小肝

The uncovered tracts and the liver wound surface were managed by some of the methods combined such as high frequency electrocoagulation, titanium clamp, suture, hemostatic gauze oppression, argon-beam coagulation, protein glue adherence, and Endo-GIA switcher. The total operative outcome, operating time, blood loss, postoperative complications and postoperative hospital stay were summarized in order to assess feasibility and safety of the clinical laparoscopic liver resection.Results: 1. Laparoscopic liver resection with clamp dissection method needs only the ordinary laparoscopic equipment. It has a low cost but causes a little more bleeding. 2. Laparoscopic liver resection operated by microwave tissue coagulation method had very little bleeding when dissecting hepatic parenchyma. The operative field is clear and the cost is low. It is a safe, convenient and effective method. 3. Ultrasound dissector is a relatively ideal appliance for laparoscopic liver resection at present because ofless bleeding during operation. But the speed is slow thus prolongs the operation time. Its separating intensity is not strong enough, and it can only be applied to patients without hepatic cirrhosis. 4. Ligsure has clamp dissection and electrocoagulation functions. It can carbonize hepatic tissue including the tracts whose diameters are less than 7mm. It has some advantage in dissecting. However, it has the shortcomings of the clamp dissector during coagulating. 5. Hand-assisted laparoscopic liver resection can make use of the flexibility and feeling of the operators left hand.

结果：1、钳夹分离切肝法不需特殊仪器设备，只要具备常规的腹腔镜器械即可实施，成本低，肝断面较易渗血；2、微波固化切肝法肝实质出血很少，视野清晰，成本低，操作简单，是一种安全、简便、有效的方法；3、超声刀是目前较为理想的切肝器械，术中出血少，但是，切割速度慢，手术时间长，而且，切割强度有限，适用于无肝硬化的肝切除；4、Ligsure具有挤压粉碎及高频电凝止血两大功能，可使包括7~以下管道的肝组织碳化、形成焦痴，具有一定的优势，但是，也存在分离钳电凝止血的缺点；5、手辅助腹腔镜肝切除可以利用术者左手的灵活性及手感，便于术中显露、分离、控制出血等，可随意协助右手及助手的主要操作，缩短了手术时间，大大提高了腹腔镜肝切除的安全性，李朝龙等的改良方法，同样达到了手辅助目的，又节省了费用；6、小切口腹腔镜辅助切肝法可以使用剖腹肝切除常规器械及剖腹肝切除技术，操作简单、可靠，适用于肝左外叶切除及右肝第V段切除；7、Endo一GIA切肝法在离断肝组织的同时闭合管道结构，多用于肝左静脉、门静脉分支、管径较大胆管的切割，缺点是不能用于较厚肝组织的切割，而且价格昂贵；8、临床巧例腹腔镜肝切除均获得成功，手术时间最短1.5h，最长sh，平均125 min，多数在100 min左右，手术出血量最少50 ml，最多500 ml，平均1 78 ml，除2例合并严重肝硬化的原发性肝癌患者术后出现少量腹水，1例术后发生胆漏外，其余无并发症，发生胆漏的1例患者术后住院40d，多数在术后一周左右出院，术后住院时间5一40d，平均gd。

Methods: 1. Experimental laparoscopic liver resection: We selected pigs as experimental models aiming to approach human beings physiological and anatomical condition. After CO2 pneumoperitoneum was established, the ligaments around liver were dissociated. Livers were cut off by the methods such as clamp dissection, microwave tissue coagulator, ultrasound dissector, Ligsure dissection, hand-assisted, short abdominal incision laparoscopy-assisted, and Endo-GIA switcher. The operation time and bleeding volume were compared between different methods of laparoscopic liver resection. The advantages and limitations of different methods were summarized. 2. Clinical laparoscopic liver resection: 15 cases with tumors in segment V of anterior right lobe or segments II, III of left lateral lobe or segment IV of left internal lobe were selected in this study. The liver diseases included hepatocellular cancer, hepatic cavernous hemangioma and hepatic focal nodular hyperplasia. The ligaments around liver were dissociated after CO2 pneumoperitoneum established. Laparoscopic liver resection were carried out by some of the methods combined such as clamp dissection, microwave tissue coagulator, hand-assisted, short abdominal incision laparoscopy-assisted, ultrasound dissector, rotation and suction dissector.

1、实验性腹腔镜肝切除：以猪为实验动物，旨在接近人体的生理、解剖环境下进行实验，建立操作空间后游离肝脏周围韧带，采用钳夹分离切肝法、微波刀切肝法、超声刀切肝法、Ligsure切肝法、手辅助腹腔镜肝切除法、小切口腹腔镜辅助切肝法、Endo-GIA切肝法等方法实施腹腔镜下肝切除，比较不同切肝方法的手术时间、出血量，总结各种方法的优越性及其局限性。2、临床腹腔镜肝切除：选择肿瘤位于肝右前叶第Ⅴ段、肝左外叶第Ⅱ、Ⅲ段及左内叶第Ⅳ段的15例患者，病种包括原发性肝癌、肝海绵状血管瘤、肝脏局灶性增生，建立气腹后游离肝脏周围韧带，采用钳夹分离断肝、微波刀固化后断肝、手辅助腹腔镜肝切除、小切口腹腔镜辅助肝切除、超声刀断肝、旋吸断肝等多种方法分离切线肝组织，暴露管道结构，再采用高频电凝、钛夹夹闭、缝扎止血、止血纱布覆盖、氩气刀止血、生物胶止血、Endo-GIA处理等多种方法相结合处理肝断面，统计手术完成情况、手术时间、手术出血量、术后并发症及术后住院时间等，评价腹腔镜肝切除的可行性及安全性。

OVCs were isolated by density ladder centrifugation in the 4th week, and then OVC's morphology was observed under transmission electromicroscrope and immunocytochemistry were performed to detect the expression of ICAM-1. Results Observing OVC's morphology under transmission electromicroscrope showed that OVC was infantile and undifferentiated with big nucleus, clear nucleolus, large nucleoplasm-ratio, small mitochondria, and little endoplast.

结果 透射电镜下观察到OVCs超微结构的改变为核大，核/浆比大，核仁小，胞浆内细胞器少，可见少量内质网和小线粒体，整个细胞呈幼稚、未分化状态；ICAM-1免疫细胞化学检测阳性；损伤肝组织HE染色和ICAM-1免疫组化检测显示，肝损伤初期，Hering管周围OVCs增生并且ICAM-1阳性表达，随着肝损伤的加重，OVCs继续增生，并且，OVCs沿增生的肝纤维向肝小叶迁移，同时，ICAM-1阳性表达也继续增多，并逐渐向肝小叶弥散分布；透射电镜下观察到，肝损伤初期，OVCs在Hering管周围增生，肝纤维随之增生，增生的OVCs与肝纤维黏附生长。

OVCs were isolated by density ladder centrifugation in the 4th week, and then OVC's morphology was observed under transmission electromicroscrope and immunocytochemistry were performed to detect the expression of ICAM-1. Results Observing OVC's morphology under transmission electromicroscrope showed that OVC was infantile and undifferentiated with big nucleus, clear nucleolus, large nucleoplasm-ratio, small mitochondria, and little endoplast. In initial stage of damaged liver, OVCs and the expression of ICAM-1 mostly distributed around Hering duct, and then gradually increased and expanded toward hepatic lobule, shown by staining paraffin sections with HE, immunochemistry and transmission electromicroscrope. Immunocytochemistry indicated that ICAM-1 expression on OVCs was positive.

结果 透射电镜下观察到OVCs超微结构的改变为核大，核/浆比大，核仁小，胞浆内细胞器少，可见少量内质网和小线粒体，整个细胞呈幼稚、未分化状态；ICAM-1免疫细胞化学检测阳性；损伤肝组织HE染色和ICAM-1免疫组化检测显示，肝损伤初期，Hering管周围OVCs增生并且ICAM-1阳性表达，随着肝损伤的加重，OVCs继续增生，并且，OVCs沿增生的肝纤维向肝小叶迁移，同时，ICAM-1阳性表达也继续增多，并逐渐向肝小叶弥散分布；透射电镜下观察到，肝损伤初期，OVCs在Hering管周围增生，肝纤维随之增生，增生的OVCs与肝纤维黏附生长。

Results Observing OVC's morphology under transmission electromicroscrope showed that OVC was infantile and undifferentiated with big nucleus, clear nucleolus, large nucleoplasm-ratio, small mitochondria, and little endoplast. In initial stage of damaged liver, OVCs and the expression of ICAM-1 mostly distributed around Hering duct, and then gradually increased and expanded toward hepatic lobule, shown by staining paraffin sections with HE, immunochemistry and transmission electromicroscrope. Immunocytochemistry indicated that ICAM-1 expression on OVCs was positive.

结果 透射电镜下观察到OVCs超微结构的改变为核大，核/浆比大，核仁小，胞浆内细胞器少，可见少量内质网和小线粒体，整个细胞呈幼稚、未分化状态；ICAM-1免疫细胞化学检测阳性；损伤肝组织HE染色和ICAM-1免疫组化检测显示，肝损伤初期，Hering管周围OVCs增生并且ICAM-1阳性表达，随着肝损伤的加重，OVCs继续增生，并且，OVCs沿增生的肝纤维向肝小叶迁移，同时，ICAM-1阳性表达也继续增多，并逐渐向肝小叶弥散分布；透射电镜下观察到，肝损伤初期，OVCs在Hering管周围增生，肝纤维随之增生，增生的OVCs与肝纤维黏附生长。

(1)Both the liver regeneration and apoptosis are influenced by conspicuous bilirubinemia, hepatectomy and hepatic artery resection in rats after obstructive jaundice, especially by the liver resection volume and conspicuous bilirubinemia.(2) Under the condition of conspicuous bilirubinemia, the influence of 70% PH with HAR on liver regeneration and apoptosis is severer than its counterpart of 42% in the rats. Thus, the former is not safe and should be avoided and the later can be used.

高胆红素血症时，肝切除量是影响大鼠肝切除联合肝动脉切除实施安全性的重要因素，42%肝切除联合肝固有动脉切除、胆肠再通内引流，对肝细胞再生和凋亡影响较小，安全可行；70%肝切除联合肝动脉切除、胆肠再通内引流后肝细胞再生显著受抑制，凋亡增多，死亡率高，应避免实施。

The feature was different between dysplastic small hepatocytes with crowd and proliferative nodules of hepatocytes.

小肝细胞和胆管上皮细胞的不典型增生是肝细胞癌和胆管癌的癌前病变。

Ambient salinity and dietary protein level only had significant interaction on the body ash content, while no significant interaction effects were observed in other parameters. Tubules of shrimp fed with CP30 and CP40 had the normal structure, though CP40 increased the number of R cells. Tubules of shrimps fed with CP20 had relatively fewer R cells and arranged incompactly. And the basal membranes of partial tubules were in disrepair. While tubules of shrimps fed with CP50 compactly arranged with much ambiguous materials in B cells.

饲料蛋白质含量明显影响了凡纳滨对虾肝胰腺的组织结构，投喂CP30和CP40饵料的对虾肝小体基膜完整，投喂CP40对虾的肝小体中还出现了大量的存储细胞；而投喂CP20饵料的对虾肝小体分布松散，R细胞数量较小，并且部分肝小体基膜破损；而投喂CP50饵料的对虾的肝小体排列紧密，且B细胞内出现大量内容物质。

RESULTS: On day 2 after PH, oval cells began to proliferate around the portal area, and matrilin-2 deposition was observed in the hepatic sinusoids in the periportal area. On day 9, proliferating oval cells were present in the hepatic acini, and matrilin-2 upregulation was noted. On day 12, as oval cells differentiated to form hepatocellular nodules, matrilin-2 was distributed mainly in the periphery of the nodules, and little protein was present in the nodules.

结果： 肝脏部分切除术(partial hepatectomy， PH)后第2天，卵圆细胞开始向门静脉周围区域增殖， Matrilin-2主要出现在门静脉周围的肝窦状隙内；术后第9天，卵圆细胞进一步向肝实质内增殖， Matrilin-2表达增加；术后第12天，随着卵圆细胞分化为小肝细胞结节，大多数Matrilin-2位于结节周边，少数出现在结节内。

For the first 2 recipients,one case developed stenosis of the right hepatic vein anastomoses,the other one developed small-for-size syndrome and died.

前2例受者中，1例发生肝静脉吻合口狭窄，1例因发生小肝综合征，死于肝功进行性恶化。

The labia have now been sutured together almost completely.The drains and the Foley catheter come out at the top.

此刻阴唇已经几乎完全的缝在一起了，排除多余淤血体液的管子和Foley导管从顶端冒出来。

To get the business done, I suggest we split the difference in price.

为了做成这笔生意，我建议我们在价格上大家各让一半。