目的研究依達拉奉影響肝臟缺血再灌注過程中TNF-α的表達情況，探討依達拉奉對肝臟缺血再灌注損傷的逆轉作用。 方法將80只Wistar大鼠編號，根據計算機產生隨機數字，前40為一組，后40為一組，分為實驗組和對照組2組，建立常溫下部分肝缺血再灌注損傷動物模型。 在肝臟缺血再灌注損傷開始前1 h和開始時對實驗組大鼠給予依達拉奉注射液10 ml，對照組則給予同等容量的生理鹽水。分別于再灌注后0、1、2及4 h測定肝臟脂質過氧化物酶（LPO）和肝臟谷草轉氨酶(AST) 濃度； 應用RT-PCR法檢測肝組織TNF-α mRNA含量，并測定肝組織和血清中TNF-α水平； 應用TUNEL染色法檢測缺血肝組織的細胞凋亡情況。結果再灌注后1、2及4 h，實驗組大鼠肝臟LPO及AST濃度均明顯低于對照組（Plt;0.001）； 實驗組再灌注后1 h時肝組織TNF-α mRNA表達量、肝組織和血清TNF-α含量均明顯升高且達峰值，但均明顯低于對照組（Plt;0.05）； 再灌注后各時相實驗組肝細胞凋亡率明顯升高，但均明顯低于對照組（Plt;0.05）。 結論依達拉奉能抑制氧化應激反應，從而降低肝缺血再灌注損傷； 并顯著減少炎性細胞因子TNF-α的產生，抑制炎性反應的發生，減少肝細胞的凋亡。
Ｏｕｒ ｔｅｃｈｎｉｑｕｅ ｆｏｒ ａｕｘｉｌｉａｒｙ ｌｉｖｅｒ ｔｒａｎｓｐｌａｎｔａｔｉｏｎ ｗａｓ ｂａｓｅｄ ｏｎ ｔｈｅ ｔｅｃｈｎｉｑｕｅ ｄｅｓｃｒｉｂｅｄ ｂｙ Ｈｅｓｓ ｗｉｔｈ ｔｈｅ ｅｘｃｅｐｔｉｏｎ ｏｆ ｔｈｅ ｌｅｎｇｔｈ ｏｆ ｔｈｅ ｃｕｆｆ ｏｆ ｔｈｅ ｇｒａｆｔ ｖｅｎａ ｃａｖａ ａｎｄ ｅｓｔａｂｌｉｓｈｍｅｎｔ ｏｆ ｔｈｅ ｐｏｒｔａｌ ｖｅｉｎ ａｎａｓｔｏｍｏｓｉｓ．Ａ ｔｏｔａｌ ｏｆ ６０ ａｕｘｉｌｉａｒｙ ｌｉｖｅｒ ｔｒａｎｓｐｌａｎｔａｔｉｏｎｓ ｗｅｒｅ ｐｅｒｆｏｒｍｅｄ，ｏｆ ｗｈｉｃｈ ２４ ｗｅｒｅ ｄｅｆｉｎｉｔｉｖｅ ｏｐｅｒａｔｉｏｎ．Ｉｎ ｔｈｅ ５ ｄｅｆｉｎｉｔｉｖｅ ｏｐｅｒａｔｉｏｎｓ ｔｈｅ ｇｒａｆｔｓ ｓｕｒｖｉｖａｌ ａｓｓｅｓｓｅｄ ｂｙ ９７ｍＴｃｓｏｄｉｕｍ ｐｈｙｔａｔｅ ｄｅｍｏｎｓｔｒａｔｅｄ ａ １ｗｅｅｋ ｓｕｒｖｉｖａｌ ｏｆ １００％．Ｈｏｗ ｔｏ ｒｅｄｕｃｅ ｔｈｅ ｃｏｍｐｌｉｃａｔｉｏｎｓ ｉｎ ａｕｘｉｌｉａｒｙ ｌｉｖｅｒ ｔｒａｎｓｐｌａｎｔａｔｉｏｎ ｉｎ ｒａｔｓ ｉｓ ｄｉｓｃｕｓｓｅｄ ｉｎ ｔｈｅ ａｒｔｉｃｌｅ．
目的探討肝臟移植術后早期腸內營養支持的價值。方法在術中將鼻腸管放置至屈氏韌帶或空腸輸出袢下30 cm， 術后第2天開始恒速灌注瑞素，量由500 ml/d逐漸增加到1 200 ml/d，速度由20 ml/h增至100 ml/h。分別于術后第2天及第8天觀察患者的白蛋白、前白蛋白、轉鐵蛋白、尿尿素氮和氮平衡。結果前白蛋白、轉鐵蛋白和氮平衡均有顯著改善，白蛋白無明顯變化。結論肝臟移植術后早期腸內營養支持可以有效改善患者的營養狀況和促進患者的恢復，并且可以減少患者的營養支持費用。
ObjectiveTo compare clinical effect of percutaneous radiofrequency ablation (RFA) and open repeated hepatectomy (ORH) in treatment of liver cancer with late recurrence (recurrence time >12 months) and single tumor diameter ≤5 cm.MethodsThe patients with advanced intrahepatic recurrence after first operation for liver cancer in this hospital from January 2013 to December 2019 were retrospectively collected, who were treated with ORH (ORH group) or percutaneous RFA (RFA group) and met the inclusion criteria. The overall survival rate and disease-free survival rate of the two groups were compared after 1∶1 matching by propensity score matching (PSM), while the factors affecting survival were stratified.ResultsA total of 244 patients with recurrent liver cancer were collected, including 134 patients in the ORH group, 110 patients in the RFA group. The patients in the two groups were matched with 1∶1 by PSM, 90 patients in each group. The median overall survival time of the ORH group and the RFA group was 54 months and 45 months, respectively. There were no significant differences in the curves of cumulative overall survival and cumulative disease-free survival between the two groups (P=0.221, P=0.199). The incidence of severe complications in the ORH group was higher than that in the RFA group (10.00% versus 2.22%, P=0.029). A further subgroup analysis showed that the overall survival time of the ORH group was longer than that of the RFA group when the diameter of recurrent liver cancer was 3 to 5 cm (P=0.035), which had no significant differences for the patients with AFP (>400 μg/L or ≤400 μg/L), tumors number (single or multiple), and tumor diameter ≤3 cm between the two groups (P>0.05).ConclusionsPercutaneous RFA is effective and safe in treatment of advanced recurrent liver cancer, its overall survival and disease-free survival are similar to ORH treatment. However, when diameter of recurrent tumor is3–5 cm, ORH treatment has a advantage in prolonging survival time of patients.
目的探討近端脾腎分流聯合賁門周圍血管離斷術治療肝硬變門脈高壓癥的療效。方法回顧分析我院1994~2004年10年期間應用近端脾腎分流聯合賁門周圍血管離斷術治療62例肝硬變門脈高壓病例。結果本組無手術死亡，隨訪56例，隨訪時間4~56個月，隨訪結果： 26例肝功能較前有所改善，49例靜脈曲張明顯減輕，無靜脈破裂出血； 發生吻合口血栓5例，肝性腦病3例，因肝衰死亡3例。結論近端脾腎分流聯合賁門周圍血管離斷術治療肝硬變門脈高壓癥效果好，療效滿意。
Objective To explore the feasibility of recombinant adeno-associated virus (rAAV) as a vector for the gene therapy of liver cancer. Methods The rAAV/enhance green fluorescein protein (EGFP) recombinant was prepared by the routine method of two plasmids cotransfection.Results The experiment showed that one 10cm plate could produce 107-108 infection unit recombinant by the method of two plasmids cotransfection, and the transduction of HepG2 cell was increased with the increase of infection dosage of rAAV. About 100 multiplicity of infection (MOI) AAV vector could make all the tumor cell light. Conclusion Liver cancer cell can be efficiently transduced by rAAV, and AAV vector may be a valuable vector for the gene therapy of liver cancer.