Clinical characteristics, diagnosis and treatment of digestive tract leakage after orthotopic liver transplantation / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the clinical characteristics, diagnosis and treatment of digestive tract leakage after orthotopic liver transplantation (OLT).</p><p><b>METHODS</b>Sixty-one recipients had digestive tract leakage in early stage after OLT among 1173 cases from January 2000 to December 2010. There were 55 male and 6 female patients, aging from 36 to 61 years, with a median of 45 years. Digestive tract leakage included bile leakage (46 cases), gastric leakage (5 cases), duodenal leakage (1 case), jejunal leakage (4 cases), ileal leakage (1 case) and colon transversum leakage (4 cases). Ten of recipients with gastrointestinal leakage had 1 to 3 times of abdominal surgery before OLT. Abdominal drainage was used in 28 cases with bile leakage, and additionally, endoscopic retrograde cholangiopancreatography, endoscopic nasobiliary drainage and stenting were performed for 8 of them, and surgical neoplasty for another 18 patients with bile leakage. Simple surgical neoplasty of perforation was performed for 13 patients with gastrointestinal leakage, and diverticulectomy and neoplasty for 1 case with duodenal leakage, and partial jejunostomy for one severe jejunal leakage. Nutritional support was administered for all of cases.</p><p><b>RESULTS</b>The incidence rate of digestive tract leakage in early stage after OLT was 5.20% (61/1173). Intra-operative iatrogenic injury of gastrointestinal tract was occurred in 6 cases with gastrointestinal leakage. After treatment, 11 cases died of multiple organ failure resulted from severe infection, with mortality of 18.0% (11/61), including 4 cases with bile leakage, with the mortality of 8.6% (4/46), and 7 cases with gastrointestinal tract leakage, with the mortality of 46.6% (7/15). The remanent 50 cases through comprehensive treatment with a span of 1 to 3 months recovered and discharged healthily. No digestive tract leakage reoccurred in the follow-up of 6 to 84 months.</p><p><b>CONCLUSIONS</b>The morbidity of digestive tract leakage in early stage after OLT is low, but its mortality is high, especially for gastrointestinal tract leakage. High dose corticosteroids therapy, history of abdominal operation and intra-operative iatrogenic injury may be high risk factor. Comprehensive treatment is crucial for improving prognosis.</p>

Effect of Campath-1H induction on immunosuppression in small intestine transplantation / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the effect of Campath-1H induction on immunosuppression in small intestine transplantation.</p><p><b>METHODS</b>Clinical data of a patient who underwent small intestine transplantation were retrospectively summarized.</p><p><b>RESULTS</b>Intraoperative Campath-1H induction by intravenous injection was administered. Triple immunosuppression(FK506, MMF and methylprednisolone) was used postoperatively. The lymphocyte and leukocyte decreased significantly following Campath-1H induction, and returned to normal after adjusting the dose of immunosuppressant and use of colony stimulating factor. There were no acute rejection, graft versus host disease, or severe infection during the immediate postoperative period. The patient recovered and discharged.</p><p><b>CONCLUSION</b>Intraoperative Campath-1H induction and postoperative triple immunosuppression using FK506, MMF, and methylprednisolone may prevent rejection and graft versus host disease in the early stage after small intestine transplantation.</p>

Application of steroids minimization immunosuppressive regimen in liver transplantation / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the safety and feasibility of steroids minimization immunosuppressive regimen in liver transplantation.</p><p><b>METHODS</b>One hundred and sixteen patients in line with the selecting criteria from January 2005 to June 2008 were divided into three groups according to the withdrawal of steroids: 40 cases in 3 months withdrawal group, 40 cases in 7 d withdrawal group and the other 36 cases in 24 h withdrawal group. The difference of recipients' survival, infection, acute rejection and steroids resistant acute rejection, wound healing, recurrence of HBV and hepatocellular cell (HCC), new on-set of diabetes, hyperlipidemia and hypertension between the three groups were compared.</p><p><b>RESULTS</b>The difference of recipients' survival, acute rejection including steroids resistant acute rejection, recurrence of HBV and HCC, hyperlipidemia between the three groups were not significant (P > 0.05), the incidence of wound un-healing and hypertension in 24 h withdrawal group was significantly lower than that in the other 2 groups (P < 0.05), the incidence of infection and new on-set diabetes in 24 h withdrawal group and 7 d withdrawal group was significantly lower than that in 3 months withdrawal group (P < 0.05).</p><p><b>CONCLUSION</b>Steroids minimization immunosuppressive strategy is safe and feasible in liver transplantation field, it will significantly reduce the steroids related complications without increasing the risk of rejection.</p>

Clinical and pathological analysis of chronic rejection following orthotopic liver transplantation / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the clinical manifestation and pathological features of chronic rejection (CR) and the management of CR after orthotopic liver transplantation (OLT).</p><p><b>METHODS</b>From January 2004 to December 2006, there were 516 patients who had undergone OLT. All the clinical and pathological data were collected and retrospectively studied. Clinical manifestation, histopathological feature, diagnosis and anti-rejection treatment of CR were summarized and analyzed.</p><p><b>RESULTS</b>The incidence of CR was 2.3% (12/516), including 7 cases with early phases of CR and 5 cases with late phases of CR. The main pathological changes of CR were the vanishing bile duct syndrome and obliterative arteriopathy;and the early stage of CR were the damage of inter lobular bile duct, necrotic inflammation in central lobule, and inflammatory cells infiltration in portal area. Among 12 patients with CR, 7 cases with early CR were reversed by methylprednisolone (MP) pulse treatment and adjusting immunosuppressant dose, including 2 cases of whom were prescribed OKT3 treatment and 2 cases treated by ATG, and 5 cases with late CR underwent liver retransplantation (re-LT). Two patients died from infection, 1 case died from multiple organ failure in perioperative period after re-LT, another 2 cases were cured by re-LT, and the CR related mortality was 25.0% (3/12).</p><p><b>CONCLUSIONS</b>Chronic rejection following OLT is lack of typical clinical manifestation and pathological features, and the pathological changes can overlap and coexist. Post-transplant liver biopsy and graft specimen after re-LT is still "gold standard" to CR diagnosis. Some of early CRs can be reversed by early diagnosis and early treatment; for late CR recipient, re-LT should be considered.</p>

Etiology and management of postoperative gastrointestinal bleeding after orthotopic liver transplantation / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the causes and treatment of postoperative gastrointestinal bleeding after orthotopic liver transplantation (OLT).</p><p><b>METHODS</b>Clinical data of 776 patients after OLT between January 2000 and December 2006 were analyzed retrospectively.The experiences in diagnosis and treatment of postoperative gastrointestinal bleeding after OLT were reviewed.</p><p><b>RESULTS</b>Gastrointestinal bleeding occurred in 18 patients (2.3%) after OLT, among whom 8 (44.5%) were from peptic ulcer, 3 (16.7%) from gastric and esophageal varices, 3 (16.7%) from gastroduodenitis, 3 (16.7%) from hemobilia, and 1 (5.6%) had diverticular bleeding in the jejunum. These 18 patients with gastrointestinal bleeding were managed with conservative treatment, endoscopic treatment, radiological interventional embolism,or exploratory laparotomy. Five patients died of gastrointestinal bleeding and the gastrointestinal bleeding-related mortality rate was 27.8%. After a mean follow up of 3.5 years, only 1 patient died of recurrence of hepatic cellular carcinoma while others survived disease-free.</p><p><b>CONCLUSIONS</b>Gastrointestinal bleeding may occur from different sites after OLT and the mortality is high. Prompt identification of the source of bleeding and correct management are required to improve the prognosis.</p>

Evaluation of quality of life after simultaneous pancreas-kidney transplantation / 南方医科大学学报

<p><b>OBJECTIVE</b>To evaluate the influence of simultaneous pancreas-kidney (SPK) transplantation on the quality of life of diabetic recipients with end-stage renal disease.</p><p><b>METHODS</b>We performed a retrospective analysis of the data of diabetic patients with end-stage renal disease and evaluated the quality of life of the recipients using SF-36 health survey.</p><p><b>RESULTS</b>One patient died of cerebrovascular accident, and 7 patients recovered smoothly. During the follow-up lasting for a mean of 23.3 months, the blood glucose, C-peptide and creatine levels of the patients remained stable. The score of 8 domains of SF-36 of the diabetic recipient at 2 years after SPK transplantation showed a significant improvement compared with that before the operation, similar to that of Chinese normal population(P > 0.05).</p><p><b>CONCLUSIONS</b>SPK transplantation can achieve a significant improvement of the quality of life of diabetic patients with end-stage renal disease.</p>

Clinical analysis on multivisceral transplantation / 中华外科杂志

<p><b>OBJECTIVE</b>To assess the indication, surgical and post-operative complications of the multivisceral transplantation.</p><p><b>METHODS</b>The post-transplant complications of 8 patients who underwent multivisceral transplantation between May 2004 and May 2010 were analyzed. There were 7 male and 1 female, aged from 28 to 65 years. Five patients who suffered from non-resectable advanced upper abdominal malignancy experienced the liver, stomach, spleen, pancreas, duodenum, omentum and variable amounts of the colon resection, and then underwent standard multivisceral transplantation (included liver, stomach, pancreaticoduodenal and small bowel). After underwent hepatectomy while retaining the native pancreas and entire gastrointestinal, three recipients with end-stage liver cirrhosis and type 2 insulin-dependent diabetes mellitus (IDDM) was performed combined en bloc liver/pancreaticoduodenal transplantation.</p><p><b>RESULTS</b>Since the third day post-operation, all recipients no longer needed exogenous insulin and had normal blood glucose concentrations. Two weeks after transplantation, their liver function almost became normal. For the 5 recipients who suffered abdominal malignancy, the longest survival period was 326 days. Cause of death are recurrent tumor (n = 2), multiple organ failure (n = 3). All the 5 patients experienced infection. For 3 patients suffered cirrhosis and IDDM, the longest survival was over 18 month. Excepting the case 8 died of graft versus host disease, all were still living without apparently post-transplant complication.</p><p><b>CONCLUSIONS</b>Multivisceral transplantation is an alternative in the treatment of the patients with benign massive abdominal pathologies. Careful patient selection and technical modification are crucial to improve the outcome of these patients.</p>

Two-dose steroid combined with two-dose daclizumab and tacrolimus regimen in liver transplant recipients / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the efficiency and safety of two-dose steroid combined with two-dose daclizumab and tacrolimus (FK506) regimen in liver transplant recipients.</p><p><b>METHODS</b>There were 74 patients who treated in the First Affiliated Hospital of Sun Yat-Sen University from September 2006 to March 2008. Expect for 7 patients who didn't measure up, 67 adult liver transplant recipients were randomized into two groups: conventional protocol group (n = 35) in which steroid was withdrawn in 3 months after operation, and two-dose steroid group (n = 32). Comparison of rejection, infection (bacteria, fungal and cytomegalovirus) and metabolic complications rates were studied between two groups.</p><p><b>RESULTS</b>There were significant differences between two groups in the rate of early postoperation hyperglycemia, the average dosage of insulin consumption among hyperglycemia recipients as well as the rate of diabetes mellitus, hypertension and infection during the follow-up period (P < 0.05). The rate of hypertension in early postoperation period, hyperlipemia and rejection rate during the follow-up period were similar in two groups (P > 0.05).</p><p><b>CONCLUSIONS</b>Two-dose steroid combined with two-dose daclizumab and tacrolimus would be a safe and efficient immunosuppression strategy without increase the acute rejection rate hazard, that could reduce post-transplant infection and other complications from side-effect of long-term usage of steroid.</p>

Prevention and management of hepatitis B virus reinfection after liver transplantation / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the prevention and treatment of hepatitis B virus (HBV) reinfection and recurrence after orthotopic liver transplantation (OLT) for HBV related end-stage liver disease.</p><p><b>METHODS</b>The clinical data of 316 patients undergoing allograft orthotopic liver transplantation who lived more than 6 months and had HBV infection preoperative with complete data from March 2001 to March 2007 at the First Affiliated Hospital of Sun Yat-sen University. According to the HBV prevention strategy, these patients were divided into two groups: group with pure lamivudine (LAM) (n = 106) and group with lamivudine plus intramuscular injection of low dose anti-hepatis B immunoglobulin (HBIG) (n = 210).</p><p><b>RESULTS</b>Mean follow-up was 33.6 months. The rate of HBsAg negative conversion 1 week after OLT of the LAM group was 82.1% (87/106), significantly lower than that of LAM + HBIG group [91.0% (191/210), P < 0.05]. The rates of HBV reinfection, HBV recurrence, and YMDD mutation of the lamivudine group was 17.0% (18/106), 11.3% (12/106) and 8.5% (9/106) respectively, all significantly higher than those of LAM + HBIG group [6.2% (13/210), 3.8% (8/210) and 2.4% (5/210) respectively, P < 0.05 respectively]. All patients with HBV reinfection or HBV recurrence were treated with Adefovir, Entecavir or increased dose of HBIG and achieved better curative effect.</p><p><b>CONCLUSIONS</b>The therapy with high dose of HBIG combining with adefovir or entecavir is better for patients who have HBV reinfection. Patients with HBV recurrence after OLT should be administrated reasonable liver aid, immunity regulation and anti-hepatic fibrosis to obtain better transplant liver histological results and normal transplant liver function.</p>

Conversion to rapamycin in liver transpant recipients with renal insufficiency / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the efficacy of conversion from calcineurin-inhibitor (CNI) to rapamycin in liver recipients with CNI-associated renal insufficiency.</p><p><b>METHODS</b>This retrospective study examined the liver transplant recipients who had switched from CNI to rapamycin between January 2004 and June 2008 in the first affiliated hospital of Sun Yat-sen University. The data of renal function before and after the conversion were analyzed by Wilcoxon sum rank test, and rapamycin-related adverse effects were also observed.</p><p><b>RESULTS</b>Compared with that before conversion, the renal funtion 4 months after the conversion improved significantly (P<0.05). The blood lipid level 3 months after the conversion increased significantly (P<0.05) but were well controlled.</p><p><b>CONCLUSION</b>Rapamycin can be used safely as a good alternative in liver transplant recipients with CNI-related renal insufficiency.</p>

The etiology and management of postoperative hyperbilirubinemia after orthotopic liver transplantation / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To investigate the causes and treatment of postoperative hyperbilirubinemia after orthotopic liver transplantation.</p><p><b>METHODS</b>Clinical data of 368 cases of orthotopic liver transplantation patients from the First Affiliated Hospital of Sun Yat-sen University between 2004 and 2005 were analyzed retrospectively.</p><p><b>RESULTS</b>Three hundred and sixty-eight patients experienced 396 incidents of hyperbilirubinemia, including 183 incidents of preoperative hyperbilirubinemia (46.2%), 46 incidents of ischemia-reperfusion injury (11.6%), 36 incidents of acute rejection (9.1%), 78 incidents of biliary complications (19.7%), 24 incidents of blood vessel complications (6.1%), 23 incidents of recurrence of the primary disease (5.8%) and 6 incidents of tacrolimus (FK506) toxicity (1.5%). The comprehensive management targeted to the etiology and symptoms were applied to all patients with hyperbilirubinemia.</p><p><b>CONCLUSION</b>Hyperbilirubinemia is a common clinical manifestation after liver transplantation with multiple and complicated causes. The key point for successful treatment is to identify the causes. To reach the aim of treatment and obtain long-term survival of the recipients, it is very important to make a correct diagnosis and give reasonable therapeutic regimens as soon as possible.</p>

The analysis of portal vein thrombosis following orthotopic liver transplantation / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate and summarize the experience in clinical presentation, diagnosis and treatment of portal vein thrombosis after orthotopic liver transplantation (OLT).</p><p><b>METHODS</b>The clinical data of 402 patients who underwent OLT from January 2003 to February 2007 were reviewed. A retrospective study was performed on etiology, prognosis and treatment in 9 cases of portal vein thrombosis after OLT.</p><p><b>RESULTS</b>All of the 9 cases received anticoagulant and antiaggregation therapy, within whom one underwent percutaneous transluminal angioplasty and stent placement, one underwent retransplantation after failure of thrombolysis therapy, and one received surgical embolectomy. Six patients died of multiple organ failure on 9th, 30th, 34th, 40th, 48th, 6 2nd days, respectively, while 3 patients survived.</p><p><b>CONCLUSIONS</b>The major risk factors of portal vein thrombosis after OLT were pathological changes in portal vein, abnormal blood stream dynamics, hypercoagulable status and improper surgical technique. Prophylactic intervention to patients with high risk factors, early diagnosis and aggressive comprehensive therapy on portal vein thrombosis patients are essential to improve prognosis.</p>

Evaluation of efficacy and safety on steroid withdraw at the seventh day after liver transplantation / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate efficacy and safety on steroid withdrawal at the seventh day after liver transplantation.</p><p><b>METHODS</b>Seventy-six adult patients undergoing first cadaveric liver transplantation from October 2005 to October 2007 were randomly divided into 7 day (n = 40) and 3 month (n = 36) steroid withdrawal groups. All patients received FK506 3 mg and intravenous methylprednisolone 1000 mg during intra-operation and FK506 thereafter was adjusted to predefined 8 - 12 microg/L from day 1 to month 6. Patients in 7 day steroid withdrawal group received 500, 240, 200, 160, 80, 40 and 20 mg intravenous methylprednisolone tapered daily from postoperative day 1 to day 7. In 3 month steroid withdrawal group, patients received the same protocol as 7 day steroid withdrawal group for intravenous methylprednisolone tapered daily from postoperative day 1 to day 7 and thereafter received oral prednisone 48, 40, 32, 24, 16, 8, 4 mg tapered every 3 days and maintained 4 mg to the 3(rd) month. All patients were followed up for 6 months. The incidence of treated acute rejection and side effects were evaluated between two groups.</p><p><b>RESULTS</b>A total of 69 cases were fully followed up, and 7 cases were discontinued including death (n = 2), server infection (n = 2), protocol violation (n = 2) and retransplantation (n = 1). There were no statistical difference between 2 groups concerning the incidence of acute rejection, hypertension, hyperlipemia and other adverse events (P > 0.05), but significant difference in incidence of diabetes (17.5% vs. 38.9%, P = 0.047).</p><p><b>CONCLUSION</b>Steroid withdrawal strategy at day 7 is same safety and efficacy as steroid withdrawal at 3 month.</p>

The cause and management of postoperative venous outflow obstruction after orthotopic liver transplantation / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the causes and treatment of postoperative venous outflow obstruction after orthotopic liver transplantation (OLT).</p><p><b>METHODS</b>Clinical data of 776 patients after OLT were analyzed retrospectively between January 2000 and December 2006. The accumulated experiences in diagnosis and treatment of postoperative outflow obstruction after OLT were reviewed.</p><p><b>RESULTS</b>Venous outflow obstruction occurred in 10 patients (1.29%) after OLT, among those 6 had supra-hepatic inferior vena cava (IVC) stenosis, 2 had IVC stenosis of the post-hepatic segment, and 2 had outflow obstruction of hepatic vein. The diagnosis was confirmed by inferior vena cavography in all the patients. Of the 10 patients, 8 received percutaneous transluminal angioplasty (PTA) or metallic stent replacement, and 2 underwent liver retransplantation (re-LT) when interventional therapy failed. Three patients died from outflow obstruction, so the outflow obstruction related mortality was 30% in the patients.</p><p><b>CONCLUSIONS</b>Complications of outflow obstruction after OLT were associated with surgical technique like vascular anastomosis, various types of cavo-caval anastomosis and graft size mismatch between donor and recipient. Making an early diagnosis and giving timely treatment including interventional therapy or re-LT is the key to improve the prognosis of outflow obstruction.</p>

Culture and identification of mouse myeloid semimature dendritic cells / 中国医学科学院学报

<p><b>OBJECTIVE</b>To investigate the methods of culturing and identifying mouse myeloid semimature dendritic cell (smDC) in vitro.</p><p><b>METHODS</b>Myeloid monocytes derived from 6-week-old C57 BL/6 mice were cultured in RPMI-1640 medium containing 10% fetal bovine serum, 2 ng/ml recombinant murine granulocyte macrophage-colony stimulating factor (GM-CSF), and 20 ng/ml recombinant murine interleukin (IL)-4 for 9 days. Then cells were incubated with 40 ng/ml tumor necrosis factor-alpha (TNF-alpha) for 24 hours to obtain smDC. Meanwhile, smDC was differentiated into mature dendritic cell (mDC) or immature dendritic cell (iDC) by treatment with 1 micro/m1 lipopolysaccharide (LPS) or without LPS. The morphological features of smDC were assayed by inverted microscopy and scanning electron microscopy. Surface markers such as CD11c, CD4O, CD8O, CD86, and MHC-II were tested by flow cytometry. IL-1beta, IL-6, IL-12, and IL-10 in the supernatant were tested by ELISA. The activation of allogene lymphocyte (BALB/c mice) stimulated by C57BL/6 myeloid smDC in mixed lymphocyte reaction was examined by Cell Counting Kit-8 in vitro.</p><p><b>RESULTS</b>The shape of smDC was round or oval-shaped, and the diameter of smDC was about 15 microm. The length of smDC dendrite was between 5 to 10 microm. smDC, iDC, and mDC all expressed high level of CD11 c. The expressions of MHC-II, CD40, CD80, and CD86 on smDC were higher than those of iDC and lower than those of mDC. IL-1beta, IL-6, and IL-12 secretion of smDC was significantly lower than that of mDC (P < 0.01), and IL-12 was significantly lower than that of iDC (P < 0.05), while no significant difference of IL-1beta and IL-6 secretion was found between smDC and iDC (P > 0.05). Furthermore, IL-10 secretion was not significantly different among these three kinds of DCs (P > 0.05). The effect of allogene lymphocytes activation on smDC was significantly lower than that of mDC and positive control (P < 0.01), but had no significant difference when compared with that of iDC and negative control (P > 0.05).</p><p><b>CONCLUSIONS</b>smDC may be a relatively independent dendritic cell sub-population in terms of function and morphology. It is a feasible way to induce myeloid monocytes to differentiate into smDC using GM-CSF, IL-4, and TNF-alpha in vitro.</p>

Adult-to-adult living donor liver transplantation in treating acute liver failure using extended right lobe graft / 中华外科杂志

<p><b>OBJECTIVE</b>To report experience in adult-to-adult living donor liver transplantation for acute liver failure using extended right lobe graft.</p><p><b>METHODS</b>A 42-year-old male with acute liver failure received adult-to-adult living donor liver transplantation using extended right lobe graft. Volumetric analysis with computed tomography (CT) revealed that the volume of donor's extended right liver with medial hepatic vein (MHV) amounted to approximately 1.3% of the recipient's body weight. The donor hepatic vein and recipient inferior vena cava were reconstructed and then anastomosed end to side. The portal veins, hepatic arteries and bile ducts were anastomosed end-to-end, respectively.</p><p><b>RESULTS</b>The operations in donor and recipient were all successful. The donor recovered uneventfully. The recipient regained consciousness in 8 hours and got normal liver function 14 days after transplantation. On day 16 after transplantation, transaminases such as alanine transaminase, aspartate transaminase increased expeditiously in the recipient and was controlled effectively with methylprednisolone (1000 mg). The recipient and donor has survived for 8 months healthily without vascular and bile duct complications.</p><p><b>CONCLUSIONS</b>Adult-to-adult living donor liver transplantation for acute liver failure using extended right lobe graft can achieve superior results when performed by an experienced team in hepatectomy and transplantation. This technique extends the success of living donor liver transplantation and opens a new donor pool for adults to receive a timely graft of adequate function.</p>

Study of surgical procedures of abdominal organ cluster transplantation / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the surgical procedures and therapeutic effect of organ cluster transplantation in treating abdominal multiple organ malignant tumors.</p><p><b>METHODS</b>Two patients with abdominal multiple organ malignant tumors received organ cluster transplantation in May and August 2004. The excised specimen included liver, pancreas, duodenum, stomach, spleen, mesenteric and epigastric lymph nodes. The transplanted organs included liver, pancreas, duodenum. Superior mesenteric artery was involved in the malignancy in one case and was transected and anastomosed to right common iliac artery.</p><p><b>RESULTS</b>The patients waked up 4 and 5 hours post operation and began recovering 3 and 5 days after. Dynamic examinations showed that the functions of grafted liver, pancreas and duodenum obtained normal function in 10 days post the transplantation. One patient survived for 12 months postoperatively and died of recurrence of cancer; The other recovered uneventfully after transplantation, and discharged automatically 20 days after.</p><p><b>CONCLUSIONS</b>Abdominal organ cluster transplantation is technically feasible and effective for patients with abdominal multiple organ malignant tumors.</p>

Therapeutic effects of percutaneous alternating cryogenic-heating therapy for nonresectable hepa-tocellular carcinoma / 中国癌症杂志

Purpose:To study the therapeutic effects of beta-ultrasound guided percutaneous alternating cryogenic- heating therapy(ACHT) through liver puncture combined with other regional therapy for advanced hepatocellular carcinoma. Methods:68 patients with advanced hepatocelluar carcinomas were divided into 4 groups.Group A,17 patients are treated with ACHT plus transcatheter hepatic arterial chemoembolization(TACE).Group B,16 patients were treated with ACHT plus intravenous chemotherapy;GroupC,19 patients were treated with TACE only;GroupD,16 patients were treated with in- travenous chemotherapy only.Results:In ACHT+TACE group,the rate of complete response(CR) plus partial response (PR) was 88.2%,the 0.5-,1-year survival rates were 94.1%,94.1%,the rate of AFP decreased was 84.6%.In ACHT+ ICT group,the rate of complete response(CR) plus partial response(PR) was 87.5%,the 0.5-,1-year survival rates were 87.5%,68.8%,the rate of AFP decreased was 78.6%.In the TACE group,the rate of complete response(CR) plus par- tial response(PR) was 57.6%,the 0.5-,1-year survival rates were78.9%,42.1%,the rate of AFP decreased was 69.2%. In ICT group,the rate of complete response(CR) plus partial response(PR) was 25.0%,the 0.5-,1-year survival rates were 50.0%,18.8%,the rate of AFP decreased was 41.7%.For CR+PR,ACHT+TACE group and ACHT+ICT group were significantly higher than TACE group and ICT group,but significant changes between ACHT+TACE group and ACHT +ICT group were not found.For survival rates,ACHT+TACE group was significantly higher than the other 3 groups, ACHT+ICT group was significantly higher than ICT group.There were no serious side effects after chemotherapy except that 5 patients' leucocytes decreased to degree Ⅲ.The postoperative complications after ACHT included bleeding,hemoglo- binuria and reactive thoracic,which disappeared after short term treated.Conclusions:Alternating cryogenic-heating therapy (ACHT) through liver puncture combined with other regional therapy is effective in treating advanced hepatocellular carci- noma and its side effects and postoperative complications are mild.