Objective To study the risk factors of complications after hepatectomy for intrahepatic stone.Method Clinical data of 363 patients with hepatolithiasis receiving elected hepatic resection in past 4 years in our hospital were analyzed retrospectively.Postoperative complications were recorded.Possible risk factors pertaining to the development of complications were identified using univariate and multivariate analysis.Results the surgical mortality was 0.6%(2/363).Postoperative complications occurred in 110 of 363 patients(30.3%).The morbidity included wound infection/liquafication in 42 cases(11.6%),pleural effusion in 41(11.3%),subphrenic collection in 36 (9.9%),bile leakage in 21(5.8%),intra-abdominal collection/infection in 13(3.6%),gastrointestinal bleeding in 3(0.8%),biliary hemorrhage in 2(0.6%),hepatic function insufficiency in 1 (0.3%).The multivariate logistic regression analysis identified that previous history of biliary surgery (P=0.042,odds ratio[OR]=0.617,95%confidence interval[CI]:0.388 to 0.982)and operative time(P=0.0001,odds ratio[OR]=0.994,95%confidence interval[CI]:0.991 to 0.997)were the independent risk factors for development of complications after hepatoectomy for hepatolithiasis.Conclusion Previous history of biliary duct surgery and operative time are the independent risk factors for development of complications after hepatoectomy for intrahepatic stone.For patients with previous biliary surgery,adequate preoperative preparation,improving operative skills and shortening operative time are critical important to prevent occurrence of complications.

ObjectiveTo investigate the protective effects and its mechanism of ischemia postconditioning (IPO) in hepatic ischemia-reperfusion injury (IRI) in liver cirrhotic rats.MethodsThirty liver cirrhotic Sprague-Dawley (SD) rats were randomly divided into three groups according to the random table methods: ischemia postconditioning (IPO) group, IRI group, and pure hepatectomy (PH) group with 10 rats in each group. Rats in IPO group underwent partial hepatectomy (40%), and the first portal was occluded for 20 min, then 3 times of ischemia-reperfusion were performed, and ifnally continuous reperfusion. Rats in IRI group underwent partial hepatectomy (40%), and the ifrst portal was occluded for 20 min, then continuous reperfusion was performed. Rats in PH group underwent partial hepatectomy (40%) only. Inferior vena cava blood was collected at 6, 24 h after operation. Levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), proportion of cluster of differentiation (CD) 4+, CD8+, regulatory T cells (Treg) and levels of interleukin (IL)-4, IL-10 were tested. Comparison of three groups was conducted by one way analysis of variance and pairwise comparison by LSD-t test.ResultsAfter 6 h reperfusion, levels of ALT and AST in IPO group [(1 623±378) , (1 993±469) U/L] were signiifcantly lower than those in IRI group [(2 690±549) , (3 020±577) U/L] (LSD-t=-4.21,-3.72; P<0.05). After 24 h reperfusion, levels of ALT and AST in IPO group [(307±76) , (555±137) U/L] were still signiifcantly lower than those in IRI group [(518±105) , (1 050±355) U/L] (LSD-t=-4.06,-3.37;P<0.05). After 6 h reperfusion, proportion of CD4+, CD8+, CD4+/CD8+ ratio, Treg, and levels of IL-4, IL-10 in IPO group were (57±5) %, (25±3) %, 2.3±0.5, (8.9±0.4) %, (1.27±0.25) mg/L, (0.61±0.03) mg/L, respectively. While in IRI group, they were (52±6)%, (12±3) %, 4.5±0.8, (7.3±0.3) %, (0.66±0.11) mg/L, (0.34±0.06) mg/L, respectively. In IPO group, CD8+, Treg, IL-4 and IL-10 increased signiifcantly, while CD4+/CD8+ ratio decreased signiifcantly, compared with those in IRI group (LSD-t= 7.74, 6.67, 5.52, 9.31,-6.69;P<0.05).ConclusionIPO can prevent from hepatic IRI injury in liver cirrhotic rats through decreasing the immune injury.

ObjectiveTo investigate the value of preoperative prognostic nutritional index (PNI) in postoperative survival prognosis of hepatocellular carcinoma (HCC) patients.Methods Clinical data of 322 HCC patients undergoing radical resection in the First Affiliated Hospital of Sun Yat-sen University between January 2006 and December 2009 were retrospectively studied. Among the 322 patients, 286 were males and 36 were females with the age ranging from 21 to 79 years old and the median age of 51 years old. The informed consents of all patients were obtained and the local ethical committee approval had been received. PNI value was calculated according to the examination results 1 week before surgery, then the patients were divided into the high PNI group (n=253) and low PNI group (n=69). The relationship between PNI and postoperative survival time was observed, and the value of preoperative PNI in postoperative survival prognosis was analyzed. The survival analysis was conducted using Kaplan-Meier method and Log-rank test, and the multivariate analysis was conducted using Cox proportional hazards model.ResultsThe 1-, 3-, 5-year disease free survival rate was respectively 48.0%, 34.9% and 31.3% in high PNI group, and 33.3%, 15.8% and 11.7% in low PNI group. The disease free survival in high PNI group was significantly better than that in low PNI group (χ2=9.990,P<0.05). The 1-, 3-, 5-year overall survival rate was respectively 72.3%, 49.0% and 42.6% in high PNI group, and 65.2%, 36.2% and 25.9% in low PNI group. The overall survival in high PNI group was significantly better than that in low PNI group (χ2=8.172,P<0.05). The results of the multivariate analysis showed that AFP, tumor number, tumor diameter, portal vein tumor thrombus (PVTT) and PNI were the independent risk factors for disease free survival rate (HR=1.355, 0.783, 2.295, 1.920, 0.710;P<0.05), and tumor number, tumor diameter, PVTT and PNI were the independent risk factors for overall survival rate (HR=0.780, 2.340, 2.013, 0.653;P<0.05).ConclusionsPreoperative PNI is the independent risk factor for postoperative survival prognosis of HCC patients and can be used as the common index for predicting postoperative survival of HCC patients.