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BACKGROUND@#After major liver resection, the volume status of patients is still undetermined. However, few concerns have been raised about postoperative fluid management. We aimed to compare gut function recovery and short-term prognosis of the patients after laparoscopic liver resection (LLR) with or without inferior vena cava (IVC) respiratory variability-directed fluid therapy in the anesthesia intensive care unit (AICU).@*METHODS@#This randomized controlled clinical trial enrolled 70 patients undergoing LLR. The IVC respiratory variability was used to optimize fluid management of the intervention group in AICU, while the standard practice of fluid management was used for the control group. The primary outcome was the time to flatus after surgery. The secondary outcomes included other indicators of gut function recovery after surgery, postoperative length of hospital stay (LOS), liver and kidney function, the severity of oxidative stress, and the incidence of severe complications associated with hepatectomy.@*RESULTS@#Compared with patients receiving standard fluid management, patients in the intervention group had a shorter time to anal exhaust after surgery (1.5 ± 0.6 days vs. 2.0 ± 0.8 days) and lower C-reactive protein activity (21.4 [95% confidence interval (CI): 11.9-36.7] mg/L vs. 44.8 [95%CI: 26.9-63.1] mg/L) 24 h after surgery. There were no significant differences in the time to defecation, serum concentrations of D -lactic acid, malondialdehyde, renal function, and frequency of severe postoperative complications as well as the LOS between the groups.@*CONCLUSION@#Postoperative IVC respiratory variability-directed fluid therapy in AICU was facilitated in bowel movement but elicited a negligible beneficial effect on the short-term prognosis of patients undergoing LLR.@*TRIAL REGISTRATION@#ChiCTR-INR-17013093.
Subject(s)
Humans , Hepatectomy , Vena Cava, Inferior/surgery , Liver , Laparoscopy , Fluid TherapyABSTRACT
In the past 30 years, laparoscopic hepatectomy has developed rapidly, which multi-dimensionally promoted the innovation of hepatectomy technology and strategy. This is mainly attributed to the key factors such as the improvement of domestic and foreign scholars′ under-standing of liver anatomy, the conversion and application of laparotomy technology, the expansion of laparoscopic vision and the feedback in surgery related fields. The authors summarize the enlighten-ment, development, promotion and sublimation of laparoscopic hepatectomy, and discuss the classi-fication and evolution of the surgical approach of laparoscopic hepatectomy.
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Objective:To investigate the clinical value of split domino donor auxiliary liver transplantation.Methods:The retrospective and descriptive study was conducted. The clinco-pathological data of 3 liver transplantation recipients who were admitted to Nanjing Drum Tower Hospital affiliated to Nanjing University Medical School and 1 liver transplantation recipient who was admitted to external hospital in September 2018 were collected. The first case was male, aged 22 years, who was diagnosed as type II citrullinemia (CTLN2). The second case undergoing liver transplantation in external hospital was male, aged 59 years, who was diagnosed as decompensated alcoholic cirrhosis. The third case was female, aged 52 years, who was diagnosed as hepatocellular carcinoma of right lobe of liver. The fourth case was female, aged 51 years, who was diagnosed as hepatocellular carcinoma of right lobe of liver. The donor liver from a brain and cardiac death donor was split in vitro into the left liver and the right liver, in which the right liver without middle hepatic vein, and the modified piggyback liver transplantation using the left liver and the classical orthotropic liver transplantation using the right liver was conducted on the first and the second case, respectively. The original liver of the first case was split in vivo into the left liver and the right liver, and the piggyback auxiliary liver transplantation using the left liver and the piggyback auxiliary liver transplantation using the right liver was conducted on the third and the fourth case who underwent extended right hemihepatectomy, respectively. Observation indicators: (1) intraoperative situations; (2) follow-up. Follow-up was conducted using outpatient examination and telephone interview to detect liver function, liver imaging, complication and survival of recipients up to October 2021.Results:(1) Intraoperative situations. Liver transplantation was conducted successfully on the first, third and fourth case, with the operation time, the volume of intraoperative blood loss, the donor liver cold ischemia time, the graft-to-recipient weight ratio were 400 minutes, 370 minutes, 390 minutes, 600 mL, 1 300 mL, 1 600 mL, 230 minutes, 152 minutes, 135 minutes, 1.2%, 0.8%, 1.1%. (2) Follow-up. B-ultrasound examination of the first, third and fourth case after liver transplantation showed that the blood flow was normal, and all the 3 cases discharged and were followed up at postoperative 1, 6 and 12 month. The liver function, the level of blood ammonia and citrulline were normal of the first, third and fourth case at postoperative 1 week. Imaging examina-tion showed normal liver morphology of the first and third case, and a transplanted liver atrophy caused by portal vein steal of the fourth case. ① The level of alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBil), direct bilirubin (DBil) of the first case before liver transplantation, at postoperative 1 day, 2 day, 3 day, 7 day, 10 day, 6 month and 1 year were 22.8 U/L, 404.1 U/L, 355.5 U/L, 289.6 U/L, 31.0 U/L, 23.1 U/L, 42.1 U/L and 25.8 U/L, 31.5 U/L, 517.7 U/L, 327.6 U/L, 172.9 U/L, 15.9 U/L, 21.4 U/L, 47.5 U/L and 29.7 U/L, 3.8 μmol/L, 92.1 μmol/L, 87.4 μmol/L, 79.7 μmol/L, 90.1 μmol/L, 130.6 μmol/L, 33.8 μmol/L and 25.4 μmol/L, 2.3 μmol/L, 47.0 μmol/L, 44.1 μmol/L, 47.1 μmol/L, 57.4 μmol/L, 70.9 μmol/L, 24.7 μmol/L and 9.7 μmol/L, respectively. The level of citrulline and blood ammonia of the first case before and after liver transplantation were 999.0 μmol/L, 196.0 μmol/L and 14.6 μmol/L, 9.0 μmol/L, respectively. The first case was followed up for 3 years and survived without any liver transplantation related complication. ② The level of ALT, AST, TBil, DBil of the third case before liver transplantation, at postoperative 1 day, 2 day, 3 day, 7 day, 10 day, 6 month and 1 year were 21.3 U/L, 143.9 U/L, 182.0 U/L, 132.0 U/L, 17.2 U/L, 10.1 U/L, 17.6 U/L and 16.8 U/L,20.0 U/L, 291.0 U/L, 227.5 U/L, 106.4 U/L, 15.8 U/L, 10.8 U/L, 17.1 U/L and 19.4 U/L, 6.8 μmol/L, 50.9 μmol/L, 45.0 μmol/L, 34.0 μmol/L, 32.4 μmol/L, 22.3 μmol/L, 12.8 μmol/L and 14.9 μmol/L, 2.5 μmol/L, 18.4 μmol/L, 17.2 μmol/L, 14.9 μmol/L, 14.8 μmol/L, 12.1 μmol/L, 3.6 μmol/L and 4.4 μmol/L. The level of citrulline and blood ammonia of the third case after liver transplantation were 24.9 μmol/L and 16.0 μmol/L. The third case was followed up for 3 years and survived without any liver transplantation related complication. ③ The level of ALT, AST, TBil, DBil of the fourth case before liver transplantation, at postoperative 1 day, 2 day, 3 day, 7 day, 10 day, 6 month and 1 year were 35.0 U/L, 268.7 U/L, 682.0 U/L, 425.8 U/L, 57.5 U/L, 34.0 U/L, 29.4 U/L and 18.1 U/L, 37.0 U/L, 419.1 U/L, 436.2 U/L, 139.5 U/L, 35.2 U/L, 32.4 U/L, 54.7 U/L and 32.8 U/L, 7.1 μmol/L, 64.2 μmol/L, 41.4 μmol/L, 17.6 μmol/L, 34.2 μmol/L, 48.7 μmol/L, 14.1 μmol/L and 21.8 μmol/L, 2.8 μmol/L, 18.9 μmol/L, 16.1 μmol/L, 6.0 μmol/L, 14.6 μmol/L, 26.7 μmol/L, 3.9 μmol/L, 11.8 μmol/L. The level of citrulline and blood ammonia of the fourth case after liver transplantation were 8.4 μmol/L and 47.0 μmol/L. One week after surgery, the transplanted right liver of the fourth case occurred atrophy due to blood stealing from the right branch of the portal vein. B-ultrasound examination showed that the reflux of the hepatic artery and hepatic vein was unobstructed. Immunosuppressants were discontinued 3 months after operation on the fourth case and there was no complication such as rejection, bile leakage, biliary stricture, thrombosis and vascular stricture during follow-up. The fourth case died of lung metastasis 19 months after operation.Conclusion:Split domino donor auxiliary liver transplantation can be used for the treatment of metabolic liver disease and advanced hepatocellular carcinoma.
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Objective To study the functions and mechanisms of glutamine 1 (GLS1) in intrahepatic cholangiocarcinoma (ICC) cell to 5-fluorouraeil (5-FU) chemosensitivity.Methods The expression and relation between GLS1 and major vault protein (MVP) in cholangiocarcinoma were analyzed by bioinformatics database.Western blot and immunohistochemistry were used to detect the expression of GLS1 and MVP in 42 ICC tissues,and the correlation between GLS1 and MVP was studied by statistics.The regulation of GLS1 in ICC cell were evaluated by siRNA interference and pcDNA overexpression,and then tested the interference and overexpression efficiency of GLS1 by Western blotting.The chemosensitivity to 5-Fu was tested by cell counting kit-8 (CCK-8).Results The expression of GLS1 and MVP in ICC tissues was significantly up-regulated (tGLSI =3.963;tMVP =3.131,P ＜ 0.05),and the expression of GLS1 was positively correlated with MVP(r2 =0.351 7,P ＜ 0.05).Knockdown of GLS1 in QBC939 cells enhanced chemosensitivity of QBC939 cells to 5-Fu and notably downregulated MVP expression,while enforced expression of GLS1 in RBE cells promoted MVP expression and reduce cell sensitivity to 5-fluorouracil chemosensitivity.Conclusions GLS1 regulates the chemosensitivity of ICC cells to 5-Fu,and its mechanism may relates to the regulation of MVP.
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Objective@#To investigate the risk factors of perineal incision complications after abdominoperineal resection (APR) for rectal cancer, and to establish a nomogram model to predict the complications of perineal incision.@*Methods@#A case-control study was conducted to retrospectively collect the medical records of 213 patients with colorectal cancer who underwent APR at the First Affiliated Hospital of Nanjing Medical University from January 2010 to December 2016. The complications of perineal incision after APR were classified according to the modified Clavien-Dindo classification of surgical complications (Version 2019), and the complications of grade II and above were defined as "clinically significant complications" .Twenty-two factors related to complication of perineal incision, such as gender, age, surgical procedure, surgical approach, perineal repair, placement of drainage tube, skin position of drainage tube, operation time, intraoperative blood loss, preoperative radiotherapy and chemotherapy, intraoperative local perfusion chemotherapy, tumor classification, pathological grade, tumor T stage, tumor TNM stage and so on, were analyzed by chi-square test for univariate risk factor of complication in all variables, and variables with P<0.2 in univariate analysis were further included in multivariate analysis. Logistic regression analysis was used to screen out independent risk factors. R software (R 3.3.2) was introduced. The rms software package was used to construct a nomogram prediction model. The C-index was calculated (higher meaning better consistency with actual risk) to evaluate the discriminant degree of the model. The Bootstrap method was used to repeat the sampling for internal verification. A total of 42 patients with colorectal cancer who underwent APR from January 2017 to December 2017 at the First Affiliated Hospital of Nanjing Medical University were externally validated, and the corrected C-index was calculated. The model conformity was determined by comparing the C-index calibration difference between the predicted and actual risks.@*Results@#Of the 213 patients with colorectal cancer, 131 were male and 82 were female, with mean age of (59.6±11.6) years. The incidence of postoperative perineal incision complications was 20.2% (43/213), including 27 cases of Clavien-Dindo II and above complications. Univariate analysis showed that the Eastern Cancer Cooperative Group (ECOG) score, preoperative albumin, skin position of drainage tube, intraoperative blood loss, preoperative radiotherapy and chemotherapy were associated with complications of postoperative perineal incision (All P<0.05) . Multivariate analysis showed that preoperative albumin levels ≤38 g/L (OR=105.261, 95% CI: 7.781 to 1423.998, P<0.001), perinead drainage (OR=11.493, 95% CI: 1.379 to 95.767, P=0.024), intraoperative blood loss >110 ml (OR=6.476, 95% CI: 1.505 to 27.863, P=0.012) and preoperative radiotherapy and chemotherapy (OR=7.479, 95% CI: 1.887 to 29.640, P=0.004) were postoperative clinically significant independent risk factors for perineal incision complications. The nomogram model was established. Preoperative albumin level <38 g/L was for 100 points, the preoperative chemoradiotherapy was for 52.5 points, the intraoperative blood loss >110 ml was for 28.5 points, and the perineal drainage was for 17.5 points. Adding all the points was the total score, and the complication rate corresponding to the total score was the predicted rate of the model. The model had a C-index of 0.863. After internal verification, the C-index dropped by 0.005. External verification showed a C-index of 0.841.@*Conclusions@#Preoperative nutritional status, skin position of drainage tube, intraoperative blood loss and preoperative radiotherapy and chemotherapy may affect the occurrence of perineal wound complications after APR for rectal cancer. The nomogram model constructed in this study is helpful for predicting the probability of clinically significant complications after APR.
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<p><b>OBJECTIVE</b>To investigate the risk factors of postoperative perineal wound complications after abdominoperineal resection for rectal cancer.</p><p><b>METHODS</b>The databases of Medline, Embase, Web of Science, Ovid, Cochrane Library, CBM, CNKI, VIP and WANFANG were searched for the studies of abdominoperineal resection up to October 2016. The quality of the included studies was assessed by using "Cochrane collaboration's tool for assessing risk of bias" and "the Newcastle-Ottawa Scale". The meta-analyses were performed with Review Manager 4.3 software.</p><p><b>RESULTS</b>Eight randomized controlled trials and 33 non-randomized controlled trials with 15 287 patients were enrolled. Meta-analyses showed that neoadjuvant radiotherapy (OR=2.55, 95%CI: 1.66 to 3.93, P<0.01) and obesity (OR=2.12, 95%CI: 1.05 to 4.26, P=0.04) significantly increased the morbidity of perineal wound complication after abdominoperineal resection for rectal cancer; omentoplasty(OR=0.30, 95%CI: 0.14 to 0.67, P=0.003), presacral space clysis (OR=0.11, 95%CI: 0.01 to 0.94, P=0.04), abdominal drainage (OR=0.36, 95%CI: 0.21 to 0.63, P<0.01), perineal skin drainage(OR=41.72, 95%CI: 2.39 to 727.90, P=0.01) and local application of antibiotics (OR=0.17,95%CI: 0.07 to 0.40, P<0.01) significantly decreased the morbidity of perineal wound complication; however, extralevator abdominoperineal excision (OR=0.88, 95%CI: 0.57 to 1.35, P=0.56), laparoscopic procedure (OR=1.02, 95%CI: 0.47 to 2.21, P=0.96), biologic mesh reconstruction (OR=1.81, 95%CI: 0.95 to 3.46, P=0.07), myocutaneous flap reconstruction (OR=1.32, 95%CI: 0.18 to 9.91, P=0.79) and negative pressure drainage(OR=0.69, 95%CI: 0.35 to 1.34, P=0.27) had no influence on the healing of perineal wound.</p><p><b>CONCLUSIONS</b>Numerous factors can affect the occurrence of perineal wound complication after abdominoperineal resection for rectal cancer. Due to the limitations of enrolled studies, multicenter large scale and high-quality randomized controlled trials are required to validate the current results.</p>
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Objective To track the migration and incorporation of intravenously injected, magneti?cally labeled endothelial progenitor cells ( EPCs) from mouse bone marrow into the blood vessels in a rapid?ly growing HCC model by microMR (7.0 T). Methods This study was approved by the Institutional Com?mittee on Animal Research. H22 hepatic ascitic cancer cells was directly injected into the left liver lobe of BALB/c nude mice ( n=15) . EPCs derived from bone marrow of C57BL/6 mice were isolated and cultured. The third passage EPCs were collected and labeled with 25 μg/ml superparamagnetic iron oxide ( SPIO) and poly?l?lysine (PLL) complex (SPIO?PLL). MTT assay and flow cytometry were used to evaluate the difference of growth curve and apoptosis between labeled and unlabeled EPCs. EPCs labeled with SPIO?PLL were injected into mice via tail vein in experiment group (on the 3rd day after establishing HCC model) (n=15) and control group (n=6). The signal changes of tumor (the 1st, 3rd and 7th day after transplantation) were observed by microMR. Prussian blue staining and immunohistochemistry staining of CD31 were per?formed. MRI findings were confirmed by histomorphology. Two?sample t test was used to analyze the data. Results Single tumor was showed in the liver of all mice 3 d after establishing models. Labeling with SPIO?PLL at a concentration of 25μg/ml did not alter cell growth curve ( measured by MTT assay;t=0.281, P>0.05) and cell apoptosis (analyzed by flow cytometry). The apoptosis rates of SPIO?PLL labeled and un?labled EPCs were (12.31±1.43)% and (11.57±1.24)% in early stage, and (0.55±0.07)% and (0.49± 0?05)% in late stage. No significant differences were observed between them (t=0.967, 1.060; both P>0?05) . Migration and incorporation of transplanted and labeled cells into tumor were documented with in vivo microMR as low signal intensity at the tumor periphery as early as the 3rd day after EPCs administration in preformed tumors (4/5). Prussian blue staining showed iron?positive cells at the sites corresponding to low signal intensity on MRI. The positive cells expressing CD31 existed in intratumoral and peritumoral vessels. There was no signal change in control group at all time points. Conclusions MRI can demonstrate the in?corporation of magnetic labeled mouse EPCs into the implanted hepatoma. It may be helpful for early diagno?sis and therapy of liver tumor.
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The metabolic properties of cancer cells diverge significantly from those of normal cells. Energy production in cancer cells is abnormally dependent on aerobic glycolysis. In addition,cancer cells have other metabolic characteristics,such as increasing fatty acid synthesis and glutamine metabolism. Emerging evidences show that many key enzymes in dysregulated Warburg-like glucose metabolism,fatty acid synthesis and glutaminolysis are linked to drug resistance in cancer treatment. For example, lactate dehydrogenase A contributes to paclitaxel/trastuzuma resistance in breast cancer, fatty acid synthase is linked to docetaxel/trastuzumab/adriamycin resistance in breast cancer, and glutaminolysis is linked to cisplatin resistance in gastric cancer. Therefore,targeting cellular metabolism may improve the response to cancer therapeutics,and the combination of chemotherapeutic drugs with cellular metabolism inhibitors may overcome drug resistance in cancer therapy. This review discussed the relationship between dysregulated cellular metabolism and chemotherapy resistance, and the way in which targeting of metabolic enzymes can help overcome the resistance to cancer therapy or enhance the efficacy of common therapeutic agents.
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Progress in multi-disciplinary therapy for primary liver cancer (PLC) increases the 5-year survival rate from 2.6％ to 20.6％.However,the overall survival rate failed to increase significantly in the past twenty years because of lack of standardization in treatment of PLC.It is important to establish clinical guidelines which are based on randomized controlled trials,meta analysis,or systematic reviews.This review summarizes the pertinent clinical trials on PLC therapies published before October 2010.The articles were selected by a comprehensive literature search using the terms ‘liver neoplasms',‘ hepatectomy',‘ liver transplantation',‘ transarterial chemoembolization',‘ radiofrequency ablation',‘ percutaneous ethanol injection',‘ radiotherapy',‘ biological therapy',‘ chemotherapy',or ‘ Chinese herbs’.
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Objective To discuss the method of the surgical treatment for retained and regenerate hepaticolithiasis, and to improve the theraputic level. Methods In recent 5 years,in our hospital,136 cases of retained and regenerate hepaticolithiasis were treated by combination of hepatolobectomy with other operation, and these cases were analyzed retrospectivly. Results One patient died after operation (0. 7%),8 patients had other complications including: biliary fistuta(6 cases, 4.4%), subphrenic abscess (2 cases,1.5%). All cases were visited for 2.5 - 8.3 years, 115 (84.6%) cases had not any symptom, 6 (4.4%)cases had infection of biliary tract, 6(4.4%) cases had retained calculus, 9(6.6%) cases recurred calculus 2 -5 years after operation. Conclusion Retained and regenerate hepaticolithiasis should be treated by combination of hepatolobectomy with other operation and fiber choledochoscope and B ultrasound of operation, which can increase therapeutic effect.
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Objective To find antigens related with hepatocellular carcinoma(HCC).Methods Human Zinc Finger Protein 216(ZNF216) was identified by SEREX(serological analysis of recombinant cDNA expression libraries,SEREX).The 6His fusion protein of ZNF216 was expressed by bacteria and purified with a nickel affinity chromatography column.The level of anti-ZNF216 antibody in the sera was detected by ELISA,andZNF216 mRNA level in HCC tissue and its peripheral normal tissue was detected by RT-PCR.Results The level of anti-ZNF216 antibody in the sera of HCC patients was higher than that of healthy individuals.ZNF216 mRNA level in HCC tissue is evidently higher than peripheral normal tissue.Conclusion The over-expression of ZNF216 in the HCC sera and tissue indicates that ZNF216 perhaps plays a role in HCC.
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OBJECTIVE To find out about the transverse section use rate of antimicrobials in our hospital. METHODS A transverse section survey was made from midnight on June 24,2004 to midnight on June 25,2004 within all the inpatients. RESULTS Among 1132 inpatients,the transverse section use rate of antimicrobials was 58.83%,the combined medication ratio being 34.08%.Of all antimicrobial takers 65.92% were given single drug,31.68% double,and 2.40% were given triple.Among all departments of the hospital,the universal ICU had the highest use rate which was 100.00%,next to which were those in the departments of nephrology and gynecology,being respectively 90.00% and 87.23%.The antimicrobial use rate in surgical department(69.68%) was remarkably higher than that in medical department(43.08%).The departments of ophthalmology and otorhinolaryngology had the highest prophylactic use rate which was 83.64%.Rate of etiological examination for therapeutic medication in the whole hospital was 35.97%. CONCLUSIONS The transverse section use rate of antimicrobial in our hospital is slightly higher than the national average use rate.The constituent ratio of prophylactic medication is on the high side and the rate of etiological examination for therapeutic medication is on the low side.Management should be further strengthened for rational use of antimicrobials.
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Objective Using polysulfon fibers, a new bioartificial liver was developed. This study was to evaluate the efficacy of this bioartificial liver in the support of a disfunctioned liver. Methods Hepatocytes were procured from swine using Seglen′s methods. The bioartificial liver was constructed based on polysulfon bioreactor with a procurement of 10 10 hepatocytes, and was applied in 12 acute liver failure patients for 14 sessions. Each BAL treatment lasted 6 hours. The general conditions of the patients and the biochemical parameters were evaluated. Results After treatment with bioartificial liver, ammonia, prothrombin time and total bilirubin level significantly decreased (all P
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Objective To evaluate the effect of abdominal drains on difficult cholecystectomy.Method 894 cases of difficult cholecystectomy from Jan. 1988 to Jun. 1999 were retrospectively analysed.Results The incidences of complication, reoperation and death in drain group were 6.81%,1.16% and 0.33%，respectively while those in non-drain group were 33.56%,9.59% and 4.11% respectively.There was significant difference between the two groups.Conclusion Abdominal drains should be laid routinely in difficult cholecystectomy.
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ObjectiveTo evaluate intraoperative cholangiograhy during cholecystectomy for patients with preoperative benign gallbladder disease. Methods Unexpected biliary disease and anomaly found by intraoperative cholangiography in 904 cases of preoperatively diagnosed simple gallbladder stone and polypoid lesions were analyzed. Results Choledocholithiasis was found in 79 cases, anomalous pancreaticobiliary junction (APBJ)in 21, gallbladder cystic duct variations in 28, right accessory hepatic duct in 4 . Conclusions Intraoperative cholangiograhy during the process of simple cholecystectomy helps to discover preoperatively mis-diagnosed choledocholithiasis, hence to avoid secondary exploration of common bile duct which is otherwise inevitable, it may also demonstrate the anomalous pancreaticobiliary junction and bile ductal anatomic variations.
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Objective To discuss the relationship of congenital choledochus cyst(CCC)with occurrence of pancreatitis in adults and methods of surgical treatment.Methods The clinical data of 17 adult patients with congenital choledochus cyst who underwent surgical treatment from 1997-2005 were analyzed retrospectively.Results Clinical diagnosis was made mainly by B-ultrasound,MRCP,intraoperative cholangiography,ERCP and CT scans.Among 17 cases,10 cases were congenital choledochus cyst typeⅠ,4 cases type Ⅱ,1 case type Ⅲ,1 case type Ⅳ and 1 case type Ⅴ;and associated with cholelithiasis in 14 cases(bile pigment stone in 11cases,cholesterol calculus 3cases),chronic cholecytitis 5 cases,polypoid lesions of gallbladder 1 case,anomalous pancreaticobiliary junction(APBJ)10 cases,and pancreatitis 10 cases.Resection of extrahepatic cyst with Roux-y hepaticojejunostimy was performed in 15 cases,preserving pylorus pancreatoduodinectomy in 1 case,and cholecystectomy and T tube drainage in 1 case.Excellent and good results were achieved on follow-up in 14 out of the 17 CCC cases undergoing surgical treatment,while pancreatitis occurred in 2 cases and unexpected death in 1 case.Conclusions Pancreatitis is apt to occurr in CCC with APBJ and bile pigment stone in choledochus.The incidence of pancreatitis in CCC and APBJ(P-B)can be decreased by resection of extrahepatic cyst and Roux-en-Y hepaticojejunostimy and cholecystectomy.
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Objective To establish a new model of acute hepatic failure in canines for bioartificial liver treatment research . Methods Acute hepatic failure was induced by end to side portocaval shunt combined with common bile duct ligation and transection. The survival rate, liver function, ammonia, Fischer's ratio (BCAA/AAA) and pathological change of injury liver were investigated. Results The ammonia, ALT, AKP, total bilirubin and PT were elevated dramatically and Fischer's ratio declined significantly 14 days after the operation. The survival rate of the models decreased with time 14 days after the operation. Pathological examination of liver tissues revealed evidence of cholestasis, inflammation with accumulation of neutrophils, degeneration and necrosis of hepatocytes.Conclusions End to side portocaval shunt combined with common bile duct ligation and transection can produce a satisfactory acute hepatic failure model in canines, which could be used in the study of bioartificial liver.