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Objective To compare the difference of clinical efficacy between surgical magnifying glass and surgical microscope assisted hepatic artery reconstruction in living donor liver transplantation (LDLT). Methods Clinical data of 272 donors and recipients undergoing LDLT were retrospectively analyzed. According to different patterns of hepatic artery reconstruction, all recipients were divided into the magnifying glass group (n=189) and microscope group (n=83). The operation time, intraoperative blood loss, hepatic artery reconstruction site, diameter of anastomosis, incidence of postoperative complications and survival rate of recipients were statistically compared between two groups. Results Compared with the microscope group, the operation time, hepatic artery reconstruction time and intraoperative blood loss were significantly less in the magnifying glass group (all P < 0.001). The most common site of hepatic artery reconstruction was the right hepatic artery in two groups, and the diameter of anastomosis was (2.1±0.9) mm in the magnifying glass group and (2.1±0.8) mm in the microscope group, with no statistical significance between two groups (P > 0.05). The 1-, 2- and 3-year survival rates of recipients in the magnifying glass group were 88%, 86% and 85%, which did not significantly differ from 89%, 87% and 86% in the microscope group (all P > 0.05). The incidence of postoperative complications did not significantly differ between two groups (all P > 0.05). Conclusions The efficacy and safety of hepatic artery reconstruction in LDLT under surgical magnifying glass are equivalent to those under surgical microscope, with less operation workload and intraoperative blood loss. For experienced transplantation surgeons, it is recommended to perform hepatic artery reconstruction assisted by surgical magnifying glass.
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ObjectiveTo investigate the correlation between serum CA125 level and the severity of liver dysfunction in patients with liver cirrhosis. MethodsWanfang Data, CNKI, CBM, and VIP were searched for Chinese articles on the correlation between serum CA125 level and the severity of liver dysfunction in patients with liver cirrhosis published from January, 2008 to October, 2018, with a liver cirrhosis group and a normal control group in each article. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) was used for quality assessment. The mean and standard deviation of CA125 in liver cirrhosis group, healthy control group, and liver cirrhosis groups with different Child-Pugh classes were analyzed. Meta-Analyst software was used to calculate the standardized mean deviation (SMD) of CA125 in each group and perform the meta-analysis. A heterogeneity analysis was performed for the studies included in this study; a random effects model was used in case of significant heterogeneity, while a fixed effect model was used in case of insignificant heterogeneity. A one-way analysis of variance was used for comparison of continuous data between multiple groups. ResultsA total of 15 articles were included in this study. The meta-analysis showed that the liver cirrhosis group had a significantly higher serum CA125 level than the healthy control group (181.18±110.76 U/ml vs 15.10±7.15 U/ml, SMD=2.28, 95% confidence interval: 1.81-2.76, P＜0.001). The level of CA125 increased significantly with the increase in Child-Pugh class (F=15.704, P＜0.001). ConclusionSerum CA125 level is correlated with the severity of liver dysfunction in patients with liver cirrhosis and thus has a certain value in evaluating the severity of liver dysfunction and predicting prognosis.
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Objective To investigate the clinical value of assessment of the left ventricular function in pa-tients with post-hepatitis b cirrhosis using Tei index and its related parameters measured by Tissue Dopple Imaging. Methods Ninety-seven subjects were enrolled,with 43 ones in the normal control group,and 54 ones in the post-hepatitis b cirrhosis group. According to the Child-Pugh grading standard,patients in the post-hepatitis b cirrhosis group were divided into grade Child A(24 cases),grade Child B(15 cases)and grade Child c(15 cases). Color ul-trasonograph was used to detect the left ventricle Tei indexes of patients in each group,and comparison was made in the differences of the parameters among all groups. Results (1)The Tei index,IRT/ET and ICT/ET of left ven-tricular in the liver cirrhosis group were higher than those in the normal/control group,with significant differences between the two groups(P < 0.05). The Tei index,IRT/ET and ICT/ET of the left ventricular increased gradually in patients of grade Child A,B,and C,and significant differences were observed in Tei index,IRT/ET(P < 0.05), but no significant diference in ICT/ET was found.(2)There were no significant difference in LVEF and Ea/Aa be-tween the cirrhosis group and the normal control group. LVEF and Ea/Aa in grade Child C were significantly lower than those in the normal control group(P < 0.05). Conclusion Tei index is superior to conventional echocardiog-raphy on assessment of the left ventricular function in patients with liver cirrhosis. Patients with higher the Child-Pugh score may be suffered from the worse the left ventricular function,especially the diastolic dysfunction.
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Objective To investigate MELD and Child-Pugh in the patients with decompensated liver cirrhosis.Methods 41 cases of death and 71 survivors were graded with MELD and Child-Pugh and compared.Results The deaths' MELD and Child-Pugh score was (17.93?8.22 )and (10.07?1.84),the survivors' was (11.18?6.54 ) and (8.04?2.09)(P=0.000).Among the deaths and survivors,MELD≤9 was 14.63% and 42.25%(P =0.003),MELD 20-29 was 26.83% and 8.45%(P=0.009),Child A was 21.95% and 56.34%(P=0.000),Child C was 29.27% and 5.63%(P=0.001).Conclusion The deaths' MELD and Child-Pugh score is higher than the survivors'.The MELD score can act as a disease severity and prognosis index for patients with decompensated liver cirrhosis.