腹腔间隔室综合征（abdominal compartment syndrome, ACS）是一个近百年来未引起重视的问题。19世纪末至20世纪初, Marey、Heinricios和Wendt等发现，腹内压升高到27~46 cmH2O时可导致动物呼吸功能不全、心血管功能紊乱和肾功能不全，甚至死亡。随着基础医学和临床研究的进展，已证实腹内压升高对多器官系统功能有影响。Kron等［1］在80年代首次使用ACS一词来描述腹主动脉瘤手术后腹内高压（intraabdominal hypertension, IAH）所致的病理生理学改变。目前，ACS是指由于IAH所导致的心血管、肺、肾等内脏及腹壁、腹壁伤口和颅内损害，而与引起IAH的原因无关，它还包括IAH对内脏的单独损害以及与心、肺、肾功能不全无关的其它不利影响。其实在外科实践中，特别是在危重患者治疗过程中，腹腔压力升高导致多器官系统功能受损的情况相当普遍。但文献报道的ACS的发生率差别很大，一般为1%~14%［2，3］，最高达52%［4］，这可能是由于各家报道的病例不同，病情严重程度不同所致。
随着人口的老龄化，越来越多的有症状或无症状的冠心病患者需接受非心脏外科手术。接受非心脏外科手术而死亡的患者大约有50%是由于心脏并发症所致［1］。围手术期发生的心脏并发症大约5%～10%为心肌梗死，主要发生于术后头3天，其病死率很高，可达32%～69%［2，3］。术后发生心肌梗死或不稳定型心绞痛的患者发生心血管问题的几率增加20倍［4］。因此，如何评估非心脏外科手术患者的心脏危险性，如何预防围手术期心脏并发症的发生，已成为外科医生十分关注的一个问题。
Objective To summarize the role of the relationship between liver cancer and cellular immunological function, and the role of immune therapy in clinical application. Methods To analyze the relationship between liver cancer and cellular immunological function, and the present research situation of immune therapy for liver cancer in clinical application retrospectively via review the related domestic and foreign literatures. Results The cellular immune dysfunction existed in all liver cancer patients. The state of body’s cellular immunological function is closely related with the arising and development of liver cancer, and the lowness of cellular immunological function is an important factor of hepatocellular carcinoma hard to cure or recurrence and metastasis. Immune therapy plays an important role in the treatment of liver cancer by adjusting the body’s cellular immunological function. Conclusions Liver cancer is closely related with the body’s cellular immunological function. Immune therapy is expected to offer a new way for the treatment of liver cancer, which can also be used as an important auxiliary treatment way.
【Abstract】Objective To search for the drug that promots the hepatocyte regeneration after partial hepatectomy. Methods Quantitative morphometry technique, 3H-TdR in vivo test and arterial ketone body ratio (AKBR) were employed to evaluate the energy metabolism, DNA synthesis, and liver cell nuclear mitosis and hepatocyte regeneration of the residual liver tissue in rats after partial lobectomy when treated with human growth hormone (hGH) and placebo. Results After partial hepatectomy in the experimental group, liver cell nuclear mitosis，nuclear density, new liver cell numbers, AKBR and 3H-TdR in vivo test were much higher than those in the control group (P＜0.01 or P＜0.05). Conclusion hGH promotes the hepatocyte regeneration of the residual liver.
In order to investigater the effect of nutritional support on nutrients metabolism after liver resection,we researched into the hepatectomy and total parenteral nutrition model in rats.The features of the model were no fasting before surgery,10% glucose subcutaneous injection prior to operation avoiding of blood loss and shortening of the surgical process.The 7-day mortality was markedly decreased.Anesthetized with phenobarbital(25mg/kg) injection in combination of ether inhalation,the rats recovered quickly from anesthesia and developed almost no infection of the respiratory tract after hepatectomy.The rats were supplied parenterally energy of 573kJ/kg and a marked improvement in survival was achieved after liver resection.By applying dual preventive rotation equipment of protective spring and IN-Stopper,nutrient solution could be safely infused.
目的:探讨经脐入路行腹腔镜胆囊切除术的可行性。方法:对6例患者采用仅在脐部切开一个切口进行腹腔镜胆囊切除术。结果:6例患者手术均获成功,无中转常规腹腔镜手术或开腹手术。手术时间80～130min,无出血、胆管损伤等并发症发生。术后1d出院,术后1月门诊随访,患者恢复顺利,除脐部外,腹壁无手术瘢痕。结论:经脐入路腹腔镜胆囊切除术技术上是可行的,但难度较大,在开展手术初期应慎重选择病例。