Objective To explore the effect of relative warm ischemia (RWI) on bile nature and component in rats self-liver transplantation.Methods Thirty two rats were randomly divided into group Ⅰ (control group),group Ⅱ (RWI 0 min),group Ⅲ (RWI 30 min),and group Ⅳ (RWI 60 min).The levels of bile phospholipids (PL),total bile acids (TBA),and PL/TBA ratio were detected early after self-liver transplantation.The concentration changes of hydrophilic and hydrophobic bile acids were examined.Results Only PL concentration of group Ⅱ seemed to be lower than that of group Ⅰ (P ＜ 0.05),without any change for other indexes.Compared with group Ⅱ,only the PL and TBA concentrations of the group Ⅲ were decreased significantly (P ＜ 0.05),and no significant difference was found between two groups on PL/TBA ratio and mole fractions of bile acids (P ＞ 0.05).Compared to group Ⅱ,the concentrations of PL and TBA,PL/TBA ratio,and the mole fraction of taurocholic-β-mouse acid (T-β-MC) were much lower in group Ⅳ (P ＜ 0.05),and the mole fraction of taurocholic acid (TC) were higher in group Ⅳ (P ＜ 0.05).Conclusions RWI caused changes of PL/TBA ratio,hydrophilicity and hydrophobicity of bile early after liver transplantation,and the changes were directly proportional to the RWI time.The property of bile in early transplantation seemed not to be changed when the relative warm ischemia time was less than 30 min.When the RWI time was longer than 60 min,the bile component was changed obviously and the toxicity was increased.In liver transplantation,arterial anastomosis should be completed as soon as possible,and the RWI time should be less than 30 min.

0.05),but the injury was more serious in hilar bile duct compared with those of the proximal and distal common bile ducts(P

Objective To comparatively study the ischemia-reperfusion injuries caused by heterogeneity of different positions of the biliary system and different construction patterns of the peribiliary vascular plexus. Methods Thirty rats were randomly divided into 3 groups: Group Ⅰ , sham operated; Group Ⅱ , 1h ischemia in biliary tract followed by 1h reperfusion; Group Ⅲ, 1h ischemia in biliary tract followed by 2h reperfusion. TUNEL assay, pathomorphology score determination and ultrastructural quantitative analysis were performed on epithelium of the hilar bile duct, proximal common bile duct and interlobular bile duct. Results In groupⅡ , TUNEL assay and pathomorphology score showed no statistical difference between proximal common bile duct and interlobular bile duct (P＞0.05) but showed significant differences in the hilar bile duct(P＜0.05). Mean volume (V) of mitochondria and area density of microvilli were obviously serious in the hilar bile duct but obviously slight in the proximal common bile duct(P＜0. 05). In group Ⅲ, the results of the above detections showed that the most severe was in hilar bile duct, followed by the interlobular bile duct and proximal common bile duct(P＜0. 05). Conclusion Different injuries in various parts of the biliary system are caused by heterogeneity of biliary epithelial cells and construction patterns of the peribiliary vascular plexus. It also provides the experimental basis to explain the higher incidences of hilar bile duct stricture. It could be taken as the best position when the bile duct is anastomosed.

BACKGROUND: Studieshave shown that long time of warm ischemia or cold preservation would injury the biliary tract in liver transplantation. However, whether relative warm ischemia (RWI) of biliary tract would result in bile component changes is unclearly. OBJECTIVE: To establish auto-liver transplantation bile ducts RWI models, observe the effects of RWI on the bile salts and phospholipid concentration secreted by the donor liver, and to study the correlation between the total bile salt/phosphoUpid ratio (TBA, PL ratio) and billary tract injury. METHODS: A total of 32 SD rats were selected for auto-liver transplantation models with bile ducts RWI, and the rats were randomly divided into 4 groups (n=8). In Group Ⅰ (sham operation group), rats only received liver dissociation without any cold reperfusion. The RWI time of Group Ⅱ,Ⅲ, and Ⅳ were 0 minutes, 30 minutes and 60 minutes, respectively. The concentration of TBA in bile was measured with enzymatic cycling assay, andPL with enzymic colorimetric. Pathological observation with light microscope and ultrastructural observation with transmission electron microscope were performed on the hilar bile duct. The endothelial cell apoptosis was detected with TUNEL assay. The correlation between TBA, PL ratio and biliary injury was analyzed. RESULTS AND CONCLUSION: One rat died, the other 31 rats were included in the final analysis. RWI could change the composition of bile secreted by donor liver, raise the TBA/PL ratio, and increase the bile toxicity. These changes had a positive correlation to RWI time, and the changes were obviously with time prolonged. In addition, the changes are closely related to the biliary tract injury. This study shows an important mechanism of the biliary tract injury caused by RWI-injury.

Objective To investigate the safety,feasibility and effectivity of laparoscopic left hemihepatectomy for left hepatolithiasis.Methods From Jan.2005 to Dec.2013,36 patients with left hepatolithiasis underwent laparoscopic left hemihepatectomy (group LH),in comparison with 39 other patients who underwent conventional open left hemihepatectomy (group OH).The blood supply to left liver was dissected and cut off first.The liver parenchyma was transected and the left hepatic vein was dissected and clamped.Intraoperative choledochoscopy was carried out through the stump of left bile duct,laparoscopic choledocholithotomy and T-tube drainage were carried out when stones were found in the common or right bile duct.Blood loss,rate of residual stone,complication rate between the two groups were compared.Results The success rate of operation was 100％.Compared with group OH,group LH had shorter postoperative hospitalization,less incision infection and fewer analgesia needed(t =3.75,x2 =4.11,x2 =22.12,P ＜0.05).There was no statistical difference for blood loss,rate of transfusion,and postoperative complications such as bile leakage,pleural effusion,ascites,residual stones (t =0.66,x2 =0.70,x2 =0.01,x2 =0.52,x2 =0.01,x2 =0.28,x2 =0.01,P ＞ 0.05).Conclusions Laparoscopic left hemihepatectomy is safe,feasible,and effective for hepatolithiasis of the left liver lobe.

Objective To study the value of combination detection of four markers in predicting the early recurrence and metastasis after hepatectomy.Methods Peripheral blood samples were obtained from 40 primary hepatocellular carcinoma and controls,Reverse transcription-polymerase chain reaction (RT-PCR) was used to detect AFP mRNA,h-TERT mRNA,CD44v6 mRNA and MAGE-1 mRNA in PBMC.Results The positive rate of AFP mRNA,h-TERT mRNA,CD44v6 mRNA,MAGE-1 mRNA was 50％,62.5％,55％,37.5％ in PHC patients.The positive expression rate of AFP mRNA and hTERT mRNA were 15％,30％ in patients with chronic active hepatitis,there was significant difference in the positive expression rate of two groups (respectively,~ =6.910,5.640,all P ＜ 0.05).There was no expression of the four markers in peripheral blood of healthy adults.Eight patients showed recurrence or metastasis in 9 PHC patients who has positive expression of the four markers,while none of patients who has no expression of any of four markers showed recurrence or metastasis.The difference among the groups was statistically significant (x2 =9.244,P ＜ 0.01).Conclusions The combinatorial detection of AFP mRNA,h-TERT mRNA,CD44v6 mRNA and MAGE mRNA expression increased the accuracy of predicting recurrence or metastasis of PHC patients in early postoperative phase.