Objective To analyze the impact of obesity on short-term prognosis in patients who underwent surgery for cirrhotic portal hypertension with hypersplenism.Methods The clinical data of 310 patients with cirrhotic portal hypertension who underwent splenectomy and portaazygous devascularization between Apr.2002 and Jue.2012 were prospectively analyzed.According to the body mass index (BMI),these patients were divided into the non-obesity group (BMI ＜ 28 kg/m2) and the obesity group (BMI ≥28 kg/m2).There were 78 patients in the obesity group (male:female 56:22; mean age 48.7 ± 8.3years).There were 232 patients in the non-obesity group (male:female 166:66; mean age 46.3 ± 6.9years).The postoperative outcomes in the two groups were analyzed.Results When compared with the nonobesity group,there were significant differences in age (48.7 ± 8.3 in obesity group vs 46.3 ± 6.9 years in non-obesity group),perioperative blood transfusion (400 ± 100 vs 200 ± 100 ml),intraoperative blood loss (370 ± 110 vs 240 ±60 ml),operation time (180 ±40 vs 150 ±35 min),serum albumin level after surgery (28.1 ±2.6 vs 31.2 ±2.3 g/L),drainage volume (280 ±70 vs 230 ±60 ml) and hospital stays (10.5 ±3.0 vs 8.5 ± 2.5 days) in the obesity group (P ＜ 0.05).However,there were no significant differences in gender,preoperative level of liver function,platelet counts (preoperative and postoperative) and postoperative deaths (P ＞ 0.05).Conclusion BMI was a significant independent prognosis risk factor for patients with cirrhotic portal hypertension undergone splenectomy and portaazygous devascularization.

Objective To investigate the effects of preoperative nutrition support on postopreative clinical outcome in patients with nutritional risk with pancreaticoduodenectomy.Methods Forty six patients with pancreaticoduodenectomy complicated with malnutrition from June 2011 to September 2013 in Department of Hepatobiliary and Lapoaroscopic Surgery of People's Hospital of Wuhan University were randomly divided into experimental group (n =23) and control group (n =23) with random number table,patients in experimental group received preoperative nutrition support,but patients in control group did not receive preoperative nutrition support.The preoperative and postoperative nutritional status,the incidence of postoperative complications,the length of hospital stay,and the cost of hospitalization in the two groups of patients was compared.Results In terms of intra-operative blood loss and the operative time,experimental group was significantly lower than those in control group [(340 ±90)min vs (420 ± 104)min,(761 ± 100)ml vs (901 ± 150)ml,P＜0.01],on the 1st day of preoperation,the 1st day,7th day and 14th day of post operation,the levels of serum albumin was significantly higher than those in control group [(30.6 ± 1.8) g/L vs (24.6±2.2) g/L on the,P＜0.05];and on the 1st day of pre-operation,the 1st day,7th day of post operation,the levels of transferrin were significantly higher in experimental group than in control group [(3.23 ± 0.65) g/L vs (2.38 ± 0.49) g/L on the,P ＜ 0.05);the rate of post operative complication were significantly lower in experimental group than that in control group (52.2％ vs 21.7％,P=0.000);the postoperative anal exhaust time was earlier in experimental group than that in control group [(6.4 ± 0.6) d vs (9.5 ± 0.6) d,P =0.000),and the length of hospital stay was shorter in experimental group [(20.1 ± 6.5) d vs (26.7 ± 9.5) d,P =0.014),and the cost in experimental group was lower [(99 ± 13) thousand yuan vs (115 ± 13) thousand yuan,P =0.000),however,the cost of nutrition support between the two groups was not significantly different (P =0.210).Conclusions Preoperative nutrition support is helpful to reduce the incidence of postoperative complications,shorten the length of hospital stay,to save medical costs for patients with pancreaticoduodenectomy.

Objective To evaluate the therapeutic effectiveness and safety of combining chemoembolization using microspheres with iodized oil in the treatment of patients with hepatocellular cancer.Methods According to the inclusion and exclusion criteria,two reviewers independently completed the whole process of data search,selection,collection and quality assessment.The Medline,Cancer Lit,PUBMED,EMBASE,Cochrane Library,CNKI,CBM,VIP,Wanfang Data and Grey literature were searched for randomized controlled trails (RCTs) on combining chemoembolization using microspheres with iodized oil in the treatment of liver cancer.The search was from January 2005 to December 2012.The software package Rev Man 5.1 (the Cochrane collaboration) was used to conduct the Meta-analysis and to analyze the data.Results Of the 159 trials selected out from January 2005 and December 2012 for review,only five RCT involving 471 patients were finally included into the analysis.When compared with chemoembolization by iodized oil alone,the combination treatment significantly improved the therapeutic effectiveness (CR + PR).However,there was no obvious difference between the two methods of treatment in the incidence of adverse reaction.Conclusions Combining chemoembolization using microspheres with iodized oil for patients with hepatocellular cancer was effective in controlling liver cancer progression.There is still a need to reduce the incidence of adverse reaction in future.

Objective To explore feasibility of laparoscopic hepatectomy for hepatic hemangioma.Methods Twelve patients were treated by laparoscopic hepatectomy, including left lateral lobectomy in 5 cases and local liver resection in 7 cases. Three cases of hepatic hemangioma associated with gallbladder stone were performed cholecystectomy synchronously. Results Laparoscopic procedures were successfully performed in all 12 cases. The mean operative time was 155 min. The mean blood loss was 230 mL. The mean postoperative hospital stay was 8 days. The pospostoperative recovery was smooth except that 1 case had pulmonary infection. During a follow-up of 6-20 months for 12 cases,there were no recurrence. Conclusion Laparoscopic hepatectomy for hepatic hemangioma is safe and feasibile with good effect under the condition of strict indication selection and experienced surgeons operating.

Objective To explore ffie effects of magnesium isoglycyrrhizinate injection,polyene phosphatidylcholine(PPC)and reduced glutathione(GSH)in patients with liver cirrhosis accompanied by benign obstructive jaundice after surSery.Methods Fifty-nine patients with liver cirrhosis and benign obstructive jaundice caused by gallstones were selected,and all of them were treated with magnesium isoglycyrrhizinate injection and GSH preoperatively.Thirty-one odd number patients received magnesium isoglycyrrhizinate injection,PPC and GSH treatment(group A)after surgery immediately,28 even number patients still continued to be treated with magnesium isoglycyrrhizinate injection and GSH(group B).The plasma alanine aminotransferase(ALT),aspartate aminotramsferase(AST),total cholesterol(TBIL)and cholinesterase(ChE),and prealbumin at the time of 1,3 and 7 day after surgery were compared between the two groups.Results Seven patients were excluded from this research including 3 cases in group A,4 cases in group B.The plasma ALT,AST,TBIL of the group A at postoperative 3,7 day[(193 ± 48)and(63 ± 17)U/L,(194 ± 57)and(54 ± 19)U/L,(99 ± 20)and(28 ± 9)μmol/L]were significantly lower than those of the group B[(235 ± 50)and(103 ± 33)U/L,(235 ± 64)and(82 ± 22)U/L,(127 ± 45)and(43 ± 18)μ mol/L,respectively](P＜ 0.05),whereas the plasma ChE and prealbumin of the group A[(3781 ± 294)and(4405 ± 469)U/L,(0.22 ± 0.07)and(0.30 ± 0.04)g/L]were significantly higher than those of the there were obvious differences of the plasma ChE and prealbumin at postoperative 3 or 7 day compared with those at postoperative 1 or 3 day in the group A(P ＜ 0.05).But this were improved at postoperative 7 day compared with those at postoperative 3 day in the group B(P＜ 0.05).Conclusion Combined treatment of magnesium isoglycyrrhizinate injection,PPC and GSH can be more effective to reduce the injury of the liver cells and promote the recovery of liver function for patients with liver cirrhosis and obstructive jaundice.

Objective To compare the efficacy of open and laparoscopic fenestration for congenital liver cysts.Methods We analyzed the clinical data of 71 cases with congenital liver cysts,who were treated at our department from June 2000 to June 2006. Among the cases,34 received open fenestration (laparotomy group),and the other 37 underwent laparoscopic fenestration (laparoscopy group). The operation time,perioperative blood loss,postoperative hospital stay,and cost of hospitalization were compared between the two groups. Results The laparoscopy group had significantly shorter operation time [(45?15) min vs (75?15) min,t=-7.016,P=0.000],fewer perioperative blood loss [(24?8) ml vs (50?12) ml,t=-10.823,P=0.000],and shorter postoperative hospital stay [(7.6?1.3) d vs (12.2?2.1) d,t=-11.196,P=0.000] than those in the laparotomy group; whereas no significant difference was observed in the cost of hospitalization between the two groups [(10210?1090) RMB vs (10180?1130) RMB,t=0.114,P=0.910]. None of the patients in both the groups showed bile leakage or massive hemorrhage after the operation. Among the cases,62 patients (62/71,87.3%; 32 in laparoscopy group,and 30 in laparotomy group) received a mean of 25-month follow-up (ranged from 6 to 48 months),during the period,one case of recurrent cyst was detected by B-ultrasonography in laparotomy group. The rate of recurrence was 1.6% (1/62). Conclusions Laparoscopic fenestration can be a replacement of open fenestration owing to its advantages in short operation time and postoperative hospital stay and less hemorrhage and quicker recovery.

Objective To report our experiences in difficult laparoscopic cholecystectomy (LC). Methods The clinical data of 201 cases of difficult LC performed from March 2006 to December 2008 were analyzed retrospectively,and the surgical operation approaches were summarized. The cases included 107 patients with pyknotic conglutination around the gallbladder or gallbladder triangle area,38 patients with gallbladder neck stone,11 patients with suppuration or gangrene of the gallbladder,18 patients with atrophy of the gallbladder,and 17 patients with operation history in the upper abdomen. Results The LC was completed in 193 of the cases,the other 8 cases were converted to open surgery. The causes for conversion to open surgery included intractable bleeding at the gallbladder triangle in 3 patients,the gallbladder being covered by stomach,colon and duodenum in 1,gallbladder gangrene in 1,bile leakage resulted from slightly lacerations of the posterior wall at the confluence of the gallbladder and bile duct in 2,and frozen likeness of the gallbladder triangle in 1. The complications of LC included intestinal obstruction (1 case),pulmonary infection with respiratory dysfunction (1 case),and postoperative bleeding (1 cases). No extrahepatic bile duct injury and death occurred in this series. Conclusions For difficult LC,we must abide by the rules as follows: to dissect as far as possible adjoin to the gallbladder;to discriminate the tissues or organs before cutting it;to execute LC in combination with mute and acuminate dissection and antegrade and retrograde approach for resection;to make pneumoperitoneum through a small incision for patients with history of operations in the upper abdomen. Only obey the laparoscopic surgical principle and use correct surgical approaches,can we reduce the incidence rates of complications and conversion to open surgery.

Considerable clinical and experimental evidence supports that liver injury in acute pancreatitis (AP) is a sign for the potential progression to systemic inflammatory reaction.The Kupffer cells,various cytokines and macrophage migration inhibitory factor (MIF) play important roles in the pathogenesis of AP associated liver injury.However,the specific molecular mechanism of the liver damage remains uncertain.Therefore,efforts should be made to clarify the regulatory mechanism and related cell signaling disorders of liver injury in AP,which could not only identify novel therapeutic targets,but also provide new insight into improving the clinical treatment.Here our review discusses the recent research progress on the etiology,pathology and diagnosis and treatments of liver injury in AP.

Objectives To study the effect of preoperative platelet transfusion for splenectomy and devascularization in the prevention of intraoperative and postoperative bleeding.Methods The 230 patients with cirrhosis and portal hypertension who received splenectomy and periesophagogastric davascularization were divided into strata A,B and C according to the platelet counts.Stratum A patients had a platelet count of less than 30× 10/L,B between 30× 10/L and 50× 109/L,and C more than 50 × 109/L.The patients in each stratum were then randomly divided into a preoperative transfusion group (T group) and a non-transfusion group (NT group).The amounts of intraoperative bleeding,postoperative drainage in 48 hours after operation,rates of postoperative bleeding,and general medical conditions were compared.Results A comparison in stratum A showed lower amounts of intraoperative bleeding and 48 hour postoperative drainage,and a lower rate of bleeding in the T group (P＜0.05).There were no significant differences between the T and the NT groups in strata B and C (P＞0.05).Conclusions For patients with a platelet count lower than 30 × 109/L,preoperative platelet transfusion significantly reduced bleeding suggesting that preoperative platelet transfusion for splenectomy and periesophagogastric devascularization should be a routine.For those patients whose platelet count was above 30 × 109/L,platelet transfusion is not recommended.

Objective　To study anticipated value of the retention rate of indocyanine green at 15 minutes after injection (ICGR15) and oral glucose tolerance test (OGTT) on hepatic function reserve in patients with primary hepatic cancer (PHC). Methods　58 patients with PHC were divided into 3 groups according to the recovery after operation for PHC. Of them, 29 cases showed good recovery (group A), 18 mild liver dysfunction (group B) and 11 severe liver dysfunction (group C) respectively. ICGR 15, OGTT, routine liver function tests were performed in all 　patients preoperatively. Results　　ICGR15 in group C(24.17%±6.59%) obviously increased than that in group A(11.42%±3.91%,P<0.01) and in group B(16.28±6.07%, P<0.01). 　Blood glucose lever of 120 min after glucose loading test in group C (9.91 mmol/L±3.09 mmol/L)was significantly higher than that in group A(5.42 mmol/L±0.83 mmol/L, (P<0.01)and group B(6.68±1.61, P<0.01). 　The accuracy (81.0%,86.2%), positive (90.6%, 93.5%) 　and negative prediction value (72.5%, 74.4%) of OGTT and ICGR 15 were respectively significent greater than those of Pugh's scoring (P<0.01).Conclusions　ICGR15 and OGTT are worthwhile indicators to assess hepatic function reserve for patients with PHC. Combination of both ICGR15 and OGTT has higher predictive value on hepatic function reserve.