Objective: To review the experience of donor selection and right lobe hepatectomy in adult-to-adult live donor liver transplantation.
Methods: From May 1996 to December 2001, 89 live donor liver transplants using right lobe grafts were performed at Queen Mary Hospital, Hong Kong. All donors had received psychological counseling before donor operations. They were screened by laboratory tests including complete blood cell count, liver and renal biochemistry, and viral serology studies. Computed tomography (CT), CT volumetry and hepatic arteriography were routinely performed. All donors underwent the operations using the method designed by us.
Results: The median duration of the operations was 8.8 hours. The median blood loss recorded 466 ml. The median intensive care unit and hospital stays were 2 and 10 days, respectively. There was no donor mortality. Complications of donor operations included wound infection, urinary tract infection, biliary stricture, cholestasis, subphrenic collection, bowel obstruction and incision hernia, etc. All donors have recovered and returned to their previous occupations.
Conclusions: Live donation of right lobe grafts for adult-to-adult liver transplantation is safe, provided that donor selection is strict and utmost care is exercised during the operation.

Objective: To sum up the preliminary experience in living related liver transplantation (LRLT).
Methods: A 9-month-old male infant with biliary atresia (BA) who had undergone an unsuccessful Kasai operation was defined as a candidate for LRLT. The donor was his 30-year-old mother. Her lateral lobe of the left liver was transplanted into the infant’s body as the graft. The left branches of the portal vein, left hepatic artery and left hepatic vein of the graft were end-to-end anastomosed to the portal vein, hepatic artery proper and hepatic vein of the recipient respectively. Biliary drainage was reestablished via Roux-en-Y operation.
Results: The donor retained her liver function within 2 weeks after the operation. Steroid and FK506 were prescribed in immunosuppressive therapy for the recipient. The blood bilirubin level of the infant decreased to normal 2 weeks after operation. No acute rejection occurred. Biliary leakage in the early period after the transplantation was controlled by drainage, and E.coli infection was effectively treated with antibiotics. The donor and recipient are in satisfactory condition to the present.
Conclusion: LRLT is advisable for children with biliary atresia.

Intrahepatic cholestasis occurs commonly after liver transplantation and may be caused by infections, drugs, and acute or chronic rejection. Some disorders may be managed medically, but others often require re-transplantation. Prompt recognition and specific treatment can improve the outcome of liver recipients.

Objectives: To assess transjugular intrahepatic portosystemic shunt (TIPSS) as an effective bridge between the control of variceal bleeding or refractory ascites and orthotopic liver transplantation (OLTx) and to examine whether TIPSS influences the operative procedures of OLTx.
Methods: Five patients treated by TIPSS prior to OLTx were retrospectively reviewed.
Results: The patients were followed up for 2-7 months (average 4.2 months) after transplantation. Transplantation was performed at a mean of 9.6 months (range 0.2-24.7) after TIPSS insertion. In four patients, stents were predominantly intrahepatic and they did not interfere with OLTx. In one patient, the stent extended into the portal vein, requiring removal during OLTx by division of the stent with the recipient portal vein. All patients are alive and none has portal vein thrombosis. No difference was observed in operation time, blood transfusion, and the length of hospital stay.
Conclusions: TIPSS is an effective bridge to OLTx for the control of variceal hemorrhage or refractory ascites. Our results suggest that TIPSS does not increase surgical morbidity or mortality, but optimal TIPSS placement within the liver is emphasized to facilitate subsequent OLTx.

Objective: To observe the clinical efficacy of transcatheter arterial chemoembolization(TACE) and TACE+MLT (melatonin) on inoperable advanced primary hepatocellular carcinoma.
Methods: From January 1997 to January 1998, one hundred patients with inoperable advanced primary hepatocellular carcinoma were treated separately by TACE (50) and TACE+MLT (20 mg/d at 8∶00 PM orally, 7 days before TACE)(50).
Results: The effective rates (WHO standards) of TACE and TACE+MLT were 16% and 28% respectively (P<0.05). After TACE or TACE+MLT, the resection rate at two-stage of TACE was 4% or 14% (P<0.01). The 0.5-, 1- and 2-year survival rates in the TACE group were 82%, 54% and 26% respectively; in the TACE+MLT group 100%, 68% and 40% respectively. The results were significantly better in the TACE+MLT group than in the TACE group. MLT could protect liver function from the damage caused by TACE. The IL-2 levels of all patients significantly increased, whereas sIL-2R expressions decreased after TACE+MLT as compared with the TACE group (P<0.01).
Conclusions: With definite protection and treatment effect on the liver function damage caused by TACE, MLT can enhance the immunological activities of patients. It also can improve the effect of TACE by increasing the survival and resection rate after two-stage operation.

Objective: To evaluate retrospectively the feasibility and effect of hepatic trisegmentectomy in therapy of huge neoplasms of the liver.
Methods: From July 1993 to October 1999, 29 patients with huge hepatic neoplasms underwent hepatic trisegmentectomy. Of these, 23 patients suffered from primary liver cancer, 1 hepatic infiltration of gallbladder cancer, 1 metastasis of colon cancer, 1 hepatic angiosarcoma, 1 hepatic neurofibroma, and 2 huge liver cysts. Twenty-six patients were subjected to right trisegmentectomy and the rest 3 left trisegmentectomy. All trisegmentectomies were performed under normothermic interruption of the porta hepatis at single time and these interruptions lasted 15 to 40 minutes.
Results: The relatively good effect was seen in our series. The 1-, 3-, 5-year survival rates for primary liver cancer patients were 63.6%, 36.4% and 27.3%, respectively. The survival period for the patients with hepatic infiltration of gallbladder cancer and liver metastasis of colon cancer was 6 months. Those with hepatic angiosarcoma, hepatic neurofibroma and huge liver cysts have been surviving 35, 26, 25 and 40 months, respectively. Major complications were noted in 5 patients, and one (3.4%, 1/29) died.
Conclusion: Hepatic trisegmentectomy is safe and effective in treatment of huge hepatic neoplasms if its indications and operative techniques are properly mastered.

Objective: To investigate the factors affecting prognosis of patients with primary hepatocellular carcinoma (PHC) after resection.
Methods: From 1976 to 1992, 213 patients with PHC treated with hepatectomy were followed up for more than 5 years. Thirty-one of the patients who had survived for more than 5 years were compared with 56 patients who had survived for less than 5 years.
Results: Early detection of tumor, radical resection, number of tumors, capsule formation, operation safe distance, presence of portal tumor embolus, presence of cirrhosis and tumor size were important factors affecting the prognosis of patients with PHC. The proportion of small liver cancer in the patients who had survived for more than 5 years was greatly larger than that in the control group.
Conclusions: Early detection of tumor and radical resection are of value in raising the 5-year survival rate. Much remains to be investigated about the relationship between safe margin distance and prognosis of patients with PHC.

Objective: To define the conditions of hepatitis C virus (HCV) infections, and geographic and demographic distributions of genotypes in China.
Methods: HCV infected patients were selected from individuals with different patterns of liver diseases and high risk populations in different parts of China. Genotypes of HCV in some isolates were further analyzed, based on the data from our laboratory studies and some carefully selected published literatures.
Results: The anti-HCV positive rates were 9.7% in patients with acute hepatitis, 13.3% in patients with chronic hepatitis, 18.3% in patients with hepatocellular carcinoma, 33.0% in patients with liver cirrhosis, and 43.2% in patients with posttransfusional hepatitis (average, 16.2% in patients with liver diseases). The anti-HCV positive rates in the high risk populations were 36.4% in leukemic patients, 43.0% in hemodialysis patients, 12.7% in blood donors, 64.1% in drug abusers, 13.1% in prostitutes, and 2.57% in naturally healthy people. At least 4 clades (clades 1, 2, 3 and 6) of HCV were found in China with different geographic and demographic distributions. Genotype 1b was the most widely distributed genotype, and genotype 3 was mainly found in Yunnan Province, Southwest China.
Conclusion: China has a high incidence of HCV infection. Our results will provide a strategic basis for diagnosis, treatment and possibly prophylaxis of hepatitis C virus diseases.

Objective: To study the relationship between the serum levels of hyaluronic acid (HA), procollagen type Ⅲ (PCⅢ), collagen type Ⅳ (CⅣ) and the histological degree of hepatic fibrosis evaluated by image analysis, and the clinical significance of serum HA, PCⅢ, CⅣ in the diagnosis of hepatic fibrosis in patients with chronic viral hepatitis.
Methods: The concentrations of serum HA, PCⅢ, CⅣ in 151 patients with chronic viral hepatitis were measured by radioimmunoassay. Liver biopsies were performed in all the patients. Histological sections of 4 μm thickness were stained with Masson’s trichrome for fibrosis assessment. Morphometric quantitative measurements for hepatic fibrosis assessment in the 4 μm sections were performed using a fully automated image analysis system. Serum levels of HA, PCⅢ, and CⅣ were analyzed at different stages of liver pathology and compared with the morphometric quantitative measurements of hepatic fibrosis.
Results: The serum levels of HA, PCⅢ, CⅣ all elevated gradually with the progression of the disease, and all reached the highest in patients with liver cirrhosis. There was a significant difference in the levels of these 3 components between liver cirrhosis group and the other groups (P<0.05). They all increased steadily with the histological stages of hepatic fibrosis, and reached the highest levels in stage IV. The serum levels of HA, PCⅢ, CⅣ were all positively correlated with the histological stages of liver sections and the morphometric measurement (P<0.001). The coefficients with stages were 0.694, 0.493, 0.552 (P<0.001), respectively and with surface density of total collagen on liver biopsy sections by image analysis were 0.715, 0.595, 0.573 (P<0.001), respectively.
Conclusion: The serum levels of HA, PCⅢ, CⅣ were in consistent with the degree of hepatic fibrosis, and the determination of these marks is valuable for detecting hepatic fibrosis.

Objective: To investigate the effect of Fuzhenghuayu decoction on autocrine activation of hepatic stellate cell (HSC).
Methods: The drug serum containing Fuzhenghuayu decoction was collected from normal rats, and cultured with activated HSC in vitro. The conditioned medium from the drug serum treated HSC was added to primary cultured quiescent HSC. Cell proliferation was assayed by tetrazolium colorimetric test, and the contents of type I collagen and vascular endothelial growth factor (VEGF) in the supernatant were measured with ELISA.
Results: The conditioned medium from activated HSC could stimulate the quiescent HSC proliferation and type I collagen secretion. The drug serum inhibited this stimulating action and VEGF secretion from the activated HSC.
Conclusion: Fuzhenghuayu decoction acts effectively against the autocrine activation pathway of HSC. The mechanism may be associated with the inhibition of the secretion of VEGF by activated HSC.

Portal hypertension is a common disease with high mortality and serious influence on the life quality of patients. At present, shunt and disconnection are commonly used for the treatment of portal hypertension. In recent years, combined procedures of shunt and disconnection have evoked the potential interest of surgeons. Initial experimental studies and clinical observations showed that the combined procedures are ideal for treating portal hypertension. Transjugular intrahepatic portacaval shunt (TIPS) is a new minimally invasive technique in treating portal hypertension. Some surgeons have tried to perform disconnection under laparoscopy with success. Liver transplantation will be the focus of portal hypertension surgery in the future.

Objective: To evaluate the hemodynamic changes of hepatic artery (HA), portal vein (PV) and tumors in hepatic cancer patients treated by cluster electrode radio-frequency ablation with the aid of color Doppler flow imaging (CDFI).
Methods: The hemodynamic changes of HA, PV and 42 tumors in 30 cases of hepatic cancer were investigated by CDFI one week before and after cluster electrode radio-frequency ablation.
Results: One week after radio-frequency ablation, the velocity of HA decreased (P<0.05), but the diameter and velocity of PV unchanged. Before radio-frequency ablation, blood signals were observed in 35 cancer nodes (83.0% of all 42 nodes). After radio-frequency ablation, blood signals were reduced in 15 nodes and disappeared in 14 nodes. Early investigation implied that the decrease of blood supply was parallel with the reduction of node size. However, the outcome in case of huge nodes with double blood supply was not as promising as those small nodes.
Conclusion: CDFI is useful to assess blood supply in ablation of hepatic cancer by using cluster electrode radio-frequency therapy.

Objective: To analyze the pre- and post-contrast CT findings of liver focal nodular hyperplasia (FNH) so as to improve their diagnostic accuracy.
Methods: Pre- and post-contrast tri-phase (arterial, portal venous and delayed) scans were performed in 21 patients with FNH proved surgically and pathologically. Transcatheter arterial angiography was performed in 2 patients.
Results: Pre-contrast scans showed hypodensity in 16 patients, isodensity in 5, and punctate, streak and radial scars in 12. Except central scar, all lesions were markedly and homogeneously enhanced in the arterial phase. Nine of the 21 patients showed dilated and tortuous arteries in the central and peripheral areas of the focus. In the portal venous phase, focal density was decreased, though still higher or slightly higher in FNH than in parenchyma. In the delayed phase, the lesions showed isodensity or slight hypodensity. Enhanced capsules were seen in 3 patients. Dilated arteries and drainage veins were seen on angiographic images.
Conclusion: The characteristic manifestations of FNH on multiphasic helical CT scan are of great significance in diagnosing FNH and choosing viable therapy.

Objective: To study the effect of reorganized-human growth hormone (r-hGH) on cycle kinetics and apoptosis of liver cancer cells or 7402 cells.
Methods: Liver cancer cells were cultured for 24 hours with r-hGH at different concentrations with or without cisplatin (DDP). Cells undergoing apoptosis and differentiation were determined by flow cytometry (FCM).
Results: Comparison of the results in culture with and without r-hGH showed that the percentage of cells in G0-G1 phase dropped (P<0.05), whereas in S phase increased (P<0.05). Adding of r-hGH and DDP to the culture medium increased the apoptosis of liver cancer cells more significantly than adding DDP only (P<0.05).
Conclusions: Liver cancer cells might express the hGH receptor. In vitro r-hGH might induce the differentiation of liver cancer cells, stimulate the combination of DNA, and reduce the cells in G0-G1 phases. These improve the sensibility of tumors to the special-staged chemical treatment. Chemotherapy together with r-hGH may increase the apoptosis of liver cancer cells.

Nucleic acid vaccine or DNA vaccine is a hopeful vaccine to prevent and treat viral hepatitis. Problems exist in different DNA vaccines for HBV or HCV. Optimal animal model should be established study vaccine against hepatitis. Apart from the strategy to enhance the efficiency of DNA vaccine, combined use of cytokines or chemokines, different routes of inoculation, design of optimal vector, ISS insertion in the plasmid vectors, etc to enhance the efficiency of DNA vaccine are reviewed.

Objective: To analyse the emergence of YMDD motif (tyrosine-methionine-aspartate-aspartate) variants in patients with hepatitis B treated with lamivudine.
Methods: The amino acid substitution from methionine or isoleucine at the YMDD motif at the HBV polymerase gene is a main mutation resistant to lamivudine treatment. Generated from a fragment of domain C of the polymerase gene, patients’HBV DNA, which had been positive previously became positive again ever since it had been negative during lamivudine therapy. Variants were detected by cleavage of the products of the three PCRs with following enzymes: FokI, SspI, Alw441. The results of PCR-RELP were analysed by 8.4% polypropylene acidemide gel electrophoresis. PCR-RFLP assay was compared to direct sequencing.
Results: HBV DNA was positive again in 33 patients and positive for one year in 2 patients. YMDD variants were detected in serum 14 of 35 patients, YIDD variants in 4, YVDD variants in 6, and YI/MDD variants in 1; all were in concordance with the results of direct sequencing. The samples of other 3 patients showed YI/VDD mutations, as shown by direct sequencing. The results of PCR-RFLP assay of the mixed sera of YIDD and YVDD variants were similar to those sera of YI/VDD variants.
Conclusion: PCR-RFLP is suitable for rapid detection of YMDD variants of viral polymerase in hepatitis B virus patients treated with lamivudine.

Objective: To investigate the complex functions of HBV preS1 protein, we constructed HBV preS1 gene expression vector and expressed it in yeast cells.
Methods: Polymerase chain reaction (PCR) was performed to amplify the gene of HBV preS1 from the plasmid pCP10 containing the whole DNA fragment of HBV ayw subtype as template and the PCR product was cloned into the pGEM-T vector for sequencing. After being identified, the HBV preS1 gene was cut from the pGEM-T vector by EcoR I and Pst I restriction enzymes, and cloned into yeast expressive plasmid pGBKT7 to constructe pGBKT7-preS1 recombinant expressive plasmid. This plasmid was transformed into yeast cell AH109 and expressed in it. The yeast protein was isolated and analyzed with sodium dodecyl sulfate-polyacrylamide gel electrophoresis(SDS-PAGE) and Western blotting.
Results: The HBV preS1 gene was amplified successfully and identified by DNA sequencing. The PCR products were coincided completely with the reported sequence. The digested fragments were cloned into the pGBKT7 vector and transformed into yeast cell AH109. The results of SDS-PAGE and Western blotting assay showed: (1) The HBV preS1 protein was expressed and existed in yeast cells; (2) The molecular weight of the expression product was about 30 000 D.
Conclusion: The HBV preS1 gene was successfully cloned and expressed in yeast cells.

Objective: To study the effects of percutaneous ethanol injection (PEI) in treatment of hepatocellular carcinoma (HCC).
Methods: Blood samples were taken from 9 HCC patients and detected by nested RT-PCR to find out AFPmRNA after PEI treatment 3-5 times within 2 weeks.
Results: Three (44.44%) of 4 patients with AFPmRNA positive turned to be negative after PEI treatment and 1 with AFPmRNA positive (11.11%) lasted within 2 weeks.
Conclusion: PEI may diminish the possibility of distant metastasis of HCC.

Objective: To study the relationship between the degree of hepatic fibrosis and serum fibrosis markers.
Methods: Liver biopsies were performed in 67 patients with hepatitis. The sections were stained with hematoxylin eosin and immunohistochemical stain. Staging of hepatic fibrosis was made microscopically. The serum levels of hyaluronic acid(HA), type III procollagen(PC-III), laminin(LN), and type IV collagen (IV-C) were measured by radioimmunoassay.
Results: The serum levels of HA, PC-III, LN and IV-C were elevated from S1 to S4 because of the increase of hepatic fibrosis. The serum concentrations of HA, PC-III, LN and IV-C were increased with the progress of disease, with the highest concentration at the stage of cirrhosis.
Conclusion: The stages of hepatic fibrosis are correlated with the serum levels of HA, PC-III, LN and IV-C, which as markers may play a role in detecting the degree of hepatic fibrosis.

Background: Intermittent Pringle manoeuvre resulted in less blood loss and better preservation of liver function when it was applied for fewer than 120 minutes. The mechanism of better preservation of liver function under intermittent Pringle manoeuvre at molecular level remains unclear. Furthermore, the ultrastructural features in the liver with chronic diseases under intermittent Pringle manoeuvre have not been studied. The aim of the study is to investigate the expression of stress genes and ultrastructural change of the liver under intermittent Pringle manoeuvre.
Methods: From July 1995 to February 1998, 131 patients underwent hepatectomy for liver tumours (61 patients without Pringle manoeuvre and 70 patients with intermittent Pringle manoeuvre). Twenty-five patients (15 with Pringle manoeuvre and 10 without Pringle manoeuvre) were included in the study of hepatic stress gene expression during hepatectomy. Twenty-two patients (18 patients with intermittent Pringle manoeuvre and four patients without Pringle manoeuvre) were randomly assigned for electron microscopic examination.
Results: For the expression of stress genes, both the heat shock genes (HSP 70A and HSC 70) and acute phase genes (TNF-α and interleukin-6) were detected simultaneously in the patients with or without intermittent Pringle manoeuvre. The patients under intermittent Pringle manoeuvre had relatively higher mRNA levels of heat shock gene 70 family, which is related to intracellular repair and protection. Induction of TNF-α and interleukin-6 genes, which contributed to ischaemia-reperfusion injury and postoperative complication, was not found in the patients under intermittent Pringle manoeuvre. Under the electron microscopy, the hepatic ultrastructure was well maintained under intermittent Pringle manoeuvre whatever the liver status, even when the accumulated ischaemic duration was extended to 120 min.
Conclusion: Intermittent Pringle manoeuvre induced relatively higher expression of heat shock genes, which are related to intracellular homeostasis, and is consistent with the well maintenance of liver ultrastructure.

Objective: To study the synthesis of heat shock protein 70 (HSP70) by zinc (ZnSO4) and its protective effect during cold preservation in rat liver by establishment of a simple cold preservation model.
Methods: Wistar rats were divided into 5 groups (n=6): control group untreated before operation; Zn-1, Zn-2, and Zn-3 groups treated before operation with zinc sulfate (Zn2+ 5 mg/kg, 10 mg/kg, 15 mg/kg respectively); H group treated with heat shock (42.5 ℃×15 min). The livers of the rats were preserved in UW solution for 6, 12, 24 hours. The results of heat shock protein (HSP) synthesis were analyzed with Western blot. The aspartate aminotransferase (AST) and lactic dehydrogenase (LDH) values of perfusion and histological findings were evaluated.
Results: A great amount of HSPs was synthesized after pretreatment with zinc and heat shock. The AST and LDH values of the Zn-l, Zn-2 and H groups were significantly lower than those of the C group (P<0.05). But the value of the Zn-3 group was much higher. Histologically, mild injury was observed in the Zn-1, Zn-2 and H groups, but severe injury in the Zn-3 group.
Conclusions: Zn2+, as a potent and feasible inducer of HSP expression, is able to protect the liver for cold preservation. Proper induction dosage of Zn2+ ranges from 5 mg/kg to 10 mg/kg, and Zn2+ 15 mg/kg could not be a stress conditioning factor for its adverse effect on rat liver.

Objective: To investigate the distribution of the population with low level HBsAg in serum and the characteri-stics of their HBV serologic markers.
Methods: We detected HBsAg, HBeAg, anti-HBc, anti-HBe, and anti-HBs in the serum samples from 8089 non-hepatitis inpatients and defined the patients with HBsAg concentration equal to or less than 5 μg/L by using the AxSYM microparticle enzyme immunoassay (MEIA) system.
Results: 189 patients with HBsAg equal to or low than 5 μg/L (2.34% of all 8089 patients and 23.16% of 816 HBsAg positive patients) included 84 (44.40%), 33(17.5%) and 72 (38.10%) with HBsAg equal to or less than 1 μg/L, 1-2 μg/L and 2-5 μg/L respectively. Most of these patients were detected with “positive for HBsAg, anti-HBc and anti-HBe but negative for HBeAg and anti-HBs”, and anti-HBc antibodies were frequently present in their sera.
Conclusions: The population with low level HBsAg in serum should not be neglected and it is important to improve the test sensitivity of HBsAg and to detect the other HBV serologic markers.

Objective: To describe the causes and treatment of iatrogenic bile duct injury caused by cholecystectomy.
Methods: 182 patients with iatrogenic extrahepatic bile duct injury from 4 university hospitals of China were reviewed. Details of primary cholecystectomy, biliary reconstruction as well as postoperative management were recorded. All patients were followed up for at least 6 months (6 months to 9 years, median 3.5 years). The adequacy of repair was assessed by regular evaluation of the patients’ clinical status and liver function variables. Hepatobiliary B-ultrasonography was used routinely in the follow up of patients, and magnetic resonance cholangiopancreatography was applied in the patients suggestive of abnormality.
Results: In 152 patients, bile duct injury happened during open cholecystectomy, and in 30 patients during laparoscopic cholecystectomy. All the injuries developed during anterograde cholecystectomy (at the Calot’s triangle). All the patients with these injuries underwent choledochocholedochostomy or Roux-en-Y choledochojejunostomy with good results (161 patients), recurrent stricture (11), and death (10).
Conclusions: During cholecystectomy, the Calot’s triangle should be identified anatomically, but retrograde cholecystectomy is the optimal choice. Bile duct injury should be discovered as soon as possible and be managed timely. Different operative methods are optional according to the degree of injury and the postoperative period.

Objective: To assess the value of helical CT in the diagnosis of liver diseases.
Methods: 59 patients with different liver diseases were examined by two-phase or multi-phase dynamic helical CT.
Results: Small hepatocellular carcinoma showed a higher density in the arterial phase, and a lower density in the portal vein phase. Large hepatic carcinoma showed a mixed pattern of higher-density in the arterial phase, and a lower density in the portal vein phase. Metastasis carcinoma showed an "oxeye sign” in the portal vein phase. Hemangioma was not obviously enhanced in the early arterial phase, marginally enhanced in the arterial phase, and equally-densed in the balanced phase.
Conclusion: Two-phase helical CT is of value in improving the detection rate of or determining the features of hepatic diseases by two-phase helical dynamic scan (2.0-3.0 ml/s speed, and delay time 25-30 s and 70-85 s).

Objective: To improve early diagnosis of primary gallbladder carcinoma (PGC) and the understanding of its pathogenesis, pathological stages and prognosis.
Methods: The data from 679 patients with PGC treated in our hospital from 1956 to 1998 were analyzed retrospectively.
Results: The incidence of PGC has been increasing in recent years, and the treatment is not satisfactory. Upon diagnosis, most patients with PGC were at advanced stage. PGC was usually found in elderly women. The ratio of man to woman was 1∶3. The gallstone, closely related to PGC, was found in 60% of the patients with PGC. The diagnostic accordance rate before and after operation was low. In most patients, PGC was found unexpectedly during operation for gallstone or acute cholecystitis. Many patients with PGC missed the opportunity of diagnosis and therapy because doctor only noticed the diagnosis of gallstone. Pathological classification revealed that PGC in most patients (84.4%) were adenocarcinoma. Imaging helped to find early-stage cases and improve prognosis.
Conclusions: Understanding of pathogenesis, pathological stages and prognosis of PGC and proper use of various examinations are essential to the early diagnosis and treatment of the disease.

Objective: To review our experience in and the results of resecting liver tumors involving the hepatocaval confluence under intermittent portal triad clamping (PTC).
Methods: Sixty-eight consecutive patients with liver tumors involving the hepatocaval confluence underwent hepatectomies with liver parenchymal transections under intermittent PTC.
Results: All the tumors were successfully resected under PTC, except for one in which the infrahepatic inferior vena cava was concomitantly occluded in addition to PTC. There was neither operative death nor uncontrollable massive bleeding or air embolism occurred in our patients. The bleedings from the main and short hepatic veins and right adrenal veins were properly managed during the operation, with a mean intraoperative blood loss of 1400 ml. Of the 68 tumors resected, 65 were hepatocellular carcinomas (HCC). Their 1-, 2-, 3- and 4-year suvival rates were 64.11%, 52.82%, 44.90% and 36.98%, respectively, and the patients with HCC with capsules survived significantly longer than those with HCC without capsules.
Conclusions: The liver tumors involving the hepatocaval confluence could be safely resected simply under PTC, without routine use of total hepatic vascular exclusion. As for HCCs in this area, the tumor with capsule is a better indicator for surgical resection than that without capsule.

Objective: To retrospectively study the early complications of excision with hepaticoenterostomy for infants and children with choledochal cysts.
Methods: We analyzed 16 patients with early postoperative complications out of 173 patients with congenital choledochal cysts aged 27 days to 14 years (mean 2.4 years) who had undergone excisional procedures and biliary tract reconstruction.
Results: The early complications included bile leakage (10 patients), abdominal wall dehiscence (3), and hepatic failure, pancreatic juice leakage and postoperative intussusception (each in 1) respectively. Three patients died from bile leakage and 1 from postoperative hepatic failure. No statistical differences were observed between the procedures of biliary tract reconstruction with j
ejunal segment interposition hepaticoduodenostomy and Roux-en-Y hepaticojejunostomy (P>0.75). The morbidity was significantly higher in infants below 1 year than in children (P<0.005). Prevention and treatment of the complications were discussed.
Conclusion: Bile leakage and abdominal wall dehiscence are major early postoperative complications. The morbidity of cholechal cysts is higher in infants than in children. Exploratory laparotomy should not be delayed when biliary leakage with diffuse peritonitis appears. The “tension suture in the fascial space of the abdominal wall” is useful to prevent and treat wound dehiscence.

Objective: To investigate the value of urinary trypsi-nogen activation peptide (TAP) in the early prediction of severe acute pancreatitis and to compare it with acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ).
Methods: We assessed the predictive value of urinary TAP concentrations measured by a competitive enzyme-linked immunosorbent assay. Urine samples were collected for detecting TAP concentrations at admission, and 24, 48, and 72 h from 41 patients with acute pancreatitis (12 with severe disease, 29 with mild disease) who presented within 48 h the onset of symptoms and from 11 control patients, while APACHE Ⅱ scores were recorded at 48 h after admission.
Results: The peak median urinary TAP concentration was seen at admission. The median urinary TAP concentration at admission for severe pancreatitis (95 nmol/L) was significantly higher than the median for patients with mild pancreatitis (20 nmol/L, P<0.005) and controls (15 nmol/L, P<0.005). TAP concentrations were significantly higher in patients with severe acute pancreatitis than the median in patients with mild pancreatitis (P<0.05) and controls (P<0.05) on days 2 to 3. The median APACHE Ⅱ scores of severe patients were significantly different from those of mild patients (10.5 vs 6.0, P<0.01). The sensitivity, specificity, positive predictive, and negative predictive values of an admission urinary TAP≥35 nmol/L for severe pancreatitis were 91.7%, 89.7%, 78.6% and 96.3%, whereas 48 h after admission the values for APACHE Ⅱ scores (≥9) were 75.0%, 72.7%, 52.9% and 87.5%. In prediction of disease severity, the urine TAP concentration was much better than APACHE Ⅱ at 48 h.
Conclusions: Urinary TAP obtained at the first 48 h of the onset of symptoms can predict severe acute pancreatitis. In prediction of disease severity, the urinary TAP is much better than APACHE Ⅱ score.

Objective: To explore the objective basis of the time and characterstics of refeeding of patients with acute pancreatitis (AP).
Methods: AP patients were randomly divided into routine group (n=105) and special group (n=99). The refeeding time and characteristics of the routine group were based on their levels of blood and urine amylase, function of the gastrointestinal tract, and symptoms and signs, and those of the special group on their imaging changes of ultrasonography and CT of the pancreas. Clinical data from the groups were analyzed prospectively and statistically.
Results: At the beginning of refeeding, patients of the two groups showed a high recurrence rate of abdominal pain (routine group, 9.1%; special group, 10.5%), but no AP relapse. Three days to 2 weeks after refeeding, the patients of the routine group had a higher recurrence rate of abdominal pain (11.1%) and a relapse rate of AP(14.1%) as compared with those of the special group (P<0.05). Two weeks later, both rates decreased apparently. However, 3 days to 4 weeks after refeeding, the patients of the special group had no recurrence of abdominal pain and relapse of AP. Imaging changes of the pancreas and peripancreatic tissue were not consistent with the symptoms and signs of AP patients. The higher the Balthazar CT grading and APACHE-Ⅱ score, the higher the recurrence rate of abdominal pain and the relapse rate of AP after refeeding (P<0.05).
Conclusions: Symptoms and signs were usually discordant to the imaging changes of the pancreas in AP patients. Imaging changes of the pancreas might serve as a basis for the best occasion of refeeding light semi-fluid or light food in AP patients.

Objective: To evaluate the value of MR dynamic Gadolinium-enhanced fast multiplanar spoiled gradient-echo (FMPSPGR) and spin-echo (SE) T1-weighted fat-suppressed techniques in the diagnosis of pancreatic carcinoma.
Methods: Eighteen cases of pancreatic carcinoma veri-fied by surgical and pathologic results were examined by MR, and the MR sequences included SE T1WI, FSE T2WI, SE T1-weighted fat-suppressed and dynamic Gadolinium-enhanced FMPSPGR.
Results: Of 18 pancreatic carcinomas, 10, 6, and 2 tumors showed respectively hypo-intensity, iso-intensity and hyper-intensity on SE T1WI, meanwhile, 8, 6, and 4 tumors displayed hyper-intensity, iso-intensity and hypo-intensity on FSE T2WI in comparison with the normal pancreatic tissue. All of the tumors showed hypo-intensity on SE T1-weighted fat-suppressed and also obvious non-enhancement or slight enhancement on MR dynamic Gadolinium-enhanced FMPSPGR images during the arterial dominant phase scanning.
Conclusion: SE T1-weighted fat-suppressed and MR dynamic Gadolinium-enhanced FMPSPGR sequences could evidently improve the sensitivity and specificity in the diagnosis of pancreatic carcinoma.

Objective: To discuss the clinical features of patients with heterotopic pancreas, their diagnosis and surgical treatment.
Methods: Seven patients with heterotopic pancreas were treated surgically in our hospital from August 1992 to March 1999.
Results: Of the 7 patients, 4 had heterotopic pancreas located in the duodenum, 2 in the jejunum, and 1 in the stomach. Four patients experienced abdominal pain, 3 icterus, 1 duodenal obstruction, and 1 digestive tract bleeding. Three patients were complicated by cholelithiasis, and 1 patient was complicated by diverticulum of the jejunum. All seven patients were misdiagnosed or undefined preoperatively. They underwent surgery and were confirmed pathologically.
Conclusions: Heterotopic pancreas is extremely difficult to diagnose before operation since no specific clinical signs are seen in such patients. Once diagnosed with symptoms or not, the patients should undergo surgery for correct diagnosis and avoidance of relative complications.

Objective: To study the clinical significance and effect of p21, p53 protein as well as proliferating cell nuclear antigen (PCNA) on the occurrence and development of pancreatic carcinoma.
Method: p21, p53 protein and PCNA expressions were detected in specimens from 30 patients with pancreatic carcinoma and 3 samples of normal pancreatic tissue by immunohistochemistry. The data were analyzed together with clinical findings.
Results: The positive expression rates of p21 and p53 proteins were 75.0% and 57.3% respectively in pancreatic carcinoma, which were significantly different from those in the normal tissue (P<0.05). p21 and p53 proteins were positively correlated (P<0.05). The positive expression of PCNA was 43.33%±17.99%, that was significantly higher than that in the normal pancreatic tissue (P<0.05). The expression of PCNA was correlated with the histological grade (P<0.05). The positive expression rate was consistent with the exacerbation of cancer. The expression was also correlated significantly with prognosis and p53 expression (P<0.05).
Conclusions: The occurrence and development of pancreatic cancer are the result of associated function for many oncogenes and antioncogenes. PCNA may be helpful to identify malignant degree and prognosis of pancreatic cancer.

Objective: To elucidate the expression of the bcl-2 gene in association with both biological characteristics of human primary pancreatic carcinoma and patient’s prognosis.
Methods: The s-p immunohistochemistry assay was used to detect the expression of the bcl-2 gene on paraffin-embedded sections from 97 cases of primary pancreatic carcinoma, 32 cases of pancreatitis, and 21 cases of normal pancreas.
Results: Among the 97 cases of pancreatic carcinoma, 70 (72.2%) showed positive staining for the bcl-2 protein. In the 32 cases of pancreatitis, 3 (9.4%) showed positive immunostaining for the bcl-2, and in the normal pancreas cases, 1 (4.8%) showed positive immunostaining for the bcl-2. However, the positive staining rates of the bcl-2 protein were lower in tumor tissue from the patients with metastases and tumor-node-metastasis (TNM) stages III, IV than in those from those with non-metastases, well differentiation, non-invasion and TNM stages I, II. The patients with positive immunostaining of bcl-2 have a longer postoperative survival than those with negative staining.
Conclusions: Pancreatic carcinoma expressed a high positivity for bcl-2. Findings suggested that the overexpression of bcl-2 is related to the carcinogenesis and progression of human pancreatic carcinoma. Bcl-2 might be one of the parameters in terms of biological characteristics and good prognosis in patients with pancreatic carcinoma.

Objective: To investigate the relation of transfer growth factor (TGF-β1) and β-glucuronidase (β-GCD) on the occurrence and progress of pancreatic cancer.
Methods: The expression of TGF-β1 and β-GCD in the pancreatic cancer tissue and normal pancreatic tissue was determined synchronously using ABC method of immunohistochemistry.
Results: The percentage of TGF-β1 positive cells was significantly higher in pancreatic cancer tissue (43.8%±5.2%) than in adjacent pancreatic tissue (28.7%±3.6%, P<0.01). The worse the cancer cells differentiated and lymph nodes metastasis, the more over-expression of TGF-β1. The percentage of β-GCD positive cells was also significantly higher in the pancreatic cancer tissue (62.5%±4.1%) than in the adjacent pancreatic tissue (33.5%±2.8%, P<0.01). The degree of over-expression of β-GCD was related to the degree of cancer cells differentiation, but not to the lymph nodes metastasis. The expression of TGF-β1 was significantly correlated with the expression of β-GCD in pancreatic cancer tissue.
Conclusions: The genesis of pancreatic cancer results from multi-factor, multi-step and multi-gene variation. The synchronous detection of TGF-β1 and β-GCD helps to determine the malignant degree of tumors and the prognosis of patients with such disease.