Objective To summarize the application and advancement of liver transplantation for hepatic metastasis from neuroendocrine tumor. Methods Domestic and overseas publications on the study of liver transplantation for hepatic metastasis from neuroendocrine tumor in recent years were collected and reviewed. Results Liver transplantation can offer good relief of symptoms, long disease-free intervals, and potential cure in individual patients with hepatic metastatic tumor. Important selection criteria are well-differentiated tumors and a low proliferation rate (Ki67＜10%). Conclusion In carefully selected patients with metastatic neuroendocrine tumors, liver transplantation is an appropriate option.
ObjectiveTo summarize the experiences of precise liver resection for giant complex hepatic neoplasm. MethodsFifty-two cases of giant complex hepatic neoplasms were resected using precise liver resection techniques from April 2008 to August 2009. Hepatic functional reserve and liver imaging were evaluated before operation. Appropriate surgical approach, halfhepatic blood flow occlusion, new technique of liver resection, and intraoperative ultrasonography were applied during operation. ResultsThe mean operative time, halfhepatic blood occlusion time, blood loss, recovery of alanine aminotransferase, and total bilirubin were 350 min (210－440 min), 43 min (8－57 min), 370 ml (250－1 150 ml), 10 d (7－14 d), and 4.5 d (3－10 d), respectively. Only 6 patients had mild bile leakage. No liver failure and other major complications emerged, and no death happened. ConclusionPrecise liver resection is a safe and effective approach for giant complex hepatic neoplasm.
ObjectiveTo intend to propose a new clinical classification of congenital biliary dilatation (CBD) which is more concise and suitable for diagnosis and treatment, and explore feasibility and reliability of the new classification. MethodsBased on the preoperative imaging data of patients with CBD admitted to the Department of Pediatric Surgery of West China Hospital of Sichuan University, from January 2015 to December 2018, a new classification of CBD was accomplished according to the site of bile duct dilatation lesions, which was named HUAXI CBD classification. The CBD was classified into 4 types: type Ⅰ (distal extra-hepatic bile duct dilatation), type Ⅱ (distal extra-hepatic combined with right and left primary hepatic bile duct dilatation), type Ⅲ (extra-hepatic combined with secondary and above hepatic bile duct dilatation), and type Ⅳ (intra-hepatic bile duct dilatation). Meanwhile, the feasibility and reliability of the HUAXI CBD classification were analyzed. ResultsA total of 300 patients with CBD were included in this study. According to the HUAXI CBD classification method, 240 cases were type Ⅰ, 48 cases were type Ⅱ, 10 cases were type Ⅲ, and 2 cases were type Ⅳ. For type Ⅰ, 236 patients underwent cholecystectomy and Roux-en-Y hepaticojejunostomy and 4 cases were treated non-operatively; For type Ⅱ, 48 patients underwent cholecystectomy, central hepatic duct reconstruction and Roux-en-Y hepaticojejunostomy; For type Ⅲ, 9 patients underwent cholecystectomy and Roux-en-Y hepaticojejunostomy, 5 of which had intrahepatic dilatation confined to part of the liver lobe and underwent partial hepatectomy with intra-hepaticojejunostomy. One case was treated with percutaneous transhepatic cholangial drainage (PTCD) only; two type Ⅳ patients were treated with PTCD only. Patients with type Ⅰ had a normal hepatobiliary function after surgery and a good prognosis; patients with type Ⅱ had good recovery of liver function in 37 cases (77.1%), but 11 cases (22.9%) had postoperative complications during follow-up; patients with type Ⅲ and Ⅳ had high incidence of cholangitis (6/10, 2/2, respectively) and choledocholithiasis (5/10, 2/2, respectively) after surgery, especially those with diffuse intrahepatic dilatation having a poor prognosis, eventually developing cirrhosis and necessitating liver transplantation. ConclusionThe HUAXI CBD classification is consistent with treatment principles, concise and easy to remember, and more suitable for pediatric clinical application, which can effectively assist in the selection of clinical treatment strategies for children with BD.
Objective To investigate quality of life of pediatric living donor liver transplantation recipient (PLDLTR) and analyze it’s influencing factors. Methods The convenient sampling method was adopted. Fifty-three PLDLTRs from May 2012 to January 2017 in the West China Hospital of Sichuan University were selected. At the same time, 56 children who participated in the physical examination and had no abnormality results were selected as reference (control group), their age and gender matched with the PLDLTRs. A general data inventory and a self-assessment scale for children’s quality of life (Pediatric Quality of Life Inventory 4 Generic Core Scales, PedsQL4.0) were used to evaluate the quality of life of the 53 PLDLTRs. Results A total of 53 questionnaires were distributed to all the 2 groups, all of them were effectively recovered. The points of quality of life of the physiological function, emotional function, social function, and school performance for the PLDLTRs were significantly higher than those of the control group (P<0.050), which for the PLDLTRs with male and more than 3 years after the operation were significantly higher than those of the PLDLTRs with female and within 1 year after the operation (P<0.050). For the PLDLTRs with age >4 years old, the points of the emotional function, social function, and school performance were significantly higher than those of the PLDLTRs with age ≤4 years old. For the PLDLTRs without postoperative complications, the points of quality of life of the physiological function, emotional function, and school performance were significantly higher than those of the PLDLTRs with Ⅱ grade of postoperative complications (P<0.050). Conclusions Life quality of PLDLTR is poorer than that of normal children. Postoperative time, postoperative complications, age, and gender are certainly associated with quality of life for PLDLTR.
Objective To discuss diagnosis and treatment strategy of vanishing bile duct syndrome. Method The clinical data of 1 child patient with suspected biliary atresia who received the liver transplantation in the West China Hospital of Sichuan University was retrospectively analyzed. Results The child patient underwent the liver transplantation due to the liver failure, and the postoperative pathological results indicated the vanishing bile duct syndrome accompanied by the formation of secondary (incomplete segmentation) cholestatic liver cirrhosis, the postoperative recovery was good. After 11 months of follow-up, the liver function, coagulation function, and blood flow of the transplanted liver were not obviously abnormal. The height and weight were suitable for the same age. Conclusion At present, there are many etiologies and complicated pathogenesis of vanishing bile duct syndrome, and liver transplantation is an ultimate effective treatment.