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Table of Content

    30 April 2020, Volume 25 Issue 4
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    Liver Cancer Liver
    Ultrasound-guided percutaneous microwave ablation in the treatment of large hepatocellular carcinoma in the cauda lobe (a report of 13 cases)
    CUI Dan, DING Min, LI Wei-jian, CHI Jia-chang, LI Ping, ZHAI Bo
    2020, 25(4):  355-358. 
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    Objective To evaluate the safety and efficacy of microwave ablation for large primary liver tumor in the caudate lobe.Methods The clinical data of 13 patients with large primary liver tumors in the caudate lobe treated by microwave ablation in our hospital from December 2011 to September 2018 were collected. And the complete ablation rate, complications and prognosis of these patients were analyzed. Results All the 13 patients were ablated successfully.The complete ablation rate was 76.9% for the first ablation and the overall ablation rate was 92.3%.The 1-year, 2-year and 3-year overall survival rates were 84.5%, 74.0% and 49.4%, respectively. Ablation-related obstructive jaundice occurred in 2 patients, which subsided after treatment, and no death was observed.Conclusion For large tumors in the caudate lobe of the liver at high risk sites, microwave ablation is safe, effective and feasible. And it can be used as a potential treatment of non-resectable liver tumors.
    Clinical application of three-dimensional reconstruction and hepatectomy simulation system in guiding right hemihepatectomy for tumor
    JIANG Lei, CHEN Yan-ling, CAI Xin-ran, HONG Hai-jie, PAN Wei, LI Ge, LIN Sheng-zhe, CAO Zhen-jun
    2020, 25(4):  359-361. 
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    Objective To evaluate the clinical value of three-dimensional reconstruction and hepatectomy simulation system in guiding right hemihepatectomy for tumor.Methods A retrospective analysis was made in 24 patients with primary hepatocellular carcinoma who underwent right hemihepatectomy from January 2017 to May 2018 in our hospital. These cases were randomly divided into 2 groups, 14 cases in three-dimensional reconstruction group and 10 cases in control group. The operation time, intraoperative blood loss, postoperative liver dysfunction, postoperative complications and hospitalization time after operation were recorded. Results The 2 groups successfully completed the operation without intraoperative complications such as massive hemorrhage. No complications such as hepatic dysfunction, hepatic failure, bile leakage occurred in three-dimensional reconstruction group after operation. In control group, only 1 case had transient hepatic insufficiency after operation. The operation time and postoperative hospitalization time were significantly shorter in three-dimensional reconstruction group than those in control group [(54.9±5.7) minutes vs. (73.7±7.3) minutes, (6.6±2.2) days vs. (8.5±1.9) days]. The intraoperative blood loss was significantly less in three-dimensional reconstruction group than that in control group [(124.3±25.2) ml vs. (248.0±65.9) ml]. And the postoperative alanine aminotransferase level was significantly lower in three-dimensional reconstruction group than that in control group [(124.3±25.2) U/L vs. (411.1±95.7) U/L].Conclusion Three-dimensional reconstruction and hepatectomy simulation system can accurately reconstruct the course of intrahepatic vessels and its anatomical relationship with tumors, and accurately display residual liver volume and tumor volume. It provides a reliable basis for surgical design of right hemihepatectomy for tumor, reduces the occurrence of intraoperative and postoperative complications, and shortens the hospitalization time of patients after operation. It has important clinical value for right hemihepatectomy for tumor.
    Correlation between MR signal characteristics and microvascular invasion in small hepatocellular carcinoma
    LI Peng, WANG Wei-wei, AN Wei-min, DONG Jing-hui
    2020, 25(4):  362-364. 
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    Objective To analyze the correlation between magnetic resonance (MR) signal characteristics and microvascular invasion (MVI) in small hepatocellular carcinoma (sHCC).Methods Patients diagnosed with sHCC who received dynamic contrast-enhanced MR scan within 1 month before operation from December 2010 to January 2019 in our hospital were enrolled. And all the cases were divided into MVI group and non-MVI group according to pathological diagnosis, alpha-fetoprotein (AFP) positive group and negative group according to AFP level. Preoperative MR, T1WI, T2WI and DWI sequence, as well as signal values of arterial, portal and delayed phase of dynamic enhanced scanning were recorded. The signal value ratio of the lesions to the adjacent liver in arterial, portal and delayed phase was calculated. Results For 33 patients enrolled in the study, there were 22 cases with MVI, 11 cases with non-MVI, 17 cases with positive AFP and 16 cases with negative AFP. In patients with positive AFP, there was significant difference in the signal characteristics of arterial and delayed phase between MVI group and non-MVI group (P<0.05), but no significant difference in T1WI, T2WI and DWI sequence. However, in patients with negative AFP, there was no significant difference in T1WI, T2WI, DWI sequence and dynamic contrast-enhanced scan between groups.Conclusion MR signal features of dynamic contrast-enhanced scan could be used to predict the presence of MVI in sHCC.
    Fibrosis & Cirrhosis
    Clinical observation of hysteroscopic surgery in patients with decompensated liver cirrhosis
    LI Xiu-lan, LIU Qing, RAN Ran
    2020, 25(4):  365-368. 
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    Objective To investigate the safety and efficacy of hysteroscopic surgery in patients with decompensated liver cirrhosis.Methods The clinical data of hysteroscopic operations in patients with decompensated liver cirrhosis from October 2012 to November 2018 in our hospital were retrospectively analyzed. Perioperative indicators including operation time, intraoperative blood loss, postoperative hospitalization time and complications were recorded. Moreover, the laboratory examination including blood routine, liver function, biochemistry and coagulation function were monitored and compared before and after the operation. Results The operations were completed successfully in all the 45 patients. The mean operation time was (48.82 ± 38.40) minutes (ranged from 10 to 205 minutes). The mean intraoperative blood loss was (13.18 ± 35.04) ml (ranged from 2 to 100 ml). And the mean time of postoperative hospitalization was (3.78 ± 3.16) days (ranged from 1 to 13 days). The incidence of postoperative complications was 13.33% (6/45). The albumin level and platelet count were significantly lower postoperative than those preoperative [(32.04 ± 4.24) g/L vs. (33.95 ± 4.61) g/L, (67.58 ± 44.59) ×109/L vs. (71.84 ± 44.45) ×109/L, P<0.05].Conclusion It is safe and feasible for patients with decompensated liver cirrhosis to undergo hysteroscopic surgery on the basis of strict surgical indication, appropriate perioperative management, practiced hysteroscopic surgery skills, as well as emphasis on hemostasis and infection prevention.
    Hemodynamic analysis of liver cirrhosis complicated with esophageal and gastric varices rupture
    HU Hua-hua, LIU Jun, GUAN Li-yu, XU Jie-hong, YI Hong, LI Zhong-zhuan, QIN Shu-fen, DENG Xiang-yu
    2020, 25(4):  369-371. 
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    Objective To analyze the hemodynamic parameters from esophageal and gastric varices bleeding in cirrhosis.Methods The clinical data of 68 patients with liver cirrhosis complicated with esophagogastric varices diagnosed by Fujineng ultrasound gastroscopy in our hospital from October 2017 to April 2018 were retrospectively analyzed. Following up for half a year, the patients were divided into hemorrhage group and non-hemorrhage group according to whether there was venous rupture or not. There were 30 cases in hemorrhage group and 38 cases in non-hemorrhage group. The differences of sex, age, course of disease, the child-pugh score of liver function, platelet count, average diameter, average blood flow velocity measured by ultrasonography were compared between the two groups. Hemodynamic parameters affecting bleeding from esophageal and gastric varices in cirrhosis were analyzed. For closely related indicators, ROC curve was used to analyze the sensitivity and specificity. Results Eighty-six patients were followed up for half a year. 30 patients had venous rupture and bleeding, 56 patients had no bleeding. The bleeding rate of liver cirrhosis complicated with esophageal and gastric varices was 34.88%. The indexes of sex, age, course of disease, the Child-Pugh score of liver function(8.97±3.04), platelet count[(142.60±38.66)×109/mL], average diameter[(1.54±0.62)mm], average blood flow velocity[(15.79±4.17)mm/s] were measured by ultrasound. Only the mean internal diameter, average blood flow velocity were closely related to the bleeding outcomes of gastric varices rupture (r=-0.294,-0.451,P<0.05). The other indicators were not related (P>0.05). ROC curve analysis showed that the internal diameter, average blood flow velocity were positively correlated with the bleeding outcome of gastric varices rupture, and the specificity and sensitivity has significant statistical significance (P<0.05). When the inner diameter of the varicose vein inside and outside the esophageal wall is larger than 1.875 mm, the average blood flow velocity exceeds 13.75mm/s, the gastric varices are more likely to rupture and bleed.Conclusion The internal diameter and blood flow velocity of esophageal varices are positively correlated with the bleeding outcomes of gastric varices rupture. Close monitoring of the internal diameter and blood flow velocity of esophageal varices should be carried out clinically, which is of great significance in preventing bleeding outcomes of gastric varices rupture and is worthy of clinical promotion.
    Hepatitis
    Relationship between positive expression of HBAg in renal tubules and prognosis of renal function damage associated with hepatitis B virus
    LIU dong, SU Kang-le, ZHANG Cui-jie, ZHAI Ya-ling, LI Fang-hua
    2020, 25(4):  372-374. 
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    Objective To study the relationship between positive expression of tubule hepatitis b antigen (HBAg) and prognosis of hepatitis B virus related renal function injury.Methods The clinical data of 80 patients with hepatitis B related nephropathy (HBV-GN) admitted to our hospital from December 2016 to December 2018 were retrospectively analyzed. According to the presence and absence of HBAg deposition in renal tissues, all patients were divided into the HBAg deposition group and the no-HBAg deposition group, with 40 patients in each group.Compare two groups of patients with basic data and laboratory test results, including gender, age, clinical manifestation, the existence of nephrotic syndrome, nephritis syndrome, kidney damage), hepatitis B surface antigen (HBsAg), hepatitis B virus E antigen (HBeAg), albumin (Alb), low density lipoprotein (LDL), triglycerides (TG), cholesterol (TC), hemoglobin (Hb), blood uric acid (SUA), serum creatinine (Scr), hepatitis B virus DNA (HBV DNA);The differentiated information was incorporated into the multivariate Logistic regression model to identify the risk factors affecting the prognosis of HBV-GN patients. Results In the HBAg deposition group, 32 males, aged (41.54 ± 9.46) years, 24 with nephrotic syndrome, 22 with nephritis syndrome, ALB (54.37 ± 6.43) g/L, LDL (3.84 ± 1.43) mmol/L, TG (1.43 ± 0.84) mmol/L, TC (6.14 ± 1.03) mmol/L, Hb (147.54 ± 20.46) g/L, SUA (382.62 ± 94.57) μmol/L, Scr (133.75 ± 13.76) μmol/L, HBV DNA (5.43 ± 1.42) copies/mL and 30 men without HBAg deposition, aged (41.58 ± 9.53) years, 25 with nephrotic syndrome, 17 with nephritis syndrome, ALB (54.40 ± 6.58) g/L, LDL (3.81 ± 1.38) mmol/L, TG (1.44 ± 0.86) mmol/L, TC (6.11 ± 0.93) mmol/L, Hb (146.87 ± 20.41) g/L, SUA (386.54 ± 96.75) μmol/L, There was no significant difference between Scr (133.70 ± 13.54) μmol/L and HBV DNA (5.57 ± 1.34) copies/mL, P>0.05;Renal function impairment was shown in the HBAg deposition group, and patients with positive serum HBsAg and HBeAg were significantly more than those without the HBAg deposition group. (34 with renal impairment, 35 with HBsAg positive, and 33 with HBeAg positive. Twenty cases were HBsAg positive, 19 cases were HBeAg positive, P<0.05).Multivariate Logistic regression analysis confirmed that there was renal impairment. Positive HBsAg and HBeAg were risk factors affecting the prognosis of patients with HBV-GN, both P<0.05.Conclusion There are many risk factors that affect the prognosis of patients with HBV-GN, such as renal function damage and positive expression of renal tubule HBAg, which should be concerned by clinicians in clinical treatment.
    Liver Failure
    The clinical characteristics and prognosis of patients with HBV-ACLF treated by internal medicine
    GAO Peng-bin, ZHENG Huan-wei, ZHAO Xiao-yan, WANG De-hua, QIN Hao, MENG Ming-hui, ZHANG Jian-ji, YAN Shuang-huan
    2020, 25(4):  375-378. 
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    Objective To study the clinical characteristics and prognosis of patients with HBV-related acute-on-chronic liver failure (HBV-ACLF) treated by internal medicine.Methods The clinical data of 140 patients with HBV-ACLF who received comprehensive treatment of internal medicine in our hospital were retrospectively analyzed,the patients were divided into effective group and ineffective group,which accorded to the therapeutic effect.The clinical characteristics of the two groups were compared. Results The medical comprehensive treatment was effective in 98 cases,the effective rate was 70.00%, the ineffective was 42 cases and the ineffective rate was 30%. Among them, 23 cases died and the mortality rate was 16.43%.The incidence of cirrhosis, hepatic encephalopathy, gastrointestinal bleeding and hepatorenal syndrome in the effective group were lower than that in the ineffective group (P<0.05).The Logistic multivariate analysis showed that the complications such as hepatic encephalopathy (OR=1.869,95%CI=1.073~3.256), gastrointestinal bleeding (OR=3.478,95%CI=1.621~7.462), hepatorenal syndrome (OR=4.141,95%CI=1.031~5.091) and INR(OR=3.081,95%CI=1.497~6.341), Scr (OR=2.817,95%CI=1.629~4.871) and MELD scores (OR=1.305,95%CI=1.194~1.426) were independent factors which affected the efficacy (P<0.05).Conclusion The comprehensive curative effect of HBV-ACLF is affirmative.The entecavir combined with glucocorticoid is helpful to improve the curative effect.The patients who decreased liver function and elevated MELD score, the therapeutic effect of internal medicine for those with complications is worse.
    Others
    Retrospective analysis of clinical characteristics and prognosis of children with autoimmune hepatitis
    ZHAO Meng, CHEN Ming, WANG Li, HIU Sun-yi
    2020, 25(4):  379-381. 
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    Objective To study the clinical characteristics and prognosis of children with autoimmune hepatitis (AIH).Methods Clinical data of 138 children with AIH admitted to our hospital from August 2016 to August 2019 were retrospectively analyzed to analyze clinical features, treatment and prognosis. Results Among the 138 cases, 96 cases (69.57%) had AIH-1 type and 42 cases (30.43%) had AIH-2 type; Fever in 6 cases (4.35%), nausea and fatigue in 12 cases (8.70%), abnormal transaminase in 39 cases (28.26%), and jaundice in 81 cases (58.70%); Children with AIH-1 complicated with inflammatory bowel disease, primary sclerosing cholangitis, systemic lupus erythematosus and primary biliary cholangitis were 6 cases (4.35%), 9 cases (6.52%), 3 cases (2.17%) and 3 cases (2.17%), respectively. At admission, all children had abnormal liver function, and the levels of gamma globulin and immunoglobulin G in AIH-1 group were significantly higher than those in AIH-2 group (P<0.05).117 cases of liver tissue examination showed that 108 cases of interfacial hepatitis (92.31%), 9 cases of rosette (7.69%), 69 cases of plasma cell or lymphocyte infiltration (58.97%); There were 66 cases (56.41%) with liver inflammation grade G≥ grade 3, and 78 cases (66.67%) with fibrosis stage S≥ grade 3.120 cases were treated with glucocorticoid, 87 cases (72.50%) were completely relieved, 30 cases (25.00%) were partially relieved and 3 cases (2.50%) were unresponsive. 45 cases (51.72%) relapsed after complete remission.Conclusion AIH-1 type is more common in children AIH. Its clinical manifestations are complex. Liver inflammation and fibrosis in most children have progressed significantly. Hormone alone or combined with azathioprine can improve the biochemistry and pathology of children, but it is easy to recur.
    Effect of N-acetylcysteine on mitophagy of hepatocytes in mice with nonalcoholic steatohepatitis
    ZHANG Ning-ping, FANG Ying, XIE Li, WU Jian, SHEN Xi-zhong
    2020, 25(4):  382-386. 
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    Objective To investigate the effect of N-acetylcysteine (NAC) on mitophagy in mice with nonalcoholic steatohepatitis.Methods C57BL/J6 mice were fed with control diet, high-fat and high-calories (HFCD) diet and a HFCD+ NAC diet for 16 weeks. HE and Masson staining were used to evaluate liver injury. Liver function, IL-1β, blood glucose and triglyceride levels in liver tissues were detected. Immunofluorescence staining of frozen section of liver tissue was used to observe mitophagy. Changes of mRNA and protein levels of mitophagy markers in liver tissues of 3 groups of mice were compared. Results Compared to control group, the ALT [(24.9±2.12) vs (176.7±44.32)U/L, P<0.05], AST [(76.7±9.06) vs (291.3±39.66)U/L, P<0.05] and IL-1β [(2.94±0.08) vs (9.12±1.21), P<0.05] levels of HFCD group were increased. The liver function of HFCD+NAC group was improved, and the IL-1β levels were decreased [(9.12±1.21) vs (6.77±0.58)ng/L, P<0.05]. The expression of Parkin, PINK1 and LC3B II/I ratio in the liver tissues of HFCD group decreased, while the P62 level was increased. These results suggested that the level of mitophagy in HFCD group was decreased. Compared with the HFCD group, mitophagy of hepatocytes in the HFCD+NAC group improved (P<0.05).Conclusion NAC may reduce hepatocyte inflammatory progression by improving mitophagy of hepatocytes in mice with nonalcoholic steatohepatitis.