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本期导读

中华消化外科杂志 2024年第7期23卷 I0003-I0003页

作者：董家鸿全志伟沈锋周俭吕国悦杨扬徐骁朱志军孟文勃 hans j schlitt 陈志宇耿智敏冯晓彬王健东伍路黄登潘熊熊田明国张辉李小争不详

胆道疾病是外科常见病和多发病。近年来,随着新技术和新理念的不断涌现,胆道外科取得了长足进步。为展示该领域最新研究成果,总结和分享相关临床经验,规范和推动学科的进一步发展,本期重点选题为“胆道疾病”。

关键词：胆道疾病胆道外科重点选题最新研究成果临床经验外科常见病新理念多发病

Split liver transplantation: Current developments

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World journal of Gastroenterology 2018年第47期24卷 5312-5321页

作者： Christina Hackl Katharina M Schmidt Caner Süsal Bernd Dohler Martin Zidek hans j schlitt Department of Surgery University Hospital RegensburgRegensburg 93053Germany Collaborative Transplant Study (CTS) Institute of ImmunologyHeidelberg UniversityHeidelberg 69120Germany

In 1988, Rudolf Pichlmayr pioneered split liver transplantation(SLT), enabling the transplantation of one donor liver into two recipients-one pediatric and one adult patient. In the same year, Henri Bismuth and colleagues performed the first full right/full left split procedure with two adult recipients. Both splitting techniques were rapidly adopted within the transplant community. However, a SLT is technically demanding, may cause increased perioperative complications, and may potentially transform an excellent deceased donor organ into two marginal quality grafts. Thus, crucial evaluation of donor organs suitable for splitting and careful screening of potential SLT recipients is warranted. Furthermore, the logistic background of the splitting procedure as well as the organ allocation policy must be adapted to further increase the number and the safety of SLT. Under defined circumstances, in selected patients and at experienced transplant centers, SLT outcomes can be similar to those obtained in full organ LT. Thus, SLT is an important tool to reduce the donor organ shortage and waitlist mortality, especially for pediatric patients and small adults. The present review gives an overview of technical aspects, current developments, and clinical outcomes of SLT.

关键词： Liver transplantation organ shortage in situ split extended right lobe left lateral lobe living donor

5-Fluorouracil-related enhancement of adenoviral infection is Coxsackievirus-adenovirus receptor independent and associated with morphological changes in lipid membranes

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World journal of Gastroenterology 2006年第32期12卷 5168-5174页

作者： Chiara Cabrele Mandy Vogel Pompiliu Piso Markus Rentsch josef Schroder Karl W jauch hans j schlitt Alexander Beham Department of Surgery Clinic of the Regensburg University Franz-Josef-Strauss-Allee 11D-93053RegensburgGermany

瞄准：评估在 adenoviral 感染上位于 5 氟尿嘧啶(5-FU ) 的效果下面的机制。方法：表示人的结肠癌房间线的低、高的 Coxsackievirus 侵入人体气管粘膜的病菌受体(汽车) 与 5-FU 和二删除 E1 的 adenoviral 构造被对待，一转 GFP (Ad/CM... 详细信息

瞄准：评估在 adenoviral 感染上位于 5 氟尿嘧啶(5-FU ) 的效果下面的机制。方法：表示人的结肠癌房间线的低、高的 Coxsackievirus 侵入人体气管粘膜的病菌受体(汽车) 与 5-FU 和二删除 E1 的 adenoviral 构造被对待，一转 GFP (Ad/CMV-GFP ) 另外的 bax (Ad/CEA-bax ) 。感染的房间的数字被 GFP 表示监视。为了在受体评估 5-FU 的效果，释放系统， Ad/GFP 在 lipo 被包含一些并且与 5-FU 对待。Ad/GFP 版本与上层清液与 293 个房间的 PCR 和感染被估计。建筑群被使调查词法的 Ad5-GFP-liposome 的电子显微镜学在 5-FU 以后 lipo 改变一些。结果：所有房间线的感染率与新兴的 5-FU 集中从 50% ～ 98% 增加了。提高的病毒的举起独立于 CAR 表示。另外， 5-FU 对待一些释放了的 lipo 2-2.5 时间更多的侵入人体气管粘膜的病菌。而且， 5-FU-treated lipo 一些显得不规则并且象多孔一样。结论：不管汽车， Adenoviral 举起面对 5-FU 被提高并且在做两个的联合的膜与词法变化被联系在基因治疗的一种有希望的选择。

关键词： 5-氟尿嘧啶库克萨基病毒形态学病毒感染

Liver surgery in cirrhosis and portal hypertension

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World journal of Gastroenterology 2016年第9期22卷 2725-2735页

作者： Christina Hackl hans j schlitt Philipp Renner Sven A Lang Department of Surgery University Medical Center Regensburg

The prevalence of hepatic cirrhosis in Europe and the United States, currently 250 patients per 100000 inhabitants, is steadily increasing. Thus, we observe a significant increase in patients with cirrhosis and portal hypertension needing liver resections for primary ormetastatic lesions. However, extended liver resections in patients with underlying hepatic cirrhosis and portal hypertension still represent a medical challenge in regard to perioperative morbidity, surgical management and postoperative outcome. The Barcelona Clinic Liver Cancer classification recommends to restrict curative liver resections for hepatocellular carcinoma in cirrhotic patients to early tumor stages in patients with Child A cirrhosis not showing portal hypertension. However, during the last two decades, relevant improvements in preoperative diagnostic, perioperative hepatologic and intensive care management as well as in surgical techniques during hepatic resections have rendered even extended liver resections in higher-degree cirrhotic patients with portal hypertension possible. However, there are few standard indications for hepatic resections in cirrhotic patients and risk stratifications have to be performed in an interdisciplinary setting for each individual patient. We here review the indications, the preoperative risk-stratifications, the morbidity and the mortality of extended resections for primary and metastatic lesions in cirrhotic livers. Furthermore, we provide a review of literature on perioperative management in cirrhotic patients needing extrahepatic abdominal surgery and an overview of surgical options in the treatment of hepatic cirrhosis.

关键词： Liver resection Hepatocellular carcinoma Liver metastases Portal hypertension Cholangiocellular carc

Patients without hepatocellular carcinoma progression after transarterial chemoembolization benefit from liver transplantation

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World journal of Gastroenterology 2007年第5期13卷 761-767页

作者： Aiman Obed Alexander Beham Kerstin Püllmann Heinz Becker hans j schlitt Thomas Lorf Department of Surgery University of Regensburg Regensburg 93053Germany 不详 Department of Surgery University of Goettingen Goettingen 37073 Germany

AIM: To assess the outcome of patients, who under-went transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) and subsequently liver transplantation (OLT) irrespective of tumor size when no tumor progression was ***: Records, imaging studies and pathology of 84 patients with HCC were reviewed. Ten patients were not treated at all, 67 patients had TACE and 35 of them were listed for OLT. Tumor progression was monitored by ultrasound and AFP level every 6 wk. Fifteen patients showed signs of tumor progression without transplantation. The remaining 20 patients underwent OLT. Further records of 7 patients with HCC seen in histological examination after OLT were ***: The patients after TACE without tumor progression underwent transplantation and had a median survival of 92.3 mo. Patients, who did not qualify for liver transplantation or had signs of tumor progression had a median survival of 8.4 mo. The patients without treatment had a median survival of 3.8 mo. Independent of International Union Against Cancer (UICC) stages, the patients without tumor progression and subsequent OLT had longer median survival. No significant difference was seen in the OLT treated patients if they did not fulfill the Milan ***: Selection of patients for OLT based on tumor progression results in good survival. The evaluation of HCC patients should not only be based on tumor size and number of foci but also on tumor progression and growth behavior under therapy.

关键词：肝细胞癌肝移植经动脉化疗栓塞肿瘤大小

Liver transplantation for malignancy:current treatment strategies and future perspectives

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World journal of Gastroenterology 2014年第18期20卷 5331-5344页

作者： Christina Hackl hans j schlitt Gabriele I Kirchner Birgit Knoppke Martin Loss Department of Surgery University Hospital Regensburg93053 RegensburgGermany Department of Internal Medicine I University Hospital Regensburg93053 RegensburgGermany Department of Pediatrics and juvenile Medicine University Hospital Regensburg93053 RegensburgGermany

In 1967,Starzl et al performed the first successful liver transplantation for a patient diagnosed with *** the following,liver transplantation was considered ideal for complete tumor resection and potential cure from primary hepatic *** reports of liver transplantation for primary and metastatic liver cancer however showed disappointing results and the strategy was soon ***1996,Mazzaferro et al introduced the Milan criteria,offering liver transplantation to patients diagnosed with limited hepatocellular *** then,liver transplantation for malignant disease is an ongoing subject of preclinical and clinical *** this context,several aspects must be considered:(1)Given the shortage of deceased-donor organs,long-term overall and disease free survival should be comparable with results obtained in patients transplanted for nonmalignant disease;(2)In this regard,living-donor liver transplantation may in selected patients help to solve the ethical dilemma of optimal individual patient treatment vs organ allocation justice;and(3)Ongoing research focusing on perioperative therapy and antiproliferative immunosuppressive regimens may further reduce tumor recurrence in patients transplanted for malignant disease and thus improve overall *** present review gives an overview of current indications and future perspectives of liver transplantation for malignant disease.

关键词： Hepatocellular Fibrolamellar Carcinoma Cholangioce

Ileo-right hemi-colonic cervical pull-up on a non-supercharged ileocolic arterial pedicle: A technical and case report

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World journal of Gastroenterology 2016年第14期22卷 3869-3874页

作者： Andreas RR Weiss Christina Hackl Yorick Soeder hans j schlitt Marc-H Dahlke Department of Surgery University Medical Center Regensburg

Esophageal reconstruction can be challenging when stomach and colon are not anatomically intact and their use as esophageal substitutes is therefore limited. Innovative individual approaches are then necessary to restore the intestinal passage. We describe a technique in which a short stump of the right hemicolon and 25 cm of ileum on a long, non-supercharged, fully mobilized ileocolic arterial pedicle were used for esophageal reconstruction to the neck. In this case, a 65 year-old male patient had accidentally indigested hydrochloric acid which caused necrosis of his upper digestive tract. An emergency esophagectomy, gastrectomy, duodenectomy, pancreatectomy and splenectomy had been performed in an outside hospital. A cervical esophagostomy and a biliodigestive anastomosis had been created and a jejunal catheter for enteral feeding had been placed. After the patient had recovered, a reconstruction of his food passage via the left and transverse colon failed for technical reasons due to an intraoperative necrotic demarcation of the colon. Our team then faced the situation that only a short stump of the right hemi-colon was left in situ when the patient was referred to our center. After intensified nutritional therapy, we reconstructed this patient's food passage with the right hemicolonapproach described herein. After treatment of a postoperative pneumonia, the patient was discharged from hospital on the 26 th postoperative day in a good clinical condition on an oral-only diet. In conclusion, individual approaches for long-segment reconstruction of the esophagus can be technically feasible in experienced hands. They do not always require arterial supercharging or free intestinal transplantation.

关键词： Esophageal cancer Esophageal trauma Esophageal reconstruction Gastric pull-up Colonic interposition

Adeno-associated virus-mediated heme oxygenase-1 gene transfer suppresses the progression of micronodular cirrhosis in rats

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World journal of Gastroenterology 2006年第13期12卷 2016-2023页

作者： Tung-Yu Tsui Chi-Keung Lau jian Ma Gabriel Glockzin Aiman Obed hans j schlitt Sheung-Tat Fan Centre for the Study of Liver Disease and Department of Surgery the University of Hong Kong Pokfulam Hong Kong Department of Surgery University of Regensburg Medical Centre Regensburg Germany

瞄准：测试假设这项活动的那改进他我有与周期性的肝损伤联系的纤维发生的过程的氧合酶罐头 interfere，我们调查了在表示上的治疗学的潜力他我在 CCl (4 ) 的 oxygense-1 劝诱了微榴状的肝硬化模型。方法：带老鼠 HO-1 或 GFP 基因的 R... 详细信息

瞄准：测试假设这项活动的那改进他我有与周期性的肝损伤联系的纤维发生的过程的氧合酶罐头 interfere，我们调查了在表示上的治疗学的潜力他我在 CCl (4 ) 的 oxygense-1 劝诱了微榴状的肝硬化模型。方法：带老鼠 HO-1 或 GFP 基因的 Recombinant 联系 adeno 的病毒被产生。1x 10 (12 )联系 adeno 的病毒的 vg 在肝的正式就职的时候通过门注射被管理纤维变性。结果：有由 rAAV/HO-1 的 HO-1 的在表示上的老鼠肝显著地增加了的调节以一种稳定的方式的 HO 酶的活动。微榴状的肝硬化的开发显著地作为与控制相比在 rAAV/HO-1-transduced 动物被禁止。门静脉高血压显著地作为与控制相比在 rAAV/HO-1-transduced 动物被减少，而在收缩血压没有重要变化。这发现伴有激活的改进的肝生物化学，更少的渗透的巨噬细胞和更少在 rAAV/HO-1-transduced 肝的肝的星形细胞(HSC ) 。结论：改进惊讶在肝的活动压制肝硬化的发展。

关键词：血红素氧化酶基因转染肝硬化基因治疗

Sirolimus-induced drug fever and ciclosporin-induced leukencephalopathia with seizures in one liver transplant recipient

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World journal of Gastroenterology 2007年第45期13卷 6090-6093页

作者： Doris Schacherer Martina Zeitoun Roland Büttner Cornelia Gelbmann Aiman Obed hans-jürgen schlitt jürgen Schlmerich Gabi I Kirchner Department of Internal MedicineⅠ University of Regensburg Regensburg 93042 Germany Department of Surgery University of Regensburg Regensburg 93042 Germany

We describe the first case of sirolimus-induced drug fever in a female liver transplant recipient, with a history of hepatitis C-induced end-stage liver cirrhosis in 1999. In 2005, six years after transplantation, she developed calcineurin inhibitor-induced renal function impairment. Immunosuppression was switched from tacrolimus to sirolimus. Two days after the intake of sirolimus, she developed daily fever spikes, but no infectious focus was found. Antibiotic therapy had no influence on the fever. After fourteen days, sirolimus was switched back to tacrolimus and the fever disappeared. In history, the patient developed ciclosporin-induced generalized seizures eleven days after liver transplantation, followed by the development of a motoric speech disorder. Magnetic resonance imaging (MRI) findings were consistent with leucoencephalopathy, therefore immunosuppressive therapy was changed from ciclosporin to tacrolimus and the neurologic symptoms improved significantly. Our case is the first reported case of sirolimus-induced drug fever. In addition, the patient showed the rare occurrence of ciclosporin-induced leukencephalopathy with seizures.

关键词：肝移植免疫移植环孢霉素肝疾病