【摘要】目的探讨肝肠联合移植的术式、免疫抑制治疗方案与效果。方法对一中年男性短肠综合征患者施行辅助性肝肠联合移植，术后患者免疫抑制治疗采用甲波尼龙（MP）、环孢素A（CsA）、环磷酰胺（CTX）与抗淋巴细胞球蛋白（ALG）处理。结果术后观察期内移植物存活良好。结论本例采用的免疫抑制治疗方案是成功的，且手术方法操作较为简便、易行。
ObjectiveTo investigate the application of fast track surgery (FTS) in hepatobiliary surgery, and discuss the postoperative stress response and its efficacy and safety assessment. MethodsA total of 171 patients undergoing different hepatobiliary operations in our ward from August 2008 to Jule 2011 were randomly divided into control group (n=89) and FTS group (n=82). Patients in the FTS group received the improved methods while those in the control group received traditional care. A series of indicators such as hospital stay, hospital expense, duration of intravenous infusion, postoperative complications, and the C-reaction protein (CRP) and interleukin-6 (IL-6) levels in serum were observed postoperatively. ResultsFor the FTS and control group, the first exhaust time was respectively (2.4±0.3) and (3.3±0.6) days, postoperative hospital stay was (9.1±2.7) and (14.1±4.1) days, hospitalization expense was (16 432±3 012) and (21 612±1 724) yuan, all of which had significant differences (P<0.05). Before surgery and on the 1st, 3rd, 5th and 7th day after surgery, IL-6 serum level for the FTS group was respectively (8.57±2.58), (30.21±12.44), (17.41±11.73), (11.14±7.12), and (10.50±5.19) ng/L, and for the control group was respectively (9.13±2.99), (51.31±19.50), (36.82±12.33), (28.23±9.18), and (15.44±4.33) ng/L. There was no significant difference in the preoperative IL-6 level between the two groups (P>0.05), while IL-6 level was significantly lower in the FTS group than the control group after surgery (P<0.05). Before surgery and on the 1st, 3rd, 5th and 7th day after surgery, CRP serum level for the FTS group was respectively (18.41±4.01), (69.74±26.03), (45.52±20.50), (39.14±11.23), and (29.03±6.47) μg/L, and for the control group was respectively (17.74±2.11), (99.23±23.50), (86.81±17.34), (68.22±15.60), and (37.70±9.55) μg/L. There was no significant difference in the preoperative CRP level between the two groups (P>0.05), while CRP level was significantly lower in the FTS group than the control group after surgery (P<0.05). Postoperative complication rate after surgery was not significantly different between the two groups (P>0.05). ConclusionThe application of FTS in some hepatobiliary operations is effective and safe by decreasing the stress response.
ObjectiveTo observe the changes of peripheral blood lymphocyte subsets of patients with primary hepatocellular carcinoma (PHCC) treated with radiofrequency ablation (RFA). MethodsThe data of 70 cases of hospitalized patients with PHCC that voluntary accepted RFA diagnosed by clinical and pathological in our hospital between July 2011 and December 2014 were collected. According to the numbers of HCC lesions, 70 cases were divided into single focus group (n=41) and multifocal group (n=29). The changes of their immune parameters before and after RFA were analyzed. Results①The ratioes of peripheral blood CD3+/CD19-, CD3+/CD4+, CD4+/CD8+, and NK cells on 7 days and 14 days after RFA treatment of 70 cases were significantly higher than those on 1 day before RFA treatment (P < 0.05). The ratio of CD3+/CD8+ T cells reduced from 1 day before RFA treatment to 14 days after RFA treatment, but the difference was no statistically significant (P > 0.05).②The changing trend of peripheral blood lymphocyte subsets before and after RFA treatment in single focus group and multifocal group were similar to the above.③Compared with single focus group, the ratioes of peripheral blood CD3+/CD19-, CD3+/CD4+, CD4+/CD8+, and NK cells before and after RFA treatment in multifocal group were lower, and the ratio of CD3+/CD8+ T cells was higher, but the difference were not statistically significant (P > 0.05). ConclusionRFA can not only destroy small PHCC foci, but also to significantly improve immune function and enhance the anti-tumor effect.
目的 探讨射频消融术在无法实施手术的原发性肝癌患者中的临床应用效果。方法 回顾性分析2007年9月至2011年3月期间我院收治的58例由于各种原因无法手术治疗的大肝癌（＞5cm）并接受射频消融治疗患者的临床资料，射频消融前后结合超声造影的方法，术后随访并定期复查血清甲胎蛋白水平和超声造影或者肝脏增强CT。结果 58例中无一例发生与射频消融相关的死亡，22例达到完全消融（37.9%，22/58）。共51例（87.9%，51/58）获得随访，随访至2012年5月，随访时间（12.6±6.4）个月（2～21个月），随访12个月以上患者有20例（39.2%，20/51），有10例（19.6%，10/51）无肿瘤复发或者转移的迹象。22例达到完全消融的患者无瘤生存时间为（13.6±10.4）个月（3～21个月）；36例未能达到完全消融的患者中，有19例随访期间死亡，生存时间（8.3±6.1）个月（4～16个月）。结论 由于各种原因不能接受手术的大肝癌患者，射频消融作为一种有效、安全治疗方法，部分能达到完全消融的效果，而部分作为姑息性治疗手段，能一定程度上减轻患者的疼痛，达到提高生活质量的目的。
ObjectiveTo evaluate the safety and feasibility of laparoscopic hepatectomy. Methods A total of 25 patients with hepatocellular carcinoma or liver hemangioma received laparoscopic hepatectomy, and perioperative results were analyzed. ResultsOnly one patient was converted to open hepatectomy because of massive hemorrhage. Blood loss of all patients during operation ranged from 100-1 200 ml with an average of 400 ml. The total blood volume of transfusion was 200-1 000 ml (mean 400 ml) in 14 patients. The operative time was 0.8-4.0 h (mean 2.3 h). All patients had no complications such as bile leakage and infection, and discharged from hospital in 5-10 d (mean 8 d) after operation. ConclusionLaparoscopic hepatectomy is safe and feasible to some liver diseases, but should be used with caution for the patients with tumor diameter over 9 cm and hepatic large vessels invaded by cancer.