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中華肝膽外科雜志

北大核心

CSCD

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Chinese Journal of Hepatobiliary Surgery

中華醫學會主辦。本刊是中華醫學會系列雜志,范圍包括肝、膽、胰、脾外科疾病、門脈高壓、外科營養等的臨床防治與實驗研究。主要欄目：述評、熱點聚焦、學術思考、論著、實驗研究、短篇論著、病例報告、綜述等。該刊自1999年起成為 “中國科技核心期刊”，2008年被北京大學圖書館《中文核心期刊要目總覽》收錄。雜志影響因子逐年上升，是國內外同行了解我國肝膽胰脾外科專業現狀和趨勢的重要資料源和途徑。

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被引量：2308
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開始收錄時間：1995,1(1)
CNKI綜合因子：1.339
維普期刊影響因子： 1.544
萬方期刊影響因子：1.59
創刊時間：1995

國內刊號/CN：11-3884/R

國際刊號/ISSN：1007-8118
發行周期：月刊

郵發代號：82-857
主管單位：中國科學技術協會

主辦單位：中華醫學會

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郵箱：cjhbs@cmaph.org
地址：北京市西城區東河沿街69號
郵編：100052

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中華肝膽外科雜志 >2021年第012期

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1.膽囊癌細胞株的傅立葉變換紅外光譜研究
- 杜俊凱;石景森;孫學軍;徐怡莊;吳瑾光;
- 《中華肝膽外科雜志》 | 2009年第004期
摘要：Objective To establish the cell basis for the carcinoma tissue diagnosis by exploring a method to obtain the FT-IR(Fourier transform infrared)spectra of the cultured carcinoma cells with FT-IR spectroscopy,and investigating the special spectral features of the carcinoma cells comparing with the carcinoma tissues.Methods The gallbladder carcinoma tissues confirmed by histology were measured using a Nicolet Magna750-Ⅱ FT-1R spectrometer and corresponding FT-IR spectra was ob-tained.The cultured gallbladder carcinoma cells(GBC-SD)were centrifuged to provide a small pellet of cells for FT-IR analysis.The cell pellet was then placed on a specially designed salt plate made of BaF2.Then the infrared spectra were recorded by the same equipment.Based on previously estab-lished criteria,a comparative study was subsequently carried out between the spectra of the cultured carcinoma cells(GBC-SD)and that of the corresponding gallbladder tissues.Results Several infrared spectral features of the carcinoma cells were obtained.Conclusion The spectral features of the carci-noma cells can be well reflected from that of the carcinoma tissue,though the later iS more complicated which might originate from the intrinsic complexity of the tissue.This study SHOWS that the diagnosis of carcinoma tissue by FT-IR method exhibits sufficient cell basis.%目的建立膽囊癌體外培養細胞株的傅立葉變換紅外光譜(FT-IR spectroscopy)檢測的方法.對照膽囊癌組織光譜特征,研究膽囊癌細胞株的光譜表現;為紅外光譜法診斷膽囊癌奠定細胞學基礎.方法應用美國Nicolet(尼高力)公司Magna750-Ⅱ型紅外光譜儀.組織標本放置于歐米采樣器表面進行檢測,記錄紅外光譜;體外培養膽囊癌細胞株(GBC-SD)采取涂于BaF2窗片的方法,進行透射紅外光譜檢測,得到時間軸上體外培養細胞株的光譜圖;選擇特征性光譜與膽囊癌組織光譜進行比對.結果成功地獲得了體外培養膽囊癌細胞株的紅外光譜圖;膽囊癌細胞株紅外光譜特征與相應癌組織光譜特征存在異同.結論將體外培養腫瘤細胞株在BaF2窗片上涂片后.進行FT-IR測定是行之有效的細胞紅外光譜檢測手段,能得到體外培養細胞的紅外譜圖;膽囊癌組織所表現的紅外光譜特征具有膽囊癌細胞本身的紅外光譜特征,同時也具有組織自身的復雜特點;FT-IR應用于膽囊癌的定性診斷有充分的細胞學基礎.
2.重度十二指腸損傷修復手術的安全性
- Velmahos GC;Constrantinou C;Kasotakis G;鄭德華;鄒一平;
- 《中華肝膽外科雜志》 | 2009年第004期
摘要：早期的臨床研究推薦幽門曠置術作為重度十二指腸損傷的首選治療方法，然而近年來關于重度十二指腸損傷治療的爭議越來越多。該研究將單純十二指腸修復術與幽門曠置術進行比較，深入探討單純十二指腸修復術能否安全而有效的治療重度十二指腸損傷。研究回顧了1992年8月至2004年1月間193例連續收治的十二指腸損傷病人，排除了早期死亡的50例、輕度十二指腸損傷的81例以及行胰十二指腸切除術治療的12例，分析了50例重度十二指腸損傷（Ⅲ、Ⅳ、V級）。其中34例（68％）行原位十二指腸修復術（包括簡單的十二指腸修補術或部分切除、
3.更正
- 《中華肝膽外科雜志》 | 2009年第004期
摘要：無
4.原發性肝癌綜合治療進展
- 程樹群;吳孟超;
- 《中華肝膽外科雜志》 | 2009年第004期
摘要：原發性肝癌（以下簡稱肝癌）的綜合治療是指包括手術切除、介入化療、放射治療、生物治療及微創治療在內的不同治療手段的綜合或序貫應用。肝癌手術切除率低，術后又易復發，不論過去還是將來，綜合治療都具有重要的地位和作用。事實上，臨床上肝癌長期生存者，絕大多數曾獲得過兩種或兩種以上不同治療方法或同一種治療方法的反復應用。過去強調以手術切除為主的綜合治療，近年來，隨著微創外科治療的普及，新技術新方法如三維適形放療、靶向藥物的興起，
5.腹腔鏡胰腺手術的現狀和思考
- 廖泉;趙玉沛;
- 《中華肝膽外科雜志》 | 2009年第004期
摘要：隨著手術技術和設備的不斷成熟進步，近10年腹腔鏡手術逐漸被運用到胰腺疾病的診斷和治療中，例如胰腺癌的腹腔鏡探查和評估、急性壞死性胰腺炎的壞死組織清除、胰腺假性囊腫的引流、胰腺腫物摘除術、胰體尾切除術以及胰腺癌的治療等。腹腔鏡胰腺手術具有創傷小、恢復快和住院時間短等優點，得到廣大學者和病人的認可。但我們也應該清醒的認識到，腹腔鏡手術到目前為止還不能代替傳統開腹手術在胰腺外科領域中的地位，強行實施腹腔鏡手術反而會增加手術風險，并影響治療效果。
6.膽結石病人肝臟核受體LRH-1及其調控基因表達的研究
- 楊士勇;韓天權;時開網;蔡劬;姜志宏;蔣兆彥;蔡杏興;張圣道;
- 《中華肝膽外科雜志》 | 2009年第005期
摘要：目的研究膽囊膽固醇結石病人肝臟的肝臟受體類似物1(Liver receptor homolog 1,LRH-1)及其調控的三磷酸腺苷結合盒(ABC)轉運體家族成員abcg5/8的表達,探討膽固醇結石病發病的機制.方法 27例膽囊膽固醇結石病人,男6例,女21例;年齡平均52歲.10例無膽石癥的膽囊息肉病人為對照,男6例,女4例;平均年齡48歲.測定膽汁脂類成分和計算膽汁膽固醇飽和指數.實時定量PCR法測定肝臟LRH-1及abcg5/8 mRNA的表達量.結果膽石組LRH-1表達高于對照組(14.18±1.80vs7.22±2.22,P<0.05),膽石組肝臟abcg基因mRNA表達量均較對照組增高(abcg5:49.34±3.68 vs 33.48±2.77,P<0.05)abcg8:38.93±5.70 vs 18.70±3.42,P<0.05).膽石組膽汁呈膽固醇過飽和(1.17±0.02).結論該研究結果提示人類肝臟LRH-1及其調控的abcg5/8的表達增高與膽囊膽固醇結石形成有關.%Objective To investigate the mRNA expression of liver receptor homolog 1(LRH-1) gene and abcg5/8 genes regulated by LRH-1 in patients with cholesterol gallstone disease to eluci-date the biomolecular pathogenesis of gallstone formation. Methods Twenty-seven patients with cho-lesterol gallstone(CGS) and 10 controls without gallstones were enrolled in this study. The biliary composition was assayed, mRNA expression of LRH-1 and abcg 5/8 genes was determined by RT-PCR. Results The expression levels of LRH-1 and abcgS/8 genes were significantly higher in CGS patients than in controls(LRH-1:14.18±1.80 vs 7. 86±2.22; abcg5:49.34±3.68; abcg8:38. 93±5.70 vs 18. 70±3.42; P<0. 05). Conclusion CGS disease may be related to increased expression of LRH-1 and abcg 5/8 genes.
7.膽囊良惡性病變組織中CD63和MAGE-1表達及臨床病理意義
- 楊樂平;楊竹林;苗雄鷹;劉潔瓊;
- 《中華肝膽外科雜志》 | 2009年第005期
摘要：Objective To study the expression of CD63 and melanoma antigen-1(MAGE-1) and explore their elinicopathological significance in the benign and malignatnt lesions of gallbladder.Methods EnVisiom immunohistochemical method was used for detecting the expression levels of CD63 and MAGE-1 in the routinely paraffin-embedded sections of the resected specimens with gall-bladder adenoeareinoma(n=108), peritumoral tissues(n = 46), adenomatous polyp(n = 15) and chronic cholecystitis(n=35). Results The positive rate of CD63 was significantly lower in gallblad-der adenocarcinoma than in peritumoral tissues(X2=15.77, P(0.01), adenomatous polyp(X2=10. 81,P<0.01)and chronic cholecystitis(X2= 26.47, P<0.01). The positire rate of MAGE-1 was significantly higher in gallbladder adenocarcinoma than in peritumoral tissues(X2=31.27, P<0. 01),adenomatous polyp(X2= 13.57, P<0. 01), and chronic cholecystistis(X2=35.47, P<0. 01). Thepositive rate of CD63 was significantly higher in the adenomatous canceration, the maximal diameter of mass(2 cm, no-metastasis of lymphnode, no-infiltration of reginal tissues or organs than those in the moderately-or low-differentiated adenocarcinoma, the maximal diameter of mass≥ 2 cm, metastasis of lymphnode, and infiltration of regional tissues or organ(P<0.05 or P<0. 01). But the expression of MAGE1 was the opposite compared with CD63 in gallbladder adenocarcinoma(P<0. 05 or P<0. 01). Conclusion The expression levels of CD63 and/or MAGE-1 is closely related to the carcino-genesis, progression, metastasis, infiltrating potential and prognosis of gallbladder adenocarcinoma.%目的研究膽囊良惡性病變組織中CD63和黑色素瘤抗原-1(melanoma antigen-1,MAGE-1)表達水平并探討其臨床病理意義.方法 108例膽囊腺癌、46例癌旁組織、15例腺瘤性息肉和35例慢性膽囊炎組織常規制作石蠟包埋切片,CD63和MAGE-1染色方法為EnVisionTM免疫組化法.結果膽囊腺癌CD63表達陽性率明顯地低于癌旁組織(X2=15.77,P<0.01)、腺瘤性息肉(x=10.81,P<0.01)和慢性膽囊炎(X2=26.47,P<0.01);膽囊腺癌MAGE-1表達陽性率明顯地高于癌旁組織(X2=31.27,P<0.01)、腺瘤性息肉(X2=13.57,P<0.01)和慢性膽囊炎(X2=35.47,P<0.01);腺瘤癌變、腫塊最大徑<2 cm、無淋巴結轉移和未侵犯周圍組織器官病例CD63表達陽性率明顯高于中或低分化腺癌、腫塊最大徑≥2 cm、淋巴結轉移及侵犯周圍組織器官病例(P<0.05或P<0.01),但MAGE-1表達則相反(P<0.01).結論 CD63和MEGE-1表達水平與膽囊腺癌發生、進展、轉移、侵襲能力及預后有密切關系.
8.術中膽道造影在小切口膽囊切除術中的臨床價值
- 劉峰;張智平;劉金余;
- 《中華肝膽外科雜志》 | 2009年第005期
摘要：目的探討術中膽道造影(IOC)在小切口膽囊切除術(MC)中的臨床應用價值.方法對1992-2006年在小切口膽囊切除術中行膽道造影506例的臨床資料進行回顧性分析.結果造影成功493例,成功率97.4%,術中發現膽道結石49例,膽管變異4例,膽道損傷4例,擴大切口16例.結論術中膽道造影在小切口膽囊切除術中可防止術后膽管殘石發生,避免不必要膽管探查,減少擴大切口的機會,明確膽管變異,預防并及時發現膽管損傷,降低MC并發癥,提高MC質量,有較高的臨床應用價值.%Objective To determine the clinical value of intraoperative cholangiography in mini-cholecystectomy. Methods The clinical data of 506 patients receiving intraoperative cholangiography in minicholecystectomy from 1992 to 2006 in our hospital were analyzed retrospectively. Results Intr-aoperative cholangiography was successfully completed in 403 patients. The success rate was 97.4%.Stones in the bile duct in 49 patients,abnormal bite duet in 4 patients and bile duct injury in 4 patient were found. The cuts were extended in 16 patients. Conclusion Intraoperative cholangiography is of great value in inducing postoperative complications and improving the quality of MC. Therefore, it can be used to prevent residual stone after operation, avoid bile duct exploration or injury, decrease the chance of extending the cut and make sure of abnormal bile duct.
- 膽囊切除術;
- 術中膽道造影;
9.細胞周期蛋白D1在三氧化二砷抑制人膽囊癌細胞生長中的作用
- 艾志龍;陸維祺;鎖濤;劉厚寶;童賽雄;王炳生;
- 《中華肝膽外科雜志》 | 2009年第005期
摘要：目的探討細胞周期蛋白(Cyclin)D1在三氧化二砷(As2O3)抑制人膽囊癌細胞體外生長中的作用.方法不同濃度的As2O3作用于膽囊癌細胞GBC-SD,MTT法檢測細胞生長情況,流式細胞儀檢測細胞周期分布.Western印跡和RT-PCR檢測Cyclin D1、D2、D3和CDK4、K6的蛋白和mRNA表達.構建Cyclin D1的表達質粒并轉染GBC細胞,觀察Cyclin D1過表達時細胞周期的變化.結果 As2O3能抑制膽囊癌細胞生長,作用呈時間、劑量一效應關系;流式細胞儀檢測發現As2O3可將增殖過程中的膽囊癌細胞阻滯于G1期;Western印跡及RT-PCR檢測顯示Cyclin D1表達下降;過表達Cyelin D1逆轉了As2O3對細胞周期的改變.結論 Cyclin D1在As2O3抑制人膽囊癌細胞的生長中起重要作用.%Objective To investigate the role of the cyclin D1 in inhibition of human gallbladder carcinoma(hGBC) cells by arsenic trioxide(As2O3). Methods After the hGBC cells were cultured with different concentrations of As2O3, the proliferative activity of cells was detected by MTT meth-ods, the cell cycle status determined by flow cytometry as well as the protein and mRNA expression of Cyclin D1,D2,D3,CDK4 and CDK6 analyzed by Western blot and RT-PCR. hGBC cells were transi-ently transfeeted with overexpression of Cyclin D1 derived from the constructed plasmid. Meanwhile, the As2O3-induced alteration of cell cycle was detected. Results The As2O3could inhibit the growth of cells in a time-and dose-dependent manner, make ceils arrested in G, and downregulate the expres-sion of Cyclin D1. Moreover, Cyclin D1 overexpression played the negative role in As2O3-induced al-teration of cell cycle. Conclusion Cyelin D1 plays an important role in inhibition of hGBC cells by As2O3.
10.經內鏡鼻膽管引流術治療膽道術后膽漏
- 杜小軍;熊利民;羅偉昌;成時保;
- 《中華肝膽外科雜志》 | 2009年第005期
摘要：膽漏是膽道手術較為常見的并發癥之一，后果常較嚴重。筆者收集1998—2006年江西省南昌市第三醫院肝膽外科收治膽道手術后出現膽漏病人的臨床資料20例，發現經內鏡鼻膽管引流術（ENBD）治療膽道術后膽漏，臨床療效滿意、確切，現報告如下。
11.胚胎發育信號通路Sonic hedgehog在胰腺癌組織中的表達及意義
- 胡偉國;熊炯邤;王春友;劉濤;
- 《中華肝膽外科雜志》 | 2009年第005期
摘要：目的研究胚胎發育信號通路Sonic hedgehog(SHH)在胰腺癌組織中的表達及其臨床意義.方法逆轉錄聚合酶鏈反應(RT-PCR)技術和免疫組化方法檢測胰腺癌組織及癌旁組織中SHH mRNA和蛋白的表達情況.結果 78.9%(30/38)胰腺癌組織中檢測到SHH mRNA)18.4%(7/38)癌旁正常組織SHH mRNA陽性.免疫組化結果顯示:84.2%(32/38)胰腺癌組織SHH蛋白呈陽性表達;癌旁胰腺組織SHH陽性率為21.1%(8/38).兩組差異有顯著意義(P<0.01).SHH蛋白表達與年齡、腫瘤大小、TNM分期、淋巴結轉移狀況、組織學類型和腫瘤部位均無關(P>0.05).結論 SHH信號分子在胰腺癌組織中表達增高,SHH信號途徑可能在胰腺癌發生發展過程中起重要作用.%Objective To investigate the expression of sonic hedgehog(SHH) and its clinical significance in human pancreatic cancer(hPC). Methods RT-PCR and immunohistochemistry were used to determine the mRNA and protein expression of SHH in hPC tissue and normal tissues adjacent to the cancer. Results The SHH mRNA expression was detected in 78. 9%(30/38) oir the samples of pancreatic cancer, while in only 18. 4%(7/38) of those of normal tissues adjacent to the cancer. Im-munohistochernical analysis showed that the SH H protein expression rate was 84.2%(32/38) in pan-creatic cancer tissue and 21.1%(8/38) in normal tissues. There was significant difference between them(P<0. 01). Overexpression of SHH protein in pancreatic cancer had no correlation to age,tumor size, lymph node metastasis, TNM stage and pathological type(P>0. 05). Conclusion The expression level of SHH signal molecule is increased in hPC. The overexpression of SHH signaling pathway might play an important role in carcinogenesis and development of pancreatic cancer.
- 胰腺腫瘤;
- Sonic hedgehog;
12.隱匿性膽囊穿孔的CT、MRI診斷
- 紀建松;邵初曉;涂建飛;王祖飛;趙中偉;盧陳英;范曉希;
- 《中華肝膽外科雜志》 | 2009年第005期
摘要：隱匿性膽囊穿孔是膽囊炎的嚴重并發癥及外科急腹癥之一，大多數無特異性及典型臨床表現，但病情發展迅速，常發生嚴重感染、中毒性休克等較嚴重并發癥。因此，早期明確診斷是治療成敗的關鍵。現將浙江省麗水市中心醫院經CT、MRI檢查并經手術證實的13例隱匿性膽囊穿孔資料作一回顧分析，以提高本病的診斷水平。
13.16年間十二指腸乳頭旁憩室切除28例經驗
- 吳金術;彭創;田秉章;尹新民;成偉;
- 《中華肝膽外科雜志》 | 2009年第005期
摘要：十二指腸乳頭旁憩室缺乏特異性臨床表現，手術切除困難、危險。1990年1月至2006年1月，湖南省人民醫院肝膽科共收治十二指腸乳頭旁憩室病人28例，均作憩室切除。手術安全、療效良好。該文就其診斷及憩室切除技術總結如下。
14.膽囊管解剖變異的臨床處理及療效分析
- SHI Fu-xin;
- 《中華肝膽外科雜志》 | 2009年第005期
摘要：肝外膽管的先天性解剖變異是造成醫源性膽管損傷的重要原因，其中膽囊管的解剖變異較大，如膽囊管缺如、膽囊管開口于十二指腸、雙膽囊管、膽囊后膽囊管等均為較罕見的解剖變異，而以雙膽囊管更較罕見，尸檢中發現這類變異僅占2．61％。在膽囊切除術中如對膽囊管解剖變異判斷錯誤或處理不當可能會導致膽管損傷，應當予以重視。
15.MRI動態增強與多層螺旋CT增強掃描對肝外膽管癌術前分期的評價
- 崔興宇;任克;孫文閣;王強;韓敏;郭克建;劉永峰;徐克;
- 《中華肝膽外科雜志》 | 2009年第005期
摘要：目的對比分析MRI動態增強與多層螺旋CT(MSCT)增強掃描評估肝外膽管癌術前分期的準確性及臨床應用價值.方法回顧性分析經病理證實的肝外膽管癌77例,60例行多層螺旋CT增強掃描,33例行肝臟三維容積超快速多期動態增強掃描(liver acquisition with volume accel-eration,LAVA)序列檢查,其中16例同時做過此兩種檢查.根據腫瘤的形態、膽管浸潤范圍,肝動脈、門靜脈血管受累情況,有無腹腔內器官、淋巴結轉移等指征,進行TNM分期,并與病理結果對照.結果所有的原發腫瘤均被MRI動態增強掃描檢出(100%),60例肝外膽管癌原發腫瘤MSCT增強掃描檢出52例(86.7 0A).MSCT增強掃描T分期的總準確性65%(39/60),MRI動態增強檢查是93.9%(31/33)(P<0.05).MSCT增強與MRI動態增強掃描的N分期總準確性分別為55%(33/60)、81.8%(27/33)(P<0.05).兩者的M分期總準確性分別為100%(33/33)、96.7%(58/60)(P>0.05).結論在肝外膽管癌原發腫瘤病灶檢出及TNM分期準確性上,MRI動態增強掃描優于MSCT增強掃描.%Objective To evaluate the accuracy of dynamic scanning by multi-slice computed tomography(MSCT) and enhanced scanning by magnetic resonance images(MRl) for preoperative staging of extrahepatic cholangiocarcinoma(EHCC). Methods Seventy-seven patients with surgically proven EHCC were reviewed retrospectively. Sixty cases underwent dynamic MSCT. 3-dimensional contrast-enhanced dynamic magnetic resonance images(3D CE MRI) were obtained in thirty-three patients, both CT and MRI dynamic enhancement were performed in 16 cases. The radial extent (TNM staging) and the vertical extent of tumors were assessed and their correlation with pathological findings of surgical specimen analyzed. Results All of primary tumors were detected by 3-dimensional contrast-enhanced dynamic magnetic resonance imaging(100%), and 52 of 60 cases with extrahepatic EHCC detected by dynamic MSCT(86.7%). The overall accuracy of the T staging was 65%(39/60) with dynamic MSCT and 93.9%(31/33)with contrast-enhanced dynamic magnetic resonance imaging (P<0. 05). The overall accuracy of N staging was 55%(33/60) with CT and 81.8%(27/33) with MRI(P<0. 05). The overall accuracy of M staging was 100%(33/33) and 96.7%(58/60)(P>0. 05)respectively. Conclusion 3D CE MRI is more valuable than dynamic MDCT in detection of pri-mary tumors and the accuracy for TNM staging of EHCC.
16.105例膽總管壺腹結石嵌頓外科手術處理經驗
- 吳金術;成偉;田秉璋;彭創;
- 《中華肝膽外科雜志》 | 2009年第005期
摘要：目的探討膽總管壺腹結石嵌頓的外科處理方法.方法對1990年2月至2006年12月湖南省人民醫院肝膽外科收治的膽總管壺腹結石嵌頓105例進行回顧性分析.結果全組恢復平順,無膽漏、胰腺炎、十二指腸漏等并發癥.結論良好的暴露、微創外科技術的應用、長臂T管的使用、結合一系列改良手術技巧可以較滿意的處理膽總管壺腹結石嵌頓.%Objective To investigate the treatment methods for impacted stone in the common bile duct ampulla. Methods The clinical data of 105 patients with ampulla impacted stone treated in our hospital from February 1990 to December 2006 were retrospectively analyzed. Results All pa-tients were cured, there were no complications such as bile leakage, pancreatitis, duodenal fistula etc.Conclusion With good exposure of surgical fields, usage of micro-invasion surgical technical, using long limb T tube, combined with some improved surgical skills, we can deal with impacted stone in the common bile duct ampulla satisfactorily.
- 膽總管結石;
- 外科手術;
17.146例復雜肝內膽管結石的個體化治療
- 李旋;葉啟文;林楓;李林立;林德新;張代場;
- 《中華肝膽外科雜志》 | 2009年第005期
摘要：Objective To explore the feasibility of individualized treatment for complicated hep-atolithiasis. Methods The clinical data of patients with complicated hepatolithiasis treated in our hos-pital with different approaches in the past 4 years were retrospectively analyzed. Results The cura-tive rate of the disease could be promoted by preoperative careful formulation of individualized regi-men, perioperative performance of different approaches and postoperative conduction of different com-prehensive treatments according to the actual illness conditions. Conclusion As the complicated hepa-tolithiasis is complex and there is no uni{ied curing method, the important measures to impove curative rate is making detailed individualized treatment plan for every case.%目的探討個體化治療復雜肝內膽管結石的可行性.方法對福建醫大附屬臨床教學基地寧德市閩東醫院近4年來使用不同方法治療復雜肝內膽管結石總體療效進行回顧性分析.結果根據具體病情,術前制定詳細的個體化治療方案,術中采取不同的手術方式,術后采取不同的綜合治療措施,能明顯提高復雜肝內膽管結石的治愈率.結論復雜肝內膽管結石病情復雜.無統一的治療方法,但有共同的治療原則.對每個病例制定詳細的個體化治療方案是提高治愈率的重要措施.
- 膽管結石;
- 個體化治療;
18.小切口膽總管探查術安全性及療效評估的隨機對照研究
- 董科;俞小炯;溫爾剛;
- 《中華肝膽外科雜志》 | 2009年第005期
摘要：Objective To evaluate the safety, feasibility and curative effect of mini-incision ex-ploration of common bile duct. Methods In this study, 290 patients underwent min-incision explora-tion of common bile duct and 120 patients underwent open-incision exploration of common bile duct for bile duct stones and/or gallstones from 2005 to 2007. The iatrogenic bile duct injury, postoperative complication, residual stone, stone recurrence,therapeutic effect and clinical data were evaluated by randomized contrast analysis. Results Time of operation, bleeding, volume of drain pipe, time of re-covery of intestinal peristalsis and average duration in hospital were significantly lower in the group of min-incision exploration(MCE) than in the group of open-incision exploration(OCE). The iatrogentic bile duct injury occurred in 5 cases(1.72%), residual stone in 10 cases(3.45%), stone recurrence in 15 cases(5.18%) in the group of MCE, and in 2 cases(1.67%), 4 cases(3. 33%) and 6 cases respec-tively in the group of OCE. There was no marked difference between the two groups. Howevert post-operative complications occurred in 17 cases(6.8%) and 16(13.3%) in the group of MCE and OCE,respectively. There was remarkable difference between the 2 groups(P<0. 05). Conclusion Mini-in-cision exploration of common bile duct is a feasible and safe method resulting in fewer complications of iatrogentic bile duct injury, stone recurrence and residual stone.%目的系統評價小切口膽總管探查術的安全性、可行性以及療效.方法采用前瞻性隨機對照方法,分別對290例小切口和120例傳統切口行膽總管探查術的病人,就術中意外傷、術后并發癥、結石殘留、術后一般情況和預后等臨床資料進行對比分析.結果手術時間、術中出血量、術后血漿管引流量、術后腸功能恢復時間、下床活動時間、住院時間等,小切口組少于傳統切口組;小切口組術中意外損傷發生率為1.72%(5/290),術后結石殘留率為3.45%(10/290),結石復發率為5.18%(15/290);傳統切口組術中意外損傷發生率為1.67%(2/120),術后結石殘留率為3.33%(4/120),結石復發率為5.0%(6/120),統計顯示兩組差異無顯著性(P>0.05);小切口組術后發生并發癥17例,傳統組為16例,兩組比較有統計學差異(P<0.05).結論小切口膽道探查手術是一種安全、有效、預后良好、恢復時間快的手術方式.
19.胰十二指腸切除術后胃排空障礙危險因素的Logistic回歸分析
- 杜家文;寧武;裴東坡;黃林平;王正康;
- 《中華肝膽外科雜志》 | 2009年第005期
摘要：目的分析胰十二指腸切除術后胃排空障礙的危險因素.方法回顧性分析中日友好醫院1994年1月至2008年1月間101例胰十二指腸切除術病例,以手術后是否發生胃排空障礙為因變量,對病人臨床資料進行單因素及多因素非條件Logistic回歸分析.結果該組胃排空障礙發生率為27.7%(28/101),單變量分析結果表明手術方式、術中輸血量、術后血糖、術后腹腔感染、術后胰膽腸瘺發生是胃排空障礙發生的危險因素.多因素Logistic回歸分析結果表明,術后腹腔感染、手術方式、術中輸血量、術后高血糖是胃排空障礙發生的獨立危險因素,相對危險度(OR)分別為7.892、7.071、5.882和2.882.結論術后并發腹腔感染、PPPD術后、術中輸血量多、術后高血糖病人易發生胃排空障礙.%Objective To study the risk factors for functional delayed gastric emptying(FDGE)after pancreaticoduodenectomy. Methods The clinical data of 101 cases undergoing pancreaticoduode-nectomy in our hospital from January 1994 to January 2008 were reviewed retrospectively. Results The incidence of FDGE was 27.7%(28/101). Univariate analysis showed PPPD,intraoperative blood transfusions,postoperative blood glucose, postoperative abdominal infection, postoperative pancreatic fistula and biliary fistula and intestinal fistula were the risk factors for gastric emptying after pancreati-coduodenectomy. Multivariate Logistic analysis regression revealed that postoperative abdominal infec-tion,PPPD,intraoperative blood transfusions,postoperative blood glucose were independent risk fac-tors(OR = 7. 892, 7. 071,5. 882 and 2. 882) of FDGE after pancreaticoduodenectomy. Conclusion Postoperative abdominal infection, PPPD, intraoperative blood transfusions, postoperative blood glu-cose can increase the incidence of FDGE.
20.肝臟TACE術后腹腔急性大出血死亡一例
- 孫延富;薛峰;王義;
- 《中華肝膽外科雜志》 | 2009年第005期
摘要：臨床資料：死者，男，67歲。因原發性肝癌術后1個月，擬行TACE入院。以往無高血壓、心臟病史。入院查體：血壓120／70mmHg（1mmHg=0．133kPa），脈搏80次／min，心肺聽診正常，腹部體檢未見異常。實驗室檢查：血紅蛋白117g／L，血小板92×109／L，PT13．5s，肝腎功能正常。心電圖、胸片正常。B超：肝臟右葉雜亂回聲區47mm×38．6mm，肝癌術后改變。于2008年7月3日10：40，
21.胰腺癌診斷與治療的現狀與未來
- 趙玉沛;
- 《中華肝膽外科雜志》 | 2009年第005期
摘要：近年來腹部外科的發展日新月異。很多腹部疾患，包括腫瘤在內，其診斷、治療的水平隨著基礎醫學的進展，影像學技術的提高和分子診斷技術的應用而得到極大提高。但是胰腺癌的診斷和治療方面的進展卻不盡人意，仍然是腹部外科中最難獲得早期診斷、預后最差的惡性腫瘤之一。85％的胰腺癌病人就診時已屬晚期，僅20％左右可行手術治療。
22.腔鏡膽總管切開取石與內鏡乳頭括約肌切開取石術的遠期療效比較
- 陳小勛;黃順榮;林源;吳瑞正;
- 《中華肝膽外科雜志》 | 2009年第005期
摘要：Objective To investigate the advantage of laparoscopic common bile duct exploration for common bile duct stone. Methods The clinical data of the patients with common bile duct stone receiving minimally invasive surgery in Guigang People's Hospital and Guangxi People's Hospital from June 2001 to June 2006 were retrospectively analyzed. The long-term therapeutic efficacy was compared between the patients undergoing laparoscopie common bile duct exploration(LCBDE group)and those receiving endoscopic sphincterotomy(EST). Results A total of 225 cases were included in this study. Of the patients, 106 received LCBDE and 119 EST. All the patients were followed up for an average of 3.2±0.8 years(1-6 years). In LCBDE group, bile duct recurrent stones was seen in 4 cases(3.77%) and cholangitis in 3(2.83%) and no duodenal papilla stenosis. In EST group, bile duct recurrent stones was seen in 14 cases(11.76%), duodenal papilla stenosis in 9(7.56%) and cholangitis in 15 cases(12.60%). No cholangiocarcinoma was experienced in all the patients. Long-term complications such as bile duct recurrent stones, duodenal papilla stenosis and cholangitis had significant differences between the 2 groups(P<0.05). Conclusion LCBDE is better than EST for common bile duct stone with the advantage of less long-term complications.%目的探討腹腔鏡膽總管切開取石術(laparoscopic common bile duct exploration,LCBDE)治療膽總管結石的優越性.方法回顧分析2001年6月至2006年6月間,在貴港市人民醫院及廣西壯族自治區人民醫院微創中心行微創手術治療的膽總管結石的臨床資料.按手術方式不同分兩組,即LCBDE組和EST(內鏡乳頭括約肌切開取石術,endoscopic sphincterotomy)組,比較兩組的遠期療效.結果該組225例,其中LCBDE 106例,EST 119例.術后隨訪1～6年,平均(3.2±0.8)年.LCBDE組結石復發率為3.77%(4/106),反流性膽管炎的發生率為2.83%(3/106),無乳頭狹窄;EST組結石復發率為11.76%(14/119),乳頭狹窄的發生率為7.56%(9/119),反流性膽管炎的發生率為12.61%(15/119).全組病例無膽管癌發生.術后結石復發率、乳頭狹窄和反流性膽管炎的發生率在兩組間的差別均有統計學意義.結論在治療膽總管結石方面,LCBDE的遠期療效優于EST.
23.術中膽道造影應用體會:附66例
- 季勇;吳長春;吳永豐;劉興洲;
- 《中華肝膽外科雜志》 | 2009年第005期
摘要：Objective To explore the value of intraoperative cholangiography. Methods The clinical data of 66 patients receiving intraoperative cholangiography during open cholecystectomy from January 2004 to December 2007 in our hospital were retrospectively analyzed. Results Of the 66 pa-tients, 9 suffered from stone, 2 from gallbladder carotid occlusion and 55 had no stone. For the latter 55 patients, 1 had gallbladder duodenal fistula. The bile duct injury was found promptly in 9 patients. Three patients had small cystic duct and long gallbladder. All the 66 patients were cured by different approaches. Conclusion Use of intraoperative cholangiography can reduce unnecessary open explora-tion of the common bile duct, timely detec biliary anatomic variations, deformity, damage, tumors to prevent unclear anatomy and heavy inflammation in patients with bile duct injury.%目的探討術中膽道造影應用價值.方法對2004年1月至2007年12月66例開腹膽囊切除術病人行術中膽道造影術的資料進行回顧性分析.結果發現結石者9例,膽囊頸管閉塞者2例,結石陰性者55例,膽囊十二指腸內瘺1例,及時發現膽管損傷9例及膽囊管過長與小膽囊3例.均采取相應方法,一期愈合出院.結論術中膽道造影術可降低膽總管不必要切開探查率,及時發現膽道解剖變異、畸形、損傷、腫瘤等,并能預防解剖不清、炎癥重粘連明顯病人的膽管副損傷.
24.原發性肝細胞癌與HLA-DRB1基因多態性及DR抗原表達的關系
- 潘煥峰;李東復;孫天虹;王秀娟;
- 《中華肝膽外科雜志》 | 2009年第005期
摘要：Objective To investigate the association of human leucocyte antigen-DRB1 alleles and expression of HLA-DR antigen with Hepatocellular carcinoma(HCC) in Han population of Jilin area. Methods HLA-DRB1 alleles in 61 patients with chronic hepatitis B, 44 patients with hepatic cirrhosis, 62 patients with HCC, and 50 healthy controls were analyzed by using polymerase chain re-action/sequence specific primer technique. Meanwhile the expression of HLA-DR antigen in HCC tis-sues, tissues adjacent to HCC and nomal liver tissues was detected with immunohistochemical method. Results The frequency of HLA-DRB1 * 1201-3 allele in chronic hepatitis B group was higher than that in healthy control group(17. 21% vs. 8. 00% ,P=0. 0427, RR=2. 391). The frequency of HLA-DRB1 * 0701 allele in chronic hepatitis B group, hepatic cirrhosis group and HCC group was markedly higher than that in healthy control group(11. 48% vs. 2. 00%, P=0. 0066, RR=6.35; 12.50% vs.2.00%, P=0.0046, RR=7.00; 11.29% vs. 2.00%, P=0.0073, RR=6.236). The frequency of HLA-DRB1 * 1501-5 allele in HCC group was higher than that in healthy control group(18. 55% vs.9.00%, P=0. 0423, RR= 2. 303). The expression of HLA-DR antigen was negative in hepatocytes of nomal liver tissues and tissues adjacent to HCC, while 34.2% of HCC tissues expressed DR antigen which distributed on the cytomembrane and/or in cytoplasm intensively. Expression of DR antigen in HCC was not associated with tumor size, tumor lymphocyte infiltration and tumor metastasis(P>0.05) ,but it was associated with histological grade. The rate of HLA-DR antigen expression in well-differenciated cases was higher than that in poorly-differenciated ones(P<0. 05). Conclusions Alleles of HLA-DRB1 * 1201-3 and HLA-DRB1 * 0701 were closed associated with chronic hepatitis B. HLA-DRB1 * 0701 was also closed associated with hepatic cirrhosis. Alleles of HLA-DRB1 * 1501-5, HLA-DRB1 * 0701 and expression quantity of HLA-DR antigen were associated with HCC in Han popula-tion of Jilin area.%目的探討肝細胞癌(HCO與HLA-DRBl基因多態性及DR抗原表達的關系.方法應用PCR-SSP方法與免疫組化技術對61例吉林地區漢族慢性乙型肝炎,44例乙型肝炎肝硬化病人,62例HCC病人及50名健康獻血員作對照,進行了HLA-DRB1等位基因分型比較以及肝細胞癌癌組織、癌旁組織及正常肝組織的HLA-DR抗原表達進行檢測.結果慢性乙型肝炎組HLA-DRB1*1201-3等位基因表達頻率為17.21%,明顯高于正常對照組8.00%(P=0.0427,RR=2.391);慢性乙型肝炎組、乙型肝炎肝硬化組與肝癌組HLA-DRB1*0701等位基因頻率分別為11.48%、12.50%、11.29%,明顯高于正常對照組2.00%(P=0.0066,RR=6.35;P=0.0046,RR=7.00;P=0.0073,RR=6.236);HLA-DRB1*1501-5等位基因表達頻率在肝癌組為18.55%,明顯高于正常對照組9.00%(P=0.0423,RR=2.303);正常肝組織、肝癌旁組織肝細胞中HLA-DR抗原表達陰性,而34.2%的肝癌組織肝細胞膜和(或)胞漿中可見HLA-DR抗原表達,呈灶狀分布,表達程度與腫瘤大小、癌周血管浸潤及轉移無關(P>0.05),與分化程度有關(P<0.05).結論 HLA-DRB1*1201-3、HLA-DRB1*0701等基因型與吉林地區漢族人群慢性乙型肝炎患病相關聯,乙型肝炎肝硬化患病與HLA-DRB1*0701等位基因型相關聯,肝癌患病與HLA-DRB1*1501-5、HLA-DRB1*0701等位基因型及DR表達量相關聯.
25.胰腺實性假乳頭狀瘤MRI表現與病理對照分析
- 張靜;葉慧義;蔡幼銓;馬林;蔡守旺;王殿軍;
- 《中華肝膽外科雜志》 | 2009年第005期
摘要：目的描述胰腺實性假乳頭狀瘤(SPTP)MRI表現與病理所見,探討MRI診斷該腫瘤的價值.方法回顧性分析8例經手術病理證實為SPTP的MRI表現,并與病理所見對照.結果 8例均為單發的類圓形囊實性腫物,其中6例以實性為主,2例以囊性為主;4例位于胰頭,1例位于胰頸,3例位于胰尾;8例中6例最大徑為5～8.5 cm,2例分別為1.6 cm和2.2 cm.MR上囊性部分呈液性長T1長T2信號,其中6例合并腫瘤內出血,為短T1高信號,2例可見液-液平面,實性部分表現為稍長T1稍長T2信號,增強掃描囊性部分無強化,實性部分呈漸進性強化和延遲強化;MR所見8例中5例包膜不完整,2例伴有膽總管及胰管擴張;術中見3例腫瘤侵犯結腸系膜,2例侵犯十二指腸腸壁,2例腸系膜上動靜脈受侵,2例伴有膽總管擴張.MRI表現與病理所見對應良好,7例術前診斷正確,1例誤診為胃腸道間質瘤.結論 MRI能顯示胰腺實性假乳頭狀瘤的特征性表現,有助于正確的術前診斷.%Objective To describe the MRI features and pathologic findings of solid-pseudopap-illary tumor of the pancreas(SPTP) to assess the diagnostic value of MRI in this disease. Methods MR images and pathologic findings of 8 patients who underwent surgery for SPT between January 2005 and June 2007 in our hospital were retrospectively analyzed. Results All 8 cases demonstrated solitary solid-cystic masses. The tumors in 4 cases were located in the pancreatic head, 1 in the pan-creatic neck and 3 in the tail. Of the 8 cases, the maximal diameter of 6 tumors was larger than 5 cm,only 2 tumor was 1.6 cm and 2.2 cm in diameter, respectively. On MRI, 8 tumors presented as heter-ogeneous intensity with solid and cystic component. Six mainly contained solid components and the other 2 cystic components. After contrast administration, the solid parts of the lesions showed slight enhancement during arterial phase and gradual progression during portal vein phase and delay phase.But the cystic parts of the lesions were homogeneous in signal intensity and showed no enhancement.Six of the 8 cases demonstrated hemorrhage within tumors showing hyperintensity on T1WI. In 5 of the 8 cases, the discontinuous speudocapsules were detected and the tumors invaded the adjacent struc-tures. The invasion of mesocolon was detected in 3 cases during operation, the wall of duodenum was invasive in 2 cases and superior mesenteric vein was invasive in 2 cases. The common bile duct and pancreatic duct dilated in 2 cases. Accurate preoperative diagnosis was made in 7 cases whereas 1 case was misdiagnosed as gastrointestinal stromal tumor. Conclusion MR imaging can reveal the charac-teristic features of SPTP and is helpful for accurate preoperative diagnosis.
26.siRNA干擾c-FLIP表達治療膽囊癌的實驗研究
- 宗華杰;殷保兵;陳進宏;馬保金;蔡端;何祥火;
- 《中華肝膽外科雜志》 | 2009年第005期
摘要：Objective To investigate the expression of c-FLIP in gallbladder cancer and explore the effect of siRNA(small interfering RNA) to interfere expression of c-FLIP on gallbladder cancer cell line. Methods The expression of c-FLIP was detected by immunohistochemieal method in 35 ca-ses of gallbladder cancer compared with 10 cases of normal gallbladder tissue and 10 cases of gallblad-der adenoma. After being interfered by RNAi of c-FLIP, cell viability was measured by CCK-8 meth-od, morphological changes observed through phase-microscopy and apoptosis detected by flow cytome-try. Results The positive expression of e-FLIP in gallbladder cancer tissues was significantly higher than that in normal gallbladder tissues(P<0.05) and gallbladder adenoma tissues(P<0. 05). After being interfered by RNAi of c-FLIP, cell growth of gallbladder cancer cell line SGC-996 was markedly inhibited. Either in phase-microscopy or in flow eytometry, the proportion of apoptosis in samples treated with RNAi of c-FliP for 24 hours was notablely increased as compared with those untreated samples(P<0.05). Conclusion Targeted therapy of RNAi of c-FLIP might be a promising method to treat gallbladder cancer.%目的檢測c-FLIP在膽囊癌組織中的表達,探討siRNA(small interfering RNA)干擾膽囊癌細胞c-FLIP表達后對細胞生長的影響.方法用免疫組化法檢測10例正常膽囊組織,10例膽囊腺瘤和35例膽囊癌組織中c-FLIP的表達;siRNA干擾c-FLIP表達后,通過生長曲線測定、倒置相差顯微鏡檢查和流式細胞儀檢測細胞生長狀況.結果在膽囊癌組織中,c-FLIP的表達明顯高于在膽囊腺瘤(P<0.05)和正常膽囊組織中的表達(P<0.05);siRNA干擾c-FLIP表達后,膽囊癌細胞株SGC-996的生長明顯受到抑制,倒置相差顯微鏡檢查發現,干擾后細胞凋亡細胞比例明顯增加,流式細胞儀的檢查發現干擾后細胞凋亡比例與對照組相比明顯上升(P<0.05).結論 siRNA干擾c-FLIP表達的靶向治療有可能成為治療膽囊癌的新的方法.
27.膽汁對體外培養人成纖維細胞作用的實驗研究
- 熊偉;張小文;吳濤;王炳煌;鄒浩;李曉;朱紅;王琳;
- 《中華肝膽外科雜志》 | 2009年第005期
摘要：Objective To study the effect of bile on the cultured human fibroblasts to explore the role of bile in the formation of biliary sears and relative mechanisms. Methods Human bile was collected during the operations for patients with polypoid lesion of gallbladder. After being percolated,the bile of different concentrations was added into the culture medium. Morphological changes in both control group and trial group were observed under inverted microscope and electron microscope. The effect of different concentrations of bite on the proliferation of cultured fibroblasts was studied by MTT assay. The apoptosis rate and cell circle distribution were determined by FCM. Results Mor-phological observations revealed that the proliferation of fibroblasts in trial group was enhanced and the phenotype modulated by bile. The result of MTT assay showed that the correspondent OD values be-came larger when the concentrations of bile became higher. And the effect was concentration-depend-ant to some extent. FCM results showed that the apoptosis rates of cells and the proportion of cells in G0/G1stage in trial group were lower and the proportion of cells in S stage in trial group was higher than in the control group. Conclusion Human bile enhances the formation of biliary scar and biliary stricture. The integrity of biliary mucous membrane barrier plays an important role in preventing the effect of bile on fibroblast cells.%目的研究膽汁對體外培養條件下人成纖維細胞的作用,以探討膽汁在膽道瘢痕形成過程中的作用及其機制.方法術中抽取膽囊息肉病人的膽汁,過濾除菌后稀釋成不同濃度加入到體外培養的人成纖維細胞中,觀察和檢測膽汁對成纖維細胞形態學、細胞增殖活性、細胞周期及凋亡的影響.結果形態學觀察顯示膽汁促進成纖維細胞增殖和表型轉化.MTT檢測結果顯示,成纖維細胞的光密度值隨著加入膽汁濃度的升高而升高,且呈現出一定程度的濃度依賴效應.流式細胞儀檢測結果顯示,與對照組相比,實驗組成纖維細胞凋亡率下降,G0/G1期細胞比例下降,S期細胞比例增加.結論膽汁促進膽道瘢痕的形成和膽道瘢痕性狹窄的產生.完整的膽道黏膜在防止膽汁對成纖維細胞作用方面起到了重要的屏障作用.
28.免鈦夾腹腔鏡膽囊切除452例臨床應用及價值
- 阿扎提江;凱賽爾;于文慶;克力木;牛偉亞;王自立;阿里木;李義亮;張成;艾克拜爾;
- 《中華肝膽外科雜志》 | 2009年第005期
摘要：腹腔鏡膽囊切除術（LC）是目前治療膽囊良性病變的常用手術，使用鈦夾夾閉膽囊管和膽囊動脈，金屬鈦夾長期留在體內其對機體的影響及所產生的并發癥逐漸地引起人們的關注。為此筆者2004年1月至2007年10月采用免鈦夾方法完成腹腔鏡膽囊切除術452例，效果滿意，現報告如下。
29.肝類癌誤診為肝包蟲病一例
- CHEN Lun-jian;TAN Jia-zhong;WANG Long-wen;
- 《中華肝膽外科雜志》 | 2009年第005期
摘要：病人，男，40歲，俄羅斯族，牧民，主訴“間歇性腹脹腹瀉1年”，于2007年10月31日入院。既往：2年前曾在當地兩次行腹腔鏡肝包蟲摘除術。查體：神志清，右側肋下兩橫指可觸及肝下緣，右上腹壓痛（＋）；B超：肝左葉內數個中強回聲影，大小約133mm×94mm，提示：肝內多發實性占位。CT平掃＋增強：肝大，肝內可見大小不等類圓形分隔狀低密度影，增強門脈期肝內病變邊緣及分隔明顯強化，
30.加強對小腸吸收功能與膽石病發生關系的研究
- 韓天權;姜翀弋;王建承;張圣道;
- 《中華肝膽外科雜志》 | 2009年第005期
摘要：20世紀早期，膽石病（主要指膽囊結石）很自然地被認為與膽囊有關，這是由于膽囊壁炎癥為主要的發病原因，脫落的細胞成為膽汁膽固醇的來源。到了60～70年代，Small和Carey的研究建立了膽汁膽固醇過飽和是膽石形成物理化學基礎的學說，肝臟分泌的過量膽固醇構成最主要的發病因素，由此認為膽石病是與肝臟代謝性缺陷相關的疾病。

中華肝膽外科雜志的期刊信息

曾用名：肝膽胰脾外科雜志(95-97年);肝膽胰脾外科雜志;肝膽胰脾外科雜志（95-97年）
創刊時間：1995
地區：CN
語言：中文
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學科分類：外科學;

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