In 1983-1994,748 cases hepatocholelithiasis had been treated in our department, in which 372 patients underwent hepatectomy and 43 patients underwent hepatectomy of the quadrate lobe. Hepatectomy of the quadrate lobe has been performed to treat all kinds of hepatocholelithiasis, it is easy to expose 1 or 2 degree branch of biliary tree, incise the hepatobiliary stricture and perform hepatocholangiojejunostomy in the hepatic hilum.
ObjectiveTo investigate the protective effect of SadenosylLmethionine on liver regeneration and
liver function in cirrhotic rats after hepatectomy. MethodsCirrhosis was successfully induced by injection of 40%
CCl4.Then,partial hepatectomy (about 30%) was performed in all rats. Cirrhotic rats were divided into 3
groups,namely,cirrhotic group (normal saline 5 ml/d,for 15 postoperative days，n=20),treatment group 1 〔S
adenosylLmethionine 10 mg/(kg·d),for 15 postoperative days,n=16〕 and treatment group 2 〔SadenosylL
methionine 20 mg/(kg·d),15 postoperative days,n=16〕,and normal control group was also established. Animals were
sacrificed at the 15th postoperative day and 30th postoperative day to take samples for detection of liver
function (Alb,ALT,TB,TBA) and serum TNFα.Liver tissues were also observed under light microscope and electron
microscope. ResultsIn two treatment groups,at the time point (15 postoperative days or 30 postoperative
days),concentrations of ALT,TB,TBA,Alb and TNFα were decreased significantly as compared with cirrhotic group (P
＜0.01),and concentration of Alb was increased significantly (P＜0.01).In contrast, there were no obvious difference
in the same time point of different dosetreatment groups (Pgt;0.05),but the decrease of ALT,TB,TBA,TNFα and the
increase of Alb were more significant at the second time point (30th postoperative day) than the first time
point (15th postoperative day) when treated with same dose (P＜0.01).At the same time,concentration between TNF
α and ALT,TB,TBA showed a positive correlation (P＜0.01),and the concentration between TNFα and Alb showed a
negative correlation (P＜0.01).In addition, the histopathology showed SadenosylLmethionine had effects of
protecting liver function and enhancing liver regeneration. ConclusionThe study suggests that SadenosylL
methionine has the efficacy of enhancing liver regeneration and improving liver function.
Objective To refine the technique of portal inflow occlusion and parenchymal transection for laparoscopic hepatectomy in the porcine model. Methods Ten pigs were used. The portal inflow complete or selective occlusion was carried out with portal triad clamping or dissection and division of the left portal pedicle. The sequential laparoscopic local hepatectomy, left lateral lobectomy, and left medial lobectomy were performed without portal inflow occlusion. Parenchymal transection was performed with harmonic scalpel, LigaSure, microwave dissector, bipolar electrocautery, surgical clips, and endoscopic stapler. The efficacy and safety of different techniques in laparoscopic parenchymal transection of the liver were compared. Results The ischemic liver was darken with complete or selective portal triad clamping. The ischemic demarcation line between left and right lobe was obvious with the dissection and division of the left portal pedicle. There was an applicable scope of each hepatic parenchymal transection apparatus. The optimal combination of different techniques could increase efficacy and reduce hemorrhage in laparoscopic parenchymal transection of the liver. Conclusion Technical refinements of portal inflow occlusion and parenchymal transection in porcine models could provide evidences to clinical appliance of laparoscopic anatomic major hepatectomy.
ObjectiveTo evaluate the safety and feasibility of laparoscopic hepatectomy. Methods A total of 25 patients with hepatocellular carcinoma or liver hemangioma received laparoscopic hepatectomy, and perioperative results were analyzed. ResultsOnly one patient was converted to open hepatectomy because of massive hemorrhage. Blood loss of all patients during operation ranged from 100-1 200 ml with an average of 400 ml. The total blood volume of transfusion was 200-1 000 ml (mean 400 ml) in 14 patients. The operative time was 0.8-4.0 h (mean 2.3 h). All patients had no complications such as bile leakage and infection, and discharged from hospital in 5-10 d (mean 8 d) after operation. ConclusionLaparoscopic hepatectomy is safe and feasible to some liver diseases, but should be used with caution for the patients with tumor diameter over 9 cm and hepatic large vessels invaded by cancer.
【Abstract】 ObjectiveTo review the advances in techniques of hepatic blood occlusion in hepatectomy. Methods The related literatures were reviewed and analysed. ResultsThere were many techniques of hepatic blood occlusion. The most frequently used and studied techniques were hemihepatic vascular occlusion and intermittent hepatic inflow occlusion. Hepatic vascular exclusion was employed when hepatic veins and/or vena cava would be damaged. Total vascular exclusion and other techniques were rarely used. Conclusion To reduce blood loss in hepatectomy and make patient safe, based on the situation of the patient, the technique should be ingeniously selected.
One hundred and five hepatic resection were performed from 1984 to 1994. Six of these patients complicated with subphrenic infection after hepatectomy, of whom two patients died of liver failure. Subphrenic dropsy occureeed in nine cases. Subphrenic infection is easy to occur in: right or extend lobectomy, massive blood loss at operation, and in postoperative bleeding which subjects to laparotomy for lemostasis. Seecure hemostasis, avoidence of hepatic tissue devitalization during operation and effective subphenic drainage aree essential to reduce the incidencee of subphrenic infection, and routine bacterial culture of subphrenic drainage fluid will help to select propre antibiotic.
ObjectiveTo assess the effectiveness of hemihepatic vascular occlusion (HHO) and total hepatic inflow occlusion (THO) which were applied in the liver resection.
MethodsRandomized controlled trials (RCTs) comparing HHO and THO in hepatectomy were electro-nically searched from CENTRAL (Issue 1, 2013), PubMed, EMbase, CBM, CNKI and Digital Journals of Chinese Medical System. The English or Chinese version of relevant published and unpublished data and their references were also retrieved by hand. The last retrieval date was in May 2013. The data were extracted and the quality was evaluated by two reviewers independently, and then RevMan 5.2 software was used for data analysis.
ResultsTen RCTs involving 788 patients were finally included. The results of meta-analysis showed that, HHO reduced the levels of aspartate transaminase (AST) (WMD=-235.84, 95%CI-411.28 to-60.40, P=0.008) and alanine aminotransferase (ALT) (WMD=-195.52, 95%CI-351.87 to-39.16, P=0.01) in 1 day postoperatively. HHO also shortened the recovery time of AST (WMD=-3.83, 95%CI-4.52 to-3.15, P < 0.000 01) and ALT (WMD=-4.29, 95%CI-5.75 to-2.84, P < 0.000 01) postoperatively, and shortened the recovery time of gastrointestinal function (WMD=-1.52, 95%CI-2.75 to-0.29, P=0.02). However, HHO was the same as THO in intraoperative haemorrhage and postoperative transfusion and hospital stay.
ConclusionHHO applied in liver resection could relieve the damage of liver function, and shorten the recovery time of gastrointestinal function postoperatively. Due to the poor quality of the included studies, more high quality RCTs with longer follow-up are required to further verify the aforementioned conclusion.
Objective To investigate the technique and feasibility of hepatic pedicle vascular control in laparoscopic hepatectomy. Methods From May 2005 to June 2011, 95 cases of hepatectomies were performed by laparoscopy in the Department of Minimally Invasive Surgery, The First Affiliated Hospital, Guangxi Medical University.The characteristics of these cases were analyzed. Results Left lateral segmentectomy were required in 21 patients, left hepatectomy in 13 patients, right hepatectomy in 4 patients, segmentectomy in 17 patients, tumor resection in 24 patients,hemangioma resection in 5 patients, and conversions to laparotomy in 11 patients. The intermittent Pringle maneuver were performed in 39 patients. The mean vascular clamping time in Pringle maneuver was （30.84±9.51） min. The selective vascular control of inflow were performed in 56 patients， the technique included intrahepatic Glisson approach in 14 patients and controlling hepatic artery and portal vein separately in 42 patients. Pre-parenchymal transection control of hepatic outflow were performed in 12 patients, included the left hepatic vein were controlled by suturing or separating in 11 patients and right hepatic vein was controlled by separating in 1 patient. Others were controlled intraparenchymally during transection. The mean operative time was （236.80±95.97） min，mean operative blood loss was（ 551.55±497.41） ml， concentrate red blood cells transfusion volume was（ 2.60±2.23） U， and plasma transfusion volume was （211.90±179.29） ml. The postoperative complications included bleeding in 4 patients, pleural effusion in 4 patients, pneumonia in 3 patients, ascites in 7 patients, and biliary fistula in 2 patients, and dead in 1 patient. The mean hospitalization time was（ 12.47±4.18） days. At the deadline（ February 2012）, 72 cases with liver cancer were followup. The follow-up time ranged from 5 to 81 months and the mean time was（ 24.14±16.62） months， where survival rate was 68.4%（ 54/79） of 1-year and 21.5%（ 17/79） of 3-year. Conclusions The application of hepatic pedicle vascular control in laparoscopic hepatectomy is feasible.
The experimental models of chronic hepatic lesion of 40 rabbits were made by intra-abdominal injection of thioacetamide.The chronic hepatic lesion was confirmed by pathological examination and hepatectomies were performed in accordance with different measurements on each rabbit.The observations included indocyanine green retention rate,hepatic resection volume,and the outcomes of operations.The results showed that the mortality was correlative with the change of hepatic functions in the background of chronic hepatic lesion.The indocyanine green retention and the level of serum albumin are important parameters to indicate hepatic impairment.When the former was over 40% or the latter below 2.8g% the operative danger was high and the mortality was over 50%.In accordance with the classification of hepatic function,the preoperative functional state of liver were classified:grade A,B and C.the mortality of posthepatectomy were respectively 16.7%,3O%,and 72%.The multiple progressive regression equation is employed for calculating the postoperative outcome.The equation predicted the postoperative outcome with 88.9% accuracy.
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.
