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Mixed reality, as a new virtual simulation technology, has been initially applied in the field of surgery. In hepatectomy for primary liver cancer, mixed reality technology has its unique advantages in formulating and evaluating surgical plans before surgery, precise real-time navigation during surgery, and virtual liver teaching, making liver resections more accurate and personalized. This article summarizes the relevant literature at home and abroad in recent years, summarizes the research progress of mixed reality technology in assisted liver resection for primary liver cancer, and discusses its application potential and limitations.
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Liver disease-associated sarcopenia is a type of secondary sarcopenia, which is a common muscle abnormality in patients with liver cirrhosis and is often ignored by doctors. Patients with chronic liver disease often have reduced appetite, insufficient protein intake, indigestion caused by portal hypertension, and high metabolism, which accelerate the wasting of skeletal muscle. At present, sarcopenia is recognized as a risk factor which is closely related with postoperative complications and morbidity in liver surgery, and also affects the quality of life of patients with liver disease. This article reviews the current diagnosis and treatment options of sarcopenia and the impact of sarcopenia on the prognosis of liver disease, thus to provide references in clinical practice.
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Objective@#To investigate the relationship between psoas muscle index (PMI) and early postoperative survival rate and the incidence of complications after liver transplantation in adults.@*Methods@#The clinical data of 225 patients (male, n=184; female, n=41) underwent liver transplantation at the Organ Transplantation Department of First Central Clinic Institute of Tianjin Medical University from January 2014 to December 2016 were analyzed, retrospectively.Original disease: hepatitis B liver cirrhosis(44 cases), hepatitis C cirrhosis(10 cases), autoimmune liver cirrhosis(29 cases), other benign liver diseases(24 cases), liver cirrhosis with liver cancer(116 cases), hilar cholangiocarcinoma(1 case) and hepatic vascular sarcoma(1 case). The area of bilateral psoas muscle on the lower edge level of the third lumbar vertebral body was measured through preoperative CT image.The PMI was calculated using this formula: bilateral psoas muscle area (mm2)/the square of the body height (m2). According to the receiver operating characteristic curve and cut-off values, the male and female patients were divided into low PMI group and high PMI group respectively.The χ2 test, Fisher exact test and t-test was used to compare the differences in perioperative data, survival rate and postoperative complications between the two groups, respectively.@*Results@#There were 44 patients in the low PMI group, and 181 patients in the high PMI group. ICU time was longer (82.5(62.0-128.0) hours vs.69.1(56.0-104.0) hours; P=0.006) and preoperative blood urea nitrogen level (5.86(4.35-15.52) mmol/L vs. 4.94(4.05-7.06) mmol/L; P=0.012) was higher in the low PMI group than those in the high PMI group. Incidence rates of grade 5 complication (18.2%) and grade 4a complication (18.2%) were higher in the low PMI group, and 120-day cumulative survival rate was lower than that in high PMI group(81.8% vs. 95.6%, P=0.001). On the other hand, there were no significant differences in preoperative white blood cell count level, serum creatinine level, operative time, anhepatic period time, intraoperative blood loss, and incidence of postoperative grade 3 complications between the two groups(all P>0.05).@*Conclusions@#There is a significant correlation between PMI and early postoperative survival rate and incidence of complications.Patients with lower PMI has poor prognosis after liver transplantation.
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Tumor lysis syndrome (TLS) is the rapid dissolution of tumor cells and cell contents, and its metabolite is rapidly released into the blood, causing a series of complications such as high uric acid, high potassium, high phosphorus, hypocalcemia and acute renal insufficiency. TLS is commonly seen in patients with rapidly growing malignant tumors that are sensitive to chemotherapy, and which is rare in solid tumors. We found one case of primary liver cancer with acute TLS, who was given hemodialysis to protect the liver and symptomatic treatment, and the patient is on the mend.
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Objective To evaluate the effect of liver function on liver enhancement in hepatobiliary phase of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid(Gd-EOB-DTPA)-enhanced MRI.Methods Sixty-seven patients who suffered from cirrhosis and received enhanced MRI with Gd-EOB-DTPA were retrospectively analyzed,and divided into three subgroups according to ChildPugh score(45 patients in group A,20 in group B,5 in group C).All the individuals of both groups had MRI before injection,and hepatobiliary phase images were obtained at 5,10,and 20 minutes after bolus administration of Gd-EOB-DTPA.The relative enhancement(RE) was calculated by dividing the signal intensity of liver(SI) at t min after injection(SIt) by precontrast SI(SI0).The total serum bilirubin level(TB),serum albumin level(Alb) and prothrombin time(PT) were recorded.The one-way ANOVA was used to compare the RE among three groups at 5,10 and 20 minutes.SNK was used for further pairwise comparison.The effect of liver function on RE was assessed with the generalized linear model.Pearson correlation coefficients were measured between each biochemical test result(TB,Alb,PT) and RE at different time points.Results The RE at 5,10 and 20 minutes were 1.59±0.20,1.65±0.22,1.69±0.25 of group A; 1.47± 0.14,1.48±0.18,1.50±0.22 of group B,1.35±0.07,1.27±0.06,1.26±0.06 of group C.There were statistically significant differences of RE among groups at 5,10 and 20 minutes(F=5.854,11.207,9.666,P＜0.01).Statistically pairwise comparison differences of RE were found between group A and C at 5,10 and 20 minutes(P＜0.01),between B and C at 10 and 20 minutes(P＜0.05),between A and B at 10 minutes(P＜ 0.05).There were statistically significant differences of TB,Alb and PT among groups(P＜0.01).RE at 10 and 20 minutes had moderate negative correlation with TB(r=-0.483,-0.500; P＜0.01),low negative correlation with PT(r=-0.326,-0.351;P＜0.01) and weak positive correlation with Alb(r=0.290,0.292;P＜0.05).Conclusions There are differences of RE among patients with different liver function,and the RE is associated with TB,Alb and PT.Thus,it may allow us to estimate the liver function.
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ObjectiveTo summarize 20 ABO-incompatible liver transplantation cases in our hospital and explore the treatment strategy. MethodsFrom January 2009 to July 2011,20 cases donorrecipient ABO blood type not-identical liver transplantation was performed at our hospital. 16 cases were ABO-incompatible(ABO-Ⅰ) and 4 were ABO-compatible(ABO-C ).The median follow-up was (13.3 ± 9.2) months.ResultsExcept preoperative MELD score,there were no significant difference in other perioperative data,the incidence of postoperative complications and the cumulative survival rate between ABO-C and ABO-Ⅰ group.There were 5 deaths in 20 cases,2 cases in ABO-C group and 3 cases in ABO-Ⅰ group,survival rate was 75％.The cause of death was perioperative multiple organ failure in 2 cases,liver cancer recurrence in 2 cases and cerebral hemorrhage in 1 case.There were 2 cases of acute rejection,3 cases of biliary complications and 3 cases of portal vein thrombosis developing postoperatively. Eleven patients had increased serum creatinine after operation,preoperative high creatinine existed in 6 cases and it maintained posttransplant high level for more than 7 days,the serum creatinine level in other 7 patients was back to normal level in 7 days.ConclusionsA combination splenectomy before the portal vein reperfusion,the protocol of basiliximab,tacrolimus (TAC)/mycophenolate mofetil (MMF)/steroids immunosuppression treatment,postoperative peripheral vascular dilatation treatment by Alprostadil,help achieve favorable outcome in selected patients who underwent ABO-incompatible liver transplant.
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Objective To describe the feasibility of biliary reconstruction methods and to explore the preventing and curing methods for biliary complications. Methods A total of 77 cases of living donor liver transplantation were included in our study for retrospective analysis. The operation types included right lobe contain middle hepatic vein (n=29), right lobe without middle hepatic vein (n=45), left lobe (n=1) and left lateral lobe transplantation (n=1). The biliary reconstruction was performed by duct-to-duct and Roux-en-Y epaticojejunostomy. Results Fifty-four grafts had 1 bile duct and 23 had multiple ones. The duct-to-duct biliary reconstruction was performed for 75 adult cases and T-tube drainage was used in 63 patients. Meanwhile, the conventional Roux-en-Y epaticojejunostomy was utilized for 2 pediatric patients. Total biliary complication incidence was 36.4% (28/77) and the complications included bile leakage (10.4%, 8/77) and biliary stricture (26.0%, 20/77).The rate of biliary complication was remarkably different between single hepatic duct group and multiple group (P<0.05). All the 8 patients suffering from bile leakage were cured by percutaneous bile drainage guided by ultrasound. By percutaneous balloon cholangioplasty and placing stent through the T-tube tract or endoscopic retrograde balloon cholangioplasty, the liver function of biliary stricture cases got better and most cases were cured. Conclusion Protecting the blood supply of bile duct at the cutting surface and harvesting one bile duct stump as much as possible can reduce biliary complication effectively. Radiate intervention treatment such as percutaneous balloon cholangioplasty and endoscope treatment etc. are effective for treatment of biliary complications.
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Objective To invastigate the effect of living donor liver transplantation(LDLT) with middle hepatic vein(MHV) and LDLT without MHV on the donor. Methods Between August 2007and August 2008, 62 LDLT were performed, 30 LDLT with MHV (group A), 32 LDLT without MHV (group B). Before operation, comprehensive assessment the graft size, remnant liver volume (RLV), fatty liver, MHV type, and the level of portal hypertension in recipient to determine whether harvested MHV. The graft was harvested depending on the port vein and hepatic artery ischemia-line,ultrasound was used to definite the branch of MHV. The donor operative time, intraoperative blood loss, postoperative hospital stay, bilirubin, INR, ALT, albumin, and complications were recorded in detail. Results Operative time, blood loss, hospital stay between group A and group B were not significant difference. But the bilirubin, INR, ALT in group A was higher than group B; Albumin recovered slower and with more ascites in group A. The early complications post-operation were similar in the two groups. There were 2 cases with wound infection in group A and 3 in group B. 3 cases complicated with cholestasis in group A and 1 case in group B, all of them gradually recovered to normal after 2 weeks. 2 cases occurred cross-section bile leakage in either group, the patients administrated with anti-infection, external drainage and recovered;4-7 days after operation, there were 6 cases in group A and 5 cases in group B occurred delayed gastric emptying, it was alleviated after adjust diet, encouraging activities and administrated with gastrointestinal motility drugs. Conclusion Right graft with the middle hepatic vein may lead donor recovery delayed, but with precise evaluation, especially MHV type, remnant liver volume (RLV%)＞30%, preserve the drainage of V4b and the artery segment Ⅳ,it's can ensure the donor's safety.
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Objective To study the prognosis of patients with end-stage liver cirrhosis who using controlled cardiac death liver donor in situ liver transplantation. Methods Seven cases of transplants which used liver donated after cardiac death were done in our center. The preoperative and postoperative data were analyzed. The prognosis of these patients was observed. Results Except one recipient died of upper gastrointestinal bleeding at the 9th day after surgery, the remaining 6 patients were followed up for more than 12 months (mean 15.7 months) and the prognosis was satisfactory.Conclusion Patients can get good prognosis after the liver transplants with donated liver after cardiac death which meets the Maastricht Classification type Ⅲ.