At present, about one third organ transplantation recipients were hepatocellular carcinoma (HCC) patients even in the most advanced transplant center in the world. HCC especially the early primary HCC has been listed as one of the indications of liver transplantation(LT) in the most organ transplant center in the world. However, due to the tumor recurrence and metastasis following LT, many patients would be dead following transplantation in about 2 years later. Their five-year survival rate was only 50 percent in benign final phase liver disease patients. The current researches for this phenomenon were still shallow both in mechanisms and treatments. How to prevent tumor recurrence has become serious challenges and must be faced in liver transplantation surgery. Obviously, to discover the molecular mechanisms and predisposing factors of following LT recurrence, to explore appropriate standards for LT in HCC patients and to strengthen perioperative management are the only way for increasing LT efficacy.

Hepatocellular carcinoma (HCC) is one of the most common cancers in the worldwide.In recent years,the development of imaging techniques has facilitated the detection of HCC at early stages.However,HCC has a high frequency of portal vein invasion,which is reportedly observed in 11％ to 42％ of patients with HCC.Portal vein tumor thrombus(PVTT) is a crucial factor that can worsen the prognosis of HCC because it can be wide dissemination of tumor throughout the liver and cause a marked deterioration of hepatic function.It was considered that is not appropriate with surgical treatment in the past,which is treatment conservative or even give up,most of the patients died within a few months.Even if the patients have a chance to surgical resection,and the most of patients combined with TACE,portal vein stent implantation or chemotherapy postoperative,some patients can be more prolonged survival,however,due to the small tumor thrombus and micro metastases have exist before the surgery and can not be checked out.it's difficult to clean up in the surgery,easily lead to HCC recurrence postoperative.However,with the constant awareness the PVTT formation mechanism and scientific technology progress,more and more new treatment techniques is applied to clinical.This view focuses on the portal vein tumor thrombus formation mechanisms and Classic Transcatheter Arterial Chemoembolization and new treatment methods such as:Helical tomotherapy,CIK cell therapy (cytokine-induced killer cell therapy),Chemoembolization and stent combined with iodine-125 seed.

Objective To systematically evaluate the comparison of postoperative complications of laparoscopic splenectomy (LS) versus open splenectomy (OS) for hypersplenism secondary to portal hypertension of liver cirrhosis .Methods Clinical trials ,which compared the postoperative complications of LS versus OS for portal hypertension of liver cirrhosis from the PubMed ,Cochrane Li‐brary ,EMbase ,CNKI and CBM data bases from 2000 to 2013 and the RevMan 5 .2 software was used for data analysis .Results six trials with 456 patients were included .Meta‐analysis showed that there was no significant difference in incidences of postoperative bleeding(OR=0 .52 ,95% CI 0 .25 -1 .06 ,P=0 .07)or pancreatic fistual(OR=1 .09 ,95% CI 0 .33 -3 .60 ,P=0 .89) between LS and OS groups .Incidence of postoperative infection was decreased in LS group compared with OS group (OR=0 .17 ,95% CI 0 .07-0 .38 ,P<0 .01) .However ,the incidence of postoperative portal venous thrombosis was increased in LS group compared with OS group(OR=2 .14 ,95% CI 1 .23 -3 .73 ,P=0 .00) .Conclusion LS and OS own the same incidence of postoperative bleeding and pancreatic fistual .The incidence of postoperative infection was decreased in LS group compared with OS group ,meanwhile ,LS group was increased compared with OS group on incidence of postoperative portal venous thrombosis .

Objective To discuss the surgical skills and clinical value of laparoscopic splenectomy with a safe approach to the splenic hilum through first mobilizing the lower pole of the spleen.Methods A total of 88 patients with hypersplenism secondary to liver cirrhosis who underwent laparoscopic splenectomy in our department from September 2015 to September 2016 were selected into this study.And these patients were divided into two groups based on whether to take the safe approach to the splenic hilum through first mobilizing the lower pole of the spleen in laparoscopic splenectomy.The control group included 40 cases who underwent the traditonal laparoscopic splenectomy,while the observation group included 48 cases who took the safe approach to the splenic hilum through first mobilizing the lower pole of the spleen in laparoscopic splenectomy.The clinical data were collected retrospectively by medical clinical records review.Results There was no mortality occurred in this study.The blood loss of the observation group was (247.50±135.89)mL,which was obviously lower than (361.75±144.43)mL of the control group,and the difference was statistically significant (P<0.05).The operation time of the two groups were (194.69±47.99)min and (232.75±45.26)min respectively,and the difference was statistically significant (P<0.05).No significant difference was found in terms of rate of conversion to laparotomy,rate of intraoperative blood transfusion,postoperative hospital stay and complications (P>0.05).Conclusion It is very crucial for a safe approach to the splenic hilum through first mobilizing the lower pole of the spleen to establish a tunnel behind the splenic hilum in laparoscopic splenectomy.It is safe and feasible to perform a safe approach to the splenic hilum through first mobilizing the lower pole of the spleen in laparoscopic splenectomy.The technique is generalized in clinics,especially for freshmen.

Objective To investigate the protective effect and the possible mechanism of lipopolysaccharide(LPS) preconditioning on ischemia/reperfusion injury of rat graft liver.Methods Male Sprague-Dawley rats were divided into three groups(n=30 in each group): sham operation group(Sham group),orthotopic liver transplantation group(OLT group) and LPS preconditioning group(LPS group).Only dissecting hepatoduodenal ligament was perfomed in Sham group.On day one,0.1 mg/kg LPS and on day 2,3,4,5,0.5 mg/kg LPS for LPS rats and 0.5 ml PBS pathogen-free solution for OLT rats was injected through caudal vein before OLT was performed by two-cuff method in the two group rats on day 8.The levels of tumor necrosis factor-?(TNF-?),ALT, AST in inferior caval vein blood and the activities of NF-?B in hepatic tissue were detected at 0,60,180 min after dissecting hepatoduodenal ligament in Sham group and after portal vein reperfusion in OLT group and LPS group.The morphological changes of hepatic tissue were observed through light microscope and electron microscope at different time points.Results As compared with Sham group at the different time points respectively,the activities of NF-?B and the levels of TNF-? were higher in OLT group and LPS group(P

Objective To study the expression of lipopolysaccharide(LPS) receptor,CD14 in the liver tissue during acute biliary infection and its relation with production of cytokines.Methods Rat models of acute biliary infection were established by ligating the choledochus and injecting Escherichia coli O111∶B4 into the duct.The expressions of CD14 protein and mRNA in liver tissue,the plasma levels of endotoxin,TNF-? and IL-6,and phagocytosis activity of Kupffer cells(KCs) were assayed at 0,3,6,12 and 24 h after operation.Ultrastructural changes in KCs were observed by electron microscopy.Results With the course prolonging in acute biliary infection,the plasma endotoxin level was progressively increased,KCs were activated and the levels of TNF-? and IL-6 markedly were increased,while the CD14 expression obviously increased at mRNA and protein levels.Conclusion The CD14 expression is gradually increased in liver tissue during acute biliary infection.KCs are activated and releasing more and more cytokines.It might be one of the important mechanisms of that KCs improve inflammatory response during the infection.

AIM: To study the influence on the expression of proliferation cell nuclear antigen(PCNA) in rectal carcinoma through retention -enema with FUDR and 5 -FU. METHODS: 80 cases of rectal carcinomas were randomized into three groups: the FUDR group(30 cases), the 5-FU group(30 cases) and normal control group(20 cases), treated with FUDR(500mg), 5-FU(500mg) and normal saline(20ml ) everynight through retention - enema separately for serven days- Mucosa of rectal car cinoma were sampled and PCNA protein were simultaneously detected by imrnunohistochemical method on the first and eighth day. RESULTS: The expression of PCNA was significantly decreased in both FUDR group and 5 - FU group after treatment(P 0. 1). CONCLUSION:The cell proliferation of rectal carcinoma could be inhibited by FUDR and 5-FU through retention-enema. The effects of FUDR was more obvious than that of 5-FU in the same concentration. so the treating method through retention-enema with FUDR should be used as a routine therapeutic scheme befOre operation.

Objective To improve the level of diagnosis and treatment of acute appendicitis in leukemia.Method 17 cases of acute appendicitis in leukemia that were treated from 1980 to 2002 were reviewed.Result All 17 cases underwent appendectomy,16 survived the immediate postoperative period,only one died.Conclusions Leukemia were predisposed to acute appendicitis than normal during chemotherapy period and our experience supports the surgical management of acute appendicitis in leukemia.Because immunosuppression and thrombocytopenia were the main causes of additional surgical dangers,relative methods should be applied in perioperation period.The complications of incision were common,so the observation of incision should be emphasized.

Objective:To establish the acute rejection model of orthotopic liver transplantation in rat(ROLT) and observe the basic pathophysiologic changes of acute rejection.Methods:The rats were randomly divided into three groups:control group,isotransplantation group(LEW-LEW),and allotransplantation group(LEW-BN).Recipients were sacrificed on 3,5,7,and 10 days postoperatively and liver tissues and blood samples were collected.Recipient survival rate,histopathological and ultrastructural characteristics were observed.ALT,TBIL,and Alb were measured with automatic biochemical analyser.IL-2 content in serum was assayed by ELISA.Results:There was no rejection in isotransplantation from Lewis to Lewis rat resulted and 14-day survival rate reached 100%.The IL-2 concentration in serum was at normal level.On the contrary,all recipients in allotransplantation group from LEW to BN rat died among 14 days postoperatively,and hepatic histological examination showed typical acute rejection on 7 days.Liver function was severely impaired,which was indicated by significant increase of ALT and TBIL levels and apparent decrease of Alb level.The IL-2 concentration in serum was continuously increased and reached its peak value on 7 days postoperatively.Conclusion:An acute rejection experimental model of liver transplantation in rat could be stably established using Lewis rat as donor and BN rat as recipient.

Objective:To explore the cause and treatment of hemorrhage in laparoscopic cholecystectomy(LC).Methods:The clinical data of 112 cases of LC were analyzed to summarize the causes and treatment of hemorrhage.Results:The causes of hemorrhage in LC included subjective and objective elements.All of them were successfully hemostatic in different ways including reclamping,coagulation,suturing,packing hemostasis and suspension of falciform ligament of liver.Conclusion:Hemorrhage is the serious and most common complication in LC,but it can be avoided through an immediate and effective process.