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<p><b>OBJECTIVE</b>To evaluate the effect of techniques of precise liver surgery for donor hepatectomy in living donor liver transplantation.</p><p><b>METHODS</b>Eighty-nine donors aged from 19 to 57 years were performed by the same surgical team from June 2006 to December 2013 in Chinese People's Liberation Army General Hospital.Individualized surgical program were developed according to preoperative imaging examination and hepatic functional reserve examination. The evaluation included liver function, liver volume, vascular anatomy and bile duct anatomy. According to the results after the operation, preoperative evaluation accuracy, postoperative donor liver function and postoperative complications were analyzed. ANOVA analysis was used to compare the difference of graft volume by two-dimensional, three-dimensional calculation method and actual postoperative graft weight. Pearson correlation test and linear regression analysis were used to verify the correlation between the estimated graft volume each method and actual graft postoperative weight.</p><p><b>RESULTS</b>All the 89 cases operation protocol as following, there were 5 cases with left lateral lobe graft, 10 cases with left lobe liver graft, 74 cases with right lobe graft. There were 59 cases with middle hepatic vein (MHV) harvested, and 30 cases without MHV. The mean graft volume by two-dimensional, three-dimensional calculation method and actual postoperative graft weight were (656.2±134.1) ml, (631.7±143.2) ml and (614.5±137.7) ml respectively. ANOVA analysis results showed that there were no statistically significant difference in the three methods (P>0.05). Compared to the actual postoperative graft weight, the average error rate of the two methods were 7.9% and 5.3% respectively. Pearson correlation test showed the graft volume calculated by two-dimensional and three-dimensional methods had a significantly positive correlation with actual graft weight (r=0.821, 0.890, P<0.01) and linear regression analyze showed the R2 were 0.674 and 0.792, respectively. The accuracy rate of preoperative evaluation about portal vein, hepatic vein, hepatic artery and bile duct were 100%, 100%, 97.8% and 95.5%, respectively. The preoperative plan and postoperative practical scheme coincidence rate was 95.5%. Overall donor complication rate was 7.4%. All donors were alive. Sixteen donors received right lobe hepatectomy with gallbladder preserved had a good liver function and gallbladder function.</p><p><b>CONCLUSION</b>Through the precise preoperative evaluation, surgical planning, fine operation and excellent postoperative management, precise liver surgery technique can ensure the safety of donor in living donor liver transplantation.</p>
Subject(s)
Adult , Humans , Middle Aged , Young Adult , Bile Ducts , Body Weight , Hepatectomy , Methods , Hepatic Artery , Hepatic Veins , Linear Models , Liver Transplantation , Methods , Living Donors , Portal Vein , Postoperative Complications , Postoperative PeriodABSTRACT
Objective To investigate the diagnosis and surgical treatment of functional insulinomas.Methods One hundred and thirty two patients from January 2002 to May 2013 were retrospectively reviewed who was confirmed as functional insulinomas by pathology.Results There were 43 males and 89 females.56 cases were located in the head of pancreas,76 body and tail of pancreas.69 patients underwent open enucleation,48 patients had Laparoscopic surgery,5 patients underwent distal pancreatectomy,9 patients had Laparoscopic distal pancreatectomy,1 patients had pancreaticoduodenectomy.The difference of variant imaging examination in Checking insulinomas was statistical significant(P ＜0.01).Laparoscopic treatment of insulinomas was at least as safe as open treatment.Conclusions Imaging examination could improve the accuracy of preoperative diagnosis of insulinomas.Surgery was the most effective methods to cure insulinomas and Laparoscopic surgery was becoming increasingly popular in treating insulinomas.
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Objective To study the risk factors of delayed gastric emptying (DGE) after pancreaticoduodenectomy (PD).Methods Between Ja(n)uary 1st 2013 and December 31st 2013,data from 196 consecutive patients who underwent PD at the Chinese PLA General Hospital were studied retrospectively.17 factors were examined.Univariate analysis and multivariate logistic regression analysis were used to determine the relative risks.Results DGE occurred in 71 patients (36.2％).The incidences of grade A,grade B and grade C DGE were 22.4％ (44/196),6.1％ (12/196) and 7.7％ (15/196) respectively.There were three postoperative deaths.The overall mortality rate was 1.5％.BMI,Braun anastomosis,clinically relevant postoperative pancreatic fistula (CR-POPF) and intra-abdominal collection were significantly correlated with DGE on univariate analyses.BMI ≥25 kg/m2,CR-POPF,and intra-abdominal collection were independent risk factors on univariate and multivariate regression analyses.Conclusions Post-operative complications were associated with DGE.Early diagnosis and timely treatment for pancreatic fistula and abdominal collection were helpful to decrease morbidity and to promote recovery of DGE.
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For a matured digestive surgeon,pancreaticoduodenectomy (PD) is regarded as one of the most complicated and technically challenging surgical procedure.Based on the accurate interpretation of patient's preoperative imageologic data,we advocate a novel procedure which is called as G-path pylorus-preserving pancreatoduodenectomy (G-path PPPD).We deen G-path PPPD as a standardized procedure for resectable pancreatic head cancer or periampullary carcinoma,which definitely simplify the procedure,save the operative time,achieve R0 resection through en-bloc resection without interruptedly intraoperative exploration and reduce the risk of iatrogenic tumor metastasis.This article introduced the program of G-path PPPD in detail by taking a patient as an example who suffered from pancreatic head cancer accompanied with obstructive jaundice,and discussed the relevant points.
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Objective To optimize plan for right lobe living donor hepatectomy based on the territorial volume drained by the middle hepatic vein (MHV) as shown by preoperative MR image in donors.Methods Utilizing preoperative MR dynamic enhancement scanning image,virtually plot three types of hepatic parenchyma transsection plane based on the variation of including MHV for right lobe graft procurement. Results From June 2006 to May 2010,65 adult-to-adult right lobe living donor liver transplantations was performed at General Hospital of Chinese PLA,in which there were 43 grafts including MHV (66.2％,43/65 ), eight grafts including partial MHV which was dissected before the V4b abouchement ( 12.3％,8/65) and 14 grafts not including MHV (21.5％,14/65). There was no postoperative death in donors and the postoperative complications developed in 10.76％ (7/65). The recipients' perioperative mortality was 7.69％ (5/65). Ttwenty-one complications developed in 18 recipients,and the morbidity was 32.31％. The cumulative survival rates were 86％,77％ and 68％respectively for 1,2 and 3 years. Conclusions The optimizing liver resection plane could be practically designed preoperatively for right lobe graft procurement based on the territorial volume drained by MHV.
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Objective To summarize the initial experience in adult-to-adult living donor liver transplantation(ALDLT),so as to improve the efficacy of ALDLT.Methods The clinical data of 31 adult patients who undelwent ALDLT from June 2006 to February 2008 were retrospectively analyzed.Results Of all the patients,8 was with decompensated cirrhosis,7 with acute liver failure,12 with hepatocellular carcinoma,2 with purpura of liver,1 with hilar cholangiocarcinoma,and 1 with Wilson disease.The liver grafts included 25 right lobes with middle hepatic vein(MHV),3 right lobes without MHV,1 right lobe with MHV+left lateral lobe,1 right lobe with MHV+left lobe.The remaining 1 patient underwent auxiliary partial orthotopic liver transplantation with left lobe graft.Six post-transplantation complications occurred in 5 donors. Eleven post-transplantation complications occurred in 9 recipients,including 4 biliary complications,3 vascular complications,3 infection complications and 1 delayed healing of the incision.After ALDLT,2 recipients died of pulmonary infection and 1 of multiple aspergillus infection. Conclusions ALDLT has become an effective method to expand the source of liver grafts.Rational donor and recipient assessment,surgical procedure and postoperative management are key to ALDLT.
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OBJECTIVE To evaluate the effect of lamivudine on prophylaxis against hepatitis B virus(HBV) reinfection following orthotopic liver transplantation(OLT).METHODS The clinical data of 14 CLT recipients with HBV-related diseases received lamivudine(100mg/day) were retrospectively analyzed in our hospital.Hepatitis B serum markers,serum HBVDNA,and YMDD district variation were detected every two weeks.HBsAg and HBcAg in the liver specimens were examined by immunohistochemistry.Liver biopsy was conducted from the donor during operation and from the recipient postoperatively in a regular interval.RESULTS The reinfection took place in 4 patients and postoperatively(28.6%),HBV-DNA was transfered to the positive in 2 cases,and among them was 1 YMDD district produced and made a variation. Two cases with positive HBV-DNA before liver transplantation had higher HBV reinfection rate postoperatively.CONCLUSIONS Lamivudine monotherapy can effectively and definitely;preven HBV reinfection after liver transplantation HBV reinfection can produce YMDD district and make a variation again;HBV relevant diseases patient should negatively turn the HBV-DNA at the time of competent liver transplantation.