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Objective To assess the efficacy of orthotopic liver transplantation (OLT) for hepatocellular carcinoma (HCC) and the effect of recipient selection on postoperative survival. Methods The clinical data of 63 patients with primary HCC receiving OLT in this hospital from June 2000 to February 2007 were retrospectively analyzed. The cumulative survival rate after transplantation was analyzed by the Kaplan-Meier method. Results The 1-, 3- and 5-year cumulative survival rates of the 63 patients were 77.4%, 59.3%, 48. 9%, respectively. The rates in conformation with Milan criteria, UCSF criteria and beyond UCSF criteria were 93.8%, 80.8%, 80.8%; 92.1%, 79.2%,79.2%; 29.2%, 8.3%, 0, respectively. The 1-, 3-, 5-year cumulative recurrent rate of patients meeting Milan criteria, UCSF criteria and beyond UCSF criteria was 6.2%, 15.5%, 19. 2%; 7. 9%,15.9%, 20. 8% ; 70. 8%, 87. 5%, 91.7%, respectively (P＜0.01). However, tumor recurrence and survival rates were similar for patients meeting UCSF and Milan criteria (P＞0. 05). Conclusion Expansion of OLT criteria is justified for HCC and does not adversely impact the posttransplant prognosis by the UCSF criteria as compared with the Milan criteria.
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Objective To evaluate the clinical significance of a modified T-staging system for hilar cholangiocarcinoma(HCC).Methods From 1999 through 2007,98 HCC patients were stratified by the Tstaging system.Statistical differences were evaluated for resectability,radical resectability,concomitant partial hepatectomy,partial portal vein resection,histological differentiation,lymph node characteristic and survival rate.Results There were 43 HCC patients graded at T1,37 at T2 and 18 at T3 respectively.The resectability rates were 65%,40% and 11%,and radical resection was achieved in 46%,21% and 0% respectively.Resectabilities decreased with increasing T stage(χ~2=15,P<0.01;χ~2=14,P<0.01,separately).In patients with T1 and T2 tumors who underwent resection,the concomitant partial hepatectomy accounted for 60% and 73%(χ~2=0.6,P>0.05),partial portal vein resection for 3% and 33%(χ~2=4,P<0.05),poor differentiated types for 71% and 40%(χ~2=4,P<0.05),and lymph node metastasis for 50% and 40%(χ~2=0.4,P>0.05),respectively.The 1-,3-and 5-year survival rates in patients with T1 lesions were 58%,30%and 18%,in 12 patients it was 43%,11%and 0.The 1-and 2-year survival rate in T3 patients was 12%and 0.Patients witll T1 or T2 stage tumors had a significantly longer survival than those with T3(P<0.05)(Log rank χ~2=14,Breslow χ~2=12,P<0.01;Log rank χ~2=6,Breslow χ~2=4,P<0.05,individually),and the difference in survival between T1 and T2 was not significant(Log rank χ~2=2,Breslow χ~2=1,P>0.05).Conclusions The T-staging system is appropriate for preoperative evaluation in HCC patients.However,its correlation with tumor histological differentiation and lymphatic characteristics needs to be elucidated.
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Objective To search for the molecular figngerprint of ascaris lumbricoides in intrahepatic stones. Methods In 56 cases deoxyribonucleic acid (DNA) was exstracted from intrahepatic stones and surgically obtained bile duct tissues, stool and sercum examinations were performed. Based on the sequence and designed primers of ITS-2 of ascaris lumbricoides, polymerase chain reaction ( PCR) was performed. Results There were 12 positive results in 56 (21.4% ) cases of intrahepatic stones. Positive reaction appeared on the examinations of the stool on ascaris lumbricoides and the blood serum among 12 cases. Conclusions Ascaris lumbricoides DNA was found in human of intrahepatic stones, indicating that ascaris lumbricoides infection may play a role in the formation of intrahepatic stones.
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ObjectiveTo evaluate the intraoperative combined application of fibercholedochoscopy and B-type ultrasound for the treatment of intrahepatic biliary duct stones. Methods In our department 65 cases of intrahepatic biliary duct stones treated by fibercholedochoscopy and followed up for ten years were used as control. Results were compared with that of 78 cases undergoing combined management.ResultsFollow-up at first 5 years showed that patients treated with fiberbiliascopy had a much lower stone recurrent rate than that without, though difference became less significant within second 5 years. Intraoperative combined application of fibercholedochoscopy and B-ultrasound futher decreases the stone recurrence rate. ConclusionsCombining fibercholedochoscopy with B-type ultrasound intraoperatively enables the operator to locate intrahepatic biliary duct stones, reduces retained stone rate and stone recurrence.
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ObjectiveTo investigate the clinical epidemiology of intrahepatic cholelithiasis in Guangxi area. MethodsAn retrospective analysis was made on 8?585 cases of intrahepatic cholelithiasis proved by exploration in a period of 19 years. Data were collected and analyzed by computer PEMS.ResultsThe intrahepatic cholelithiasis accounted for more than one third of all biliary stone disease treated during the same period. The prevalence of intrahepatic cholelithiasis in peasants victim increased from 23.4% out of all gall stones in a period of 1981～1985 to 55.8% between 1991～1999. The constituent ratio of intrahepatic lithiasis in males was nearly the same to that in females. The peak age range of patients with intrahepatic lithiasis was 31～40, and the mortality was the highest among all biliary stone disease. ConclusionsIntrahepatic cholelithiasis is by no means a vanishing disease,especially in rural area.