Abstract:Objective:
To investigate the effect of surgical treatment and the influence factors of treatment effect in patieats with hepatocellular carcinoma (HCC). Methods :The clinical materials of 408 cases of HCC who underwent surgical intervention in recent 8 years were retrospectively analyzed. Results:The 408 patients accounted for 43.9% of patients with HCC admitted during the same time. Of the 408 patients, large HCC accounted for 81.9% of patients, 8.5% of cases complicated by portal vein thrombus (PVT) ,and 4.8% of cases complicated by bile duct thrombus (BDT). In this series, 118 cases received left external lobectomy, 97 cases received left hemihepatectomy, 112 cases received right hemihepatectomy, 73 cases received right segmentectomy , 8 cases received left and righ segmentectomy ,35 cases received hepatectomy combining with removal of PVT , 20 cases received hepatectomy combined with thrombectomy of BDT; 48 cases received hepatectomy combined with implanment of drug delivery system (DDS) (35 patients with portal vein thrombus received DDS through portal vein). Three hundred and two cases had postoperative complications, including subdiaphragm abscesses,lung infection. upper digestive tract bleeding,pleural effusion,ascites,wound spliting etc. Mortalily was 2.7%; cancer residual rate was 18.4%;postoperative recurrence and/or metastasis was 73.0%.The 1,3and 5year survival rate was 73.9%,51.3%,35.5% respectively. Conclusions: This results show that most of the patients with HCC received surgical operation treatment are in advanced stage, postoperative recurrence and/or metastasis are the main influence factors of treatment effect.

Abstract:Objective:
To investigate the effect of surgical treatment for giant primary liver cancer.Methods:One hundred and fortysix cases of giant primary liver cancer received surgical treatment in recent 11 years ware analyzed retrospectively. Of them, 99 cases underwent irregular hepatectomy ，28 hemihepatectomy and 4 right hepatic trisegmentectomy .Including 19 cases received secondary resection after preoperative TACE,meanwhile 6 cases were underwent portal venous cancer thrombus extraction， 15 cases received biopsies and DDS only, Interoprative DDS
were performed in 105 cases. Result:The postoperative complications was 10.3%, the postoperative mortality was 1.4%.The 1-,3-,5- and 10year survival rates were 56.6%, 30.2% ，14.4% and 2.1% respectively. Conclusions: The main treatment of giant liver cancer is hepatcctomy.Combination with TACE，portal thrombus extraction and DDS can improve the longterm survival.

Abstract:Objective:
To evaluate the safety and feasibility of hepatic resection for huge primary liver carcinoma(PLC). Methods:216 cases of huge PLCs(mean diameter of 14.2cm) were resected. The hepatectomies were performed under intermittent occlusion of hepatic inflow. Results:All 216 cases were successfully resected. The mean time of occlusion of hepatic inflow was 19min, the mean blood loss was 743 ml. No serious complications occurred, and only seven patients died of hepatic failure and upper gastrointestinal haemorrhage postoperatively in this series. Conclusions:Although resection of huge PLC is quite difficult, but if suitable surgical techique and perioperative management are adopted ,it is safe and feasible.

Abstract:To study the diagnosis and treatment of primary liver cancer(PLC) with bile duct cancer thrombus (BDT). Methods:The clinical data of 21 patients with PLC and BDT admitted in the past 8 years were analyzed retrospectively . Results:The major clinical manifestations were the symptoms of primary liver cancer and obstructive jaundice. The correct diagnosis rate was 76.2% before operation. The diagnosis rate of Bus, CT, MRI, ERCP and PTC was 14.3%, 9.52%, 14.3%, 71.4% and 100% respectively. The operative procedures included hepatectomy with removal of BDT (n=10), hepatectomy combined with extrahepatic bile duct resection (n=5), thrombectomy through choledochotomy with TACE (n=3), removal of BDT with HAI (n=3). The 3,5year survival rate were 43.20% and 24.60% respectively. Conclusions:Multiexaminations should be applied in the diagnosis of PLC with BDT. The comprehensive therapy including surgery and other therapies must be adoptted for PLC with BDT.

Abstract:Objective:
To evaluate the effect of combination of surgery and transcatheter hepatic arterial chemotherapic embolism(THACE) with or without placement of drug deliery system(DDS) of portal vein for hepatocellular carcinoma with portal vein tumor thrombus (PVTT). Methods:Fifteen cases of advanced HCC with PVTT were treated by hepatectomy， thrombectomy of portal vein with THACE,and 5 of the 15 cases received postoperative chemotherapy via portal vein. Results:All patients survived after operation. The survival rate of 6,12,18 months was 15,12 and 9 cases respectively. Conclusions : Operation is still an effective method for advanced HCC , postoperative comprehensive treatment can improve the survival rate.

Abstract:Objective:
To explore the therapeutic effect of dual perfusion embolization and chemotherapy via hepatic artery and portal vein(combmation treatment) in the treatment of unresectable PHC.Methods : Eightyone cases of unresectable PHC were randomly divided into two gronps: (1) Combination treatment group.Fortyone cases,These cases received embolization and chemotherapy via hepatic artery and portal vein through a drug delivery system intraoperatively,and then embolization and chemotherapy via the drug pump were given periodically. (2) TACE group.Forty cases.These cases were treated with Seldinger's technique, the dosage of drugs were the same as used in the former group during laparotomy. After 3 times of treatment, AFP, the size of tumor, liver function, body weight, abdominal perimeter, survival time of the two groups were compared.Results : The weight, AFP, decrease of tumour size in combination group were much better than those in TACE group(P<0.01); but liver function, abdominal perimeter of the two groups were no significant difference(P>0.05). The median survival time in the two groups were 18.0 months and 11.1 months (P=0.0001). The accumulating survival rate of 6, 9, 12, 24 months were 87.8%,78.0%, 68.2%,31.7% in combination group, and 70.0%, 52.5%, 30.0%, 5.0% in TACE group, respectively. The factors affecting survival were therapeutic method, liver function, size of tumour.

Abstract:Objective:
To investigate the effects and mechanism of magnetic microsphere combination of cisplatin with nano or micron ferric oxide particle on human hepatoma cell(HHC). Methods : A human hepatoma cell line BEL7402 was used in this study, 0.04μg/ml～8μg/ml of cisplatin(CDDP), cisplatin nanoferric oxide magnetic microsphere(nCDDPmm) and microferric oxide magnetic microsphere(mCDDPmm) were administered to the culture solution for culturing the BEL7402 cell as the experimental groups,and in the control groups were administered with cisplatin 0μg/ml and magnetic microsphere without cisplatin respectively. The optic density of viable cell, cytotoxity index, growth curve of cell, cell cycle, proliferation index and apoptosis were assayed by MTT method, cell count and flow cytometry respectively. Results : (1)The viable cell's optic density decreased and the cytotoxity index increased in human hepatoma cell following increasing dosages of CDDP, nCDDPmm and mCDDPmm in culture solution,presenting a dosedependent manner(r value of three drugs were 0.95, 0.91 and 0.89 respective, P＜0.01）. (2)The growth curve of human hepatoma cell numbers developed smoothly, when the dosage of the drugs and timing increased. The cell numbers in nCDDPmm group and mCDDPmm group were higher than that in CDDP group, when dose ≤0.8μg/ml, and timing from 6h to 24h. The cell numbers was no significant difference（P＞0.05）between nCDDPmm and mCDDPmm. (3)Apoptosis rate of hepatoma cell increased (P＜0.01), when dose of CDDP, nCDDPmm and mCDDPmm increased. The apoptosis rate in nCDDPmm group was highter than that in mCDDPmm group (P＜0.01). (4)The G0/G1 phase increased, and S phase decreased, when human hepatoma cell was treated by CDDP,nCDDPmm and mCDDPmm. Conclusions:The antineoplastic effects of nCDDPmm and mCDDPmm depend on the concentration of CDDP, the mechanism is mainly the apoptosis occurred in human hepatoma cell. Ferric oxide particles of nano and micron have faint stimulative proliferation of human hepatoma cell, however，it is enough to eliminate the influence of ferric oxide particle on hepatoma cell as the CDDP released slowly from nCDDPmm and mCDDPmm with time.

Abstract:Objective:
To investigate the role of detection of telomerase activity of peripheral blood mononuclear cells （PBMC）in patients with hepatocellular carcinoma (HCC). Methods :Expression of telomerase activity of PMBC was detected in patients with HCC, benign liver neoplasms, chronic liver diseases, healthy volunteers and HCC cancerous tissues using polymerase chain reaction (PCRELISA) . Results :Telomerase activity of PBMC and HCC tissues in HCC patients were 1.29±0.68 and 1.40±0.88 respectively, when the positive cutoff level was set up at 0.7,telomerase activity of cancerous tissues were positive in PBMC in all the HCC patients, the telomerase activity was a significant concordance between PBMC and cancerous tissues (Kappa=1, P<0.001). Telomerase activity of PBMC in patients with benign liver neoplasms, chronic liver diseases, healthy volunteers was 0.65±0.32，0.43±0.23，and 0.38±0.14 respectively, and all were significantly lower than that in patients with HCC （P<0.01, <0.001, <0.001 respectively）. The telomerase activity of PBMC was positive in 18 patients whose AFP > 200ug/L, and in 10 of 12 patients (83.3%) whose AFP < 200ug/L . In patients with HCC, the positive rate of telomerase activity of PBMC was significantly higher than that of serum AFP (P<0.01). Conclusions: The expression of telomerase activity of PBMC can actually reflect the expression of telomeras activety of HCC tissue, so detection of telomerase activity of PBMC is a sensitive and minimally invasive method for the diagnosis of early stage HCC.

Abstract:Objective:To study the effect of reconbinant growrh hormone(rGH) on the tumor cell proliferation in the transplantation liver tumor models in rats,to explore the advantages and disadvantages of rGH in the treatment of liver carcinoma.Methods : The male weaning rats were used to vaccinate and transgenerate by intraperitoneal injection of abdominal fluid contarning tumor cells from the celiar transplantation tumor rats, the others weaning rats were used to be the solid tumor rats by subcutaneous vaccination with abdominal fluid of tumor cells.The solid tumor were divided into pieces (2 mm×2 mm×3 mm),which were inserted into the liver of the 82 adult male rats to establish the transplantation liver tumor models.and then the models were divided into experimental group and control group randomly.After 3 days,experimental group were given rGH (0.5U／ kg·d)and control group were given via caudal vein NS for 5 days.All the rats were killed in 8d,10d,12d,respectively.The rats, tumors and livers were weighted,the number of hepatocytes,carcinoma cells and mitotic index were measured,the number of 　3HTdR incorporation in vivo was measured in 8 days after operation. Results :There were no significant difference in all the results between the two groups,except the rat's weight of 8days after operation and the tumor weight in different phase.Conclusions :The rGH has no significant effect on the proliferation of tumor cell in transplantation liver models in rats.

Abstract:Objective:
To study the significance of expression of Cyclin E in hepatocellular carcinoma (HCC). Methods:Cyclin E expressions were examined in 45 specimens of HCC and 30 specimens of paracancer tissues, and the relationship between Cyclin E with the clinicopathological parameters was determined.Among the 45 patients,19 were poor encapsulatic; 12 patients had portal vein thrombus; 11 had extrahepatic metastasis;12 had intrahepatic metastasis.Any patient had one or more of 4 conditions mentioned above was considered as invasion and metastasis. Results:The overexpression of Cyclin E in HCC tissues was seen in 16 cases (35.6%) ,but not seen in paracancer tissues. Cyclin E overexpression occurred more frequently in HCC patients with poor differentiation and portal vein thrombus (P<0.05). The overexpression of Cyclin E in HCC patients with invasive and metastsis was significantly higher than that in noninvasive and nonmetastasis patients (P<0.05). There were no significant difference between the expression of Cyclin E with patients′ age, sex, tumor size, HBsAg,AFP,capsure formation and tumor number（P>0.05）. Conclusions:Expression of Cyclin E is related with HCC carcinogenesis; differentiation, invasion and metastasis, detection of expression of Cyclin E may be helpful in the diagnosis,treatment and prediction of the prognosis of patients with HCC.

Abstract:Objective:
To study the relationship of expression of angiopoietin gene and angiogenesis in the insitu implanted hepatoma in rats. Methods: Forty Wistar rats were used to establish the insitu implanted hepatoma model by implanting Walker256 hepatoma cell line. The number of microvessel density(MVD) in hepatoma was calculated. The expression of angiopoietin mRNA was observed by insitu hybridization method. Results:The MDV in the implanted hepatoma in the first day of 1, 2 and 3 week postimplantatively were （15±4.3）/Hp，（17±3.6）/Hp，（45±7.8）/Hp respectively. The amount of MDV and expression of Ang1 mRNA were increased significantly and correlated with MDV in the hepatoma tissues and nonhepatoma tissues,and no significant difference between the two types of tissues. Expression of Ang2 mRNA was not seen in nonhepatoma tissues,but in hepatoma tissues,the expression of Ang2 was obvious. Conclusions:Angiopoietin2 mRNA may play a role in the angiogenesis of the insitu implanted hepatoma.

Abstract:Objective:
To study the alternation of nitric oxide(NO)/endothelin(ET) ratio in early stage of liver transplantation in rats, to investigate its correlation with liver function, and to observe the effect of prostaglandin E1(PGE1) on the graft function. Methods:Wister rats randomly divided into 4 group (n=8 in each group):(1)Normal control group(group A);(2)Operative control group (group B);(3)Experimental group(group C);(4)PEG1 treatment group (group D).Orthotopic liver transplantation(OLT) model was set up by "two-cuff" method.ALT, AST, NO and ET level in blood and histological change of liver graft were detected and compared at 6th hour postoperatively. Results: All the rats survived 6h in group B and D(100%),but only 5 survived in group C (62.5%). Comparing with group C, ALT, AST and ET decreased and NO increased significantly (P<0.05) in group D. The levels of NO and ET, and NO/ET ratio were correlated with ALT closely (r=-0.681,0.793 and -0.732 respectively). Obviously histological injury was observed in group C, while morphological appearance was better preserved in group B and D. Conclusions:Concentration of NO, ET and NO/ET ratio in recipient blood more conrrectly reflect the function of sinusoid endothelial cell of the graft. PGE1 can relieves endothelial injury and maintains the function of liver graft.

Abstract:Objective:
To evaluate the effect of hepatic resection for liver malignancies. Method: The clinical data including the patterns and effect of operation in 108 patients with malignant liver disease underwent hepatic resection in recent 5 years in our hospital were analyzed retrospectively.Result:Tweent-eight cases occurred complications and four died after operation . The 1-,3-year survival rate were 87.5% and 43.8% respectively. Conclusions:Surgical resection is still an effective procedure for the liver malignancies.

Abstract:Objective:
To study the significance of expression of VEGF in the hepatocellular carcinoma tissue(HCT) and the expression of AFPmRNA in the peripheral vein blood in hepatocellular carcinoma patients(HCC) with metastasis. Methods: AFPmRNA was detected in peripheral blood before operation and the expression of VEGF in HCC tissue was analyzed by immunohistochemistry after operation in 20 patients. The relations between the expression of VEGF protein and AFPmRNA with clinicpathological parameters were analyzed statistically. Results:（1）Among the 20 patients with HCC, 10 were positive expression of VEGF protein, which had no relation with the clinicopathological parameters. （2）Of the 20 patients, positive expression of AFPmRNA were detected in the peripheral blood in 15 patients, and AFP≥200μg/L were found in 13 patients.（3） AFPmRNA in the peripheral blood vein was detected in 9 of 10 patients with VEGF positive expression. Conclusions:（1）Either VEGF protein expressed in HCC tissue or AFPmRNA detected in the peripheral blood could be as a guide line to judge the tendency of the metastasis of HCC,however former is simpler and the later is more sensitive. （2）The detection of AFPmRNA in the peripheral blood is more sensitive than the detection of serum AFP lever for surveillance of the high risk patients and postoperative follow up of the patients with HCC.

Abstract:Abstract:Objective:To investigate the renal hemodynamic changes after orthotopic liver transplantation(OLT)and the correlative parameters. Methods: In 20 patients undergoing OLT for cirrhosis,the following renal arterial resistance index(RI) was measured before surgery and 7days,30days, 6 months and 1 year after operation by using color Doppler flow imaging(CDFI) and serum creatinine detection.Meanwhile the same parameters were measured in 10 healthy as controls. Results: Both RI and serum Cr rised after OLT (P<0.01), restored to normal after OLT in 1 year(P>0.05). Conclusions:Most alteration of renal hemodynamic parameters in cirrhosis are restored to normal after OLT in 1 year. Preoperative renal abnormalities and intraopterative alteration of hemodynamic may contribute to postoperative renal dysfunction.Cyclosporine(CsA) is the most likely etiologic agent of postoperative renal dysfunction.

Abstract:Objective:
To study the surgical technique of right hemihepatectomy in adult-to-adult living donor liver transplantation. Methods: Eight donors underwent right hemihepatectomy in adult-to-adult living donor liver transplantation. Among these donors operation, there were 5 right hemihepatectomy and 3 extended right hemihepatectomy. If the diameter of the auxiliary right hepatic vein more than 0.8cm, it should be reserved. The dissection line of right hemihepatectomy was at the 0.5cm~1.0cm to the right side of middle hepatic vein, and the dissection line of extended right hemihepatectomy was at 0.5cm~1.0cm to the left side of middle hepatic vein. Intraoperative cholangiogram was performed, and without inflow vascular occlusion was done during the operation.Results : The donor average operation time was 448 min (ranged from 353 min to 510 min). The average blood loss of operation was 384 ml (ranged from 170ml to 900ml). The grafts average weight was 669.4g (ranged from 445g to 900g), the right hemihepatic grafts weighted 667.0g averagely and the extended right hemihepatectic grafts weighted 673.3g averagely.
The average graft-to-recipient body weight was 1.16% (ranged from 0.76% to 1.50%). There were 2 donors occurred complications including biliary leak in 1, and dysfunction of liver and kidney in 1, all the 2 complications were cured. There was no donor mortality and all donors well recovered,All the donors were discharged within three weeks after operation.All of the 8 grafts and 8 recipients survived one year. Conclusions:The right hemihepatectomy and extended right hemihepatectomy in adult-to-adult living donor liver transplantation can be performed safely,if the liver resection techmqne is proformed exactly and successfully.

Abstract:Objective:
To study the diagnosis and prophylaxis of postoperative infections within 1 month after orthotopic liver transplantation（OLT）. Methods : Clinical date of 38 consecutive patients who underwent OLT at our institution from 2001 to 2003 were retrospectively reviewed. Result: Eighteen patients（47.4%） developed twenty-nine times infection after operation .Respiratory tract and peritoneum were the common infectious sites(37.9% and 24.1%). Enterobacter cloacae(8 of 29, 27.6%) , Escherichia coli(7 of 29, 24.1%),staphylococcus aureus(6 of 29, 20.7%) were the commonest bacterial.The mortality of infection was 38.9%（7/18）. Identified risk factors for infection including: previous transplantation; duration of operation; transfusion requirements during surgery; type of biliary anastomosis; delayed restoration of gastrointestinal function and persistent postoperative hyperglucocemia . Perioperative decontamination of the digestive tract had a protective effect. Conclusions : Infections are a major cause of death among liver transplant recipients. Reducing risk factors of infection and perioperative decontamination of the digestive tract may decrease the occurrence of postoperative infection.