Objective:To analyze the apply effect of radiofrequency ablation assisted associating liver partition and portal vein ligation for staged hepatectomy (RALPPS) in liver cancer patients with insufficient future liver remnant (FLR).Methods:The data of 29 patients who underwent RALPPS in the First Affiliated Hospital of the Army Military Medical University from June 2014 to July 2020 were analyzed, including 25 males and 4 females, aged (46.6±9.9) years. The patients were divided into the second stage group (completed the second stage operation, n=18) and the first stage group (completed only the first stage operation, n=11) according to whether they had successfully completed the second stage operation. FLR, percentage of FLR in standard liver volume (percentage of FLR), growth rate of FLR, liver function after operation, operation time and radiofrequency ablation time of first stage operation, surgical complications were compared between the two groups. Results:The percentage of FLR before the first stage operation was (30.0±7.0)% in 29 patients, and the second stage operation was completed in 18 patients (62.1%). After the first stage operation, the aspartate aminotransferase and alanine aminotransferase in the second stage group were 519.0 (362.9, 696.0) U/L and 391.8 (297.2, 591.1) U/L, which were better than those of the first stage group 931.0 (711.7, 1131.9) U/L and 851.3 (426.6, 888.0) U/L (both P<0.05). There was no significant difference between the two groups in FLR and percentage of FLR before the first stage operation, duration time, amount of bleeding and time of radiofrequency ablation of the first stage operation (all P>0.05). In the second stage group, the interval between two operations was (21.6±6.7) days, the FLR before the second stage operation was (623.2±101.8) cm 3, the FLR percentage was (49.0±7.0)%, and the FLR growth rate was (19.0±5.0)%. In the first stage group, there were 11 patients (100.0%) who developed complication after first stage operation, induding 7 patients (63.6%) with complication above Clavien-Dindo grade Ⅲb. In the second stage group, 18 patients (100.0%) developed complication after the first stage operation. There were no complication above grade Ⅲb. The causes of 11 patients who did not completed secondary surgery included poor liver function and insufficient FLR in 4 patients, tumor progression in 6 patients, and death in 1 patient. Conclusion:RALPPS is a therapeutic option for liver cancer patients with insufficient FLR, and the therapeutic effect is reasonable.

肝癌占全球癌症死因的第3 位,我国癌症死因的第2位.目前,外科手术依然是肝癌首选的根治手段.现在推崇的精准治疗,不仅意味着技术上的精准切除,更意味着精准地选择治疗策略.肝脏具有自我再生的能力,在行肝切除术后,肝脏剩余体积(FLR)会发生增生反应,通常可以再生到术前的肝脏体积,但是肝功能恢复程度尚不能确定[1].实施大范围肝切除术仍然使病人面临发生与肝功能不全相关的并发症的风险.FLR已被证明是术后并发症的一个强有力的独立预测因素.随着肝外科水平的提高,已有多种手段用于FLR的优化,以增加肝切除术之前的预期FLR的体积和功能,大大增加了由于预期FLR不足而无法切除的病人的可切除性.虽然门静脉栓塞(PVE )等FLR优化技术作为术前策略取得了成功,但是它仍存在一定的局限性,并非适用于所有的病人.

肝内胆管结石是一种发生于左右肝管汇合部位以上的胆管内结石,常见于东亚和东南亚等国家.其中,我国也是肝内胆管结石的高发国家,且明显集中分布于沿海和长江以南的广大农村地区[1].目前,研究者普遍认为肝内胆管结石的形成与胆汁瘀滞、胆道感染、胆汁成分改变和肝脏生化及代谢缺陷等因素相关[2,3].由于其特殊的生理病理特征,导致肝内胆管结石的病情复杂多变、病程较长、术后并发症多和术后复发率高,给患者的生活质量和生命造成严重的影响,使临床治疗面临极大的挑战.目前,有证据表明肝内胆管结石的临床分型的发展对临床治疗具有重要的指导意义和推动作用.但是,当前的各种分型依然均存在一定的临床局限性.有鉴于此,深入了解肝内胆管结石的临床分型进展对于提高当前的治疗水平具有重要意义.目前有3个公认的肝内胆管结石分型体系.

The lymphocyte-derived helper T (Th) cells are critical regulators of the adaptive immune response and are associated with inflammatory disease. The most recently recognized Th-cell lineage, Th17, plays an important role in host defense against extracellular pathogens by secreting the proinflammatory cytokine, interleukin 17, and recruiting reactive oxygen species (ROS)-producing monocytes to the site of infection. However, accumulating evidence has implicated Th17-cell dysregulation as an underlying cause for some immune-related pathogenic conditions, including allograft rejection. Recent studies of human transplant patients have indicated that Th17 cells exhibit resistance to current immunosuppressive therapies that would otherwise prevent allograft rejection. In this review, we will discuss the most current research findings related to Th17-cell function in various kinds of allografts.

To investigate the expression and significance of IL-17 and IL-22 in rat orthotopic liver transplant rejection and tolerance,we established the rejection and tolerance models in rats(n = 15).The concentrations of IL-17 in plasma were measured by ELISA.And immunohistochemistry,Western blot,and real-time quantitative reverse transcriptase polymerase chain reaction(RT-PCR) were used to detect the IL-17 and IL-22 expression of cell level,protein level and mRNA level in liver.On 1,3,5,and 7 days post-transplantation,the concentrations of IL-17 in plasma of rejection group were higher than that of tolerance group.In rejection group,the expression levels of IL-17 and IL-22,including the frequencies of positive lymphocytes,protein level,and mRNA level,were significantly increased,as compared to tolerance group.Similarly,the expression of STAT3 mRNA in liver of rejection group was higher than that of tolerance group.The results suggested that IL-17 and IL-22 are participated in the development of graft rejection after liver transplantation,and worked via STAT3 activation.