Objective To compare the effect of two chemotherapeutic patterns after hepatectomy of hepatocellular carcinoma （HCC） with portal vein tumor thrombi（PVTT）. Methods The clinical data of 51 HCC patients with PVTT who were treated in our department from June 2006 to December 2011 were analyzed retrospectively. Fifty-one HCC patients with PVTT who were performed hepatectomy and treatment of antivirus and improve immune were divided into two groups according to chemotherapeutic patterns after operation： portal vein infusion drug deliver system （PVIDDS）group （n=19） and transcatheter arterial chemoembolization（TACE） group（n=32），and to compare the treatment effect of the two groups. Results The recurrence rate of 1-month, 1-year，3-year， and 5-year after operation in TACE group was 3.1%（1/32），46.9%（15/32），84.4%（27/32）， and 100%（32/32），respectively. And in PVIDDS group, which was 5.3%（1/19），52.6%（10/19），100%（19/19）， and 100%（19/19），respectively. There were no differences in recurrence rate of 1-month, 1-year, and 5-year after operation in two groups（P＞0.05）. Recurrence rate of 3-year after operation in TACE group was lower than that in PVIDDS group（P＜0.05）. There were no differences in medial survival time（17.1 months vs.15.9 months）， survival rate of 1-year（93.8% vs.94.7%） and 3-year（40.6% vs. 36.8%） after operation in TACE group and PVIDDS group（P＞0.05）. Survival rate of 5-year after operation in TACE group was higher than that in PVIDDS group（21.9% vs.0, P＜0.05）. The rate of complication in TACE group was lower than that in PVIDDS group（65.6% vs.94.7%，P＜0.05）. Conclusions If the HCC patients with PVTT could endure operation，surgical resection should be considered firstly，furthermore antivirus treatment, improving immune，and chemotherapy should be considered after operation. The effect of TACE is better than PVIDDS.
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.
Objective To explore the diagnosis and treatment for patients with portal vein thrombosis or tumor embolus in perioperative period of liver transplantation. Methods Eight patients at terminal stage of liver diseases and with portal vein thrombosis or tumor embolus underwent liver transplantation in this hospitatal from October 1999 to January 2006. Their clinical information and survival situation were retrospectively analyzed. Results It was diagnosed correctly before operations that portal vein thrombosis or tumor embolus occurred in 8 patients of 61 patients (13.1%) who underwent liver transplantation (grade Ⅰ: 3 cases; grade Ⅱ: 5 cases). The thrombosis in the portal vein of 6 cases were dislodged and the portal vein with tumor embolus were removed in 2 patients who underwent end-to-end anastomosis. All patients received anticogulation therapy after operations. The post-operative 6-month survival rate was 62.5%. Conclusion Accurate diagnosis before operation, correct method of surgery and reasonable management after operation may have significant effects on the patients with portal vein thrombosis or tumor embolus.
Objective To decrease the operative difficulty, with the purpose of looking for an orthotopic liver autotransplantation model which not only materializes the liver transplantation but also possesses higher survival rate. Methods This model was established via portal vein perfusion in thirty rats, and from which the result of the liver after perfusion, the operative time and the survival rate were observed. Liver tissues were researched at 24 h after operation under the light microscope. Results This model was easy to be perfused, the operative time was (48±3.0) min and the survival rate was 96.7% (29/30). The structure of hepatic tissue was basically normal with a little hydropic degeneration under the light microscope. Few erythrocytes residual occurred in the interlobular arteries under the light microscope. Conclusion The orthotopic liver autotransplantation model via portal vein perfusion has an exclusively blockage pattern which possesses a higher survival rate. It prevents the injury of immunological rejection and purely reflects the hepatic ischemia-reperfusion. But it is better to be applied in the non-hepatic artery anastomosis or the research nothing to do with the hepatic artery because the hepatic artery does not have sufficient perfusion.
Objective To investigate the effects of different reperfusion sequence on hepatic warm ischemia-reperfusion injury and its related mechanisms. Methods Ninety-six healthy male Sprague Dawley rats were randomly divided into 6 groups by using random digits method (n=16, each)： Sham operation group, only shammed operation for negative control; the other 5 groups were all experimental groups, which were divided according to different reperfusion sequences of portal vein and hepatic artery: reperfusion first through the portal vein for 1 min with subsequent full reperfusion group, reperfusion first through the portal vein for 2 min with subsequent full reperfusion group, reperfusion first through the hepatic artery for 1 min with subsequent full reperfusion group, reperfusion first through the hepatic artery for 2 min with subsequent full reperfusion group, simultaneous reperfusion through the portal vein and hepatic artery group. Each group was further randomly divided into two subgroups (n=8, each) for sample collection at 2, 4 hours after reperfusion respectively. Serum alanine aminotransferase (ALT), aspartate aminotransferase (AST) and malondialdehyde (MDA), superoxide dismutase (SOD) and glutathion (GSH) in hepatic tissue were detected respectively. HE staining of histopathologic slides was used to observe the morphological changes of hepatic tissue. TUNEL method was used to assess the apoptosis index (AI) of hepatocytes. Results The liver of rat was approximately normal in the sham operation group with lower levels of ALT, AST, MDA and AI, and higher levels of SOD and GSH as compared with all the experimental groups (P＜0.01). Less hepatic ischemia-reperfusion injury was found in reperfusion first through the portal vein for 1 min with subsequent full reperfusion group, whose ALT, AST, MDA and AI levels were significantly lower than those of the other experimental groups (P＜0.05 or P＜0.01), and its SOD and GSH levels were higher than those of the other experimental groups (P＜0.05 or P＜0.01). HE staining also showed milder hepatic injury in reperfusion first through the portal vein for 1 min with subsequent full reperfusion group as compared with the other experimental groups. Conclusion Hepatic reperfusion first through portal vein for short time with subsequent full reperfusion could depress the synthesis of free oxygen radicals and suppress apoptosis of hepatocytes, thus relieving hepatic ischemia-reperfusion injury.
To investigate the cause of septicemia in patients with obstructive jaundice,the correlationship between intra-biliary tract pressure(IBTP),portal veinous flow rate(PVFR)and interleukin-2(IL-2),soluble interleukin-2 receptor(sIL-2R),T lymphocyte subpopulation in patient with obstructive jaundice(Group A)has been studied.Group A was subdivided into A1,emergency operation group;A2,elective surgery group;A3,patient’s age over 60 years and A4,age under 60.Ninety patients with simple gallstone(Group B)were also tested as a contrast.The result showed that of all Group A,CD3+,CD4+,CD8+ before operation were much lower than those 10 days after operation(Plt;0.05 or Plt;0.01),while the postoperative sIL-2R was significantly higher than that of 10 days after operation(Plt;0.01),in Group A1,emergency surgery,the preoperative sIL-2R was much more higher than that in others of the jaundice group(Plt;0.01).Corralation analysis showed IBTP was negatively corralated to IL-2,CD3+,CD4+,CD8+,but it had positive correlation with sIL-2R(Plt;0.01).PVFR was positively correlated to IL-2(Plt;0.01).These indicate that obstructive jaundice with infection is closely related to the decreased host immunity.
ObjectiveTo investigate the hotspots and frontiers and to reveal research trends of cirrhosis with portal vein thrombosis (PVT) by visual analysis.MethodsWe explored the distributions, key citations and research trends of articles on cirrhosis with PVT published from 1991 to 2020 by citation analysis, co-word analysis, and burst detection by information visual software CiteSpace.ResultsThe quantity of articles on cirrhosis with PVT had been increasing over time. The management of PVT remained the hotspots, while the efficacy and prognosis of anticoagulation of PVT as well as the risk factors and underlying mechanisms of PVT had been frontiers in recent years.ConclusionsAnticoagulation and risk factors have been hotspots and frontiers in recent years.
Objective To investigate the expressions of transforming growth factor (TGF) -α and -β1 after 90% portal branch ligation (PBL) in rats. Methods Ninety-six SD rats were randomly divided into sham operation group and portal vein branches ligation group. The weight of both ligated and unligated lobes of liver were measured on 0.5, 1, 3, 5, 7, 14, 21, and 28 d after operation. The morphological changes of the unligated liver lobes were observed by microscope. The expressions of proliferating cell nuclear antigen (PCNA), TGF-α, and TGF-β1 of the unligated liver lobes were detected by immunohistochemistry. Results After the ligation of 90% portal vein branches, hepatic lobe at the ligated side diminished progressively after ligation, whereas the lobes of the unligated side underwent compensatory regeneration. The ratio of unligated lobes weight to the whole liver increased slowly within 1 d, speeded up significantly during 1-5 d period, increased slowly on 5 d, and reached plateau phase on 7 d after operation. The expressions of PCNA protein markedly increased within 0.5-3 d (Plt;0.01), which reached the peak on 5 d and decreased slightly on 7 d after operation, but still higher than sham operation group level, and then gradually returned to the level of sham operation group lately. The expressions of TGF-α and TGF-β1 in the unligated liver lobes markedly increased on 0.5 d, and reached the peak on 3 d and 1 d respectively， and then gradually returned to the level of sham operation group in 7-28 d after operation. Conclusion Ligation of 90% portal branches can induce active regeneration of unligated liver lobes in rats, whose initiation and proliferation are involved in the expressions of TGF-α and TGF-β1 protein.
ObjectiveTo summarize the progress and clinical application of portal vein embolization (PVE). MethodsDomestic and international publications about the PVE were retrieved and reviewed. ResultsPVE could effectively increase the perioperative security when selected at the appropriate time during liver resection surgery. However, there were some disputes on the best choice of the PVE in material, the use of dosage, and the clinical operation method. ConclusionsPVE as a method to induce liver to compensation, has a prominent role in increasing liver subtotal security, and improving the survival rate of patients. But it needs to be researched further to improve technique to promote future liver remnant hyperplasia compensatory faster and better.
Objective To investigate the diagnosis of organized thrombus in portal vein (PVOT) in liver transplantation. Methods The clinical data of 32 patients with PVOT who took the orthotopic liver transplantation (OLT) from January 2005 to January 2006 (271 cases) in this institute were retrospectively analyzed. Color doppler imaging (CDI), double helical CT plus three dimensional CT angiography (CTA) were taken before operation. CDI was performed during operation to look for the varicose vein, it was also used to reconstruct portal vein and measure the blood velocity in the portal vein. Results 23/32 (71.8%) cases had taken surgical treatment or interventional therapy before OLT. The grades of thrombus were as follows: gradeⅠ, 14/32; grade Ⅱ, 11/32; grade Ⅲ, 1/32; grade Ⅳ, 6/32. Twenty-eight cases of PVOT were diagnosed before operation, with accuracy of 87.5%. CDI was performed in 20 cases during operation, and 17 cases of collateral shunts were ligated with the monitor of ultrasound after the reconstruction of portal vein. The mean velocity of portal vein was (30.13±16.41) cm/s before the ligation of shunting veins, and the mean velocity was (46.36±19.82) cm/s after ligating the shunt veins. Conclusion Posibility of having PVOT for patients who had surgical treatment before OLT were much higher than who did not. CT and CTA could evaluate the portal vein system before operation, and performing CDI during operation may be important for the optimal reconstruction of portal vein.