【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.
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.
目的 对肝门胆管癌外科治疗疗效进行评价。 方法 回顾分析2007年3月－2012年3月收治的156例肝门胆管癌患者的临床资料。按手术方式将患者分为手术切除组（n=45）、胆道引流组（n=78）和姑息治疗组（n=33），并对住院期间并发症发生率、病死率及生存时间等进行分析。 结果 156例患者根治性切率为23.1%不同治疗方式住院期间病死率差异无统计学意义（P＜0.05）；手术治疗组与姑息治疗组并发症发生率差异有统计学意义（P＜0.05）。手术切除组、胆道引流组、姑息治疗组的1、3、5年累积生存率分别为64.4%、17.8%、0.0%；40.2%、12.6%、12.6%；17.7%、7.1%、0.0%，手术切除组生存情况明显好于其他两组（P＜0.05）。 结论 不建议所有患者术前均引流可减黄，且可以不过分强调R0切除。胆道引流可一定程度改善预后，但近远期胆道感染相关并发症发生率较高。
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.
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.