Nested stromal-epithelial tumour of the liver:An unusual liver entity

Nested stromal-epithelial tumours(NSETs)of the liver have been reported to be extremely unusual primary hepatic neoplasms.To date,few cases have been described in the literature.NSETs have been defined as non-hepatocytic and non-biliary tumours of the liver consisting of nests of epithelial and spindled cells,myofibroblastic stroma and variable intralesional calcification and ossification.Here,we report a case of a young female who underwent liver resection for a large hepatic lesion that proved to be a calcifying NSET on pathological examination.Details about the clinical and histopathological features of the tumour are reported.

Zinc-α2-glycoprotein 1 attenuates non-alcoholic fatty liver disease by negatively regulating tumour necrosis factor-α

BACKGROUND Zinc-α2-glycoprotein 1 (AZGP1) plays important roles in metabolism-related diseases. The underlying molecular mechanisms and therapeutic effects of AZGP1 remain unknown in non-alcoholic fatty liver disease (NAFLD). AIM To explore the effects and potential mechanism of AZGP1 on NAFLD in vivo and in vitro. METHODS The expression of AZGP1 and its effects on hepatocytes were examined in NAFLD patients, CCl4-treated mice fed a high fat diet (HFD), and human LO2 cells. RESULTS AZGP1 levels were significantly decreased in liver tissues of NAFLD patients and mice. AZGP1 knockdown was found to activate inflammation;enhance steatogenesis, including promoting lipogenesis [sterol regulatory elementbinding protein (SREBP)-1c, liver X receptor (LXR), fatty acid synthase (FAS), acetyl-CoA carboxylase (ACC), and stearoyl CoA desaturase 1 (SCD)-1], increasing lipid transport and accumulation [fatty acid transport protein (FATP), carnitine palmitoyl transferase (CPT)-1A, and adiponectin], and reducing fatty acid β-oxidation [farnesoid X receptor (FXR) and peroxisome proliferator-activated receptor (PPAR)-α];accelerate proliferation;and reverse apoptosis in LO2 cells. AZGP1 overexpression (OV-AZGP1) had the opposite effects. Furthermore, AZGP1 alleviated NAFLD by blocking TNF-α-mediated inflammation and intracellular lipid deposition, promoting proliferation, and inhibiting apoptosis in LO2 cells. Finally, treatment with OV-AZGP1 plasmid dramatically improved liver injury and eliminated liver fat in NAFLD mice. CONCLUSION AZGP1 attenuates NAFLD with regard to ameliorating inflammation, accelerating lipolysis, promoting proliferation, and reducing apoptosis by negatively regulating TNF-α. AZGP1 is suggested to be a novel promising therapeutic target for NAFLD.

Rare presentation of self-resolving multifocal inflammatory pseudo-tumour of liver

Inflammatory pseudo-tumour(IPT) of the liver is a rare condition with the appearance of a tumour-like space occupying lesion. Aetiology and natural history is not known for these benign lesions, as they are commonly diagnosed as malignant lesions and frequently undergo surgical resection since spontaneous resolution is very rare. Multifocal IPT involving both lobes of liver are rarely reported. Here we report a unique case of multifocal IPT of the liver which resolved spontaneously within 5 wk period.

Liver transplantation for hilar cholangiocarcinoma

The most appropriate treatment for Klatskin tumor(KT)with a curative intention is multimodal therapy based on achieving resection with tumour-free margins(R0resections)combined with other types of neoadjuvant or adjuvant treatment(the most important factor affecting KT survival is the possibility of R0 resections,achieving 5-year survival rate of 40%-50%).Thirty to forty percent of patients with KT are inoperable and present a 5-year survival rate of 0%.In irresectable non-disseminated KT patients,using liver transplantation without neoadjuvant treatment,the 5-year survival rate increase to 38%,reaching 50%survival in early stage.In selected cases,with liver transplantation and neoadjuvant treatment(chemotherapy and radiotherapy),the actuarial survival rate is 65%at 5 years and 59%at 10 years.In conclusion,correct staging,neoadjuvant treatment,living donor and priority on the liver transplant waiting list may lead to improved results.

Living donor liver transplantation with abdominal wall reconstruction for hepatocellular carcinoma with needle track seeding

Malignant cell seeding in subcutaneous tissues along the needle track and/or percutaneous biliary drainage catheters is rare complication, but pose various technical issues in planning surgical treatment of such patients. If underlying primary hepatic malignancy can be treated, an aggressive resection of subcutaneous tissue bearing cancer cell with subsequent abdominal wall reconstruction has been sporadically reported. But, when hepatic resection is not possible due to underlying advanced cirrhosis, liver transplantation along with abdominal wall resection and subsequent reconstruction remains only feasible option. Herein, we describe our successful experience of living donor liver transplantation for hepatocellular carcinoma with fullthickness abdominal wall resection bearing the tumor seeding followed by reconstruction in single stage surgery.

Towards a Field Theoretical Stochastic Model for Description of Tumour Growth

We develop a field theory-inspired stochastic model for description of tumour growth based on an analogy with an SI epidemic model, where the susceptible individuals (S) would represent the healthy cells and the infected ones (I), the cancer cells. From this model, we obtain a curve describing the tumour volume as a function of time, which can be compared to available experimental data.

Retrospective cohort study of statin therapy effect on resected colorectal liver metastases

BACKGROUND Above and beyond their role in cardiovascular risk reduction,statins appear to have a chemopreventive role in some gastro-intestinal cancers.In the quest for new chemopreventive agents,some existing established drugs such as statins have shown potential for re-purposing as chemoprevention.Probing existing drugs,whose pharmacodynamics are familiar,for novel beneficial effects offers a more cost-effective and less time-consuming strategy than establishing brand new drugs whose pharmacodynamic profile is unfamiliar.Observational studies show statins decrease the risk of developing colorectal cancer but there are no published studies exploring the potential impact of statins on carcinogenesis in colorectal liver metastases(CRLM).AIM To evaluate impact of statins on outcomes of CRLM resection,and secondarily to assess if statins influence CRLM histo-pathology.METHODS We conducted a retrospective cohort study of patients operated for CRLM over a 13-year period from 2005 to 2017.Patients were identified from a prospective database maintained in our Tertiary care hospital.All 586 patients included the study had undergone resection of CRLM following discussion at multidisclipinary team meeting,some patients requiring neoadjuvant chemotherapy to downstage CRLM prior to surgery.We analysed patient demographics,operative details,CRLM histopathology,Index of Deprivation,neutrophil-to-lymphocyte ratio,platelet-to-lymphocyte ratio and chemotherapy use in relation to clinical outcome.Statistics were performed using SPSS version 16.0;significance taken at 5%.RESULTS Liver resection for CRLM was undertaken in 586 patients at a median age of 68(range 19 to 88)years.Statin therapy was used by 181 patients.Median follow-up time was 23(range 12-96)mo and further colorectal cancer metastases developed in 267 patients.A total of 131 patients died.Multi-variate analysis identified 6 independent predictors of poorer disease-free survival:Synchronous presentation,multiple tumours,tumour size≥5 cm,moderate-severe steatosis,peri-neural invasion,and R1-resection margin.Poorer overall survival was significantly associated with neo-adjuvant chemotherapy,major hepatectomy,peri-neural invasion and R1-resection margin.Neither histo-pathological nor radiological traits of CRLM were affected by statins,and,there was no demonstrable effect of statin therapy on patient outcomes.CONCLUSION Statin therapy does not affect patient survival following liver resection for CRLM.We postulate the reason for this key finding is that statins do not modulate tumour biology of CRLM.

肝细胞肝癌肿瘤标志物诊断的新进展

中国疾病预防控制中心数据显示,肝癌位居我国恶性肿瘤死因第2位,是死亡率较高的恶性肿瘤。肝癌具有早期诊断困难(约50%漏诊)、恶性程度高、异质性强及进展迅速等特点,早期诊断可提升治疗效果,延长患者生存期。肝癌的主要病理类型为肝细胞肝癌(hepatocellular carcinoma,HCC),其肿瘤标志物包括甲胎蛋白(α-fetoprotein,AFP)、维生素K缺乏或拮抗剂Ⅱ诱导的凝血酶原(protein induced by vitamin K deficiency or antagonist-Ⅱ,PIVKA-Ⅱ)、α-L-岩藻糖苷酶(α-L-fucosidase,AFU)等,检测简单且高效,但由于HCC的异质性,部分患者的标志物水平未出现异常,52%的小型HCC(<3 cm)患者为AFP阴性,影响HCC诊断的准确率。一些新型肿瘤标志物已被发现,包括循环肿瘤细胞(circulating tumour cell,CTC)、循环游离核酸(包括循环游离DNA(circulating cell-free DNA,cfDNA)和微小RNA(microRNA,miRNA)以及外泌体等。90.81%的CTC阳性HCC患者(包括早期疾病患者),在随访3~5个月后可检测到非常小的HCC结节,表明CTC与HCC特征高度相关,术后监测CTC水平可在临床检测到复发结节出现之前预测HCC复发;cfDNA可作为HCC早期诊断的有效工具,而检测ctDNA内的突变可指导靶向治疗;miRNA可作为诊断疾病和监测疾病进展、预后情况的生物标志物;联合检测AFP与lncRNAs Panel(包含3种循环外泌体来源的长链非编码RNA,即ENSG00000248932.1、ENST00000440688.1、ENST00000457302.2)显示出比单独检测AFP更高的灵敏度和特异度(曲线下面积为0.910和0.408),可预测HCC的发生并动态监测HCC的转移。但这类新型肿瘤标志物仍具有一定的局限性,如由于这类标志物通常以较低水平存在,可能会导致较高的假阴性,并且缺乏标准化的分析前变量和分析变量,在稳定性方面具有局限性。这类肿瘤标志物目前仍不建议独立用于HCC的早期筛查、监测或是在临床上大规模应用,仅可作为传统诊断方法的补充。本文将对近年来肿瘤标志物在HCC诊断中的研究进展进行综述,总结传统肿瘤标志物(AFP、PIVKA-Ⅱ和AFU等)效能,介绍新型肿瘤标志物(CTC、cfDNA、ctDNA、miRNA和外泌体等)的研究进展及临床应用,并对未来提升HCC诊断准确率进行展望。

Glisson蒂横断式肝切除术在小儿肝脏肿瘤手术中的应用效果分析

目的分析Glisson蒂横断式肝切除术在小儿肝脏肿瘤手术中的应用效果。方法回顾性分析2019年10月至2022年10月山西省儿童医院普外科收治的18例原发性肝脏肿瘤患儿的临床资料,对治疗结果及患者预后进行总结分析。结果18例患儿均通过Glisson蒂横断式肝切除术成功行相应的肝段或肝叶切除,均未发生围术期死亡,手术时间为(204.52±46.84)min,术中出血量为(245.73±56.86)ml,术中输血量为(200.84±50.57)ml。与术前相比,患儿术后1周血小板(PLT)和总胆汁酸(TB)水平降低,差异有统计学意义(P<0.05)。白细胞(WBC)、红细胞(RBC)、血红蛋白(Hb)、甲胎蛋白(AFP)、白蛋白(ALB)、谷草转氨酶(AST)、谷丙转氨酶(ALT)和乳酸脱氢酶(LDH)等指标在手术前后比较差异无统计学意义(P>0.05)。7例肝母细胞瘤患儿术后血清AFP较术前显著升高[234.00(44.00,550.00)vs 140.00(23.00,495.00);Z=4.846,P=0.018]。截至2023年6月,10例良性肝肿瘤患儿生长发育正常,均未复发,生存率为100%;8例恶性肝肿瘤患儿中,1例肝母细胞瘤患儿在术后6个月复发,予C5VD方案化疗3个疗程,复查腹部CT示肿瘤体积明显缩小,其余7例术后未复发。结论Glisson蒂横断式肝切除术治疗小儿原发性肝脏肿瘤安全、有效。

结直肠癌肝转移预测及预后的影像组学综述

结直肠癌在国内外都是高发病率和高死亡率的肿瘤疾病,肝脏是结直肠癌血行转移最主要的靶器官,尽早准确地预测结直肠癌肝转移的发生以及监测患者治疗的预后反应,对患者的诊断和治疗尤为关键。新兴的影像组学为精准预测结直肠癌肝转移以及评估预后提供新的可能。对现有的结直肠癌肝转移影像组学研究进行综述,首先介绍结直肠癌肝转移研究的临床意义以及现有研究存在的缺陷,然后阐述结直肠癌肝转移影像组学的分析流程,接着对结直肠癌肝转移影像组学的4个研究方向展开综述,包括肝转移病理生长模式预测、隐匿性肝转移预测、肝转移疗效预后评估、肝转移患者生存期预后评估;阐明各个方向的最新研究进展及存在的缺陷性;最后对结直肠癌肝转移影像组学的未来发展趋势进行展望。

扩散加权成像b值大小对肝脏良恶性病变的鉴别诊断价值

目的探讨不同b值情况下扩散加权成像ADC值对肝脏良恶性病变的鉴别诊断价值。方法 76例肝占位性病变、11例肝硬化病人行CT及MRI平扫加增强,DWI扫描,选取3种b值(300,500,700s/mm2)各扫描1次,测量正常肝脏及肝硬化肝脏的ADC值。同时测量病灶及相同层面的肝右叶无病灶肝实质ADC值,比较正常肝脏及肝硬化肝脏在3种b值时ADC值有无显著性差异,良恶性病变的ADC值及病灶与周围肝组织ADC值比值有无显著性差异。正常对照组30例,CT或MRI检查肝脏未见异常改变,肝功能化验各项指标均正常,CT和MR、DWI扫描方法同上。应用2个独立样本的Wilcoxon秩和检验进行统计学分析,比较良、恶性病变的ADC值是否有显著性差异。结果 76例肝脏占位性病变,恶性肿瘤25例,其中肝细胞肝癌13例,转移瘤10例,胆管细胞癌2例;良性病变51例,其中海绵状血管瘤23例,肝囊肿18例,肝脓肿7例,局灶性结节增生(FNH)3例。3种b值下正常肝脏的ADC值无显著性差异;正常肝脏与肝硬化的ADC值比较无显著性差异;恶性肿瘤ADC值明显低于良性病变,统计学上有显著差异(P<0.05),b=300时,以1.6×10-3mm2/s为阈值,鉴别良恶性病变的敏感性、特异性和准确性分别为71.4%、80.6%和76.9%;b=500时,以1.65×10-3mm2/s为阈值,分别为95.0%、78.1%和73.1%;b=700时,以1.41×10-3mm2/s为阈值,分别为90%、77.5%和77.5%;恶性、良性病变病灶ADC/肝脏ADC比值比较具有显著性差异,P<0.05;以病灶与肝脏ADC的比值小于1.0为阈值,b=300时,诊断恶性病变的敏感性、特异性和准确性分别为60.0%、81.8%和73.6%;b=500时,分别为65.0%、86.1%和78.6%;b=700时,分别为75.0%、94.9%和88.1%。肝脓肿的ADC值变化较大,波动范围0.98～2.61×10-3mm2/s。结论肝脏恶性肿瘤的ADC值显著低于良性病变,恶性病灶与周围肝实质ADC值比值低于良性病变比值,取b=500,以ADC值1.65×10-3mm2/s为阈值,敏感性和特异性较高。但良恶性病变的ADC值仍有部分重叠,肝脓肿的ADC值变化差异较大,需结合常规MRI检查及临床症状和实验室检查。

64层螺旋CT在射频消融治疗肝脏肿瘤中的应用价值

目的:探讨64层螺旋CT在射频消融治疗肝脏肿瘤中的应用价值。方法:总结89例肝脏肿瘤患者在CT引导下行射频消融的治疗情况,根据病变的不同,选择合适的扫描方法和重建方式,合理应用64层螺旋CT的薄层重建、多平面重建、快速扫描、增强扫描及其特有的穿刺活检软件等,及时观察电极针在病灶中的位置及与周围组织关系。结果:在64层螺旋CT的引导下,穿刺针100%插入肿瘤内部,实时地观察扫描结果,能够尽量避免并发症的发生,当出现并发症后可以及时发现处理。多平面重建后,多角度观察能够避开肿瘤周围的重要结构,肿瘤的残留少,射频消融的效果好。治疗有效率可达95%以上。结论:合理应用64层螺旋CT,能够使肿瘤与周围结构显示清晰,达到射频消融的效果,还可以降低患者的辐射剂量。

电针足三里对脓毒症大鼠促炎症因子所致肝损伤的保护作用

目的研究电针足三里(ST36)对脓毒症大鼠促炎症因子所致肝损伤的保护作用。方法雄性SD大鼠32只,采用盲肠结扎穿孔术(CLP)制备大鼠脓毒症模型,随机分为CLP+电针(electr-acupanctrue,EA)足三里组(CLP/EA组)、CLP+假电针(shame EA)组(CLP/SEA组)、迷走神经切断(vagotomy,VA)+CLP组(VA/CLP)和迷切后CLP再电针组(VA/CLP/EA组),每组8只。EA组持续针刺双侧足三里30min,强度为2mA,2-100Hz。CLP/SEA组采用相同频率和强度刺激非经非穴(足三里外侧旁开0.5cm)30min。VA组先手术切断腹腔迷走神经再行CLP。各组大鼠于CLP术后6h取血检测血浆谷丙转氨酶(ALT)活性,然后处死取肝组织,检测肿瘤坏死因子-α(TNF-α)和一氧化氮(NO)含量、髓过氧化物(MPO)活性以及肝组织含水率。结果 CLP后6h,CLP/EA组肝组织促炎因子TNF-α、NO、MPO水平、ALT活性及肝组织含水率均显著低于其余3组(P<0.05);VA/CLP组和VA/CLP/EA组TNF-α、NO和ALT显著高于CLP/SEA组(P<0.05);VA/CLP/EA组与VA/CLP组上述指标的变化无统计学差别(P>0.05)。结论电针足三里显著抑制CLP大鼠肝脏促炎症因子水平,减轻肝组织水肿和功能损害;切断腹腔迷走神经能显著减轻或消除EA的作用,上调肝组织促炎症因子水平、加重肝组织损害。电针足三里的抗炎和肝损伤保护机制可能与兴奋胆碱能抗炎通路有关。

肝动脉栓塞化疗治疗巨块型肝癌

目的 探讨肝动脉栓塞化疗对巨块型肝癌的治疗作用。方法 回顾性分析 46例不可切除的巨块型肝癌栓塞化疗的治疗效果。肿瘤直径 1 2～ 1 9cm,平均 1 3.73± 1 .2 7cm。 35例经皮股动脉穿刺插管肝动脉栓塞化疗 ,1 1例不成功者行开腹插管肝动脉栓塞化疗。每例栓塞化疗 1～ 6次(平均 2 .4次 )。结果 1 8例获二期切除 ;1年、2年、3年及 5年生存率分别为 73.9%、44.4%、42 .9%及 2 3.5%。结论 肝动脉栓塞化疗是不能切除的巨块型肝癌的有效治疗方法。

肝脏良性占位性病变41例外科治疗分析

目的总结和探讨常见肝脏良性占位性病变及其外科治疗。方法回顾性分析41例肝脏良性占位性病变的分类及外科治疗。结果肝血管瘤18例,肝囊肿6例,肝脓肿5例,肝包虫病3例,肝细胞腺瘤2例,硬化性结节2例,肝平滑肌瘤1例,肝血管平滑肌脂肪瘤1例,炎性肉芽肿1例,局限性脂肪增生1例,结核1例。手术治愈率100%。并发症发生率12.2%(541)。结论肝切除术是治疗肝脏良性占位性病变的安全、有效方法。

丹参对大鼠肝癌恶性梗阻性黄疸时肝癌发展的影响

目的:观察大鼠恶性梗阻性黄疸时丹参对肝癌发展的影响。方法: 用Walker 256肝癌株近肝门部肝实质内种植致移植性肝癌侵袭高位胆管,造成胆道癌性狭窄,建立SD大鼠恶性梗阻性黄疸模型。将模型鼠随机分成4组,在腹腔内分别注射等量的生理盐水 (n=12)、肌苷 +维生素C(n=20)、丹参 (n=20)和 5 氟尿嘧啶 (n=20),观察其对肝癌发展的影响。结果:丹参组肝癌瘤体体积减小、抑癌率及抑转移率明显高于生理盐水组和肌苷+维生素C组,差异有统计学意义(P< 0. 01);而与 5 氟尿嘧啶组比较差异无统计学意义 (P>0. 05)。结论:丹参在肝癌致梗阻性黄疸时具有抑制肝癌生长、转移作用。

乙肝病毒阳性的实体瘤患者化疗期间肝功能变化

目的 观察乙肝病毒阳性的实体瘤患者化疗期肝功能变化 ,了解肝功能损伤与疾病种类及乙肝标志物的关系。方法 2 0 0例乙肝病毒阳性的住院实体瘤患者接收全身化疗或动脉插管化疗 ,化疗前后检测肝功能变化。结果 Ⅰ度以上肝功能损害占 4 0 5 % (81/ 2 0 0 ) ,病种以恶性淋巴瘤和原发性肝癌居多 ,乙肝标志物中以HBsAg(+ )及HBeAb(+ )者肝功能损害发生率高 ,HBsAb(+ )者发生率低。结论 乙肝病毒阳性的实体瘤患者化疗期肝功能损伤发生率较高 ,尤其恶性淋巴瘤及HBsAg、HBeAb阳性患者 ,化疗前常规检测乙肝标志物十分必要。

无锡太湖水域藻类毒素污染与人群健康关系研究

[目的 ] 揭示无锡太湖水域藻类毒素污染现状 ,初步探讨微囊藻毒素 (Microcystin ,MC)对人群肝脏酶影响和与消化道恶性肿瘤死亡率的关系。 [方法 ] 设暴露组和非暴露组 ,调查水样和鱼样MC含量及消化道肿瘤死亡率。 [结果 ] 水样总的阳性率为 2 9.35 %,均值为 14 13.0 2pg/mL ,太湖水阳性率最高为 10 0 %,深井水最安全。 7种鱼类MC阳性率为 10 0 %,肝脏中MC均值高于肌肉 ,分别为 2 8.8ng/ g和 4.0ng/ g。肝脏酶指标GGT和AP暴露组高于非暴露组 ,差异有极显著性 (P <0 .0 1)。随着水中MC暴露等级的升高 ,男性各部位合计肿瘤标化死亡率也升高 ,而女性不明显。 [结论 ] 无锡太湖水域MC污染严重 ,常规水处理不能将毒素完全去除 ,MC污染饮水—湖中生物—动物链状危险确已存在 ,对人群健康已构成一定威胁 ,必须引起重视。

^(125)I-抗AFP抗体介入导向治疗肝癌的药物体内代谢和疗效观察

目的 :研究 1 2 5I 抗AFP抗体经肝动脉介入灌注后的体内代谢特点 ,并探讨导向综合治疗中晚期原发性肝癌的疗效。方法 :经肝动脉灌注 1 2 5I 抗AFP结合化疗栓塞 (TACE)和静脉滴注CD3 AK细胞综合治疗原发性肝癌患者 2 1例 ,检测 1 2 5I 抗AFP抗体在病人体内的药代动力学各项参数及体内生物学分布特点 ,并对比观察导向治疗组与对照组临床疗效。结果 :1 2 5I 抗AFP抗体血中放射性T1 2 α、T1 2 β分别为 1.85± 1.79及 15 6 .46± 6 5 .11小时 ,尿放射活性半排时间为 94小时 ,器官体表外辐射强度测定提示肝脏相对其他器官有强度较强及时间较长的放射性积蓄 ,肝脏SPECT检查瘤 肝比平均值为 2 .1± 0 .6 ,。导向组和对照组的有效率为 6 1.9%(13 2 1)与 2 5 .0 %(5 2 0 ) ,1年累计生存率比较亦为 6 1.9%与 2 5 .0 %,差异均有显著性 (P <0 .0 5 )。结论 :1 2 5I 抗AFP抗体经肝动脉给药后可选择性滞留在肝肿瘤内较长时间而起持续内照射作用 ,与TACE和免疫治疗应用是肝癌综合治疗的有效方案。

肝素盐水联合无水乙醇清洗手术器械祛除灭活肿瘤细胞的研究

目的 探讨适用于术中快捷、彻底的器械无瘤处理方法,以提高恶性肿瘤术中器械肿瘤细胞无瘤处理效果.方法 选择T1～3N0M0分级原发性肝癌行肿瘤切除患者60例,将手术切除肿瘤时所使用的器械随机分为肝素盐水组、无水乙醇组、肝素盐水联合无水乙醇组（联合组）以及生理盐水组（对照组）四组,分别置于肝素盐水、无水乙醇、生理盐水中以5～6次/s频率震荡涮洗10s,其中联合组顺序为肝素盐水5 s、无水乙醇5 s.各组获得60份样本.检测四组手术器械涮洗液及四种方法处理后器械残留的肿瘤细胞数.结果 四组器械残留及携带肿瘤细胞数和阳性率比较,差异有统计学意义（均P＜0.01）,其中联合组细胞数和阳性率均为0.结论 肝素盐水涮洗器械能快速祛除肿瘤细胞,无水乙醇涮洗器械能快速灭活肿瘤细胞;肝素盐水联合无水乙醇涮洗,使手术器械无瘤效果达到最佳.