As an essential technique involved in complicated liver surgery,portal vein reconstruction results in eradication of macro- or microscopic tumor residual on surgical margins when combined with precise hepatectomy,improving both the living quality and the survival rate of patients.The application of this reconstruction technique needs precise evaluation of pre-operational image data,clearly dissection of portal vessels and tremendous amount of collaborative effort by the surgery team. Other techniques performed during the surgical procedure include intra-operative ultrasound scan,revitalizing the cryopreserved vessels,and angioplasty.

Intrahepatic bile duct stones located at the upper part of the hepatic duct.The percentage of intrahepatic biliary cholesterol calculus is increasing in recent years,and the incidence of this type of bile duct stones is free from infection or obstruction.The formation of intrahepatic bile duct stones might not only related to the micro-environment changes in the biliary tract,but also related to the changes of metabolic function of hepatocytes or cholangiocytes.In this article,the mechanism of biliary hydrodynamics on the formation of intrahepatic bile duct stones was reviewed.

Objective To evaluate the therapeutic effect and safety of precise hepatectomy for primary liver cancer.nethods A total of 103 liver cancer patients who had been admitted to Drum Tower Hospital from July 2007 to October 2009 were divided into precise hepatectomy group(n=54)and routine hepatectomy group (n=49).Peri-and postoperative conditions and the results of follow-up of patients in the 2 groups were compared.All data were analyzed via t test or Fisher exact test.Results No perioperative mortality was observed in the 2 groups.Mean blood loss was(635±608)ml in precise hepatectomy group and(929±1044)ml in routine hepatectomy group,with no significant difference between the 2 groups(t=1.722,P>0.05).Intraoperative blood transfusion volume,postoperative level of aspartate transaminase,positive rate of resection margin and incidence of postoperative complications were(222±381)ml,(158±121)U/L,2%(1/54)and 7%(4/54)in precise hepatectomy group,and were(542±785)ml,(292±347)U/L,18%(9/49)and 24%(12/49)in routine hepatectomy group,with significant difference between the 2 groups(t=2.590,2.558,P<0.05).The 1-year tumor recurrence rate and 1-year survival were 24%(8/33)and 85%(28/33)in precise hepatectomy group,42%(20/48)and 77%(37/48)in routine hepatectomy group,with no significant difference(P>0.05).Conclusion Precise hepatectomy is safe and effective in the treatment of liver caner without much injury to patients.

Surgery is so far the most widely used and effective treatment of neoplastic diseases.However,residual tumour cells during surgery remain a major trigger of cancer recurrence and matastasis.Although intraoperative rapid pathological R0 resection can be achieved based on preoperative imageological examination,but for small satellite lesions and the naked eye can not find the error quickly and so often cause pathological presence of residual tumour cells.Thus,quick and accurate identification of residual cancer cells is crucial for prognosis of cancer patients.Indocyanine green (ICG) is a new type of fluorochrome that can stain tumours under the near-infrared fluorescence during surgery,the paper will be reviewed latest developments in the reagent for fluorescence in tumours.

Objective To analyze the incidence of BK virus (BKV) infection after kidney transplantation in our center and to evaluate the efficacy and safety of conversion treatment with Mizoribine (MZR) on BKV infection after kidney transplantation.Methods The information of recipients who received BK virus screening in hospital or outpatient during 2015-02 to 2016-12 in our center was retrospectively analyzed.The recipients positive for BKV were divided into experiment group (given conversion treatment with MZR) and control group (not given MZR conversion) according to the inclusion criteria.The negative rate of BKV,AR,hyperuricemia and the function of renal allograft during the conversion treatment with MZR were observed.Results 182 recipients accepted BKV screening during 2015-02 to 2016-12 and 68 cases were positive.The positive rate of BKV was 38.5 ％.The positive rate of peripheral blood specimens and midstream urine specimens was 7.1％ and 36.8％ respectively.Twelve recipients were positive for BKV in both peripheral blood specimens and midstream urine specimens.There were 27 recipients in experiment group and 36 cases in control group.Fourteen recipients positive for BKV became negative after MZR conversion in experiment group and the negative rate was up to 51.9％.The mean time of negative rate was 3.2 ± 2.7 (1-10) months after MZR conversion.During the conversion treatment with MZR,AR occurred in 1 case and was reversed by the impact therapy with Thymoglobulin in experiment group.The value of serum uric acid was maintained stable before and after MZR conversion under the action of uric-acidlowering drug.The renal function was kept stable in both experiment group and control group after renal transplantation.No deaths and renal allograft failure cases occurred in both groups during the research period.The 2-year survival rate for patients and kidneys was both 100％.Conclusion The incidence of BKV infection after kidney transplantation was high and the treatment scheme of MZR conversion was safe and effective.

Objective To investigate the effects of structured triglyceride on hepatic function,nutritional status,inflammatory reaction and immunologic function of patients with primary liver cancer after hepatectomy.Methods A prospective,double-blind,randomized,controlled clinical trial was conducted based on the clinical data of 80 patients with primary liver cancer who underwent hepatectomy at the Drum Tower Hospital from January 2011 to December 2012.All the 80 patients were allocated into the testing group (40 patients) and the control group (40 patients) based on a random number table,and received isometrical nitrogen and isocaloric parenteral nutritional support therapy for 7 days after operation.Structured triglyceride (STG) and physical mixed medium chain/long chain triglycerides (MCT/LCT) were applied to the patients in the testing group and the control group,respectively.The hepatic function,nutritional status,inflammatory reaction,immunologic function and prognosis of patients were compared between the 2 groups.The measurement data with normal distribution were presented as (x) ± s.The comparision between groups was evaluated with an independent sample t test.The trend analyses for variables were done using the repeated measures ANOVA.The measurement data with skew distribution were described as M(P25,P75) and analyzed by the analysis of variance.The count data were analyzed using the chi-square test.Results All the 80 patients who were screened for eligibility were randomly divided into the testing group (40 patients) and the control group (40 patients).The alanine transaminase (ALT),aspartate transaminase (AST),prealbumin,choline esterase,C-reactive protein,IgG,IgM,IgA,CD3 +,CD4 +,CD8 + and CD4 +/CD8 + in the 2 groups showed a range of variations before operation and at postoperative day 5 and 7.The ALT,AST,prealbumin,choline esterase,C-reactive protein,IgG,IgM,IgA,CD3 +,CD4 +,CD8 + and CD4+/CD8 + from preoperation to postoperative day 7 were from (36 ± 10)U/L,(37 ± 13)U/L,(233 ±42)mg/L,(154±32)U/L,(8.1 ±1.6)mg/L,(14±5)g/L,(3.2±1.3)g/L,(2.1 ±1.3)g/L,55.6％±6.8％,37.5％±2.0％,25.9％±2.9％ and 1.5 ±0.5 to (83 ±33)U/L,(63 ±42)U/L,(208 ±37)mg/L,(145 ±26)U/L,(30.3 ±8.6)mg/L,(12 ±3)g/L,(2.8 ±1.6)g/L,(2.0 ±1.2)g/L,46.2％±3.9％,33.4％±3.1％,27.9％±3.0％ and 1.2 ±0.4 in the control group,and from (36 ± 12)U/L,(36 ± 14)U/L,(231 ±45)mg/L,(149 ±25)U/L,(7.6 ± 1.8)mg/L,(13 ±5)g/L,(3.3 ±0.7)g/L,(2.1 ± 1.1)g/L,54.2％±6.3％,37.6％±3.5％,24.8％±3.4％ and 1.5 ±0.4 to (43 ±30)U/L,(40 ±33)U/L,(255 ±44)mg/L,(153 ±27)U/L,(21.7 ±11.2)mg/L,(17 ±4)g/L,(4.1 ± 1.7)g/L,(2.4 ± 1.9)g/L,57.9％±3.2％,39.2％ ± 2.9％ 22.7％ ± 3.4％ and 1.7 ± 0.4 in the testing group,respectively,showing significant differences between the 2 groups (F =94.71,86.40,64.22,16.77,8.18,37.23,11.52,22.58,50.30,26.44,13.16,44.84,P ＜ 0.05).There were no significant differences in the level of ALT,AST,prealbumin,choline esterase,C-reactive protein,IgA,CD8 + and CD4 +/CD8 + at postoperative day 5 between the 2 groups (t =1.24,1.03,0.91,1.02,0.53,0.68,1.61,0.98,P＞0.05).There were significant differences in the IgG,IgM,CD3+and CD4 + at postoperative day 5 between the 2 groups (t =2.58,3.15,3.87,2.46,P ＜ 0.05).There were significant differences in the levels of ALT,AST,prealbumin,choline esterase,C-reactive protein,IgG,IgM,IgA,CD3 +,CD4 +,CD8 + and CD4 +/CD8 + at postoperative day 7 between the 2 groups (t =4.83,2.79,5.58,2.12,3.10,2.53,4.17,2.35,3.45,2.98,3.12,3.75,P ＜0.05).The body weight of patients at postoperative day 7 and duration of hospital stay in the control group were (57 ± 6) kg and (9.9 ± 1.5) days,which were significantly different from (61 ± 8) kg and (8.8 ± 1.3) days in the testing group (t =3.67,2.71,P ＜ 0.05).Conclusion Structured triglyceride can effectively improve the recovery of hepatic function,nutrition status and immunologic function and reduce inflammatory reaction for the patients with primary liver cancer after hepatectomy.

Objective To explore the optimal surgical treatment strategy of advanced gallbladder carcinoma (Nevin Ⅲ - Ⅴ ), with an aim to prolong patients' overall survival. Methods 17 patients with advanced gallbladder carcinoma were reviewed. Their preoperative diagnosis, surgical treatment, complications and survival time were studied. Results The diagnosis of advanced gallbladder carcinoma was done using different medical imaging techniques, but incorrect diagnosis still happened. There is a wide range of surgical treatment for advanced gallbladder carcinoma. Controversy still exists as whether lymph node resection should be done. In our patients, 35.3% of the 13a lymph nodes and 23. 5% of the 8 lymph nodes were positive for metastasis, which showed that lymph node resection should be carried out. Extended surgery was sometime required to ensure a R0 resection.The main complications of surgery were intraabdominal infection, bile leakage and paralytic ileus.Conclusion An aggressive surgical approach for advanced gallbladder carcinoma is required to ensure a R0 resection, which contributed to better overall survival.

Objective: To design the proficiency testing (PT) project (No. NIFDC-PT-183) for assays of bismuth potassium citrate capsules and organize to assess the proficiency of complexometric titration in laboratories, and provide some technical analyses and advices.
Methods: Two groups of samples with different concentration were prepared. The uniformity was evaluated with one-way analysis of variance and the stability was confirmed with t-test, whose results all conformed the requirements. The samples with three combinations were randomly distributed to 279 laboratories. The determination was performed according to the assays of bismuth potassium citrate capsules in Volume Ⅱ of the Chinese Pharmacopoeia 2015. The median value and normalized interquartile range (NIQR) of robust statistical analysis was adopted and Z-scores were used to evaluate the results from each of laboratories.
Results: Among 279 laboratories, 240 laboratories results were satisfactory, 23 were questionable, and the other 16 were unsatisfied. The satisfaction rate was 86.0%.
Conclusion: The overall capacity of national laboratories for assays of bismuth potassium citrate capsules is good while a portion of participants require further improvement.

Objective:To explore the clinical efficacy of dual-kidney transplantation from infant donors to adult recipients.Methods:From December 2012 to November 2020 in Organ Transplant Center First Affiliated Hospital Sun Yat-sen University, rertrospective reviews were conducted for clinical data of 25 pairs of infant donors and adult recipients. The survival rates were calculated for both recipients and transplanted kidneys at Year 1/3/5 post-transplantation. And the postoperative recovery status and the postoperative incidence of adverse events of recipients were observed.Results:The survival rates of recipients were all 95.8% at Year 1/3/5 and those of transplanted kidney and dealth-cancelling transplanted kidney all 87.2%. One case died due to acute inferior-wall cardiac infarction while three others lost renal functions for vascular thrombosis, ureteral stenosis and urinary fistula. Except for loss of renal function and death, the postoperative estimated golmerular fitration rate was (99.35±21.78), (103.11±29.20) and (114.99±28.55) ml/(min·1.73 m 2) at Year 1/2/3 respectively. Conclusions:Selecting proper recipients, standardizing donor acquisition and surgical procedures and strengthening perioperative managements may expand the donor pool. The overall outcomes are excellent for adult recipients with dual-kidney transplantation from donations after infants' death.

OBJECTIVE: To explore and analyze the clinical characteristics and treatment strategy of severe complications caused by esophageal foreign bodies. METHOD: A retrospective study was carried out on 49 cases with foreign bodies in esophagus through careful analysis of their clinical data to explore the associated problems with etiology and therapy. Among this complications, there were cases of 13 periesophageal abscess, 20 cases of abscess in the neck, 11 cases of mediastinal abscess, 3 tracheoesophageal fistula, 1 case of aorta injury and 1 septicemia. RESULT: Forty-eight (97.96%) of the patients recovered while one died. CONCLUSION Hard esophagoscopy under general anesthesia is the main therapeutic strategy to take out the esophageal foreign bodies. When it failed or severe complications such as perforation or others emerged, open surgery like lateral neck incision or thoracotomy supplemented with positive and timely supporting therapy are vital and essential.
Adolescent ; Adult ; Aged ; Child ; Child, Preschool ; Esophagus ; Female ; Foreign Bodies ; complications ; surgery ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Young Adult