Partial liver resection and liver transplantation are potentially curative treatment for hepatocellular carcinoma(HCC). For patients with compensated (Child-Pugh class A) cirrhosis, liver resection used to be the mainstay of treatment. For early HCC with poor liver function (Child Pugh classes B and C), liver transplantation is universally

Cholangiocarcinoma is a rarely malignant tumor with poor overall prognosis. Radical surgery is the only strategy to improve the long-term survival of patients with cholangio-carcinoma of early-stage. For most patients with advanced cholangiocarcinoma, systematic treatment has become the main strategy. But the available first-line drugs for the treatment of cholangiocarcinoma are limited and the curative effect is limited. In recent years, immunotherapy strategies such as immune checkpoint inhibitors have achieved encouraging results in a variety of solid tumors by using the host immune system to carry out effective anti-tumor responses. The authors summarize the research advances of immune checkpoint inhibitors in the treatment of cholangiocarcinoma.

Objective To investigate the effects of different reperfusion sequence on hepatic warm ischemia-reperfusion injury and its related mechanisms.Methods Ninety-six healthy male Sprague Dawley rats were randomly divided into 6 groups by using random digits method(n=16,each): Sham operation group,only shammed operation for negative control;the other 5 groups were all experimental groups,which were divided according to different reperfusion sequences of portal vein and hepatic artery: reperfusion first through the portal vein for 1 min with subsequent full reperfusion group,reperfusion first through the portal vein for 2 min with subsequent full reperfusion group,reperfusion first through the hepatic artery for 1 min with subsequent full reperfusion group,reperfusion first through the hepatic artery for 2 min with subsequent full reperfusion group,simultaneous reperfusion through the portal vein and hepatic artery group.Each group was further randomly divided into two subgroups(n=8,each) for sample collection at 2,4 hours after reperfusion respectively.Serum alanine aminotransferase(ALT),aspartate aminotransferase(AST) and malondialdehyde(MDA),superoxide dismutase(SOD) and glutathion(GSH) in hepatic tissue were detected respectively.HE staining of histopathologic slides was used to observe the morphological changes of hepatic tissue.TUNEL method was used to assess the apoptosis index(AI) of hepatocytes.Results The liver of rat was approximately normal in the sham operation group with lower levels of ALT,AST,MDA and AI,and higher levels of SOD and GSH as compared with all the experimental groups(P

Objective To compare the effectiveness and advantage of salvage liver transplantation post-resection with primary liver transplantation for HCC patients. Methods Medline, Embase, Cochrane, CBMdisc, CNKI and Wanfang Database were searched. Randomized and nonrandomized controlled trials comparing primary liver transplantation with salvage liver transplantation were analyzed. Ten retrospective studies involving 1115 patients were included. 164 received salvage liver transplantation,and 951 patients received primary liver transplantation. Results In most researches, the two groups of patients were similar for age, sex,and cirrhosis severity at time of transplantation. Some researches showed no difference in tumor size and number between the two groups. Few studies referred to microvascular invasion. Most of the researches showed there was no significant difference in blood loss,operative time,overall survival and disease-free survival between the two groups. Conclusion Compared to primary liver transplantation, salvage liver transplantation after liver resection is associated with similar operative time, risks and overall survival. Resection first and salvage liver transplantation for recurrent tumors or liver failure seem to be a feasible treatment strategy for hepatocelluar carcinoma,especially in early-stage.

Objective To investigate a safe method for donor's hepatectomy in living donor liver transplantation (LDLT).Methods Of the 14 patients with endstage liver diseases undergoing LDLT successfully since Jan. 1995, 2 cases were subjected to extensive left lateral hepatetomy,10 to extensive left hepatetomy including middel hepatic vein and 2 to right hepatetomy. Results Bile leakge occurred only in one patients after removal of the T tube. All patients received a period of 1 month to 5 years. No complain was found. The function of the liver in all patients was normal. Conclusion The operative risk of donor hepatetomy is minimal if it is performed by experienced liver surgeons.

Objective To improve the vascular anastomosis of the rat small intestinal transplantation, reduce the ischemia of transplanted intestine and make it apt to survive, simplify the operation procedure, elevate the operation success rate. Methods Artery anastomosis was done by employing the cuff anastomosis between a segment of donor abdominal aorta with superior mesenteric artery and recipient abdominal aorta, and venous anastomosis by employing the cuff anastomosis between donor's portal vein and recipient's left renal vein, namely Tri cuff anastomosis. Results Sixty six out of 70 transplant operation cases survived with the operation success rate being 92.9 % . Total operation time was about 2 3 h . The average time for the arterial anatomosis and venous anastomosis was (5?2) min and (2?1) min, respectively. Conclusion The method simplifies the rat small intestine transplantation, shortens the operation time and improves the operation survival rate.

Objective To evaluate living-related liver transplantation (LRLT) for the treatment of Wilson′s disease. MethodsBetween Jan. 2001 and Oct. 2003,LRLT was performed in 20 patients (mean age 11.1 years) of late staged Wilson′s disease. Among them emergency transplantation was performed in 3 patients. Donor livers were all from patient′s parents. ResultsSurgery was successful in all donors and recipients, liver function test and serum ceruloplasmin reached normal level one month after transplantation. One patient died of severe rejection. Discharged patients were followed up from 2～33 months (mean 18.9 months). [WT5”HZ]ConclusionsLiving related liver transplantation is an effective treatment for Wilson′s disease complicated with hepatic dysfunction.

Objective To investigate the clinical manifestations, histopathological patterns, and methods of diagnosis and treatment of primary malignant duodenal tumors. Methods The data of 82 patients with primary malignant duodenal tumors confirmed by pathology and admitted to our hospital over a 10-year period were analyzed retrospectively. Results Tumor location:Tumors were located in the peripapilla region in 64 cases, at the descending portion of the duodenum in 11 cases, at other regions of the duodenum in 7 cases. The common presenting symptoms and signs were abdominal pain in 57 cases, jaundice 53 cases, and gastrointestinal bleeding in 41 cases. In these patients, radical resection of tumor was performed in 36 cases, palliative resection of tumor in 31cases,and operative intervention was not done in 15 cases.The 5-year survival rate of followed-up patients in this group was 2.4%. Conclusions The common presenting symptoms and signs of patients with primary malignant duodenal tumors were abdominal pain, jaundice and GI bleeding, but these patients usually lack specific symptoms and signs. The chief pathologic type is adenocarcinoma and the predisposed site of occurrence is the duodenal papillary region and the descending duodenum . CT, B ultrasonography and gastroduodenoscopy are the chief measures for the diagnosis of primary duodenal malignant tumors, and surgical resection is the main modality of treatment of this disease. The prognosis of primary duodenal malignant tumors is very poor.

Objective To study the anatomical variations adjacent to the umbilical portion of the left portal vein (U-point) radiologically and to determine their impact on treatment of hilar cholangiocarcinoma (HCCA).Methods From January 2014 to February 2016,47 consecutive patients who were diagnosed to suffer from Bismuth type Ⅰ,Ⅱ or Ⅲ a HCCA in our institution were retrospectively studied.All these patients underwent enhanced CT examination preoperatively and three-dimensional (3D) models were then reconstructed.Results Any variations of the left biliary system in relation to the U-point were analyzed.The findings showed that:B2 and B3 united above or lateral to the U-point in 31 patients (65.9％);B2 and B3 united medial to the U-point in 4 patients (8.5％);and B4 converged into B3 prior to B2 in 6 patients (12.8％).Rare variations were observed in 6 patients (12.8％).For the confluence patterns of B4:the central type was found in 10 patients (21.3％),the peripheral type in 35 patients (74.5％) and the combined type in 2 patients (4.2％).Analysis of the relationship between B1l and the confluence of B2 and B3 showed the distance to be (31.6 ± 6.2) mm in the above or the lateral patterns and (13.7 ± 4.7) mm in the medial pattern.The difference was significant (P ＜0.05).The distance from B1l to B4 was (7.1 ± 2.0) mm in the central and combined types but (16.4 ±4.0) mm in the peripheral type.The difference was significant (P ＜ 0.05).The left hepatic artery showed variations in the origin and course pattern in 4 (8.5％) and 6 patients (12.8％),respectively.The two-dimensional (2D) and 3D imagings showed excellent consistency in the evaluation of variations of the left biliary system in relation to the U-point and the left hepatic artery.Conclusions It is very important to know the variations of the left biliary and the vascular systems adjacent to the U-point in preoperative evaluating on resectability of HCCA.An accurate assessment could be accomplished using 2D imaging alone.However,3D reconstruction is a useful technique to use in complex case with locally advanced tumors.

BACKGROUND: Recently,liver transplantation technique has been developed rapidly,and prevention of ischemia/reperfusion injury and protection of liver regeneration have become a research focus.Ischemic preconditioning(IPC)is an effective method for protecting liver ischemic injury.However,the mechanism remains controversial.OBJECTIVE: To investigate the mechanism of IPC on hepatic injury and regeneration after reduced-size rat liver transplantation.METHODS: Animals were randomly divided into 3 groups.Rat reduced-size liver transplantation model was established in liver transplantation group.IPC+liver transplantation group underwent first porta hepatis blocking for 10 minutes before liver graft reperfusion,followed by reperfusion for 15 minutes.The ligament around the liver was dissociated in the sham-surgery group.The samples were collected 0.5,2,6 and 24 hours post-operation.The hepatic injury was examined by the serum alanine aminotransferase(ALT)and hepatic tissue histopathology analysis of grafts.Semi-quantitative immunohistochemistry and westernblotting were used to examine the redox factor-1(Ref-1)protein expression.The hepatic regeneration of the grafts was examined by the expression of proliferating cell nuclear antigen(PCNA)in hepatic cells.RESULTS AND CONCLUSION: Compared with liver transplantation group,the ALT values at 6 and 24 hours after operation in IPC group decreased significantly(P < 0.05; P < 0.01).Pathological analysis indicated that there were lots of inflammation cells around the portal veins,the serious sinus hepaticus dilation and damage of hepatic tissue in liver transplantation group.However,the tissue injury observed in IPC group was comparatively slight.Semi-quantitative immunohistochemistry revealed that Ref-1 protein was more abundant in IPC grafts tissue compared to liver transplantation group.These observations were supported by westernblotting studies where Ref-1 protein was shown to be over-expressed in IPC specimens at 24 hours after reduced-size liver transplantation(P < 0.05).In addition,the number of PCNA-positive cells in IPC group was more than liver transplantation group at 2,6 and 24 hours after operation(P < 0.05).IPC improves hepatic regeneration and relieves grafts injury in earlier period after reduced-size rat liver transplantation,which is associated with the over-expression of Ref-1protein.