Objective:To analyze the efficacy and safety of modified associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) in the treatment of patients with primary liver cancer.Methods:Clinical data of 83 patients with hepatocellular carcinoma (HCC) undergoing hemihepatectomy in the Department of Hepatobiliary and Pancreatic Tumor Surgery of Gansu Provincial Cancer Hospital between January 2022 and November 2023 were retrospectively analyzed, including 53 males and 30 females, aged (54.0±6.5) years. According to the treatment protocol, patients were divided into the control group ( n=41), in which patients underwent traditional ALPPS, and the observation group ( n=42), in which patients underwent modified ALPPS (occlusion of portal venous branch using vascular clips, combined with radiofrequency ablation for physical separation of the diseased lobe, without liver mobilization). The completion rate of staged surgery, interval between surgeries, future liver remnant (FLR) growth rate at 7 days after first-stage surgery, alanine transaminase (ALT) and aspartate transaminase (AST) levels at 5 days after fisrt-stage surgery, and postoperative complications (ascites, nausea, and vomiting, etc.) were compared between the groups. Results:The completion rate of staged surgery was 95.2% (40/42) in the observation group and 90.2% (37/41) in the control group ( χ2=0.62, P=0.431). The ALT and AST levels at 5 days after first-stage surgery were (550.4±86.0) U/L and (327.1±52.8) U/L in the observation group, respectively, which were significantly lower than those in the control group (861.6±106.3) U/L and (533.8±73.7) U/L, respectively ( t=13.13 and P<0.001, t=12.93 and P<0.001). The FLR growth rate were higher in the observation group than that in the control group [(80.4±10.3)% vs (49.3±5.7)%; t=13.13, P<0.001] and the interval between procedures were also shorter in the observation group (10.9±2.1 vs 22.4±4.8, d; t=9.65, P<0.001). The intraoperative blood loss of the first-stage surgery was lower in the observation group than that in the control group (350.5±45.2 vs 825.5±21.7, ml; t=21.43, P<0.001). The total complication rates after the first-stage surgery were 11.9% (5/42) in the observation group and 19.5% (8/41) in the control group, while after the second-stage surgery, the complication rates were 7.5% (3/40) and 18.9% (7/37), respectively, with no statistically significant differences ( χ2=0.65 and P=0.419, χ2=1.81 and 0.177, respectively). Conclusion:The modified ALPPS offers better postoperative liver function, reduced surgical trauma, accelerated FLR growth, and a shorter interval between procedures, demonstrating a favorable safety in the treatment of primary liver cancer.

Objective:To analyze the efficacy and safety of modified associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) in the treatment of patients with primary liver cancer.Methods:Clinical data of 83 patients with hepatocellular carcinoma (HCC) undergoing hemihepatectomy in the Department of Hepatobiliary and Pancreatic Tumor Surgery of Gansu Provincial Cancer Hospital between January 2022 and November 2023 were retrospectively analyzed, including 53 males and 30 females, aged (54.0±6.5) years. According to the treatment protocol, patients were divided into the control group ( n=41), in which patients underwent traditional ALPPS, and the observation group ( n=42), in which patients underwent modified ALPPS (occlusion of portal venous branch using vascular clips, combined with radiofrequency ablation for physical separation of the diseased lobe, without liver mobilization). The completion rate of staged surgery, interval between surgeries, future liver remnant (FLR) growth rate at 7 days after first-stage surgery, alanine transaminase (ALT) and aspartate transaminase (AST) levels at 5 days after fisrt-stage surgery, and postoperative complications (ascites, nausea, and vomiting, etc.) were compared between the groups. Results:The completion rate of staged surgery was 95.2% (40/42) in the observation group and 90.2% (37/41) in the control group ( χ2=0.62, P=0.431). The ALT and AST levels at 5 days after first-stage surgery were (550.4±86.0) U/L and (327.1±52.8) U/L in the observation group, respectively, which were significantly lower than those in the control group (861.6±106.3) U/L and (533.8±73.7) U/L, respectively ( t=13.13 and P<0.001, t=12.93 and P<0.001). The FLR growth rate were higher in the observation group than that in the control group [(80.4±10.3)% vs (49.3±5.7)%; t=13.13, P<0.001] and the interval between procedures were also shorter in the observation group (10.9±2.1 vs 22.4±4.8, d; t=9.65, P<0.001). The intraoperative blood loss of the first-stage surgery was lower in the observation group than that in the control group (350.5±45.2 vs 825.5±21.7, ml; t=21.43, P<0.001). The total complication rates after the first-stage surgery were 11.9% (5/42) in the observation group and 19.5% (8/41) in the control group, while after the second-stage surgery, the complication rates were 7.5% (3/40) and 18.9% (7/37), respectively, with no statistically significant differences ( χ2=0.65 and P=0.419, χ2=1.81 and 0.177, respectively). Conclusion:The modified ALPPS offers better postoperative liver function, reduced surgical trauma, accelerated FLR growth, and a shorter interval between procedures, demonstrating a favorable safety in the treatment of primary liver cancer.

OBJECTIVE: To review the development of adult and pediatric liver transplantation in Tianjin First Center Hospital, and to enhance academic exchanges, improve technological innovation, and jointly promote the progress and maturity in the field of liver transplantation. METHODS: The development of liver transplantation in Tianjin First Center Hospital was analyzed. The clinical data of adult and pediatric liver transplantation from September 1998 to September 2018 were collected. The important events and technological innovation achievements of liver transplantation during the 20 years were summarized. RESULTS: The first clinical liver transplantation was attempted in Tianjin First Central Hospital in April 1980. The first long-term survival adult liver transplantation in China was completed in 1994 (11 years survival after the operation). The specialized team of liver transplantation was formally established in September 1998. The 20-year clinical exploration and progress reflected the characteristics of era changes and technological innovation during the rapid development of liver transplantation in China. Our center performed liver re-transplantation in January 1999, reduced-size pediatric liver transplantation in August 2000. In May 2001, we organized the formulation for the preventive and treatment plan for hepatitis B recurrence after liver transplantation. We performed combined liver and kidney transplantation in July 2002, split liver transplantation (SLT) in April 2004, the first domino liver transplantation (DLT) in August 2005. Pediatric living donor liver transplantation (LDLT) was initiated in October 2006, adult LDLT was carried out in August 2007. In September 2007, the first living donor combined liver and kidney transplantation from the same donor in Asia was performed. The first domino+living donor double grafts liver transplantation in the world was performed in January 2009. In March 2011, we performed laparoscopically assisted right hepatic lobe liver transplantation (LDLT) with middle hepatic vein. In May 2014, living donor laparoscopic left lateral lobe procurement was successfully established. In April 2016, simultaneous liver, pancreas and kidney multi-organ transplantation was completed. Domino donor-auxiliary liver transplantation was performed in February 2017. In December 2017, extracorporeal membrane oxygenation (ECMO)-supported liver transplantation in a patient with severe pulmonary hypertension was successfully completed. Liver transplantation combined with partial splenectomy was established in April 2018. Cross-domino liver transplantation (hypersensitive kidney transplantation with auxiliary liver transplantation+pediatric liver transplantation) was performed in May 2018. During the 20 years, the team has performed or assisted other centers in Beijing, Shanghai, Guangzhou and Shenzhen to carry out more than 10 000 cases of liver transplantations. A total of 7 043 cases of various types of liver transplantation were performed in the single center of the hospital (6 005 adult liver transplantations and 1 038 pediatric liver transplantations). Concerning adult liver transplantation, the cumulative 1-year, 3-year and 5-year survival rate from September 1998 to March 2003 were 83.1%, 73.0% and 69.0%, from April 2003 to March 2009 were 85.3%, 76.2% and 72.1% and from April 2009 to September 2018 were 87.5%, 79.2% and 75.1%, respectively. The cumulative 1-year, 3-year and 5-year survival rate for pediatric liver transplantation were 93.5%, 92.2% and 90.2%, respectively. The nucleoside (acid) analogue combined with low dose hepatitis B immunoglobulin (HBIG) was developed to prevent the recurrence of hepatitis B after liver transplantation, this plan has reduced the recurrence rate of hepatitis B and the 5-year re-infection rate of hepatitis B virus (HBV) after liver transplantation significantly. The risk assessment system for tumor recurrence after liver transplantation was established and individual treatment method was established based on this assessment system. Continuous exploration and improvement of liver transplantation for liver cancer, liver re-transplantation, liver transplantation with portal vein thrombosis, SLT, DLT and multi-organ combined transplantation have significantly improved the clinical efficacy of patients and the post-operative survival rate. CONCLUSIONS The liver transplantation team of Tianjin First Center Hospital has carried out a scientific and technological exploration on the key problems and technical difficulties of clinical liver transplantation. This work strongly has initiated and promoted the rapid development of liver transplantation in China. The restrictive barrier of hepatitis B recurrence after liver transplantation has been overcome. The risk prevention and control system of tumor recurrence after liver transplantation has been established. A series of innovative achievements that can be popularized have been achieved in the field of complex liver transplantation and expansion of donor liver source. The iterative progress and sustainable development of liver transplantation have been realized.
China ; Humans ; Liver Transplantation

Objective To investigate the value of cerebral state index (CSI) in monitoring the consciousness state of patients with brain trauma.Methods The consciousness sates of 218 patients with craniocerebral trauma were assessed by three experienced specialists by Glasgow Coma Scale (GCS),and the CSI of the patients were measured by Cerebral State Monitor.Correlation between GCS and CSI as well as the distribution of CSI in various consciousness defined by GCS were discussed.The predictive value of CSI in discriminating different conscious states of the patients was also analyzed.Results The Cochran Q test showed that there was a consistency of the GCS judged by three specialists (P ＞ 0.05),and the CSI of the patients was positively correlated with the GCS (r=0.819,P＜0.001).A gradual decrease in the CSI was found across categories of the various consciousness states,including sobriety,somnolence,confusion,light coma,coma in moderate depth and deep coma.The receiver operating characteristic curve (ROC) analysis showed that CSI could significantly discriminate the different consciousness states of the patients (P ＜0.001).The area under the curve (AUC) for the consciousness was 0.995 for deep coma,0.984 for sobriety,0.815 for coma in moderate depth,0.769 for somnolence,0.768 for light coma and 0.695 for confusion,respectively.Conclusion CSI can be used to monitor the severity of craniocerebral trauma.

Objective To investigate the value of cerebral state index (CSI) in monitoring the consciousness state of patients with brain trauma.Methods The consciousness sates of 218 patients with craniocerebral trauma were assessed by three experienced specialists by Glasgow Coma Scale (GCS),and the CSI of the patients were measured by Cerebral State Monitor.Correlation between GCS and CSI as well as the distribution of CSI in various consciousness defined by GCS were discussed.The predictive value of CSI in discriminating different conscious states of the patients was also analyzed.Results The Cochran Q test showed that there was a consistency of the GCS judged by three specialists (P ＞ 0.05),and the CSI of the patients was positively correlated with the GCS (r=0.819,P＜0.001).A gradual decrease in the CSI was found across categories of the various consciousness states,including sobriety,somnolence,confusion,light coma,coma in moderate depth and deep coma.The receiver operating characteristic curve (ROC) analysis showed that CSI could significantly discriminate the different consciousness states of the patients (P ＜0.001).The area under the curve (AUC) for the consciousness was 0.995 for deep coma,0.984 for sobriety,0.815 for coma in moderate depth,0.769 for somnolence,0.768 for light coma and 0.695 for confusion,respectively.Conclusion CSI can be used to monitor the severity of craniocerebral trauma.

Objective To investigate the effect of self-care ability assessment on rehabilitation of patients after breast cancer operation. Methods A total of 84 patients after breast cancer operation were randomly divided into observation group and control group on average. Patients in the control group were given conventional nursing care after operation. Based on it, patients in the observation group were given self-care ability assessment, which guided life care and functional exercise of affected limb. The scores of compliance of functional exercise, the length of stay, the total cost of hospitalization and the activity of affected shoulder were compared in the two groups. Results The scores of physical exercise dimension, post-operative notes dimension, initiative to seek advice dimension and total score of the compliance scale in the observation group were (29. 8 ± 5. 5), (18. 7 ± 1. 1), (13. 8 ± 1. 2),(62. 3 ± 6. 8) ,which were significantly higher than those of the control group (t=3. 802, 5. 340, 8. 574, 6. 292,respectively;P<0. 05). The length of stay and the total cost of hospitalization in the observation group were also significantly higher than these of the control group [(14.1 ±0. 7) days vs (23 635. 4 ± 2 011. 7) yuan] (t =6. 959,3. 333,respectively;P <0. 05). Three months after operation, the activity of flexion, abduction, extension, internal rotation and external rotation of the affected shoulder of the observation group were (157. 86 ± 16. 83)°, (152. 37 ± 23. 15)°, (48. 18 ± 5. 39)°, (62.33 ±6.80)°,which were significantly higher than the control group(t=3. 939, 3. 207, 4. 254, 6. 267, 3. 879,respectively;P<0. 05). Conclusions Self-care ability assessment can improve the functional exercise compliance of patients after breast cancer operation, reduce the length of hospitalization and economic pressure. It is beneficial to the recovery of affected upper limb function as well.