Objective To review researches on the relation between marrow stromal cells(MSCs) and repair of bone defect. Methods The latest original literatures about marrow stromal cells and their use in the treatment of bone defect were extensively reviewed. Results Marrow stromal cells were induced to osteoblasts under proper conditions and showed the potential of bone formation in vivo. The methods of bone tissue engineering using MSCs as seed cells and gene therapy using MSCs as target cells were bothuseful in the repair of bone defect.Conclusion MSCs have a promising future in the repair of bone defect.
目的 探討肝臟局灶性結節性增生（FNH）的臨床診斷與治療，以提高對FNH的認識。方法 回顧性分析我院普通外科2004年7月至2011年7月期間收治的21例經術后病理證實為FNH的臨床資料。結果 本組21例FNH患者中男6例，女15例，平均年齡31.1歲。單發19例，多發2例。9例為體檢發現，無不適癥狀；12例有右上腹隱痛不適癥狀，均無肝炎、肝硬變病史；1例女性患者有長期口服雌激素病史。化驗檢查：谷丙轉氨酶輕度升高1例，其余肝功能檢查、腫瘤標志物及HBsAg均為陰性。術前影像學檢查診斷符合率：彩超檢查為42.9% （6/14），CT檢查為50.0% （6/12），MRI檢查為38.5% （5/13）。術后均恢復良好，隨訪至今無復發。結論 FNH術前確診率仍較低，主要依賴術后病理學檢查。對于術前診斷不明確、病灶巨大或有臨床癥狀者仍應采取手術切除治療。
目的探討肝細胞癌合并脾功能亢進患者同期行肝癌切除和脾切除的安全性及可行性。 方法回顧性分析2001年11月至2012年4月期間筆者所在醫院收治的52例肝細胞癌合并脾功能亢進同期施行肝癌切除和脾切除患者的臨床資料。 結果肝癌切除聯合脾切除19例，肝癌切除聯合脾切除加賁門周圍血管離斷術33例。手術時間（249.63±40.90）min（182～340 min），術中出血量（580.77±260.31）mL（200～1 700）mL。全組無死亡病例，術后并發癥包括：胸腔積液11例，肺內感染3例，肝斷面感染3例，膽汁漏1例，切口感染2例，高膽紅素血癥3例，門靜脈系統血栓形成22例，均經保守治療后好轉。術后第14天，患者的白細胞和血小板計數分別由術前的（3.19±1.59）×109/L和（53.96±18.94）×109/L升至（8.86±5.06）×109/L和（464.90±189.27）×109/L（P＜0.05）；術后紅細胞計數變化不明顯，甚至有輕度下降。 結論對于肝細胞癌合并脾功能亢進患者，選擇合適的病例同期行肝癌切除和脾切除是安全可行的，而且脾切除有助于緩解脾功能亢進。
ObjectiveTo summarize experiences of surgical treatment of complex giant cavernous hemangioma of the liver. MethodThe clinical data of 55 patients with complex hepatic cavernous hemangioma with tumor diameter more than 10 cm and in close proximity to hepatic hilar region or vena cava inferior underwent surgical treatment from January 2009 to December 2014 were analyzed retrospectively. ResultsAmong these 55 patients with complex giant cavernous hemangioma,13 cases (23.6%) were male,42 cases (76.4%) were female.The median age was 49.2 years (range from 23 to 68 years).Hepatic hemangioma with multiple lesions was most common (71.0%,39/55).The tumor happened mostly in the right hepatic lobe (47.3%,26/55).The median size of complex giant cavernous hemangioma was 16.2 cm (10.2-50.0 cm).The liver functions of all the patients were normal (Child-Pugh A).Different methods of hepatic inflow occlusion and surgical procedures were performed according to the tumor location and size.Of the patients,17 cases were underwent Pringle maneuver,12 cases were underwent modified Pringle maneuver and 1 case was underwent hemihepatic vascular occlusion;28 cases were treated by extracapsular enucleation,27 cases by liver resection.The average operative time was 202 min (85-420 min).The average intraoperative blood loss was 855.5 mL (50-3 000 mL).Twenty-six cases (47.3%) had no blood transfusion,and 10 cases (18.2%) had autologous blood transfusion.The associated complications occurred in 7 patients after surgery,and no surgical death occurred.The median postoperative hospital stay was 14.8 d. ConclusionsThe essential points in operation for the complex giant cavernous hemangioma are the control and management of the operative massive bleeding,and the preservation of the normal hepatic parenchyma as much as possible.The surgical treatment is safe and feasible under the proper hepatic inflow occlusion and resection methods.The prevention and management of bile leakage is also important.
Objective To explore and summarize the curative effect and experience of emergency devascularization for treatment of upper gastrointestinal bleeding due to portal hypertension. Melthods The clinical data of 42 patients with upper gastrointestinal bleeding due to portal hypertension， undergoing emergency devascularization from March 2006 to July 2011 in Shengjing Hospital of China Medical University were retrospectively analyzed. Results Of the 42 cases， 29 patients underwent emergency splenectomy plus esophagogastric devascularization， 8 patients underwent emergency spleen artery ligation plus esophagogastric devascularization， and 5 patients only underwent emergency esophagogastric devascularization. The hemostasis rate at 3 hours after emergent disconnection operation was 100%. One patient died of liver failure on 8 days after operation. Three patients supervened with hemorrhage in abdominal cavity on 2 days after operation， and succeeded in hemostasis by conservative treatment. Other patients were successfullydischarged from hospital after postoperative rehabilitation for 2-4 weeks. All cases were followed up regular in 1 year after operation， 5 patients were lost to follow-up. Among the 36 cases followed up， rehaemorrhagia occurred in 1 patientin 8 months after operation， cured by endoscopic variceal ligation subsequently. A primary liver cancer occurred in 1 patient during physical examination in 7 months after operation， followed by partial hepatectomy. Other patients could complete daily life and work. Conclusions The patients suffering from upper gastrointestinal bleeding due to portal hypertension are likely to benefit from appropriate operations. Decisive emergency devascularization can stop the bleeding rapidly and effectively， and save the lives of those patients.