本文基于单因素实验和灰色关联度分析了弱碱三元驱油剂对破乳剂破乳效果的影响.研究结果表明,随着HPAM、石油磺酸盐、Na2CO3质量浓度的增加,SY-689破乳剂的破乳效果变差.当体系含有破乳剂时,与不含破乳剂的体系相比,三种驱油剂与油相含水量的灰色绝对关联度均有所降低,石油磺酸盐与水相含油量的灰色绝对关联度由0.9940下降到0.6305,但HPAM与水相含油量的灰色绝对关联度由0.5175升高到0.5695,Na2CO3与水相含油量的灰色绝对关联度由0.6486升高到0.9340.综合对比含破乳剂体系的灰色绝对关联度得出,与油相含水量相关性较强的驱油剂依次是石油磺酸盐和Na2CO3,与水相含油量相关性较强的驱油剂依次是Na2CO3和石油磺酸盐,因此石油磺酸盐和Na2CO3的质量浓度是跟踪破乳剂的适应性时需要重点考虑的因素.本文通过分析弱碱三元驱油剂对破乳剂破乳效果的影响规律,为现场破乳剂应用的跟踪评价提供了借鉴.

目的 探讨淋巴结清扫(lymph node dissection,LND)对术前影像学诊断淋巴结阴性的肝内胆管癌(intrahepatic cholangiocarcinoma,ICC)病人预后的影响.方法 回顾性收集2014年1月至2019年9月在中国医科大学附属盛京医院普通外科行根治性手术且术前影像学诊断淋巴结阴性的ICC病人临床资料.采用倾向性评分匹配(PSM)减少选择偏倚,比较淋巴结清扫组(LND组)与淋巴结未清扫组(NLND组)病人的术后短期及长期疗效.结果 研究共纳入影像学诊断淋巴结阴性ICC病人92例,其中LND组43例,NLND组49例.PSM后每组各36例,两组手术时间[(347.2±258.3)min比(306.1±273.7)min]、术后并发症发生率[27.78％(10/36)比22.22％(8/36)]和术后住院时间[(12.05±9.48)d比(11.81±4.72)d],差异均无统计学意义(P>0.05);LND组术中出血量多于NLND组[(265.61±98.52)mL比(220.47±96.53)mL,t=2.421,P=0.049],术后拔管时间LND组也长于NLND组[(7.41±3.05)d比(7.29±2.91)d,t=3.697,P=0.013];LND组和NLND组中位无复发生存时间分别为13个月和9个月(χ2=6.195,P=0.012),中位总生存时间分别为20个月和15个月(χ2=6.601,P=0.010).L ND组1、2年无复发生存率分别为54.6％、28.0％,NLND组分别为28.7％、9.6％(P<0.05);LND组1、2年总生存率分别为79.7％、37.2％,NLND组分别为60.4％、12.6％(P<0.05).结论 淋巴结清扫并不会明显增加术前影像学诊断淋巴结阴性的ICC病人的手术风险,但能使病人生存明显获益.

In this work, the corrosion behavior of the CaCO3 layer deposited on the NaCl-alkaline/surfactant/polymer flooding pipeline steel is studied. The results showed that in the non-galvanically-coupled state, localized corrosion occurred on the CaCO3 deposit electrode, and uniform corrosion occurred on the bare electrode. The corrosion of the carbon steel was inhibited by the deposited CaCO3 layer, and the galvanic corrosion occurred, which promoted the corrosion of the bare electrode and inhibited the corrosion of the CaCO3 deposit electrode. The polarity of the bare electrode and the CaCO3 deposit electrode was reversed after the 1 h immersion. During the immersion period below 1 h, the CaCO3 deposit electrode was the anode and the bare electrode was the cathode. However, after the immersion for 1 h, the bare electrode became the anode, and the CaCO3 deposit electrode became the cathode.

弱碱三元复合驱采出液乳化严重,油水分离的速度及程度,影响其经济效益.采用恒温静沉分离、多重光散射仪、脱水率等手段,研究了加热条件下清水型、聚醚型、多乙烯多胺型破乳剂对大庆油田某弱碱三元复合驱乳状液的破乳效果.结果 表明,在加热条件下,3类破乳剂对弱碱三元复合驱均有不同程度的破乳效果,3类破乳剂中100#(聚醚型)破乳剂的破乳脱水速率较快.温度越高,破乳速率越高,乳状液的分离效果越好,温度升高至55℃时,出现极值温度点,乳状液的破乳效果最好,温度继续升高,乳状液反而出现乳化现象.10#聚醚型破乳剂在10mg· L-1油相、水相具有良好的破乳效果,适合大庆油田某区块弱碱三元复合驱采出液破乳.

回顾性分析了2015年12月至2018年11月施行胸腔镜辅助微波消融治疗的6例Ⅶ、Ⅷ段膈顶部小肝癌患者的临床资料。所有患者均完成胸腔镜下微波消融治疗，无中转开腹手术。5例肿瘤初次达到完全消融，1例肿瘤消融不完全者经补救消融后达到完全消融；1例因合并严重脾功能亢进术后腹腔内渗血，经保守治疗后好转。术后随访时间8～43个月，所有患者局部消融部位病变无进展，3例肝内复发，1例发生胸腰椎转移。我们认为本方法安全可行，是一种治疗Ⅶ、Ⅷ段膈顶部小肝癌较为有效的治疗手段，但需严格把握手术适应证。

Objective:To investigate the safety and clinical efficacy of alternate region entry blood flow occlusion in hepatectomy for patients with hepatocellular carcinoma complicated with cirrhosis.Methods:This was a retrospective case-control study. From September 2016 to April 2020, 56 cases of liver cancer with liver cirrhosis from Guangyuan Traditional Chinese Medicine Hospital were selected. According to the different ways of blood flow blocking into the liver, they were divided into the alternating-block group (26 cases) and the traditional-block group (30 cases). The perioperative indicators of the two groups were counted respectively, including changes of alanine aminotransferase (ALT), aspartate aminotransferase (AST), interleukin-6 (IL-6), tumor necrosis factor α (TNF-α), leutriene C4 (LTC4) before and after operation on day 1, 3 and 7. The occurrence of postoperative complications were compared between the two groups.Results:The intraoperative blood loss in the alternating-block group was significantly lower than that in the conventional block group, and the difference was statistically significant (P<0.05), while the other perioperative indicators showed no statistical significance. There were no statistically significant differences in ALT, AST, IL-6, TNF-α and LTC4 levels between the two groups before surgery, and the levels in the traditional-block group were all higher than those in the alternating-block group after the operation, with statistically significant differences (P<0.05). The incidence of postoperative complications in the alternating-block group was lower than that in the traditional-block group (P<0.05).Conclusion:Compared with Pringle method, alternate regional blood flow blocking in hepatectomy for patients with hepatocellular carcinoma complicated with cirrhosis can reduce intraoperative bleeding, alleviate liver injury, depress reperfusion stress reaction and incidence of complications, which is safe and feasible, and more conducive to postoperative recovery of patients.

Purpose This study aimed to compare the efficacy and safety of ultrasound-guided percutaneous microwave ablation (MWA) for hepatocellular carcinoma (HCC) adjacent to large vessels with those far from large vessels. Methods The clinical data of patients who underwent ultrasound-guided percutaneous MWA for HCC were retrospectively analyzed between January 2011 and December 2018 in Shengjing Hospital. Patients with HCC adjacent to large vessels were included in the Vessel group, the remaining patients were included in the Control group. Propensity score matching analysis was used to reduce confounding bias. The rates of complete ablation, local recurrence, recurrence-free survival (RFS), overall survival (OS) and complications were compared between the two groups. Results A total of 134 patients with 157 nodules (size range, 0.6–3.8 cm) were enrolled in this study, 23 in the Vessel group and 111 in the Control group. A total of 21 patients in the Vessel group (91.3%) and 105 patients in the Control group (94.6%) achieved complete ablation (p = .902). Following 1:2 propensity score matching, 22 patients were included in the Vessel group and 40 patients were enrolled in the Control group. Local recurrence was observed in 2 (9.1%) patients in the Vessel group and 5 (12.5%) in the Control group (p = .86). No significant difference in local recurrence rate, RFS and OS were observed between the two groups. Conclusions Ultrasound-guided percutaneous MWA appears to be a safe procedure and can achieve comparable oncological efficacy for HCC abutting large vessels.

肝内胆管细胞癌是一种具有高度侵袭性的肝脏恶性肿瘤,手术切除是目前唯一可能获得治愈的有效手段.淋巴结转移给准确判断根治性切除范围带来困难,国际上对于是否需要常规行淋巴结清扫以及清扫范围尚无共识.归纳并分析了目前对术前诊断无淋巴结转移的患者行预防性清扫淋巴结所存在的争议和问题,希望能为肝内胆管细胞癌的根治性切除提供参考.

目的:分析并总结肝细胞癌肉瘤(hepatocellular carcinosarcoma,HCS)的临床特征、影像学特征、治疗方式与预后的关系.方法:回顾性分析中国医科大学附属盛京医院2009年11月至2020年5月病理学诊断为HCS的患者资料.总结HCS的特点,比较治疗方式及预后.结果:共纳入11例患者,男性7例,女性4例.中位年龄58(41～71)岁,中位肿瘤直径7(2.0～15.6)cm.2例肿瘤位于左半肝,9例肿瘤位于右半肝,9例患者乙型肝炎,2例AFP>20 ng/mL,6例CA19-9>40 U/mL.影像学显示所有病灶为混合密度,其中2例病灶中心含囊性变、4例含坏死区.中位无瘤生存时间6(2～87)个月,中位总生存时间12(3～87)个月.1、3、5年生存率分别为54.5％、36.4％、11.1％.根治性(R0)切除1例,姑息性切除10例,1例R0切除及3例多学科综合治疗患者与其他患者相比生存时间显著延长.结论:HCS发病率低,侵袭性强,预后差.CA19-9特异性较AFP和CEA高,病灶以坏死或囊变为较显著特征,术前难以确诊.发现时R0切除几率很小,多学科综合治疗有利于患者预后.

Intrahepatic cholangiocarcinoma (ICC) is the second most frequently occurring primary liver cancer. It has been reported that the causes of late diagnosis of ICC are a high degree of malignancy, early metastasis, and diffusion. Most patients visit the hospital because of jaundice or discomfort due to the surrounding compression. ICC commonly recurs after resection, and chemotherapy is not sensitive. Therefore, patients have a poor prognosis and a low survival rate. Currently, a multidisciplinary approach based on surgery is recommended for ICC patients who can undergo surgical excision, and local treatment combined with chemotherapy is the main com-prehensive treatment for patients with advanced ICC who cannot undergo surgical resection. In recent years, it has been found that immunotherapy can involve the autoimmune system to remove tumor cells, and molecular-targeted therapy can kill tumor cells by in-hibiting cell membrane surface molecules that promote tumorigenesis and development. At present, these two treatment modalities have become the research focus of ICC therapy, and progress has been made. The research status is reviewed in this paper.

目的 探讨肝血管瘤术中应用自体血回输技术的优势、存在的问题和应用指征.方法 纳入中国医科大学附属盛京医院2014年4月至2018年10月接受手术治疗且术中应用自体血回输的肝血管瘤病人的临床资料,根据肿瘤位置、肿瘤直径将51例病例资料分为"简单组"和"复杂组".分析病人围手术期指标和术后并发症.结果 两组病人性别、年龄、肿瘤数量、肝门阻断情况及手术方式差异无统计学意义(P>0.05),但"复杂组"肿瘤直径大于"简单组"(P=0.035)."复杂组"的手术时间、失血量和回输血量均高于"简单组"(P<0.05)."简单组"和"复杂组"中分别有1例和5例额外输入异体血,但二者差异无统计学意义(P>0.05);两组病人术后胃肠道功能恢复时间、留置引流管时间、术后住院时间差异均无统计学意义(均P>0.05);术后并发症主要包括盆腹腔积液、胸腔积液、肺不张、胆汁漏和术后腹腔内出血,两组差异均无统计学意义(均P>0.05)."复杂组"中未输异体血的病例术后血常规及凝血功能指标均无较大波动,可在短期内恢复正常.所有病人围手术期未见过敏、溶血、发热等输血相关不良反应.结论 肝血管瘤术中应用自体血回输疗效可靠且安全,有一定经济效益.位于肝4a段、6段、7段和尾状叶的肿瘤,以及位于肝左外叶、4b段、5段和8段且瘤体≥10 cm的肿瘤更符合应用指征.

PURPOSE:In this study, we evaluated the efficacy of microwave ablation-assisted laparoscopic hepatectomy (MLH) for the management of hepatocellular carcinoma (HCC) in cirrhotic patients. METHODS:Data from HCC patients with liver cirrhosis who underwent laparoscopic hepatectomy (LH) or MLH in Shengjing Hospital (Shenyang, China) were retrospectively analyzed from January 2013 to June 2017. The demographic characteristics, clinical features, intraoperative parameters and surgical outcomes were analyzed and compared. Propensity scores matching (PSM) analysis was used to minimize bias. RESULTS:A total of 54 patients were enrolled in the MLH group and 39 patients in the LH group. Following 1:1 matching by PSM analysis, 26 patients were selected from each group. Compared to the LH group, patients in the MLH group had significantly decreased intraoperative bleeding (48.0 vs. 203.9 ml, p < .0001) and reduced demand for hepatic inflow occlusion (0 vs. 6, p = .009). No significant difference was observed in average operation time (155.7 vs. 148.5 min) and postoperative hospitalization time (8.3 vs. 9.3 d) between the MLH and LH groups. Similarly, the 1-year and 3-year recurrence-free survival (RFS) rates as well as the 1-year and 3-year overall survival (OS) rates of the MLH and LH groups were not significantly different (83.1 vs. 82.4% and 64.6 vs. 36.6% as well as 100 vs. 95.8% and 93.8 vs. 59.1%, respectively: p > .05). CONCLUSIONS:MLH significantly decreased intraoperative bleeding and reduced the need for hepatic occlusion without compromising the surgical outcome. Therefore, microwave ablation could be a valuable tool for LH in HCC patients with cirrhosis.