Impact of microwave dealing with the cutting surface on the hepatocellular carcinoma recurrence after hepatectomy / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To explore the impact of microwave dealing with cutting surface on perioperative liver function recovery and recurrence and metastasis after hepatectomy for HCC.</p><p><b>METHODS</b>Clinical data of 133 patients with HCC from March 2009 to November 2010 were retrospectively analyzed. They were divided into the conventional surgery group (66 cases) and microwave treatment group (67 cases). A domestic ECO-100 microwave knife was inserted into the liver cutting surface 0.5 cm from the cutting edge, and repeated multi-point burning with an average time of 25 minutes in the microwave treatment group. Then the perioperative liver function recovery and recurrence and metastasis in the two groups were compared.</p><p><b>RESULTS</b>The operation time of conventional surgery group was (158.0 ± 31.0) minutes, and that of microwave treatment group was significantly longer (181.0 ± 28.0) minutes (P=0.027). There were no significant differences in the liver function recovery between the two groups (P>0.05). There were 6 cases of recurrence and metastasis after 6 months and 9 cases after 12 months in the microwave treatment group, while there were 15 cases of recurrence and metastasis after 6 months and 20 cases after 12 months in the conventional surgery group, showing a significant difference (P=0.034 and 0.022, respectively).</p><p><b>CONCLUSIONS</b>Microwave dealing with the cutting surface has no significant effect on perioperative liver function recovery in hepatectomy. However, microwave treatment can reduce the in situ recurrence in HCC patients within the first year after surgery, indicating a good clinical application value.</p>

Diagnosis and surgical treatment of hepatic perivascular epithelioid cell carcinoma / 中华消化外科杂志

Objective To investigate the clinical featurcs of hepatic perivascular epithelioid cell carcinoma (PEComa) and the experiments in the surgical treatment of PEComa.Methods The clinical data of 16 patients with hepatic PEComa who received surgical treatment at the First Affiliated Hospital of Nanjing Medical University from January 2008 to January 2012 were retrospectively analyzed.The incidence,clinical manifestations,imagiong characteristics,surgical outcomes and pathological manifestations of this disease were analyzed.B sonography,hepatic function test,tumor markers test and epigastric computed tomography (CT) were applied to detect tumor recurrence and metastasis.The follow-up was ended in December 2012.Result Middle aged and female patients took large part of the patients.Of the 16 patients,8 had no subjective symptoms,and other patients had discomfort in the right upper quadrant,pain or tenderness of the liver.All the tumors were solitary,and most of them located at the right liver (11 tumors were in the right liver,4 in the left liver,1 in the caudate lobe).No specific features were detected by preoperative B sonography,while inhomogeneous low density in the tumor region was detected on by CT.All the patients received partial liver resection without morbidity and morality.The results of immunohistochemistry showed that thc expressions of HMB-45,Melan-A and vascular smooth muscle actin were positive.The mean time of follow-up was 27.9 months (range,9.0-46.0 months),no tumor recurrence and death was observed during the follow-up.Conclusions Middle aged females are susceptive to hepatic PEComa,and patients have no specific clinical presentations.Preoperative CT examination is helpful for differential diagnosis of PEComa,and partical hepatectomy can achieve satisfactory short-term clinical outcomes.

Living donor liver transplantation for end-stage liver disease / 中华消化外科杂志

objective To investigate preoperative donor and recipient assessment,choice of surgical options in living donor liver transplantation(LDLT).Methods The clinical data of 95 patients who underwent LDLT from January 1995 to October 2007 in our center were retrospectively analyzed.Of all,92 recipients were benign end-stage liver disease patients (including 45 patients with Wilson disease),and 3 were malignant hepatic carcinbma patients.Results Thirty-one fight lobes without middle hepatic vein(MHV),3 right lobes with MHV,51 left lobes with MHV.and 10 left lobes or left lateral lobes without MHV were obtained.All the donors recovered after operation. Recipients with benign end-stage liver disease were followed up for 1 to 86 months,and the 1-,3-,5-year accumulative survival rates were 89%(82 cases),78%(71 cases)and 73%(67 cases),respectively. The 1-,3-,5-year survival rates of patients with Wilson disease were 92%(42 cases),89%(40 cases)and 76%(34 cases),respectively. For the 3 patients with malignant hepatic carcinoma,2 died and 1 was alive and well. The copper metabolism was back to normal in both donors and recipients. Conclusions Establishment of a system for the safety of donors is basic for LDLT. The key to raise the recipients' survival rates is to choose the optimal surgical approach. LDLT is effective in treating Wilson disease.

Application of microsurgical technique to hepatic artery reconstruction in liver transplantation / 中华外科杂志

<p><b>OBJECTIVE</b>To explore the value of the microsurgical technique in the reconstruction of hepatic artery.</p><p><b>METHODS</b>From September 2000 to June 2001, we performed liver transplantation for 11 patients including living related liver transplantation (4) and 7 orthotopic liver transplantation (7). Arterial reconstruction was performed under an operating microscope.</p><p><b>RESULTS</b>No patients developed hepatic arterial thrombosis and serious complication, nor death for multiple organ failure.</p><p><b>CONCLUSION</b>Microsurgical technique in reconstruction of the hepatic artery can improve surgical outcome, not only in orthotopic liver transplantation but also in living related liver transplantation.</p>

Multimodal approach to clinical liver transplantation / 中华外科杂志

<p><b>OBJECTIVE</b>To sum up the clinical experience of liver transplantation.</p><p><b>METHOD</b>A retrospective study was made in 11 patients receiving living donor liver transplantation (LDLT)/and 14 patients having orthotopic liver transplantation (OLT), including one time operation of reduced size liver retransplantation and one time operation of cadaveric liver retransplantation.</p><p><b>RESULTS</b>The voluntary donors were a sister and 10 mothers of recipients. The location of graft included 3 patients of segment II, III, part of IV (not including intermediate hepatic veins), 6 patients of segment II, III, IV (including intermediate hepatic veins), and 2 patients of V, VI, VII, VIII (not including intermediate hepatic veins). The weight range of graft was 270 - 620 g. Twenty-four recipients achieved a long-term survival and retained normal liver function during the follow-up. Only 1 patient died from serious rejection on the 72nd day postoperatively. Ten patients with hepatitis B cirrhosis were treated with lamivudine and anti-HBVIg, and HBV-DNA in serum was negative during the follow-up for 4 approximately 21 months. Copperoxidase, ceruloplasmin and main indexes of liver function became normal in all patients with Wilson's Disease. Postoperative complications included abdominal hemorrhage (2 patients), acute respiratory distress syndrome (5), acute rejection (4), and acute renal function failure (2).</p><p><b>CONCLUSIONS</b>The wise solution to improve the result of liver transplantation and optimize liver resources is the "multimodal approach", by which all kinds of techniques for liver transplantation including CLT, LDLT and RSLT should well developed.</p>

Early enteral nutritional support in patients of liver transplantation / 中国普通外科杂志

Objective To evaluate early enteral nutrition in patients after liver transplantation. Methods This is a prospective, randomized trial consisting of 63 patients divided into two groups to receive TPN and early enteral nutrition respectively for a week. Patients' nutritional status, liver function, nutritional expense and the incidence of postoperative infections and other complications were compared between the two groups. Result Early enteral nutrition after liver transplantation can improve the nutritional condition and it is helpful for the recovery of the liver function. It decreases the rate of postoperative infections and other complications. Conclusions Early enteral nutritional support is feasible alternative to TPN in patients of liver transplantation.