The interal changes of immunoglobulins in serum and bile among the rabbit models in partial biliary obstruction group (BO),partial biliary obstruction with infection group(BOI)and normal controls(Con)were studied. Concentrations of serum immunoglobulin A(IgA)in BO and BOI groups increase remarkably in all phases(Plt;0.001),Concentrations of serum IgG in both groups increase with the formation of gallstones. The IgG and IgA contents of bile samples in BO and BOI groups with negetive bacterial culture were much higher than that of the control group(Plt;0.05),but the Ig contents of bile with postive culture slightly lower than that of the control group.This experiment suggest in the formation of gallstones,the immunoglobulins of serum and bile had changed significantly.The Ig contents of bile have a relationship with the bacterial infection. Immunoglobulin A takes an important role in gallstone formation.
【Abstract】ObjectiveTo analyse the current situation and advance in perioperative therapy of liver transplantation for primary hepatocellular carcinoma(HCC).MethodsThe published papers on current situation and advance in the perioperative therapy of liver transplantation for HCC were reviewed.ResultsThe survival rate of liver transplantation for HCC in early stage has been the same as that for benign liver diseases up to now. However, it is still a difficult problem to improve the survival rate of liver transplantation for advanced HCC. The ideal perioperative therapies of liver transplantation for HCC should be helpful to suppress the growth of tumor while the HCC patients are waiting for donated livers, to diminish or eliminate the intraoperative spread or implantation of tumor cells and to repress the micrometastasis postoperatively. The current perioperative therapies of liver transplantation for HCC include hepatic arterial chemoembolization, systemic chemotherapy, radiotherapy, percutaneous ethanol injection into HCC and radiofrequency ablation etc. ConclusionThe perioperative assistant therapy of HCC can not only save time for patients before liver transplantation but also improve the survival rate after operation.
目的 对肝门胆管癌外科治疗疗效进行评价。 方法 回顾分析2007年3月－2012年3月收治的156例肝门胆管癌患者的临床资料。按手术方式将患者分为手术切除组（n=45）、胆道引流组（n=78）和姑息治疗组（n=33），并对住院期间并发症发生率、病死率及生存时间等进行分析。 结果 156例患者根治性切率为23.1%不同治疗方式住院期间病死率差异无统计学意义（P＜0.05）；手术治疗组与姑息治疗组并发症发生率差异有统计学意义（P＜0.05）。手术切除组、胆道引流组、姑息治疗组的1、3、5年累积生存率分别为64.4%、17.8%、0.0%；40.2%、12.6%、12.6%；17.7%、7.1%、0.0%，手术切除组生存情况明显好于其他两组（P＜0.05）。 结论 不建议所有患者术前均引流可减黄，且可以不过分强调R0切除。胆道引流可一定程度改善预后，但近远期胆道感染相关并发症发生率较高。
【摘要】 目的 探讨外科手术治疗原发性腹膜后肿瘤的方法和影响患者预后的因素。 方法 回顾分析2002年5月-2008年5月收治的70例原发性腹膜后肿瘤患者的临床表现、影像学检查、手术治疗及随访情况。 结果 70例患者均进行了手术治疗，其中良性肿瘤20例（28.57%），恶性肿瘤50例（72.43%），良恶之比为1∶2.5；完整切除肿瘤者58例（82.86%），肿瘤部分切除者7例（10%），肿瘤广泛转移行组织活检者5例（7.14%），联合器官切除者18例（25.71%）。术后随访1~5年恶性肿瘤患者45例，其中肿瘤完全切除组1、3、5年的生存率分别为91.67%、66.67%、22.22%，肿瘤部分切除组分别为66.67%、33.33%、0%。两组比较差异有统计学（Plt;0.01）。研究发现肿瘤的大小、病理类型、是否完整切除是影响肿瘤局部复发、患者生存率的重要因素。 结论 早期诊断、充分的术前准备、肿瘤的全切除率能显著改善患者术后远期生存率。【Abstract】 Objective To investigate the surgical management for primary retroperitoneal tumors (PRT) and the factors influencing the prognosis after operation. Methods The clinical manifestation, image data, treatment and prognosis of 70 patients with primary retroperitoneal tumor from May 2002 to May 2008 were retrospectively analyzed. Results All of the patients with PRT had undergone the operations, in whom 20 (28.57%) had benign tumors and 50 (72.43%) had malignant tumors with a ratio of 1:2.5. Among these patients, 58 (82.86%) had complete resection, 7 (10%) had incomplete resection, five (7.14%) had surgical biopsies and 18 (25.71%) had combined resection of the organs. A total of 45 patients with malignant tumors were followed up for one month to five years. The one-, three-, and five-year survival rates of the patients in complete resection group was 91.67%, 66.67% and 22.22%, respectively; and was 66.67%, 33.33%, and 0%, respectively in incomplete resection group. The differences between the two groups were significant (Plt;0.001). The results showed that the completeness of tumor, sizes, and histological type were associated closely with local recurrence and prognosis. Conclusion Early diagnosis, sufficient preoperative preparation and complete tumor resection play important roles in reducing the recurrence and improving the long-term survival rate.
Objective To discuss the therapeutic effectiveness of surgical approach to complex intrahepatolithiasis with biliary liver cirrhosis.Methods A case of complex intrahepatolithiasis with biliary liver cirrohosis, portal hypertension was treated with splenectomy and pericardial devascularization plus left hepatectomy and portal cholangio plasty with T tube drainage. Results Follow up one year and a half after operation, no symptom of cholangitis was found, and there is no relapse up to date. Conclusion Combined operation of hepatectomy with splenectomy is an ideal and effective treatment for complex intrahepatolithiasis with biliary liver cirrhosis.
Tumors located in the middle lobe of liver were usually subjected to extended hemihepatectomy due to its special anatomical location and high surgical difficulty. However, the incidence of postoperative liver failure and mortality increased accordingly for patients with liver cirrhosis and poor liver function because more liver parenchyma was resected. Therefore, some researchers proposed to use central hepatectomy to treat. However, due to the higher-level technology and the higher risk, it had not been carried out routinely following decades. Later, with the rapid development of laparoscopic technology in the liver surgery and its advantages such as small trauma, rapid postoperative recovery, and the same efficacy as open liver surgery, the reports on laparoscopic central hepatectomy (LCH) at home and abroad had been increasing year by year. Especially, with the standardization of LCH, the development of LCH will be promoted. LCH might become the mainstream of surgical treatment of middle liver tumors in the future.