Objective:To explore the treatment and effect of ABO-different orthotopic liver transplantation(OLT).Methods:Fifteen cases of ABO-different OLT were analyzed retrospectively.Six cases of ABO-different but compatible OLT were treated routinely.In 9 cases of ABO-incompatible OLT,plasma exchange was done in 1 case before operation,splenectomy was done in 5 cases during operation,the hepatic artery and biliary duct anastomosis were performed by the microvascular technique.The immuno suppressive protocol included a quadruple drug therapy,and anticoagulant therapy were performed postoperation.Results:No complications were found in 6 cases of ABO-different but compatible OLT.Of the 9 cases of ABO-incompatible OLT,4 patients recovered smoothly without complications.Postoperative complications included acute rejection in 3 patients,biliary nonanastomotic stricture in 4 patients,and 3 cases died.Conclusion:The effect of ABO-different but compatible OLT is good.ABO-incompatible OLT can be used when the graft is scarce,but we should manage to decrease the complications.

Objective To analyze the individual immunosuppressive protocol (IP) after liver transplantation (LT) in benign end-stage liver disease. Methods The clinical data of 645 patients with benign end-stage liver disease undergoing LT in our institute from April 2002 to Aug 2010 wen analyzed retrospectively. 146 cases from Apr. 2002 to Dec. 2004 were in stage one, and triple therapy containing tacrolimus (Tac), mycophenolate mofetil (MMF) and methylprednisolone (MP) was used;273 cases from Jan. 2005 to Dec 2007 were in stage two, and the less dose of immunosuppressant than stage one was used; 226 cases from Jan. 2008 to Aug. 2010 were in stage three, and they wen divided into conventional group and severe patient group according to their preoperative model for endstage liver disease (MELD) score and patient condition, the individual IP was used. Results The overall survival rate of patients with MELD score <25 was 88. 9 % in stage one, 94. 2 % in stage two, and 95. 4 % in stage three; The overall survival rate of patients with MELD score ≥25 was 67. 7 % in stage one, 73. 4 % in stage two, and 82. 0 % in stage three. The incidence of rejection ir cases with MELD score <25 had no significant difference (P>0. 05). The incidence of rejection in cases with MELD score ≥25 in stage two and stage three was higher slightly than in stage one (P<0. 05). Conclusion The IP after liver transplantation should be individualized according to recipient conditions, which can increase survival rate.

Objective:To investigate the management in patients with complete portal vein (PV) and superior mesenteric vein (SMV) thrombosis during liver transplantation (LT). Methods:Seven patients with complete PV and SMV thrombosis undergone LT, The reconstruction of PV were the anastomosis PV to varicose coronary vein in 3 cases, PV to varicose vein near hilus of spleen in 2 case, PV to varicose vein in front of common bile duct in 1 case, PV to varicose right gastro-epiploic vein in 1 case. Results:All patients undergone successful LT. One case died 7 days after the transplantation of multi-organic nonfunction, but the PV was patent. One case was found stenosis at the anastomosis 6 months after LT, and he was cured by percutaneous transhepatic portography and stent placement. Other patients were followed-up12~22 months, the PVs were patent, and had sufficient blood supply, and they have normal liver and kidney functions now. Conclusion :The anastomosis between graft portal vein and the splanchnic varicose vein may be a applicable choice for the patients with complete PV and SMV thrombosis during LT.

Objective: To study the surgical strategy of portal vein organized thrombosis ( PVOT ) during liver transplantation ( LT ) . Methods: The clinical data of 41 patients with PVOT performed LT from January 2005 to June 2006 ( 359 cases ) in our institute was retrospectively analyzed . The reconstruction of portal vein ( PV ) were removing thrombosis in 22 cases , throm- boendovenectomy in 10 cases , PV to splanchnic varicose vein in 8 cases , cavoportal hemitranspo- sition in 1 case . Results: 1 case died of multiple organ failure , 1 case died of hepatic artery bleeding . Retransplantation and portosystemic shunt vein ligation were performed in 1 case 14 days after LT because of its insufficient PV flow 2 cases were found anastomotic stenosis and they were cured by balloon angioplasty and stent placement via hepatic vein . Other patients were followed up 6 to 20 months , all of them had normal PV flow . Conclusion: Thromboen- dovenectomy or removing thrombosis is applicable to manage PVOT during LT .

Objective To explore the treatment of ABO-incompatible orthotopic liver transplantation. Methods Nine cases of ABO-incompatible liver transplantation performed in our hospital were analyzed retrospectively. Plasma exchange was done before the operation in 1 case. Hepatic artery and biliary duct anastomosis were performed by the microvascular technique. Splenectomy was done during operation in 5 cases. The immunosuppressive protocol included a quadruple drug therapy. Blood oxygen saturation was maintained above 95% and anticoagulant therapy was performed after operation.Results Four patients recovered smoothly without complications. Postoperative complications included acute rejection in 3 patients and biliary nonanastomotic stricture in 4. Three patients died. Conclusion ABO-incompatible orthotopic liver transplantation can be used when the graft is scarce, and should manage to decrease the complications.

Objective To evaluate the influence of age on the surgical risk and prognosis for elderly patients who suffered from lumbar spinal stenosis.Methods A total of 129 patients above 70 years old with lumbar stenosis from January 2015 to August 2018 were divided into 4 groups by age:younger than 69 years,70-74 years,75-79 years and 80 years and above.50 patients below 69 years old were chosen at random as control group.Different parameters such as operation methods,predicted complication rate (POSSUM score),actual complication rate,number of operation levels,operation time,surgical blood loss,occult blood loss,total hospital stay,postoperative hospital stay,hospital cost and the ODI score in 3 months followup were recorded.The surgical risk and prognosis of elderly patients were analyzed by comparing the differences of above parameters between different age groups.Results There was no significant correlation between different age groups and surgical methods (F=15.637,P=0.208).The operation time and surgical blood loss both showed no significant difference between 4 groups.The predicted incidence of complications (POSSUM score) in group older than 80 years old (38.5％+12.34％) and 75-79 years old (41.1％+ 11.82％) were higher than the group younger than 69 years old (28.4％+ 15.44％).There was no significant difference between the two groups over 75 years old,and there was no significant difference between the 70-74 years old group and the other three groups.The actual incidence of complications was 43.75％ in group over 80 years old,42.86％ in group 75-79 years old and 42.03％ in group 70-74 years old.The actual complication rate of the group younger than 69 years was lower than other three groups,and the three other groups showed no significant difference between each other.The totally hospital stay and numbers of operation levels in groups 75-79 and 80 years and above were higher than groups 70-74 and 69 years and below.There was no significant difference in those parameters between groups 75-79 and 80 years and above,and between groups 70-74 years and 69 years and below.The ODI scores between 4 groups also showed no significant difference.Conclusion The risk of surgery for lumbar disc stenosis patients older than 75 years has increased,but the patient's surgical outcome has not decreased.Old age should not be a key factor in determining whether a patient is suitable for surgery.

Objective Diffusion/perfusion-weighted MRI (DWI、PWI) was performed to evaluate growth and vascularity of implanted C6 rat gliomas. Methods 36 female Wistar rats were implanted of C6 glioma cells intracerebrally. Between 1 and 4 weeks after implantation, eight to ten different rats were imaged with T_1WI, T_2Weighted imaging, DWI, PWI, and postcontrast T_1WI at each weekly time point. After MRI, each rat brain was examined histologically using HE and immunohistochemical staining for CD34. Results On DWIs, statistical differences of apparent diffusion coefficient (ADC) values for both the solid tumor component and peritumoral region were present comparing 3-4 weeks with 1-2 weeks after implantation (P

Objective:To investigate the renal injury of portal hypertensive rat after one hour of occlusion of portal vein and inferior vena cava.Methods:Healthy male Wistar rats were taken randomly as normal control、portal hypertensive control and trial group.The recoverable portal hypertensive model was induced firstly.Three weeks later ,15 model rats were taken randomly as portal hypertensive control group,others had another operation and were divided randomly into 0,6h,12h,24h,48h,72h,7d group according to different reperfusion time after 1 hour of occlusion of portal vein and inferior vena cava.At the corresponding time points after reperfusion,the examinations below were done:serum ALT,TBIL,BUN,Cr concentrations;mor-phological changes of liver and kidney,the ultrastructure of renal tissue.Results:Serum and Cr in trail group reached their peak value 12~24 hours after reperfusion,then decreased gradually,and returned to normal 72 hours after reperfusion.The main injury of kidney was located in proximal tubular epithelial cell ,it peaked at 12 hours and 24 hours after reperfusion,the sporadic karyopyknosis and karyorrhexis could be seen,but the basement membrane preserved well.48 hours later,the restoration could be seen.7 days later it restored obviously.Conclusion:There are obvious injury in tubular epithelial cell in the portal hypertensive rat after 1 hour of occlusion of portal vein and inferior vena cava.But the injury of kidney is reversible.

Objective To analyse our clinical experience in pediatric living donor liver transplantation (PLDLT).Methods The clinical data of 45 patients who underwent PLDLT in our hospital from April 2005 to April 2014 were retrospectively studied and their preoperative,intraoperative and postoperative data were analyzed.Results All donors recovered well.The graft to recipient weight ratio (GRWR) ranged from 1.0％ ～ 6.4％ (2.5％ ± 1.2％).Size reduction of graft were performed in 2 patients.An interposition venous conduit from the confluence of the native right and left portal vein (PV) to the graft PV was carried out in 1 patient,venous grafts for revascularization of the tributaries of the middle hepatic vein from segment Ⅴ and Ⅷ were used in 3 patients,and a venous patch for revascularization of the left hepatic vein was used in 2 patients.Hepatic artery re-reconstruction was performed in 3 patients after hypoperfusion was detected on intraoperative Doppler ultrasound.The postoperative complications included acute rejection (n =2),vascular complications (n =7),biliary complications (n =11),and infectious complications (n =27).The 1-,2-and 5-year survival rates were all 84.4％.Seven of 45 recipients died within one year post transplantation,with 3 patients who died of vascular complications,and 4 patients who died of infection.The differences in age [(50.8 ± 49.8) months vs (12.6 ± 14.9) months],body weight [(16.2 ± 10.5) kg vs (7.3 ± 1.7) kg],serum total bilirubin [(177.0 ± 126.5) μmol/L vs (301.9 ± 110.6)μmol/L],Pediatric end-stage liver disease (PELD) score (16.1 ± 12.1 vs 26.2 ± 11.3) and GRWR (2.2％ ± 0.8％ vs 4.2％ ± 1.6％) between the survival and the dead groups were significant (P ＜ 0.05).Conclusions PLDLT is an effective method to treat children with end-stage liver disease.Using a multidisciplinary approach in the preoperative management,excellent surgical techniques,and proper postoperative management are extremely helpful to improve postoperative survival rate.

Objective To investigate the characteristics of infection and risk factors after pediatric living donor liver transplantation (PLDLT).Method Form April 2005 to April 2014 the clinical data of 45 cases of PLDLT in General Hospital of Chinese People's Armed Police Forces were retrospectively investigated,and the difference between the patients after PLDLT with infection and those without infection was analyzed.Result Eighty-four infections occurred in 27 (60.0％) of 45 patients,including 25 cases of bacterial infections,14 cases of viral infections,and 3 cases of candida albicans infections.Most infections occurring within 3 months after PLDLT have been found to be caused by bacteria,viruses and fungi.The trough level of tacrolimus (Tac) was in target therapeutic window in 16/20 infected patients and more than 10 ng/mL in 4/20 infected patients within 3 months after PLDLT,and there were 12/16 infected patients with the trough level of Tac of more than 10 ng/mL 3 months post-PLDLT,with the difference being significant (P＜0.05).Multivariate analysis revealed that post-transplant infection was significantly related with the factors as weight＜10 kg,age ＜12 months,biliary intestinal anastomosis,pediatric end-stage liver disease (PELD) score,ChildPugh score,total bilirubin,blood loss per kg body weight and graft to recipient weight ratio (GRWR).Logistic regression analysis suggested that PELD score was independent risk factor of infection after PLDLT.Conclusion The infection after PLDLT has their special characteristics.The proper irnmunosuppressive protocol and control of above risk factors are helpful to decrease the incidence of infection after PLDLT.