Diagnosis and treatment of unsuspected gallbladder carcinoma / 第二军医大学学报

Objective: To summarize our experience on the diagnosis and treatment of unsuspected gallbladder carcinoma (UGC). Methods: The clinical data of 15 patients with AGC, who were treated in our hospital from January 2000 to December 2007, were retrospectively analyzed; and the clinical diagnosis and treatment experience was summarized. Results: Preoperative diagnosis showed that the 15 cases included gallstone in 12 cases, gallbladder polypi in 2, and gallstone associated with polypi in 1. All cases were incidentally discovered during operation, with 5 during open cholecystectomy and 10 during laparoscopic cholecystectomy. All 15 cases were confirmed of gallbladder carcinoma by pathological examination after operation. The tumor stage included Nevin stage I in 3 cases, stage II in 7, stage III in 4 and stage IV in 1. The patients with UGC at Nevin stage I were closely followed up; those at Nevin stage II, III underwent radical correction of gallbladder carcinoma; and those at Nevin stage IV received extended radical resection of gallbladder cancer. The median follow-up time was 5.0 years. Two patients died and 13 survived; 5 patients survived for more than 5 years, with a 5-year survival rate of 84.8%. Conclusion: It is difficult to diagnose early gallbladder carcinoma before operation. The surgeons should be alert to the possibility of gallbladder carcinoma before and during the operation. Routine examination of the resected gallbladder tissues and frozen sections are necessary for suspected lesions. Immediate radical resection is an effective measure to improve the prognosis of UGC. Re-exploration and radical resection should be performed on UGC of Nevin stage II-IV.

Surgical treatment of caudate hepatolithiasis / 第二军医大学学报

Objective: To summarize our experience on surgical treatment of caudate hepatolithiasis, so as to improve the diagnosis and treatment of caudate hepatolithasis. Methods: The clinical data, mode of operation, post-operation complications, and follow up findings were retrospectively analyzed in 19 patients with caudate hepatolithasis from Jan. 2000 to Dec. 2006. Results: The 19 cases included 8 males and 11 females. Totally they had undergone 30 times of operation, with 12 cases only had once, 4 had twice, 2 had thrice, and 1 had 4 times. All cases received B ultrasound, CT, MRCP or ERCP and were confirmed to have caudate hepatolithiasis. Fourteen cases were complicated with opening stonosis of caudate bile duct. Eleven cases received caudate lobe resection. Eight cases received caudate expansion of the bile duct or plastic repair of duct + caudate duct exploration and calculus extraction, with a success rate of 100% and the patients were stone free after surgery. Eighteen patients (94.7%) were followed up for a mean of (17.6±2.3) months. Two cases had stone recurrence. The excellent and good rate was 88.9% in the present cohort; all those who received resection of the caudate lobe had excellent or good outcomes. Conclusion: It is very complex and difficult to treat caudate bile duct stone; caudate duct exploration and calculus extraction usually have unsatisfactory outcomes. Caudate lobe resection can clear the lesions and has a good long-term effect, which is largely dependent on the rich experience and the skillfulness of the surgeons.

Experience of right hemihepatectomy for treatment of hepatolithiasis in the right or both lobes / 第二军医大学学报

Objective: To summarize our experience on right hemihepatectomy for treatment of hepatolithiasis. Methods: The clinical data of thirty-nine patients suffering from intrahepatic bile duct stones, who had undergone right hemihepatectomy in our hospital from Jan. 2000 to Dec. 2006, were retrospectively analyzed. The outcomes of operation, complication, and the follow-up findings were analyzed; and the clinical experience was summarized. Results: The 39 patients included 8 males and 31 females, with an age range of 23-65 years old and a mean of (44.2 ± 10.5) years old. All patients had various degrees of hepatobiliary stricture. All cases underwent right hemihepatectomy plus eholedoehotomy and T-tube drainage, including 28 also had cholecystectomy, 1 had additional left lateral hepatectomy, 1 had choledoehocystomy plus hepatojejunostomy, and 1 had demolishment of anastomotie stoma of choledochoduodenostomy. The post-operation complications included pleural effusion (17.9%), subphrenic infection (12.8%), liver failure (7.7%), biliary fistula (5.1%), and infection of incisional wound (5.l%). Two patients (5.1%) died of liver failure during the hospital stay. One was indicated of having intrahepatic cholangiocarcinoma and died of recurrence of cholangiocarcinoma 6 months after operation. Thirty-six patients (92.3%) received long-term follow-up (a median of [42.5±2.5] months) and 34 (94.4%) of them were symptom free. Excellent outcomes were achieved in the 31 patients with isolated right intrahepatic bile duct stones. Conclusion: Right hemihepatectomy is effective for right hepatolithiasis, especially for patients combined with right hepatic duct stricture. However, it should be noted that the operation is very difficult and has many complications, so the indications and contraindications of right hemihepatectomy should be strictly selected.

Protecting actions of Peristrophe roxburghiane on liver functions and structure in fatty liver rats caused by insulin resistance / 中国中药杂志

<p><b>OBJECTIVE</b>To observe the protecting actions of Peristrophe roxburghiane on liver functions and structure in fatty liver rats caused by insulin resistance.</p><p><b>METHOD</b>High-fat-sugar diet was fed in rats to produce insulin resistance and fatty liver model, and then P. roxburghiane was administered for 8 weeks, and the rats were killed and the blood was sampled to measure the levels of FFA, TC, TG, HDL-C and LDL-C, and the activities of AST, ALT. The fasting serum glucose (FBG) and insulin were measured, and insulin-sensitivity index was calculated. The liver was weighed and collected to calculate liver index and measured the activities of GSH-PX, SOD, CAT and the amount of MDA.</p><p><b>RESULT</b>High and low dosage of P. roxburghiane can decrease the levels of FFA, TG and increase the level of HDL-C, reduce the activities of ALT, AST and liver index, and reduce the damaged degree of the liver tissue significantly. High and low dosage of P. roxburghiane can significantly enhance the activities of SOD, CAT, and GSH-PX, reduce the amount of MDA.</p><p><b>CONCLUSION</b>P. roxburghiane possesses regulating action on the serum lipid, blood glucose and insulin, and improving liver functions of fatty liver rats induced by high-fat-sugar diet, and the acting mechanism may be concerned with enhanced antioxidative ability.</p>

Prospective study of liver parenchyma volume in hepatectomy of primary liver cancer / 中华外科杂志

<p><b>OBJECTIVE</b>To explore the secure resection margin (RM) of hepatectomy for primary liver cancer (PLC) with the coexistence of cirrhosis or hepatitis by studying the correlations of the resected liver parenchyma volume with postoperative liver function, complication and RM clinically.</p><p><b>METHODS</b>The volume of tumor and the surrounding liver in resected liver specimen was measured and calculated in continuous 76 PLC patients prospectively, and the total liver parenchyma volume was measured and calculated using computed tomography (CT) images in former 40 patients. Under ideal circumstances, the surrounding liver volume, which would be resected theoretically, was calculated according to various sizes of tumors and RMs. The correlations of the resected liver volume or hepatic parenchyma-resected rate (HPRR) with postoperative liver function, complication and RM were analysed.</p><p><b>RESULTS</b>The RM was (5 +/- 7) mm in 76 patients. The volume of the tumors and the surrounding liver in the specimens were (107 +/- 203) cm(3) and (153 +/- 120) cm(3), respectively. In 40 patients, the total nontumorous liver volume using CT images was (1079 +/- 179) cm(3), and HPRR was (14 +/- 9)%. There were statistically significant differences in HPRR (P < 0.05) between three groups with complication score 0, 1-2 and 3-6 points, the value of the first group were lower than that of the third group at the level P < 0.05. The significant factors affecting liver function and complication are HPRR, the size of operation, the time of hepatic portal occlusion and the resected liver volume (P < 0.05) apart from preoperative liver function.</p><p><b>CONCLUSIONS</b>When hepatectomy was performed in PLC patients with preoperative liver function of Child A grade and the coexistence of cirrhosis or hepatitis, 30% HPRR was a lower limit for greatly increasing the chance of developing serious postoperative complications, while 20% HPRR was a safe upper limit for achieves quick postoperative recovery or developing only a few mild complications. When PLC patients without macroscopic tumor thrombi or macrosatellites undergo hepatectomy, 10 mm RM is enough to ensure sufficient liver function residue and achieve complete micrometastasis clearance in liver parenchyma surrounding the lesion if the diameter of a tumor is less than 10 cm and 6 mm RM is enough to ensure sufficient liver function residue and obtain 99% micrometastasis clearance if the diameter of a tumor is greater than 10 cm, while with macroscopic tumor thrombi or macrosatellites, 20 mm RM is enough to ensure sufficient liver function residue and achieve 99% micrometastasis clearance if the diameter of a tumor is less than 6 cm.</p>