Abstract:Abstract:Objective:To understand the clinical and pathological characteristics of hepatocellular carcinoma（HCC） with family aggregation (FH), and investigate the possible causes of HCC with FH aggregation.
Methods :The clinical and pathological data of 25 patients with HCC with FH and 39 patients with HCC with non-family aggregation(NF) were collected and compared.
Results:No significant difference was found in incidence of HCC, differentiation of tumor cells, the presence or absence of tumor capsule or venous tumor thrombosis, level of AFP and rate of recurrence at year after surgery between group FH and group NF (P>0.05). The gender ratio （male-to-female）、the HBV infection rate and the 3-year recurrence rate after surgery in Group FH was higher than that in Group NF（P＜0.05）. The average age、the pathological stage of liver fibrosis and HBV-DNA copy number in Group FH was lower than that in Group NF（P＜0.05）.
Conclusions:Genetic predisposition to disease and increased susceptibility to environmental carcinogens in the family may contribute to HCC with family aggregation.

Abstract:Abstract:Objective:To investigate the change of immune function and liver function in cases of hepatocellular carcinoma(HCC) with hypersplenism after concomitant splenectomy and liver resection.
Methods :The clinical data of 126 cases of HCC with hypersplenism were analyzed retrospectively. They were divided into two groups according to the different treatment: 58 cases underwent concomitant splenectomy and hepatectomy (group A), 68 cases underwent hepatectomy only (group B). The total serum bilirubin and aminotransferase levels and immune function were compared between the two groups.
Results:At 7 days after operation, the total serum bilirubin (TBIL) concentration was （25±6）μmol/L and （38±12）μmol/L respectively in group A and group B （P<0.05）；The alanine aminotransferase (ALT) and the aspartate aminotransferase(AST) were（49.8±35.8）u/L and （71.8±57.4）u/L，（45.6±39.3）u/L and （61.4±41.2）u/L respectively, in group A and group B on the 12th postoperative day（all P<0.05）. The levels of CD4 and CD4/CD8 were（41.7±4.2） and （32.6±3.5），（1.9±0.21） and （1.1±0.18）, respeetively in group A and group B（all P<0.05）. The postoperative morbidity was 7.24 %(10/58) and 16.18(11/68), respectively, in group A and group B (P>0.05). The 3-and 5-year disease-free survival rates in group A were 50.0 %(14/28) and 77.50 %(3/8) respectively, which were significantly higher than those of group B［32.26 %(10/31) and 20.0 %(2/10), P<0.05］.
Conclusions:Concomitant splenectomy and hepatectomy for HCC with hypersplenism may promote the recovery of balance in the subgroup of T-cell, and improve the patient′s antitumor immune function. It can alleviate the bilirubin metabolism burden, and promote recovery of liver function. The 3-and 5-year tumor-free survival rates were improved significantly with no increase of postoperative morbidity.

Abstract:Abstract:Objective:To explore the method and curative effect of therapy for spontaneous rupture and hemorrhage of liver cancer.
Methods :Thirty-five cases of spontaneous rupture and hemorrhage of liver cancer admitted to our hospital from January 1998 to February 2007 were reviewed. Among them, 12 cases underwent radical operation (including 5 cases of operation after interventional therapy), 9 cases had palliative operation and 19 cases received interventional therapy (5 cases had radical operation later).
Results:In the radical operation group, the bleeding completely stopped after operation, but 1 case died of hepatic failure. In the palliative operation group, 3 cases had re-bleeding and two of them died of hepatic failure. In the interventional therapy group, 1 case had re-bleeding, 2 cases had hepatic failure and one of them died. In the 12 cases of radical operation, there were 9 cases of one-year survival, 7 cases of two-year survial and 4 cases of five-year survival. In 9 cases of palliative operation, there were 2 cases of one-year survival and 1 case of two-year survival. In 14 cases of interventional therapy, the one-year, two-year and five-year survival were 8 cases, 4 cases and 1 case, respectively.
Conclusions:For spontaneous rupture and hemorrhage of liver cancer, interventional therapy can stop bleeding effectively with less complications, and can prolong survival time, so it can be used as the first choice for patients who have no chance of radical resection. Furthermore, hepatic arteriography can evaluate the possibility of radical operation and avoid unnecessary emergency operation.

Abstract:Abstract:Objective:To observe the protective effect of PGE1 in rat ischemia-reperfusion injury and to investigate the possible mechanism.
Methods :After the model of in situ hepatic I/R injury was established in 24 rats, the rats were randomly divided into sham operation (S) group,ischemia-reperfusion(I/R) group and Prostaglandin E1 (PGE1) group.The serum concentrations of liver enzyme levels,superoxidase dismutase (SOD)，malondialdehyde(MDA) and myeloperoxidase(MPO) were measured respectively,and the hepatic pathological changes were observed.
Results:The liver enzyme levels，MDA and MPO were significantly higher，and activity of SOD was lower in groups of I/R and PGE1 group than those in S group (P＜0.01）.Compared with I/R group,liver functional parameters,MDA and MPO were lower in PGE1 group（P＜0.01）,and the activity of SOD was higher in PGE1 group（P＜0.01）; meanwhile，the hepatic congestion and pathological damage were also obviously relieved in PGE1 group.
Conclusions:PGE1 could relieve the I/R injury of liver,and the mechanism may be by improving tissue antioxidation capability and decrease of neutrophilic leukocyte aggregation.

Abstract:Abstract:Objective:To explore the expression of B7-1 and B7-2 in cold ischemia/reperfusion (I/R) injury in the rat liver and its immunological role.
Methods :Thirty rats were divided into three groups randomly. Group A: sham operation group; group B: cold ischemia for 20 minutes and reperfusion; and group C: cold ischemia for 30 minutes and reperfusion. The expression of B7-1 and B7-2 mRNA in the livers was analyzed by real-time reverse transcription polymerase chain reaction(RT-PCR).
Results:B7-1 mRNA expressions in group B and C were 0.529±0.089 and 0.618±0.074 respectively, which were significantly higher than those in group A(0.131±0.012, P<0.01). B7-2 mRNA expressions in group B and C were 0.474±0.132 and 0.682±0.095 respectively, which were significantly higher than those in group A(0.163±0.054, P<0.01). In addition, both B7-1 and B7-2 levels were higher in group C than group B.
Conclusions:Cold ischemia/reperfusion injury may increase the immunogenicity of the liver by upregulating B7-1 and B7-2.

Abstract:Abstract:Objective:To evaluate recombinant adenovirus microspheres encapsulated with antisense MRP (as-mrp) on reversion of hepatocellular carcinoma.
Methods :The rats were divided randomly into 5 groups:control group; hepatic arterial injection of normal saline group, microspheres carrying no viruses group, rAdV carrying as-mrp group, and microspheres with encapsulation of as-mrp rAdV (MER) group. The theraputic effect were observed.
Results:The tumor growth inhibition and the mean life time in MER group were superior to than of other 4 groups (P<0.05). The tumor tissue were observed to have fluorescence intensity, but was negative in other tissues.
Conclusions:Recombinant adenovirus microspheres can effectively inhibit HCC.

Abstract:Abstract:Objective:To explore the expression characteristics of cell keratin 19 (CK19) in different subpopulations of HepG2 cell lines of human hepatocellular carcinoma ( HCC ).
Methods :Immunocytochemical staining was performed to show the expression of CK19 in SP and non-SP cells.
Results:With the Hoechst 33342 extrusion assay, SP cells were found to account for 1.6% of the HepG2 cells, and CK19 was much more expressed in SP cells than in non-SP cells.
Conclusions:The differential expression of CK19 can be seen in HepG2 cell lines, and most CK19 positive cells are from SP cells, indicating that HCC is heterogeneous.

Abstract:Abstract:Objective:To investigate the role of hypoxia-inducible factor-1 alpha in portal hypertensive gastropathy through a study of the expression of hypoxia inducible factor-1 alpha in the gastric mucosa of portal hypertensive rats.
Methods :The portal hypertensive gastropathy models were established by portal vein-ligation, and sham-operated rats were used simultaneously as controls. The expression of HIF-1α、VEGF and CD34 in rat stomach tissues was detected by using immunohistology and MVD was counted under CD34 staining.
Results:The expression level of HIF-1α,VEGF and CD34 in the portal hypertensive gastropathy group was significantly higher than that in the sham-operated group (P<0.01).
Conclusions: The overexpression of HIF-1α may play an important role in the pathogenesis of portal hypertensive gastropathy.

Abstract:Abstract:Objective:To investigate the techniques of establishment of a model of combined liver-kidney transplantation in rats.
Methods :Healthy male SD rats were used as donors and recipients. The donor liver and kidney were resected simultaneously. The donor′s liver was transplanted on the basis of Kamada′s cuff technique. The donor′s renal artery and ureter were respectively anastomosed end-to-end to the recipient′s right renal artery and right ureter.
Results:60 cases of combined liver-kidney transplantation in rats were performed, among which 50 cases were successful. The successful rate was 83.3%.
Conclusions:This model of combined liver-kidney transplantation in rats can increase the success rate of operation, shorten the operation time and decrease the rate of postoperative complications. It is convenient, stable and reliable.

Abstract:Abstract:Objective:To evaluate the effect of radiofrequency ablation (RFA) comblined with high frequency hyperthermia (HFH) and transcatheter arterial chemoembolization (TACE) on rabbit liver VX2 tumor.
Methods :Rabbit liver VX2 tumor models were divied into the following group: Group A, RFA+TACE+HFH; Group B, RFA+HFH; Group C, FA+TACE; Group D, TACE+HFH.The changes of ALT, hot shock protein 70(HSP 70)expression of liver and dendritic cells (DCs) expression of spleen before and after therapy were observed.
Results:(1)ALT: value of ALT was markedly elevated on 1d after therapy in all groups, but was greatest in Group A and also was the slowest to recover at 14 d; the degree of elevation was least in Group B and was the fastest to recover (P<0.05). (2)HSP70 expression: It was markedly elevated in Group A and was still the highest at 14 d; the degree of elevation was least in Group D and was the lowest at 14 d (P<0.05).(3).DCs expression: There was no difference between Groups A and B at 14 d and 7 d (P>0.05); and Groups C and D were markedly lower than the A and B group, and declined more quickly (P<0.05).
Conclusions:RFA+TACE+HFH can effectively activate the expression of Hsp70 and DCs, and enhance antitumorimmunopotency of the organism, but, at the same time, can most markedly damage liver function. Therefore, their combined use should be given an all-round consideration.

Abstract:Abstract:Objective:To study the effect of expression of RNA interference targeting protein kinase B (PKB) gene transfection mediated by nanoparticles(NP) on intimal hyperplasia (IH) in vein grafts of rats.
Methods :Nanoparticle PKB short hairpin RNA(shRNA) gene complex was prepared with PLGA and PVA. Autogenous vein graft model was established in 72 rats by transplanting internal jugular vein to carotid artery. The models were randomly divided into 3 groups: (1) PKB shRNA group: PKB-shRNA gene mediated by NP were transfected into the veins before anastomosis. (2) Empty vector group: the veins were transfected by empty vector mediated by NP. (3) Control group (no transfection). The grafted veins were harvested 3, 7, 14 and 28 days after the operation respectively. The mRNA and protein expression of PKB were determined by Northern blot and Western blot. IH was observed by HE and Verhoeff stain. The presence of apoptotic VSMC was detected by TUNEL stain.
Results:Compared to empty vector group and control group, PKB shRNA group had less expression of mRNA and protein of PKB gene(P＜0.05), less IH in the vein graft especially during 7~28d(P＜0.01), and more apoptofic VSMC (P<0.05).
Conclusions:Nanoparticle is an effective gene transfecting carrier, and RNA interference targeting PKB expression can prevent IH and promote VSMC apoptosis after vein grafting.

Abstract:Abstract:Objective:To investigate the application of temporary cavoportal hemitransposition (TCPHT) during conventional orthotopic liver transplant (OLT) in patients with portal vein thrombus (PVT) .
Methods :A group of eleven patients who underwent TCPHT (TCPHT group) was compared with another group of twenty-one patients without TCPHT (control group) among thirty-two adult OLT recipients with PVT of Yerdel′ Ⅲor Ⅳ degree during the recent 5 years. Duration of operation and anhepatic phase, and urinary production in anhepatic and reperfusion phase, and parameters of systemic hemodynamics such as mean artrial blood pressure(MAP), central venous pressure(CVP) and pulmonary arterial wedge pressure(PAWP) were comparatively analysed by case-control study.
Results:No difference in surgical duration and anhepatic time (P>0.05) was found between two groups. There was no significant difference of renal function parameters between the 2 groups at the first day post-transplantation, but the TCPHT group had an improved mean urinary output during anhepatic phase ［(64.09±20.79)mL vs (25.90±12.17)mL, P=0.033］; overall urinary production after reperfusion of TCPHT group and controls was (1 254.56±311.81)mL and (800.00±375.83)mL respectively (P=0.002); cases requiring hemodialysis in TCPHT group decreased markedly (P=0.032). Systemic hemodynamics between TCHHT and control group showed MAP after reperfusion (76.45±12.67) mmHg vs (66.52±7.48)mmHg (P=0.032), CVP(13.96±1.74)cm H2O vs (12.44±1.07)cm H2O(P=0.005), and PAWP(24.04±1.48) mmHg vs (22.81±1.23)mmHg (P=0.018), respectively.
Conclusions:The results suggests that TCPHT is a reliable surgical technique in OLT patients with HVT. This surgical strategy could effectively stabilize systemic hemodynamics and decrease the rate of postoperative renal failure,and without increase in the difficulty of operation.

Abstract:Abstract:Objective:To study the pathologic features, the clinicopathologic classification, rational diagnosis, and methods and principles of surgical treatment of Budd-Chiari syndrome (B-CS).
Methods :The clinical data of 172 cases of B-CS treated by surgery were retrospectively analyzed.
Results:All the 172 cases of B-CS underwent operation or the combination of operation and interventional therapy, including: (1)percutaneous transluminal angioplasty(PTA) and/or stenting of the inferior vena cava(IVC) in 99 cases; (2) percutaneous transhepatic angioplasty and/or stenting of the hepatic venous in 10 cases; (3) cavocaval shunt in 7 cases; (4) modified splenopneumopexy in 12 cases; (5) trans right atrium finger or balloon membranotomy in 5 cases; (6)radical resection of membrane and thrombus in 5 cases; (7) mesocaval shunt in 11 cases; (8) mesojugular shunt in 3 cases; (9) mesoatrium shunt in 5 cases; (10) IVC-atrium shunt in 4 cases; (11) mesocaval shunt combined with PTA and stenting of the IVC in 5 cases.Operative death rate was 1.2％（2/172）.During the follow up period of 3 months to 7 years, 12 patients had recurrence (7.0%), of whom 4 died of hepatic failure, and the other patients recovered satisfactorily.
Conclusions:Various imaging techniques should be adopted to make a definite diagnosis of Budd-Chiari syndrome before operation.Different operative procedures should be used according to the distinct clinicopathologic type of Budd-chiari syndrome.

Abstract:Abstract:Objective:To study the effect of combination of esophageal varices and spleen interventional embolization for portal hypertention with gastroesophageal variceal bleeding.
Methods :A comparative study was done as follows: In treatment group, percutaneous transhepatic variceal embolization with TH glue combined with partial splenic embolization was performed in 66 patients with cirrhotic portal hypertension; in control group, 54 patients were treated by devasculization and subtotal splenectomy with retroperitoneal splenic transposition . The follow-up period ranged from 2 to 60 months ( averages 20 months).
Results:(1)In treatment group ,the rates of emergency control of hemorrhage and rebleeding was 100% and 3.3% respectively. In the control guoup, the rate of rebleeding was 4.8%.(2) In the treatment group, at 2 months and 1 year postoperation, PHG was unchanged compared with that of preoperation. In the control group, at 2 months postoperation, PHG was significantly aggravated compared with that of preoperation（P＜0.05）, but at 1 year postoperation, PHG was significantly improved compared with that of preoperation (P＜0.05). There was no significant difference between the two groups in change of PHG (P＞0.05). (3) In the treatment group, the rate of disappearance, improvement, absence and aggravation change of G-E varices was 20.4%, 59.3%, 18.3%, and 1.8% , respectively, and in the control group, the varices disappearance rate was 20%, improvement rate 52%, and absence rate 28%. There was no significant difference between the two groups (P＞0.05). (4) Free pressure of portal vein (FPP) significantly declined at post-operation in the two groups （P＜0.05）. In the treatment group, average decline of FPP was (2.55±6.93) cmH2O, and in the control group it was (2.46±7.07) cmH2O.
Conclusions:Combined interventional embolization has the advantages of controlling variceal hemorrage and decreasing portal venous pressure, and does not aggravate PHG. The result shows that this method possessed an effect similar to that of subtotal splenectomy with retroperitonal splenic transposition and devascularization.

Abstract:Abstract:Objective:To analyze the cause of in-hospital death from variceal bleeding in cirrhotic patients with portal hypertension.
Methods :The clinical data of variceal bleeding in cirrhotic patients with portal hypertension admitted in recent three years to our hospital were analyzed retrospectively.
Results:Among the186 cases of variceal bleeding, 130 patients received elective operation, and 3 of them（2.31 %） died from hepatic failure or other complications; 28 patients received salvage surgery and 5 of them（17.86 %）died from hepatic failure or the other complications; 28 patients had nonoperative treatment, and 16 died, of which 12 patients died from uncontrolled bleeding.
Conclusions:Massive bleeding uncontrolled by nonoperative treatment and failure to perform prompt operation are the chief reasons for inhospital death in portal hypertensive patients with ruptured bleeding gastroesophageal varices. Prompt emergency surgery is of vital importance in decreasing mortality from massive bleeding in these portal hypertension patients.

Abstract:Abstract:Objective:To investigate the molecular mechanism of camptothecin enhancement of TRAIL-induced apoptosis in hepatocellular carcinoma cell lines.
Methods :The HepG2 and Hep3B cell cycles were analysed by flow cytometry after co-treated with camptothecin and TRAIL, and the expression of signal transduction protein, such as Caspase-8, Caspase-3, Caspase-9, DR4, DR5, DcR1, c-FLIP, RIP, Cytc, Smac, Bid were detected by Western blot before and after the treatment.
Results:Pretreatment with lower dose of Camptothecin could increase the sensitivity of HepG2 and Hep3B cells to TRAIL-induced apoptosis, and could downregulate the expression of c-FLIP and RIP, upregulate the expression of Cytc, Smac and Bid, but had no effect on the expression of DR4, DR5 and DcR1.
Conclusions:Camptothecin could sensitize HepG2 and Hep3B cells to TRAIL-induced apoptosis, and the mechanism is by downregulation of c-FLIP and RIP, activation of apoptosis death receptor pathway, upregulation of Bid and amplification of the mitochondrial pathway. The expression of death receptor not involved in this process.

Abstract:肝脏的缺血再灌注损伤是肝脏外科面临的一个重要课题。近年来，随着基础研究的深入，对肝脏的缺血再灌注损伤的机制以及预防有了进一步的认识。笔者就肝脏的缺血再灌注损伤的分子机制及中药对肝缺血再灌注损伤的预处理等相关方面的进展作一综述。

Abstract:Abstract:Objective:To study the injurious effect of active oxygen on hepatocarcinoma after ischemia and reperfusion.
Methods :The models of ischemia and reperfusion（I/R） of hepatocarcinoma were established. The model was reperfued alone or combination with perfued with hyperoxic fluid（Partial pressure of oxygen, PO2 >80) via portal vein. After reperfusion 1 h, 1 d, 3d and 7 d respectively, the concentration of superoxide dismutase（SOD） and catalase (CAT) were tested, and the apoptosis of hepatocarcinoma also was observed using terminal deoxynucleotidyl transferase-mediated dUTP nick end-labeling (TUNEL) method.
Results:The results indicated that the SOD concentration in both hepatocarcinoma tissue and normal hepatic tissues decreased following I/R and perfusion with hyperoxic fluid liquid.The concentration of CAT increased following I/R in normal hepatic tissues.In hepatocarcinoma tissue, concentration of CAT decreased after reperfusion for 1 d and reached its lowest point. After perfusion with hyperoxic fluid,the concentration of SOD in both hepatocarcinoma tissue and normal hepatic tissues decreased more quickly following I/R and the low level was still found on 7 d after reperfusion. The concentration of CAT in tissues of both groups decreased and reached the lowest level at 1 h after reperfusion, but it was restored at 3 d reperfusion in normal hepatic tissues, and in hepatocarcinoma tissue was still at lower level until 7 d after reperfusion. After I/R, the apoptotic cells increased in normal hepatic and hepatic cancer tissues, and were most marked in tissues of hepatic carcinoma at 1 d and 3 d after perfusion with hyperoxic fluid. After I/R and perfusing with hyperoxic fluid, the changes of SOD and CAT and apoptosis in hepatocarcinoma tissue were more obvious than that in normal hepatic tissues（P<0.01）.
Conclusions:Perfusion with hyperoxic fluid via portal vein can intensify hepatio ischemia and reperfusion injury, but has less effect on normal hepatic tissues.

Abstract:Abstract:Objective:To investigate the promoter methylation status and mRNA expression of SFRP1 and APC gene in hepatocellular carcinoma(HCC).
Methods :Methylation specific PCR was employed to detect the methylation status of APC and SFRP1 gene promoter in 30 HCC and their adjacent non-cancerous tissues, 10 normal hepatic tissues. Expression of SFRP1 and APC mRNA was also determined by reverse transcriptase PCR in the aforesaid tissues. The correlation between methylation and mRNA expression of the two genes and clinical data in patients with HCC was analyzed.
Results:SFRP1 promoter methylation was observed in 11/30, 4/30, 0/10 and APC promoter methylation was observed in 14/30, 5/30, 0/10 in HCC, adjacent non-cancerous tissues and normal hepatic tissues, respectively. Methylation of SFRP1 and APC genes in HCC increased significantly compared with the other two groups（P＜0.05）. No correlation was found between methylation status of SFRP1 gene and clinical data（P＞0.05）. Significant correlation between methylation of APC gene with age younger than 60 years-old and in carcinomas without pseudo-capsule were observed. Expression level of SFRP1 gene mRNA in HCC was significantly lower compared with the other two groups. Statistically significant differences of APC mRNA expression was not found among the three groups. No correlation between methylation of SFRP1 and APC genes was observed.
Conclusions:The aberrant promoter methylation of APC and SFRP1 genes are both related to hepatocarcinogenesis and HCC progress, but the relationships between methylation and mRNA expression of the genes in HCC remain unclear.

Abstract:Abstract:Objective:To study the effect of BMP-2 on apoptosis of human hepatoma HepG2 cells and the mechanisms.
Methods :Cell apoptosis was assessed by ELISA. Western blot was used to detect the expression of Bcl-2 and Fas proteins in HepG2 cells after treatment of BMP-2 .
Results:1～100ng/mL BMP-2 induced HepG2 cell apoptosis, and down-regulated Bcl-2 protein expression and increased Fas protein expression.
Conclusions:The present study suggests that BMP-2 induces HepG2 cell apoptosis may through Fas pathway.

Abstract:Abstract:Objective:To investigate the feasibility of constructing hepatocellular carcinoma cell strain in which mitofusin-2 gene is stably expressed.
Methods :Mitofusin-2 gene was inserted into the eukaryotic expressing vector pEGFP-N2 to construct expressing plasmid pEGFPmfn2. pEGFPmfn2 was transfected into hepatocellular carcinoma cell strain HepG2 by Lipofectamine 2000 and was selected with G418 for 30 d. The mRNA expression was detected by RT-PCR and protein expression by Western-blot.
Results:(1) pEGFPmfn2 expression plasmid was constructed succesfully; (2) pEGFPmfn2 was transfected into cultured HepG2 succesfully and positive cell clone was obtained; (3) mitofusin-2 gene was stably expressed in transfected HepG2/mfn2.
Conclusions:Hepatocellular carcinoma cell strain HepG2 with stable mitofusin-2 gene expression was successfully constructed, which could be applied to explore the role of mitofusin-2 gene in the genesis and development of hepatic carcinoma.