Does enhanced recovery after surgery programs improve clinical outcomes in liver cancer surgery?

Enhanced recovery after surgery(ERAS)programs have been widely applied in liver surgery since the publication of the first ERAS guidelines in 2016 and the new recommendations in 2022.Liver surgery is usually performed in oncological patients(liver metastasis,hepatocellular carcinoma,cholangiocarcinoma,etc.),but the real impact of liver surgery ERAS programs in oncological outcomes is not clearly defined.Theoretical advantages of ERAS programs are:ERAS decreases postoperative complication rates and has been demonstrated a clear relationship between complications and oncological outcomes;a better and faster posto-perative recovery should let oncologic teams begin chemotherapeutic regimens on time;prehabilitation and nutrition actions before surgery should also improve the performance status of the patients receiving chemotherapy.So,ERAS could be another way to improve our oncological results.We will discuss the literature about liver surgery ERAS focusing on its oncological implications and future investigations projects.

Clinical observation of gastrointestinal function recovery in patients after hepatobiliary surgery

BACKGROUND The liver is an important metabolic and digestive organ in the human body,ca-pable of producing bile,clotting factors,and vitamins.AIM To investigate the recovery of gastrointestinal function in patients after hepato-biliary surgery and identify effective rehabilitation measures.METHODS A total of 200 patients who underwent hepatobiliary surgery in our hospital in 2022 were selected as the study subjects.They were divided into a control group and a study group based on the extent of the surgery,with 100 patients in each group.The control group received routine treatment,while the study group re-ceived targeted interventions,including early enteral nutrition support,drinking water before gas discharge,and large bowel enema,to promote postoperative gastrointestinal function recovery.The recovery of gastrointestinal function was compared between the two groups.RESULTS Compared with the control group,patients in the study group had better recovery of bowel sounds and less accumulation of fluids in the liver bed and gallbladder fossa(P<0.05).They also had shorter time to gas discharge and first meal(P<0.05),higher overall effective rate of gastrointestinal function recovery(P<0.05),and lower incidence of postoperative complications(P<0.05).CONCLUSION Targeted nursing interventions(early nutritional support,drinking water before gas discharge,and enema)can effectively promote gastrointestinal function recovery in patients undergoing hepatobiliary surgery and reduce the incidence of complications,which is worthy of promotion.

Enhanced recovery after surgery program in the patients undergoing hepatectomy for benign liver lesions

Background:Enhanced recovery after surgery(ERAS)has shown effectiveness in terms of reducing the hospital stay and cost.However,the benefit of ERAS in patients undergoing hepatectomy for benign liver lesions is still unclear.Methods:ERAS was implemented in our center since March 1st,2018.From September 2016 to Febru-ary 2018,109 patients were enrolled into the control group,and from March 2018 to June 2019,124 patients were enrolled into the ERAS group.All the indicators related to operation,liver functions,and postoperative outcomes were included in the analysis.Results:The clinicopathologic baselines were similar in these two groups.A significantly higher propor-tion of patients underwent laparoscopic surgery in the ERAS group.On the whole,intraoperative blood loss(100.00 mL vs.200.00 mL,P<0.001),blood transfusion(3.23%vs.10.09%,P=0.033),total bilirubin(17.10μmol/L vs.21.00μmol/L,P=0.041),D-dimer(2.08μg/mL vs.2.57μg/mL,P=0.031),postoperative hospital stay(5.00 d vs.6.00 d,P<0.001),and postoperative morbidity(16.13%vs.32.11%,P=0.008)were significantly shorter or less in the ERAS group than those in the control group.After stratified by operation methods,ERAS group showed significantly shorter postoperative hospital stay in both open and laparoscopic operation(both P<0.001).In patients underwent open surgery,ERAS group demonstrated significantly shorter operative duration(131.76±8.75 min vs.160.73±7.23 min,P=0.016),less intra-operative blood loss(200.00 mL vs.450.00 mL,P=0.008)and less postoperative morbidity(16.00%vs.44.44%,P=0.040).Conclusions:ERAS program may be safe and effective for the patients underwent hepatectomy,especially open surgery,for benign liver lesions.

Pre-hepatectomy type Ⅳ collagen 7S predicts post-hepatectomy liver failure and recovery

BACKGROUND Liver resection is an effective treatment for benign and malignant liver tumors.However,a method for preoperative evaluation of hepatic reserve has not yet been established.Previously reported assessments of preoperative hepatic reserve focused only on liver failure in the early postoperative period and did not consider the long-term recovery of hepatic reserve.When determining eligibility for hepatectomy,the underlying pathophysiology needs to be considered to determine if the functional hepatic reserve can withstand both surgery and any postoperative therapy.AIM To identify pre-hepatectomy factors associated with both early postoperative liver failure and long-term postoperative liver function recovery.METHODS This study was a retrospective cohort study.We retrospectively investigated 215 patients who underwent hepatectomy at our hospital between May 2013 and December 2016.Early post-hepatectomy liver failure(PHLF)was defined using the International Study Group of Liver Surgery’s definition of PHLF.Long-term postoperative recovery of liver function was defined as the time taken for serum total bilirubin and albumin levels to return to levels of<2 mg/dL and>2.8 g/dL,respectively,and the time taken for Child-Pugh score to return to Child-Pugh class A.RESULTS Preoperative type IV collagen 7S was identified as a significant independent factor associated with both PHLF and postoperative long-term recovery of liver function.Further analysis revealed that the time taken for the recovery of Child-Pugh scores and serum total bilirubin and albumin levels was significantly shorter in patients with type IV collagen 7S≤6 ng/mL than in those with type IV collagen 7S>6 ng/mL.In additional analyses,similar results were observed in patients without chronic viral hepatitis associated with fibrosis.CONCLUSION Preoperative type IV collagen 7S is a preoperative predictor of PHLF and longterm postoperative liver function recovery.It can also be used in patients without chronic hepatitis virus.

Individualized peri-operative fluid therapy facilitating early-phase recovery after liver transplantation

AIM:To investigate the correlation between peri-operative fluid therapy and early-phase recovery after liver transplantation(LT) by retrospectively reviewing 102 consecutive recipients.METHODS:Based on whether or not the patients had pulmonary complications,the patients were categorized into non-pulmonary and pulmonary groups.Twentyeight peri-operative variables were analyzed in both groups to screen for the factors related to the occurrence of early pulmonary complications.RESULTS:The starting hemoglobin(Hb) value,an intra-operative transfusion > 100 mL/kg,and a fluid balance ≤-14 mL/kg on the first day and the second or third day post-operatively were significant factors for early pulmonary complications.The extubation time,time to initial passage of flatus,or intensive care unit length of stay were significantly prolonged in patients who had not received an intra-operative transfusion ≤ 100 mL/kg or a fluid balance ≤-14 mL/kg on the first day and the second or the third day post-operatively.Moreover,these patients had poorer results in arterial blood gas analysis.CONCLUSION:It is important to offer a precise and individualized fluid therapy during the peri-operative period to the patients undergoing LT for cirrhosis-associated hepatocellular carcinoma.

Enhanced recovery after surgery in liver transplantation:Challenges and feasibility

BACKGROUND Enhanced recovery after surgery(ERAS)started a revolution that changed age-old surgical stereotypical practices regarding the overall management of the surgical patient.In the last decade,ERAS has gained significant acceptance in the community of general surgery,in addition to several other surgical specialties,as the evidence of its advantages continues to grow.One of the last remaining fields,given its significant complexity and intricate nature,is liver transplantation(LT).AIM To investigate the existing efforts at implementing ERAS in LT.METHODS We conducted a systematic review of the existing studies that evaluate ERAS in orthotopic LT,with a multimodal approach and focusing on measurable clinical primary endpoints,namely length of hospital stay.RESULTS All studies demonstrated a considerable decrease in length of hospital stay,with no readmission or negative impact of the ERAS protocol applied to the postoperative course.CONCLUSIONS ERAS is a well-validated multimodal approach for almost all types of surgical procedures,and its future in selected LT patients seems promising,as the preliminary results advocate for the safety and efficacy of ERAS in the field of LT.

Enhanced recovery after surgery in laparoscopic major liver resection: A propensity score matching analysis

Objective:Even though enhanced recovery after surgery(ERAS)has been applied to liver resection worldwide,there is a lack of evidence covering its feasibility in laparoscopic major hepatectomy.This study aimed to preliminarily evaluate the superiority of ERAS in major liver resection.Methods:The data were collected from patients who underwent laparoscopic major hepatectomy from July 2014 to November 2020 in Sir Run Run Shaw Hospital,Zhejiang University School of Medicine.The baseline characteristics,pathological features,surgical outcomes,medical costs,and postoperative pain scores were compared before and after propensity score matching(PSM).The patients were divided into the ERAS group and the routine group based on the treatment protocols.Results:Eighty-one patients who underwent laparoscopic major hepatectomy were retrospectively enrolled in the study.Before PSM,there were differences in pathology(p¼0.037)and surgical extent(p¼0.011)between the ERAS group(n¼42)and routine group(n¼39).After PSM,26 patients from each group were matched.For surgical outcomes,patients in the ERAS group had a significantly lower postoperative complication incidence than patients in the routine group(28.6%vs.53.8%,RR:0.531[0.303,0.929],p¼0.021)before PSM.However,after PSM,superiority was not observed in the ERAS group(30.8%vs.53.8%,RR:0.571[0.290,1.13],p¼0.092).The duration of abdominal tube retention(before PSM:5.0 d vs.10.0 d,p<0.001;after PSM:6.0 d vs.9.0 d,p¼0.001),the duration of urinary tube retention(before PSM:1.0 d vs.2.0 d,p<0.001;after PSM:1.0 d vs.2.0 d,p¼0.002),and hospital stay(before PSM:6.0 d vs.11.0 d,p<0.001;after PSM:7.0 d vs.11.5 d,p<0.001)was significantly shorter in the ERAS group than in the routine group.A significant benefit on postoperative day 3(2 vs.3,p¼0.038)was observed with respect to the alleviation of pain after PSM.Conclusions:Our preliminary study revealed the superiority of ERAS in the setting of major liver resection,although further investigations in a large number of patients from multiple institutions are needed to evaluate the feasibility of ERAS.

阶梯思维护理对肝癌手术患者肝功能、术后恢复情况及生活质量的影响

目的:分析阶梯思维护理对肝癌手术患者肝功能、术后恢复情况及生活质量的影响。方法:选取2021年1月—2022年6月福建医科大学肿瘤临床医学院收治的80例肝癌手术患者。根据患者的意愿将其分为观察组(40例)和对照组(40例)。对照组给予常规护理,观察组在对照组的基础上给予阶梯思维护理。比较两组护理前后肝功能、生活质量及术后恢复情况。结果:护理后,两组天冬氨酸氨基转移酶(aspartate transaminase,AST)、丙氨酸转氨酶(alanine transaminase,ALT)、总胆红素(total bilirubin,TBIL)水平均降低,观察组AST、ALT、TBIL水平均低于对照组,差异有统计学意义(P<0.05)。护理后,两组躯体功能、角色功能、情绪功能评分均升高,观察组躯体功能、角色功能、情绪功能评分均高于对照组,差异有统计学意义(P<0.05)。观察组肠鸣音恢复时间、排便时间、排气时间、下床活动时间均显著早于对照组,差异有统计学意义(P<0.05)。结论:阶梯思维护理能有效改善肝癌手术患者肝功能,提升术后恢复效果和患者的生活质量。

环磷酸腺苷在大面积烧伤患者全身麻醉手术中的肝保护作用分析

目的:分析环磷酸腺苷(cAMP)在大面积烧伤患者全身麻醉手术中的肝保护作用。方法:选取2022年1月—2024年1月内蒙古包钢医院收治的大面积烧伤患者60例作为研究对象,采用单双号法随机分为对照组与观察组,各30例。两组均给予气管插管全身麻醉,观察组给予cAMP。比较两组肝功能指标及麻醉效果。结果:手术开始后5 min、手术开始后60 min、手术开始后90 min、手术开始后120 min,两组外周血丙氨酸氨基转移酶、天门冬氨酸氨基转移酶、总胆红素、间接胆红素水平高于治疗前,但观察组低于对照组,差异有统计学意义(P<0.05)。观察组麻醉苏醒时间、住院时间短于对照组,差异有统计学意义(P<0.05)。结论:cAMP在大面积烧伤患者全身麻醉手术中的肝保护作用显著,患者术中血清肝功能指标稳定,麻醉及术后恢复快。

血液灌流治疗在急性重度有机磷中毒患者抢救中的应用效果

目的探讨血液灌流(hemoperfusion,HP)治疗对急性重度有机磷中毒(acute severe organophosphorus poisoning,ASOPP)患者抢救结果及病情恢复时间的影响。方法回顾性分析2021年9月—2023年5月浙江省人民医院毕节医院收治的82例ASOPP患者临床资料,依据治疗方法将患者分为2组,各41例。对照组采用硫酸阿托品注射液联合碘解磷定注射液治疗,观察组在对照组基础上加用HP治疗,2组均连续治疗3 d。对比2组抢救结果、病情恢复时间[意识恢复时间、脱机时间、血清胆碱酯酶(acetylcholinesterase,ACHE)活性恢复时间]、肝肾功能[天冬氨酸转氨酶(glutamic oxaloacetic transaminase,AST)、丙氨酸转氨酶(glutamic pyruvic transaminase,ALT)、血肌酐(serum creatinine,Scr)和尿氮素水平(blood urea nitrogen,BUN)]、神经功能[腓总神经运动传导速度(motor nerve conduction velocity,MCV)、感觉传导速度(sensory nerve conduction velocity,SCV)和F波潜伏期]和并发症(呼吸急促、心律失常、血液病变、低血压)。结果观察组抢救成功率为97.56%,高于对照组的80.49%,差异有统计学意义(P<0.05);观察组患者意识恢复时间为(3.54±1.28)h,脱机时间为(2.72±0.91)d,ACHE活性恢复时间为(4.15±1.12)d,短于对照组的(9.38±1.53)h、(7.09±1.45)d、(6.72±1.69)d,差异有统计学意义(P<0.05);治疗后,观察组AST为(26.13±5.15)U/L,ALT为(25.04±7.62)U/L,Scr为(110.69±20.15)μmol/L,BUN为(7.25±0.58)mmol/L,均低于对照组的(35.16±8.65)U/L、(40.76±10.28)U/L、(174.56±26.47)μmol/L、(9.62±1.08)mmol/L,差异有统计学意义(P<0.05);治疗后,观察组MCV为(48.26±8.32)m/s,SCV为(46.37±8.02)m/s,均高于对照组的(40.06±6.12)m/s、(39.54±6.35)m/s;F波潜伏期为(21.89±2.42)ms,低于对照组的(26.56±3.17)ms,差异有统计学意义(P<0.05);观察组的并发症总发生率为9.09%(3/33),和对照组的15.00%(6/40)比较,差异无统计学意义(P>0.05)。结论应用HP治疗ASOPP患者可提高抢救成功率,缩短病情恢复时间,改善肝肾功能和神经功能,减少并发症的发生。

多学科个性化动态营养干预对促进老年原发性肝癌患者术后恢复效果的影响

目的 分析多学科个性化动态营养干预对促进老年原发性肝癌患者术后恢复效果的影响。方法 选取开滦总医院2022年1―12月收治的接受营养风险筛查2002(nutritional risk screening 2002,NRS 2002)风险评估且存在营养不良风险的老年原发性肝癌患者80例作为研究对象,按随机数字表法分为对照组(n=40)和干预组(n=40)。对照组给予常规术后护理,干预组给予多学科个体化动态营养干预。比较两组患者术后恢复评分、术后恢复速度指标及护理前后患者的衰弱程度、绝望量表评分和营养指标。结果 干预组患者术后早期进食时间、肛门排气时间、达到目标70%进食量时间均显著早于对照组(均P <0.05),干预组患者住院天数显著短于对照组(P <0.05),干预组患者住院费用显著少于对照组(P <0.05)。干预组患者术后7 d恢复评分显著高于对照组(P <0.05)。两组患者护理后健康状况、社会支持、自制力、情绪指标评分均有所下降(均P <0.05),且干预组下降幅度均显著大于对照组(均P <0.05)。两组患者护理后对未来感觉评分和对未来期望评分均有所下降(均P <0.05),且干预组患者评分下降幅度均显著大于对照组(均P <0.05)。干预组患者术后并发症发生率明显显著低于对照组(P <0.05)。结论 多学科个性化动态营养干预促进老年原发性肝癌患者术后恢复的临床效果较好。

国际肝移植学会《肝移植手术加速康复共识建议》要点解读

肝移植作为终末期肝病唯一有效的治疗手段,具有手术复杂、时间长、创伤大等特点,患者术后恢复面临感染、腹腔出血、排斥反应等诸多挑战,直接影响康复质量。加速术后康复(enhanced recovery after surgery,ERAS)作为一种新型围术期管理策略,可有效促进患者术后康复,目前已广泛应用于外科各领域,但目前我国肝移植领域尚缺乏全面、科学的ERAS共识方案。2022年12月,国际肝移植学会发布了首个《肝移植手术加速康复共识建议》,对接受死亡后器官捐献和活体器官捐献的肝移植受者、活体肝移植供者ERAS策略提出建议。本文对该共识要点进行详细解读,以期为我国肝移植患者围术期ERAS实践提供参考。

肝癌患者术后出院饮食依从性研究

目的调查肝癌患者术后出院饮食依从性的现状,并分析其相关影响因素。方法采用方便抽样的方法,选取2021年11月—2022年3月福州市某三甲医院的肝癌术后的患者作为研究对象,收集一般资料于术后出院一个月随访并填写饮食依从性量表,进行数据分析。结果肝癌患者术后饮食依从性总分为(31.30±3.34)分,饮食依从性在年龄、文化程度、居住地、家庭人均月收入方面上存在差异,即年龄≤60岁、学历在大专以上、居住在城镇、家庭人均月收入>5000元的研究对象饮食依从性得分较高(均P<0.05)。Pearson相关性分析显示,研究对象饮食依从性与年龄和居住地之间呈负相关,饮食依从性与文化程度和收入之间呈正相关。结论肝癌患者术后出院饮食依从性总体较好,在临床护理中,应加强对年龄大于60岁、文化程度较低、家庭人均月收入较低人群的关注,开展个体化的健康教育将能提高患者的饮食依从性,从而促进机体的恢复。

右美托咪定在肝癌手术患者中的应用效果

目的探讨右美托咪定(DEX)在肝癌手术患者中的应用效果。方法依据麻醉诱导前是否使用DEX将98例肝癌手术患者分为观察组(n=46)和对照组(n=52)。观察组患者在麻醉诱导前15 min给予1.0μg/kg的DEX,对照组患者在麻醉诱导前15 min给予等量的0.9%氯化钠溶液。比较两组患者的疼痛指标[神经肽Y(NPY)、P物质(SP)、多巴胺(DA)]、血流动力学指标[心率(HR)、平均动脉压(MAP)]、胃肠功能指标[胃泌素(GAS)、胃动素(MTL)、胆囊收缩素(CCK)]、术后恢复指标及术后院内感染情况。结果手术后3天,两组患者NPY、SP、DA水平均高于本组手术前,观察组患者NPY、SP、DA水平均低于对照组,差异均有统计学意义(P﹤0.05)。麻醉诱导后(T1)至手术后2 h(T4),观察组患者MAP、HR均明显低于对照组,差异均有统计学意义(P﹤0.01)。手术后3天,两组患者CCK水平均高于本组手术前,GAS、MTL水平均低于本组手术前,观察组患者GAS、MTL水平均高于对照组,CCK水平低于对照组,差异均有统计学意义(P﹤0.05)。观察组患者的苏醒时间、首次下床活动时间、首次肛门排气时间、首次排便时间、术后住院时间均明显短于对照组,差异均有统计学意义(P﹤0.01)。观察组患者的术后院内感染率低于对照组,差异有统计学意义(P﹤0.05)。结论麻醉诱导前给予DEX对肝癌手术患者具有良好的镇痛效果,对患者的血流动力学和胃肠功能影响较小,可以促进患者术后恢复并且降低术后院内感染率。

基于自我管理导向的5A护理模式在肝癌肝切除术患者中的应用

目的探讨基于自我管理导向的5A护理模式在肝癌肝切除术患者中的应用效果,以期为肝癌肝切除患者的护理干预提供参考。方法选取2021年10月—2023年10月于南京大学医学院附属盐城第一医院进行肝切除术的125例肝癌患者,采用随机数字表法分为对照组(62例)和观察组(63例)。对照组患者接受常规护理模式干预,观察组患者接受基于自我管理导向的5A护理模式干预。比较2组患者干预前后的自我管理能力、生活质量,术后康复情况以及并发症发生情况。结果观察组患者术后通气时间、术后引流时间、伤口愈合时间、住院时间均短于对照组,差异均有统计学意义(P<0.05)。2组患者干预前自我管理能力量表(ESCA)的自我概念、自我护理责任感、自我护理技能、健康知识水平4个维度评分及总分比较,差异均无统计学意义(P>0.05);2组患者干预后ESCA量表的4个维度评分及总分均高于干预前,且观察组均高于对照组,差异均有统计学意义(P<0.05)。2组患者干预前生活质量测定量表简表(SF-36)的生理职能、生理功能、社会功能、躯体疼痛、情感职能、精神健康、活力、总体健康8个维度评分比较,差异均无统计学意义(P>0.05);2组患者干预后SF-36量表的8个维度评分均高于干预前,且观察组均高于对照组,差异均有统计学意义(P<0.05)。观察组患者术后并发症发生率为1.59%(1/63),低于对照组的12.90%(8/62),差异有统计学意义(χ^(2)=6.664,P=0.010)。结论对肝癌肝切除术患者采用基于自我管理导向的5A护理模式干预,能够有效促进患者术后康复,提升患者自我管理能力,提高患者生活质量,降低并发症发生风险,值得在临床推广。

肝脓肿穿刺置管引流术的临床疗效探析

目的研究对肝脓肿患者应用穿刺置管引流术治疗的效果。方法随机选取2021年10月—2022年10月周宁县医院收治的76例肝脓肿患者为研究对象,应用随机数表法分为对照组(38例,切开置管引流术)和观察组(38例,超声引导下经皮肝脏穿刺置管引流术),对比两组治疗效果。结果观察组退热时间为(3.23±0.72)d,拔管时间为(10.24±1.12)d,住院时间为(13.28±1.32)d,显著短于对照组[退热时间(5.86±0.90)d,拔管时间(13.15±1.26)d,住院时间(16.97±2.14)d],差异有统计学意义(t=14.066、10.641、9.047,P均<0.05)。同时观察组炎症指标、生活质量表、视觉模拟评分、并发症发生率均优于对照组,差异有统计学意义(P均<0.05)。结论对肝脓肿患者采取超声设备辅助下经皮肝脏穿刺置管引流术,经治疗后患者术后康复速度更快,快速缓解炎症反应,减轻患者的痛苦,且并发症更少,安全有效。

反馈—问题解决护理模式干预对原发性肝癌介入治疗患者疾病接受度及术后康复的影响

目的:探讨反馈—问题解决护理模式干预对原发性肝癌(PLC)介入治疗患者疾病接受度及术后康复的影响,为临床护理提供依据。方法:选取2022年1—12月福建省肿瘤医院收治的82例PLC患者作为研究对象,按照入院时间先后将其分为常规组与干预组,每组各41例。常规组采用常规护理,干预组在常规护理基础上实施反馈—问题解决护理模式干预。比较两组患者干预前后自我效能感[一般自我效能感量表(GSES)评分]、疾病接受度[中文版疾病接受度量表(AIS-CHI)评分]、生命质量[癌症患者生命质量核心量表(QLQ-30)评分]、术后康复及并发症发生情况。结果:干预后,干预组患者GSES及AIS-CHI评分均明显高于常规组,差异均有统计学意义(t=6.122、9.019,P<0.05)。干预后,干预组患者QLQ-30各维度评分均明显高于常规组,差异均有统计学意义(t=3.927、5.917、5.296、5.409、5.801、5.278,P<0.05)。干预组患者术后排气时间、进食时间、排便时间、下床活动时间及住院时间均明显短于常规组,差异均有统计学意义(t=4.970、7.449、9.719、5.577、12.794,P<0.05)。干预组患者术后并发症发生率明显低于常规组,差异有统计学意义(χ^(2)=6.248,P<0.05)。结论:反馈—问题解决护理模式干预可提升PLC介入治疗患者的疾病接受度,增强其自我效能感,促进患者术后康复,提高患者生命质量。

腹腔镜下左肝蒂阻断术治疗对肝内胆管结石的疗效观察

目的:探究腹腔镜下左肝蒂阻断术治疗对肝内胆管结石疗效。方法:选取2020年5月至2022年9月我院收治的63例肝内胆管结石患者作为研究对象,按照随机数字表法分为观察组(n=32)和对照组(n=31)。对照组患者接受传统开腹手术治疗,观察组患者接受腹腔镜左肝蒂阻断术治疗。比较两组患者术后恢复指标、肝功能指标水平、生活质量调查量表(Medical Outcomes Study 36-Item Short Form Health Survey,SF-36)评分、两组患者切口感染、胆漏及腹腔积液等不良反应发生情况。结果:术后观察组各恢复指标、丙氨酸氨基转移酶(Alanine aminotransferase,ALT)、天冬氨酸氨基转移酶(Aspartate aminotransferase,AST)及总胆红素(Total bilirubin,TBIL)水平均低于对照组(P<0.05);治疗后观察组SF-36各方面评分均高于对照组(P<0.05);观察组不良反应总发生率明显低于对照组(χ^(2)=4.510,P=0.034)。结论:腹腔镜下左肝蒂阻断术治疗肝内胆管结石患者有利于促进其术后恢复,缩短病程,还可促进肝功能以及生活质量的改善,安全性高。

Multipotent mesenchymal stromal cells:A promisingstrategy to manage alcoholic liver disease

Chronic alcohol consumption is a major cause of liver disease.The term alcoholic liver disease(ALD)refers to a spectrum of mild to severe disorders including steatosis,steatohepatitis,cirrhosis,and hepatocellular carcinoma.With limited therapeutic options,stem cell therapy offers significant potential for these patients.In this article,we review the pathophysiologic features of ALD and the therapeutic mechanisms of multipotent mesenchymal stromal cells,also referred to as mesenchymal stem cells(MSCs),based on their potential to differentiate into hepatocytes,their immunomodulatory properties,their potential to promote residual hepatocyte regeneration,and their capacity to inhibit hepatic stellate cells.The perfect match between ALD pathogenesis and MSC therapeutic mechanisms,together with encouraging,available preclinical data,allow us to support the notion that MSC transplantation is a promising therapeutic strategy to manage ALD onset and progression.

抑肝扶脾针法配合耳穴压豆治疗儿童抽动障碍对中医证候积分及不良反应的影响

目的观察在对儿童抽动障碍患儿治疗中按照抑肝扶脾针法配合耳穴压豆进行治疗对于中医证候积分改善以及不良反应控制的作用。方法按照比较治疗观察的形式开展探究,纳入80例患儿为研究对象,时间为2020年1月—2022年10月,按照双盲法分组的方式,取组内40例患儿开展常规治疗,作为对照组,剩下40例患儿则开展抑肝扶脾针法配合耳穴压豆治疗,作为观察组。对两组患儿恢复情况进行比较。结果患儿中医证候积分在治疗前差异无统计学意义(P>0.05),治疗后观察组低于对照组(P<0.05)。统计两组患儿整体治疗效果,观察组有效率高于对照组(P<0.05)。比较患儿在治疗过程中不良反应情况,观察组发生率低于对照组(P<0.05)。比较两组患儿在治疗期间耶鲁评分,在治疗前两组患儿评分差异无统计学意义(P>0.05),在治疗后1、2、3、4周,观察组耶鲁评分均低于优势(P<0.05)。结论在对儿童抽动障碍患儿进行治疗的过程中按照抑肝扶脾针法配合耳穴压豆进行治疗,可以有效提升临床对该部分患儿的治疗效果,改善患儿中医证候积分,并降低患儿不良反应发生率,可以达到帮助患儿进行恢复的目的,能够促使患儿抽动障碍症状在较短时间内得到改善。