目的 探讨胰十二指肠切除术后出血的原因及其预防和治疗措施。方法 对我院1977~2002年期间210例胰十二指肠切除术病例进行回顾性分析。结果 发生术后出血39例（18.6%），其中上消化道出血33例次（15.7%），腹腔内出血10例次（4.8%）。术后死亡的18例中14例合并术后出血； 出血合并其他并发症患者的死亡率（57.1%，12/21）明显高于单纯出血病例（11.1%，2/18），与出血并存的并发症中以吻合口漏、腹腔内感染和肝、肾功能衰竭最为常见。近两年来术后出血率（10.5%）较90年代（19.8%）和90年代前（26.2%）减少。术后出血患者术前总胆红素≥342 μmol/L者的比例及术中出血和输血量均明显高于未出血病例。结论 精细熟练的操作、严密吻合、彻底止血及有效预防其他并发症的发生是减少术后出血及死亡的关键，术前重度黄疸、术中大量出血和输血将增加患者术后出血的危险性。
Selectionofandinfluenceofseveralhepatovascularocclusionsonintraoperativeandpostoperativefactorswereinvestigatedinaseriesofhepatocelluarcarcinoma(HCC)patientsundergoingliverresection.Comparisonandstatisticalanalysisofseveralobservationindexeswerecarriedoutin163HCCpatientsexperiencingliverresectionwithdifferentvascularocclusions,versus65caseswithoutvascularocclusions,whichselectedfromourhospitalduringthesameperiodoverthepast5years.Results:Hepatovascularocclusionsproducedsomeliverparenchymainjury,althoughcontrollingintraoperativebleeding.Inthestudy,advantagesanddisadvantagesofthreehepatovascularocclusionsweredemonstrated,including:①simplicityandconvenienceinportaltriadclamping(PTC);butocclusiontimelimitedandresultinginsevereliverfunctioninjury;②widerliverfunctioninjuryandquickerrecoverydespitelongerocclusioninhemihepaticvascularocclusions(HVO);③limitedapplicationofnormothermichepaticvascularexclusion(NHVE)forwastetimeandcomplexity.WeconcludethatHVOisrecommendedasthefirstselectionformostliverresection,exceptportalandcentraltumors.
【Abstract】ObjectiveTo investigate the inhibitory effects and the mechanisms of octreotide (OCT) on the growth of hepatocellular carcinoma (HCC). MethodsBel7402 HCC cells were studied for proliferative ability by MTT assay, morphology by light microscopy, adhesive and invasive ability by cell adhesion and “wound strack” experiments. Immunofluorescence flow cytometry was used for study of cMet expression and cell cycle as well. Furthermore, the effects of OCT on tumor growth metastasis were investigated in nude mice with implanted HCC. The expression of cMet in implanted tumor cells was studied by immunohistochemistry. ResultsWith OCT treatment, the proliferative ability of Bel7402 cells and cell morphology didn’t change. The adhesive and invasive ability decreased compared with no OCT treatment cells (P＜0.05). The ratio of G0/G1 cells increased markedly (P＜0.05). The proportion of Bel7402 cells expressing cMet was reduced significantly (P＜0.05). The growth of implanted tumor was inhibited with OCT treatment (P＜0.05). The intensity of cMet expression in OCT group was remarkably weaker than that in control group. In addition, no recurrence and metastasis was found in OCT group 7 weeks after curative resection of xenografts, while 3 cases in controd group were observed to have the recurrence and metastasis. The intensity of cMet immunolabeling in the metastatic tumors was higher than that in xenografts of control group, but the difference was not significant. ConclusionOCT inhibits the growth of HCC by downregulation of cMet.
Objective To study the effect and feasibility of gradual oral diethylnitrosamine (DENA) induced liver cirrhotic model in rats under avoirdupois monitoring. Methods Fifty Wistar rats (6 weeks old) were divided into 3 groups: normal control group （n=10）, traditional DENA induction group (receiving traditional oral DENA treatment, n=20）, gradual DENA induction group (receiving gradual oral DENA treatment under avoirdupois monitoring, n=20). The weight, mortality and liver cirrhosis formation were observed. Results After 4 weeks of inducing cirrhosis, the weight of traditional DENA induction group 〔(234.9±27.1) g〕 was significantly lower than that of normal control group 〔(264.8±33.7) g, P＜0.05〕. After 8 weeks of inducing cirrhosis, the weight of traditional DENA induction group 〔(251.5±34.3) g〕 was significantly lower than that of normal control group 〔(303.2±49.4) g， P＜0.01〕 and gradual DENA induction group 〔(277.5±27.6) g， P＜0.05〕. However, the difference between normal control group and gradual DENA induction group was not remarkable (P＞0.05). The mortality in traditional DENA induction group (35%) was significantly higher than that in normal control group (0) and gradual DENA induction group (0)， P＜0.05. But the rate of cirrhosis formation both in traditional DENA induction group and gradual DENA induction group was 100%. Conclusion Oral DENA induced cirrhotic model in rats is a simple, reproducible and reliable technique. Gradual oral technique, in which DENA is given under avoirdupois monitoring, can improve rat’s security and reduce mortality.