1982年 · 第02卷第04期

This article presents some experiences in hepatectomy in treating 467 cases during the period of 1960-1981 with an operative mortality of 10.6% in 60s and 0.9% in 70s and no death in recent yr. Of the 467 cases, the malignancies were found in 286 and benign lesions in 179. Of these cases, extensive and hemihepatectomies were performed in 194 patients, lobectomy or partial resection in 273 cases. The incidence of complications including hemorrhage, hepatic insufficiency and infection was 10.2% (48 cases). Nineteen cases died within one month postoperatively with an overall opeative mortality of 4.0%. Followed up results showed that 177 patients of nonmalignant tumors are still living well postoperatively. In 14 cases of metastatic cancer, the median survival time after operation was 1.4 yr. The 5-yr postoperative survival rate of primary liver cancer was 24.8%, while the cases of malignant tumors sized less than 5 cm in diameter had a 5-yr survival rate of 53.8%. The authors focus the discussion on selection of patients, judging the possibility of resection of the tumor during exploration, improvement of operative technic and prevention and management of complication.

Clinico-pathologic relationship in 50 cases of acute and subacute severe viral hepatitis was studied. It was found that clinically diagnosed fulminant viral hepatitis cases presented two different pathologic patterns: (1) consisted of severe swelling of liver cells with various degrees of focal necrosis; 3 of the 16 cases died (18.7%), and (2) consisted of massive or submassive necrosis; all 13 cases with massive necrosis died, while 10 of the 21 cases with submassive necrosis died (47.6%). On the basis of clinicopathologic analysis, the authors suggest that severe viral hepatitis may be classified as: (1) fulminant hydropic hepatitis; (2) fulminant necrotic hepatitis, and (3) submassive necrotic hepatitis. The clinical diagnositic criteria of each type are also discussed.

Findings of paraneoplastic syndromes in a retrospective study of 403 patients of primary liver cancer treated in this hospital between 1975 to 1982 are presented. The incidences of erythrocytosis, hypoglycemia, hypercalcemia, hyperfibrinogenemia and thrombocytosis, in this series were 7.2% (26/363), 8.0% (10/25), 10.0% (2/10), 26.6% (74/278), and 1.5% (6/403), respectively. The data showed that the occurrence of paraneoplastic syndromes in primary liver cancer was not uncommon and hyperfibrinogenemia was relatively common. Typical cases of primary liver cancer associated with erythrocytosis, hypoglycemia, hypercalcemia, hyperfilbrinogenemia and thromobocythemia are reported. The pathogenesis and main differential points of paraneoplatic syndromes in primary liver cancer are discussed respectively. The authors suggest that clinical recognition and paying due attention to paraneoplastic syndrome might promote the early diagnosis of primary liver cancer.

This paper reports 6 cases of portal hypertension treated by end-to side portacaval shunt and an anastomosis between the right gastroepiploic artery and the reopened umbilical vein for arterilization of the intrahepatic vein. All patients had been observed for 6-24 mo. Five patients needed no restriction of protein intake, and they were free from encephalopathy. One patient developed mild encephalopathy on excessive protein intake. There was no ascites or recurrence of bleeding postoperatively. The results of rheohepatography and liver function tests before and after operatoin were almost similar. The postoperative courses were uneventful in all patients with no operative death. One case with Child C class liver function died ten mo after operation from liver failure.

Serum ferritin was estimated by immunoradioassay in 29 males with chronic liver diseases including 18 cases of cirrhosis and 11 cases of primary or secondary liver cancer, and also in 100 healthy blood donors. The mean values were 185 ± 87.52 ng/ml, and 129 ± 25.78 ng/ml respectively. The difference between the mean serum ferritin values of liver cancer patients from that of normal controls is statistically significant (P<0.05). Serum ferritin estimation, therefore, may provide a useful marker in the diagnosis and differential diagnosis of liver disease.

The purpose of this study is to observe the effect of Angelica Sinesis on the liver damage. Thirty four adult male rats weighing from 203 to 274 gm were used. The animals were radonmyl divded into 3 groups, ead, consisfed of 10 rats A single dose of D-Galactosamine (D/Gal 100mg/kg) was given intraperitoneally to each group. Three hr later, intraperitoneal injections (twice a day) of isotonic saline (10ml/kg), vitamin C (10ml/kg) and 25% Angelica Sinensis (10 ml/kg) were given, respectively. The remaining 4 untreated rats served as normal control. 96 hr after D-Gal administration, blood were taken from the heart and SGPT value, prothrombin time and blood sugar studied. All the animals were sacrificed thereafter. Their liver tissues were investigated histochemically, pathohistologically and electron-microscopically. The biochemical analyses showed no differences among the 3 groups. The liver tissues of rats received saline or vitamin C presented prominent changes histochemically and pathologically, whereas the liver tissues from animals receveid Angelica Sinesis appeared to have only slight changes resembling the normal control. This indicates that Angelica Sinensis seems to have some protective effect on the liver against damage induced by D-Gal. Its mechanism is unknown and needs further study.

Fifty two patients with chronic active hepatitis (CAH) admitted during 1962 to 1980 were studied. The diagnosis of all cases was confirmed by liver biopsy or necropsy. Among these 52 patients, 29 cases had a history of viral hepatitis, of which 26 showed persistent or recurrent elevation of aminotransferase and 3 developed jaundice and ascites with worsening of liver function. The remaining 23 cases had no history of viral hepatitis, of which 8 had an abrupt onset with features indistinguishable from submassive necrosis and from extrahepatic biliary duct obstruction, and 15 had an insidious onset with clinical manifestations of GI bleeding, ascites, splenomegaly and hepatomegaly as seen in liver cirrhosis or primary hepatocellular carcinoma. According to the clinical characteristics, the CAH could be grouped into 4 patterns: (1) general pattern, (2) cirrhotic pattern, (3) severe pattern, and (4) cholestatic pattern. The problems concerning cryptogenic and insidious CAH are also discussed.

The barium filling phase of stomach in erect position was investigated in 1000 cases. Among them 69 cases of malignancies, 81 of ulcers, 5 of leiomyoma and leiomyosarcoma, ulcers of duodenal bulb, gastritis, and tumors in the vicinity of stomach etc. were found through the analyses of gastral shape, its margin of contour, angular incision, double contrast shadow and sign of exogenic oppression. By the routine examination, double contrast examination and gastroendoscopy, the gastral angle of U-type or its 3 subtypes with smooth margin, regular and soft quality was considered to be normal. The shape of the normal gastral angle may be changed by the lesions in situ and / or those in the vicinity of it.

Sixteen cases (two men and fourteen women) with focal nodular hyperplasia of the liver (FNH) are reported. Twelve of the 14 women had taken oral contraceptives for 1-15 yr. There was no operative mortality. Thirteen patients were followed up ½ to 11½ yr. No further growth and recurrence of these lesions were observed. According to this data and that of other authors, it seems that in contradistinction to liver cell adenoma (LCA) the FNH is not induced, but may be promoted by contraceptives. It occurs mostly in women in child bearing age. In comparison with LCA, serious complications (e.g. bleeding) are seldom in FNH. Diagnosis of FNH should be always confirmed by pathology. Spontaneous regressions were reported. Surgical treatment is not necessary, generally, its indication depends upon the operative risk. Immediate cessation of all contraceptives is mandatory.