部分肝切除

摘要： 2022年3月,上海交通大学医学院附属新华医院移植科顾劲扬主任联合上海中医药大学附属曙光医院孔晓妮教授在Hepatology在线发表题为C-C motif chemokine ligand 5 confines liver regeneration by down-regulating reparative macrophage-derived hepatocyte growth factor in a forkhead box O 3a-dependent manner的研究论文。该研究发现,在活体肝移植的健康供体和部分肝切除小鼠模型中,阻断趋化因子配体5(C-C motif chemokine ligand 5,CCL5)促进了肝脏再生,从而将CCL5鉴定为肝脏再生的重要负调节因子。该研究提出抑制CCL5是改善肝切除术后肝功能恢复的一种有前景的策略,有望降低肝切除术后肝功能衰竭的死亡率。

摘要： 目的 比较射频消融与部分肝切除术治疗原发性小肝癌的效果.方法 选取2015-08-2017-08间鄢陵县人民医院收治的48例原发性小肝癌患者.将行射频消融治疗的患者作为观察组,行部分肝切除术的患者作为对照组,各24例.比较2组患者术后的肝功能指标、住院时间及住院费用.结果 术后观察组患者的肝功能指标均优于对照组,住院时间及住院费用均少于对照组,差异有统计学意义(P<0.05).结论 与部分肝切除术比较,射频消融治疗原发性小肝癌,对患者术后肝功能影响小,且费用低、疗程短,有利于促进患者的恢复.

摘要： Objective To observe the expression of transforming growth factor alpha (TGF-α) during liver regeneration after partial hepatectomy and splenic artery ligation,and study the influence of the splenic artery ligation on liver regeneration.Methods Seventy-two male rats were randomly divided into three groups:the sham operation group (A group) given the sham operation;70％ hepatectomy group (B group) given 70％ liver resection;70％ hepatectomy and splenic artery ligation group (C group) griven splenic artery ligation and 70％ liver resection.Each group was divided into subgroups of 24,48,72 h after the operation.The expression levels of TGF-α in liver tissues were measured by immunohistochemical methods.Serum TGF-α levels were determined by enzyme-linked immunosorbent assay (ELISA).Results As compared with A group,the levels of serum TGF-α at 24,48 and 72 h after the operation was significantly incressed in the B group [(242.35 ± 9.33),(163.64 ± 9.22),(206.42 ± 8.42) pg/ml] and C group [(259.00 ± 11.50),(170.77 ± 9.04),(212.12 ± 10.63) pg/ml,P =0.000].The ex pression levels of TGF-α in liver tissues were notably increased at 24,48 and 72 h after the operation in the B group and C group (P =0.000).As compared with B group,the level of serum TGF-α and the ex pression of TGF-α in liver tissues were both increased at 24 h after the operation in C group (P =0.006,P=0.019).There were no significant differences between B group and C group in the level of serum TGF-α and the expression of TGF-α in liver tissues at 48 and 72 h (P =0.163,P =0.074,P =0.194,P =0.096).Conclusion The expression of TGF-α at 24 h after the 70％ hepatectomy was promoted by the splenic artery ligation.The finding demonstrated that the splenic artery ligation can promote liver regen eration at early stage (about 24 h) after 70％ liver resection in rats.%目的 观察脾动脉结扎对部分肝切除大鼠肝脏再生过程中转化生长因子-α(TGF-α)表达的影响,探讨脾动脉结扎对肝再生的影响.方法 将72只雄性SD大鼠随机分为3组:假手术组(A组):假手术处理;70％肝切除组(B组):行70％肝切除;70％肝切除±脾动脉结扎组(C组):结扎脾动脉,其余操作同B组.每组再分为3个阶段检测:术后24h、术后48 h、术后72 h,采用免疫组织化学方法检测肝组织中TGF-α的表达,采用酶联免疫吸附试验(ELISA)检测血清中TGF-α的水平.结果 与A组比较,术后24、48和72 h血清TGF-α水平在B组[(242.35±9.33)、(163.64±9.22)、(206.42 ±8.42) pg/ml]和C组[(259.00±11.50)、(170.77±9.04)、(212.12± 10.63) pg/ml]均明显升高(P=0.000);术后24、48、72 h肝组织中TGF-α的表达水平均明显增高(P =0.000).与B组比较,C组术后24 h血清中TGF-α水平和肝组织中TGF-α的表达水平均增高(P=0.006,P=0.019),在术后48、72 h血清中TGF-α水平和肝组织中TGF-α的表达水平与C组比较差异无统计学意义(P=0.163、P=0.074;P =0.194、P=0.096).结论 结扎脾动脉可促进70％肝切除大鼠术后24 h TGF-α的表达,提示脾动脉结扎可能促进了70％肝切除大鼠术后早期(24 h)肝脏的再生.

摘要： 目的 研究白介素22融合蛋白(IL-22-FP)对刀豆蛋白A(ConA)诱导急性肝损伤后行70%肝切除手术(PHx)的小鼠术后肝再生及肝脏保护的作用.方法 建立小鼠ConA肝损伤和PHx手术模型,术后32 h通过过量麻醉法处死小鼠.5-溴脱氧尿嘧啶核苷染色,观察小鼠肝脏再生情况;全自动生化分析仪检测小鼠血清谷丙转氨酶(ALT)和谷草转氨酶(AST)水平;HE染色观察小鼠肝脏组织损伤情况;Western blot法检测小鼠肝组织中增值细胞核抗原(PCNA)、细胞周期蛋白D1(CycliD1)、信号转导子及转录激活子3(STAT3)及p-STAT3蛋白的表达情况.结果 ConA+PHx+IL-22-FP组小鼠同ConA+PHx+rh-IL-22组及其他组小鼠相比,表现出更多的肝细胞增殖和更高的肝指数(肝脏重量/体重);HE染色显示ConA+PHx+IL-22-FP组小鼠肝脏坏死及炎症细胞浸润程度较低;生化检测显示ConA+PHx+IL-22-FP组血清ALT和AST水平明显低于其他组;Western blot结果表明ConA+PHx+IL-22-FP组小鼠的肝脏组织PCNA、CyclinD1和p-STAT3蛋白的表达量也明显高于其他组.结论 IL-22-FP能够促进由ConA诱导肝损伤的小鼠PHx后的肝再生,并表现出显著的肝脏保护作用.%Objective To study the effects of IL-22-Fc fusion protein(IL-22-FP) on liver regeneration and hepatoprotection in mice after partial hepatectomy(PHx) under Concanavalin A(ConA) induced hepatic injury condition.Methods ConA-induced liver injury and partial hepatectomy model was built firstly, liver injury and regeneration was checked at 32 hours after hepatectomy.Hepatic cells proliferation were detected by 5-bromodeoxyuridine staining of liver tissue.The degree of liver injury and hepatic necrosis were demonstrated by HE staining.Serum alanine aminotransferase(ALT) and aspartate aminotransferase(AST) levels in mice were measured with automatic biochemical analyzer.The expression levels of PCNA,CyclinD1 and p-STAT3 protein were tested by Western blot technique.Results Compared with the recombinant human IL-22 treatment group and other groups, both the proliferation of hepatic cells and the liver weight/body weight(LW/BW) ratios of the IL-22-FP treatment group(the experimental group) were significantly increased.The degree of liver necrosis and inflammatory cells infiltration shown in HE staining in the experimental group were apparently reduced.The serum ALT and AST levels were significantly decreased in the experimental group than in the other groups.The expression of PCNA,CyclinD1 and p-STAT3 protein in the experimental group were obviously up-regulated than that in the other groups.Conclusion Treatment with IL-22-FP contributes to the liver protection and regeneration in mice with hepatectomy after ConA-induced liver injury.

摘要： Objectiye This study aims to explore the influence of platelet administration via portal vein on liver regeneration of cirrhotic rats with 30% hepatectomy. Methods In order to establish the model of liver cirrhosis,we used the method of gavage with Carbon tetrachloride oily mixture. According to different interfered factors,cirrhotic rats was divided into the following three groups:platelet injection via the portal vein after 30% hepatectomy group(group 1,n = 18);saline injection via portal vein after 30% hepatectomy group(group 2,n = 18);the only 30%hepatectomy group(group 3,n = 18);another 16 normal SD rats after 30% hepatectomy treated as a normal control group(group 4,n = 16). The liver regeneration were calculated through the calculation of the residual liver weight / body weight ratio and the check of ki67 by immunohisto-chemical staining mothed in postoperative 12 h,24 h and 48 h. Results The residual liver weight / body weight ratio in 48 hours after hepatecto-my in group 1 and group 4 is much more higher than group 2 and 3 with statistical significance( P 0. 05). HE staining of liver cirrhosis tissues showed more proliferation in con-nective tissues,obvious pseudolobules,vacuoles deformation in hepatocellular cells etc. Immunohistochemical results showed that Ki - 67 positive stained cells increased over time. Compared with group 2 and group 3,the proportion of proliferating stained cells in group 1 increased significantly with statistical significance( P < 0. 05). Conclusion Platelet injection via portal vein can promote liver regeneration in cirrhotic rat after partial liver resection and has no significant effect on liver function.%目的：探讨经门静脉输注血小板对肝硬化大鼠行部分肝切除术后残肝再生的影响。方法采用四氯化碳油性混合液灌注，建立肝硬化模型。模型制作成功的 SD 大鼠行30%肝切除后按处理因素的不同分为以下3组：经门静脉注射血小板组（组1，n =18）；经门静脉注射生理盐水组（组2，n =18）：仅行30%肝切手术组（组3，n =18）；另取16只正常 SD 大鼠，行30%肝切作为正常对照组（组4，n =16）。术后12 h、24 h、48 h 测定大鼠血清肝功能，通过计算残肝重量与体重比和肝脏组织 Ki67免疫组化染色来观察肝再生情况。结果术后48 h 所测得的剩余肝脏与体重比值中，组1、组4 较组2、组3 高，差异具有统计学意义（ P <0.05）；在术后12 h、24 h、48 h，各组肝功能变化差异无统计学意义（ P ＞0.05）。肝硬化组别 HE 染色显示结缔组织增生明显，假小叶形成明显，部分肝细胞体积增大，空泡变形，部分肝细胞肝窦间隙增宽。免疫组化结果显示，组1 12 h、24 h、48 h 后，发现有 Ki -67阳性染色细胞，且与组2、3相比，阳性染色细胞的比率明显增加，差异具有统计学意义（ P <0.05）。结论经门静脉注射血小板能促进肝硬化大鼠部分肝切术后肝再生，且对肝功能无明显影响。

摘要： 目的：比较正常及肝纤维化小鼠行肝脏大范围切除后的肝再生情况，研究肝纤维化对肝切除后肝脏损伤和肝再生的影响。方法选择120只C57/BL6小鼠，用随机数字表法将其分为对照组和实验组，每组各60只。实验组背部皮下注射40%四氯化碳（CCl4）玉米油溶液诱导肝纤维化模型，对照组给予等量玉米油。6周后肝纤维化成模，两组行肝左、中叶切除。分别于术后3小时、6小时、12小时、24小时、48小时和72小时处死小鼠，采集血液标本与残存肝脏组织，检测血清丙氨酸转氨酶（ALT）、天冬氨酸转氨酶（AST）水平，肝组织病理，肝重体重比值和增殖细胞核抗原（PCNA），观察肝脏损伤及再生差异。结果肝切除后，实验组各时间点ALT、AST呈先升高后降低趋势，均在12小时达到峰值，且与对照组相比具有统计学差异〔ALT（U/L）：923.11±41.26比869.55±33.65；AST（U/L）：976.69±48.65比744.77±21.42，均P＜0.05〕；肝脏病理显示，实验组正常肝小叶破坏，有假小叶形成，肝细胞索排列紊乱，肝细胞出现变性坏死，损伤较重，而对照组肝小叶及细胞形态正常，损伤较轻；肝体重比及PCNA检测显示，相对于对照组，实验组肝再生延迟或缓慢，增殖细胞核抗原（PCNA）阳性表达细胞数在48小时达到高峰，且PCNA阳性细胞数显著降低〔PCNA阳性细胞数（个）：92.33±10.68比176.33±14.74，P＜0.05〕。结论肝纤维化病变可使小鼠大范围肝切除后肝脏损伤加重，肝再生减缓。%Objective To compare the liver regeneration after a wide range of hepatectomy between normal mice and liver fibrosis mice,studying the influences of liver fibrosis on liver damage and liver regeneration after hepatectomy.Methods A total number of120 C57/BL6 mice were divided into control group and experimental group using random number table, fibrosis was induced in the experimental group by administration of40% carbon tetrachoride(CCl4) corn oil solution, while the control group were given corn oil only. Two groups were subjected to the left and middle hepatic lobe liver resection after6 weeks. The blood samples and remaining liver tissue were collected at3 hours,6 hours,12 hours,24 hours,48 hours and72 hours after hepatectomy to detect the serum alanine aminotransferase(ALT), aspartate transaminase(AST) levels, liver tissue pathology, the liver weight ratio and proliferating cell nuclear antigen(PCNA), the differences of damage and regeneration were observed.Results ALT and AST were significantly higher in the experimental group as compared to the controls after hepatectomy. They reached peak value at12 hours and had significant differences compared with control group〔ALT(U/L):923.11±41.26vs.869.55±33.65;AST(U/L):976.69±48.65vs.744.77±21.42, allP<0.05〕. Pathology results showed that experimental group were damaged more seriously than controls. Liver regeneration was slow in the experimental group as compared to the controls in the liver weight ratio and PCNA staining. In48 hours, it reached peak value and the number of PCNA positive cells were significantly decreased compared with control group(number of PCNA positive cells:92.33±10.68 vs.176.33±14.74, P<0.05).Conclusion Liver fibrosis lesions may aggravate liver injury and slow down the liver regeneration after a wide range of hepatectomy in mice.

摘要： 目的:研究片仔癀对70％肝切除小鼠肝再生的影响,为临床肝再生用药研究提供动物模型.方法:将8周龄雄性C57BL/6小鼠随机分为实验组(片仔癀预处理组)和对照组(生理盐水预处理组).采用70％肝切除方法建立肝再生模型,术前连续两周通过灌胃给予小鼠片仔癀0.2 mg/g体质量(实验组)和生理盐水(对照组).第14天灌胃完片仔癀和生理盐水2h后对两组小鼠分别进行70％肝切除手术(PH).用肝质量/体质量比、实时荧光定量聚合酶链式反应(Real Time PCR)、丙氨酸转氨酶(ALT)和免疫组化等研究方法来评估片仔癀对小鼠部分肝切除手术后肝再生的影响.结果:与对照组相比,70％肝切除手术后48、72、168 h,实验组肝质量/体质量比降低,差异具有统计学意义(P＜0.05);术后12、24、48、72 h,实验组血清ALT水平升高,差异具有统计学意义(P＜0.05);术后12、24、48、72、168 h,实验组肝细胞生长因子(HGF)降低;术后48 h,实验组Ki-67表达量低于对照组.结论:片仔癀对70％肝切除小鼠的肝再生产生抑制作用,延缓了肝再生过程.

摘要： 目的:评价规范化疼痛管理在原发性肝癌部分肝切除患者围手术期中的应用效果.方法:将47例患者随机分为对照组和观察组,对照组采用传统的术后疼痛干预,观察组实施规范化疼痛管理,比较两组患者手术后疼痛评分、肠道通气时间、下床活动时间、睡眠时长、住院天数、住院总费用.结果:观察组患者手术后疼痛评分明显低于对照组,睡眠时长明显长于对照组,肠道通气时间、下床活动时间、住院天数、住院总费用明显短于对照组,两组比较均有统计学意义(P<0.05).结论:规范化疼痛管理有效提高了部分肝切除术后患者的镇痛效果,加快了患者康复,减少了住院费用.

摘要： 肝部分切除后肝脏的再生是一个极其复杂的病理生理过程,涉及多种与细胞增殖有关蛋白基因的上调和转录因子的激活.目前,有关启动、维持及终止肝再生分子机制的研究仍较活跃,是再生医学领域的研究热点之一.研究肝细胞的再生机制可为临床上促进肝脏再生、防治肝衰竭奠定理论基础,具有十分重要临床的意义.本文就部分肝切除后肝细胞再生的启动、增殖和终止的分子机制作一综述.

摘要： Objective:To screen and identify the differential expression of miRNAs in rat serum post traumatic in-jury by the miRNA microarray technique. Methods:We chose partial hepatectomy(PH)as traumatic injury model. The serum ALT,AST,CRP and histological changes of the liver were measured to evaluate the severity of trauma. The miRNA microarray was used to assess the level and composition of serum miRNAs. The target genes of candidate miR-NA were predicted by bioinformatics software(MiRand and TargetScan). Results:There was significantly differential expression of miRNAs in rat serum post traumatic injury(24 miRNAs were more than 2 - fold up - regulated). Espe-cially,the expression of miR - 9 showed the highest up - regulated(more than 50 - fold). The results showed that CDH1,E - cadherin,MTHFD2,PDYN,MCPIP1,BCL2L11,CMA1,Map3k1 may be the target genes of miR - 9. Con-clusion:Injury caused by abdominal operation could make significant change in the spectra and levels of serum miR-NAs,suggesting that miRNAs may be involved in regulating the stress response post trauma.%目的：应用 miRNA 芯片技术建立大鼠腹部手术应激后血清 miRNA 差异表达谱，从中发现与早期手术创伤后应激相关的 miRNAs。方法：建立大鼠部分肝切除手术模型。检测手术前后大鼠血清中 ALT、AST 和CRP 浓度水平及肝脏病理改变，评估腹部创伤后大鼠应激情况。采用 miRNA 表达谱芯片筛选手术前后大鼠血清中差异表达的 miRNAs，并采用实时荧光定量 RT - PCR（real - time RT - PCR）进行验证。采用生物信息学软件（MiRand 和 TargetScan）预测候选 miRNA 的靶基因。结果：血清 miRNA 表达谱出现明显改变，24个miRNAs 在2/3部分肝切除术（PH）后24h 大鼠血清中表达明显升高，特别是 miR -9，其在2/3PH 术后24h 大鼠血清中的表达水平为术前的50多倍，real - time RT - PCR 检测 miR -9的结果与芯片结果相符。通过生物信息学预测，CDH1、E - cadherin、MTHFD2、PDYN、MCPIP1、BCL2L11、CMA1、Map3k1等可能是 miR -9的靶基因。结论：腹部手术创伤后，大鼠血清表达谱发生明显变化，提示 miRNA 可能参与调控创伤后应激反应。

摘要： 完全腹腔镜下绕肝带法二步切除病患侧肝的手术方法：(1)病人在全麻状态下行完全腹腔镜手术，用绕肝带法手术结扎，将待切除的病患侧肝的门静脉分支，同时使用绕肝带束紧左右肝之间的连接部位来阻断待切除的病患侧肝与需保留的半侧肝之间的交通血流，在肝门部留置1根腹腔引流管后关腹，完成第一次手术；(2)病人第一次手术后逐渐恢复饮食，休养6‑15天，使需保留的半侧肝脏的体积增大至预期余肝体积，所述预期余肝体积为标准肝脏体积的30‑40％以上；(3)待病人需保留的半侧肝脏的体积增大至预期余肝体积，然后进行第二次手术，在全麻下行完全腹腔镜手术，将病患半侧肝脏切除，休养至完全康复。还包括专用于上述手术方法的压力可调式肝脏束紧装置。

摘要： 本发明提供一种用于在部分膀胱切除术之后取代膀胱壁的一部分的补片(1)，其包括得自于PGA纱线且设有星形支承框架的纺织物(2)，该框架是柔性的且协调的，由多个径向条带(3)形成，这些条带通过PGA/PLA共聚物注射制造而成，所述补片(1)适合于在插入到患者体内之后使得组织重建过程所产生的自体同源的纤维囊细胞在该补片上生长。

摘要： 本发明公开了用于在部分膀胱切除术后替代一部分膀胱壁的补片(1；100)。具有大约600微米厚度的所述补片(1；100)由多层柔软的硅树脂膜(2)制成，从而使其具有足够的弹性，从而能够经受由于膀胱膨胀和收缩导致的扩张。

摘要： 一种在部分肝脏切除术后促进小鼠肝种植瘤生长的方法，包括小鼠肝癌细胞系的培养、裸鼠肩胛部种植瘤的构建、小鼠不同比例肝脏切除模型的建立、小鼠肝脏种植瘤模型的构建在内的步骤。并对部分肝脏切术后接种瘤组织块，接种后每天经腹腔注射Hh信号抑制剂。本发明的方案表面促进肝切除术后肝再生的Hh信号通路同时也能促进肝种植瘤的生长，提示Hh信号通路可能成为防治肝癌复发和转移的新靶点，阻断Hh信号通路对肝癌复发的防治作用值得进一步研究，本发明的结果对肝癌切除术复发防治的研究具有重要的意义。

摘要： 本发明公开了一种腹腔镜肝切除治疗肝内胆管癌的远期预后的动态列线图模型构建方法、系统及应用。本发明收集了接受腹腔镜根治性肝切除治疗的共365例连续ICC患者的临床病理资料，根据纳入和排除标准，确定最终总队列，并将总队列随机分为训练集和验证集，利用多因素Cox比例风险回归模型筛选出来的远期预后的独立影响因素构建列线图。内部和外部验证证明本发明的基于CA19‑9、CA12‑5、腔镜术中中转开腹和淋巴结转移状态等肝内胆管癌患者腹腔镜肝切除术后远期预后的独立危险因素构建的生存列线图模型具有较好的区分度、校准度和临床实用性。这有助于临床医生对接受腹腔镜肝切除的肝内胆管癌患者的远期预后进行早期预测，并根据预测结果采取及时有效的诊治措施。

摘要： 本发明提供一种用于在部分膀胱切除术之后取代膀胱壁的一部分的补片(1)，其包括得自于PGA纱线且设有星形支承框架的纺织物(2)，该框架是柔性的且协调的，由多个径向条带(3)形成，这些条带通过PGA/PLA共聚物注射制造而成，所述补片(1)适合于在插入到患者体内之后使得组织重建过程所产生的自体同源的纤维囊细胞在该补片上生长。

摘要： 本发明公开了用于在部分膀胱切除术后替代一部分膀胱壁的补片(1；100)。具有大约600微米厚度的所述补片(1；100)由多层柔软的硅树脂膜(2)制成，从而使其具有足够的弹性，从而能够经受由于膀胱膨胀和收缩导致的扩张。

摘要： 本发明公开了一种基于腰部横切口的肝肿瘤切除装置，包括支撑套，支撑套的内部开设有工作孔，工作孔中装设有用于固定腹腔镜的支撑座，工作孔一侧区域用于放置抓钳和电刀，另一侧区域用于放置电钩和可吸收夹；抓钳与电钩协同配合以实现明确肿瘤位置、显露出肝右后叶、分离肝脏周围粘捏离断三角韧带及右冠状韧带，电刀沿着肿瘤边缘画出预切线，并结合ligasure沿着预切线逐步解剖分离出肝血管瘤。本发明结构简单，适用于只需在腰部右侧开3cm的口就能进行手术的改进方法，规避传统在肚子上开很大的口带来的术中风险以及术后恢复问题。

摘要： 本公开提供了包含与支持物偶联并且包含一个或多个可切割或可切除部分的核酸分子的组合物。还提供了富集并测序核酸分子的方法。

摘要： 用肝刷可以将肝细胞刷除，实行肝部分切除手术。肝刷包括刷毛、刷毛载体和手柄等。刷毛采用尼龙线制成，长度为10～15mm，直径为0.3～0.5mm。肝刷包括手动和电动两种。电动圆柱形刷轮可以通过软轴驱动。用此法时沿切割线刷出一条沟槽，保留直径0.5mm以上的肝内管道，结扎后切断。术中肝脏管道系统处于封闭状态，血液、胆汁不会外流，所以不必阻断肝门，无缺血、缺氧坏死之忧。术后并发症机率低，降低了手术风险。