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Objective:To compare the treatment outcomes of neoadjoint therapy combined with liver transplantation versus radical hepatectomy for patients with surgically resectable hilar cholangiocarcinoma.Methods:A retrospective study was performed on the data of 64 patients with resectable hilar cholangiocarcinoma operated from January 2009 to December 2014 at the Organ Transplantation Department of the First Central Hospital of Tianjin. There were 43 males and 21 females, with an average age of 61.2 years. There were 45 patients who underwent radical hepatectomy in the liver resection group, and 19 patients who underwent combined neoadjuvant therapy (radiotherapy combined with 5-fluorouracil intravenous drip, transcatheter lumen radiotherapy, capecitabine oral administration) and liver transplantation in the liver transplantation group. The recurrence rates and survival rate were compared between groups.Results:The 1, 3 and 5 years cumulative survival rates of the liver transplantation group were 89.5%, 73.7% and 63.2%, respectively, which were significantly better than those of the liver resection group (80.0%, 53.3% and 35.6%) ( P<0.05). The postoperative tumor recurrence rate in the liver transplantation group was 31.6% (6/19), which was significantly lower than that in the liver resection group of 60.0% (27/45) ( P<0.05). Subgroup analysis using postoperative pathological results showed the cumulative survival rates of patients without lymph node metastasis (N 0) and those with negative resection margins (R 0) were not significantly different between groups ( P>0.05). However, for patients with regional lymph node invasion (N 1) and with R 0 resection margin, the cumulative survival rates at 1, 3 and 5 years after liver transplantation were 83.3%, 66.7% and 50.0%, respectively, which were significantly superior to the 64.3%, 28.6% and 14.3% of the liver resection group ( P<0.05). Conclusion:Hepatectomy is recommended for patients with N 0 R 0 resectable hilar cholangiocarcinoma. For patients with hilar cholangiocarcinoma with marginally resectable N 1R 0, neoadjuvant therapy combined with liver transplantation resulted in significantly better long-term overall survival than resection.
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Objective To compare the difference of clinical efficacy between surgical magnifying glass and surgical microscope assisted hepatic artery reconstruction in living donor liver transplantation (LDLT). Methods Clinical data of 272 donors and recipients undergoing LDLT were retrospectively analyzed. According to different patterns of hepatic artery reconstruction, all recipients were divided into the magnifying glass group (n=189) and microscope group (n=83). The operation time, intraoperative blood loss, hepatic artery reconstruction site, diameter of anastomosis, incidence of postoperative complications and survival rate of recipients were statistically compared between two groups. Results Compared with the microscope group, the operation time, hepatic artery reconstruction time and intraoperative blood loss were significantly less in the magnifying glass group (all P < 0.001). The most common site of hepatic artery reconstruction was the right hepatic artery in two groups, and the diameter of anastomosis was (2.1±0.9) mm in the magnifying glass group and (2.1±0.8) mm in the microscope group, with no statistical significance between two groups (P > 0.05). The 1-, 2- and 3-year survival rates of recipients in the magnifying glass group were 88%, 86% and 85%, which did not significantly differ from 89%, 87% and 86% in the microscope group (all P > 0.05). The incidence of postoperative complications did not significantly differ between two groups (all P > 0.05). Conclusions The efficacy and safety of hepatic artery reconstruction in LDLT under surgical magnifying glass are equivalent to those under surgical microscope, with less operation workload and intraoperative blood loss. For experienced transplantation surgeons, it is recommended to perform hepatic artery reconstruction assisted by surgical magnifying glass.
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Objective To investigate and analyze the applications of liver grafts from donation after death children (≤5 kg) in pediatric liver transplantation.Methods A retrospective analysis was conducted on 18 cases of pediatric recipients using liver grafts from donation after death children (≤5 kg) during January 2013 to December 2015.The survival rate of patients,recovery of liver function,incidence of lung infection,vascular complications and biliary complications were observed,and the causes of deaths were analyzed.Results The median follow-up time of all the patients was 28.4 months (0.06-52.2 months).The 1-and 3-year cumulative survival rate was the same 88.9％,the incidence of lung infection was 22.2％,of vessel complications was 33.3％,and biliary complication rate was 11.1％.Two cases died after liver transplantation.Conclusion The applications of liver donation after death children (≤5 kg) were satisfactory,but there is still relatively limited experience,and further observation and research are needed.
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To study the chemical constituents of Trichosanthes kirilowii Maxim., chromatographic methods such as D101 macroporous resin, silica gel column chromatographic technology, Sephadex LH-20, octadecylsilyl (ODS) column chromatographic technique and preparative HPLC were used and nine compounds were isolated from a 95% (v/v) ethanol extract of the plant. By using spectroscopic techniques including 1H NMR, 13C NMR, 1H-1H COSY, HSQC and HMBC, these compounds were identified as 5-ethoxymethyl-1-carboxyl propyl-1H-pyrrole-2-carbaldehyde (1), 5-hydroxymethyl-2-furfural (2), chrysoeriol (3), 4'-hydroxyscutellarin (4), vanillic acid (5), alpha-spinasterol (6), beta-D-glucopyranosyl-a-spinasterol (7), stigmast-7-en-3beta-ol (8), and adenosine (9), separately. Among them, compound 1 is a new compound, and compounds 3, 4 and 5 are isolated from the genus Trichosanthes kirilowii Maxim. for the first time.
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ObjectiveTo investigate the diagnosis and treatment of hepatic venous outflow obstruction(HVOO) after pediatric liver transplantation.MethodsFrom Jan.2000 to Dec.2009,48 children received liver transplantation in the Department of Liver Transplantation,First Central Hospital,Tianjin.There were 3 patients who developed HVOO (2 received liver transplantation in our center,while the third from another centre).The HVOO was diagnosed by color Doppler ultrasound (CDUS),computed tomography (CT),and angiography of inferior vena cava (IVC).The patients received balloon dilation and/or stent placement and followed-up with regular monitoring.ResultsIn our center,the incidence rate of HVOO was 4.17％ (2/48).The time of onset was 2 months to 1 year postoperatively.The pressure gradient between the hepatic vein and the right atrium was from 6 to 30mmHg.After treatment,the venous pressure gradient decreased from 4 to 10mmHg.Resolution of clinical symptoms was achieved in these patients.HVOO relapsed in two patients who received balloon angioplasty only.The clinical symptoms were relieved after repeated balloon dilation in one and stent placement in the other.There were no further complications after these procedures.All patients were alive at a follow-up from 2 months to 9 years.ConclusionThe incidence of HVOO after pediatric liver transplantation was not high,but HVOO led to serious consequences.Balloon dilation and/or stent implantation were safe and efficacious treatments for HVOO after pediatric liver transplantation.
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Objective To evaluate the preventive effect of combination of low-dose HBIg and Nucleoside analogues on recurrence of hepatitis B after liver transplantation. Methods Retrospectively analyzed HBV status and recurrence in patients accepting Nucleoside analogues plus low-dose HBIg as prophylaxis treatment after liver transplantation for HBV-related end-stage liver disease from December 1998 to Octomber 2009 in our center. Results In all the 1506 patients whose survival time >30 d after liver transplantation, 37 patients showed HBV recurrence, the HBV cumulative-recurrence rate of 1, 2, 3, 4, 5 and 6y was 1.3%,2. 4%,2. 7%,2. 9%,3. 7% and 4.6% respectively. The time of recurrence varied from 0. 3 to 66. 6 months (median 12. 8 months) after transplantation. Virus mutation could be tested in 9 cases of the 37 recurrence patients, including 4 YMDD cases, 2 YMDD + YIDD cases, 1 YMDD+YVDD cases, 1 YVDD case,and 1 YIDD case. Conclusions Liver transplantation is the principal therapeutic method for the patient with end-stage liver diseases related to HBV, with the effectively prophylaxis treatment to aim directly at HBV recurrence. If the patients who got HBV recurrence received targeted treatments, the situation can be controlled satisfactorily.
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Objective To investigate the safety of donors and recipients in living donor liver transplantation (adults to infants). Methods From September 2006 to November 2009, 8 living donor liver transplantations were performed, and all of the recipients were diagnosed as having congenital biliary atresia. Triphasic liver computed tomography was used to display the shape of the liver and calculate total liver and liver lobes volumes in donors. Magnetic resonance cholangiopancreatography (MRCP) was used to examine the conditions of the bile tract. Suitable liver lobe was resected depending on the condition of recipients' abdomen. After the operation, all of the recipients received treatments including anti-rejection, anti-infection, etc. All the donors received liver protection and antisecretory treatments. The preoperative, intraoperative and postoperative states of donors and recipients were analyzed. Results All of the operations were performed successfully. For the grafts, 6 left lateral lobes, 1 hepatic S3 and 1 reduced-size hepatic S3 were obtained. The weight of lobe grafts was 148-302 g (235. 9 ± 53. 6 g). The ratio of graft weight to recipient weight ranged from 2. 11% to 3. 36 % (2. 65 % ± 0. 48 %). During a follow-up period of 3-40 months (median 18 months), there was no donor mortality, but 2 (25%) donors experienced complications. One (12. 5 %) of the 8 recipients died, and the remaining developed 13 cases/times of complications.Conclusion Accurate assessment of recipients and donors preoperatively, suitable resection of the grafts and precise operation intraoperatively, and careful treatment postoperatively can ensure safety of the recipients and donors to the maximum extent.
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Fracture problem of orthodontic wires was discussed in this paper. The calculation formulae of bending stress and tensile stress were obtained. All main factors that affect bending stress and tensile stress of orthodontic wires were analyzed and discussed. It was concluded that the main causes of fracture of orthodontic wires were fatigue and static disruption. Some improving proposals for preventing fracture of orthodontic wires were put forward.