Chen Xiaoping

Hepatic resection under the guidance of B-mode ultrasonography

SummaryFrom Dec. 1987 to June 1988, we performed hepatic resection on 8 cases of primary liver cancel and 10 cases of benign liver tumor under the guidance Of B-mode ultrasound. Of 18 cases, 2 received light hemihepatectomy, 5 underwent left hemihepatectomy or left lateral lobectomy, 9 had segmentectomy and 2 were treated by tumor removal. There was no operative death. Postoperatively, plcural effusion occurred in 3 cases and biliary fistula in 2 cases. The hospitalization time was 14–52 days with a mean of 29 days. Our results showed that the intraoperative B-mode ultrasound could not only demonstrate the number, size and boundary of lesions but also exhibit the location and orientation of the intrahepatic conduit system and its 3-dimensional relation with the lesions. It is very helpful in dealing with the intrahepatic vessels and ducts.

Studies on the Relationship between Multidrug Resistance 1 Gene and Pancreatic Cancer

AbstractTo study the relationship between the expressions of multidrug-resistance, n 1 (mdr1) gene-coded mRNA and its product P-glycoprotein (P-gp) and biological characteristics n of tumor cells in patients with previously untreated primary pancreatic cancer (PC) for guiding n significance to the clinical treatment. Expression of mdr1 mRNA and P-gp on paraffin embedded n sections was detected by in situ polymerase chain reaction (ISPCR) and immunohistochemistry n correspondingly from 150 cases of normal and abnormal pancreatic tissues including 97, 32 n and 21 cases of pancreatic cancer, pancreatitis and P-gp were mainly found on the apical n plasma membranes and in cytoplasms of endothelial duct cells in tumor and normal tissues. n The positive staining rates of expression of the mdr1 mRNA and P-gp detected in all pancreatic n tumors were significantly higher than that in pancreatitis and normal tissues correspondingly n (P<0.05). Moreover, higher expressions of mdr1 mRNA and P-gp in tumor cells were n correlated with some biological characteristics of PC, such as the degree of differentiation, n aggressiveness and TNM stage of tumors (P<0.05). However, there was no correlation between n the rate of expression of mdr1 mRNA and P-gp and some clinical findings including age, sex, n location and tumor size. The expression of mdr1 gene was associated with “natural” n multi-drug resistance in PC. There was an important guiding significance between the detection n of expression of mdr1 gene and prediction of the sensitivity to chemotherapy of PC. n Meanwhile, it probably could be used as one of profoundly parameters to assess the degrees of n differentiation and prognosis in PC.

An experimental study of auxiliary partial liver allotransplantation in dogs

Different experimental models of auxiliary partial liver transplantation (APLT) in dogs are described in the present paper. The results of paraorthotopic APLT with the graft placed in the right parahepatic fossa were relatively favourable because of good reestablishment of blood supply and drainage of bile duct. In this group, however, the survival time of the dogs submitted to reestablishment of arterial and portal circulation was longer than of those submitted to arterial revascularization only. Histologically, donor hepatocellular regeneration was observed in the former, but there was no such regeneration in the latter. It has further been proved that splanchnic blood supply is of importance to the viability of the graft and the survival of the animal. The experimental results, at the same time, show that auxiliary transplantation of 37 % of the liver is not only of suitable bulk for transplantation, but also provides adequate liver function and promotes regeneration of the host liver.SummaryDifferent experimental models of auxiliary partial liver transplantation (APLT) in dogs are described in the present paper. The results of paraorthotopic APLT with the graft placed in the right parahepatic fossa were relatively favourable because of good reestablishment of blood supply and drainage of bile duct. In this group, however, the survival time of the dogs submitted to reestablishment of arterial and portal circulation was longer than of those submitted to arterial revascularization only. Histologically, donor hepatocellular regeneration was observed in the former, but there was no such regeneration in the latter. It has further been proved that splanchnic blood supply is of importance to the viability of the graft and the survival of the animal. The experimental results, at the same time, show that auxiliary transplantation of 37 % of the liver is not only of suitable bulk for transplantation, but also provides adequate liver function and promotes regeneration of the host liver.

New concepts and techniques of hepato-pancreato-biliary surgery

Surgery is the most effective and preferred treatment for hepato-pancreato-biliary (HPB) tumors. The improvement of HPB surgery technique mainly focus on reducing the amount of bleeding, improving the safety of operation, simplifying the operation, reducing the complications and mortality all the time. As one of the largest HPB centers in China, hepatic center of Tongji hospital has set up a series of new concepts and new techniques of HPB surgery since 1980s. We proposed a new classification standard of hepatocellular carcinoma (HCC) to guide the surgical procedures and evaluation of prognosis. According to this method, HCCs lager than 5 cm were defined as lager (>5 cm and ³ 10 cm). Traditionally, the large/huge HCC patients were thought can’t tolerate hepatectomy because of the insufficient residual liver volume. However, we confirmed the feasibility and safety of the resection of large/huge HCC and applied it in clinic concurrently in 1990s, which greatly extended the inclusion criteria for operation. Serious intraoperative bleeding is another constraint for resection of large/huge HCC. In order to reduce the intraoperative bleeding and increase the safety of major hepatectomies, three new bleeding control techniques for hepatectomy were established: Infrahepatic inferior vena cava clamping combine with occlusion of the portal triad; tying up of inflow and outflow vessels without dissecting the hilus of the liver; and implementation of the liver double-hanging maneuver through the retrohepatic avascular tunnel on the right side of the inferior vena cava. According to the AASLD and the EASL guidelines for HCC management, patients with portal vein tumor thrombosis (PVTT) are excluded from either surgical treatment or TACE, and only palliative therapies are recommended. However, our studies confirmed treating PVTT patient by indicated surgical protocol according to the location and extension of PVTT is safety and effective. Based on the guideline set by western countries, liver resection is contraindicated in patients with portal hypertension. But in China, 85%–90% patients with HCC showed various degrees of liver cirrhosis, and a large proportion of these patients presented clinical signs of portal hypertension. Thus, we set up a surgical treatment strategy (limited liver resection plus splenectomy with or without devascularization of gastroesophageal varices) for HCC combined with portal hypertension. There are still controversies on the optimal extent of hepaticresection to achieve a high percentage of R0 resection for hilarcholangiocarcinoma. We proposed a new concept that treats hilar cholangiocarcinoma using minor liver resection which showed lower operative morbidity and good prognosis. We also created new surgical procedures such as new intrahepatic cholangiojujunostomy for multiple intrahepatic biliary ductal openings and the inserting bilio- jejunostomy for iatrogenic bile duct injury were all invented and proved to be available in clinic. In order to diminish pancreatic leakage, we established Chen’s U-suture technique for end-to-end invaginated pancreaticojejunostomy following pancreaticoduodenectomy. Many end-stage liver disease patients died due to severe shortage of organ donors. To address the shortage, we are the first to establish auxiliary partial orthotopic liver transplantation technique in the world and applied it in clinic successfully.

An experimental study on somatostatin receptors in the brains of hepatic encephaiopathy rats

SummaryThe present study was undertaken to evaluate the effect of somatostatin (SS) receptor, a brain-gut peptide receptor which is capable of inhibiting central neurons, on the pathogenesis of hepatic encephaiopathy (HE). By means of radioligand binding assay, SS receptors in crude synaptosomal membrane of rat brains were investigated in a rat model of HE induced by partial hepatectomy following carbon tetrachloride intoxication and in controls. Binding to SS receptor was studied using125 I-SS as radiolgand Scatchard analysis of binding data was linear, yielding a dissociation constant (Kd) of 3. 99 ±0. 22 nmol/L and a maximal binding capacity (Bmax) of 238 ±14.2 fmol/mg of protein in HE rats. Only increased Bmax values were observed (P0.50), in HE rats as compared with those in controls. The results suggest that the changes of SS receptors in brains play a significant role in the pathogenesis of HE. The mechanism of HE induced by the alterations of SS receptors in the brains was discussed in this paper.