Objective To evaluate the outcome of liver transplantation in patients with recurrent liver cancer after resection. Methods Data of 23 patients underwent liver transplantation for recurrent liver cancer from April 2001 to March 2008 were retrospectively collected and analyzed. Results Previous history of liver resection had little negative effect in subsequent liver transplantation in technical aspect. Liver function recovered uneventfully after transplantation in all cases. Alpha fetoprotein (AFP) recovered to normal value in 13 of 17 cases with elevated AFP before transplantation within one month after operation. Five cases (21.74%) had postoperative complications. Nineteen cases (82.61%) were followed up, average follow-up duration were 610 days. There were 5 cases (26.32%) of cancer recurrence and 6 deaths during follow-up, survival rate was 68.42%. Conclusion Liver transplantation is a reasonable treatment for recurrent liver cancer after resection.
Objective To study the effect of recombinant growth hormone (rhGH) on improvement of liver function and liver regeneration in animal and patients after hepatectomy. Methods The liver cirrhosis model of SD species mouse was set up, then the mouse were randomly divided into experiment group and control group, then 30%-40% liver of all the models were resected, rhGH was used by hypodermic injection (0.2-0.4ml/100g) in experimental group, and the equal dose of N.S. were given in control group every day. Then liver function, arterial blood ketone body ratio(AKBR), and the regenerated liver/body weight ratio (RL/W) were determined, histopathology of the cirrhosis with microscope and electron microscope and the mitotic index (MI) of liver cell on 7, 14 and 28th day after operation were observed. Clinically,39 hepatectomized patients were randomly divided into experiment group and control group, liver function, PA， Glu, RI and AKBR were measured preoperatively and on 1, 7,14th day after operation. Postoperative clinical course were also compared between the two groups. Results In the animal experiment group, as compared with the control group, AKBR was obviously higher (P＜0.01), seruim level of total protein and PA were increased faster (P＜0.05), and RL/W was higher. The mitotic index of liver cell was increased faster on 14th day, the numbers of regenerated liver cell with double nucleus and rough endoplasmic reticulum were higher in 14 and 28th day. In the clinical experiment group, as compared with the control group, serum total bilirubin, alanine aminotransferase and aspartate aminotransferase were lower on 7 and 14th postoperative day (P＜0.05). Serum albumin, PA, Glu, RI and AKBR were higher on 7, 14th postoperative day (P＜0.05). Conclusion Both experimental and clinical study show that the rhGH can promote liver regeneration and improve liver function after hepatectomy.
Objective To explore the curative effect of surgical treatment for primary liver cancer with portal vein tumor thrombus（PVTT）. Methods The clinical data of 227 patients who were performed surgical treatment because of primary liver cancer with PVTT were analyzed retrospectively. Results Two hundreds and seventeen cases were performed surgical resection, 14 cases died from postoperative complications. The median survival time was 17.7 months, and the l-, 2-, 3-, and 5-year survival rates were 61.9%, 37.2%, 21.7%, and 4.0% respectively. There were 40 cases with PVTT ofⅠtype, the l-, 2-, 3-, and 5-year survival rates were 82.3% , 61.7%, 38.6%, and 6.6% respectively，which was obviously higher than those with PVTT of Ⅱ type （n=129, 61.1%, 34.3%, 20.8%, and 5.3%） and PVTT of Ⅲ type （n=48, 46.8%, 24.0%, 9.6%, and 0）, P＜0.05. There were 84 cases whose PVTT and tumor were resected together, the l-, 2-, 3-, and 5-year survival rates were 67.3%, 43.2%, 28.1%, and 7.9% respectively，which were obviously higher than those patients whose PVTT were removed from cross-section of liver （n= 85, 65.1%, 38.8%, 22.3%, and 3.4%） and patients whose PVTT were removed by cutting the portal vein （n=48, 46.8%, 24.0%, 9.6%, and 0）, P＜0.05. The l-, 2-, 3-, and 5-year survival rates of 76 cases who received postoperative therapy of TACE/TAI were 75.3%, 53.2%, 33.1%, and 5.7% respectively, which were obviously higher than those patients who were not received any postoperative therapy （n=141, 54.8%, 29.1%, 15.9%, and 3.2%）, P＜0.05. Conclusions Surgical treatment is an effective treatment for primary liver cancer with PVTT. Surgery should strive for resecting the tumor and PVTT together, and postoperative therapy of TACE/TAI may have a favorable effect on the long term survival rate.
Objective To approach the indications， techniques features， and efficacy of laparoscopic hepatectomy for liver tumor. Methods The clinical data and follow-up results of 61 patients who received laparoscopic hepatectomy at our institute from January， 2007 to December， 2012 were retrospectively analyzed. Results Of the 61 patients， 16 cases were with primary liver cancer， 1 case with liver adenocarcinoma， 2 cases with metastatic liver cancer， 31 cases with hepatic hemangioma， and 11 cases with other benign liver diseases （including hepatocellular adenoma， focal nodular hyperplasia， hepatic cysts， and mucinous cystadenoma）. The average tumor diameter was 5.6 cm （2-15 cm）. The surgical approaches includes laparoscopic hepatic left lateral lobectomy （42 cases）， right posterior lobectomy （2 cases）， hepatectomy of segmentⅥ （3 cases）， hepatectomy of segmentsⅦ/Ⅷ， Ⅳa， and caudate lobe （one respectively）. Non-anntomic and wedge resection were performed on 11 patients. The mean operating time， blood loss， postoperative hospital stay， and postoperative complication rate were （124±65） min （50-200min）， （251±145） mL （50-1 000mL），（7.3±3.6） d （4-11d）， and 16.3% （10/61）， respectively. In 19 cases with malignant liver lesions， 15 cases were followed up mean for 26 months （1-48 months）. One of them died in 1 year after operation for multiple organ dysfunction， others were survival. Conclusions Experienced laparoscopic surgery doctors selected appropriate cases， used proper blood inflow oclussion and liver resction methods， and cared for tumor-free principle， the laparoscopic hepatectomy for malignant and benign tumors of liver could be safe and effective to carry out.
Controlling intraoperative bleeding is the core technology of liver surgery, and it is also an important way to improve the benefits of liver surgery and reduce the risk of surgery. In recent years, a number of methods to maintain low central venous pressure have been proposed, including inferior vena cava clamping, restricted fluid infusion, postural changes, intraoperative assisted ventilation, intraoperative hypovolemic venous incision, etc. In addition, more and more indicators used to guide intraoperative fluid input management to maintain low central venous pressure have been discovered, including global end-diastolic volume and stroke volume variability. Therefore, this article summarizes the relationship between low central venous pressure and surgical effect in liver surgery, and the ways to achieve low central venous pressure on the basis of previous research.
Objective To study the protective effects of pre-storing glycogen on warm ischemia reperfusion injury during partial hepatectomy. Methods Thirty-eight patients were randomly divided into a trial group (n=19) and a control group (n=19). In the trial group, patients were given high concentration glucose intravenously during the 24 hours before the operation. The hepatic lesion was resected after portal triad clamping in the two groups. Liver function of all patients was measured before the operation and the first and fifth days after the operation. Normal hepatic tissue was biopsied to measured hepatic tissue glycogen contents before the operation and the change of superoxide dismutase (SOD) at the point of pre-ischemia, post-ischemia, and reperfusion 2 hour. Bcl-2 mRNA, a well known anti-apoptotic factor, was also detected using quantitative polymerase chain reaction. Results The hepatic tissue glycogen content of the trial group was significantly higher than that of the control group before the operation (Plt;0.01). Liver function of the trial group was significantly better than that of the control group on the first and fifth day after operation (Plt;0.05). There was significant difference in SOD activity between the two groups at the end of hepatic vascular occlusion and at the point of 2-hour reperfusion (Plt;0.05). Furthermore Bcl-2 mRNA expression of the trial group was notably up-regulated at the point of 2-hour reperfusion compared to the control group. Conclusion Pre-store storing glycogen might protect liver ischemia reperfusion injury caused by hepatic vascular occlusion during partial hepatectomy. The potential mechanism might be that pre-storing glycogen enhances Bcl-2 expression.
ObjectiveTo investigate the protective effect of SadenosylLmethionine on liver regeneration and liver function in cirrhotic rats after hepatectomy. MethodsCirrhosis was successfully induced by injection of 40% CCl4.Then,partial hepatectomy (about 30%) was performed in all rats. Cirrhotic rats were divided into 3 groups,namely,cirrhotic group (normal saline 5 ml/d,for 15 postoperative days，n=20),treatment group 1 〔S adenosylLmethionine 10 mg/(kg·d),for 15 postoperative days,n=16〕 and treatment group 2 〔SadenosylL methionine 20 mg/(kg·d),15 postoperative days,n=16〕,and normal control group was also established. Animals were sacrificed at the 15th postoperative day and 30th postoperative day to take samples for detection of liver function (Alb,ALT,TB,TBA) and serum TNFα.Liver tissues were also observed under light microscope and electron microscope. ResultsIn two treatment groups,at the time point (15 postoperative days or 30 postoperative days),concentrations of ALT,TB,TBA,Alb and TNFα were decreased significantly as compared with cirrhotic group (P ＜0.01),and concentration of Alb was increased significantly (P＜0.01).In contrast, there were no obvious difference in the same time point of different dosetreatment groups (Pgt;0.05),but the decrease of ALT,TB,TBA,TNFα and the increase of Alb were more significant at the second time point (30th postoperative day) than the first time point (15th postoperative day) when treated with same dose (P＜0.01).At the same time,concentration between TNF α and ALT,TB,TBA showed a positive correlation (P＜0.01),and the concentration between TNFα and Alb showed a negative correlation (P＜0.01).In addition, the histopathology showed SadenosylLmethionine had effects of protecting liver function and enhancing liver regeneration. ConclusionThe study suggests that SadenosylL methionine has the efficacy of enhancing liver regeneration and improving liver function.
ObjectiveTo study the effectiveness of liver function, hepatic energy metabolism, regeneration, and apoptosis on the obstructive jaundice rat after partial hepatectomy (PH) combined with internal biliary drainage under the condition of conspicuous bilirubinemia. MethodsOne hundred and twenty male SD rats were used in research, six of whom were divided into sham operation (SO) group. Twenty rats underwent bridge operation between common bile duct and duodenum after 70% PH (70%PH group), and 6 rats out of the 94 rats who underwent common bile duct ligation (CBDL) for 5 d were randomly selected as CBDL group, and the residual rats were done the second operations after 5 d and were divided into three groups: bile duct obstruction combined with reperfusion of bile flow group （BDO-RBF group， n=20), 42% PH with BDO-RBF group (n=20), and 70%PH with BDO-RBF group (n=25). Levels of TB, ALT, ALB, and ALP in serum; HGF, bcl-2 mRNA and protein； ATP, ADP, and AMP; hepatocyte proliferation/apoptosis index in hepatic tissues were dynamically observed after operation (24 h, 72 h, and 7 d), respectively. The liver function and hepatocyte energy metabolism were only detected in the SO group. ResultsRats without obstructive jaundice would have an excellent liver regeneration after 70% PH, while the liver function and hepatocyte energy metabolism could recover rapidly. The liver function, hepatocyte energy metabolism, HGF and bcl-2 mRNA and protein of liver tissue and the hepatocyte proliferation/apoptosis index in partial (42% or 70%) hepatectomy combined with internal biliary drainage in obstructive jaundice group were significantly influenced while recovered rapidly (Plt;0.05). ConclusionsUnder the condition of conspicuous bilirubinemia, the influences of hepatectomy combined with internal biliary drainage on hepatocyte energy metabolism, liver function, hepatocyte regeneration and apoptosis are severer than that of normal rats who underwent 70% hepatectomy, while also make the rats recover rapidly in hyperbilirubinemia groups. The database suggest that it is not necessary to do preoperative external biliary drainage before performing liver resection.
The treatment of liver cancer is still a challenge in the world, and it is mainly refers to hepatocellular carcinoma (HCC). There are many factors affecting the overall survival rate of HCC; the recurrence of HCC is the main risk factor affecting the survival of patients, hence, it is urgent to explore the clinical treatment of recurrent HCC to obtain long-term survival of the patients. Up to now, surgical treatment is a radical treatment for HCC. Similarly, liver resection and liver transplantation are still the main therapy methods for recurrent HCC. In addition, radiofrequency ablation and transcatheter arterial chemoembolization and other local treatments still play an irresistible role. Therefore, emphasizing the postoperative follow-up of patients, diagnosing recurrent HCC in early stage, paying attention to the risk factors of HCC recurrence and selecting a suitable treatment plan for individuals are critical ways to prolong the survival of patients.
Objective To investigate the technique and feasibility of hepatic pedicle vascular control in laparoscopic hepatectomy. Methods From May 2005 to June 2011, 95 cases of hepatectomies were performed by laparoscopy in the Department of Minimally Invasive Surgery, The First Affiliated Hospital, Guangxi Medical University.The characteristics of these cases were analyzed. Results Left lateral segmentectomy were required in 21 patients, left hepatectomy in 13 patients, right hepatectomy in 4 patients, segmentectomy in 17 patients, tumor resection in 24 patients,hemangioma resection in 5 patients, and conversions to laparotomy in 11 patients. The intermittent Pringle maneuver were performed in 39 patients. The mean vascular clamping time in Pringle maneuver was （30.84±9.51） min. The selective vascular control of inflow were performed in 56 patients， the technique included intrahepatic Glisson approach in 14 patients and controlling hepatic artery and portal vein separately in 42 patients. Pre-parenchymal transection control of hepatic outflow were performed in 12 patients, included the left hepatic vein were controlled by suturing or separating in 11 patients and right hepatic vein was controlled by separating in 1 patient. Others were controlled intraparenchymally during transection. The mean operative time was （236.80±95.97） min，mean operative blood loss was（ 551.55±497.41） ml， concentrate red blood cells transfusion volume was（ 2.60±2.23） U， and plasma transfusion volume was （211.90±179.29） ml. The postoperative complications included bleeding in 4 patients, pleural effusion in 4 patients, pneumonia in 3 patients, ascites in 7 patients, and biliary fistula in 2 patients, and dead in 1 patient. The mean hospitalization time was（ 12.47±4.18） days. At the deadline（ February 2012）, 72 cases with liver cancer were followup. The follow-up time ranged from 5 to 81 months and the mean time was（ 24.14±16.62） months， where survival rate was 68.4%（ 54/79） of 1-year and 21.5%（ 17/79） of 3-year. Conclusions The application of hepatic pedicle vascular control in laparoscopic hepatectomy is feasible.