Graft-versus-host disease (GVHD) after liver transplantation is a rare but fatal complication, with the incidence rate ＜ 1% and mortality of 85%.The occurrence of GVHD is due to the cellular immune response of donor T lymphocytes to recipient tissues, which may involve the skin,gastrointestinal tract, and bone marrow.The typical clinical manifestations of GVHD include rash, fever,diarrhea, and decreased whole blood cells.The Branch of Organ Transplant of China Medical Association,combined with Branch of Organ Transplant Physicians of Chinese Medical Doctor Association organize experts to develop the Chinese Expert Consensus On The Diagnosis And Treatment Of Acute Graft-Versus-Host Disease After Liver Transplantation (2024 edition), which elaborates on the pathogenesis, risk factors,clinical manifestations, diagnosis and treatment of GVHD.The aim is to standardize and optimize the clinical diagnosis and treatment of GVHD after liver transplantation, and to propose diagnostic processes and treatment suggestions to improve the prognosis of GVHD recipients after liver transplantation.
In recent years, laparoscopic liver surgery has developed rapidly along with the progress in laparoscopic technology and concept, equipment and device updates and deepening understanding of liver anatomy.At present, the integration of medicine and artificial intelligence technology has been increasingly strengthened.The potential application of emerging technology extended reality (XR) including augmented reality (AR), virtual reality (VR) and mixed reality (MR) in the field of medicine has captivated widespread attention.Especially in the intraoperative imaging registration, which is the key development direction of precision medicine.XR may bring unprecedented innovation to endoscopic liver surgery in the future.
Liver transplantation is the most effective treatment for end-stage liver disease.However, the shortage of donor liver severely restricts the development of liver transplantation.Therefore,the extended standard donor liver has been gradually applied in liver transplantation, and steatotic donor liver is an important part.However, steatosis is a critical factor lowering the quality of donor liver allografts and affecting clinical prognosis of liver transplantation.Hence, the defatting strategies for donor liver allografts remain to be investigated.With deepening exploration of the mechanism of hepatic lipid metabolism, an increasing amount of medicines have been adopted to reduce excessive accumulation of liver lipids.In addition, the development of mechanical perfusion strategies provides a novel defatting technology for donor liver allografts.Defatting drugs can function when added into the perfusion solution, and ultimately alleviate the degree of steatosis of donor livers, mitigate tissue injuries, and enable the application of more steatotic donor livers in clinical liver transplantation.In this article, recent research progress in the application of liver lipid-lowering drugs and mechanical perfusion in defatting for donor liver allografts were reviewed.
Liver cancer has become one of the common malignant tumors worldwide.At present,multiple approaches have been employed to treat liver cancer.Among them, anatomical hepatectomy is recognized as the recommended and optimal surgical treatment for liver cancer at home and abroad, whereas it still has certain limitations.Due to specific fluorescence properties, indocyanine green (ICG) can be used for fluorescence imaging during liver surgery and plays a pivotal role in assisting anatomical hepatectomy.In recent years, ICG has also been reported to be applied in preoperative interventional therapy of liver cancer.In this article, the development and application of ICG in anatomical hepatectomy were reviewed.
Living donor liver transplantation is one of common patterns of liver transplantation.In countries where donors are scarce, it can effectively alleviate the shortage of donor livers and lower the mortality of patients awaiting liver transplantation.In recent years, with the development of minimally invasive liver surgery, laparoscopic technology has been widely employed in the field of living donor liver transplantation.Due to slight surgical trauma, mild postoperative pain, rapid recovery and slight donors'mental burden, it has rapidly become one of the research hotspots in the field of liver transplantation.Laparoscopic left lateral hepatic lobectomy of living donor liver has become the standard procedure for living donor liver resection in children.However, laparoscopic left and right hepatectomy of living donor liver remains in the development stage, and the feasibility and safety have not been fully evaluated.In this article,the development, surgical types, problems and challenges of laparoscopic living donor liver resection were discussed, and the development trend in the future was predicted, aiming to accelerate the development and improvement of laparoscopic living donor liver resection.
Laparoscopic caudate lobe resection is considered as an extremely challenging liver surgery, primarily due to the anatomical position of caudate lobe and adjacent major intrahepatic and extrahepatic vessels, including inferior vena cava, middle hepatic vein, right hepatic vein and portal vein,etc.The risk of intraoperative bleeding is high.Consequently, caudate lobe resection has been considered as the most challenging procedure of liver surgery.In recent years, with surgeons' in-depth understanding of caudate lobe anatomy, persistent improvement of minimally invasive surgical technology, rapid development of medical imaging and equipment and gradual improvement of perioperative nursing, laparoscopic caudate lobe resection has been gradually applied in large-scale hepatobiliary surgery centers in China.In this article,the progress in clinical application of laparoscopic caudate lobe resection was reviewed, aiming to provide reference for clinical application of laparoscopic caudate lobe resection.
Hepatocellular carcinoma (HCC) is one of the common malignant tumors in China.Due to hidden early onset, most HCC patients are classified in the middle and late stages upon diagnosis.Surgical resection rate is relatively low, and conventional non-surgical treatment yields poor clinical efficacy.In recent years, with rapid development of targeted therapy and immunotherapy, transformational therapy of HCC has captivated widespread attention.Transformational therapy of HCC refers to transforming unresectable HCC into resectable HCC through local/systemic therapy and benefiting from surgical resection.In this article,research progress in transformational therapy of HCC was reviewed.
To explore the risk factors of neoplastic gallbladder polyps, and construct a prediction model for neoplastic gallbladder polyps based on random forest algorithm.
Methods
Clinicopathological data of 745 patients with gallbladder polyps who underwent cholecystectomy in 11 medical centers from January 2015 to August 2023 were collected.The informed consents of all patients were obtained and the local ethical committee approval was received.Among them, 286 patients were male and 459 female, aged from 18 to 80 years, with a median age of 46 years.The maximum diameter of gallbladder polyps was ranged from 10 to 15 mm, and the median diameter was 11 mm.Univariate analysis of the risk factors of neoplastic gallbladder polyps was conducted by Chi-square test or Mann Whitney U test.According to the admission date, they were divided into the training set (n=588) and test set (n=157).The training set was used to construct the random forest prediction model, and the test set was utilized to validate the prediction model.The prediction performance of this model was assessed by the area under the ROC curve (AUC) and confusion matrix.
Results
In this study, non-neoplastic gallbladder polyps patients accounted for 87.2%(650/745), including 518 cases of cholesterol polyps, 55 cases of inflammatory polyps and 47 cases of adenomatous hyperplasia.The proportion of neoplastic gallbladder polyps was 12.8%(95/745), including 83 cases of gallbladder adenomas and 12 cases of T1 gallbladder carcinomas.Univariate analysis showed that the number of polyp, maximum and minimum diameter of polyp, polyp short diameter, polyp basal status, polyp location and echo intensity were correlated with the incidence of neoplastic gallbladder polyps (χ2=20.675, Z=-4.694, Z=-2.595, χ2=6.692, Z=3.935, Z=-2.690; P＜0.05).Based on the risk factors of neoplastic gallbladder polyps and the ranking of importance, a random forest prediction model was constructed.The AUC of the training and test sets was 0.79 and 0.69, with a sensitivity of 0.74 and 0.63 and a specificity of 0.75 and 0.68, respectively.Based on the random forest prediction model and confusion matrix analysis of neoplastic gallbladder polyps, the accuracy of the training and test sets was 75% and 68%,respectively.
Conclusions
The incidence of neoplastic gallbladder polyps is significantly correlated with the number of polyp, polyp size, polyp basal status, polyp location and echo intensity, etc.The prediction model based on random forest algorithm contributes to identifying neoplastic gallbladder polyps and providing decision support for surgical diagnosis, treatment and follow-up strategy for patients with gallbladder polyps.
To investigate the risk factors of very early recurrence (VER) in patients with intrahepatic cholangiocarcinoma (ICC) after surgery.
Methods
Clinicals data of 445 ICC patients undergoing surgery in Mengchao Hepatobiliary Hospital of Fujian Medical University,Oriental Hepatobiliary Surgery Hospital of Naval Medical University, Zhongda Hospital Affiliated to Southeast University, the Second Affiliated Hospital of Zhejiang University School of Medicine, the First Affiliated Hospital of Army Medical University, Peking Union Medical College Cancer Hospital of Chinese Academy of Medical Sciences, Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology, Beijing Friendship Hospital Affiliated to Capital Medical University, West China Hospital of Sichuan University, Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Xuanwu Hospital of Capital Medical University, Affiliated Hospital of North Sichuan Medical College and Beijing Tiantan Hospital Affiliated to Capital Medical University from December 2011 to December 2017 were retrospectively analyzed.The informed consents of all patients were obtained and the local ethical committee approval was received.Among them, 270 patients were male and 175 female, aged from 23 to 88 years, with a median age of 57 years.The tumor diameter was ranged from 1.1 to 20.4 cm, with a median diameter of 6.0 cm.According to the recurrence of ICC within postoperative 6 months, they were divided into the VER group (n=328) and non-VER group (n=117).Postoperative follow-up data were assessed by univariate and multivariate Logistic regression analyses.Survival analysis was conducted by using Kaplan-Meier method and Log-rank test.
Results
Multivariate Logistic regression analysis showed that gender (OR=0.51, 95%CI: 0.32-0.84), age(OR=0.97, 95%CI: 0.95-0.99), tumor number (OR=1.28, 95%CI: 1.06-1.54), pathological type (OR=0.40,95%CI: 0.16-0.99) and maximum tumor diameter (OR=1.10, 95%CI: 1.02-1.17) were the independent risk factors of VER in ICC patients after surgery (all P＜0.05).Postoperative follow-up was ranged from 6 to 73 months, with a median follow-up time of 21 months.During postoperative follow-up, 236 patients died and 209 cases survived.The 1-, 3- and 5-year survival rates in the VER and non-VER groups were 60.71%, 7.14%, 0 and 89.90%, 54.40% and 25.30%, respectively, and the differences were statistically significant (χ2=88.844, P＜0.001).
Conclusions
Pathological type, tumor number and maximum tumor diameter are the independent risk factors of VER in ICC patients after surgery.ICC patients with VER obtain poor prognosis.
To analyze related data by genome-wide association studies (GWAS) and evaluate preventive effect of simvastatin on cholelithiasis by Mendelian randomization (MR).
Methods
MR was adopted to evaluate the preventive effect of simvastatin on cholelithiasis with genetic variants as instrumental variables.Based on the published gene data in ieuopen GWAS database, the single nucleotide polymorphism (SNP) with significant association with simvastatin was selected as an instrumental variable using R language platform.The causal association between simvastatin and cholelithiasis was evaluated by inverse-variance weighted (IVW), weighted median (WM) and MR-Egger methods, respectively.The forest and scatter plots of simvastatin and the risk of cholelithiasis associated with SNP were delineated.
Results
A total of 36 SNPs associated with simvastatin were screened.IVW (OR=0.956, 95%CI: 0.935-0.978, P=8.57×10-5),WM (OR=0.957, 95%CI: 0.926-0.983, P=1.82×10-3) and MR-Egger regression analyses (OR=0.963,95%CI: 0.922-1.007, P=1.07×10-1) showed negative causal association between simvastatin and cholelithiasis.MR-Egger regression analysis indicated no pleiotropic effect (intercept=-6.36×10-5, P=0.69).According to the slope of the straight line in the scatter plot, the causal correlation estimates were similar among IVW, WM and MR-Egger regression methods.With every one standard deviation (SD) increase of simvastatin, the risk of cholelithiasis decreased by approximately 4.4%.
Conclusions
MR analysis of two samples demonstrates that there is a negative causal association between simvastatin and the risk of cholelithiasis.The risk of cholelithiasis will decreased by approximately 4.4% with every one SD increase of simvastatin.
To systematically evaluate the safety and efficacy of photodynamic therapy
(PDT) in palliative treatment of advanced cholangiocarcinoma.
Methods
Studies related to PDT, palliative resection and simple stent implantation for advanced cholangiocarcinoma published from January 1, 2005 to January 30, 2023 were searched from PubMed, SCI, CNKI and Wanfang databases.Meta-analysis was carried out by RevMan 5.3 software.
Results
A total of 14 studies were included, including 12 studies consisting of 871 patients receiving PDT and stent drainage, and 2 studies comprising 159 cases undergoing PDT and palliative resection.Meta-analysis showed that compared with the stent drainage group, the incidence of overall complications (OR=0.87, 95%CI: 0.40-1.90) and cholangitis (OR=1.34, 95%CI: 0.80-2.25) had no statistical significance in the PDT group (both P＞0.05).Compared with the stent drainage group, the 1-, 2- and 3-year survival rates (OR=4.78, 95%CI: 2.02-11.33; OR=2.80, 95%CI: 1.35-5.78; OR=3.75, 95%CI: 1.09-12.93),and the median survival (OR=6.23, 95%CI: 6.07-6.40) were significantly better in the PDT group (all P＜0.05).However, there were no significant differences in 1-year (OR=0.69, 95%CI: 0.34-1.38) and 3-year survival rates (OR=0.60, 95%CI: 0.27-1.34) between the PDT and palliative resection groups (both P＞0.05).
Conclusions
PDT can improve the survival of patients with advanced cholangiocarcinoma receiving palliative treatment.PDT yields equivalent efficacy to palliative resection and has multiple advantages of safety, rapid recovery, mild trauma and repeated use, which is a promising treatment for advanced cholangiocarcinoma.
To construct a preoperative prediction model for microvascular invasion(MVI) of hepatocellular carcinoma (HCC) based on Meta-analysis.
Methods
Studies related to prediction model for MVI of HCC published at home and abroad was retrieved.The retrieval results were screened and the data were extracted.The quality of included studies was assessed by Newcastle-Ottawa Scale (NOS).Meta-analysis was carried out for the included studies.The risk factors with significant combined effects were extracted and the risk values were combined according to the results.The prediction model was constructed and a nomogram was delineated.64 HCC patients undergoing surgery in Chifeng Municipal Hospital from January 2020 to January 2023 were selected into the model validation set.The prediction performance of this model was evaluated by the area under the ROC curve (AUC).The accuracy and clinical practicability of this model were analyzed by the calibration curve and decision curve analysis.
Results
A total of 20 cohort studies consisting of 4 021 HCC patients were included.In the Meta-analysis of these 20 studies, 7 risk factors were finally screened after combined effects, including AFP (OR=1.38, 95%CI: 1.22-1.54), GGT (OR=1.49, 95%CI: 1.14-1.83)and ALB (OR=0.90, 95%CI: 0.78-1.02), intratumoral artery (OR=3.48, 95%CI: 3.12-3.85), peritumoral enhancement (OR=2.49, 95%CI: 1.94-3.04), tumor diameter (OR=2.93, 95%CI: 2.59-3.27) and extrahepatic growth (OR= 2.08, 95%CI: 1.75-2.42), respectively.7 risk factors were divided into the imaging feature group,laboratory index group and combined group, and assigned with values, and 3 models were constructed to predict early postoperative recurrence of HCC.The AUC of the model in the combined group was 0.877, and the sensitivity and specificity were 0.813 and 0.875, respectively.The prediction performance of this model was almost consistent with the actual values, indicating high clinical benefits.
Conclusions
Meta-analysis demonstrates that the risk factors of MVI in HCC include AFP, GGT, ALB, intratumoral artery, peritumoral enhancement, tumor diameter and extrahepatic growth.The prediction model for MVI risk based on Metaanalysis yields favorable prediction performance, which can be used as an assessment tool for the risk of MVI.
To evaluate clinical efficacy of laparoscopic left hemihepatectomy combined with bile duct exploration via the left hepatic duct stump for complex left hepatic bile duct stones complicated with common bile duct stones.
Methods
Clinical data of 27 patients with complex left hepatic bile duct stones complicated with common bile duct stones admitted to General Hospital of Central Theater Command from June 2018 to June 2022 were retrospectively analyzed.The informed consents of all patients were obtained and the local ethical committee approval was received.Among them, 11 patients were male and 16 female, aged from 31 to 79 years, with a median age of 58 years.12 patients underwent laparoscopic left hemihepatectomy combined with common bile duct exploration via the left hepatic duct stump (laparoscopic group), 15 cases underwent traditional open partial hepatectomy combined with common bile duct exploration and T tube drainage (traditional group).Operation time and postoperative pain score between two groups were compared by t test.The incidence of postoperative complications and stone clearance rate were compared by Fisher's exact test.
Results
Bile duct stones were removed in all patients, and no patient died.Only one case of liver failure occurred in the traditional group.The average operation time, postoperative pain score, length of hospital stay and hospital expense in the laparoscopic group were (276±41) min, 1.3±0.5,(13±3) d and (7.7±1.1)×104 yuan, which were significantly less than (315±49) min, 2.2±0.4, (19±7) d and(9.5±2.7)×104 yuan in the traditional group (t=-2.172, -3.950, -2.885, -2.301; P＜0.05), respectively.1 patient developed incisional infection in the laparoscopic group and 7 cases in the traditional group, and the difference was statistically significant (P＜0.05).In the laparoscopic group, 2 patients presented with postoperative bile leakage and 1 patient experienced stone recurrence, and 3 and 2 cases in the traditional group, with no statistical significance between two groups (P＞0.999).No bile duct injury, stenosis or other adverse events were reported during postoperative follow-up.
Conclusions
Laparoscopic left hemihepatectomy combined with common bile duct exploration via the left hepatic duct stump has multiple advantages, such as high safety and efficacy, minimal invasiveness, rapid postoperative recovery, low incidence of postoperative complications and low hospital expense compared with traditional open surgery.
To investigate the risk factors and preventive measures for bile leakage after surgical resection of central hepatic tumors.
Methods
Clinical data of 148 patients with central hepatic tumors who underwent partial hepatectomy in the First Affiliated Hospital of Harbin Medical University from July 2017 to July 2023 were retrospectively analyzed.The informed consents of all patients were obtained and the local ethical committee approval was received.Among them, 54 patients were male and 94 female,aged from 25 to 75 years, with a median age of 50 years.Primary diseases: 27 patients were diagnosed with hepatocellular carcinoma, 109 cases of hepatic hemangioma, 6 cases of intrahepatic cholangiocarcinoma,4 cases of atypical hyperplasia nodules, 1 case of hepatic echinococcosis and 1 case of melanoma.All patients were divided into the bile leakage and non-bile leakage groups according to the incidence of bile leakage after surgery.The risk factors of postoperative bile leakage were determined by univariate and multivariate Logistic regression analyses.
Results
All patients successfully completed procedures.The median operation time was 4.0(1.0-9.0) h, and intraoperative blood loss was 248(10-4 000) ml.The incidence of postoperative bile leakage was 10.8%(16/148), and the incidence time of bile leakage was 5.6(2.0-12.0) d after surgery.One patient was cured by abdominal drainage combined with biliary stent, and the remaining 15 cases were treated with abdominal drainage.Univariate analysis showed that age, gender, preoperative AST and ALB levels, ICGR15, malignant tumor, diabetes mellitus, viral hepatitis, operation time, postoperative TB, ALT, AST, ALB and activated partial thromboplastin time (APTT) levels were associated with the incidence of postoperative bile leakage (all P＜0.05).Multivariate Logistic regression analysis revealed that operation time was an independent risk factor for bile leakage after surgical resection of central liver tumors(OR=2.57, 95%CI: 1.33-4.97, P＜0.05).
Conclusions
Operation time is an independent risk factor for bile leakage in patients after surgical resection of central liver tumors.During perioperative period, extensive efforts should be made to improve basic status of patients, understand imaging data of patients and shorten operation time.
To evaluate the safety and efficacy of radiotherapy combined with targeted neoadjuvant immunotherapy for intrahepatic cholangiocarcinoma (ICC).
Methods
Clinical data of 6 ICC patients who received radiotherapy combined with targeted immunotherapy in Beijing Tsinghua Changgung Hospital from January 2020 to November 2022 were retrospectively analyzed.The informed consents of all patients were obtained and the local ethical committee approval was received.Among them, 4 patients were male and 2 female, aged from 52 to 77 years, with a median age of 66 years.According to the Response Evaluation Criteria in Solid Tumors (RECIST version 1.1), clinical efficacy was evaluated as complete response (CR), partial response (PR), stable disease (SD) and progressive disease (PD), respectively.The objective response rate (ORR) and disease control rate (DCR) were calculated.The severity of adverse events was evaluated using the Common Terminology Criteria for Adverse Events (CTCAE) version 5.0.Survival analysis was performed by Kaplan-Meier method.
Results
During the neoadjuvant treatment,5 cases obtained PR and 1 case achieved SD.The ORR and DCR were 5/6 and 6/6, respectively.The overall incidence of adverse reactions was 4/6, and 1/6 for ＞grade 3 adverse reactions.During follow-up, 6 patients survived, including 5 cases of progress-free survival (PFS).Survival analysis showed that the median overall survival (OS) was 26.1 months and the median PFS was 19.0 months.The R0 resection rate reached 100% in 6 patients after neoadjuvant therapy.The postoperative 1-year OS rate was 100% and 83.3% for 1-year PFS.
Conclusions
Radiotherapy combined with targeted neoadjuvant immunotherapy is safe and efficacious for ICC.
To evaluate the efficacy and share the experience of TACE combined with targeted immunotherapy for middle stage and advanced liver cancer.
Methods
A 50-year-old male patient was admitted to our hospital due to ＂a liver mass detected in physical examination＂ on June 12, 2021.Diagnosis upon admission: primary liver cancer (CNLC stage Ⅲa), chronic hepatitis B and cholecystolithiasis.Child-Pugh A, and Eastern Cooperative Oncology Group-Performance Status (ECOG-PS)score was 0.Preliminary evaluation indicated that radical resection could not be performed, and subsequent multidisciplinary team (MDT) diagnosis and treatment consultation recommended TACE combined with targeted immunotherapy.The protocol was given as follows: 8 mg of lenvatinib once a day and 200 mg of camrelizumab once every two weeks.After 6-month targeted immunotherapy and twice TACE, the tumor was significantly controlled.
Results
After active preoperative preparations, associating liver partition and portal vein ligation for staged hepatectomy (ALPPS)-Ⅰ stage surgery was performed on January 27, 2022.Laparoscopic ligation of the right portal vein combined with hepatic tissue dissection and cholecystectomy was adopted.Laparoscopic right trisectionectomy was performed on April 22, 2022.The patient achieved successful postoperative recovery without postoperative complications.Postoperative pathological examination showed that the liver lesion was coagulation necrosis, and multinucleated giant cell reaction and granulation tissue hyperplasia could be seen on the margins of necrotic tissues.No cancer was found in the liver tissue ≥ 1 cm and ＜ 1 cm from the lesion, and no tumor thrombus was found in the vessels.In the postoperative follow-up until August, 2023, no recurrence or metastasis was found.Portal vein tumor thrombus was absent.Until the paper submission date, the patient was continually treated with lenvatinib combined with camrelizumab.
Conclusions
ALPPS after TACE combined with targeted immunotherapy can bring benefits to partial patients with middle stage or advanced liver cancer.
To evaluate the safety and efficacy of laparoscopic ultrasound (LUS)-guided radiofrequency ablation (RFA) in the treatment of malignant liver tumors.
Methods
Clinical data of
47 patients with malignant liver tumors who underwent LUS-guided RFA in Beijing Luhe Hospital affiliated
to Capital Medical University from January 2017 to June 2022 were retrospectively analyzed.The informed consents of all patients were obtained and the local ethical committee approval was received.Among them, 33 patients were male and 14 female, aged from 37 to 86 years, with a median age of 64 years.14 patients were diagnosed with hepatocellular carcinoma (HCC) and 33 cases of colorectal cancer liver metastasis (CRLM).The tumor diameter was ranged from 0.5 to 3.5 cm, with a median diameter of 1.6 cm.The complete ablation rate and perioperative complications were observed.The survival and tumor recurrence were recorded during follow-up.Survival analysis was performed by Kaplan-Meier method.
Results
All procedures were successfully completed without conversion to open surgery.72 lesions from 47 patients were treated with RFA.The median number of liver tumors treated by RFA was 1.5 (1.0-5.0).The complete ablation rate reached 97%(70/72).Transaminase levels were increased to different degrees at postoperative 1 d, and then significantly decreased at postoperative 3 d.One case developed postoperative liver abscess, which was cured by puncture and drainage.No severe complications and death occurred during perioperative period.The length of postoperative hospital stay was 4.6 (1.0-12.0) d.The postoperative 1- and 3-year overall survival rates were 95.8% and 90.3%, and the 1- and 3-year recurrence-free survival rates were 82.3% and 67.7%,respectively.
Conclusions
LUS-guided RFA is a simple, safe and efficacious treatment for malignant liver tumors, which yields a low incidence of postoperative complications and satisfactory therapeutic effect.It can be utilized as an important treatment for patients ineligible for surgical resection.
To investigate the application of full-process management with finger-pinching hepatectomy as the core technology in severe liver trauma involving hepatic vein trunk.
Methods
Clinical data of 18 patients with severe liver trauma involving hepatic vein trunk admitted to the First People's Hospital of Chenzhou from January 2017 to July 2023 were retrospectively analyzed.The informed consents of all patients and/or their family members were obtained and the local ethical committee approval was received.Among them, 10 patients were male and 8 female, aged from 2.5 to 65.0 years, with a median age of 32.5 years.According to the American Association for the Surgery of Trauma (AAST) grading scale, all patients were classified as grade Ⅴ liver trauma.Standardized full-process management was adopted before, during and after surgery.Preoperative preparations were rapidly made.Intraoperatively, liver resection was performed by finger pinching, gauze packing was used to stop bleeding, chief surgeon coordinated with the assistant surgeon to repair and suture the inferior vena cava rupture and hepatic vein trunk rupture using atraumatic sutures.Perioperative status and efficacy of all patients were observed.
Results
16 cases were successfully treated, including 11 cases undergoing once abdominal surgery at one time and the remaining 5 cases were treated with gauze packing according to the theory of damage control surgery and then the gauze was taken out by secondary or multiple surgeries.The treatment success rate reached 89%(16/18).2 cases died.One 8-year-old boy died from intraoperative massive hemorrhage of the inferior vena cava and air embolism.Another 2.5-year-old girl died from excessive blood loss during surgery.The liver resection time was ranged from 5 to 30 min, and the median liver resection time was 20 min.The remaining 16 patients were discharged smoothly.
Conclusions
For patients with severe liver trauma involving hepatic vein trunk,the full-process management with ＂finger-pinching hepatectomy＂ as the core technology can significantly improve the treatment success rate.
To evaluate the clinical value of contrast-enhanced ultrasound (CEUS)in the diagnosis of liver rupture in Xizang, China.
Methods
On November 22, 2022, a 47-year-old female patient from Xizang was admitted to the hospital due to ＂the right upper abdominal pain for 1 h after being injured by the cattle horn＂.Physical examination revealed stable vital signs, a 5-cm transverse wound in the right upper abdomen, subcutaneous tissue exposure and blood oozing.The muscles of the right upper abdomen were tense, positive for tenderness.The patient had percussion tenderness of the liver area.Ultrasound and CEUS diagnosis by color Doppler ultrasound to confirm the incidence of liver rupture and active bleeding, providing evidence for subsequent clinical diagnosis and treatment.
Results
Abdominal ultrasound showed that the liver size and morphology were normal, with smooth surface and even echo in liver parenchyma.A patchy mixed echo area, approximately 30 mm×22 mm in size, could be seen beneath the S5 capsule in the right lobe.The possibility of liver rupture and hematocele in the abdominal cavity was considered.CEUS was performed by injection of 1.5 ml contrast agent through the elbow vein.The abnormal echo area of S5 liver segment was observed for the first time, and there was no enhancement in the arterial,portal venous and delayed phases, respectively.Secondary CEUS was conducted to observe hepatic capsule and peritoneal effusion and detect no evident microbubble overflow.Combined with CEUS, the diagnosis of liver rupture was made.No evident signs of active bleeding were found.Ultrasound-guided catheter drainage of peritoneal effusion was performed, and dark-red bloody fluid was drained.Subsequently, the patient lay down for resting, anti-infection and symptomatic treatment.The patient showed stable vital signs and was discharged.At 3 weeks after discharge, color Doppler ultrasound showed that the echo of liver parenchyma was uniform, the echo area beneath liver capsule was significantly decreased, and no evident dark fluid area was found.The patient restored normal life without any discomfort.
Conclusions
CEUS is a timely, reliable and convenient diagnostic tool for liver rupture in Xizang, which is worthy of widespread application at grassroot-level hospitals.
To investigate the role of FOXO signaling pathway mediated by IGF-1 in liver regeneration after the associating liver partition and portal vein ligation for staged hepatectomy(ALPPS) in rat models.
Methods
36 male Wistar rats were raised in SPF-grade laboratory environment,and all procedures met the requirements of laboratory animal ethics.Wistar rat models of ALPPS (ALPPS group), portal vein ligation (PVL group) and sham surgery (Sham group) were established.The regeneration of liver tissues at postoperative 24, 48 and 72 h was observed by Ki-67 immunohistochemical staining.At postoperative 72 h, transcriptome sequencing was performed in liver tissues.The key gene of insulinlike growth factor (IGF-1) was screened by bioinformatics methods such as weighted gene co-expression network analysis (WGCNA) and KEGG enrichment analysis.The relative expression of IGF-1 in rat liver was validated by RT-qPCR.Comparison among three groups was conducted by one-way ANOVA and LSD-t test.
Results
Immunohistochemical staining showed that the number of Ki-67 positive cells in liver tissues in the ALPPS and PVL groups was gradually increased at postoperative 24, 48 and 72 h, and the expression level of Ki-67 at postoperative 72 h was the highest in the ALPPS group (F=927.28, P＜0.05), significantly higher than those in the PVL and Sham groups (LSD-t=13.45, 42.15; both P＜0.05).The genes were divided into six modules by WGCNA, and the blue KMEblue module showed the highest correlation with ALPPS(r=0.69, P=0.002).Analysis of the blue module (containing 4 073 genes) showed that IGF-1 gene showed the highest connectivity in this module.KEGG enrichment analysis revealed 10 related signaling pathways, and found that FOXO, P53 and cell cycle signaling pathways were intimately correlated with liver regeneration.Among them, IGF-1 showed the highest connectivity in the FOXO signaling pathway.RT-qPCR indicated that compared with the PVL and Sham groups, the expression level of IGF-1 mRNA at postoperative 72 h was significantly up-regulated in the ALPPS group (F=4.989, P＜0.05), significantly higher than those in the PVL and Sham groups (LSD-t=2.43, 2.96; both P＜0.05).
Conclusions
IGF-1 in the FOXO signaling pathway may mediate liver regeneration after ALPPS in rats.
Microvascular invasion (MVI) of liver cancer is an independent risk factor for postoperative recurrence of liver cancer.Accurate preoperative prediction of the occurrence of MVI of liver cancerplays a significant role in guiding subsequent treatment and improve clinical prognosis.In recent years,radiomics have obtained significant progress in this field.In this article,research progress in preoperative prediction of MVI by clinical parameters, semantic features of traditional and emerging radiomics were reviewed, aiming to provide assistance for subsequent research.
This review presented the application and research progress of different drainage methods in patients with acute cholecystitis, including percutaneous transhepatic gallbladder biliary drainage(PTGBD), endoscopic transpapillary gallbladder drainage (ETGBD) and endoscopic ultrasound-guided biliary drainage (EUS-GBD), of patients highlighting historical development, technical characteristics, clinical application, adverse events, complications and long-term efficacy of each drainage method.By comparing advantages, disadvantages, indications of different drainage methods, clinical success rate and technical success rate were analyzed, and the research direction in the future was predicted, aiming to provide reference for selecting strategies in clinical practice and to improve the therapeutic effect and quality of life of patients with acute cholecystitis.
