Objective To study the surgical treatment and the related risk factors of cholangioenterostomy anastomotic stenosis.Methods We retrospectively analysed the clinical data of 41 patients who underwent surgical treatment for cholangioenterostomy anastomotic stenosis in the PLA General Hospital from January 1,2008 to November 30,2014.Results All patients' clinical symptoms were alleviated and they were discharged home.No one died perioperatively.Anastomotic restenosis happened in 5 patients.Conclusions Reoperation for cholangioenterostomy anastomotic stenosis was difficult.The surgeon should make the anastomosis as large as possible to decrease the risk of restenosis.A T tube should be used when necessary.

The precise surgical treatment for hepatobiliary diseases has been a challenging topic in hepatobiliary surgery for a long time.A perfect preoperative plan can help the surgeon make R0 resection of the lesion and preserve the healthy tissue as much as possible.In addition,all of these depend on the application of different imaging modalities,especially three-dimensional reconstruction technique.But some limitations of 3D reconstruction should be noted:different surgeons may have different views for one object because of different observation points;or it cannot be used for intraoperative re-orientation and so on.3D printed model can overcome some disadvantages of 3D reconstruction.This paper reviewed related literature that reported the usage of 3D printed model in hepatobiliary surgery.

Objective To summarize the experiences got from perioperative management for intravital liver transplantation. Methods Of 30 cases of intravital liver transplantation, executed from June 2006 to December 2007 in the General Hospital of PLA, the data of perioperative management were retrospectively analyzed. Among the recipients, 26 received right hepatic lobe including middle hepatic vein (MHV), 2 received right hepatic lobe without MHV, 1 received complementary liver transplantation with MHV in left half liver, and the remained one received right hepatic lobe plus left external lobe including MHV. The primary diseases in the recipients included serious chronic hepatitis (8 cases), primary hepatocarcinoma (9 cases), fulminant hepatic failure (5 cases), final-stage cirrhosis (5 cases), and one each of liver purpura, liver angiosarcoma and Kinnier-Wilson syndrome. On Child-Pugh status, 5 cases in grade A, 9 in grade B and 16 in grade C. The score on the model for end-stage of liver disease (MEHD) was 27.7 (6.8-45.6). The total and right half liver volumes of donors were evaluated by conventional 3-D CT, and well-provided preoperative evaluation was done to both donors and recipients. Results For donors the average length of stay was 11 days (9-15) and average blood loss was 341 ml (160-1200ml), only one donor suffered from intra-operative blood loss of 1200 ml and then received 600 ml of concentrated erythrocytes. No severe complications were found in donors, and all of them recovered finally. The complications occurred in 5 recipients (16.7%), including bile leakage (2 cases), pulmonary infection (2 cases) and one case of diffusive Aspergillus infection. The survival rate of recipients was 90% (27/30), 2 recipients died from severe pulmonary infection and 1 from diffusive Aspergillus infection. Conclusion Sufficient pre-operative assessment for both donors and recipients and exquisite technology are the keys for a successful liver transplantation, and well-provided perioperative managements are also requirements.

Objective To explore the etiology and clinical prevention regime for hepatitis B virus reinfection in patients after orthotopic liver transplantation. Methods One hundred and twenty eight orthotopic liver transplantation recipients with hepatitis B virus related end-stage liver diseases were analyzed retrospectively. The patients' primary diseases included chronic fulminant hepatitis B, end-stage liver cirrhosis and liver carcinoma. All the patients were given lamivudine pre-transplantation to prevent hepatitis B virus reinfection. Single lamivudine was administered post-transplantation in 3 cases; lamivudine combined with hepatitis B immunoglobulin were given in 125 cases. Adefovir dipivoxil was administered to the patients with hepatitis B virus reinfection. All the patients were followed-up for 3～48 months. Results Two out of the three patients who received single lamivudine developed hepatitis B virus reinfection. The reinfection occurred in one patient 6 months after orthotopic liver transplantation, and the other patient was found to be reinfected 9 months after transplantation. Five out of the 125 patients who received lamivudine and hepatitis B immunoglobulin (small dosage) developed hepatitis B virus reinfection. To 3 patients with hepatitis B virus reinfection adefovir dipivoxil was given, and hepatitis B virus-DNA negative conversion was observed after three months of treatment. Conclusions Treatment with lamivudine and low dose of hepatitis B immunoglobulin post-transplantation may offer an effective prevention against hepatitis B virus reinfection. Adefovir dipivoxil is effective for patients with reinfection of hepatitis B virus by suppressing its variant replication.

BACKGROUND:Perioperative treatment of emergency liver transplantation for acute hepatic failure is extremely different from common liver transplantation, due to complex conditions, high risk, several complications, and high mortality. OBJECTIVE:To summarize the experience of emergency liver transplantation for acute hepatic failure during the perioperative period, and to increase the success rate in treatment of acute hepatic failure. METHODS:A retrospective analysis was undertaken on the clinical data of 38 cases undergone emergency liver transplantation for acute hepatic failure. There were 21 male and 17 female, who aged 15-69 years. Among them, 23 cases had hepatitis B virus (including 2 cases with hepatitis B and C virus), 7 cases had Wilsons disease, 3 cases had mushroom poisoning, 2 cases had unknown liver damage, 1 case had Tripterygium wilfordi poisoning, 1 case had decompensation after partial liver resection due to trauma, and 1 case had liver transplantation from corpse. RESULTS AND CONCLUSION:The survival time of the involve patients was 13-1 740 days, and the median survival time was 634 days. Perioperative survival rate was 76%, 1-year survival rate was 63%, and 2-year survival rate was 58%. During the perioperation nine cases died of brain edema and intracranial hypertension, renal failure, severe pulmonary infection, multiple organ failure, coagulation disorders (intracranial hemorrhage, upper digestive tract hemorrhage), acute respiratory distress syndrome and primary graft non-function. At present, emergency liver transplantation is stil the most effective way for acute liver failure. Hemorrhage, infection and rejection are the leading causes of the death. Each perioperative treatment is of great significance for the success of liver transplantation and long-term survival.

For a matured digestive surgeon,pancreaticoduodenectomy (PD) is regarded as one of the most complicated and technically challenging surgical procedure.Based on the accurate interpretation of patient's preoperative imageologic data,we advocate a novel procedure which is called as G-path pylorus-preserving pancreatoduodenectomy (G-path PPPD).We deen G-path PPPD as a standardized procedure for resectable pancreatic head cancer or periampullary carcinoma,which definitely simplify the procedure,save the operative time,achieve R0 resection through en-bloc resection without interruptedly intraoperative exploration and reduce the risk of iatrogenic tumor metastasis.This article introduced the program of G-path PPPD in detail by taking a patient as an example who suffered from pancreatic head cancer accompanied with obstructive jaundice,and discussed the relevant points.

Objective To investigate the feasibility and outcome of resection and reconstruction of hepatic artery in hilar cholangiocacinoma (HCC).Methods The data of 29 patients with HCC with hepatic artery reconstruction carried out from March 2009 to August 2013 in our center were retrospectively analyzed.23 right hepatic arteries and 6 common hepatic arteries were involved.In-situ anastomosis was carried out in 20 patients and a double anastomosis using gastrodoudenal artery grafts was carried out in 9 patients.Results There were no arterial thrombosis or other related complications on prolonged follow-up.Conclusion Hepatic artery resection and reconstruction should be carried out if the artery was invaded by a hilar cholangiocarcinoma to produce a high resection rate and a better outcome.

Objective To explore the effect of ulinastatin on coagulation function of elderly patients after hip replacement.MethodsTotally 120 patients undergoing elective hip replacement in our hospital were chosen.According to the stratified randomization method, all patients were divided into observation group and control group with 60 in each.The control group received oral Xarelto combined with other conventional treatment, while the observation group received ulinastatin on the basis of the treatment regimen of the control group.The coagulation parameters and clinical manifestations were compared between two groups.ResultsTwo days after operation, the TT, APTT, PT, DD and FIB between the two groups showed statistically significant difference (t=-5.300,-2.319,-2.409,-2.325,-3.567;P<0.05).The hospital stay,CRP,TXB2 and total drainage volume in observation group 5d after operation were lower than those in control group, between the two groups showed statistically significant difference (t=-2.529,-2.082,-3.388,-2.887;P<0.05).The patients with elevated blood urea and serum creatinine in observation group were obviously less than that of control group, but the patients with nausea in observation group were obviously higher than those in control group,between the two groups showed statistically significant difference (χ2=5.217,5.926,8.571;P<0.05).The patients with deep vein thrombosis in observation group were obviously higher than those in control group,between the two groups showed statistically significant difference (χ2=8.571, P<0.05).ConclusionUlinastatin can significantly improve the hypercoagulable state of patients after hip replacement and reduce the incidence of deep vein thrombosis, and plays an important role in promoting wound healing and immunity recovery.

Objective To summarize the clinical experience of hepatic artery bypass reconstruction using gastroduodenal artery in radical resection of hilar cholangiocarcinoma,and to provide assistance for surgeons applying artery reconstruction technique correctly in radical operation of hilar cholangiocarcinoma.Methods 9 cases of hilar cholangiocarcinoma with hepatic artery invasion wcrc subjected to radical resection combined with tumor invaded hepatic artery resection and reconstruction.Hepatic artery bypass reconstruction was performed by end-to end anastomosis,using the gastroduodenal artery interposition graft.The clinical data of these patients were reviewed retrospectively.Results All tumors of these cases with hilar cholangiocarcinoma were involved right hepatic artery,and the in volvement length was not less than 2 cm.The artery reconstruction was one-time successfully per formed in all cases.The median time required for anastomosis was (23.0±3.1) min.No postoperative complications,the dysfunction of gastrointestinal peristalsis or abnormal gastric drainage volume for example,related to the gastro-duodenal artery resection was observed.None of the patients devel oped any complications related to the arterial bypass reconstruction in the follow-up period,which was confirmed by abdominal CT scan.Conclusion Hepatic bypass reconstruction using gastro duodenal artery graft decreases the morbidity related to artery reconstruction and has little effect on gastrointes tinal function,which is the optimal choice for arterial reconstruction in radical operation for hilar cholangiocarcinoma.

ObjectiveTo share the experience of arterial plasty and reconstruction of variant arteries in living donor liver transplantation. MethodsFrom September 2006 to May 2010, 73 living donor liver grafts (64 cases using the right lobe,9 cases using left lobe) were used in patients with end-stage liver disease. The hepatic arteries were evaluated preoperatively with computed tomography and magnetic resonance angiography. Back-table arterial plasty was performed under a microscope or a loupe according to arterial variation. We described technical points based on anatomic variations. There were 13 (17. 8 ％) liver grafts with anatomic hepatic arterial variations and all of these cases were subjected to back-table reconstruction with interrupted 8-0 or 9-0 nonabsorbable nylon monofilament sutures according to the diameter of artery. ResultsIn 3 cases, the associate right hepatic arteries that were arisen from superior esenteric arteris (SMA) were reconstructed to cystic arteries. In 2 cases with the associate right hepatic arteries arisen from the abdominal trunk, the right hepatic arteries and associate right hepatic arteries of donors were anastomosed with right hepatic arteries and left hepatic arteries in recipients respectively. In 2 donors, hepatic arteries had branches, which were reconstructed. All of the arterial plasty were conducted on a back table. No arterial thrombosis was found during a postoperative follow-up period of 6 months. ConclusionLive donor liver transplantation using the right lobe with hepatic artery variation can be performed safely, but there is a potential operative risk of severe complication after transplantation. Tominimize operative difficulties and complications, back-table reconstruction should be applied and proper treatment is given according to individual situations to ensure a safe and satisfactory outcome