【 Abstract 】 Objective To investigate the precautionary effect of fibrin glue on postoperative bleeding and bile leakage when used in partial hepatic resection. Methods House-hold rabbit partial hepatectomy model was prepared and 40 rabbits were divided into sham operation （ SO) group (n=10), control group (n=10) and protocol group (n=20) randomly. The SO rabbits received laparotomy only, while both the control and protocol group received partial hepatectomy. Fibrin glue was used in the protocol group following electric coagulation therapy while the control group received electric coagulation therapy only. The animals’ diet, weight and adverse effects were observed then, and the celiac drainage volume, levels of hemoglobin (Hg), WBC and TBil in celiac outflow and ALT, AST, LDH and TBil in rabbit serum were checked on schedule after operation. Results The average blood loss volume and operation time in the protocol group were (16.0±2.7) ml and (23.7±2.9) min respectively, which were lower than those in the control group 〔 (20.8 ± 3.5) ml and (27.3 ± 2.9) min (P ＜ 0.01) 〕 . The celiac drainage volume, levels of Hg, WBC and TBil in celiac outflow decreased gradually on postoperative days in protocol groups (P ＜ 0.05). The levels of Hg in celiac outflow of the protocol group on the 1st, 2nd and 7th postoperative day were lower than those of the control group (P ＜ 0.05), and the result of TBil was the same on the 1st, 2nd, 3rd, 5th and 7th postoperative day (P ＜ 0.05). The serum ALT, AST, LDH and TBil levels in the control and protocol groups were higher than those in the SO group significantly (P ＜ 0.01), while the serum ALT, AST (except on the 3rd postoperative day) and LDH levels in the protocol group were lower than those in the control group (P ＜ 0.05) in significance.All animals had good appetite, normal weight gain and no adverse reaction and death occurred. Conclusion Application of fibrin glue may effectively prevent and cure the postoperative bleeding and bile leakage in partial hepatectomy without any adverse reaction.
ObjectiveTo summarize the progress of transient elastography in predicting the prognosis of hepatic surgery. MethodsThe related literatures were reviewed. ResultsLiver stiffness can be measured by using transient elastography.In patients with hepatocarcinoma, the liver stiffness measurements are higher, the more likely they are to have surgical complications and hepatocarcinoma recurrence.Liver transplant recipients with higher liver stiffness measurements tend to have higher acute rejection and hepatitis C recurrence rates. ConclusionTransient elastography can evaluate hepatic functional reserve to help improve the outcome of hepatic surgery.
ObjectiveTo evaluate long-term therapeutic effect of esophagogastric devascularization without splenectomy in treatment of portal hypertension with esophagogastric varices hemorrhage. MethodsThe patients who took esophagogastric devascularization without splenectomy from 2008 to 2013 were followed-up in clinic or through phone. The remission of esophagogastric varices, rebleeding, survival and long-term postoperative complications were observed. ResultsA total of 32 patients were taken esophagogastric devascularization without splenectomy in Peking University People's Hospital from 2008 to 2013. One patient died during the perioperative period. Twenty-three patients were followed-up for 10-81 months with an average 45.5 months, of whom 7 patients had rebleeding, 5 patients died, 3 patients had new onset portal vein thrombosis, 2 patients had esophageal anastomotic strictures. ConclusionEsophagogastric devascularization without splenectomy is an effective method in treatment of portal hypertension with esophagogastric varices hemorrhage in selected patients.
Objective To evaluate the therapeutic effect of selective paraesophagogastric devascularization withoutsplenectomy in treatment of portal hypertension with upper gastrointestinal hemorrhage. Methods The clinical data of 27 patients who received selective paraesophagogastric devascularization without splenectomy from 2008 to 2011 were retrospectively analyzed. The hemogram， hepatic function， perioperative compliations， and free portal pressure （FPP） were observed. The patients were followed-up and the re-bleeding rate and survival rate were observed. Results The FPP decreased significantly（P＜0.05） after operation. The complication rate was 33.3%（9/27） after operation， including2 cases（7.4%） stress ulcer bleeding， 1 case （3.7%） acute bleeding portal hypertensive gastropathy， 1 case （3.7%） deep venous thrombosis， 1 case （3.7%） acute lung injury， 1 case （3.7%） death of hepatic encephalopathy， 3 cases（11.1%） new onset portal vein thrombosis. Twenty-four patients were followed up for an average of 27 months （8-57 months）. The overal survival rate was 92.6% （25/27）. Conclusion Selective paraesophagogastric devascularization without splenectomy is an effective method for treatment of portal hypertension with upper gastrointestinal hemorrhage.
Objective To study the value of the clinical application of stereography and measurement of liver volume in cirrhotic patients with portal hypertension. Methods By use of the personal computer and the software of threedimensional reconstruction and measurement system of liver faultage photograph, the liver volume in vivo was successfully measured and the threedimensional image of the liver rebuilt in 46 posthepatitic cirrhotics who were selected for orthotopic liver transplantation and in 30 noncirrhotic controls, and comparison with the reference volume of recipient liver was obtained by means of water deplacement after transplantation. Results The liver volume of cirrhotic patients with portal hypertension measured by software and water deplacement was (983.33±206.11) cm3, and (904.93±209.56) cm3 respectively. Comparison by means of linear regression analysis between volume measurement on threedimensional reconstruction software and reference volume showed a nearly ideal correlation coefficient(r=0.969,P＜0.01), the average error was 8.66%.The average of liver volume in controls was (1287.00±96.18) cm3, and was positively correlated to the height，weight and body surface area (r=0.845,0.833,0.932 respectively,P＜0.01)，and was different from that of cirrhotics. Liver volume of cirrhoitic patients with portal hypertension was related to their ChildPugh classification. The liver volume of patients in Child C group was significantly smaller than that of patients of Child B group, and was significantly correlated with Alb （r=0.496, P＜0.01） and TBIL（r=-0.493, P＜0.01）,PT(r=-0.517, P＜0.01), but was not significantly correlated with ALT（r=0.206，Pgt;0.05）,portal pressure（r=-0.093，P=0.539） and portosystemic shunt index (r=0.044，P=0.769). Conclusion The volume measurement of the liver by the threedimensional software is relatively accurate. Liver volume of cirrhotic patients with portal hypertension was significantly related to their liver function,and can reflect the liver reserve function.
Objective To compare the clinical efficacy and safety of different surgical methods in the treatment of early-stage gallbladder carcinoma (GBC). Methods The clinical data of 43 patients with early-stage GBC who received treatment in Peking University People’s Hospital from Jan. 2010 to Dec. 2016 were retrospectively analyzed. According to the surgical methods, the patients were divided into laparoscopic cholecystectomy (LC)+lymph node dissection (LND)+radiofrequency ablation (RA) group, open cholecystectomy (OC)+LND+RA group, and OC+LND+liver resection (LA) group. Operation duration, intraoperative blood loss, postoperative hospital stay, surgical complications, and long-term survival were compared among the 3 groups. Results All the 43 patients performed successful surgery without perioperative death. ① Operation duration and postoperative hospital stay. The differences of operation duration and postoperative hospital stay among the 3 groups were statistically significant (P<0.05). Compared with the LC+LND+RA group, operation duration and postoperative hospital stay of the OC+LND+RA group and the OC+LND+LR group were longer (P<0.017), but there was no statistically significant difference between the OC+LND+RA group and the OC+LND+LR group (P>0.017). ② Intraoperative blood loss. The difference of intraoperative blood loss among the 3 groups was statistically significant (P<0.001). Compared with the OC+LND+LR group, the intraoperative blood loss was lower in the LC+LND+RA group and the OC+LND+RA group (P<0.017), but there was no significant difference between the LC+LND+RA group and the OC+LND+RA group (P=0.172). ③ Postoperative complications. There was no significant difference in the incidence of postoperative complications among the 3 groups (P=0.326). ④ Long-term survival. There was no significant difference in survival curves among the 3 groups (P=0.057). Conclusions The method of cholecystectomy combined with LND and RA of gallbladder bed can achieve the radical effect on early-stage GBC (Tis–T2). Laparoscopic surgery, in particular, has shorter operation duration and faster recovery.
Objective To evaluate the therapeutic effects of percutaneous microwave ablation (MWA) for metastatic liver cancer. Methods Ultrasound-guided percutaneous MWA technique was used to treat 27 cases of hepatic metastases with 69 nodules 〔0.9-13.2 (3.0±2.0) cm in diameter〕. Local therapeutic effect, local and distant recurrence rate and survival rate were evaluated respectively. Results The complete ablation (CA) rate which was used to evaluate the local therapeutic effects was 92.8% (64/69), with 100% (34/34), 92.3%(24/26) and 66.7% (6/9) in a diameter of nodules lt;3.0 cm, 3.0-5.0 cm and ≥5.0 cm respectively. The CA rate was lower in the group of a diameter of nodules ≥5.0 cm as compared with other two groups (Plt;0.05). The local recurrence rate was 9.4% (6/64), with 2.9% (1/34), 16.7% (4/24) and 16.7% (1/6) in a diameter of nodules lt;3.0 cm, 3.0-5.0 cm and ≥5.0 cm respectively. The intrahepatic distant recurrence rate was 44.4% (12/27). The follow-up time after MWA was 3－34 (17.0±8.7) months. During the follow-up period, 6 months, 1 and 2-year cumulative survival rate was 88.9%, 63.0% and 34.4% respectively, with a mean survival time of 17.8 months, and with a median survival time of 19.0 months.Conclusion Percutaneous MWA treatment offers satisfactory local tumoricidal efficacy to metastatic liver cancer and the patients with recurrence and new metastases can be therapy repeatedly to improve long-term survival.