Volume 14,Issue 2,2005 Table of Contents

1 Changes of serum level of tumor necrosis factor and alpha fetoprotein in patients with primary hepatic cancer before and after radiofrequency ablation

LI Jinmao , BAO Enwu , MA Qingjiu , LAI Danian , LU Jianguo , GAO Deming

2005, 14(2):2. DOI: 10.7659/j.issn.1005-6947.2005.02.002

[Abstract](513) [HTML](0) [PDF 871.63 K](564)

Abstract:
Abstract:Objective
To investigate the changes of serum levels of TNF and AFP in patients with primary hepatocellular carcinoma(PHC) before and after radiofrequency ablation(RFA) and their correlation with changes in the patients′ immunological function,so as to monitor the therapeutic effect of RFA in PHC
Methods The serum levels of TNF and AFP were measured in 20 healthy individuals(control group) and in 112 patients with PHC (treatment group) preRFA, postRFA. The results were compared and analysed for correlation with changes in the patients′ immunological function.
Results Mean serum level of TNF and AFP in treatment group preRFA was significantly higher than that of control group(P<0.01).At 7 days postRFA,the serum level of TNF showed no significant change（P>0.05）,but the level of AFP decreased significantly(P<0.01). At 14 days postRFA,the serum level of TNF decreased significantly(P<0.01),but it was still higher than that of control group(P<0.01), and the serum level of AFP compared with that of control group was not significanly different（P>0.05）.No relationship was found between changes in the levels of TNF and AFP(r=0.195,P>0.05). RFA showed a marked shortterm therapeutic effect for patients with PHC.〖WTHZ〗Conclusions After RFA treatment of patients with PHC,the serum levels of TNF and AFP decreased,and this suggests an augmentation of organism immune function. The serum levels of TNF and AFP can assist in the assessment of the therapeutic effect and prognosis of primary hepatic carcinoma.

2 Hepatectomy for hepatocellular carcinoma associated with cirrhosis

CHEN Xiangping，TANG Zhenghua，ZHANG Yuhua , YU Meiying

2005, 14(2):3. DOI: 10.7659/j.issn.1005-6947.2005.02.003

[Abstract](827) [HTML](0) [PDF 878.90 K](634)

Abstract:
Abstract:Objective To define the factors that influence the safety of hepatectomy for hepatocellular carcinoma(HCC) associated with cirrhosis. Methods Based on the patients treated before and after February 1997,229 cases of HCC associated with cirrhosis were divided into two groups, Group A and Group B,respectively. The patients′ general condition, operative procedure, morbidity and mortality rates were compared between the two groups. The factors that influenced surgical morbidity were analysed.
Results In group B, patients′ average age was higher (P<0.05). Blood loss, blood transfusion requirement during the operation, morbidity and mortality rates were significantly reduced in group B(P<0.05). Operation time and blood transfusion were independent factors that influenced postoperative morbidity and mortality.
Conclusions Before operation, the scope of the operation is decided by a correct assessment of the function of the liver and the size of the postoperative liver remnant. During the operation,technical improvement can shorten the time of operation, reduce blood loss and prevent bile leakage. After operation, isovolumic fluid infusion is given, along with nutritional support and early intestinal nutrition. In this way,the safety of hepatectomy for HCC associated with cirrhosis can be greatly enhanced.

3 Study on differential genes expression in HBVrelated heptocellular carcinoma

HUANG Yukun , FAN Xuegong , QIU Fu , Li Jiang

2005, 14(2):4. DOI: 10.7659/j.issn.1005-6947.2005.02.004

[Abstract](758) [HTML](0) [PDF 881.72 K](655)

Abstract:
Abstract:Objective
To investigate the expression of oncogenes and tumor suppressor genes in hepatitis B virus (HBV) related hepatocellular carcinoma (HCC).
Methods mRNA was extracted from cancerous and paracancerous tissues of 22 patients with HBVrelated HCC and synthesized into cDNA. The cDNA labeled with 33pdATP was hybridized for cDNA microarray each consisting of 3170 genes or expressed sequence tags (EST). The differential expression genes were searched in gene data base and verified using RTPCR.
Results The differential expression of 1369 genes or EST was identified including 121 genes or EST altered 2 times or more in cancerous tissues compared with paracancerous tissues. Compared with paracancerous tissues, 88 showed overexpression and 33 genes were downregulated. The positive expression of transmembrane 4 superfamily member 1 (TM4SF1) in cancerous tissues was 86.4% and could not be detected in paracancerous tissues （P＜0.001）. The positive expression of suppression of tumorigenicity 14 (ST14) in paracancerous tissues of HBVrelated HCC patients was 72.8% and could not be detected in cancerous tissues （P＜0.01）.
Conclusions The positive expression of TM4SF1 in cancerous tissues，and ST14 in paracancerous tissues of HCC were related to the development of HBVrelated HCC.

4 Expressions and clinical significance of multidrug resistance associated protein gene (MRP) and lung resistance protein gene (LRP) in hepatocellular carcinoma (HCC)

WANG Bailin , YANG Haiyan , ZHAI Shuping , CHEN Xiaoping , ZHONG Yong , ZHANG Qingye , MENG Lei

2005, 14(2):5. DOI: 10.7659/j.issn.1005-6947.2005.02.005

[Abstract](668) [HTML](0) [PDF 884.80 K](700)

Abstract:
Abstract:Objective To study the expressions and significance of MRP and LRP in HCC.
Methods The expressions of two genes were examined in three tissues (54 cases of HCC, 24 paracancer and 12 posthepatitis cirrhosis tissues) by SP immunohistochemical and PCR techniques.
Results MRP and LRP were expressed in three tissues, with significantly higher rates in HCC than others (P<0.05). The MRP expression positively correlated with the LRP expression in HCC (r=0.312, P<0.05; r=0.328, P<0.05), and was related to the degree of HCC differentiation (P<0.05). In the patients with positive gene expression,the AFP decresing rate was higher and the average survival after chemotherapy was longer than the negative expression group(P<0.05),but there was no relationship between LRP expressions and the average survival time.
Conclusions Multidrug resistance (MDR) of HCC is related to MRP、LRP expressions, and is initiated by intrinsic MDR. Monitoring of MRP and LRP may help to prospectively evaluate drug resistance. MRP may be relates to the prognosis of HCC patients.

5 Relationship of expression between STAT1，STAT2 and hMLH1，hMSH2 in hepatocellar carcinoma

ZHOU Jun , ZHONG Dewu , HUA Songwen , DAI Weidong , YI Shijian

2005, 14(2):6. DOI: 10.7659/j.issn.1005-6947.2005.02.006

[Abstract](532) [HTML](0) [PDF 876.90 K](681)

Abstract:
Abstract:Objective To study the significance and expression relationship among STAT1,STAT2 and hMLH1,hMSH2 proteins in hepatocellur carcinoma(HCC).
Methods SABC immunohistochemistry method was used to detect the expression of STAT1,STAT2,hMLH1 and hMSH2 proteins in cancer tissues and paracancer tissue from 37 patients of HCC.
Results The positive rates and expressive levels of STAT1,STAT2,and hMLH1, hMSH2 in HCC was significantly lower than those in paracancer liver tissues(P<0.05). The level of expression of the 4 proteins in welldifferented cancer tissue was significanty higher than that in poorly differentiated cancer tissue(P<0.05). A positive correlation was found for STAT1 and hMSH2,STAT2 and hMLH1,hMSH2 (P<0.05) in paracancer liver tissues.
Conclusions The data suggest that STAT1,STAT2 and hMLH1,hMSH2 may play an important roie in the early stage of malignant transformation of hepatocytes.

6 Significance of MRP1/CD9 protein expression in human hepatocellular carcinoma

ZHANG Weiguo , WANG Yi , WU Weiqing , XIAN Zhihong , GUAN Xinyuan , WU Mengchao

2005, 14(2):7. DOI: 10.7659/j.issn.1005-6947.2005.02.007

[Abstract](747) [HTML](0) [PDF 880.82 K](699)

Abstract:
Abstract:Objective To investigate the expression of MRP1/CD9 protein in human hepatocellular carcinoma (HCC),and its relationship to carcinoma invasion and metastasis.
Methods The specimens of tissue microarray from 152 primary hepatocellular carcinomas with paracancerous liver tissue, 22 tumor emboli,4 intrahepatic satellite metastases, 17 extrahepatic metastases ,and 5 normal livers, respectively, were constructed and used for detection of MRP1/CD9 expression by immunohistochemistry.
Results Immunohistochemical analysis of tissue microarrays demonstrated MRP1/CD9 protein expression in 27.0%(41/152)of the primary HCCs. The expression of MRP1/CD9 protein was higher in HCCs without cancer thrombi than in those with cancer thrombi (40.48%vs21.82%，P<0.05). MRP1/CD9 protein expression was also inversely correlated with the tumor size (≤10cm vs >10cm, P<0.01), pathological grade (P=0.043), and the serum level of AFP (≤20μg/L vs >20μg/L, P=0.029). Conclusions Loss of MRP1/CD9 protein expression may be associated with invasion and metastases of hepatocellular carcinoma.

7 A study of hepatocyte apoptosis and its gene expression in patients with liver cirrhosis and portal hypertension

YAN Yukuang , PENG Haifeng , LIU Nengying , LI Dening , DUAN Junying , YANG Zhen

2005, 14(2):8. DOI: 10.7659/j.issn.1005-6947.2005.02.008

[Abstract](725) [HTML](0) [PDF 862.86 K](657)

Abstract:
Abstract:Objective
To study the relationship of hepatocyte apoptosis and gene expression of liver cirrhosis and primary hepatic carcinoma.
Methods Specimens of liver tissue from patients with liver cirrhosis and portal hypertension and normal subjects were examined by transmission electron microscope to detect apoptotic cells and primary cancer gene expression.
Results The number of apoptotic cells and the apoptotic index of cirrhotic liver tissue was higher than that of normal subjects.Immunostaining of bcl2,cmyc,cfos was negative in normal liver tissue,but was overexpressed in cirrhosis.
Conclusions Hepatocyte apoptosis plays a certain role in the development of hepatic cirrhosis. The oncogenes bcl2,cmyc,cfos take part in the regulation of hepatocyte apoptosis.

8 Effect of endothelin1 monoclonal antibody on apoptosis of hepatocytes during ischemia/reperfusion injury of liver transplantation in rats

HUANG Zhiheng , WANG Chengyou , NI Yong , ZHANG Minjie , CHEN Guihua

2005, 14(2):9. DOI: 10.7659/j.issn.1005-6947.2005.02.009

[Abstract](630) [HTML](0) [PDF 869.21 K](635)

Abstract:
Abstract:Objective To evaluate the role of hepatocyte apoptosis in ischemia/reperfusion injury of grafted liver and the effects of endothelin1 (ET1) monoclonol antibody on hepatocyte apoptosis.
Methods Othotopic liver transplantation rats were divided into two groups: with and without ET1 antibody. The concentrations of ET1 of plasma and liver tissue were measured. The parameters of liver fuction were determined. The concentration of malondialdehyde (MDA) was measured and the number of apoptotic hepatocytes in grafts liver was determined.
Results The levels of ET1, ALT in serum, and ET1, MDA and apoptotic cells in the grafted liver after ischemia/reperfusion were significantly increased compared with normal values. In the ET1 antibody group, the levels of ET1, ALT, MDA and apoptotic cells were significantly decreased. 〖WTHZ〗Conclusions ET1 monoclonal antibody can attenuate ischemia/reperfusion injury by decreasing lipid peroxide reaction, and decreasing apoptosis of hepatocytes and thus protect the liver graft.

9 Significance of TLR2 expression in ischemic liver tissue after liver ischemia/reperfusion in mice

ZHANG Jinxiang , WU Heshui , WANG Hui , WANG Yang , TIAN Yuan , ZHENG Qichang

2005, 14(2):10. DOI: 10.7659/j.issn.1005-6947.2005.02.010

[Abstract](697) [HTML](0) [PDF 884.12 K](545)

Abstract:
Abstract:Objective To explore Tolllike receptor2 (TLR2) expression after partial liver ischemia/reperfusion (I/R) in BALB/c mice and its relationship with liver function impairment.
Methods All the animals were randomly divided into ischemia/reperfusion injury (I/R) and sham operation (S) groups. Total RNA was extracted from the liver samples and the expression of TLR2 mRNA was analyzed quantitatively by realtime PCR method. Membrane protein was extracted, and the expression of TLR2 protein was detected by western blot method. Portal vein serum and plasma were taken for further detection of the levels of alanine aminotransferase (ALT), tumor necrosis factor alpha (TNFα) and endotoxin.
Results After 1h of partial liver ischemia and 4 h of reperfusion, the expression of TLR2 mRNA and TLR2 protein were both remarkably upregulated in tissues of ischemic liver lobes in I/R group compared with that in S group (value of TLR2mRNA: 1.06±0.91vs5.08±1.32,P<0.01; value of OD: 433.91±25.53vs102.86±13.58, P<0.01)，as well as the levels of portal vein TNFα and ALT (level of TNFα: 112.52±14.41 pg/ml vs 5.96±4.43 pg/ml, P<0.01；level of ALT: 848.33±271.37U/L vs 42.39±14.75 U/L,P<0.01) . The levels of endotoxin in portal vein remained constantly below the normal level，and the difference between both groups was not significant (P>0.05).
Conclusions TLR2mRNA and TLR2 protein expression were upregulated in tissues of ischemic liver lobes after partial I/R injury in mice, and were associated with increased levels of portal vein ALT and TNFα,and impairment of liver function.

10 Reconstruction of heptic artery for vascular anomalies of recipient in orthotopic liver transplantation

ZHU Xiaofeng , HE Xiaoshun , Ma Yi , QIAN Shikun , JU Weiqiang , WANG Dongping , WU Zhiwei , ZHANG Xiangliang , HUANG Jiefu

2005, 14(2):11. DOI: 10.7659/j.issn.1005-6947.2005.02.011

[Abstract](648) [HTML](0) [PDF 870.97 K](721)

Abstract:
Abstract:Objective To investigate the methods and effectiveness of heterotopic reconstruetion of hepatic artery in orthotopic liver transplantation.
Methods The methods of heterotopic hepatic artery reconstruction and postoperative management of 36 cases of recipient vascular anomalies among 440 cases of liver transplantation performed in our hospital over a tenyear period,were retospectively analysed.
Results In 10 of 36 recipients the donor hepatic artery was anastomosed to recipient infrarenal aorta ,10 to the suprarenal aorta,4 to the left gastric artery and 2 to the splenic artery. Five patients died perioperatively with patency of hepatic artery, and 31 recipients have survived for 3 to 48 months without hepatic artery complications; 1 patient had to receive liver retransplantation because of ischemic necrosis of bile duct.
Conclusions In cases of disease or anomaly of recipient hepatic artery during liver transplantation,the heterotopic reconstruction of donor hepatic artery to the infarenal or suprarenal aorta,splenic artery or left gastric artery of the reeipient is indicated,and the results are satisfactory.

11 Change in hypersplenism after orthotopic liver transplantation

JIANG Bin , SONG Shibing , XIU Dianrong , YANG Xiaoxia , YUAN Jiong , WANG Changming , ZHANG Tongling

2005, 14(2):12. DOI: 10.7659/j.issn.1005-6947.2005.02.012

[Abstract](765) [HTML](0) [PDF 862.96 K](740)

Abstract:
Abstract:Objective
To observe the changes in hypersplenism after orthotopic liver transplantation(OLT) and investigate the effect of OLT on hypersplenism. Methods Based on the clinical data of 14 eligible OLT patients operated on in our hospital during two and a half years, an analysis of the preoperative values of the thickness of the spleen, blood WBC and PLT count was made,and the postoperative pattern of changes of portal flow velocity was observed.
Results Blood WBC and PLT count returned to normal 1 month after the operation, and the thickness of spleen reduced about 17.0% in the first month , but had no additional change at 1 year later. Portal flow velocity increased significantly 1 month after operation , then decreased slowly in the first year. Portal flow velocity , blood WBC and PLT count were all significantly related to the thickness of the spleen.
Conclusions The high velocity of portal flow after OLT was mostly attributed to increased flow from the splenic vein; the main cause of the decrease in the level of blood WBC and PLT in hypersplenism before operation is augmentation of splenic volume; the recuperation of hypersplenism after OLT relies on the extent of reversion of splenic volume. It is not necessary to perform splenectomy in patients with hypersplenism when they receive OLT.

12 Surgical treatment of hepatic cavernous hemangioma in the central area of liver：a report of 32 cases

XU Peiqin , DANG Xiaowei

2005, 14(2):13. DOI: 10.7659/j.issn.1005-6947.2005.02.013

[Abstract](861) [HTML](0) [PDF 866.69 K](664)

Abstract:
Abstract:Objective
To discuss the experiences of surgical treatment of hepatic cavernous hemangioma in a peculiar position.
Methods We retrospectively analyzed the clinical data of 32 cases of cavernous hemangioma in the central area of the liver.
Results All of the hepatic cavernous hemangiomas were resected successfully by extracapsular dissection. Intraoperative hemorrhage volume varied from 50ml to 10000ml, and in 12 patients the amount of blood transfusion was 400ml to 4000ml. 5 cases (15.6%) had postoperative complications, including right pleural effusion(3 cases), bile leakage(1 case), and subdiaphragmatic fluid collection(1 case). The mortality rate was 3.1%（1/32）. 26 cases were followed up for a median of（3.09±0.93）yrs, and there was no recurrence of hemangioma.
Conclusions Familiarity with the liver anatomy and proficient operative methods are the key get to successful surgical treatment of these hemangiomas and reduce complications. Extracapsular dissection is a safe and effective way to treat hepatic cavernous hemangioma.

13 Percutaneous puncture insertion of widebore tube in the treatment of echinococcosis:a report of 1561 cases

JIAO Guotang , WANG Xiaozhi , GAO Hong , PANG Qi , HE Bi , XIA Li , YU Li

2005, 14(2):14. DOI: 10.7659/j.issn.1005-6947.2005.02.014

[Abstract](609) [HTML](0) [PDF 866.86 K](745)

Abstract:
Abstract:Objective
To investigate the effectiveness of drug therapy and percutaneous puncture insertion of widebore tube for suction and curettage in the treatment of echinococsosis.
Methods Oral Fu Fang Xiao Bao tablet or Albendazole,25mg/kg per day, for 3 months was followed by percutaneous puncture insertion of widebore tube for suction and curettage of liquefied necrotic and fragmented scoleces of hydatid cyst and daughter cysts.
Results Of 1561 cases treated by this method,complete follow up data was obtained for 1482 patients. Postoperative complications occurred only in 6 patients(0.004%), and all fully recovered after treatment.There was no operative mortality. At follow up of over one and a half years, the hydatid cysts disappeared in 1262 cases(85.2%),and the cysts decreased in size by 95% or more,and showed eggshell calcification in 220 cases(14.8%),so the cure rate was 100%.Two cases had ectopic recurrence,a recurrence rate of 0.001%.
Conclusions The combined use of antiechinococcal drugs and puncture insertion of widebore tube for suction and curettage to treat echinococcosis is a safe and minimally invasive methed,with few complications,quick recovery,low recurrence rate and high cure rate.

14 The causes and management of postsplenectomy fever in patients with portal hypertension

ZHU Xiongwei , CHEN Gangliang , WANG Qiang , HU Zhiqian , CHEN Xueyun

2005, 14(2):15. DOI: 10.7659/j.issn.1005-6947.2005.02.015

[Abstract](884) [HTML](0) [PDF 867.09 K](927)

Abstract:
Abstract:Objective
To investigate the cause and management of postsplenectomy fever in portal hypertensive patients.
Methods The clinical data of 295 portal hypertension patients undergoing splenectomy from 1990 to 2003 were reviewed. Among these，80 patients suffered from a continuous fever higher than 38.5℃ for more than 2 weeks postoperatively.
Results Except for two patients with unknown cause, 78 of 295 patients with continuous fever were caused by complications such as splenoportal thrombosis(35 cases), infection of hematocele or hydrops in splenic recess(20 cases), left subphrenic infection(7 cases), pneumonia and hydrothorax or empyema(5 cases), 3 cases each of postoperative abscess of tail of pancreas,winary tract infection and inteclion of surgical incision, 1 case of leakage of esophageal anastomosis and intraabdominal infection in 1 case. The lasting fever was related to the grade of liver function(P<0.01). The surgical modality adopted was not related to the continuous fever or splenoportal thrombosis(P>0.05).
Conclusions Splenoportal thrombosis, and hematocele, hydrops or infection in the splenic recess were the main causes of persistent fever after splenectomy. Prevention and treatment of infection and amelioration of hepatic function will help to reduce the rate of postoperative continuous fever.

15 Interventional therapy for BuddChiari syndrome:a report of 355 cases

FENG Liushun , TANG Zhe , CHEN Xiaoping , MA Xiuxian , LI Tianxiao , XU Peiqin

2005, 14(2):16. DOI: 10.7659/j.issn.1005-6947.2005.02.016

[Abstract](568) [HTML](0) [PDF 868.24 K](693)

Abstract:
Abstract:Objective
To investigate the effect of interventional therapy for BuddChiari Syndrome(BCS).
Methods 355 patients with BCS were examined with phlebography of inferior vena cava(PIVC) and percutaneous transhepatic hepatovenography(PTHV).The interventional procedures were based on the pathological changes of inferior vena cava(IVC) and main hepatic veins(MHVs).The procedures included PTA and/or stent placement of IVC,percutaneous transhepatic recanalization and dilation (PTHRD)of MHVs,and percutaneous transjugular or transinferior vena cava recanalization and dilation with stent placement of MHVs(PTJRD and PTIRD ), percutaneous transhepatic recanalization or transinferior vena cava recanalization and dilation with stent placement of associated hepatic veins(AHVs).
Results The success rate and recurrence rate were 96.0%（240/250） and 10.0 %（24/240）, respectively, in PTA; the success rate was 91.4%（32/35 ） in PTHRD of MHVs; 90.0%（18/20 ） in PTJRD and PTIRD of MHVs, 100.0%（10/10） in PTJRD and PTIRD of AHVs; 90.0 %（ 9/10 ） in PTA and stent placement plus PTHRD of AHVs. Severe complications occurred in 10 cases (2.8%).
Conclusions Interventional therapy is simple, safe and effective for patients with some types of BuddChiari Syndrome.

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