目的 探讨白试验在肝切除手术中检测漏胆的价值。方法 笔者所在医院2008年1月至2013年1月期间在肝切除手术中采用白试验联合干纱布擦拭法检测漏胆56例。即在肝切除手术操作末期，用干纱布擦拭法确认无漏胆后，经胆囊管或左右肝管插管注入5%无菌脂肪乳剂10～30mL，同时用手阻断远端胆总管。观察肝切除手术创面的白色液体渗出情况，对渗出白色液体处予以间断缝合。重复操作，至断面无白色液体渗出为止。结果 56例患者经术中检测，发现漏胆17例（漏胆检出率为30.4%），每例发现漏胆1～6处（平均2.9处），术中均予以确切缝合以关闭漏胆处，且重复试验操作，证实均再无漏胆。术后发生漏胆2例（3.6%），经相应治疗后痊愈出院。全部患者出院后均随访3～6个月（平均3.8个月），无膈下积液或膈下感染病例发生。结论 术中白试验能够发现漏胆的精确部位，不会污染肝切除手术创面，并能够无限次地重复试验，值得临床推广。
ObjectiveTo explore the relationship between the expressions of fibronectin (FN) and phosphatase and tensin homology deleted on ehromosome ten (PTEN) in hepatocellular carcinoma (HCC) tissues and the clinical pathological features. MethodsThe expressions of FN and PTEN were detected by using Western blot and immunohistochemistry respectively in 83 HCC tissues and para-carcinoma tissues, 47 hepatic cirrhosis tissues and 11 normal hepatic tissues. The correlations between the expressions of FN and PTEN and the clinicopathologic features of HCC patients were analyzed. ResultsThe positive expression rate of FN protein in HCC tissues was significantly higher than those in para-carcinoma tissue, normal hepatic tissue, and liver cirrhosis tissues (P<0.05); meanwhile the expression of PTEN was opposite (P<0.05). The positive expression rate of FN protein in para-carcinoma tissues was also obviously higher than that liver cirrhosis tissues and normal hepatic tissues (P<0.05), meanwhile the expression of PTEN was opposite (P<0.05). The positive expression rate of FN protein was higher in HCC tissues with cancer embolus, lymphatic metastasis, positive AFP, and multiple tumor (P<0.05), but there were no statistically significant differences in FN protein expression, gender, age, HBsAg, degree of tumor differentiation, and size of tumor (P>0.05). The positive expression rate of PTEN was lower in HCC tissues with high-medium differentiation, cancer embolus, positive AFP, lymphatic metastasis, and tumor diameter ≥2 cm (P<0.05), there were no statistically significant differences in PTEN expression, gender, age, HBsAg, and the number of tumor (P>0.05). ConclusionsThe abnormal expressions of FN and PTEN in HCC tissues which may play a role in promoting or inhibiting occurrence, development, invasion, and metastasis of HCC. The abnormal expressions of both can be used as molecular biological markers for the malignant degree, invasion, and metastasis of HCC.