【Abstract】ObjectiveTo analyse the current situation and advance in perioperative therapy of liver transplantation for primary hepatocellular carcinoma(HCC).MethodsThe published papers on current situation and advance in the perioperative therapy of liver transplantation for HCC were reviewed.ResultsThe survival rate of liver transplantation for HCC in early stage has been the same as that for benign liver diseases up to now. However, it is still a difficult problem to improve the survival rate of liver transplantation for advanced HCC. The ideal perioperative therapies of liver transplantation for HCC should be helpful to suppress the growth of tumor while the HCC patients are waiting for donated livers, to diminish or eliminate the intraoperative spread or implantation of tumor cells and to repress the micrometastasis postoperatively. The current perioperative therapies of liver transplantation for HCC include hepatic arterial chemoembolization, systemic chemotherapy, radiotherapy, percutaneous ethanol injection into HCC and radiofrequency ablation etc. ConclusionThe perioperative assistant therapy of HCC can not only save time for patients before liver transplantation but also improve the survival rate after operation.
目的 對肝門膽管癌外科治療療效進行評價。 方法 回顧分析2007年3月－2012年3月收治的156例肝門膽管癌患者的臨床資料。按手術方式將患者分為手術切除組（n=45）、膽道引流組（n=78）和姑息治療組（n=33），并對住院期間并發癥發生率、病死率及生存時間等進行分析。 結果 156例患者根治性切率為23.1%不同治療方式住院期間病死率差異無統計學意義（P＜0.05）；手術治療組與姑息治療組并發癥發生率差異有統計學意義（P＜0.05）。手術切除組、膽道引流組、姑息治療組的1、3、5年累積生存率分別為64.4%、17.8%、0.0%；40.2%、12.6%、12.6%；17.7%、7.1%、0.0%，手術切除組生存情況明顯好于其他兩組（P＜0.05）。 結論 不建議所有患者術前均引流可減黃，且可以不過分強調R0切除。膽道引流可一定程度改善預后，但近遠期膽道感染相關并發癥發生率較高。
The interal changes of immunoglobulins in serum and bile among the rabbit models in partial biliary obstruction group (BO),partial biliary obstruction with infection group(BOI)and normal controls(Con)were studied. Concentrations of serum immunoglobulin A(IgA)in BO and BOI groups increase remarkably in all phases(Plt;0.001),Concentrations of serum IgG in both groups increase with the formation of gallstones. The IgG and IgA contents of bile samples in BO and BOI groups with negetive bacterial culture were much higher than that of the control group(Plt;0.05),but the Ig contents of bile with postive culture slightly lower than that of the control group.This experiment suggest in the formation of gallstones,the immunoglobulins of serum and bile had changed significantly.The Ig contents of bile have a relationship with the bacterial infection. Immunoglobulin A takes an important role in gallstone formation.
Objective To discuss the therapeutic effectiveness of surgical approach to complex intrahepatolithiasis with biliary liver cirrhosis.Methods A case of complex intrahepatolithiasis with biliary liver cirrohosis, portal hypertension was treated with splenectomy and pericardial devascularization plus left hepatectomy and portal cholangio plasty with T tube drainage. Results Follow up one year and a half after operation, no symptom of cholangitis was found, and there is no relapse up to date. Conclusion Combined operation of hepatectomy with splenectomy is an ideal and effective treatment for complex intrahepatolithiasis with biliary liver cirrhosis.
Objective To observe the protective effect on retinal ganglion cells (RGC) and the safety of intravitreal injected acteoside in rats. Methods A total of 50 male Sprague Dawley rats with the weight of 190-210 g were used in this study. Fifteen rats were used for safety experiment of intravitreal injection of acteoside. The rats were divided into group A, B, C, control group and blank group, three rats in each group. The rats in group A, B and C were received intravitreal injection of 5 mu;l acteoside at the concentration of 1, 2, and 5 mg/ml, respectively. Phosphate buffer solution (PBS) was injected in rats of control group. No treatment was performed for blank group. The retinal structure was examined by hematoxylin-eosin (HE) staining of retinal frozen sections at one, two and three weeks after injection. The retinal ultrastructure was examined by ultrathin section under transmission electron microscope at one and three weeks after injection. Others 35 rats were used for experiment of protective effect of acteoside on RGC. The rats were divided into operation group A and B (n=8), sham operation group C and D (n=8), and blank group (n=3). The optic nerve of rats in operation group was clamped for 10 seconds after optic nerve exposure, while the optic nerve of rats in sham operation group was exposed only. The rats in operation group A and B were received intravitreal injection with 5 mu;l acteoside (1 mg/ml) and 5 mu;l PBS respectively. The rats in sham operation group C and D were received intravitreal injection with 1 mu;l acteoside (1 mg/ml) and 1 mu;l PBS respectively. No treatment was performed for blank group. The retinal structure was examined by HE staining of retinal frozen sections at one, two and four weeks after injection. Immunohistochemistry was used to measure the expression of growth associated protein 43 (GAP-43). RGC apoptosis was assessed by the terminal deoxynucleotidyl transferase mediated dUTPbiotin nickend labelling (TUNEL) method. Software of SPSS 13.0 was used for the data statistical analysis in this study. Results In the safety experiment of intravitreal injected acteoside, there was no abnormity of cornea, anterior chamber, lens, vitreous cavity and retina after injection. At one, two and three weeks after injection, the retina structure was normal without significant apoptosis, necrosis and inflammatory cell infiltration. The ganglion cell layer showed slightly edema; there was no obvious change of retinal ultrastructure after injection of acteoside with 5 mg/ml and 2 mg/ml, but slight change with the format of 1 mg/ml. Transmission electron microscopy showed that intravitreal injection of 5 mu;l acteoside at the concentration of 2 or 5 mg/ml can induce significant changes of micro-structures of retina, while injections at 1mg/ml can only induce minor changes.In the experiment of protective effect of acteoside on RGC, light microscope revealed that the cell showed typical changes of apoptosis in operation group, but not in sham operation group and blank group. At the first and second week after injection, compared with the sham operation group and blank group, the RGC number was decreased in operation group. The difference of RGC numbers between operation group A and B was statistically different (F=26.206,P＜0.05). The RGC numbers in operation group continues to decrease at the fourth week after injection, there was obvious difference compared with the first and second week after injection (F=17.364,P＜0.05), but there was no difference of RGC numbers among sham operation intragroup and between sham operation group and blank group at all the time points. Immunohistochemistry showed that at the first week after injection, the integrated absorbance (IA) value in operation group was higher than that in other groups (F=33.466,P＜0.05); there was no difference of IA value between operation group A and B. At the second week after injection,IA value in operation group A had slightly declined, but higher than that in operation group B (F=14.391,P＜0.05). At the fourth week after injection,IA value in operation group A declined further, but also higher than that in other groups (F=4.178,P＜0.05). TUNEL showed that on the first week after injection, RGC apoptosis rate in operation group was increased than that in other groups (F=15.365,P＜0.05). At the second week after injection, RGC apoptosis rate in operation group was decreased, and it in operation group A was lower than that in operation group B (F=15.365,P＜0.05). At the fourth week after injection, RGC apoptosis rate in operation group was decreased obviously, there was no difference compared with other groups (F=2.057,P＞0.05). There was no difference of RGC apoptosis rate between sham operation group and blank group at all the time points. Conclusion Intravitreal injection of 5 mu;l acteoside (1 mg/ml) is safe for rat retina, and can upregulate GAP-43 expression and inhibit RGC apoptosis in optic nerve crush rats.
Objective To explore primary surgical treatment experience of typeⅣ hilar cholangiocarcinoma. Methods From April 2008 to April 2011，20 patients with type Ⅳ hilar cholangiocarcinoma were enrolled into the same surgical group in Department of Hepatobiliary and Pancreatic Surgery of West China Hospital of Sichuan University.The intra- and post-operative results were analyzed.Results The total resection rate was 75%，which was consisted of 10 cases of radical excision and 5 cases of non-radical excision.Seven patients received left hepatic trisegmentectomy and caudate lobe resection including anterior and posterior right hepatic duct reconstruction，hepatojejunostomy，and Roux-en-Y jejunojejunostomy.Six patients received enlarged left hepatic trisegmentectomy and caudate lobe resection including left intrahepatic and extrahepatic duct reconstruction，hepatojejunostomy，and Roux-en-Y jejunojejunostomy. Two patients received quadrate lobe resection including two cholangioenterostomies after anterior and posterior right hepatic duct reconstruction，and left intrahepatic and extrahepatic duct reconstruction.After percutaneous transhepatic cholangial drainage （PTCD） and portal vein embolization （PVE），two patients with total bilirubins ＞400 mmol/L received radical excision and non-radical excision，respectively.Three patients only received PTCD during operation due to wide liver and distant metastasis，and two patients received T tube drainage during operation and postoperative PTCD due to left and right portal vein involvement. All 15 patients who received lesion resection survived more than one year， whereas another five patients whose lesions can not been resec ted only survived from 3 to 6 months with the mean of 4.2 months.No death occurred during the perioperative period. Conclusions For patients with type Ⅳ hilar cholangiocarcinoma， preoperative evaluation and tumor resection shall conducted so as to relieve obstruction of biliary tract，otherwise PTCD and PVE prior to the final lesion resection shall be performed.