BACKGROUNDBiliary cast syndrome (BCS) was a postoperative complication of orthotopic liver transplantation (OLT), and the reason for BSC was considered to relate with ischemic type biliary lesions. This study aimed to evaluate the relationship between BCS following OLT and the hepatic artery resistance index (HARI), and to observe pathological changes and morphology of biliary casts.

METHODSTotally, 18 patients were diagnosed with BCS by cholangiography following OLT using choledochoscope or endoscopic retrograde cholangiopancreatography. In addition, 36 patients who did not present with BCS in the corresponding period had detectable postoperative HARI on weeks 1, 2, 3 shown by color Doppler flow imaging. The compositions of biliary casts were analyzed by pathological examination and scanning electron microscopy.

RESULTSHARI values of the BCS group were significantly decreased as compared with the non-BCS group on postoperative weeks 2 and 3 (P < 0.05). Odds ratio (OR) analysis of HARI 1, HARI 2, HARI 3 following the operation was >1 (OR = 1.300; 1.223; and 1.889, respectively). The OR of HARI 3 was statistically significant (OR = 1.889; 95% confidence interval = 1.166-7.490; P = 0.024). The compositions of biliary casts were different when bile duct stones were present. Furthermore, vascular epithelial cells were found by pathological examination in biliary casts.

CONCLUSIONSHARI may possibly serve as an independent risk factor and early predictive factor of BCS. Components and formation of biliary casts and bile duct stones are different.

Aged ; Biliary Tract Diseases ; pathology ; Cholangiopancreatography, Endoscopic Retrograde ; methods ; Female ; Hepatic Artery ; surgery ; Humans ; Liver Transplantation ; adverse effects ; Male ; Middle Aged

OBJECTIVETo discuss the risk factors of splenic arterial steal syndrome (SASS) after orthotopic liver transplantation.

METHODSTwenty-four cases who confirmed SASS after liver transplantation in Tianjin First Central Hospital between June 2005 and June 2013 were analyzed retrospectively. Another 96 cases were selected randomly from those patients of the same time with no complication of SASS patients postoperatively as control group. Clinical data of two groups including diameter of splenic artery and hepatic artery preoperatively, weight of graft, weight of recipients, cold/warm ischemia time, an hepatic period and operation time and so on were collected. Others including hepatic artery peak systolic velocity (PSV), end diastolic velocity (EDV), blood flow resistance index and portal vein average velocity (PVF) on the first day after liver transplantation, the day before diagnosis, the day when diagnosed, the 1, 3, 7 days after treatment in SASS group and on 1, 3, 7, 9, 11, 14 days after liver transplantation in control group. Statistical analysis were made between two groups.

RESULTSThe splenic artery/hepatic artery ratio preoperatively and weight of donor liver,and the GRWR in SASS group and control group were 1.26 and 1.00, 1 032 g and 1 075 g, (1.40±0.30)% and (1.82±0.21)% respectively, with significantly statistical differences (Z=-6.40, Z=-2.22, t=-6.50; all P<0.05). The warm ischemia time, the cold ischemia time, the anhepatic period and operation time in SASS group and control group were 3.5 minutes and 4.0 minutes, 10.25 hours and 10.10 hours, 43 minutes and 45 minutes, 8.7 hours and 8.7 hours, with no significantly statistical differences (all P>0.05). RI of hepatic went up gradually in the early time after transplantation while dropped obviously when spleen artery spring coils embolization was received (P<0.01) and trended to stable two weeks later.

CONCLUSIONSSplenic artery/hepatic artery ratio and GRWR are the positive and negative risk factors respectively for SASS. The gradual rising of hepatic RI in the early time after transplantation may be the warning signal SASS and spleen artery spring coils embolization is the effective strategy for SASS after liver transplantation.

Cold Ischemia ; Embolization, Therapeutic ; Hepatic Artery ; pathology ; Humans ; Liver ; surgery ; Liver Transplantation ; adverse effects ; Retrospective Studies ; Risk Factors ; Spleen ; blood supply ; Splenic Artery ; pathology ; Vascular Diseases ; epidemiology ; Warm Ischemia

Liver transplantation is the only solution for end-stage liver diseases. The common hepatic artery (CHA) arises from the coeliac trunk (CT), and the right (RHA) and left hepatic (LHA) arteries are its terminal branches. An abnormal arterial pattern would influence the surgical outcome. The anterior layer of the lesser omentum of a female cadaver was cleaned to identify the CHA, which was traced backwards for its origin and toward the porta hepatis for its terminal branches. In this case, the replaced RHA originated from the CT and ran posterior to the portal vein and the common bile duct. The replaced LHA arose from the left gastric artery. The CHA originated from the CT and branched out as the middle hepatic and gastroduodenal arteries. The replaced RHA and LHA with alteration in relation to the neighbouring structures is a complex and rare variant. Knowledge of this uncommon arterial anomaly is beneficial for hepatobiliary surgeons.
Cadaver ; Education, Medical ; Female ; Hepatic Artery ; anatomy & histology ; pathology ; Humans ; Liver ; blood supply ; surgery ; Models, Anatomic

OBJECTIVESTo classify the courses of the abnormal hepatic arteries originated from superior mesenteric artery in patients with gastric cancer, and to define its application in the D2 radical gastrectomy in those patients.

METHODSEighty-six patients with gastric cancer who had received D2 radical gastrectomy by the same surgeon between January 2008 and June 2010 were included in this study. All patients received the preoperative multislice spiral computed tomoangiography (MSCTA) to classify the abnormal hepatic artery originated from the superior mesenteric artery, which was verified during the surgery. Postoperative immunohistochemistry of the lymphoid tissues around the abnormal hepatic artery was performed by recombinant human cytokeratin 20 (CK20) and carcino-embryonic antigen (CEA) to verify the micrometastasis.

RESULTSIn this group, the abnormal hepatic artery originated from the superior mesenteric artery were found with MSCTA and verified by operation in 14 patients, including 12 men and 2 women. The mean age was 62 years. Of the 14 cases with abnormal hepatic artery, 3 cases were found with abnormal common hepatic artery and 11 cases with abnormal right hepatic artery. The total mutation rate is 16.3%. In those patients, the hepatic artery ran in front of the pancreas in 1 case and behind the pancreas in 13 cases. It was difficult to dissect the abnormal hepatic artery, especially for the post-pancreas type in D2 lymphadenectomy, for fear of damaging the abnormal blood vessel and pancreas. The operation time in cases with abnormal hepatic artery was significantly longer than that in patients with normal hepatic artery [(218.8 ± 23.9) min vs. (179.6 ± 18.5) min]. Immunohistochemical analysis revealed no metastasis in the lymphoid tissues surrounding the abnormal artery.

CONCLUSIONSAbnormal hepatic arteries originated from the superior mesenteric artery can be classified into pre-pancreas type and post-pancreas type. The dissection of the abnormal hepatic artery is not advocated in D2 radical gastrectomy for no lymph node metastasis is found around the abnormal hepatic artery in this study.

Aged ; Female ; Gastrectomy ; Hepatic Artery ; pathology ; Humans ; Lymph Node Excision ; methods ; Lymph Nodes ; pathology ; Lymphatic Metastasis ; Male ; Mesenteric Artery, Superior ; pathology ; Middle Aged ; Stomach Neoplasms ; pathology ; surgery

OBJECTIVE: We assessed the outcomes of a simplified technique for the percutaneous placement of a hepatic artery port-catheter system for chemotherapy infusion in advanced hepatocellular carcinoma with portal vein invasion. MATERIALS AND METHODS: From February 2003 to February 2008, percutaneous hepatic artery port-catheter insertion was performed in 122 patients who had hepatocellular carcinoma with portal vein invasion. The arterial access route was the common femoral artery. The tip of the catheter was wedged into the right gastroepiploic artery without an additional fixation device. A side hole was positioned at the distal common hepatic artery to allow the delivery of chemotherapeutic agents into the hepatic arteries. Coil embolization was performed only to redistribute to the hepatic arteries or to prevent the inadvertent delivery of chemotherapeutic agents into extrahepatic arteries. The port chamber was created at either the supra-inguinal or infra-inguinal region. RESULTS: Technical success was achieved in all patients. Proper positioning of the side hole was checked before each scheduled chemotherapy session by port angiography. Catheter-related complications occurred in 19 patients (16%). Revision was achieved in 15 of 18 patients (83%). CONCLUSION: This simplified method demonstrates excellent technical feasibility, an acceptable range of complications, and is hence recommended for the management of advanced hepatocellular carcinoma with portal vein thrombosis.
Angiography ; Antineoplastic Agents/*administration & dosage ; Carcinoma, Hepatocellular/*drug therapy/pathology ; *Catheters, Indwelling/adverse effects ; Embolization, Therapeutic ; Female ; Femoral Artery/surgery ; Fluoroscopy ; *Hepatic Artery ; Humans ; Infusions, Intra-Arterial ; Liver Neoplasms/*drug therapy/pathology ; Male ; Middle Aged ; Portal Vein/*pathology ; *Radiography, Interventional ; Treatment Outcome

OBJECTIVETo investigate the value of virtual surgery in hepatic artery reconstruction in liver recipients with type II hepatic artery variation.

METHODSA patient with cholangiocellular carcinoma and a healthy individual were scanned using 64-slice spiral CT, and image segmentation and three-dimensional (3D) reconstruction were performed using an image processing system. The 3D models in STL format were then imported to the FreeForm Modeling System for smoothing and refinement. Hepatic artery reconstruction was performed in simulated liver transplantation using the virtual surgery system with force feedback (PHANTOM).

RESULTSThe reconstructed model contained the liver, hepatic arteries, biliary system, and bile duct tumor emboli and displayed the entire branching of the hepatic artery with type II variation. Using the virtual surgery system, arterial reconstruction was performed by anastomosing the donor celiac trunk and the recipient abdominal aorta with the virtual scalpel and needle.

CONCLUSIONThe reconstructed model allows clearer views of the 3D structures of the arteries in the liver and helps in preoperative preparations and surgical planning of artery reconstruction during liver transplantation. This approach may also help reduce the surgical risks and potential complications.

Computer Simulation ; Computer-Assisted Instruction ; methods ; Female ; Hepatic Artery ; abnormalities ; surgery ; Humans ; Imaging, Three-Dimensional ; methods ; Liver Neoplasms ; diagnostic imaging ; pathology ; surgery ; Liver Transplantation ; Middle Aged ; Surgery, Computer-Assisted ; methods ; Tomography, Spiral Computed

Antineoplastic Agents ; therapeutic use ; Carcinoma, Hepatocellular ; pathology ; surgery ; therapy ; Catheter Ablation ; methods ; Chemoembolization, Therapeutic ; Combined Modality Therapy ; Hepatectomy ; methods ; Hepatic Artery ; Humans ; Lung Neoplasms ; pathology ; surgery ; therapy ; Neoplasm Staging ; Radiotherapy, Conformal

Bile Duct Neoplasms ; pathology ; surgery ; Bile Ducts, Intrahepatic ; Cholangiocarcinoma ; pathology ; surgery ; Hepatectomy ; methods ; Hepatic Artery ; pathology ; surgery ; Humans ; Lymph Node Excision ; methods ; Portal Vein ; pathology ; surgery

OBJECTIVETo evaluate the role of vascular resection and reconstruction in the treatment of hilar cholangiocarcinoma.

METHODS117 patients with potentially resectable hilar cholangiocarcinoma underwent exploration. Twenty-one patients had exploration or drainage only due to distant metastases, and the other 96 patients received surgical resection. Thirty-one of those had vascular resection and reconstruction, including portal vein resection alone in 21 patients, combined hepatic artery and portal vein resection in 2 and hepatic artery resection alone in 8. Therefore, the patients were divided into four groups: non-surgical resection (21), portal vain resection (21), hepatic artery resection (10) and non-vascular resection (65) and their clinical data were reviewed retrospectively.

RESULTSThe hepatic artery resection group had significantly higher perioperative morbidity and mortality rate (80.0% and 20.0%) than non-vascular resection group (16.9% and 1.5%), respectively, (P < 0.05), while no significant difference was found between the portal vein resection alone group and the non-vascular resection group (P > 0.05). Of all resected vessel specimens, vascular wall invasion beyond the adventitia was pathologically confirmed in 82.6% of the portal veins and 50.0% of the hepatic arteries. The 1-, 3- and 5-year survival rates were 59.0%, 34.0%, and 16.0% in the non-vascular resection group, versus 44.0%, 23.0% and 11.0% in the portal vein resection alone group (P < 0.05) and 18.0%, 0 and 0 in the hepatic artery resection group (P < 0.01), respectively, with a significant difference among the three groups. The 1-, 3- and 5-year survival rates in the non-surgical resection group were 13.0%, 0 and 0, respectively, which were similar to those in the hepatic artery resection group. Though a significant difference in survival rates existed between the portal vein resection alone group and non-resected group (P < 0.001), no significant difference was found between the hepatic artery resection group and non-resected group (P > 0.05).

CONCLUSIONBoth portal vein and hepatic artery resection can improve resection rate for hilar cholangiocarcinoma, and portal vein resection may improve the prognosis in selected patients. However, hepatic artery resection can not improve survival and may even lead to an increase of perioperative morbidity and mortality.

Adult ; Aged ; Bile Duct Neoplasms ; mortality ; surgery ; Bile Ducts, Intrahepatic ; Cholangiocarcinoma ; mortality ; surgery ; Female ; Follow-Up Studies ; Hepatic Artery ; pathology ; surgery ; Humans ; Male ; Middle Aged ; Neoplasm Invasiveness ; Portal Vein ; pathology ; surgery ; Reconstructive Surgical Procedures ; mortality ; Retrospective Studies ; Survival Rate ; Vascular Surgical Procedures ; mortality

OBJECTIVETo study the regularity of splanchnic hemodynamic changes after orthotopic liver transplantation (OLT) for patients with portal hypertension. At the same time, effect of such changes on splenomegaly, hypersplenism, collateral circulation and the postoperative liver function was discussed.

METHODSBetween June 2002 and October 2005, 173 liver transplantations were performed. In 38 patients with portal hypertension undergoing OLT, the following parameters were measured before surgery and subsequently at 1, 3, 5, 7 days, 1, 6 months and 1, 2, 3 years after operation by using Color Doppler sonography: portal blood flow mean velocity (PBV), portal blood flow volume (PBF), hepatic artery resistance indexes (HA-RI) and spleen size. The same parameters were measured in 8 patients with acute liver failure and 20 healthy controls. Meanwhile to observe liver function and varicose vein of esophagus.

RESULTSIn cirrhotics, PBV and PBF increased immediately after transplantation [from (13.7 +/- 4.2) cm/s to (58.4 +/- 25.2) cm/s and from (958 +/- 445) ml/min to (3024 +/- 1207) ml/min respectively, P < 0.05]. HA-RI also augmented [from (0.65 +/- 0.11) to (0.74 +/- 0.12), P < 0.05]. PBV returned to normal values after 6 months, PBF returned to normal value after 2 years. Spleen size decreased significantly, but splenomegaly persisted after 3 years. In addition the esophagogastric varix ameliorated significantly.

CONCLUSIONSAbnormal splanchnic hemodynamic changes for patients with portal hypertension still will long-term exist after OLT, but does not effect recovery of hypersplenism, esophagogastric varix and liver function.

Adolescent ; Adult ; Aged ; Child ; Female ; Follow-Up Studies ; Hemodynamics ; Hepatic Artery ; physiopathology ; Humans ; Hypertension, Portal ; pathology ; physiopathology ; surgery ; Intraoperative Period ; Liver ; physiopathology ; Liver Transplantation ; Male ; Middle Aged ; Portal Vein ; physiopathology ; Splanchnic Circulation ; physiology ; Spleen ; pathology