Objective To observe the effects of atorvastatin and cytokine signaling inhibitor AG490 on the residual liver function and the survival time of 90% hepatectomy rats. Methods Rats were divided randomly into three groups after surgery: control group without treatment; Ato group administrated with atorvastatin (20 mg?kg -1?d -1) through NG tube one day before and three days after the surgery and AG490 group, intraperitoneally given AG490 (1 mg?kg -1?12h -1) beginning intraoperatively for 4 times. The health status and liver regeneration were observed and recorded. Results All rats in control group died within 24 hours. Both atorvastatin and AG490 significantly prolonged the survival time of rats after surgery (25.6 h & 30.6 h vs. 10.7 h,P

Objective To investigate changes of GP73 after hepatectomy and its correlations with hepatocellular carcinoma (HCC) recurrence. Methods Perioperative serum GP73 was monitored in hepatic hemangioma and HCC patients undergoing hepatectomy. Clinicopathologic features and follow-up results were collected to evaluate the relationship between serum GP73 level and patients' prognosis.Results There was no statistical difference between preoperative GP73 and postoperative GP73 in hepatic hemangioma group.While preoperative GP73 in HCC group was 9.9(3.7 - 15.8) relative unit (RU),and that on POD3 (postoperative day 3 ) was 9.1 ( 3.4 - 13.3 ) RU,on POD7 was 74.3 ( 1.7 - 9.0) RU,on POD14 was 3.3(2.1 -5.4) RU ( F =72.606,P ＜ 0.001 ).HCC recurred in 21 cases during follow-up,GP73 in recurrent cases [ 11.0 (8.4 - 13.8 ) RU ] was significantly higher than postoperative trough values while it was not different from their preoperative GP73 level [ 9.9 ( 2.9 - 15.0) RU ] ( Z =1.185,P ＞0.05). The preoperative GP73 level between recurrent subgroup and nonrecurrent subgroup was not significantly different (Z =- 1.546,P ＞ 0.05 ).Preoperative GP73 did not correlate to patients' survival.Conclusions Hepatectomy for HCC leads to a significant decrease of GP73 and postoperative HCC recurrence accompanies reelevation of GP73. GP73 could be used as a postoperative monitor for HCC recurrence.

Objective To evaluate permissive hypocaloric intake in postoperative patients by a prospective, randomized, controlled trial. MethodsForty-two postoperative patients were randomly assigned to receive 117kJ?kg~ -1?d~ -1in control group, and 75kJ?kg~ -1?d~ -1in experimental group intravenously. Blood routine, liver and renal functions were measured one day before and day 1, 3, 5 post operation. Blood glucose level, insulin intervention, infectious complications, hospital stay, and relevant cost were also evaluated. ResultsHypocaloric intake in the experimental group post-operatively did not influence the hemoglobin level, liver function, and other indicators in the serum. The fasting blood glucose and glucose levels after infusion, as well as the volume of insulin intervention were significantly higher in the control group during 4 days of parenteral nutrition. Experimental group had lower relevant hospital cost, while two groups had similar duration of hospital stay. ConclusionPermissive hypocaloric intake shortly after surgery does not influence the patient nutritional status, besides it avoids to some extent the hyperglycemia, reduces the need for insulin intervention .

Objective To investigate the effect of Ulinastatin, a urinary trypsin inhibitor on the outcome of patients undergoing liver resection. Methods In this prospective, randomized, and controlled clinical study, 42 patients undergoing hepatectomy were randomly divided into treatment group and control group. In treatment group Ulinastatin was given on the day of surgery and the three consecutive days. Blood was tested for biochemistry. ResultsSerum ALT and AST levels in treatment group were significantly lower than those in control group 12 hours post-operation, especially in patients undergoing multisegmentectomy. Difference became insignificant at the time point of 60 hours post-operation. Administration of Ulinastatin resulted in faster decrease of serum bilirubin level in patients undergoing small volume hepatectomy, and no effect on coagulative function was observed. Conclusions The protective effects of urinary trypsin inhibitor exist mainly in early stage of major liver resection.

Objective To study the effect of urinary trypsin inhibitor (UTI) on the release of inflammatory media and oxidation reaction and the mechanism by which UTI protects postoperative liver function following hepatectomy. Methods This was a prospective, randomized, controlled clinical trail, in which cases undergoing hepatectomy were divided into control group (n = 15) and treatment group (n = 15). UTI was administered beginning the day of operation and three days post-op consecutively in the treatment group. Serum CD4, CD8, C-reactive protein(CRP), and gene expressions of IL-1, Il-6, TNF-alpha, iNOS were measured. Results TNF-alpha and iNOS levels significantly decreased in treatment group compared with control 12 hours after surgery (0. 053?0. 02 & 0. 12?0. 04 vs. 0. 084?0. 01 & 0. 21?0. 02, all P

Objective.Th purpose of this study was to determine the impact of intraoperative ultrasound(IOUS)on the management of patients with neoplasms of the liver.Methods.Forty-nine patients operated on for liver or other pathologic processes were examined intraopertively with 5.0 MHz special ultrasound transducers during surgical exploration of the abdomen.Subjects were evaluated because of known or suspected disease of the liver.Preoperative imaging studies included percutaneous ultrasound(n＝49),magnetic resonance imaging(n＝11),and computed tomography(n＝34).Intraoperative evaluation on all patients included inspection,bimanual palpation,and ultrasnography.Comparison between preoperative imagings and IOUS were analysed.Results.Sensitivity for detection of hepatic neoplasms showed in intraoperative ultrasound,percutaneous ultrasound,magnetic resonance imaging andcomputed tomography as 100%(23/23),74%(17/23),74%(14/19) and 75%(6/8).Specificity showed 100%(26/26),100%(26/26),93%(14/15) and 67(2/3).In seven patients(14%),the neoplasms were not found by inspection,bimanual palpation,and identified only by IOUS.Conclusions.Intraoperative ultrasound is the most sensitive and specific method for detection and surgery of liver neoplasms,especially the occult neoplasms and small size lesion(＜2cm).

Objective To investigate the effect and long-term prognosis of patients who underwent hepatectomy for hepatolithiasis. Methods We retrospectively analyzed the medical records of 98 patients with hepatolithiasis who were treated by hepatectomy in Peking Union Medical College Hospital.Results Male/femah:1/1.7;median age:55 years old.58 cases(59.2%)had been treated before;among them.50 by surgery.In 88 cages(89.8%)hepatolithiasis involved the left lobe only,in 2(2.0%) only the right lobe involved.and in 8(8.2%)both left and right lobe were involved.51(52.0%)had extrahepatic biliary stones,30(30.6%)had biliary duct strictures,28(28.6%)had a history of biliary ascariasis.and 5(5.1%)had a concurrent biliary tract malignancy.All received partial hepatectomy according to the stone location;for the 8 bilaterally involved patients,left hepatectomy and right lithotomy were performed.Postoperative complications occurredin 14 cases(14.3%),and there were2perioperative deaths(2.0%).Seventy-eight patients(79.6%)have beenfollowedupfor over1 yearwith no tumors;the results were excellent or good in 91.0%;the stone residue and recurrence rate were both 2.0%.Conclusions Hepatectomy not only eliminates calcuci,but also removes diseased biliary tracts,with advantages of low residue stone and recurrence rate.

Objective To investigate the impact of vascular inflow occlusion of the liver on arterial lactate level and pH value. Methods In this study, 68 patients who underwent hepatectomy from January 2006 to December 2008 were retrospectively studied. The patients were assigned to one of the three study groups according the vascular inflow status: clamping of portal vein and hepatic artery in the hepatic pedicle (n = 20), hemihepatectomy under total hemihepatic vascular exclusion (THVE, n = 22), and non-vascular occlusion (n = 26). Postoperative arterial blood gas analysis including systemic arterial lactate concentration, and liver and renal function tests were performed. Results Systemic arterial blood lactate levels significantly elevated in the portal clamping and THVE groups (5.53 ±2. 31 mmol/L and 5.62 ±2.52mmol/L, respectively), compared to the non-occlusion group (3. 37 ± 1.56 mmol/L, P < 0. 05) ;significant increase in arterial HCO3- level was observed in the THVE group in comparison to the nonocclusion group (19. 68 ± 3. 82) mmol/L vs. (21.65 ± 2. 48) mmol/L, (P < 0. 05). There were no significant differences as to the changes of pH values, liver and renal function tests between the three groups. Conclusions Vascular inflow deprivation may result in significantly increased arterial lactate level. Thus, intense surveillance of blood lactate level with prompt treatment is necessary to prevent postoperative hyperlactatemia and metabolic acidosis.

Objective To summarize the clinical diagnosis and treatment of nodular regenerative hyperplasia of the liver. Methods Retrospective analysis was made on the clinical manifestations,imagings, laboratory tests, diagnosis, treatment and prognosis of 18 consecutive cases finally established as NRH during the past 26 years. Results 15 of the 18 cases showed portal hypertension, 4 cases showed mono or multiple occupations of the liver, 8 cases suffered from concurrent autoimmune diseases, 3 cases were suspected of blood diseases. Preoperatively, 13 cases were diagnosed as cirrhosis, 2 cases were diagnosed as liver cancer or focal nodular hyperplasia ( FNH). All cases were diagnosed by operative wedging biopsy. 3 cases received splenectomy, 4 cases received disconnection /Phemister surgery, 3 cases received liver occupation/liver lobe resection, 1 case received partial small bowel resection, and 1 case received spleen artery restrictive surgery. Postoperatively, symptoms of portal hypertension relieved obviously. Follow-up study showed most of the patients were stable and prognosis of the NRH was good.Conclusions NRH may relate to the disturbance of liver blood supply, and most common clinical manifestation is portal hypertension, and can combine with immune diseases, hematopathy also can present single or multiple liver occupations. Differential diagnoses include liver cirrhosis, FNH, idiopathic portal hypertension. Diagnosis of NRH relies on liver wedging biopsy. Surgery can relive concurrent portal hypertension.

Purpose: The systemic inflammation response index (SIRI) has been reported to have prognostic ability in various solid tumors but has not been studied in gallbladder cancer (GBC). We aimed to determine its prognostic value in GBC. Materials and Methods: From 2003 to 2017, patients with confirmed GBC were recruited. To determine the SIRI’s optimal cutoff value, a time-dependent receiver operating characteristic curve was applied. Univariate and multivariate Cox analyses were performed for the recognition of significant factors. Then the cohort was randomly divided into the training and the validation set. A nomogram was constructed using the SIRI and other selected indicators in the training set, and compared with the TNM staging system. C-index, calibration plots, and decision curve analysis were performed to assess the nomogram’s clinical utility. Results: One hundred twenty-four patients were included. The SIRI’s optimal cutoff value divided patients into high (≥ 0.89) and low SIRI (< 0.89) groups. Kaplan-Meier curves according to SIRI levels were significantly different (p < 0.001). The high SIRI group tended to stay longer in hospital and lost more blood during surgery. SIRI, body mass index, weight loss, carbohydrate antigen 19-9, radical surgery, and TNM stage were combined to generate a nomogram (C-index, 0.821 in the training cohort, 0.828 in the validation cohort) that was significantly superior to the TNM staging system both in the training (C-index, 0.655) and validation cohort (C-index, 0.649). Conclusion The SIRI is an independent predictor of prognosis in GBC. A nomogram based on the SIRI may help physicians to precisely stratify patients and implement individualized treatment.