Objective To research the effects of recombinant growth hormone (rhGH) with total parenteral nutrition (TPN) on nitrogen balance and nutritional state of the patients following major abdominal surgery. Methods We randomly selected 45 patients receiving TPN after major abdominal surgery and distributed them to study group (rhGH+TPN, n＝30) and control group (TPN only, n＝15). For 7 days after operation, every one was given rhGH 4u or replaced by hypodermic injection of normal saline (control group). Results TPN+rhGH promoted the rehabilitant of nitrogen balance, heightened the level of plasma albumin and transferrin and increased the weight and creatinin/height index (CHI), but the thickness of triceps skin fold (TSF) had no significant change in patients following major abdominal surgery. Conclusion The rhGH can improve the effects of TPN.
ObjectiveTo investigate the change of cellmediated immunity in gut mucosa after major hepatectomy and to study its relationship with the bacteria translocation.MethodsFortyeight Spraguedawley adult male rats were randomly allocated into two groups, the sham operation group and the operation group. Besides without the hepatectomy, the sham operation group has the same course with the operation group. Seventy percent hepatectomy rats are divided as postoperative 6 h group (n=6)，12 h group (n=6)，24 h group (n=6) and 72 h group (n=6). Sixhour, 12hour, 24hour and 72hour after operation specimens were taken from jejunoileum respectively. Immunohistochemical staining was performed on frozen sections and image pattern analysis was used. We also investigate the change of liver function. ResultsTwentyfour hours and 72 hours after 70% hepatectomy, there was a significant reduction in the number of CD3+，CD4+and CD8+ T lymphocytes in the mucosal lamina propria of the operation group compared with the sham operation group （Plt;0.05）. There was significant difference between these two groups in liver function change （Plt;0.05）.ConclusionThere is an altered pattern of intestinal mucosal T lymphocytes after major hepatectomy, then the local cellmediated immunity was depressed, which may be the cause of translocation of enteric bacteria.
【Abstract】ObjectiveTo compare the effects of self-designed KYL solution on rat liver preservation with UW solution. Methods Using non-circulated isolated perfused rat liver,SD rat livers were randomly preserved for 0、4、8、16、24 and 48 hours with self-designed KYL solution or UW solution. The effects were assessed by measuring the bile production, the contents of AST， ALT，LDH，free radical（ MDA） and SOD in KrebsHenseleit’s perfusate and the content of intracellar calaium of the rat hepatocytes, and by observing the morphological changes in liver. At the same time, the normal saline was used to preserve the rats liver as negative comparison to know if KYL solution and UW solution can prevent the ischemiareperfusion injury in rat liver transplantation.Results At different periods within 16 hours of preservation,the bile production of the rat livers which were preserved by KYL solution were more than those were preserved by UW solution （P＜0.01）, JP2The contents of AST， ALT and LDH in Krebs-Henseleit’s perfusate were near in UW solution’s. The content of intracellar calaium of the rat hepatocytes which were preserved by KYL solution were less than those were preserved by UW solution （P＜0.01）. In KYL group, the content of MDA was lower than that UW group, the content of SOD was higher than that UW group at 24 and 48 h(P＜0.01). Morphological changes in both groups were almost same. All variables of both groups were better than the rat livers preserved by the normal saline. It was proved that both KYL solution and UW solution could protect the rat livers. Conclusion The study indicated that the effects of self-designed KYL solution on rat liver preservation are similar to that of UW solution. The bile production after reperfusion and the content of intracellar calaium of the rat hepatocytes in KYL group are better than those in UW group .The effect of prevention of rat hepatocellular oedema by self-designed KYL solution are worse than that of UW solution.
目的总结1例亲体部分肝移植的临床体会。方法受者为5.5岁男童，诊断为先天性肝脏巨大肿瘤; 供者为患儿母亲，34岁; 切取供者肝脏的左叶并原位移植给患儿。术后给予抗感染、抗免疫排斥反应等支持治疗。结果患儿手术历时9 h，失血250 ml; 供者手术历时3 h，失血450 ml。术后供、受者均健康存活，肝功能正常。结论活体肝部分移植技术是可行的，良好的手术及术后处理是确保肝移植手术成功的关键。
目的探讨肝肾联合移植的手术技术及临床治疗经验。方法对1例原发性弥漫性肝癌、肝硬变合并肾病综合征、慢性肾功能衰竭患者施行一期肝肾联合移植术，肝移植采用改良背驮式肝移植技术，肾移植采用常规方法。术前、术后行全身辅助性化疗。结果移植肝肾发挥功能，无手术并发症发生，术后3个月无肿瘤复发征象及远处转移，AFP下降到25 μg/L以下。结论对常规手术无法切除且无远处转移的肝癌合并肾功能衰竭者行肝肾联合移植，可以取得较好的临床治疗效果。
目的探索乙型肝炎DNA阳性的终末期肝病患者肝移植前快速转阴及肝移植术后复发的防治。方法4例乙型肝炎两对半小三阳、HBVDNA(-)的患者术前开始联合口服拉米夫定(lamivudine) 及泛昔洛韦, 术后3个月内治疗同前, 3个月后仅口服拉米夫定维持至今； 2例乙型肝炎两对半大三阳、HBVDNA(+)的患者, 术前除口服拉米夫定及泛昔洛韦外, 同时肌注乙肝免疫球蛋白共14 d,肝移植术中无肝期快速静脉滴注15 000 u静脉用乙肝免疫球蛋白，术后3个月内联合口服拉米夫定及泛昔洛韦, 术后3个月内治疗同前, 3个月后仅口服拉米夫定维持至今。结果1例患者术后第19天死于肺部霉菌感染,1例患者第49天死于肝动脉及门静脉栓塞; 4例患者长期存活, 生存时间最长的患者已接近3年,术后全部患者均未发现有乙型肝炎复发。结论拉米夫定、乙肝免疫球蛋白及泛昔洛韦联合使用可使乙型肝炎DNA阳性的终末期肝病患者在肝移植前快速转阴，并能预防乙肝复发。