A simple model of canine auto-trasplantation of liver was set up by ourselves, and the effects of hepatic artery ischemia (HAI) on ultrastructure of liver and biliary duct transplanted were observed. The results showed that the liver and biliary cells swelled slightly, mitochondrial matrix was loose and ridges were vague just often perfusion. Afte HAI for 3 hours the edema of hepatic and biliary cells aggravated cytoplasm was loose, mitochondria enlarged and partly vacuolar degenerated, ridges broke or disappeared, flocculent focal densites was seen in the matrix, endoplasmic retculum distended obviously, and the ribosome depolymerizated. So we consider that HAI causes obvious damage to hepatic and biliary cells. These indicate that HAI is one of the important factors of complication after liver transplantation, especially some biliary complications.
ObjectiveTo analyze the effect and incidence rate of major postoperative complications of pericardial devascularization in treatment of portal hypertension. MethodsEnglish and Chinese literatures about pericardial deva-scularization in treatment of portal hypertension were searched through Medline, Elsevier, PubMed, CNKI, and WanFang database, and meta analysis was taken in the process by using R-2.15 software. ResultsIn total of 671 literatures were searched and 23 were selected finally according to inclusion criteria and exclusion criteria.The results of meta analysis showed that, the effect of pericardial devascularization in treatment of portal hypertension were as follows:the incidence rate of rebleeding was 21%(95% CI: 0.18-0.24), the incidence rate of hepatic encephalopathy was 4%(95% CI: 0.02-0.06), the incidence rate of ascites was 29%(95% CI: 0.14-0.47), mortality of operation was 3%(95% CI: 0.02-0.04), mortality was 23%(95% CI: 0.15-0.33). ConclusionsThere is a certain incidence rate of complications of pericardial devascularization, of which the most common complication is rebleeding.So, it is necessary to do further improvement and development of pericardial devascularization.
Objective To study the effect on liver hemodynamics of portal arterialization and complete shunt (PACS), splenorenal shut （SRS） and peripheral cardia divided vessel (PCDV). Methods The preparation of canine model was made. Group PCDV accepted a splenectomy and peripheral cardia divided vessel, while the group SRS accepted a spleen-renal vein shunt. Group PACS accepted a splenectomy, splenic artery and upper portal vein anastomosis, and complete portal-caval shunt. The blood pressure and flow of the portal system were observed. The hepatic function was also measured before and 2 weeks after the three kinds of operation. Results In the PCDV group, the postoperative PVF decreased in 17% while PVP decreased in 5%. In the SRS group, the postoperative PVF decreased in 51% while PVP decreased in 51%. In the PACS group, the postoperative hepatic inflow PVF increased to 180% of the former while PVP increased to 196%; the caval-inflow PVF increased to 130% of the former while PVP decreased to 46%. The results of PACS group had a magnificent statistic difference comparing with those two traditional operations （P＜0.05，P＜0.01）. ALT obviously increased after SRS （P＜0.05）, whereas slightly changed after the other two. Conclusion PACS can significantly increase the hepatic inflow and decreased the blood pressure of the portal system with a pleasant dog survival, and without obvious influence to the hepatic function. It may be a worthy attempt in the treatment of portal hypertension and need more research work going on.
Objective To validate the mechanism of effect of hepatic artery ischemia on biliary fibrosis after liver transplantation and the prevention method. Methods Eighteen male dogs were established into the concise auto orthotopic liver transplantation models and assigned into three groups randomly: hepatic artery ischemia (HAI) group, TBB group (transferred the blood by a bridge duct ) and control group, each group contained 6 dogs. After opening portal vein, the samples were cut from liver in each group at the time of 6 h, 3 d and 14 d. The pathological modifications of intrahepatic bile ducts were observed and expression of transforming growth factor-β1 (TGF-β1) were detected in the three times. Expressions of Smad3 and phosphate-Smad3 as well as mRNA of α-smooth muscle actin (α-SMA) in intrahepatic bile ducts were detected 14 d after opening portal vein.Results Compared with control group, the collagen deposition and lumens stenosis in biliary vessel wall were more obviously in HAI group. In TBB group, the pathological modifications were slighter compared with HAI group. The positive cell index of TGF-β1 reached peak on day 3 after opening portal vein, then decreased in TBB group, and which in HAI group kept increase and was significantly higher than that in TBB group （Plt;0.05）. The expression level of phosphate-Smad3 and transcriptional level of α-SMA mRNA were 1.04±0.13 and 1.12±0.55 in TBB group on day 14 after opening portal vein, which were significantly higher than those in control group (0.59±0.09 and 0.46±0.18) and lower than those in HAI group (1.82±0.18 and 1.86±0.73), the diversities among three groups were significant (Plt;0.05). There was not significant difference of expression of Smads among three groups (Pgt;0.05). Conclusions Hepatic artery ischemia could increase the deposition of collagen fibers and the transdifferentiation of myofibroblast in bile duct and result in the biliary fibrosis by activating the TGF-β1/Smads signaling pathway. The bridging bypass device could lessen the biliary fibrosis caused by hepatic artery ischemia by inhibiting the activation of TGF-β1/Smads signal transduction passageway.
Objective To summarize the effect of the splenectomy in patients with portal hypertension on the occurrence and recurrence of hepatocellular carcinoma. Methods The related literatures about the splenectomy in patients with hepatocirrhosis combined with portal hypertension or patients with hepatocellular carcinoma combined with portal hypertension in recent years were reviewed. Results At present, most academics considered that, for patients with hepatocirrhosis combined with portal hypertension, splenectomy could reduce the occurrence of hepatocellular carcinoma. For patients with hepatocellular carcinoma combined with portal hypertension, splenectomy+hepatectomy didn’t increase the perioperative mortality, and it could reduce the recurrence rate of hepatocellular carcinoma. Conclusion Splenectomy for patients with portal hypertension is safe, and it can inhibit the occurrence and progress of hepatocellular carcinoma, however, the specific mechanism remain needs further study.
Objective To evaluate hepatic functional reserve and investigate the clinical value through measuring hepatic functional blood flow by D-sorbitol clearance rate and liver volume changes with CT. Methods Ninety-two patients with portal hypertension due to posthepatic cirrhosis were investigated (cirrhosis group). Twenty healthy volunteers were used as control group. D-sorbitol was infused intravenously at a steady rate. Blood and urine were collected and recorded once before infusion and at 120, 150 and 180 min after infusion, and their concentrations of D-sorbitol were examined by enzyme spectrophotometry. From pharmacokinetic equations, hepatic clearance rate of D-sorbitol (CLH) was calculated. Total hepatic blood flow (QTOTAL) was measured by Doppler sonography, intrahepatic shunt rate (RINS) was obtained. The liver volume change rate was obtained in patients with cirrhosis through the abdominal CT scan. The relations among the indicators, Child classification and postoperative complications were studied. Results After D-sorbitol was infused intravenously for 120 min, the plasma concentration was at the steady state. The plasma concentration was (0.189±0.05) mmol/L in control group and (0.358±0.06) mmol/L in cirrhosis group (Plt;0.01). CLH was (1 248.3±210.5) ml/min in control group and (812.7±112.4) ml/min in cirrhosis group (Plt;0.01). Although QTOTAL in cirrhosis group was declined, compared with the control group 〔(1 280.6±131.4) ml/min vs. (1 362.4±126.9) ml/min〕, Pgt;0.05, while RINS increased markedly 〔(36.54±10.65)% vs. (8.37±3.32)%, Plt;0.01〕. In cirrhosis group, the mean liver volume of Child A, B and C patients were (1 057±249) cm3, (851±148) cm3 and (663±77) cm3 respectively. There were significant differences among the mean liver volume (Plt;0.05). The liver volume was significantly smaller in Child B and C patients than that in Child A (Plt;0.05, Plt;0.01). When CLH was less than 600 ml/min, and liver volume decreased by more than 40%, postoperative complications increased significantly. CLH and the liver volume change rate were not in absolutely good accordance with Child classification. Conclusion The hepatic clearance of D-sorbitol and the quantitative determination of the liver volume with CT can be an objective evaluation of the liver metabolism of the inherent capacity and the hepatic functional blood flow changes. It contributes to the correct understanding of the hepatic functional reserve and lay the foundation for determining a reasonable treatment plan, surgical methods and time.
ObjectiveTo understand the current situation in the treatment of hepatic echinococcosis. MethodThe literatures about operation treatment, drug treatment, and the clinical pathway of hepatic echinococcosis were reviewed. ResultsCurrently, with the continuous development of surgical techniques and the application of minimally invasive surgery, the operative treatments of hepatic echinococcosis had made a great progress, it was still the preferred treatment for the disease. Liver transplantation was made as the final choice. The use of aspiration, sclerotherapy or interventional technique brought a hope for patients intolerant to laparotomy. Moreover, chemotherapy drugs, Chinese herbal medicine, and drug combinations also achieved a very good effect in the treatment of hepatic echinococcosis. The clinical pathway provided a good direction for the treatment of hepatic echinococcosis. ConclusionFor the treatment of hepatic echinococcosis various, we should choice a reasonable treatment according to the specific circumstances of patients, to achieve the best therapeutic effect with minimal trauma.
ObjectiveTo evaluate the effects of combined TACE and PVC regarding the survival and diseasefree survival rate in hepatocellular carcinoma (HCC) patients. MethodsThe relevant articles were searchd by a database search of PubMed, EMBASE, Cochrane Library (CENTRAL) Databases, Web of Science, Sciencedirect, National Institute of Health Clinical Trials Database, CNKI, WANFANG Database, and VIP Database. The analysis of the data was performed using Revman 5.1 Software. ResultsBy searching and selecting, a total of ten articles met the inclusion criteria, of which 6 were in the postoperative group, and 4 were in the no-operative group. There were no statistical significance of heterogeneity in each group through subgroup analyzed. The pooled OR showed that combined TACE and PVC could significantly increase the 1-, 2-, and/or 3-year survival and disease-free survival rates compared with TACE alone for HCC patients. The pooled OR and 95% CI of the 1-, 2-and/or 3-year survival and disease-free survival rate, respectively, were as follows:In operative group, 1-year disease-free survival rate 2.09, 1.21-3.61; 3-year disease-free survival rate 3.62, 1.88-6.97; 1-year survival rate 2.25, 1.30-3.87; 3-year survival rate 1.96, 1.20-3.21. In no-perative group:1-year survival rate 3.90, 2.33-6.54; 2-year survival rate 5.30, 1.87-15.06. Conlusions Compared with TACE alone, postoperative adjuvant combined TACE and PVC can significantly increase the 1-, and 3-year survival and disease-free survival rates. For no-perative group, adjuvant combined TACE and PVC can significantly increase the 1-, and 2-year survival rates. Based on the limitations of this meta-analysis (this article is included in the high quality literature less), clinicians should be cautious by using our findings.
ObjectiveTo compare the effect and safety between laparoscopic versus laparotomy D2 radical gastrectomy for advanced gastric cancer. MethodsTwo hundred and seventeen patients with advanced gastric cancer who were treated in our hospital from March 2011 to March 2014 were selected as research objects. According to surgical method, they were divided into laparoscopy group (103 patients received laparoscopic D2 radical gastrectomy) and laparotomy group (114 patients received laparotomy D2 radical gastrectomy). Comparison of the surgical effect-related indicators between 2 groups was performed. ResultsIn the aspect of intra-operative indicators:the operation time, proximal margin length, distal margin length, and the number of removal lymph node between the 2 groups did not significantly differed with each other (P>0.05); while the bleeding volume and the length of incision in laparoscopy group were significantly less (shorter) than those of laparotomy group (P<0.05). In the aspect of post-operative indicators:the time to first flatus, time to resumed oral intake, time to ambulation, post-operative hospital stay, time of analgesics given, and the total incidence of postoperative complication in laparoscopy group were significantly shorter (less or lower) than those of laparotomy group (P<0.05), the operating cost in laparoscopy group was significantly higher than that of the laparotomy group (P<0.05), but there was no significant difference in total treatment cost, mortality of gastric cancer, and recurrence or metastasis rate between the 2 groups (P>0.05). ConclusionsBoth laparoscopic and laparotomy D2 radical gastrectomy in treatment of advanced gastric cancer can obtain good clinical effect. But compared with laparotomy D2 radical gastrectomy, laparoscopic D2 radical gastrectomy can reduce operative wound, reduce incidence of complications, improve postoperative recovery, and has higher safety.