Objective To evaluate the outcome of liver transplantation in patients with recurrent liver cancer after resection. Methods Data of 23 patients underwent liver transplantation for recurrent liver cancer from April 2001 to March 2008 were retrospectively collected and analyzed. Results Previous history of liver resection had little negative effect in subsequent liver transplantation in technical aspect. Liver function recovered uneventfully after transplantation in all cases. Alpha fetoprotein (AFP) recovered to normal value in 13 of 17 cases with elevated AFP before transplantation within one month after operation. Five cases (21.74%) had postoperative complications. Nineteen cases (82.61%) were followed up, average follow-up duration were 610 days. There were 5 cases (26.32%) of cancer recurrence and 6 deaths during follow-up, survival rate was 68.42%. Conclusion Liver transplantation is a reasonable treatment for recurrent liver cancer after resection.
ObjectiveTo figure out the factors affecting the prognosis of liver transplantation and the research progress on methods for predicting the prognosis of liver transplantation so as to provide guidance and reference for the distribution of liver sources and the perioperative treatment of liver transplantation.MethodThe literatures related to the factors influencing the prognosis of liver transplantation and the methods in predicting the prognosis were searched in the PubMed, CNKI, Wanfang, and other databases and the results were analyzed and summarized.ResultsThe liver transplantation was an effective method in the treatment of end-stage liver diseases. The main factors affecting the prognosis of liver transplantation included the change of internal environment, systemic inflammatory response, and general systemic conditions. On the basis of Model for End-stage Liver Disease (MELD), the new prediction model built in combination with the blood sodium ion, lactate, muscle mass, or reticulocyte count and hemoglobin concentration had improved the prognostic prediction ability of liver transplantation.ConclusionsIt is possible to predict the prognosis of patients with liver transplantation more accurately by selecting a more targeted prediction model combined with the factors affecting the prognosis of liver transplantation. It might provide a reference for perioperative management and treatment and make the limited liver source play the most role and save more lives.
Objective To evaluate safety and long-term efficacy of fully covered self-expandable mental stent (FCSEMS) in treatment of biliary stricture after liver transplantation (LT). Methods From January 2010 to June 2018, the data of patients with the biliary stricture after the LT underwent the endoscopic retrograde cholangiagraphy (ERCP) at the First Hospital of Lanzhou University were collected retrospectively. The therapeutic effect of the FCSEMS was evaluated. Results A total of 21 patients with the biliary stricture after the LT were treated. The success rate of the stent placement was 100%. The FCSEMSs were used in 7 cases and the only multiple plastic stents (MPSs) were used in 14 cases. There were no significant differences in the gender, age, time of biliary stricture, frequency of ERCP, recurrence time of biliary stricture, cure time of biliary stricture, curative effect, recurrence of biliary stricture, and incidence of complications between the patients treated with the FCSEMS and the MPS (P>0.050), but the number of plastic stents in the patients treated with the FCSEMS was significantly less than that in the patients treated only with the plastic stents (P<0.050), while the duration of stent retention was longer than that in the patients treated only with the plastic stents (P<0.050). Six patients were cured, 1 was remitted, and 2 were relapsed by the FCSEMS. Eight were cured, 3 were remitted, 3 were ineffective, and 5 were relapsed by the MPS alone. Conclusions FCSEMS might be an safe effective alternative to plastic stent in treatment of biliary stricture after LT, resulting in a longer duration placement, less number of plastic stent use. It is necessary to further accumulate cases to validate cure rate and recurrence rate of biliary stricture.
Ｏｕｒ ｔｅｃｈｎｉｑｕｅ ｆｏｒ ａｕｘｉｌｉａｒｙ ｌｉｖｅｒ ｔｒａｎｓｐｌａｎｔａｔｉｏｎ ｗａｓ ｂａｓｅｄ ｏｎ ｔｈｅ ｔｅｃｈｎｉｑｕｅ ｄｅｓｃｒｉｂｅｄ ｂｙ Ｈｅｓｓ ｗｉｔｈ ｔｈｅ ｅｘｃｅｐｔｉｏｎ ｏｆ ｔｈｅ ｌｅｎｇｔｈ ｏｆ ｔｈｅ ｃｕｆｆ ｏｆ ｔｈｅ ｇｒａｆｔ ｖｅｎａ ｃａｖａ ａｎｄ ｅｓｔａｂｌｉｓｈｍｅｎｔ ｏｆ ｔｈｅ ｐｏｒｔａｌ ｖｅｉｎ ａｎａｓｔｏｍｏｓｉｓ．Ａ ｔｏｔａｌ ｏｆ ６０ ａｕｘｉｌｉａｒｙ ｌｉｖｅｒ ｔｒａｎｓｐｌａｎｔａｔｉｏｎｓ ｗｅｒｅ ｐｅｒｆｏｒｍｅｄ，ｏｆ ｗｈｉｃｈ ２４ ｗｅｒｅ ｄｅｆｉｎｉｔｉｖｅ ｏｐｅｒａｔｉｏｎ．Ｉｎ ｔｈｅ ５ ｄｅｆｉｎｉｔｉｖｅ ｏｐｅｒａｔｉｏｎｓ ｔｈｅ ｇｒａｆｔｓ ｓｕｒｖｉｖａｌ ａｓｓｅｓｓｅｄ ｂｙ ９７ｍＴｃｓｏｄｉｕｍ ｐｈｙｔａｔｅ ｄｅｍｏｎｓｔｒａｔｅｄ ａ １ｗｅｅｋ ｓｕｒｖｉｖａｌ ｏｆ １００％．Ｈｏｗ ｔｏ ｒｅｄｕｃｅ ｔｈｅ ｃｏｍｐｌｉｃａｔｉｏｎｓ ｉｎ ａｕｘｉｌｉａｒｙ ｌｉｖｅｒ ｔｒａｎｓｐｌａｎｔａｔｉｏｎ ｉｎ ｒａｔｓ ｉｓ ｄｉｓｃｕｓｓｅｄ ｉｎ ｔｈｅ ａｒｔｉｃｌｅ．
Objective To investigate the surgical technique of reduced sized liver transplantation. Methods A reduced size liver transplantation was successfully performed on a 11-year old girl with incurable caroli′s disease. Results The recovery of liver graft function was good after the operation in this patients without complications. Conclusion Reduced size liver transplantation is a safe and effective technique for pediatric liver transplantation to provide liver graft. Authors introduced their experiences of surgical technique in this patient.
摘要:目的:探討床旁超聲檢查在肝移植術后下腔靜脈(IVC)并發癥診斷中的應用價值。方法:對424例肝移植術后患者進行床旁超聲檢查,對下腔靜脈并發癥,包括狹窄及栓塞的資料進行回顧性分析和總結。結果:床旁超聲檢查發現下腔靜脈并發癥患者18例,其中狹窄6例,栓塞12例。結論:床旁超聲檢查在肝移植術后,尤其是對術后早期發生的下腔靜脈并發癥的診斷及監測具有重要的作用,為臨床診斷和治療提供及時、有價值的影像學依據。Abstract: Objective: To evaluate the value of bedside ultrasound in diagnosis and monitoring of inferior vena cava (IVC) complications after liver transplantation. Methods: 424 cases with liver transplantation were examined by bedside ultrasound after the operations. The results of IVC complications,including thrombosis and stenosis, were analyzed and summarized. Results: 18 cases with IVC complications were detected by bedside ultrasound, including 6 cases of stenosis and 12 cases of thrombosis. Conclusion: Bedside ultrasound is important for diagnosing and monitoring IVC thrombosis and stenosis after liver transplantation, especially in the earlier period. It could provide valuable imaging for clinical diagnosis and treatment promptly.
【Abstract】Objective To study the anatomy of the hepatic arteries and imitate the way to deal with the hepatic arteries in the living liver transplantation of the left lateral lobe.Methods Thirty normal adult livers were anatomyzed and 30 casting models of livers were observed. The lengths, diameters and distributaries of the hepatic arteries were described.Results The blood supply of the left lateral region came from proper hepatic artery, left hepatic artery and middle hepatic artery. The aberrant arteries included left inferior phrenic artery, left gastric artery and right gastric artery. They branched to supply the upper segment and the inferior segment.Conclusion There are five types of hepatic arteries to supply the left liver lobe. The anatomy of hepatic arteries should be studied and a reasonable approach to gain a liver graft should be designed before transplantation. The hepatic arteries should be dealt with so as to anastomose with recipient hepatic arteries.
Objective To investigate the effect on expression regulation of calmodulin-dependent kinases casades (CaMK) Ⅱ on liver function after liver transplantation in rats. Methods Allogeneic orthotopic liver transplantation model was established by using the classic two-cuff method. The lentiviral expression systems of CaMKⅡγ protein and CaMKⅡγ shRNA were constructed. The lentiviral vector expressing CaMKⅡγ shRNA and the lentiviral vector expressing CaMKⅡγ protein were perfused into the rat after liver transplantation respectively, and the corresponding blank vector and normal saline were perfused into the control group at the same time. The serum levels of ALT and AST were measured at different time points of inferior vena cava blood in rats. Results The serum ALT and AST levels were debased in the after transplantation rats whose lentiviral vector expressing CaMKⅡγ shRNA (P<0.05). The serum ALT and AST levels were raised in the after transplantation rats whose lentiviral vector expressing CaMKⅡγ protein (P<0.05). There were no significant difference of serum ALT and AST levels between the blank control group and the saline group (P>0.05). Conclusion Specific blocking of CaMK Ⅱ signaling pathway can effectively reduce the serum ALT and AST levels after liver transplantation in rats, and enhanced CaMK Ⅱ signaling pathway increases the serum ALT and AST levels after liver transplantation in rats.
Objective To establish the rat orthotopic liver transplantation model by characterizing the blood supply of hepatic artery with the Cuff skill and the modified arterial sleeve anastomosis, to explore the possible mechanisms of acute rejection and the express of Fractalkine (Fkn) in the early stage after hepatic allograft operation. Methods SD rats were selected as donors and Wistar rats as receptor for the rejection model of orthotopic liver transplantation. Recipient rats were divided into 2 groups randomly after operationand the drugs were given intraperitoneally once a day in each group. In the experimental group, cyclosporine A (CsA) was delivered with 3 mg/kg. In the control group, only normal saline was given with 3 ml/kg. Condition of survivals were observed. The rejection actvity index (RAI) and the expression of Fkn of liver tissue were observed after 3rd, 5th and 7th days in 5 rats. The rest of rats in each group were fed and given drug or normal saline until they were died and the mean survival time were recorded. Results There were 18 survivals in control group, and 19 in experimental group after liver transplantation. Condition of survivals in experimental group was better than that of control group. The mean survival times of experimental group(19.50±4.51 days) was significantly longer than that of control group(7.60±1.60 days), showing statistically significant difference (P＜0.05). After 3rd, 5th and 7th days of transplantation, RAI of control group were 3.80±0.35,5.90±0.87 and 7.50±1.30,respectively;RAI of experimental group were 3.10±0.21,3.90±0.41 and 4.50±0.52.Therewasstatistically significant difference in RAI between 2 groups on the 7th day after transplantation (Plt;0.01). On the 3rd,5th and 7th days after transplantation, the Fkn of control group was 8.20±0.57,21.30±3.30 and 25.70±4.91, and that of experimental group was 8.30±0.56,10.30±0.67 and 11.70±1.23. There were statistically significant differences in Fkn between 2 groups on the 5th, 7th days after transplantation (Plt;0.01). Conclusion Fkn is a participant inacute rejection after the rat orthotopic liver transplantation and can be chosen as a useful target in the diagnosis of acute rejection. CsA has immunosuppressive property in the condition of acute rejection in the rat orthotopic liver transplantation, which may be result from the decreased the level of Fkn.