With the worldwide increase in adult-to-adult live donor liver transplantation, more profound basic and clinical medical research has ensued to solve the key problem of graft failure following liver transplantation. The present status of the study of small-for-size liver syndrome was summarized. Its definition, risk factors, pathogenesis,clinical manifestations, prevention and treatment were included.

Objective To explore the role of somatostatin in protecting small-for-size liver after hepatectomy in rats with cirrhosis.Methods Forty-eight rats with cirrhosis were randomly divided into somatostatin group (group S,n =24) and normal saline control group (group N,n =24).All rats from the two groups were measured with baseline portal vein pressure and blood flow volume.Additionally,at the endpoints of 15,30 and 60 min after ischemia/reperfusion with hepatic inflow occlusion,portal vein pressure and blood flow volume were detected from both groups.Liver function test was also measured at the endpoints of 1,3,5,24 h after ischemia/reperfusion for groups S and N.Results After 15-min ischemia/reperfusion,the portal vein pressure was higher in the rats of group S than that in group N [(19.4 ± 0.8) cmH2O vs.(22.5 ± 1.2) cmH2O (1 cmH2O =0.098 kPa)],there was significant difference (P ＜ 0.05).After 30 min ischemia/reperfusion,portal vein pressure results were (17.1 ± 0.8) cmH2O and (19.7 ± 0.8) cmH2O in group S and group N,respectively,P ＜ 0.05.At different endpoints,portal blood flow volume results were all higher in both groups than baseline figures.Furthermore,maximum portal blood flow volume was observed at the endpoint of 15 min ischemia/reperfusion in both groups,and lower in group S than group N [(10.1 ±0.4)ml/min vs.(11.9 ±0.5)ml/min,P＜0.05].Liver function test revealed AST,ALT,TBil exceed normal limits in rats of both groups,which elevated along prolonged ischemia/reperfusion.One week after hepatectomy,the survival of rats treated with somatostatin (group S,7/10) was superior to saline control group (group N,2/10),P ＜0.05.Future liver volume increased in rats from both groups,much significant increase was determined in group S [(5.5 ± 0.4) g vs.(6.6 ± 0.3) g,P ＜ 0.05].Conclusions Somatostatin might improve portal vein hypertension status in the early stage of small-for-size liver after hepatectomy,and decrease portal blood flow.Furthermore,it could alleviate small-for-size liver injury associated with portal vein hypertension and hyperperfusion,and benefit liver regeneration and improve postoperative survival in rats with cirrhosis.

Jaundice occurs in 19%-40% of the hepatocellular carcinoma (HCC) patients. HCC associated jaundice may be divided into hepatocellular and icteric types in terms of its underlying pathophysiology. The jaundice of icteric type is caused by obstruction of the bile duct through cancer embolus, blood clot, biliary sludge, tumor compression or infiltration. Jaundice and epigastric discomforts are the main clinical manifestations. In the present case, severe acute pancreatitis and acute cholangitis presenting as initial complaints of icteric type HCC were quite rare. A tumor located at the central lobe of the liver and a cancer embolus at the lower part of the common bile duct (CBD) were detected by CT scan. Curative resection of HCC with CBD exploration eradicated both the tumor and the embolus, and no recurrence was found after a 36 month follow-up.

OBJECTIVE: To evaluate the risk of hepatectomy by detecting liver functional reserve preoperatively for patients with primary hepatolithiasis. METHODS: The clinical data of 134 patients with primary hepatolithiasis who underwent hepatectomy were reviewed. In terms of evaluation methods for preoperative liver functional reserve they were divided into a Child-Pugh group (group CP) and an indocyanine green group (group ICG). The preoperative and intraoperative parameters, and the incidence of postoperative complications were analyzed. RESULTS: Liver failure was more common in group CP (12.85%) than that in group ICG (1.56%, P<0.05). The overall complication rate in group CP (37.14%) was higher than in group ICG (18.75%, P<0.05). CONCLUSION ICG15 retention test is more accurate in evaluating liver functional reserve than Child-Pugh scoring system. It may predict the postoperative liver failure in patients with primary hepatolithiasis undergoing hepatectomy, decrease postoperative complications, and increase operation safety.
Adult ; Bile Duct Diseases ; surgery ; Bile Ducts, Intrahepatic ; surgery ; Cholelithiasis ; surgery ; Female ; Hepatectomy ; adverse effects ; Humans ; Liver Failure ; etiology ; prevention & control ; Liver Function Tests ; Male ; Middle Aged ; Patient Selection ; Postoperative Complications ; prevention & control ; Preoperative Care ; Retrospective Studies ; Risk Factors

Objective To summarize the clinical experience of standard piggyback liver transplantation(SPBLT) and modified piggy-back liver transplantation(MPBLT) in the treatment of Wilson′s disease(WD).Methods The clinical records of 29 cases of WD who underwent piggyback liver transplantation over the recent 12 years were analyzed retrospestively.Among them,there were 22 male and 7 female patients,with 6cases aged 8-14y and 23 cases aged 24-37y,who underwent liver transplantation because of chronic advanced liver disease(18cases),fulminant hepatic failure(2 cases),or with normal liver function(9 case),and among them,24 cases showed neurological dysfunction.The modes of operation included SPBLT(13 cases) and MPBLT(16 cases).Results The patients were followed up for 1 month-12 years with the median follow-up time of 47 months.Four patients died in the perioperative period,of which 2 died of hepatic failure due to obstruction of hepatic venous return after SPBLT,and 2 died of hepatic artery thrombosis and bile leakage combined with severe infection.The recipient survival rate at 1 year and 3 years was 86% and 79% respectively.One patient has survived for 12 years.All the levels of serum copper and copper-protein recovered to normal in four weeks post-operatively.Neurological symptoms improved in varying degrees after operation.Conclusions WD patients who undergo PBLT can expect a satisfactory clinical outcome and a good quality of life,and MPBLT can effectively reduce the complications of operation and improve the operation survival rate.