ObjectiveTo investigate the clinical epidemiology of intrahepatic cholelithiasis in Guangxi area. MethodsAn retrospective analysis was made on 8?585 cases of intrahepatic cholelithiasis proved by exploration in a period of 19 years. Data were collected and analyzed by computer PEMS.ResultsThe intrahepatic cholelithiasis accounted for more than one third of all biliary stone disease treated during the same period. The prevalence of intrahepatic cholelithiasis in peasants victim increased from 23.4% out of all gall stones in a period of 1981～1985 to 55.8% between 1991～1999. The constituent ratio of intrahepatic lithiasis in males was nearly the same to that in females. The peak age range of patients with intrahepatic lithiasis was 31～40, and the mortality was the highest among all biliary stone disease. ConclusionsIntrahepatic cholelithiasis is by no means a vanishing disease,especially in rural area.

ObjectiveTo evaluate the intraoperative combined application of fibercholedochoscopy and B-type ultrasound for the treatment of intrahepatic biliary duct stones. Methods In our department 65 cases of intrahepatic biliary duct stones treated by fibercholedochoscopy and followed up for ten years were used as control. Results were compared with that of 78 cases undergoing combined management.ResultsFollow-up at first 5 years showed that patients treated with fiberbiliascopy had a much lower stone recurrent rate than that without, though difference became less significant within second 5 years. Intraoperative combined application of fibercholedochoscopy and B-ultrasound futher decreases the stone recurrence rate. ConclusionsCombining fibercholedochoscopy with B-type ultrasound intraoperatively enables the operator to locate intrahepatic biliary duct stones, reduces retained stone rate and stone recurrence.

Objective To investigate the long-term effect of recombinate human growth hormone(rhGH) on the immune function in patients with liver cancer. Methods Fifty patients with hepatoma who underwent hepatectomy were randomly divided into two groups:(1)Control group;(2)rhGH treatment(GH) group. All patients were treated with TPN for five days postoperatively,and additionally the patients in the GH group received rhGH(8U/d IH) in the evening for seven days. Results IgG,IgM,CD3,CD4 in the control group and CD8 in the GH group were significantly lower on day 10 postoperatively than that on preoperative days. IgG in the GH group significantly increased on day 15. The 1 year and 3 year survival rate and recurrent rate were not different between the two groups. Conclusions rhGH therapy can improve the immune function of patients with hepatoma who underwent hepatectomy and has no side effect on the long term survival and recurrence.

Objective To summarize our experience in the diagnosis and treatment of malignant peritoneal mesothelioma(MPM). Methods Clinical data of 10 patients admitted with MPM were analyzed retrospectively. Results The main symptoms of MPM were intraabdominal mass and abdominal pain in these patients; Seven patients were of localized type, 3 cases were of diffused type; Preoperatively 7 cases were misdiagnosed as other intraperitoneal tumor, 9 patients underwent laparotomy and tumor resection for a total 16 times, including once in 4 cases, two times in 3 cases, and three times in 2 cases. Seven patients received curative resection in initial operation. Five patients died within one year, 6 cases within two years, Tumors recurred postoperatively in 4 cases. 1 case is still survival 9 years after. Conclusion Being comparatively rare, MPM is often misdiagnosed, the prognosis is very poor, curative resection sometimes provides a long survival for localized type of MPM, when combined with perioperative comprehensive therapy.

Objective To determine the risk factors of biliary complications (BC) after liver transplantation (LT),and to provide a theoretical basis to reduce the rate of postoperative biliary complications.Method A meta-analysis was carried out using Revman 5.1.Results Eighteen studies were identified,including 524 patients in the case study group (BC group) and 3967 patients in the control group (Non-BC group).There were no significant differences in donor age,recipient age,primary disease,warm ischemia time,second warm ischemia time,anhepatic phase time and cytomegalovirus infection.The incidence of biliary complications after liver transplantation was significantly different in male than female patients (OR: 1.40; 95％ CI: 1.09～ 1.79;P=0.008).Child C hepatic function increased the incidence of postoperative biliary complications (OR: 1.95; 95％ CI: 1.02 ～3.76;P=0.04).Using a T-tube for biliary reconstruction significantly increased the incidence of postoperative biliary complications (OR: 2.00 ; 95 ％ CI: 1.30～ 3.08 ; P 0.002).The incidence of biliary complications after liver transplantation was significantly different in patients with rejection than those without (OR: 1.80;95％ CI:1.11～2.93;P 0.02).Patients with hepatic artery complications were associated with a higher incidence of postoperative biliary complications (OR: 3.15;95％ CI: 1.37～7.23 ;P=0.007).Patients in the BC group had a significantly longer cold ischemia time and operative time (P＜0.01).Conclusions A male recipient,Child C hepatic function,T-tube drainage,rejection,hepatic artery complications,prolonged cold ischemia time and prolonged operative time were factors affecting the risk of biliary complications.Biliary complications after liver transplantation had no relationship with donor age,recipient age,primary disease,warm ischemia time,second warm ischemia time,anhepatic phase time,and the presence or absence of cytomegalovirus infection.

Objective To investigate the protective effect and mechanism of irbesartan and edaravone on the rat liver transplantation model using small-for-size graft during acute phase of reperfusion.MethodsWe used 300 S-D rats for small-for-size graft liver transplantation,and the light rats were used as donors.Survived recipients were divided into five groups according table of random number:group A,control group; group B,edaravone treatment group; group C,irbesartan treatment group; group D,irbesartan and edaravone treatment group; group E,sham operation group.The rat 30％ small-for-size graft model was established.Six rats in each group were sacrificed randomly at 6th and 24th h after reperfusion respectively. The survival rate of animals and portal pressure were investigated.The rats in every group were sacrificed and blood samples were collected for liver function measurement.The contents of SOD and MDA in liver tissues were measured.Fresh liver tissue was used to detect the mRNA expression of Egr-1,ET1 and Bax by RT-PCR. Paraffinembedded liver specimens were used to assay apoptosis (TUNEL).Six rats at each time point in each group were studied.Results(1) One-week survival rate in the groups A,B,C,D and E was 8.33％(1/12),33.3％ (4/12),58.7％ (7/12),83.3％ (10/12),and 100％ (12/12),respectively,P＜0.05; (2) There was significant difference in the portal pressure,ALT,AST,MDA,SOD,Egr-1,ET-1,Bax,and the apoptotic index between treatment groups and control group,especially in the group D,P＜0.05 or P＜0.01.Conclusion Irbesartan and edaravone could protect small-for-size graft in partial liver transplantation probably by reducing portal vein pressure and diminishing ischemia reperfusion injury.The combined use of Irbesartan and edaravone is more effective than irbesartan or edaravone used alone.

Objective To search for the molecular figngerprint of ascaris lumbricoides in intrahepatic stones. Methods In 56 cases deoxyribonucleic acid (DNA) was exstracted from intrahepatic stones and surgically obtained bile duct tissues, stool and sercum examinations were performed. Based on the sequence and designed primers of ITS-2 of ascaris lumbricoides, polymerase chain reaction ( PCR) was performed. Results There were 12 positive results in 56 (21.4% ) cases of intrahepatic stones. Positive reaction appeared on the examinations of the stool on ascaris lumbricoides and the blood serum among 12 cases. Conclusions Ascaris lumbricoides DNA was found in human of intrahepatic stones, indicating that ascaris lumbricoides infection may play a role in the formation of intrahepatic stones.

ObjectiveTo investigate the clinical significance of admission hemoglobin (Hb) value for posttransplantation early respiratory complications in cirrhotic hepatocellular carcinoma (HCC) patients undergoing liver transplantation (LT).MethodsBetween April 2001 and February 2010,the medical record of 100 consecutive liver recipients at First Affiliated Hospital of Guangxi Medial University were retrospectively reviewed. Pulmonary complications developed in 45 patients after LT. Using bivariate correlation analysis between the admission Hb value and pulmonary complications screened for the threshold value of admission Hb value affecting early-phase pulmonary complications.According to the threshold value of admission Hb,LT recipients could be divided into two groups. Twenty-seven peri-operative clinical parameters were analyzed in the two groups.ResultsAdmission Hb ≤ 100 g/L was the threshold value affecting postoperative pulmonary complications.The duration of time to initial passage of flatus and the ICU length of stay were significantly prolonged in patients with admission Hb values ≤ 100 g/L,in which poorer arterial blood gas analyses were common. ConclusionsThe admission Hb value of patients with cirrhosisassociated hepatocellular carcinoma affects the early-phase prognosis after LT.

Objective To assess the efficacy of orthotopic liver transplantation (OLT) for hepatocellular carcinoma (HCC) and the effect of recipient selection on postoperative survival. Methods The clinical data of 63 patients with primary HCC receiving OLT in this hospital from June 2000 to February 2007 were retrospectively analyzed. The cumulative survival rate after transplantation was analyzed by the Kaplan-Meier method. Results The 1-, 3- and 5-year cumulative survival rates of the 63 patients were 77.4%, 59.3%, 48. 9%, respectively. The rates in conformation with Milan criteria, UCSF criteria and beyond UCSF criteria were 93.8%, 80.8%, 80.8%; 92.1%, 79.2%,79.2%; 29.2%, 8.3%, 0, respectively. The 1-, 3-, 5-year cumulative recurrent rate of patients meeting Milan criteria, UCSF criteria and beyond UCSF criteria was 6.2%, 15.5%, 19. 2%; 7. 9%,15.9%, 20. 8% ; 70. 8%, 87. 5%, 91.7%, respectively (P＜0.01). However, tumor recurrence and survival rates were similar for patients meeting UCSF and Milan criteria (P＞0. 05). Conclusion Expansion of OLT criteria is justified for HCC and does not adversely impact the posttransplant prognosis by the UCSF criteria as compared with the Milan criteria.

Objective To evaluate the clinical significance of a modified T-staging system for hilar cholangiocarcinoma(HCC).Methods From 1999 through 2007,98 HCC patients were stratified by the Tstaging system.Statistical differences were evaluated for resectability,radical resectability,concomitant partial hepatectomy,partial portal vein resection,histological differentiation,lymph node characteristic and survival rate.Results There were 43 HCC patients graded at T1,37 at T2 and 18 at T3 respectively.The resectability rates were 65%,40% and 11%,and radical resection was achieved in 46%,21% and 0% respectively.Resectabilities decreased with increasing T stage(χ~2=15,P<0.01;χ~2=14,P<0.01,separately).In patients with T1 and T2 tumors who underwent resection,the concomitant partial hepatectomy accounted for 60% and 73%(χ~2=0.6,P>0.05),partial portal vein resection for 3% and 33%(χ~2=4,P<0.05),poor differentiated types for 71% and 40%(χ~2=4,P<0.05),and lymph node metastasis for 50% and 40%(χ~2=0.4,P>0.05),respectively.The 1-,3-and 5-year survival rates in patients with T1 lesions were 58%,30%and 18%,in 12 patients it was 43%,11%and 0.The 1-and 2-year survival rate in T3 patients was 12%and 0.Patients witll T1 or T2 stage tumors had a significantly longer survival than those with T3(P<0.05)(Log rank χ~2=14,Breslow χ~2=12,P<0.01;Log rank χ~2=6,Breslow χ~2=4,P<0.05,individually),and the difference in survival between T1 and T2 was not significant(Log rank χ~2=2,Breslow χ~2=1,P>0.05).Conclusions The T-staging system is appropriate for preoperative evaluation in HCC patients.However,its correlation with tumor histological differentiation and lymphatic characteristics needs to be elucidated.