Abstract:

Abstract:To investigate the methods of hepatic arterial reconstruction in orthotopic liver transplantation(OLT), and the prevention and management of associated complications, so as to improve the therapeatic results and donor survival rate of OLT.Methods：The clinical data of 85 cases of orthotopic liver transplantation performed in our institute from May 1995 to May 2004 were retrospectively analysed. Hepatic artery reconstruction was made by use of Carrel′s patch of donor celiac artery or bifurcation of donor common hepatic artery and splenic artery anastoniosed to left and right hepatic artery of recipient in 16 cases(18.82%), to bifurcation of gastroduodenal and proper hepatic arteries of recipient in 61 cases(71.76%), or use of donor iliac artery interposition graft to abdominal aorta in 8 cases(9.42%). Regular heparin or lowmolecularweight heparin as a prophylactic anticoagulation therapy was maintained during and after operation as indicated by prothrombin time. Intraand postoperative Doppler ultrasonography was used to monitor hepatic arterial blood supply.Results：Hepatic artery thrombosis(HAT) was observed in 1 case intraoperatively(overall incidence 1.2%).Thrombectomy and reconstruction of the arterial anastomosis were performed immediately.This patient currently has a survival time of 13 months without HAT. HAT was not observed in any of the other 84 cases during the follow up of 2 to 52 months.Conclusions： Hepatic artery thrombosis may be minimized by proper selection of anastomotic site of hepatic artery reconstruction and effective use of postoperative anticoagulation.Close followup by Doppler ultrasonography may make a prompt diagnosis of HAT, salvage grafts and avoid retransplantation.

Abstract:Objective：To investigate an improved technique of orthotopic liver transplantation with the “twocuff method” in rats, and to observe allograft rejection after transplantation. Methods：30 Wistar rats were grafted with livers of SD rats and 30 SD rats were grafted with livers of SD rats by using a modified “twocuff technique” and examined for postoperative rejection. Results：The anhepatic period was about 15 minutes. The 24hour survival rate was 100%. The Wistar rats grafted with SD livers died 8 to 15 days after liver transplantation, and the histopathologic examination showed various degrees of allograft rejection. The SD rats grafted with livers of SD rats had a survival rate of 97% at 3 weeks postoperatively. Conclusions：The modified “twocuff technique” can effectively reduce operative time, decrease postoperative complications and increase the survival rate of othortopic liver transplantation in rats. The transplantation model of Wistar rats grafted with livers of SD rats can be used to study allograft rejection.

Abstract:Objective：To investigate the establishment of a rat model of orthotopic liver transplantation with more complete and easier performance of graft perfusion and easier control of warm ischemic time. Methods：A modification of Kamada twocuff method was used. Cold perfusion of donor livers was done through the ascending aorta. Suture anastomosis of suprahepatic vena cava was performed. Infrahepatic vena cava and portal vein anastomoses were done by the cuff technique. The bile duct was anastomosed with internal stent. The nonheartbeating donor(NHBD) graft model of orthotopic liver transplantation in rats was thus established.Results：The survival rate of recipients grafted from NHBD with perfusion of ascending aorta was 95% (38/40) for 1 day and 85.5% (35/40) for 7 days. Conclusions：The livers of NHBD as grafts harvested with perfusion through ascending aorta had more complete and homogeneous perfusion, perfusion was easier to perform and warm ischemia time was more accurately controlled. The oneweek posttransplantion survival rate was longer than that reported in the literature.

Abstract:Objective：To study the role of hepatic glycogen reserve in pretecting the ischemiareperfusion injury of rat liver. Methods：A model of rat liver warm ischemia and reperfusion injury (WIRI) was set up. Rats were divided into 4 groups：(1)Group H, given 25% glucose by tail vein injection(2ml,q6h,iv);(2)group L, food was not supplied (drinking unlimited) 24 hours before warm ischemia; (3)control group (group C), rats took food freely; and (4)sham operation group (group N). After 45 min of ischemia, reperfusion for 1/4h，1/2h and 1h, blood was taken to test for ICGR15and GLT(glucagon loading test). Meanwhile, the levels of enzymes (including AST, ALT, AKP) were observed. Results：(1) Hepatic functional reserve (HFP)： ①ICGR15： groupN<groupＨ<groupＣ<groupＬ(P<0.05 or P<0.01). ②GLT： cAMP level in plasma after GLT and cAMP answering rate (CAR)： group N>groupＨ>group C>groupＬ(P<0.01).There were significant differences of ICGR15, GLT between the periods of reperfusion of 1/2h，1/4h and 1h in group H, C and L (P<0.05 or P<0.01). (2) Enzyme level： There were signlficant differences in the same periods among the four groups (P<0.05 or P<0.01), groupN<groupＨ<groupＣ<group L. No difference was observed between 1/2h and 1/4h enzyme level in the groups(P>0.05). (3)Histopathologic changes in the liver：They were significantly milder in group H than in groups C and L, and the changes in group H were similar to group N. The changes in group L were the most severe. Conclusions：(1)Prophylactic increase of hepatic glycogen storage could counteract the injury of hepatic functional reserve that occurs during warm ischemia and reperfusion. (2)The changes of hepatic functional reserve that occurs during warm ischemia reperfusion can be earlier and more sensitively reflected by ICGR15 and GLT than by the routine enzyme parameters of hepatic function.

Abstract:Objective：To compare the injury to hepatocarcinoma and normal liver tissues following ischemia and reperfusion. Methods：The hepatocarcinoma(HC) models were established by injectin of VX2 tumor tissue suspension fluid into the leftmiddle lobe of liver of rabbits. After the models were established, the models left hepatic vessels were occluded for 60 minus, then followed by various intervals of reperfusion, and the levels of superoxide dismutase (SOD) and malondialdehyde (MDA) were measured, and apoptotic changes in the hepatocarcinoma and normal hepatic tissues were observed by means of HE staining and TUNEL method. Results：The concentration of SOD decreased significantly in hepatocarcinoma tissue and reached the lowest point at 1h after ischemia and reperfusion (64.59±4.97NU/mgprot), then gradually rebounded, but, at 7d after reperfusion, it still retained at a lower level(121.12±6.88NU/mgprot) than that before reperfusion. In contrast with normal liver tissues,the concentration of MDA decreased in the hepatocarcinoma tissues following ischemia and reperfusion, the changs of MDA were similar to SOD. The apoptotic cells in hepatocarcinoma tissues increased to the highest point at 1 day following reperfusion, but 7d after reperfusion, the number of positive cells were more than before reperfusion, and the apoptotic rate was higher in hepatocarcinoma tissues compared with the normal liver tissues. Conclusions：In comparison with normal liver tissue, hepatocarcinoma tissue is more suscepible to the injury of ischemia and reperfusion.

Abstract:Objective：To investigate the expression of hepatic apolipoprotein M (apoM) mRNA and serum apoM during early stage of hepatic ischemia reperfusion injury in rats. Methods：Rat models of hepatic ischemiareperfusion injury (IRI) were established. Forty healthy male SD rats were randomly divived into five groups(each group containing eight rats)：Shamoperation group(control); IRI groups, animals experienced 1 hr ischemia and then followed by various reperfusion intervals(0.5,1.0,2.0 and 3.0 hrs, respectively). Results：Serum alanineaminotransferase (ALT) levels and the liver injury degree histologically were increased with the prolongation of hepatic reperfusion time. The apoMmRNA level in liver was markedly decreased in the group that had reperfusion for 0.5hr compared to the sham group. However, it increased gradually in groups that had reperfusion for 1hr to 3hrs. Serum apoM protein level showed a similar tendency with apoMnRNA, but it increased after reperfusion for 2 hrs. Conclusions：It is concluded that apoM expression pattern shows rapid and significant changes during hepatic ischemiareperfusion injury, which suggests that apoM might have the characteristic of acute phase reactive protein.

Abstract:Objective：To investigate the feasibility and isolation efficiency of percutaneous selective isolated hepatic perfusion chemotherapy(PSIHP). Methods：Six pigs underwent the procedure of routine transhepatic arterial infusion(HAI) and 6 underwent PSIHP.5FU was used in this study. The drug(5FU) concentration of blood from hepatic and systemic veins of both groups was observed. Liver tissue was investigated for pathologic changes. Results：The peak level of 5FU concentration in blood from right hepatic vein and systemic vein in HAI group was（4082.530±415.213）mg/L and （1682.230±216.834)mg/L respectively.In PSIHP group, the peak level(5FU) was（5321.711±517.318）mg/L and（510.834±52.518）mg/L, respectively.There was a statistically significant difference between HAI group an PSIHP group(P<0.01). The level of 5FU concentration in blood from right hepatic vein of PSIHP group(postfiltration) was（1192.063±114.864）mg/L and the filtration rate of charcoal hemoperfusion was（77.6±0.9%）. The damage of perfused area of liver tissue was more serious in PSIHP group compared with HAI group. Conclusions：PSIHP is a simple and feasible method for isolated hepatic perfusion. Compared with HAI, PSIHP can increase the concentration level of chemotherapeutic agents in regional liver, and can even more markedly decrease the drug concentration in systemic circulation and decrease toxic side effcts.

Abstract:Objective：To investigate the mechanism of adriamycininduced apoptosis of hepatic carcinoma HCC9204 cells, and study the expression of apoptosisassociated genes Bcl2 and Bax. Methods：TUNEL method and flow cytometry were used to detect the effect of adriamycin on the multiplication cycle of human hepatic cancer ACC9204 cells, and the cell apoptosis. The expression of Bel2 and Bax protein in ACC9204 cells was examined. Results：Adriamycin markedly induced apoptosis of HCC9204 cells, and typical characteristics of apoptosis were detected by staining. On cell cytometric analysis 24h after drug treatment, a significant subG1 peak was detected. HCC9204 cells treated with adriamycin showed significant down regulation of Bel2 protein expression, but it was not significantly different from that of the control group(P>0.05). Conclusions：Adriamycin can induce apoptosis of cancer cells, and this is an important mechanism for its anticancer effect. This effect may be related to the down regulation of Bel2 expression.

Abstract:Objective：To study the value of Creactive protein (CRP) and interleukin6(IL6) in the diagnosis of acute pancreatitis (AP) associated with infection. Methods：Sixty SD rats were randomly assigned into group AP (n=40) and shamoperation group (S, n=20). Plasma CRP and IL6 were detected before AP(0h), and at 12h, 24h and 48h after AP. Serum amylase detection and ascitic bacteria culture were carried out at 48h. Results：（1）In AP group, 36 rats were alive. Ascitic infection developed in 16 cases (group AP1), and not in the other 20 cases (group AP2). （2）Plasma CRP and IL6 levels in group AP1 and AP2 were significantly higher than those in group S (all, P<0.01). In group AP1, compared to group AP2, except the CRP concentrations at 48h had a significant increase(P<0.01), at all the other time periods, no significant differences of plasma IL6 and CRP concentrations were observed (all, P>0.05). (3)In group AP1, IL6 and CRP elevated significantly at all time periods after the model setup (P<0.05). But in group AP2, elevation of IL6 and CRP was only observed at 12h(both, P<0.05), and there was no significant difference between 24h and 48h (P>0.05). Conclusions：Plasma CRP has predictive value in the diagnosis of early infection in acute pancreatitis, but plasma IL6 is not sensitive to secondary bacteria infection in acute pancreatitis.

Abstract:Objective：To investigate the clinical results of hepatectomy for bleeding of spontaneous rupture of hepatocellular carcinoma (HCC). Methods：The clinical data of 24 cases admitted to our hospital from Jan 1990 to Mar 2004 was analyzed retrospectively.Results：Surgical hemostasis was achieved successfully in 100.0% (24/24) of patients. The postoperative mortality rate was 4.1% (1/24), and the complication rate 12.5%（4/24）. Liver function recovered within two weeks after operation. The length of hospital stay was 14.75±6.25 days.Twenty-one patients were followedup from 6 month to 36 months. 8 patients died from recurrence within 10 months postoperatively; 10 patients survived over 1 year, 1 patient over 2 years and 1 over 3 years. The overall 1year survival rate was 58.3%（13/24）.Conclusions：In the management of bleeding of spontaneous rupture of HCC, hepatectomy can effectively stop the bleeding and excise the tumor at the same operation. In some patients, a radical excision can be achieved, and, if the patient′s condition permits it, hepatectomy should be the treatment of choice.

Abstract:Objective：To evaluate the effect of suture ligation around the tumor combined with intratumoral drug injection to treat hepatic cavernous hemangioma. Methods：Twentytwo cases of hepatic cavernous hemangioma underwent laparatomy and suture ligation around the tumor plus intratumoral drug injection under direct vision. Results：There was no postoperative mortality or morbidity. 22 patients were followed up for 3 months to 4 years. After this treatment for hepatic cavernous hemangioma, the success rate was 100%, and the significantly success rate was 76.19%. Conclusions：The combined therapy for hepatic cavernous hemangioma is safe, reliable, simple and easy to perform.

Abstract:Objective：To evaluate the characteristics of MRI of common hepatic lesions by using measurement of T1,T2 and ADC on the MRI and DWI. Methods：MRI and DWI were obtained in 100 patients with common hepatic lesions, and T1,T2,ADCs and the ratios of the ADC of lesion/liver were estimated. Results：Average T1,T2 and ADCs of hepatic lesions were as follows： hepatocellular carcinoma, (843.92±167.75) ms , (73.90±14.21) ms and（0.99±0.26）×10-3mm2/s respectively; hepatic metastasis, (946.89±186.13) ms, (76.39±19.76) ms and（1.17±0.32）×10-3mm2/s respectively; hepatic cavernous hemangioma, (1102.33±213.12)ms, (142.32±28.51) ms and (1.81±0.42)×10-3mm2/s respectively; hepatic cyst, (1516.32±617.84)ms ,(247.33±112.52)ms and (3.11±0.38)×10-3mm2/s respectively. The ratio of the ADC of lesion/liver：hepatocellular carcinoma was 0.89±0.17, and significantly lower than the ratio of hepatic metastases(1.27±0.21, P＜0.05). Conclusions：Quantative study of hepatic lesions using T2, ADC and the ratios of the ADCs of lesion/liver, can accurately distinguish the nature of the lesions, and MR1 can accurately diagnose and differentiate hepatic lesions.

Abstract:Objective：To discuss the diagnosis and treatment of rupture of spleen in a baselevel hospital with limited conditions. Methods：The clinical data, diagnosis of bleeding by ultrasound, and results of nonoperative and operative treatment of 317 patients with rupture of spleen in Vila Central Hospital of the Republic of Vanuatu were retrospectively analyzed. Results：Ultrasound diagnosed 30 patients with subcapsular hemorrhage and 287 patients with true rupture of spleen. Based on ultrasound results, conservative treatment was used for 29 patients and 288 patients underwent operation. Conclusions：Ultrasonography had a high positive diagnostic rate for rupture of spleen, and the diagnosis of bleeding volume was consistent with the findings at operation. The findings on ultrasonography can be considered in selection of cases with appropriate indications for splenectomy. Ultrasonography is an effective method for use in the treatment of rupture of spleen.

Abstract:Objective：To investigate the criteria and clinical significance of diagnostic classification of multiple organ dysfunction syndrome(MODS) in patients with severe multiple trauma. Methods：The clinical data of 132 cases of MODS resulted from severe multiple trauma(ISS>20) were analyzed.Results：MODS was staged according to “Lu shan conference” diagnostic criteria.In this group of patients there were 27 deaths(24.7%),of which 1 patient(3.9%) was stage I,7 patients(15.6%) stage II,9 patients(45%) stage III,and 10 patients(90.9%) stage IV.Prognosis varied with stage of MODS.The incidence of MODS increased with higher scores of body injury, and mortality rate increased with the increase of the number of failured organs.Conclusions： The diagnostic classification of MODS has obvious clinical significance. It provides clinicians with an important basis for early diagnosis and treatment of MODS.