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Objective To investigate the clinical value of preventative surgical resection in the treatment of extra-hepatic portal vein aneurysm.Methods The method of retrospective descriptive study was conducted.The clinical data of 1 patient with extra-hepatic portal vein aneurysm who was admitted to the Guangzhou General Hospital of Guangzhou Military Command of PLA in May 2014 were collected.The patient suffered from dull pain in his epigastrium,with no obvious causative factors.The patient recieved abdominal B-ultrasound,CT scans abdominal and superior mesenteric artery,angiographies after admission in May 2014,and was diagnosed as with extra-hepatic portal vein aneurysm.The preventative surgical resection was selected according to the patient's individual health status.Extra-hepatic portal vein aneurysm resection was conducted under the guidance of intraoperative ultrasonography after abdominal exploration.A double-cavity drainage tube was placed in the venturis hole when portal vein aneurysm was dissected and removed.Then the abdomen was closed.The patient received regular perioperative management.The operation time,volume of intraoperative blood loss,time for diet recovery,time of drainage tube removal,postoperative complications,results of laboratory tests,results of imaging findings,healing of incision,time of postoperative discharge from hospital,results of pathologic examination and follow-up were observed.Follow-up using outpatient examination or telephone interview was performed to detect the inspect status of portal vein and inspect recurrence of portal vein aneurysm by abdominal B-ultrasound and CT examinations till December 2014.Results The patient underwent successful extra-hepatic portal vein aneurysm resection.The operation time was 85 minutes and the volume of intraoperative blood loss was around 150 mL.The patient gradually returned to normal diet and self-care ability at postoperative day 3,and the abdominal drainage tube was removed at postoperative day 3.No postoperative complications including hemorrhage,portal vein thrombosis and dysfunction of liver were detected after operation.There were normal levels of blood routine and blood biochemical test.Postoperative B-ultrasound examination showed smooth blood flow in portal vein and the abdominal blood vessel CT angiography presented clear image of the portal vein,with smooth blood flow and normal lumen.The surgical incision recovered very well and the patient was discharged from hospital at postoperative day 9.Results of postopeartive pathologic examination showed that there were cystic-like tissues with simple squamous epithelium cells on the interior,the wall of which consisted of smooth muscle was in accordance of the structure of vein.The patient didn't receive any other special treatment or take medicines postoperatively.The patient had good physical health and can take care of himself during six-month follow-up,without narrow portal vein,recurrence of portal vein aneurysm and other complications.Conclusion Preventative surgical resection is safe and feasible for extra-hepatic portal vein aneurysm,with a good efficacy.
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Objective To investigate the application and clinical value of donation after citizens death (DCD) in salvage liver transplantation (SLT).Method The clinical data of 12 recipients who underwent SLT from DCD of 12 donors at the Guangzhou General Hospital of Guangzhou Military Area from October 2010 to December 2013 were retrospectively analyzed.Of the donors,there was one case of type of China-Ⅰ,2 cases of the type of China-Ⅱ and 9 cases of the type of China-Ⅲ.Extracorporeal membrane oxygenation (ECMO) was applied to donation after brain and cardiac death to avoid warm ischemia.Of the recipients,6 met the Milan criteria,3 UCSF(The University of California,San Francisco) criteria and 3 Hangzhou criteria respectively.Orthotopic liver transplantation was performed on recipients.Eleven recipients received end-to-end anastomosis of the bile duct and followed up regularly.Result Liver transplantation was successfully performed on all recipients.No mortality during operation,no recovering delay and non-function of the transplanted liver occurred.Postoperative complications occurred in 4 cases,2 patients died,and 2 patients recovered and discharged after the second surgery.Ten recipients had a long-term survival.Two cases of hepatocellular carcinoma (HCC) recurrence were still alive after active treatment.The longest survival time was 42 months.All of them had no long-term complications such as biliary stricture.Conclusion The role and status of SLT in the treatment of HCC has become increasingly,and there will be more and more use of DCD donor in SLT.To ensure the DCD donors safely and effectively applied in SLT,we should grasp the characteristics of SLT,choose the appropriate DCD donor according to recipients,and rationally use the ECMO to protect the graft quality.
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ObjectiveTo summarize the early clinical experience of the extracorporeal membrane oxygenation (ECMO) for protecting the liver donation after cardiac death (DCD).Methods Review and analysis the clinical data of 17 cases of liver transplantation with the donors from Chinese citizen after cardiac death from July 2009 to May 2011 in our liver transplantation center,and comprehend the primary diseases and the relevant index of the donors,the flow-sheet of donation and obtain of the organs from the donation after cardiac death,and the apply methods of extracorporeal membrane oxygenation during those processes.ResultsAll 17 cases had been diagnosed as brain death before,and waited for cardiac death,so all were clearly the donation of brain death plus cardiac death(DBCD).During the processes waiting for cardiac death,extracorporeal membrane oxygenation were introducted in every case,and the using time were 51-380 (mean 187)min.The donation after brain death plus cardiac death (DBCD) were all harvested liver donors and were transplanted to 17 receivers respectively.In our center,there was no operational death in liver transplantation in this series.The post-operation liver function recovered satisfactory,without transplant liver non-function or recovering delay.One case died of the pulmonary infection one month later after operation,and the other 16 cases all survived and were followed up to now.The longest survival time was 29 months.ConclusionThe donation after brain death plus cardiac death (DBCD) was the special donation type for citizen in China.The extracorporeal membrane oxygenation (ECMO) could well control the warm ischemia for protecting the liver donor just without ethics dispute.So,the using of the extracorporeal membrane oxygenation (ECMO) for the liver donation after cardiac death(DCD)of citizen in our China have very important contribution.
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Objective To summarize the clinical experiences in liver transplantation from donation after cardiac death donors. Methods The clinical data of 20 recipients who underwent liver transplantation from donation after cardiac death of 20 donors at the Guangzhou General Hospital of Guangzhou Military Area from July 2006 to May 2011 were retrospectively analyzed.Extracorporeal membrane oxygenation (ECMO) was applied to donors with brain and cardiac death to avoid warm ischemia.Donors in type Ⅲ according to the Maastricht classification did not receive ECMO.Liver grafts were obtained 5 minutes after the stop of heartbeat of the donors.Orthotopic liver transplantation was performed on recipients.Seventeen recipients received end-to-end bile duct anastomosis and 3 received cholangioenterostomy.All the recipients were followed up regularly.The survival curve was drawn by Kaplan-Meier method.Results Of the 20 donors,2 ( 10％ ) were in the type of Maastricht Ⅲ and 18 (90％) were donation after brain and cardiac death donors.Liver transplantation was successfully performed on all recipients,and the mean operation time,duration of anhepatic phase,mean volume of blood loss and duration of postoperative intensive care unit stay were (6.2 ± 2.7 ) hours,( 54 ± 13 ) minutes,( 2305 ± 1311 ) ml and (44 ±35) hours,respectively.There was no mortality during operation,and no recovering delay and non-function of the transplanted liver occurred.One recipient died of sepsis and 1 died of pulmonary infection at 1 month after operation,the other 18 recipients all survived.The longest survival time was 58 months.Conclusions Donation after cardiac death is the main source of liver grafts in China currently,and donation after brain and cardiac death is the main type.Establishment of rational flow-sheets of the donation after cardiac death and liver transplantation,rational application of ECMO for protecting the liver grafts are helpful for the work of organ donation after brain and cardiac death.
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Objective To study the anatomy of the hepatic arteries and imitate the way to deal with the hepatic arteries in the living liver transplantation of the left lateral lobe.Methods Thirty normal adult livers were anatomyzed and 30 casting models of livers were observed. The lengths, diameters and distributaries of the hepatic arteries were described Results The blood supply of the left lateral region came from proper hepatic artery, left hepatic artery and middle hepatic artery. The aberrant arteries included left inferior phrenic artery, left gastric artery and right gastric artery. They branched to supply the upper segment and the inferior segment Conclusion There are five types of hepatic arteries to supply the left liver lobe. The anatomy of hepatic arteries should be studied and a reasonable approach to gain a liver graft should be designed before transplantation. The hepatic arteries should be dealt with so as to anastomose with recipient hepatic arteries.