Objective:To evaluate the effect of parental liver donation on early acute cellular rejection(ACR)after liver transplantation(LT)in children aged under one year.Methods:From January 2018 to January 2021, retrospective review is conducted for clinical data of living donor LT recipients and donors aged under 1 year at Tianjin First Central Hospital.Donor livers are assigned into two groups of paternal donor liver(156 cases)and maternal donor liver(206 cases)according to the source of donor liver, Clinical characteristics and postoperative ACR occurrence of two groups are analyzed.Results:The rates of ACR during early postoperative period is 14.9%(54/362), 20.5%(32/156)in paternal liver donor group and 10.7%(22/206)in maternal liver donor group.There is statistically significant difference(λ 2=6.763, P=0.009).In analysis of gender matching of donor recipients, the rates of ACR is 22.6% in paternal donor group and 10.3% in maternal donor group.There is statistically significant difference(λ 2=5.411, P=0.020).Median time of initial postoperative ACR is 13.00(8.25~20.25)day in paternal liver donor group and 17.00(9.00~28.25)day in maternal donor group.The difference is not statistically significant( P>0.05). ACR is mostly mild-to-moderate in two groups . Conclusions:In living donor LT for children aged under 1 year, the rates of early ACR is lower for maternal donor than that for paternal donor, especially in female recipients.

Objective:To explore the reconstruction strategy and technical selection of S3 hepatic vein with middle hepatic vein confluence in pediatric liver transplantation(LT)using living donor left lateral segment to lower the risk of vascular complications caused by variant grafts.Methods:From January 2015 to June 2021, retrospective analysis is performed for 840 consecutive cases of pediatric living donor LT using left lateral segment(LLS).There are 32 cases of S3 hepatic vein with middle hepatic vein confluence with an overall incidence of 3.81%.Individualized reconstruction strategies are implemented according to the specific conditions of variation and different interposition vessels available: group I unification venoplasty technique with interposition vein graft is employed for reconstructing HV from grafts, prolonged S3 is formed into a single opening with S2 and then anastomosed with recipient(21 cases); group Ⅱ dual HV reconstructions were performed(11 cases); venoplasty of recipients'LHV, MHV and inferior vena cava(IVC)is performed for creating a large orifice for anastomosis with S2 HV from graft and S3 is anastomosed with stump of recipient right HV directly or interposed blood vessels.Clinical features and prognosis of two groups, the incidence, treatment and prognosis of HVOO and the incidence of HVOO between variant and non-variant groups were compared.Results:The median follow-up time of variant group(32 cases)is 23.8 month with an incidence of HVOO at 15.6%.During the same period, the non-variant group incidence of HVOO is 4.5%.There is inter-group statistical difference( P=0.014).The only statistical difference between groups Ⅰ and Ⅱ is ultrasonic blood flow velocity of S3 HV at 14 POD [(39.15±16.37)vs(20.05±8.52)cm/s, P=0.001].HVOO occurred in 7 cases and 6 cases respectively in groupⅠ and group Ⅱ.There is no statistical difference( P=0.310).There are no intractable vascular complications.Long-term vascular patency of allogeneic and autologous interposition vein is satisfactory and there is no graft failure or mortality related to HVOO. Conclusions:Selecting strategies and techniques for reconstructing S3 hepatic vein with middle hepatic vein confluence at our center are reasonable, safe and effective.And the overall treatment efficacy is satisfactory.Reasonable selection of multidimensional reconstruction methods and accurate application of various technologies are conducive to improving patient prognosis.

1 临床资料 患儿男性,3岁7个月.上腹包块伴腹壁静脉曲张4个月入院.CT显示:肿瘤位于肝脏右叶、左内叶、尾状叶,约62 mm×57 mm×50 mm,肝后下腔静脉、肝右静脉、肝中静脉和心房内异常占位性病变,无远处转移.诊断:① 肝母细胞瘤(Ⅰ、Ⅳ、Ⅴ、Ⅵ、Ⅶ、Ⅷ段),伴下腔静脉肾静脉水平以上、肝右静脉、肝中静脉以及右心房瘤栓形成;② 继发性布-加综合征,腹水.2020年1月8日于本院小儿肝移植科行自体肝移植.

回顾性分析天津市第一中心医院器官移植中心2019年收治的1例Ⅰ型戈谢病(GD)行肝移植受者的临床诊治过程，其围手术期恢复顺利，轻度胰瘘经持续冲洗引流后治愈。随访1年后，肝功能完全正常，营养不良彻底改善，骨痛消失，贫血完全纠正。 β-葡糖脑苷脂酶活性较术前明显升高，呈逐步升高趋势，但目前仍低于正常值。术后未行ERT，长期预后有待观察。肝移植是Ⅰ型GD受者ESLD的挽救生命的唯一治疗选择，长期预后良好，长期随访活检显示移植肝脏无戈谢病病理表现。

Objective To investigate the risk factors for early complications after liver transplantation and to improve the prognosis .Methods The clinical data of 147 patients who underwent orthotopic liver transplantation in the Hepatic Transplantation Center of The First Hos - pital of Jilin University from September 2011 to April 2017 were retrospectively analyzed.According to the presence or absence of early com - plications after surgery, these patients were divided into non -complication group (n =11) and complication group (n =136).The possible factors associated with early complications after surgery were collected , including donor factors (age and whether the blood type of the donor matches that of the recipient), recipient factors (sex, age, primary disease, Model for End -Stage Liver Disease [MELD] score, aspartate aminotransferase [AST], alanine aminotransferase[ALT], albumin [Alb], platelet [PLT], hemoglobin [Hb], fibrinogen, total bilirubin,creatinine, PLT/Alb ratio [PAR], and neutrophil /lymphocyte ratio [NLR]), intraoperative factors (cold ischemia time, warm ischemia time, intraoperative blood loss, and duration of anhepatic phase), and postoperative factors (AST and ALT immediately and 12, 24, 48,and 72 hours after operation).The clinical data were analyzed to investigate the association between these factors and early complications .The t test was used for comparison of normally distributed continuous data ; the Mann -Whitney U test was used for comparison of non -normally distributed continuous data.The chi -square test was used for comparison of categorical data .Backward logistic regression was used for multivariate analysis.Results MELD score (t =-3.86,P =0.002), Alb (t =2.19,P =0.049), PLT (Z =467.00,P =0.039),PAR (Z =500.00,P =0.068), fibrinogen (t =1.80,P =0.096), TBil (Z =-1.98,P =0.047), preoperative AST (Z =417.00,P =0.015), and preoperative ALT (Z =501.50,P =0.070) were associated with postoperative complications .PAR and preoperative AST were independent risk factors for early complications (odds ratio [OR] =3.84, 95% confidence interval [CI]: 1.03 -14.34, P <0.05; OR =0.25, 95% CI: 0.07 -0.94, P <0.05).The 147 patients were divided into high -PAR group (PAR ≥3 ×109 /g; n =55) and low - PAR group (PAR <3 ×109 /g; n =92); PAR was associated with postoperative vascular and biliary complications (χ2 =2.87, P =0.090;χ2 =3.54,P =0.060).The 147 patients were divided into normal preoperative AST group (AST <40 U/L; n =93) and abnormal preoperative AST group (AST ≥40 U/L; n =54); preoperative AST level was associated with postoperative pleural effusion (χ2 =3.03,P =0.082).Conclusion Fibrinogen, PLT, Alb, TBil, PAR, MELD score, and preoperative AST and ALT are associated with the develop -ment of early complications after liver transplantation , and PAR and preoperative AST are independent risk factors for early complications . To improve the prognosis and postoperative survival , these factors, particularly PAR, should be fully assessed for the liver transplantation re - cipient before operation, and specific interventions should be provided accordingly .

Gallbladder cancer has many characteristics such as rapid progression, difficult early diagnosis, low R0 resection rate, and poor prognosis. In recent years, extended radical resections including hepatopancreatoduodenectomy (HPD) have been performed for patients with advanced gallbladder carcinoma that invades the common bile duct, duodenum, and portal vein, but with no distant metastasis in many large medical centers. This procedure can significantly increase the R0 resection rate and prolong the survival time of patients. But due to the high rate of complications and high mortality in the patients treated with HPD, many surgeons still have little confidence in this procedure. This article reviews the current application of HPD in advanced gallbladder cancer, related problems, complications, and surgical indications, and suggests that HPD can be selected according to strict surgical indications.

动脉粥样硬化（atherosclerosis，AS）是血管病中的常见疾病，其发病率和致死率较高，严重影响人类健康。动脉粥样硬化的发病机制临床上尚不明确，但多年来，各国病理学家纷纷提出发病机制的假说，本文对各假说进行了分析，以探讨AS的发病机制。