Objective To investigate the preventive measures for bleeding in laparoscopic hepatectomy. Methods The candidates for laparoscopic hepatectomy were 22 patients with live lesions， including 5 patients with primary liver cancer， 16 patients with liver hemangioma， and 1 patient with metastatic liver cancer. The tumors locatedthe left lateral lobe in 15 cases， caudate lobe in 1 case， segmentⅣin 2 cases， and segmentⅥ in 4 cases. The meandiameter of tumors was 4cm （2-10cm）. The surgical approaches included the left lateral lobectomy （15 cases）， leftlateral lobectomy of caudate （1 case）， and nonanatomic and wedge resection were performed in 6 cases. Results Twenty-two cases underwent laparoscopic liver resection， there were no conversion to open and operative death. The mean operative time was 115min （65-142min）， the mean blood loss was 450mL （270-780mL）， the mean length of hospital stay after operation was 6.5 days （3-11 days）. Conclusion Control liver section hemorrhage is a key technique in laparoscopic hepatectomy.
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.
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 investigate the effect of glucagon-like peptide-1(GLP-1) on impaired glucose tolerance due to stress postoperatively. Methods The rats were allocated randomly to one of three groups, group Ⅰ was subdivided into group Ⅰg which received an intravenous glucose load (0.5 g/kg glucose), and group Ⅰglp which received the same glucose load with GLP-1 (0.3 nmol/kg) during intravenous glucose tolerance test (IVGTT). Rats in group Ⅱg and group Ⅱglp in group Ⅱ were infused respectively the same intravenous glucose tolerance test as group Ⅰ on the first, third and fifth day after 65% liver resection. And rats in group Ⅲ were injected the same glucose load with GLP-1 (0.45 nmol/kg) during IVGTT on the first day after hepatectomy. The peak glucose levels, glucose levels at 30 minutes and the area under the curve (AUC0-30) were investigated among groups. Results The peak glucose levels, glucose levels at 30 minutes and AUC0-30 were significantly lower in group Ⅰglp than those in group Ⅰg. And the values were significantly higher in group Ⅱg than those in group Ⅰg on the first, third and fifth day after operation. There was no significant difference between group Ⅱglp and group Ⅱg in the peak glucose levels on the first day after liver resection, but the peak glucose levels and AUC0-30 were significantly lower in group Ⅲ than those in group Ⅱg and group Ⅱglp, and the glucose levels at 30 minutes were significantly lower in group Ⅲ than those in group Ⅱg too on the first day. The peak glucose levels were significantly lower in group Ⅱglpthan those in group Ⅱg on the third and fifth postoperative day and in group Ⅱglp on the first day too, and the glucose levels at 30 minutes and AUC0-30 were also significantly lower in group Ⅱglp than those in group Ⅱg, but they were similar between group Ⅱglp and group Ⅰg. Conclusion Glucose intolerance is a feature of stress after hepatectomy, and GLP-1, injected in conjunction with the IVGTT, increased the clearance of glucose. The contribution of GLP-1 to reducing blood glucose was decreased significantly at early phase postoperatively, but its action was enhanced by the way of dosage dependence. The action of GLP-1 was enhanced with the degree of stress reduction and then returned to normal.
ObjectiveTo explore the effect of carbamazepine (CBZ) on liver regeneration following partial hepatectomy (PH) in rats.
MethodsSixty male Sprague-Dawley rats were randomly divided into CBZ group and control group, thirty rats in every group, all the rats were underwent 70% hepatectomy. In the CBZ group, all the rats were feed with 5% CBZ at a dose 250 mg/kg at 2 hours before PH, everyday after PH, and the last administration was at 2 hours before sacrifice. In the control group, all the rats were feed with the same quantitative and frequency dimethyl sulfoxide as 5% CBZ of the CBZ group. On day 1 before PH and on day 1, 2, 3, 5, and 8 after PH, the liver to body weight ratio, ALT, hepatocyte growth factor (HGF), and Ki-67 of each group were observed.
Results①On day 2, 3, 5 after PH, the liver to body weight ratios of the CBZ group were significantly higher than those of the control group (P < 0.05). On the other time point, there was no significant difference of the liver to body weight ratio between two groups (P > 0.05).②On all the time point, there was no significant difference of the serum ALT level between two groups (P > 0.05).③On day 1, 2, 3 after PH, the serum levels of HGF in the CBZ group were significantly higher than those in the control group (P < 0.05). On the other time point, there was no significant difference of the serum HGF level between two groups (P > 0.05).④On day 2 after PH, the expression of Ki-67 in the CBZ group was significantly higher than that in the control group (P < 0.05). On the other time point, there was no significant difference of the expression of Ki-67 between two groups (P > 0.05).
ConclusionThe results suggest that administration of CBZ has a promotive effect on liver regeneration following PH in rats and this effect might be through promotion of hepatocyte proliferation.
Objective To approach the indications， techniques features， and efficacy of laparoscopic hepatectomy for liver tumor. Methods The clinical data and follow-up results of 61 patients who received laparoscopic hepatectomy at our institute from January， 2007 to December， 2012 were retrospectively analyzed. Results Of the 61 patients， 16 cases were with primary liver cancer， 1 case with liver adenocarcinoma， 2 cases with metastatic liver cancer， 31 cases with hepatic hemangioma， and 11 cases with other benign liver diseases （including hepatocellular adenoma， focal nodular hyperplasia， hepatic cysts， and mucinous cystadenoma）. The average tumor diameter was 5.6 cm （2-15 cm）. The surgical approaches includes laparoscopic hepatic left lateral lobectomy （42 cases）， right posterior lobectomy （2 cases）， hepatectomy of segmentⅥ （3 cases）， hepatectomy of segmentsⅦ/Ⅷ， Ⅳa， and caudate lobe （one respectively）. Non-anntomic and wedge resection were performed on 11 patients. The mean operating time， blood loss， postoperative hospital stay， and postoperative complication rate were （124±65） min （50-200min）， （251±145） mL （50-1 000mL），（7.3±3.6） d （4-11d）， and 16.3% （10/61）， respectively. In 19 cases with malignant liver lesions， 15 cases were followed up mean for 26 months （1-48 months）. One of them died in 1 year after operation for multiple organ dysfunction， others were survival. Conclusions Experienced laparoscopic surgery doctors selected appropriate cases， used proper blood inflow oclussion and liver resction methods， and cared for tumor-free principle， the laparoscopic hepatectomy for malignant and benign tumors of liver could be safe and effective to carry out.
ObjectiveTo summarize recent researches on mechanism of the hepatic ischemic preconditioning (IPC) and its clinical applications on hepatectomy and liver transplantation. MethodsRelevant references about basic and clinical researches of hepatic IPC were collected and reviewed. ResultsRecent experimental researches indicated that IPC could relieve hepatic ischemiareperfusion injury (IRI) by remaining and improving energy metabolism of liver, regulating microcirculation disorder, decreasing the production of lipid peroxidation and oxyradical. It could also inhibit the activation of inflammatory cells and the release of cytokine, suppress cell apoptosis and induce the release of endogenous protective substance. Till now, most of the clinical researches had confirmed the protective function of hepatic IPC, but there were still some references with opposite opinions. ConclusionHepatic IPC could relieve liver IRI, but its clinical application value on hepatectomy and liver transplantation still need more researches to prove.
In order to observe the effect of hepatocyte growth promoting factor (pHGF) on liver regeneration of rat with cirrhosis after hepatectomy, IBAS Ⅱ auto image analysis technology was used to measure the variety of DNA ploid rate of hepatocytes and OPTDM of enzymes by liver histochemistry after hepatectomy; serum levels of the glutamicpyruvic transaminase (SGPT) and indocyanine green retention rate in 15 minute (ICG15) were tested to measure the function of the remanent liver. The results revealed that tetraploid hepatocytes lowered greatly and diploid, quintploid and ＞quintploid hepatocytes increased apparently in group A. OPTDM of enzymes by liver histochemistry showed no significant difference at the first day after operation in each group (Ｐ＞0.05); SDH and LDH of group A were significantly higher than those of group B and AkP, AcP were significantly lower at the second or fifth day after hepatectomy. Serum tests showed that SGPT, ICG15 of group A decreased apparently at the fifth day after operation. The results demonstrate that pHGF not only stimulates the regeneration of the remanent liver but also accelerates the functional mature of the regenerative hepatocytes and the functional recovery of the remanent liver after resection of cirrhotic liver of rats.
ObjectiveTo evaluate and discuss the various surgical methods for hepatic echinococcosis.
MethodsFour hundred and two patients with hepatic echinococcosis were treated in West China Hospital of Sichuan University from 2009 to 2014 and 271 of them were undergone surgical treatment. The cystic echinococcosis was in 195 patients, including 80 cases performed classic endocystectomy or subtotal cystectomy, 109 performed total cystectomy or hepatectomy, 6 cases performed palliative surgery. The alveolar echinococcosis was in 76 patients, including 7 cases performed palliative surgery, 54 cases performed hepatectomy, 12 cases performed liver allotransplantation, and 3 cases performed liver autotransplantation.
Results①The draining time, the rate of postoperative complications, and the recurrence was (18.6±2.7) d, 21.2% (17/80), and 15.0%(12/80) respectively in the cases of cystic echinococcosis underwent classic endocystectomy or subtotal cystectomy, which were significantly higher than those cases of cystic echinococcosis underwent total cystectomy or hepatectomy〔(5.4±0.6) d, 7.3% (8/109), and 0.9% (1/109), respectively, P < 0.05〕.②The draining time and the recurrence was (5.9±0.7) d and 1.8% (1/54) respectively in the cases of alveolar echinococcosis underwent hepatectomy, which were significantly lower than those in the cases of alveolar echinococcosis took palliative surgery〔(9.7±1.4) d and 57.1% (4/7), respectively, P < 0.01〕. The 12 patients underwent liver transplantation were complete rehabilitation, while the rest 3 were death.
Conclusions①Total cystectomy or hepatectomy should be the first choice for cystic echinococcosis; Palliative treatment could improve the symptoms of unresectable patients with cystic echinococcosis.②Hepatectomy should be the first choice for alveolar echinococcosis, palliative surgery could only be used to alleviate symptoms and physical signs, delay the progression of this disease.③Liver transplantation might be an alternative for advanced hepatic echinococcosis.
Objective To develop hepatic surgical planning software for hepatic operation on deciding the rational operational scheme and simulating procedures before the operation to accomplish the precise liver resection and decrease the operational risk. Methods3D-econstruction of liver was restored from spiral computed tomography (CT) data by using LiVirtue software. The liver and its anatomic structures were reconstructed to illuminate the location of the tumor and its related vessels to design a rational operational scheme. The virtul results, such as liver volume, hepatic sections, anatomy of portal vein and hepatic veins or possible operation plans, were compared with the actual situations during the operations. Results3D models of liver, tumor and their relative vessels were reconstructed successfully. Preoperative planning and intra-perative navigation based on the models ensured the safety of liver resection in our 32 cases of right lobe tumors. This preoperative simulation allowed surgeons to dissect the liver with reduced complications. These models could be also viewed and manipulated on personal computers.ConclusionThe LiVirtue is very helpful in the hepatic surgery, for clearly disclosing hepatic structures, rationally deciding operation schemes, virtually simulating the operations. This preoperative estimation from 3D model of liver benefits a lot to complicated liver resection.
