Surgical resection is the best way to treat liver cancer,but the effect of tumor with post-operational metastasis and relapse post-operational was severely restricted.Metastasis and relapse of hepatocellular carcinoma(HCC) is not only a serious threat to people' s health,but also a heavy burden to the family and society.The recognized marker of HCC now is AFP,but the lack of specificity and the bionomics limit it to be the marker of metastasis and relapse of HCC.With the developing of gene technology,AFP mRNA,the prosoma of AFP,is used as a marker of monitoring the metastasis and relapse of HCC.We review AFP mRNA monitoring in HCC with metastasis and relapse.

Objective To study the regulation of iodine solution dissemination through the portal vein duo to compression of liver tissue in SD rat models.Methods SD rats were divided into three groups:liver segment blocking group,non-liver segment blocking group and placebo group.Right anterior segments of liver were blocked by blocking ribbon before the compression of liver tissue in liver segment blocking group,the liver tissue was pressed in 20 times.The procedures were all the same with blocking groups in non-liver segment blocking group except that the liver tissue is free from blocking.Placebo group only was opened and closed the abdomens.The iodine solution was injected into the liver tissue in right anterior segments and iodine ball should be confirmed under the X-ray in every experimental rats.The severity of the iodine predations in the liver was divided into four degree:Degree A indicated the iodine ball was in situ;no predations;Predations were in right anterior segments only in degree B;Degree C was found iodine spots in other liver segments except right anterior segments;Degree D indicated iodine spread to other organs.The iodine balls were pressed under the pressure between 10 and 15 mm Hg.Results Majority of iodine balls(36/45,80%)were formed successfully in liver tissues.Compression of the iodine balls in liver tissues can cause iodine predations in the vessels in liver.The severity of the dissemination was related to the pressure and the range of the pressings.The blocking of the liver segments before the operation can reduce the predations of iodine.Conclusion Pressing of the liver tissue can caused the iodine balls disseminate in vessels,cancer cells or cause thrombus disseminate in the vessels,Which can be reduced by avoiding the compression of the liver or tumom during the operation.

Objective To assess the value of color Doppler flow imaging (CDFI) in indicating the recurrence and prognosis of liver cancer.Methods Two hundred and eighty-seven patients with primary liver cancer were enrolled,thirty-seven cases received operations ( 12.9% ).The size,profile,margin,echogen,blood supply of the tumors were observed preoperatively by CDFI. Twenty-eight patients were followed for 0.5 to 5 years.Results Recurrent nodules were seen in 24 cases (85.7%) during five years.Lesions larger than 5 cm recurred much earlier than those less than 5 cm in the diameter of the patients( P

From August 2007 to April 2011,hepatocellular carcinoma (HCC) (n =40),paraHCC tissues (n =10),seminoma (n =10) and cavernous hemangioma (n =10) were selected.And the method of immunohistochemical streptavidin-perosidase was applied to detect the protein expression of Nanog.The expression ratios of Nanog were 17/40 (42％),1/10,0/10 and 5/5 in HCC,para-HCC tissues,seminoma and cavernous hemangioma respectively.Its expression showed no significant correlation with the patient gender,age,serum alpha fetoprotein (AFP),hepatitis B surface antigen (HBsAg),differentiation,Child grade and TNM stage ( P ＞ 0.05 ).It may be used as a surface marker of liver cancer stem cell.

Objective To study the pathology and treatment of huge nonhepatic tumors in the right upper quadrant of abdomen.Methods The clinical data of 9 patients with huge nonhepatic tumor in the right upper quadrant of abdomen treated surgically at our hospital from May 2004 to December 2009 were retrospectively analyzed.Results Preoperative imaging failed to define the tumors as nonhepatic in original in 7 patients and operation failed to recognize the origin of the tumors in 2 patients.All the tumors were successfully resected,with combined hemigastectomy in 1 patient,partial resection of the lateral wall of the infrahepatic vena cava in 2,complete resection of adipose capsule of the right kidney in 2,pancreatoduodenectomy plus transverse colectomy in 1,and transection of pancreatic duct of the body and tail of the pancreas and pancreaticojejunostomy in 1.The median operation time was 390 min (318-660 min).The median intraoperative blood loss was 2560 ml (400-6000 ml).The median intraoperative blood transfusion was 2450 ml (0 -5250 ml).The average diameter of the resected tumor was 14.5 cm (11-30 cm),and the average tumor weight was 2465 g (960-5100 g).Postoperative pathological diagnoses showed that 8 patients had malignant tumors and 1 had a potentially malignant and undifferentiated tumor (solid pseudopapillary tumor of pancreas).Perioperative pancreatic anastomotic leak occurred in 1 patient,and there were no severe postoperative complications and operative death in this series.Tumor recurrence was detected 5 months following operation in 1 patient.The 1,2-,3-year survival rates were 100％,56％,33％,respectively.One patient survived for more than 5 years.Conclusions Huge non-hepatic tumors in the right upper quadrant of abdomen could easily be misdiagnosed as hepatic neoplasms.The surgical resection rate was high.The prognosis for patients who received resectional treatment was satisfactory.

Objective To summarize the results of a new pancreaticojejunostomy technique designed to decrease incidence of pancreatic leakage in pancreatoduodenectomy.Methods The clinical data of 11 cases of pancreatoduodenectomy using remnant pancreatico-jejunum end-to-end anastomosis with external drainage of full pancreatic juice was analyzed retrospectively.Briefly,5-0 bioabsorbable suture was penetrated through the pancreatic stump and stent and then circulated the pancreatic stump for 2 circles and ligated.Octreotide was not administered in any cases post-operation.Results The operation was simple and timespared.Neither pancreatic leakage nor postoperative bleeding occurred in the cases.From 4 months to 3 years following operation,no other complications were found in all cases.Conclusions The method was safe,feasible and effective to decrease incidence of pancreatic leakage in pancreatoduodenectomy.

Objective To investigate the effect of iodine-125 seed implantation in the treatment of unresectable pancreatic carcinoma.Methods A total of 26 pancreatic carcinoma patients were retrospectively analyzed.Patients undergoing palliative operation in combination with iodine-125 seed implantation.jundice recovery,objective tumor response,pain relieved,clinical benefit response,median survival time and complication were investigated.Results Half of cases with jundice has reduced and totally normal in 3 weeks.Abdominal pain was relieved in 94.7％ patients,average recovery duration was (5.0 ± 1.5) d.18 cases had gastroenterol function disorder (69.2％),gastroparesis in six cases (23％) and average recover time was (16 ± 5.1) d.24 of 26 cases were follow up study,median survival time was (12 ± 5.1) months,objective tumor response was smaller than preoperation in 9,no change in 10 and 5 cases became larger than before.Conclusions Palliative operation in combination with iodine-125 seed implantation is safe and effective in the treatment of unresectable pancreatic carcinoma.

Objective To study aminopeptidase N/CD13 expression in hepatocellular carcinoma and its relationship with clinical data and proguosis in patients with hepatocellular carcinoma.Methods The immunohistochemical SP method was used to detect the CD13 monoclonal antibody in 40 cases of hepatocellular carcinoma,10 cases of corresponding para-carcinoma and 10 cases of cavernous hemangioma.Results Forty cases ( 100％ ) hepatocellular carcinoma tissues were seen varying degrees of CD13 expression,3 (30％) corresponding para-carcinoma tissues were weakly positive,and 10 cases of cavernous hemangioma with no expression.The expression rate of CD13 was not significantly correlated with the patient gender,age,serum AFP value,HbsAg,differentiation,CHILD grade and TNM stage (P＞0.05).But the expression of CD13 was closely related with the patient serum AFP value,HbsAg,differentiation ( P ＜ 0.05 ).By the survival function graph we could find the expression rate was negativly correlated with survival in patients,but the expression was not significantly correlated with tumor relapse.Conclusion CD13 can be used as the surface marker of liver cancer stem cells,and it is expected to become an effective indicator of prognosis in patients with hepatocellular carcinoma.

Objective To study the complications after laparoscopic bile duct exploration.MethodsTwo approaches for bile duct exploration were used in 105 patients: (1) laparoscopic transcystic common bile duct exploration (LTCBDE) was used for patients with gallstones with choledocholithiasis and cystic duct dilation. No T tube was used for drainage, (2) Laparoscopic common bile duct exploration (LCBDE) was used for patients with gallstones with choledocholithiasis but without cystic duct dilation. The common bile duct was sutured primarily without T tube drainage in those patients with a small number of stones. T tube drainage was used in those patients with many stones or severe edema at the lower end of the common bile duct. ResultsWe carried out LTCBDE+ LC in 70 patients and LCBDE+LC in 35 patients, 14 patients had T tube drainage and 21 patients had no T tubes in the latter group of patients. Postoperatively, there were ascites in 17 patients (LTCBDE 6 and LCBDE 11 ), biliary peritonitis in 5 patients (1 LTCBDE and 4 LCBDE), abdominal pain in 13 patients (LTCBDE 4 and LCBDE 9), and fever in 11 patients (LTCBD 3 and LCBDE 8). All the complications responded to conservative treatment. 14 patients in the LCBDE group had residual stones.Choledochoscopy was used to remove the residual stones.There was no pancreatitis. Conclusions Adequate preoperative workup, good clinical judgment and precise treatment skill help to reduce complication rates after operation for gallstones with choledocholithiasis.

Objective To study the application of cyctic duct dilatiion in bile duct exploration through the cystic duct by laparoscope combined with choledochoscope.Methods LC + laparoscopic transcyctic common bile duct exploration were performed in gallstones combined choledocholithiasis in 70 cases.The dilation of cyctic duct was performed by gas-baloon or metal dilator in 39 cases.The dilation of cyctic duct was not performed in 31 cases.Results There was one case of bile leakage and one case of cystic duct damaging in cystic duct dilation group.One case was found bleeding in abdomen postoperation in non-dilation group.Abdominal drainage was(60 ±11)mL and(55 ±8)mL in dilation group and non-dilation group,respectively.Conclusions The dilation of cyctic duct is simple and safe to create the tunnel for common bile duct exploration through the cystic duct by choledochoscope.