Laparoscopic associating liver partition and portal vein ligation for staged hepatectomy(ALPPS) is an innovative surgical procedure with technical challenges and the risk of surgery,its use in the treatment of hepatocellular carcinoma with cirrhosis is still at an early and exploratory stage.Based on the clinical data and follow-up results of 11 cases of laparoscopic ALPPS for the treatment of hepatocellular carcinoma with cirrhosis,the author summarized the indications,techniques,complications,perioperative and oncology results of the procedure preliminarily.This study has provided technical experience and implementation plan in clinical practice of laparoscopic ALPPS for the treatment of hepatocellular carcinoma with cirrhosis.

Minimally invasive surgery is the trend of development of modern surgery.As the representative of minimally invasive surgery,laparoscopy has widely been used in surgeries for visceral diseases.Liver is the biggest solid organ in the abdominal cavity,with complicated anatomical structure and important biological functions.Laparoscopic hepatic surgeries were thought to be difficult and with high risk.In recent years,laparoscopic surgery has been widely applied in the hepatic surgery as the improvement of laparoscopic techniques and instruments.The application of laparoscopy has been extended from marginal and local resection for hepatic benign diseases to major hepatectomy,resection of liver graft,hepatectomy at special location and anatomical segmentectomy.In China,patients with liver cancer or hepatolithiasis have high recurrence rate,and part of the patients had to receive reoperation.Furthermore,patients with hepatic cancer were usually complicated with hepatic cirrhosis,and patients with hepatolithiasis were easily complicated with hepatic atrophy,hepatic cirrhosis or cavoportal transposition,which hinder the application of laparoscopy for the treatment of liver cancer and hepatolithiasis.In this article,we investigate the application and update of laparoscopic techniques in anatomical hepatectomy and re-hepatectomy based on the experiences of 800 cases of laparoscopic hepatectomy.

Liver transplantation is the only effective way to save the lives of patients with end-stage liver disease and acute liver failure, but the shortage of donor liver limits the clinical application of liver transplantation. There is few report on living donor liver transplantation using the otherwise discarded partial liver after laparoscopic hepatectomy for benign liver tumor, and there are no corresponding standards and specifications for donor selection, surgical indications, preoperative evaluation, surgical planning, operation process and technical points. Based on the clinical practice of laparoscopic hepatectomy, and combined with relevant literature, the author discusses the feasibility and problems of using the otherwise discarded partial liver after laparoscopic hepatectomy for living donor liver transplantation.

Objective　To investigate factors influencing the incidence of massive bleeding caused by stress ulcer in severe acute pancreatiti s (SAP) and explore the effectiveness of measures for its prevention and treatme nt.　Methods　Clinical data of 121 pat ients with SAP were reviewed retrospectively in our center between 1993 and 1998 .The incidence of massive bleeding caused by stress ulcer in SAP, its affecting factors and the results of prevention and treatment were evaluated.　Results　The incidence of stress ulcer massive b leeding in SAP was 11.6% (14/121). The risk factors included the age of patient s, the severity of the disease, concomitant bile duct lithiasis obstruction, pan creatic abscess, pseudocyst and a history of surgical debridement and drainage. Five out of 6 patients treated conservatively died, while only 1 out of 8 treate d surgically died (P＜0.01).　Conclusion　Massive bleeding stress ulcer most often occurred in elderly SAP p atients, especially those of biliogenic, with pancreatic abscess and pseudocyst. Somatostain administration effectively decreases the incidence of bleeding. E mergency operation is mandatory when conservative measures fail to stop the bl eeding.

Objective:To explore the factors influencing colonization of Mutans streptococci (MS) on teeth of children.Methods:Dental colonization of MS was investigated in 123 children aged from 7 to 42 months in Beijing. Oral examination was performed. Information of nursing habits, diet history etc. was obtained from parent questionnaires.Results:Logistic regression analysis showed that the number of erupted teeth and the intake of sugar-containing food were positively related with MS colonization, their WALD values were 17.411(P=0.000) and 5.637(P=0.018) respectively,OR values were 3.287 and 2.739 respectively.Conclusion:The main factors influencing the colonization of MS were the number of erupted teeth and the intake of sugar-containing food.

Objective To explore the effects of selective external biliary drainage (SEBD) on the liver function of rats with obstructive jaundice. Methods The rates of right hepatic lobe weight against body weight of SD rats in SEBD group and total external biliary drainage (TEBD) group were calculated at day 0, 1, 4, 7, 10 after external biliary drainage. The mRNA and protein expressions of multidrug resistance-associated protein 2 (MRP2) and bile salt export pump (BSEP) were detected by RT-PCR and Western blot. Results Compared with TEBD group, the rate of right hepatic lobe weight against body weight and mRNA and protein expression of MRP2 and BSEP were significantly higher in SEBD group (t=15.569, P <0.05 ; t =4.485, 7.143, 9.169, 5.178, P <0.05). Conclusions SEBD improves the liver function of rats with obstructive jaundice, which may be related to the compensatory increase of remnant liver volume and elevation of expression per volume of membrane transport proteins.

Objective To investigate the protective effect of pentoxifylline (PTX) on bile duct in grafts against ischemia-reperfusion (IR) injury and its potential mechanisms in the animal model of OLTx in miniature swines. Methods After PTX was added to the preservation solution and administrated through hepatic artery, changes of blood flow, activity of ATPase, apoptosis of epithelial cells, and pathomorphology of the bile duct were investigated in the animal model of OLTx in miniature swines. The animals were divided into IR, IR+NS, and IR + PTX groups. Results The results showed that the incidence of biliary necrosis was significantly lower in IR+PTX group than that in IR and IR +NS groups. When compared with those in IR and IR +NS groups, GGT and ALP levels, numbers of apoptosis cells, and scores of pathomorphology were significantly decreased in IR+PTX group, while blood flow, activity of Na +-K +ATPase, Ca 2+ -ATPase of bile duct in grafts were significantly elevated. Conclusion These results suggest that PTX has multiple antagonistic effects against IR injuries of the bile duct. The effects of PTX on bile duct of grafts against IR injuries are possibly correlated with the improvement of the microcirculation, preservation of the ATPase activity of the bile duct, and suppression of the apoptosis of the bile duct cells.

Objective To provide a reliable model of orthotopic liver transplantation in rats and study surgical techniques for improving the quality of the operation. Methods The model was established by modified Kamada’s cuff technique. The time of cold preservation was 60 min. The successful rate of the method and one-week survival rate were observed. Results In 135 cases undergoing orthotopic liver transplantation, one-week survival rate was 89.2% . The successful rate of the model was 95.6% . Conclusions The key for success in rat liver transplantation is the shortened anhepatic period and delicate and skillful surgical manipulation. Also some detailed modified techniques should be used.

Objective To investigate the auxiliary effects of huaier granule on hepatoeellular carcinoma (HCC)patients after liver transplantation.Methods Sixty HCC patients who had undergone liver transplantation from Julv 2004 to June 2006 and met the standard of UCSF were involved in this study.All patients were divided into huaier granule group(n=20),chemotherapy group(n=15),huaier granule+chemotherapy group (n=15)and control group(n=10).The white blood cell count,liver function,cell immunity and immunologieal reiection were detected.The 1-year tumor recurrence rate wag calculated.Results The white blood cell counts in chemotherapy group 1,3,and 6 months after treatment were significantly lower than that before treatment (F=62.053,58.472,49.807,P＜0.05).The changes of white blood cell counts of the other 3 groups before and aftertreatment were small.The difference on the white blood cell counts of the 4 groups had no statistical 8ignincanee(F=102.361,113.412,87.572,P＜0.05).The NK activity,CD4+/CD8+ ratio,IL-2 level in huaier granule group and huaier granule+chemotherapy group 1,3,6 months after treatment were significantly higher than those before treatment,and were significantly higher than those in chemotherapy group and control group(P＜0.05).No immunological rejection occurred in all the groups.Two patients in each group had recurrence and metastasis of HCC within 1 year after the treatment.and the incidence in control group was higher than the other 3 groups(P＜0.05). Conclusions Humer granule can increase the white blood cell count which is decreased after chemotherapy,impmve cellular immunity,and effectively suppress the recurrence and metastasis of HCC at the first year after operation.

Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) is a breakthrough in the field of hepatobiliary surgery.The remnant liver regeneration was stimulated during the first stage of the operation,and the radical resection of the tumor could be successfully carried out during the second stage of the operation.ALPPS is a new approach for patients with tumor which is previously considered unresectable during one hospital stay.In April 2014,a patient with hepatocellular carcinoma (HCC) in the right liver and liver cirrhosis was admitted to the Southwest Hospital.Preoperative examination confirmed that the ratio of the remnant liver volume to the standard liver volume was 26.9％,which indicated that the patient was inappropriate to receive radical resection of HCC.Therefore,totally laparoscopic ALPPS was applied.In the first stage of the operation,the portal vein ligation associated with liver hanging tape placement and in situ splitting of liver were carried out after hanging the Glisson's pedicle under the laparoscope.Thirteen days after the first stage of the operation,the ratio of the remnant liver volume to the standard liver volume was 40.6％.The second stage of the operation was carried out 14 days after the first stage of the operation.The right hepatic pedicle and right hepatic vein were transected with a stapler.The tumor was removed after full mobilization of the right liver.The distance between the resection margin to the tumor was 1.5 cm.No complications were detected after the first stage of the operation,while the patient was complicated with pleural effusion after the second stage of the operation and was cured by pleural puncture and drainage.The patient was discharged at postoperative day 9 and followed up at postoperative month 1.The results of follow-up confirmed that the hepatic function was normal,and no mass occupying lesions and pleural effusion were detected.Totally laparoscopic ALPPS is safe and feasible with satisfactory short-term efficacy.