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MTL and SEC expression in hepatic ischemia-reperfusion intestinal congestion and effects of Salvia Miltiorrhiza pretreatment on it

Zhiyong ZHANG ; Xiaoping CHEN ; Qiping LU

Chinese Journal of Hepatobiliary Surgery.2010;16(7):527-530. doi:10.3760/cma.j.issn.1007-8118.2010.07.014

Objective To study the excitability gastrointestinal hormone MTL and inhibitory gastrointestinal hormone SEC expression in the intestinal congestion and the effects of Salvia miltior-rhiza pretreatment at different time limits in 45min of rat hepatic ischemia-reperfusion to explore its possible mechanism and significance. Methods 80 rats were randomly divided into 4 groups: normal control group(CO group), sham-operated group(SO group), injury group(IR group), salvia miltior-rhiza pretreatment group(SM group). Non-invasive artery clamp was used to clip then slacken the he-patic pedicle to produce animal model of ischemia-reperfusion. The clamp time was 45 min. The rats in Salvia miltiorrhiza pretreatment group were injected 40 ml/kg saline with 6 g/kg Salvia Miltiorrhiza from caudal vein 30 min before clamping hepatic pedicle. While in the sham-operated group, the porta hepatis was dissected after laparotomy and hepatic pedicle not clamped. The upper jejunums at differ-ent reperfusion time phases (0 h, 3 h, 12 h, 24 h, 72 h) were made into specimens respectively, and then MTL and SEC immunohistochemical measurement were conducted. Results At 0 min of hepatic ischemia-reperfusion digestive tract congestion, the MTL expression of upper jejunum went down,SEC expression of upper jejunum went up. With the reperfusion time extending, the MTL expression also descended to minimum at 24 h, but SEC expression increased to reach the peak at 24 h. The ex-pression of these 2 hormones gradually returned to normal at 72h. The MTL expression of Salvia milt-iorrhiza pretreatment group was higher, SEC expression of SM group were lower than the IR group in each time phase of reperfusion. Conclusion The intestinal congestive injury caused by liver ischemia can down-regulate the excitability of gastrointestinal hormone MTL and up-regulate the gastrointesti-nal inhibitory gastrointestinal hormone SEC expression at reperfusion to inhibit gastrointestinal motili-ty. Salvia miltiorrhiza preconditioning can partly weaken the descending of jejunal MTL and increasing of the jejunal SEC expression, which may contribute to the early recovery of gastrointestinal motility.

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Effects of HGF in Celsior solution on levels of INF-γ. IL-4 and IL-10 in a rat liver transplantation model

Tao LI ; Huamei TANG ; Xing SUN ; Guoqiang QIU ; Zhihai PENG

Chinese Journal of Hepatobiliary Surgery.2010;16(7):524-526. doi:10.3760/cma.j.issn.1007-8118.2010.07.013

Objective To explore the impact of recombinant human hepatocyte growth factor (rhHGF) in Celsior (CS) solution on the expression of INF-γ, IL-4 and IL-10 in a rat liver transplan-tation model. Methods After flushed with CS solution with addition of rhHGF (experimental group) or saline (control group), NHBD livers were stored at 4℃; for 16 h.then they were transplanted using the two-cuff technique with arterial reconstruction. The serum levels of INF-γ, IL-4 and IL-10 at lh after reperfusion were detected using ELISA. The INF-γ, IL-4 and IL-10 mRNA in the corresponding liver tissue were determined by RT-PCR. The 7-day survival rate was calculated and the histopatho-logical examination results were analyzed by hematoxylin and eosin staining. Results Compared with the control group, the experimental group showed lower INF-γ level and higher IL-4 and IL-10 levels in serum at 1 h after reperfusion (P<0. 05). The level of INF-γ mRNA in liver tissue was significant decreased at 1 h after reperfusion (P<0. 05) , and the level of IL-4 and IL-10 mRNA was significantly increased in the experimental group (P<0. 05). In experimental group, recipients got a better survival rate and histopathological examination showed a well-preserved hepatic architecture without hepatocyte necrosis, milder sinusoidal and portal congestion. Conclusion Adding exogenous rhHGF in CS solu-tion can protect NHBD livers from ischemia-reperfusion injury and prolong the survival in rats, which might be due to down-regulation of TNF-γ and up-regulation of IL-4 and IL-10.

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Management experience of portal vein thrombosis of liver transplantation

Zhengxin WANG ; Wenyuan GUO ; Ruidong LI ; Xiaogang GAO ; Hong FU ; Jun MA ; Zhijia NI ; Guoshan DING ; Zhiren FU

Chinese Journal of Hepatobiliary Surgery.2010;16(7):500-503. doi:10.3760/cma.j.issn.1007-8118.2010.07.007

Objective To investigate the surgical options for the management of portal vein thrombosis (PVT) during liver transplantation and its impact on the outcome of patients. Methods 773 cases of liver transplantation were analyzed retrospectively. PVT occurred in 107 patients, inclu-ding 59 of grade Ⅰ ,33 of grade Ⅱ, 12 of grade Ⅲ and 3 of grade Ⅳ. Simple thrombectomy or thrombus-extraction was performed in grade Ⅰ and Ⅱ. 12 patients with grade Ⅲ received thrombus-extraction or using the donor iliac vein to act as a bridge between the donor portal vein and host superior mesenteric vein. Two cases of grade Ⅳ received a modified cavo-portal hemitransposition and one case received portal-vena coronaria varication anastomosis. Results Liver function had a good recover and the perio-perative mortality is 4. 3% in grade Ⅰ and Ⅱ. In grade Ⅲ , 5 cases received thrombus-extraction had a normal liver function after transplantation and had no died. 2 cases among the other 7 cases using por-tal vein reconstruction had bad liver function and died. The liver function recovered well after trans-plantation and there was no died in grade Ⅳ. Conclusions PVT is not a contraindication for liver transplantation. Good results can be obtained by applying reasonable operative procedures individually.

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Effects of portal vein thrombosis on parameters in recipients of orthotopic liver transplantation

Weilong ZOU ; Xinguo CHEN ; Yunjin ZANG ; Zhongyang SHEN

Chinese Journal of Hepatobiliary Surgery.2010;16(7):496-499. doi:10.3760/cma.j.issn.1007-8118.2010.07.006

Objective To investigate the impacts of preoperative portal vein thrombosis (PVT) on intraoperative or postoperative parameters in patients receiving orthotopic liver transplantation (OLT). Methods The clinical data of 836 patients undergoing OLT in our hospital from February 2002 to February 2007 were retrospectively analyzed. Of the 836 patients, 71 had preoperative PVT (PVT group) and the other 765 had not (control group). Intraoperative patameters (operative dura-tion, anhepatic phase duration, blood transfusion volume) and postoperative parameters (ICU stay and hospitalization time, portal rethrombosis posttransplantation, graft function, portal vein flow, death rate in perioperation and 1-, 3-, 5-year survival rate) were compared between the 2 groups. Results The operative duration and anheptic phase duration were significantly higher in the PVT group than in the control (792. 47±62. 29 min vs 516. 18±86. 30 min, P<0. 01, 77. 53±24. 76 min vs 48. 55±31. 20 min, P<0. 05). Perioperative blood transfusion volume, average ICU stay and hospitalization duration were not significantly different between the 2 groups. The incidence of postoperative portal rethrombosis was remarkably higher in PVT group than in the control (9. 86% vs 1. 44% , P<0. 01).No significant differences in the graft function and portal vein flow (PVF) between the 2 groups except for a higher PVF in the PVT group on the 90th d(41. 43±17. 19 vs 19. 85±11. 39, P<0. 05). We noticed slightly higher death rate in perioperative and lower 1-, 3-, 5-year survival rate in the PVT group. Conclusion Preoperative PVT can gain the same favorable outcomes as in those without PVT in spite of readily intraoperative complex.

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Advancement in surgical treatment of intrahepatic cholangiocarcinoma

Lei ZHANG ; Xinyu BI ; Ping ZHAO

Chinese Journal of Hepatobiliary Surgery.2010;16(9):718-720. doi:10.3760/cma.j.issn.1007-8118.2010.09.028

Intrahepatic cholangiocarcinoma (ICC) has the significant characteristics of regional spread and lymphatic metastasis. Radical resection provides the only chance for long-term survival of patients with ICC. Anatomic or extended hepatectomy is the most optimal treatment. The value of hepatic resection with lymph node dissection and the area of lymph node dissection are controversial. Palliative resection improves prognosis of some patients. Secondary hepatectomy also benefits some patients with late (＞1 year) intrahepatic recurrence. Liver transplantation is only performed for highly selected prophase-patients or prudent clinical trials, and a combination with adjuvant treatment such as chemo-radiotherapy after operation is suggested.

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Inhibition of HBV replication by small interference RNA in HepG2.2.15 cells

Wenbin LI ; Wei WU ; Heng WU ; Zhiyu XIAO ; Qing LIN ; Jie WANG

Chinese Journal of Hepatobiliary Surgery.2010;16(9):688-691. doi:10.3760/cma.j.issn.1007-8118.2010.09.015

Objective Virus-specific RNA interference (RNAi) is a powerful inhibitor of gene expression and replication of HBV. It is known to have high efficiency, specificity, and few side effects. We wanted to evaluate the effects of siRNA silencing HBV replication on the growth of hepatocellular carcinomatic(HCC) cells to find out an ideal method for treatment of HCC. Methods We transfected siRNA into HepG2.2. 15 cells (HCC cell inserting HBV gene) and detected the HBsAg and HBV DNA copies for evaluating the inhibitory effects of siRNA. Then we evaluated cell growth and self-renewal ability after transfection of siRNA by MTT. Results The HBsAg level and HBV DNA copies were reduced after the transfection of siRNA, the highest inhibition rate was 83.9%,while the inhibition rate of HBV DNA copies reached 73. 4%. The siRNA group's growth ability and self-renewal rate were lower than the control group in 5 days. Conclusion siRNA can effectively inhibit HBV replication and expression in HepG2.2.15 cells and silencing HBV replication can inhibit HepG2.2.15 cell's growth and self-renewal.

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Comparative study on ischemia-reperfusion injuries caused by heterogeneity of different positions of biliary system in liver graft in rats

Hongfeng ZHAO ; Jie ZHOU ; Yu WANG ; Xuanlei REN

Chinese Journal of Hepatobiliary Surgery.2010;16(9):683-687. doi:10.3760/cma.j.issn.1007-8118.2010.09.014

Objective To comparatively study the ischemia-reperfusion injuries caused by heterogeneity of different positions of the biliary system and different construction patterns of the peribiliary vascular plexus. Methods Thirty rats were randomly divided into 3 groups: Group Ⅰ , sham operated; Group Ⅱ , 1h ischemia in biliary tract followed by 1h reperfusion; Group Ⅲ, 1h ischemia in biliary tract followed by 2h reperfusion. TUNEL assay, pathomorphology score determination and ultrastructural quantitative analysis were performed on epithelium of the hilar bile duct, proximal common bile duct and interlobular bile duct. Results In groupⅡ , TUNEL assay and pathomorphology score showed no statistical difference between proximal common bile duct and interlobular bile duct (P＞0.05) but showed significant differences in the hilar bile duct(P＜0.05). Mean volume (V) of mitochondria and area density of microvilli were obviously serious in the hilar bile duct but obviously slight in the proximal common bile duct(P＜0. 05). In group Ⅲ, the results of the above detections showed that the most severe was in hilar bile duct, followed by the interlobular bile duct and proximal common bile duct(P＜0. 05). Conclusion Different injuries in various parts of the biliary system are caused by heterogeneity of biliary epithelial cells and construction patterns of the peribiliary vascular plexus. It also provides the experimental basis to explain the higher incidences of hilar bile duct stricture. It could be taken as the best position when the bile duct is anastomosed.

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A rare case of anatomical variations of cystic duct

Nan XU ; Lisheng JIANG ; Lünan YAN ; Jiayin YANG ; Wentao WANG ; Mingqing XU

Chinese Journal of Hepatobiliary Surgery.2010;16(9):675-677. doi:10.3760/cma.j.issn.1007-8118.2010.09.011

Objective To discuss the influence of anatomical variations of the cystic duct on preoperative diagnosis and operational scheme for cholecystectomy. Methods A 47-year-old woman was admitted to our hospital with diagnosis of cholecystolithiasis. Ultrasonography suggested minimal intra- and extrahepatic ductal dilatation. Laboratory tests showed that serum levels of alanine aminotransferase, aspartate aminotransferase and alkaline phosphatase were 189 IU/L, 366 IU/L and 144 IU/L, respectively. In order to make a certain diagnosis, the patient received both magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP). Results MRCP showed the bile duct slightly dilated with a shuttle shape figure and a lower signal with a strip form in it. MRCP could not confirm the quality of this signal and was doubtful of choledochus diaphragma. Subsequently, ERCP was applied to demonstrate that the cystic duct was collateral with the common hepatic duct when arriving into its left side and converged into the bile duct with a lower position, which was the reason for why MRCP misjudged the formation of choledochus diaphragma in the bile duct. Finally, the patient underwent open cholecystectomy. Conclusion There are some kinds of variations in the cystic duct including course, appearance and location of confluence. Combing MRCP with ERCP can significantly elevate the diagnostic accuracy of the cystic duct before operation, especially in those patients with doubtful diagnosis upon admission. To avoid biliary injury as much as possible, open cholecystectomy is superior to the laparoscopic cholecystectomy (LC)with regard to the patients suffering from cholecystolithiasis complicated with variation of the cystic duct.

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Sequential therapy for biliary ascariasis in 19 cases

Jinsheng LIU ; Lu YUAN

Chinese Journal of Hepatobiliary Surgery.2010;16(9):673-674. doi:10.3760/cma.j.issn.1007-8118.2010.09.010

Objective To improve the curative effect of non-invasive therapy for biliary ascariasis to shorten the course of treatment and minimize the chance of invasive managements such as surgery and endoscopic therapy. Methods The sequential therapy was conducted as: intravenous injection of vitamin C → oral administration of acid drug → expel the worm in the biliary tract. Results For the 19 cases of biliary ascariasis, 15 responded to the conservative treatment after one course of treatment,2 responded to it after two courses, 1 after 3 courses and 1 did not. Conclusion Sequential therapy is effective, convenient and simple for biliary ascariasis and it can reduce the chance of invasive management.

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Clinical analysis of short- and long-term complications after endoscopic Oddi's sphincterotomy in 95 patients

Ningli CHAI ; Jun WAN ; Benyan WU ; Changhao CAI ; Shiping XU ; Haitian HU ; Xinan QIAO ; Shuiping SUN ; Feng GAO ; Yunqing ZHU

Chinese Journal of Hepatobiliary Surgery.2010;16(9):659-663. doi:10.3760/cma.j.issn.1007-8118.2010.09.006

Objective To investigate the short- and long-term complications after endoscopic Oddi's sphincterotomy (EST) upon endoscopic retrograde cholangiopancreatography (ERCP) procedure and determine whether the size of EST correlates to the occurrence of EST complications.Methods 95 cases receiving EST in the process of ERCP in our hospital were studied and followed up. The patients were divided into large, moderate and small incision groups according to the size of EST and the states of short-term and long-term EST complications were statistically analyzed.Results The incidence of short-term complications of EST was 18. 94% (18/95). They included bleeding in the process of ERCP in 11 cases, delayed bleeding in 3, acute pancreatitis in 1, acute cholangitis in 2 and duodenal perforation in 1. All these patients but 1 with duodenal perforation were discharged after undergoing symptomatic treatments. Eleven out of the 95 patients had long-term complications (11.57 % ). These included biliary system infection in 5 cases, recurrent calculus of bile duct in 3, papilla stricture in 1 and chronic relapsing pancreatitis in 2. All 11 patients recovered after therapeutic ERCP again or symptomatic drug treatments. There was no significant difference in incidence of short-term (χ2 =2.433, P=0.296) or long-term complications (χ2 = 1.151, P=0.562) among the 3 groups. Furthermore, there was no statistical correlation between the incision size of Oddi and complications including operative bleeding (P=0.109), short-term complications (P=0.124) and longterm complications(P=0.402). Conclusion There are many short-term and long-term complications after EST, but there is no correlation between the complications and the incision size of Oddi. The occurring rate of complications might be reduced through accurate direction of papilla incision, avoidance from injury of blood vessel, keeping bile drainage unobstructed and protection of the function of Oddi sphincter as far as possible in the process of ERCP.

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