Introduction With the continuous advancement of surgical technique,com-bined vascular resection has become increasingly common dur-ing complex surgical procedures.In such cases,ensuring the safe and effective reconstruction of blood vessels after resection is of paramount importance.When direct vascular reconstruction is not feasible,the application of vascular grafts becomes necessary to re-store vascular continuity and function.Commonly employed vascu-lar grafts in clinical practice include allogeneic graft vessels(AGVs),autologous vessels,and artificial vessels.Among these,AGVs offer distinct advantages particularly in its complex structures and sat-isfying histocompatibility,making it a valuable option for vascular reconstruction.

肝胆外科相关疾病病因及发病机制复杂,临床表现多样,与其他腹部外科疾病的鉴别存在困难,治疗原则具有独特性.肝胆外科的专业性和抽象性,决定了对临床教学更高的要求.近年来,新的教学方法不断被应用于临床教学实践中,其中以问题为基础的教学法(problem-based learning,PBL)和以案例为基础的教学法(case-based learning,CBL)备受关注,PBL教学法的优势主要在于以学生为中心,促进自主学习,在教师的引导下,以问题为导向,通过信息获取、归纳、推理和总结,提高学生解决问题的思维能力.CBL教学法可以为临床医学生提供形象化的情景模式,让学生充分接触案例诊疗过程,增强了临床思维能力.两者的结合可以优势互补,提高学生思辨能力、激发学习主动性并提升临床实践能力,改善了教学的总体满意度.文章旨在对两种教学法在肝胆外科临床教学中的联合应用进展进行综述.

Objective:To evaluate the survival benefit of combined splenectomy in patients with liver cancer complicated with portal hypertension after radical resection.Methods:Clinical data of 138 patients with liver cancer complicated with portal hypertension who underwent radical resection in Beijing You'an Hospital Affiliated to Capital Medical University from March 2011 to May 2019 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 84 patients were male and 54 female, aged from 26 to 76 years, with a median age of 55 years. According to different surgical methods and liver cancer stages, all patients were divided into radical resection combined with splenectomy group (HS group, n=96), including 48 cases of T1 stage liver cancer (HS1 group), 39 cases of T2 stage (HS2 group) and 9 cases of T3 stage (HS3 group). 42 patients withT1 stage liver cancer who received radical resection alone were used as controls (HA1 group). Survival analysis was performed by Kaplan-Meier method and Log-rank test. Perioperative status between two groups was compared by t test, Mann-Whitney U test or Chi-square test.Results:The median RFS and OS in the HS groupwere 22.3 and 46.0 months. The postoperative 1-, 2-, 5-year RFS were 90.2%, 76.5%, 51.0% in the HS1 group,48.6%, 24.3%, 10.8% in the HS2 group, and 42.9%, 28.6%, 28.6% in the HS3 group, respectively. The differences were statistically significant in the postoperative 1-, 2-, 5-year RFS among three groups (χ2=22.276, 26.206, 17.124; P<0.05). The postoperative 1-, 2-, 5-year OS were 95.8%, 79.2%, 47.9% in the HS1 group, 84.6%, 69.2%, 25.6% in the HS2 group, and 77.7%, 55.6%, 33.3% in the HS3 group, respectively. The differences in the postoperative 5-year OS were statistically significant among three groups (χ2=11.416, P<0.05). In the HS1 and HA1 groups, the postoperative 1- and 2-year RFS were 95.0%, 81.0% and 81.3%, 66.7% respectively, and the differences were statistically significant (χ2=6.378, 4.944; P<0.05). In the HS1 and HA1 groups,20 and 2 patients had a history of varicose vein rupture and bleeding, and the difference was statistically significant (χ2=14.581, P<0.05). The median Hb before operation was 115(49) and 126(20) g/L, PTA was 73%(12%) and 78%(7%), liver stiffness was 19(12) and 15(10) kPa, intraoperative blood loss was 300(275) and 150(100) ml, operation time was 4.1(2.3) and 3.5(1.6) h, respectively. The differences were statistically significant (Z=-2.115, -2.768, 2.374, 3.171, 2.804; P<0.05). No patient died early after surgery in two groups.Conclusions:Combined splenectomy can improve early RFS of patients with T1 stage liver cancer complicated with portal hypertension after radical resection. A high proportion of preoperative gastrointestinal bleeding history, poor coagulation and high grade of liver cirrhosis are observed in these patients. Although combined splenectomy increases operation time and intraoperative bleeding, it is generally safe.

e16128 Background: Hepatocellular carcinoma (HCC) is a type of aggressive disease with poor prognosis. Although surgery is the most effective therapy for early liver cancer, recurrence rate is up to 50%. Therefore, it is crucial to predict the recurrence for improvement of prognosis of liver cancer. This study aim is to establish a prognostic model using for the prediction of recurrence in HCC. Methods: We collected the genomic and clinical data of 372 patients from the cancer genome atlas (TCGA) database. Mutational signature were established based on univariate Cox analysis and least absolute shrinkage and selection operation (LASSO) Cox regression analysis. A prognostic signature model were developed. Results: The patients with higher pathological T stage (p < 0.001) and old age (p = 0.05) were associated with a worse DFS. In addtion, patients with a HRD score over 24 had a worse DFS compared to those in patients with HRD score less than 24 (p < 0.001). Based on the 1 year DFS, 112 differential mutation gene (DMEs) and 326 differential expressed genes (DEGs) were identified. The univariate Cox and LASSO Cox regression models were employed to select 47 DMEs and 9 gene expression construct an prognosis model. The AUC is 0.612. A nomogram of DFS was established based on the prognosis model, HRD, and tumor stage. The AUC is 0.812 in training set and 0.842 in validation set. Conclusions: We established and validated a novel nomogram model based the genomic and clinical factors for predict DFS in Hepatocellular Carcinoma patients. This model has good predictive value for prognosis, which could improve the risk stratification and individual treatment of Hepatocellular Carcinoma patients.

目的 总结腹腔镜脾切断流术(laparoscopic splenectomy and esophagogastric devascularization,LSED)治疗门静脉高压消化道出血的诊治经验及手术入路.方法 选取2018年1月至2020年4月首都医科大学附属北京佑安医院收治的因门静脉高压导致顽固性消化道出血接受LSED治疗的24例患者,分析其临床疗效及手术入路.结果 24例患者中有22例(91.7％)应用腹膜后优先解剖入路,术中平均出血量为402.1 ml,术后复查WBC和PLT较术前显著回升(P＜0.05),最常见的并发症为腹水(8/24,33.3％)和一过性胰漏(5/24,20.8％),均对症处理痊愈,无二次手术及死亡病例.术后早期、3个月及1年的门静脉血栓形成率分别为4.2％、41.7％和33.3％,术后1年内消化道出血复发率为4.2％.结论 LSED治疗门静脉高压消化道出血安全有效,腹膜后优先解剖手术入路可以提供清晰的安全边界,有助于LSED的成功实施.

BACKGROUND We aimed to create a novel predictive model through comparing the prognostic accuracy of the current mainstream scoring models in predicting the short-term outcome of patients with hepatitis B-related acute-on-chronic liver failure (HBACLF) undergoing liver transplantation (LT). MATERIAL AND METHODS Data on patients with HBACLF undergoing LT were retrospectively collected and analyzed. The area under the time-dependent receiver operating characteristic curve of 16 scoring models was calculated to evaluate their performance in predicting short-term survival after LT. Univariate analyses and LASSO regression were used to identify the independent variables, which were further selected by Cox stepwise regression. RESULTS A total of 135 patients were enrolled. Among the 16 scoring models, MELD-Na performed the best in predicting 3-month mortality after LT, with an AUC of 0.716. LASSO regression analysis revealed that only the MELD-Na was confirmed as an independent predictor (HR 1.0481, 95% C.I [1.0136, 1.0838], P<0.05). Cox stepwise regression identified 4 variables - MELD-Na, sex, systemic infection, and placement of T-tube during operation - which were used to construct a novel prognostic model with a C-index of 0.844 and a Brier score of 0.131 after internal validation and a C-index of 0.824 (95% C.I [0.658, 0.989]) and a Brier score of 0.119 in the external validation cohort at 3 months. CONCLUSIONS Compared with other scoring models, MELD-Na was an independent factor in predicting short-term outcome after LT. The constructed novel predictive model could exert clinical benefits on early prognostic assessment and case selection.

OBJECTIVE:To evaluate and explore the effectiveness of the new prevention and control measures for the donor-derived infection (DDI) associated with CRO after liver transplantation.METHODS:The data of 120 organ donors and recipients from January 2018 to May 2020 were retrospectively analyzed at The Liver Transplantation Center of Beijing Youan Hospital, Capital Medical University, to investigate the epidemiological status of CRO in donors. The cases were divided into two groups. The implemented group was treated according to the execution of a clustered CRO prevention and control measure based on active screening combined with early initiation of prophylactic/therapeutic administration of antibiotics. The effectiveness of the prevention and control measures was evaluated by comparing the length of postoperative ICU stay, total postoperative length of hospital stay, duration of ventilator use, duration of restricted antibiotics use, the incidence of DDI, incidence and composition distribution of DDI-related CRO, and incidence of severe DDI-relevant adverse events between the two groups.RESULTS:There was a high detection rate of 39.32% (105 strains) of drug-resistant bacteria in the donors. Fifty-six strains of CRO were detected. Participants in group B, which implemented the new prevention and control measures, were transferred out of the ICU sooner (P = 0.023), used fewer restrictive antibiotics (P = 0.003), and were discharged more quickly (P = 0.013) than those in group A. Postoperative DDI incidences (P = 0.113) and severe DDI-related adverse events were not statistically different between the two groups (P = 0.062). CR-Kp-related DDI was less common in group B (P = 0.021).CONCLUSION:The situation of donor-derived drug-resistant bacterial infections remains critical. The clustered prevention and control measures for CRO based on active screening combined with early initiation of prophylactic/therapeutic application of antibiotics would be beneficial.

Background: The survival benefits of radical treatment (resection or radiofrequency ablation) combined with splenectomy for primary hepatocellular carcinoma (HCC) in patients with liver-cirrhosis-associated portal hypertension (PH) remain to be clarified. Methods: 96 patients undertaking HCC radical treatment combined with splenectomy (HS group) were retrospectively analyzed, 48 of whom belonged to HCC stage T1 (HSS group). Another 42 patients at stage T1 with PH who received hepatectomy (or radiofrequency ablation) alone (HA group) during the same period served as the control group. Recurrence-free survival (RFS) and overall survival (OS) were compared at each time point between the HSS and HA group. The risk factors affecting early RFS and OS were confirmed through COX multivariate analysis. Results: The median RFS was 22.3 months and the mean median OS was 46 months in the HS group. As such, 1-year, 2-year, 3-year, and 5-year RFS rates in the HSS and HA group were 95% and 81% (p = 0.041), 81% and 67% (p = 0.05), 64% and 62% (p = 1.00), and 29% and 45% (p = 0.10), respectively. Further, 1-year, 3-year, and 5-year OS rates in the HSS and HA group were 98% and 98% (p = 1.00), 79% and 88% (p = 0.50), and 60% and 64% (p = 0.61), respectively. Cox multivariate analysis showed that preoperative irregular anti-viral therapy, Child-Pugh grade B liver function, vascular invasion, and microvascular invasion (MVI) were independent risk factors for early postoperative RFS (within 2 years), and preoperative irregular anti-viral therapy and vascular invasion were independent risk factors for 5-year OS. Conclusions: Radical treatment of HCC combined with synchronous splenectomy, especially applicable to patients with Child-Pugh grade A liver function, can significantly improve early postoperative RFS in patients with stage T1 HCC and liver-cirrhosis-associated portal hypertension, but fail to improve OS.

Objective:To explore the risk factors of early severe complications in patients with liver failure after liver transplantation.Methods:Clinical data of 132 patients with liver failure who initially underwent orthotopic liver transplantation in Beijing You'an Hospital, Capital Medical University from January 2004 to December 2013 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 109 patients were male and 23 female, aged (44±10) years on average. According to the Clavien-Dindo classification, patients with early postoperative complications of grade Ⅲb or above were assigned into the severe complication group (n=41), and those with complications below grade Ⅲb were allocated into the non-severe complication group (n=91). Univariate analysis of the risk factors of severe complications was performed by t test or Chi-square test. Multivariate analysis was conducted by Logistic regression analysis.Results:Univariate analysis showed that preoperative MELD score, preoperative plasma exchange, cold ischemia time, marginal donor, surgical pattern and intraoperative T-tube indwelling were significantly correlated with the incidence of early severe complications after liver transplantation for liver failure (χ2=4.425, 5.069, 5.672, 4.105, 6.352, 6.293; P<0.05). Multivariate Logistic regression analysis demonstrated that preoperative MELD score≥25, classic liver transplantation and intraoperative T-tube indwelling were the independent risk factors for early severe complications after liver transplantation in patients with liver failure (OR=3.202, 4.510, 3.047; P<0.05), and preoperative plasma exchange was an independent protective factor (OR=0.330, P<0.05).Conclusions:Preoperative MELD score≥25, classic liver transplantation and intraoperative T-tube indwelling are more likely to cause early severe complications in liver failure patients after liver transplantation, whereas preoperative plasma exchange can lower the risk of early severe complications.

Purpose We aimed to investigate the effect of celecoxib on rats with liver cancer through the extracellular signal-regulated kinase (ERK)/c-Jun N-terminal kinase (JNK)/p38 pathway. Methods Sprague-Dawley rats (n=36) were divided into 3 groups (n=12 per group) randomly. In model group, the liver cancer model was established, and normal saline was intraperitoneally injected. In celecoxib group, the liver cancer model was also established, and celecoxib was intraperitoneally injected. After intervention for 30 d, the samples were taken. The body weight of rats was measured before modeling and before sampling. The morphology of liver tissues was observed via hematoxylin-eosin (HE) staining, the expressions of related proteins and messenger ribonucleic acids (mRNAs) were determined via Western blotting and quantitative polymerase chain reaction (qPCR), respectively, and the protein expressions of cysteinyl aspartate specific proteinase 3 (Caspase3) and Cyclin D1 in liver tissues were detected. Results Before modeling, there was no difference in t.

Objective:To compare the prognostic accuracy of 16 pre-transplant scoring models in predicting the post-transplant short-term outcome of patients with hepatitis B-related acute-on-chronic liver failure (HBACLF), and to explore an efficient predictive model.Methods:A retrospective analysis of the clinical data of HBACLF patients who underwent liver transplantation at the Liver Transplant Center of Beijing Youan Hospital from August 2004 to September 2014. Score of 16 models (CTP, UNOS-MELD, Updated-MELD, Integrated-MELD, MELD-Na, MLED Na, CLIF-SOFA, CLIF-OFs, CLIF-C ACLFs, CLIF-C ADs, Refit MELD, Refit MELD Na, MELD-AS, Zheng's Risk, UKELD, MESO) was based on time-dependent operation characteristic curve, and the area under the curve (AUC) was calculated to evaluate the prediction accuracy of 3-month survival after transplantation. Selection of univariate factors associated with postoperative short-term mortality was performed, and then 16 scoring models one by one with statistically significant mortality-related factors were entered into LASSO regression (Least Absolute Shrinkage and Selection Operator regression) to confirm the independent variables. Finally, a predictive model was constructed by Cox regression.Results:A total of 135 patients were included in this study, including 106 males and 29 females, aged (45.0±10.5) years old. Among the 16 scoring models, the AUC of MELD-Na and CLIF-SOFA were more than 0.7 in early survival prediction after liver transplant. The MELD-Na was confirmed as an independent predictive variable in the final model with univariate and LASSO regression multivariate selection analysis ( HR=1.0481, 95% CI: 1.0136-1.0838, P<0.05). The model was constructed by MELD-Na and combined with other clinical parameters (female, systemic infection, placement of T tube during operation) could better predict the early survival after liver transplant. The overall C-index of the final model was 0.886, and the C-index at 3-month after liver transplant was 0.844 through internal validation (Bootstrap). Conclusion:Compared with other scoring models, MELD-Na and CLIF-SOFA were better for early survival prediction after liver transplantation for patients with HBACLF. The constructed predictive model based on MELD-Na was superior than single MELD-Na or CLIF-SOFA in prognostic assessment and case selection.

e16140 Background: Hepatocellular carcinoma (HCC) is one of the most common malignancies and leading cause of cancer deaths worldwide. Biomarkers contribute to predict the response of targeted treatments and immunotherapy. Therapy directed toward homologous recombination deficiency (HRD) is now approved in ovarian and breast cancer, but the pattern of HRD is not clear in HCC. The HRD phenotype has been defined as the presence of a non-silent somatic mutation in homologous recombination-related (HRR) genes. Thus, we aimed to analyze the molecular characteristics of resectable HCC, including HRR genes. Methods: Matched tumor/normal DNA from resectable HCC patients (N = 53) were analyzed by whole exome sequencing (WES) or Acornmed panel with 808 cancer-related genes. Results: Overall, 94.3% (50/53) patients exhibited genetic alterations. TP53, ARID1A, PTEN and NBPF1 were the most commonly mutated genes in resectable HCC. In addtion, 35.9% patinets harbored at least one HRR genes mutation. The frequently mutated genes were BRCA2 (4.4%), BRCA1(4.0%), ATM (3.9 %), and RAD50 (3.8%). Interesting, frequency of HRR genes mutation in the Chinese cohort was higher than that in TCGA (35.9 % vs 20.9%). Analysis of carcinogenic pathways shown that ERBB and PI3K-AKT signaling pathway were the common signaling pathway. In resectable HCC, 32.08% (17/53) patients disclosed high TMB (highest 25%). Further analysis found that PTEN mutations were remarkably associated with low TMB (p < 0.05). Conclusions: This study contributes to understand the molecular characteristics of patients with resectable HCC, which will be useful to guide personalized therapy and promote the clinical management in this population. Furthermore, the study suggested that it is feasibility for resectable HCC patients received PARP inhibitors, DNA-damaging chemotherapies, and immune checkpoint blockade therapy.

肝细胞癌是全世界最常见恶性肿瘤之一,随着对健康体检的重视及影像学技术的发展,原发性小肝癌(直径≤3cm)的确诊率逐步增高.在小肝癌的背景下,手术切除、消融及肝移植仍是治疗的基石.本文将就手术切除、消融及肝移植临床应用现状及进展进行综述.

Objective To investigate the risk factors for early portal venous system thrombosis (PVST) after devascularization with splenectomy in cirrhotic patients with portal hypertension and to explore the preventive effects of blood activating, anticoagulation and antiplatelet therapy.Methods A retrospective study was conducted on 320 patients with portal hypertension post liver cirrhosis in our hospital from January 2011 to December 2016.All patients were treated with splenectomy and devascularization, and followed up after operation.Clinical data were collected including the occurrence of PVST.The patients with PVST were treated with blood activating, anticoagulation and antiplatelet therapy (low molecular dextran + vitamin K1 + dipyridamole + warfarin), and the changes of blood coagulation indexes were recorded.Results There were 60 patients developing PVST after operation in the 320 patients with an incidence of 18.8％.Parameters including spleen size, splenic vein diameter, portal vein diameter, flow velocity of portal vein blood, blood transfusion volume, postoperative platelet count and postoperative D-dimer level in PVST group (n=60) were significantly different from those in non-PVST group (n=260) (P＜0.05).Multivariate logistic regression analysis showed that the postoperative platelet count, postoperative D-dimer level and blood flow velocity of portal vein were the main independent risk factors for PVST (P＜0.05).The area under the receiver-operating characteristic (AUROC) curve of D-dimer for the diagnosis of PVST was 0.794 with 95％ confidence interval (CI) of 0.724-0.863 (P＜0.05), and the diagnostic cut-off point was 3.55mg/L.The AUROC curve of postoperative platelet count for the diagnosis of PVST was 0.754 with 95％CI of 0.672～0.836 (P＜0.05), and the diagnostic cut-off point was 435.5×109/L.The prothrombin time and activated partial thromboplastin time at month 1 were significantly lower than those at day 1after operation in PVST group, respectively (9.22±2.13 svs.11.67±1.84 sand 35.39±9.14 svs.41.94±10.92 s, both P＜0.05).Conclusion The occurrence of PVST after devascularization with splenectomy in patients with portal hypertension post liver cirrhosis is common.The postoperative platelet count, postoperative D-dimer and blood flow velocity of portal vein are the main risk factors for the PVST.The blood activating, anticoagulation and antiplatelet therapy might effectively prevent the PVST.

Background. Preoperative evaluation is extremely important for patients undergoing liver transplantation (LT) for acute-on-chronic liver failure (ACLF). It is unclear that whether preoperative Model for End-Stage Liver Disease-Serum Sodium (MELD-Na) score has a decisive effect on the complication grade after LF for ACLF. This study is aimed to explore the value of preoperative MELD-Na scores in predicting complication severity grades post LT for ACLF. Methods. One hundred fifty-nine patients enrolled in the study who underwent LT for ACLF between August 1, 2004, and September 1, 2014, were retrospectively analyzed. The Accordion Severity Grading system was adopted to classify the complication severity grade post LT: Grade 1 (mild), grade 2 (moderate), grades 3-5 (severe), and grade 6 (death). The area under the curve was calculated by plotting the receiver operating characteristic curve for evaluating the diagnostic accuracy of MELD-Na score for severe grade and mortality after LT. The correlation between MELD-Na score with complication severity grade post LT was demonstrated by Spearman correlation and multivariate analysis. The MELD-Na based nomogram was constructed to predict short-term mortality (grade 6). Results. The incidences of postoperative complications at all grade levels were: grade 2: 43 patients (27.0%, MELD-Na 27.3 +/- 7.4), grade 3: 41 patients (25.8%, MELD-Na 32.7 +/- 12.4), grade 4: 31 patients (19.5%, MELD-Na 34.3 +/- 12.1), grade 5: 9 patients (5.7%, MELD-Na 30.7 +/- 12.3), grade 6: 35 patients (22%, MELD-Na 37.1 +/- 10.4). There was no grade 1 patient. The area under the curve of the MELD-Na scores for severe and death group were 0.631 (P < .05, 95% confidence interval [CI], 0.533-0.728) and 0.670 (P < .05, 95% CI, 0.574-0.766) respectively. The MELD-Na score was significantly correlated with the Accordion Severity Grade (rho 0.297, P < .01) by Spearman correlation analysis. Multivariate analysis confirmed that a MELD-Na score >= 25 was the only risk factor for postoperative severe grade complications (P < .05, odds ratio = 4.35) and that MELD-Na > 35 was one risk factor for postoperative mortality (P < .01, hazard ratio = 4.72). MELD-Na >= 35 combined with other parameters (female, age, systematic infection, and intraoperative placement of the T-tube) in a constructed nomogram model had a good calibration curve with C-concordance of 0.790. Conclusions. MELD-Na scores are significantly correlated with Accordion Severity Grades. It can effectively predict the complication severity grade after LT for ACLF.

Objective To study the impact of splenectomy and devascularization on liver function and liver fibrosis in patients with non-cirrhotic portal hypertension (NCPH). Methods The clinical data of patients with NCPH who were treated in Beijing You'an Hospital of Capital Medical University from April 2008 to December 2017 were retrospectively analyzed. The patients were divided into the observation group (n=16 ) and the control group ( n =30 ) according to their treatment methods. The observation group underwent splenectomy combined with devascularization, while the control group received conservative treatment. The changes in liver function, ascites, varicose vein rupture and bleeding before and after treat-ment, and the changes in liver blood flow before and after treatment in the observation group were compared. Results The before and after treatment of the 2 groups in ALT, AST, total bilirubin, albumin showed no statistically significant difference (P＞0. 05). Six months after treatment, the rates of ascites and bleeding were significantly higher than the observation group, (P＜0. 05). Ten patients who had a history of preoper-ative variceal hemorrhage in the observation group did not bleed within 6 months after treatment. Further-more, in the observation group after treatment when compared with the control group, the PC-Ⅲ [(32. 3 ± 12. 1) g/L vs. (56. 7 ± 15. 3)g/L],Ⅵ-C [(46. 6 ± 35. 0) g/L vs. (121. 3 ± 30. 4)g/L], LN [(32. 5 ± 10. 5) g/L vs. (65. 8 ± 11. 1) g/L] were significantly lower than the control group ( P ＜0. 05). The preoperative portal venous blood flow in the observation group was significantly higher than that after surgery [(1 056. 8 ± 679. 8) ml/min vs. (481. 0 ± 227. 6) ml/min, P＜0. 05]. Conclusion Splenectomy and devascularization effectively stopped variceal bleeding and delayed liver fibrosis in NCPH patients without affecting the liver function.

Objective To evaluate the effects of different liver transplantation approaches on the incidence of postoperative complications in patients with liver failure using Clavien-Dindo classification. Methods Clinical data of 132 patients with liver failure who underwent orthotopic liver transplantation for the first time in Beijing You'an Hospital Affiliated to Capital Medical University from January 2004 to December 2013 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 109 patients were male and 23 female, aged (44±10) years on average. All the patients were divided into the classic group (n=25), classical venous bypass group (n=29) and piggyback group (n=78). Postoperative complications were graded by Clavien-Dindo classification, Postoperative complications of Ⅲb and above were defined as the severe complications early after liver transplantation. The incidence of postoperative complications was compared by Chi-square test. Results The incidence of severe complications early after liver transplantation was 31%(41/132). Grade Ⅲb, Ⅳ and Ⅴ complications were observed in 6, 14 and 21 cases, respectively. The incidence of severe complications early after liver transplantation in the classic, classical bypass and piggyback groups were 52%(13/25), 28%(8/29) and 26%(20/78) , respectively, with significant differences were observed (χ2=6.352, P<0.05). The incidence of severe complications in piggyback group was significant lower than that in classic group (χ2=6.041, P<0.017). Conclusions Different liver transplantation approaches exert effects upon the incidence of postoperative complications in patients with liver failure. The incidence of severe complications early after piggyback liver transplantation is relatively low. Key words: Liver transplantation; Technique of operation; Postoperative complications; Clavien-Dindo classification

The present clinical trial assessed the effect of double-dose administration of replication-deficient adenovirus-thymidine kinase and ganciclovir (ADV-TK/GCV) in patients with advanced hepatocellular carcinoma (HCC) who underwent liver transplantation (LT). Eighty-six patients with single tumor diameters >5cm or multiple tumors with diameters >3cm each, regardless of vascular invasion, were examined over a follow-up period of 61 months. All patients underwent orthotopic LT; 43 received LT only, and 43 received LT plus double-dose ADV-TK/GCV gene therapy (LT + ADV-TK/GCV). Recurrence-free survival (RFS) and overall survival (OS) rates, as well as therapeutic safety, were assessed. The RFS and OS rates in LT + ADV-TK/GCV patients at 3 years (55.9% and 60.3%, respectively) were significantly higher than those in the LT-only group (13.5% and 19.3%, respectively; p<0.001). LT + ADV-TK/GCV patients without vascular invasion showed significant improvement in RFS (73.7%) and OS (68.6%). LT + ADV-TK/GCV patients without extrahepatic vascular invasion experienced higher OS versus LT-only patients. Double-dose ADV-TK/GCV gene therapy combined with LT was safe and improved RFS and OS in advanced HCC patients without vascular invasion over the 5-year follow-up period. The potential to select patients with intrahepatic and extrahepatic vascular invasion for LT requires further confirmation.

Idiopathic noncirrhotic portal hypertension (INCPH) is an uncommon disease of intrahepatic portal hypertension with associated clinical manifestations such as esophageal varices,hypersplenism and ascites.This diagnosis is rendered following the exclusion of other causes of portal hypertension,including cirrhosis,other presinusoidal,sinusoidal and post sinusoidal causes of portal hypertension and splanchnic venous thrombosis.INCPH is relatively uncommon in the western world,and the terminology and diagnostic criteria of INCPH remain controversial.Histological features commonly observed in INCPH are nodular regeneration of the hepatocytes,phlebosclerosis,increased number of portal vessels,sinusoidal dilatation,periportal shunting vessels,perisinusoidal fibrosis and rudimentary portal tracts.It's urge to look for this condition in a number of clinical settings,including cryptogenic cirrhosis,a disease known to be associated with INCPH,drug administration,and even chronic alterations in liver fimction tests.Once INCPH is clinically suspected,liver histology becomes mandatory for the correct diagnosis.However,the pathologists should be familiar with the histological features of INCPH,especially in cases in which histology is not only requested to exclude liver cirrhosis.

目的 评价经内镜逆行胰胆管造影(endoscopic retrograde cholangiopancreatography,ERCP)下放置全覆膜自膨式可回收金属支架(fully-covered self-expandable metal stents,FCSEMS)治疗肝移植术后胆管吻合口狭窄(anastomotic biliary strictures,ABSs)的效果.方法 采用回顾性横断面研究方法,收集2015年1月至2017年4月首都医科大学附属北京佑安医院行肝移植(166例次肝移植)术后(3～60个月)出现ABSs、并于北京大学第一医院外科内镜中心进行内镜下FCSEMS治疗的12例病人资料,统计手术成功率、临床缓解率和并发症发生率等,总结及评价FCSEMS治疗肝移植术后ABSs的安全性及有效性.结果 12例病人中,接受FCSEMS治疗14例次获得成功:其中2例病人术后经2次支架治疗.1例病人内镜插管失败,结合经皮肝穿刺胆管引流(percutaneous transhepatic biliary drainage,PTCD)穿刺通过导丝插管成功,手术成功率为92.8％(13/14);临床缓解率为100％;术后发生急性胰腺炎1例,高淀粉酶血症3例,手术并发症发生率为28.6％(4/14);12例病人支架取出顺利,均无支架脱落及支架移位;所有病人FCSEMS植入术后无严重的手术并发症及死亡发生.结论 肝移植术后ABSs采用FCSEMS治疗,安全性及有效性均较高,可作为目前肝移植术后ABSs的一线治疗方法.