Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) is a new surgical management which brings hopes of cure to patients with primary or metastatic liver tumor who do not have sufficient future liver remnant (FLR).This review summarizes the current research on the development,indication,surgical procedures and safety of ALPPS.It also discusses the major concerns and unanswered doubts of ALPPS,such as the comparison with selective portal vein embolization (PVE) and the long-term oncological progression.

Clinical symptoms,multi screeming characters and pathological features of 15 cases of FNH were analysed retrospectively.11 cases were treated by operation.The results showed that three quarters(12/15) of the patients were male.Only one third(5/15) of the patients were diagnosed as FNH according to multi screeming of B US,CT and MRI.There were no complications for the 11 cases after operation.The results indicated it is difficult to diagnose FNH only by multi screeming methods.Operation is the best option for the treatment of FNH.

Objective To determine the prognostic factors after radical resection (RR) for hepatocellular carcinoma (HCC).Methods Altogether 144 patients who had undergone RR for HCC from 1988 through 1995 were included for a univariate and a Cox multivariate analysis.Nineteen factors contributing to overall survival rate (SR) and disease-free SR were analysed.Results The 5-year SR and disease-free SR (N=144) were 47.3% and 23.9%,separately.Multivariate analysis revealed that classification of RR was the signficant factor to overall SR,and presence of vessel invasion was the signficant factor to disease-free SR.The 5-year SR and disease-free SR in the patholngically RR and clinically RR groups were 60.2%,29.0% and 14.0%,0%,respectively.The 5-year disease-free SR in the group without (or with) vessel invasion was 27.8% (or 0%).Conclusions The classification of RR is the determinative prngnostie factor.Pathologically RR is the first option for patients with in- dications.It is essential to improve adjuvant therapy to decrease postoperative recurrence and metastasis rates.

Objective To investigate the diagnosis and treatment of pseudotumorous pancreatitis. Methods A retrospective clinical analysis was made on 20 cases with pseudotumorous pancreatitis in one stage from 1983.7 to 2004.5. Resulds There were 14 males and 6 females. Jaundice and abdominal pain were the major complaints. 17 cases underwent surgery, including cholangiojejunum Roux-en-Y anastomosis in 11cases, pancreatoduodenectomy in 3 cases, laparotomy and biopay in 3 cases . 3 cases underwent US-guided needle biopsy. All the 15 cases who were followed up had no jaundice at all after operation and abdominal pain relief was achieved to various degree. Conclusion It's difficult to diagnose pseudotumorous pancreatitis before operation. Hepatojejunal Roux-en-Y anastomosis was suitable for the patients with obstructive jaundice. When refractory abdominal pain was encountered or intraoperative pathologic diagnose was diffcult, pancreaticoduodenectomy should be recommended.

Objective To investigate the prognostic factors of EGC patients,especially the relationship between prognosis and tumor size.Methods Clinical data of 119 EGC cases from 1998 to 2002 were analyzed retrospectively.Results The overall 5-year survival rate was 90.9%.and the survival rate of patients with tumor D＜2 cm.2 cm≤D＜4 cm and D≥4 cm respectively was 100%,92.0%and 80.8%(P=0.024).In this group,tumor stage,lymph node metastasis and tumor invasion depth did not affect the survival statistically.There was no correlation between tumor size and other prognostic factors.Conclusion Tumor size is an independent prognostic factor of patients with EGC,which may have some relevance to the surgical approach of EGC.

Objective:To investigate the therapeutic effect of continuous blood purification (CBP) on acute pancreatitis (AP) and its influence on prognosis.Methods:200 patients with AP in our hospital from January 2010 to December 2016 were selected as the subjects,and they were divided into conventional treatment group and CBP treatment group according to the random number table method,600 cases in each group.The conventional treatment group was received conventional drug therapy,and the CBP treatment group was treated with CBP on the basis of commonly used drugs.The disappeared time of clinical symptoms after treatment and the changes of inflammatory factors and the changes of intestinal function before and 72 h after treatment were compared between the two groups,the mortality rate was compared between the two groups at 7 d after treatment.Results:Abdominal pain disappeared time,abdominal distension disappeared time and abdominal tenderness disappeared time in CBP treatment group after treatment were lower than the conventional treatment group (P＜0.05).There was no significant difference in the levels of endotoxin,C reactive protein (CRP),amylase (AMS),two amine oxidase and malondialdehyde before treatment in the two groups (P＞0.05).At 72 h after treatment,endotoxin,CRP,AMS,two amine oxidase and malondialdehyde levels were lower than those before treatment,and the CBP treatment group was lower than the conventional treatment group (P＜0.05).The mortality rate of CBP treatment group was lower than that of conventional treatment group at 7 d after treatment,the difference was statistically significant (P＜0.05).Conclusion:CBP can effectively improve the clinical therapeutic effect of AP,and improve the clinical prognosis of patients.

Objective To summarize experiences associated with hepatectomy of huge liver neoplasm.Methods Two hundred and sixty six consecutive cases of huge liver neoplasm undergoing hepatectomy from January 1987 to December 2005 at Chinese PLA General Hospital were analized retrospectively based on the clinical data.Results There were 174 males and 92 females with the average age of(44.8 ± 12.2)years(range 7-76 yrs).Among them,93 cases were with benign neoplasms.The maximum diameter of tumors was 30 cm and hemangioma accounted for 86.0%(80 cases).The other 173 cases were huge liver malignant neoplasms with the maximum diameter of 33 cm,hepatocellular carcinoma accounted for 73.4%(127 cases).The average diameter of all tumors was(14.7 ±4.0)cm(range 10.2-33.0 cm).HBsAg(+)was found in 40.49% of cases.Numbers of resected segments averaged(3.3 ±1.2)in benign cases and(3.1 ±1.2)in malignant ones without significant difference between the two groups(t=1.710,P=0.310).Postoperative complications occurred in 17.29% of cases and the hospital mortality was 0.75%.The postoperative 1-,3-and 5-year survival rates in patients with malignant liver tumors were 58.3%,39.7% and 27.5%,respectively.Conclusions Hepatectomy of huge liver benign and malignant neoplasms can be performed safely with low morbidity and mortality,provided that it is carried out with skillful surgical expertise and optimized perioperative management.

Objective To summarize the experience in surgical treatment of hepatic cavernous hemangioma (HCH). Methods The clinical data of 345 patients who received HCH resection in General Hospital of PLA from 1986 to 2005 were retrospectively analyzed. Results The ratio between male and female patients was 1/1.8. Eighteen patients (5.2%) were incidentally found with HCH during or after operation. Most of the HCH were located in the right lobe, with the proportion of 16.2% (56/345). Ninety-one patients (26.5%) had small HCH (diameter<5.0 cm), 173 (50.3%) had large HCH (diameter ranging from 5.0-10.0 cm), and 80 (23.2%) had giant HCH (diameter>10.0 cm). The mean diameter of the HCH was (8.0±5.0) cm. Three hundred and twenty-three (99.7%) patients were with Child pugh A. Right subcostal incision and enucleation were performed on all patients. The incidence of postoperative complications and mortality were 11.3% (39/345) and 0.3% (1/345), respectively. Caudate lobe resection was performed on 9 of 11 patients with the tumor located in caudate lobe. Conclusions Some HCHs may be easy to be misdiagnosed as hepatic solid tumor. HCH resection (inclu-ding hepatic caudate lobectomy) is safe for patients with HCH, and the most severe operative complication is massive bleeding during hepatectomy.

Objective To assess the surgical treatment of iatrogenic biliary strictures. Methods The clinical data of 235 patients with iatrogenic biliary injuries and strictures who had been admitted to our hospital from January 1989 to December 2006 were reviewed retrospectively. Cholangio-jejunal Roux-en-Y anastomosis (n=182), surgical repair with pediele flap of autogenous tissues (n=34), end-to-end choledocho-choledo-chostomy (n= 12), common bile duct incision and figuration +T-tube drainage ( n =6) and liver transplanta-tion ( n = 1 ) were applied to the patients. Results A total of 189 patients were followed up for 1 to 10 years. The total excellent and good rate was 94.7% (179/189). The recurrence rate of the biliary stricture was 5.3% (10/189), and the main cause of which were biliary cirrhosis, selerosing cholangitis and calculus. One patient with severe biliary cirrhosis and portal hypertension died of liver failure postoperatively. Conclusions The cholangio-jejunal Roux-en-Y anastomosis is a reliable and effective method. Surgical repair of the bile duet with pedicle flap of autogenous tissues could preserve the function of the sphincter of Oddi, but the long-term effect needs further investigation. Biliary stent is not usually necessary to install. Liver transplantation is efficient for the patients with end stage of biliary diseases caused by biliary stricture.

ObjectiveTo evaluate the safety and effects of pseudomonas aerug PA-MSHA vaccine on cytoimmunity in advanced gastric cancer patients. MethodsSeventy two patients with advanced gastric cancer were randomly divided into experimental group and control group. Tumor bed was treated intraoperatively by pseudomonas vaccine injection in experimental group.The venous bloods were sampled prior to surgery (preoperative) and on days 10,20,and 30 postoperatively.The total lymphocyte count and lymphocyte subpopulations were detected while the postoperative complications and adverse drug reaction were observed,prognosis was evaluated. ResultsThe total lymphocyte count(P =0.042) and the counts ofCD3+ lymphocyte(P =0.027) and NK cell increased (P =0.012) obviously in experimental group.CD8+ lymphocyte decreased(P =0.037),but the counts of CI4+ lymphocyte and CD4+/CD8+ were not significantly different.Complications were not significantly different in the two groups.One year survival rate was longer ( 94.9％ ) in experimental group than that in the control group ( 83.3％ ) ( P =0.022 ).ConclusionsPeritoneal cavity administration with pseudomonas aerug vaccine was safe,and effectively helps regulate cytoimmunity in postoperative patients of advanced gastric carcinoma.