Abstract:Abstract:Objective:To explore the operative technique of liver retransplantation. Methods:The clinical data of 24 patients who underwent liver retransplantation in the recent 4 years in our center were reviewed. In all of the patients a modified piggy-back liver transplantation was adopted. Extracorporeal venous bypass was used in 6 cases, and no bypass was used in 18 cases. We anastomosed the suprahepatic inferior vena cava to the annexed vena cava in a modified piggy-back figuration. The portal vein was reconstructed by end-to-end anastomosis. In 17 cases the hepaticy artery was anastomosed end-to-end, and in the other 7 cases was anastomosed to abdominal aorta by interposition graft. In 6 cases the biliary tract was reconstructed by end-to-end anastomosis, and in the others by choledochojejunostomy. All of the patients were routinely followed up after operation. Results:Postoperative mortality of liver retransplantation was 41.6% (10/24). The cause of death was sepsis in 7 patients, intraoperative bleeding in 2, and cerebral hemorrhage in 1. The other patients(14/24,58.4%) successfully recovered after liver retransplantation. The complication rate in this group was 21.4%%(3/14), including biliary tract complications in 2 patients, and wound dehiscence in 1. Conclusions:There was no significant difference in operative time and blood loss between liver retransplantation and primary transplantation. The key for success is to adopt individuation in selection of methods for liver retransplantation. The difficulty of liver retransplantation is exposure and mobilization of inferior vena cava. The probability of interposition graft from hepatic artery to abdominal aorta and choledochojejunostomy is higer than that of primary liver transplantation.

Abstract:Abstract:Objective:To study the efficacy of emergency orthotopic liver transplantation(EOLT) for acute hepatic failure(ALT). Methods:A retrospective review was undertaken on the clinical data of 8 patients undergoing emergency liver transplantation for ALT. Results:The 8 patients completely regained consciousness in 12 to 72 hours after operation. No case developed central nervous complications. One case of severe hepatitis complicated by acute renal failure died of respiratory infection and ARDS on postoperative day 7. One case who refused to take medication died from chronic rejection 12 months after operation. One case was complicated by bile duct stricture and biliary sludge at 14 months postoperatively and survived for 18 months. Four of the other 5 cases were followed up for 17 months and 1 cases for 14 months, and thir quality of life was excellent. 3 of them have returned to work. Conclusions:Emergency orthotopic liver thansplantation is an effective means to treat ALF. Intensive care and effective treatment preoperatively are pre-requisite conditions to ensure the success of EOLT.

Abstract:Abstract:Objective:To explore the causative factors affecting long-term biliary tract complications after orthotopic liver transplantation (OLT). Methods:A retrospective analysis of the clinical data of 41 patients who had survived more than 6 months after OLT was undertaken. Among these 41 cases, 29 patients (group A) recovered without any biliary tract complications, but 12 patients(group B) had biliary tract complictions long-term after OLT. The following clinical data were compared between group A and group B: patient′s age and sex, primary disease, liver function grade of recipient, period of donor brain death to aorta cold perfusion(the first warm ischemia period, warm ischaemia time 1), cold ischemia period, period from portal vein reperfusion and hepatic artery reperfusion for new liver(second warm ischemia time), operation period, volume of operative blood loss, and the rate of hepatic artery thrombosis. Results:The patient′s age in group A was younger than that in group B (46.9±10.5 ys vs 53.7±7.4 ys, P<0.05)；The second warm ischemia period in group A was shorter than that in group B (63.38±22.97mins vs 81.25±30.87 mins, P<0.05 )；The blood loss in group A was less than that in group B (3 817.2±1 402 mL vs 5 579.2±1 801.4mL, P<0.05). The donor liver with first warm ischemia beyond 5 minutes and cold ischemia beyond 8 hours was found in 12 cases(12/29) in group A, and 6 cases in group B (6/12, P>0.05 ). Conclusions:The length of the first warm ischemia period and cold storage period does not affect the occurrence of biliary tract complications. The second warm ischemia period influenced the complications of biliary tract after OLT, and should be as short as possible. It seems that biliary tract complictions occur more frequently in elderly patients following OLT.

Abstract:Abstract:Objective:To explore the prevention and treatment of early pulmonary infection after liver transplant. Methods:A retrospective analysis was carried out on the clinical data of 34 cases suffered from post-transplant pulmonary infection among 62 cases of liver transplant. Results:Among the 34 cases, 27 cases recovered and 7 cases died. The sputum of 27 cases was cultured positive for bacteria and fungus including Gram-negative bacteria(51.9%), Gram-positive bacteria (29.6%) and fungus (18.5%), cytomegalovirus 1 case, EB virus in 1 case, and pathogens unknown in 5 cases. Conclusions:Gram-negative bacteria are the main pathogens of pulmonary infection after liver transplant. The critical stage of pulmonary infection is the first week after operation. The perioperative management of respiratory tract and rational use of antibiotics are important for prevention and treatment of post-transplant pulmonary infection.

Abstract:Abstract:Objective:To develop a rapid donor liver harvesting method in orthotopic liver transplantation in rats, and to study the stability and the success rate of the model. Methods:A total of 200 healthy adult male SD rats were randomly divided into two groups: the experimental group (rapid donor liver harvesting transplant group), and the control group (conventional liver transplant group). The operation time, cold ischemic time and warm ischemic time of the donor liver, recipient post-transplation liver function and the success rate of the operation between the 2 grous were cpmpared. Results:In the control group, the operation time of donor harvesting was (33.8±4.2) min，warm ischemic time and cold ischemic time of donor liver was(3.5±1.2) min and (62.0±4.2) min，with a 80% rate of success. The new method reduced the time for donor surgery to (13.1±2.2)min, and reduced the warm ischemic time and cold ischemic time of donor liver to 0 min and (38.0±3.1)min respectively，and with a 94% rate of success(all P<0.05). In addition，recipient liver function recovered more quickly in the experimental group. Conclusions:The novel model of rapid donor liver harvesting in rat orthotopic liver transplantation reduces the operation time, improves the quality of the donor liver, and enhances the success rate of operation, and provides a more scientific model for relevant researches．

Abstract:Abstract:Objective:To investigate the effects of liver transplantation on function and morphological changes of spleen in hepatic cirrhosis rats. Methods:Hepatic cirrhosis model was established in rats by subcutaneous injections of carbon tetrachloride. Liver transplantation model was established with two-cuff technique. The portal vein pressure, and morphological changes of spleen were observed before and after liver transplantation in hepatic cirrhosis rats. The serum tuftsin level before and after liver transplantation were detected.Results:Before liver transplantation, PVP was increased from 6.28 mmHg to 14.03mmHg（P<0.01）. Pathological sections of spleen showed that the areas of white pulp were decreased from 23.47% to 7.70%（P<0.01），and the areas of spleen trabecula were increased from 1.75% to 4.46%（P<0.01）. Meanwhile, the level of serum tuftsin was significantly decreased from 466.7ng/mL to 321.8ng/mL（P<0.01）.After liver transplantation, PVP was significantly decreased from 14.03mmHg to 6.33mmHg（P<0.01）.Pathological sections of spleen showed that the areas of white pulp were increased from 7.70% to 15.07%（P<0.01）, and the areas of spleen trabecula were decreased from 4.46% to 3.11%（P<0.05）.Meanwhile, the level of serum tuftsin was increased from 321.8ng/mL to 432.5ng/mL（P<0.01）.Conclusions:Portal vein hypertension in hepatic cirrhosis rats could be relieved after liver transplantation. Liver transplantation can improve the impaired function of spleen.

Abstract:Abstract:Objective:To investigate the protective function of panax notoginseng saponins(PNS) on grafted liver during ischemia-reperfusion in rat with orthotopic liver transplantation. Methods:After establishing rat orthotopic liver transplantation model, the rats were randomly divided into three groups:the experimental group(P),the control group(N), and sham operation group(S). The levels of serum ALT and AST were determined,the hepatic pathohistological changes were observed,the expression of caspase-3 and TNF-α were examined by immunohistochemistry, and the apoptotic hepatocytes in grafted liver were detected by TUNEL method. Results:The levels of ALT, AST, and the expression of caspase-3 and TNF-α,and apoptotic cells in grafted liver were significantly higher in the control group than that in the experimental group. Conclusions:PNS can protect the grafted liver from injury during ischemia-reperfusion in rat orthotopic liver transplantation.

Abstract:Abstract:Objective:To study the protective effects of taurine on liver and kidney injury induced by intestinal ischemia-reperfusion (I/R) in rats. Methods:Male Wistar rats were randomly assigned into Sham，I/R, and taurine groups. Thirty min before operation, 2% taurine (200 mg/kg) was injected via dorsal vein of the rat′s penis. Intestinal ischemia-reperfusion was produced by occlusion of superior mesenteric artery for one hour later, then the blood flow was restored by removing the clamps. Blood samples were taken from rats in I/R and taurine groups at 1.5, 3, 6 and 12h after reperfusion, and the serum levels of ALT, AST, BUN and Cr were measured to evaluate the functions of liver and kidney. Tissues from livers and kidneys were cryostated and stained with hematoxylin and eosin to observe changes in histological pathology. TUNEL was also performed to examine apoptotic cells and the average light density levels were measured. Results:The serum levels of ALT, AST, BUN and Cr in I/R group were significantly higher than those in Sham group (P<0.05),

Abstract:Abstract:Objective:To investigate the significance of hepatocellular apoptosis in evaluation of liver reserve function.Methods:Analsis of 54 cases who underwent partial hepatectomy, including 10 cases of hemangioma of liver (control group), and 44 cases of hepatopathy (32 cases of liver cancer and 12 cases of intrahepatic bile duct stone, hepatopathy group), including 24 cases of liver cirrhosis(cirrhosis group)and 20 cases with no liver cirrhosis (non-cirrhosis group) . At operation, liver tissue was taken for determination of cirrhosis and apoptosis. In cirrhosis group, 2 groups were divided according to the 95% confidence interval of apoptosis indexes（ AI<0.0381 group，AI≥0.0381 group）. Cirrhosis and the degree of recovery of hepatic functions at postoperation were analysed and compared with hepatocellular AI.Results:AI in the hepatopathy groups were significantly higher than control group(P=0.000), AI in the cirrhosis groups(0.046±0.022) were significantly higher than non-cirrhosis groups(0.0267±0.021) (P<0.05). The accuracy rate of AI for predecting the liver reserve function was 79.55%, and was significantly higher than that of Child class（P=0.05）. Conclusions:AI of hepatic cells could serve as a sensitive indicator of hepatic function imparment, and can be for predicting change of liver function and liver reserve function.

Abstract:Abstract:Objective:To observe the effects and mechanism of antisense HIF-1α gene on implanted human primary hepatic carcinoma of nude mouse．Methods:Tumors were established by subcutaneous injection of 3×106 tumor cells，named SMMC-7721，into the back of nude mice．Once the tumor grew to 0.4cm in diameter, the mice were divided randomly into three groups with injected respectively with NS、empty plamid PcDNA3、and antisense HIF-1α plasmid．Half group of the nude mice were used to observe the tumor growth curve，and the other half were to obtain the tumor samples to be used in the examinations of the expression of angiostatin、HIF-1α, VEGF, MVD and cell apoptosis．Results:Tumors grew rapidly in the control group than that in the antisense HIF-1α group. In antisense HIF-1α gene therapy resulted in low expression of HIF-1α, MVD and VEGF than those in 2 control groups(P<0.05~0.01); but in HIF-1α group. AI was higher than that in the control group（P＜0.01）.Conclusions:Antisense HIF-1α gene therapy is a promising approach to treat human liver cancer by suppression of tumor growth and tumor angiogenesis and by induction of cell apoptosis．

Abstract:Abstract:Objective:To investigate the relationship between hypoxia inducible factor-1α、angiopoietin2 and vascular endothelial growth factor and angiogenesis in hepatocellular carcinoma (HCC). Methods:The expression of hypoxia inducible factor-1α、angiopoietin2 and vascular endothelial growth factor mRNA was detected in 52 HCC surgical specimens. And microvessel density (MVD) in tissue specimens of patients with coexpression of the parameters was examined. Results:Of the 52 surgical specimens, 36 cases had over expression of HIF-α、angiopoietin and VEGF protein, and coexpression of HIF-α and angiopoietin and VEGF mRNA in 38 of 52 cases. The expression of HIF-α、angiopoietin was related with the expression of VEGF (r1= 0.783，P<0.01，r2=0.427，P<0.05，r3=0.433，P<0.05) . In the cases of over expression of HIF-α、angiopoietin and VEGF protein and mRNA, the average MVD was［（45.4 ±8.90）/HP］ significantly higher than that of cases with non coexpression group［(13.6±3.30)/HP］（P<0.05). Conclusions:HIF-α、angiopoietin and VEGF are possible angiogenic factors in the angiogenesis in HCC. Tumor tissue hypoxia may be the initiating factor.

Abstract:Abstract:Objective:To compare radiofrequency ablation(RFA) alone and RFA combined with ethanol injection(EI) by multi-pronged injection needle(Quadra-Fuse) in ablating the pig liver. Methods:Twelve pigs were divided into two groups. Groups A underwent a combination of RFA and EI ablation of the liver, group B underwent RFA alone as control. All pigs were sacrificed immediately after treatment. Ablated area with surrounding liver parenchyma was excised for gross and histological examination. Results:The longest diameter of ablation area of the liver was 4.7±0.4cm and 4.1±0.2cm in group A and group B, respectively (P<0.05). The durations of ablation in group A and group B were 9.8±0.9 and 14.7±1.3min, respectively (P<0.05). Histological staining revealed no viable hepatocytes from the center to margins of the ablated area in two groups. There was a zone of transition surrounding the ablated necrotic area that showed hepatocytes degeneration, necrosis, hyperemia and hemorrhage, etc; infiltration of leucocytes and lymphocytes could be seen in tissues 1cm distal to the margin of necrotic area. Conclusions:RFA combined with ethanol injection can induce more great necrotic area and short ablating time than that of RFA alone did in normal pig liver tissue.

Abstract:Abstract:Objective:To investigate the ischemic injury of hepatic cell caused by hepatic artery occlusion. Methods:The hepatic artery was occluded in 20 dogs via operation, while the portal vein remained patent . Specimens were gained from the right liver at four time points:before occlusion of the hepatic artery , 20 minutes, 40 minutes and 60 minutes after artery occlusion. Each specimen was examined by HE and BCL-2 by immunohistochemistry. The gray scale of BCL-2 in HE sections was detected. Results:Hepatic cellular injury was obvious 20 minutes after occlusion of the hepatic artery. Irreversible hepatic cellular injury was observed 60 minutes after hepatic artery occlusion. The results showed that the gray scale of BCL-2 at every time point after hepatic artery occlusion were significantly different from that before hepatic artery occlusion(P<0.0001). Besides, the hepatic cell injury and BCL-2 expression at 20 minutes and 40minutes after occlusion was significantly different from that of 60 minutes(P<0.0001),respectively. Conclusions:There was obvious hepatic cellular injury 20 minutes after hepatic artery occlusion, and irreversible hepatic cellular injury occured 60 minutes after hepatic artery occlusion.

Abstract:Abstract:Objective:To investigate the inhibitiory effect of tacrolimus(FK506) and adriamycin(ADM) on hepatocellular carcinoma. Methods:HepG-2 cells were cultured, and divided into 4 groups, namely control、FK506、ADM、FK506+ADM groups, the cells were trated by the drugs for 24 to 48 hours respectively. The inhibitory rate of the cells was measured by MTT assay, and cell cycle and cell apoptotic rate were detected by flow cytometry(FCM). Results:The ability of tumor cell growth were inhibited by FK506 after 48h; the apoptosis ratio was increased when FK506 was below 100μｇ/L, and when it exceeded that value, the apoptosis ratio was decreased. FK506 and ADM significantly prolonged cell G2 phase; combined tacrolimus and adriamycin had synergistic role effect on arresting the cell in G2 phase, FK506 combined with adriamycin demonstrated synergistic effect on apoptosis. Conclusions:FK506 could inhibit the growth of hepatocellular carcinoma, arrest the cell in G2 phase, and increase apoptosis. FK506 combined with adriamycin demonstrated synergistic inhibitory effect on hepatocellular carcinoma.

Abstract:Abstract:Objective:To study the clinical characteristics, and the diagnosis and treatment of single and multiple pyogenic liver abscess. Methods:In past 25 years, 148 pyogenic liver abscess patients treated in our hospital were divided into single and multiple abscess groups. Clinical features, methods of treatment, and outcome were assessed and compared in the 2 groups. Results:A biliary origin was most frequently found in multiple abscesses than that in with single abscess(P=0.018). Mean age, duration of symptoms and length of hospital stay were higher in patients with multiple abscesses (P=0.023, 0.043， 0.015). High levels of alkaline phosphatase and low levels of albumin were more frequently seen in cases of multiple abscesses than in those of single ones(P=0.021 and 0.039). The lesions were most frequently located on the right lobe in single abscess group (P=0.002); and in the multiple abscess group, the two lobes were usually involved (P<0.001). E.coli was the most frequently cultured organism in either the single or multiple abscess groups. Antibiotic therapy alone was most frequently used in multiple abscess group (P=0.022), and percutaneous aspiration or catheter drainage usually used in single group (P=0.021). ARDS was most frequently seen in the multiple abscesses group (P=0.03). The morality rate was higher in multiple abscess group(P=0.025). Conclusions:Compared with single abscess group, multiple abscess group had the following features:the patient was older, duration of symptoms was longer, co-existing biliary diseases, invasion of two lobes, prone to develop ARDS and higher morality rate. Operation and/or simple antibiotic therapy are important therapies for multiple abscesses.

Abstract:Abstract:Objective:To investigate the effects of ulinastatin on liver function of patients with cholelithiasis and liver cirrhosis during postoperative period. Methods:Ninty-seven cholelithiasis patients with liver cirrhosis who received surgical treatment in a period of 5 years were randomly divided into control group and therapeutic group. The ulinastatin was given by intravenous drip in the therapeutic group for 3 days postoperatively. The liver function was determined in both groups 1 day before operative and on post operative 1d, 3d, and 5d respectively, and the postoperative complication rate was observed. Results:The postoperative complication rate of therapeutic group was significantly lower and the liver function improvement was obviously better than that of the control group. Conclusions:The use of ulinastatin during the post operative period could protect the liver function and reduce the complication rate in patients with liver cirrhosis receive cholelithiasis surgery.

Abstract:Abstract:Objective:To study the characteristics and surgical treatment of elderly patients with hilar cholangiocarcinoma. Methods:The clinical data and follow-up data of 64 hilar cholangio-carcinoma patients, who aged≥65 years, treated in our hospital from 1995 to 2005 were retrospectively analysed. Results:All 64 cases underwent operative treatment that included radical resection in 26 cases, palliative resection in 10 cases, internal drainage in 14 cases and external drainage in 14 cases. After surgical resection the 1- and 2-year survival rate was 62.5% and 37.5%, respectively.Conclusions:The prognosis of hilar cholangiocarcinoma in the elderly patient is poor. At present, the most effective treatment for hilar cholabgiocarcinoma is surgical resection.