ObjectiveTo summarize the current status and the management of colorectal cancer liver metastases (CRCLM) in the elderly and to explore the therapeutic principles and methods. MethodsForeign and domestic literatrues on management of CRCLM were reviewed and analyzed. ResultsColorectal cancer was still one of the most common malignancy and the most common site for metastasis was liver. In the past years, the incidence of colorectal cancer in the elderly was gradually going up. A similar outcome can be achieved for the appropriate elder metastasis patients compared to the young group, although they were in worse physical conditions. Surgical resection was still the only possible treatment for cure to the resectable CRCLM, chemotherapy and biological therapy were also valuable adjunct therapies. For unresectable liver metastases, alternative treatments were recommended, such as radiofrequency ablation and hepatic artery infusion, etc. ConclusionAccording to the characteristic of CRCLM and the physical features of the eldrly patients, a better outcome should be obtained through multipledisciplinary individualized therapy.
目的 探讨肝脏局灶性结节性增生（FNH）的临床诊断与治疗，以提高对FNH的认识。方法 回顾性分析我院普通外科2004年7月至2011年7月期间收治的21例经术后病理证实为FNH的临床资料。结果 本组21例FNH患者中男6例，女15例，平均年龄31.1岁。单发19例，多发2例。9例为体检发现，无不适症状；12例有右上腹隐痛不适症状，均无肝炎、肝硬变病史；1例女性患者有长期口服雌激素病史。化验检查：谷丙转氨酶轻度升高1例，其余肝功能检查、肿瘤标志物及HBsAg均为阴性。术前影像学检查诊断符合率：彩超检查为42.9% （6/14），CT检查为50.0% （6/12），MRI检查为38.5% （5/13）。术后均恢复良好，随访至今无复发。结论 FNH术前确诊率仍较低，主要依赖术后病理学检查。对于术前诊断不明确、病灶巨大或有临床症状者仍应采取手术切除治疗。
Objective To explore and summarize the curative effect and experience of emergency devascularization for treatment of upper gastrointestinal bleeding due to portal hypertension. Melthods The clinical data of 42 patients with upper gastrointestinal bleeding due to portal hypertension， undergoing emergency devascularization from March 2006 to July 2011 in Shengjing Hospital of China Medical University were retrospectively analyzed. Results Of the 42 cases， 29 patients underwent emergency splenectomy plus esophagogastric devascularization， 8 patients underwent emergency spleen artery ligation plus esophagogastric devascularization， and 5 patients only underwent emergency esophagogastric devascularization. The hemostasis rate at 3 hours after emergent disconnection operation was 100%. One patient died of liver failure on 8 days after operation. Three patients supervened with hemorrhage in abdominal cavity on 2 days after operation， and succeeded in hemostasis by conservative treatment. Other patients were successfullydischarged from hospital after postoperative rehabilitation for 2-4 weeks. All cases were followed up regular in 1 year after operation， 5 patients were lost to follow-up. Among the 36 cases followed up， rehaemorrhagia occurred in 1 patientin 8 months after operation， cured by endoscopic variceal ligation subsequently. A primary liver cancer occurred in 1 patient during physical examination in 7 months after operation， followed by partial hepatectomy. Other patients could complete daily life and work. Conclusions The patients suffering from upper gastrointestinal bleeding due to portal hypertension are likely to benefit from appropriate operations. Decisive emergency devascularization can stop the bleeding rapidly and effectively， and save the lives of those patients.
目的探讨肝细胞癌合并脾功能亢进患者同期行肝癌切除和脾切除的安全性及可行性。 方法回顾性分析2001年11月至2012年4月期间笔者所在医院收治的52例肝细胞癌合并脾功能亢进同期施行肝癌切除和脾切除患者的临床资料。 结果肝癌切除联合脾切除19例，肝癌切除联合脾切除加贲门周围血管离断术33例。手术时间（249.63±40.90）min（182～340 min），术中出血量（580.77±260.31）mL（200～1 700）mL。全组无死亡病例，术后并发症包括：胸腔积液11例，肺内感染3例，肝断面感染3例，胆汁漏1例，切口感染2例，高胆红素血症3例，门静脉系统血栓形成22例，均经保守治疗后好转。术后第14天，患者的白细胞和血小板计数分别由术前的（3.19±1.59）×109/L和（53.96±18.94）×109/L升至（8.86±5.06）×109/L和（464.90±189.27）×109/L（P＜0.05）；术后红细胞计数变化不明显，甚至有轻度下降。 结论对于肝细胞癌合并脾功能亢进患者，选择合适的病例同期行肝癌切除和脾切除是安全可行的，而且脾切除有助于缓解脾功能亢进。
ObjectiveTo summarize experiences of surgical treatment of complex giant cavernous hemangioma of the liver. MethodThe clinical data of 55 patients with complex hepatic cavernous hemangioma with tumor diameter more than 10 cm and in close proximity to hepatic hilar region or vena cava inferior underwent surgical treatment from January 2009 to December 2014 were analyzed retrospectively. ResultsAmong these 55 patients with complex giant cavernous hemangioma,13 cases (23.6%) were male,42 cases (76.4%) were female.The median age was 49.2 years (range from 23 to 68 years).Hepatic hemangioma with multiple lesions was most common (71.0%,39/55).The tumor happened mostly in the right hepatic lobe (47.3%,26/55).The median size of complex giant cavernous hemangioma was 16.2 cm (10.2-50.0 cm).The liver functions of all the patients were normal (Child-Pugh A).Different methods of hepatic inflow occlusion and surgical procedures were performed according to the tumor location and size.Of the patients,17 cases were underwent Pringle maneuver,12 cases were underwent modified Pringle maneuver and 1 case was underwent hemihepatic vascular occlusion;28 cases were treated by extracapsular enucleation,27 cases by liver resection.The average operative time was 202 min (85-420 min).The average intraoperative blood loss was 855.5 mL (50-3 000 mL).Twenty-six cases (47.3%) had no blood transfusion,and 10 cases (18.2%) had autologous blood transfusion.The associated complications occurred in 7 patients after surgery,and no surgical death occurred.The median postoperative hospital stay was 14.8 d. ConclusionsThe essential points in operation for the complex giant cavernous hemangioma are the control and management of the operative massive bleeding,and the preservation of the normal hepatic parenchyma as much as possible.The surgical treatment is safe and feasible under the proper hepatic inflow occlusion and resection methods.The prevention and management of bile leakage is also important.