Caudate lobectomy is still a great challenge for surgeons due to unique anatomy of caudate lobe.A 38-year-old male patient with a huge recurrent hepatic cancer (diameter =16 cm) in caudate lobe received caudate lobectomy with portal triad and inferior vena cava clamping.The operation was paused due to hemorrhage (volume of blood loss =1000 ml).After heat preservation and blood transfusion,the caudate lobectomy was completely removed with inferior vena cava clamping.The patient gradually recovered,and no tumor recurrence was detected during the follow up (14 months).Caudate lobectomy could be safely carried out under the condition of accurate preoperational estimation,clear indication for surgery and precise hepatectomy.

With the era of precision hepatic surgery coming,the hepatic surgery has been promoted to brand-new level,which would be more accurate and meticulous.However,all those advances,such as super-thin computed tomography scan,three-dimensional imaging and the technology of threedimensional printing,have not promoted the clinic results for patients overtly.The optimal curative effect could be attained,if there is a perfect combination of operators' experience and those advanced imaging.For two issues,the time of vascular inflow occlusion and residual hepatic volume,operators could flexiblely use of clinic existing researches with surgical team and instruments according to the medical condition of patients.Precision hepatic surgery could be promoted to a higher level through constantly clinical research and innovations.

Biliary cystic tumors (BCTs) are rare cystic tumors and are accounted for less than 5％ of liver cysts.BCTs are very common in middle-aged and elderly women,and depend on diagnosis of imaging including papillary projection or multilocular cystic liver mass.BCTs are frequently misdiagnosed due to the absence of specific diagnostic indicators,which should differentiate from diagnosis of hepatic cystic.Complete surgical resection is the first choice for BCTs with a good out-come,in addition to low recurrence.Once recurrence was identified in follow-up,BCTs can be treated by reoperation with a good outcome.

Objective To investigate the clinical manifestations of chronic pancreatitis(CP)and choice of the surgical therapy. Methods The clinicopathological and follpw-up data in 91 cases surgically treated in our hospital from January 1980 to January 2006 were retrospectively analyzed.Resuits The causes for CP were biliogenic one in 34 patients(37.4%),alcohol in 14(15.3%),iniury in 8(8.8%),acute pancreatitis in 14(15.3%)and idiopathic one in 20(22%).RelaPsing upper abdominal pain was the major symptom of CP.There were only two patients that were up with endoscopic sphincterotomy(EST)and the others were operated on.The operative morbiditv was 6.6%(n=6),and mortality 1.1%(n=1).Mean hospital stay was 17.7d.For the 9l patients with preoperative pain,the pain was relieved in 88.Conclusion The best operative procedure should be chosen for treatment of CP according to causes,clinical findings,imaging records and pathological examination.

Open hepatectomy(OH) is a effective treatment for benign and malignant liver lesions. However, OH has major abdominal trauma and many postoperative complications. How to reduce OH-induced trauma is still a big problem for liver surgeon. Fortunately, the emergence of laparoscope provides a route to solve this problem. But the technology of laparoscopic liver resection is not yet mature. This article reviews some relevant circumstances about laparoscopic hepatectomy.

Secondary pancreatic infection in severe a-cute pancreatitis (SAP) was associated with mortality and the length of stay in hospital.Intensive Care Unit (ICU) identificate shock on account of the oxygen metaboilic level in earlier period of SAP and perform adequate fluid resuscita-tion.it advocate to perform organ function support and/or substitution therapy in time and think highly of coordination and combination each other among various kinds therapeutic measure.These therapeutic concept and measure will con-duce to decrease the incidence rate of MODS and secondary pancreatic infection accordingly in SAP.

Pancreatic cancer is still a dismal disease.Angiogenesis is very important for the development of pancreatic cancer.Pancreatic stellate cells (PSCs) are the main source of extra-cellular matrix of pancreatic cancer and they provide advantageous microenvironment for cancer cells.PSC could promote the angiogenesis of pancreatic cancer both in vitro and in vivo.Further studies of the angiogenesis of pancreatic cancer are helpful in learning the characteristics of development and metastasis of pancreatic cancer,and provide new treatment method in the cellular and molecular levels.

Objective To summarize recent researches on mechanism of the hepatic ischemic preconditioning(IPC) and its clinical applications on hepatectomy and liver transplantation.Methods Relevant references about basic and clinical researches of hepatic IPC were collected and reviewed.Results Recent experimental researches indicated that IPC could relieve hepatic ischemia-reperfusion injury(IRI) by remaining and improving energy metabolism of liver,regulating microcirculation disorder,decreasing the production of lipid peroxidation and oxyradical.It could also inhibit the activation of inflammatory cells and the release of cytokine,suppress cell apoptosis and induce the release of endogenous protective substance.Till now,most of the clinical researches had confirmed the protective function of hepatic IPC,but there were still some references with opposite opinions.Conclusion Hepatic IPC could relieve liver IRI,but its clinical application value on hepatectomy and liver transplantation still need more researches to prove.

Caveolin are a family that proteins are highly conserved and located at the mammalian plasma membrane.They include four isoforms:Cav-1,Cav-2,Cav-3 and Cav-4.Caveolin proteins are implicated in endocytosis,lipid metabolism and cellular signaling.There is recent evidence that Cav-1 expression levels in tumour have been associated with tumour growth and metastasis,stromal car-1 expression downregulated have been also associated with mutli-tumor metastasis.

Objective To discuss clinical factors associated with high serum bilirubin level postoperatively in patients with liver cancer. Methods In this study,130 postoperative cases of primary liver cancer were divided into two groups of high serum bilirubin and of normal bilirubin according to serum bilirubin level during two weeks of postoperation. Results Preoperative serum bilirubin、 Child grade、 operation time、 blood loss and types of hepatic vascular exclusion were correlated with the level of postoperative serum bilirubin. Types of hepatic vascular exclusion was a independent factor predicting postoperative elevation of serum bilirubin level. Conclusions Preoperative liver function, operation time, types of hepatic vascular exclusion and blood loss are all among factors influencing postoperative serum bilirubin level.