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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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Objective To explore the leaves water extract on the liver human hepatocellular carcinoma xenografts and protein expression of Bcl-2 and HSP70 .Methods From cell morphology and DNA agarose gel electrophoresis the observation leaves water extract the characteristics of the material role in human hepatoma cells ,further use of immunocytochemistry agent Western blotting analysis method oncogene Bcl-2 and tumor suppressor genes HSP70expression .Results After the processing of the the 60 mg/mL leaves water extract of liver cancer cells after 12 h ,liver cells showed severe shrinkage ,pyknosis ,highlight the cell plasma mem-brane ,immunohistochemistry and Western blotting analysis showed that during the experiment along with the oncogene Bcl-2 ex-pression weakened(P<0 .05) ,while the expression of tumor suppressor genes HSP70 had no obvious change(P<0 .05) .Conclusion Water extract of the leaves can be induced in vitro human liver cancer cell apoptosis ,and the apoptotic process may be followed by the oncogene Bcl-2 ,tumor suppressor gene expression of HSP70 relationship .
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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 investigate the laparoscopic treatment for giant intraabdominal cysts with postoperative lower body edema. Methods Five cases of giant intraabdominal cysts were given an aspiration of 1 500 ~ 2 000 ml (mean, 1 800 ml) of fluid. The aspiration was performed percutaneously in 2 cases of hepatic cyst, and under direct vision through a 1.5~2.5 cm incision around the umbilics in 3 cases of lower intraabdominal cyst. After aspiration the cysts were excised (3 cases) or fenestrated (2 cases) laparoscopically. Postoperative lower body edema was treated with diuretics either orally (2 cases) or intravenously (3 cases). Results Symptoms completely disappeared after operation in 4 cases and were significantly improved in 1 case of polycystic liver. Follow-up for 3~12 months found no recurrence. The lower body edema subsided in 5~7 days after operation. Conclusions Aspiration of cystic fluid before laparoscopic operation and postoperative administration of diuretics could get good results for patients with giant intraabdominal cysts.
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Objective To investigate the treatment of common bile duct or common hepatic duct transverse injures(CBDTI) in cholecystectomy.Methods From January 1993 to March 2008,3362 patients received cholecystectomy in our hospital,among them 5 developed CBDTI.We reviewed the clinic feature,management,and outcomes of these patients. Results Of the 5 patients,2 had common hepatic duct transverse injuries and 3 showed common bile transverse injuries.One of the five received postenterobiliary drainage and the other four underwent choledoch end-to-end anastomosis.No biliary leakage was found after the operation.One patient developed biliary stenosis and cholangitis after the end-to-end anastomosis and thus received postenterobiliary drainage.This case was followed up for 15 years,during which no abdominal pain,fever or jaundice occurred.The patient who underwent postenterobiliary drainage showed symptoms of cholangitis for 3 times whithin 2 months after the treatment;therefore,conservative therapy was carried out.Afterwards,the patient was cured and showed no abdominal pain,fever or jaundice during a 5-year follow-up.The other 3 patients who received end-to-end anastomosis were followed up for 1,2,or 4 years,no complications were noticed during the period.Conclusions Based on personal experience and the type of injury,surgeons may chose choledoch end-to-end anastomosis or postenterobiliary drainage to treat CBDTI.
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Objective To explore difficulties and countermeasures of laparoscopic cholecystectomy (LC) for treating huge gallstones. Methods Fifty-six cases of huge gallstones with a diameter of 2.0~5.3 cm (3.4?0.6 cm) were reviewed in respect of their clinical features and operative difficulties and countermeasures during laparoscopic cholecystectomy. Results The laparoscopic cholecystectomy was completed smoothly in 54 cases, with an operation time of 30~130 min (94.3?40.7 min). Conversions to open surgery were required in 2 cases because of acute suppurative cholecystitis. Moderate-to-severe adhesion was found in 41 cases (73%). White bile or absence of bile secretion was found in 23 cases (41%). There were 2 cases (4%) of small bile duct injuries in the gallbladder bed, 15 cases (27%) of liver tissue injures in the gallbladder bed, and 19 cases (34%) of intraoperative gallbladder leakage. No major bile duct injury or massive hemorrhage occurred. The postoperative hospitalization time was 3.6?1.5 days. Follow-up observations for 6~12 months (mean, 11 months) found that the symptoms disappeared and no complications were noted. Conclusions The difficulties during LC for huge gallstones lie in the thickening of the gallbladder wall that causes injuries of the liver tissue and small bile ducts in the gallbladder bed. Careful dissection and reservation of part of the gallbladder wall are effective methods to lower the incidence of complications.
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Objective To discuss the prevention and treatment of bile duct injures io the gallbladder bed during laparoscopic cholecystectomy(LC).Methods A retrospective analysis was made on clinical features,treatment,and curative effects of 15 cases of bile duct injures in the gallbladder bed out of 2 032 cases of LC from January 1997 to December 2004.Results There were 5 cases of acute attack of chronic calculous cholecystitis and 10 cases of chronic atrophic calculous cholecystitis.The location of injury was at the branches of the right hepatic ducts in 8 cases and at aberrant bile ducts in 7 cases.The injury was treated with titanium clipping in 8 cases,primary suture in 5 cases,and open surgery of bile duct repair in 2 cases because the injury was relativly large and the site of injury was near the trunk of the right hepatic duct.Postoperatively,bile leakage happened in 1 case and was cured by drainage for 5 days.Follow-up surveys for 6~36 months (mean,23 months) showed free of symptoms and no jaundice or cholangitis.Conclusions Surgical dissection closely near the gallbladder wall when mobilizing the gallbladder is the key to preventing bile duct injuries in the gallbladder bed during laparoscopic cholecystectomy.Prompt detection and proper management of the injury have satisfactory curative effects.
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Objective To evaluate the value of vascular intervention in the diagnosis and management of hemobilia. Methods With Seldinger's technique ,digital subtraction angiography of superior mesenteric artery and hepatic arteriography were performed on 3 patients with hemobilia, two of whom manifested hemobilia after the operation of liver trauma and one of whom did after the operation of command bile duct stones . Arteriography showed the bleeding vascular branch, the false aneurysm and the arteriovenous fistula. And then a small catheter was put into the bleeding focus. The bleeding branch arteries were selectively embolized with embolus of n-butyl cyanoacrylate (NBCA),PVA granule,spring wire loop and gelatin sponge. Results Two cases showed diffuse bleeding focus and another showed a local bleeding focus. Two cases had expression of false aneurysm and one showed expression of ateriovenous fistula. The artery branches of the bleeding focus were successfully embolizated and the hemobilia stopped immediately. Conclusions Vascular intervention is an effective method for the diagnosis and management of hemobilia.
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Objective To investigate the value of intraoperative choledochofiberscopy and B-ultrasonography for intrahepatic bile duct calculus. Methods After bile duct stone removal by routine instruments, choledochofiberscopy and B-ultrasonography were conducted for detecting and removing the residual cholelith in intrahepatic bile ducts. Results The incidence of residual cholelith was 29.8% (14 of 47) after stone removal by routine instruments, and it declined to 10.6% (5 of 47) ( ? 2=5.267, P
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Objective To investigate laparoscopic treatment of hepatic cysts in the right posterior lobe.Methods A four-port laparoscopic fenestration and drainage was performed in 35 patients with symptomatic hepatic cysts in the right posterior lobe(the lesion was located at the segment Ⅳ in 21 patients and at the segment Ⅶ in 14 patients) from January 1998 to December 2005.For cysts located at the superior segment of the right posterior lobe,the operation was performed through the suprahepatic approach. The liver was pressed along the anterior and inferior direction by using a pair of traction tongs for the exposure of hepatic cysts.Then the cyst was fenestrated and filled with pedicled greater omentum.For cysts located at the inferior segment of the right posterior lobe,the operation was conducted through the infrahepatic approach.The hepatocolic ligament,right triangular ligament,and connective tissues between the liver and the kidney were opened by using a harmonic scalpel.The liver was lifted with the traction tongs,and the cyst was fenestrated and filled with greater omentum.Results Laparoscopic fenestration and drainage was accomplished in all the 35 patients,without conversions to open surgery.The suprahepatic approach was adopted in 15 patients and the infrahepatic approach,in 20 patients.The operation time was 30～95 min(mean,46 min).No surgery related complications occurred.Pathological examinations in the 35 patients showed congenital cysts of liver.After operation,patients' symptoms all disappeared.The postoperative hospitalization time was 2～5 days (mean,3.8 days).All the 35 patients were followed for 6～36 months(mean,34 months).The cyst did not completely disappeared but significantly subsided in 2 patients(suprahepatic approach),without remarkable symptoms.The cysts were not obviously enlarged within 6 months.Conclusions Laparoscopic fenestration and drainage via suprahepatic or infrahepatic approach is an effective treatment for hepatic cysts in the right posterior lobe.
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Objective To investigate the diagnosis and treatment of latent perforation of peptic ulcer (LPPU) during laparoscopic cholecystectomy (LC). Methods A retrospective analysis was made on clinical data of 13 cases of LPPU diagnosed during LC from January 1994 to November 2005. Results All the 13 cases were misdiagnosed before the LC and clarified as having LPPU during the LC. Three cases of anterior duodenal bulbar perforation (0.4~0.5 cm in size) were laparoscopically repaired, whereas conversions to open repair were performed in 5 cases of duodenal perforation (0.5~1 cm in size) and 5 cases of gastric perforation (0.6~1 cm in size) because of severe adhesion or difficult performance. No surgical complications occurred. Twelve cases were followed for 6~36 months (mean, 27 months). The symptoms disappeared and gastroscopy showed healed ulcer. No recurrence of perforation was found. Conclusions Underestimation of LPPU leads to misdiagnosis, and preoperative gastrosopy can prevent it. For small perforation, laparoscopic repair and abdominal drainage can be employed. But in most cases, a conversion to open surgery is required. It is necessary to give regular internal medicine for peptic ulcer after operation.
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Objective To study a simple and effective internal bilioenterostomy for the malignant bile duct obstruction.Methods 58 obstructive jaundice patients caused by advanced carcinoma were divided into 2 groups(1)Bridge bilioenterostomy(BBES) group.Biliojejunal bypass procedue by using silica gel tube inserted into dilated bile duct and jejunum respectively combination with Bardport TM pump was performed on 25 patients .The biliary sludge were washed away through Bardport TM pump by injecting normal saline, antibiotic and 5-fluorouracil.(2)Control group.33 patients were treated with traditional biliojejunostomy. Results There was no difference in alleviating jaundice between the two groups ,but in BBES group the cholangitis rate (20.83%)and recurrent jaundice rate (9.52%) were much lower than those in control group ( 51.61% and 32.14% respectively, P