Objective: To explore the safety and efficacy of totally laparoscopic right posterior liver resection for hepatocellular carcinoma (HCC). Methods: The clinical data of 16 HCC patients undergoing laparoscopic right posterior liver resection at the First People′s Hospital of Foshan between Apr 2014 and Sep 2018 was retrospectively analyzed. Results: 14 out of the 16 cases, underwent totally laparoscopic right posterior liver resection by right hepatic Glisson pedicle transection, 2 were converted to open surgery.The operation time was (378±65) min, blood loss was (500±287) ml. There was no transfusion except for 2 cases. The median hospital stay after operation was 8 days . There was no mortality . With the median follow up period of 22 months (range 1 to 54 months). Tumor recurrence was found in one case. Conclusion Laparoscopic Glisson′s pedicle transection for right posterior liver resection for hepatocellular carcinoma was safe and effective.

Objective To investigate the clinical efficacy and safety of mesohepatectomy with Glissonean pedicle transection in the treatment of hepatocellular carcinoma (HCC) complicated with liver cirrhosis.Methods Clinical data of 20 patients with HCC complicated with liver cirrhosis who underwent mesohepatectomy with Glissonean pedicle transection in the First People's Hospital of Foshan from June 2014 to March 2017 were retrospectively analyzed.The informed consents of all patients were obtained and the local ethical committee approval was received.Among 20 patients,15 cases were male and 5 female,aged 31-64 years with a median age of 48 years.18 patients was classified with liver function Child-Pugh grade A and 2 were Child-Pugh grade B.The median indocyanine green (ICG) retention rate at 15 minutes was 0.058 (0.034-0.099) and the tumor diameter was 6.6 (3.0-13.0) cm.Results Mesohepatectomy with Glissonean pedicle transection was successfully performed in all patients.The length of porta hepatis occlusion was 23 (15-30) min,and the right lobe was 67 (60-80) min.The operation time was 390 (300-480) min,the intraoperative blood loss was 590 (200-1 500) ml and the intraoperative blood transfusion rate was 20％ (4/20).After operation,bile leakage occurred in 2 cases,and they were cured after pereutaneous drainage.No perioperative death was observed.The follow-up time was 156 to 240 months.3 cases suffered tumor recurrence during the follow-up period.Conclusions Mesohepatectomy with Glissonean pedicle transection is safe and effective.Precise anatomical hepatectomy can be achieved by choosing suitable patients,having proficient skill in Glissonean pedicle transection and precisely defining cutting surface,especially for patients with HCC complicated with liver cirrhosis.

Objective To compare the safety and efficacy of laparoscopic and open left hepatectomy for hepatocellular carcinoma (HCC).Methods Clinical data of 31 patients with HCC who underwent left hepatectomy in the First People's Hospital of Foshan from June 2011 to December 2017 were retrospectively analyzed.Among 31 patients,24 cases were male and 7 female,aged from 11 to 78 years with a median age of 58 years.Patients were divided into laparoscopic left hepatectomy group (laparoscopic group,n=17) and open left hepatectomy group (open group,n=14).The informed consents of all patients were obtained and the local ethical committee approval was received.In laparoscopic group,two-step Endo-GIA laparoscopic left hepatectomy was performed,and conventional hepatectomy was performed in open group.The postoperative length of hospital stay was compared by t test.The intraoperative blood loss was compared by rank-sum test.The incidence of postoperative complications was compared by Chisquare test.Results All patients underwent operation successfully without perioperative death.The median intraoperative blood loss in laparoscopic group was 100(50-500) ml,significantly less than 325(50-900) ml in open group (Z=-2.180,P＜0.05).The postoperative length of hospital stay in laparoscopic group was (8.4±2.3) d,significantly shorter than (10.9±2.5) d in the open group (t=-2.869,P＜0.05).5 cases developed postoperative pleural effusion in laparoscopic group,and 5 in open group,where no significant difference was observed (x2=0.140,P＞0.05).Conclusions Laparoscopic left hepatectomy is safe for HCC and has similar efficacy as open surgery,the intraoperative blood loss is less comparatively and postoperative recovery time is shorter,which can serve as a standard surgical approach in clinical practice.

Objective To summarize the clinical experience of combined liver and kidney procurement from pediatric organ donation. Methods Clinical data of 6 pediatric donors undergoing combined liver and kidney procurement in the First People's Hospital of Foshan from October 2011 to December 2016 were collected and relevant clinical experience was summarized. Results According to the diagnostic criteria for brain death (for children) established by Brain Injury Evaluation Quality Control Center of National Health and Family Planning Commission, 6 pediatric donors received combined liver and kidney procurement for organ donation under the status of brain death. Modified liver-kidney perfusion was performed by external iliac arterial intubation using No.7 suction catheter, or arteria iliaca communis intubation using 24 F catheter for the perfusion of portal vein and abdominal aorta, thoracic aorta occlusion. The operation time was 55-60 min. A total of 6 liver grafts and 12 renal grafts were harvested, which were successfully applied in clinical liver and renal transplantation. No primary nonfunction was observed in the liver or renal grafts. Conclusions Timely assessment of brain death, rigorous and cautious measures for organ maintenance and modified techniques for combined liver and kidney procurement play a key role in the success of combined liver and kidney procurement from pediatric organ donation.

Objective To evaluate the application value of donor liver from organ donation after citizen's death (organ donation) in clinical liver transplantation. Methods Clinical data of 75 pairs of donors and recipients undergoing liver transplantation from organ donation in the First People's Hospital of Foshan from October 2011 to December 2016 were retrospectively analyzed. The conditions of the donors were strictly evaluated. Clinical prognosis and the incidence of postoperative complications of the recipients were summarized. Results The 1-year and 3-year accumulated survival rates of 75 liver transplantation recipients were 88% and 78%. Four recipients died from the recurrence and metastasis of liver cancer, 1 case from graft-versus-host disease, 1 case from severe pulmonary infection, 1 case from recurrence of virus B hepatitis (hepatitis B) and liver failure, 1 case from postoperative multiple organ failure and 1 case from massive hemorrhage of the upper digestive tract. Thirteen recipients suffered from biliary tract stenosis. One case was mitigated spontaneously and 1 recipient was healed after percutaneous transhepatic biliary drainage (PTBD). Eleven cases were treated with endoscopic retrograde cholangiopancreatography (ERCP). Among them, 5 cases were healed,2 recipients were switched to choledochojejunostomy and 4 cases were still monitored in clinical practice. Conclusions Liver transplantation from organ donation yields high clinical efficacy. Strict evaluation of donor conditions, standard perioperative management of the recipients, maintenance immunosuppressive therapy without adrenocortical hormone,timely and effective treatment of complications, regular postoperative follow-up are pivotal measures to guarantee the success of liver transplantation from organ donation and long-term survival of the recipients.

Objective To observe the effect of acute normovolemic hemodilution(ANH)combined with enhanced recovery after surgery(ERAS)on immune function in patients undergoing hepatic lobectomy. Methods 80 patients were divided into two groups:ERAS group(group E),ANH combined with ERAS group(group AE). bleeding volume,blood transfusion,infused fluid volume,urine output during operation and clinical index after surgery were recorded. Exhaust and defecation time ,fluid intake time and hospitalization duration were also record-ed. Blood samples were obtained from the patients at 30 min before anesthesia induction(T1),immediately(T2), 24 h(T3),3 d(T4)and 7 d(T5)after the end of operation for determination of the expression of CD3+,CD4+, CD8+ on T cells and natural killer cell. Results In group E ,CD3+,CD4+ T-lymphocytes and NK cells at T2-3 decreased as compared with T0. Compared with group E ,no allogeneic blood transfusion cases were found and clinical index duration was shorter in group AE. CD3+,CD4+T-lymphocytes and NK cells at T2-3 increased in group AE as compared with those in Group E. The difference is significant (P < 0.05). Conclusion ANH combined with ERAS can decrease allogenic blood transfusion and increase post-operation immunologic function ,shorten the postoperative hospitalization time.

Objective To study the feasibility and safety of laparoscopic hepatic caudate lobe resec tion.Methods The clinical data of seven patients who underwent laparoscopic hepatic caudate lobe resection in our hospital were retrospective analyzed.There were 3 male and 4 female patients.The mean age was 45.3 years.The primary diseases included hepatic haemangioma (n =2),metastatic liver cancer (n =2),hepatocellular carcinoma (n =1),recurrent hepatocellular carcinoma (n =1) and hepatic adenoma (n =1).The total blood loss,operation time,hospital stay after surgery and complication were analyzed.Results The surgery was successful in all these 7 patients and no patients required any conversion to open surgery.Five patients underwent partial caudate lobe resection,and the remaining 2 underwent combined left hemi hepatectomy with partial caudate lobe resection.The operation time ranged from 200 to 250 minutes with a mean of 235 minutes.The intraoperative blood loss ranged from 40 to 600 ml with a mean of 188 ml.There was no postoperative bleeding and bile leakage.The resections were all R0 resections.Conclusions Laparoscopic hepatic caudate lobe resection was safe and feasible in appropriate patients.Familiarity with anatomy of the liver caudate lobe and skilled laparoscopic techniques are important to carry out this surgery.

Objective To study the feasibility and safety of pure laparoscopic right hemihepatectomy for hepatocellular carcinoma via the anterior approach.Methods The data of five patients with hepatocellular carcinoma who underwent pure laparoscopic right hemihepatectomy at the First People's Hospital of Foshan between December 2013 and December 2016 were retrospectively analyzed.Patients'operation time,blood loss,blood transfusion rate,surgical margins,hospital stay,complication and short term outcomes were reviewed.Results All the five patients completed pure laparoscopic right hemihepatectomy without conversion to open surgery.The average (range) operation time was 6.0 (5 ～ 8) h.The average blood loss was 340 (110 ～ 600) ml.No patient received blood transfusion.The average surgical margin was 2.4 (1 ～4.5) cm.The average postoperative hospital stay was 7 (4 ～ 15) d.The average follow-up was 22 (2 ～38) months.Three patients experienced postoperative complications,which included ascites,pleural effusion,and ascites accompanied by biliary leakage,respectively.The last patient recovered well from drainage.No liver failure,cancer recurrence or death was noted.Conclusions This study demonstrated that pure laparoscopic right hemihepatotectomy via the anterior approach is a minimally invasive procedure which has the advantage of fast postoperative recovery.It was feasible and safe to treat hepatocellular carcinoma with favorable short-term outcomes.

Objective: To investigate the methods for qualitative pathological assessment of dynamic changes in liver fibrosis/cirrhosis after antiviral therapy in patients with chronic hepatitis B (CHB), since antiviral therapy can partially reverse liver fibrosis and cirrhosis caused by hepatitis B and semi-quantitative, rather than qualitative, pathological assessment is often used for the research on liver fibrosis regression. Methods: Previously untreated CHB patients with liver fibrosis and cirrhosis were enrolled, and liver biopsy was performed before treatment and at 78 weeks after the antiviral therapy based on entecavir. The follow-up assessment was performed once every half a year. Based on the proportion of different types of fibrous septum, we put forward the new qualitative criteria called P-I-R classification (predominantly progressive, predominantly regressive, and indeterminate) for evaluating dynamic changes in liver fibrosis. This classification or Ishak fibrosis stage was used to evaluate the change in liver fibrosis after treatment and Ishak liver inflammation score was used to evaluate the change in liver inflammation after treatment. Results: A total of 112 CHB patients who underwent liver biopsy before and after treatment were enrolled, and among these patients, 71 with an Ishak stage of ≥3 and qualified results of live biopsy were included in the final analysis. Based on the P-I-R classification, 58% (41/71) were classified as predominantly progressive, 29% (21/71) were classified as indeterminate, and 13% (9/71) were classified as predominantly regressive; there were no significant differences between the three groups in alanine aminotransferase, aspartate aminotransferase, albumin, HBeAg positive rate, HBV DNA, and liver stiffness (P < 0.05). After treatment, the proportion of predominantly progressive, indeterminate, or predominantly regressive patients changed to 11% (8/71), 11% (8/71), and 78% (55/71), respectively. Among the 35 patients who had no change in Ishak stage after treatment, 72% (25/35) were classified as predominantly regressive and had certain reductions in the Laennec score, percentage of collagen area, and liver stiffness. Conclusion This new P-I-R classification can be used to assess the dynamic changes in liver fibrosis after antiviral therapy in CHB patients.

Objective To investigate the efficacy of laparoscopic hepatectomy for giant hepatic hemangioma . Methods We retrospectively evaluated treatment outcomes of 23 cases of giant hepatic hemangioma undergoing laparoscopic hepatectomy from January 2010 to August 2013.The surgery was carried out by using the method of priority block or ligation of the feeding artery of hepatic hemangioma . Results Total laparoscopic hepatectomy was accomplished in 22 patients and a conversion to open surgery was required in 1 patient because of hepatic vein bleeding .There were 8 cases of left lateral segmentectomy , with a mean operative duration of (131 ±36) min, mean blood loss of (105 ±68) ml, and mean postoperative hospital stay of (4.9 ±1.6) d.There was 1 case of left lateral combined Spiegel segmentectomy , with an operative duration of 180 min, blood loss of 200 ml, and postoperative hospital stay of 6 d.There were 4 cases of left hemihepatectomy , with respective operative durations of 210 min, 80 min, 180 min, and 180 min, blood loss of 150 ml, 700 ml, 200 ml, and 100 ml, and postoperative hospital stay of 5 d, 5 d, 6 d, and 6 d.There was 1 case ofⅣ,Ⅴ, andⅧsegmental hepatectomy , with the operative duration of 420 min, blood loss of 1400 ml and postoperative hospital stay of 8 d.There were 2 cases of right hemihepatectomy , with respective operative durations of 240 min and 260 min, blood loss of 800 ml and 400 ml, and postoperative hospital stay of 12 d and 7 d.There were 2 cases of right posterior lobe hepatectomy , with respective operative durations of 180 min and 190 min, blood loss of 200 ml and 400 ml, and postoperative hospital stay of 8 d and 7 d.There were 4 cases of Ⅲ,Ⅵnonanatomical segmental hepatectomy , with respective operative durations of 110 min, 150 min, 120 min, and 120 min, blood loss of 100 ml, 200 ml, 200 ml, and 120 ml, and postoperative hospital stay of 5 d, 6 d, 5 d, and 5 d.No operative death was seen.Postoperative complications occurred in 2 cases, including 1 case of hydrothorax and 1 case of bile leakage.All the patients were followed up for 3 -12 months ( mean, 6 months ) and no recurrence was found . Conclusions Laparoscopic hepatectomy of hepatic hemangioma is safe and feasible .Priority block or ligation of feeding artery of hepatic hemangioma can reduce the blood supply of tumor and be convenient for operation .Application of multiple methods of liver blood inflow occlusion flexibly and proper management of cutting surface of liver can ensure the operation successfully .