A new anastomosis method for choledochojejunostomy by the way behind antrue pyloricum / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Reflux cholangitis has been the most common complication after Roux-en-Y choledochojejunostomy. In this study we intended to evaluate the perioperative and long-term efficacy of a new anastomosis method for choledochojejunostomy.</p><p><b>METHODS</b>Clinical data of 143 eligible patients who underwent choledochojejunostomy in the Eastern Hepatobiliary Surgery Hospital affiliated to the Second Military Medical University, China between January 2007 and December 2010 were retrospectively analyzed. Among the patients, 38 consecutive cases underwent this new anastomosis method for choledochojejunostomy (improved group, IG) and 105 underwent standard Roux-en-Y choledochojejunostomy (control group, CG). Changes in the incidence of cholangitis, the time of beginning to eat liquid meals, post-operative delayed gastric emptying and liver function between the two groups were compared.</p><p><b>RESULTS</b>There was no statistical difference in the levels of alanine transaminase, alkaline phosphomonoesterase and gamma-glutamy transferase between the two groups. The time of beginning to eat liquid meals was significantly shorter in IG than CG (P < 0.05). The incidence of delayed gastric emptying was lower in IG than CG, with statistical tendency between the two groups (P = 0.052). Among nine patients with different degrees of acute cholangitis in the two groups, one patient (2.6%) in IG and eight (7.6%) in CG suffered from acute cholangitis within six months of follow-up after discharge, but with no statistical difference between the two groups (P > 0.05). Of the nine patients with acute cholangitis, none in IG and four in CG were hospitalized for further treatment (P > 0.05).</p><p><b>CONCLUSIONS</b>Patients in IG had satisfactory perioperative and long-term prognosis with shorter time of beginning to eat liquid meals and lower incidence of delayed gastric emptying. This new procedure of choledochojejunostomy by the way behind antrue pyloricum was easy and safe to perform with no mortality and low complication rates.</p>

Hepatic vein occlusion with Satinsky clamp in hepatectomy for complicated liver tumor / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the application of an improved method of hepatic vein occlusion with Satinsky clamp when resecting the liver tumor involving second hepatic portal.</p><p><b>METHODS</b>From January 2003 to December 2010, there were totally 330 patients with liver tumor admitted, who underwent liver resection with Pringle maneuver plus hepatic vein occlusion with Satinsky clamp. Data regarding the intra-operative and post-operative course of the patients were analyzed. There were 245 male and 85 female patients, with a mean age of (50 ± 11) years. The diameter of tumor was (9 ± 6) cm. Among the 330 patients, there were 271 patients with viral hepatitis B, 215 patients with liver cirrhosis; 321 patients were in Child class A of liver function and 9 in class B. Pringle maneuver plus hepatic vein occlusion with Satinsky clamp was used to occlude the blood flow in the liver resection. The liver transection was performed with clamp-crushing technique.</p><p><b>RESULTS</b>Hepatic vein occlusion with Satinsky clamp was successful in all 330 patients. The operation time was (132 ± 29) minutes, while (7 ± 3) minutes for dissecting hepatic vein and (22 ± 7) minutes for inflow blood occlusion. The blood loss in operation was (480 ± 265) ml, with 20% of patients receiving blood transfusion. No patient had large hemorrhage and air embolism due to hepatic vein laceration. No patient died in the perioperative period. The complications included 31 patients of pleural effusion, 14 patients of seroperitoneum, 10 patients of biliary fistula, 2 patients of massive blood loss during liver resection and 2 patients of re-bleeding after operation.</p><p><b>CONCLUSION</b>The method of hepatic vein occlusion with Satinsky clamp was safe and effective.</p>

Correlation between the survival rate of the patients with synchronous hepatic metastases from gastric carcinoma after surgical resection and patient's index / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Many studies have reported the benefit of hepatic resection for solitary and metachronous metastases from gastric cancer. However, indications and surgical results for synchronous hepatic metastases from gastric carcinoma have not been clearly defined. This study was performed to assess the benefits and limits of simultaneous combined resection of both primary gastric cancer and synchronous hepatic metastases, as well as to identify prognostic factors affecting the survival.</p><p><b>METHODS</b>Between January 2005 and June 2008, 13 patients with synchronous hepatic metastases underwent simultaneous combined resection. The clinicopathologic features and the surgical results of the 13 patients were retrospectively analyzed. Patient, tumor (primary and metastatic carcinoma), and operative parameters were analyzed for their influence on survival.</p><p><b>RESULTS</b>No patient died and two patients (15.4%) developed complications during peri-operative course. The actuarial 6-month, 1-year, and 2-year survival rates after hepatic resection were 76.9%, 38.5%, and 30.8%, respectively, and two patients survived for more than 2 years after surgery without any signs of recurrences until latest follow-up. In univariate analysis, hepatic tumor distribution (P=0.01) and number of hepatic metastases (P=0.003) were significant prognostic factors that influenced survival. Factors associated with the primary lesion were not significant prognostic factors.</p><p><b>CONCLUSIONS</b>Satisfactory survival may be achieved by simultaneous combined resection of both primary gastric cancer and synchronous hepatic metastases in strictly selected patients. The number of hepatic metastases and hepatic tumor distribution are significant prognostic determinants of survival.</p>

Establishment and characterization of a human gallbladder carcinoma cell line EH-GB1 originated from a metastatic tumor / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To establish a human gallbladder carcinoma cell line derived from a metastatic gallbladder carcinoma and identify its biological characteristics.</p><p><b>METHODS</b>Tissue samples were separated from the surgical specimen obtained from a patient with metastatic carcinoma and single-cell suspension was prepared. Then the cells were cultured in DMEM medium supplemented with 15% fetal bovine serum. The morphology of tumor cells was observed under an electron microscope. The cell growth curve was plotted. The tumorigenicity of the cell line was studied by subcutaneous inoculation in SCID mice. The cells were infected by lentiviral vector carrying fluorescent report genes (lenti-GFP and lenti-Red2) separately for expressions of GFP and Red2, respectively.</p><p><b>RESULTS</b>A novel metastatic gallbladder carcinoma cell line was successfully established and named "EH-GB1". It could be passaged for over 20 generations with typical malignant epithelial morphology and a stable growth cycle of 24 h. Tumors were formed in all of the 10 SCID mice inoculated with EH-GB1 cells subcutaneously, and the tumor cells were tumor marker CA19-9-positive. Continuous expressions of fluorescent report genes were observed in EH-GB1 cells infected by lenti-GFP and lenti-Red2.</p><p><b>CONCLUSION</b>EH-GB1 cells might be the first stable cell line of human gallbladder carcinoma established from a metastatic focus of gallbladder carcinoma. This cell line with continuous expressions of GFP and Red2 might be a novel and perfect experimental model for clinical and basic research on gallbladder carcinoma.</p>

Hepatic blood inflow occlusion with/without hemihepatic artery control versus the Pringle maneuver in resection of hepatocellular carcinoma: a retrospective comparative analysis / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The Pringle maneuver, which has been the standard for hepatic resection surgery for a long time, has the major flaw of ischemic damage in the liver. The aim of this research was to evaluate hepatic blood inflow occlusion with/without hemihepatic artery control vs. the Pringle maneuver in hepatocellular carcinoma (HCC) resection.</p><p><b>METHODS</b>Two hundred and eighty-one cases of resection of HCC with hepatic blood inflow occlusion (with/without hemihepatic artery control) and the Pringle maneuver from January 2006 to December 2008 in our hospital were analyzed and compared retrospectively; among them 107 were in group I (Pringle maneuver), 98 in group II (hepatic blood inflow occlusion), and 76 in group III (hepatic blood inflow occlusion without hemihepatic artery control). The operation time, intraoperative blood loss, postoperative liver function and complications were used as the endpoints for evaluation.</p><p><b>RESULTS</b>The operative duration and intraoperative blood loss of three groups showed no significant difference; alanine aminotransferase, total bilirubin and incidence of postoperative complications were significantly lower in groups II and III postoperation than those in group I.</p><p><b>CONCLUSION</b>Hepatic blood inflow occlusion without hemihepatic artery control is safe, convenient and feasible for resection of HCC, especially for cases involving underlying diseases such as cirrhosis.</p>

Clinical study of 169 patients with hepatic angiomyolipoma / 中华外科杂志

<p><b>OBJECTIVE</b>To review and investigate the optimal preoperative diagnostic means and treatment principles of hepatic angiomyolipoma (HAML).</p><p><b>METHODS</b>The clinical features, treatment, prognostic and follow-up data of 169 HAML patients treated between January 1992 and May 2010 were retrospectively analyzed. The median age of the patients, including 46 male and 123 female (male/female, 1/2.7), was 45 years (range, 17 - 73 years). The mean case history was 0.54 year with a range of 2 d to 16 years.</p><p><b>RESULTS</b>Among the 169 patients, 149 patients (88.2%) had a solitary tumor and 96 patients (56.8%) were detected in the right lobe. The overall preoperative diagnostic rate was 13.6% and 119 patients (70.4%) were misdiagnosed as hepatocellular carcinoma or hepatic cavernous hemangioma. The diagnostic accuracy of MRI is higher than CT in distinguishing the nature of the tumor (χ² = 5.508, P = 0.019). One hundred and sixty-eight patients received surgical resection and one received percutaneous microwave coagulation therapy. One patient occurred postoperative hemorrhage and 3 patients developed hydrothorax. The postoperative mortality and recurrence for all the patients were 0. Postoperative pathology confirmed the diagnosis of hepatic angiomyolipoma. Follow-up study showed a benign course and no signs of recurrence.</p><p><b>CONCLUSIONS</b>MRI is the main diagnostic means of HAML. Treatment strategies of HAML depends largely on tumor size, location and growth rate. Surgical management is suggested to patients with the following criteria: (1) tumor size greater than 5 cm; (2) with clinical symptoms; (3) faster tumor growth; (4) the tumor located at 1, 4, 5, 8 segments of liver.</p>

Biopathological characteristics of hilar cholangiocarcinoma and the clinical significance / 中华外科杂志

<p><b>OBJECTIVE</b>To approach the biopathological features of hilar cholangiocarcinoma and surgical pathological factors which influence the long-term survivals of patients with hilar cholangiocarcinoma.</p><p><b>METHODS</b>A systemic and retrospective multi-parameter analysis was performed on 205 patients of hilar cholangiocarcinoma who received surgical treatments and had complete clinicopathological data as well as follow-up results during a ten-year-period from April 1998 to April 2008. The single factor analysis was performed on age, sex, content of pre-operative serum CA19-9, Child-pugh grading, TNM classification, operation pattern, resection margin status of bile duct, vascular invasion, adjacent liver involvement, grade differentiation, infiltration-depth of bile duct, lymph node metastasis and perineural infiltration. A multivariate analysis was performed through Cox proportional hazard model.</p><p><b>RESULTS</b>The single factor analysis showed that except age, sex and content of pre-operative serum CA19-9, the mainly significant factors influencing the survivals were Child-Pugh grading, TNM classification, operation pattern, bile duct margin, vascular invasion, adjacent liver involvement, grade differentiation, infiltrating-depth of bile duct, lymph node metastasis and perineural infiltration (P < 0.05). Lymph node metastasis and infiltration-depth of bile duct wall were found to be the two independent factors influencing overall survival by multivariate analysis through the Cox model.</p><p><b>CONCLUSIONS</b>The most important prognostic factors influencing the long-term survivals of patients with hilar cholangiocarcinoma after operation are lymph node metastasis and depth of tumor-infiltrating of involved bile duct. During the operation, standardized evaluation through frozen section should be carried out for detection of lymph node metastasis and depth of tumor-infiltrating of involved bile ducts, which can be used as the histological indicator for surgical expansion, and could be helpful to maximize avoiding the tumor cell residues and therefore, to improve the long-term effects of surgical resection.</p>

Risk factors of intrahepatic cholangiocarcinoma: a case-control study / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To explore the potential risk factors of intrahepatic cholangiocarcinoma (ICC) in China.</p><p><b>METHOD</b>A case-control study including 317 patients with pathologically confirmed ICC and 634 healthy individuals was conducted. The cases and controls were matched in age, sex and inhabitancy. Data were statistically analyzed by Chi-square test and conditional logistic regression.</p><p><b>RESULTS</b>Univariate analysis showed significant difference in HBsAg seropositivity, liver cirrhosis, hepatolithiasis, choledocholithiasis and schistosomiasis between ICC patients and healthy controls (P < 0.05). Multivariate analysis confirmed that HBsAg seropositivity, liver cirrhosis, hepatolithiasis and hepatic schistosomiasis were associated with ICC, and their adjusted odds ratio (95% confidence interval) were 10.265 (6.676-15.783), 13.101 (5.265-32.604), 18.242 (3.580-92.958), 18.435 (1.930-176.082), 15.102 (4.607-49.499) and 11.820 (3.522-39.668), respectively. The incidence of hepatic cyst, cholecystolithiasis, hepatic hemangioma, fatty liver, diabetes mellitus, smoking and drinking were not significantly different between ICC patients and controls.</p><p><b>CONCLUSIONS</b>The HBV infection, liver cirrhosis, hepatolithiasis and hepatic schistosomiasis may be the risk factors for ICC in China.</p>

Clinical application of hepatic venous occlusion for hepatectomy / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Most liver resections require clamping of the hepatic pedicle (Pringle maneuver) to avoid excessive blood loss. But Pringle maneuver can not control backflow bleeding of hepatic vein. Resection of liver tumors involving hepatic veins may cause massive hemorrhage or air embolism from the injuries of the hepatic veins. Although total hepatic vascular exclusion can prevent bleeding of the hepatic veins effectively, it also may result in systemic hemodynamic disturbance because of the inferior vena cava being clamped. Hepatic venous occlusion, a new technique, can control the inflow and outflow of the liver without clamping the vena cava.</p><p><b>METHODS</b>A total of 71 cases of liver tumors underwent resection with occlusion of more than one of the main hepatic veins. All tumors involved the second porta hepatis and at least one main hepatic vein. Ligation or occlusion with serrefines, tourniquets and auricular clamps were used in hepatic venous occlusion.</p><p><b>RESULTS</b>Of the 71 patients, ligation of the hepatic veins was used in 28 cases, occlusion with a tourniquet in 26, and occlusion with a serrefine in 17. Right hepatic veins were occluded in 38 cases, both right and middle hepatic veins in 2, the common trunk of the left and middle hepatic veins in 24, branches of the left and middle hepatic veins in 2, and all three hepatic veins in 5. Thirty-five cases underwent hemihepatic vascular occlusion, 4 alternate hemihepatic vascular occlusion, 23 portal triad clamping plus selective hepatic vein occlusion, and 9 portal triad clamping plus total hepatic vein occlusion. The third porta hepatis was isolated in 26 cases. The amount of intraoperative blood loss averaged (540 +/- 283) (range 100 to 1000) ml in the group of total hemihepatic vascular occlusion and in the group of alternate hemihepatic vascular occlusion, (620 +/- 317) (range 200 - 6000) ml in the group of portal triad clamping plus selective or total hepatic vein occlusion. All tumors were completely removed.</p><p><b>CONCLUSIONS</b>Hepatic venous occlusion applied in hepatectomy can prevent bleeding and air embolism, and is safe and effective with stable hemodynamics.</p>

The influence of tumor cells spreading in blood to relapse and distant metastasis of hepatocellular carcinoma after surgery / 中华外科杂志

<p><b>OBJECTIVE</b>To study the relationship between peripheral blood hepatocellular carcinoma cells-associated AFP mRNA and tumor relapse and metastasis.</p><p><b>METHODS</b>To detect several blood samples from the HCC patients by nested RT-PCR to find out AFP mRNA after 24 h, 72 h and one week and 4 weeks after surgery, and followed up the HCC patients for 1, 2, 3 years.</p><p><b>RESULTS</b>There were 7 patients occurred relapse or distant metastasis in 12 patients with AFP mRNA positive (7/12, 58.3%), there were 5 patients occurred relapse in 19 patients with AFP mRNA negative (5/19, 26.3%) within 1 year, there was 4 patients occurred relapse in second year (9/19, 47.3%); 5 patients occurred relapse in third year (10/19, 52.6%). Obvious connection between patients AFP mRNA positive and AFP mRNA negative was observed (P < 0.01).</p><p><b>CONCLUSIONS</b>HCC with AFP mRNA positive has more change to be recurrent compared with HCC patients with AFP mRNA negative.</p>

Effect of the amount of portal blood stasis removal on endotoxemia and liver function after liver transplantation / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the influence of the amount of portal blood stasis removal on endotoxemia and liver function after liver transplantation.</p><p><b>METHODS</b>Forty-seven patients who received liver transplantation from February 2006 to November 2007 were divided into 2 groups according to the amount of portal blood stasis removal during operation: group A (n = 26) 50 ml and group B (n = 21) 200 ml of portal blood stasis removal respectively. The levels of plasma endotoxin, D-lactate, tumor necrosis factor-alpha, interleukin-6, liver function and blood coagulation were examined and analyzed.</p><p><b>RESULTS</b>Under the condition of no significant difference in sex, age, primary liver diseases and Child-pugh's classification, cold ischemic time, total operation and anhepatic time, operation methods, volume of blood loss and transfusion, and all preoperative observations. Most of observations showed the restoration of the patients in group B was better than that in group A. The plasma levels of endotoxin, D-lactate, tumor necrosis factor-alpha, interleukin-6, alanine aminotransferase, aspartate aminotransferase, prothrombin time and activated partial thromboplastin time in group B were significantly lower than those in group A (P < 0.05). The level of plasma prealbumin in group B was significantly higher than that in group A (P < 0.05).</p><p><b>CONCLUSIONS</b>The removal of 200 ml portal blood stasis leads to a better results than that of 50 ml, and it can help alleviate endotoxemia and facilitate the restoration of the liver function after liver transplantation.</p>

Surgical resection of hepatic tumor in segment IXb by anterior transhepatic approach / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the feasibility and the effect of surgical resection of hepatic tumor originated from segment IXb.</p><p><b>METHODS</b>The cases with hepatic tumors in segment IXb who had been operated on between March 2003 and January 2007 were retrospectively reviewed.</p><p><b>RESULTS</b>A total of 15 tumors in segment IXb, including 13 primary liver cancers and 2 benign tumors with a mean diameter of (4.3 +/- 1.6) cm, were successfully resected by anterior transhepatic approach under sequential occlusions of portal tride and total hepatic vascularity or portal tride clamping only. There was no operative mortality,with a mean operative time of (190.3 +/- 37.6) min and a mean operative blood lose of (376.7 +/- 252.7) ml. All the patients had uneventful postoperative course except one who suffered from ascites and edema of the low body, which was successfully managed medically. The mean postoperative hospital stay was (13.3 +/- 6.0) d. During the follow-up of 1-47 months, two patients with benign tumor enjoyed a normal life. Among the 13 patients with primary live cancers, 1 patient died of recurrence, 2 patients remained alive with intrahepatic recurrence and 10 patients survived without any sign of relapse, with a median tumor-free survival time of 23.5 months.</p><p><b>CONCLUSIONS</b>Surgical resection of hepatic tumor in segment IXb, despite their sophisticated anatomic position, is feasible in technique with high safety. The local resection can provide the patients with potential to cure.</p>

Progress in diagnosis and treatment of primary liver cancer / 中国医学科学院学报

The early diagnosis, surgical treatment, and comprehensive treatment of primary liver cancer (PLC) have advanced greatly in recent years. Both the survival and quality of life of patients with PLC have remarkably improved. Further advances in basic research may provide new direction of the management of PLC.

Study of bloodless hepatectomy under occlusion of total hemi-hepatic vessel / 中华外科杂志

<p><b>OBJECTIVE</b>To explore the preliminary clinical evaluation of hepatectomy with total hemi-hepatic vascular exclusion.</p><p><b>METHODS</b>Twenty-eight patients with primary liver cancer were divided into two groups of hepatectomy with total hemi-hepatic vascular exclusion (group A) and total hepatic inflow occlusion (group B). The time of hepatic vascular control, intraoperative blood loss, volume of removed liver, postoperative liver function recovery and complications were compared between the two groups.</p><p><b>RESULTS</b>The intraoperative blood loss in group A was (296 +/- 240) ml, which was less significantly than that in group B [(582 +/- 497) ml] (P<0.05). The serum pre-albumin levels on the day 1, 3 and 7 after operation in group A were (164 +/- 39) mg/L, (111 +/- 17) mg/L and (104 +/- 23) mg/L, which were higher significantly than that in group B [(134 +/- 34) mg/L, (90 +/- 22) mg/L and (82 +/- 35) mg/L] (P<0.05). While the time of hepatic vascular control and volume of lost liver were no difference between the groups (P>0.05). There were no significant difference in other items between the groups.</p><p><b>CONCLUSIONS</b>Intraoperative blood loss and liver damage of hepatectomy under the total hemi-hepatic vascular exclusion could be less than that under the other methods of vascular occlusion. It could be worth improving and applying further.</p>

Role of post-operative transcatheter arterial chemoembolization in hepatocellular carcinoma with different pathological characteristics / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the efficacy of transcatheter arterial chemoembolization (TACE) on postoperative recurrence of hepatocellular carcinoma.</p><p><b>METHODS</b>A total of consecutive 823 patients with hepatocellular carcinoma from October 1996 to September 2001 were included in this study. All patients underwent curative liver resection and 126 patients (15.3%) received TACE post operation. The effects of postoperative TACE on the recurrence of hepatocellular carcinoma with different pathological characteristics such as tumor size, tumor capsule, number of nodules, vascular invasion and surgical margin was analyzed.</p><p><b>RESULTS</b>Postoperative TACE had not decreased the recurrence rate in patients with a tumor diameter less than 3 cm. Postoperative TACE increased the disease-free survival for patients with tumor diameter of 3 - 10 cm, positive in alpha fetoprotein (AFP), presented vascular invasion or patients with tumor diameter larger than 10 cm, positive in AFP, multi-nodular, presented vascular invasion, resection margin less than 1 cm.</p><p><b>CONCLUSIONS</b>Postoperative TACE can decrease recurrence rate and prolong the survival of hepatocellular carcinoma patients with high risk factors for recurrence.</p>

Comparative study of selective hepatic vascular exclusion and Pringle maneuver in hepatectomy involving the second porta hepatis / 中华外科杂志

<p><b>OBJECTIVE</b>To compare the effects of selective hepatic vascular exclusion (SHVE) and Pringle maneuver in resecting the liver tumors involving the second porta hepatis.</p><p><b>METHODS</b>From January 2000 to October 2005, 2100 liver tumors were resected, among which 235 tumors adhered to or were very close to one or more hepatic veins. Both SHVE and Pringle maneuver were used to control the blood loss during the hepatectomy. They were divided into two groups: SHVE group (125 cases) and Pringle group (110 cases). Data regarding the intra-operative and postoperative courses of the patients were analyzed. SHVE group included total SHVE (clamping of the porta hepatis and all major hepatic veins) in 25 cases and partial SHVE (clamping of the porta hepatic and one or two hepatic veins) in 100 cases. Three methods were used to occlude hepatic veins: be ligated with suture, be encircled and occluded with tourniquets and be clamped with Shatinsky clamps directly.</p><p><b>RESULTS</b>There was no difference between the 2 groups regarding the age, sex, tumor size, cirrhosis and HBsAg positive rate, ischemia time and operating time (P > 0.05). Intra-operative blood loss and transfusion requirements were decreased significantly in the SHVE group. Hepatic veins ruptured with massive blood loss in 14 and air embolism in 3 in Pringle group, but there was no massive blood loss and air embolism in SHVE group. Postoperative bleeding, reoperation, liver function failure and mortality rate were higher in Pringle group (P < 0.05), ICU stay and hospital stay were longer in Pringle group (P < 0.05).</p><p><b>CONCLUSIONS</b>SHVE is much more effective than Pringle maneuver for controlling intraoperative bleeding. It can prevent massive blood loss and air embolism resulting from hepatic veins ruptured and can reduce the postoperative complications rate and mortality rate. Clamping the hepatic veins with Shatinsky clamp is safer and easier than encircled and occluded with tourniquets.</p>

Percutaneous laser ablation in the treatment of portal vein tumor thrombus in 93 hepatocellular carcinoma patients / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To evaluate the efficacy of percutaneous laser ablation (LA) in the treatment for portal vein tumor thrombus (PVTT) of hepatocellular carcinoma (HCC).</p><p><b>METHODS</b>The PVTT of HCC patients were treated through percutaneous transhepatic laser ablation (PTLA). The survival rate, thrombus size, blood flow of embolized portal vein by thrombus, liver function, ascites and clinical presentation were observed.</p><p><b>RESULTS</b>The 6-month, 1-year and 2-year survival rate of these 93 patients were 82.8%, 53.0% and 34.1%, respectively. In 11 patients with partially occluded portal vein by PVTT, the cut-surface of the PVTT diminished significantly 6 months after LA. The color blood stream signal was seen again one day after LA in all of the other 82 patients with totally occluded portal vein by thrombus, and it could still be seen in 67 of those one month later, 57 (of 71) 3 months later, 40 (of 57) 6 months later, 27 (of 32) 1 year and 4 (of 6) 2 years later after LA. In the 38 patients who survived over 1 year, PVTT was gradually atrophied and disappeared eventually in 14, PVTT was atrophied and the portal vein changed into honeycomb-like appearance in 14. In the remaining 10 patients, PVTT continued to grow and made the portal vein enlarged. It was also observed that liver function, clinical symptom and ascites were improved in various degree after LA.</p><p><b>CONCLUSION</b>Percutaneous laser ablation might be an effective and safe treatment method for controlling portal vein tumor thrombus of hepatocellular carcinoma.</p>

Surgical management of small intrahepatic lesions adjacent to the major vasculature / 中华外科杂志

<p><b>OBJECTIVE</b>To assess the feasibility and the significance of surgical resection of small intrahepatic lesions adjacent to the major vasculature.</p><p><b>METHODS</b>The results of treatment were retrospectively reviewed in 40 patients who received operation for intrahepatic lesions less than 3 cm in diameter between Jan. 2003 and Dec. 2005. The lesions were all adjacent to the major vasculature in the liver.</p><p><b>RESULTS</b>In the 40 patients, a total of 44 small intrahepatic lesions were successfully resected with minimal morbidity and blood loss (mean 163 ml). A second lesion was found in 4 patients (10%) during intraoperative exploration. Histologically the lesion was malignant in 29 cases (including 4 cases with two lesions) and benign in 11 cases, with correct preoperative diagnosis in 62.5% of all cases. For 26 patients with hepatocellular carcinoma, the 1-, 2-, and 3-year postoperative survival rates were 90.1%, 83.2% and 64.7%, respectively, while the patients with benign lesions were cured with the operation.</p><p><b>CONCLUSIONS</b>Surgical resection of small intrahepatic lesions adjacent to the major vasculature is demanding but feasible and with satisfying effect. The significance of surgical management of these small lesions is not only excising the lesions but also making definite diagnosis and finding new lesions in some patients.</p>

Diagnosis and treatment of hepatic focal nodular hyperplasia: report of 114 cases / 中华外科杂志

<p><b>OBJECTIVE</b>To explore the diagnosis and treatment of the hepatic focal nodular hyperplasia (FNH).</p><p><b>METHODS</b>The clinical data of 114 patients with FNH proved by the pathology were analyzed retrospectively.</p><p><b>RESULTS</b>FNH occurs as a single node in 98.1%, ranging from 0.9 cm to 15.0 cm in diameter [average, (4.2 +/- 2.2) cm], only 2 patients had more than one FNH nodules. 86.0% of patients with FNH were below 50 years old. 89.5% of patients were asymptomatic. AFP was negative in all patients. Hepatitis B was negative in 4.4% (5/114) of patients. Of these patients, 50 lesions were in the left lobe, 50 in the right lobe, 6 in the mid lobe, and 8 in the caudate lobe. A big central artery was found in 3.5% (4/113) of the lesion in patients by color Doppler ultrasound. CT scan showed transient immediate enhancement in 94.3% (66/70) of patients, with central scar in 10 cases. The demonstration of a central scar in the lesion was very helpful for the diagnosis of FNH. MRI demonstrated early vigorous enhancement in 91.8% (56/61) of patients. It is strong enhancement on arterial phase and slight or obvious enhancement on portal venous phase and slightly delayed enhancement of the central scars in FNH. Eleven cases showed central scar. MRI was more helpful for the diagnosis of FNH using liver specific contrast agents: superparamagnetic iron oxide (SPIO). All patients underwent focus resection, and there was no mortality and severe complication.</p><p><b>CONCLUSION</b>FNH shows some typical clinical and imaging features. We could improve the correct diagnosis rate by comprehensively analyzing the clinical and imaging materials.</p>

Lymph node metastasis of patients with intrahepatic cholangiocarcinoma / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the relationship between lymph node metastasis and prognosis in patients of intrahepatic cholangiocarcinoma (ICC).</p><p><b>METHODS</b>A retrospective clinical analysis was made in 132 cases of ICC, who admitted to our hospital from December 1996 to June 2003. Kaplan-meier method was used to calculate their survival rates, chi(2) test to compare the difference of sample rates. Logistic regression analysis was performed to determine the factors influencing lymph node metastasis and log-rank univariate analysis was used to assess the role of lymph node metastasis in the long-survival.</p><p><b>RESULTS</b>Lymph node metastasis in hepatoduodenal ligament could be detected in all 29 preoperative and 48 postoperative lymph metastatic cases, without "jumping-metastasis". Lymph metastasis was one of the major causes of postoperative mortality, and resulted in 36 of 58 followed-up death postoperatively. According to logistic analysis, pathological types of the carcinoma (chi(2) = 4.071, P = 0.044) and periductal-infiltrating tumors (chi(2) = 3.872, P = 0.037) were significant predictors of lymph node metastasis. In all 98 radical resections, 46 cases performed skeletonization of the hepatoduodenal ligament while other 52 cases not. The median survival of the two groups was 20 months and 13 months respectively (chi(2) = 9.82, P < 0.01).</p><p><b>CONCLUSIONS</b>Lymph nodes in the hepatoduodenal ligament may be sentinel nodes for ICC lymph node metastasis. Aggressive treatment of lymph node metastasis in the hepatoduodenal ligament is an important strategy to improve the long-survival of postoperative ICC patients.</p>