Objective To investigate some improvements in the surgical techniques of adult-to-adult living donor liver transplantation( A-A LDLT) without the middle hepatic vein(MHV) for hepat-ic vein reconstruction. Methods The retrospective analysis was made on the clinical data of 11 recipi-ents who underwent the operation in A-A LDLT including the hepatic vein reconstructed in right liver lobe without MHV from June 2007 to January 2008. The key techniques included reconstructing out-flow of graft on shaping the tips of vena cava and right hepatic veins, cadaveric vein allografts stored in 4℃ UW solution within 7d being used for significant-sized hepatic vein reconstruction such as tributa-ries of the middle hepatic vein from V5, V8 and right inferior hepatic vein. Results 10 cases success-fully underwent reconstruction of outflow of graft on shaping the tips of vena cava and right hepatic veins and the outflow reconstruction ratio of V5, V8 and right inferior hepatic vein was 81. 8% (9/11), 7 one-vein reconstruction, 1 two-vein reconstruction and 1 three-vein reconstruction. 1 recipient died of renal failure and pulmonary infection 14 days after operation without venous outflow obstruc-tion. Doppler ultrasonography showed no thrombosis and the blood flowed smoothly in the right he-patic vein of other 8 recipients during the 9th to 15th mouth of follow-up. The cumulative patency rates of these 8 survivals for interposition vein grafts were 100% (11/11), 72. 7 %(8/11), 54. 5%(6/11) and 36. 5%(4/11) in 1, 3, 6 and 9 mouths, respectively. The regeneration of paramedian sectors was equivalent. Conclusion Shaping the tips of vena cava and right hepatic veins and using cadaveric vein allografts in adult-to-adult right lobe living donor liver transplantation for hepatic vein reconstruc-tion are both safe,simple and effective methods.This approach can be recommended.

Objective To analyze the role of multislice spiral CT in the diagnosis of biliary com-plications following liver transplantation. Methods Forty-four patients with biliary complications re-ceived tri-phase contrast-enhancement CT examination and cholangiography (CP) within one week af-ter the CT scanning. Using the results of CP as the standard, we investigated the efficacy of multislice spiral CT for each kind of biliary complication. All the analyses for bile duct were based on the images on the late portal venous phase and the reconstruction of images performed with multiplan reformat,Results CP depicted biliary strictures involved in extrahepatic bile duct in 23 cases (including the common bile duct and common hepatic duct), left or right hepatic duct in 24 and intrahepatic bile duct in 27. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of the CT examination were 91.3%, 83. 3% , 87. 8%, 87. 5% and 88. 2% for biliary stricture in extrahe-patic bile duct, 83. 3% , 88. 2%, 85. 4%, 90. 9% and 78. 9% for biliary stricture in left or right he-patic duct, 74.1%, 92.7%, 80.5%, 95.2% and 65.0%, for biliary stricture in intrahepatic bile duct, respectively. CT detected intrahepatic biloma in 4 cases and abscess in 2 but CP only detected biloma in 2 cases. The other 4 cases did not detected by CP because of severe biliary strictures which filled with biliary sludge. CP confirmed anastomotic bile leak in 3 cases. In these cases, CT only de-picted the fluid collection in hepatic hilum and abdominal cavity, none of the exact leak site could be detected. CP detected biliary sludge or stones in 33 cases. However, the sensitivity, specificity, accu-racy, positive predictive value and negative predictive value of the CT examination for biliary sludge or stones were 72.7%,100.0%,78.1%,100.0%and 47.6%,respectively.Meanwhile,in 1 patient with diffuse intrahepatic biliary strictures,active biliary bleeding was correctly detected by CT exami-nation and confirmed by hepatic arteriography.Conclusion Tri-phase contrast-enhancement CT exam-ination can be used as a general method for biliary complications after liver transplantation.Besides its benefits in biliary complications,it is of great value for depicting complications involved in hepatic pa-renchyma and acute biliary bleeding in the same examination.

From PubMed and CNKI medical litera-ture, To review and commentate laparoscopic surgery in trentment of hepatic hydatid disease. Since 1991, Laparo-scopic Hepatectomy is located basic period, but all kinds of laparoscopic surgery in treating hepatic hydatid cysts begin to develop completely in treating hepatic hydatid cysts. L-PAIR ( Laparoscopic puncture-aspiration-injection-reaspira-tion)had laid the foundation of course of events, Laparoscopic cholecystectomy stand out more advantages compared with open opreation. Nowdays,Laparoscopic pericystectomy is be-lieved best way in trentment of hepatic hydatid disease be-cause of Minimally invasion and radical surgery, reveals the most satisfactory effectiveness and wide foreground. Laparo-scopic Hepatectomy is exploratory works because of higher

Glycogen storage disease (GSD) is a rela-tively rare inherited metabolic disease. However, its relative rarity implies that no metabolic centre has experience of large numbers of patients and experience with long-term manage-ment is limited. In addition, there is wide variation in meth-ods of medical treatment. With the development of medical care, life-expectancy in glycogen storage disease (GSD) has improved considerably. With ageing liver adenoma may de-velop which will bring about several complications-compres-sion, hemorrhage, or even transformation into carcinomas-and needs immediate intervention. In this paper, reviews for the mechanism and surgical intervention of GSD are presented.

Hepatic fibrosis is a wound-healing re-sponse to all kinds of chronic liver injury, which if persistent can lead to cirrhosis. Once develops to cirrhosis, the only ef-fective therapy will be liver transplantation. In recent years,many scholars have taken all kinds of methods to try to pre-vent liver fibrosis developing to cirrhosis. As auto adult stem cell possesses multi-directional differentiation and none reject reaction advantages, it has become the study hotspot of nu-merous researches for hepatic fibrosis therapy and acquired significant progression.

Objective To develop an ideal cultural method to amplify embryonic hepatic stem cells and inhibit their differentiation in vitro. Methods Suspension of ED 14 Fischer (F) 344 rat em-bryonic hepatic stem cells was prepared by collagenase digestion and mechanical disaggregation. Then cells were divided into two groups randomly. The cells in group 1 were seeded into type I collagen-coated plates by adherent culture while those in group 2 were seeded into soft agar medium by suspen-sion culture. After culture for 2 weeks, the morphology and ultrastructure of cells in both groups were observed and compared by inverted microscope and transmission electron microscope, respectivley.The expression of CD90. 1 and CD49F, the two specific stem cell surface markers, was tested by flow cytometry to manifest the establishment of embryonic hepatic stem cells. Alkaline phosphatase stai-ning was used to detect stem cell differentiation. Result Embryonic hepatic stem cells in group 2 were characterized by higher nucleus-cytoplasm ratio and less cell organelles, higher expression of CD90. 1 and CD49F, and stronger positive reaction for alkaline phosphatase staining compared with those in group 1. Moreover, the cells in group 1 showed significant differentiation features. Conclusion Em-bryonic hepatic stem cells cultured suspendedly in soft agar medium experience less differentiation than those adherently cultured in serum-added culture medium, and can proliferate and form clone ball with a specific stem cell feature.

Objective To investigate the impact of CD4+ CD25+ FOXP3+ regulatory T(Treg) cells on tumor recurrence in liver transplantation for hepatocellular carcinoma (HCC). Methods Im-munohistochemistry and flow cytometry were used for analysis of the frequency of Treg. Meanwhile,it was compared with that of non-cancer liver transplantation patients. Results The frequency of CD4+CD25+ FOXP3+ regulatory T cells in the blood of HCC liver transplantation was (10. 15 ±1. 00) % , which was significantly higher than that in the normal control group (3. 20±1. 18) %. Cir-culating CD4+ CD25+ FOXP3+ Treg frequency was increased significantly and correlated with the tumor recurrence in the HCC patients. An abundant accumulation of Treg concurrent with significant-ly reduced infiltration of CD8+T cells was found in tumor regions. Conclusion Increased CD4+ D25+FoxP3+ Treg may impair the effectors function of CD8+ T cells, promote the tumor recurrence and re-present a therapeutic target for HCC liver transplantation.

Objective To compare short-term therapeutic outcomes and the safety of percutane-ous radiofrequency ablation (PRFA) with left single lung ventilation (LSLV) for liver cancer of the hepatic dome (LCHD) and that of PRFA for right liver carcinoma in favorable location. Methods Thirty one patients with hepatocellular carcinoma (belonging to LCHD) receiving PRFA with LSLV (Group LCHD) between January 2006 and January 2009 in our hospital were selected, and 45 control patients with right lobe HCC ≥1 cm away from the liver capsule, gallbladder, and main portal bran-ches were also included. One month after PRFA, residual tumors were followed up with contrast en-hanced CT and alpha fetal protein and PRFA was repeated in the presence of residual foci. Tumor-free survival time was defined as the duration from complete ablation to diagnosed local tumor progression.The Mann-Whitney test was used to compare age, tumor diameter, and average number of punctures between LCHD patients and controls. A χ2 test was used for comparison of the incidence of complica-tions and incomplete tumor ablation rate. The Kaplan-Meier's method was used for calculation of local tumor-free survival rate compared with a log-rank test. Results The incidence of right shoulder pain was significantly higher in LCHD patients than in controls (87. 1% vs 11. 1%, P<0. 01). LCHD pa-tients showed no difference from controls in the average number of punctures (2. 8±. 5 vs 3. 2±. 5,P>0. 05). Meanwhile, there was no difference between the 2 groups in average duration of treatment and hospitalization, and the complete tumor ablation rate at first PRFA. No differences were observed in the 1-, 2- and 3-year local tumor-free survival rates between LCHD patients (85. 5% , 65. 8% , and 36. 4% ,respectively) and controls (87.7%, 62. 3% , and 34.0% , respectively). Conclusion PRFA with LSLV for LCHD seems to promise comparable short-term outcomes and safety to PRFA for right liver carcinoma of fa-vorable location and should be preferred as one of the therapeutic options for LCHD patients with tumor di-ameters≤5 cm regardless of its unique location.

Objective To investigate the incidence of anatomic variations of hepatic artery and methods of procurement and reconstruction to prevent the accidental injury of the hepatic artery.Methods The clinical data of 843 patients receiving orthotopic liver transplantation (OLT) in our hos-pital from June 2001 to July 2006 were retrospectively analyzed. Liver and kidney separate procure-ment was performed for 148 cases and abdominal organ combined procurement in 695. The variations of the hepatic artery as well as the relationship between the anomalous hepatic artery and accidental in-jury of the hepatic artery were analyzed. Results Anatomic variations of hepatic artery which were most frequently observed, were the right hepatic artery originating from the superior mesenteric artery and left hepatic artery originating from left gastric artery. The rate of the anomalous hepatic artery concomitancy increased along with elevation in the rate of accidental injury. Conclusion Abdominal or-gan combined procurement can reduce the incidence of accident injury of hepatic artery. Familiarity of the he-patic arterial variation and careful anastomosis are important to reduce injury of the hepatic artery.

Objective To explore the possible role and mechanism of the Kupffer cells (KCs) in liver allo-geneic transplantation at the early stage. Methods In vitro cell contact coculture system was established. Culture supernatants were collected respectively on the 1st, 2nd, 4th, 6th d after cocul-ture and the KCs and PBMCs were harvested on the 6th day after culture. The expression of HLA-G on the membrane of the KCs and PBMCs was detected with immunochemistry. Nitrate reduction test was used to determine the concentration of nitric oxide. IFN-γ, IL-10, TGF-β1 cytokine levels in the supernatants were also measured with ELISA. The proliferation of lymphocytes was evaluated with MTT. Results six days later, no HLA-G molecules were detected on the membrane of the KCs and PBMCs. In the experimental group containing KCs, the levels of NO, IL-10 and TGF-β1 was signifi-cantly increased(P<0. 05), while the levels of IFN-γ was relatively lower(P<0. 05) as compared to the experimental group without KCs. No IL-10 and IFN-γ were detected in the control group, and on-ly few NO and TGF-β1 was found in the control group with KCs. MTT test showed that the value of optical density was lower in the experimental group with KCs than that in any other group(P<0. 05).Conclusion No HLA-G is expressed on the membrane of KCs and PBMCs after contact coculture.KCs may participate in regulating production of NO and Th2/Th3-like cytokines and suppressing the proliferation of lymphocytes, through which KCs probably take part in inducing immunotolerance of liver transplantation in early stage.