探讨先天性支气管囊肿的临床、影像学特点及治疗方法。方法:对19例经手术和病理活检证实的先天性支气管囊肿患者的临床资料进行了回顾性分析。结果:本组19例患者中,肺内囊肿15例(79%),纵隔囊肿4例。临床症状表现为咳嗽14例(74%),咯血7例,呼吸困难5例,胸痛5例;其中13例患者(68%)出现并发症,包括感染、大咯血、气胸和胸膜炎等。影像学表现为单发边界清楚的软组织或水样密度包块影4例,单发薄壁含气囊腔4例,单发圆形含气液平的包块影7例,多发环形透光影4例。所有患者均进行了开胸囊肿切除术。结论:先天性支气管囊肿多位于肺内,常见临床症状为咳嗽,影像学以单发含气液平的包块影为多见,手术切除是最好的治疗方法。
Objective To summarize clinical features, imaging findings, diagnosis, treatment, and prognosis of patients with hepatic focal nodular hyperplasia. Method The clinical data of patients with hepatic focal nodular hyperplasia who underwent hepatectomy from July 2014 to July 2016 in the Xiangya Hospital of Central South University were analyzed retrospectively. Results There were 12 males and 19 females in the 31 patients with hepatic focal nodular hyperplasia, the male-to-female ratio was 1∶1.58. The age was from 15 to 67 years old with (39.7±11.5) years old. Physical examination found 21 cases, there were symptoms in 10 cases. Laboratory examination: only 2 patients with long-term drinking history had mild AST abnormality, HBsAgs of 6 cases were positive, CA19-9 level of one patient was slightly increased (40.54 kU/L). Thirteen patients with hepatic focal nodular hyperplasia were diagnosed by imaging examination, the diagnostic rate of MRI was significantly higher than that of color Doppler ultrasound (P<0.05) or CT (P<0.05). The diameter of the lesions ranged from 2 cm to 11 cm with (4.6±2.1) cm. All lesions were resected, including 13 cases by laparoscopic hepatectomy, and 18 cases by laparotomy. Compared with by the laparotomy, the intraoperative blood loss was less (P<0.05), the hospital stay and intestinal exhaust time were shorter (P<0.05) by the laparoscopic hepatectomy. Twenty-nine patients were followed up from 3 to 24 months, no patient died, the quality of life was better, no recurrence and metastasis happened. Conclusions Hepatic focal nodular hyperplasia is benign lesion, it has a good prognosis, generally without clinical symptoms, its laboratory feature has no abnormality. The combination of multiple imagings and pathological diagnosis could improve diagnosis rate. Surgical resection should be performed for suspected malignant tumor or other hepatic occupying lesions. Laparoscopic surgery has some advantages of quick recovery and less bleeding for it.
【Abstract】ObjectiveTo compare the effects of self-designed KYL solution on rat liver preservation with UW solution. Methods Using non-circulated isolated perfused rat liver,SD rat livers were randomly preserved for 0、4、8、16、24 and 48 hours with self-designed KYL solution or UW solution. The effects were assessed by measuring the bile production, the contents of AST， ALT，LDH，free radical（ MDA） and SOD in KrebsHenseleit’s perfusate and the content of intracellar calaium of the rat hepatocytes, and by observing the morphological changes in liver. At the same time, the normal saline was used to preserve the rats liver as negative comparison to know if KYL solution and UW solution can prevent the ischemiareperfusion injury in rat liver transplantation.Results At different periods within 16 hours of preservation,the bile production of the rat livers which were preserved by KYL solution were more than those were preserved by UW solution （P＜0.01）, JP2The contents of AST， ALT and LDH in Krebs-Henseleit’s perfusate were near in UW solution’s. The content of intracellar calaium of the rat hepatocytes which were preserved by KYL solution were less than those were preserved by UW solution （P＜0.01）. In KYL group, the content of MDA was lower than that UW group, the content of SOD was higher than that UW group at 24 and 48 h(P＜0.01). Morphological changes in both groups were almost same. All variables of both groups were better than the rat livers preserved by the normal saline. It was proved that both KYL solution and UW solution could protect the rat livers. Conclusion The study indicated that the effects of self-designed KYL solution on rat liver preservation are similar to that of UW solution. The bile production after reperfusion and the content of intracellar calaium of the rat hepatocytes in KYL group are better than those in UW group .The effect of prevention of rat hepatocellular oedema by self-designed KYL solution are worse than that of UW solution.
Objective To explore the effect of cytotoxic T lymphocyte-associated antigen 4 (CTLA4-Ig) fusion protein on the function of orthotopic liver allograft. Methods Orthotopic liver allograft models of rhesus monkeys were established in this study. The survival time, liver function and morphologic changes of graft were observed, respectively. The levels of IL-2 and IL-10 were detected by ELISA. Apoptosis was monitored by TUNEL.Results The average survival of control group was 6.57 d, while the average survival of CTLA4-Ig group was 14.92 d, which was statistically prolonged (Plt;0.05). Serum ALT level was highly increased, and Alb level decreased obviously in control group. While the levels of ALT and Alb kept in normal in CTLA4-Ig group. After day 3-7, the expressions of IL-2 were highly expressed in control group, while the expressions of IL-10 in CTLA4-Ig group were higher than those of control group. The severity of rejection reaction after day 3 was weaker in CTLA4-Ig group than that of control group by histological assessment. The apoptosis index after day 3 in the liver cells was highly increased in control group as compared with the CTLA4-Ig group. Conclusions CTLA4-Ig fusion protein therapy can induce immunotolerance and prolong the survival of recipients. The increasing of cytokines IL-2 or the decreasing of cytokines IL-10 may be one of the laboratory indexes in monitoring immunotolerance of transplantation.