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Hemihepatic versus total hepatic inflow occlusion during hepatectomy:A systematic review and meta-analysis

World Journal of Gastroenterology 2011年第26期17卷 3158-3164页

作者： Hai-Qing Wang jia-yin yang Lu-Nan Yan Department of Liver and Vascu-lar Surgery Liver Transplantation Center West China Hospital ofSichuan University Chengdu 610041 Sichuan Province China Liver Transplantation Center West China Hospitalof Sichuan University Chengdu 610041 Sichuan Province China

AIM： To evaluate the clinical outcomes of patients undergoing hepatectomy with hemihepatic vascular occlusion （HHO） compared with total hepatic inflow occlusion （THO）. METHODS： Randomized controlled trials （RCTs） co- mparing hemihepatic vascular occlusion and total he- patic inflow occlusion were included by a systematic literature search. Two authors independently assessed the trials for inclusion and extracted the data. A meta- analysis was conducted to estimate blood loss, transfu- sion requirement, and liver injury based on the levels of aspartate aminotransferase （AST） and alanine arni- notransferase （ALT）. Either the fixed effects model or random effects model was used. RESULTS- Four RCTs including 338 patients met the predefined inclusion criteria. A total of 167 patients were treated with THO and 171 with HHO. Metaanalysis of AST levels on postoperative day 1 indicated higher levels in the THO group with weighted mean dif- ference （WMD） 342.27; 95% confidence intervals （CI） 217.28-467.26; P = 0.00001; I2 = 16%. Meta-analysis showed no significant difference between THO group and HHO group on blood loss, transfusion requirement, mortality, morbidity, operating time, ischemic duration, hospital stay, ALT levels on postoperative day 1, 3 and 7 and AST levels on postoperative day 3 and 7. CONCLUSION： Hemihepatic vascular occlusion does not offer satisfying benefit to the patients undergoing hepatic resection. However, they have less liver injury after liver resections.

关键词： Inflow occlusion Hemihepatic Vascular occlusion Hepatectomy Pringle maneuver

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Combined Hangzhou criteria with neutrophillymphocyte ratio is superior to other criteria in selecting liver transplantation candidates with HBV-related hepatocellular carcinoma

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Hepatobiliary & Pancreatic Diseases International 2015年第6期14卷 588-595页

作者： Guang-Qin Xiao jia-yin yang Lu-Nan Yan Liver Transplantation Center West China HospitalSichuan University Department of Biliary-Pancreatic Surgery Tongji Hospital of Tongji Medical CollegeHuazhong University of Science and Technology

BACKGROUND： The elevation of neutrophil-lymphocyte ratio （NLR） has adverse effects on the prognosis of patients with hepatocellular carcinoma （HCC） who have received liver transplantation （LT）. The Hangzhou criteria are set for selecting HCC patients for LT. The present study aimed to establish a set of new criteria combining the NLR and Hangzhou crite- ria for selecting HCC patients for LT.

关键词： Hangzhou criteria hepatocellular carcinoma liver transplantation neutrophil-lymphocyte ratio hepatitis B virus biomarker

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Pure three-dimensional laparoscopic full left hepatectomy of a living donor for an adolescent in China

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Chinese Medical Journal 2019年第2期132卷 242-244页

作者： Jiu-Lin Song Hong Wu jia-yin yang Liver Transplantation Center Department of Liver SurgeryWest China Hospital of Sichuan UniversityChengduSichuan 610041China

To the Editor:Living donor liver transplantation (LDLT) has expanded the donor pool in countries with low cadaveric organ donation ***, a left-side liver allograft is sufficient and safe for child and adolescent recipients.[1] For the sake of the donor's cosmetic demands and for early functional rehabilitation, laparoscopic technology has been used in live hepatectomy since 2002.[2] Three-dimensional visualization provides better depth perception and tactile feedback than does conventional two-dimensional laparoscopy.[3] In this report, we presented a case of pure three-dimensional laparoscopic full left live hepatectomy.

关键词： Living donor liver transplantation expanded liver

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Laparoscopic donor right hepatectomy with reconstruction of segment V and VIII tributaries of the middle hepatic vein using a cadaveric iliac artery allograft

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Chinese Medical Journal 2019年第9期132卷 1122-1124页

作者： Jiu-Lin Song Hong Wu jia-yin yang Liver Transplantation Center Department of Liver SurgeryWest China Hospital of Sichuan UniversityChengduSichuan 610041China

To the Editor:Living donor liver transplantation (LDLT) has effectively expanded the donor ***,up to 40% of living donors suffer from postoperative complications,which are mostly associated with a right subcostal lapa... 详细信息

关键词： Editor LDLT wound

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Development and validation of a predictive score for perioperative transfusion in patients with hepatocellular carcinoma undergoing liver resection

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Hepatobiliary & Pancreatic Diseases International 2015年第4期14卷 394-400页

作者： Hai-Qing Wang jian yang jia-yin yang Wen-Tao Wang Lu-Nan Yan Department of Liver Surgery West China Hospital Sichuan University

Liver resection is a major surgery requiring perioperative blood transfusion. Predicting the need for blood transfusion for patients undergoing liver resection is of great importance. The present study aimed to develop and validate a model for predicting transfusion requirement in HBV-related hepatocellular carcinoma patients undergoing liver resection. METHODS： A total of 1543 consecutive liver resections were included in the study. Randomly selected sample set of 1080 cases （70% of the study cohort） were used to develop a predic- tive score for transfusion requirement and the remaining 30% （n=463） was used to validate the score. Based on the preopera- tive and predictable intraoperative parameters, logistic regres- sion was used to identify risk factors and to create an integer score for the prediction of transfusion requirement. RESULTS： Extrahepatic procedure, major liver resection, hemoglobin level and platelets count were identified as inde- pendent predictors for transfusion requirement by logistic regression analysis. A score system integrating these 4 factors was stratified into three groups which could predict the risk of transfusion, with a rate of 11.4%, 24.7% and 57.4% for low, moderate and high risk, respectively. The prediction model appeared accurate with good discriminatory abilities, generat- ing an area under the receiver operating characteristic curve of 0.736 in the development set and 0.709 in the validation set. CONCLUSIONS： We have developed and validated an integer- based risk score to predict perioperative transfusion for pa- tients undergoing liver resection in a high-volume surgicalcenter. This score allows identifying patients at a high risk and may alter transfusion practices.

关键词： liver resection transfusion hepatocellular carcinoma

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Anterior vs conventional approach hepatectomy for large liver cancer:A meta-analysis

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World Journal of Gastroenterology 2014年第45期20卷 17235-17243页

作者： Lei Li Hai-Qing Wang Qing Wang jian yang jia-yin yang Department of Liver Surgery Liver Transplantation Center West China Hospital of Sichuan University

AIM: To evaluate the clinical outcomes and safety of anterior-and conventional-approach hepatectomy for patients with large liver tumors. METHODS: PubMed, EMBASE, Google Scholar and the Cochrane Library databases were searched for randomized controlled trials (RCTs) and controlled clinical trials comparing anterior-approach hepatectomy (AAH) and conventional-approach hepatectomy (CAH). Two observers independently extracted the data using a spreadsheet and assessed the studies for inclusion. Studies that fulfilled the inclusion criteria and addressed the clinical questions of this analysis were further assessed using either fixed effects or random effects models. RESULTS: Two RCTs and six controlled clinical trials involving 807 patients met the predefined inclusion criteria. A total of 363 patients underwent AAH and 444 underwent CAH. Meta-analysis indicated that the AAH group had fewer requirements for transfusion (OR = 0.37, 95%CI: 0.21-0.63), less recurrence (OR = 0.57, 95%CI: 0.37-0.87), and lower mortality (OR = 0.29, 95%CI: 0.13-0.63). There were no significant differences between AAH and CAH with regard to perioperative complications (OR = 0.94, 95%CI: 0.58-1.51), intraoperative tumor rupture (OR = 0.98, 95%CI: 0.40-2.40), or length of hospital stay (weighted mean difference = -0.17, 95%CI: -2.36-2.02). CONCLUSION: AAH has advantages of decreased transfusion, mortality and recurrence compared to CAH. It is a safe and effective method for large cancers requiring right hepatectomy. (C) 2014 Baishideng Publishing Group Inc. All rights reserved.

关键词： Anterior approach Conventional approach Hepatectomy Liver tumor Meta-analysis

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Robot-assisted Living-donor Left Lateral Sectionectomy

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Chinese Medical Journal 2017年第7期130卷 874-876页

作者： Ming-Heng Liao jia-yin yang Hong Wu Yong Zeng Department of Liver Surgery Liver Transplantation Division West China Hospital Sichuan University Chengdu Sichuan 610041 China

INTRODUCTION In 2002, Cherqui et al. reported the first purely laparoscopic living-donor left lateral sectionectomy （LDLLS）Yl This technique has now become a standardized procedure and has significantly shortened donor *** The da Vinci robotic surgical system was introduced into the field of liver surgery more than 10 years ago. Its flexible mechanical ＂wrist＂ and stable three-dimensional （3D） visual field help minimize risks from complicated procedures.

关键词： Laparoscopic Surgery Liver Transplantation Living Donor Robotic Surgery Sectionectomy

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Low immediate postoperative platelet count is associated with hepatic insufficiency after hepatectomy

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World Journal of Gastroenterology 2014年第33期20卷 11871-11877页

作者： Hai-Qing Wang jian yang jia-yin yang Wen-Tao Wang Lu-Nan Yan Department of Liver Surgery Liver Transplantation Center West China Hospital of Sichuan University

AIM: To investigate the relationship between low immediate postoperative platelet count and perioperative outcome after liver resection in patients with hepatocellular carcinoma (HCC). METHODS: In a cohort of 565 consecutive hepatitis B-related HCC patients who underwent major liver resection, the characteristics and clinical outcomes after liver resection were compared between patients with immediate postoperative platelet count = 100 x 10(9)/L. Risk factors for postoperative hepatic insufficiency were evaluated by multivariate analysis. RESULTS: Patients with a low immediate postoperative platelet count (= 100 x 10(9)/L. The alanine aminotransferase levels on postoperative days 3 and 5, and bilirubin on postoperative days 1, 3 and 5 were higher in patients with immediate postoperative low platelet count. Multivariate analysis revealed that immediate postoperative low platelet count, rather than preoperative low platelet count, was a significant independent risk factor for hepatic insufficiency. CONCLUSION: A low immediate postoperative platelet count is an independent risk factor for hepatic insufficiency. Platelets can mediate liver regeneration in the cirrhotic liver. (C) 2014 Baishideng Publishing Group Inc. All rights reserved.

关键词： Thrombocytopenia Hepatic insufficiency Hepatocellular carcinoma Hepatectomy Hepatitis B

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Organ transplantation management in the midst of the COVID-19 outbreak: a synopsis

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Hepatobiliary Surgery and Nutrition 2020年第2期9卷 250-252页

作者： Bo-Han Zhang Lyu-Nan Yan jia-yin yang Department of Liver Surgery and Liver Transplantation Center Organ Transplantation CenterWest China Hospital of Sichuan UniversityChengdu 610041China

On December 8,2019,the first case of unexplained pneumonia was reported in China,in Wuhan,Hubei Province(1).By March 6,2020,over 100,000 confirmed cases of coronavirus disease 2019(COVID-19),and more than 3,400 deaths have been reported worldwide(data from National Health Commission of the People’s Republic of China,Official Channels of Hong Kong,Macao and Taiwan,and World Health Organization).COVID-19,which is caused by severe acute respiratory syndrome coronavirus 2(SARS-CoV-2),is bound to have widespread ramifications on the clinical management system,organ transplantation being a prime *** on the transplant waitlist are generally in poor ***,post-transplant patients with weak immunity stemming from the long-term and regular administration of immunosuppressants are more likely to contract the SARS-CoV-2 infection than are healthy ***,when considering transplant patient safety,balancing organ allocation principles with epidemic prevention and control is a dilemma for transplant teams.

关键词： prevention Taiwan likely

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Liver resection in hepatitis B related-hepatocellular carcinoma: Clinical outcomes and safety in elderly patients

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World Journal of Gastroenterology 2014年第21期20卷 6620-6625页

作者： Hai-Qing Wang jian yang Lu-Nan Yan Xiao-Wu Zhang jia-yin yang Department of Liver Surgery Liver Transplantation CenterWest China Hospital of Sichuan University

AIM: To compare the morbidity and mortality in young and elderly hepatocellular carcinoma (HCC) patients undergoing liver resection. METHODS: We retrospectively enrolled 1543 consecutive hepatitis B (HBV)-related HCC patients undergoing elective hepatic resection in our cohort, including 207 elderly patients (>= 65 years) and 1336 younger patients (< 65 years). Patient characteristics and clinical outcomes after liver resection were compared between the two groups. RESULTS: Elderly patients had more preoperative comorbidities and lower alanine aminotransferase and aspartate aminotransferase levels. Positive rates for hepatitis B surface antigen (P < 0.001), hepatitis B e antigen (P < 0.001) and HBV DNA (P = 0.017) were more common in younger patients. Overall complications and their severity classified using the Clavien system were similar in the two groups (33.3% vs 29.6%, P = 0.271). Elderly patients had a higher rate of postoperative cardiovascular complications (3.9% vs 0.6%, P = 0.001), neurological complications (2.9% vs 0.4%, P < 0.001) and mortality (3.4% vs 1.2%, P = 0.035), and had more hospital stay requirement (13 d vs 12 d, P < 0.001) and more intensive care unit stay (36.7% vs 27.8%, P = 0.008) compared with younger patients. However, postoperative hepatic insufficiency was more common in the younger group (7.7% vs 3.4%, P = 0.024). CONCLUSION: Hepatectomy can be safely performed in elderly patients. Age should not be regarded as a contraindication to liver resection with expected higher complication and mortality rates. (C) 2014 Baishideng Publishing Group Inc. All rights reserved.

关键词： Elderly Hepatocellular carcinoma Hepatectomy Complication Hepatitis B

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