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12 December 2005, Volume 25 Issue 12 Previous Issue    Next Issue
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Clinic risk factors resulting in initial poor graft function after orthotopic liver transplantation:an analysis of 80 cases. Chen Hao,Peng Chenghong,Shen Baiyong,et al. 2005, 25(12): 1-729.  Abstract ( )   PDF (506KB) ( )   Objective：To establish the clinic risk factors resulting in initial poor graft function (IPGF) after orthotopic liver transplantation (OLT). Methods：Eighty cases of orthotopic liver transplantation admitted between June 2002 and December 2004 in Ruijin Hospital of Shanghai Jiao Tong University were analyzed retrospectively.The group of IPGF was confirmed if alanineaminotransferase (ALT) and/or aspartate aminotransferase (AST) was above 1500 IU/L within 72 hours after OLT while non IPGF group below 1500 IU/L.Recipient associated factors before OLT analyzed were age,sex,primary liver diseases and ChildPugh’s classification.Factors analyzed with perioperative period were nonheart bearting time (NHBT),cold preservation time (CIT),warm ischemic time (RWIT),liver biopsy at the end of cold ischemia and ALT and/or AST within 72 hours after OLT.Logistic regression model was applied to filter the possible factors resulting in IPGF. Results：Donor NHBT,CIT and RWIT were longer significantly in IPGF group than non IPGF group (P<0.05).In logistic regression model,NHBT was the risk factor leading to IPGF (P<0.05) while CIT,RWIT were the possible risk factors.In one case of IPGF group PGNF was appeared with moderate hepatic steatosis. Conclusion：NHBT is an important risk factor leading to IPGF while steatosis in donor liver. CIT and RWIT are potential risk factors.

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Value of low central venous pressure in reducing blood loss during hepatectomy. Liang Lijian,Wang Weidong,Huang Xiongqing,et al. 2005, 25(12): 1-726.  Abstract ( )   PDF (600KB) ( )   Objective：To assess whether blood loss will be decreased during hepatectomy for hepatocellular carcinoma (HCC) by decreasing central venous pressure (CVP). Methods：Fifty patients with HCC admitted before December 2003 were randomly allocated to the lowCVP (LCVP) liver resection group (n=25) or routine hepatectomy control group (n=25).During the parenchymal transection phase of surgery,the CVP of 2-4 mmHg and systolic blood pressure (SBP) >90 mmHg were maintained in LCVP group by management of patient's body position and drugs use.However,no special management of CVP and SBP was done in the routine hepatectomy group.The total bleeding volume,parenchymal transection bleeding volume,blood transfusion,hospital stay,postoperative hepatic and renal function changes between two groups were compared. Results：No significant differences were observed in maximal tumor diameter,type of hepatectomy,time of vascular clamping,period of operation,weight of resected liver tissue,postoperative morbidity,postoperative hepatic and renal functions between the LCVP and the control group.Total bleeding volume and parenchymal transection bleeding volume in LCVP group were (903.9±180.8) mL and (672.4±429.9) mL respectively,which were significantly lower than those in control group (W=495.5 and 543.5,P<0.01).Hospital stay in LCVP group was significantly shortened compared with control group ［(16.3±6.8) d vs (21.5±8.6 )d,W=532.5,P<0.05］. Conclusions：Lowering CVP during hepatectomy for HCC is easy to control. With the maintenance of CVP ≤4mmHg,blood loss during parenchymal transection and hospital stay are markedly decreased,and it is no detrimental effect to hepatic or renal function.

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Diagnosis and treatment of postoperative intestinal obstruction:a report of 137 cases. Yang Jianfen,Li Ning,Li Jieshou. 2005, 25(12): 1-726.  Abstract ( )   PDF (330KB) ( )   Objective:To investigate the principles of diagnosis and treatment of postoperative intestinal obstruction. Methods:The clinical data of 137 cases of postoperative intestinal obstruction treated from January 2001 to October 2004 were analyzed retrospectively. Results:All the 137 cases were cured without severe complications such as intestinal fistula and no death.The early postoperative inflammatory intestinal obstruction was occurred in 2 cases.Recurrent intestinal obstruction was occurred in 2 cases in 3-8 months after operation and all of them were cured by nonoperative approach. Conclusions:Intestinal obstruction can be caused by operation in abdomen.The diagnosis depends on the medical history,clinical manifestations, abdominal plain Xray and computed tomography.Therapeutic procedure and operative opportunity play an important role in the treatment of postoperative intestinal obstruction.Nonoperative approach should be the first choice for early postoperative inflammatory intestinal obstruction.Prompt surgery is clearly indicated and valuable for acute or being strangulative obstruction.Active operative treatment should be considered in recurrent chronic intestinal obstruction.

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Clinical significance of thyroid nodule calcification. Lai Yuanhui,Li Xiaoxi,Wang Shenming,et al. 2005, 25(12): 1-720.  Abstract ( )   PDF (308KB) ( )   Objective:To evaluate the significance of sonographically detected thyroid nodule calcification in the diagnosis of thyroid cancer. Methods:Retrospective analyze was carried out on the features of clinical finding and ultrasonic characteristics as well as pathological results of 543 patients with thyroid nodules admitted between June 2002 and August 2003 in the First Affiliated Hospital of Sun Yatsen University. Results:In 543 cases,histopathologic examination showed benign thyroid nodules was in 473 cases (87.1%) and malignancy in 70 cases (12.9%),Sonographical thyroid calcification was found in 121 cases (22.3%).The incidence of calcification in malignant thyroid nodule was higher than in benign thyroid nodule (52.9% vs 17.8%,P<0 05).Solitary thyroid nodule and nodule with enlargement of cervical lymph nodes had a higher risk of malignancy (P<0.05). Conclusions:It is founded by ultrasonography that thyroid calcification,Sunclear and irregular margins,low echo and plenty of blood flow within the thyroid nodule are reliable indication of malignancy.The surgical treatment should be performed actively.

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Clinic risk factors resulting in initial poor graft function after orthotopic liver transplantation:an analysis of 80 cases. Chen Hao,Peng Chenghong,Shen Baiyong,et al. 2005, 25(12): 1-726.  Abstract ( )   PDF (506KB) ( )   Objective：To establish the clinic risk factors resulting in initial poor graft function (IPGF) after orthotopic liver transplantation (OLT). Methods：Eighty cases of orthotopic liver transplantation admitted between June 2002 and December 2004 in Ruijin Hospital of Shanghai Jiao Tong University were analyzed retrospectively.The group of IPGF was confirmed if alanineaminotransferase (ALT) and/or aspartate aminotransferase (AST) was above 1500 IU/L within 72 hours after OLT while non IPGF group below 1500 IU/L.Recipient associated factors before OLT analyzed were age,sex,primary liver diseases and ChildPugh’s classification.Factors analyzed with perioperative period were nonheart bearting time (NHBT),cold preservation time (CIT),warm ischemic time (RWIT),liver biopsy at the end of cold ischemia and ALT and/or AST within 72 hours after OLT.Logistic regression model was applied to filter the possible factors resulting in IPGF. Results：Donor NHBT,CIT and RWIT were longer significantly in IPGF group than non IPGF group (P<0.05).In logistic regression model,NHBT was the risk factor leading to IPGF (P<0.05) while CIT,RWIT were the possible risk factors.In one case of IPGF group PGNF was appeared with moderate hepatic steatosis. Conclusion：NHBT is an important risk factor leading to IPGF while steatosis in donor liver. CIT and RWIT are potential risk factors.

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Hepatic portal cholangiocarcinoma：a clinical analysis of 55 cases. Zhang Hongyi,Zhang Hongyi,He Xiaojun,et al. 2005, 25(12): 1-720.  Abstract ( )   PDF (322KB) ( )   Objective:To analyze the effective therapeutic method of hepatic portal cholangiocarcinoma. Methods:A retrospective analysis was performed in 55 cases of hepatic portal cholangiocarcinoma admitted between January 1995 and April 2005 in Airforce General Hospital of PLA. Results:Thirtyseven cases were performed hepaticojejunostomy after resection of hepatic portal cholangiocarcinoma.Internal or external biliary drainage and canals for internal radiation were performed in those unfitted for operation.Twentyone out of 55 cases had survived more than 24 months，whereas 4 out of 21 cases died within 15 months.Other cases had survived for 4-18 months Conclusions:Surgery is the primary therapeutic method for hepatic portal cholangiocarcinoma.Internal or external biliary drainage can prolong the life span.

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Risk factors of bacterial infection after orthotopic liver transplantation:an analysis of 103 cases. Lin Haoming,Li Bo,Huo Yongzhong,et al. 2005, 25(12): 1-729.  Abstract ( )   PDF (472KB) ( )   Objective:To investigate the incidence and risk factors of bacterial infection after liver transplantation. Methods:The clinical data of 103 case of liver transplantation admitted between 2000 and 2003 in West China Hospital of Sichuan University were analyzed retrospectively.Fortyfive independent variables related to perioperative conditions were analyzed.Univariate analysis and logistic regression analysis were performed to screening the factors correlating to infective complication. Results:Fiftytwo cases developed 77 infection episodes.The infection rate was 50.49％（52／103）. Post-operative infection of G- and G+ bacteria accounted for 67.8％（103／152）and 32.2％（49／152）respectively.It was identified that duration of operation,mechanical ventilation and TPN support were related to postoperative infection. Conclusions:The liver transplantation recipients are susceptible to bacterial infections.Preventive measures aimed at risk factors are the main measures for reducing the incidence of postoperative bacterial infection.

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Endovascular repairing combined with prosthesis bypass in the treatment of DeBakey type Ⅰ ascending aortic dissection. Chang Guangqi,Li Xiaoxi,Li Songqi,et al. 2005, 25(12): 1-720.  Abstract ( )   PDF (334KB) ( )   Objective:To evaluate endovascular repairing combined with the prosthesis bypass in the treatment of DeBakey typeⅠascending aortic dissection． Methods:In 2005,two cases with DeBakey type Ⅰ ascending aortic dissection were cured successfully by endovascular repairing combined with the prosthesis bypass in the First Affiliated Hospital of Sun Yatsen University． Results:The prosthesis bypass from left subclavian artery to the left common carotid artery and right common carotid artery were performed before endovascular repairing.And the stentgraft was deployed in ascending aorta to seat the entry tear through the left femoral artery.The innominated artery and left common carotid artery were seated simultaneously．The angiography immediately after operation and 2 months postoperation demonstrated disappearing of ascending aortic dissection, with no endoleak and no obstruction on prosthesis bypass in one case．The following up postoperation in another case had shown that the general condition was well. Conclusion:Endovascular repairing combined with prosthesis bypass is a safe and effective method for DeBakey type Ⅰ ascending aortic dissection with the entry tear close to the innominated artery and the left common carotid artery．

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Clinical study on the preoperative use of total enteral tube feeding nutrition in the patients with cancer of the large intestine. Liang Weixiong,Zhang Tong,Hong Yun,et al 2005, 25(12): 1-729.  Abstract ( )   PDF (506KB) ( )   Objective:To study both the nutritional and the bowel cleared effect of the preoperative use of total enteral tube feeding nutrition in the patients with cancer of the large intestine. Methods:Forty cases of colorectal cancer admitted between January 2004 and December 2004 were randomized into 2 groups.The patients in the study group were applied with total enteral tube feeding nutrition for 7 days before operation.The patients in the control group were applied with the traditional preoperative bowel preparation.The differences of nutritional parameters,satisfactory of colon cleaning,the rate of infective complications and the recovery time of the bowel function between the two groups were compared. Results:The serum albumin,prealbumin and transferrin at the 1st day before operation and at the 7th day after operation in the study group were significantly higher than that in the control group.The recovery time of the bowel function in the study group were significantly shorter also (P<0.01).But in the study group,the satisfactory of colon cleaning，the length of stay and the rate of infective complications had no significant difference compared with the control group. Conclusions:The preoperative use of total enteral tube feeding nutrition in the patients with cancer of the large intestine will provide effective trophic action and colon cleaning.It can replace the traditional preoperative bowel preparation.

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Clinical study of hypocalorie PN with growth hormone and glutamine on the course of disease in severe ill patients. Yang Jun,Tong Danian,Qin Huanlong. 2005, 25(12): 1-726.  Abstract ( )   PDF (321KB) ( )   Objective:To observe the effect of hypocalorie PN with growth hormone and glutamine on the course of disease in severe ill patients. Methods:Between April 2004 and September 2004,30 severe ill patients were performed the treatment of conventional PN，hypocalorie PN+rhGH，hypocalorie PN+rhGH+Gln to evaluate the difference between plasma prealbumin，transferrin,nitrogen balance,endotoxin,APACHE Ⅱat the 1st,5th and 8th day,3MH,lactulose mannitol ratio at the 8th day and the prognosis at the end of treatment. Results:At the 8th day，the level of nitrogen balance,3MH,lactulose mannitol ratio,endotoxin,APACHE Ⅱ，the length of stay in the ICU in hypocalorie PN+ rhGH+Gln group was better than conventional PN group and hypocalorie PN+rhGH group. Conclusions:Hypocalorie PN+rhGH+Gln is beneficial to the severe ill patients by increasing protein synthesis.It also has a positive effect on the recovery of intestinal permeability and the improvement of the prognosis.

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Variation of the hepatic arteries of donor livers and arterial reconstruction prior to liver transplantation. Xu Chi,Chen Guihua,Lu Minqiang,et al. 2005, 25(12): 1-715.  Abstract ( )   PDF (506KB) ( )   Objective:To explore variantion type,the cause of accident injury during the operation and reconstruction menthod of the donor hepatic arteries before liver transplantation. Methods:Between October 1993 and December 2004,600 cases were performed orthotopic liver transplantation in the Liver Transplant Center of Third Affiliated Hospital of Sun Yatsen University.The anatomy and accidental injury of the hepatic artery were recorded. Vascular reconstruction was performed to obtain single artery for anastomosis. Results:The artery anatomy was anomalous in 115 (192%) out of 600 donor livers.Fiftythree variant arteries were reconstructed.Among them,39(39/53) replaced or accessory right hepatic arteries originated from superior mesenteric artery.One（1/53）replaced right artery originated from celiac trunk. Five (5/53) replaced or accessory left hepatic arteries originated from left gastric artery.The origination of 2 （2/53）variant left and 3（3/53） variant right hepatic arteries was not found.Three (3/53) replaced systems were double.Six cases （6/485） of accidental injury of normal hepatic arteries occurred during harvesting operation.And 19 cases （19/115）of accident injury of variant hepatic arteries occurred. Splenic arteries（36/53） and gastroduodenal artery（12/53） were typically used for anastomosis of the variant hepatic arteries and other complex techniques（5/53） were chosen. Conclusions:During rapid donor liver harvesting,the incidence of accident injury of hepatic artery is increased by presence of hepatic arterial variation.All variant hepatic arteries injured accidentally will be reconstructed before liver transplantation.The type of appropriate reconstruction of variant hepatic arteries is dependent upon hepatic artery anatomy.

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Primary liver cancer combined with extrahepatic malignant carcinoma:a clinical analysis of 32 cases. Huang Can,Fan Jia,Qiu Shuangjian,et al. 2005, 25(12): 1-726.  Abstract ( )   PDF (320KB) ( )   Objective:To investigate the clinical characteristics of primary liver cancer (PLC) combined with extrahepatic malignant carcinoma (EHM). Methods:Thirtytwo cases of pathologically conformed PLC combined with EHM performed surgical resection between January 1994 and December 2003 were analyzed retrospectively. Results:Hepatic tumors size ranged form 1.5 cm to 14.5 cm in diameter.Tumor size of 15 cases was not more than 5cm. HBsAg positive,HCVAb positive,AFP>20μg/L and apparent liver cirrhosis were occurred in 24 cases,2 cases,15 cases and 23 cases respectively.Eleven cases were misdiagnosed.The total 5yearsurvival rate of 32 cases was 47.1%.Among them,20 cases of PLC combined with metachronous EHM had the 5yearsurvival rate of 649％.And 12 cases of PLC combined with synchronous EHM had the 5yearsurvival rate of 0. Conclusions:(1)PLC combined with EHM has essential characteristic of PLC.(2)The prognosis of PLC combined with metachronous EHM is apparently better than synchronous.(3)PLC combined with EHM is likely to be misdiagnosed as metastatistic liver cancer.