目的 探讨肝癌合并低血糖的诊断及治疗。方法 对中国医科大学附属第四医院2010年1月至2013年4月期间收治的27例肝癌伴低血糖患者的临床资料进行回顾性分析。结果 27例患者中转移性肝癌2例，原发性肝癌25例；其中伴肝硬变9例。所有患者均给予护肝、补充能量治疗；22例行手术治疗后血糖全部控制在正常或仅轻度升高，5例因肿瘤无法切除而放弃手术治疗，其中1例伴肝硬变肝癌患者2个月后再次低血糖症状发作后死亡。结论 低血糖是肝癌少见的并发症，早期诊断及治疗有助于避免后遗症的发生并改善预后。
ObjectiveTo investigate the efficacy of lamivudine combined with low-dose hepatitis B immune globulin to prevent HBV reinfection after liver transplantation. MethodsThe clinical data of 76 cases of HBV-related liver disease after liver transplantation using lamivudine combined with low-dose hepatitis B immune globulin to prevent HBV re-infection were retrospectively analyzed, and the HBV re-infection risk factors were analyzed. ResultsSeventy-six patients' HBsAg became negative after liver transplantation, HBV re-infect in 9 cases.The re-infection rate was 9.2% (7/76) and 11.8% (9/76), respectively, in 1-year and 2-year after liver transplantation. ConclusionsLamivudine combined with low-dose hepatitis B immune globulin after liver transplantation can be effective preventing re-infection with HBV.HBeAg positive and HBV-DNA positive before liver transplantation is risk factors of HBV re-infection.
Objective To investigate the reasons and preventions of bleeding after percutaneous microwave ablation for liver cancer. Methods The data of 156 patients with liver cancer between September 2006 and December 2009 treated with percutaneous microwave ablation (226 times) were recorded. The reasons and preventions of bleeding after percutaneous microwave ablation were analyzed. Results Eleven patients (11 times) suffered from bleeding. The rate of bleeding is 4.87% (11/226), including 2 cases of biliary bleeding, 9 cases of intraperitoneal hemorrhage. All patients who suffered from bleeding firstly received medical therapy to control bleeding, 5 cases were successful; in the other 6 cases who failed in medical therapy, 1 case was stopped bleeding with opening procedures, 4 cases received transcatheter embolization to stop bleeding with gelatin sponge, 1 case died due to excessive blood loss. According to Chi-square test result, the bleeding was significantly related with liver cirrhosis, lower platelet count, obvious prolongation of prothrombin time, subcapsular tumor, Child-Pugh B/C grade, and re-ablation （P=0.044, 0.041, 0.028, 0.001, 0.016, 0.016）. The multiple variables logistic regression analysis showed that liver cirrhosis, platelet count, prothrombin time, location of tumor, and Child-Pugh grade were the influential factors of bleeding after microwave ablation （OR=5.273, P=0.036; OR=8.534, P=0.043; OR=4.893, P=0.045; OR=7.747, P=0.010; OR=6.882, P=0.015）. Conclusions There were some factors were significantly related with the bleeding after percutaneous microwave ablation: liver cirrhosis, abnormal blood clotting function （lower platelet count and prolongation of prothrombin time）, tumor located on the surface of liver, and Child-Pugh C grade. When failed to stop bleeding with medical therapy, transcatheter embolization is an effective method to control bleeding.
目的 探讨孤立性纤维性肿瘤的诊断及外科治疗方法。方法 回顾我院10年来经手术切除并行病理检查确诊为孤立性纤维性肿瘤的病例资料，就其诊断和外科治疗方法进行总结与分析。结果 共16例次患者，肿瘤分别位于胸腔、腹股沟、后腹膜、外阴、颈部、下肢等部位，无明显特异的临床症状。所有病例均行手术完全切除肿瘤，术后经病理学检查和免疫组化染色检查确诊。对患者定期随访，其中2例分别于术后5年和7年肿瘤复发，2例分别随访3年和5年后失访，2例患者分别于随访的第9个月和16个月因全身多发转移死亡，其余患者仍在随访中。结论 孤立性纤维性肿瘤大多数病例表现为局部缓慢生长的无痛性肿块，无明显的临床症状，术前诊断较困难，目前仅能依靠术后免疫组化检查确诊，手术切除是最佳的治疗方法。
ObjectiveThrough the analysis of quantitative and functional changes in peripheral blood CD4+ CD25+FOXP3+ regulatory T cells (Treg) of early HCC patients before and after operation, to discuss the operation effect on the immune function from the aspect of immune suppression. MethodsExtracted the lymphocytes of peripheral blood in HCC patients before and after operation (case group, n=15) and normal people (control group, n=5 cases), and analyze the number and function of Treg by flow cytometer after extracellular (CD4, CD25) and intracellular (FOXP3) staining. ResultsCD4+CD25+ T cells and CD25+FOXP3+ T cells in preoperative peripheral blood in case group were significantly higher than those in control group (12.43±2.57)% vs. (5.56±1.02)%, (5.14±1.4)% vs. (2.18±0.83)%, Plt;0.05). These two cells decreased at 1 week after operation. 〔(10.56±2.13)%, (4.28±1.08)%〕, but there was not statistically significant (Pgt;0.05), they decreased significantly at 2 weeks after operation 〔(7.30±0.89)%, (3.43±0.83)%， Plt;0.05〕. CD8+ T cells and CD4+CD25- T cells in preoperative peripheral blood in case group were significantly lower than those in control group 〔（23.42±1.80）% vs. （29.22±2.26）%， （36.14±1.12）% vs. （43.69±2.78）%， Plt;0.05〕， These two cells decreased significantly at 2 weeks after operation 〔（27.15±1.71）%， （40.30±2.00）%〕. The analysis on the Treg and AFP correlation found that they have low correlation (r=048, Plt;0.05 ). ConclusionsThe hepatectomy can improve the immune response of HCC patient. Treg may have a certain auxiliary significance in the diagnosis, treatment and prognosis of patients with hepatocellular carcinoma.
目的 探讨胰腺囊性肿瘤的诊断及外科治疗方法。方法 对我院2003年4月至2012年4月期间收治的19例胰腺囊性肿瘤患者的临床资料进行回顾性分析。结果 本组19例患者中浆液性囊腺瘤8例，黏液性囊腺瘤5例，导管内乳头状黏液瘤4例，实性假乳头状瘤1例，囊腺癌1例。行B超或CT发现胰腺占位病变。位于胰头部5例，胰体部8例，胰尾部6例。行肿瘤摘除术4例，保留脾脏的胰体尾切除术5例，胰体尾＋脾脏切除手术3例，胰十二指肠切除术6例，1例囊腺癌患者因肝脏转移伴腹腔广泛转移、侵犯大血管而肿瘤不能切除仅行胃空肠、胆肠吻合。术后发生胰瘘2例，腹腔感染1例，经保守治疗后康复出院。无围手术期死亡病例。19例患者均进行了随访，随访时间6～80个月，平均45.2个月。1例囊腺癌合并肝脏转移患者于术后7个月死亡，其余良性肿瘤患者均未见复发，最长已存活5年。结论 胰腺囊性肿瘤主要靠影像学检查发现，手术切除是理想的治疗方法，选择合适的术式有助于避免术后并发症的发生和改善预后。
目的 探讨微波固化在腹膜后肿瘤手术中止血的可行性。方法 对我院2008年7月至2009年8月期间收治的9例腹膜后肿瘤患者手术中应用微波固化止血。手术暴露瘤体后，应用微波治疗仪多点固化瘤体。手术切除肿瘤，不能完整切除者则再次应用微波治疗仪固化瘤床创面，尽量灭活残余肿瘤。结果 9例患者肿瘤切除后创面几乎无渗血，术中失血量（275.56±81.26） ml，手术时间（150.56±36.18） min，住院时间（14.67±2.30） d，无术后并发症发生。术后随访（10±3.97)个月，9例患者均未见复发。结论 腹膜后肿瘤手术过程中应用微波固化止血效果良好。
Objective To establish a modified mouse abdominal heterotopic heart transplantation model in order to increase the graft survival rate and reduce operative complications. Methods The heart was transplanted into the abdomen by anastomosing the donor ascending aorta and pulmonary artery to the recipient abdominal aorta and infrahepatic vena cava respectively. Hilar tissue was not alone ligated, meanwhile recipient lumbar vein was not ligated. Recipient abdominal aorta and infrahepatic vena cava were not isolated, but were liberated and obstructed simultaneously. Results Two hundred and twenty-nine formal transplantations were performed with the successful rate of 97.82% (224/229). The syngeneic graft survival time was more than 6 months. Complications: Aorta thrombus was found in 2 mice (0.87%), inferior vena cava thrombus in 1 mouse (0.44%), heart torsion in 4 mice (1.75%), hemorrhage in 4 mice (1.75%), crural paralysis in 2 mice (0.87%), intestinal obstruction in 1 mouse (0.44%), and no anesthetic accident happened. Conclusions The meliorated mouse abdominal heterotopic heart transplantation model is simple and reliable, which can reduce the operation time. Thus, the meliorated method provides a useful technique for immunologic transplantation research.
ObjectiveTo approach the role of CD4+CD25+ regulatory T cells in the maintenance of immunotolerance in mouse liver allograft. MethodsThe mouse orthotopic liver transplantation was performed. After the liver transplantation immunotolerance induction, antiCD25 monoclonal antibody (PC61) was injected into the recipients with a delayed timing to remove the CD4+CD25+ T cells. The percentage of CD4+CD25+ T cells and the expression of forkhead/winged helix transcription factor (Foxp3) in the recipients were examined. Furthermore, the survival time of the recipient was observed. ResultsC3H/HeJ recipients receiving DBA/2 hepatic allografts survived over 70 d as in the syngeneic liver transplantation (C3H/HeJ recipients receiving C3H/HeJ hepatic grafts). With various protocols of the delayed PC61 treatment, the CD4+CD25+ T cell was completely disappeared as observed. However, the removal of CD4+CD25+ regulatory T cells after the induction of transplantation immunotolerance did not affect the survival of hepatic allografts. ConclusionCD4+CD25+ regulatory T cells are not essential for the maintenance of spontaneous mouse liver transplantation immunotolerance.