence of renal diseases.     

Prophylactic sclerotherapy in high-risk cirrhotics selected by endoscopic criteria. A multicenter randomized controlled trial

Controlled trials of sclerotherapy for the prevention of the first variceal hemorrhage in cirrhotics have given conflicting results. In the present study, 106 cirrhotics were randomized to sclerotherapy (55 patients) or control group (51 patients). Admission criteria were no history of previous variceal bleeding and the presence of high-risk varices, i.e., a variceal score less than or equal to 0 according to Beppu et al. Sclerotherapy sessions were performed at time zero, 7 days, 30 days, and then monthly until eradication. Follow-up endoscopies were performed at 6-month intervals thereafter. Control patients underwent repeat endoscopy at 6-month intervals. Bleeding episodes were treated by sclerotherapy in both groups, whenever possible. Mean follow-up was 24 months. Analysis of the results was performed by the intention-to-treat method. Variceal bleeding occurred in 19 sclerotherapy patients (34.5%) and in 17 controls (35.4%, P = NS). Overall mortality was 34.5% in sclerotherapy patients and 50% in controls (P = NS). Seven of the 19 sclerotherapy patients (36.8%) and 11 of the 17 controls (64.7%) who bled died of hemorrhage (P less than 0.05, log-linear model). It is concluded that prophylactic sclerotherapy does not reduce the incidence of first variceal bleeding in cirrhotics. However, there seems to be a trend toward a lower bleeding-related mortality in sclerotherapy patients than in controls.