Anterior approach refers to a method of hepatectomy which is first to resect the hepatic parenchyma and then to free the liver; hanging maneuver refers to placing a tape before the inferior vena cava for hanging the liver during hepatectomy.In October 2011,anatomical trisectionectomy was performed on a 54-year-old male patient with large hepatocellular carcinoma in the left medical lobe and right lobe with anterior approach and hanging maneuver.The diameter of the tumor was 16 cm,and was in the ⅢA/T3NOM0 stage.The indocyanine green retention at fifteen minutes was 5.4％,and the ratio of hepatic left lateral lobe volume over the standard total liver volume was 44％.The left bile duct was slightly dilated because of the compress of the tumor.The operation started with the isolation and dissection of the inflow vessels,including the right hepatic artery,the right portal vein,the middle hepatic artery,the portal vein branches of left internal lobe.The hepatic parenchyma transection was performed along the fight side of the falciform ligament.A tape was passed between the anterior surface of inferior vena cava and liver,and the liver was suspended during the transection.The left bile duct was cut at the right side of round ligament,and then the middle hepatic vein and the right hepatic vein were resected.The ligaments around the liver were dissected and the right hepatic lobe was removed.Finally,the end-toend anastomosis between the left hepatic duct and the common hepatic duct was performed.The operation lasted for 4 hours and the intra-operative blood loss was 350 mL.The patient was recovered well.At the end of 4 months after surgery,magnetic resonance cholangiopancreatography showed that the anastomosis of the bile duct was unobstructed,and there was no recurrence of tumor inside the liver.

BACKGROUND: Mobilizing autologous or extraneous bone marrow-derived liver stem cells may promote liver regeneration, however, its safety before the large scale clinical application needs further evaluation.OBJECTIVE: Bone marrow-derived liver stem cells (BDLSCs) were induced by culturing the rat bone marrow mesenchymal cells in the medium containing 5% cholestatic sera, and then were implanted into nude mice to observe the tumorigenicity. METHODS: Rat bone marrow mesenchymal cells (BMSCs) were isolated and incubated in the medium containing 5% cholestatic sera. Immunofluorescent stain was used to detect the expression of albumin, alpha-fetoprotein and cytokeratin18 by the cultured cells. Glycogen and urea synthesis by these cells were analyzed, respectively. BDLSCs following 14 days of culture were incubated in the skin of nude mice to observe neoplasia in local site. RESULTS AND CONCLUSION: Rat BMSCs survived in the medium containing 5% cholestatic serum and formed into small colonies on the fourth day after culture. Seven days later, the colonies expanded and there appeared some polygonal cells in the peripheral area. About 14 days later, these polygonal cells were confluent and presented the shape of cobblestone. Immunofluorescent stain showed that these cells expressed cytokeratin18, albumin and alpha-fetoprotein. Staining for glycogen displayed that glycogen granules were seen in cells. From 12 to15 days after culture, urea nitrogen concentrations in the medium were gradually increased. Rat BDLSCs were incubated in the skin of nude mice. Thirty days later, no neoplasia was found in the local site, and the tissue structure was normal. This result indicated that rat BDLSCs induced with the medium containing 5% cholestatic serum might have not tumorigenicity.

Objective To investigate the clinical features of IgG4 related autoimmune pancreatitis (AIP). Methods Clinical data of 12 patients pathologically diagnosed as IgG4 related AIP in Department of Hepatopancreatobiliary Surgery, Sun Yat-sen Memorial Hospital of Sun Yat-sen University from January 2003 to December 2012 were retrospectively analyzed. The informed consents of all patients were obtained and the ethical committee approval was received. All the patients were males with a mean age of (54±13) years old. All were misdiagnosed as pancreatic head carcinoma and received pancreatoduodenectomy. Data of the clinical manifestations, laboratory, imaging and pathological examinations were collected. The patients were followed up after operations, the treatment and outcome were studied. Results The clinical manifestations of the 12 patients were abdominal pain (n=7), jaundice(n=7), emaciation(n=6) and no obvious symptom (n=1). Three cases were combined with diabetes, 1 case with chronic sialadenitis of submandibular gland. The patient's blood and urine amylase were normal. Blood gamma-glutamyl transpeptidase (GGT) increase was observed in 12 cases. Mild increase of carbohydrate antigen 19-9 (CA19-9) was observed in 9 cases. Cancer antigen (CA) 125 increase was observed in 3 cases, and carcinoembryonic antigen (CEA) increase in 2 cases. Through contrast-enhanced CT, partial pancreatic head enlargement was observed in 11 cases, in which 3 cases were observed combining with mild expansion of pancreatic duct. Through magnetic resonance imaging (MRI), sausage-like change of pancreas body was observed in 4 cases, peripancreatic sheath-like change in 5 cases. Through magnetic resonance cholangiopancreatography (MRCP), stenoses in the pancreatic duct of pancreatic head segment and distal common bile duct were observed including 4 cases of mild expansion in the distal pancreatic duct. Local invasion was not observed by imaging examinations. Lymphoplasmacytic sclerosing pancreatitis was determined by pathological examination. Positive expression of IgG4 was observed by immunohistochemistry. Twelve cases suffered from discontinuous abdominal pain after operations, in which 7 cases needed acesodyne. One case relieved after using prednisone. Conclusions Clinical manifestations of IgG4 related AIP are similar to pancreatic carcinoma and can be misdiagnosed as pancreatic carcinoma easily. The main clinical features are mild increase of blood CA19-9. Partial pancreatic head enlargement, pancreas body sausage-like change, peripancreatic sheath-like change, and no local invasion are observed by imaging examinations. Lymphoplasmacytic sclerosing pancreatitis is determined by pathological examination. Positive expression of IgG4 is observed by immunohistochemistry. Adrenocortical hormone treatment is effective.

Objective:To investigate the effectiveness of antibiotics in preventing surgical site infection (SSI) after hepatectomy.Methods:The clinical data of patients who underwent hepatic resection at the Department of Biliary and Pancreatic Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, from Jan 2019 to Dec 2021, were retrospectively analyzed.Results:A total of 509 patients were included in the study. There was no statistically significant difference in the incidence of SSI in the different prophylactic treatment time groups ( P>0.05). Univariate analysis revealed bile leakage, extent of hepatic resection, surgical procedure, level of anesthesia, and duration of surgery as potential risk factors for SSI after hepatic resection ( P<0.05); Multivariate analysis showed that bile leakage, extensive hepatic resection, open surgical approach, grade 3-4 anesthesia level, and operative time longer than 300 minutes might be independent risk factors affecting SSI after hepatectomy ( P<0.05). Conclusion:Prolonging antibiotic prophylaxis for SSI after hepatectomy may be unnecessary.