Abstract:

Objective: To investigate the anatomical characteristics of the danger zone during dissection of the retrohepatic tunnel and determine its clinical application.
Methods: Anatomical dissections were performed on the liver specimens from 20 adult cadavers, and the clinical data of 27 patients undergoing right hepatectomy with liver hanging maneuver through anterior approach were also collected. The total number of the short hepatic veins entering the inferior vena cava (IVC) at the retrohepatic portion or at the dissecting path of the retrohepatic tunnel was counted separately.
Results: In terms of anatomical findings, the majority of short hepatic veins which drain into the retrohepatic IVC were found to arise from the left and right aspects of the retrohepatic IVC, and were mainly present in the middle and lower third of the retrohepatic IVC segment. At the tunnel dissection route, the openings of the short hepatic veins were mainly present in the lower third of the anterior surface of the retrohepatic IVC with average number of 2.90±1.07, while only one case was found having a short hepatic vein in the upper third and 4 cases were found having a short hepatic vein in the middle third of the retrohepatic IVC. The inferior right hepatic vein was found mostly present in the middle and lower third of the retrohepatic segment and its occurrence rate was 85.0% (17/20). In terms of the intraoperative record, the short hepatic veins entering the retrohepatic IVC were mainly concentrated in the lower third of the course of retrohepatic tunnel, the average number of short hepatic veins was 3.21±1.67, the distance of this zone in most cases from top to bottom was about 3-4 cm and the occurrence rate of the inferior right hepatic vein in this zone was 85.2%. Of the 27 patients, only one case had a short hepatic vein entering the anterior middle segment of the retrohepatic IVC. 
Conclusion: The danger zone of the retrohepatic tunnel is located in the anterior surface of the lower segment of retrohepatic IVC with a distance of 3-4 cm (from top to bottom), where a few short hepatic veins along with the inferior right hepatic vein enter the retrohepatic IVC. This area has unique anatomical characteristics. The key to the success of creation of the retrohepatic tunnel is based on a strong knowledge of the anatomy of this zone and then its dissection in the anatomical plane.

Abstract:

Objective:  To explore the surgical treatment for large primary liver cancer.
Methods: The clinical data of 109 patients with large primary liver cancer undergoing hepatectomy were retrospectively reviewed.
Results: The maximum diameters of the tumors  ranged from 10.5 to 30 cm with the average of (14.46±3.84) cm, and 92 cases were single and 17 cases were multiple lesions. The tumor location was within the left lobe in 41 cases, right lobe in 63 cases and entended over half of the liver in 5 cases. Eighty-three cases were combined with posthepatitic cirrhosis, 5 cases complicated by rupture and bleeding of the liver cancer, 19 cases had tumor embolus of portal vein (4 cases with tumor embolus of bile duct) and 15 cases had metastasis to the hilar or juxta-hepatic  lymph nodes. The preoperative liver function grade was Child's grade A in 101 cases and grade B in 8 cases. The AFP levels of 98 cases were higher than 500 μg/L and in 11 cases were below 20 μg/L. Two cases were in clinical stage IIa, 92 cases in stage IIb and 15 cases in stage IIIa. Forty-two cases underwent anatomic liver resection and 67 cases underwent local resection, and the intraoperative blood loss was 400-2, 200 mL. No hospital death occurred, and the incidence of postoperative complications was 75.23%. Sixty-eight cases were followed up for 2 to 72 months, of whom the 5 cases with rupture and bleeding of the liver cancer survived for 8 to 13 months after surgery, and the 1-, 3-, and 5-year survival rate of the remaining 63 cases without tumor rupture was 44.07%, 13.06% and 7.84%, respectively after elective hepatectomy. 
Conclusion: Surgical treatment offers effective short-term in results patients with large primary liver cancer, but its long-term efficacy remains to be improved. One-stage resection may be feasible for ruptured large primary liver cancer in selected cases.

Abstract:

Objective: To investigate the methods of surgical treatment for large primary liver cancer (LPLC).
Methods: The clinical data of 180 patients with large LPLC admitted to our hospital from January 2002 to December 2009 were retrospectively reviewed. The presence of cirrhosis, tumor size, lesion location, clinical stage and comorbidities were analyzed.
Results: All the 180 patients underwent surgical treatment, of whom 170 cases were hepatocellular carcinoma, 7 cases were cholangiocarcinoma and 3 cases were mixed hepatic carcinoma. The average size (maximum diameter) of the tumors was 9 (5.3-26.3) cm and 150 cases were accompanied with cirrhosis. Of the patients, anatomic hepatectomy was performed in 112 cases and non-anatomic hepatectomy was performed in 68 cases; the procedures were performed with pringle maneuver in 88 cases, selective hemihepatic vascular clamping in 62 cases, total hepatic vascular exclusion in 10 cases and without hepatic vascular occlusion in 20 cases, respectively. The incidence of postoperative complications was 13.89% (25/180) and the mortality was rate 1.61% (3/180). The 1- 3- and 5-year overall survival rate of these patients was 76.11%, 48.89% and 30.0%, respectively.
Conclusion: Surgical resection-based comprehensive therapy is the main treatment method for large LPLC, and second-stage resection should be strived for after transcatheter arterial chemoembolization (TACE) for those presenting with formidable large LPLC. The rational choice of hepatic blood flow occlusion is a key to ensure operative success and smooth postoperative recovery.

Abstract:

Objective: To assess the application value of the principle of damage control surgery (DCS) in treatment of liver trauma.
Methods: The clinical data of 168 patients with major hepatic trauma greater than grade III were retrospectively analyzed. The patients were divided into two groups according to whether the DCS principle had been applied or not, and then the differences in average operating time, complications, mortality and length of hospital stay between the two groups were compared.
Results: The length of hospital stay of the DCS group was longer than that of the one-stage operation group [ (24.5±3.2) d vs. (16.4±4.1) d] (P<0.05), while the average operating time, postoperative complication incidence and mortality of the DCS group were significantly lower than those of the one-stage operation group[(102±27) min vs. (224±35)min; 26.3% vs. 38.4%; 15.8% vs. 30.1%)] (all P<0.05).
Conclusion: The DCS principle is beneficial for management of patients with hepatic trauma, because it can reduce postoperative complications and mortality.

Abstract:

Objective: To determine the clinical features and prognosis of portal hypertension (PH) combined with hepatocellular carcinoma (HCC).
Methods: The clinical data of PH patients combined with HCC (HCC-PH) and the patients with liver cirrhosis-induced PH (LC-PH) admitted and treated in our department during the same 8-year period were retrospectively analyzed. Univariate and multivariate survival analysis were conducted using Cox proportional hazard model. Receiver operating characteristic (ROC) curves were used to determine the cutoff values of continuous variables.
Results: Compared with the clinical features of the LC-PH patients, the HCC-PH patients showed higher incidence of esophagogastric varices, portal hypertensive gastropathy and concomitant portal vein thrombus, but lower incidence of compensatory enlargement of the portal vein luminal diameter (≥1.3 cm) and mild hypersplenism. Compared to LC-PH patients, the HCC-PH patients had worse liver function and poorer survival outcomes after upper gastrointestinal bleeding. Multivariate analysis revealed that the combination of HCC, aspartate aminotransferase (AST) ≥ 65.6 U/L, presence of portal vein (tumor) thrombus, total bilirubin (TBIL) ≥ 34.0 μmol/L and albumin (ALB) value were factors affecting the survival of PH patients.
Conclusion: The clinical features of HCC-PH is different from those of LC-PH, so HCC-PH cannot be simply treated as LC-PH. A combination of HCC is the most important factor affecting the survival of PH patients.

Abstract:

Objective: To investigate the feasibility of liver transplantation using the independent medial split liver graft, so as to broaden the sources of donor liver.
Methods: Healthy adult mongrel dogs were divided into donor group (n=12, 20-25 kg) and recipient group (n=12, 10-15 kg), and each of the donors was then randomly paired with a recipient. In the donor operation, the middle part of the liver (quadrate lobe and right medial lobe) was splitted in vivo, and then along with the medial portal branch, middle hepatic artery and hepatic duct, the independent medial split liver graft was procured and weighed after in situ perfusion. In the recipient operation, a temporary portacaval shunt was created before hepatectomy; implantation was done by piggyback technique, whereby the outflow orifice of the graft was anastomosed to the anterior wall of the recipient vena cava in an end-to-side manner, and the blood flow of the transplanted liver was restored by an end-to-end anastomosis of the donor medial portal branch and the main trunk of the recipient portal vein, and finally the reconstruction of the hepatic artery and biliary duct was performed. The biliary tract and abdominal drainage were detected daily after operation. After recipient's death, autopsy was done and pathological examination of the graft specimen was performed.
Results: The canine liver was divided by deep fissures into seven lobes, which are connected by meager parenchymal bridges. The quadrate lobe and right medial lobe are supplied by the medial portal branches and middle hepatic artery, and their blood is returned via the middle hepatic vein; biliary drainage is by the middle hepatic duct. In the donor group, the in situ splitting procedures were all accomplished, and the average operative duration was (215.0±67.7) min and bleeding volume was (229.3±66.5) mL. The graft-recipient weight ratio (GRWR) of middle part liver graft [(1.3±0.3) %] was significantly different (P<0.01) from that of the presumed left part graft [(2.1±0.4) %] and right part graft [(0.9±0.1) %] (both P<0.01). In the recipient group, the mean operative time was (327.6±75.3) min, blood loss was (415.5±79.8) mL and anhepatic time was (33.6±7.5) min. All the 12 grafts were successfully implanted, the cold ischemia time was (41.9±12.1) min, and the bile secretion was observed at (8.3±3.6) min after portal reperfusion. The parameters of liver function of the recipients were changed on the first day after surgery and then gradually returned to normal. The median survival time of the recipients was 92.5 (18-272) h, and no case died from surgical procedure complications such as anastomotic bleeding and thrombosis.
Conclusion: This canine model proves that the central part of the liver can be splitted as a graft separately, and it may provide an alternative idea for expanding the sources of donor liver.

Abstract:

Objective: To analyse the common causes of unsuccessful orthotopic liver transplantation in rats, and provide an appropriate treatment strategy.
Methods: Over a period of 10 months, orthotopic liver transplantation model was performed by modified Kamada two-cuff technique in 150 rats. Completion of a set of 50 consecutive cases was regarded as an experimental stage, so the whole experimental course was partitioned into three stages: early, middle and late stage. The causes of transplantation failure in each stage were analyzed separately and summarized.
Results: In the early stage, the major causes leading to failure of rat orthotopic liver transplantation were pneumothorax (5.8%), intraoperative bleeding (10.6%), and exended anhepatic phase (50.4%), while those in the middle and late stage were failed anastomosis of suprahepatic inferior vena cava (21.0%), extended anhepatic phase (20.6%), failed anastomosis of portal vein and infrahepatic inferior vena cava (17.6%), and failed bile duct reconstruction (5.6%).
Conclusion: There are many causes of unsuccessful orthotopic liver transplantation in rats, among which, the anhepatic phase is the most critical factor affecting the results. Timely identification of the causes of unsuccessful transplantation and finding the appropriate solutions are helpful to the novice operators.

Abstract:

Objective: To investigate the protective effect of ω-3 polyunsaturated fatty acid (ω-3PUFA) on the remnant liver in rat with partial hepatectomy and its mechanism. Methods: Male SD rats were randomly divided into sham operated control group, model group (partial hepatectomy + normal saline), low dose ω-3PUFA treatment group (partial hepatectomy + 1 mL/kg ω-3PUFA) and high dose ω-3PUFA treatment group (partial hepatectomy + 2 mL/kg ω-3PUFA). The histopathological change of the remnant liver was dynamically assessed by light microscope at day 1, 2, 3 and 5 after surgery. In addition, the expression of occludin protein and the ultramicrostructural features of the hepatic cells were examined at day 3 after surgery. Results: The histopathological findings showed that the hepatic cells and histological structures were severely damaged, while the pathological changes of the two doses of ω-3PUFA treatment groups were of markedly lesser degree but no obvious difference was noted between themselves. The expression levels of occludin protein of the two doses of ω-3PUFA treatment groups were markedly higher than that of the model group, but were similar between themselves. The electron microscopic observations revealed that the tight junctions between hepatic cells were severely disrupted, while these structures of the two doses of ω-3PUFA treatment groups were maintained relatively intact, and the high dose group was better than that of low dose group in this respect. Conclusion: The perioperative administration of ω-3PUFA can increase the occludin expression and preserve the ultramicrostructures of hepatic cells in rat with partial liver resection, which may be responsible for its effect of hepatic barrier protection.

Abstract:Objective: To assess the immunosafety of a novel bioartificial liver (BAL) system. Methods: The novel BAL system was constructed with the multilayer flat-plate bioreactor based on nanofiber scaffolds and the coculture system consisted of porcine hepatocytes and bone marrow mesenchymal stem cells. Normal beagles underwent extracorporeal circulation perfusion with this novel BAL system for 6 hours, and the blood and medium samples were collected at regular intervals from the BAL system during operation. The levels of IgG, IgM and CH50 (C3) in the medium and the pre-, intra- and postoperative plasma were detected by ELISA assay. The routine blood tests of the beagles were performed before and after operation. The deposition of immune proteins in the cell material surface of the bioreactor and tissues from heart, liver, spleen, lung and kidney of the beagles were determined by immunofluorescence assay. Results: The levels of IgG and IgM of the beagles had no significant increase or decrease during and after the 6-hour extracorporeal circulation, while the level of CH50 had a transient decrease during operation, then quickly recovered to normal level, and no severe allergic or rejection reaction occurred. There was only a very small amount of IgG and CH50 detected in the medium of the bioreactor. No significant increase or decrease of white blood cells, platelets or lymphocytes after operation was found on routine blood tests. A very small deposition of IgG and C3 was detected in the cell material surface of the bioreactor but no deposition of IgG or IgM or C3 was detected in any of the important organs. Conclusion: The novel BAL system has a satisfactory immunosafety profile.

Abstract:

Objective: To observe the inhibitory effect of RNA interference (RNAi) on the expression of nodal gene in human hepatocellular carcinoma (HCC) cells, and explore the feasibility of nodal gene targeting in HCC gene therapy. Methods: SMMC-7721 cells were transfected with the plasmid vector containing a short hairpin RNA (shRNA) sequence targeting the nodal gene. After assessing the transfection efficiency, the nodal gene and protein expression was detected by real-time quantitive PCR and Western blot,respectively. Furthermore, the effect of nodal gene interference on the proliferation of SMMC-7721 cells in vitro was studied. Results: The plasmid containing shRNA had excellent transfection efficiency in SMMC-7721 cells. After transfection, the expression of nodal mRNA and protein of SMMC-7721 cells was significantly inhibited, and their proliferation in vitro was also significantly suppressed. Conclusion: The nodal gene and protein expression as well as cell proliferation of HCC cells can be effectively inhibited by RNAi technique, so nodal gene may be a potential therapeutic target for HCC.

Abstract:

Objective: To investigate the relation of caveolin-1 with invasion and metastasis of hepatocellular carcinoma (HCC) and possible underlying mechanism. Methods: The caveolin-1 mRNA expressions in the tumor tissues from HCC patients with intrahepatic metastasis and their adjacent tissues, as well as cirrhosis and normal liver tissues were detected by real-time PCR method. The caveolin-1 protein expressions in the tumor tissues from HCC patients with intrahepatic metastasis and their adjacent tissues were determined by Western blot analysis. Immunohistochemical staining was performed on the HCC specimens from 75 HCC cases to detect the expression of caveolin-1, vascular endothelial growth factor (VEGF), CD34 and α-smooth muscle actin (α-SMA), and then the relations of caveolin-1, VEGF, microvessel density (MVD) and unpaired artery (UA) with the clinicopathological factors of HCC patients were analyzed. Results: Of the HCC patients with intrahepatic metastasis, the expression level of caveolin-1 mRNA in tumor tissues was significantly higher than that in their adjacent tissues, cirrhosis and normal liver tissues (all P<0.05), and its protein expression in tumor tissues was significantly higher than that in their adjacent tissues. The increased expression of caveolin-1 in HCC was associated with metastasis (P<0.05), and caveolin-1 expression was positively correlated with VEGF expression, MVD and UA (r=0.293, P=0.011; r=0.361, P=0.001; r=0.388, P=0.001). Conclusion: Increased caveolin-1 expression may promote the invasion and metastasis of HCC and the possible mechanism is that it induces VEGF expression in HCC and thereby enhances tumor angiogenesis.

Abstract:

Objective: To investigate the construction of eukaryotic expressing vector containing human full-length Tip30 gene (pAAV-TIP30) and observe its expression in the transfected hepatocellular carcinoma (HCC) cell line HepG2. Methods: Using the mRNA extracted from normal human liver tissue as a template, Tip30 gene was amplified through reverse transcription polymerase chain reaction (RT-PCR) method. The PCR products were digested with BamH I and Xba I, and cloned into eukaryotic expressing vector pAAV-MCS. The recombinant plasmids were then transfected into the HepG2 cells and the expression of TIP30 protein in the host cells was detected by Western blot analysis. Results: Full-length TIP30 gene was correctly amplified by RT-PCR method. The identity of the cloning of TIP30 gene in pAAV-MCS was confirmed by restrictive enzyme digestion and sequencing. Western blot showed that the protein expression of TIP30 increased in the HepG2 cells, after they were transfected with the recombinant plasmids. Conclusion: Recombinant plasmid pAAV-Tip30 has been cloned and transfected into HepG2 cells successfully, which can provide a basis for the further investigation of the effects of TIP30 gene on HCC and the underlying mechanisms as well.

Abstract:

Objective: To investigate the effect of the recombinant plasmid containing CD147-shRNA on the proliferative and migration ability of SMMC-7721 cells. Methods: The previously constructed and screened recombinant plasmid pBS/U6/CD147-shRNA3 was transfected into the SMMC-7721 cells. After that, the proliferation and migration ability of SMMC-7721 cells were detected by MTT and wound healing assay, respectively. Results: The MTT results showed that the proliferation of SMMC-7721 cells was significantly inhibited in a concentration dependent manner after transfection with pBS/U6/CD147-shRNA3 (0.3 and 1 μg), and the maximum percent inhibition was 32.2%. The scratch wound closure of the SMMC-7721 cells transfected with the control plasmid was almost complete after 24 hours and, in contrast, the scratch wound healing capability of the SMMC-7721 cells transfected with pBS/U6/CD147-shRNA3 was much weakened. Conclusion: CD147 gene silencing has inhibitory effect on the proliferation and migration of SMMC-7721 cells.

Abstract:

Objective: To investigate the methylation status at the promoter region of the p16INK4a and retinoblastoma (Rb) gene in cirrhosis liver tissue and its relations with the protein expression of the two genes. Methods: The DNA methylation status and protein expression of p16INK4a and Rb in the liver tissues from 65 patients with cirrhosis and 20 healthy subjects were detected by PCR and immunohistochemical staining, respectively. Results: No abnormal methylation of p16INK4a and Rb gene was detected in any of the 20 cases of normal liver tissue, while the methylation ratios of the p16INK4a and Rb gene in the cirrhosis liver tissue were 40% (26/65) and 36.9% (24/65), respectively. The integrated optical densities (IOD) of the p16INK4a and Rb protein expression in the normal liver tissue were 225.7±27.4 and 254.7±34.8, while those in the cirrhosis liver tissue were 32.4±7.5 and 45.2±6.4, respectively, and both differences had statistical significance (both P<0.05). Conclusion: Cirrhosis liver tissue has abnormal methylation of p16INK4a and Rb gene and decreased expression of p16INK4a and Rb protein, and the resulting loss of cell cycle control may be involved in the occurrence and development of liver cirrhosis.

Abstract:

Objective: To investigate the effects and features of three methods, namely, carbon tetrachloride (CCl4), thioacetamide (TAA) and porcine serum induction, to create hepatic fibrosis in rats. Methods: Seventy-two SD rats were equally randomized into CCl4 group, TAA group, porcine serum group and control group, and then the rats were subcutaneously injected with 40% CCl4 (0.5 mL/100 g), 0.03% TAA (200 mg/kg), porcine serum (0.5 mL/per rat) and normal saline (0.1 mL/kg) twice a week, respectively. The general status and body weight changes of the rats were observed. At the end of the 3rd, 6th and 9th week of the experiment, the serum levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), hyaluronic acid (HA) and malondialdehyde (MDA) of the rats were detected, and HE staining was performed on the rat liver tissues to observe the morphological changes of the liver tissues, and to stage and score the degree of liver fibrosis, respectively. Results: The body weight gain of rats in CCl4 group and TAA group was significantly lower than that in control group (both P<0.05), but it had no significant difference between the porcine serum group and control group. The ALT levels at the three time points of TAA group were all significantly increased (all P<0.05), while there was no obvious elevation in CCl4 group and porcine serum group. The AST level increased significantly at the 3rd week but declined to some extent at the 6th and 9th week, and it increased significantly in TAA group at each time point (all P<0.05) and had no obvious change in porcine serum group. The MDA and HA levels of the three experimental groups all increased to some extent at the three time points (all P<0.05), and both MDA and HA levels increased most obviously in TAA group. At the 9th week, all the three experimental groups exhibited varying degrees of granular degeneration of the hepatic cells and abnormal proliferation of fibrous tissue in the portal tracts. The stages and SSS scores of liver fibrosis of the three experimental groups were all significantly different from those of the control group (all P<0.05). At the 9th week, the SSS score of the TAA group was higher than that of the CCl4 group (P<0.05), while CCl4 group was higher than porcine serum group (P<0.05). Conclusion: All the three methods can induce hepatic fibrosis in rats, and the effect of TAA is slightly better than CCl4. The method of porcine serum induction exerts minor overall injury to the animals.

Abstract:

Objective: To observe the expression of S-phase kinase-associated protein 2 (Skp2) in the remnant liver tissue of rat with partial hepatectomy so as to determine its role in liver regeneration. Methods: Rats underwent 70% partial heptectomy and the their remnant liver tissues were collected at 12, 24, 48, 72 and 168 h after respectively pectively, after surgery. The expressions of Skp2 and proliferating cell nuclear antigen (PCNA) protein in the regenerating liver tissue were detected by immunohistochemical staining. Results: The expressions of Skp2 and PCNA in the remnant liver tissue of the rats with partial hepatectomy were all significantly higher than those of the sham operated rats at the observation time of 12, 24, 48 and 72 h, respectively after surgery (all P<0.01). Both the Skp2 and PCNA expression reached their maximal levels at 48 h after hepatectomy and there was a significant correlation between them (r=0.9085, P<0.05). Conclusion: Skp2 plays an important role in liver regeneration after partial hepatectomy.

Abstract:

Objective: To investigate the expression of the inhibitor of differentiation/DNA binding-1 (ID-1) and its relations with Ki-67 and vascular endothelial growth factor (VEGF) in rectal cancer tissues as well as their clinical significance. Methods: The expressions of ID-1, Ki-67 and VEGF in rectal cancer tissues from 62 patients were detected by immunohistochemical staining and the relations among them were analyzed. Results: There were positive correlations between the expressions of ID-1 and Ki-67, ID-1 and VEGF, and Ki-67 and VEGF (r=0.89, 0.78, 0.92, all P<0.05), and the high expressions of these three proteins were associated with the degree of infiltration of the rectal cancer cells. Conclusion: The high expressions of ID-1, Ki67 and VEGF in rectal cancer tissues are possibly related to the invasion and metastasis of rectal cancer, and the detection of them may have certain significance in treatment and estimation of prognosis of rectal cancer.

Abstract:

Objective: To investigate the therapeutic effect of Fuan decoction on postoperative ileus (POI) and its related mechanisms. Methods: Ninety mice were randomized into sham operated control group, POI model group and Fuan decoction pretreatment group, and then the rats underwent the conventional procedure of POI establishment or sham operation, respectively. The content of tryptase and histamine of the small intestinal tissue was detected by ELISA method. The number of mesenteric mast cells was counted and their degranulation was observed under light microscope after toluidine blue staining. The myeloperoxidase (MPO) activity of the small intestinal tissue was determined by colorimetric method and the carbon powder moving rate was also measured. Results: The content of tryptase and histamine, and the MPO activity of the POI model group were all increased significantly compared with those of the sham operated control group (all P<0.01), but the elevations of these parameters were remarkably inhibited in the Fuan decoction pretreatment group and these had statistical differences compared with the POI model group (all P<0.01). No significant difference in the number of mast cells was found among the groups, but the degranulation of mesenteric mast cells was evident in POI model group and was inhibited in Fuan decoction pretreatment group. The carbon powder moving rate was significantly decreased in POI model group after surgery (P<0.01), which was significantly higher in Fuan decoction pretreatment group than that of the POI model group (P<0.01). Conclusion: Fuan decoction can reduce the production of intestinal tryptase and histamine after surgery and inhibit the degranulation of mast cells and their inducttion of inflammatory response, and thus it has the effect of preventing and alleviating postoperative Ileus.

Abstract:

Objective: To investigate the causes of the intraoperative and early postoperative complications of laparoscopy-assisted distal gastrectomy (LADG) and their management. Methods: The clinical data of 82 patients undergoing LADG from January 2007 to September 2011 were analyzed retrospectively. Results: Two cases were converted to open surgery and the intraoperative complications included six cases of intraoperative bleeding, three cases of subcutaneous emphysema, two cases of hypercapnia and four cases of transverse mesocolon injury. The postoperative complications comprised of two cases of intra-abdominal bleeding, two cases of port-site infection, one case of port-site hematoma, four cases of duodenal stump leakage, and one case each of anastomotic leakage, anastomotic stenosis, anastomotic bleeding and lymph leakage. All the intra- and postoperative complications were resolved by proper management and no death occurred. Conclusion: The surgical difficulties of LADG and the inexperienced or novice operators are responsible for the majority of the LADG complications The avoidance of the intra- and postoperative complications of LADG requires not only performing the standard operating procedure strictly, but also improving the skill and proficiency of the operators as well as enhancing the coordinated cooperation of the surgical team.

Abstract:

Objective: To assess the value of gastrografin (meglumine diatrizoate) contrast in diagnosis of upper gastrointestinal (GI) tract perforation. Methods: The clinical data of 112 patients with clinically suspected upper GI tract perforation who underwent gastrografin contrast examination were retrospectively analyzed. The patients were dynamically observed by fluoroscopy to determine whether there was leakage of the contrast agent from the stomach or duodenum and x-ray films were taken for analysis. The result was positive for upper GI tract perforation if contrast agent leakage was present and vice versa. Results: All the 112 patients underwent gastrografin contrast examination, of whom 72 cases had positive findings that included 31 cases of stomach perforation (27 cases of perforated gastric ulcer and 4 cases of perforated gastric cancer) and 41 cases of duodenal bulb perforation due to peptic ulcer. Of the remaining 40 patients with negative finding, 39 cases were identified to have other diseases by CT, emergency gastroscopy examination or exploratory laparotomy, but one case was found to be perforation of the posterior gastric wall on exploratory laparotomy. The coincidence rate of gastrografin contrast examination in diagnosis of upper GI tract perforation was 99.1%, and the sensitivity and specificity rate was 98.6% and 100%, respectively. No false positive case was found but there was one false negative case in the whole group. Conclusion: Gastrografin contrast has important application value in diagnosis of upper GI tract perforation, as it is safe, effective, and of relatively low cost.

Abstract:

Liver dysfunction or liver failure after hepatectomy is closely related to the remnant liver volume. This paper reviewed the recent progress in the study of remnant liver volume. The main contents include the relationship between liver volume and liver function, the application of CT and three-dimensional reconstruction in liver volume measurement, and the domestic and foreign progress in the study of the relative residual live volume(RLV%) and the standard remnant liver volume(SRLV).

Abstract:

The evaluation of liver function reserve, one of the key problems of hepatic surgery, is the fundamental and technical guarantee for the safe executioin of hepatectomy. The recent research developments on liver function assessment in the clinical application of liver disease were reviewed, and mainly included the proposal, development and application of Child-Pugh classification , MELD and APACHE-II scoring system, their application to hepatic surgery. The main aspect of this paper is comment on MELD scoring system.