Objective To explore the indications for liver transplantation among patients with hepatolithiasis.Methods Data from 1 431 consecutive patients with hepatolithiasis who underwent surgical treatment from January 2000 to December 2006 were retrospectively collected for analysis.Surgical procedures included T-tube insertion combined with intraoperative cholangioscopic removal of intrahepatic stones,hepatectomy,cholangiojejunostomy,and liver transplantation.Results Nine hundred and sixty-one patients who had a stone located in the left or right intrahepatic duct underwent hepatectomy or T-tube insertion combined with intraoperative cholangioscopic removal of intrahepatic stones.The rate of residual stones was 7.5%(72/961).Four hundred and seventy patients who had a stone located in the bilateral intrahepatic ducts underwent surgical procedures other than liver transplantation;the rate of residual stones was 21.7%(102/470).Only 15 patients with hepatolithiasis underwent liver transplantation;they all survived.According to the degree of biliary cirrhosis,recipients were divided into 2 groups: a group with biliary decompensated cirrhosis(n=7),or group with biliary compensated cirrhosis or noncirrhosis group(n=8).There were significant differences in operative times,transfusion volumes and blood losses between 2 groups(P

Objective To report the diagnosis and treatment of hilar cholangiocarcinoma.Methods The relevant information about the hispathological feature, transfer ways, clinical manifestation, laboratory examination, imaging feature, immunohistochemical examination and treatment ways were gathered from previous original articles, and checking the latest issues of appropriate journals.Results The clinical manifestation, laboratory examination, and imaging feature of hilar cholangiocarcinoma were due to the neoplasm obstructing bile duct and sequent infection of bile duct. The diagnosis was depanded on the combining clinical manifestation, laboratory examination and imaging feature. The value of immunohistochemical examination was not clear. Radical surgery was the best treatment of unique curing the neoplasm. By-pass surgery was used in the late phase patients to solve the obstruction of bile and digest duct. The effect of unique chemical treatment was not perfect. It did’t generally propose the treatment of orthotopic liver transplantation.Conclusion The perfect prognosis of hilar cholangiocarcinoma is depended on early diagnosis and redical surgery.

Objective To introduce the birth and development of model of end-stage liver disease(MELD) and evaluate its effect on liver transplantation(LT) as a new scoring system.Methods Literatures of MELD applied in LT were analyzed retrospectively.Results MELD scoring system was used for predicting the prognosis of patients with end-stage liver disease and the death risk of candidates on waiting LT extensively and the order of organ sharing was determined by its predicable results.Conclusion MELD has been had a successful initial implementation for predicting the short-term survival probability and mortality in patients with end-stage liver disease,and meeting the goal of providing a system of allocation that emphasizes the urgency of the candidate while diminishing the reliance on waiting time,which has been proven to be a powerful tool for auditing the liver allocation system.

Objective This study was conducted to build experimental model of orthotopic liver transplantation in rat(ROLT) with the character of acute rejection;and to study the effect of cytotoxic T lymphocyte antigen 4 immunoglobulin G(CTLA4-Ig) on prevention of rejection and the induction of immune tolerance of ROLT.(Methods Build model) of Wistar→SD ROLT(performed by the two cuff method) with character of acute rejection.Recipients were injected with CTLA4-Ig 75 ?g per ROLT into abdominal cavity after 2 days of operation.Contrast was made with no treatment group,the clinical characters,the liver function,the transplantated liver pathologic character and the concentrations of TNF-? in serum were observed and measured on postoperative day 7.In treatment group,all above observation were done on postoperative month 4.Above all,determination of the effect of CTLA4-Ig on preventing acute rejection and inducing tolerance in ROLT was observed.Results ①Recipients(no treatment group) died one by one within 6th～14th days;pathologic character of rejection in transplantation liver could be found;② In treatment group,on postoperative day 7 and month 4,no clinical rejection character and no pathologic character of rejection in transplantation liver were found and serum concentration of cytokins related to TNF-? found lower than that of contrast group(P

Objective To study the advances in use of imaging in the evaluation of living donor liver.Methods The literatures in recent years on the use of imaging in evaluation of living donor liver were reviewed.Results Preoperative computed tomography(CT) and magnetic resonance imaging(MRI) in the donor allowed accurate determination of liver volume and rough determination of macrovesicular hepatic steatosis of the liver.CT angiography could assess the anatomy of hepatic artery,portal vein and hepatic veins.Intraoperative cholangiography allowed detection of the anatomy of the biliary tree.Conclusion Imaging techniques are widely used in the evaluation of liver volume,vasculature and biliary system in the living donor liver.

Objective To explore the changes of colon motility of the rats in multiple organ dysfunction syndrome (MODS) induced bacterial peritonitis and the effects of IL-6, TNF-? and induce nitricoxide synthase (iNOS) on colon motility. Methods Wistar rats were divided into two groups, which were the control group and the MODS group. The number of stool, the amplitude changes of circular smooth muscle strip, the length of smooth muscle cell, and the changes of serum NO in two groups were observed. The expressions of IL-6, TNF-? and iNOS protein and IL-6 mRNA, TNF-? mRNA and iNOS mRNA in distal colon were investigated by using immunohistochemical methods and RT-PCR. Results The numbers of stool and the amplitude in the MODS group were lower than those of the control group (P

Objective To evaluate the suitability of the biodegradable microsphere encapsulation of adenovirus as a targeting vector for gene therapy of hepatocellular carcinoma. Methods Encapsulate the recombinant adenovirus in PLG poly (lactic/glycolic) copolymer by the solution evaporation method, the release test and the bioactivity of viruses incorporated in vitro were studied. Results More than 19.3% of adenovirus was encapsulated in PLG microspheres. The release test shows that the adenovirus was released for more than 200 h, 50% were shed within the first 100 h, and their activity was retained. Conclusion Recombinant adenovirus can be formulated in a polymer preparation of PLG with retention of bioactivity. It may be a valuable vector for the gene therapy of liver cancer.

Objective To review the advances in techniques of hepatic blood occlusion in hepatectomy.Methods The related literatures were reviewed and analysed.Results There were many techniques of hepatic blood occlusion.The most frequently used and studied techniques were hemihepatic vascular occlusion and intermittent hepatic inflow occlusion.Hepatic vascular exclusion was employed when hepatic veins and/or vena cava would be damaged.Total vascular exclusion and other techniques were rarely used.Conclusion To reduce blood loss in hepatectomy and make patient safe,based on the situation of the patient,the technique should be ingeniously selected.

Objective To evaluate the outcome of liver transplantation in patients with recurrent liver cancer after resection.Methods Data of 23 patients underwent liver transplantation for recurrent liver cancer from April 2001 to March 2008 were retrospectively collected and analyzed.Results Previous history of liver resection had little negative effect in subsequent liver transplantation in technical aspect.Liver function recovered uneventfully after transplantation in all cases.Alpha fetoprotein(AFP) recovered to normal value in 13 of 17 cases with elevated AFP before transplantation within one month after operation.Five cases(21.74%) had postoperative complications.Nineteen cases(82.61%) were followed up,average follow-up duration were 610 days.There were 5 cases(26.32%) of cancer recurrence and 6 deaths during follow-up,survival rate was 68.42%.Conclusion Liver transplantation is a reasonable treatment for recurrent liver cancer after resection.

Objective To summarize the application and advancement of liver transplantation for hepatic metastasis from neuroendocrine tumor. Methods Domestic and overseas publications on the study of liver transplantation for hepatic metastasis from neuroendocrine tumor in recent years were collected and reviewed. Results Liver transplantation can offer good relief of symptoms, long disease-free intervals, and potential cure in individual patients with hepatic metastatic tumor. Important selection criteria are well-differentiated tumors and a low proliferation rate (Ki67