Function of peribiliary glands as well as its relationship with ischemic-type biliary lesions / 中华消化外科杂志

Peribiliary glands (PBG) is a kind of microscopic structure around the intra-hepatic bile ducts and extrahepatic bile ducts. PBG not only participates in maintaining the normal physiological function of biliary epithelial tissue, but also plays an important role in its damage and repair process. Biliary tree stem/progenitor cells in PBG are important cell sources of biliary epithelial regeneration and repair. PBG and the surrounding peribiliary vascular plexus are key influencing factors for the occurrence of ischemic-type biliary lesions (ITBL) after liver transplantation. Based on relevant literatures and clinical practice, the authors summarize the function of PBG as well as its relationship with ITBL.

Acute-on-chronic liver failure treated by split liver transplantation:a single-center experience on 9 cases / 中华普通外科杂志

Objective:To evaluate the short-term efficacy of split liver transplantation (SLT) in patients with acute-on-chronic liver failure (ACLF).Methods:The clinical data of 9 ACLF patients receiving SLT in our center from Mar 2021 to May 2022 were retrospectively analyzed to evaluate its safety and efficacy.Results:The preoperative APASL ACLF Research consortium (AARC) score of the 9 ACLF patients was 8 points in 1 case, 9 points in 3 cases, 10 points in 3 cases, 11 points in 1 case and 12 points in 1 case, 7 cases were in AARC-ACLF grade 2, and 2 cases in grade 3.In-situ liver splitting was performed in 9 deceased donors, including 4 classical split cases, 5 full size split cases. Among these 9 ACLF patients, 2 received left half liver transplantation, 3 received right half liver transplantation, and 4 received extended right lobe liver transplantation. After transplantation, all 9 recipients were discharged fully recovered, 1 case developed Clavien grade Ⅳa complication and 2 cases developed Clavien grade Ⅲb complication.After SLT treatment the median postoperative hospital stay was 27 days, the 1-year survival rate was 100%, and the organ survival rate was 88.9%.Conclusion:Split liver transplantation is a safe and feasible treatment method for ACLF patients.

Patients with perihilar cholangiocarcinoma resection combined with portal vein resection and reconstruction / 中华肝胆外科杂志

Objective:To study the safety and efficacy of combining portal vein resection and reconstruction (PVR) with resection of perihilar cholangiocarcinoma (PHC).Methods:A total of 104 patients with PHC who underwent hepatectomies for either biliary resection alone or biliary resection combined with PVR from October 2006 to December 2019 at the Department of Hepatopancreatobiliary, Ningbo Medical Center of Lihuili Hospital entered into this study. There were 63 males and 41 females, with the age of (64.4±10.4) years. The control group consisted of 75 patients who underwent biliary resection alone, while the PVR group consisted 29 patients with biliary resection combined with PVR. The patient characteristics and the follow-up outcomes of the two groups were analyzed and compared. Survival analyses were performed using the Kaplan Meier method with the log-rank test.Results:Wedge resection of portal vein, side to side anastomosis in 2 cases, segmental resection and end to end anastomosis in 27 cases. The time taken for PVR and portal vein resection were (12.7±2.9)(range 8 to 18)min and (20.7±7.3)(range 8 to 38) mm, respectively. The estimated blood loss for the PVR group was significantly more than the control group [ M( Q1, Q3)] 800.0 (600.0, 1 500.0) ml vs. 600.0(500.0, 1 000.0) ml ( P<0.05). Based on postoperative pathological studies, the proportion of lymph node metastasis was significantly higher in the PVR group than the control group (58.6% vs. 32.0%, P<0.05). Clavien-Dindo grade Ⅲ and above complications were 30.7%(23/75) and 34.5%(10/29) in the control and PVR groups, respectively ( P>0.05). The re-operation and postoperative 90 days mortality rates were 9.3%(7/75) and 2.7%(2/75) in the control group, compared with 3.4%(1/29) and 0 in the PVR group, respectively (both P>0.05). The 1-, 3- and 5-year survival rates were 81.1%, 44.8% and 36.4% respectively for the control group and 78.1%, 35.9% and 31.4% for the PVR group (χ 2=0.33, P=0.570). Conclusion:When compared to biliary resection alone, biliary resection combined with PVR did not significantly increase postoperative complication and mortality rates, but with comparable long-term survival outcomes. Combined biliary resection with PVR was safe and improved the resection rate in selected patients with locally advanced PHC.

Modification and innovation of in-situ full-left/full-right liver splitting technique / 中华器官移植杂志

Objective:To explore the feasibility of technological modification and innovation of full-left/full-right liver splitting in situ for donors and examine the safety of clinical application for liver transplantation (LT).Methods:From March 2021 to June 2022, clinical and surgical data are retrospectively reviewed for 27 donors undergoing full-left/full-right liver splitting in situ and the corresponding 49 recipients undergoing full-left/full-right LT.According to the split liver technique used in donor liver surgery, they are divided into conventional split group(group A, 13 cases)and innovative split group(group B, 14 cases). The corresponding recipients are divided into two groups of recipient C(25 cases)and recipient D(24 cases). General profiles, intraoperative findings, type of vascular allocation and short-term outcomes in two groups are compared.After full-size split liver transplantation(fSLT), follow-ups continued until the end of September 2022.Results:There are 23 males and 4 females in donors.The causes of mortality for donors are traumatic head injury(12 cases)cerebrovascular accident(13 cases)and anoxia encephalopathy(2 cases). Baseline characteristics of two groups indicate that body weight and body mass index(BMI)are higher in group B and blood sodium level is lower than that in group A( P<0.05). No statistical differences exist for the others.Liver splitting time is significantly shorter in group B than that in group A(175 vs.230 min, P=0.022). No significant inter-group difference exists in type of vascular allocation.Retrohepatic inferior vena cava(IVC)is split in one case in group A and 10 cases in group B( P=0.001). Among 20 cases of right hemiliver requiring a reconstruction of segment Ⅴ/Ⅷ venous outflow, 12 cases in group A and 3 cases in group B are reconstructed with conventional independent bridging method(independent type)while another 5 cases in group B reconstruct with innovated technique by bridging Ⅴ/Ⅷ vein for splitting IVC with iliac vessel and molding all outflows as one for anastomosis(combined typ e). There is significant inter-group difference( P=0.004). No significant differences exist in operative duration, anhepatic phase or blood loss between groups C and B, except for T tube retaining in 7 cases of group A and 14 cases of group D( P=0.032). Twelve cases developed a total of 26 instances of≥Clavien-Dindo grade Ⅲ complications.Of which, 7 cases in group C and 5 cases in group D show no significant difference in postoperative morbidity.However, for serious biliary complications(≥Clavien Dindo grade Ⅲ), there are 6 cases in group C versus none in group D( P=0.016). Two cases died from postoperative complication with a postoperative mortality rate of 4.1%.Postoperative hospital stay is similar in two groups.And accumulates 6/12-month survivals were 95.9% and 87.7% for grafts and 95.9% and 92.4% for recipients respectively. Conclusions:Operative duration of full-left/full-right liver splitting in situ tends to shorten with an accumulation of a certain amount of cases.Technological modification and innovation in IVC splitting and segment Ⅴ/Ⅷ vein reconstruction should be further validated as both feasible and safe by short-term outcomes of the corresponding recipients.

Choice of reoperation for recurrent hepatocellular carcinoma: a study based on propensity score matching / 中华器官移植杂志

Objective:The aims of this study were to compare the efficacy between salvage liver transplantation (sLT) and rehepatectomy (RR) basing on the propensity score matching (PSM), and to explore the prognositc factors of patients with recurrent hepatocellular carcinoma (HCC).Methods:124 patients with intrahepatic recurrence after hepatectomy in our center from January 2012 to August 2018 were divided into sLT group( n=46) and RR group( n=78). 34 patients were selected for data analysis base on 1∶1 propensity score matching (PSM). The advantages and disadvantages of the two surgical methods and the prognostic factors of the patients were discussed by comparing the basic clinical data, OS and DFS of the two groups before and after matching. Results:Before matching, the pre-operative serum total bilirubin, the occurrence of multiple tumors, the proportion of preoperative TACE and the proportion of patients within Milan criteria of the sLT group were higher than those of the RR group, and the maximum tumor diameter of the sLT group was shorter than that of the RR group ( P<0.05); the time of operation, the amount of intra-operative blood loss, the positive of MVI and the proportion of postoperative Clavien grade Ⅲ and above of RR group were higher than those of RR group ( P<0.05). After matching, the operation time, intra-operative blood loss and the proportion of postoperative complications of sLT group were higher than those of RR group; there was nosignificant difference between 1-, 3- and 5- years OS of sLT group and RR group( P>0.05), the 1-, 3- and 5-years DFS of sLT group were better than those of RR group( P<0.05); AFP≥100 μg/L was the independent risk factor of OS, and the type of operation and AFP≥100 μg/L were independent risk factors of DFS. Conclusions:The pre-operative condition of sLT group was more severe, and the operation time, intra-operative blood loss and post-operative severe complication rate of sLT group were higher than those of RR group, and the DFS time of sLT group was longer than that of RR group, but there was no significant difference in OS between the two groups.

The impact of intraoperative pancreatic resection margin status on prognosis of patients with pancreatic head cancer / 中华肝胆外科杂志

Objective@#To study the impact of intraoperative pancreatic resection margin status on prognosis in patients with pancreatic head cancer.@*Methods@#The clinical and follow-up data of 109 patients who underwent pancreaticoduodenectomy at Ningbo Lihuili Hospital from March 2012 to October 2018 were analyzed retrospectively. The association of intraoperative resection margin status and other clinicopathological factors on prognosis was analyzed by the Kaplan-Meier method and the Cox proportional hazard model. Logistic multivariate analysis was used to study factors influencing the margin status.@*Results@#Of 109 patients, 20 had a positive intraoperative resection margin, and 89 had a negative margin. Postoperative pathological examination showed that all the patients had a negative surgical margin. Univariate analysis suggested that CA19-9 before operation, preoperative adjuvant chemotherapy, intraoperative pancreatic resection margin status, maximum diameter of tumor, perineural invasion, lymphovascular invasion, tumor differentiation, and N staging were significantly related to survival in the entire cohort (all P<0.05). Multivariate analysis showed CA19-9 ≥37 IU/ml, perineural invasion, lymph node metastasis, tumor diameter ≥4 cm and poor tumor differentiation were independent risk factors of bad prognosis (P<0.05). Univariate analysis of prognosis showed significant differences in lifetime prognosis between the positive margin group and the negative group (median survival time: 11 months vs. 21 months, P<0.05), but a positive resection margin was not an independent risk factor on prognosis (P>0.05). Analysis of the clinicopathological factors between the two groups showed that in the positive pancreatic neck margin group, the distribution of adverse pathologic factors like low tumor differentiation, tumor diameter ≥4 cm, perineural invasion and lymphovascular invasion were significantly different compared with the negative group (P<0.05). Tumor diameter ≥4 cm (OR=5.72, 95%CI: 1.60~20.49) and low tumor differentiation (OR=3.79, 95%CI: 1.20~11.95) were independent influencing factors of positive margin on logistic multivariate analysis.@*Conclusions@#Intraoperative pancreatic positive margin was not an independent risk factor of prognosis, but it was meaningful in predicting survival. Presence of positive margins was often combined with existence of some adverse pathological features, such as large tumor diameter and low tumor differentiation. Prognosis of patients with a positive margin was often poor. A positive pancreatic margin was an intraoperative marker of poor tumor biology in patients with pancreatic ductal adenocarcinoma.

Liver transplantation using donation after cardiac death: A single-center experience of 115 cases / 中华普通外科杂志

Objective To investigate the clinical outcomes of liver transplantation by using donation after cardiac death (DCD) in single center.Methods The clinical data of 115 DCD donors and recipients of liver transplantation from Jan 2012 to Sep 2017 at our institution were analyzed,including preoperative general data,intraoperative status,and postoperative early complications.Patients were followed up to Oct 30th,2017.The measurement data with normal distribution were analyzed by t test,the enumeration data were analyzed by chi-square test or Fisher exact probability test,and the Kaplan-Meier method was used for survival analysis.Results All of the 115 donors were within China category Ⅲ using the classification of China donor after cardiac death.Donor graft mean warm ischemic time and cold ischemic time was (10 ± 4) min and (6.1 ± 1.7) h,respectively.All of the recipients underwent liver transplantation successfully.The mean preoperation MELD score was 14 ± 7.Seven patients were ABO-incompatible liver transplantation (A→O,3 cases,B→O 2 cases,AB→O 1 case,AB→A 1 case).19 patients (16.5％) had postoperative complications (Clavien-Dindo classification grade Ⅲ-Ⅴ).The perioperative mortality was 2.6％ (3 cases).All patients were followed up for an average (21 ± 17) mon.Patients 1-,3-,and 5-year survival rates were 93.6％,81.8％,and 77.5％,respectively.Conclusion The outcome of DCD liver transplantation is favorable at our institution under careful donor and recipient selection and intensive perioperative management.

Effect of ectopic splitting combined with portal vein ligation on rat liver regeneration / 中华普通外科杂志

Objective To explore the effect of ectopic splitting combined with portal vein ligation on rat liver regeneration.Methods Sixty Sprague-Dawley rats were randomly divided into four groups (n =15):portal vein ligation group (PVL group),associating liver partition with PVL group (ALPP group),associating spleen partition combined with PVL group (ASPP group) and associating kidney partition combined with PVL group (AKPP group).Hepatic regeneration rate (HRR),ALT,AST and hepatocyte proliferating cell nuclear antigen (PCNA) were detected on the 2nd,4th and 7th day after operation.Results On the 4th and 7th day,in ALPP group,ASPP group and AKPP group,there was an obvious hyperplasia (F =3.750,P ＜ 0.05;F =16.398,P ＜ 0.01) in the right middle lobe of the liver and higher PCNA (F=6.860,P＜0.01;F=3.810,P＜0.05) in the liver tissue than in PVL group.And ALPP group had significantly higher ALT and AST level on the 2nd and 4th day (ALT:F =8.812,F =21.929;AST:F =36.393,F =6.468;P ＜ 0.01).Conclusions Ectopic splitting combined with PVL can significantly promote rat's liver regeneration,possibly by inflammatory response,stress response and high expression of certain cytokines.

Analysis of total pancreaticoduodenectomy in 28 patients with pancreatic cancer / 中华肝胆外科杂志

Objective To study the clinical outcomes of 28 pancreatic cancer patients who underwent total pancreaticoduodenectomy.Method The clinical data of 28 patients with pancreatic cancer who underwent total pancreaticoduodenectomy from January 2009 to March 2015 were retrospectively analyzed.Results Among the 28 patients,complications occurred in 11 (39.2％) after the operation.There were 7 patient having Grade Ⅱ,4 Grade] complications.No patient died within 30 days after the operation.Fol low-up of 25 patients showed a median survival of 13.5 months.There were 24 patients with pancreatic ductal adenocarcinoma,and the median survival was 13 months.Conclusions Total pancreaticoduodenectomy could not improve long-term survival but it decreased postoperative complications and improved postoperative quality of life.In selected patients,total pancreaticoduodenectomy could be a rational option.

Application of liver volumetry in hepatectomy / 中华肝胆外科杂志

Liver volume can reflect the change of parenchyma volume and functional reserve of liver.Liver volumetry is commonly achieved by imaging methods such as ultrasound,CT and MRI,while CT volumetry is most commonly used in clinical practice.This article discussed the decision making among different liver volumetry methods and associated applications in hepatectomy.

Value and safety of the surgery with vascular resection and reconstruction for pancreatic cancer / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the value and safety of the surgery with vascular resection and reconstruction during pancreatectomy for pancreatic cancer.</p><p><b>METHODS</b>The clinical data of 206 patients with pancreatic cancer who underwent radical resection were retrospectively analyzed from January 2009 to March 2014 in Lihuili Hospital, Medical center of Ningbo.All cases were divided into non-vascular resection group(132 cases), the combined vein resection group(66 cases) and the combined arterial resection group(8 cases). The peri-operation data, the incidence of postoperative complications and the survival were compared in pairs among three groups.All patients were followed up till September 2014.</p><p><b>RESULTS</b>There were no statistical differences for the preoperative data among three groups.The operation time and the blood loss (M(QR)) were (347±96)minutes and (500(400)) ml in non-vascular resection group, (425±91)minutes and (800(500))ml in combined vein resection group, (508±120)minutes and (1 750(2 075))ml in combined arterial resection group, with significant differences among three groups(all P<0.01). The incidence of postoperative complication was 16.7%(22/132) in non-vascular resection group, 28.8%(19/66) in combined vein resection group, and 6 cases in combined arterial resection group, respectively.There were significant differences between non-vascular resection group and combined vein resection group(P<0.05), non-vascular resection group and combined arterial resection group(P<0.05), as well as between combined vein resection group and combined arterial resection group(P<0.05). The median survival time was 15 months for non-vascular resection group, 15 months for combined vein resection group, and 12 months for combined arterial resection group.No significant difference was found among three groups(all P>0.05). The postoperative mortality was nil for all of groups.</p><p><b>CONCLUSIONS</b>Compared with non-vascular resection, combined vein resection can be performed safely with a similar prognosis. The surgery of combined arterial resection could only be justified when R0 resection for pancreatic cancer could be achieved for highly selected patients.</p>

Rectification procedures for patients after nonstandard cholangioenterostomy and improper endoscopic retrograde biliary drainage / 中华肝胆外科杂志

Objective To discuss the harm and the rectification procedures for patients who have received nonstandard cholangioenterostomy and improper endoscopic retrograde biliary drainage.Method The clinical data of 55 patients who had received nonstandard cholangioenterostomy and improper endoscopic retrograde biliary drainage seen at the Ningbo LiHuiLi Hospital between 2004.6 to2011.12 were retrospectively analyzed.Results There were 23 patients who had stones located intrahepatically which had not been dealt with in the previous operation; 16 patients received choledochoduodenostomy; 5 patients received side-to-side or side-to-end cholangiojejunostomy (with no division of the common bile duct) ; 2 patients developed anastomotic stricture after nonstandard cholangioenterostomy; 3 patients had a short efferent loop of jejunum; and 6 patients had improper endoscopic retrograde biliary drainage.Through reoperative rectification,all patients had satisfactory therapeutic outcomes.Conclusions For hepatolithiasis patients,nonstandard cholangioenterostomy and improper endoscopic retrograde biliary drainage not only cause harm to the patients,but also force patients to have a reoperation.Thus,following strict operative indications,choosing the right operation and improving on the operative skills are the keys to prevent a reoperation.

Transcatheter arterial chemoembolization after liver resection for hepatocellular carcinoma with portal vein tumor thrombus / 中华肝胆外科杂志

ObjectiveTo study the efficacy of transcatheter arterial chemoembolization (TACE) after liver resection for hepatocellular carcinoma (HCC) with tumor thrombus in the main trunk and/or first branch of portal vein,and to clarify prognostic factors affecting survival.Methods From 2005 to 2009,there were 358 consecutive patients with HCC who underwent surgical resection in our Department.In 55 patients (15 ％),portal vein tumor thrombus (PVTT) was found intraoperatively or postoperatively during histopathological examinations to involve the first portal branch,main portal trunk,or contralateral portal branch.In this retrospective study,these 55 patients were divided into two groups:Group A,29 patients received postoperative TACE,and Group B,26 patients who did not receive TACE.The clinical data and survivals were compared between the two groups.Prognostic factors were indentified using univariate analysis,followed by multivariate regression analysis using the Cox proportional hazards model.ResultsThere were no significant differences in the demographic clinical data between Group A and Group B.The overall 1-,2- and 3-year survivals for the 55 patients were 63.3 ％,51.4 ％ and 43.5 ％,respectively.The accumulative 1-,2- and 3-year survivals for group A were 71.4 ％,60.1 ％ and 50.1 ％,respectively.The corresponding figures for group B were 56.7％,21.7％ and 10.4％,respectively.Multiple tumors,intrahepatic metastases,hepatic vein thrombus,and invasive type of tumor thrombus were found to be risk factors for short-term survival on univariate analysis,while the latter 3 factors were further found to be significant prognostic factors in the Cox proportional hazards model.Postoperative TACE was shown to be a significant factor in both univariate and multivariate analyses.ConclusionLiver resection was beneficial for some patients with portal vein tumor thrombus.Postoperative TACE further improved the prognosis and prolonged survivals in these patients.

Intrahepatic biliary papillomatosis:a report of 9 cases / 中华肝胆外科杂志

Objective Intrahepatic biliary papillomatosis(IBP)is a rare disease that is characterized by multiple numerous papillary adenomas in the intrahepatic biliary duct(IBD).The clinical features and outcome,however,are not well known.The clinicopathologic features,treatments and follow-up results were retrospectively analyzed in order to improve the efficiency of diagnosis and treatment for the disease.Methods Between August 2006 and October 2008,9 patients were diagnosed with IBP by histological findings at a tertiary referral center,Ningbo Medical Center(University of Ningbo,College of Medicine,Ningbo,China).The authors retrospectively reviewed the medical records to obtain clinical,radiological and pathologic data.The therapeutic results and follow-up data were also reviewed.Results The ratio of male to female was 2:7 and the middle age was 59 years.Repeated episodes of fever and right upper quadrant abdominal pain with or without jaundice were the common clinical manifestations.There were intrahepatic choledocholithiasis and/or history of previous biliary operation in 8 cases.The level of CA19-9 and CEA were almost normal.Imaging workup demonstrated cyst-like dilatation of intrahepatic biliary tree with or without liver atrophy,which were more obvious in the mucin-hypersecreting IBP.All of the 9 cases underwent curative resection with an adequate resection margin.Macroscopic findings demonstrated that the tumors of 9 cases were all located in the left lobe with mucin-hypersecreting type in 7 cases.The diameter of numerous papillary granular was usually less than 10 mm(from 2 to 5 mm.frequently)and friable,that filled the dilated IHD dispersive.Fine fibrovascular cores lined by dysplastic epithelial cells were frequently found under microscope.Few foci of stromalinvasion were noticed in the two cases with malignant transformation.All of the 9 cases survived and there was no recurrence.Conclusion IBP occurs more often in middle and old women who have history of biliary disease. Repeated episodes of cholangitis are the common clinical manifestations. Extra- and intrahepatic biliary tract dilatation is the common imaging finding.MRCP/ERCP is more valuable than others in diagnosis. Clinical and histological finding shows that IBP is a premalignant disease with high malignant potential. Curative resection should be done as earlyas possible for the long-term survival rate. The use of cholangioscopy in operation and rapid biopsy of resection margin will benefit the curative resection.

Reduced liver toxicity and drug leakage during chemotherapy of retrograde isolated hepatic perfusion in rat liver / 中华肝胆外科杂志

Objective The retrograde isolated hepatic perfusion (RIHP) model was used to compare with the isolated hepatic perfusion (IHP) model in reducing the rate of normal hepatic tissue toxicity and peripheral drug leakage during chemotherapy in rat liver. Methods A total of 90 male Sprague-Dawley rats weighing 300-350 g were randomized into 3 groups with 30 rats in each. Group A: perfusion with Lactated Ringer'S Solution through arteria hepatica (RA) and portal vein (PV),the inferior vena cava was used as an outflow tract of perfusate. Group B: For isolated hepatic perfusion (IHP), Fluorouracil (5-FU) was added into the perfusate at a dose of 350mg/kg and introduced in to the liver through arteria hepatica, portal vein was perfused by Lactated Ringer'S Solution, and the inferior vena cava was used as an outflow tract of perfusate. Group C: by using retrograde isolated hepatic perfusion (RIHP), the solution which contains 350 mg/kg Fluorouracil (5-FU) was also introduced through arteria hepatica, the inferior vena cava was introduced with Lactated Ringer'S Solution;the portal vein was used as an outflow tract of the perfusate. On day 1, 3, 5 and 7 after the perfusion in all groups, blood serum ALT test and liver histopathology test were performed. The peripheral blood drug levels were measured with high performance liquid chromatographic(HPLC) system in group B and group C. Results The survival rate was 90%, 86.7% and 90% in group A, B and C,respectively. No statistically significant difference was observed in the survival rate among the 3groups. In all the three groups, serum ALT levels were the highest on the first day after IHP: (481.6±207.6)μmol/LingroupA;(1641. 6±658.0) μmol/LingroupBand( 913. 0±353. 5)μmol/Lin group C. Significant higher serum ALT levels were observed by comparing group B and C with A(P＜0. 05). Meanwhile, the serum ALT levels were significantly higher in group B than in group C (P＜0.05). The peaks of peripheral blood drug concentration during the perfusion were 131.2±29.4μg/ml in group B and 65.3±28. 4μg/ml in group C. Significant difference was observed (P＜0. 05). Liver biopsies of group A showed mild changes on the first day after IHP and returned to normal after 7 days. Group B showed severe changes on the first day after IHP and local necrosis still existed after 7 days. Group C showed moderate changes as compared with group B on the first day after IHP and also returned to normal after 7 days. Conclusion Retrograde isolated hepatic perfusion (RIHP) can reduce the liver toxicity compared to isolated hepatic perfusion (IHP). Hopefully, RIHP will be considered as a safer way in regional chemotherapy in liver cancer.

The efficacy and toxicity of Oxaliplatin in rabbit inoculated VX2 hepatic cancer during isolated hepatic perfusion with retrograde outflow / 中华普通外科杂志

Objective To study the anti-tumor effect and liver toxicity of Oxaliplatin (L-OHP)from different outflow tracts, we implemented isolated perfusion on rabbit VX2 tumor model with L-OHP.Methods In this study, 60 rabbits in which VX2 liver cancer were established were randomly divided into three groups ( A = B = C = 20). Group A and B were taken isolated hepatic perfusion with 5 mg/kg L-OHP,while group C was normal control, which was taken isolated hepatic perfusion without L-OHP. Perfusion fluid flowed through the hepatic veins in group A, while in group B and C perfusion fluid flowed through the portal vein. Blood biochemistry、liver histopathology 、vascular endothelial growth factor (VEGF) expression and hepatocyte apoptosis index (AI) in the postoperative 6th and 12th hour were examined. L-OHP concentration was measured during the perfusion with RP-HPLC in group A and B. Results Serum ALT、AST rose significantly in all three groups in the 6th and 12th hour postoperatively, and that in group A was higher than either group B or C. Differences in serum ALT、AST level between group A and B, B and C, A and C were all statistically significant (tALT = 2. 328、tALT =7. 116、tALT =3. 124,P ＜ 0.05;tAST =2.547、tAST =4. 710、tAST = 2. 238, P ＜ 0. 05 ). The differences of L-OHP concentration in the liver and systemic circulation between group A and B was statistically significant(t =3.091, P ＜0. 05;t =2. 778,P ＜0. 05),however the difference between group A and B of L-OHP concentration in the tumor tissue and outflow tract was not statistically significant( t = 1. 461, P ＞ 0. 05; t = 0. 223, P ＞ 0. 05 ). Hepatic pathology in group A was more serious than that in group B in the 12th hour postoperatively. The levels of VEGF expression in liver tumor tissue in postoperative 12th hour, in group A and B were significantly lower comparing with group C (tAC =2.728, P ＜ 0.05;tBC =3.397,P ＜0.01). Between group A and B, the difference was not statistically significant ( t = 0. 591, P ＞ 0. 05 ). Differences in hepatocyte apoptosis index ( AI ) in the postoperative 12th hour between group A and C, A and B, B and C were all statistically significant( tAB=3. 689, P ＜ 0. 01 ;tAC = 5. 067, P ＜ 0. 01 ;tBC = 2. 607, P ＜ 0. 05 ), and with that in group A being higher than either in group B or C. Conclusions L-OHP had a significant anti-tumor effect in isolated hepatic perfusion; Chemotherapy infusion fluid flowing through the portal vein retrogradely was a more complete and safer way of regional chemotherapy than antegrade flowing through the hepatic vein.

As2O3toxicity on rat liver during retrograde isolated hepatic perfnsion / 中华普通外科杂志

Objective To study As2O3toxicity on rat liver in a retrograde isolated hepatic perfusion model. Methods In this study 104 male Sprague-Dawley rats weighing between 300 and 400 g were used. Eight male SD rats were used for preoperatively normal control and the remaining rats were randomly divided into 4 subgroups receiving As2O3at dosage of 0 mg/kg,0.75 mg/kg, 1.5 mg/kg, 3 mg/kg respectively. Modified RIHP was used in which As2O3was infused through hepatic artery. Ringer's lactate was retrogradly infused through hepatic veins and the portal vein was used as the outflow tract. Hepatic function, pathology and liver enzymes were assessed at different time points. As2O3concentration was monitered during the perfusion in rats of subgroup C. Results Serum ALT and AST rose to the peak on the first day, returning to normal after 3 or 7 days in all four subgroups. There was no difference between the peak levels of serum ALT and AST between subgroup A and B. Differences in serum ALT、AST level between subgroup A and C, A and D, B and C, B and D, C and D were all statistically significant (FALT=40.811,P<0.01;FAST= 48.212,P <0.01). On day 7, ALT and AST in subgroup D were still statistically higher when compared with that of other subgroups and normal control (FALT=13.928, P<0.01;FAST=17.942, P<0.01), and the hepatic pathology showed necrosis of the hepatocyte. The peak levels of As2O3were 13.21±0.82(μg/ ml) and 0.09±0.008 (μg/ml)in rats liver and systemic circulation in subgroup C during isolated perfuision. There were significant differences between the peak levels of concentration of As2O3in rats liver and systemic circulation (t=35.758,P<0.01). Conclusions The hepatic toxicity is reversible caused by As2O3when given at a dosage of 1.5 mg/kg of As2O3in a murine model of RIHP.

Laparoscopic hepatectomy:a report of 20 cases / 中国普通外科杂志

Objective To evaluate the maneuvre of curettage and aspiration(LTCA) in laparoscopic hepatectomy. MethodsWe used Peng′s multifunctional operative dissector(PMOD) to perform laparoscopic liver transection by maneuvre of curettage and aspiration in 20 cases undergoing laparoscopic hepatectomy. Results Procedures were all successful. The recovery was uneventful without any complications. Mean operative time was 105 minutes, the average bleeding volume was 420 ml, the largest excised sample size was 10 cm?9 cm?7 cm. All patients were discharged within one week. ConclusionsThe new technique-LTCA can be used in laparoscopic hepatectomy, it has the advantages of clear anatomy, good exposure of canal construction, rapid liver transection, satisfactory hemostasis and clear operative field.