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Objective:To compare the clinical efficacy of percutaneous transhepatic gallbladder drainage (PTGBD) combined with delayed laparoscopic cholecystectomy (LC) with direct LC in the treatment of acute cholecystitis.Methods:A single-center case-control retrospective study was used. Sixty-three patients with acute cholecystitis with onset time ≥ 72 hours during the period from August 1, 2021 to December 10, 2022 in the Department of Hepatobiliary Surgery of the 900TH Hospital of Joint Logistics Support Force were selected. There were 38 males and 25 females, aged (57.3±15.4) years, with an age range of 28-87 years. According to whether PTGBD treatment was performed before LC, they were divided into experimental group ( n=29) and control group ( n=34). Experimental group was treated with PTGBD combined with delayed LC and control group was treated with LC only.The differences in operative time, intra-operative bleeding, intra-operative transit open rate, post-operative hospital days, total hospital days, hospital costs, short-term post-operative complications of LC and post-operative time to exhaustion were compared and analysed between the two groups. Measurement data with normal distribution were expressed as mean±standard deviation ( ± s), and independent sample t-test was used for comparison between groups.Measurement data with skewed distribution were expressed as M( Q1, Q3), and rank sum test was used for comparison between groups; Chi-square test was used to compare the counting data groups. Results:Intraoperative bleeding, total hospital days, hospital costs and postoperative time to exhaustion were 0(0, 50) mL, 13(11, 18) d, 29 015.0 (22 791.6, 39 000.8) yuan and 1(1, 2) d in the experimental group and 50(0, 88) mL, 7(6, 11) d, 16 015.0 (15 832.1, 22 185.1) yuan, 2(1, 3) d, the difference was statistically significant between the two groups( P<0.05). In the experimental group, the operative time, the intraoperative transit open rate, the number of postoperative hospital days, and the incidence of short-term postoperative complications of LC were 80 (55, 115) min, 13.8%, 5 (3, 7) days, 34.5%, respectively, compared with 98(70, 125) min, 20.6%, 5(3, 6) days, 38.2% in the control group, the difference between the two groups was not statistically significant ( P>0.05). Conclusion:The clinical efficacy of PTGBD combined with delayed LC is better than direct line LC, and it is feasible and effective for patients with cholecystitis whose inflammatory indexes have returned to normal and who have high gallbladder tone.
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Objective To explore the effect of the contrast frame mirror and the corneal contact lens correction on the optical properties of the human eye.Methods120 cases of myopia patients from 2014 September to September 2015 in our hospital for vision correction were randomly divided into two groups: control group, observation group wearing frame mirror, wearing contact lens, the optical properties of the eye were compared between the two groups.ResultsThe corrected visual acuity of observation group hadno significant difference compared with the control group;no significant difference in the values of refractive foveal contrast;foveal refractive value contrast in the two groups had no statistical difference;the observation group T30 degrees for peripheral refraction was (1.00±0.21) D, N30°peripheralrefraction was (0.34±0.08) D,were significantly lower than the control group (P<0.05).The good rate of observation group was significantly higher than the control group, the incidence of corneal complications was significantly lower than that of the control group (P<0.05).ConclusionThe frame and the corneal contact lens can be well corrected visual acuity, the corneal contact lens for the correction of certain peripheral hyperopic defocus has advantages, can effectively reduce the peripheral hyperopic defocus, delaying myopia, and improve the comfort and safety.
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Objective To prospectively evaluate changes in T2 relaxation times in the meniscus with warm-up excise using MRI in healthy knees,and explore the feasibility of evaluating the morphological changes of meniscus after acute warming-up by T2 time response.Methods A total of 40 healthy adult volunteers were enrolled,which included 15 males and 25 females;aged 22-30 years old with mean age of 26.32 ± 2.1.T2 mapping sequential imaging was performed to measure the T2 time of medial and lateral anterior,body,posterior before and after warm-up exercise.A paired Student's t test was used to determine the effects of warm-up exercise on T2 times.Results All volunteers showed a significant increase in T2 values after warm-up exercise in all meniscus compartments (P =0.000),which may indicate changes in the biochemical composition of meniscal tissue.The lateral body compartment experienced more increment than medial anterior (P ＜ 0.05),medial posterior (P ＜ 0.05) and lateral posterior parts (P ＜ 0.05) after warm-up exercise.Conclusion Longer T2 values after warm-up exercise suggest increment in the water content of knee meniscus,which may indicate improvements in the physiological activity and protection of meniscus.T2 values in menisci have the potential to be used as biomarkers for identifying meniscus changes after exercise.
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Objective To prospectively evaluate changes in T2 relaxation times in the meniscus with warm-up excise using MRI in healthy knees,and explore the feasibility of evaluating the morphological changes of meniscus after acute warming-up by T2 time response.Methods A total of 40 healthy adult volunteers were enrolled,which included 15 males and 25 females;aged 22-30 years old with mean age of 26.32 ± 2.1.T2 mapping sequential imaging was performed to measure the T2 time of medial and lateral anterior,body,posterior before and after warm-up exercise.A paired Student's t test was used to determine the effects of warm-up exercise on T2 times.Results All volunteers showed a significant increase in T2 values after warm-up exercise in all meniscus compartments (P =0.000),which may indicate changes in the biochemical composition of meniscal tissue.The lateral body compartment experienced more increment than medial anterior (P ＜ 0.05),medial posterior (P ＜ 0.05) and lateral posterior parts (P ＜ 0.05) after warm-up exercise.Conclusion Longer T2 values after warm-up exercise suggest increment in the water content of knee meniscus,which may indicate improvements in the physiological activity and protection of meniscus.T2 values in menisci have the potential to be used as biomarkers for identifying meniscus changes after exercise.
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Objective To evaluate the curative effect of salvage liver transplantation and repeated hepatectomy for recurrent hepatocel-lular carcinoma.Methods The data of 72 patients with recurrent hepatocellular carcinoma fulfilling Child-Pugh A and the Milan criteria from September 2004 to August 2010 were retrospectively studied.According to different treatments,53 patients were divided into repeated hepatec-tomy group,and 19 patients were divided into salvage liver transplantation group.The overall survival rates and disease-free survival rates after operation were evaluated by Kaplan-Meier method.COX proportional hazard was used for univariate analysis and multivariate analysis to eval-uate the risk factors for prognosis.Results The 1-year,3-year and 5-year survival rates were 86.79%,62.26% and 45.28% in repeated hepatectomy group,and 89.47%,68.42%and 57.89% in the salvage liver transplantation group respectively.There was no significant differ-ence in the overall survival rates between the two groups (χ2 =2.530,P =0.112).The 1-year,3-year and 5-year disease-free survival rates were 67.92%,47.17% and 35.85%in the repeated hepatectomy group,94.74%,68.42% and 52.63% in the salvage liver transplantation group respectively.There was a significant difference in the disease-free survival rates between the two groups(χ2 =4.395,P =0.036).The univariate analysis and multivariate analysis indicated that microvascular invasion,satellite lesion and multiple tumors were the independent risk factors to influence the survival.Conclusion The salvage liver transplantation obtains a better effect for the patients fulfilling Child-Pugh A and the Milan criteria,which is an effective method in the treatment of hepatocellular carcinoma.
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Objective To investigate the effects of celastrol on the cell growth and apoptosis of human gallbladder cancer NOZ cells,and explore its potential molecular mechanism.Methods NOZ cell were cultured in vitro.And CCK-8 assay,Annexin V-FITC/PI staining method,cell cycle analysis were conducted to investigate the effects of celastrol on the growth and apoptosis of NOZ cells after being treated with drugs.The mitochondrial membrane potential and Bax and Bcl-2 protein expression level were determined by Rhodamine 123 and Western blot,respectively.Results Celastrol could inhibit NOZ cell growth,and the IC50 value was 5.3 μmol/L.Annexin-V/PI staining showed that cell apoptosis of NOZ cells were induced as the celastrol concentration increased,and the apoptosis ratio of control group was 4.4％,while the apoptosis rates of the test groups (2,5,10 p mol/L) were 7.4％,27.1％ and 43.4％,respectively.In addition,cell cycle analysis revealed that celastrol could induce G1-phase arrest.The G1-phase rate of control group was 25.6％,while the G1-phase rates of the test groups (2,5,10 μmol/L) were 36.5％,45.7％ and 92.5％,respectively.The mitochondrial membrane potential was measured after treatment with celastrol and the results indicated that the mitochondrial membrane potential was significantly decreased.Western Blot showed that the protein expression of Bax increased and Bcl-2 decreased in a time-dependent manner after treatment with celastrol.Conclusions Celastrol may inhibit cell proliferation of human gallbladder cancer NOZ cells and induce cell apoptosis partly by inducing the loss of mitochondrial membrane potential.
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Objective To investigate the effect and safety of Atropine preparations of 0.1%and 0.01%concentrations in the treatment of Ametropia.Methods 123 cases of ametropia from April 2014 to August 2015 in ophthalmic hospital of ningbo were randomly selected and divided into three groups, 41 cases in each group.High concentration group received 0.1%atropine sulfate eye drops treatment,low concentration group received 0.01%atropine sulfate eye drops treatment,and the control group received artificial tear mytear,and three groups were treated for one year.Changes in vision, refraction, intraocular pressure and axial length of the eye were compared after the treatment.Results High concentration group >low concentration group >control group in the the difference of distant visual acuity before and after the treatment ( Plow concentration group>high concentration group in the refractive index,intraocular pressure and ocular axis length difference before and after treatment (P<0.05),and the effective rate in the low concentration group 85.37%and high concentration group 90.24%had no significant difference.Adverse effects rate in high concentration group was 21.95%which was higher than low concentration group 4.88%(P<0.05).Conclusion 0.1%and 0.01%concentrations of atropine were effective control of Ametropia in flexion and axial length spectrophotometry, and then improve the visual acuity, and the former is better,but the 0.01%concentrations had higher safety.
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According to the Organ Injury Scale Grading System of the American Association for the Surgery of Trauma (AAST-OIS),grade Ⅴ liver trauma is always complicated with retrohepatic inferior vena cava injury and less bile duct injury,and it is extremely severe and difficult to be treated.Timely and fast judgment,emergent exploration and effective repair of the injured bile duct are the key points for the treatment of bile duct injury.One patient with grade Ⅴ liver trauma combined with hilar bile duct transection injury was admitted to the Fuzhou General Hospital of Nanjing Military Command on August 30,2013.The rupture of left and right liver junction was detected by preoperative multidisciplinary consultation and emergency open surgery at admission hour 4.There was left and right hepatic duct bifurcation rupture at the first hepatic hilum.Non-functional liver tissues were excised.Breakage left and middle hepatic vein were sutured by polymer suture line.Liver traumatic bleeding and bile duct were sutured and ligatured individually.Left and right hepatic duct laceration was sutured by 6-0 PDS suture line.A hole in the stomach wall was opened fist,and then most part of the gastric contents was removed and the gastric wall was reparied by stapler.Patient received the postoperative symptomatic treatment with gradual recovery,and was discharged from hospital at admission day 26.The patient was readmitted to the hospital at 31 days of discharge due to outflow of purulent fluid from abdominal cavity drainage tube,and was treated by ceftriaxone sodium and tazobactam sodium according to the results of drug sensitive test and continuous peritoneal lavage.The abdominal cavity drainage tube and left and right hepatic duct drainage tube were removed at postoperative day 83.The patient was discharged from hospital at readmission day 28,and was followed up till December 2014 with good recovery and without complication.
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Objective To investigate the clinical effect of cryosurgery in the preoperative preparation of liver transplantation in treating liver cancer.Method This study reviewed retrospectively clinical data from 74 patients who underwent cryosurgery of liver cancer before liver transplantation.According to the differences between transplantation programs,74 patients were divided into 2 groups:26 patients in Argon-helium cryoablation group (AHC group) and 48 patients in transcatheter arterial chemoembolization group (TACE group).Whether the patients in two groups met the standard of Milan after treatment,as well as the incidence rate of complication,waiting time for transplantation and MELD score before transplantation were compared between two groups after preoperative therapy.What's more,operation time,no liver time,amount of bleeding,PT and serum level of aminotransferase at 1st,3rd,and 5th day after transplantation were analyzed.Abdominal drainage fluid volume,the incidence of infection,acute rejection,kidney failure,biliary complication,and vascular complication in two groups were also compared.Disease free survival rate was counted after two years by outpatient follow-up.Result Only 3 cases in two groups exceeded Milan standard after treatment,one in AHC group and two in TACE group.The complication incidence and waiting time in two groups had no statistically significant differences.The MELD score in AHC group was significantly lower than in TACE group before transplantation.The operation time,amount of bleeding and transfusion requirements in AHC group were also significantly lower than in TACE group.The time without liver in two groups had no statistically significant difference.The speed of liver function recover was faster in ACH group,and the abdominal drainage fluid volume was less.There were no significant differences in incidence of postoperative complications between two groups (P＞0.05).Conclusion Cryosurgery therapy has little effect on liver functions after treatment.It is a good therapy for liver cancer patients before liver transplantation.
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Objective To investigate the effects of intracavity double pipe suction in the duodenal rupture repair.Methods The clinical data of 56 patients with duodenal rupture repair who were admitted to Fuzhou General Hospital from January 2003 to January 2014 were retrospectively analyzed.Thirty-one patients and 25 patients received the simple drainage (simple drainage group) and intracavity double pipe suction (intracavity double pipe suction group) for duodenal rupture repair.Quantitative data were presented by $ ± s,repeated measures analysis of variance and the t-test were used to evaluate quantitative data,respectively.Count data were analyzed using Chi-square test or Fisher's exact test.Results Volume of drainage of patients in the intracavity double pipe suction group at day 1,2,3,4,5,6,7 were (220 ± 54) mL,(284 ± 65) mL,(368 ± 35) mL,(413 ± 41) mL,(454 ± 62) mL,(714 ± 96) mL and (852 ± 121) mL,compared with (102 ± 30) mL,(124 ± 29)mL,(186 ±26)mL,(110 ±21)mL,(167 ±31)mL,(193 ±35)mL and (182 ±44)mL in the simple drainage group,with a significant difference between the 2 groups (F =65.214,P ＜ 0.05).The volumes of drainage of the 2 patterns were compared at postoperative day 1 to 7,with a significant difference (t =9.532,11.624,13.421,15.257,14.147,18.311,20.135,P ＜0.05).The incidence of duodenal fistula,intraperitoneal infection and wound infection in the simple drainage group were 29.0％ (9/31),41.9％ (13/31) and 51.6％ (16/31),compared with 4.0％ (1/25),12.0％ (3/25) and 16.0％ (4/25) in the intracavity double pipe suction group,showing a significant difference between the 2 groups (x2 =4.460,6.077,7.645,P ＜ 0.05).The incidence of pancreatic fistula and pulmonary infection in the sample drainage group and intracavity double pipe suction group were 16.1％ (5/31) and 29.0％ (9/31),8.0％ (2/25) and 12.0％ (3/25),with no significant difference between the 2 groups (x2 =0.836,2.385,P ＞ 0.05).The duration of hospital stay and hospital expenses in the simple drainage group and the intracavity double pipe suction group were (30 ± 14) days and(12 ± 6) x 104 yuan,(21 ± 7) days and (7 ± 5) x 104 yuan,respectively,with significant difference between the 2 groups (t =3.161,2.913,P ＜ 0.05).Conclusion The intracavity double pipe suction for duodenal rupture repair is simple and effective for significantly improving the prognosis of patients and reducing the duration of hospital stay and hospital expenses.
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Objective To investigate the clinical efficacies of the conservative and surgical treatment of grade m and Ⅳ traumatic hepatic rapture.Methods The clinical data of 77 patients with traumatic hepatic rapture were analyzed.All the patients were admitted to the Fuzhou General Hospital of Nanjing Military Command from January 2004 to June 2014.According to the Organ Injury Scale grading system of the American Association for the Surgery of Trauma (AAST-OIS) and the Becker classification,there were 44 patients and 33 patients had grade Ⅲ and grade Ⅳ traumatic hepatic rapture,respectively.The vital signs,condition of the wound and the resuhs of imaging examination were comprehensively analyzed,and the conservative and surgical treatment methods were selected accordingly.Patients were followed up via outpatient examination or telephone interview till September 2014.Results There were 19 patients received conservative treatment and 25 received surgical treatment among the 44 patients with grade m traumatic hepatic rapture,and 5 received conservative treatment and 28 received surgical treatment among the 33 patients with type Ⅳ traumatic hepatic rapture.Thirty-one patients received suture of the liver,18 received partial hepatectomy and 4 received damage control surgery.All the 77 patients were cured without perioperative death.For patients with grade m traumatic hepatic rapture,the duration of hospital stay were (12 ± 9)days and (20 ± 15)days for patients received conservative and surgical treatment,respectively; and for patients with grade Ⅳ traumatic hepatic rapture,the duration of hospital stay were (17 ± 3) days and (34 ± 25) days for patients received conservative and surgical treatment,respectively.Nineteen patients had complications,including 10 with hepatic abscess,5 with bile leakage (cured by puncture and drainage),2 with pseudoaneurysm (cured by interventional therapy with digital subtraction angiography),1 with adhesive intestinal obstruction and delayed hemorrhage (cured by operation for 2 times).Seventy-one patients were followed up,with the rate of 92.2％ (71/77).The median time of follow-up was 7 months (range,3-15 months).Only 1 patient was complicated with hepatic abscess at postoperative month 13,and was cured by puncture and drainage,and the other patients were live and well.Conclusions The success rate of operation for patients with grade m traumatic hepatic rapture is relatively high with short hospital stay and quick recovery of patients.The indication of conservative treatment for patients with grade Ⅳ traumatic hepatic rapture should be strictly controlled,and the surgical treatment is the main means of therapy.Hepatic abscess,bile leakage and pseudoaneurysm are the common complications for patients with traumatic hepatic rapture.
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Objective To study the influence of preoperative splenectomy on liver transplantation for portal hypertension and the management of complications.Methods From January 2008 to January 2013,a total of 136 patients underwent liver transplantation for portal hypertension (PHT) in Hepatobiliary Surgery Center,Fuzhou General Hospital of PLA Nanjing Military Region.Pre-liver transplantation splenectomy was carried out in 19 patients.We randomly selected according to the operation time 50 cases of liver transplantation as the control group.The operation time,bleeding,blood transfusion,infection,the incidence of acute rejection,biliary complication rate,survival rate,postoperative platelet recovery and arteriovenous thrombosis were analyzed.Results The preoperative group has longer surgical time,intraoperative blood loss,blood transfusion volume increased obviously,infection rate increased significantly compared with the control group.The accumulate survival rate of preoperative splenectomy group was significantly lower than that of the control group.The platelet count of the preoperative splenectomy group was significantly higher than that of the control group.The platelet count of both groups experienced the process of first rise after falling.Although the platelet count of the preoperative splenectomy group was higher than that of the control group,but there was no statistically significant difference.Conclusions Liver transplantation in PHT patients with previous splenectomy may lead to some unfavorable consequences including increases of technical diffculty of surgery,operative duration,intraoperative bleeding,postoperative infection and other serious complications,and surgical mortality.Therefore,splenectomy should be performed cautiously for the patients who may receive liver transplantation in the future.
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Objective To explore the localization diagnosis method of lumbar intervertebral foramen stenosis by multi-di-mensional MRI scans of lumbar nerve roots. Methods Twenty-one patients with lumbar intervertebral foramen stenosis were fol-lowed up from June 2006 to June 2011 postoperatively, 10 cases of male, 11 cases of female;36 to 65 years old, average 45.6 years. The medical history is six to thirty six months, an average of 9.4 years;5 cases have low back pain with unilateral leg pain and 16 cases showed unilateral leg pain only. The height of intervertebral space and foramen intervertebrale were measured on the X-rays of lumbar lateral position. Lumbar nerve roots MR imaging at the position of axial, coronal and sagittal scan were performed separately to the patients who were clinically suspected to suffer from lumbar intervertebral foramen stenosis. A definitive diagno-sis of the location of nerve root compression and structural changes surrounding the nerve root can be obtained. Surgical operation was performed to confirm the accuracy of the MRI imaging diagnosis. Results There were 9 cases of lumbar intervertebral fora-men stenosis caused by lumbar disc herniation. The other 12 cases are caused by zygapophyseal joint hyperplasia. All cases of lumbar intervertebral foramen stenosis located at the low back. By comparing MR images of lumbar intervertebral foramen stenosis with surgical procedure,the surgical observation of 21 patients completely coincided with the preoperative localization diagnosis, coincidence rate was 100%(21/21). After surgical treatment, 20 cases achieved a complete remission of leg pain and 1 case was not satisfactory. Conclusion MRI imaging at the position of axial, coronal and sagittal scan for lumbar nerve roots were useful to rigorous localization diagnosis of lumbar intervertebral foramen stenosis, and can provide accurate radiological evidence for sur-gery program.
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Designing of natural product-like compounds using natural products as template structures is an important strategy for the discovery of new drugs. Gambogic acid (GA), which is a Garcinia natural product with a unique caged xanthone scaffold, inhibits potent antitumor activity both in vitro and in vivo. This review summarized the researches on the identification of the antitumor pharmacophore of GA, and the design, structural optimization and structure-activity relationship (SAR) of natural product-like caged xanthones based on it.
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This study is to establish a paclitaxel [PTX]-resistant human cervical carcinoma HeLa cell line [HeLa/PTX] and to investigate its redox characteristics and the expression of taxol resistance gene 1 [Txr1]. HeLa cells were treated with PTX and effects of PTX on cell proliferation were detected through cell counting and the MTT assay. Levels of cellular reactive oxygen species [ROS], reduced glutathione [GSH], and oxidized glutathione [GSSG] as well as the ratio of GSH to GSSG were measured by the 2,7-difluorescein diacetate [DCFH-DA] method and the 5,5?-dithiobis[2- nitrobenzoic acid] [DTNB] method. Activities of superoxide dismutase [SOD], catalase [CAT], and glutathione peroxidase [GPx] were determined by the nitrite formation method, the molybdate colorimetric method, and the DTNB colorimetric method, respectively. The level of Txr1 mRNA was determined by real-time PCR. Compared with the regular HeLa cells, HeLa/PTX cells were larger in size and had more cytoplasmic granules. The population doubling time for HeLa/PTX cells was 1.32 times of that of HeLa cells [P < 0.01]. HeLa/PTX cells showed stronger resistance to PTX than HeLa cells with a resistance index of 122.69. HeLa/PTX cells had higher levels of ROS [P < 0.01] and Txr1 mRNA [P < 0.01], lower level of GSH [P < 0.05], and lower activities of SOD [P < 0.01] and GPx [P < 0.05] than HeLa cells. HeLa/PTX cells, with higher levels of ROS and Txr1 mRNA expression, are more resistant to PTX than HeLa cells
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Objective To explore the effects of different body positions at the expiratory phase thinsection multi-slice spiral CT on the diagnosis of pulmonary air trapping after allogeneic hematopoietic stem cell transplantation(allo-HSCT).Methods Thirty-one allo-HSCT patients underwent the expiratory phase low-dose MSCT lung scanning at supine and prone positions to detect whether they have air trapping lesion,the volume percent of air trapping region (CT value ≤-700 HU at expiratory phase) against the whole lung was measured by using GE workstation after grading.Statistical analysis on lesion detection rate was performed with McNemar test and volume percent with rank sum test.Results Air trapping regions were observed in 8 patients (25.8％,8/31) who performed CT scan at the supine position,while 15 cases (48.4％,15/31)were positive for prone position CT scan.Seven cases showed positive results at both body positions.Statistical significance in the positive detection rate at supine and prone positions was found (x2 =4.00,P =0.039).The volume fraction of the two positions was 13 for supine position and 21 for prone position with statistical significance (Z =-3.37,P =0.001).Sensitivity at prone position CT scan to detect air trapping was much higher than that at supine position CT scan.Conclusion For allo-HSCT patients with chronic rejection reaction,performing expiratory phase thin-section CT scan and prone position scan can not only improve the detection rate of lung forepart lesions,but also preliminarily evaluate the severity of the air trapping,which can provide a basis for the early diagnosis and treatment in clinics.
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Objective To investigate the methods for reconstructing portal vein in liver transplantation patients with grade Ⅳ portal vein thrombosis.Methods Clinical data of 6 patients with grade Ⅳ portal vein thrombosis who underwent liver transplantations were analyzed retrospectively.Different portal vein reconstructing approaches were applied: 4 patients underwent portal vein anastomosis with internal organ varicosis vein (group A),and 2 patients underwent portal vein arterialization (group B). Portal venous flow was monitored by intraoperative ultrasound and postoperative liver function was tested periodically during follow-up.Results In group A,one patient died of celiac infection 2 months post-transplantation.The remaining three patients were followed up for 14-17 months,and their portal veins remained smooth without thrombosis and with mitigated esophageal varicosity.In group B,one patient,with recurrent upper gastrointestinal bleeding,died of celiac infection 47 days after liver transplantation.The patient was followed up for 33 months with satisfactory liver and kidney functions although stomach esophagus varicosity was aggravated.Portal vein blood flow in groups A and B was 1258 ± 345 and 2275 ± 247 ml/min respectively after anastomosis by intraoperative color Dopplar ultrasound monitoring. Aspertate aminotransferase (AST) in group B was significantly lower on the fourth day after liver transplantation,and alanine aminotransferase (ALT) in group B was significantly lower on the 3rd,4th,5th and 6th day after liver transplantation than in group A (all P＜0.05).Serum total bilirubin (TBIL) had no statistically significant difference during the 10 days post-operation (P＞0.05).Conclusion Patients with grade Ⅳ portal vein thrombosis may achieve a satisfactory clinical effect by reconstructing portal vein through anastomosis of donor portal vein with internal organ? varicosis vein.PVA may be associated with early recovery of graft function and may be an effective remedial measure for patients with grade Ⅳ portal vein thrombosis who undergo liver transplantation.
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Objective To compare the efficacies of hepatectomy and liver transplantation for patients with hepatocellular carcinoma (HCC) fulfilling the Milan criteria.Methods From July 2002 to February 2009,121 patients with HCC combined with hepatic cirrhosis fulfilling the Milan criteria were admitted to the Fuzhou General Hospital.Eighty-nine patients who received hepatectomy were in the hepatectomy group,and 32 patients who received liver transplantation were in the liver transplantation group.There were no significant difference in the age,gender,etiology of liver disease,the size of the largest tumor,number of tumors,microscopic venous invasion,microsatellite lesion and tumor differentiation between the 2 groups.The clinical data of the patients in the 2 groups were retrospectively analyzed.The overall survival and disease-free survival were evaluated by Kaplan-Meier method,and differences in survival rates between the 2 groups were determined by Log-rank test.COX proportional hazard was used for univariate and multivariate analysis to evaluate the risk factors for prognosis.Results The median period of follow-up was 37 months.The 1-,3-,5-year survival rates were 86％,63％ and 44％ in the hepatectomy group,and 87％,70％ and 62％ in the liver transplantation group.There was no significant difference in the overall survival rate between the 2 groups (x2 =1.092,P ＞ 0.05).The 1-,3-,5-year disease-free survival rates were 68％,44％ and 26％ in the hepatectomy group,and 80％,65％ and 52％ in the liver transplantation group.There was a significant difference in the disease-free survival rate between the 2 groups (x2 =4.712,P ＜ 0.05).The result of univariate analysis revealed that microscopic venous invasion and microsatellite lesion were significantly correlated with the survival (Wald =9.625,7.340,P ＜ 0.05),and the result of multivariate analysis indicated that microscopic venous invasion was the independent risk factor influencing the survival (Wald =5.008,P ＜ 0.05).Conclusions As for patients with HCC fulfilling the Milan criteria,the overall survival rate of patients who received hepatectomy is not different from those who received liver transplantation,but the disease-free survival rate of patients who received liver transplantation is higher than those who received hepatectomy.Microscopic venous invasion is an independent risk factor influencing the survival.
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Objective To study the effects of ischemia-reperfusion in liver transplantation on the pathophysiological changes of the lung and mechanisms of lung injury. Methods We studied 23 patients who received liver transplantation at Fuzhou General Hospital of PLA. We cut a small piece of the right lung for pathological study and for L-1β and TNF-a immunohistochemistry studies at 5 minutes after the beginning of operation (Ta), 5 minutes before the portal vein was opened (Tb) and three hours after the new liver was transplanted (Tc). We also collected peripheral blood to study the concentration of IL-1β and TNF-a in the plasma at the beginning of operation (T1), the portal vein 5 minutes before opening, the portal vein (T2) ten minutes after the opening (T3) , and one hour after the new liver was transplanted (T4), three hours after the new liver was transplanted (T5), and 12 hours after operation (T6). Results The cytokines TNF-a and IL-1β in peripheral blood were not obviously increased in the portal vein before it was opened, but were significantly increased after the portal vein was opened. Comparison of T1 and T2 separately with T3, T4 and T5 showed significant differences (P<0. 01). In light and electron microscopy, the structures of the lung tissues were normal at Ta and did not change significantly at Tb. There were significant abnormalities at Tc. The average positive points of TNF-a and IL-1β expressions in the lung tissues at Tc were significantly higher than Ta and Tb(P<0. 01). Conclusion Ischemia-reperfusion in liver transplantation led to a serious systemic inflammatory syndrome,and acute lung injury. TNF-a and IL-1β were involved in acute lung injury.
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BACKGROUND: The affected liver can be completely removed by liver transplantation,long-term efficacy is superior to liver resection,the 5-year survival rate reaches 70% H1.In addition,liver transplantation can avoid a serious risk for incomplete liver function caused by hepatic resection in the case of liver dysfunction.OBJECTIVE: To retrospectively analyze the treatment effects and importance of orthotoplc liver transplantation for primary hepatic cancer patients.METHODS: A total of 75 patients with primary hepatic cancer treated by orthotopic liver transplantation in Department of Hepatobiliary Surgery,Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA from March 1980 to December 2008 were involved in the analysis for the postoperative survival rates and recurrence of tumors.RESULTS AND CONCLUSION: For all the patients,the total postoperative survival rate in the 1st,2nd and 3rd year was 86.6%,66.7% and 53.3% respectively,the disease free survival rate was 65.2%,53.9%,34.1%.Their mean survival time is 25 months.For the patients in line with Milan standard,the postoperative survival rate in the 1st,2nd and 3rd year was 88.4%,72.5% and57.9% respectively,the disease free survival rate was 77.6%,62.3%,51.8%.Their mean survival time is 39 months.Tumor recurrence occurred within one year in all six patients who were beyond Milan standard.Two patients died in one year after operation,the survival rate at postoperative one year was 66.7% and the remanent four patients all died in the 2nd year after operation.Orthotopic liver transplantation was one of the effective treatments for pdmary hepatic cancer patients.The patients which were measured up to Milan standard would have the best curative effects.