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 evaluate the clinical application value of hemihepatic vascular occlusion through hilar plate in laparoscopic hemihepatectomy.Methods Clinical data of 32 patients undergoing laparoscopic hemihepatectomy in the First People's Hospital of Foshan from September 2010 to December 2017 were retrospectively analyzed.The informed consents of all patients were obtained and the local ethical committee approval was received.Among 32 patients,20 cases were male and 12 were female,aged 28-71 years with a median age of 46 years.Laparoscopic left hemihepatectomy was performed in 18 cases and laparoscopic right hemihepatectomy in 14 cases.Intraoperative and postoperative physical conditions were observed.Results 30 cases successfully underwent hemihepatic vascular occlusion through hilar plate,1 case was converted to intrathecal dissection of hepatic artery and portal vein due to local hepatic portal adhesion and 1 case was converted to open surgery due to hepatic portal hemorrhage induced by severe liver cirrhosis.During the process of liver resection,4 cases were converted to open surgery due to massive hemorrhage.The average length of hemihepatic vascular occlusion through hilar plate was (12±5) min,the operation time was (176±52) min and the median intraoperative blood loss was 360 (50-1 400) ml.Postoperative bile leakage occurred in 9 cases,who were cured after adequate drainage.Liver trauma bleeding was observed in 1 case,who was cured after blood transfusion.Postoperative length of hospital stay was (7.1 ±2.6) d.No postoperative liver failure or perioperative death occurred.Conclusions Hemihepatic vascular occlusion through hilar plate is a feasible,efficacious,safe and reliable approach for hepatic blood flow occlusion,which can be applied in laparoscopic hemihepatectomy.

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.

ObjectiveTo investigate the application value of laparoscopic radiofrequency ablation (LRFA) in the treatment of complicated hepatocellular carcinoma (HCC).MethodsClinical data of 40 patients with complicated HCC undergoing LRFA in the First People's Hospital of Foshan between October 2010 and June 2012 were retrospectively analyzed. Most HCC lesions were located at special sites or the patients had a bleeding tendency. Among the patients, 32 were males and 8 were females, with the age ranging from 39 to 79 years old and the median of 57 years old. Imageological examination indicated that 22 patients were with single lesion and 18 were with multiple lesions. The median diameter of the lesions was 2.6(1.0-5.0) cm. The informed consents of all patients were obtained and the local ethical committee approval was received. All patients underwent LRFA under the guide of laparoscopic ultrasound. Enhanced computed tomography (CT) was performed 1 month after surgery to check the tumor ablation, and enhanced CT or magnetic resonance imaging (MRI) was performed every 3 months after surgery to check the tumor recurrence.ResultsLRFA was performed successfully on all the patients. After surgery, 6 cases developed moderate ascites and 3 developed pleural effusion. No bleeding, liver failure, bile duct injury or gastrointestinal tract damage was observed. The incidence of postoperative complications was 22% (9/40). No perioperative death was observed. The complete ablation rate of the tumors was 90% (36/40), and tumor recurrence was observed in 24 cases after surgery, including 2 of primary recurrence and 22 of ectopic recurrence. The 1-, 2- and 4-year tumor recurrence rate was respectively 35%, 50% and 60%. ConclusionsFor the patients with HCC at special sites or at high risk of bleeding, LRFA is safe and effective in the short and mid-term treatment. It is an important supplement to percutaneous radiofrequency ablation.

Objective To explore the application value of hemi-hepatic blood flow occlusion through descending hilar plate in laparoscopic anatomic hepatectomy.Methods The clinical data of 15 patients who underwent laparoscopic anatomic hepatectomy by hemi-hepatic blood flow occlusion using descending hilar plate technique at the First People's hospital of Foshan between August 2012 and May 2014 were retrospectively analyzed.The hilar plate was bluntly dissected to expose the left and right Glissonean pedicles.Either side of Glissonean pedicle was tied up with a turnable aspirator with a cotton rope or shoelace and then bypassed the back of hilar plate.Anatomic hepatectomy was performed when hemi-hepatic blood flow was occluded.The follow-up by telephone interview and outpatient examination was done till October 2014.Results Among the 15 patients,the conversion to open surgery was done in 1 patient,Pringle maneuver in 1 patient,and hemi-hepatic blood flow occlusion by descending the hilar plate in 14 patients.Thirteen patients received succesfully laparoscopic anatomic hepatectomy by hemi-hepatic blood flow occlusion using descending hilar plate technique,including 4 of left hemihepatectomy,4 of left lateral lobectomy,2 of right hemihepatectomy,1 of right posterior lobectomy,1 of segment Ⅳ hepatectomy and 1 of segment Ⅵ hepatectomy.Bile duct exploration was applied to 4 patients with left hepatic duct stones and T-tube was placed in 2 patients.Nine and 4 patients received left and right hemi-hepatic blood flow occlusion,respectively.The operation time,mean volume of intraoperative blood loss and time of hemi-hepatic blood flow occlusion in 13 patients were (196 ±63)minutes,320 mL (range,50-1 200 mL) and (51 ± 20)minutes,respectively.The time of descending the hilar plate in 14 patients was (10 ±4)minutes.Among the 13 patients,bile leakage was detected in 1 patient with a maximum volume of drainage of 120 mL/day,liver wound bleeding in 1 patient with a volume of abdominal bloodstained drainage of 400 mL at postoperative day 2.Two patients were cured by conservative treatment,and no liver failure and perioperative death were occurred.The duration of hospital stay was (6.9 ± 2.4)days.Among the 15 patients,2 patients were loss to follow-up and other patients were followed up for 5-26 months with good survival,1 patient died.Conclusion Hemi-hepatic blood flow occlusion through descending hilar plate in laparoscopic anatomic hepatectomy is safe and feasible.

Objective To investigate the safety and feasibility of modified hand-assisted laparoscopic surgery (MHALS) in the abdominal surgery.Methods The clinical data of 8 patients who underwent long-sleeved MHALS at the First People's Hospital of Foshan between September 2014 and January 2015 were retrospectively analyzed.Among the 8 patients,right liver cancer with intrahepatic metastasis was found in 2 patients,left liver cancer in 1 patient,hepatic peripheral nerve sheath tumor in 1 patient,left retroperitoneal leiomyosarcoma in 1 patient,extra-and intra-hepatic cholangiolithiasis in 1 patient,choledochocyst in 1 patient and ampulla cancer in 1 patient.Laparoscopic protection sleeve went through the middle of incision-retractor,and then wrapped around it about 10 cm.Incision-retractor was fixed at the abdominal incision firstly,laparoscopic procedures were performed when the wrist of assisted hand was bound and fixed by the distal of sleeve.The patients were followed up by outpatient examination and telephone interview till March 2015.Results All the 8 patients underwent successful MHALS,including 1 of right hemihepatectomy in situ,1 of ligation of right portal vein + left liver split (the patient gave up two-stage operation due to intractable ascites and elevated bilirubin),1 of hepatic left lateral lobectomy (the patient underwent hemostatic sutures in open surgery due to hemorrhage of liver's cutting surface),1 of hepatic peripheral nerve sheath tumor resection,1 of left retroperitoneal leiomyosarcoma resection,1 of choledocholithotomy + left hepatectomy + cholecystectomy + T tube drainage,1 of choledochocyst + biliary enteric drainage and 1 of pancreaticoduodenectomy.Four patients had assisted incision of 4 cm,and another 4 patients of 7 cm.Eight patients were followed up for a median time of 3 months (range,2-7 months).The patient who received ligation of right portal vein + left liver split died at postoperative month 3,and the others didn't have recurrence of tumor or lithiasis.Conclusion The MHALS is safe and feasible in the abdominal surgery.

Objective To investigate the application value of continuous irrigation and vacuum suction by subcutaneous drainage tube for prevention of abdominal type Ⅳ incision infection.Methods A prospective,single-blind, randomized, controlled study was conducted based on the clinical data of 123 patients with abdominal type Ⅳ incision infection who were admitted to the First People's Hospital of Foshan between January 2008 and July 2014.Patients were divided into the experimental group and the control group based on the random number table and received open surgery.Patients in the experimental group were placed subcutaneous drainage tube with postoperative continuous irrigation and vacuum suction, while patients in the control group adopted the method of traditional abdominal closure without subcutaneous drainage tube.The levels of preoperative hemoglobin (Hb) and albumin (Alb), severity grading according to the American Society of Anesthetheologists (ASA), levels of Hb and Alb at postoperative day 1, 3, 7 were recorded and postoperative incision infection and bacteria culture were observed.Patients received bi-weekly regular return visit by outpatient evamination after discharged up to 3 months after suture removal.Measurement data with normal distribution were presented as x-± s and comparison between groups was analyzed by t test.Measurement data with skew distribution were presented as M (Qn) and comparison between groups were analyzed by rank sum test.Repeated measures data were analyzed by the repeated measures ANOVA.Count data were analyzed by the chi-square test.Results One hundred and twenty-three patients were screened for eligibility, and 65 were allocated into the experimental group and 58 into the control group.The levels of Hb and Alb at postoperative day 1, 3, 7 were (111 ± 15) g/L, (107 ± 18) g/L, (108 ± 13) g/L and 30 g/L (26 g/L,32 g/L), 31 g/L(28 g/L,33 g/L), 35 g/L(32 g/L,37 g/L) in the experimental group and (112 ± 13)g/L, (106 ±16)g/L, (106 ± 12)g/L and 30 g/L(25 g/L,32 g/L), 32 g/L(29 g/L,33 g/L), 37 g/L (32 g/L,38 g/L) in the control group, with no significant difference in the changing trends of the above indexes between the 2 groups (F =0.124, 0.007, P ＞ 0.05).There were 4 patients with incision infection in the experimental group and 12 patients in the control group, showing a significant difference (x2=2.723, P ＜ 0.05).The infections occurred at postoperative 4-6 days confined to subcutaneous tissues and unreached to muscular and below layers, and then were cured by incision open drainage without recurrence.Patients without incision infection were removed the stitches at postoperative 7-9 days.Incision bacteria cultures showed that Escherichia coli was detected in 8 cases (including 1 complicated with Enterococcus faecalis and 1 complicated with Klebsiella pneumonia and Pseudomonas aeruginosa), Pseudomonas aeruginosa in 1 case, Klebsiella pneumonia in 2 cases, Acinetobacter baumanii in 1 case, Enterobacter cloacae in 1 case and no bacteria in 3 cases.All the patients were followed up for 3 months after incision healing and survived well without recurrence and complications such as incision split and incision fistula.Conclusion Continuous irrigation and vacuum suction by subcutaneous drainage tube can be operated easily and effectively reduce the postoperative infection rate in abdominal type Ⅳ incision.

Objective To summarize the feasibility and safety of fast perfusion through abdominal aorta and portal vein in combined liver and kidney procurement from organ donation. Methods Clinical data of 43 donors of donation after cardiac death (DCD)undergoing combined liver and kidney procurement in the First People’s Hospital of Foshan from September 201 1 to June 2014 were analyzed retrospectively. Among the 43 donors,15 cases were China DCD donor category Ⅰ (donor after brain death) (C-Ⅰ),1 case was category Ⅱ (donor after cardiac death) (C-Ⅱ)and 27 cases were categoryⅢ(C-Ⅲ). Combined abdominal aorta and portal vein perfusion with fast cannulation were performed. Results The time from abdomen incision to abdominal aorta cannulation was 1.5-2.0 min. Forty-three livers and eighty-six kidneys were procured from 43 donors. The warm ischemia time (WIT)was 0 for C-Ⅰ donors,and was 3-21 min for the other donors (mean:10 min). Two liver grafts were discarded for major injury of the porta hepatis and severe fatty liver respectively. Eighteen kidney grafts were discarded for kidney stones, kidney atrophy, high level of preoperative serum creatinine,severe renal atherosclerosis,renal microvessel thrombosis,multiple renal cyst, kidney traumatic rupture,etc. The total discard rate of donor organs was 16%. Conclusions Fast perfusion through abdominal aorta and portal vein is a simple and safe method in combined procurement liver and kidney from organ donation.

group was significantly longer than that in the low MELD score group (P <0.05).And there was no significant difference in the length of hospital stay,mortality during hospitalization,incidence of early complications, follow-up time and overall survival rate between two groups (all in P >0.05).The peak level of aspartate aminotransferase (AST)in the high MELD score group was significantly higher compared with that in the low MELD score group (P <0.05 ).The incidence of bile leakage,abdominal abscess and liver dysfunction significantly differed between two groups (all in P <0.05 ).Conclusions It is a safe and short-term efficacious approach to perform liver transplantation with organs obtained from Chinese donation after citizens’ death in patients with high MELD score liver recipients.