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Liver graft preservation methods during cold ischemia phase and normothermic machine perfusion

World Journal of Gastrointestinal Surgery 2019年第3期11卷 126-142页

作者： Konstantin Y Tchilikidi Department of Surgery Altai State Medical University

The growing demand for donor organs requires measures to expand donor pool.Those include extended criteria donors, such as elderly people, steatotic livers,donation after cardiac death, etc. Static cold storage to reduce metabolic requirements developed by Collins in late 1960 s is the mainstay and the golden standard for donated organ protection. Hypothermic machine perfusion provides dynamic organ preservation at 4°C with protracted infusion of metabolic substrates to the graft during the ex vivo period. It has been used instead of static cold storage or after it as short perfusion in transplant center. Normothermic machine perfusion(NMP) delivers oxygen, and nutrition at physiological temperature mimicking regular environment in order to support cellular function. This would minimize effects of ischemia/reperfusion injury.Potentially, NMP may help to estimate graft functionality before implantation into a recipient. Clinical studies demonstrated at least its non-inferiority or better outcomes vs static cold storage. Regular grafts donated after brain death could be safely preserved with convenient static cold storage. Except for prolonged ischemia time where hypothermic machine perfusion started in transplant center could be estimated to provide possible positive reconditioning effect. Use of hypothermic machine perfusion in regular donation instead of static cold storage or in extended criteria donors requires further investigation. Multicenter randomized clinical trial supposed to be completed in December 2021. Extended criteria donors need additional measures for graft storage and assessment until its implantation. NMP is actively evaluating promising method for this purpose.Future studies are necessary for precise estimation and confirmation to issue clinical practice recommendations.

关键词： Liver graft preservation Graft preservation solutions Static cold storage Hypothermic machine perfusion Normothermic machine perfusion Ischemia-reperfusion injury Marginal grafts Donation after cardiac death Extended criteria donors Transpla complications

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Enhanced recovery after surgery programs hasten recovery after colorectal resections

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World Journal of Gastrointestinal Surgery 2011年第1期3卷 1-6页

作者： Ned Abraham Sinan Albayati Coffs Harbour Campus Faculty of MedicineUniversity of New South Wales

Colorectal resection was traditionally associated with significant morbidity and prolonged stay in hospital.Laparoscopic colorectal resection was first described in 1991 as a minimally invasive form of colorectal surgery.It was later on assessed by multiple randomized controlled trials and meta-analysis and was found to be associated with a faster recovery,lower complication rates and a shorter stay in hospital compared with open resection.To assess the effect of enhanced recovery after surgery (ERAS) program on postoperative length of stay after elective colorectal resections,a literature review was conducted,supplemented by the results of 111 ERAS colorectal resections at regional NWS Hospital using a protocol based on the Fast Track approach described by Kehlet in 1999.ERAS has been shown to improve postoperative recovery,reduce length of stay and enhance early return to normal function when compared with traditional colorectal surgical protocols.The role of laparoscopic surgery in colorectal resections within a fast-track (ERAS) program is controversial.The current evidence suggests that within such a program,there is no difference between laparoscopic and open colorectal surgery in terms of postoperative recovery rates or length of hospital stay.

关键词： Enhanced recovery after surgery Colorectal surgery Laparoscopy

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The　study　of　IL-1 β,TNF-α,IL-6　gene　expression　and　plasma　levels　on　hemodialysis　before　and　after　dialyzer　reuse

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Chinese Medical Journal 1997年第7期 12-15页

作者：钱家麒余志远戴慧莉黄佩文张庆怡程砜陈诗书

Objective To investigate the biocompatibility of dialyzer reuse. Methods Twenty two hemodialysis patients were randomized into cuprophan (CU,7), polymethylmethacrylate (PMMA,7) and polysulphone (PS,8) membrane groups to observe IL 1 β, TNF α, IL 6 gene expression and their plasma levels by using themselvesas control with enzyme linked immunosorbent assay (ELISA), reverse transcription polymerase chain reaction (RT PCR) and in situ hybridization. Results Plasma levels of interlukin 1β (IL 1 β), tumor necrosis factor α (TNF α), interleukin 6 (IL 6) were 14.07±3.32 pg/ml, 67.41±19.79 pg/ml, 83.67±40.34 pg/ml; 12.80±3.01 pg/ml, 49.65±9.75 pg/ml, 33.36±12.14 pg/ml and 14.41±3.16 pg/ml, 80.56±23.22 pg/ml, 48.14±16.01 pg/ml, repectively, after patients dialyzed with CU, PMMA and PS membranes. Plasma cytokine levels decreased after reuse compared with those before resue in each group. But no significant difference was found between them (P>0.05); the levels of IL 1β, TNF α, IL 6 gene expression after reuse were 5.61±0.33, 2.11±0.12, 5.04±0.19%; 2.43±0.19, 1.29±0.11, 3.48± 0.20% and 2.48±0.20, 1.24±0.11, 3.22±0.20% respectivley by in situ hybridization, and 0.92±0.07,0.63± 0.05, 0.53±0.05; 0.61±0.06, 0.47±0.04, 0.37±0.03 and 0.59 ±0.05, 0.44±0.04, 0.38±0.03 by RT PCR, respec tively. after reuse there was significant decrease as comnared with that before reuse (P<0.001, P<0.005 and P<0.05, respectively). Conclusions This suggested reprocessing dialyzer with formaldehyde reduced cytokine release and gene expression in peripheral blood mononuclear cells and enhanced dialyzer biocompatibility.It would be beneficial to reduce the dialysis cost and may reduce the complication related to a long term hemodialysis.

关键词：钱家麒 levels plasma and before hemodialysis after dialyzer study 志远 IL-6

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One successful case of 6-organ-failure after severe polytrauma

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Chinese Medical Journal 1998年第2期 91-93页

作者：孙长怡李力群马占忠

Ｏｎｅｓｕｃｃｅｓｆｕｌｃａｓｅｏｆ６ｏｒｇａｎｆａｉｌｕｒｅａｆｔｅｒｓｅｖｅｒｅｐｏｌｙｔｒａｕｍａＳｕｎＣｈａｎｇｙｉ孙长怡，ＬｉＬｉｑｕｎ李力群ａｎｄＭａＺｈａｎｚｈｏｎｇ马占忠ＳｕｒｇｅｒｙＩｎｔｅｎｓ... 详细信息

Ｏｎｅｓｕｃｃｅｓｆｕｌｃａｓｅｏｆ６ｏｒｇａｎｆａｉｌｕｒｅａｆｔｅｒｓｅｖｅｒｅｐｏｌｙｔｒａｕｍａＳｕｎＣｈａｎｇｙｉ孙长怡，ＬｉＬｉｑｕｎ李力群ａｎｄＭａＺｈａｎｚｈｏｎｇ马占忠ＳｕｒｇｅｒｙＩｎｔｅｎｓｉｖｅＣａｒｅＵｎｉｔ，Ｂｅｉｊｉ...

关键词：李力群 successful organ-failure severe case polytrauma One after

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Selecting incision-dominant cases for robotic liver resection:towards outpatient hepatectomy with rapid recovery

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Hepatobiliary Surgery and Nutrition 2018年第2期7卷 77-84页

作者： Laleh G.Melstrom Susanne G.Warner Yanghee Woo Virginia Sun Byrne Lee Gagandeep Singh Yuman Fong Department of Surgery City of Hope Medical CenterDuarteCAUSA

Background:The premise of minimally invasive surgery(MIS)is to minimize facial and muscle injury in order to enhance recovery from surgery.Robotic MIS surgery for resection of tumors in solid organs is gaining traction,though clear superiority of this approach is lacking and robotic surgery is more expensive.Our philosophy in robotically-assisted hepatectomy has been to employ this approach for cases where location of tumors make difficult a classical laparoscopic approach(superior/posterior tumors),and cases where the incision for an open operation dominates the course of recovery.Methods:This is a retrospective review of a prospectively collected database.Results:In this study we report 97 cases of liver resection subjected to the robotic approach,of which 90%were resected robotically.The mean operative time was 186±9 min;mean blood loss was 111±15 mL,and complications occurred in 9%.Two thirds of the patients remained in hospital 3 days or less,including three patients subjected to hemihepatectomy(2 left and 1 right).Fourteen individuals were discharged on the same day.The strongest predictors of long hospital stay(>3 days)were major hepatectomy(P=0.007),complications(P=0.008),and operative time>210 min(P=0.001).Conclusions:With thoughtful case selection,this is a first demonstration that hepatectomy can be conducted as an out-patient or short-stay procedure.

关键词： Adoption of minimally invasive surgery(MIS) enhanced recovery after surgery(ERAS) robotic MIS hepatectomy surgical outcome

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RECOMBINANT　HUMAN　GRANULOCYTE　COLONY－STIMULATING　FACTOR　after　ALLOGENEIC　BONE　MARROW　TRANSPLANTATION

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Chinese Medical Journal 1996年第11期 12-16页

作者：黄晓军郭乃榄范韫明陆道培

ＲＥＣＯＭＢＩＮＡＮＴＨＵＭＡＮＧＲＡＮＵＬＯＣＹＴＥＣＯＬＯＮＹ－ＳＴＩＭＵＬＡＴＩＮＧＦＡＣＴＯＲＡＦＴＥＲＡＬＬＯＧＥＮＥＩＣＢＯＮＥＭＡＲＲＯＷＴＲＡＮＳＰＬＡＮＴＡＴＩＯＮＨｕａｎｇＸｉａｏｊｕｎ黄晓军，Ｇ... 详细信息

ＲＥＣＯＭＢＩＮＡＮＴＨＵＭＡＮＧＲＡＮＵＬＯＣＹＴＥＣＯＬＯＮＹ－ＳＴＩＭＵＬＡＴＩＮＧＦＡＣＴＯＲＡＦＴＥＲＡＬＬＯＧＥＮＥＩＣＢＯＮＥＭＡＲＲＯＷＴＲＡＮＳＰＬＡＮＴＡＴＩＯＮＨｕａｎｇＸｉａｏｊｕｎ黄晓军，ＧｕｏＮａｉｌａｎ郭乃榄，ＦａｎＹｕ...

关键词：黄晓陆道培 after

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Conservative management of patients with histological incomplete exci-sion of cervical intraepithelial neoplasia after large loop excision of transformation zone

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Chinese Medical Journal 1997年第8期 41-43页

作者：陈洁霜余启文骆绮霞冼世源邓灿洪

Objective To evaluate conservative management of patients with histological incomplete excision of CIN after large loop excision of transformation zone (LLETZ). Methods Two hundred and seventeen patients with high grade CIN were treated with LLETZ from October 1, 1992 to December 31, 1994. Fifty three patients (24.4%) had incomplete excision on histology. All patients were followed up cytologically every 3 to 6 months during the first 18 months and then yearly till December 1996. Those patients with positive endocervical margins were followed up with both cervical smear and endocervical smear. Results The mean follow up duration was 30.4 months. Ten patients were found to have persistent or recurrent disease. Five patients had second LLETZ and complete excision was achieved in 4 of them, one patient had cone biopsy and two had hysterectomy. One patient was found to have stage Ⅰa cervical cancer. Conclusion A report of incomplete excision of CIN after LLETZ calls for follow up with cytology and colposcopy and not aggressive retreatment.

关键词： patients management after Conservative

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Clinical features of the femoral head necrosis caused by gross teres ligament after reduction for the developmental dislocation of the hip

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Chinese Medical Journal 1998年第11期 39-41页

作者：马瑞雪吉士俊刘卫东周永德

Abstract Objective To observe the clinical features of the femoral head necrosis caused by a gross teres ligament after reduction of developmental dislocation of the hip and study its pathological causes. Methods Ten hips with necrosis of the femoral head after reduction of developmental dislocation of the hip were observed. X ray images of the hip were retrospectively reviewed with regard to the acetabular index, the acetabular head index, the shapes and the development of the femoral heads. The operative findings were analyzed. Results No growth or delayed growth of the femoral head and the acetabular index was found after reduction. The recovery of acetabulum was very slow. All of the cases showed the same features: femoral head necrosis, subluxation, and acetabular dysplasia. A gross teres ligament was proved during surgical operation. The femoral head recovered gradually after the operation. Conclusions The gross tissue interposed (a gross teres ligament) is another important pathogenesis of femoral head necrosis after the reduction of developmental dislocation of the hip. It is necessary to recognize it before reduction by imaging examinations.

关键词： features the femoral head Clinical after

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Evolutionary regularity of acetabular dysplasia after reduction of develop-mental dislocation of the hip

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Chinese Medical Journal 1997年第5期 26-28页

作者：马瑞雪吉士俊周永德刘卫东张立军

Objective To observe the developmental changes of the acetabulum after reduction of developmental dislocation of the hip and require evolutionary regularity of acetabular dysplasia. Methods A follow up in an average of 7.4 years was carried out in 117 patients (161 hips) with developmental dislocation of the hip after reduction. By the series of X ray films, acetabular index, acetabular head index, Sharp’s angle, ACM angle (Idelberger’s angle) and anteversion were observed. At the same time, centre head distance discrepancy was measured. Results Acetabular index returned to normal gradually as the time went by and significantly within one year after the reduction of developmental dislocation of the hip. The process of recovery was nearly stable three years later. Acetabular index in the dysplasia group was above 39° before reduction and decreased slowly after the reduction. However, it was still up to 30° after 3 years observation. The value of centre head distance discrepancy decreased gradually as the years went by after reduction. Conclusions If acetabular index before reduction is above 39° and is still up to 30° three years after reduction, acetabular dysplasia can be diagnosed.

关键词：吉士俊 after dysplasia hip the develop-mental dislocation regularity reduction Evolutionary acetabular

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A study on cholangitis after hepatic portoenterostomy for biliary atresia

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Chinese Medical Journal 1997年第5期 15-17页

作者：刘钧澄李桂生赖炳耀

Objective To investigate the clinical manifestations and factors relating to prognosis in biliary atresia (BA). Methods Twenty four cases were reviewed on clinical manifestations and bile flow after operation. All patients underwent hepatic portoenterostomy. Results Twenty three cases (95%) got bile flow postoperatively. Sixteen (69%) of 23 patients had 27 episodes of cholangitis. There were significant differences (Pafter cholangitis. Cholangitis also affected the life quality of BA patients. Conclusion We consider that early finding and prevention of cholangitis can improve the prognosis of BA patients.

关键词：刘钧澄李桂生 after

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