Value and reasonable choice of reoperation for recurrence of hepatocellular carcinoma after operation / 中国实用外科杂志

For recurrent hepatocellular carcinoma(HCC),hepatectomy is an active and active treatment method.Choosing appropriate cases will get good results. RecurrentHCC complies with Milan criteria,ECOG score is 0-2,andsalvage liver transplantation(SLT) can be considered. If thediameter of the tumor is less than 5 cm,single or multiplelesions are concentrated in a certain area,located at the edgeof the liver,and the liver function is good,hepatectomy should be the first choice. Laparoscopic surgery may also beconsidered in units with good equipment and accumulatedexperience. For recurrent HCC with tumor diameter > 5 cm,aslong as liver reserve function is allowed and FRLV issufficient,it should be actively strived for resection again. If ithas been proved that recurrent HCC originated from a singlecenter or combined with MVI,comprehensive treatment shouldbe rationally arranged. Besides hepatectomy,RFA,TACE,TACE + RFA and targeted drugs should be sequentiallycombined. Otherwise,the effect of hepatectomy alone is notideal. If recurrent HCC is accompanied by decompensation ofliver function,severe cirrhosis,portal hypertension,andinvasion of the main intrahepatic vascular trunk,it isrecommended to abandon reoperation and adopt other non-surgical treatment.

Radiofrequency-assisted anterior approach right hepatectomy for hepatocellular carcinoma / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the safety and efficacy of radiofrequency-assisted anterior approach right hepatectomy for hepatocellular carcinoma (HCC).</p><p><b>METHODS</b>The clinic data of 12 HCC patients who underwent radiofrequency-assisted anterior approach right hepatectomy from January 2010 to July 2011 was analyzed retrospectively. Surgical techniques and treatment response were retrospectively reviewed. All the 12 patients were male, aging from 38 to 57 years with a mean of (48 ± 6) years. Ten of the 12 patients were infected with hepatitis B virus. A retrohepatic tunnel anterior to the surface of the inferior vena cava (IVC) was developed. The liver was hanged away from the IVC and radiofrequency was carried out along the Cantline's line. Scalpel was used to cut off the liver parenchyma along the middle of the ablated area until the parenchyma was fully resected. After short hepatic veins and the right hepatic vein were ligated, ligaments of right liver were fully isolated and right liver was resected. The t test was performed between 2 groups.</p><p><b>RESULTS</b>The surgical time was 165 to 295 minutes, with a mean of (230 ± 55) minutes. The bleeding was 150 to 1500 ml, with a mean of (516 ± 378) ml, which was better than those of anterior approach right hepatectomy ((1291 ± 1159) ml) and classical right hepatectomy ((2129 ± 2012) ml; t = 1.236, 3.265; P < 0.05). The postoperative hospital stay was 8 - 19 days, with a mean of (12 ± 4) days. There were no medical complications and no postoperative death. All patients were cured and discharged.</p><p><b>CONCLUSIONS</b>Radiofrequency-assisted anterior approach right hepatectomy for HCC is safe and effective and could effectively decrease intra-operative bleeding and shorten surgical time.</p>

Clinic predictors of efficacy and adverse events of sorafenib therapy for advanced hepatocellular carcinoma patients / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the clinic predictors of efficacy and adverse events of sorafenib in treating with advanced hepatocellular carcinoma (HCC) patients.</p><p><b>METHODS</b>From December 2008 to October 2011, 54 patients received sorafenib for unresectable or metastatic HCC. There were 46 male and 8 female patients. The mean age was 48.7 years (ranging from 21 to 77 years). Patients received sorafenib orally 400 mg twice daily on a continuous dosing schedule with 6 weeks counting as a single cycle. Tumor response was assessed according to the Response Evaluation Criteria in Solid Tumor and toxicity grading was performed using the National Cancer Institute Common Toxicity Criteria version 3.0. The relationship between different clinic variable factors and curative effects of sorafenib was analyzed by using Cox proportion hazard regression analysis.</p><p><b>RESULTS</b>HCC was etiological related to HBV in 52 patients (96.3%). Following sorafenib therapy, 2 patients (3.7%) achieved a partial response and 24 patients (44.4%) achieved stable disease, with a disease control rate of 48.1%. The median time to progression (TTP) was 3.8 months. Multivariate analysis showed that greater Child and Eastern Cooperative Oncology Group (ECOG) grade were independent predictors of shorter TTP (HR = 1.361, 95%CI: 1.081 - 12.665, P = 0.041; HR = 1.449, 95%CI: 1.151 - 12.305, P = 0.032). The common adverse events were hand-foot syndrome (64.8%), alopecia (46.3%), and diarrhea (44.4%).</p><p><b>CONCLUSIONS</b>Single-agent sorafenib demonstrates good efficacy and acceptable tolerability in treating advanced HCC. The presents of Child class A and ECOG performance grade 0 predict better response to sorafenib in advanced HCC patients.</p>

Role of tissue factor in hepatocellular carcinoma genesis, invasion and metastasis / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Numerous studies indicate that tissue factor (TF), namely tissue thromboplastin, has a close relationship with malignant tumor genesis and progress. It contributes to blood coagulation as well as the regulation of cellular differentiation, the formation of blood vessels, and also tumor recurrence and metastasis. The present study aimed to detect TF expression in hepatocellular carcinoma (HCC) patients and to elucidate its association with prognosis and clinical features of the disease.</p><p><b>METHODS</b>The plasma TF levels of 50 HCC patients and 30 controls were assayed by ELISA. The expressions of TF mRNA and protein in HCC tissues, adjacent tissues and normal tissues were detected by reverse transcription-polymerase chain reaction (RT-PCR) and Western blotting. The acquired data were analyzed with related clinic-pathological documents. The patients were followed up for five years, and the relationship between TF and prognosis was analyzed.</p><p><b>RESULTS</b>The plasma TF levels were significantly increased in HCC compared to the controls (P < 0.05), presenting a close relationship with differentiation level, tumor size and hepatocirrhosis occurrence (P < 0.05). There were remarkably higher values in cases of lymphatic metastasis, extrahepatic metastasis and portal tumor thrombus (PTT) (P < 0.05) compared to non-metastasis or non-tumor thrombus, but no significant difference with different focus number or envelope (P > 0.05). The positive rates and the relative expression of TF mRNA in HCC tissue were 63.0% (17/27) and 0.567 ± 0.268, respectively, significantly higher than that in adjacent tissues or normal tissues (P < 0.05). In the patients with positive results, the relative expression intensity varied significantly with different tumor size and index of local invasion and metastasis (P < 0.05). The positive rates and the relative expression intensities of TF protein in HCC tissue were 74.1% (20/27) and 4.093 ± 1.256, respectively, significantly higher than those in adjacent tissue or normal tissue (P < 0.05). In the patients with positive results, the relative expression intensity showed significant difference in different tumor size, differentiation level, and index of local invasion and metastasis (P < 0.05).</p><p><b>CONCLUSIONS</b>The TF levels were significantly higher in plasma and tissues of HCC patients, presenting a close relationship with the index of invasion and metastasis. It indicated that TF might be related to differentiation and metastasis of HCC.</p>

Combination with vascular resection and reconstruction in resection of hilar cholangiocarcinoma / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the value of vascular resection and reconstruction in resection of hilar cholangiocarcinoma.</p><p><b>METHODS</b>The clinical data of 17 patients with hilar cholangiocarcinoma received resection in combination with vascular resection and reconstruction from January 2000 to September 2009 was retrospectively analyzed. Among the 17 patients, 6 underwent portal vein segmental resection and end-to-end anastomosis, 3 underwent portal vein wedge resection, 1 underwent hepatic artery ligature, 2 underwent hepatic artery segmental resection and end-to-end anastomosis, 1 underwent portal vein arterialization, 1 underwent portal vein wedge resection and hepatic artery ligature simultaneously, 2 underwent portal vein segmental resection and hepatic artery segmental resection and end-to-end anastomosis simultaneously, 1 underwent portal vein segmental resection and right hepatic artery and gastroduodenal artery end-to-end anastomosis simultaneously.</p><p><b>RESULTS</b>Four patients died and the mortality was 4/17. Three patients died of renal dysfunction followed with multiple organ dysfunction and 1 patient died of sepsis shock. Among the 13 survive patients, 6 had a smooth postoperative recover and 7 developed complications: 3 had bile leakage, 1 had respiratory failure, 1 had cholangitis due to obstruction of U tube, 1 had abdominal infection and thrombosis in portal vein system and 1 had portal vein stenosis and liver abscess. Follow-up investigation showed that the median survival time was 18 months and four patients still alive.</p><p><b>CONCLUSIONS</b>Combination of vascular resection and reconstruction in the resection of hilar cholangiocarcinoma may help to improve the resection rate but still have a high postoperative risk. The complications of renal dysfunction should be alert during the postoperative observation. The procedure of hepatic arterial reconstruction may help to reduce postoperative morbidity.</p>

The impact of preoperative biliary drainage on surgical morbidity in hilar cholangiocarcinoma patients / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the impact of preoperative biliary drainage on surgical morbidity in hilar cholangiocarcinoma patients underwent surgery.</p><p><b>METHODS</b>One hundred and eleven consecutive patients with hilar cholangiocarcinoma whose serum total bilirubin (TBIL) level > 85 micromol/L and underwent surgery in the period from June 1998 to August 2007 were enrolled. There were 67 male and 44 female patients, aged from 26 to 82 years old with a mean of 56 years old.</p><p><b>RESULTS</b>Fifty-five patients underwent preoperative biliary drainage with a mean of 11.4 d of drainage period (drainage group), the other (n = 56) were the non-drainage group. The preoperative TBIL level of drainage group was (154 +/- 69) micromol/L, which was significantly lower than the value of pre-drainage (256 +/- 136) micromol/L (P = 0.000) and the value of non-drainage group (268 +/- 174) micromol/L (P = 0.005). ALT and GGT levels could be lowered by preoperative biliary drainage. The postoperative complications of these two groups were comparable (36.3% vs. 28.6%, P = 0.381). Four patients in drainage group and 5 patients in non-drainage group died of liver failure. Multivariate logistic regression indicated that hepatectomy (OR = 0.284, P = 0.003) was the independent risk factor associated with postoperative morbidity. Bismuth-Corlette classification (OR = 0.211, P = 0.028) was the independent risk factor linked to postoperative mortality.</p><p><b>CONCLUSIONS</b>Preoperative biliary drainage could alleviate liver injury due to hyperbilirubin, but it could not decrease the surgical morbidity and postoperative mortality. Concomitant hepatectomy and Bismuth-Corlette classification were independent risk factors linked to surgical risks.</p>

Long-term outcome and prognostic factors of intrahepatic cholangiocarcinoma / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The management of intrahepatic cholangiocarcinoma (ICC) remains a challenge due to poor prognosis. The aim of this study was to summarize the surgical management experience in recent 10 years and to identify the influencing factors related to outcome of patients with ICC in a single hepatobiliary center.</p><p><b>METHODS</b>From January 1995 to June 2005, 136 patients with ICC undergoing surgery were reviewed retrospectively. Survival rates of patients were calculated using the Kaplan-Meier method and compared by using the log-rank test. The prognostic factors were identified by the Cox regression model.</p><p><b>RESULTS</b>Seventy-nine of 136 patients underwent resection, and 65 of 79 patients were curative (R0). The surgical mortality was 2.2%. The 1-, 3- and 5-year survival rates of patients undergoing R0 resection were 72.1%, 35.6% and 20.1% respectively, which were significantly longer than those who underwent palliative resection and exploration, respectively (P < 0.01). At stage IV of the disease, 10 patients who underwent aggressive curative resection achieved a better median survival than those (n = 12) without resection (14 months vs 3 months, P < 0.001). The independent prognostic factors of the whole group were TNM stage (OR, 2.013, P = 0.008) and curative resection (OR, 2.957, P = 0.003). Higher TNM stage (OR, 1.894, P = 0.004) and lymph node metastasis (OR, 4.248, P = 0.005) linked to poor prognosis after R0 resection. For patients without lymph node metastasis, the median survival of those who underwent regional lymphadenectomy was comparable with those who did not (18 months vs 22 months, P = 0.817).</p><p><b>CONCLUSIONS</b>R0 resection is mandatory for ICC patient to achieve long-term survival. Aggressive resection benefits for selected patients with local advanced disease. Higher TNM stage and lymph node metastasis were poor prognostic factors for ICC patients after R0 resection.</p>

Combined hepatic resection and intraoperative thermal ablation for multifocal hepatocellular carcinoma / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the safety and efficacy of hepatic resection combined with intraoperative ablation to treat multifocal hepatocellular carcinoma.</p><p><b>METHODS</b>Clinical data of patients diagnosed with multifocal hepatocellular carcinoma and treated with hepatic resection combined with intraoperative ablation from March 1998 to September 2007 were retrospectively reviewed. Treatment response, postoperative complications and survival data were analyzed.</p><p><b>RESULTS</b>Combined treatment modalities were well tolerated except one patient dying of postoperative hepatic functional failure. The postoperative complication rate was 23.5% with a mortality rate of 6.7%. Postoperative complication included wound infection (1 case), bile leakage (1 case), subphrenic and pleural effusion (1 case), ablation-associated liver abscess (1 case), all of which were treated with non-surgical methods. The median survival time was 25.9 months. The 1, 3, 5 year survival rates were 70.6% (12/17), 23.5% (4/17), 17.6% (3/17), respectively. Three patients survived more than 5 years after surgery. Up to April 2008, 4 patients were still alive.</p><p><b>CONCLUSION</b>Hepatectomy combined with intraoperative thermal ablation provides a treatment modality for patients with multifocal hepatocellular carcinoma and may improve the prognosis.</p>

Changes in TGF-beta1/Smads signaling pathway in rats with chemical hepatocarcinogenesis / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the changes in transforming growth factor beta 1 (TGF-beta1)/Smads signaling pathway in rats with chemical hepatocarcinogenesis.</p><p><b>METHODS</b>Fresh diethylnitrosamine (DENA) solution was administered in SD rats to induce hepatocellular carcinoma (HCC). The protein expressions of TGF-beta1, phosphorylated Smad2, Smad4 and Smad7 were detected in these rats with immunohistochemistry, and the mRNA expression of Smad4 was evaluated with RT-PCR.</p><p><b>RESULTS</b>Cirrhotic nodules occurred in the rats 8 weeks after DENA treatment, and HCC nodules were found 16 weeks after the treatment. In the normal liver tissue, very low levels of TGF-beta1 and Smad4 expressions, low Smad7 expression and high phosphorylated Smad2 expression were detected. The development of liver cirrhosis was accompanied by increased expressions of TGF-beta1, Smad4 and Smad7 but at 8 weeks after DENA treatment, the expression of phosphorylated Smad2 was significantly decreased, followed then by gradual increment till nearly the normal level. Twenty-two weeks after DENA treatment, Smad4 expression in liver tissue decreased markedly as compared with the levels at 8 and 16 weeks. The expressions of Smad4 and phosphorylated Smad2 in the HCC tissue was significantly lower than those in normal liver tissue.</p><p><b>CONCLUSION</b>Hepatocarcinogenesis involves very complex mechanisms, can can be related partially to the decreased Smad4 and phosphorylated Smad2 expression and TGFbeta1 and Smad7 overexpression in advanced stage of liver cirrhosis.</p>

Determination of the postoperative effect on intestinal structure and myoelectric motility in rabbits: modified uncut jejunal loop versus Roux-en-Y biliodigestive anastomosis / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate influences on intestinal structure and myoelectric motility between modified uncut jejunal loop and Roux-en-Y procedures for biliodigestive anastomosis.</p><p><b>METHODS</b>Fifteen rabbits were randomized in modified uncut jejunal loop group, Roux-en-Y group and control group. Traced fasting slow-wave frequency (SWF) before biliodigestive diversion and 25 d postoperative (POD25) during laparotomy. Before the second laparotomy on POD21, the fasting SWF, percentage of abroad migrating myoelectric complex (MMC%), the postprandial spike potential frequency (SPF) and percentage of abroad propagation (SP%) were recorded in vivo. Compared myoelectric recordings according to parameters above. On POD90, harvested the stitched ligation of ascending loop and part of descending loop in uncut group, and biliary limb in R-Y animals, which assessed under HE, c-kit labeling immunohistochemical staining and transmission electron microscope(TEM).</p><p><b>RESULTS</b>On POD25, SWF declined mildly in uncut group (8.4%) and markedly in R-Y group (23.8%) respectively. The difference was significant (P<0.05). Before laparotomy on POD21 when abdomen closed, between uncut and control animals, there were statistical difference in fasting SWF and postprandial SPF (P<0.05), while no significance in MMC% and SP% (P>0.05). Moreover, differences of each parameters between R-Y group and control or uncut group were markedly statistical (P<0.01). Abroad myoelectric propagation through the ligated segment can be observed in uncut animals. Meanwhile, ectopic pacemaker was detected locating in the proximal segment of the Roux limb and triggering retrograde propagation in R-Y animals. On POD90, no recanalization were observed In uncut animals. Furthermore, occluded lumen with mild atrophic mucosa under microscope and c-kit labeling cells located in the inner circular muscle layer were observed, which proven to be Interstitial cells of Cajal (ICCs) by TEM. In R-Y animals, lumen of the Roux limb dilated. There's no significant difference in c-kit labeling area between R-Y and uncut animals by image analysis system. Reductions of processes and intercellular gap junction in ICCs, and loose interconnections between ICCs and SMCS or nerve endings were observed in R-Y animals.</p><p><b>CONCLUSIONS</b>Impaired gastrointestinal motility after the Roux-en-Y procedure may due to the aberrant interstitial cells of Cajal. Modified uncut technique reveals a reliable and effective alternative for biliodigestive reconstruction.</p>

A survey of bile duct injuries sustained during laparoscopic cholecystectomy / 中华外科杂志

<p><b>OBJECTIVE</b>To summarize the reasons for bile duct injury (BDI) after laparoscopic cholecystectomy (LC), and to determine the effect of multiple treatment after BDI.</p><p><b>METHODS</b>A retrospective cohort study was performed. The medical records of 110 patients diagnosed with BDI after LC from October 1993 to November 2007, in ten large hospitals in Guangdong of China, were reviewed.</p><p><b>RESULTS</b>Among 110 patients with BDI, 58 cases (52.7%) were local patients, whereas 52 cases (47.3%) were transferred from outside hospitals. Reasons for BDI following LC were: (1) Lack of experience of the LC operator (48.2%); (2) LC performed during acute cholecystitis (20.0%); (3) The structure of Calot triangle was unclear (15.5%); (4) Variable anatomical position (11.8%); (5) Intra-operation bleeding (4.5%). The commonest sites of injury were the choledochus and common hepatic duct (76.4%). Following BDI, endoscopic stenting or operative repair was performed in 106 patients. The overall success rate was 95.3% (101/106), with a mortality rate was 0.9% (1/106). Cholangitis occurred in 3.8% (4/106) cases. Choledocho-enterostomy operation was performed in almost 60.0% (63/106) cases, and the success rate was 93.7% (59/63). Endoscopic stenting or operative repair was performed immediately following BDI in 23.6% (25/106) patients, the success rate was 100%; and within 30 days in 63.2% (67/106) patients. Eighty-eight out of 106 patients who underwent repair were successful following the first operative procedure.</p><p><b>CONCLUSIONS</b>Factors such as an un-experienced operator and unclear anatomical position were causes of BDI following LC. Early operative repair should be regarded as the treatment of choice, in patients diagnosed with BDI. Early refer to an experienced hepatobiliary operator ensures a high success rate.</p>

Effect of branched-chain amino acid-rich parenteral nutrition on protein metabolism after partial hepatectomy in rats with liver cirrhosis / 南方医科大学学报

<p><b>OBJECTIVE</b>To observe the effect of parenteral nutrition (PN) with branched-chain amino acid supplementation on protein metabolism after partial hepatectomy in rats with liver cirrhosis.</p><p><b>METHODS</b>Eighteen rats with liver cirrhosis were randomly divided into pre-operation group (n=6), post-operation 8.5% Novamin PN group (n=6) and post-operation 10% Hepa PN group (n=6), with 6 normal rats severing as the normal control group. Five days after the operation, serum albumin (ALB), insulin-like growth factor I (IGF-1) and plasma amino acid spectrum were measured, and ALB mRNA level in the liver was assayed using RT-PCR.</p><p><b>RESULTS</b>Postoperative serum ALB was similar between 10% Hepa PN and 8.5% Novamine PN groups, but the rats in the latter group showed significantly increased serum IGF-1 level, Fischer ratio and hepatic ALB mRNA expression (P<0.05).</p><p><b>CONCLUSION</b>Administration of PN with branched-chain amino acid supplementation can ameliorate plasma amino acid spectrum and increase protein synthesis in rats with liver cirrhosis after partial hepatectomy.</p>

Effect of Shenfu injection in postoperative recovery after abdominal surgery / 中国中药杂志

<p><b>OBJECTIVE</b>To investigate the effect of Shenfu injection (SF) in postoperative recovery after abdominal surgery.</p><p><b>METHOD</b>150 patients were randomly divided into control group (75) and SF group (75). The efficacy were evaluated with the time of passage of gas by anus, information of wound healing, blood routine, blood coagulaton function, liver function. Changes recovery factor, immune index and hemorheological index were detected too.</p><p><b>RESULT</b>The time of passage of gas by anus in SF group was significantly shorter than that in control group. Blood routine, blood coagulaton function, liver function showed no significant difference in the two group of preoperative and postoperative. Whole blood viscosity, blood reduced viscosity and plasma fibrinogen viscosity in SF group were significantly lower than that in control group after operation. IgG and IgA in SF group was significantly higher than that in control group after operation. IgG and CD4+/CD8+ in control group was significantly higher after operation than that in before operation. Among tissue damage plerosis correlation factor, the blood levels of superoxide dismutase (SOD) in SF group and control group is significantly lower than that in preoperation (P < 0.05), SOD in SF group was significantly higher than that in control group after operation. The blood levels of malondialdehyde (MDA) in SF group and control group is significantly higher than that in preoperation (P < 0.05). MDA in SF group was significantly lower than that in control group after operation. Whole blood viscosity, blood reduced viscosity and plasma fibrinogen viscosity in control group after operation were significantly higher than that before operation.</p><p><b>CONCLUSION</b>SF can stimulate the immune system and reduce the blood viscosity. It is contribute to the patients' rehabilitation.</p>

Efficacy of postoperative chemotherapy combined with immunotherapy for hepatocellular carcinoma with major portal vein tumor thrombus / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the efficacy of surgical treatment combined with immunochemotherapy via portal vein for hepatocellular carcinoma (HCC) with major portal vein tumor thrombus (PVTT).</p><p><b>METHODS</b>Between January 2001 and December 2005 76 HCC patients with tumor thrombus in portal trunk and (or) the first-order branch were recruited into the study. Patients were divided into group A (n = 29) and B (n = 47). Patients in group A were treated with hepatectomy plus portal thrombectomy in combination with postoperative adjuvant immunochemotherapy administered via portal vein. The immunochemotherapy regimen consisted of 5-Fluorouracil, Adriamycin, platinol and alpha-Interferon (PIAF). Patients in group B were subjected to hepatectomy plus thrombectomy alone. Survival rates were compared between two groups, and prognostic factors were identified.</p><p><b>RESULTS</b>Half-, One-, two- and three-year cumulative survival rates were markedly greater in group A than group B, being 82.3% vs 52.7%, 46.5% vs 20.2%, 14.3% vs 5.8%, 14.3% vs 5.8%, respectively. Group A had a significantly longer median survival time and median tumor-free survival time as compared with group B, being 11.5 months vs 6.0 months (P = 0.010), 4.5 months vs 2.4 months (P = 0.032), respectively. Multivariate analysis revealed that immunochemotherapy, pathological grading and tumor size were independent factors for survival times. And immunochemotherapy and pathological grading were independent factors for tumor-free survival time.</p><p><b>CONCLUSIONS</b>Surgical resection combined with adjuvant immunochemotherapy via portal vein represents as an effective modality for HCC with PVTT.</p>

Hepatic perfusion changes after interventional disconnection evaluated by CT perfusion imaging / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the changes in hepatic perfusion after interventional obliteration in patients with cirrhosis and portal hypertension by means of spiral CT perfusion imaging.</p><p><b>METHODS</b>Twenty-three patients who suffered from cirrhosis and portal hypertension were selected to undergo interventional disconnection. Partial spleen embolization (PSE) was performed in 15 patients and PSE combined with percutaneous transhepatic obliteration (PTO) was carried out in 8 patients. Hepatic perfusion was carried out pre- and post-operation. The density-time curve was obtained from the interest region of liver, abdominal artery, portal vein. The parameters of perfusion were calculated by the means of deconvolution simultaneously.</p><p><b>RESULTS</b>The portal vein perfusion (PVP) decreased in patients with PSE, but total hepatic blood perfusion was not statistically different from that of pre-operation. After treatment, the hepatic artery perfusion increased obviously. PVP decreased from 0.862 to 0.722 ml x min(-1) x ml(-1) but was not statistically different from that of pre-operation. Hepatic arterial perfusion and total hepatic blood perfusion increased from 0.128, 0.990 ml x min(-1)x ml(-1) pre-operatively to 0.290, 1.021 ml x min(-1) x ml(-1) postoperatively in patients with PSE combined with PTO.</p><p><b>CONCLUSIONS</b>Spiral CT perfusion could objectively reflect the hemodynamic change in hepatic parenchyma after the interventional vascular obliteration.</p>

Experience of surgical resection of 103 hilar cholangiocarcinoma / 中华外科杂志

<p><b>OBJECTIVE</b>To summarize the experience of surgical resection of 103 hilar cholangiocarcinoma.</p><p><b>METHODS</b>One hundred and three consecutive cases of hilar cholangiocarcinoma who underwent surgical resection at our hospital over the past ten years were reviewed retrospectively. The clinical data and long-term outcome were analyzed.</p><p><b>RESULTS</b>Out of 103 cases, 43 patients underwent radical resection (41.7%), and 60 patients underwent palliative resection. There were 34 patients developed postoperative complications and 8 patients died in hospital. For the radical resection group, the median survival time was 29.9 months and 1-year, 3-year, 5-year survival rate was 69.6%, 42.0%, 20.9%, respectively, which was significant greater than 34.1%, 10.2%, 0 of the palliative resection group (P < 0.05). Over the past five years, 42 cases underwent pre-operative drainage of bile and the rate of combined liver resection reached 53.8%. The tumor radical resection rate has increased to 45.7%, the median survival time have reached 24.7 months (P < 0.05).</p><p><b>CONCLUSIONS</b>Improvement of pre-operative management, intraoperative pathology for resection margin, and combined liver resection may help in increasing the radical resection rate. Radical resection can improve postoperative survival, and produce a satisfactory outcome for patient with hepatic hilar cholangiocarcinoma.</p>

The timing of hepatectomy for hepatolithiasis complicated with acute cholangitis / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the optimal timing of hepatectomy for intrahepatic lithiasis complicated with acute cholangitis.</p><p><b>METHODS</b>One hundred and twenty-six patients with hepatolithiasis who had a history of acute cholangitis and underwent hepatectomy were reviewed retrospectively. According to the period between the surgery and last attack of acute cholangitis, 126 patients were divided into 3 groups: > 3 months (group A, n = 73), 1 approximately 3 months (group B, n = 28), < 1 month (group C, n = 25). The operation time, blood loss, hospital stay, postoperative complications and stone residual rate were compared among the groups.</p><p><b>RESULTS</b>The intraoperative blood loss of C group was (644.0 +/- 625.7) ml, which was significantly higher than those of A and B group [(409.2 +/- 250.7) ml and (423.2 +/- 237.1) ml, respectively]. The numbers of patients who needed transfusion and the amount of blood transfusion in group C were also higher than those of group A and B. The incidence rate of complications, residual stone in group C were all markedly higher than those of group A and B. The period of hospital stay in group C was much longer than that in group A and B.</p><p><b>CONCLUSIONS</b>The optimal timing of hepatectomy for hepatolithiasis complicated with acute cholangitis is at least one month after subsidence of cholangitis.</p>

Surgical treatment for 68 patients with Caroli's disease / 中华外科杂志

<p><b>OBJECTIVE</b>To retrospectively investigate the diagnosis and the outcome of Caroli's disease treated by surgical procedures.</p><p><b>METHODS</b>The clinical data of 68 patients with Caroli's disease treated by surgical procedures between 1996 and 2002 were reviewed, retrospectively.</p><p><b>RESULTS</b>The patients, with a M/F ratio of 1:1.35 and a mean age of 46, presented mainly with recurrent cholangitis. Of all the patients, 26 had a history of operation for cholelithiasis or cholangitis. On admission, the image investigations suggested that the lesions located at left lobe in 44 patients, right lobe in 9 patients, and whole liver in 15 patients. The coexisting cyst in common bile duct was found in 20 patients. The malignant transformation was found in 5 patients (8.8%). Hepatectomy was performed in 82.4% of patients, with a morbidity rate of 15.0% and mortality rate of 0 after the surgery. The long-term outcome of symptom-free in hepatectomy group was 90.2%, significantly higher than the 33.3% in non-hepatectomy group (P < 0.01) after a 3 to 10 years of follow-up.</p><p><b>CONCLUSIONS</b>Hepatectomy offers a curative procedure for local Caroli's disease, and liver transplantation is a good option for diffuse sufferers.</p>

The study of inhibition effect of octreotide on the growth of hepatocellular carcinoma xenografts in situ in nude mice / 中华外科杂志

<p><b>OBJECTIVE</b>To observe the effect of octreotide (OCT) on inhibiting hepatocellular carcinoma (HCC) and investigate its mechanisms.</p><p><b>METHODS</b>Nude mice bearing xenografts in situ were treated with OCT or saline control for 7 weeks since tumor implantation. The immunohistochemistry for somatostatin receptor 2 (SSTR2), cMet, transforming growth factor beta1 (TGFbeta1), phospho-Smad2, Smad4 and Smad7 was performed. SSTR2 and Smad4 mRNA expression was measured by semi-quantitative RT-PCR.</p><p><b>RESULTS</b>After OCT treatment, the mean tumor weight in mice given OCT (0.17 +/- 0.14 g) was significantly lower than that of the control group (0.53 +/- 0.06 g). The inhibition rate of tumor was 67.9%. mRNA and protein expression of SSTR2, Smad4 in tumor cells of the treatment group were significantly more than that of the control group. cMet expression in OCT group was remarkably lower than that in control group. Between two groups, the expression of TGFbeta1, phospho-Smad2 and Smad7 were not remarkably different. In addition, phospho-Smad2 expression in HCC was significantly less than that of the normal hepatic cell.</p><p><b>CONCLUSION</b>OCT can inhibit the growth of HCC xenografts markedly. The mechanisms of OCT-induced inhibition effect may be related to up-regulating SSTR2 expression, down-regulating cMet, and recovering the function of TGFbeta/Smads-induced antitumor. In addition, the decreased expression of phospho-Smad2 may be an important feature of Bel7402 cells.</p>

Effects of amino acid solution and recombinant human growth hormone on growth hormone/insulin like growth factor-1 axis in rats with liver cirrhosis / 中华外科杂志

<p><b>OBJECTIVE</b>To explore the effects of amino acid solution and recombinant human growth hormone on growth hormone/insulin like growth factor-1 (GH/IGF-1) axis after partial hepatectomy in rats with liver cirrhosis.</p><p><b>METHODS</b>Six normal rats severed as normal group, while 30 rats with liver cirrhosis were randomly divided into preoperation group, 1 day postoperative group, 8.5% Novamin PN for 5 days postoperative group, 10% Hepa PN for 5 days postoperative group and rhGH + 10% Hepa PN for 5 days postoperative group. Liver function, blood glucose and serum GH, IGF-1, IGFBP-3 were determined. ALB mRNA, IGF-1 mRNA and IGFBP-3 mRNA levels in liver tissues were detected by RT-PCR. Liver Ki67 immunohistochemistry staining was studied.</p><p><b>RESULTS</b>Compared with the 8.5% Novamine PN group, serum ALT [(103 +/- 23) IU/L vs (154 +/- 45) IU/L], ALP [(571 +/- 92) IU/L vs (972 +/- 252) IU/L], GH [(1.55 +/- 0.12) ng/ml vs (1.81 +/- 0.11) ng/ml] level were lower (P < 0.05), serum IGF-1 [(966 +/- 55) ng/ml vs (813 +/- 43) ng/ml] and IGFBP-3 [(8.1 +/- 0.3) ng/ml vs (6.9 +/- 0.2) ng/ml] level and the expression of hepatic ALB mRNA (1.24 +/- 0.06 vs 1.02 +/- 0.09), IGF-1 mRNA (0.85 +/- 0.00 vs 0.60 +/- 0.03), IGFBP-3 mRNA (0.69 +/- 0.02 vs 0.58 +/- 0.09) were higher in the 10% Hepa PN group (P < 0.05), but there was no difference in liver Ki67 labeling index [(4.8 +/- 0.3)% vs (4.4 +/- 0.4%)] (P > 0.05). Compared with the 10% Hepa PN group, serum ALP [(434 +/- 41) IU/L vs (571 +/- 92) IU/L] was much lower (P < 0.05), serum ALB [(37.0 +/- 1.8) g/L vs (32.8 +/- 1.2) g/L], blood glucose [(7.6 +/- 1.3) mmol/L vs (4.9 +/- 0.7) mmol/L], GH [(3.00 +/- 0.61) ng/ml vs (1.55 +/- 0.12) ng/ml], IGF-1 [(1100 +/- 32) ng/ml vs (966 +/- 55) ng/ml], IGFBP-3 [(9.3 +/- 0.2) ng/ml vs (8.1 +/- 0.3) ng/ml] level, the expression of hepatic ALB mRNA (1.35 +/- 0.04 vs 1.24 +/- 0.06), IGF-1 mRNA (0.97 +/- 0.00 vs 0.85 +/- 0.00) and liver Ki67 labeling index [(5.4 +/- 0.3)% vs (4.8 +/- 0.3%)] were higher (P < 0.05) in the rhGH + 10% Hepa PN group.</p><p><b>CONCLUSIONS</b>Amino acid solution and recombinant human growth hormone can influence the GH/IGF-1 axis in rats with liver cirrhosis. It may be helpful in selecting and evaluating nutrient by measuring the serum IGF-1 and IGFBP-3 level.</p>