目的探讨介入治疗在肝外伤术后胆道出血和胆瘘并发症中的作用。方法6例肝外伤术后胆道并发症（胆道出血1例，胆瘘3例，胆道出血合并胆瘘2例）采用介入治疗。胆道出血行肝动脉出血分支血管栓塞，胆瘘采用B超引导下穿刺置管引流。结果3 例胆道出血（肝动脉出血）血管成功栓塞，随访3~6个月未再发生出血。5例胆瘘行B超引导下穿刺置管引流，3例引流3~4周痊愈，1例因引流效果差改手术置管引流6周痊愈，1例伴脓肿者手术置管引流2个半月痊愈。结论介入治疗是处理胆道出血和胆瘘并发症的有效措施。
Objective To evaluate the hemostatic effect of selective artery embolization in treatment for traumatic hepatic rupture bleeding. Methods The clinical data of 63 patients with traumatic hepatic rupture treated in this hospital from Jan. 2004 to Jun. 2011 were analyzed retrospectively. With Seldinger technique， a catheter was introduced into the liver artery via the right femoral artery for angiography. Once the bleeding site was identified， microcatheter was placed into the hemorrhagic vessels to control the bleeding with polyvinyl alcohol or gelatin sponges. Results The hepatic arteriography was successfully performed in 63 cases， the results showed hepatic left-artery bleeding in 8 cases， hepatic right-artery bleeding in 39 cases， and hepatic left- and right-artery bleeding in 10 cases. Fifty-seven cases received selective arterial embolization and successful hemostasia， including one embolization in 36 cases， two embolizations in 11 cases， and more than two embolizations in 10 cases. Six patients without obvious hemorrhage didn’t receive selective arterial embolization. There was no bleeding again case and no dead case. The hemoglobin and hematocrit returned to normal in one week after embolization. No hemorrhage or other complications happened during follow-up for 0.5 to 1 year. Conclusion The selective arterial embolization is an effective， safe and minimally invasive method for hemostasia of patients with traumatic hepatic rupture.
【Abstract】ObjectiveTo explore the appropriate surgical management of the primary hepatocellular carcinoma with hypersplenism. MethodsOf 67 patients who has primary hepatocellular carcinoma with hypersplenism, 17 cases had hepatectomy combined with splenectomy, 7 cases had hepatectomy only, and the other 43 patients were treated with hepatic artery embolization and splenic artery embolization. ResultsThe symptoms of hypersplenism disappeared and the hemogram became normal 30 d after operation in 17 patients who had hepatectomy combined with splenectomy, but worsened in 7 patients who only had simple hepatectomy and 6 cases of those patients were treated with splenic artery embolization 3-7 months after operation. In 43 patients treated with hepatic artery embolization and splenic artery embolization, 79%（34/43）had improved hypersplenism symptoms and the hemogram became normal. ConclusionThe treatment of primary hepatocellular carcinoma with hypersplenism should be strived for hepatectomy combined with splenectomy. If the liver mass cannot be resected, hepatic artery embolization and splenic artery embolization should be chosen.
Objective To summarize and further investigate the initial experience of organ procurement process for organ donation after cardiac death （DCD）. Methods The clinical data，the selected standard，and the organ procurement process of 28 cases of DCD from July 2009 to January 2012 in the liver transplantation center of Guangzhou General Hospital were reviewed and analyzed. Results Twenty-eight cases of DCD all had donated organs successfully. Among these cases，there were 3 cases （10.7%） of the Maastricht Ⅲ， and one case （3.6%） of the Maastricht Ⅳ，and 24 cases （85.7%） of the organ donation after brain death plus cardiac death （DBCD）．Three cases of the Maastricht Ⅲ were practiced the organ procurement process of DCD．One case of the Maastricht Ⅳ was practiced the organ procurement process of DBCD without the extracorporeal membrane oxygenation （ECMO）．Twenty-four cases of DBCD were practiced the organ procurement process of DBCD with the ECMO．The donator warm ischemic time was zero min in DBCD，18 min in Maastricht Ⅳ，and mean 25 min （22-28 min） in MaastrichtⅢ．All the donated organs included 28 livers，40 kidneys，and 2 hearts．And all these organs had been practiced the liver transplantation，the kidney transplantation，and the heart transplantation. Conclusions The organ procurement process for organ DCD includes the DCD process and the DBCD process in China，and the later includes the organ procurement process with the ECMO and without the ECMO．The ECMO could well control the warm ischemia for protecting the donors just without ethics dispute. So，the using of the ECMO for the organ DCD of citizen in China has a very important contribution．