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 investigate the clinical choice on graft size and the type of donor's hepatectomy in adult living related partial liver transplantation. Methods The literatures in recent years on the donor's evaluation, the size of liver grafts, the types of donor hepatectomy and safety of donor in adult living related partial liver transplantation were reviewed.Results The size of liver graft is a crucial factor related to the safety of donor and the prognosis of the recipient. GW/ESLW≥30%, GW/BW≥0.8% may be the lowest limits. Left lobe contained middle hepatic vein, extended left lobe with left-side caudle lobe, right lobe or extended right lobe contained middle hepatic vein may be the practical choice.Conclusion It is important to make a reasonable choice of liver graft according to the estimation of GW/ESLW or GW/BW, and the anatomy of liver in adult living related partial liver transplantation.

Objective To explore the relationship between mdr1 gene expression of hepatocellular carcinoma (HCC) and pathological characteristics,chemotherapy and prognosis. Methods The mdr1 gene expression of HCC in 56 patients with the methods of immunohistochemistry was studied. The results were analysed with the pathological data by statistic methods. Results The positive expression of mdr1 gene in cancer tissues and pericancerous tissues of HCC were 30/56(53.6%) and 19/56 (33.9%) respectively. The difference was statistically significant (? 2=4.39, P

Objective To investigate the reversal of the multidrug resistant gene mdr1 in vivo by antisense oligodeoxynucleotide (ASODN) on the basis of study in vitro. Methods The cultured drug-resistant human hepatocellular carcinoma cells were injected under the skin of axilla to establish the tumor model of nude mice. mdr1 ASODN accompanied by Lipofectamine were injected locally and ADM was injected intraperitoneally. Control 1 and control 2 were locally injected by Lipofectamine and normal saline separately, and ADM was also injected intraperitoneally. Results As time went on the tumor size increased and from the 5th day on alterations were marked, tumor size in different time phase showed marked difference to the prior time phase with significant difference (P 0.05). The results suggested that SODN and Lipofectamine showed no marked effect on tumor growth of nude mice and ASODN had marked inhibition effect on tumor growth.Conclusion mdr1 ASODN can also reverse multidrug resistance of drug-resistant human hepatocellular carcinoma cells in vivo. After the treatment the tumor’s growth in nude mice will slow down in a range of time.

Objective To review the advances in overcoming multidrug resistance of tumors caused by mdr1 gene. Methods Different ways of overcoming multidrug resistance of tumors caused by mdr1 gene in the literatures were reviewed. Results One of the important reasons causing multidrug resistance was due to the overexpression of mdr1 gene and its product P-glycoprotein. There were two ways to overcome multidrug resistance of tumors through mdr1 genes mRNA and its product P-glycoprotein effectively.Conclusion The clinical test of the unitary way to overcome multidrug resistance of tumors is unsatisfactory, combining different ways to overcome multidrug resistance of tumors will be the hot spot of tumors research in the future.

Objective To find out if apoptosis is induced after intra-radiotherapy and its effects on pericarcinomal tissue. Methods From 1994 to 1998, 44 patients with unresectable liver cancer received 32 P-GMS intra-radiotherapy. After 2 to 6 months the tumors in 3 cases could be resected and we used this cases as the treatment group. We use 4 patients with resectional HCC of same age, diseased region, differentiated but without anyother therapy as the control group. The TUNEL staining was used to stain the resected tissue, and the apoptosis index was counted. Results The apoptosis index of carcinoma was 29%～34%, average (31?16)% in the treatment group and that of the control group was 4%～6%, average (5?12.2)%. The apoptosis index of pericarcinomal tissue was 27%～37%, average (35?11)% in the treatment group and that of the control group was 0.3%～5%, average (4.1?3.3)%. Conclusion 32 P-GMS intra-radiotherapy can enhance the apoptosis of HCC and its adjacent tissue.

Objective To establish an efficient, effective hepatocyte isolation technique in order to increase cell production and decrease the prime cost. Methods The inferior vena cava below diaphragm was dissected and ligatured, and the inferior vena cava below liver was separated. Subsequently, the liver was perfused with EGTA through the portal vein while the inferior vena cava below liver was opened, and then the liver was harvested. The liver tissue was cut into 1 mm?1 mm?1 mm and digested at 37 ℃ water bath with Ⅳ collagenase for 30-40 minutes, then the hepatocytes were purified and cultured in CO 2 incubator. The production and function of hepatocytes were assessed. Results The isolated hepatocytes using this technique were more than 95% among the all isolated cells. No statistic difference was found in cell production and cell function comparing with traditional technique. But this technique was simplified and more economically. Conclusion This modified hepatocyte isolation technique is efficient and effective. It can ensure the amount of production and purity of hepatocytes.

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