To investigate the cause of septicemia in patients with obstructive jaundice,the correlationship between intra-biliary tract pressure(IBTP),portal veinous flow rate(PVFR)and interleukin-2(IL-2),soluble interleukin-2 receptor(sIL-2R),T lymphocyte subpopulation in patient with obstructive jaundice(Group A)has been studied.Group A was subdivided into A1,emergency operation group;A2,elective surgery group;A3,patient’s age over 60 years and A4,age under 60.Ninety patients with simple gallstone(Group B)were also tested as a contrast.The result showed that of all Group A,CD3+,CD4+,CD8+ before operation were much lower than those 10 days after operation(Plt;0.05 or Plt;0.01),while the postoperative sIL-2R was significantly higher than that of 10 days after operation(Plt;0.01),in Group A1,emergency surgery,the preoperative sIL-2R was much more higher than that in others of the jaundice group(Plt;0.01).Corralation analysis showed IBTP was negatively corralated to IL-2,CD3+,CD4+,CD8+,but it had positive correlation with sIL-2R(Plt;0.01).PVFR was positively correlated to IL-2(Plt;0.01).These indicate that obstructive jaundice with infection is closely related to the decreased host immunity.
ObjectiveTo understand the latest progress of transcatheter arterial chemoembolization (TACE)-based combination therapies for unresectable liver metastasis from colorectal carcinoma, and to explore the safe and effective combination therapies in order to controlling the rapid progress of disease and improving the quality of life of patients.
MethodsThe literatures about TACE-based combination therapies of liver metastasis from colorectal carcinoma and the latest advance in researches of this field at home and abroad were collected, and the application of combination therapies, the advantages and features of the combined treatments were reviewed.
ResultsTACE was a safe and effective therapeutic modality in treating primary liver cancer or secondary liver cancer.Compared with a single treatment, TACE-based combination therapies had distinct advantages to patients with liver metastasis from colorectal carcinoma not only improved the quality of life but also prolonged the survival time.With the emerging of various kinds of new drugs and the rapid development of a variety of interventional treatments, it could bring long-term survival benifit for patients with liver metastasis from colorectal carcinoma.
ConclusionsDoctors should pay attention to the combined treatments of patients with liver metastasis from colorectal carcinoma, improve the knowledge of personalized medication about advanced tumors and actively promote more usage of combination therapies.
Objective To improve the curative resection rate of hilar cholangiocarcinoma (H-CC).Methods Lileratures about surgical treatment of H-CC were collected and reviewed. Results The crucial points are as follow: ①Early diagnosis; ②Recognition of the invasion to liver; ③Rational resection of the tumor with associated vessels; ④Reduction of postoperative complications. Conclusion Improved longterm resection effects on H-CC is possible.
ObjectiveTo investigate the hotspots and frontiers and to reveal research trends of cirrhosis with portal vein thrombosis (PVT) by visual analysis.MethodsWe explored the distributions, key citations and research trends of articles on cirrhosis with PVT published from 1991 to 2020 by citation analysis, co-word analysis, and burst detection by information visual software CiteSpace.ResultsThe quantity of articles on cirrhosis with PVT had been increasing over time. The management of PVT remained the hotspots, while the efficacy and prognosis of anticoagulation of PVT as well as the risk factors and underlying mechanisms of PVT had been frontiers in recent years.ConclusionsAnticoagulation and risk factors have been hotspots and frontiers in recent years.
ObjectiveTo investigate the risk factors of postoperative portal vein thrombosis (PVT) after devascu-larization in patients with cirrhotic portal hypertension.
MethodsThe clinical data of 40 patients with cirrhotic portal hypertension treated with splenectomy and gastric pericardial devascularization were retrospectively analyzed to investigate the related risk factors.
ResultsA total of 12 of the 40 patients suffered from PVT (30.00%). The results of multivariate analysis showed that portal vein diameter, postoperative portal vein velocity, platelet count at 2 weeks postoperatively, and postoperative portal vein pressure were the factors influencing the incidence of PVT after devascularization. Patients with the greater portal vein diameter and platelet count at 2 weeks postoperatively, the lower postoperative portal vein velocity and postoperative portal vein pressure, had higher ratio of PVT (P < 0.05).
ConclusionPortal vein diameter, portal vein blood flow velocity, platelet count, and postoperative portal vein pressure were the main risk factors for PVT after surgery in patients with cirrhotic portal hypertension.
Objective To investigate the expressions of transforming growth factor (TGF) -α and -β1 after 90% portal branch ligation (PBL) in rats. Methods Ninety-six SD rats were randomly divided into sham operation group and portal vein branches ligation group. The weight of both ligated and unligated lobes of liver were measured on 0.5, 1, 3, 5, 7, 14, 21, and 28 d after operation. The morphological changes of the unligated liver lobes were observed by microscope. The expressions of proliferating cell nuclear antigen (PCNA), TGF-α, and TGF-β1 of the unligated liver lobes were detected by immunohistochemistry. Results After the ligation of 90% portal vein branches, hepatic lobe at the ligated side diminished progressively after ligation, whereas the lobes of the unligated side underwent compensatory regeneration. The ratio of unligated lobes weight to the whole liver increased slowly within 1 d, speeded up significantly during 1-5 d period, increased slowly on 5 d, and reached plateau phase on 7 d after operation. The expressions of PCNA protein markedly increased within 0.5-3 d (Plt;0.01), which reached the peak on 5 d and decreased slightly on 7 d after operation, but still higher than sham operation group level, and then gradually returned to the level of sham operation group lately. The expressions of TGF-α and TGF-β1 in the unligated liver lobes markedly increased on 0.5 d, and reached the peak on 3 d and 1 d respectively， and then gradually returned to the level of sham operation group in 7-28 d after operation. Conclusion Ligation of 90% portal branches can induce active regeneration of unligated liver lobes in rats, whose initiation and proliferation are involved in the expressions of TGF-α and TGF-β1 protein.
Objective To explore the diagnosis and treatment for patients with portal vein thrombosis or tumor embolus in perioperative period of liver transplantation. Methods Eight patients at terminal stage of liver diseases and with portal vein thrombosis or tumor embolus underwent liver transplantation in this hospitatal from October 1999 to January 2006. Their clinical information and survival situation were retrospectively analyzed. Results It was diagnosed correctly before operations that portal vein thrombosis or tumor embolus occurred in 8 patients of 61 patients (13.1%) who underwent liver transplantation (grade Ⅰ: 3 cases; grade Ⅱ: 5 cases). The thrombosis in the portal vein of 6 cases were dislodged and the portal vein with tumor embolus were removed in 2 patients who underwent end-to-end anastomosis. All patients received anticogulation therapy after operations. The post-operative 6-month survival rate was 62.5%. Conclusion Accurate diagnosis before operation, correct method of surgery and reasonable management after operation may have significant effects on the patients with portal vein thrombosis or tumor embolus.
Objective To explore the curative effect of surgical treatment for primary liver cancer with portal vein tumor thrombus（PVTT）. Methods The clinical data of 227 patients who were performed surgical treatment because of primary liver cancer with PVTT were analyzed retrospectively. Results Two hundreds and seventeen cases were performed surgical resection, 14 cases died from postoperative complications. The median survival time was 17.7 months, and the l-, 2-, 3-, and 5-year survival rates were 61.9%, 37.2%, 21.7%, and 4.0% respectively. There were 40 cases with PVTT ofⅠtype, the l-, 2-, 3-, and 5-year survival rates were 82.3% , 61.7%, 38.6%, and 6.6% respectively，which was obviously higher than those with PVTT of Ⅱ type （n=129, 61.1%, 34.3%, 20.8%, and 5.3%） and PVTT of Ⅲ type （n=48, 46.8%, 24.0%, 9.6%, and 0）, P＜0.05. There were 84 cases whose PVTT and tumor were resected together, the l-, 2-, 3-, and 5-year survival rates were 67.3%, 43.2%, 28.1%, and 7.9% respectively，which were obviously higher than those patients whose PVTT were removed from cross-section of liver （n= 85, 65.1%, 38.8%, 22.3%, and 3.4%） and patients whose PVTT were removed by cutting the portal vein （n=48, 46.8%, 24.0%, 9.6%, and 0）, P＜0.05. The l-, 2-, 3-, and 5-year survival rates of 76 cases who received postoperative therapy of TACE/TAI were 75.3%, 53.2%, 33.1%, and 5.7% respectively, which were obviously higher than those patients who were not received any postoperative therapy （n=141, 54.8%, 29.1%, 15.9%, and 3.2%）, P＜0.05. Conclusions Surgical treatment is an effective treatment for primary liver cancer with PVTT. Surgery should strive for resecting the tumor and PVTT together, and postoperative therapy of TACE/TAI may have a favorable effect on the long term survival rate.
ObjectiveTo evaluate value of percutaneous interventional treatment for portal vein thrombosis combined with occlusion following liver transplantation.
Method The data of 3 patients with portal vein thrombosis combined with occlusion following liver transplantation underwent interventional treatment were analyzed retrospectively.
Resultsthe mural thrombi were detected preoperatively in the portal venous trunk for the 3 patients, all of which were classified as Yerdel's grade 1 and were underwent porto-portal anastomosis without thrombectomy during liver transplantation. Portal vein thrombosis combined with occlusion occured after 8 months postoperatively. The percutaneous transhepatic balloon venoplasty and self-expanding metallic stents placement was performed in 3 patients. The interventional treatment was successfully achieved in all the patients. The follow-up period ranged from 28 to 38 months, no complications occurred following interventional treatment, the graft function and survival of patients were good.
ConclusionPercutaneous interventional treatment is an efficacious and safe method to treat portal vein thrombosis combined with occlusion.
Objective To compare the effect of two chemotherapeutic patterns after hepatectomy of hepatocellular carcinoma （HCC） with portal vein tumor thrombi（PVTT）. Methods The clinical data of 51 HCC patients with PVTT who were treated in our department from June 2006 to December 2011 were analyzed retrospectively. Fifty-one HCC patients with PVTT who were performed hepatectomy and treatment of antivirus and improve immune were divided into two groups according to chemotherapeutic patterns after operation： portal vein infusion drug deliver system （PVIDDS）group （n=19） and transcatheter arterial chemoembolization（TACE） group（n=32），and to compare the treatment effect of the two groups. Results The recurrence rate of 1-month, 1-year，3-year， and 5-year after operation in TACE group was 3.1%（1/32），46.9%（15/32），84.4%（27/32）， and 100%（32/32），respectively. And in PVIDDS group, which was 5.3%（1/19），52.6%（10/19），100%（19/19）， and 100%（19/19），respectively. There were no differences in recurrence rate of 1-month, 1-year, and 5-year after operation in two groups（P＞0.05）. Recurrence rate of 3-year after operation in TACE group was lower than that in PVIDDS group（P＜0.05）. There were no differences in medial survival time（17.1 months vs.15.9 months）， survival rate of 1-year（93.8% vs.94.7%） and 3-year（40.6% vs. 36.8%） after operation in TACE group and PVIDDS group（P＞0.05）. Survival rate of 5-year after operation in TACE group was higher than that in PVIDDS group（21.9% vs.0, P＜0.05）. The rate of complication in TACE group was lower than that in PVIDDS group（65.6% vs.94.7%，P＜0.05）. Conclusions If the HCC patients with PVTT could endure operation，surgical resection should be considered firstly，furthermore antivirus treatment, improving immune，and chemotherapy should be considered after operation. The effect of TACE is better than PVIDDS.
