AIM:To evaluate different standard liver volume (SLV) formula and verify the applicability of the formulae for Chinese adults.METHODS: Data from 70 cases of living donor liver transplantation (LDLT) performed at our t...AIM:To evaluate different standard liver volume (SLV) formula and verify the applicability of the formulae for Chinese adults.METHODS: Data from 70 cases of living donor liver transplantation (LDLT) performed at our transplantation centers between January 2008 and April 2009 were analyzed. SLV was estimated using our recently reported formula [the Chengdu formula: SLV (mL)=11.5×body weight (kg) + 334] and other reported formulae used for Chinese adults. Actual intraoperative liver volumes were obtained from a review of the patients' medical records.RESULTS: The actual right liver volume was not significantly different from the estimated right liver volume determined by the Chengdu formula, but was significantly smaller than estimates using the Heinemann, Urata, Vauthey, and Lee formulae (P<0.01), and signif icantly larger than estimates using the Fan formula (P<0.05).CONCLUSION: The Chengdu formula was demonstrated to be reliable by its application in LDLT.展开更多
AIM To obtain a reference range of morphological indices and establish a formula to accurately predict standard liver volume(SLV) in Chinese adults.METHODS Computed tomography(CT)-estimated total liver volume(CTLV) wa...AIM To obtain a reference range of morphological indices and establish a formula to accurately predict standard liver volume(SLV) in Chinese adults.METHODS Computed tomography(CT)-estimated total liver volume(CTLV) was determined in 369 Chinese adults. Age,sex,body weight,body height,body mass index,and body surface area(BSA) were recorded using CT. Total splenic volume,portal venous diameter(PVD),splenic venous diameter(SVD),and portal venous cross-sectional area(PVCSA) were also measured by CT. Stepwise multiple linear regression analysis was performed to evaluate the impact of each parameter on CTLV and to develop a new SLV formula. The accuracy of the new formula was compared with the existing formulas in a validation group.RESULTS The average CTLV was 1205.41 ± 257.53 cm3(range,593.80-2250.10 cm3). The average of PVD,SVD and PVCSA was 9.34 ± 1.51 mm,7.40 ± 1.31 mm and 173.22 ± 48.11 mm2,respectively. The CT-estimated splenic volume of healthy adults varied markedly(range,46.60-2892.30 cm3). Sex,age,body height,body weight,body mass index,and BSA were significantly correlated with CTLV. BSA showed the strongest correlation(r = 0.546,P < 0.001),and was used to establish a new model for calculating SLV: SLV(cm3) = 758.259 × BSA(m2)-124.272(R2 = 0.299,P < 0.001). This formula also predicted CTLV more accurately than the existing formulas,but overestimated CTLV in elderly subjects > 70 years of age,and underestimated liver volume when CTLV was > 1800 cm3.CONCLUSION Our new BSA-based formula is more accurate than other formulas in estimating SLV in Chinese adults.展开更多
AIM:To determine whether and how magnetic resonance imaging(MRI)-based total liver volume(TLV) and diffusion weighted imaging(DWI) could predict liver fibrosis.METHODS:Sixteen experimental mature mini-pigs(6 males,10 ...AIM:To determine whether and how magnetic resonance imaging(MRI)-based total liver volume(TLV) and diffusion weighted imaging(DWI) could predict liver fibrosis.METHODS:Sixteen experimental mature mini-pigs(6 males,10 females),weighing between 20.0 and 24.0 kg were prospectively used to model liver fibrosis induced by intraperitoneal injection of 40% CCl4 dissolved in fat emulsion twice a week for 16 wk,and by feeding 40% CCl4 mixed with maize flour twice daily for the subsequent 5 wk.All the survival animals underwent percutaneous liver biopsy and DWI using b = 300,500 and 800 s/mm2 followed by abdominal gadolinium-enhanced MRI at the 0,5th,9th,16th and 21st weekend after beginning of the modeling.TLV was obtained on enhanced MRI,and apparent diffusion coefficient(ADC) was obtained on DWI.Hepatic tissue specimens were stained with hematoxylin and Masson' s trichrome staining for staging liver fibrosis.Pathological specimens were scored using the human METAVIR classification system.Statistical analyses were performed to determine whether and how the TLV and ADC could be used to predict the stage of liver fibrosis.RESULTS:TLV increased from stage 0 to 2 and decreased from stage 3(r = 0.211;P < 0.001).There was a difference in TLV between stage 0-1 and 2-4(P = 0.03) whereas no difference between stage 0-2 and 3-4(P = 0.71).TLV could predict stage ≥ 2 [area under receiver operating characteristic curve(AUC) = 0.682].There was a decrease in ADC values with increasing stage of fibrosis for b = 300,500 and 800 s/mm2(r =-0.418,-0.535 and-0.622,respectively;all P < 0.001).Differences were found between stage 0-1 and 2-4 in ADC values for b = 300,500 and 800 s/mm2,and between stage 0-2 and 3-4 for b = 500 or 800 s/mm2(all P < 0.05).For predicting stage ≥ 2 and ≥ 3,AUC was 0.803 and 0.847 for b = 500 s/mm2,and 0.848 and 0.887 for b = 800 s/mm2,respectively.CONCLUSION:ADC for b = 500 or 800 s/mm2 could be better than TLV and ADC for b = 300 s/mm2 to pre-dict fibrosis stage ≥ 2 or ≥ 3.展开更多
AIM:To evaluate the relationship between donor safety and remnant liver volume in right lobe living donor liver transplantation(LDLT).METHODS:From July 2001 to January 2009,our liver transplant centers carried out 197...AIM:To evaluate the relationship between donor safety and remnant liver volume in right lobe living donor liver transplantation(LDLT).METHODS:From July 2001 to January 2009,our liver transplant centers carried out 197 LDLTs.The clinical data from 151 cases of adult right lobe living donors(not including the middle hepatic vein) were analyzed.The conditions of the three groups of donors were well matched in terms of the studied parameters.The donors' preoperative data,intraoperative and postoperative data were calculated for the three groups:Group 1 remnant liver volume(RLV) < 35%,group 2 RLV 36%-40%,and group 3 RLV > 40%.Comparisons included the different remnant liver volumes on postoperative liver function recovery and the impact of systemic conditions.Correlations between remnant liver volume and post-operative complications were also analyzed.RESULTS:The donors' anthroposomatology data,op-eration time,and preoperative donor blood test indicators were calculated for the three groups.No significant differences were observed between the donors' gender,age,height,weight,and operation time.According to the Chengdu standard liver volume formula,the total liver volume of group 1 was 1072.88 ± 131.06 mL,group 2 was 1043.84 ± 97.11 mL,and group 3 was 1065.33 ± 136.02 mL.The three groups showed no statistically significant differences.When the volume of the remnant liver was less than 35% of the total liver volume,the volume of the remnant had a significant effect on the recovery of liver function and intensive care unit time.In addition,the occurrence of complications was closely related to the remnant liver volume.When the volume of the remnant liver was more than 35% of the total liver volume,the remnant volume change had no significant effect on donor recovery.CONCLUSION:To ensure donor safety,the remnant liver volume should be greater than the standard liver volume(35%) in right lobe living donor liver transplantation.展开更多
BACKGROUND Liver cancer resection,especially in patients with hemihepatectomy or extended hemihepatectomy,often leads to poor prognosis,such as liver insufficiency and even liver failure and death,because the standard...BACKGROUND Liver cancer resection,especially in patients with hemihepatectomy or extended hemihepatectomy,often leads to poor prognosis,such as liver insufficiency and even liver failure and death,because the standard residual liver volume(SRLV)cannot be fully compensated after surgery.AIM To explore the risk factors of poor prognosis after hemihepatectomy for hepatocellular carcinoma and evaluate the application value of related prognostic approaches.METHODS The clinical data of 35 patients with primary liver cancer in Nantong Third People's Hospital from February 2016 to July 2020 were retrospectively analyzed.The receiver operating characteristic curve was created using medcac19.0.4 to compare the critical values of the SRLV in different stages of liver fibrosis after hemihepatectomy with those of liver dysfunction after hemihepatectomy.It was constructed by combining the Child-Pugh score to evaluate its application value in predicting liver function compensation.RESULTS The liver stiffness measure(LSM)value and SRLV were associated with liver dysfunction after hemihepatectomy.Logistic regression analysis showed that an LSM value≥25 kPa[odds ratio(OR)=6.254,P<0.05]and SRLV≤0.290 L/m^(2)(OR=5.686,P<0.05)were independent risk factors for postoperative liver dysfunction.The accuracy of the new liver reserve evaluation model for predicting postoperative liver function was higher than that of the Child-Pugh score(P<0.05).CONCLUSION SRLV and LSM values can be used to evaluate the safety of hemihepatectomy.The new liver reserve evaluation model has good application potential in the evaluation of liver reserve function after hemihepatectomy.展开更多
AIM:To investigate whether liver lobe volume and albumin(ALB) could predict the presence and severity of liver cirrhosis,and esophageal varices.METHODS:Seventy-one cirrhotic patients with hepatitis B and 21 healthy in...AIM:To investigate whether liver lobe volume and albumin(ALB) could predict the presence and severity of liver cirrhosis,and esophageal varices.METHODS:Seventy-one cirrhotic patients with hepatitis B and 21 healthy individuals were enrolled in this study.All the participants underwent abdominal enhanced magnetic resonance imaging to measure each liver lobe volume,and biochemical workup for testing ALB and Child-Pugh class.All cirrhotic patients underwent upper gastrointestinal endoscopy to show the presence of cirrhotic esophageal varices.Right liver lobe volume(RV),left medial liver lobe volume(LMV),left lateral liver lobe volume(LLV),and caudate lobe volume(CV) were measured using enhanced magnetic resonance imaging.The ratios of RV to ALB(RV/ALB),LMV to ALB(LMV/ALB),LLV to ALB(LLV/ALB) and CV to ALB(CV/ALB) were calculated.Statistical analyses were performed to determine whether and how the combination of liver lobe volume measured using magnetic resonance imaging and albumin could predict the presence and severity of liver cirrhosis,and the presence of esophageal varices.RESULTS:RV,LMV,LLV and CV decreased(r =-0.51-0.373; all P < 0.05),while RV/ALB increased(r = 0.424; P < 0.05),with the progress of Child-Pugh classof liver cirrhosis.RV,LMV,CV,LLV/ALB and CV/ALB could identify presence of liver cirrhosis; LLV and LMV could distinguish Child-Pugh class A from B; RV,LMV,LLV,CV,RV/ALB and LLV/ALB could distinguish class A from C; RV and LLV/ALB could differentiate B from C; and RV,RV/ALB and CV/ALB could identify presence of esophageal varices(all P < 0.05).Among these parameters,CV/ALB could best identify the presence of liver cirrhosis,with an area under receiver operating characteristic curve(AUC) of 0.860,a sensitivity of 82.0% and a specificity of 83.0%.LLV could best distinguish class A from B,with an AUC of 0.761,a sensitivity of 74.4% and a specificity of 73.1%.RV could best distinguish class A from C,with an AUC of 0.900,a sensitivity of 90.3% and a specificity of 84.5%.LLV/ALB could best distinguish class B from C,with an AUC of 0.900,a sensitivity of 93.8% and a specificity of 81.5%.RV/ALB could best identify esophageal varices,with an AUC of 0.890,a sensitivity of 80.0% and a specificity of 83.5%.CONCLUSION:The combination of liver lobe volume and ALB has potential to identify presence and severity of cirrhosis,and presence of esophageal varices.展开更多
AIM： To explore a method for quantitative assessment of hepatic functional reserve by combining computed tomography （CT） volumetry with CT grading of liver cirrhosis before liver resection in patients with hepatoce...AIM： To explore a method for quantitative assessment of hepatic functional reserve by combining computed tomography （CT） volumetry with CT grading of liver cirrhosis before liver resection in patients with hepatocellular carcinoma. METHODS： CT images of 55 patients undergoing liver resection were studied prospectively. The degree of liver cirrhosis was referred as ＂CT grade＂ and the percentage of remnant liver volume （PRLV） [PRLV = predicted RLV/predicted total liver volume （PTLV） × 100%; PTLV （mL） = 121.75 ＋ 16.49 × body mass （kg）] were calculated by adding slice by slice of CT liver images. The postoperative RLV, pathologic stages of liver fibrosis in non-tumor area and survival time in these cases were analyzed. RESULTS： There was a significant difference in survival time between the group with PRLV ≤ 50% and the group with PRLV 〉 50% （X^2= 4.988, P = 0.026）, and between the group with CT grade 0/1 and the group with CT grade 2/3 （X^2= 5.429, P = 0.026）. With combination of the both parameters, an oblique line was identified according to the distribution of 32 survivors versus 23 deceased subjects. The mortality rate above the line was 7.1% （1/14）, and that below the line was 53.7% （22/41）, indicating a significant difference between the two rates （X^2 = 9.281, P = 0.002, P 〈 0.05）. CONCLUSION： PRLV and CT grades are significantly correlated with hepatic functional reserve. The predicted line using these two parameters is useful in candidates undergoing liver resection for judging hepatic functional reserve.展开更多
AIMTo assess the effect of long-term oral nucleos(t)ide analogues (NUCs) therapy on liver volume change in patients with suppress hepatitis B virus (HBV)-related liver cirrhosis.METHODSWe reviewed the data of na&#...AIMTo assess the effect of long-term oral nucleos(t)ide analogues (NUCs) therapy on liver volume change in patients with suppress hepatitis B virus (HBV)-related liver cirrhosis.METHODSWe reviewed the data of naïve patients with HBV-related liver cirrhosis, who had taken oral NUCs therapy, between 2003 and 2007 at Chonbuk University Hospital. We analyzed two consecutive sets of abdominal computerized tomography scans-one at the time of treatment initiation and another at the second-year follow-up. Liver volume was calculated by 3-dimensional liver extraction volumetry program.RESULTSA total of 55 patients (34 males) were included. There was 114.3 mL ± 167.8 mL (12.9% ± 17.9%) of increase in liver volume during the two years of NUCs therapy (993.8 mL ± 242.8 mL at baseline vs 1108.1 mL ± 263.3 mL at two-year follow-up, P < 0.001). The ratio of the measured baseline liver volume to the estimated standard liver volume was improved from 70.8% to 78.0%. An increase in liver volume was shown not only in patients with compensated cirrhosis (P = 0.046) but also in those with decompensated cirrhosis (P < 0.001). Significant factors for volume increases were Child-Turcotte-Pugh grade and model for end-stage liver disease score improvement without virological breakthrough. In multiple linear regression analysis, delta albumin and delta alanine aminotransferase levels showed a significant association with the increase in liver volume (P = 0.002 and 0.005, respectively).CONCLUSIONLong-term oral NUCs therapy in patients with HBV-related liver cirrhosis lead to significant increase in liver volume assessed with 3-dimensional liver extraction volumetry program.展开更多
The amount of the future liver remnant volume is fun-damental for hepato-biliary surgery, representing animportant potential risk-factor for the development ofpost-hepatectomy liver failure. Despite this, there isno u...The amount of the future liver remnant volume is fun-damental for hepato-biliary surgery, representing animportant potential risk-factor for the development ofpost-hepatectomy liver failure. Despite this, there isno uniform consensus about the amount of hepaticparenchyma that can be safely resected, nor about themodality that should be chosen for this evaluation. Thepre-operative evaluation of hepatic volume, along witha precise identification of vascular and biliar anatomyand variants, are therefore necessary to reduce surgi-cal complications, especially for extensive resections.Some studies have tried to validate imaging methods[ultrasound, computed tomography(CT), magneticresonance imaging] for the assessment of liver volume,but there is no clear evidence about the most accuratemethod for this evaluation. Furthermore, this volumet-ric evaluation seems to have a certain degree of error,tending to overestimate the actual hepatic volume,therefore some conversion factors, which should givea more reliable evaluation of liver volume, have been proposed. It is widespread among non-radiologists the use of independent software for an off-site volumetric analysis, performed on digital imaging and communica-tions in medicine images with their own personal com-puter, but very few studies have provided a validation of these methods. Moreover, while the pre-transplanta-tion volumetric assessment is fundamental, it remains unclear whether it should be routinely performed in all patients undergoing liver resection. In this editorial the role of imaging in the estimation of liver volume is dis-cussed, providing a review of the most recent literature and a brief personal series of correlations between liver volumes and resection specimens' weight, in order to assess the precision of the volumetric CT evaluation.展开更多
BACKGROUND Inadequate volume of future liver remnant(FLR)is a major challenge for hepatobiliary surgeons treating large or multiple liver tumors.As an alternative to associating liver partition and portal vein ligatio...BACKGROUND Inadequate volume of future liver remnant(FLR)is a major challenge for hepatobiliary surgeons treating large or multiple liver tumors.As an alternative to associating liver partition and portal vein ligation(ALPPS)for staged hepatectomy and liver venous deprivation(LVD)using stage 1 interventional radiology for vascular embolization combined with stage 2 open liver resection have been used.CASE SUMMARY A novel modified LVD technique was performed in a patient with pancreatic neuroendocrine tumor with liver metastases by using stage 1 laparoscopic ligation of the right hepatic vein,right posterior portal vein,and short hepatic veins combined with local excision of three liver metastases in the left hemiliver.The operation was followed three days later by interventional radiology to embolize an anomalous right anterior portal vein to complete LVD.A stage 2 laparoscopic right hemihepatectomy and pancreaticosplenectomy were then carried out.CONCLUSION The minimally invasive technique promoted a rapid increase,comparable to ALPPS,in volume of the FLR after the stage 1 operation to allow the laparoscopic stage 2 resection to be performed.展开更多
The shortage of deceased donor organs has prompted the development of alternative liver grafts for transplantation.Living-donor liver transplantation(LDLT)has emerged as a viable option,expanding the donor pool and en...The shortage of deceased donor organs has prompted the development of alternative liver grafts for transplantation.Living-donor liver transplantation(LDLT)has emerged as a viable option,expanding the donor pool and enabling timely transplantation with favorable graft function and improved long-term outcomes.An accurate evaluation of the donor liver’s volumetry(LV)and anatomical study is crucial to ensure adequate future liver remnant,graft volume and precise liver resection.Thus,ensuring donor safety and an appropriate graftto-recipient weight ratio.Manual LV(MLV)using computed tomography has traditionally been considered the gold standard for assessing liver volume.However,the method has been limited by cost,subjectivity,and variability.Automated LV techniques employing advanced segmentation algorithms offer improved reproducibility,reduced variability,and enhanced efficiency compared to manual measurements.However,the accuracy of automated LV requires further investigation.The study provides a comprehensive review of traditional and emerging LV methods,including semi-automated image processing,automated LV techniques,and machine learning-based approaches.Additionally,the study discusses the respective strengths and weaknesses of each of the aforementioned techniques.The use of artificial intelligence(AI)technologies,including machine learning and deep learning,is expected to become a routine part of surgical planning in the near future.The implementation of AI is expected to enable faster and more accurate image study interpretations,improve workflow efficiency,and enhance the safety,speed,and cost-effectiveness of the procedures.Accurate preoperative assessment of the liver plays a crucial role in ensuring safe donor selection and improved outcomes in LDLT.MLV has inherent limitations that have led to the adoption of semi-automated and automated software solutions.Moreover,AI has tremendous potential for LV and segmentation;however,its widespread use is hindered by cost and availability.Therefore,the integration of multiple specialties is necessary to embrace technology and explore its possibilities,ranging from patient counseling to intraoperative decision-making through automation and AI.展开更多
Objective: To analyze the volumetric modifications of the non tumourous part of the liver when liver metastases (LM) decrease under chemotherapy. Methods: Patients were highly selected based on the following criteria:...Objective: To analyze the volumetric modifications of the non tumourous part of the liver when liver metastases (LM) decrease under chemotherapy. Methods: Patients were highly selected based on the following criteria: multiple bilateral large colorectal LM, response of LM attaining at least 85% under chemotherapy. The volumes and ratios of the whole liver, of the LM, and mainly of the non tumourous (normal) part of the liver, were measured on CT scan before and after chemotherapy. Results: Only ten (5%) among 198 treated patients were eligible. Nine of them had received intra-arterial chemotherapy. Metastatic involvement was initially 34% before chemotherapy (range: 13% - 75%), and was 5% (range: 1% - 25%) after chemotherapy. The whole liver volume decreased by 41% (range: 23% - 68%) after chemotherapy. The non metastatic liver (volume and ratio) decreased after chemotherapy in 6 patients and increased in 4 patients. The volume and ratio increased in the 4 patients whose disease initially exhibited the highest metastatic involvement (p = 0.01). Conclusion: The volume of the non metastatic part of the liver varied slightly under standard chemotherapy. Intra-arterial chemotherapy induces dramatic responses, but also liver injury which impairs liver regeneration. However increasing volumes were observed when initial tumour involvement was major.展开更多
AIM： To study the liver and spleen volume variations in hepatic fibrosis patients at different histopathological stages. METHODS： Multidetector computed tomography （MDCT） scan was performed in 85 hepatic fibrosis ...AIM： To study the liver and spleen volume variations in hepatic fibrosis patients at different histopathological stages. METHODS： Multidetector computed tomography （MDCT） scan was performed in 85 hepatic fibrosis patients. Liver volume （LV） and spleen volume （SV） were measured. Fifteen healthy individuals served as a control group （SO）. The patients were divided into stage 1 （S1） group （n = 34）, stage 2 （S2） group （n = 25）, stage 3 （S3） group （n = 16）, and stage 4 （S4） group （n = 10） according to their histopathological stage of liver fibrosis. RESULTS： The LV and standard LV （SLV） had a tendency to increase with the severity of fibrosis, but no statistical difference was observed in the 5 groups （LV： F = 0.245, P = 0.912; SLV： F = 1.902, P = 0.116）. The SV was gradually increased with the severity of fibrosis, and a statistically significant difference in SV was observed among the 5 groups （P 〈 0.01）. The LV/SV ratio and SLV/SV ratio were gradually decreased with the aggravation of hepatic fibrosis, and statistically significant differences in both LV/SV and SLV/SV were found among the 5 groups （P 〈 0.01）.CONCLUSION： The absence of obvious LV reduction in patients with chronic liver disease may be a morphological index of patients without liver cirrhosis. The SV is related to the severity of fibrosis, and the spleen of patients with advanced fibrosis is enlarged evidently. The LV/SV ratio and SLV/SV ratio are of a significant clinical value in the diagnosis of advanced liver fibrosis.展开更多
Graft procurement in adult living donor liver transplantation(LDLT)faces persistent challenges in balancing volumetric adequacy and donor safety.This study introduces two-stage portal vein ligation and reperfusion for...Graft procurement in adult living donor liver transplantation(LDLT)faces persistent challenges in balancing volumetric adequacy and donor safety.This study introduces two-stage portal vein ligation and reperfusion for graft procurement in LDLT(PVLR-LT),which aims to expand the left lateral lobe for achieving adequate grafts,thereby circumventing technical and anatomical limitations of conventional approaches.In a rat model,the PVLR-LT group underwent selective portal vein ligation(step I)to induce targeted hypertrophy,followed by reperfusion and transplantation(step II).Outcomes were compared among PVLR-LT,negative controls,and standard-volume controls.Staged portal flow modulation effectively redistributed hepatic mass allocation,yielding grafts with graft recipient weight ratio approximately double that of negative controls and equivalent to standard-volume controls.Donors experienced no mortality,with only transient enzyme elevation.Recipient survival in the PVLR-LT group significantly exceeded that of the negative control group and was non-inferior to that of the standard-volume control group,while hepatic enzyme peaks were markedly lower than those in standard-volume control recipients.This study provides a promising proof of concept,establishing the feasibility of using PVLR-LT to convert the surgically straightforward left lateral segment into right lobe-sized grafts through staged portal flow modulation and demonstrating the translational potential for laparoscopic LDLT.展开更多
Background:In living donor liver transplantation,the remnant liver volume(RLV)is important when selecting a donor,and it should usually exceed 35%.However,there have been no studies on the preservation of the caudate ...Background:In living donor liver transplantation,the remnant liver volume(RLV)is important when selecting a donor,and it should usually exceed 35%.However,there have been no studies on the preservation of the caudate lobe in donors with marginal RLV.This study aimed to analyze and preserve the paracaval branch by using donor right hepatectomy(DRH).Methods:We retrospectively reviewed data from liver donors who underwent DRH between August 2022 and July 2023.The paracaval branch was classified based on its origin[right,left,or bifurcation of main portal vein(MPV)].For the left or bifurcation types,the paracaval branch was categorized by size and the paracaval portion volume was measured.The expected preserved area after paracaval portion-preserving DRH was estimated.Results:Among the 87 donors,the paracaval branch originated from the right portal vein(RPV)in 41(47.1%),left portal vein(LPV)in 37(42.5%),and bifurcation in 9(10.3%).Of 46 donors with LPV or bifurcation type,21(45.7%)had a large size,13(28.3%)had a medium size,and 12(26.1%)had a small size.Excluding two donors with poor image quality,the liver volume of the paracaval portion averaged 38.0 mL[2.9%of the total liver volume(TLV)].The mean expected preserved area was 27.3 mL(2.1%of the TLV).Four donors in our center underwent paracaval portion-preserving DRH,with an expected preserved area of 35.6 mL(2.7%),164.7 mL(12.3%),and 70.2 mL(4.6%),20.3 mL(2.0%)in each case.Conclusions:Our paracaval branch classification suggests that more than half of the donors could potentially benefit from paracaval portion-preserving DRH,particularly for large LPV or bifurcation types reaching the liver surface,thus enhancing donor safety for marginal donors with a small RLV.展开更多
BACKGROUND Repeated application of the Pringle maneuver is a key obstacle to safe minimally invasive repeat liver resection(MISRLR).However,limited technical guidance is available.AIM To study the utility of newly dev...BACKGROUND Repeated application of the Pringle maneuver is a key obstacle to safe minimally invasive repeat liver resection(MISRLR).However,limited technical guidance is available.AIM To study the utility of newly developed Pringle taping method guided by liver surface in MISRLR.METHODS We retrospectively reviewed 72 cases of MISRLR performed by a single surgeon at two centers from August 2015 to July 2024.Beginning in October 2019,a liver surface-guided encirclement of hepatoduodenal ligament(LSEH)was used for repeat Pringle taping.Perioperative outcomes including Pringle taping success,operative time,blood loss,conversion rate,morbidity,and mortality were assessed.RESULTS Laparoscopic and robotic approaches were used in 63 patients and 9 patients,respectively.The median operative time,blood loss,and hospital stay were 331.5 minutes,70 mL,and 8 days,respectively.Open conversion occurred in two cases(2.8%)due to severe adhesions and right renal vein injury.Clavien-Dindo grade≥III complications occurred in 5.6%of cases with no mortality.Anti-adhesion barriers were used in 54 patients(75.0%).LSEH was attempted in 57 cases,improving Pringle taping success from 33.0%to 91.4%(P<0.001).LSEH succeeded in all patients with prior open liver resection(n=11).Among 6 patients in whom LSEH failed,3 patients(50.0%)had undergone a third liver resection,and 1 patient had a history of distal gastrectomy with choledochoduodenostomy.CONCLUSION The newly developed LSEH technique for Pringle taping in MISRLR was feasible,enhancing safety and reproducibility even in patients with a history of open liver resection.展开更多
Metabolic dysfunction-associated steatotic liver disease(MASLD),formerly known as nonalcoholic fatty liver disease,is a chronic liver disease characterized by hepatic lipid deposition and hepatocellular steatosis,resu...Metabolic dysfunction-associated steatotic liver disease(MASLD),formerly known as nonalcoholic fatty liver disease,is a chronic liver disease characterized by hepatic lipid deposition and hepatocellular steatosis,resulting from nonalcoholic causes and closely linked to metabolic dysfunction[1].It is strongly associated with metabolic abnormalities,including type 2 diabetes,overweight,and obesity.The global prevalence of MASLD is estimated to be approximately 25%−33%,and its incidence is rising rapidly,particularly among younger populations,due to increasingly prevalent unhealthy lifestyle behaviors such as sleep deprivation,sedentary habits,and diets rich in calories.展开更多
Objective:To evaluate the hepatoprotective effects of skate-derived bioactives-collagen peptides(CPs)and chondroitin-against ethanol(EtOH)-induced liver injury and to elucidate their underlying mechanisms.Methods:The ...Objective:To evaluate the hepatoprotective effects of skate-derived bioactives-collagen peptides(CPs)and chondroitin-against ethanol(EtOH)-induced liver injury and to elucidate their underlying mechanisms.Methods:The protective effects of CPs and chondroitin were assessed in different in vitro and in vivo EtOH-induced injury models.Oxidative stress was evaluated by measuring reactive oxygen species production and antioxidant markers(NRF2 and GCLC).EtOH metabolism was examined by measuring alchohol-metabolizing enzymes(alcohol dehydrogenase and aldehyde dehydrogenase)and cytochrome P450 enzymes.Furthermore,lipid dysregulation was assessed by Oil Red O staining and determination of lipogenic markers(SREBP-1 and FAS).Liver injury was also evaluated by measuring serum glutamate oxaloacetate transaminase and glutamate pyruvate transaminase,and performing histological analysis.Results:In hepatocytes and zebrafish,both CPs and chondroitin reduced oxidative stress,downregulated cytochrome P450 enzymes and lipogenic markers,and enhanced antioxidant defenses,with chondroitin showing the strongest hepatoprotection.In EtOH-fed mice,chondroitin significantly improved liver enzyme profiles,reduced hepatic lipid accumulation and inflammation,and restored antioxidant and metabolic homeostasis.Conclusions:Skate-derived chondroitin significantly attenuates EtOH-induced liver injury by modulating oxidative stress,EtOH metabolism,and lipid regulation.These findings demonstrate the hepatoprotective potential of chondroitin in different preclinical models of alcohol-induced liver damage.展开更多
Background:High-mobility group box 1(HMGB1)is a critical damage-associated molecular pattern protein that participates in diverse physiological and pathological processes.However,its relevance to the prognosis of arti...Background:High-mobility group box 1(HMGB1)is a critical damage-associated molecular pattern protein that participates in diverse physiological and pathological processes.However,its relevance to the prognosis of artificial liver support therapy in patients with acute liver injury(ALF)remains unclear.Methods:Bioinformatics analyses were performed to identify HMGB1-interacting proteins and associated inflammatory signaling pathways.Peripheral blood samples were collected from ALF patients before and after artificial liver support therapy,and serum HMGB1 concentrations were quantified using ELISA.Primary mouse hepatocytes were stimulated with lipopolysaccharide(LPS)in vitro and HMGB1 expression was verified by western blot.Results:Single-cell transcriptomic profiling showed that HMGB1 is widely expressed across tissues and predominantly localized in the nucleus.In the liver,HMGB1 was primarily expressed in hepatocytes and hepatic stellate cells.STRING database analysis revealed that human HMGB1 interacts with multiple proteins,including TLR4,TP53,and BECN1.The constructed interaction network comprised 11 nodes with an average local clustering coefficient of 0.888,and the protein–protein interaction enrichment P-value was 1.42×10^(-5),indicating significant enrichment.Gene Ontology and KEGG pathway enrichment analyses demonstrated that HMGB1 is closely linked to inflammatory and injury-related signaling pathways,including the TLR and NLR pathways.Metabolomic profiling revealed significant metabolic alterations between patients with ALF and healthy controls under both positive and negative ion modes and functional analysis showed necroptosis was activated.The cell viability gradually decreased with time and dose under LPS treatment and extracellular HMGB1 was upregulated in LPS induced ALF model and patients(P<0.05).Serum HMGB1/RIPK3/MLKL levels were markedly elevated in ALF patients compared with controls(P<0.05)and progressively declined following artificial liver support therapy.Furthermore,elevated HMGB1 concentrations were positively correlated with unfavorable clinical outcomes.Conclusion:Peripheral blood HMGB1 levels are significantly increased in patients with acute liver failure,decrease following artificial liver support therapy,and are positively associated with poor clinical prognosis.展开更多
文摘AIM:To evaluate different standard liver volume (SLV) formula and verify the applicability of the formulae for Chinese adults.METHODS: Data from 70 cases of living donor liver transplantation (LDLT) performed at our transplantation centers between January 2008 and April 2009 were analyzed. SLV was estimated using our recently reported formula [the Chengdu formula: SLV (mL)=11.5×body weight (kg) + 334] and other reported formulae used for Chinese adults. Actual intraoperative liver volumes were obtained from a review of the patients' medical records.RESULTS: The actual right liver volume was not significantly different from the estimated right liver volume determined by the Chengdu formula, but was significantly smaller than estimates using the Heinemann, Urata, Vauthey, and Lee formulae (P<0.01), and signif icantly larger than estimates using the Fan formula (P<0.05).CONCLUSION: The Chengdu formula was demonstrated to be reliable by its application in LDLT.
文摘AIM To obtain a reference range of morphological indices and establish a formula to accurately predict standard liver volume(SLV) in Chinese adults.METHODS Computed tomography(CT)-estimated total liver volume(CTLV) was determined in 369 Chinese adults. Age,sex,body weight,body height,body mass index,and body surface area(BSA) were recorded using CT. Total splenic volume,portal venous diameter(PVD),splenic venous diameter(SVD),and portal venous cross-sectional area(PVCSA) were also measured by CT. Stepwise multiple linear regression analysis was performed to evaluate the impact of each parameter on CTLV and to develop a new SLV formula. The accuracy of the new formula was compared with the existing formulas in a validation group.RESULTS The average CTLV was 1205.41 ± 257.53 cm3(range,593.80-2250.10 cm3). The average of PVD,SVD and PVCSA was 9.34 ± 1.51 mm,7.40 ± 1.31 mm and 173.22 ± 48.11 mm2,respectively. The CT-estimated splenic volume of healthy adults varied markedly(range,46.60-2892.30 cm3). Sex,age,body height,body weight,body mass index,and BSA were significantly correlated with CTLV. BSA showed the strongest correlation(r = 0.546,P < 0.001),and was used to establish a new model for calculating SLV: SLV(cm3) = 758.259 × BSA(m2)-124.272(R2 = 0.299,P < 0.001). This formula also predicted CTLV more accurately than the existing formulas,but overestimated CTLV in elderly subjects > 70 years of age,and underestimated liver volume when CTLV was > 1800 cm3.CONCLUSION Our new BSA-based formula is more accurate than other formulas in estimating SLV in Chinese adults.
基金Supported by National Natural Science Foundation of China,No. 81050033Key Projects in the Sichuan Province Science and Technology Pillar Program,No. 2011SZ0237the Science Fund for Distinguished Young Scholars of Sichuan Province,China,No. 2010JQ0039
文摘AIM:To determine whether and how magnetic resonance imaging(MRI)-based total liver volume(TLV) and diffusion weighted imaging(DWI) could predict liver fibrosis.METHODS:Sixteen experimental mature mini-pigs(6 males,10 females),weighing between 20.0 and 24.0 kg were prospectively used to model liver fibrosis induced by intraperitoneal injection of 40% CCl4 dissolved in fat emulsion twice a week for 16 wk,and by feeding 40% CCl4 mixed with maize flour twice daily for the subsequent 5 wk.All the survival animals underwent percutaneous liver biopsy and DWI using b = 300,500 and 800 s/mm2 followed by abdominal gadolinium-enhanced MRI at the 0,5th,9th,16th and 21st weekend after beginning of the modeling.TLV was obtained on enhanced MRI,and apparent diffusion coefficient(ADC) was obtained on DWI.Hepatic tissue specimens were stained with hematoxylin and Masson' s trichrome staining for staging liver fibrosis.Pathological specimens were scored using the human METAVIR classification system.Statistical analyses were performed to determine whether and how the TLV and ADC could be used to predict the stage of liver fibrosis.RESULTS:TLV increased from stage 0 to 2 and decreased from stage 3(r = 0.211;P < 0.001).There was a difference in TLV between stage 0-1 and 2-4(P = 0.03) whereas no difference between stage 0-2 and 3-4(P = 0.71).TLV could predict stage ≥ 2 [area under receiver operating characteristic curve(AUC) = 0.682].There was a decrease in ADC values with increasing stage of fibrosis for b = 300,500 and 800 s/mm2(r =-0.418,-0.535 and-0.622,respectively;all P < 0.001).Differences were found between stage 0-1 and 2-4 in ADC values for b = 300,500 and 800 s/mm2,and between stage 0-2 and 3-4 for b = 500 or 800 s/mm2(all P < 0.05).For predicting stage ≥ 2 and ≥ 3,AUC was 0.803 and 0.847 for b = 500 s/mm2,and 0.848 and 0.887 for b = 800 s/mm2,respectively.CONCLUSION:ADC for b = 500 or 800 s/mm2 could be better than TLV and ADC for b = 300 s/mm2 to pre-dict fibrosis stage ≥ 2 or ≥ 3.
文摘AIM:To evaluate the relationship between donor safety and remnant liver volume in right lobe living donor liver transplantation(LDLT).METHODS:From July 2001 to January 2009,our liver transplant centers carried out 197 LDLTs.The clinical data from 151 cases of adult right lobe living donors(not including the middle hepatic vein) were analyzed.The conditions of the three groups of donors were well matched in terms of the studied parameters.The donors' preoperative data,intraoperative and postoperative data were calculated for the three groups:Group 1 remnant liver volume(RLV) < 35%,group 2 RLV 36%-40%,and group 3 RLV > 40%.Comparisons included the different remnant liver volumes on postoperative liver function recovery and the impact of systemic conditions.Correlations between remnant liver volume and post-operative complications were also analyzed.RESULTS:The donors' anthroposomatology data,op-eration time,and preoperative donor blood test indicators were calculated for the three groups.No significant differences were observed between the donors' gender,age,height,weight,and operation time.According to the Chengdu standard liver volume formula,the total liver volume of group 1 was 1072.88 ± 131.06 mL,group 2 was 1043.84 ± 97.11 mL,and group 3 was 1065.33 ± 136.02 mL.The three groups showed no statistically significant differences.When the volume of the remnant liver was less than 35% of the total liver volume,the volume of the remnant had a significant effect on the recovery of liver function and intensive care unit time.In addition,the occurrence of complications was closely related to the remnant liver volume.When the volume of the remnant liver was more than 35% of the total liver volume,the remnant volume change had no significant effect on donor recovery.CONCLUSION:To ensure donor safety,the remnant liver volume should be greater than the standard liver volume(35%) in right lobe living donor liver transplantation.
基金Supported by Nantong Municipal Health Commission,No.MSZ2022036 and No.QN2022041Nantong Science and Technology Bureau,No.JCZ2022036.
文摘BACKGROUND Liver cancer resection,especially in patients with hemihepatectomy or extended hemihepatectomy,often leads to poor prognosis,such as liver insufficiency and even liver failure and death,because the standard residual liver volume(SRLV)cannot be fully compensated after surgery.AIM To explore the risk factors of poor prognosis after hemihepatectomy for hepatocellular carcinoma and evaluate the application value of related prognostic approaches.METHODS The clinical data of 35 patients with primary liver cancer in Nantong Third People's Hospital from February 2016 to July 2020 were retrospectively analyzed.The receiver operating characteristic curve was created using medcac19.0.4 to compare the critical values of the SRLV in different stages of liver fibrosis after hemihepatectomy with those of liver dysfunction after hemihepatectomy.It was constructed by combining the Child-Pugh score to evaluate its application value in predicting liver function compensation.RESULTS The liver stiffness measure(LSM)value and SRLV were associated with liver dysfunction after hemihepatectomy.Logistic regression analysis showed that an LSM value≥25 kPa[odds ratio(OR)=6.254,P<0.05]and SRLV≤0.290 L/m^(2)(OR=5.686,P<0.05)were independent risk factors for postoperative liver dysfunction.The accuracy of the new liver reserve evaluation model for predicting postoperative liver function was higher than that of the Child-Pugh score(P<0.05).CONCLUSION SRLV and LSM values can be used to evaluate the safety of hemihepatectomy.The new liver reserve evaluation model has good application potential in the evaluation of liver reserve function after hemihepatectomy.
基金Supported by National Natural Science Foundation of China,No.81050033Key Projects in the Sichuan Province Science and Technology Pillar Program,No.2011SZ0237+2 种基金the Science Foundation for Distinguished Young Scholars of Sichuan Province in China,No.2010JQ0039Key Science and Technology Project of Chinese Ministry of Public Health,No.2014114Natural Science Key Project of North Sichuan Medical College,No.CBY12-A-ZD03
文摘AIM:To investigate whether liver lobe volume and albumin(ALB) could predict the presence and severity of liver cirrhosis,and esophageal varices.METHODS:Seventy-one cirrhotic patients with hepatitis B and 21 healthy individuals were enrolled in this study.All the participants underwent abdominal enhanced magnetic resonance imaging to measure each liver lobe volume,and biochemical workup for testing ALB and Child-Pugh class.All cirrhotic patients underwent upper gastrointestinal endoscopy to show the presence of cirrhotic esophageal varices.Right liver lobe volume(RV),left medial liver lobe volume(LMV),left lateral liver lobe volume(LLV),and caudate lobe volume(CV) were measured using enhanced magnetic resonance imaging.The ratios of RV to ALB(RV/ALB),LMV to ALB(LMV/ALB),LLV to ALB(LLV/ALB) and CV to ALB(CV/ALB) were calculated.Statistical analyses were performed to determine whether and how the combination of liver lobe volume measured using magnetic resonance imaging and albumin could predict the presence and severity of liver cirrhosis,and the presence of esophageal varices.RESULTS:RV,LMV,LLV and CV decreased(r =-0.51-0.373; all P < 0.05),while RV/ALB increased(r = 0.424; P < 0.05),with the progress of Child-Pugh classof liver cirrhosis.RV,LMV,CV,LLV/ALB and CV/ALB could identify presence of liver cirrhosis; LLV and LMV could distinguish Child-Pugh class A from B; RV,LMV,LLV,CV,RV/ALB and LLV/ALB could distinguish class A from C; RV and LLV/ALB could differentiate B from C; and RV,RV/ALB and CV/ALB could identify presence of esophageal varices(all P < 0.05).Among these parameters,CV/ALB could best identify the presence of liver cirrhosis,with an area under receiver operating characteristic curve(AUC) of 0.860,a sensitivity of 82.0% and a specificity of 83.0%.LLV could best distinguish class A from B,with an AUC of 0.761,a sensitivity of 74.4% and a specificity of 73.1%.RV could best distinguish class A from C,with an AUC of 0.900,a sensitivity of 90.3% and a specificity of 84.5%.LLV/ALB could best distinguish class B from C,with an AUC of 0.900,a sensitivity of 93.8% and a specificity of 81.5%.RV/ALB could best identify esophageal varices,with an AUC of 0.890,a sensitivity of 80.0% and a specificity of 83.5%.CONCLUSION:The combination of liver lobe volume and ALB has potential to identify presence and severity of cirrhosis,and presence of esophageal varices.
基金Supported by the Natural Science Foundation of Hainan Province, No. 30527
文摘AIM： To explore a method for quantitative assessment of hepatic functional reserve by combining computed tomography （CT） volumetry with CT grading of liver cirrhosis before liver resection in patients with hepatocellular carcinoma. METHODS： CT images of 55 patients undergoing liver resection were studied prospectively. The degree of liver cirrhosis was referred as ＂CT grade＂ and the percentage of remnant liver volume （PRLV） [PRLV = predicted RLV/predicted total liver volume （PTLV） × 100%; PTLV （mL） = 121.75 ＋ 16.49 × body mass （kg）] were calculated by adding slice by slice of CT liver images. The postoperative RLV, pathologic stages of liver fibrosis in non-tumor area and survival time in these cases were analyzed. RESULTS： There was a significant difference in survival time between the group with PRLV ≤ 50% and the group with PRLV 〉 50% （X^2= 4.988, P = 0.026）, and between the group with CT grade 0/1 and the group with CT grade 2/3 （X^2= 5.429, P = 0.026）. With combination of the both parameters, an oblique line was identified according to the distribution of 32 survivors versus 23 deceased subjects. The mortality rate above the line was 7.1% （1/14）, and that below the line was 53.7% （22/41）, indicating a significant difference between the two rates （X^2 = 9.281, P = 0.002, P 〈 0.05）. CONCLUSION： PRLV and CT grades are significantly correlated with hepatic functional reserve. The predicted line using these two parameters is useful in candidates undergoing liver resection for judging hepatic functional reserve.
文摘AIMTo assess the effect of long-term oral nucleos(t)ide analogues (NUCs) therapy on liver volume change in patients with suppress hepatitis B virus (HBV)-related liver cirrhosis.METHODSWe reviewed the data of naïve patients with HBV-related liver cirrhosis, who had taken oral NUCs therapy, between 2003 and 2007 at Chonbuk University Hospital. We analyzed two consecutive sets of abdominal computerized tomography scans-one at the time of treatment initiation and another at the second-year follow-up. Liver volume was calculated by 3-dimensional liver extraction volumetry program.RESULTSA total of 55 patients (34 males) were included. There was 114.3 mL ± 167.8 mL (12.9% ± 17.9%) of increase in liver volume during the two years of NUCs therapy (993.8 mL ± 242.8 mL at baseline vs 1108.1 mL ± 263.3 mL at two-year follow-up, P < 0.001). The ratio of the measured baseline liver volume to the estimated standard liver volume was improved from 70.8% to 78.0%. An increase in liver volume was shown not only in patients with compensated cirrhosis (P = 0.046) but also in those with decompensated cirrhosis (P < 0.001). Significant factors for volume increases were Child-Turcotte-Pugh grade and model for end-stage liver disease score improvement without virological breakthrough. In multiple linear regression analysis, delta albumin and delta alanine aminotransferase levels showed a significant association with the increase in liver volume (P = 0.002 and 0.005, respectively).CONCLUSIONLong-term oral NUCs therapy in patients with HBV-related liver cirrhosis lead to significant increase in liver volume assessed with 3-dimensional liver extraction volumetry program.
文摘The amount of the future liver remnant volume is fun-damental for hepato-biliary surgery, representing animportant potential risk-factor for the development ofpost-hepatectomy liver failure. Despite this, there isno uniform consensus about the amount of hepaticparenchyma that can be safely resected, nor about themodality that should be chosen for this evaluation. Thepre-operative evaluation of hepatic volume, along witha precise identification of vascular and biliar anatomyand variants, are therefore necessary to reduce surgi-cal complications, especially for extensive resections.Some studies have tried to validate imaging methods[ultrasound, computed tomography(CT), magneticresonance imaging] for the assessment of liver volume,but there is no clear evidence about the most accuratemethod for this evaluation. Furthermore, this volumet-ric evaluation seems to have a certain degree of error,tending to overestimate the actual hepatic volume,therefore some conversion factors, which should givea more reliable evaluation of liver volume, have been proposed. It is widespread among non-radiologists the use of independent software for an off-site volumetric analysis, performed on digital imaging and communica-tions in medicine images with their own personal com-puter, but very few studies have provided a validation of these methods. Moreover, while the pre-transplanta-tion volumetric assessment is fundamental, it remains unclear whether it should be routinely performed in all patients undergoing liver resection. In this editorial the role of imaging in the estimation of liver volume is dis-cussed, providing a review of the most recent literature and a brief personal series of correlations between liver volumes and resection specimens' weight, in order to assess the precision of the volumetric CT evaluation.
文摘BACKGROUND Inadequate volume of future liver remnant(FLR)is a major challenge for hepatobiliary surgeons treating large or multiple liver tumors.As an alternative to associating liver partition and portal vein ligation(ALPPS)for staged hepatectomy and liver venous deprivation(LVD)using stage 1 interventional radiology for vascular embolization combined with stage 2 open liver resection have been used.CASE SUMMARY A novel modified LVD technique was performed in a patient with pancreatic neuroendocrine tumor with liver metastases by using stage 1 laparoscopic ligation of the right hepatic vein,right posterior portal vein,and short hepatic veins combined with local excision of three liver metastases in the left hemiliver.The operation was followed three days later by interventional radiology to embolize an anomalous right anterior portal vein to complete LVD.A stage 2 laparoscopic right hemihepatectomy and pancreaticosplenectomy were then carried out.CONCLUSION The minimally invasive technique promoted a rapid increase,comparable to ALPPS,in volume of the FLR after the stage 1 operation to allow the laparoscopic stage 2 resection to be performed.
基金Supported by Part by The Coordenação de Aperfeiçoamento de Pessoal de Nível Superior–Brasil(CAPES).
文摘The shortage of deceased donor organs has prompted the development of alternative liver grafts for transplantation.Living-donor liver transplantation(LDLT)has emerged as a viable option,expanding the donor pool and enabling timely transplantation with favorable graft function and improved long-term outcomes.An accurate evaluation of the donor liver’s volumetry(LV)and anatomical study is crucial to ensure adequate future liver remnant,graft volume and precise liver resection.Thus,ensuring donor safety and an appropriate graftto-recipient weight ratio.Manual LV(MLV)using computed tomography has traditionally been considered the gold standard for assessing liver volume.However,the method has been limited by cost,subjectivity,and variability.Automated LV techniques employing advanced segmentation algorithms offer improved reproducibility,reduced variability,and enhanced efficiency compared to manual measurements.However,the accuracy of automated LV requires further investigation.The study provides a comprehensive review of traditional and emerging LV methods,including semi-automated image processing,automated LV techniques,and machine learning-based approaches.Additionally,the study discusses the respective strengths and weaknesses of each of the aforementioned techniques.The use of artificial intelligence(AI)technologies,including machine learning and deep learning,is expected to become a routine part of surgical planning in the near future.The implementation of AI is expected to enable faster and more accurate image study interpretations,improve workflow efficiency,and enhance the safety,speed,and cost-effectiveness of the procedures.Accurate preoperative assessment of the liver plays a crucial role in ensuring safe donor selection and improved outcomes in LDLT.MLV has inherent limitations that have led to the adoption of semi-automated and automated software solutions.Moreover,AI has tremendous potential for LV and segmentation;however,its widespread use is hindered by cost and availability.Therefore,the integration of multiple specialties is necessary to embrace technology and explore its possibilities,ranging from patient counseling to intraoperative decision-making through automation and AI.
文摘Objective: To analyze the volumetric modifications of the non tumourous part of the liver when liver metastases (LM) decrease under chemotherapy. Methods: Patients were highly selected based on the following criteria: multiple bilateral large colorectal LM, response of LM attaining at least 85% under chemotherapy. The volumes and ratios of the whole liver, of the LM, and mainly of the non tumourous (normal) part of the liver, were measured on CT scan before and after chemotherapy. Results: Only ten (5%) among 198 treated patients were eligible. Nine of them had received intra-arterial chemotherapy. Metastatic involvement was initially 34% before chemotherapy (range: 13% - 75%), and was 5% (range: 1% - 25%) after chemotherapy. The whole liver volume decreased by 41% (range: 23% - 68%) after chemotherapy. The non metastatic liver (volume and ratio) decreased after chemotherapy in 6 patients and increased in 4 patients. The volume and ratio increased in the 4 patients whose disease initially exhibited the highest metastatic involvement (p = 0.01). Conclusion: The volume of the non metastatic part of the liver varied slightly under standard chemotherapy. Intra-arterial chemotherapy induces dramatic responses, but also liver injury which impairs liver regeneration. However increasing volumes were observed when initial tumour involvement was major.
基金Supported by Science and Technology Program of Beijing Education Committee,No.KM200810025002
文摘AIM： To study the liver and spleen volume variations in hepatic fibrosis patients at different histopathological stages. METHODS： Multidetector computed tomography （MDCT） scan was performed in 85 hepatic fibrosis patients. Liver volume （LV） and spleen volume （SV） were measured. Fifteen healthy individuals served as a control group （SO）. The patients were divided into stage 1 （S1） group （n = 34）, stage 2 （S2） group （n = 25）, stage 3 （S3） group （n = 16）, and stage 4 （S4） group （n = 10） according to their histopathological stage of liver fibrosis. RESULTS： The LV and standard LV （SLV） had a tendency to increase with the severity of fibrosis, but no statistical difference was observed in the 5 groups （LV： F = 0.245, P = 0.912; SLV： F = 1.902, P = 0.116）. The SV was gradually increased with the severity of fibrosis, and a statistically significant difference in SV was observed among the 5 groups （P 〈 0.01）. The LV/SV ratio and SLV/SV ratio were gradually decreased with the aggravation of hepatic fibrosis, and statistically significant differences in both LV/SV and SLV/SV were found among the 5 groups （P 〈 0.01）.CONCLUSION： The absence of obvious LV reduction in patients with chronic liver disease may be a morphological index of patients without liver cirrhosis. The SV is related to the severity of fibrosis, and the spleen of patients with advanced fibrosis is enlarged evidently. The LV/SV ratio and SLV/SV ratio are of a significant clinical value in the diagnosis of advanced liver fibrosis.
基金supported by grants from the General Program of National Natural Science Foundation of China(No.82470683)National Key Research and Development Program of China(No.2021YFA1100500)+2 种基金The Innovation Team of Hangzhou Medical College(No.CXLJ202401)Key Research&Development Program of Zhejiang Province(No.2022C03108)Ningbo Top Medical and Health Research Program(No.2024020818).
文摘Graft procurement in adult living donor liver transplantation(LDLT)faces persistent challenges in balancing volumetric adequacy and donor safety.This study introduces two-stage portal vein ligation and reperfusion for graft procurement in LDLT(PVLR-LT),which aims to expand the left lateral lobe for achieving adequate grafts,thereby circumventing technical and anatomical limitations of conventional approaches.In a rat model,the PVLR-LT group underwent selective portal vein ligation(step I)to induce targeted hypertrophy,followed by reperfusion and transplantation(step II).Outcomes were compared among PVLR-LT,negative controls,and standard-volume controls.Staged portal flow modulation effectively redistributed hepatic mass allocation,yielding grafts with graft recipient weight ratio approximately double that of negative controls and equivalent to standard-volume controls.Donors experienced no mortality,with only transient enzyme elevation.Recipient survival in the PVLR-LT group significantly exceeded that of the negative control group and was non-inferior to that of the standard-volume control group,while hepatic enzyme peaks were markedly lower than those in standard-volume control recipients.This study provides a promising proof of concept,establishing the feasibility of using PVLR-LT to convert the surgically straightforward left lateral segment into right lobe-sized grafts through staged portal flow modulation and demonstrating the translational potential for laparoscopic LDLT.
文摘Background:In living donor liver transplantation,the remnant liver volume(RLV)is important when selecting a donor,and it should usually exceed 35%.However,there have been no studies on the preservation of the caudate lobe in donors with marginal RLV.This study aimed to analyze and preserve the paracaval branch by using donor right hepatectomy(DRH).Methods:We retrospectively reviewed data from liver donors who underwent DRH between August 2022 and July 2023.The paracaval branch was classified based on its origin[right,left,or bifurcation of main portal vein(MPV)].For the left or bifurcation types,the paracaval branch was categorized by size and the paracaval portion volume was measured.The expected preserved area after paracaval portion-preserving DRH was estimated.Results:Among the 87 donors,the paracaval branch originated from the right portal vein(RPV)in 41(47.1%),left portal vein(LPV)in 37(42.5%),and bifurcation in 9(10.3%).Of 46 donors with LPV or bifurcation type,21(45.7%)had a large size,13(28.3%)had a medium size,and 12(26.1%)had a small size.Excluding two donors with poor image quality,the liver volume of the paracaval portion averaged 38.0 mL[2.9%of the total liver volume(TLV)].The mean expected preserved area was 27.3 mL(2.1%of the TLV).Four donors in our center underwent paracaval portion-preserving DRH,with an expected preserved area of 35.6 mL(2.7%),164.7 mL(12.3%),and 70.2 mL(4.6%),20.3 mL(2.0%)in each case.Conclusions:Our paracaval branch classification suggests that more than half of the donors could potentially benefit from paracaval portion-preserving DRH,particularly for large LPV or bifurcation types reaching the liver surface,thus enhancing donor safety for marginal donors with a small RLV.
文摘BACKGROUND Repeated application of the Pringle maneuver is a key obstacle to safe minimally invasive repeat liver resection(MISRLR).However,limited technical guidance is available.AIM To study the utility of newly developed Pringle taping method guided by liver surface in MISRLR.METHODS We retrospectively reviewed 72 cases of MISRLR performed by a single surgeon at two centers from August 2015 to July 2024.Beginning in October 2019,a liver surface-guided encirclement of hepatoduodenal ligament(LSEH)was used for repeat Pringle taping.Perioperative outcomes including Pringle taping success,operative time,blood loss,conversion rate,morbidity,and mortality were assessed.RESULTS Laparoscopic and robotic approaches were used in 63 patients and 9 patients,respectively.The median operative time,blood loss,and hospital stay were 331.5 minutes,70 mL,and 8 days,respectively.Open conversion occurred in two cases(2.8%)due to severe adhesions and right renal vein injury.Clavien-Dindo grade≥III complications occurred in 5.6%of cases with no mortality.Anti-adhesion barriers were used in 54 patients(75.0%).LSEH was attempted in 57 cases,improving Pringle taping success from 33.0%to 91.4%(P<0.001).LSEH succeeded in all patients with prior open liver resection(n=11).Among 6 patients in whom LSEH failed,3 patients(50.0%)had undergone a third liver resection,and 1 patient had a history of distal gastrectomy with choledochoduodenostomy.CONCLUSION The newly developed LSEH technique for Pringle taping in MISRLR was feasible,enhancing safety and reproducibility even in patients with a history of open liver resection.
文摘Metabolic dysfunction-associated steatotic liver disease(MASLD),formerly known as nonalcoholic fatty liver disease,is a chronic liver disease characterized by hepatic lipid deposition and hepatocellular steatosis,resulting from nonalcoholic causes and closely linked to metabolic dysfunction[1].It is strongly associated with metabolic abnormalities,including type 2 diabetes,overweight,and obesity.The global prevalence of MASLD is estimated to be approximately 25%−33%,and its incidence is rising rapidly,particularly among younger populations,due to increasingly prevalent unhealthy lifestyle behaviors such as sleep deprivation,sedentary habits,and diets rich in calories.
基金supported by the National Research Foundation of Korea grant funded by the Korean government(Grant no.:RS-2022-NR070862).
文摘Objective:To evaluate the hepatoprotective effects of skate-derived bioactives-collagen peptides(CPs)and chondroitin-against ethanol(EtOH)-induced liver injury and to elucidate their underlying mechanisms.Methods:The protective effects of CPs and chondroitin were assessed in different in vitro and in vivo EtOH-induced injury models.Oxidative stress was evaluated by measuring reactive oxygen species production and antioxidant markers(NRF2 and GCLC).EtOH metabolism was examined by measuring alchohol-metabolizing enzymes(alcohol dehydrogenase and aldehyde dehydrogenase)and cytochrome P450 enzymes.Furthermore,lipid dysregulation was assessed by Oil Red O staining and determination of lipogenic markers(SREBP-1 and FAS).Liver injury was also evaluated by measuring serum glutamate oxaloacetate transaminase and glutamate pyruvate transaminase,and performing histological analysis.Results:In hepatocytes and zebrafish,both CPs and chondroitin reduced oxidative stress,downregulated cytochrome P450 enzymes and lipogenic markers,and enhanced antioxidant defenses,with chondroitin showing the strongest hepatoprotection.In EtOH-fed mice,chondroitin significantly improved liver enzyme profiles,reduced hepatic lipid accumulation and inflammation,and restored antioxidant and metabolic homeostasis.Conclusions:Skate-derived chondroitin significantly attenuates EtOH-induced liver injury by modulating oxidative stress,EtOH metabolism,and lipid regulation.These findings demonstrate the hepatoprotective potential of chondroitin in different preclinical models of alcohol-induced liver damage.
基金supported by the National Natural Science Foundation of China(No.82360120)the Kunming Medical University Joint Special Project on Applied Basic Research(202401AY070001-134),and project iGandanF-1082022-RGG049+2 种基金the Open Project of Yunnan Provincial Clinical Medical Center for Digestive System Diseases(2022LCZXXF-XH07/17)the 14th Undergraduate Scientific Research Project of Mudanjiang Medical University(2024057)Yunnan Provincial Key Laboratory of Clinical Virology(No.2023A4010403-04).
文摘Background:High-mobility group box 1(HMGB1)is a critical damage-associated molecular pattern protein that participates in diverse physiological and pathological processes.However,its relevance to the prognosis of artificial liver support therapy in patients with acute liver injury(ALF)remains unclear.Methods:Bioinformatics analyses were performed to identify HMGB1-interacting proteins and associated inflammatory signaling pathways.Peripheral blood samples were collected from ALF patients before and after artificial liver support therapy,and serum HMGB1 concentrations were quantified using ELISA.Primary mouse hepatocytes were stimulated with lipopolysaccharide(LPS)in vitro and HMGB1 expression was verified by western blot.Results:Single-cell transcriptomic profiling showed that HMGB1 is widely expressed across tissues and predominantly localized in the nucleus.In the liver,HMGB1 was primarily expressed in hepatocytes and hepatic stellate cells.STRING database analysis revealed that human HMGB1 interacts with multiple proteins,including TLR4,TP53,and BECN1.The constructed interaction network comprised 11 nodes with an average local clustering coefficient of 0.888,and the protein–protein interaction enrichment P-value was 1.42×10^(-5),indicating significant enrichment.Gene Ontology and KEGG pathway enrichment analyses demonstrated that HMGB1 is closely linked to inflammatory and injury-related signaling pathways,including the TLR and NLR pathways.Metabolomic profiling revealed significant metabolic alterations between patients with ALF and healthy controls under both positive and negative ion modes and functional analysis showed necroptosis was activated.The cell viability gradually decreased with time and dose under LPS treatment and extracellular HMGB1 was upregulated in LPS induced ALF model and patients(P<0.05).Serum HMGB1/RIPK3/MLKL levels were markedly elevated in ALF patients compared with controls(P<0.05)and progressively declined following artificial liver support therapy.Furthermore,elevated HMGB1 concentrations were positively correlated with unfavorable clinical outcomes.Conclusion:Peripheral blood HMGB1 levels are significantly increased in patients with acute liver failure,decrease following artificial liver support therapy,and are positively associated with poor clinical prognosis.
