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Expression and clinical significance of survivin in primary hepatocellular carcinoma

Chinese Journal of Hepatobiliary Surgery.2009;15(12):902-904. doi:10.3760/cma.j.issn.1007-8118.2009.12.007

Objective To investgate the expression and the clinical significance of survivin in the primary hepatocellular carcinoma (HCC). Methods S-P immunohistochemical staining was performed to detect the expression of survivin in 50 samples of HCC tissue and 20 of normal liver tissue. Results The positive rate of survivin expression in HCC was 66. 0% (33/50) , which was significantly higher than that in normol liver tissues (negative expression) (P<0. 001). The expression of survivin was correlated with intrahepatic dissemination and multiple masses (P = 0. 019, P=0. 030). The high survivin expression was associated with the survival time less than three years(P = 0. 018). Conclusion The survivin may play certain roles in the oncogenesis and progression of HCC. Detection of the survivin can supply certain evidence on prognosis of primary hepatocellular carcinoma.

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Application of liver hanging maneuver in difficult right hemihepatectomy: a report of 40 cases

Tianqiang SONG ; Qiang LI

Chinese Journal of Hepatobiliary Surgery.2009;15(10):735-737. doi:10.3760/cma.j.issn.1007-8118.2009.10.005

Objective To confirm the feasibility and security of the liver hanging maneuver in difficult right hemihepatectomy.Methods Medical records of 40 conseeutive patients considered for difficult right hemihepatectomy were reviewed.The patients were grouped into two groups in pairs:group 1 (using the hanging maneuver) in 20 and group 2 (using the traditional maneuver) in the left 20.Results It was successful in 20 patients and the overall feasibility was 100%.Operative duration,bleeding,transfusion,average stay and complications in group 1 were lower than those of group2.Conclusion The liver hanging maneuver not only has high feasibility but also improves the security in difficult right hemihepatectomy.

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Treatment of 62 cases of mixed pattern Budd-Chiari syndrome using superior mesenteric vein-caval-right atrium Y shape shunt with artificial vascular graft

Yewei ZHANG ; Huanzhou XUE ; Xuehao WANG

Chinese Journal of Hepatobiliary Surgery.2009;15(10):723-727. doi:10.3760/cma.j.issn.1007-8118.2009.10.002

Objective To explore the application value of superior mesenteric vein-caval-right atrium Y shape shunt (abbr.SMV-CV-RA Y shape shunt) as a new approach for treatment of mixed pattern Budd-Chiari syndrome (B-CS).Methods The clinical data of 101 cases of mixed pattern B-CS patients were evaluated for the curative effect.Of the 101 patients,62 were treated with superior ruesenteric vein-caval-right atrium Y shape shunt,26 with splenic vein-caval shunt and 13 with superior mesenteric vein-caval shunt using artificial vascular graft.Results Compared with the plastocyte count of patients receiving splenic vein-caval shunt and superior mesenteric vein-caval shunt,the plastocyte count of 62 cases undergoing SMV-CV-RA shunt increased obviously after operation (P＜0.05).The portal vein pressure of patients with SMV-CV-RA shunt decreased significantly (P＜0.05),but the pressure of patients in splenic vein-caval shunt group and superior mesenteric vein-caval shunt group deceased slightly (P＞0.05).The incidence of hepatic encephalopathy in one year after operation was not significantly different among the 3 groups (P＞0.05).The incidence was 3.2%(2/62),0% (0/26),0% (0/13),respectively.The recanalization rate of artificial vascular graft was 95.2%(59/62),69.2%(18/25),38.4%(5/13),respectively in SMV-CV-RA shunt group,splenic vein-caval shunt group and superior mesenteric vein-caval shunt group.The recanalization rate of artificial vascular graft in SMV-CV-RA shunt group was increased significantly (P＜0.05).Conclusion Compared with splenic vein-caval shunt and superior mesenteric vein-caval shunt,the SMV-CV-RA Y shape shunt can get satisfactory effeet in curing massive hemorrhage of gastrointestinal tract for cutting down the pressure of portal vein and inferior vena.Otherwise,the shunt could eliminate hypersplenia of patients.The splenic vein-caval shunt and superior mesenteric vein-caval shunt are not effective in curing the mixed pattern B-CS.

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Growth pattern and phenotype identification of hepatic stem cells from mice

Weihui LIU ; Ren LI ; Kefeng DOU

Chinese Journal of Hepatobiliary Surgery.2009;15(10):768-771. doi:10.3760/cma.j.issn.1007-8118.2009.10.016

Objective To study the proliferation and differentiation patterns of hepatic stem cells from mice cultured in vitro isolated identify their characteristics.Methods Mice were divided into 5 groups according to the pregnant (embryo days,ED13,ED15 and ED18) or born age (day0 and 3).Hepatic stem cells were isolated and cultured in vitro.The amount of the stem cells as well as their growing situation and differentiation pattern were observed and compared among different groups and markers of stem cells (CD117,CD90.1,CD49f,c-Met),hepatic cells(AFP) were used to identify the cultures.Resulls The cells with best situation of growing as colonies were obtained from ED15 group.Their expression of specific markers suggested that they were hepatic stem cells.The stem cells isolated from ED15 mice in subculturing proliferated in line pattern and differentiated in reverse line pattern.The expression of AFP varied as normal distribution as cell differentiation development.Conclusion Most cells have characteristics of hepatic stem cells isolated from fetal liver and the number of these cells decreases gradually as embryo duration prolongs.The hepatic stem cells proliferate in line pattern and differentiate into hepatic cells after in vitro culture.

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Clinicopathological observation of serous microcystic adenoma of pancreas

Wei ZHANG ; Yujun LI

Chinese Journal of Hepatobiliary Surgery.2009;15(7):499-501. doi:10.3760/cma.j.issn.1007-8118.2009.07.006

Objective To investigate the clinicopathologieal features of serous microcystic adenoma of the pancreas. Methods Clinicopathological analysis, histochemieal and immunohistochemical studies were performed in 12 cases of serous microcystic adenoma of the pancreas with follow-up. Results The patients included 9 females and 3 males who ranged in age from 35 to 70 (mean=51.5). Seven patients were discov-ered by check-up incidentally and 5 for the symptoms as upper abdominal uncomfortable or pain. Tumors varied in size from 2.0 cm to 13 cm in maximal diameter(mean=6.0 cm), and all had a multicystic appear-ance. Histologically, all tumors were composed of numerous microcysts lined by a single layer of cuboidal or flattened cells. The tumor cells contained clear cytoplasm with glycogen and centrally located round nuclei mostly uniform without any atypia. Mitoses were very rare or absent. Histochemically, the tumor cells were positive for PAS and negative for AB-PAS. Immunohistochemieally, the tumor cells revealed diffuse positivi-ty of cytokeratins and epithelial membrane antigen, whereas CEA, CgA, Syn, CD34, Vimentin, P53 and S-100 protein were negative. Follow-up in 10 patients (range from 12 to 71 months) showed no recurrence of serous cystadenomas. Conclusion Serous microcystic adenoma of the pancreas is an extremely rare tumor. It is often non-symptomatic. Its diagnosis is mainly dependent on its unique morphological immunohistochemical features. It's biology behavior is necessary to study.

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Curative effect of choledo-choledochostomy in different operations

Jie HUANG ; Jie ZHANG ; Daguang TIAN

Chinese Journal of Hepatobiliary Surgery.2009;15(9):667-670. doi:10.3760/cma.j.issn.1007-8118.2009.09.010

Objective To discuss the curative effect of Choledo-choledochostomy by observing different means of biliary duct reconstruction in the iatrogenic bile duct damage and the liver trans-plant. Method The clinical data of 19 patients who were found to have iatrogenic bile duct injury dur-ing operation and immediately repaired and 66 patients receiving liver transplantation in our hospital in the past 10 years were retrospectively analyzed. Meanwhile, the means for bile duct reconstruction were discussed. Results The rate of curative effect of the Choledo-choledochostomy was 86.6% for iatrogenie bile duct injury. However, whether to leave the T-tube or not was not a determinant factor for the procedure in liver transplantation (P>0. 05). Conclusion Choledo-choledochostomy has good curative effect for iatrogenic bile duct injury and liver transplantation. During the operation, the bile duct may not be excessively freed to guarantee blood supply in at the anastomosis site to further en-hance the curative effect.

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Emergency management of iatrogenic injury of portal vein and superior mesenteric vein

Zhiqing GAO ; Youchi FU ; Zhengcai LIU

Chinese Journal of Hepatobiliary Surgery.2009;15(9):645-646. doi:10.3760/cma.j.issn.1007-8118.2009.09.002

Objective To explore the emergency management and prevention of iatrogenic injury of in-ferior vena cava. Methods A retrospective study was undertaken to investigate the operative procedure and post-operative outcome of 7 patients suffering from iatrogenic injury of inferior vena cava in the course of three nephrectomy, one fight adrenal gland tumor resection, one fight surgical kidney, one right upper retro-peritoneal tumor and one pancreaticoduodenectomy. The gross hemorrhage was controlled by local pressure. Then, abdominal incision was done. Firm pressure on the inferior vena cava was performed to right side for temporary control of hemorrhage. The bleeding part could be found when the hematocele was cleaned. And continuous suture should be done with 3-0 silk or absorbable suture after the crevasse was clamped. Results In these 7 cases, 1 died of hemorrhagic shock and the other 6 had significant effect postoperatively. The asso-ciated injuries were healed well except 1 case of slight edema of lower extremity. Conclusion Iatrogenic inju-ry of inferior vena cava can be treated successfully with correct procedure. Furthermore, the injury could be avoided with exactitude intraoperative procedure.

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Comparison between laparoscopic common bile duct exploration and endoscopic sphincterotomy combined with laparoscopic cholecystectomy in treating cholecystolithiasis with choledocholithiasis

Liguo ZHOU ; Caixi TANG ; Hongbing ZHOU

Chinese Journal of Hepatobiliary Surgery.2009;15(9):679-681. doi:10.3760/cma.j.issn.1007-8118.2009.09.014

Objective To evaluate the effect of LC+LCBDE and EST+LC in treating the cho-leeystolithiasis with choledocholithiasis. Methods The clinical data of 256 patients treated in our hos-pital were retrospectively analyzed. Of the 256 patients, 132 were treated by LC+LCBDE and 124 by EST combined with LC. The clinical data of the two groups was compared in operation success rate, operation time and cost, complication rate and operative hospital stay. Results There was no statisti-cal difference in the operation success rate, complication rate, operative hospital stay between 2 groups. However, there were significant differences in the operation time and cost between the 2 gruops. Conclusion There are respective indications, advantages and disadvantages in the two groups. EST+LC is the better choice for patients with a CBD<1.0 cm in diameter, stones impacted in the distal CBD, or old age. Otherwise, the better way is LC+LCBDE for patients with a CBD>1. 0 cm in diameter and multiple choledocholithiasis, especially in young and middle-aged people.

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Cause of the duodenal perforation due to endoscopic sphincterotomy: an analysis of 24 cases

Yuyuan ZHAO

Chinese Journal of Hepatobiliary Surgery.2009;15(9):659-661. doi:10.3760/cma.j.issn.1007-8118.2009.09.008

Objective To analyze the cause of the duodenal perforation due to endoscopic sphincterotomy (EST) and explore the methods to prevent this condition. Methods A total of 24 pa-tients with bile duct disease underwent EST and complicated duodenal perforation at our hospital and other 4 hospitals in last 4 years were retrospectively reviewed. Result Thirteen patients were treated by medicine and 6 of them died. For the 11 patients treated by operation, 5 of them died. The total mortality was 45.83%. Conclusion The incidence of duodenal perforation is <1% after the endo-scopic sphincterotomy. In case of such complications, the mortality is high. Improper operation indi-cation of EST, inadequate training of operators etc. are the reasons for it. More attention should be paid to the prevention of such complications.

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Expression of thymidine phosphorylase in hepatocellular carcinoma and its clinical significance

Weifan LIU ; Changneng KE ; Rongjiang LI

Chinese Journal of Hepatobiliary Surgery.2009;15(8):571-574. doi:10.3760/cma.j.issn.1007-8118.2009.08.005

Objective To determine the significance of thymidine phosphorylase for prognosis of HCC.Methods The clinical data and pathological finding of 65 patients with HCC treated in our hospital were retrospectively analyzed.Immunohistochemical staining was performed to evaluate the expression of TP and MVD count.Statistical analysis was used to analyze the relationship between TP expression and other pathological parameters.Survival curves in 54 patients were plotted using the Kaplan-Meier method.Results The positive expressed rate of HCC tissues was significantly higher than that of normal liver tissues (P<0.01).MVD count in positive-TP group and negative-TP group was respectively 16.14±5.11,10.11±4.55.The difference between two groups had statistical significance (P<0.01).TP expression was positively correlated with tumor size,Edmondson-Steiner grade,tumor capsule status,microsatellite marker and tumor thrombi in portal vein (TTPV).The rate of postoperational recurrence after one,two and three years in TP-positive group was respectively 40%,66.7%,79.2% and it was respectively 27.4%,31.3% and 45.7% in TP-negative group.The postoperative recurrence rate after two years and three years in poitive-TP group was significantly higher than that in negative-TP group (P<0.01).In 54 patients with HCC followed up successfully,the total survival rate in TP-positive group was significantly lower than in TP-negative group (P<0.01).Conclusion TP plays an important role in neovascularization of HCC and TP may be a new prognosis index of HCC.

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