Split liver transplantation (SLT) can expand the donor pool and alleviate the donor shortage contradiction,shorten waiting time and reduce the mortality of patients on the waiting list.Compared with whole liver transplantation,key factors,such as selection of donor and recipient,distribution of graft vascular,technique point of splitting and preservation of the liver graft,deeply impact the clinical effect of SLT.With the deepening knowledge about partial graft liver transplantation and development of organ preservation technology,surgical techniques and progressive prevention means against complications,SLT will have a broader space for development.

Biliary atresia (BA) is a disease because of extrahepatic bile duct obstruction occurred in whole or in part,which may lead to cholestatic cirrhosis and liver failure.Most infant patients will die within 1 year if not treated by operation.Liver transplantation is the only way to cure the disease.Now the operation indications,operation time,characteristics and prognosis of liver transplantation in BA are introduced.

Objective To perform the sentinel lymph node biopsy (SLNB) in the patients with early breast cancer by the strict screening conditions and to analyze the accuracy of the sentinel lymph node for predicting the axillary lymph node status .Methods SLNB combined with methylene blue dye and isotope was performed in 266 cases of early breast cancer treated in this department with full treatment courses .Then the axillary lymph node dissection(ALND) was routinely conducted .With the pathological ex-amination as the standard ,the related factors affecting SLNB were analyzed .Results The detection rate of SLN ,accuracy rate ,sen-sitivity and the false negative rate were 100% ,98 .5% ,95 .56% and 4 .44% respectively ;the accuracy of SLN was significantly cor-related with the tumor size ,pathological type and axillary lymph node status(P<0 .01);the false negative rate of SLN was related with the tumor location(P<0 .05) .Conclusion The combination of methylene blue dye and isotope used in SLNB is feasible in the patients with early breast cancer ,SLN could accurately predict the axillary lymph node metastasis status .

Liver transplantation is currently the only treatment option for end-stage liver disease,but it is limited by the lack of high quality donor livers.The ongoing liver donor shortage could be alleviated by the consequent expansion of do-nor criteria to include the use of livers that would once have been discarded as unsuitable,marginal livers.Static cold storage,the current gold standard of organ preservation,is incapable of reversing the ischemic damage these organs have sustained.In hepatic transplantation,the limitations of cold storage are reflected in the significantly higher rates of early al]ograft dysfunction,primary non-function,and local ischemic cholangiopathy,especially seen with older,steatotic and donation after cardiac death (DCD) grafts.The existing cold storage technology has restricted the use of this kind of organs and machine perfusion preservation technology becomes an alternative choice.In this paper,we review the research progress on machine perfusion preservation of livers,and introduce the normothermic machine perfusion.

BACKGROUND:Daclizumab can be special y combined with the inerleukin-2 receptor on the surface of activated T cells in human body, and this method can reflect the close of interleukin-2 receptor thus inferring the effect of induction therapy. At present, the daclizumab has been widely used in renal transplantation, but there is no consensus on its clinical application in liver transplantation. OBJECTIVE:To investigate the expression of serum CD25+T cells and soluble interleukin-2 receptor in the patients receiving daclizumab for liver transplantation during perioperative period. METHODS:A total of 58 patients received orthotopic liver transplant for the first time were included and then the patients were randomly divided into two groups:control group (n=28) and treatment group (n=30). The patients in the two groups were treated with tacrolimus, mycophenolate mofetil and corticosteroids triple immunosuppressive regimen. The patients in the treatment group received immune induction therapy with daclizumab, and the patients in the control group did not receive daclizumab. RESULTS AND CONCLUSION:Flow cytometry and enzyme-linked immunosorbent assay showed the expression levels of CD25+T cells in the treatment group were significantly lower than those in the control group at different time points after liver transplantation (P<0.01);and the expression levels of soluble interleukin-2 receptor in the treatment group were lower than those in the control group during transplantation and at the first day after transplantation (P<0.05, P<0.01). At 6 months after transplantation, the incidence of acute rejection was decreased in the treatment group (P<0.01). The results indicate that daclizumab can effectively suppress the expression level of CD25+T cells, as wel as the expression level of soluble interleukin-2 receptor in the peripheral blood in the early stage of liver transplantation, thus effectively reducing the rate of acute rejection.

Gastroesophageal varices hemorrhage is a common complication of portal hypertension. Drug and endoscopic therapy have become the basic treatments for varices. Transjugular intrahepatic portal venous shunt is recommended for the management of refractory or recurrent variceal hemorrhage. Liver transplantation will be considered when variceal hemorrhage becomes fatal and traditional therapies are with high risk, contraindicated, or have unsatisfactory results. Patients who received traditional treatments can achieve short-term efficacy and even stabilize the disease for a long time. However, if these treatments lead to complications such as portal vein thrombosis and hepatorenal syndrome, it may increase the risk of liver transplantation complications and affect the patient’s prognosis. Elevated portal venous pressure has a variety of adverse effects on systemic circulation, which can cause hepatopulmonary syndrome, portal pulmonary hypertension, refractory ascites, etc. In these cases, liver transplantation should be performed as early as possible. Conventional treatments are unsatisfactory. In addition, frailty may be worsened after traditional treatment, which will significantly increase the risk of liver transplantation. With the increase of model for end-stage liver disease, the requirement for donor liver volume will also has been increased, which will also affect the implementation of living donor liver transplantation. Some patients with portal hypertension may have poor quality of life and it may also become a clinical indication for liver transplantation. These liver transplant-related issues should be evaluated when administering traditional therapies. Traditional therapies aimed at improving the patient's condition, delaying or controlling complications should not interfere with the consequent implementation of liver transplantation. Improving the long-term overall survival rate and quality of life of patients with portal hypertension is the ultimate standard of all treatments.

OBJECTIVE:To observe clinical efficacy and safety of rhBNP combined with levosimendan in the treatment of acute heart failure,and to investigated the effects of drug combination on serum UA and BNP levels. METHODS:68 patients with acute heart failure were randomly divided into observation group and control group,with 34 cases in each group. Both groups re-ceived routine treatment;control group was additionally given Levosimendan injection 5 ml added into 0.9% Sodium chloride in-jection 45 ml with persistent micropump injection:at pump rate of 12 μg/(kg·min)within first 1 h,and then at pump rate of 0.5μg/(kg·min)for consecutive 23 h;observation group was additionally given rhBNP 1.5 μg/kg for intravenous shock,and then giv-en consecutive intravenous injection of rhBNP at rate of 7.5 ng/(kg·min)continuous 3-7 days on the basis of control group. Clini-cal efficacy of 2 groups were observed,and serum levels of UA and BNP,heart function index,the safety of drug use were ob-served before and after treatment. RESULTS:After treatment,total effective rate of observation group(94.11%)was significantly higher than that of control group (70.59%),with statistical significance (P<0.05). The improvement of serum levels of UA and BNP in observation group was more significant than in control group,with statistical significance (P<0.05). The stroke volume and left ventricular ejection fraction of observation group were significantly better than those of control group,with statistical signif-icance (P<0.05). There was no statistical significance in the incidence of ADR between observation group (2.94%) and control group(5.88%)(P>0.05). CONCLUSIONS:rhBNP combined with levosimendan have significant clinical efficacy and high safety in the treatment of acute heart failure.

Objective To explore the feasibility and clinical efficacy of hand assisted laparoscopic splenectomy (HALS) for ruptured spleen. Methods From January 2002 to October 2002, HALS was performed in 12 cases, among whom were 8 cases combined with other viceral trauma. Results HALS was accomplished successfully in 10 cases and laparotomy in 2. In 10 cases, the operation time of HALS averaged 102.5 minutes. The mean post operative hospitalization was 5.8 days in 4 cases with only spleen trauma and 15.5 days in 6 combined with other viceral trauma. Conclusions HALS is a feasible, effective and safe surgical procedure for the cases with Buntain CT scalingⅡ or Ⅲ spleen trauma with no severe combined trauma.

Objective To evaluate the diagnosis and treatment of chronic pancreatitis complicated by stricture and dilation of the pancreatic duct. Methods The clinical data of 27 patients of chronic pancreatitis with stricture and dilation of the pancreatic duct undergoing operation in our hospital from 1990 to 1999 were analyzed retrospectively. Results Of the 27 patients, the positive diagnosis rate was 89% by B-US, 100% by CT, 100% by MRCP, 100% by ERCP. All patients received surgical operation, 12 patients received Partington procedure, 3 distal pancreatectomy, 4 pylorus preserving pancreaticoduodenectomy, 4 Beger procedure, 2 Frey procedure, 2 pancreatic cystojejunostmy. The complication rate was 11%. Postoperatively 89%(24/27) patients achieved pain relief,78%(18/23) gained in body weight, and diabetes significantly relieved in 5 cases(33%). Conclusion Appropriate diagnosis and treatment are very important for improving the patients′ life quality and natural history of chronic pancreatitis with stricture and dilation of the pancreatic duct.

Objective To explore the effect and significance of systemic inflammatory response syndrome(SIRS )score in predicting prognosis in acute craniocerebral trauma. Methods The clinical data of 620 patients were collected at admission from January 2003 to December 2007, GCS and SIRS score were calculated in 24 hours.The relation of the mortality rates and GCS score were analyzed in different SIRS score patients by controlling age. Results With SIRS score increasing,mortality rates increased as well,and pa-tients with SIRS (score≥2) mortality rates had significantly higher,and also in the same age and GCS score group.Mortality rotes were significant in staifistics (P<0.05). Conclusion SIRS score is significant inde-pendent predicting prognosis in acute craniocerebral trauma and in clinic.