Clinical value of split domino donor auxiliary liver transplantation / 中华消化外科杂志

Objective:To investigate the clinical value of split domino donor auxiliary liver transplantation.Methods:The retrospective and descriptive study was conducted. The clinco-pathological data of 3 liver transplantation recipients who were admitted to Nanjing Drum Tower Hospital affiliated to Nanjing University Medical School and 1 liver transplantation recipient who was admitted to external hospital in September 2018 were collected. The first case was male, aged 22 years, who was diagnosed as type II citrullinemia (CTLN2). The second case undergoing liver transplantation in external hospital was male, aged 59 years, who was diagnosed as decompensated alcoholic cirrhosis. The third case was female, aged 52 years, who was diagnosed as hepatocellular carcinoma of right lobe of liver. The fourth case was female, aged 51 years, who was diagnosed as hepatocellular carcinoma of right lobe of liver. The donor liver from a brain and cardiac death donor was split in vitro into the left liver and the right liver, in which the right liver without middle hepatic vein, and the modified piggyback liver transplantation using the left liver and the classical orthotropic liver transplantation using the right liver was conducted on the first and the second case, respectively. The original liver of the first case was split in vivo into the left liver and the right liver, and the piggyback auxiliary liver transplantation using the left liver and the piggyback auxiliary liver transplantation using the right liver was conducted on the third and the fourth case who underwent extended right hemihepatectomy, respectively. Observation indicators: (1) intraoperative situations; (2) follow-up. Follow-up was conducted using outpatient examination and telephone interview to detect liver function, liver imaging, complication and survival of recipients up to October 2021.Results:(1) Intraoperative situations. Liver transplantation was conducted successfully on the first, third and fourth case, with the operation time, the volume of intraoperative blood loss, the donor liver cold ischemia time, the graft-to-recipient weight ratio were 400 minutes, 370 minutes, 390 minutes, 600 mL, 1 300 mL, 1 600 mL, 230 minutes, 152 minutes, 135 minutes, 1.2%, 0.8%, 1.1%. (2) Follow-up. B-ultrasound examination of the first, third and fourth case after liver transplantation showed that the blood flow was normal, and all the 3 cases discharged and were followed up at postoperative 1, 6 and 12 month. The liver function, the level of blood ammonia and citrulline were normal of the first, third and fourth case at postoperative 1 week. Imaging examina-tion showed normal liver morphology of the first and third case, and a transplanted liver atrophy caused by portal vein steal of the fourth case. ① The level of alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBil), direct bilirubin (DBil) of the first case before liver transplantation, at postoperative 1 day, 2 day, 3 day, 7 day, 10 day, 6 month and 1 year were 22.8 U/L, 404.1 U/L, 355.5 U/L, 289.6 U/L, 31.0 U/L, 23.1 U/L, 42.1 U/L and 25.8 U/L, 31.5 U/L, 517.7 U/L, 327.6 U/L, 172.9 U/L, 15.9 U/L, 21.4 U/L, 47.5 U/L and 29.7 U/L, 3.8 μmol/L, 92.1 μmol/L, 87.4 μmol/L, 79.7 μmol/L, 90.1 μmol/L, 130.6 μmol/L, 33.8 μmol/L and 25.4 μmol/L, 2.3 μmol/L, 47.0 μmol/L, 44.1 μmol/L, 47.1 μmol/L, 57.4 μmol/L, 70.9 μmol/L, 24.7 μmol/L and 9.7 μmol/L, respectively. The level of citrulline and blood ammonia of the first case before and after liver transplantation were 999.0 μmol/L, 196.0 μmol/L and 14.6 μmol/L, 9.0 μmol/L, respectively. The first case was followed up for 3 years and survived without any liver transplantation related complication. ② The level of ALT, AST, TBil, DBil of the third case before liver transplantation, at postoperative 1 day, 2 day, 3 day, 7 day, 10 day, 6 month and 1 year were 21.3 U/L, 143.9 U/L, 182.0 U/L, 132.0 U/L, 17.2 U/L, 10.1 U/L, 17.6 U/L and 16.8 U/L,20.0 U/L, 291.0 U/L, 227.5 U/L, 106.4 U/L, 15.8 U/L, 10.8 U/L, 17.1 U/L and 19.4 U/L, 6.8 μmol/L, 50.9 μmol/L, 45.0 μmol/L, 34.0 μmol/L, 32.4 μmol/L, 22.3 μmol/L, 12.8 μmol/L and 14.9 μmol/L, 2.5 μmol/L, 18.4 μmol/L, 17.2 μmol/L, 14.9 μmol/L, 14.8 μmol/L, 12.1 μmol/L, 3.6 μmol/L and 4.4 μmol/L. The level of citrulline and blood ammonia of the third case after liver transplantation were 24.9 μmol/L and 16.0 μmol/L. The third case was followed up for 3 years and survived without any liver transplantation related complication. ③ The level of ALT, AST, TBil, DBil of the fourth case before liver transplantation, at postoperative 1 day, 2 day, 3 day, 7 day, 10 day, 6 month and 1 year were 35.0 U/L, 268.7 U/L, 682.0 U/L, 425.8 U/L, 57.5 U/L, 34.0 U/L, 29.4 U/L and 18.1 U/L, 37.0 U/L, 419.1 U/L, 436.2 U/L, 139.5 U/L, 35.2 U/L, 32.4 U/L, 54.7 U/L and 32.8 U/L, 7.1 μmol/L, 64.2 μmol/L, 41.4 μmol/L, 17.6 μmol/L, 34.2 μmol/L, 48.7 μmol/L, 14.1 μmol/L and 21.8 μmol/L, 2.8 μmol/L, 18.9 μmol/L, 16.1 μmol/L, 6.0 μmol/L, 14.6 μmol/L, 26.7 μmol/L, 3.9 μmol/L, 11.8 μmol/L. The level of citrulline and blood ammonia of the fourth case after liver transplantation were 8.4 μmol/L and 47.0 μmol/L. One week after surgery, the transplanted right liver of the fourth case occurred atrophy due to blood stealing from the right branch of the portal vein. B-ultrasound examination showed that the reflux of the hepatic artery and hepatic vein was unobstructed. Immunosuppressants were discontinued 3 months after operation on the fourth case and there was no complication such as rejection, bile leakage, biliary stricture, thrombosis and vascular stricture during follow-up. The fourth case died of lung metastasis 19 months after operation.Conclusion:Split domino donor auxiliary liver transplantation can be used for the treatment of metabolic liver disease and advanced hepatocellular carcinoma.

Discussion on the technique of resection of liver tumor in the caudate lobe / 中华肝胆外科杂志

The caudate lobe of liver is anatomically divided into three parts: Spiegel portion, inferior vena cava portion and caudate process. The caudate lobe of the liver is located in the dorsal side of the liver, adjacent to the inferior vena cava, the three hepatic veins, and the left and right portal veins. The location of the caudate lobe depends on the location of anatomical landmarks and the location of staining, especially negative staining techniques. The left approach is suitable for Spiegel resection, and the right approach is suitable for paracentral resection of the inferior vena cava and caudate process. The dorsal approach and anterior approach combined with other approaches can achieve complete caudate resection. This article showed the combination of multimodal approach with total caudate lobectomy, partial caudate lobectomy and laparoscopic caudate lobectomy.

Process in targeted contrast agents for cancer imaging / 中国药科大学学报

The application of medical imaging technology is playing an important role in diagnosis and treatment of cancer.In clinic,the most commonly used imaging technology to detect cancers are X-ray computed tomo graphy,nuclide imaging,magnetic resonance imaging and near-infrared fluorescence imaging.Contrast agents could enhance imaging signals and increase the sensitivity and accuracy of cancer detection.Neverthness,most of clinically used contrast agents have problems such as short retention time and tumor targeting insufficient,which is not favorable to cancer detecting.So it is of great significance to develop tumor targeting contrast agents.Currently,targeting strategies are divided into three types:passive targeting,active targeting and activatable targeting.In this review,we conclude the recent progress and applications of tumor targeting contrast agents of different imaging modilities.Besides,the future development of tumor targeting contrast agents is also prospected.

Research progress on liver regeneration after partial hepatectomy of fatty liver disease / 中华肝胆外科杂志

Fatty liver disease is a kind disease characterized by liver parenchyma cell degeneration caused by a variety of metabolic abnormalities.Fatty liver disease could be considered as a risk factor for partial hepatectomy,because it can not only increase intraoperative and postoperative morbidity and mortality,but also reduce the survival rate of liver transplant recipients.Therefore,this study focuses on the impact of fatty liver disease on liver regeneration after partial hepatectomy,which could guide the clinical strategy for the implementation of liver resection.This paper overviews the recent progress on the impact of fatty liver disease on liver regeneration after partial hepatectomy and the related mechanism.

Reconstruction of portal vein in liver surgery / 中华肝胆外科杂志

As an essential technique involved in complicated liver surgery,portal vein reconstruction results in eradication of macro- or microscopic tumor residual on surgical margins when combined with precise hepatectomy,improving both the living quality and the survival rate of patients.The application of this reconstruction technique needs precise evaluation of pre-operational image data,clearly dissection of portal vessels and tremendous amount of collaborative effort by the surgery team. Other techniques performed during the surgical procedure include intra-operative ultrasound scan,revitalizing the cryopreserved vessels,and angioplasty.

Surgical treatment strategy of advanced gallbladder carcinoma: report on 17 cases / 中华肝胆外科杂志

Objective To explore the optimal surgical treatment strategy of advanced gallbladder carcinoma (Nevin Ⅲ - Ⅴ ), with an aim to prolong patients' overall survival. Methods 17 patients with advanced gallbladder carcinoma were reviewed. Their preoperative diagnosis, surgical treatment, complications and survival time were studied. Results The diagnosis of advanced gallbladder carcinoma was done using different medical imaging techniques, but incorrect diagnosis still happened. There is a wide range of surgical treatment for advanced gallbladder carcinoma. Controversy still exists as whether lymph node resection should be done. In our patients, 35.3% of the 13a lymph nodes and 23. 5% of the 8 lymph nodes were positive for metastasis, which showed that lymph node resection should be carried out. Extended surgery was sometime required to ensure a R0 resection.The main complications of surgery were intraabdominal infection, bile leakage and paralytic ileus.Conclusion An aggressive surgical approach for advanced gallbladder carcinoma is required to ensure a R0 resection, which contributed to better overall survival.

Immune effectiveness of A/H1N1 influenza vaccine immunization in 505 health care workers within three months after vaccination / 中华传染病杂志

Objective To investigate the immunization effect of influenza A/H1N1 vaccine in health care workers (HCW) in Inner Mongolia Greater Khingan Mountains area. Methods Five hundred and five HCW who received A/H1N1 influenza vaccination (immunized group) and 129 staffs who didn't receive the vaccination (unimmunized group) were randomly sampled for semiquantitative testing of serum H1N1 antibody (IgG) levels by enzyme-linked immunosorbent assay (ELISA).Results were analyzed and stratified by age, sex, occupation and the time interval between the time of vaccination and serum sample collection. The antibody positive rates of the two groups were compared by x2test. Results There were 401 (79. 4%) HCW whose H1N1 antibody were positive and 50 (9.9%) whose antibody were weak positive among 505 immunized HCW. While among 129 unimmunized HCW, there were 59 (45.7%) whose antibody were positive and 15 (11.6%) whose antibody were weak positive. The seroconversion rates of specific antibody were not significantly different among the different age groups after receiving A/H1N1 influenza vaccine (P＞ 0.05).However, there were statistical differences of the seroconversion rates among different sex groups (men 95.7% vs women 87.4% in immunized group, x2=6.40, P＜0.05; and men 73.3% vs women 52.5% in unimmunized group, x2 =4.07, P＜0.05) and different occupation groups (doctor 86.0% vs nurse 94.5% in immunized group, x2 = 9. 16, P＜0.01; and doctor 43. 8% vs nurse 75.0% in unimmunized group, x2=12.61, P＜0.01 ). The seroconversion rate was 81.5% after 80 to 89 days of vaccination, which was significantly lower than those after 30 to 39, 50 to 59 days and 60 to 69 days of vaccination, which was 100.0%, 94.7% and 93.6%, respectively (x2 =3.96, P ＜0.05; x2=7.15, P ＜0. 01; x2 = 9. 98, P＜0. 01). Conclusions A/H1N1 influenza vaccination can induce effective immune response in HCW in Greater Khingan Mountains area of Inner Mongolia. However,the level of specific antibody significantly reduces after 80 to 89 days of vaccination.

Evaluation of precise hepatectomy for primary liver cancer / 中华消化外科杂志

Objective To evaluate the therapeutic effect and safety of precise hepatectomy for primary liver cancer.nethods A total of 103 liver cancer patients who had been admitted to Drum Tower Hospital from July 2007 to October 2009 were divided into precise hepatectomy group(n=54)and routine hepatectomy group (n=49).Peri-and postoperative conditions and the results of follow-up of patients in the 2 groups were compared.All data were analyzed via t test or Fisher exact test.Results No perioperative mortality was observed in the 2 groups.Mean blood loss was(635±608)ml in precise hepatectomy group and(929±1044)ml in routine hepatectomy group,with no significant difference between the 2 groups(t=1.722,P>0.05).Intraoperative blood transfusion volume,postoperative level of aspartate transaminase,positive rate of resection margin and incidence of postoperative complications were(222±381)ml,(158±121)U/L,2%(1/54)and 7%(4/54)in precise hepatectomy group,and were(542±785)ml,(292±347)U/L,18%(9/49)and 24%(12/49)in routine hepatectomy group,with significant difference between the 2 groups(t=2.590,2.558,P<0.05).The 1-year tumor recurrence rate and 1-year survival were 24%(8/33)and 85%(28/33)in precise hepatectomy group,42%(20/48)and 77%(37/48)in routine hepatectomy group,with no significant difference(P>0.05).Conclusion Precise hepatectomy is safe and effective in the treatment of liver caner without much injury to patients.

The development of a bioartificial liver and its application in acute liver failure patients / 中国普通外科杂志

Objective Using polysulfon fibers, a new bioartificial liver was developed. This study was to evaluate the efficacy of this bioartificial liver in the support of a disfunctioned liver. Methods Hepatocytes were procured from swine using Seglen′s methods. The bioartificial liver was constructed based on polysulfon bioreactor with a procurement of 10 10 hepatocytes, and was applied in 12 acute liver failure patients for 14 sessions. Each BAL treatment lasted 6 hours. The general conditions of the patients and the biochemical parameters were evaluated. Results After treatment with bioartificial liver, ammonia, prothrombin time and total bilirubin level significantly decreased (all P

Neurological complications after liver transplantation: report of 28 cases / 中华器官移植杂志

Objective To study the classification, its incidence and some related factors of neurological complications after liver transplantation.Methods 166 cases of orthotopic liver transplantation were retrospectively studied. The classification and the incidence of the neurological complications were analyzed. In addition, the patients were divided into two groups, according to whether they suffered from neurological complications or not, to study the difference of related factors, which included gender, age, primary disease, type of operation procedure, operation time, non-hepatic time, ischemia time of donor liver, blood loss, blood infusion and immunosuppressive regimen.Results Neurological complications occurred in 28 cases (32 times), which included encephalopathy, seizure, stroke, infection of central nervous system, serious para-pyramidal syndrome and peripheral neuropathy. The total incidence was 16.9 %. Between the neurological complication group and non-neurological-complication group, no difference was found in gender, age, type of operation procedure, operation time, non-hepatic time, ischemia time of donor liver, blood loss, blood infusion and immunosuppressive regimen, but the neurological complications were closely related with primary diseases. The incidence of neurological complications was 30 % in acute liver failure, followed by post-hepatitis B liver cirrhosis (21 %), primary liver carcinoma (17.8 %), Wilson disease (16.7 %) and primary biliary liver cirrhosis (12.5 %). Interestingly as a sole complication disease, the incidence of encephalopathy in acute liver failure was 15 %, that was much higher than that in other primary disease. So was the peripheral neuropathy, which was 10 % in primary liver carcinoma.Conclusions The neurological complication is a kind of serious disease with high incidence after liver transplantation. Its onset may have some relationships with the primary liver disease.

Establishment of a new canine model of acute hepatic failure / 中国普通外科杂志

Objective To establish a new model of acute hepatic failure in canines for bioartificial liver treatment research . Methods Acute hepatic failure was induced by end to side portocaval shunt combined with common bile duct ligation and transection. The survival rate, liver function, ammonia, Fischer's ratio (BCAA/AAA) and pathological change of injury liver were investigated. Results The ammonia, ALT, AKP, total bilirubin and PT were elevated dramatically and Fischer's ratio declined significantly 14 days after the operation. The survival rate of the models decreased with time 14 days after the operation. Pathological examination of liver tissues revealed evidence of cholestasis, inflammation with accumulation of neutrophils, degeneration and necrosis of hepatocytes.Conclusions End to side portocaval shunt combined with common bile duct ligation and transection can produce a satisfactory acute hepatic failure model in canines, which could be used in the study of bioartificial liver.