1.To advocate precise hepatectomy and recreate the legend of Prometheus
Chinese Journal of Digestive Surgery 2010;9(1):4-5
From ancient to present,liver has always been a mystery and magical organ.As the largest glandular organ of the body,liver has many vital functions.Its regenerative capabilities and functional reservation allow major resection of up to 80%of its volume.Many diseases,such as liver cancer,cirrhosis and hepatolithiasis Can affect liver,and the mainstay of curative treatment is liver resection.Technological advances play an important role in modern surgery,and a new surgical paradigm characterized by precision has evolved.Recently,we haveadvocated the concept of"precise hepatectomy"on the basis of modem anatomy,physiology,oncology,imaging and surgical techniques,which is characterized by minimal invasion,liversaving and maximally restoration of liver function.Related subjects,including computer sciences,imaging and information are needed to be combined to create a new alliance of treatment.Although,there are still many theoretical and technical problems about liver resection and liver function preservation.With the development of science and technology,precise hepatectomy will further improve the outcomes of liver surgery.
2.Anatomic hepatectomy for the treatment of hepatolithiasis
Jiahong DONG ; Zhiqiang HUANG ; Jingxiu CAI
Chinese Journal of General Surgery 2001;0(07):-
Objective To evaluate the long term results of regular hepatic resection for hepatolithiasis.Methods Five hundred and fourteen patients with hepatolithiasis underwent hepatic resection from Jan. 1975 to Dec. 1998 in Southwest Hospital. The indications included stones confined to one segment or one lobe of the liver, significant atrophy of the portion of the liver harboring the stones from repeated episodes of obstruction and infection, multiple strictures of the ducts in the affected portion of the liver. Resection of S 2 and S 3 was performed in 284 patients, S 2, S 3 and S 4 in 98 patients, S 6 and S 7 in 26 patients, S 5, S 6, S 7 and S 8 in 37 patients; both of the left and right hepatic lobes were partially resected in 23 patients. Additional biliary procedures including choledochojejunostomy and common bile duct exploration were performed in 296 patients.Results The operative mortality was 2 1%, and the morbidity rate was 8 4%. The majority of complications were biliary fistulas (2 9%), subphrenic infection (4 5%), peritoneal abscesses (0 4%) and liver failure (0 6%). Long term follow up on 436 patients at a median of 9 1 years showed that 75 9% were symptom free, 14 5% had occassional mild attacks of cholangitis, 9 6% had severe cholangitis requiring further surgical intervention.Conclusion Anatomic hepatic resection is the most effective treatment and the therapy of choise to eradicate intrahapatic stone foci in cases of hepatolithiasis .
3.Histological changes in the homograft costal cartilage after different modes of processing
Xiaoli DONG ; Zhiqiang WANG ; Lijie ZHAI
Chinese Archives of Otolaryngology-Head and Neck Surgery 2006;0(04):-
OBJECTIVE To compare different methods of processing of homograft costal cartilage. METHODS Homograft costal cartilage samples were processesd by three methods-irradiation, freezing, and alcohol fixation-before being inserted into the rabbit nasal dorsum. They were taken out 12 weeks later and evaluated for histological responses under a optical microscope. RESULTS The histological responses consisted of inflammatory cell infiltration, necrosis, vasal responses and fibroplasia. The was a significant different in degree of inflammatory cell infiltration and necrosis in all three groups(P
4.The relationship between the pathological type of the cancer and postoperative recurrence in early gastric carcinoma
Xiangyu WANG ; Zhiqiang ZHENG ; Jianda DONG
Chinese Journal of General Surgery 1993;0(02):-
Objective To explore the relationship between the pathologic features of the cancer and postoperative recurrence in patients with early stage gastric carcinoma.Methods 139 patients with early stage gastric carcinoma underwent radical resection in our hospital from 1984 to 1995. All cases were followed up for more than 5 years. ? 2 test was used for statistical analysis.Results 7 cases died of hematogenic metastasis, 3 cases died of lymph node metastasis, and stump carcinoma was found in the other 3 cases. The recurrent rate was significantly higher in submucosal tumors (14.1%) than in mucosal tumors (1.9%), in lymphatic and vascular vessel invasion-positive cases (37.5%) than in negative cases (7.6%), in lymph node positive (31.3%) than in negative (6.5%), in synchronous multiple gastric cancer (33.3%) than in solitary tumors (7.9%)(P
5.Morphological study on peribiliary vascular plexus of hepatic portal bile duct in rat
Min XIAO ; Zhiqiang HUANG ; Jiahong DONG
Medical Journal of Chinese People's Liberation Army 1982;0(03):-
Objective To study the morphological structure and the hemodynamics of peribiliary vascular plexus(PVP) of hepatic portal bile duct in rat in vivo,so as to provide an experimental method and accumulate data for further study on the bile duct complications occuring after liver transplantation,operations for bile duct stenosis and other hepatobiliary diseases.Methods Forty SD rats were randomly and equally divided into 2 groups: the control group and the ink-injection group(n=20),microcirculation laser scan confocal microscopy was used to observe the morphological structure and the hemodynamic features of PVP on rat′s hepatic portal bile duct after the bile duct was stained with indocyanine green and the hepatic artery was perfused with ink.Results Morphologically it was showed that PVP were comprised of three layers: the spatial structure of PVP appeared dentriform from outer layer to intermediate layer,and then transformed into a network from intermediate layer to inner layer.The outer layer vessels seemed to be dendritic and located within the ductal wall at 0-60?m scanning from the adventitia,and the branches appeared sparse and straight.The diameter of artery and vein was very different.The vessels of intermediate layer showed as an intricate network and located within the ductal wall in the depth of 40-80?m,and the ranification was rich and tortuous.Inner layer vessels adjacent to the intima appeared to be a plenus in hexagons with 120? intersect angles and uniform diameter.Hemodynamics showed that the flow rate in the artery was higher than that in the vein of PVP.Conclusion The technique,employing microcirculation laser scan confocalmicroscopy,to observe the morphological structure and the hemodynamic features of PVP,may reveal the morphological structure and hemodynamic features limpidly,both macroscopically and dynamically.It can be used as an important tool for the study of bile duct complications after liver transplantation,bile duct stenosis or other hepatobiliary diseases.
6.Management strategy of non-penetrating hepatic trauma
Canrong LU ; Zhiqiang HUANG ; Jiahong DONG
Medical Journal of Chinese People's Liberation Army 2001;0(08):-
Objective To explore the current status of non-operative management strategy for blunt hepatic trauma. Methods The clinical data of patients with blunt hepatic trauma admitted to our hospital during the past 15 years were retrospectively analyzed, and the new standpoints in the selection of therapeutic strategy for blunt hepatic trauma were elucidated with referance to recent litereture, especially regarding the different opinions in non-operative management in the treatment of blunt hepatic trauma between the developed countries and China. Results The concept in the selection of therapeutic strategy for blunt hepatic trauma in China lagged relatively behind the advanced countries. Compared with that in the developed countries, the percentage of non-operative management was significantly lower in China (10%-30% vs 50%-80%), and the fewer CT scanning was carried out in the patients with stable hemodynamics. Conclusion Non-operative management is becoming one of the most important strategies in the treatment of blunt hepatic trauma nowadays. Non-operative management is widely acknowledged as the first choice for blunt hepatic trauma, especially for those with stable hemodynamics. This new trend should be more emphasized in China. Besides, CT scanning as a diagnostic tool should be carried out as frequently as possible in those patients with stable hemodynamics.
7.Effects of Static Wrist on Radial Nerve Palsy
Zhiqiang XIE ; Jiangqin LIU ; Jiang DONG
Chinese Journal of Rehabilitation Theory and Practice 2012;18(9):866-867
Objective To explore the effects of static wrist on radial nerve palsies. Methods 60 patients with radial nerve palsies were devided into wrist group (n=20), acupuncture group (n=20) and intermediate-frequency (IF) group (n=20), who accepted static wrist wearing, electroacupuncture, and intermediate-frequency electro-stimulation respectively. Results The efficacy was not significantly different among these groups, but the time out of working and the cost for the management were the least in the wrist group. Conclusion Wearing static wrist is not only effective on radial nerve palsies, but also reduce the loss of working time and cost of treatment
8.MicroRNA differential expression in liver cirrhosis rats undergoing human umbilical cord mesenchymal stem cell transplantation
Xiangzhong LIU ; Zhiqiang ZOU ; Guiqiang WANG ; Dong LI ; Zhiying SHAO
Chinese Journal of Tissue Engineering Research 2015;(23):3674-3680
BACKGROUND:Human umbilical cord mesenchymal stem cels (hUC-MSCs) can obviously relieve liver cirrhosis, and thereby repair liver injury. However, the molecular mechanism of hUC-MSCs therapy for liver cirrhosis is limited at present, and especialy the non-coding RNA regulation of hepatic gene changes has not been detailed. OBJECTIVE:To investigate the changes of microRNA after hUC-MSCs therapy in rats with liver cirrhosis. METHODS:Liver cirrhosis models were established in rats using carbon tetrachloride subcutaneous injection plus oral administration of alcohol. At 8 weeks after modeling, hUC-MSCs were injectedvia the tail vein once a week for 4 consecutive weeks. At 1 week after the last injection, rat liver tissues were colected for paraffin embedding. Liver RNA was extracted for gene chip analysis. Blood samples were colected and analyzed using an automatic biochemical analyzer to detect the changes of liver function. RESULTS AND CONCLUSION:Alanine aminotransferase, aspartate aminotransferase and gamma-glutamyl transpeptidase were improved significantly after hUC-MSCs therapy. Fat lesions and necrosis of hepatocytes were significantly reduced. MicroRNA expression microarray hybridization analysis and PCR results showed that rno-miR-369-5p, rno-miR-3584-5p and rno-miR-153* were down-regulated during modeling and increased after hUC-MSCs therapy. And rno-miR-93, rno-miR-199a-3p, rno-miR-195, rno-let-7a and rno-miR-19a were firstly up-regulated in the process of modeling and then down-regulated obviously after hUC-MSCs therapy. These results suggest that hUC-MSCs may reverse liver cirrhosis and liver cel damage through up-regulation of rno-miR-369-5p, rno-miR-3584-5p and rno-miR-153*, and down-regulation of rno-miR-93, rno-miR-199a-3p, rno-miR-195, rno-let-7a and rno-miR-19a.
9.Cutaneous metastasis of cholangiocarcinoma in six cases
Bo LIU ; Jing WANG ; Xiaoqiang HUANG ; Jiahong DONG ; Zhiqiang HUANG
Chinese Journal of General Surgery 2010;25(11):910-912
Objective To analyze the clinical characteristics and therapeutic effects of cutaneous metastasis from cholangiocarcinoma. Methods From 2006 to 2009, clinical data of 6 patients found with cutaneous metastasis from cholangiocarcinoma were reported. Perineural and vascular invasion were all found in the primary cholangiocarcinoma in these 6 cases with cutaneous metastasis and results were compared with 60 cases of cholangiocarcinoma without cutaneous metastasis. Follow-up to the 6 patients with cutaneous metastases was conducted at an interval of three months. Results One patient with mixed hepatocellular and cholangiocellular carcinoma developed cutaneous metastatic tumor and the pathological diagnosis was cholangiocellular carcinoma. Three patients with hilar cholangiocarcinoma and two patients with distal cholangiocarcinoma presented cutaneous metastases. All six cases of the primary cancers and cutaneous metastases were diagnosed as moderately- poorly differentiated adenocarcinoma. And there was perineural and vascular invasion in the primary tumors. Perineural and vascular invasion of primary cancer was found in 17of 60 patients with cholangiocarcinoma and without cutaneous metastasis. The cutaneous metastasis was positively correlated to the perineural and vascular invasion in the primary tumor (χ2 = 12. 7288, P <0. 001 ). Two of 6 cases presenting solitary nodular cutaneous metastasis received skin tumor excision. These two patients survived 8 and 10 months respectively. Among four patients with multiple cutaneous metastases,two cases received chemotherapy and survived 3 and 6 months respectively, the other two cases refusing treatment survived 3 and 4 months respectively. Conclusions Cutaneous metastasis usually occurred at cholangiocarcinoma with lower differentation and perineural and vascular invasion in the primary tumor.Solitary nodular cutaneous metastasis could be excised, multiple cutaneous metastases had poor prognosis.
10.Changing strategy of severe acute pancreatitis management
Zhiqiang HUANG ; Qing SONG ; Zhiwei LIU ; Shouwang CAI ; Jiahong DONG
Chinese Journal of Digestive Surgery 2010;09(5):321-325
In 1989, Fitz defined and classified severe acute pancreatitis (SAP) and he thought that surgical treatment of SAP is feasible. Since then, the strategy of treating SAP was a controversial issue over past decades. Currently, relevant literatures reported that medical or minimally invasive treatments are superior to surgical treatment, while it is too early to make the final conclusion because of the complexity of SAP. From 1989 to 2008, 1852 patients with acute pancreatitis were treated at the General Hospital of PLA, and the clinical data of 18 patients who died of SAP were retrospectively analyzed. Based on the analysis, we concluded that medical conservative therapy and surgical operative therapy should not be opposed to each other. Selecting ideal timing and appropriate operation on the basis of pathological changes of retroperitoneum and pancreatitis should be considered seriously, and the new concept of "miniaturization of trauma" should also be introduced in treating SAP.