目的探討肝細胞癌合并脾功能亢進患者同期行肝癌切除和脾切除的安全性及可行性。 方法回顧性分析2001年11月至2012年4月期間筆者所在醫院收治的52例肝細胞癌合并脾功能亢進同期施行肝癌切除和脾切除患者的臨床資料。 結果肝癌切除聯合脾切除19例，肝癌切除聯合脾切除加賁門周圍血管離斷術33例。手術時間（249.63±40.90）min（182～340 min），術中出血量（580.77±260.31）mL（200～1 700）mL。全組無死亡病例，術后并發癥包括：胸腔積液11例，肺內感染3例，肝斷面感染3例，膽汁漏1例，切口感染2例，高膽紅素血癥3例，門靜脈系統血栓形成22例，均經保守治療后好轉。術后第14天，患者的白細胞和血小板計數分別由術前的（3.19±1.59）×109/L和（53.96±18.94）×109/L升至（8.86±5.06）×109/L和（464.90±189.27）×109/L（P＜0.05）；術后紅細胞計數變化不明顯，甚至有輕度下降。 結論對于肝細胞癌合并脾功能亢進患者，選擇合適的病例同期行肝癌切除和脾切除是安全可行的，而且脾切除有助于緩解脾功能亢進。
Objective To study the effect of recombinant growth hormone (rhGH) on improvement of liver function and liver regeneration in animal and patients after hepatectomy. Methods The liver cirrhosis model of SD species mouse was set up, then the mouse were randomly divided into experiment group and control group, then 30%-40% liver of all the models were resected, rhGH was used by hypodermic injection (0.2-0.4ml/100g) in experimental group, and the equal dose of N.S. were given in control group every day. Then liver function, arterial blood ketone body ratio(AKBR), and the regenerated liver/body weight ratio (RL/W) were determined, histopathology of the cirrhosis with microscope and electron microscope and the mitotic index (MI) of liver cell on 7, 14 and 28th day after operation were observed. Clinically,39 hepatectomized patients were randomly divided into experiment group and control group, liver function, PA， Glu, RI and AKBR were measured preoperatively and on 1, 7,14th day after operation. Postoperative clinical course were also compared between the two groups. Results In the animal experiment group, as compared with the control group, AKBR was obviously higher (P＜0.01), seruim level of total protein and PA were increased faster (P＜0.05), and RL/W was higher. The mitotic index of liver cell was increased faster on 14th day, the numbers of regenerated liver cell with double nucleus and rough endoplasmic reticulum were higher in 14 and 28th day. In the clinical experiment group, as compared with the control group, serum total bilirubin, alanine aminotransferase and aspartate aminotransferase were lower on 7 and 14th postoperative day (P＜0.05). Serum albumin, PA, Glu, RI and AKBR were higher on 7, 14th postoperative day (P＜0.05). Conclusion Both experimental and clinical study show that the rhGH can promote liver regeneration and improve liver function after hepatectomy.
Objective To compare therapeutic effects of associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) and transcatheter arterial chemoembolization (TACE) on patients with advanced hepatocellular carcinoma. Methods Thirty-five patients with advanced hepatocellular carcinoma admitted in the Department of Hepatobiliary and Pancreatic Surgery of Shiyan Taihe Hospital Affiliated to Hubei University of Medicine from August 1, 2014 to August 1, 2015 were randomly divided into ALPPS group and TACE group, in which 17 cases treated by the ALPPS and 18 cases treated by the TACE. The survival, changes of liver function and life quality, postoperative complications and mortality were compared in these two groups. The follow-up was performed by the telephone and the outpatient. Results ① The baselines such as the age, gender, diameter of tumor, complications had no significant differences in these two groups (P>0.05). ② The changes of liver function and life quality after operation in the ALPPS group were significantly better than those in the TACE group (P<0.05). ③ The complications after operation were observed in 5 cases (there were 2 cases of bile leakage, 1 case of intraabdominal bleeding, 1 case of peritoneal effusion, and 1 case of pulmonary infection) in the ALPPS group, which in 13 cases (there were 6 cases of nausea and vomiting, 4 cases of liver function damage, 2 cases of granulocytopenia, 1 case of fever) in the TACE group. The rate of the overall complications in the ALPPS group was significantly lower than that in the TACE group (5/17versus 13/18, P=0.018). ④ The overall survival in the the ALPPS group was significantly better than that in the TACE group (P=0.024). During follow-up period, the deaths happened in 3 cases duo to hepatocellular carcinoma and 1 case duo to traffic accident, 1 case was lost on month 8, 12 cases were still alive in the ALPPS group; the deaths happened in 10 cases duo to hepatocellular carcinoma, 1 case duo to coronary disease, and 1 case duo to cerebral infarction, 6 cases were still alive in the TACE group. Conclusion Preliminary results of limited cases in this study show that ALPPS has a better effect than TACE on patients with advanced hepatocellular carcinoma.
ObjectiveTo summarize and analyze the application of ex vivo liver resection and autotransplantation (ELRA) in the treatment of hepatobiliary diseases. MethodThe related literature about ELRA used to treat various hepatobiliary space-occupyingdiseases at home and abroad in recent years was comprehensively searched and summarized. ResultsELRA had overcome the limitations of limited operational space in traditional surgery for the treatment of hepatobiliary space-occupying diseases reduced dependence on donor livers, and avoided post-transplant rejection. It had been applied in the treatment of hepatic alveolar echinococcosis, liver cancer, cholangiocarcinoma, and rare liver space-occupying diseases. ConclusionsWith the maturation of ELRA techniques and the continuous improvement of ex vivo liver perfusion technology, along with rigorous preoperative evaluation and meticulous postoperative management, postoperative complications of ELRA have significantly decreased compared to the initial stages of its application. By strictly adhering to surgical indications, this procedure is expected to be used treatment in an increasing number of hepatobiliary space-occupying diseases.
ObjectiveTo summarize short-term and long-term effects of ex vivo liver resection followed by autotransplantation (Abbreviation: autotransplantation) in treatment of advanced hepatic alveolar echinococcosis (HAE).MethodThe clinical data and follow-up data of 17 patients with advanced HAE who underwent autotransplantation from November 2016 to July 2019 in the Ganzi Tibetan Autonomous Prefecture People’s Hospital were retrospectively analyzed.ResultsThe autotransplantations were performed successfully in the 17 patients with advanced HAE. Ten patients underwent the inferior vena cava (IVC) reconstruction with autologous saphenous veins, 5 patients underwent the artificial revascularization, 1 patient underwent the direct anastomosis of the original IVC, and 1 patient didn’t reconstructed (the retroperitoneal collateral circulation was abundant). The mean liver graft mass was 681.3 g (365–1 350 g) and operation time was 11.5 h (9–16 h). The median anhepatic period was 312 min (175–450 min), blood loss was 2 000 mL(950–4 500 mL), red blood cell suspension transfusion was 6.4 U (1–20 U), and fresh frozen plasma was 1.1 L (0.8–2.0 L). The postoperative hospital stay was 5 to 45 d with an average of 25.6 d. There were 4 patients with the postoperative hepatic enveloping effusion, 1 patient with bile leakage, and 1 patient with bile duct stenosis. All of them were treated and cured, and no death occurred. The follow-up time of 17 patients was 3 to 35 months with an average of 9.5 months, no recurrence of HAE and distant metastasis were observed.ConclusionsIn highlands, autotransplantation in treatment of advanced HAE patients with different IVC reconstruction is satisfactory, but it has a higher risk and is difficult. Choice of intraoperative reconstruction materials, judgment of posterior peritoneal collateral circulation, presence or absence of tension in end-to-end anastomosis of the IVC require precise consideration. At the same time, anticoagulation therapy and complications management are difficult, and it is only suitable for plateau medical center with rich experience.
Objective To evaluate the effect of pulse dye-densitometry by indocyanine green test (PDD-ICG)on the assessment of hepatic function reserve. MethodsSeventy-five hepatic carcinoma patients aimed to accept hepatectomy from March 2007 to February 2008 at West China Hospital were prospectively included in this study.Patients were grouped by dysfunction grade of hepatic function and the indexes before operation were compared.Furthermore, patients were grouped by K and R15 value to compare the moderate and severe liver dysfunction ratio, respectively. ResultsSixty cases manifested slight liver dysfunction,12 cases manifested moderate liver dysfunction,and 3 cases manifested severe liver dysfunction(the latter was took into moderate group due to the cases were too few).The difference of Child-Pugh score and common liver function examination indexes such as PT and INR before operation was not significant betweentwo groups(P＞0.05).ButPDD-ICG experiment indexes(K and R15)were remarkable different betweentwo groups(P＜0.05).The patients were divided into two groups according to K and R15 value,respectively.The rate of moderate and severe liver dysfunction was significant different between K＜0.158/min groupand K≥0.158/min group(47.1% vs. 12.1%,P＜0.05),and likewise moderate and severe liver dysfunction was significant different between R15≤10% group and R15＞10% group(15.9% vs.41.7%,P＜0.05）. ConclusionPDD-ICG is an effective and easyto evaluate hepatic function reserve of patient undergone hepatectomy.Therefore,it may give clinical instruction to predict and avoid the liver dysfunction after operation.