ObjectiveTo understand the effect of nitric oxide (NO) on the formation of hyperdynamic circulatory syndrome (HCS) and the influence of level of NO on HCS. MethodsAfter establishment of stable HCS in partial portal vein ligated rats,the quantity of NO in blood of portal vein and the activity of nitric oxide synthase (NOS) in liver were determined by pre and post injection of inhabitor of NOS (NGmethylLarginine) and hemodynamics was supervised simultaneously.ResultsThe quantity of NO was paralleled with the activity of NOS and was elevated markedly by 24 hours after operation and reached the top by 48 hours after surgery. These sequential changes were coincided with the dilation of general vascularture. There was a close relation between this changes and the formation of HCS.The quantity of NO and the activity of NOS were decreased significantly to the level of the control group after injection of NGmethylLarginine (LNMMA). LNMMA inhabited the activity of NOS and blocked the production of NO. HCS ameliorated obviously. ConclusionNO plays an important role in initiating the dilation of general vascularture and plays a critical role in the formation of HCS. HCS will be ameliorated obviously or be blocked completely by eliminating the effect of NO and the portal pressure will decreased significantly or recover to normal range.
Six patients with moderate to advanced primary carcinoma of the liver were treated in this hospital with perfusion chemotherapy and embolization through the regional portal vein under the guidance of B-ultrasongraph rather than (with) operatie catheteization of the portal vein. The results show that all the tumor masses were reduced in size after the treatment (1.2-3.2cm, average value 1.9cm). It might be a new way for treating the primary carcinom of liver. The detailed procedure is descibed and the effects are also discussed in this article.
ObjectiveTo summarize the clinical experience of retropancreatic tunnel established by superior mesenteric vein-approach in a child with cavernous transformation of the portal vein (CTPV) during Rex bypass. MethodThe retropancreatic tunnel was created by the superior mesenteric vein-approach during Rex bypass in a child with CTPV who was admitted to our hospital in September, 2023. Clinical data were retrospectively analyzed. ResultsFor the 4-year-old male child who was diagnosed with CTPV, after the establishment of the retropancreatic tunnel by superior mesenteric vein-approach, the portal vein was quickly identified, thus simplifying the portal dissection. The operation time of Rex bypass was about 8 hours, and intraoperative blood loss was about 60 mL. After a 3-month follow-up, the child recovered well with patent bypass vessels. ConclusionThe surgical strategy proposed by our team can simplify the Rex bypass, resulting in more rapid and safe access to the vascular anastomosis site.
ObjectiveTo investigate the role of endoplasmic reticulum stress in liver regeneration after associating liver partition and portal vein ligation for staged hepatectomy (ALPPS).MethodsSeventy-two C57bl/6 mice were randomly divided into ALPPS group, portal vein ligation group (PVL group), and sham operation group (Sham group), 24 mice in each group. And then one-stage ALPPS operation, simple PVL, and sham operation will be performed. Six mice were randomized selected of the three groups on the 1st, 2nd, 4th, and 7th day after surgery, respectively, the liver weight to body weight ratio (FLR/BW) of each group was measured, and the liver tissues were taken for immunohistochemical staining to calculate the proportion of Ki-67 positive cells, Western blot was used to detect the expression levels of X-box binding protein 1 (XBP1) and inositol-requiring enzyme 1α (IRE1α) proteins.Results① FLR/BW: On the 4th day and the 7th day after operation, the FLR/BW of the Sham group, PVL group, and ALPPS group increased in sequence at the same time, and the difference between the three groups was statistically significant (P<0.05). ② Ki-67 positive cell ratio: On the 2nd day after operation, the ratio of Ki-67 positive cells in the Sham group, PVL group, and ALPPS group increased sequentially, and the difference between the two groups was statistically significant (P<0.05). On the 4th day after operation, the ratio of Ki-67 positive cells in the PVL group and the ALPPS group were still higher than that of the Sham group (P<0.05). ③ Expression levels of XBP1 and IRE1α: On the 2nd and 4th postoperative day, the expression levels of XBP1 and IRE1α in the ALPPS group were higher than those in the Sham group and the PVL group (P<0.05). On the 7th day after surgery, the expression levels of XBP1 and IRE1α in the ALPPS group were higher than those in the Sham group (P<0.05), while compared with the PVL group, the expression level of XBP1 in the ALPPS group was still higher (P<0.05).ConclusionsALPPS-induced liver regeneration is more advantageous than traditional PVL in mice. It may be attributed to the obvious endoplasmic reticulum stress activation after ALPPS leading to the up-regulation of IRE1α-XBP1 expression, which is involved in the regulation of hepatocyte cell cycle and promotes hepatocyte proliferation, thus promoting rapid liver regeneration.
ObjectiveTo explore the clinical application of variant associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) combined with inferior vena cava reconstruction for end stage hepatic alveolar echinococcosis (HAE).MethodThe clinical data of one case with HAE who treated in Organ Transplantation Center of Sichuan Provincial People’s Hospital in November 2017 was analyzed retrospectively.ResultsComputed tomography revealed that the three hepatic veins and retrohepatic inferior vena cava were invaded by multiple and giant hydatid lesions. Only the segment 6 retained the complete portal vein and hepatic vein return branch. Remnant liver volume/standard liver volume (RLV/SLV) of this patient was 24.9%. Surgical exploration was performed after preoperative examination. In the first stage, ligation of the left portal vein and the right anterior lobe portal vein were performed to increase portal blood supply at S6 while partial split of the liver. The patient recovered well after operation without complications such as bile leakage and infection. Six months after the first stage surgery, the second stage surgery was performed, and RLV/SLV measured before surgery was 48.3%. S1–5/S7–8 were completely removed and the hepatic inferior vena cava was reconstructed with artificial blood vessels. The patient was discharged on 10 days after operation, and there was no complications and relapses occurred during the 18 months follow-up period.ConclusionsVariant ALPPS combined with inferior vena cava reconstruction is an effective attempt to treat end stage HAE with multiple and giant hydatid lesions and insufficient RLV.
Portal hypertension (PHT) is a common complication of liver cirrhosis, which could be measured by the means of portal vein pressure (PVP). However, there is no report about an effective and reliable way to achieve noninvasive assessment of PVP so far. In this study, firstly, we collected ultrasound images and echo signals of different ultrasound contrast agent (UCA) concentrations and different pressure ranges in a low-pressure environment based on an in vitro simulation device. Then, the amplitudes of the subharmonics in the echo signal were obtained by ultrasound grayscale image construction and fast Fourier transform (FFT). Finally, we analyzed the relationship between subharmonic amplitude (SA) and bionic portal vein pressure (BPVP) through linear regression. As a result, in the pressure range of 7.5–45 mm Hg and 8–20 mm Hg, the linear correlation coefficients (LCC) between SA and BPVP were 0.927 and 0.913 respectively when the UCA concentration was 1∶3 000, and LCC were 0.737 and 0.568 respectively when the UCA concentration was 1∶6 000. Particularly, LCC was increased to 0.968 and 0.916 respectively while the SAs of two UCA concentrations were used as the features of BPVP. Therefore, the results show a good performance on the linear relationship between SA and BPVP, and the LCC will be improved by using SAs obtained at different UCA concentrations as the features of BPVP. The proposed method provides reliable experimental verification for noninvasive evaluation of PVP through SA in clinical practice, which could be a guidance for improving the accuracy of PVP assessment.
Objective To review the advancement of surgical therapy for cavernous transformation of portal vein. Methods The relevant literatures on therapy for cavernous transformation of portal vein in recent years were collected and reviewed. Results The main symptoms of the patients are repeated haematemesis and hemafecia, hypersplenotrophy and hypersplenia. Most cases can be detected by ultrasonography or portal venography. Splenectomy and by-pass technique plus disconnection are the preferred operation. Conclusion Therapy for cavernous transformation of portal vein will be further developed.
ObjectiveTo summarize the treatment and experience of percutaneous transhepatic portal vein recanalization by endovascular approach for treatment of cavernous transformation of the portal vein (CTPV) in a child. MethodThe clinical data of a child with idiopathic CTPV who underwent percutaneous transhepatic portal vein recanalization by endovascular approach were retrospectively analyzed. ResultsWe described a novel percutaneous transhepatic portal vein recanalization approach that had successfully treated a child with idiopathic CTPV following a multidisciplinary team evaluation. The operation time was 1.5 h and blood loss was approximately 1 mL. The child recovered uneventfully at 9-month follow-up, without any clinical evidence of CTPV complications. ConclusionIn light of our successful management, we can envision that the portal vein recanalization is an important therapeutic supplement for treating CTPV and will result in a paradigm change.
ObjectiveTo summarize the progress of associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) and evolution of surgical procedure improvement, so as to summarize experience in selecting appropriate surgical method for patients. MethodThe domestic and foreign literature on the evolution of ALPPS surgical procedure improvement in recent years was reviewed. ResultsIn the decade since the emergence of ALPPS, the ALPPS had been rapidly developed in the hepatobiliary surgery. The ALPPS promoted a rapid increase in future liver remnant during a relatively shorter period to contribute to resectability of liver tumors and reduce the rate of postoperative liver failure, the patients with intermediate to advanced and huge liver cancer could obtain the surgical radical resection. In recent years, the domestic and foreign experts had refined the ALPPS procedure, which mainly focused on the operation of hepatic section separation and hepatic artery flow restriction in stage Ⅰ surgery, including partial ALPPS, radiofrequency ablation ALPPS, tourniquet ALPPS, transcatheter arterial embolization ALPPS, hepatic artery ringed and operation ALPPS, as well as laparoscopic ALPPS and robotic ALPPS with minimally invasive approach. ConclusionsDespite the ongoing controversy over ALPPS, with the continuous progress and innovation of improved procedures and the utilization of laparoscope and robot in surgery, the trauma of ALPPS surgery has a further reduction, and the morbidity and mortality have gradually been decreased. It is believed that with the continuous advancement and improvement of ALPPS surgery technology, the indications and safety of ALPPS will be further enhanced, bringing hope to more patients with intermediate to advanced liver cancer with huge tumors.
ObjectiveTo summarize a patient diagnosed as Bismuth type Ⅲa hilar cholangiocarcinoma who unerwent the curative surgery combined with partial portal vein resection and reconstruction+hilar bile duct formation+Roux-en-Y choledochojejunostomy, meanwhile we reviewed the current status of surgical treatment of hilar cholangiocarcinoma at home and abroad.MethodsTo retrospectively summarized and analyzed the clinical data of one case of Bismuth type Ⅲa hilar cholangiocarcinoma. The preoperative total bilirubin of this patient was 346.8 μmol/L, and this patient underwent the curative surgery combined with partial portal vein resection and reconstruction+hilar bile duct formation+Roux-en-Y choledochojejunostomy after reducing jaundice by percutaneous transhepatic biliary drainage (PTBD). Then we retrieved domestic and foreign related literatures.ResultsOperative time of this patient was about 290 min and intraoperative bleeding was about 350 mL. No intraoperative blood transfusion occurred. The results of pathological examination showed middle-differentiatied adenocarcinoma of hilar bile duct with negative tumor margins and no regional lymph node metastasis (0/14). The postoperative recovery was uneventful with hospital stay time of 9 days and without any complication. The patient had been followed-up in the outpatient department for 3 years,and was generally in good condition. The evidence of recurrence or metastasis wasn’t found.ConclusionsPre-operative biliary drainage can improve the safety of operation and reduce the incidence of postoperative complications, extend liver resection for the patient with Bismuth type Ⅲa hilar cholangiocarcinoma, which can improve R0 resection rate and extend postoperative survival.