BACKGROUNDHepatic artery variations are frequent clinical occurrences. The aim of this study was to investigate the characteristic course of variant hepatic arteries originating from the superior mesenteric artery for the purpose of providing instructions for abdominal tumor surgery.

METHODSThe course of variant hepatic arteries originating from the superior mesenteric artery was studied in 400 patients with liver cancer confirmed by digital subtraction angiography (DSA) and multi-slice spiral computed tomography angiography (MSCTA), and 86 patients with gastric cancer confirmed by preoperative MSCTA between June 2008 and June 2010 in the First Affiliated Hospital of Guangxi Medical University.

RESULTSHepatic artery variations originating from the superior mesenteric artery were noticed in 49 liver cancer patients and 14 gastric cancer patients (total 63 cases), with a variation rate of 12.96%, including two cases (3.17%) where the hepatic arteries ran along the anterior pancreas, and 61 cases (96.83%) where the hepatic arteries ran along the posterior pancreas.

CONCLUSIONSHepatic artery variations originating from the superior mesenteric artery present as two types: the pre-pancreas type and the post-pancreas type with the latter predominating. This finding is of clinical significance in abdominal tumor surgeries where clearance of portal lymph nodes is needed.

Hepatic Artery ; physiology ; Humans ; Liver Neoplasms ; surgery ; Mesenteric Artery, Superior ; physiology ; Middle Aged ; Stomach Neoplasms ; surgery

Animals ; Humans ; Liver Failure, Acute ; surgery ; Liver Transplantation ; methods ; mortality ; physiology ; Living Donors

OBJECTIVETo explore the effects of different hepatic inflow occlusion methods on liver regeneration in rats after partial hepatectomy (PH).

METHODSMale Wistar-Furth rats were randomly assigned to three groups: control group, underwent 68% hepatectomy alone; occlusion of portal triad (OPT) group, subjected to occlusion of portal triad under portal blood bypass; and occlusion of portal vein (OPV) group, subjected to occlusion of portal vein under portal blood bypass. Blood flow was occluded for 20, 30, and 40 minutes before 68% hepatectomy. According to the 7-day survival of each group, a same occlusion time T was set. Each group was divided into two subgroups (n = 8), in which animals were killed 3 and 7 days later. Liver regeneration was calculated as a percent of initial liver weight. Immunohistochemistry for proliferating cell nuclear antigen (PCNA) and Ki-67 was performed to quantify proliferating cells. In addition, functional liver volume represented by 99Tc(m)-GSA radioactivity was assessed.

RESULTSThe safe tolerance limit time was 30 minutes for OPT group and 40 minutes for OPV group. At 3 days after PH, no significant difference was observed in the regeneration rate of each group (P > 0.05). However, liver radioactive activity, PCNA labeling index, and Ki-67 index of OPV group was significantly higher than those of OPT group (P < 0.05); the latter were similar to those of control group (P > 0.05). At 7 days after PH, no significant difference was observed in all indexes among three groups (P > 0.05).

CONCLUSIONCompared with Pringle maneuver, preserving the hepatic artery flow during portal triad blood inflow occlusion can promote remnant liver regeneration early after PH.

Animals ; Hepatectomy ; methods ; Liver ; blood supply ; surgery ; Liver Regeneration ; physiology ; Male ; Postoperative Period ; Rats ; Rats, Wistar

OBJECTIVETo assess the effect of temporary occlusion of hepatic blood inflow on hepatic cancer treated with diode-laser induced thermocogation (LITT).

METHODSThe carcinoma Walker-256 was implanted in 40 SD rat livers. Twelve days later, the animals were randomly divided into 4 groups. Group A received LITT alone; group B received hepatic artery temporary occlusion during LITT; group C received portal vein temporary occlusion during LITT; group D received hepatic artery and portal vein temporary occlusion during LITT. Tumors were exposed to 810 nm diode-laser light at 0.95 watts for 10 min from a scanner tip applicator placed in the tumor. At the same time, the intrahepatic temperature distribution in rats with liver tumors was measured per 2 min during thermocoagulation. Tumor control was examined immediately 7 and 14 d after thermocoagulation.

RESULTSThere was significant difference of intrahepatic temperature distribution in rats with liver tumors among the 4 groups (P<0.05) except when group C samples were compared with group D samples at each time point, and group B samples were compared with group C samples at 120 s (P>0.05). Light microscopic examination of the histologic section samples revealed three separate zones: regular hyperthermic coagulation necrosis zone, transition zone and reference zone. Compared with the samples in group A and group B, group C and group D samples had more clear margin among the three zones.

CONCLUSIONThe hepatic blood inflow occlusion, especially portal vein hepatic blood inflow occlusion, or all hepatic blood inflow occlusion considerably increased the efficacy of LITT in the treatment of liver cancer.

Animals ; Laser Coagulation ; Liver Circulation ; physiology ; Liver Neoplasms ; blood supply ; surgery ; Rats ; Temperature ; Time Factors

BACKGROUND/AIMS: We experimented with different ablation methods and two types of microwave antennas to determine whether microwave ablation (MWA) increases intrahepatic pressure and to identify an MWA protocol that avoids increasing intrahepatic pressure. METHODS: MWA was performed using either a single-step standard ablation or a stepwise increment ablation paired with either a 16-gauge (G) 2-cm antenna or a 14G 4-cm antenna. We compared the maximum pressures and total ablation volumes. RESULTS: The mean maximum intrahepatic pressures and ablation volumes were as follows: 16G single-step: 37+/-33.4 mm Hg and 4.63 cm3; 16G multistep: 31+/-18.7 mm Hg and 3.75 cm3; 14G single-step: 114+/-45.4 mm Hg and 15.33 cm3; and 14G multistep: 106+/-43.8 mm Hg and 10.98 cm3. The intrahepatic pressure rose during MWA, but there were no statistically significant differences between the single and multistep methods when the same gauge antennae were used. The total ablation volume was different only in the 14G groups (p<0.05). CONCLUSIONS: We demonstrated an increase in intrahepatic pressure during MWA. The multistep method may be used to prevent increased intrahepatic pressure after applying the proper power.
Ablation Techniques/instrumentation/*methods ; Animals ; Cattle ; Liver/*physiology/surgery ; Medical Illustration ; *Microwaves ; Models, Animal ; *Pressure

OBJECTIVETo explore the impact of microwave dealing with cutting surface on perioperative liver function recovery and recurrence and metastasis after hepatectomy for HCC.

METHODSClinical data of 133 patients with HCC from March 2009 to November 2010 were retrospectively analyzed. They were divided into the conventional surgery group (66 cases) and microwave treatment group (67 cases). A domestic ECO-100 microwave knife was inserted into the liver cutting surface 0.5 cm from the cutting edge, and repeated multi-point burning with an average time of 25 minutes in the microwave treatment group. Then the perioperative liver function recovery and recurrence and metastasis in the two groups were compared.

RESULTSThe operation time of conventional surgery group was (158.0 ± 31.0) minutes, and that of microwave treatment group was significantly longer (181.0 ± 28.0) minutes (P=0.027). There were no significant differences in the liver function recovery between the two groups (P>0.05). There were 6 cases of recurrence and metastasis after 6 months and 9 cases after 12 months in the microwave treatment group, while there were 15 cases of recurrence and metastasis after 6 months and 20 cases after 12 months in the conventional surgery group, showing a significant difference (P=0.034 and 0.022, respectively).

CONCLUSIONSMicrowave dealing with the cutting surface has no significant effect on perioperative liver function recovery in hepatectomy. However, microwave treatment can reduce the in situ recurrence in HCC patients within the first year after surgery, indicating a good clinical application value.

Carcinoma, Hepatocellular ; surgery ; therapy ; Hepatectomy ; Humans ; Liver ; physiology ; Liver Neoplasms ; surgery ; therapy ; Microwaves ; therapeutic use ; Neoplasm Recurrence, Local ; prevention & control ; Operative Time ; Recovery of Function ; Retrospective Studies

OBJECTIVE: We wanted to compare the efficiency of multipolar radiofrequency ablation (RFA) using three perfused-cooled electrodes with multiple overlapping- and simultaneous monopolar techniques for creating an ablation zone in ex vivo bovine livers and in in vivo porcine livers. MATERIALS AND METHODS: In the ex vivo experiments, we used a 200 W generator (Valleylab, CC-3 model) and three perfused-cooled electrodes or internally cooled electrodes to create 30 coagulation zones by performing consecutive monopolar RFA (group A, n = 10), simultaneous monopolar RFA (group B, n = 10) or multipolar RFA (group C, n = 10) in explanted bovine livers. In the consecutive mode, three ablation spheres were created by sequentially applying 150 watts radiofrequency (RF) energy to the internally cooled electrodes for 12 minutes each for a total of 36 minutes. In the simultaneous monopolar and multipolar modes, RF energy was concurrently applied to the three perfused-cooled electrodes for 20 minutes at 150 watt with instillation of 6% hypertonic saline at 2 mL/min. During RFA, we measured the temperatures of the treated area at its center. The changes in impedance, the current and liver temperature during RFA, as well as the dimensions of the thermal ablation zones, were compared among the three groups. In the in vivo experiments, three coagulations were created by performing multipolar RFA in a pig via laparotomy with using same parameter as the ex vivo study. RESULTS: In the ex vivo experiments, the impedance was gradually decreased during the RFA in groups B and C, but in group A, the impedance was increased during RFA and this induced activation by the pulsed RF technique. In groups A, B and C, the mean final-temperature values were 80 +/- 10 degrees C, 69+/-18 degrees C and 79 +/- 12 degrees C, respectively (p < 0.05). The multipolar mode created a larger volume of ablation than did the other modes: 37.6 +/-4.0 cm3 (group A); 44.9 +/- 12.7 cm3 (group B); and 78.9 +/- 6.9 cm3 (group C) (p < 0.05). In the in vivo experiment, the pig well tolerated the RFA procedure and no major complications occurred during the 4 days of the follow-up period. The mean volume of coagulations produced by multipolar RFA in the pig liver was 60.5+/-17.9 cm3. CONCLUSION: For the multiple probe RFA, the multipolar mode with hypertonic saline instillation was more efficient in generating larger areas of thermal ablation than either the consecutive or simultaneous monopolar modes.
Tomography, X-Ray Computed ; Swine ; Necrosis ; Liver Neoplasms/pathology/surgery ; Liver/pathology/physiology/radiography/*surgery ; Equipment Design ; *Electrodes ; Cattle ; Catheter Ablation/*instrumentation/methods ; Body Temperature ; Animals

Living donor liver transplantation (LDLT) is a curative treatment for end stage liver disease. It is advantageous due to the shortage of deceased donors. However, in LDLT, whether the middle hepatic vein (MHV) should be preserved in donors remains controversial. We conducted searches in Pubmed, Embase, Cochrane Library, Web of Science, Ovid, and Google Scholar using the key words "living donor liver transplantation" and "middle hepatic vein". Due to ethical issues, there were no randomized control trails focusing on MHV in LDLT. The majority of reports were retrospective studies. We examined the reference lists to identify related investigations. Google Scholar was then used to obtain full texts. Nine observational studies were analyzed. There were no significant differences in liver function (WMD, -5.51; P=0.12) and complications (RR, 0.98; P=0.89) in donors with or without MHV. However, the liver function in recipients was greatly improved after LDLT with MHV (WMD, -78.32; P=0.01). No definite conclusion was obtained in terms of the liver regeneration indices between LDLT with or without MHV. It was conclude that grafts with MHV in LDLT favor recipient outcomes and do not harm the living donor if a careful preoperative evaluation is performed.
Adult ; Databases, Bibliographic ; Female ; Graft Survival ; Hepatic Veins ; surgery ; Humans ; Liver ; blood supply ; physiology ; Liver Transplantation ; Living Donors ; Male ; Middle Aged ; Observational Studies as Topic ; Prognosis

OBJECTIVETo perform a meta-analysis of randomized controlled trials (RCTs) assessing the benefit of providing branched chain amino acid (BCAA)-enriched nutrition to improve hepatic function in patients undergoing hepatic operation.

METHODSThe electronic databases of PubMed, Springerlink, the Chinese Biomedical Database (CBM), the Cochrane Library, and the China National Knowledge Infrastructure (CNKI) were searched for relevant RCTs using the following search terms: nutritional support, enteral nutrition, parenteral nutrition, hepatic/liver surgery, liver cirrhosis, cancer, hepatectomy, and liver transplantation. The quality of the retrieved RCTs was assessed according to the scale developed by the Cochrane Collaboration. The meta-analysis was conducted using RevMan software, version 5.2.

RESULTSA total of 11 relevant RCTs, representing 510 patients, were included in the meta-analysis. Compared to patients in the control (normal nutrition) group, the patients in the BCAA group experienced an effective improvement in hepatic function, as evidenced by significant decreases in total bilirubin (by 0.07 mumol/L; 95% confidence interval (CI): -0.18 to 0.05, P more than 0.05]. In addition, the BCAA group showed improvements in plasma levels of albumin (weighted mean difference (WMD) = 0.07; 95% CI: 0.06, 0.24, P less than 0.05) and alanine aminotransferase (WMD = +5.61; 95% CI: -8.63 to 19.86, P more than 0.05] but neither of the changes reached the threshold of a statistically significant improvement. The BCAA group did however show significantly lower complication rate after operation (65%, 95% CI: 0.48, 0.87, P less than 0.01] and mean duration of hospital stay (4.61 days; 95% CI: -6.61, -2.61, P less than 0.01].

CONCLUSIONBCAA-enriched nutrition improves hepatic function in patients undergoing hepatic operation, thereby helping to reduce the complication risk, duration of hospital stay, and financial burden. BCAA-enriched nutrition is a safe and effective therapy and further clinical application may be beneficial.

Amino Acids, Branched-Chain ; therapeutic use ; Hepatectomy ; methods ; Humans ; Intraoperative Period ; Liver ; physiology ; surgery ; Liver Transplantation ; methods ; Nutritional Support ; methods ; Randomized Controlled Trials as Topic

OBJECTIVETo investigate whether RNA interference (RNAi) of LXRα gene in donor rats with fatty liver improves liver graft function after transplantation.

METHODSFifty donor SD rats were fed a high-fat diet and 56% alcohol to induce macrovesicular steatosis exceeding 60% in the liver. The donor rats were injected via the portal veins with 7 × 10⁷ TU LXRα-RNAi-LV mixture (n=25) or negative control-LV (NC-LV) vector (n=25) 72 h before orthotopic liver transplantation. At 2, 24, and 72 h after the transplantation, the recipient rats were sacrificed to examine liver transaminases, liver graft histology, immunostaining (TUNEL), and protein and mRNA levels of LXRα.

RESULTSLentivirus-LXRα RNAi inhibited LXRα gene expression at both the mRNA and protein levels in the liver graft and reduced the expressions of SREBP-1c and CD36 as compared with the controls, resulting also in reduced fatty acid accumulation in the hepatocytes. The recipient rats receiving RNAi-treated grafts showed more obvious reduction in serum ALT, AST, IL-1β and TNF-α levels, and exhibited milder hepatic pathologies than the control rats after the transplantation. TUNEL assay demonstrated a significant reduction in cell apoptosis in LXRα-RNAi-LV-treated liver grafts, and the rats receiving treated liver grafts had a prolonged mean overall survival time.

CONCLUSIONLXRα-RNAi-LV treatment of the donor rats with fatty liver can significantly down-regulate LXRα gene expression in the liver graft and improve the graft function and recipient rat survival after liver transplantation.

Animals ; Fatty Liver ; genetics ; surgery ; Gene Expression Regulation ; Hepatocytes ; cytology ; Lentivirus ; Liver ; physiology ; Liver Transplantation ; Liver X Receptors ; Orphan Nuclear Receptors ; genetics ; RNA Interference ; RNA, Messenger ; Rats ; Rats, Sprague-Dawley