Objective To explore the causation,diagnosis and management of iatrogenic bile duct injury(BDI) of laparoscopic cholecystectomy(LC).Methods A total of 1 656 patients undergoing laparoscopic cholecystectomy in our department during the last 7 years were included in this study for retrospective analysis.Results There were 274 patients with gallbladder polyps,168 patients with acute calculous cholecystitis and 1214 patients with chronic calculous cholecystitis.There were 15 BDIs associated with LC(0.91%).A total of 8 BDI patients were diagnosed during cholecystectomy.The remaining 7 BDI patients were diagnosed postoperatively.The intraoperative diagnosis of BDI was made on the discovery of bile leakage or double biliary stump during cholecystectomy.Clinical features,diagnostic abdominocentesis and imaging findings formed the basis of diagnosis of BDI postoperatively.One BDI patient was treated by repairing the injuried common bile duct with a T-tube drinage.Four BDI patients were treated by end-to-end anastomosis of injuried bile duct,and one of the four patients was reoperated with Roux-en-Y hepaticojejunostomy because of bile leakage.The remaining 10 BDI patients were treated by Roux-en-Y hepaticojejunostomy,and good results were achieved in all of these patients.Conclusions There is no relationship between the etiology of gallbladder disease and BDI during laparoscopic cholecystectomy.Good results can be achieved if BDI is diagnosed early and treated properly during or after operation.Roux-en-Y hepaticojejunostomy is the primary operation method for treating BDI.

Objetive To investigate the effect of Fasudil on the hepatic ischemia repeffusion injury on rats of obstructive jaundice.Methods 160 mature SD rats were randomly assigned into 2 large groups,namely experimental group (Group A) and control group (Group B).While each large group was subdivided into 4 subgroups,including sham operation subgroups(Group A1 and B1),obstructive jaundice model subgroups(Group A2 and B2),ischemia reperfusion model subgroups (Group A3 and B3)and obstructive jaundice plus ischemia reperfusion model subgroups (Group A4 and B4).In Group A2 and B2,obstructive jaundice models were made on rats by double ligating and cutting the common bile ducts.In Group A3 and B3,the ischemia reperfusion injury models were built by blocking the hepatic portal vessel for 30 minutes before reperfusion.In Group A4 and B4,the ischemia reperfusion injury models were built in 1 week after building the obstructive jaundice models.For Group A,10 mg/kg fasudil was intraperitoneally injected at 30 minutes before ischemia.For Group B,equal amount of physiological saline was injected.Samples were gained on zero hour,1 hour,2 hour and 6 hour post reperfusion.The serum indexes for liver function and serum Endothelin 1 level were tested and analyzed through SPSS.Pathological changes of liver were viewed correspondingly.Results Compared to control groups (Group Bs),experimental groups (Groups As) have better liver function,lower Endothelin 1 level (P ＜ 0.05),as well as less severe microscopic histological damage.Conclusion Fasudil can effectively protect rats of obstructive jaundice from hepatic ischemia reperfusion injury.

Objective To investigate the protective effects of different doses of fasudil on hepatic ischemia/reperfussion (I/R) injury in rats with liver cirrhosis.Methods Cirrhosis was induced in rats by subcutaneous injection of 60％ carbon tetrachloride (CC14) corn oil solution (0.4 ml/100 g) twice a week for twelve weeks.Five percent of alcohol was given intermittently in drinking water.Then 40 cirrhotic rats were randomized into 4 groups.In sham group,sham operation was performed.In I/R group A and B,whole rat livers were subjected to warm ischemia by clamping the hepatic artery and portal vein for 30 min.In group A,the selected rats were pretreated with low-dose fasudil 1 mg/kg (intraperitoneal injection) 30 min before the induction of ischemia,and in group B,with high-dose 10 mg/kg.The serum levels of alanine aminotransferase (ALT) and endothelin-1 (ET-1),and the liver tissue superoxide dismutase (SOD)activity,malondialdehyde (MDA) content,the expression of HIF-1a (hypoxia-inducible fador-1a) were measured after reperfusion for 6 hours.Hepatic pathologic changes were observed under microscope.Results Compared with I/R group,the serum ALT,AST,ET-1 levels,MDA content and the expression of HIF-1 a were markedly decreased in group B,while the SOD activity significantly increased (P ＜ 0.05).And the pathologic changes were less severe in group B.Conclusion The high-dose fasudil markedly lessened the expression of HIF-1a,up-regulated the concentration of SOD,and lowered the levels of MDA and ET-1,protecting against heoatic ischemia/reperfusion injury in rats with liver cirrhosis.

Objective To investigate the surgical approaches and effects for small hepatocellular carcinoma(HCC) with biliary tumor thrombi.Mothods The clinical data of 14 small HCC patients with biliary tumor thrombi who underwent surgical intervention were analyzed retrospectively.Results The postoperative mean survival time of patient with removal of biliary tumor thrombi(n=4) was 7 months.Three patients underwent limited hepatectomy and removal of biliary tumor thrombi,2 of them survived 4 and 21 months respectively,the other cases underwent second operation 2 months later for recurred tumor in liver.Eight patients underwent left or right hemihepatectomy and removal of biliary tumor thrombi,3 of them combined with extrahepatic bile duct resection and reconstruction.Survival times of these patients were 55 months,53 months,44 months(still alive),31 months(still alive),29 months,18 months,11 months(still alive) and 1 month respectively.Conclusions Regular hemihepatectomy,meanwhile combined with the invaded extrahepatic bile duct resection,might help to prolong the survival time of patients of small HCC with biliary tumor thrombi.

Objective To estabhsh a rat portacaval shunt model of portal vein arterialization (PVA)by using right renal artery,andtoinvestigateitsinfluence on portal velnpressure,liver funciton and hepatic pathology.Method Forty-three Sprague-Dawley rats were assigned to PVA group(33 rats)and control group(10 rats).Portal pressure,liver function and pathological changes were evaluated at day 2,2 weeks and 2 months after surgery,respectively.Results The experimental model was successfully established in 30 out of 33(91%)rats.At day 2,2 weeks and 2 months after the operation,the portal pressure increased significanfly(P<0.05)compared with the control group,but no significant differences were found in the senrum level of alanine amlnotransferase,total bilirubin,total bile acid and creatinine.There were no patholgiccal changes from day 2 to 2 weeks after surgery,only postoperative expanslon of the sinusoidal snace was found on 2 months after surgery.Conclusion The rat model of PVA by renal artery was successfully established with the hand-suture mierosurgical techniques.The portal vein pressure maintained at a high level after PVA,meanwhile,no negative effect was found on the liver function and hepatic histological structure changes.

Objective To study the predictive value of preoperative blood CD4 +/CD8 + ratio in postoperative recurrence after hepatectomy for patients with hepatocellular carcinoma.Methods The clinical data of 67 patients who underwent hepatectomy for hepatocellular carcinoma at The Fifth Hospital Affiliated to Sun Yat-sen University were analyzed retrospectively.Using the preoperative blood CD4 +/CD8 + ratio,these patients were divided into 2 groups,the CD4 +/CD8 + ＜ 1 group and the CD4 +/CD8 + ≥ 1 group.These patients were followed up at the outpatient clinic and/or by telephone till June 2013.The Cox ratio risk pattern analysis was used to determine the significant risk factors of tumor recurrence.Results On univariate analysis,preoperative AFP ≥400 μg/L,maximum diameter of tumor ＞ 5 cm,number of tumor ＞ 3,CD4 +/CD8 + ＜ 1,vascular invasion,positive resection margin,and portal vein tumor thrombus were risk factors of poor disease-free survival (P ＜ 0.05).On multivariant analysis,CD4 +/CD8 + ＜ 1,number of tumor ＞ 3,and portal vein tumor thrombus were independent predictors of poor disease-free survival after hepatectomy for hepatocellular carcinoma (P ＜ 0.05).Conclusions Preoperative CD4 +/CD8 + ＜ 1 was an independent adverse predictor of poor disease-free survival.It was valuable in predicting postoperative recurrence of hepatocellular carcinoma.

Objective To explore the value of preoperative spleen-liver volume ratio for predicting recurrence of primary liver cancer after hepatectomy.Methods Clinical data of 75 cases of hepatocellular carcinoma undergoing hepatectomy were analyzed retrospectively.According to the preoperative spleen-liver volume ratio,these patients were divided into 2 groups:those with spleen-liver volume ratio ＜ 0.8,and spleen-liver volume ratio≥0.8.Patients were followed-up until March 2014.Cox ratio risk pattern analysis was used for the recurrent correlative factors.Results Univariate analysis showed that preoperative AFPL3％ ≥ 10％,the maximum diameter of the tumor ＞ 5 cm,the number of tumor ＞ 3,spleen-liver volume ratio ≥0.8,vascular invasion,positive resection margin and hepatic or portal vein tumor thrombus were all risk factors of poor disease-free survival (P ＜ 0.05).Cox regression analysis revealed that spleen-liver volume ratio ≥0.8,AFP-L3％ ≥10％,the maximum diameter of the tumor ＞5 cm and hepatic or portal vein tumor thrombus were independent predictors of poor disease-free survival after hepatectomy for hepatocellular carcinoma(P ＜ 0.05).Conclusions Preoperative spleen-liver volume ratio ≥0.8 was an independent adverse predictor of poor disease-free survival.

Objective To investigate the impacts of portal vein arterialization (PVA) on the hepatic hemodynamics in rats with liver cirrhosis. Methods Fifty rats with liver cirrhosis model were randomly divided into PVA group (n=40) and control group (n=10) according to the random number table method. Rats in the PVA group underwent PVA + portacaval shunt. Rats in the control group received no treatment. The variation of portal vein inner diameter, max velocity (Vmax), blood flow and pressure of rats in each
group were measured at the time of 1 week (T1), 2 weeks (T2), 4 weeks (T3) and 8 weeks (T4) after operation or enrolling in the group. Parameters of every time points within the group were compared by one-way analysis of variance and pairwise comparison was conducted by LSD-t test. Comparison between groups was conducted by t test. Results Arterial blood flow signal was observed in the portal vein in PVA group after operation. The inner diameters of portal vein at T1, T2, T3, T4 in PVA group [(2.23±0.19), (2.34±0.26), (2.43±0.27), (2.47±0.22) mm ] were significantly enlarged compared with that in control group [(1.91±0.19) mm (t=3.77, 4.22, 5.01, 6.05; P<0.05). The inner diameter of portal vein at T4 was significantly enlarged compared with T1 (LSD-t=2.61, P<0.05). The Vmax of portal vein at T1, T2, T3, T4 in PVA group [ (39.5±2.0), (40.4±2.5), (39.4±2.7) , (38.8±2.6) cm/s] were significantly increased compared with that in control group [(11.3±2.1) cm/s] (t=30.57, 28.13, 26.05, 26.25; P<0.05). The blood flow of portal vein at T1, T2, T3, T4 in PVA group [ (53±10), (60±14), (67±15), (64±10)ml/min] were significantly increased compared with that in control group [(11±4) ml/min] (t=12.71, 10.66, 11.44, 16.00; P<0.05). The blood flow of portal vein at T3 was significantly increased compared with T1 (LSD-t=2.39, P<0.05). The portal vein pressure at T1, T2, T3, T4 in PVA group [(18.3±1.6), (18.5±1.4), (18.3±1.5), (18.2±1.4) cmH2O] (1 cmH2O=0.098 kPa ) were significantly increased compared with that in control group [ (16.3±1.7) cmH2O] (t=2.80, 3.14, 2.93, 2.83; P<0.05). Conclusions PVA can effectively increase the inflow of liver. It will not lead to a continual increase in the inner diameter, Vmax, blood flow, pressure of portal vein but keep a high maintenance level.

ObjectiveTo investigate the impacts of portal vein arterializations (PVA) on the liver regeneration in rats with liver cirrhosis.MethodsFifty rats with liver cirrhosis model were randomly divided into PVA group (n=40) and control group (n=10) according to the random number table method. Rats in PVA group underwent PVA+portocaval shunt. Rats in control group received no treatments. The ratio of hepatic wet weight to body weight, the hepatocyte percentage of positive proliferating cell nuclear antigen (PCNA) and hepatocyte percentage in DNA synthesis phase (S phase) in each group were measured at the time of 1 week (T1), 2 weeks (T2), 4 weeks (T3) and 8 weeks (T4) after operation or enrolling in the group. Parameters of every time points inside the group were compared by one-way analysis of variance and pairwise comparison was conducted by LSD-t test. Comparison between groups was conducted byt test.Results The ratio of hepatic wet weight to body weight at T1,T2,T3,T4 in PVA group [(3.72±0.26)%, (3.81±0.27)%, (3.83±0.31)%, (3.78±0.31)%] were signiifcantly increased compared with that in control group [(2.84±0.37)%] (t=6.11,6.64,6.49,6.17;P<0.05). The hepatocyte percentage of positive PCNA at T1, T2, T3, T4 in PVA group [(76±6)%, (69±8)%, (20±5)%, (15±4)% ] were signiifcantly increased compared with that in control group [(11±2)%] (t=34.48, 22.87,5.69,2.93;P<0.05). The hepatocyte percentage of positive PCNA at different time points inside the PVA group decreased gradually as time extended, where signiifcant difference was observed (F=316.20,P<0.05). The hepatocyte percentage in S phase at T1, T2, T3, T4 in PVA group [(27.0±1.2)%, (20.5±1.4)%, (16.2±1.3)%, (13.5±1.3)%] were signiifcantly increased compared with that in control group [(11.6±1.9)%] (t=21.97, 12.15, 6.30, 2.68;P<0.05). The hepatocyte percentage in S phase at different time points inside the PVA group decreased gradually as time extended, where signiifcant difference was observed (F=208.00,P<0.05).ConclusionsPVA can effectively promote liver regeneration in rats with liver cirrhosis and the effect declines as time extends.