A brief discussion of Glisson pedic-first approach in laparoscopic anatomical hepatectomy / 中华肝胆外科杂志

With the continuous in-depth understanding of liver anatomy and the progress of surgical techniques, laparoscopic hepatectomy has been developed rapidly, especially the laparoscopic anatomic hepatectomy has become the most commonly surgical method. The dissection and treatment of liver Glisson pedicle is the core techniques of laparoscopic anatomic hepatectomy. The Glisson hepatic pedicle approach has been widely used in open and laparoscopic anatomical hepatectomy, especially in laparoscopic hepatectomy. The possible advantages over the traditional approach are still under debate, and there is no standard surgical approach for pedicle dissection to date. This article introduces Glisson pedicle approach and the advantages and clinical application of laparoscopic anatomical hepatectomy with Glisson pedicle approach.

Clinical efficacy of laparoscopic hepatectomy for intrahepatic cholangiocarcinoma / 中华消化外科杂志

Objective To investigate the clinical efficacy of laparoscopic hepatectomy for intrahepatic cholangiocarcinoma (ICC).Methods The retrospective cross-sectional study was conducted.The clinicopathological data of 62 patients with ICC who were admitted to Mengchao Hepatobiliary Hospital of Fujian Medical University (32 patients) and the First Hospital Affiliated to Army Medical University (30 patients) between January 2013 and January 2018 were collected;there were 35 males and 27 females,aged from 25 to 77 years,with an average of 60 years.According to the preoperative and intraoperative situations,lymph node dissection was performed,and anatomical or non-anatomical laparoscopic hepatectomy were performed based on tumor size and location.Observation indicators:(1) surgical and postoperative recovery;(2) pathological examination results;(3) follow-up and survival situations.Follow-up was conducted by telephone interview and outpatient examination once every 3 months to detect tumor-free survival and overall survival of patients up to June 2018.Measurement data with normal distribution were represented as Mean±SD.Measurement data with skewed distribution were represented as M (range).Count data were described as absolute number and percentage.The survival curve and rate were drawn and calculated by the Kaplan-Meier method.Results (1) Surgical and postoperative recovery:all the 62 patients received successful laparoscopic hepatectomy,without conversion to open surgery or preoperative death,including 40 with anatomical hepatectomy and 22 with non-anatomical hepatectomy.There were 18 patients undergoing regional lymph node dissection.The operation time of 62 patients was (217±86)minutes.Of 62 patients,12 had hepatic vascular occlusion using the Pringle method with a total occlusion time of (14±7)minutes,45 received selective hepatic vascular occlusion and 5 did not receive hepatic portal occlusion.The volume of intraoperative blood loss was 282 mL (range,20-2 500 mL).Four patients had intraoperative infusion of suspended red blood cells.The time for out-of-bed activity,time to initial anal exsufflation,time of abdominal drainage-tube removal,recovery time of liver function to normal level were 1 day (range,1-3 days),2.5 days (2.0-4.0 days),(4.4±1.3)days,(6.8±1.6) days.There was no liver failure.Six of 62 patients had postoperative complications,including 5 with thoracic and abdominal effusion,3 with abdominal infection,2 with pulmonary infection,2 with bile leakage,1 with intraperitoneal hemorrhage,1 with urinary retention,1 with postoperative incision infection,multiple complications might occur in the same patient.Two of 6 patients with complications of Clavien-Dindo Ⅲ were improved by symptomatic treatment.The other patients had no clear complications.The duration of postoperative hospital stay was (13±9) days.Thirteen patients received preventive TACE treatment after surgery,9 received 4-6 courses of chemotherapy,2 received both TACE and chemotherapy with chemotherapy drug of Tegafur or gemcitabine combined with cisplatin.(2) Pathological examination results:the tumor diameter of 62 patients was (5.4±3.3)cm,including 38 with the diameter ≤ 5 cm and 24 with the diameter ＞5 cm.There were 56 patients of mass-forming type,4 of intraductal growth type and 2 of periductal infiltrating type.High-,moderate-,poor-differentiated adenocarcinoma were respectively detected in 10,37 and 15 of 62 patients.The distance of surgical margins to tumor was ＞ 1.0 cm in 57 patients.There were 60 patients with negative surgical margin,1 patient of intraductal growth type and 1 of periductal infiltrating type with positive margin.Lymph node dissection was performed in 18 patients,among which 11 were pathologically positive,otherwise,there were 16 patients with microvascular invasion,and 4 patients with peripheral nerve infiltration.TNM stages of 62 patients:stage Ⅰ A,stage Ⅰ B,stage Ⅱ and stage ⅢB were respectively detected in 14,23,14 and11 patients.(3) Follow-up and survival situations:62 patients were followed up for (22± 12) months.The 1-and 3-year disease-free survival rates were 65.2％ and 39.8％ respectively.The 1-and 3-year overall survival rates were 89.6％ and 52.5％ respectively.During the follow-up,2 of 44 patients without lymph node dissection had liver portal lymph node metastasis,1 had extensive lymph node metastasis,2 died of other causes at 6 months and 18 months after operation.Conclusion Routine laparoscopic radical resection of intrahepatic cholangiocarcinoma with regional lymph node dissection is safe and effective,however,laparoscopic hepatectomy should be carefully selected for intraductal growth type and periductal infiltration type.

Expression of thioredoxin-2 for monitoring minimal residual disease in acute leukemia / 中南大学学报(医学版)

OBJECTIVE@#To investigate the significance of human thioredoxin-2 (TRX-2) in monitoring minimal residual disease (MRD) in acute leukemia (AL).@*METHODS@#We used real-time quantitative PCR to serially quantitize TRX-2 expression levels in the bone marrow of AL patients at diagnosis (n=68), at complete hematologic remission (CHR, n=57) and at relapse (n=25). Another 25 normal donors served as normal controls. The upper limit of the bone marrow at 91 was regarded as the reference. TRX-2 expression level at CHR with 91). TRX-2 level was correlated to the expression level of MRD.@*CONCLUSION@#TRX-2 may be the marker for AL and used in MRD monitoring.

Inducement of rat liver transplantation tolerance by Treg cells and imDCs / 中华器官移植杂志

Objective To explore the effects of combined infusion of Treg cells from recipient rats and imDCs from donor rats prolonging the survival time of rats undergoing allogeneic orthotopic liver transplantation.Methods One hundred cases of rat allogeneic orthotopic liver transplantation were performed by using modified two-cuff method: DA rats served as donors,and Lewis rats as recipients,which were divided into 5 groups: acute rejection group,mDC group,imDC group,Treg group,co-infusion group (imDC-Treg group).2 × 106 imDC,2 × 106 mDC and 1 × 107 Treg cells were respectively injected to Lewis rats in every group via caudal vein before transplantation.Four Lewis rats from each group were randomly sacrificed on the day 3,7 and 10 after transplantation.Liver function (ALT and TBIL) and changes of cytokines (IL-10,IL-2 and TGF-β) were evaluated in peripheral blood.The pathological changes of the liver graft were observed.The DNA fragmentation characteristics of apoptosis in the liver were detected by using TUNEL staining.Survival analysis was performed on remnant rats.Results The liver function in imDC-Treg group had reverted to normal faster than that in the control groups.ELISA revealed that at day 7,the serum levels of IL-10 and TGF-β were higher,and the serum levels of IL-2 were lower in imDC-Treg group.Liver pathology demonstrated that there was only a slight number of mononuclear cell infiltration in hepatic graft afterorthotopic liver transplantation in co-infusion group (imDC-Treg group),which belonged to a nonidentified or slight type of acute rejection,and the liver graft showed regeneration of hepatocytes along with a small number of neutrophile granulocyte infiltration at the day 10.TUNEL staining indicated that the number of apoptotic T cells was much less in control groups than in imDC-Treg groups.The survival time of recipients in Treg-imDC group was 37 days,significantly longer than in irnDC group (23 days) and Treg group (15 days).Conclusion Infusion of imDC from donor rats or Treg from recipient rats alone couldn't induce long-term allograft survival of recipients after allogeneic rat liver transplantation.The co-infusion of Treg and imDC significantly prolonged the survival time of rats subject to allogeneic liver transplantation.