Split liver transplantation (SLT) can expand the donor pool and alleviate the donor shortage contradiction,shorten waiting time and reduce the mortality of patients on the waiting list.Compared with whole liver transplantation,key factors,such as selection of donor and recipient,distribution of graft vascular,technique point of splitting and preservation of the liver graft,deeply impact the clinical effect of SLT.With the deepening knowledge about partial graft liver transplantation and development of organ preservation technology,surgical techniques and progressive prevention means against complications,SLT will have a broader space for development.

Biliary atresia (BA) is a disease because of extrahepatic bile duct obstruction occurred in whole or in part,which may lead to cholestatic cirrhosis and liver failure.Most infant patients will die within 1 year if not treated by operation.Liver transplantation is the only way to cure the disease.Now the operation indications,operation time,characteristics and prognosis of liver transplantation in BA are introduced.

Liver transplantation is currently the only treatment option for end-stage liver disease,but it is limited by the lack of high quality donor livers.The ongoing liver donor shortage could be alleviated by the consequent expansion of do-nor criteria to include the use of livers that would once have been discarded as unsuitable,marginal livers.Static cold storage,the current gold standard of organ preservation,is incapable of reversing the ischemic damage these organs have sustained.In hepatic transplantation,the limitations of cold storage are reflected in the significantly higher rates of early al]ograft dysfunction,primary non-function,and local ischemic cholangiopathy,especially seen with older,steatotic and donation after cardiac death (DCD) grafts.The existing cold storage technology has restricted the use of this kind of organs and machine perfusion preservation technology becomes an alternative choice.In this paper,we review the research progress on machine perfusion preservation of livers,and introduce the normothermic machine perfusion.

Gastroesophageal varices hemorrhage is a common complication of portal hypertension. Drug and endoscopic therapy have become the basic treatments for varices. Transjugular intrahepatic portal venous shunt is recommended for the management of refractory or recurrent variceal hemorrhage. Liver transplantation will be considered when variceal hemorrhage becomes fatal and traditional therapies are with high risk, contraindicated, or have unsatisfactory results. Patients who received traditional treatments can achieve short-term efficacy and even stabilize the disease for a long time. However, if these treatments lead to complications such as portal vein thrombosis and hepatorenal syndrome, it may increase the risk of liver transplantation complications and affect the patient’s prognosis. Elevated portal venous pressure has a variety of adverse effects on systemic circulation, which can cause hepatopulmonary syndrome, portal pulmonary hypertension, refractory ascites, etc. In these cases, liver transplantation should be performed as early as possible. Conventional treatments are unsatisfactory. In addition, frailty may be worsened after traditional treatment, which will significantly increase the risk of liver transplantation. With the increase of model for end-stage liver disease, the requirement for donor liver volume will also has been increased, which will also affect the implementation of living donor liver transplantation. Some patients with portal hypertension may have poor quality of life and it may also become a clinical indication for liver transplantation. These liver transplant-related issues should be evaluated when administering traditional therapies. Traditional therapies aimed at improving the patient's condition, delaying or controlling complications should not interfere with the consequent implementation of liver transplantation. Improving the long-term overall survival rate and quality of life of patients with portal hypertension is the ultimate standard of all treatments.

Objective To perform the sentinel lymph node biopsy (SLNB) in the patients with early breast cancer by the strict screening conditions and to analyze the accuracy of the sentinel lymph node for predicting the axillary lymph node status .Methods SLNB combined with methylene blue dye and isotope was performed in 266 cases of early breast cancer treated in this department with full treatment courses .Then the axillary lymph node dissection(ALND) was routinely conducted .With the pathological ex-amination as the standard ,the related factors affecting SLNB were analyzed .Results The detection rate of SLN ,accuracy rate ,sen-sitivity and the false negative rate were 100% ,98 .5% ,95 .56% and 4 .44% respectively ;the accuracy of SLN was significantly cor-related with the tumor size ,pathological type and axillary lymph node status(P<0 .01);the false negative rate of SLN was related with the tumor location(P<0 .05) .Conclusion The combination of methylene blue dye and isotope used in SLNB is feasible in the patients with early breast cancer ,SLN could accurately predict the axillary lymph node metastasis status .

BACKGROUND:Daclizumab can be special y combined with the inerleukin-2 receptor on the surface of activated T cells in human body, and this method can reflect the close of interleukin-2 receptor thus inferring the effect of induction therapy. At present, the daclizumab has been widely used in renal transplantation, but there is no consensus on its clinical application in liver transplantation. OBJECTIVE:To investigate the expression of serum CD25+T cells and soluble interleukin-2 receptor in the patients receiving daclizumab for liver transplantation during perioperative period. METHODS:A total of 58 patients received orthotopic liver transplant for the first time were included and then the patients were randomly divided into two groups:control group (n=28) and treatment group (n=30). The patients in the two groups were treated with tacrolimus, mycophenolate mofetil and corticosteroids triple immunosuppressive regimen. The patients in the treatment group received immune induction therapy with daclizumab, and the patients in the control group did not receive daclizumab. RESULTS AND CONCLUSION:Flow cytometry and enzyme-linked immunosorbent assay showed the expression levels of CD25+T cells in the treatment group were significantly lower than those in the control group at different time points after liver transplantation (P<0.01);and the expression levels of soluble interleukin-2 receptor in the treatment group were lower than those in the control group during transplantation and at the first day after transplantation (P<0.05, P<0.01). At 6 months after transplantation, the incidence of acute rejection was decreased in the treatment group (P<0.01). The results indicate that daclizumab can effectively suppress the expression level of CD25+T cells, as wel as the expression level of soluble interleukin-2 receptor in the peripheral blood in the early stage of liver transplantation, thus effectively reducing the rate of acute rejection.

Objective To explore the surgical treatment for perforation of gastric carcinoma. Methods The clinical data of 74 cases with perforation of gastric carcinoma which underwent different surgical procedures from January 1988 to January 1998 were analyzed retrospectively. Results Thirty patients underwent repair of perforation; 24 received partial gastrectomy and 20 radical gastrectomy. Postoperative complication occurrence was 6. 8% and mortality 1.4%. One-, 3- and 5-year survival rates were 3.3% , 0, 0 in repair gastrectomy group; 54. 2% , 25.0%, 0 in partial group; 75.0%, 55.0% ,20. 0% in radical group. Conclusion Radical gastrectomy and positive treatment can prolong the survival time and improve the quality of life of the patient with perforation of gastric carcinoma.

Objective To explore the surgical treatment for perforation of gastric carcinoma. Methods The clinical data of 74 cases with perforation of gastric carcinoma which underwent different surgical procedures from January 1988 to January 1998 were analyzed retrospectively. Results Thirty patients underwent repair of perforation; 24 received partial gastrectomy and 20 radical gastrectomy. Postoperative complication occurrence was 6. 8% and mortality 1.4%. One-, 3- and 5-year survival rates were 3.3% , 0, 0 in repair gastrectomy group; 54. 2% , 25.0%, 0 in partial group; 75.0%, 55.0% ,20. 0% in radical group. Conclusion Radical gastrectomy and positive treatment can prolong the survival time and improve the quality of life of the patient with perforation of gastric carcinoma.

Objective To investigate the efficacy of pegylated interferon (Peg-IFN) plus ribavirin to treat hepatitis C virus (HCV) recurrence, and analyze possible factors associated with sustained viral responses (SVR). Methods The enrolled 39 patients, who had recurrence of hepatitis C after liver transplantation and received antiretroviral therapy, were analyzed. Treatment was discontinued in 21 patients due to side effects, and the remaining 18 patients [13 males, 5 female,median age of 54 (27-67) years, treatment duration of 25-105 weeks)] were subjected to whole standard treatment. During the treatment, HCV RNA was measured at 4, 12, 24, and 24 weeks after HCV negative change as well as drug withdrawal. SVR was defined as HCV RNA negativity within 24 weeks after the drug withdrawal. The following variables were analyzed: ages, gender,pretreatment viral load, genotype, early viral response (EVR), levels of alanine aminotransferase before treatment and their association with SVR. Results The mean treatment duration was 57weeks with an SVR achieved in 4/18 (22. 2 %). Statistical analysis revealed that the genotype of non1B (P=0.023), RNA ＜106 copy/ml (P= 0. 044) before treatment and EVR (P=0.019) were the variables associated with SVR. Conclusion Genotype of nor-1B, low level RNA before treatment and EVR were the effective predictors of interferon antiviral therapy for recurrent hepatitis C after liver transplantation.

Objective To evaluate the clinical value of ulinastatin on the treatment of systemic inflammatory response syndrome in severe acute panereatitis. Method Eighty-four patients with severe a-cute pancreatitis were randomly divided into two groups. In the treatment group (42 cases),on the base of routine treatment, ulinastatin was administered intravenously for seven days after hospitalization, while in the control group only routine treatment was given (42 cases) to. Inflammatory factors in serum, the change of liver function and renal function were measured in two groups before and after the treatment, and the clinical efficacy were observed. Results There was significant difference, in the serum level of tumor necrosis factor-α, interleukin-1, interleukin-6, alanine aminotransferase, aspartate aminotransferase, blood urea nitrogen and creatinine on the 7th day between two groups (P < 0.05 or < 0.01 ) ,there were significant differences in the incidence of complications, hospitalization time, incidence of multi-organ failure between two groups [14.3%(6/42) vs 38.1%(16/42), (29.4 ± 1.5)d vs (34.4 ± 1.8)d, 28.6%(12/42) vs 47.6%(20/42), P<0.01 or <0.05 ]. Conclusions Ulinastatin can suppress the secretion and release of some inflammatory factors, protect the important viscera functions and reduce the incidence of complications, and it has favorable clinical efficacy.