Objective:To evaluate the risk of HBV recurrence after liver transplantation in patients with end-stage hepatitis B related liver disease, and to explore the indications for antiviral therapy withdrawal.Methods:The data of HBV DNA, cccDNA in liver puncture tissues and peripheral blood in 31 patients after liver transplantation was retrospectively analyzed.Results:Among the 31 patients, 15 (48%) had detectable and quantified HBV DNA in liver biopsy tissue, while their HBV related serological indicators were negative, suggesting an occult HBV infection in some patients. The study found 15 out of 19 cases who were taking Entecavir were cccDNA negative (78.9%), compared to 5 out of 12 cases (41.6%) in Lamivudine regiment ( P=0.03). Conclusions:Hidden HBV infection can be detected by amplifying cccDNA and HBV DNA in liver puncture tissue by using ddPCR. Entecavir is superior to lamivudine in the clearance of cccDNA.

Objective:To analyze the long-term cumulative survival and tumor-free survival of hepatocellular carcinoma (HCC) patients after liver transplantation, as well as the influencing factors.Methods:We conducted a retrospective study on 228 HCC patients receiving liver transplantation from May 1, 2000 to May 1, 2012 at the Department of Hepatobiliary Surgery, Peking University People's Hospital. A total of 166 patients met the recruit criteria. The patients' perioperative data and follow-up data were collected. We analyzed the cumulative survival and tumor-free survival of the recipients, as well as the influencing factors.Results:The 1-, 5- and 10-year cumulative survival of the 166 HCC patients were 80.7%, 52.4% and 45.8%, respectively, while the 1-, 5- and 10-year tumor-free survival of these patients were 60.2%, 47.6% and 44.0%, respectively. Among these patients,a total of 96 recipients met the University of California, San Francisco (UCSF) criteria, whose 1-, 5- and 10-year cumulative survival were 83.3%, 66.7%, and 59.4%, respectively, and tumor-free survival were 74.0%, 62.5% and 57.3%, respectively. Multivariate analysis showed that beyond the UCSF criteria, alpha fetoprotein (AFP) ≥ 400 ng/ml before transplantation and poorly differentiated carcinoma were independent factors affecting cumulative survival and tumor-free survival ( P < 0.05). Conclusions:Liver transplantation is an effective treatment of HCC. Besides the size and the number of the tumors, AFP ≥ 400 ng/ml before transplantation and poorly differentiated tumors are independent factors affecting the long-term cumulative survival and tumor-free survival of HCC patients.

Objective:To explore the clinical efficacy of radical surgery after successful conversion therapy for liver cancer.Methods:We retrospectively analyzed the clinical data of 10 patients with liver cancer who underwent successful conversion therapy and subsequent radical surgery in Peking University People's Hospital from Nov 2019 to Dec 2021.Results:The median age of the 10 patients was 64 (51.25,68.50) years. The median number of conversion therapy cycles was 11 (4.75,25.00). No serious adverse reactions were found in the patients during conversion therapy. After conversion therapy, 8 patients underwent partial hepatectomy, and 2 patients underwent radiofrequency ablation. Postoperative complications occurred in 4 patients. All complications were classified as Clavien-Dindo grade Ⅰ or Ⅱ. The median follow-up time was 13 (9.75,49.75) weeks. Three patients had tumor recurrence after surgery. Among the patients with tumor recurrence, 1 patient died of liver failure.Conclusions:Conversion therapy is an effective treatment for patients with clinically unresectable liver cancer. The incidence of serious adverse reactions in conversion therapy for liver cancer is low. The radical surgery can be safely performed in patients with good general condition and liver function. Radical surgery after conversion therapy can prolong the survival time of patients for unresectable liver cancer.

Objective:To compare the clinical effects of microwave ablation (MWA) and surgical resection in the treatment of small hepatocellular carcinoma(SHCC).Methods:Sixty five SHCC patients with intact clinical data, treated in the Center of Hepatobiliary Surgery, Peking University People's Hospital between Feb 2005 and Aug 2012, were enrolled in this study. Among them, 30 patients were treated by MWA, and the other 35 by hepatectomy. Follow-up was conducted from Mar 2013 to Feb 2021. The differences in long-term survival, intraoperative blood loss, operative time, postoperative complications, performance status (PS), and postoperative hospital stay were compared between the two groups.Results:The survival probability at 1, 3, 5 and 10 years was 93.2%, 82.5%, 55.6% and 41.2%, respectively, in the MWA group, and 97.1%, 82.6%, 67.2% and 48.3%, in the resection group ( P=0.347). The MWA group had less perioperative complications, less blood loss, shorter operation time, better PS score and better hospital stay than the surgical resection group (all P<0.001).There was no statistically significant difference in the survival rate between BCLC stage 0~A1 and A2~A4 patients( P=0.773, 0.536). Conclusions:Microwave ablation in the treatment of small hepatocellular carcinoma can achieve similar results as hepatectomy with less traumatic,better postoperative PS score and shorter postoperative hospital stay.

Objective To investigate the effect of Roux-en-Y hilar-jejunum anastomosis in surgical resection of hilar cholangiocarcinoma.Methods The clinical data of 31 patients with hilar cholangiocarcinoma admitted from Feb 2009 to Feb 2017 who underwent Roux-en-Y hilar-jejunum anastomosis after resection were retrospectively analyzed.Results According to Bismuth-Corlette classification there were 6 cases of Ⅲ a,6 cases of Ⅲ b and 19 cases of type Ⅳ.These patients all successfully underwent Roux-en-Y hilar-jejunum anastomosis,with intraoperative blood loss of 50-4 000 ml [on average of (1 146 ± 1 082) ml].The average operation time was (346 ± 118) min,and the average hilar-jejunum anastomosis time was (35 ± 13) min.The average postoperative hospital stay was (20 ± 11)days.There were 25 cases of R0 resection (80.6％).The postoperative complication rate was 25.8％(8/31).The overall median survival time was 21 months,and the 1-,3-,and 5-year survival rates were 68.8％,14.6％ and 3.6％,respectively.During the follow-up period,7 cases of reflux cholangitis,5 cases of biliary anastomotic stenosis,and 1 case of adhesive intestinal obstruction were found.Conclusion The hilar-jejunum anastomosis is simple,safe,widely applicable prcedure,which is easy to perform.

Objective To summarize the experience of diagnosis and treatment of rare type of hepatic benign space occupying lesions.Methods The clinical data of 113 patients with rare type of hepatic benign space occupying lesions confirmed by surgery and pathology from Jan 2009 to Dec 2018 were retrospectively analyzed.Results There were 51 males and 62 females,age ranging from 12 to 83 years,with an average of 44.3 years.91.2％ of the 113 cases were single lesions and 8.8％ were multiple lesions.Surgical methods included hepatectomy in 98 cases,ablation therapy in 12 cases and hepatectomy combined with ablation in 3 cases.There were 21 types of pathology in 113 patients.The top five types were focal nodular hyperplasia (30 cases),hepatocellular adenoma (16 cases),dysplasia nodules (14 cases),perivascular epithelioid cell tumors (12 cases),and mucinous cystic neoplasms (11 cases),accounting for 73.5％ cases.All the patients were alive in the follow-up period ranging from 6 to 120 months.Conclusion Preoperative diagnosis of rare benign space-occupying lesions of the liver is very difficult.Preoperative MRI is helpful for diagnosis.Conservative treatment or follow-up observation can be considered for the type malignancy have never been reported.For the borderline types or those with difficulty in definite diagnosis,surgical removal is recommended.

Objective To investigate the clinical manifestations,imaging features and prognosis of mixed liver cancer.Methods The clinical and pathological data of 26 patients with combined hepatocellular carcinoma and cholangiocarcinoma (cHCC-CC) pathologically diagnosed after liver resection were retrospectively analyzed,and the relevant factors affecting the prognosis were statistically analyzed.Results Of the 26 cHCC-CC patients,19 were on background of chronic viral hepatitis,including 17 chronic viral hepatitis B and 2 chronic viral hepatitis C.There were 18 cases having AFP≥20ng/ml,9 cases were with carbohydrate antigen 199 (CA199) ≥ 37U/ml,and 5 cases with carcinoembryonic antigen (CEA) ≥5ng/ml.The 1-,3-,and 5-year postoperative survival rates were 68.8％,34.4％,and 17.4％.Multivariate analysis showed that serum CA199≥37U/ ml(x2 =5.687,P =0.019) was an independent risk factor for patients' survival.Conclusion Most cHCC-CC is found in association with chronic viral hepatitis.Serum CA199 ≥37U/ml is an independent risk factor affecting patients survival.

Objective To investigate the clinical efficacy and prognostic factors for combined caudate lobectomy radical resection plus broad lymph node dissection in patients of hilar cholangiocarcinoma.Methods The clinical data and follow-up results of patients with hilar cholangiocarcinoma surgically treated from Feb 2008 to Feb 2017 were retrospectively analyzed.Result The R0 resection rate[72.2％ (13/18) vs 43.9％ (18/41)],operation time [(433 ± 136) min vs (302 ± 122) min],intraoperative blood loss [(1 789 ± 1 091) ml vs (776 ± 755) ml] and postoperative complication rate [66.7％ (12/18) vs 36.6％ (15/41)]were significantly higher in the hepatic lobe combined with caudate lobe resection group than that without caudate lobe resection group (P ＜ 0.05).The median survival time of patients with enlarged lymph node dissection was longer than that of patients with regional lymph node dissection (33 months vs 13 months,P ＜0.05).Univariate and multivariate analysis showed that the preoperative serum CA199 level ＞ 1 000 U/ml,the degree of microscopic margin and tumor TNM stage were significantly correlated with the prognosis of the patients (P ＜ 0.05).Conclusion Combined with caudate lobe resection can improve R0 resection rate.Targeted lymph node dissection helps prolong survival.The degree of microscopic margin,preoperative CA199 and TNM staging are independent risk factors for the prognosis of patients with hilar cholangiocarcinoma.

Objective To investigate the diagnosis and treatment of upper gastrointestinal hemorrhage caused by pancreatic segmental portal hypertension.Methods The clinical diagnosis and follow-up data of 13 patients with upper gastrointestinal hemorrhage caused by pancreatic segmental portal hypertension from Jan 2010 to Dec 2017 were retrospectively analyzed.Results Of the 13 patients,5 had pancreatic pseudocysts and 8 had chronic pancreatitis.All of them had a history of hematemesis or (and) tarry feces,and 2 of them had a history of hemorrhagic shock.13 patients had isolated gastric varices,and 5 of them had varicose veins in the lower esophagus.13 patients had splenomegaly and hypersplenism,and all patients underwent splenectomy.All patients were followed up,and the varicose veins were significantly improved or disappeared.During 1 year to 8 years of follow-up,there was no rebleeding.Conclusion Splenectomy cures upper gastrointestinal hemorrhage caused by rupture of the varicose veins in patients of pancreatic segmental portal hypertension.Preoperative interventional spleen artery embolization can reduce the difficulty of spleen resection.

Objective To analyze the complicationsin patients surviving over ten years after liver transplantation.MethodsTotal 397 patients underwent liver transplantation from May 2000 to May 2008 at Department of Hepatobiliary Surgery,Peking University People's Hospital,among whom 217 patients survived for ≥10years;after 12 cases with incomplete data were excluded,205 cases were enrolled in the study.The complications of patients after liver transplantation were analyzed.Results The survival rate of patients over 10 years after liver transplantation was 51.6％ (205/397).In 205 patients surviving ≥10years after liver transplantation,the incidence of de novo neoplasms was 3.9％ (n=8);the prevalence of hyperuricemia,obesity,hyperlipidemia,metabolic syndrome,hypertension,and diabetes was 54.1％ (n=111),52.2％ (n=107),48.3％ (n=99),46.8％ (n=96),42.9％ (n=88),and 18.5％ (n=38),respectively.The recurrence rate of hepatitis B and the incidence of newly infected hepatitis B were 2.0％ (n=4) and 1.0％ (n=2),respectively.The incidence of cardiovascular and cerebrovascular events,renal insufficiency and biliary complications were 2.0％ (n=4),4.9％ (n=10) and 12.2％ (n=25),respectively.Fourteen patients dies 10 years after liver transplantation,the causes of death were cancer (n=4),biliary complications (n=4),recurrence of hepatitis B (n=2),cardio-cerebrovascular disease (n=2),renal insufficiency (n=1),and secondary liver transplantation (n=1).Conclusion Liver transplantation may prolong survival of patients with terminal liver diseases.The neoplasms,metabolic diseases,cardiovascular and cerebrovascular diseases,hepatitis B recurrence and chronic renal damage would affect the long-term survival of patients after liver transplantation.