Abstract:

Objective：To investigate the clinical character and risk factors of  biliary complications after liver transplantation.
Methods：The clinical data of 172 cases undergoing liver transplantation in the five and a half years in Nanfang Hospital were studied retrospectively. Forty-four independent variables were analyzed by univariate analysis and logistic regression to screen out the risk factors.
Results：Bliary complications occurred in 32 cases（18.6%）, including 10 cases of biliary leakage, 14 cases of biliary stricture without leakage, 5 cases of biliary calculi without stricture or leakage, 2 cases of simple biliary infection and 1 case of simple hemobilia. The median occurring time of biliary complications was 22(3-585)d after surgery. Logistic regression analysis showed four independent risk factors related with biliary complications: acute rejection(P＜0.001), chronic rejection(P=0.030),  useing T-tube(P=0.005), and the hepatic arterial resistive index（RI） lower than 0.66 one month after transplantation(P=0.026).
Conclusions：Rigorous monitoring of hepatic arterial flow, preventative anticoagulant therapy, normative antirejection therapy, bile duct reconstruction without T-tube are the keypoints to reduce the incidence of biliary complications.

Abstract:

Objective：To evaluate the effectiveness of a new strategy in ABO-incompatible liver transplantation.
Methods：We retrospectively analyzed the clinical records of 4 cases of ABO-incompatible  allogeneic orthotopic liver transplantation performed in our hospital. Among them, 3 blood type O recipients received livers from blood type AB donors, and one type A RH（-）recipient received liver from blood type AB RH（+）donor. A new strategy of perioperative mangement was used for prevention of acute rejection, that included perioperative mangement with quadri-immunosuppressant, PPE, postoperational infusion of IVIG and prostaglandin E1, splenectomy and De-Escalation of antibiotics to prevent and treat postoperative infection.
Results：One patient had antibody-mediated rejection three days after operation and recovered after plasma exchange combined with high dose steroid treatments; 2 patients had acute renal failure and recovered after continuous venovenous hemofiltration(CVVH) for 2 weeks. All patients had infection postoperatively, but all  were cured and successfally discharged. Through 2-10 months of follow up, all patients have survived with normal hepatic and renal function.
Conclusions：The use of quadri-immunosuppression, PPE, postoperational infusion of IVIG and prostaglandin E1, splenectomy and De-Escalation of antibiotics  may be an effective strategy for ABO- incompatible liver transplantation.

Abstract:

Objective：To investigate the expression of TNF-α and IL-2 in acute rejection of liver transplantation and evaluate their value as predictive indicators of acute rejection.
Methods：After orthotopic liver transplantation models was established in rats, real-time fluorescent quantitative reverse transcriptase polymerase chain reaction (RT-PCR) was used to detect the gene expression of TNF-α and IL-2 in the transplanted liver. The relationship between TNF-α/IL-2 expression and acute rejection was analyzed based on histopathological standard of acute rejection.
Results：On day 3,5 and 7 after transplantation, acute rejection occurred in the graft of all allogenic transplantation rats, and the mean levels of TNF-α and IL-2 in liver tissues were significantly higher in allogenic transplantation group than those in syngenic transplantation group.
Conclusions：TNF-α and IL-2 expression are related to the development of acute rejection after liver transplantation, and may be used as sensitive and reliable accessory indicators in detecting acute rejection.

Abstract:

Objective：To explore the impact and significance of hypoxia preconditioning on the activation of serum endotoxin after orthotopic liver autotransplantation in rats.
Methods：A modified orthopotic liver autotransplantation model was used to study the ischemia reperfusion injury in liver transplantation.Sprague-Dawley rats were randomly divided into the following three groups: normal control(NC)group, autotransplantation (AT)group,and hypoxia preconditioning(HP)group; there were 24 rats in each group. HP Group was given an 8% oxygen-mixed gas for 90 minutes before the operation. At 1,6 and 12 hours after the operation, the rats were killed and the following tests were conducted: (1) blood was drawn to determine the levels of ALT and AST; (2)Intestinal tissue was sampled to observe the changes of the microstructure and ultrastructure of the intestinal cells under optical microscopy and transmission electron microscope;(3) ELISA kits were used to measure serum endotoxin.
Results：The serum levels of ALT, AST and  endotoxin of HP group were significantly lower than those of AT group (P＜0.05) at 1,6 and 12 hours after the orthopotic liver autotransplantation. Injury of the intestinal mucosal of HP group was significantly less than that of AT group, and injury of the mitochondria of HP group was significantly less than that of AT group.
Conclusions：HP can reduce the level of serum endotoxin in orthotopic liver autotransplantation in rats by protecting the intestinal mucosa, decreasing translocation of intestinal endotoxin, and thus mitigating the damage of transplanted liver.This may have some relation to reducing the injury of the mitochondria after ischemia and hypoxia, improving the energy supply of cells and improving the ability of cells to resist hypoxia.

Abstract:

Objective：To investigate the safety of extended hepatic lobectomy for huge primary hepatic carcinoma (HPLC).
Methods：A retrospective analysis was made on the clinical data of 69 patients with HPLC who underwent extended lobectomy in our hospital within the recent 7 years. The data included preoperative liver functional reserve, liver resection volume, remnant liver volume and postoperative recovery and survival.
Results： Preoperatively,  ICGR15 was≤15% in all the patients, and the  estimated anatomic liver resection volume was 50% to 70%. Forty-three patients received radical liver resection and 26 palliative resection. Three patients died within 1 month after operation; the operative death rate was 4.3%. Postoperative complications occurred in 27.5% of the patients, but all recovered after treatment.
Conclusions：Assessment of hepatic functional reserve combined with accurate computer-aided measurements of liver volume can provide a reliable basis to determine the safe resected volume and proper limit of liver resection.

Abstract:

Objective：To compare the impact of the type of resection (anatomic versus non-anatomic) on early mortality in patients with hepatocellular carcinoma (HCC) and to explore factors related to early mortality in patients after resection of hepatic tumor.
Methods：Fifty-two patients with similar clinico-pathologic data were randomaly divided into 2 groups for curative liver resection for HCC, 25 patients underwent anatomic resection of at least one liver segment (group A) and 27 patients underwent non-anatomic resection (group B). We compared the age, gender, HbsAg, preoperative serum albumin, alpha-fetoprotein (AFP), postoperative pathologic diagnosis, TNM stage, tumor size, portal vein tumor thrombosis, duration of hospital stay and follow-up in the two groups.
Results：The one year mortality was 20.0% in anatomic resection group and 25.9% in non-anatomic resection group. No significant difference was detected in early mortality and complications between the 2 groups. The blood loss during operation of anatomic resection group was less than that of non-anatomic resection group (P=0.006). Factor contributing to early mortality was presence of portal vein tumor thrombosis (P=0.019).
Conclusions：There is no significant difference in early mortality between anatomic and non-anatomic liver resection. The presence of portal vein tumor thrombosis could be a major factor to predict early mortality.

Abstract:

Objective：To investigate the impact of hydroxyethyl starch solution（HES130/0.4）therapy after hepatectomy for HCC patients associated with liver cirrhosis.
Methods：Between January 2009 and May 2010, 108 post-hepatectomy patients with HCC associated with liver cirrhosis were enrolled in this prospective, non-randomized controlled study. The 54 postoperative patients in the treatment group received hydroxyethyl starch solution（HES130/0.4）treatment daily for the first three postoperative days; the other 54 postoperative patients in the control group were given intravenous albumin therapy.Preoperative and postoperative alanine aminotransferase, aspartate aminotransferase, albumin, C-reactive protein, the incidence of postoperative complications and  postoperative length of stay were compared.
Results：Preoperative clinical data, type of liver resection and operative bleeding of the 2 groups were comparable (P＞0.05).There was no significant difference in alanine aminotransferase, aspartate aminotransferase, albumin and the incidence of postoperative complications between the two groups.Compared with the control group，the C-reactive protein level on the second day after surgery was significantly lower in the treatment group（t=6.351，P=0.000）, and the C-reactive protein level on day 4 and day 7 after surgery also declined, but not significantly（P＞0.05）.The postoperative complications included infection of incisional wound, pleural effusion, ascites, pulmonary infection，abdominal bleeding, bile fistula and abdominal infection. In the control group, 39 patients had one or more of the complications mentioned  above (72.2%, 39/54), and in the treatment group, only 28 patients developed complications(51.9%, 28/54).  the incidence of postoperative complications was significant difference between the 2 groups(χ2＝4.757, P=0.047).
Conclusions：Hydroxyethyl starch solution（HES130/0.4）treatment  in the early period after hepatectomy for HCC associated with liver cirrhosis can effectively obviate the use of albumin, control postoperative inflammation and reduce the perioperative incidence of complications.

Abstract:

Objective：To investigate the features of postoperative serum bilirubin changes and the clinical factors associated with high serum bilirubin level in patients with primary liver cancer  after resection.
Methods：The clinical data of 97 patients with primary liver cancer who underwent hepatectomy were analysed retrospectively. The cases were divided into two groups: high serum bilirubin group and normal bilirubin group, respectively, according to serum bilirubin level during two weeks after operation. The features of postoperative serum bilirubin changes and the causitive factors of postoperative high serum bilirubin were analyzed.
Results：The postoperative serum bilirubin reached the peak value［(21.5±9.2)μmol/L］ on d4, and then decreased to normal on d14 in normal bilirubin group. But in high serum bilirubin group the postoperative serum bilirubin reached the peak value［(49.2±25.4)μmol/L］ on the d7, and was still twice more than the normal value ［(36.1±17.6)μmol/L］on  d14. Preoperative serum bilirubin,Child′s grade, types of hepatic vascular occlusion, blood loss, blood transfusion, and postoperative hyponatremia were related with postoperative high serum bilirubin. Preoperative serum bilirubin was an independent factor in predicting postoperative high serum bilirubin(OR=5.406,χ2=11.319,P=0.001）.
Conclusions：It is very important to monitor the posthepatectomy serum bilirubin value dynamically. Preventon and treatment of the causes of perioperative high serum bilirubin may help to decrease the complications of hepatectomy.

Abstract:

Objective：To study the perioperative changes of blood lipids in hepatocellular carcinoma（HCC） patients undergoing hepatectomy and their relationship with prealbumin and aminopherase.
Methods：Triglyceride, cholesterol, prealbumin and transaminase levels were detected in 126 HCC patients undergoing hepatectomy before operation and day 1, 3 and 7 after operation.
Results：Preoperatively, compared to the control group, HCC patients had significantly lower level of cholesterol (P<0.01). On day 1, 3 and 7 after operation, the level of triglyceride and cholesterol reduced significantly compared with preoperative levels. Changes of cholesterol level and ALT were reversely related (r=-0.231, P<0.05), and the change of cholestrol level had no relevant relationship with prealbumin（r=0.082, P>0.05）.
Conclusions：HCC patients may have metabolic disorder of blood lipids; the postoperatively low level of blood lipids may be related to surgical stress and damage of liver function.

Abstract:

Objective：To study the expression of MyD88 and STAT3 in hepatocellular cancer (HCC) tissues and its signicficance.
Methods：S-P immunohistological assay was applied to detect the expression of MyD88 and STAT3 protein in specimens from hepatocellular carcinoma tissues and adjacent liver tissues of 82 HCC cases. Correlation analysis was used to determine the relation of MyD88 and STAT3 with the clinicopathological data.
Results：The positive rate of MyD88 and STAT3 expression was 67.1% and 69.5% respectively in 82 hepatocellular carcinoma tissues, which were significantly higher than the positive rate (11% and 8.5% respectively) in adjacent tissues（P＜0.05). STAT3 expression was positively correlated with MyD88 (r=0.578，P=0.002).  MyD88 and STAT3 expression were correlated with patient′s gender, differitiation of HCC, HBV infection and cirrhosis (P＜0.05), but not with lumor size, venous invasion (P>0.05).
Conclusions：MyD88 and STAT3 genes are significantly over expressed in HCC tissues and may promote the initiation and development of HCC by cell proliferation and immune escape.

Abstract:

Objective：To investigate the expression of HtrA1 serine protease in  primary hepatocellular carcinoma(HCC) tissue and its relationship with the tumor pathological characteristics.
Methods：HCC tissues and adjacent liver tissues was obtained from 37 hepatocellular carcinoma patients after hepatectomy. Expression levels of HtrA1 serine protease mRNA  were quantitatively analyzed by real-time PCR.
Results：HtrA1 mRNA in liver tumors was 1.2729±0.9911,and HtrA1 mRNA in adjacent tissue was  3.8667±2.8099.The HtrA1 mRNA in adjacent liver tissues were higher than those in hepatocellular carcinoma tissues(P=0.000). Multivariate Logistic regression analysis showed that the level of HtrA1 mRNA, tumor metastasis and tumor capsule were the most important significantly independent  factors for HCC venous invasion.
Conclusions：The expression of HtrA1 in HCC could be as an indicator of the prognosis, metastasis and recurrence.

Abstract:

Objective：To quantitatively detect the expression level of RUNX3 in human primary hepatocellular carcinoma (HCC) by real-time fluorescent quantitative RT-PCR, and assess its relationship with the clinicopathological features of the disease.
Methods：Total RNA isolated from samples, including sixty-five HCC, adjacent liver tissues, six human liver cancer cell lines and a human normal liver cell line, were reversed into cDNA. Real-time fluorescent quantitative RT-PCR method was used to analyze the expression level of RUNX3 gene. All the quantitative results were confirmed by Western blotting.
Results：The expression of RUNX3 mRNA  was 4.2-fold lower in HCC tissues than in adjacent liver tissues (P<0.001), 8-fold lower in 18 HCC tissues,4-fold lower in 21 HCC tissues and 2-fold lower in 3 HCC tissues. A signicficant down-regulation of RUNX3 mRNA was found in 66.67%(4/6）of liver tumor cell lines. Furthermore, Western blot analysis showed that there was also significant difference in RUNX3 protein expression between the HCC and adjacent liver tissues, which was in accordant with the results of quantitative RT-PCR analysis of RUNX3 mRNA levels. Lower expression showed significant correlation to cirrhosis (P=0.028) and histologic type of HCC (P=0.000).
Conclusions：The expression of RUNX3 is decreased in HCC. The RUNX3 gene may play an important role in the development of HCC.

Abstract:

Objective：To study the protective effect and mechanism of genistein preconditioning on hepatic ischemia-reperfusion injury in rats.
Methods：Fifty-four SD rats were randomly divided into three groups: Group A: I/R group, rats underwent 60 min of 70% hepatic ischemia and reperfusion; Group B: genistein precondition group, rats received genistein (2 mg/kg) prior to I/R; Group C: sham operation group, rats only underwent laparotomy without vascular occlusion. Serum and liver samples were collected at 2 h, 6 h and 12 h after the 3 models were established. Serum alanine aminotransferase (ALT), aspartate aminotransferase (AST) and hepatic tissue malondialdehyde(MDA) were measured by an automatic biochemical analyzer, expression of casepase-3 of the liver was detected by immunohistochemical staining, and the pathological changes of liver were examined.
Results：Compared with I/R group, in Group B(GST), the level of serum AST, ALT and the expression of MDA and casepase-3 were significantly reduced (P<0.05), and the pathological changes of the liver were ameliorated significantly.
Conclusions：Genistein preconditioning can protect liver from I/R injury by modulating oxidative stress and inhibiting apoptosis. 

Abstract:

Objective：To investigate the effectiveness of dietary nitrite supplements  on hepatic ischemia-reperfusion(I/R) injury in rats. 
Methods：Wistar rats were randomly divided into 3 groups: I/R group, nitrite precondition group(N group) and sham operation group (S group). Ischemia and reperfusion of liver was conducted in the I/R group and N group.In N group, nitrite was added to the drinnking water and given to rats at 7 days before making I/R model. In the 3 groups, the level of serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), and the content of superoxide dismutase (SOD), hepatic tissue malondialdehyde(MDA) and nitric oxide (NO),nitric oxide synthase (NOS) were determined; cell apoptosis was detected by Hoechst staining and liver histopathological changes were observed.Results：The levels of serum AST, ALT, MDA and apoptosis in I/R group were markedly abnormal; but in N group, the above mentioned abnormal changes were significantly reduced and the level of NO was significantly higher as compared with I/R group (P<0.01), while NOS remained relatively unchanged in N group.
Conclusions：Dietary nitrite has significant protective effect on the hepatic ischemia-reperfusion injury in rats.

Abstract:

Objective：To investigate the protective effect of atractylodes macrocephalaon polysaccharide on ischemia-reperfusion（I/R）injury of liver in rats.
Methods：A total of 54 male SD rats were randomly divided into 3 groups: sham group, I/R group and  preconditional treatment of atractylodes macrocephalaon polysaccharide group (Group PC). The rats were killed at 1，6，24h after 60 mins of models conducted, and the serum ALT and AST level, the expression of ICAM-1 mRNA and IL-1 in liver tissue were observed.
Results：Compared with sham group, the ALT and AST levels,  the expression of ICAM-1 mRNA and IL-1 were significantly increased in PC and  I/R groups, but compared to I/R group, the ALT and AST levels and the expression of ICAM-1 mRNA and IL-1 in PC group were significantly decreased (P＜0.05).
Conclusions：Atractylodes macrocephalaon polysaccharide may have protection to ischemic injury of rat liver through reduction of ICAM-1 expression and  decrease production of IL-1.

Abstract:

Objective：To evaluate the value of CT perfusion imaging(CTP) for assessment of liver ischemia reperfusion injury (I/R) in a rabbit model using 256-slice spiral CT.
Methods：Rabbits underwent 60 min of left lobar ischemia and then were divided into 6, 12 and 24 h of reperfusion groups, and one sham operation group (n=6, for each group).All the rabbits were imaged with a CT perfusion protocol. The perfusion indices of hepatic arterial perfusion (HAP), hepatic portal perfusion (HPP), total liver perfusion (TLP) and hepatic perfusion index (HPI) were measured after obtaining perfusion index maps on workstation. Liver samples underwent histological examination after every group had completed scan workuop.
Results：(1) Heterogeneity of hepatic microvascular flow patterns appeared in the I/R 6, 12 and 24 h groups (low perfusion area or infarcted regions). (2) In infarcted regions of I/R groups, the HPP, TLP and HAP were lower than those of sham group except the HAP in I/R 6 h group, but HPI was higher compared to sham group. The perfusion parameters in the non-infarction area were declined. (3)There were significant differences in CT perfusion parameters between infarction and non-infarction area.
Conclusions：CTP can objectively and quantitatively reflect the alterations of liver hemodynamics in I/R injury.

Abstract:

Objective：To explore the experience on the diagnosis and treatment of hepatic focal nodular hyperplasia (FNH).
Methods：Clinical data of 31 FNH patients, including the clinical manifestations,laboratory tests, imaging, diagnosis and treatment, were studied retrospectively.
Results：Twenty-five cases (80.6%) were young adults (less than 40 years old). Most of the patients（74.2%，23/31） had no obvious symptoms, and HBsAg positive was only in one case. All the patients had normal liver functions, while AFP、CA19-9 and other tumor markers were within normal range. Twenty-seven patients had a single solitary focus and 4 had two lesions.Most of the lesions were located in hepatic segments  Ⅳ, Ⅴ and  Ⅷ. Lesion sizes ranged between 0.5 cm and 15.0 cm. The rate of diagnosis in this group was 3.2% by color Doppler ultrasound, 32.1% (9/28) by CT, 20% (2/10) by MRI, and 0% (0/3) by hepatic artery angiography. Correct preoperative diagnosis was made in only 3 cases (9.7%). Thirteen cases  (41.9%) were misdiagnosed as liver cancer, 4 misdiagnosed as hepatic adenoma, 2 misdiagnosed as hepatic hemangioma and 9 cases had indefinite diagnosis. Twenty-nine cases underwent hepatic resection, and 2 cases were treated conservatively after the diagnosis was confirmed by the comprehensive utilization of biopsy and imaging examinations. Follow-up time was 8 months to 6.5 years,and all the operated patients suffered no relapse. Two patients, who were treated conservatively, were followed up for 18 months to 53 months, and they were all alive, without significant changes in lesion sizes.
Conclusions：Most cases of FNH have no clinical symptoms, and an effective method to improve the diagnostic accuracy of FNH is by the comprehensive analysis of the imaging examinations.The patients suspected of FNH may undergo percutaneous biopsy and those symptomless patients who have a definite diagnosis of FNH, may be treated by regular and close observation.

Abstract:

Objective：To explore the value of MELD scoring system in assessing hepatic functional reserve in patients with chronic hepatic injury.
Methods：Retrospective analysis of  the preoperative MELD scores of 38 patients with chronic hepatic injury undergoing liver transplantation was made,  the  quantitative values of liver fibrosis by computer-assisted digital image analysis was evaluated after operation, and the correlation between the  MELD score and the percentage of liver fibrosis was analyzed.
Results：A positive linear correlation was found between MELD score and the percentage of hepatic fibrosis in patients with chronic hepatic injury. In the Child-Pugh A,B and C groups, the MELD score had significant difference(P＜0.01).
Conclusions：MELD scoring system can be used to predict the hepatic functional reserve in patients with chronic hepatic injury.

Abstract:

Objective：To evaluate the clinical manifestations, therapeutic characteristics, postoperative complications and perioperative management of elderly patients with gastric cancer. 
Methods：Clinical data of 101 aged paients with gastric cancer were retrospectively analyzed. The analysis mainly focused on the management of preoperative coexistent diseases and postoperative complications.
Results：Gastric cancer patients more than 70 years old  (aged patient group) had non-specific clinical manifestations and significantly higher rate of preoperative coexistent diseases compared to the control group of gastric cancer patients who were less than 70 years of age (49.5% vs. 21.3%, respectively, P<0.05). The postoperative complication rate in the elderly patients (18.8%) and younger patients (15.2%) was not significantly different (P<0.05). Among the elderly patients with gastric cancer, 98 cases (97%) underwent surgical resection, including 87 cases (86.1%) who had radical resection.
Conclusions：The rate of preoperative coexistent diseases and postoperative complications are higher in aged patients with gastric cancer. Reinforcement of perioperative management of aged patients with gastric cancer could significantly reduce the incidence of  postoperatvie complications and improve the survival rate and quality of patient′s life.