This study explores the significance of using two-dimensional shear wave elastography(2D-SWE)to assess liver stiffness(LS)and spleen area(SPA)for predicting post-hepatectomy liver failure(PHLF).By providing a non-inva...This study explores the significance of using two-dimensional shear wave elastography(2D-SWE)to assess liver stiffness(LS)and spleen area(SPA)for predicting post-hepatectomy liver failure(PHLF).By providing a non-invasive method to measure LS,which correlates with the degree of liver fibrosis,and SPA,an indicator of portal hypertension,2D-SWE offers a comprehensive evaluation of a patient’s hepatic status.These advancements are particularly crucial in hepatic surgery,where accurate preoperative assessments are essential for optimizing surgical outcomes and minimizing complications.This letter highlights the prac-tical implications of integrating 2D-SWE into clinical practice,emphasizing its potential to improve patient safety and surgical precision by enhancing the ability to predict PHLF and tailor surgical approaches accordingly.展开更多
Background:Laparoscopic hepatectomy(LH)has become increasingly popular for liver neoplasms,but its safety and effectiveness remain controversial.Hepatic hemangiomas are the most common benign liver neoplasm;the main a...Background:Laparoscopic hepatectomy(LH)has become increasingly popular for liver neoplasms,but its safety and effectiveness remain controversial.Hepatic hemangiomas are the most common benign liver neoplasm;the main approaches to hepatic hemangiomas include open hepatectomy(OH)and LH.In this study,we compared early outcomes between patients undergoing OH and those with LH.Methods:Patients underwent OH or LH in our hospital for hepatic hemangiomas between December 2013 and December 2017 were enrolled.All patients underwent comprehensive preoperative evaluations.The clinicopathological index and risk factors of hemangioma resection were assessed.Results:In total,41 patients underwent OH while 53 underwent LH.There was no significant difference in any preoperative clinical variables,including liver function,prothrombin time,or platelet count.Hepatic portal occlusion time and operative time were 39.74 vs.38.35 minutes(P=0.717)and 197.20 vs.203.68 minutes(P=0.652)in the OH and LH groups,respectively.No mortality nor significant perioperative complications were observed between the two groups.In LH group,two cases were converted to OH,one for an oversized tumor and the other for hemorrhage.Compared with OH patients,those with LH had less blood loss(361.69 vs.437.81 m L,P=0.024),shorter postoperative hospital stay(7.98 vs.11.07 days,P=0.001),and lower postoperative C-reactive protein(43.63 vs.58.21 mg/L,P=0.026).Conclusions:LH is superior to OH in terms of postoperative recovery and blood loss for selected patients with hepatic hemangioma.展开更多
AIM: To study whether central hepatectomy(CH) canachieve similar overall patient survival and disease-freesurvival rates as conventional major hepatectomies ornot.METHODS: A systematic literature search was per-formed...AIM: To study whether central hepatectomy(CH) canachieve similar overall patient survival and disease-freesurvival rates as conventional major hepatectomies ornot.METHODS: A systematic literature search was per-formed in MEDLINE for articles published from January1983 to June 2013 to evaluate the evidence for andagainst CH in the management of central hepatic malig-nancies and to compare the perioperative variables andoutcomes of CH to lobar/extended hemihepatectomy. RESULTS: A total of 895 patients were included from21 relevant studies. Most of these patients who un-derwent CH were a sub-cohort of larger liver resectionstudies. Only 4 studies directly compared Central vshemi-/extended hepatectomies. The range of opera-tive time for CH was reported to be 115 to 627 min andPringle's maneuver was used for vascular control in themajority of studies. The mean intraoperative blood lossduring CH ranged from 380 to 2450 mL. The reportedmorbidity rates ranged from 5.1% to 61.1%, the most common surgical complication was bile leakage and the most common cause of mortality was liver failure. Mor-tality ranged from 0.0% to 7.1% with an overall mor-tality of 2.3% following CH. The 1-year overall survival(OS) for patients underwent CH for hepatocellular car-cinoma ranged from 67% to 94%; with the 3-year and 5-year OS having a reported range of 44% to 66.8%, and 31.7% to 66.8% respectively. CONCLUSION: Based on current literature, CH is a promising option for anatomical parenchymal-preserv-ing procedure in patients with centrally located liver malignancies; it appears to be safe and comparable in both perioperative, early and long term outcomes when compared to patients undergoing hemi-/extended hepatectomy. More prospective studies are awaited to further define its role.展开更多
BACKGROUND Hepatocellular carcinoma(HCC)is the world’s sixth most common malignant tumor and the third cause of cancer death.Although great progress has been made in hepatectomy,it is still associated with a certain ...BACKGROUND Hepatocellular carcinoma(HCC)is the world’s sixth most common malignant tumor and the third cause of cancer death.Although great progress has been made in hepatectomy,it is still associated with a certain degree of risk of posthepatectomy liver failure(PHLF),which extends the length of hospital stay and remains the leading cause of postoperative death.Studies have shown that assessment of hepatic functional reserve before hepatectomy is beneficial for reducing the incidence of PHLF.AIM To assess the value of model for end-stage liver disease(MELD)score combined with standardized future liver remnant(sFLR)volume in predicting PHLF in patients undergoing hepatectomy for HCC.METHODS This study was attended by 238 patients with HCC who underwent hepatectomy between January 2015 and January 2018.Discrimination of sFLR volume,MELD score,and sFLR/MELD ratio to predict PHLF was evaluated according to the area under the receiver operating characteristic curve.RESULTS The patients were divided into two groups according to whether PHLF occurred after hepatectomy.The incidence of PHLF was 8.4%in our research.The incidence of PHLF increased with the decrease in sFLR volume and the increase in MELD score.Both sFLR volume and MELD score were considered independent predictive factors for PHLF.Moreover,the cut-off value of the sFLR/MELD score to predict PHLF was 0.078(P<0.001).This suggests that an sFLR/MELD≥0.078 indicates a higher incidence of PHLF than an sFLR/MELD<0.078.CONCLUSION MELD combined with sFLR is a reliable and effective PHLF predictor,which is superior to MELD score or sFLR volume alone.展开更多
AIM: To investigate the relationship between low immediate postoperative platelet count and perioperative outcome after liver resection in patients with hepatocellular carcinoma (HCC). METHODS: In a cohort of 565 cons...AIM: To investigate the relationship between low immediate postoperative platelet count and perioperative outcome after liver resection in patients with hepatocellular carcinoma (HCC). METHODS: In a cohort of 565 consecutive hepatitis B-related HCC patients who underwent major liver resection, the characteristics and clinical outcomes after liver resection were compared between patients with immediate postoperative platelet count < 100 x 10(9)/L and patients with platelet count >= 100 x 10(9)/L. Risk factors for postoperative hepatic insufficiency were evaluated by multivariate analysis. RESULTS: Patients with a low immediate postoperative platelet count (< 100 x 10(9)/L) had more grade III-V. complications (20.5% vs 12.4%, P = 0.016), and higher rates of postoperative liver failure (6.8% vs 2.6%, P = 0.02), hepatic insufficiency (31.5% vs 21.2%, P < 0.001) and mortality (6.8% vs 0.5%, P < 0.001), compared to patients with a platelet count >= 100 x 10(9)/L. The alanine aminotransferase levels on postoperative days 3 and 5, and bilirubin on postoperative days 1, 3 and 5 were higher in patients with immediate postoperative low platelet count. Multivariate analysis revealed that immediate postoperative low platelet count, rather than preoperative low platelet count, was a significant independent risk factor for hepatic insufficiency. CONCLUSION: A low immediate postoperative platelet count is an independent risk factor for hepatic insufficiency. Platelets can mediate liver regeneration in the cirrhotic liver. (C) 2014 Baishideng Publishing Group Inc. All rights reserved.展开更多
AIM： To study the effects of obstructive jaundice on liver regeneration after partial hepatectomy. METHODS： Hepatocyte growth factor （HGF）, its receptor, c-Met, vascular endothelial growth factor （VEGF） and tran...AIM： To study the effects of obstructive jaundice on liver regeneration after partial hepatectomy. METHODS： Hepatocyte growth factor （HGF）, its receptor, c-Met, vascular endothelial growth factor （VEGF） and transforming growth factor-β1 （TGF-β1） mRNA expression in both liver tissue and isolated liver cells were investigated after biliary obstruction （BO） by quantitative reverse-transcription polymerase chain reaction （RT-PCR） using a LightCycler. Immunohistochemical staining for desmin and e-smooth muscle actin （α-SNA） was also studied. Regenerating liver weight and proliferating cell nuclear antigen （PCNA） labeling index, and growth factor expression were then evaluated after 70% hepatectomy with concomitant internal bUiary drainage in BO rats or sham-operated rats. RESULTS： Hepatic TGF-β1 mRNA levels increased significantly 14 days after BO, and further increased with duration of cholestasis. Meanwhile, HGF and VEGF tended to increase, but was not significant. In cell isolates, TGF-β1 mRNA was found mainly in the hepatic stellate cell （HSC） fraction. Immunohistochemical studies revealed an increased number of HSCs （desmin-positive cells） and activated HSCs （α-SMA-positive cells） in portal areas after BO. In a hepatectomy model, liver regeneration was delayed in BO rats, as compared to sham-operated rats. TGF-β1 mRNA was significantly up-regulated up to 48 h after hepatectomy, and the earlier HGF mRNA peak was lost in BO rats. CONCLUSION： BO induces HSCs proliferation and activation, leading to up-regulation of TGF-β1 mRNA and suppression of HGF mRNA in livers. These altered expression patterns may be strongly involved in delayed liver regeneration after hepatectomy with obstructive jaundice.展开更多
The middle hepatic vein (MHV) lies in the midplane of the liver. The classical teaching of right or left hepatectomy is transection of liver I cm to the right or left wall of the MHV in order to avoid bleeding. Howeve...The middle hepatic vein (MHV) lies in the midplane of the liver. The classical teaching of right or left hepatectomy is transection of liver I cm to the right or left wall of the MHV in order to avoid bleeding. However, guidance of liver transection is lost if the course of the MHV is not known. By exposing the MHV early in the phase of liver transection and following its course to the inferior vena cava, a precise liver transection plane could be obtained. Such technique has the potential of achieving adequate tumor-free resection margin, avoiding damage to intrahepatic portal pedicles, preserving venous drainage and functional liver tissue, and less postoperative infection.展开更多
Background: Laparoscopic anatomic hepatectomy remains challenging because of the complex interior structures of the liver. Our novel strategy includes the Glissonian approach and the major hepatic vein first, which se...Background: Laparoscopic anatomic hepatectomy remains challenging because of the complex interior structures of the liver. Our novel strategy includes the Glissonian approach and the major hepatic vein first, which serves to define the external and internal landmarks for laparoscopic anatomic hepatectomy.Methods: Eleven cases underwent laparoscopic anatomic hepatectomy, including three right hepatectomies, three left hepatectomies, three right posterior hepatectomies, and two mesohepatectomies. The Glissonian approach was used to transect the hepatic pedicles as external demarcation. The major hepatic vein near the hepatic portal was exposed and served as the internal landmark for parenchymal transection. The liver parenchyma below and above the major hepatic vein was transected along the major hepatic vein. Fifty-nine subjects were used to compare the distance between the major hepatic vein and secondary Glisson pedicles among different liver diseases.Results: The average operative time was 327 min with an estimated blood loss of 554.55 m L. Only two patients received three units of packed red blood cells. The others recovered normally and were discharged on postoperative day 7. The distance between right posterior Glissonian pedicle and right hepatic vein was shorter in the patients with cirrhosis than that without cirrhosis, and this distance was even shorter in patients with hepatocellular carcinoma.Conclusion: The Glissonian approach with the major hepatic vein first is easy and feasible for laparoscopic anatomic hepatectomy, especially in patients with hepatocellular carcinoma and cirrhosis.展开更多
The outcome after curative resection for hepatocellular carcinoma(HCC)remains unsatisfactory due to the high recurrence rate after surgery.In patients with hepatitis B virus(HBV)-related HCC,which is the majority of p...The outcome after curative resection for hepatocellular carcinoma(HCC)remains unsatisfactory due to the high recurrence rate after surgery.In patients with hepatitis B virus(HBV)-related HCC,which is the majority of patients with HCC in Asia,a high viral load is a strong risk factor for HCC recurrence.It is logical to believe that antiviral therapy may improve the postoperative outcome by promoting viral clearance and hepatocyte regeneration,as well as improving residual liver volume in HCC patients with hepatitis B.However,the effect of antiviral therapy on clinical outcomes after liver resection in patients with HBV-related HCC remains to be established.There are two main groups of antiviral treatment for HBV-oral nucleos(t)ide analogues and interferon.Interferon treatment reduces the overall incidence of HBV-related HCC in sustained re-sponders.However,side effects may limit its long-term clinical application.Nucleos(t)ide analogues carry fewer side effects and are potent in terms of viral suppression when compared to interferon and are typically implemented for patients with more advanced liver diseases.They may also improve the outcome after curative resection for HBV-related HCC.There are increasing evidence to suggest that antiviral therapy could suppress HBV,decrease the perioperative reactivation of viral replication,reduce liver injury,preserve the liver function before and after operation,and may lower the risk of HCC recurrence.After all,antiviral therapy may improve the survival after liver resection by reducing recurrence and delaying the liver damage by the virus,resulting in a higher chance of receiving aggressive salvage therapy during HCC recurrence.展开更多
BACKGROUND： In order to preserve functional liver parenchyma, extended central hepatectomy （segments 4, 5, 7 and 8 resection） was proposed for the management of centrally located hepatocellular carcinoma invading t...BACKGROUND： In order to preserve functional liver parenchyma, extended central hepatectomy （segments 4, 5, 7 and 8 resection） was proposed for the management of centrally located hepatocellular carcinoma invading the right and middle hepatic veins, reconstructing segment 6 outflow in the absence of the thick inferior right hepatic vein. The present study was to describe our surgical techniques of extended central hepatectomy.METHODS： Between 2008 and 2012, 5 patients with centrally located hepatocellular carcinoma invading or in the vicinity of the right and middle hepatic veins underwent extended central hepatectomy. The thick inferior right hepatic vein was preserved during dissection. Gore-Tex graft was used for segment 6 outflow reconstruction in the absence of the thick inferior right hepatic vein.RESULTS： The mean future remnant liver volume for segments 2 and 3 was 28% versus 45% on segment 6 preservation. The mean tumor diameter was 7.4 cm. The thick inferior right hepatic vein was found in 1 patient. Outflow reconstruction from segment 6 was performed in 4 patients. Postoperative complications included bile leakage （1 patient）, pleural effusion （2） and liver failure （1）. The rate of graft patency was 75%. There was no perioperative mortality.CONCLUSION： Extended central hepatectomy is a safe alternative for extended hepatic resection in selected patients attempting to preserve the functional liver parenchyma.展开更多
AIM:To establish a reliable definition of postoperative liver failure(PLF)and allow the prediction of outcomes after hepatectomy.METHODS:The clinical data of 478 consecutive patients who underwent hepatectomy were ret...AIM:To establish a reliable definition of postoperative liver failure(PLF)and allow the prediction of outcomes after hepatectomy.METHODS:The clinical data of 478 consecutive patients who underwent hepatectomy were retrospectively analyzed.The examined prognostic factors included the ratio of total bilirubin(TBIL)on postoperative day(POD)X to TBIL on POD 1(TBIL-r1)and the ratio of the international normalized ratio(INR)on POD X to the INR on POD 1(INR-r1)for PODs 3,5 and 7.Student’s t test,theχ2test,logistic regression,survival analysis and receiver operating curve analysis were used to evaluate risk factors and establish the definition of postoperative liver failure(PLF).RESULTS:Fourteen patients(2.9%)died of liver failure within 3 mo of surgery.Significant differences were found between patients who died of liver failure and the remaining patients in terms of TBIL-r1 and INR-r1on PODs 3,5 and 7.The combination of TBIL-r1 and INR-r1 on POD 5 showed strong predictive power for liver failure-related death(sensitivity 92.9%and specificity 90.1%).The hepatic damage score(HDs),which was derived from TBIL-r1 and INR-r1,was used to define the degree of metabolic functional impairment after resection as mild(HDs=0),reversible hepatic"dysfunction"(HDs=1)or fatal hepatic failure(HDs=2).Furthermore,the indocyanine green retention rate at 15 min(ICG-R15)and the number of resected segments(RSs)were identified as independent predictors of the HDs.A linear relationship was found between ICG-R15 and RSs in the HDs=2 group.The regression equation was:RSs=-0.168×ICG-R15+5.625(r2=0.613,F=14.257,P=0.004).CONCLUSION:PLF can be defined by the HDs,which accurately predicts liver failure-related death after liver resection.Furthermore,the ICG-R15 and RSs can be used as selection criteria for hepatectomy.展开更多
A 69-year-old man was admitted to our hospital in October 2003,for further examination of two liver tumors.He was diagnosed with hepatocellular carcinoma(HCC) arising from decompensated hepatitis B virus(HBV)-related ...A 69-year-old man was admitted to our hospital in October 2003,for further examination of two liver tumors.He was diagnosed with hepatocellular carcinoma(HCC) arising from decompensated hepatitis B virus(HBV)-related cirrhosis.Long-term lamivudine administration improved liver function dramatically despite repeated treatment for HCC.His Child-Pugh score was 9 points at start of lamivudine treatment,improving to 5 points after 1 year.His indocyanine green at 15 min after injection test score was 48%before lamivudine treat-ment,improving to 22%after 2 years and to 5%after 4 years.Radiofrequency ablation controlled the HCC foci and maintained his liver function.In April 2009,abdominal computed tomography revealed a tumor thrombus in the right portal vein.Since his indocyanine green test results had improved to less than 10%,we performed a right hepatectomy,which was successful.To our knowledge,there have been no documented reports of patients undergoing successful right hepatectomy for HCC arising from decompensated cirrhosis.The findings observed in our patient indicate the importance of nucleoside analogs for treating HBV-related HCC.展开更多
AIM To establish a rat model for evaluating the maturity of liver regeneration derived from associating liver partition and portal vein ligation for staged hepatectomy(ALPPS).METHODS In the present study, ALPPS, parti...AIM To establish a rat model for evaluating the maturity of liver regeneration derived from associating liver partition and portal vein ligation for staged hepatectomy(ALPPS).METHODS In the present study, ALPPS, partial hepatecotmy(PHx), and sham rat models were established initially, which were validated by significant increase of proliferative markers including Ki-67, proliferating cell nuclear antigen, and cyclin D1. In the setting of accelerated proliferation in volume at the second and fifth day after ALPPS, the characteristics of newborn hepatocytes, as well as specific markers of progenitor hepatic cell, were identified. Afterwards, the detection of liver function followed by cluster analysis of functional gene expression were performed to evaluate the maturity.RESULTS Compared with PHx and sham groups, the proliferation of f LR was significantly higher in ALPPS group(P = 0.023 and 0.001 at second day, P = 0.034 and P < 0.001 at fifth day after stage I). Meanwhile, the increased expression of proliferative markers including Ki-67, proliferating cell nuclear antigen, and cyclin D1 verified the accelerated liver regeneration derived from ALPPS procedure. However, ALPPS-induced Sox9 positive hepatocytes significantly increased beyond the portal triad, which indicated the progenitor hepatic cell was potentially involved. And the characteristics of ALPPSinduced hepatocytes indicated the lower expression of hepatocyte nuclear factor 4 and anti-tryptase in early proliferative stage. Both suggested the immaturity of ALPPS-derived liver regeneration. Additionally, the detection of liver function and functional genes expression confirmed the immaturity of renascent hepatocytes derived in early stage of ALPPS-derived liver regeneration.CONCLUSION Our study revealed the immaturity of ALPPS-derived proliferation in early regenerative response, which indicated that the volumetric assessment overestimated the functional proliferation. This could be convincing evidence that the stage Ⅱ of ALPPS should be performed prudently in patients with marginally adequate f LR, as the ALPPS-derived proliferation in volume lags behind the functional regeneration.展开更多
Hepatic epithelioid hemangioendothelioma(HEH)is a rare neoplasm of vascular origin with variable malignant potential.Because most patients with this condition have multiple bilobar lesions,liver transplantation is the...Hepatic epithelioid hemangioendothelioma(HEH)is a rare neoplasm of vascular origin with variable malignant potential.Because most patients with this condition have multiple bilobar lesions,liver transplantation is the standard treatment,and hepatectomy is much less frequently indicated.We describe a case of a 35-yearold woman with unresectable multiple bilobar HEH successfully treated by combination treatment with hepatectomy and carbon-ion radiotherapy.This case is very meaningful since it demonstrated the effectiveness of carbon-ion radiotherapy for HEH and the possibility of expanding the curative treatment options for multiple bilobar hepatic tumors.展开更多
AIM:To investigate the effect of the neuropeptides bombesin(BBS)and neurotensin(NT)on oval cell proliferation in partially hepatectomized rats not pretreated with a known hepatocyte inhibitor.METHODS:Seventy male Wist...AIM:To investigate the effect of the neuropeptides bombesin(BBS)and neurotensin(NT)on oval cell proliferation in partially hepatectomized rats not pretreated with a known hepatocyte inhibitor.METHODS:Seventy male Wistar rats were randomly divided into five groups:Ⅰ=controls,Ⅱ=sham operated,Ⅲ=partial hepatectomy 70%(PHx),Ⅳ=PHx+ BBS(30μg/kg per day),Ⅴ=PHx+NT(300μg/kg per day).Forty eight hours after liver resection,portal en-dotoxin levels and hepatic glutathione redox state were determined.α-fetoprotein(AFP)mRNA(in situ hybridisation),cytokeratin-19 and Ki67 antigen expression (immunohistochemistry)and apoptosis(TUNEL)were evaluated on liver tissue samples.Cells with morphological features of oval cells that were cytokeratin-19 (+)and AFP mRNA(+)were scored in morphometric analysis and their proliferation was recorded.In addition,the proliferation and apoptotic rates of hepatocytes were determined.RESULTS:In the control and sham operated groups,oval cells were significantly less compared to groups Ⅲ,ⅣandⅤ(P<0.001).The neuropeptides BBS and NT significantly increased the proliferation of oval cells compared to groupⅢ(P<0.001).In addition,BBS and NT induced a significant increase of hepatocyte proliferation(P<0.001),whereas it decreased their apoptotic activity(P<0.001)compared to groupⅢ.BBS and NT significantly decreased portal endotoxemia (P<0.001)and increased the hepatic GSH:GSSG ratio (P<0.05 and P<0.001,respectively)compared to groupⅢ.CONCLUSION:BBS and NT stimulated oval cell proliferation in a model of liver regeneration,without use of concomitant suppression of hepatocyte proliferation as oval cell activation stimuli,and improved the hepatocyte regenerative response.This peptides-induced combined stimulation of oval cell and hepatocyte proliferation might serve as a possible treatment modality for several liver diseases.展开更多
To our best knowledge, no case of a tumor that was incidentally detected during living donor hepatectomy(LDH) has been reported in the English language medical literature. We present two cases in which grade Ⅰ neuroe...To our best knowledge, no case of a tumor that was incidentally detected during living donor hepatectomy(LDH) has been reported in the English language medical literature. We present two cases in which grade Ⅰ neuroendocrine tumors(NET) were incidentally detected during our twelve-year LDH experience. First Case: A 26-yearold male underwent LDH for his brother suffering from HBV-related chronic liver disease(CLD). After right lobe LDH, intestinal length was measured as part of a study concerning the relationship between small intestinal lengths and surgical procedure. At this stage, a mass lesion with a size of 10 mm × 10 mm was detected on the antimesenteric surface, approximately 90 cm proximal to the ileocecal valve. A wedge resection with primary intestinal anastomosis was performed. Second Case: A 29-year-old male underwent right lobe LDH for his father with hepatitis B virus(HBV)-related CLD. An abdominal exploration immediately prior to the closure of the incision revealed that the appendix vermiformis was edematous and had firmness with a size of 8-10 mm at its tip. An appendectomy was performed. The pathological examinations of the specimens of both patients revealedgrade 1 NET. In conclusion, even if patients undergoing LDH are healthy individuals, whole abdominal cavity should be gently palpated and all findings recorded after completing laparotomy. Suspected masses or lesions should be confirmed by frozen section examination. Such an approach would avert potential medicolegal issues.展开更多
BACKGROUND Sarcopenia may be associated with hepatocellular carcinoma(HCC)following hepatectomy.But traditional single clinical variables are still insufficient to predict recurrence.We still lack effective prediction...BACKGROUND Sarcopenia may be associated with hepatocellular carcinoma(HCC)following hepatectomy.But traditional single clinical variables are still insufficient to predict recurrence.We still lack effective prediction models for recent recurrence(time to recurrence<2 years)after hepatectomy for HCC.AIM To establish an interventable prediction model to estimate recurrence-free survival(RFS)after hepatectomy for HCC based on sarcopenia.METHODS We retrospectively analyzed 283 hepatitis B-related HCC patients who underwent curative hepatectomy for the first time,and the skeletal muscle index at the third lumbar spine was measured by preoperative computed tomography.94 of these patients were enrolled for external validation.Cox multivariate analysis was per-formed to identify the risk factors of postoperative recurrence in training cohort.A nomogram model was developed to predict the RFS of HCC patients,and its predictive performance was validated.The predictive efficacy of this model was evaluated using the receiver operating characteristic curve.RESULTS Multivariate analysis showed that sarcopenia[Hazard ratio(HR)=1.767,95%CI:1.166-2.678,P<0.05],alpha-fetoprotein≥40 ng/mL(HR=1.984,95%CI:1.307-3.011,P<0.05),the maximum diameter of tumor>5 cm(HR=2.222,95%CI:1.285-3.842,P<0.05),and hepatitis B virus DNA level≥2000 IU/mL(HR=2.1,95%CI:1.407-3.135,P<0.05)were independent risk factors associated with postoperative recurrence of HCC.Based on the sarcopenia to assess the RFS model of hepatectomy with hepatitis B-related liver cancer disease(SAMD)was established combined with other the above risk factors.The area under the curve of the SAMD model was 0.782(95%CI:0.705-0.858)in the training cohort(sensitivity 81%,specificity 63%)and 0.773(95%CI:0.707-0.838)in the validation cohort.Besides,a SAMD score≥110 was better to distinguish the high-risk group of postoperative recurrence of HCC.CONCLUSION Sarcopenia is associated with recent recurrence after hepatectomy for hepatitis B-related HCC.A nutritional status-based prediction model is first established for postoperative recurrence of hepatitis B-related HCC,which is superior to other models and contributes to prognosis prediction.展开更多
BACKGROUND Rapid regeneration of the residual liver is one of the key determinants of successful partial hepatectomy(PHx).At present,there is a lack of recognized safe,effective,and stable drugs to promote liver regen...BACKGROUND Rapid regeneration of the residual liver is one of the key determinants of successful partial hepatectomy(PHx).At present,there is a lack of recognized safe,effective,and stable drugs to promote liver regeneration.It has been reported that vagus nerve signaling is beneficial to liver regeneration,but the potential mechanism at play here is not fully understood.AIM To explore the effect and mechanism of hepatic vagus nerve in liver regeneration after PHx.METHODS A PHx plus hepatic vagotomy(Hv)mouse model was established.The effect of Hv on liver regeneration after PHx was determined by comparing the liver regeneration levels of the PHx-Hv group and the PHx-sham group mice.In order to further investigate the role of interleukin(IL)-22 in liver regeneration inhibition mediated by Hv,the levels of IL-22 in the PHx-Hv group and the PHx-sham group was measured.The degree of liver injury in the PHx-Hv group and the PHx-sham group mice was detected to determine the role of the hepatic vagus nerve in liver injury after PHx.RESULTS Compared to control-group mice,Hv mice showed severe liver injury and weakened liver regeneration after PHx.Further research found that Hv downregulates the production of IL-22 induced by PHx and blocks activation of the signal transducer and activator of transcription 3(STAT3)pathway then reduces the expression of various mitogenic and anti-apoptotic proteins after PHx.Exogenous IL-22 reverses the inhibition of liver regeneration induced by Hv and alleviates liver injury,while treatment with IL-22 binding protein(an inhibitor of IL-22 signaling)reduce the concentration of IL-22 induced by PHx,inhibits the activation of the STAT3 signaling pathway in the liver after PHx,thereby hindering liver regeneration and aggravating liver injury in PHx-sham mice.CONCLUSION Hv attenuates liver regeneration after hepatectomy,and the mechanism may be related to the fact that Hv downregulates the production of IL-22,then blocks activation of the STAT3 pathway.展开更多
Objective:The purpose of this study was to analyze risk factors for development of post-hepatectomy liver dysfunction in primary liver cancer(PLC)patients with concurrent hepatic schistosomiasis and chronic hepatitis....Objective:The purpose of this study was to analyze risk factors for development of post-hepatectomy liver dysfunction in primary liver cancer(PLC)patients with concurrent hepatic schistosomiasis and chronic hepatitis.Methods:A retrospective analysis of 73 PLC patients with concurrent hepatic schistosomiasis and chronic hepatitis,of which 16 patients developed liver dysfunction(persistent ascites or pleural effusion or occurrence of liver-related potentially fatal complications)following hepatectomy,was performed.After clinical characteristics were recorded,preoperative liver function parameters and surgery-related parameters in these patients were assessed.Seventeen potential risk factors for post-hepatectomy liver dysfunction were identified.The association between these potential risk factors and post-hepatectomy liver dysfunction then was analyzed.Results:Univariate analysis showed that liver cirrhosis,intraoperative blood loss,and preoperative total bilirubin were associated with the development of post-hepatectomy liver dysfunction.Multivariate logistic regression analysis of these three factors revealed that intraoperative blood loss≥600 mL and cirrhosis were two independent risk factors for post-hepatectomy liver dysfunction in PLC patients with concurrent hepatic schistosomiasis and chronic hepatitis.Conclusion:Keeping intraoperative blood loss below 600 mL can help avoid the development of post-hepatectomy liver dysfunction in liver cancer patients with concurrent hepatic schistosomiasis and chronic hepatitis.For patients with concomitant liver cirrhosis,every effort should be made to minimize potential liver function impairment induced by other adverse factors.展开更多
OBJECTIVE: To determine whether the anatomic characteristics of the left hepatic vein, middle hepatic vein and common trunk could influence the operation procedures of left hepatectomy. METHOD: Fifteen fresh human liv...OBJECTIVE: To determine whether the anatomic characteristics of the left hepatic vein, middle hepatic vein and common trunk could influence the operation procedures of left hepatectomy. METHOD: Fifteen fresh human liver specimens were dissected and their anatomic characteristics were recorded. RESULTS: The left hepatic vein and middle hepatic vein formed the common trunk of 1.2±0.4 cm in length in the 15 liver specimens. The angle between the left hepatic vein and middle hepatic vein was 91±18.3°. CONCLUSION: The left hepatic vein should not be sutured and ligated blindly in left hepatectomy because there might be a potential damage to the middle hepatic vein.展开更多
基金Supported by Guangdong Medical Science and Technology Research Fund Project,No.A2024475.
文摘This study explores the significance of using two-dimensional shear wave elastography(2D-SWE)to assess liver stiffness(LS)and spleen area(SPA)for predicting post-hepatectomy liver failure(PHLF).By providing a non-invasive method to measure LS,which correlates with the degree of liver fibrosis,and SPA,an indicator of portal hypertension,2D-SWE offers a comprehensive evaluation of a patient’s hepatic status.These advancements are particularly crucial in hepatic surgery,where accurate preoperative assessments are essential for optimizing surgical outcomes and minimizing complications.This letter highlights the prac-tical implications of integrating 2D-SWE into clinical practice,emphasizing its potential to improve patient safety and surgical precision by enhancing the ability to predict PHLF and tailor surgical approaches accordingly.
基金supported by grants from the National Natural Science Foundation of China(81201621 and 81372455)Key Clinical Departments and Outstanding Physicians in Jiangsu Province。
文摘Background:Laparoscopic hepatectomy(LH)has become increasingly popular for liver neoplasms,but its safety and effectiveness remain controversial.Hepatic hemangiomas are the most common benign liver neoplasm;the main approaches to hepatic hemangiomas include open hepatectomy(OH)and LH.In this study,we compared early outcomes between patients undergoing OH and those with LH.Methods:Patients underwent OH or LH in our hospital for hepatic hemangiomas between December 2013 and December 2017 were enrolled.All patients underwent comprehensive preoperative evaluations.The clinicopathological index and risk factors of hemangioma resection were assessed.Results:In total,41 patients underwent OH while 53 underwent LH.There was no significant difference in any preoperative clinical variables,including liver function,prothrombin time,or platelet count.Hepatic portal occlusion time and operative time were 39.74 vs.38.35 minutes(P=0.717)and 197.20 vs.203.68 minutes(P=0.652)in the OH and LH groups,respectively.No mortality nor significant perioperative complications were observed between the two groups.In LH group,two cases were converted to OH,one for an oversized tumor and the other for hemorrhage.Compared with OH patients,those with LH had less blood loss(361.69 vs.437.81 m L,P=0.024),shorter postoperative hospital stay(7.98 vs.11.07 days,P=0.001),and lower postoperative C-reactive protein(43.63 vs.58.21 mg/L,P=0.026).Conclusions:LH is superior to OH in terms of postoperative recovery and blood loss for selected patients with hepatic hemangioma.
文摘AIM: To study whether central hepatectomy(CH) canachieve similar overall patient survival and disease-freesurvival rates as conventional major hepatectomies ornot.METHODS: A systematic literature search was per-formed in MEDLINE for articles published from January1983 to June 2013 to evaluate the evidence for andagainst CH in the management of central hepatic malig-nancies and to compare the perioperative variables andoutcomes of CH to lobar/extended hemihepatectomy. RESULTS: A total of 895 patients were included from21 relevant studies. Most of these patients who un-derwent CH were a sub-cohort of larger liver resectionstudies. Only 4 studies directly compared Central vshemi-/extended hepatectomies. The range of opera-tive time for CH was reported to be 115 to 627 min andPringle's maneuver was used for vascular control in themajority of studies. The mean intraoperative blood lossduring CH ranged from 380 to 2450 mL. The reportedmorbidity rates ranged from 5.1% to 61.1%, the most common surgical complication was bile leakage and the most common cause of mortality was liver failure. Mor-tality ranged from 0.0% to 7.1% with an overall mor-tality of 2.3% following CH. The 1-year overall survival(OS) for patients underwent CH for hepatocellular car-cinoma ranged from 67% to 94%; with the 3-year and 5-year OS having a reported range of 44% to 66.8%, and 31.7% to 66.8% respectively. CONCLUSION: Based on current literature, CH is a promising option for anatomical parenchymal-preserv-ing procedure in patients with centrally located liver malignancies; it appears to be safe and comparable in both perioperative, early and long term outcomes when compared to patients undergoing hemi-/extended hepatectomy. More prospective studies are awaited to further define its role.
基金Supported by the National Natural Science Foundation of China,No.81970569,No.81773293,and No.31660266Natural Science Foundation of Hunan Province,No.2015JJ4083,No.2019JJ50874,and No.2018JJ3758
文摘BACKGROUND Hepatocellular carcinoma(HCC)is the world’s sixth most common malignant tumor and the third cause of cancer death.Although great progress has been made in hepatectomy,it is still associated with a certain degree of risk of posthepatectomy liver failure(PHLF),which extends the length of hospital stay and remains the leading cause of postoperative death.Studies have shown that assessment of hepatic functional reserve before hepatectomy is beneficial for reducing the incidence of PHLF.AIM To assess the value of model for end-stage liver disease(MELD)score combined with standardized future liver remnant(sFLR)volume in predicting PHLF in patients undergoing hepatectomy for HCC.METHODS This study was attended by 238 patients with HCC who underwent hepatectomy between January 2015 and January 2018.Discrimination of sFLR volume,MELD score,and sFLR/MELD ratio to predict PHLF was evaluated according to the area under the receiver operating characteristic curve.RESULTS The patients were divided into two groups according to whether PHLF occurred after hepatectomy.The incidence of PHLF was 8.4%in our research.The incidence of PHLF increased with the decrease in sFLR volume and the increase in MELD score.Both sFLR volume and MELD score were considered independent predictive factors for PHLF.Moreover,the cut-off value of the sFLR/MELD score to predict PHLF was 0.078(P<0.001).This suggests that an sFLR/MELD≥0.078 indicates a higher incidence of PHLF than an sFLR/MELD<0.078.CONCLUSION MELD combined with sFLR is a reliable and effective PHLF predictor,which is superior to MELD score or sFLR volume alone.
基金Supported by Grants from the National Science and Technology Major Project of China,No.2012ZX10002-016 and No.2012ZX10002-017
文摘AIM: To investigate the relationship between low immediate postoperative platelet count and perioperative outcome after liver resection in patients with hepatocellular carcinoma (HCC). METHODS: In a cohort of 565 consecutive hepatitis B-related HCC patients who underwent major liver resection, the characteristics and clinical outcomes after liver resection were compared between patients with immediate postoperative platelet count < 100 x 10(9)/L and patients with platelet count >= 100 x 10(9)/L. Risk factors for postoperative hepatic insufficiency were evaluated by multivariate analysis. RESULTS: Patients with a low immediate postoperative platelet count (< 100 x 10(9)/L) had more grade III-V. complications (20.5% vs 12.4%, P = 0.016), and higher rates of postoperative liver failure (6.8% vs 2.6%, P = 0.02), hepatic insufficiency (31.5% vs 21.2%, P < 0.001) and mortality (6.8% vs 0.5%, P < 0.001), compared to patients with a platelet count >= 100 x 10(9)/L. The alanine aminotransferase levels on postoperative days 3 and 5, and bilirubin on postoperative days 1, 3 and 5 were higher in patients with immediate postoperative low platelet count. Multivariate analysis revealed that immediate postoperative low platelet count, rather than preoperative low platelet count, was a significant independent risk factor for hepatic insufficiency. CONCLUSION: A low immediate postoperative platelet count is an independent risk factor for hepatic insufficiency. Platelets can mediate liver regeneration in the cirrhotic liver. (C) 2014 Baishideng Publishing Group Inc. All rights reserved.
文摘AIM： To study the effects of obstructive jaundice on liver regeneration after partial hepatectomy. METHODS： Hepatocyte growth factor （HGF）, its receptor, c-Met, vascular endothelial growth factor （VEGF） and transforming growth factor-β1 （TGF-β1） mRNA expression in both liver tissue and isolated liver cells were investigated after biliary obstruction （BO） by quantitative reverse-transcription polymerase chain reaction （RT-PCR） using a LightCycler. Immunohistochemical staining for desmin and e-smooth muscle actin （α-SNA） was also studied. Regenerating liver weight and proliferating cell nuclear antigen （PCNA） labeling index, and growth factor expression were then evaluated after 70% hepatectomy with concomitant internal bUiary drainage in BO rats or sham-operated rats. RESULTS： Hepatic TGF-β1 mRNA levels increased significantly 14 days after BO, and further increased with duration of cholestasis. Meanwhile, HGF and VEGF tended to increase, but was not significant. In cell isolates, TGF-β1 mRNA was found mainly in the hepatic stellate cell （HSC） fraction. Immunohistochemical studies revealed an increased number of HSCs （desmin-positive cells） and activated HSCs （α-SMA-positive cells） in portal areas after BO. In a hepatectomy model, liver regeneration was delayed in BO rats, as compared to sham-operated rats. TGF-β1 mRNA was significantly up-regulated up to 48 h after hepatectomy, and the earlier HGF mRNA peak was lost in BO rats. CONCLUSION： BO induces HSCs proliferation and activation, leading to up-regulation of TGF-β1 mRNA and suppression of HGF mRNA in livers. These altered expression patterns may be strongly involved in delayed liver regeneration after hepatectomy with obstructive jaundice.
文摘The middle hepatic vein (MHV) lies in the midplane of the liver. The classical teaching of right or left hepatectomy is transection of liver I cm to the right or left wall of the MHV in order to avoid bleeding. However, guidance of liver transection is lost if the course of the MHV is not known. By exposing the MHV early in the phase of liver transection and following its course to the inferior vena cava, a precise liver transection plane could be obtained. Such technique has the potential of achieving adequate tumor-free resection margin, avoiding damage to intrahepatic portal pedicles, preserving venous drainage and functional liver tissue, and less postoperative infection.
基金supported by grants from the National Natural Science Foundation of China(81372455)Jiangsu Provincial Medical Talent
文摘Background: Laparoscopic anatomic hepatectomy remains challenging because of the complex interior structures of the liver. Our novel strategy includes the Glissonian approach and the major hepatic vein first, which serves to define the external and internal landmarks for laparoscopic anatomic hepatectomy.Methods: Eleven cases underwent laparoscopic anatomic hepatectomy, including three right hepatectomies, three left hepatectomies, three right posterior hepatectomies, and two mesohepatectomies. The Glissonian approach was used to transect the hepatic pedicles as external demarcation. The major hepatic vein near the hepatic portal was exposed and served as the internal landmark for parenchymal transection. The liver parenchyma below and above the major hepatic vein was transected along the major hepatic vein. Fifty-nine subjects were used to compare the distance between the major hepatic vein and secondary Glisson pedicles among different liver diseases.Results: The average operative time was 327 min with an estimated blood loss of 554.55 m L. Only two patients received three units of packed red blood cells. The others recovered normally and were discharged on postoperative day 7. The distance between right posterior Glissonian pedicle and right hepatic vein was shorter in the patients with cirrhosis than that without cirrhosis, and this distance was even shorter in patients with hepatocellular carcinoma.Conclusion: The Glissonian approach with the major hepatic vein first is easy and feasible for laparoscopic anatomic hepatectomy, especially in patients with hepatocellular carcinoma and cirrhosis.
文摘The outcome after curative resection for hepatocellular carcinoma(HCC)remains unsatisfactory due to the high recurrence rate after surgery.In patients with hepatitis B virus(HBV)-related HCC,which is the majority of patients with HCC in Asia,a high viral load is a strong risk factor for HCC recurrence.It is logical to believe that antiviral therapy may improve the postoperative outcome by promoting viral clearance and hepatocyte regeneration,as well as improving residual liver volume in HCC patients with hepatitis B.However,the effect of antiviral therapy on clinical outcomes after liver resection in patients with HBV-related HCC remains to be established.There are two main groups of antiviral treatment for HBV-oral nucleos(t)ide analogues and interferon.Interferon treatment reduces the overall incidence of HBV-related HCC in sustained re-sponders.However,side effects may limit its long-term clinical application.Nucleos(t)ide analogues carry fewer side effects and are potent in terms of viral suppression when compared to interferon and are typically implemented for patients with more advanced liver diseases.They may also improve the outcome after curative resection for HBV-related HCC.There are increasing evidence to suggest that antiviral therapy could suppress HBV,decrease the perioperative reactivation of viral replication,reduce liver injury,preserve the liver function before and after operation,and may lower the risk of HCC recurrence.After all,antiviral therapy may improve the survival after liver resection by reducing recurrence and delaying the liver damage by the virus,resulting in a higher chance of receiving aggressive salvage therapy during HCC recurrence.
文摘BACKGROUND： In order to preserve functional liver parenchyma, extended central hepatectomy （segments 4, 5, 7 and 8 resection） was proposed for the management of centrally located hepatocellular carcinoma invading the right and middle hepatic veins, reconstructing segment 6 outflow in the absence of the thick inferior right hepatic vein. The present study was to describe our surgical techniques of extended central hepatectomy.METHODS： Between 2008 and 2012, 5 patients with centrally located hepatocellular carcinoma invading or in the vicinity of the right and middle hepatic veins underwent extended central hepatectomy. The thick inferior right hepatic vein was preserved during dissection. Gore-Tex graft was used for segment 6 outflow reconstruction in the absence of the thick inferior right hepatic vein.RESULTS： The mean future remnant liver volume for segments 2 and 3 was 28% versus 45% on segment 6 preservation. The mean tumor diameter was 7.4 cm. The thick inferior right hepatic vein was found in 1 patient. Outflow reconstruction from segment 6 was performed in 4 patients. Postoperative complications included bile leakage （1 patient）, pleural effusion （2） and liver failure （1）. The rate of graft patency was 75%. There was no perioperative mortality.CONCLUSION： Extended central hepatectomy is a safe alternative for extended hepatic resection in selected patients attempting to preserve the functional liver parenchyma.
文摘AIM:To establish a reliable definition of postoperative liver failure(PLF)and allow the prediction of outcomes after hepatectomy.METHODS:The clinical data of 478 consecutive patients who underwent hepatectomy were retrospectively analyzed.The examined prognostic factors included the ratio of total bilirubin(TBIL)on postoperative day(POD)X to TBIL on POD 1(TBIL-r1)and the ratio of the international normalized ratio(INR)on POD X to the INR on POD 1(INR-r1)for PODs 3,5 and 7.Student’s t test,theχ2test,logistic regression,survival analysis and receiver operating curve analysis were used to evaluate risk factors and establish the definition of postoperative liver failure(PLF).RESULTS:Fourteen patients(2.9%)died of liver failure within 3 mo of surgery.Significant differences were found between patients who died of liver failure and the remaining patients in terms of TBIL-r1 and INR-r1on PODs 3,5 and 7.The combination of TBIL-r1 and INR-r1 on POD 5 showed strong predictive power for liver failure-related death(sensitivity 92.9%and specificity 90.1%).The hepatic damage score(HDs),which was derived from TBIL-r1 and INR-r1,was used to define the degree of metabolic functional impairment after resection as mild(HDs=0),reversible hepatic"dysfunction"(HDs=1)or fatal hepatic failure(HDs=2).Furthermore,the indocyanine green retention rate at 15 min(ICG-R15)and the number of resected segments(RSs)were identified as independent predictors of the HDs.A linear relationship was found between ICG-R15 and RSs in the HDs=2 group.The regression equation was:RSs=-0.168×ICG-R15+5.625(r2=0.613,F=14.257,P=0.004).CONCLUSION:PLF can be defined by the HDs,which accurately predicts liver failure-related death after liver resection.Furthermore,the ICG-R15 and RSs can be used as selection criteria for hepatectomy.
文摘A 69-year-old man was admitted to our hospital in October 2003,for further examination of two liver tumors.He was diagnosed with hepatocellular carcinoma(HCC) arising from decompensated hepatitis B virus(HBV)-related cirrhosis.Long-term lamivudine administration improved liver function dramatically despite repeated treatment for HCC.His Child-Pugh score was 9 points at start of lamivudine treatment,improving to 5 points after 1 year.His indocyanine green at 15 min after injection test score was 48%before lamivudine treat-ment,improving to 22%after 2 years and to 5%after 4 years.Radiofrequency ablation controlled the HCC foci and maintained his liver function.In April 2009,abdominal computed tomography revealed a tumor thrombus in the right portal vein.Since his indocyanine green test results had improved to less than 10%,we performed a right hepatectomy,which was successful.To our knowledge,there have been no documented reports of patients undergoing successful right hepatectomy for HCC arising from decompensated cirrhosis.The findings observed in our patient indicate the importance of nucleoside analogs for treating HBV-related HCC.
基金Supported by the Major Scientific and Technological Project of Zhejiang Province,China,No.2015C03026
文摘AIM To establish a rat model for evaluating the maturity of liver regeneration derived from associating liver partition and portal vein ligation for staged hepatectomy(ALPPS).METHODS In the present study, ALPPS, partial hepatecotmy(PHx), and sham rat models were established initially, which were validated by significant increase of proliferative markers including Ki-67, proliferating cell nuclear antigen, and cyclin D1. In the setting of accelerated proliferation in volume at the second and fifth day after ALPPS, the characteristics of newborn hepatocytes, as well as specific markers of progenitor hepatic cell, were identified. Afterwards, the detection of liver function followed by cluster analysis of functional gene expression were performed to evaluate the maturity.RESULTS Compared with PHx and sham groups, the proliferation of f LR was significantly higher in ALPPS group(P = 0.023 and 0.001 at second day, P = 0.034 and P < 0.001 at fifth day after stage I). Meanwhile, the increased expression of proliferative markers including Ki-67, proliferating cell nuclear antigen, and cyclin D1 verified the accelerated liver regeneration derived from ALPPS procedure. However, ALPPS-induced Sox9 positive hepatocytes significantly increased beyond the portal triad, which indicated the progenitor hepatic cell was potentially involved. And the characteristics of ALPPSinduced hepatocytes indicated the lower expression of hepatocyte nuclear factor 4 and anti-tryptase in early proliferative stage. Both suggested the immaturity of ALPPS-derived liver regeneration. Additionally, the detection of liver function and functional genes expression confirmed the immaturity of renascent hepatocytes derived in early stage of ALPPS-derived liver regeneration.CONCLUSION Our study revealed the immaturity of ALPPS-derived proliferation in early regenerative response, which indicated that the volumetric assessment overestimated the functional proliferation. This could be convincing evidence that the stage Ⅱ of ALPPS should be performed prudently in patients with marginally adequate f LR, as the ALPPS-derived proliferation in volume lags behind the functional regeneration.
文摘Hepatic epithelioid hemangioendothelioma(HEH)is a rare neoplasm of vascular origin with variable malignant potential.Because most patients with this condition have multiple bilobar lesions,liver transplantation is the standard treatment,and hepatectomy is much less frequently indicated.We describe a case of a 35-yearold woman with unresectable multiple bilobar HEH successfully treated by combination treatment with hepatectomy and carbon-ion radiotherapy.This case is very meaningful since it demonstrated the effectiveness of carbon-ion radiotherapy for HEH and the possibility of expanding the curative treatment options for multiple bilobar hepatic tumors.
文摘AIM:To investigate the effect of the neuropeptides bombesin(BBS)and neurotensin(NT)on oval cell proliferation in partially hepatectomized rats not pretreated with a known hepatocyte inhibitor.METHODS:Seventy male Wistar rats were randomly divided into five groups:Ⅰ=controls,Ⅱ=sham operated,Ⅲ=partial hepatectomy 70%(PHx),Ⅳ=PHx+ BBS(30μg/kg per day),Ⅴ=PHx+NT(300μg/kg per day).Forty eight hours after liver resection,portal en-dotoxin levels and hepatic glutathione redox state were determined.α-fetoprotein(AFP)mRNA(in situ hybridisation),cytokeratin-19 and Ki67 antigen expression (immunohistochemistry)and apoptosis(TUNEL)were evaluated on liver tissue samples.Cells with morphological features of oval cells that were cytokeratin-19 (+)and AFP mRNA(+)were scored in morphometric analysis and their proliferation was recorded.In addition,the proliferation and apoptotic rates of hepatocytes were determined.RESULTS:In the control and sham operated groups,oval cells were significantly less compared to groups Ⅲ,ⅣandⅤ(P<0.001).The neuropeptides BBS and NT significantly increased the proliferation of oval cells compared to groupⅢ(P<0.001).In addition,BBS and NT induced a significant increase of hepatocyte proliferation(P<0.001),whereas it decreased their apoptotic activity(P<0.001)compared to groupⅢ.BBS and NT significantly decreased portal endotoxemia (P<0.001)and increased the hepatic GSH:GSSG ratio (P<0.05 and P<0.001,respectively)compared to groupⅢ.CONCLUSION:BBS and NT stimulated oval cell proliferation in a model of liver regeneration,without use of concomitant suppression of hepatocyte proliferation as oval cell activation stimuli,and improved the hepatocyte regenerative response.This peptides-induced combined stimulation of oval cell and hepatocyte proliferation might serve as a possible treatment modality for several liver diseases.
文摘To our best knowledge, no case of a tumor that was incidentally detected during living donor hepatectomy(LDH) has been reported in the English language medical literature. We present two cases in which grade Ⅰ neuroendocrine tumors(NET) were incidentally detected during our twelve-year LDH experience. First Case: A 26-yearold male underwent LDH for his brother suffering from HBV-related chronic liver disease(CLD). After right lobe LDH, intestinal length was measured as part of a study concerning the relationship between small intestinal lengths and surgical procedure. At this stage, a mass lesion with a size of 10 mm × 10 mm was detected on the antimesenteric surface, approximately 90 cm proximal to the ileocecal valve. A wedge resection with primary intestinal anastomosis was performed. Second Case: A 29-year-old male underwent right lobe LDH for his father with hepatitis B virus(HBV)-related CLD. An abdominal exploration immediately prior to the closure of the incision revealed that the appendix vermiformis was edematous and had firmness with a size of 8-10 mm at its tip. An appendectomy was performed. The pathological examinations of the specimens of both patients revealedgrade 1 NET. In conclusion, even if patients undergoing LDH are healthy individuals, whole abdominal cavity should be gently palpated and all findings recorded after completing laparotomy. Suspected masses or lesions should be confirmed by frozen section examination. Such an approach would avert potential medicolegal issues.
基金Supported by Guizhou Provincial Science and Technology Projects,No.[2021]013 and No.[2021]053Doctor Foundation of Guizhou Provincial People's Hospital,No.GZSYBS[2021]07.
文摘BACKGROUND Sarcopenia may be associated with hepatocellular carcinoma(HCC)following hepatectomy.But traditional single clinical variables are still insufficient to predict recurrence.We still lack effective prediction models for recent recurrence(time to recurrence<2 years)after hepatectomy for HCC.AIM To establish an interventable prediction model to estimate recurrence-free survival(RFS)after hepatectomy for HCC based on sarcopenia.METHODS We retrospectively analyzed 283 hepatitis B-related HCC patients who underwent curative hepatectomy for the first time,and the skeletal muscle index at the third lumbar spine was measured by preoperative computed tomography.94 of these patients were enrolled for external validation.Cox multivariate analysis was per-formed to identify the risk factors of postoperative recurrence in training cohort.A nomogram model was developed to predict the RFS of HCC patients,and its predictive performance was validated.The predictive efficacy of this model was evaluated using the receiver operating characteristic curve.RESULTS Multivariate analysis showed that sarcopenia[Hazard ratio(HR)=1.767,95%CI:1.166-2.678,P<0.05],alpha-fetoprotein≥40 ng/mL(HR=1.984,95%CI:1.307-3.011,P<0.05),the maximum diameter of tumor>5 cm(HR=2.222,95%CI:1.285-3.842,P<0.05),and hepatitis B virus DNA level≥2000 IU/mL(HR=2.1,95%CI:1.407-3.135,P<0.05)were independent risk factors associated with postoperative recurrence of HCC.Based on the sarcopenia to assess the RFS model of hepatectomy with hepatitis B-related liver cancer disease(SAMD)was established combined with other the above risk factors.The area under the curve of the SAMD model was 0.782(95%CI:0.705-0.858)in the training cohort(sensitivity 81%,specificity 63%)and 0.773(95%CI:0.707-0.838)in the validation cohort.Besides,a SAMD score≥110 was better to distinguish the high-risk group of postoperative recurrence of HCC.CONCLUSION Sarcopenia is associated with recent recurrence after hepatectomy for hepatitis B-related HCC.A nutritional status-based prediction model is first established for postoperative recurrence of hepatitis B-related HCC,which is superior to other models and contributes to prognosis prediction.
基金Supported by the Natural Science Foundation of Zhejiang Province,No.LQ20H310002the Scientific Technology Projects of Health and Medicine of Zhejiang Province,No.2020KY308and the Huzhou Science and Technology Fund,No.2020GY39.
文摘BACKGROUND Rapid regeneration of the residual liver is one of the key determinants of successful partial hepatectomy(PHx).At present,there is a lack of recognized safe,effective,and stable drugs to promote liver regeneration.It has been reported that vagus nerve signaling is beneficial to liver regeneration,but the potential mechanism at play here is not fully understood.AIM To explore the effect and mechanism of hepatic vagus nerve in liver regeneration after PHx.METHODS A PHx plus hepatic vagotomy(Hv)mouse model was established.The effect of Hv on liver regeneration after PHx was determined by comparing the liver regeneration levels of the PHx-Hv group and the PHx-sham group mice.In order to further investigate the role of interleukin(IL)-22 in liver regeneration inhibition mediated by Hv,the levels of IL-22 in the PHx-Hv group and the PHx-sham group was measured.The degree of liver injury in the PHx-Hv group and the PHx-sham group mice was detected to determine the role of the hepatic vagus nerve in liver injury after PHx.RESULTS Compared to control-group mice,Hv mice showed severe liver injury and weakened liver regeneration after PHx.Further research found that Hv downregulates the production of IL-22 induced by PHx and blocks activation of the signal transducer and activator of transcription 3(STAT3)pathway then reduces the expression of various mitogenic and anti-apoptotic proteins after PHx.Exogenous IL-22 reverses the inhibition of liver regeneration induced by Hv and alleviates liver injury,while treatment with IL-22 binding protein(an inhibitor of IL-22 signaling)reduce the concentration of IL-22 induced by PHx,inhibits the activation of the STAT3 signaling pathway in the liver after PHx,thereby hindering liver regeneration and aggravating liver injury in PHx-sham mice.CONCLUSION Hv attenuates liver regeneration after hepatectomy,and the mechanism may be related to the fact that Hv downregulates the production of IL-22,then blocks activation of the STAT3 pathway.
文摘Objective:The purpose of this study was to analyze risk factors for development of post-hepatectomy liver dysfunction in primary liver cancer(PLC)patients with concurrent hepatic schistosomiasis and chronic hepatitis.Methods:A retrospective analysis of 73 PLC patients with concurrent hepatic schistosomiasis and chronic hepatitis,of which 16 patients developed liver dysfunction(persistent ascites or pleural effusion or occurrence of liver-related potentially fatal complications)following hepatectomy,was performed.After clinical characteristics were recorded,preoperative liver function parameters and surgery-related parameters in these patients were assessed.Seventeen potential risk factors for post-hepatectomy liver dysfunction were identified.The association between these potential risk factors and post-hepatectomy liver dysfunction then was analyzed.Results:Univariate analysis showed that liver cirrhosis,intraoperative blood loss,and preoperative total bilirubin were associated with the development of post-hepatectomy liver dysfunction.Multivariate logistic regression analysis of these three factors revealed that intraoperative blood loss≥600 mL and cirrhosis were two independent risk factors for post-hepatectomy liver dysfunction in PLC patients with concurrent hepatic schistosomiasis and chronic hepatitis.Conclusion:Keeping intraoperative blood loss below 600 mL can help avoid the development of post-hepatectomy liver dysfunction in liver cancer patients with concurrent hepatic schistosomiasis and chronic hepatitis.For patients with concomitant liver cirrhosis,every effort should be made to minimize potential liver function impairment induced by other adverse factors.
文摘OBJECTIVE: To determine whether the anatomic characteristics of the left hepatic vein, middle hepatic vein and common trunk could influence the operation procedures of left hepatectomy. METHOD: Fifteen fresh human liver specimens were dissected and their anatomic characteristics were recorded. RESULTS: The left hepatic vein and middle hepatic vein formed the common trunk of 1.2±0.4 cm in length in the 15 liver specimens. The angle between the left hepatic vein and middle hepatic vein was 91±18.3°. CONCLUSION: The left hepatic vein should not be sutured and ligated blindly in left hepatectomy because there might be a potential damage to the middle hepatic vein.
