Objective To investigate the relation between artery location for anastomosis and recipient’s hepatic arterial anatomic variation or pathological abnormity in adult liver transplantation. Methods From March 2004 to July 2006, 80 cases of adult orthotopic liver transplantation (OLT) were performed in this hospital. Preoperative magnetic resonance angiography combined with operative artery dissection were performed to recognize and classify the hepatic arterial variation or pathological abnormity, then the arterial anastomotic location and stoma diameter were recorded. The location and diameter of anastomosis were compared between variation group and non-variation group. Results The recipient’s hepatic arterial variation rate was 11.3%(9/80), 8/9 of variable artery were right hepatic arteries which arose from gastroduodenal artery (GDA), common hepatic artery (CHA), celiac artery or superior mesenteric artery. The locations for anastomosis were the branch patches of CHA (7/9) and GDA (2/9). The pathological abnormities comprised of hepatic arterial intimal dissection (1 case) and hepatic arterial stenosis (1 case), the corresponding anastomotic location was the end of CHA in former case and anterior wall of suprarenal aorta in latter case. The proportion of anastomotic locations differed statistically between variation group and non-variation group (χ2=18.679, P＜0.01). The anastomotic diameter of CHA branch patch in variation group had no statistic difference compared with branch patch of CHA or proper hepatic artery (PHA) in non-variation group (Pgt;0.05). Conclusion The recipient’s hepatic arterial variation influences the selection of locations for anastomosis, the branch patch of CHA is the preferred location. The anastomotic stoma diameter of PHA branch patch in non-variation group obtains a similar size of CHA branch patch in variation group, the PHA branch patch can be used as a common location when arterial variations are absent.
ObjectiveTo study the effectiveness of liver function, hepatic energy metabolism, regeneration, and apoptosis on the obstructive jaundice rat after partial hepatectomy (PH) combined with internal biliary drainage under the condition of conspicuous bilirubinemia. MethodsOne hundred and twenty male SD rats were used in research, six of whom were divided into sham operation (SO) group. Twenty rats underwent bridge operation between common bile duct and duodenum after 70% PH (70%PH group), and 6 rats out of the 94 rats who underwent common bile duct ligation (CBDL) for 5 d were randomly selected as CBDL group, and the residual rats were done the second operations after 5 d and were divided into three groups: bile duct obstruction combined with reperfusion of bile flow group （BDO-RBF group， n=20), 42% PH with BDO-RBF group (n=20), and 70%PH with BDO-RBF group (n=25). Levels of TB, ALT, ALB, and ALP in serum; HGF, bcl-2 mRNA and protein； ATP, ADP, and AMP; hepatocyte proliferation/apoptosis index in hepatic tissues were dynamically observed after operation (24 h, 72 h, and 7 d), respectively. The liver function and hepatocyte energy metabolism were only detected in the SO group. ResultsRats without obstructive jaundice would have an excellent liver regeneration after 70% PH, while the liver function and hepatocyte energy metabolism could recover rapidly. The liver function, hepatocyte energy metabolism, HGF and bcl-2 mRNA and protein of liver tissue and the hepatocyte proliferation/apoptosis index in partial (42% or 70%) hepatectomy combined with internal biliary drainage in obstructive jaundice group were significantly influenced while recovered rapidly (Plt;0.05). ConclusionsUnder the condition of conspicuous bilirubinemia, the influences of hepatectomy combined with internal biliary drainage on hepatocyte energy metabolism, liver function, hepatocyte regeneration and apoptosis are severer than that of normal rats who underwent 70% hepatectomy, while also make the rats recover rapidly in hyperbilirubinemia groups. The database suggest that it is not necessary to do preoperative external biliary drainage before performing liver resection.
ObjectiveTo investigate the prognostic impact of tumor location in gallbladder carcinoma in different sites and evaluate the effect of surgical operation on the median survival time of patients.MethodsFrom 2012 to 2016, 382 patients with gallbladder cancer in the Eastern Hepatobiliary Surgery Hospital were divided into 163 cases of gallbladder duct cancer and 219 cases of gallbladder bottom and body cancer. They were received radical resection, extended radical resection and palliative resection.ResultsThe mean survival time was (19.57+15.63) months in the bottom and body cancer group, (14.62+11.12) months in the cystic duct carcinoma group, and the survival time was significantly different between the two groups (P<0.05). After radical surgery, the mean survival time in the cystic duct carcinoma group and the bottom and body cancer group were (23.82±12.47) months and (30.63±17.81) months, respectively, there was no significant difference between the two groups (P>0.05). The multivariate analysis indicated that tumor location, surgical radical therapy, clinical stage, pathological grade, and pathological classification were all independent risk factors influencing the prognosis of patients (P<0.05). There was no significant difference in median survival time between the two groups (P>0.05).ConclusionsThe prognosis of patients with cystic duct gallbladder carcinoma is worse than that of patients with the bottom and body cancer of the gallbladder, but the prognosis of the two groups after radical resection is similar. The prognosis of patients with extended radical operation according to the condition is similar to that of routine radical operation. There are some differences in clinical stage, pathological grade and pathological classification between the two groups of gallbladder cancer patients. In addition, the great differences exist in the surgical methods, especially in extended radical operation. Therefore, the treatment of gallbladder cancer in these two locations should be treated differently.
ObjectiveTo assess the methodological quality of guidelines for bronchoscopic alveolar lavage. MethodsCNKI, VIP, WanFang Data, CBM, Web of Science, PubMed, EMbase databases and medlive.cn, the National Guideline Clearinghouse (NGC), the National Guideline International Network (GIN), the Scottish Intercollegiate Guidelines Network (SIGN), the National Institute for Clinical Excellence (NICE), and the World Health Organization (WHO) websites were electronically searched to collect guidelines of bronchoscopic alveolar lavage from inception to December 2020. Two reviewers independently screened literature, extracted data, and assessed the methodological quality of the guidelines by using AGREE Ⅱ tool. ResultsA total of 19 guidelines were included, with 5 from China, 5 from the USA, 3 from Europe, 2 from the UK, 1 from Australia, 1 from Israel, 1 from Spain, and 1 from India. The average standard score rates of the 19 guidelines in the six fields were 50.73% for scope and purpose, 20.02% for participants, 15.13% for formulation rigor, 36.40% for clarity of presentation, 3.51% for applicability, and 22.37% for editorial independence.ConclusionsThe quality of bronchoalveolar lavage guidelines remains relatively low.