Objective To study the correlation between liver fibroindex and prognosis of hepatocellular carcinoma after hepatectomy.Methods The clinical data of 77 patients with hepatocellular carcinoma who underwent hepatectomy at the 5th Hospital Affiliated to Sun Yat-sen University from 2009 October to 2014 December were analyzed retrospectively.Using data from preoperative Fibroindex,these patients were divided into 2 groups,Group 1:Fibroindex ≤5.4,and Group 2:Fibroindex ＞5.4.The clinical pathological parameters and postoperative disease free survival rates in these groups were analyzed.The Cox ratio risk pattern analysis was used for factors correlating recurrence.Results The parameters in the 2 groups which included sex (35/0 vs 29/13),type of cirrhosis (23/12 vs 14/28),numbers of tumor (35/0 vs 26/16),maximal diameter of tumor (31/4 vs 23/19),vascular invasion status (32/3 vs 26/16),resection margin status (35/0 vs 36/6),hepatic vein/portal vein tumor thrombus status (35/0 vs 29/13),perioperative change of HBV DNA levels (23/12 vs 15/27)were correlated with postoperative recurrence,and they all showed significant differences (P ＜ 0.05).Disease free survival rate in Group 2 was lower than Group 1 (71.4％,33.7％,22.4％ vs 94.3％,46.2％,46.2％,P ＜ 0.05).The Cox regression analysis showed Fibroindex ＞ 5.4,AFP-L3％ ≥ 10％,and number of tumor ＞ 3 to be independent predictors of poor disease-free survival after hepatectomy for hepatocellular carcinoma (P ＜ 0.05).Conclusions Preoperative Fibroindex ＞ 5.4 was an independent adverse predictor of poor disease-free survival.It was valuable to predict postoperative recurrence in hepatocellular carcinoma patients.

Objective To discuss the clinical significance of anomalous origination of right gastric artery in interventional treatment for hepatocellular carcinoma(HCC).Methods The dynamic enhanced CT scanning of the liver with a 64-slice spiral CT unit was performed in 72 HCC patients.In arterial phase,maximum intensity projection(MIP) and volume reconstruction technique(VRT) were used to observe the origin of the right gastric artery and its relationship with the hepatic artery.The findings were compared with the angiographic results.Results Of the total 72 cases,the anomalous origin of the right gastric artery was found in 43(59.8%).The anomalous origins of the right gastric artery included proper hepatic artery(n=19),left hepatic artery(n=17),gastroduodenal artery(n=4),right hepatic artery(n=2) and common hepatic artery(n=1).The results obtained from three-dimensional reconstruction were in good accordance with angiographic findings.Conclusion The anomalously originated right gastric artery most commonly originates from the left hepatic artery.Three-dimensional reconstruction obtained from the 64-slice spiral CT scans can provide the clear and reliable images of the right gastric artery,which is very helpful for the interventional procedure.

Objective To discuss the feasibility of displaying the extrahepatic feeding arteries in hepatocellular carcinoma with the help of multi-slice spiral CT 3D reconstruction and to assess the clinical value of this technique. Methods Triple-phase enhanced CT scanning with a 64-slice spiral CT scanner was performed in 89 patients with advanced primary hepatocellular carcinoma (HCC). Three-dimensional reconstruction techniques,including maximum intensity projection (MIP) and volume rendering (VR),with arterial phase images,were used to display the origination and course of both the intrahepatic and extrahepatic supplying arteries of HCC. The results were compared with the angiographic findings. Results Of 59 cases with massive type HCC,extrahepatic supplying arteries were found in 33. In 21 cases of diffuse type HCC four showed extrahepatic supplying arteries,and in nine cases of nodular type HCC only one had extra-hepatic supplying arteries. The HCC could get their extrahepatic blood supply via eight pathways. A total of 44 extrahepatic supplying arteries were detected,and 19 anomalously originated hepatic arteries were found. Conclusion The extrahepatic supplying arteries in hepatocellular carcinoma are common findings and their supplying pattern are extremely varied,which may be associated with the type and location of the tumors. Three-dimensional reconstruction technique with the help of triple-phase enhanced CT scanning on a 64-slice spiral CT scanner can provide excellent images as vivid and ideal as angiography can afford. Therefore,the times of angiography examination,the use of contrast media as well as the dose of radiation to both the patients and the physicians can be reduced as far as possible. The detailed information about extrahepatic blood supply is very useful for improving the therapeutic result of HCC.

0.05), but the symptom of fever and character of respiratory tract's secretion of the patients in experiment group took turns for better obviously than the control group's ( P

Preoperative diagnosis of biliary obstruction mainly depends on imaging examination.Percutaneous transhepatic cholangiography (PTC) is a common method in detecting biliary obstruction.PTC combined with computed tomography (CT) could enhance the diagnostic rate.From April 2009 to April 2011,8 patients with biliary obstruction were admitted to the Shenzhen Hospital of Peking University.Contrast solution (30 ml of iodine solution at a concentration of 1.5％ -2.0％)was injected through a PTC tube,and then CT scan was performed.An iohexol contrast solution at a concentration of 300 mgl/ml was injected at a dosage of 1.5 ml/kg and at 3-5 ml/s,then the arterial phase,venous phase and delayed phase were scanned.The original data were uploaded to Vitrea 2 workstation for multiplane reconstruction,maximum intensity projection and volume rendering.The procedure was successfully performed on all patients,and the position of the biliary obstruction was identified in 7 patients.Five patients were diagnosed as with hilar cholangiocarcinoma,1 with sclerosing cholangitis and 2 with adenoma of the distal common bile duct.The patients' symptoms were alleviated after percutaneous transhepatic biliary drainage.

Objective To study the clinical outcome of endoscopic vessel harvesting system (EVH) for the treatment of lower limbs varicose veins.Methods Patients (n =41) with varicose veins admitted from Jan 2011 to May 2013 were randomly divided into EVH group (n =20) and stripping group (n =21).Indexes as postoperative VAPS (48 hours and 1 week),subcutaneous ecchymosis (1 week),hematoma(1 week),skin numbness (1 week),CEAP classification (3 months),surgery effect and satisfaction scores(3 months) were compared between the two groups.Results 48 hours and 1 week VAPS was lower in EVH group(P ＜0.01).After EVH there was less subcutaneous ecchymosis (1 week),hematoma(1 week) and skin numbness (1 week) (all P ＜ 0.01).Postoperative CEAP classification improved significantly in both groups (P ＜ 0.01),while surgery effect and satisfaction scores (3 months) were better in EVH group (P ＜ 0.05).Conclusions EVH is a safe and minimally invasive technique in treatment of varicose veins of the lower limbs.

Objective To explore the value of preoperative spleen-liver volume ratio for predicting recurrence of primary liver cancer after hepatectomy.Methods Clinical data of 75 cases of hepatocellular carcinoma undergoing hepatectomy were analyzed retrospectively.According to the preoperative spleen-liver volume ratio,these patients were divided into 2 groups:those with spleen-liver volume ratio ＜ 0.8,and spleen-liver volume ratio≥0.8.Patients were followed-up until March 2014.Cox ratio risk pattern analysis was used for the recurrent correlative factors.Results Univariate analysis showed that preoperative AFPL3％ ≥ 10％,the maximum diameter of the tumor ＞ 5 cm,the number of tumor ＞ 3,spleen-liver volume ratio ≥0.8,vascular invasion,positive resection margin and hepatic or portal vein tumor thrombus were all risk factors of poor disease-free survival (P ＜ 0.05).Cox regression analysis revealed that spleen-liver volume ratio ≥0.8,AFP-L3％ ≥10％,the maximum diameter of the tumor ＞5 cm and hepatic or portal vein tumor thrombus were independent predictors of poor disease-free survival after hepatectomy for hepatocellular carcinoma(P ＜ 0.05).Conclusions Preoperative spleen-liver volume ratio ≥0.8 was an independent adverse predictor of poor disease-free survival.

Objective To study the predictive value of preoperative blood CD4 +/CD8 + ratio in postoperative recurrence after hepatectomy for patients with hepatocellular carcinoma.Methods The clinical data of 67 patients who underwent hepatectomy for hepatocellular carcinoma at The Fifth Hospital Affiliated to Sun Yat-sen University were analyzed retrospectively.Using the preoperative blood CD4 +/CD8 + ratio,these patients were divided into 2 groups,the CD4 +/CD8 + ＜ 1 group and the CD4 +/CD8 + ≥ 1 group.These patients were followed up at the outpatient clinic and/or by telephone till June 2013.The Cox ratio risk pattern analysis was used to determine the significant risk factors of tumor recurrence.Results On univariate analysis,preoperative AFP ≥400 μg/L,maximum diameter of tumor ＞ 5 cm,number of tumor ＞ 3,CD4 +/CD8 + ＜ 1,vascular invasion,positive resection margin,and portal vein tumor thrombus were risk factors of poor disease-free survival (P ＜ 0.05).On multivariant analysis,CD4 +/CD8 + ＜ 1,number of tumor ＞ 3,and portal vein tumor thrombus were independent predictors of poor disease-free survival after hepatectomy for hepatocellular carcinoma (P ＜ 0.05).Conclusions Preoperative CD4 +/CD8 + ＜ 1 was an independent adverse predictor of poor disease-free survival.It was valuable in predicting postoperative recurrence of hepatocellular carcinoma.

BACKGROUND:Previous studies have reported the cause and treatment of biliary complication. However, how to improve operative technique for preventing the complication is rarely reported.
OBJECTIVE:To explore the effect of operational skil s during liver transplantation on biliary complications.
METHODS:Biliary complications in 475 patients who underwent liver transplantation were retrospectively analyzed. The relationship between operational skil s and biliary complications after liver transplantation was observed. The potential risk factors about operative technique were summarized. Some preventive interventions for biliary complications were suggested.
RESULTS AND CONCLUSION:Biliary complication was diagnosed in 36 (7.6%) of 475 patients who underwent liver transplantation. They were nonanastomotic biliary stricture (n=19, 4.0%), anastomotic biliary stricture (n=7, 1.5%), biliary leakage (n=3, 0.6%), twisted common biliary duct (n=3, 0.6%), residual common duct stone (n=1, 0.2%), and neoformative common duct stone (n=3, 0.6%). There was no difference in the incidence of nonanastomotic biliary stricture among the three biliary anastomotic styles. The possibility of anastomotic biliary stricture in placing T-drainage tube group was lower than the other two groups according to clinical data. Nevertheless, there was no statistical difference between these three groups. Infusing UW into the liver from cranial mesenteric vein and douching the biliary duct immediately while taking the donor could decrease the incidence of biliary complication after liver transplantation (P=0.013 and P=0.018, OR=0.26 and OR=0.28), the later factor could also decrease the incidence of nonanastomotic biliary stricture (P=0.001, OR=0.09). Meanwhile, some operational skil s also decrease the incidence of biliary complications, such as protecting the artery around the biliary duct, and elevating the liver when suturing the common biliary duct.