Inflammatory pseudotumor of the liver is a rare benign lesion that can mimic a malignant liver nioplasm. A case of inflammatory pseudotumor of the liver found in association with a malignant gastrointestinal stromal t...Inflammatory pseudotumor of the liver is a rare benign lesion that can mimic a malignant liver nioplasm. A case of inflammatory pseudotumor of the liver found in association with a malignant gastrointestinal stromal tumor (GIST) of the small bowel was reported. The inflammatory pseudotumor was misdiagnosed as a metastasis from the GIST by frozen section. A correct diagnosis was made only after histopathological examination of the paraffin section of the resescted specimen. This case is psrticularly interesting because of the association of the two rare pathological entities and the diagnostic dilemma that arose from the similarity of their histological appearances. To our knowledge,this association has not been reported in the literature.展开更多
Including the middle hepatic vein in the right lobe liver graft has the advantage of providing direct venous drainage of the right anterior segment. To allow unimpeded passage of blood flow, we previously designed ven...Including the middle hepatic vein in the right lobe liver graft has the advantage of providing direct venous drainage of the right anterior segment. To allow unimpeded passage of blood flow, we previously designed venoplasty of the middle and right hepatic veins. We found that venoplasty is also feasible when the inferior right hepatic vein is near to the right hepatic vein, or when multiple segment 8 hepatic vein orifices are exposed adjacent to the middle hepatic vein at the graft transection surface. By joining the hepatic vein orifices into a single opening, the anastomosis into the inferior vena cava is much facilitated. The technique is simple, yet versatile , and able to cope with variation of the configurations of the hepatic vein.展开更多
BACKGROUND: Liver failure is the most common cause of mortality for patients undergoing partial hepatectomy. Given adequate liver function and remnant liver volume and absence of co-morbid illness, the cause of liver ...BACKGROUND: Liver failure is the most common cause of mortality for patients undergoing partial hepatectomy. Given adequate liver function and remnant liver volume and absence of co-morbid illness, the cause of liver failure is frequently related to technical errors, which induces mas- sive bleeding and ischemic damage to the liver remnant. DATA RESOURCES: From author' s practice at Queen Mary Hospital, the University of Hong Kong. RESULTS: To avoid technical errors leading to liver ische- mia and failure, adequate exposure, control of bleeding during liver transection, and planning of transection plane are important. Ultrasonic dissector is the best instrument in liver transection. Its careful use can reduce blood loss and help recognize the hepatic vein, the exposure of which serves as an important landmark for a correct transection plane. Even without Pringle maneuver, minimum bleeding during transection could be achieved. CONCLUSION: Protection of the liver remnant is impor- tant to patient survival after partial hepatectomy. It is achieved by meticulous surgical techniques that reduce bleeding to a minimum.展开更多
AIM: To evaluate the outcome of transarterial chemoembolization (TACE) in patients with unresectable hepatocellular carcinoma (HCC) <5 cm in diameter eligible for radiofrequency ablation (RFA).METHODS: The treatment-...AIM: To evaluate the outcome of transarterial chemoembolization (TACE) in patients with unresectable hepatocellular carcinoma (HCC) <5 cm in diameter eligible for radiofrequency ablation (RFA).METHODS: The treatment-related mortality, morbidity,long-term survival, and prognostic factors of HCC patients who had TACE and fulfilled the present inclusion criteria for RFA were evaluated.RESULTS: Of the 748 patients treated with TACE between January 1990 and December 2002, 114 patients were also eligible for RFA. The treatment-related mortality and morbidity were 1% and 19%, respectively. Survival at 1, 3, and 5 years was 80%, 43%, and 23%, respectively. Older age and a high albumin level were associated with a better survival, whereas a high α-fetoprotein level (AFP) and the size of the largest tumor >3 cm in diameter were adverse prognostic factors in multivariate analysis.CONCLUSION: The morbidity, mortality, and survival data after TACE for small HCCs eligible for RFA are comparable to those reported after RFA in the literature. Our data suggest the need for a randomized comparison of the two treatment modalities for small HCCs.展开更多
Surgical resection with a tumor-free margin is the onlycurative treatment for hilar cholangiocarcinoma (Klatskin tumor). However, over half of the patients present late with unresectable tumors. Radiotherapy using ext...Surgical resection with a tumor-free margin is the onlycurative treatment for hilar cholangiocarcinoma (Klatskin tumor). However, over half of the patients present late with unresectable tumors. Radiotherapy using external beamirradiation or intraluminal brachytherapy (ILBT) has been used to treat unresectable hilar cholangiocarcinoma with satisfactory outcome. We reported a patient with unresectable hilar cholangiocarcinoma surviving more than 6 years after combined external beam irradiation and ILBT.展开更多
The shortage of cadaveric livers has sparked aninterest in adult live donor liver transplantation. Rightlobe donor hepatectomy is frequently required to ob-tain a graft of adequate size for adult recipients. Thisproce...The shortage of cadaveric livers has sparked aninterest in adult live donor liver transplantation. Rightlobe donor hepatectomy is frequently required to ob-tain a graft of adequate size for adult recipients. Thisprocedure requires not only a precise understanding ofliver anatomy and anatomic anomaly, but also themeans of assessing them. This review focuses on thekey points in adult live donor liver transplantation us-ing the right lobe combined with our own experiencein 81 cases including graft size, related anatomicalanomaly and imaging evaluation of donor.展开更多
AIM: To investigate the precise role of membrane type1-matrix metalloproteinase (MT1-MMP) in hepatocellular carcinoma (HCC) metastasis.METHODS: Human HCC cells Hep3B with overexpression of MT1-MMP were established by ...AIM: To investigate the precise role of membrane type1-matrix metalloproteinase (MT1-MMP) in hepatocellular carcinoma (HCC) metastasis.METHODS: Human HCC cells Hep3B with overexpression of MT1-MMP were established by stable transfection, and compared with control cells carrying the empty vector.Cells were examined in vivo for their differences in the metastatic ability of athymic nude mice, and analyzed in vitro for their differences in invasion ability by invasion chamber coated with Matrigel, adhesion towards collagen I and migration through culture chamber. Cell proliferation and apoptosis in adherent and suspension status were evaluated by MTT and flow cytometry analysis.RESULTS: We found that overexpression of MT1-MMP could increase intrahepatic metastasis in nude mice with orthotopic implantation of HCC cells (incidence of 100%[MT1-MMP transfectants] vs 40% [vector control transfectants], P<0.05). MT1-MMP could also enhance cell invasion through Matrigel (107.7 vs 39.3 cells/field,P<0.001), adhesion towards matrix (0.30 vs 0.12absorbance unit at 540 nm, P<0.001), cell migration(89.3 vs 39.0 cells/field, P<0.001), and cell proliferation(24.3 vs 40.5 h/doubling, P<0.001). We also observed that MT1-MMP supported cell survival (71.4% vs 23.9%,P<0.001) with reduced apoptosis (43.7% vs51.0%, P<0.05)in an attachment-free environment.CONCLUSION: MT1-MMP overexpression could enhance metastasis. In addition to its active role in matrix degradation during tumor invasion, MT1-MMP enhances tumor cell survival upon challenge of detachment, which is important during metastasis when cells enter the circulation.展开更多
AIM: To investigate the biological impacts of 'hot-spot'mutations on genotype B and C HBV X proteins (HBx).METHODS: Five types of'hot-spot' mutations of genotype B or C HBV X genes, which sequentially ...AIM: To investigate the biological impacts of 'hot-spot'mutations on genotype B and C HBV X proteins (HBx).METHODS: Five types of'hot-spot' mutations of genotype B or C HBV X genes, which sequentially lead to the amino acid substitutions of HBx as I127T, F132Y, K130M+V131I,I127T+K130M+V131I, or K130M+V131I+F132Y, respectively,were generated by means of site-directed mutagenesis.To evaluate the anti-proliferative effects, HBx or related mutants' expression vectors were transfected separately to the Chang cells by lipofectamine, and the cells were cultured in hygromycin selective medium for 14 d, drug-resistant colonies were fixed with cold methanol, stained with Giemsa dyes and scored (increase of the colonies indicated the reduction of the anti-proliferation activity,and vice versa). Different types of HBx expression vectors were co-transfected separately with the reporter plasmid pCMVβ to Chang cells, which were lysed 48 h post-transfection and the intra-cellular β-galactosidase activities were monitored (increase of the β-galactosidase activities indicated the reduction of the transactivation activity, and vice versa). All data obtained were calculated by paired-samples t-test.RESULTS: As compared to standard genotype B HBx,mutants of I127T and I127T+K130M+V131I showed higher transactivation and anti-proliferative activities, while the mutants of F132Y, K130M+V131I, and K130M+V131I+F132Y showed lower activities. As compared to standard genotype C HBx, I127T mutant showed higher transactivation activity, while the other four types of mutants showed no differences. With regard to anti-proliferative activity,compared to standard genotype C HBx, F132Y and K130M+V131I mutants showed lower activities, and K130M+V131I +F132Y mutant, on the other hand, showed higher activity,while the mutants of I127T and I127T+K130M+V131I showed no differences.CONCLUSION: 'Hot-spot' mutations affect the antiproliferation and transactivation activities of genotype B and/or C HBx, and the biological impacts of most 'hot-spot' mutations on HBx are genotype B and C differentiated.展开更多
AIM: To evaluate the correlation between serum vascular cellular adhesion molecule-1 (VCAM-1) levels and clinicopathological features in patients with hepatocellular carcinoma (HCC).METHODS: Ninety-six patients who un...AIM: To evaluate the correlation between serum vascular cellular adhesion molecule-1 (VCAM-1) levels and clinicopathological features in patients with hepatocellular carcinoma (HCC).METHODS: Ninety-six patients who underwent HCC resection were recruited in the study. Preoperative serum levels of soluble VCAM-1 were measured by enzyme-linked immunosorbent assay.RESULTS: Serum VCAM-1 level in HCC patients was inversely correlated with platelet count (r=-0.431,P<0.001)and serum albumin level (r=-0.279, P<0.001), and positively correlated with serum bilirubin level (r=-0.379, P<0.001).Serum VCAM-1 level was not associated with tumor characteristics such as tumor size, venous invasion,presence of microsatellite nodules, tumor grade and tumor stage. Serum VCAM-1 level was significantly higher in HCC patients with cirrhosis compared with those without cirrhosis (median 704 vs 546 ng/mL, P<0.001). Furthermore, a significantly better disease-free survival was observed in HCC patients with low VCAM-1 level (P=0.019).CONCLUSION: Serum VCAM-1 level appears to reflect the severity of underlying chronic liver disease rather than the tumor status in HCC patients, and low preoperative serum VCAM-1 level is predictive of better disease-free survival after surgery.展开更多
ABSTRACT: Fulminant hepatic failure is a medical emer-gency. When this condition declared itself irreversible, atimely liver transplantation is the only effective treatment.A 34-year-old Chinese with fulminant hepatic...ABSTRACT: Fulminant hepatic failure is a medical emer-gency. When this condition declared itself irreversible, atimely liver transplantation is the only effective treatment.A 34-year-old Chinese with fulminant hepatic failure wasevaluated as a potential liver transplantation candidate. Onthe erect chest radiograph, Chilaiditi' s sign has developedover a very short period of a week due to rapid shrinkage ofthe liver. Awareness of Chilaiditi' s sign facilitated distin-guishing the condition of free gas under the diaphragm dueto bowel perforation and subphrenic abscess by gas formingmicro-organisms. Rapidity of onset of this sign parallels thedeterioration of liver function and reflects the urgency ofcondition.展开更多
Background: Intermittent Pringle manoeuvre resul- ted in less blood loss and better preservation of liver function when it was applied for fewer than 120 mi- nutes. The mechanism of better preservation of liver functi...Background: Intermittent Pringle manoeuvre resul- ted in less blood loss and better preservation of liver function when it was applied for fewer than 120 mi- nutes. The mechanism of better preservation of liver function under intermittent Pringle manoeuvre at molecular level remains unclear. Furthermore, the ultrastructural features in the liver with chronic di- seases under intermittent Pringle manoeuvre have not been studied. The aim of the study is to investigate the expression of stress genes and ultrastructural change of the liver under intermittent Pringle ma- noeuvre. Methods: From July 1995 to February 1998, 131 pa- tients underwent hepatectomy for liver tumours (61 patients without Pringle manoeuvre and 70 patients with intermittent Pringle manoeuvre). Twenty-five patients (15 with Pringle manoeuvre and 10 without Pringle manoeuvre) were included in the study of he- patic stress gene expression during hepatectomy. Twenty-two patients (18 patients with intermittent Pringle manoeuvre and four patients without Pringle manoeuvre) were randomly assigned for electron mi- croscopic examination. Results: For the expression of stress genes, both the heat shock genes (HSP 70A and HSC 70) and acute phase genes (TNF-α and interleukin-6) were detec- ted simultaneously in the patients with or without in- termittent Pringle manoeuvre. The patients under in- termittent Pringle manoeuvre had relatively higher mRNA levels of heat shock gene 70 family, which is related to intracellular repair and protection. Induc- tion of TNF-α and interleukin-6 genes, which con- tributed to ischaemia-reperfusion injury and posto- perative complication, was not found in the patients under intermittent Pringle manoeuvre. Under the e- lectron microscopy, the hepatic ultrastructure was well maintained under intermittent Pringle manoeu- vre whatever the liver status, even when the accumu- lated ischaemic duration was extended to 120 min. Conclusion: Intermittent Pringle manoeuvre induced relatively higher expression of heat shock genes, which are related to intracellular homeostasis, and is consistent with the well maintenance of liver ultra- structure.展开更多
文摘Inflammatory pseudotumor of the liver is a rare benign lesion that can mimic a malignant liver nioplasm. A case of inflammatory pseudotumor of the liver found in association with a malignant gastrointestinal stromal tumor (GIST) of the small bowel was reported. The inflammatory pseudotumor was misdiagnosed as a metastasis from the GIST by frozen section. A correct diagnosis was made only after histopathological examination of the paraffin section of the resescted specimen. This case is psrticularly interesting because of the association of the two rare pathological entities and the diagnostic dilemma that arose from the similarity of their histological appearances. To our knowledge,this association has not been reported in the literature.
基金This study was supported by Sun C. Y. Research Foundation for Hepatobiliary and Pancreatic Surgery ot the Uni- versity of Hong Kong.
文摘Including the middle hepatic vein in the right lobe liver graft has the advantage of providing direct venous drainage of the right anterior segment. To allow unimpeded passage of blood flow, we previously designed venoplasty of the middle and right hepatic veins. We found that venoplasty is also feasible when the inferior right hepatic vein is near to the right hepatic vein, or when multiple segment 8 hepatic vein orifices are exposed adjacent to the middle hepatic vein at the graft transection surface. By joining the hepatic vein orifices into a single opening, the anastomosis into the inferior vena cava is much facilitated. The technique is simple, yet versatile , and able to cope with variation of the configurations of the hepatic vein.
文摘BACKGROUND: Liver failure is the most common cause of mortality for patients undergoing partial hepatectomy. Given adequate liver function and remnant liver volume and absence of co-morbid illness, the cause of liver failure is frequently related to technical errors, which induces mas- sive bleeding and ischemic damage to the liver remnant. DATA RESOURCES: From author' s practice at Queen Mary Hospital, the University of Hong Kong. RESULTS: To avoid technical errors leading to liver ische- mia and failure, adequate exposure, control of bleeding during liver transection, and planning of transection plane are important. Ultrasonic dissector is the best instrument in liver transection. Its careful use can reduce blood loss and help recognize the hepatic vein, the exposure of which serves as an important landmark for a correct transection plane. Even without Pringle maneuver, minimum bleeding during transection could be achieved. CONCLUSION: Protection of the liver remnant is impor- tant to patient survival after partial hepatectomy. It is achieved by meticulous surgical techniques that reduce bleeding to a minimum.
基金Supported by the Sun CY Research Foundation for Hepatobiliary and Pancreatic Surgery of the University of Hong Kong, China
文摘AIM: To evaluate the outcome of transarterial chemoembolization (TACE) in patients with unresectable hepatocellular carcinoma (HCC) <5 cm in diameter eligible for radiofrequency ablation (RFA).METHODS: The treatment-related mortality, morbidity,long-term survival, and prognostic factors of HCC patients who had TACE and fulfilled the present inclusion criteria for RFA were evaluated.RESULTS: Of the 748 patients treated with TACE between January 1990 and December 2002, 114 patients were also eligible for RFA. The treatment-related mortality and morbidity were 1% and 19%, respectively. Survival at 1, 3, and 5 years was 80%, 43%, and 23%, respectively. Older age and a high albumin level were associated with a better survival, whereas a high α-fetoprotein level (AFP) and the size of the largest tumor >3 cm in diameter were adverse prognostic factors in multivariate analysis.CONCLUSION: The morbidity, mortality, and survival data after TACE for small HCCs eligible for RFA are comparable to those reported after RFA in the literature. Our data suggest the need for a randomized comparison of the two treatment modalities for small HCCs.
文摘Surgical resection with a tumor-free margin is the onlycurative treatment for hilar cholangiocarcinoma (Klatskin tumor). However, over half of the patients present late with unresectable tumors. Radiotherapy using external beamirradiation or intraluminal brachytherapy (ILBT) has been used to treat unresectable hilar cholangiocarcinoma with satisfactory outcome. We reported a patient with unresectable hilar cholangiocarcinoma surviving more than 6 years after combined external beam irradiation and ILBT.
文摘The shortage of cadaveric livers has sparked aninterest in adult live donor liver transplantation. Rightlobe donor hepatectomy is frequently required to ob-tain a graft of adequate size for adult recipients. Thisprocedure requires not only a precise understanding ofliver anatomy and anatomic anomaly, but also themeans of assessing them. This review focuses on thekey points in adult live donor liver transplantation us-ing the right lobe combined with our own experiencein 81 cases including graft size, related anatomicalanomaly and imaging evaluation of donor.
基金Supported by the Seed Funding Program of the University of Hong Kong
文摘AIM: To investigate the precise role of membrane type1-matrix metalloproteinase (MT1-MMP) in hepatocellular carcinoma (HCC) metastasis.METHODS: Human HCC cells Hep3B with overexpression of MT1-MMP were established by stable transfection, and compared with control cells carrying the empty vector.Cells were examined in vivo for their differences in the metastatic ability of athymic nude mice, and analyzed in vitro for their differences in invasion ability by invasion chamber coated with Matrigel, adhesion towards collagen I and migration through culture chamber. Cell proliferation and apoptosis in adherent and suspension status were evaluated by MTT and flow cytometry analysis.RESULTS: We found that overexpression of MT1-MMP could increase intrahepatic metastasis in nude mice with orthotopic implantation of HCC cells (incidence of 100%[MT1-MMP transfectants] vs 40% [vector control transfectants], P<0.05). MT1-MMP could also enhance cell invasion through Matrigel (107.7 vs 39.3 cells/field,P<0.001), adhesion towards matrix (0.30 vs 0.12absorbance unit at 540 nm, P<0.001), cell migration(89.3 vs 39.0 cells/field, P<0.001), and cell proliferation(24.3 vs 40.5 h/doubling, P<0.001). We also observed that MT1-MMP supported cell survival (71.4% vs 23.9%,P<0.001) with reduced apoptosis (43.7% vs51.0%, P<0.05)in an attachment-free environment.CONCLUSION: MT1-MMP overexpression could enhance metastasis. In addition to its active role in matrix degradation during tumor invasion, MT1-MMP enhances tumor cell survival upon challenge of detachment, which is important during metastasis when cells enter the circulation.
基金Supported by the Foundation for the Author of National Excellent Doctoral Dissertation of PR China, No. 200359Fujian Natural Science Key Foundation, No, 2002F005Fujian Science and Technology Innovation Foundation for Young Scientists, No.2001J058
文摘AIM: To investigate the biological impacts of 'hot-spot'mutations on genotype B and C HBV X proteins (HBx).METHODS: Five types of'hot-spot' mutations of genotype B or C HBV X genes, which sequentially lead to the amino acid substitutions of HBx as I127T, F132Y, K130M+V131I,I127T+K130M+V131I, or K130M+V131I+F132Y, respectively,were generated by means of site-directed mutagenesis.To evaluate the anti-proliferative effects, HBx or related mutants' expression vectors were transfected separately to the Chang cells by lipofectamine, and the cells were cultured in hygromycin selective medium for 14 d, drug-resistant colonies were fixed with cold methanol, stained with Giemsa dyes and scored (increase of the colonies indicated the reduction of the anti-proliferation activity,and vice versa). Different types of HBx expression vectors were co-transfected separately with the reporter plasmid pCMVβ to Chang cells, which were lysed 48 h post-transfection and the intra-cellular β-galactosidase activities were monitored (increase of the β-galactosidase activities indicated the reduction of the transactivation activity, and vice versa). All data obtained were calculated by paired-samples t-test.RESULTS: As compared to standard genotype B HBx,mutants of I127T and I127T+K130M+V131I showed higher transactivation and anti-proliferative activities, while the mutants of F132Y, K130M+V131I, and K130M+V131I+F132Y showed lower activities. As compared to standard genotype C HBx, I127T mutant showed higher transactivation activity, while the other four types of mutants showed no differences. With regard to anti-proliferative activity,compared to standard genotype C HBx, F132Y and K130M+V131I mutants showed lower activities, and K130M+V131I +F132Y mutant, on the other hand, showed higher activity,while the mutants of I127T and I127T+K130M+V131I showed no differences.CONCLUSION: 'Hot-spot' mutations affect the antiproliferation and transactivation activities of genotype B and/or C HBx, and the biological impacts of most 'hot-spot' mutations on HBx are genotype B and C differentiated.
基金Supported by the Committee on Research-and Conferences Grant of the University of Hong Kong 2002-2003 and Sun CY Research Foundation for Hepatobiliary and Pancreatic Surgery of the University of Hong Kong,China
文摘AIM: To evaluate the correlation between serum vascular cellular adhesion molecule-1 (VCAM-1) levels and clinicopathological features in patients with hepatocellular carcinoma (HCC).METHODS: Ninety-six patients who underwent HCC resection were recruited in the study. Preoperative serum levels of soluble VCAM-1 were measured by enzyme-linked immunosorbent assay.RESULTS: Serum VCAM-1 level in HCC patients was inversely correlated with platelet count (r=-0.431,P<0.001)and serum albumin level (r=-0.279, P<0.001), and positively correlated with serum bilirubin level (r=-0.379, P<0.001).Serum VCAM-1 level was not associated with tumor characteristics such as tumor size, venous invasion,presence of microsatellite nodules, tumor grade and tumor stage. Serum VCAM-1 level was significantly higher in HCC patients with cirrhosis compared with those without cirrhosis (median 704 vs 546 ng/mL, P<0.001). Furthermore, a significantly better disease-free survival was observed in HCC patients with low VCAM-1 level (P=0.019).CONCLUSION: Serum VCAM-1 level appears to reflect the severity of underlying chronic liver disease rather than the tumor status in HCC patients, and low preoperative serum VCAM-1 level is predictive of better disease-free survival after surgery.
文摘ABSTRACT: Fulminant hepatic failure is a medical emer-gency. When this condition declared itself irreversible, atimely liver transplantation is the only effective treatment.A 34-year-old Chinese with fulminant hepatic failure wasevaluated as a potential liver transplantation candidate. Onthe erect chest radiograph, Chilaiditi' s sign has developedover a very short period of a week due to rapid shrinkage ofthe liver. Awareness of Chilaiditi' s sign facilitated distin-guishing the condition of free gas under the diaphragm dueto bowel perforation and subphrenic abscess by gas formingmicro-organisms. Rapidity of onset of this sign parallels thedeterioration of liver function and reflects the urgency ofcondition.
文摘Background: Intermittent Pringle manoeuvre resul- ted in less blood loss and better preservation of liver function when it was applied for fewer than 120 mi- nutes. The mechanism of better preservation of liver function under intermittent Pringle manoeuvre at molecular level remains unclear. Furthermore, the ultrastructural features in the liver with chronic di- seases under intermittent Pringle manoeuvre have not been studied. The aim of the study is to investigate the expression of stress genes and ultrastructural change of the liver under intermittent Pringle ma- noeuvre. Methods: From July 1995 to February 1998, 131 pa- tients underwent hepatectomy for liver tumours (61 patients without Pringle manoeuvre and 70 patients with intermittent Pringle manoeuvre). Twenty-five patients (15 with Pringle manoeuvre and 10 without Pringle manoeuvre) were included in the study of he- patic stress gene expression during hepatectomy. Twenty-two patients (18 patients with intermittent Pringle manoeuvre and four patients without Pringle manoeuvre) were randomly assigned for electron mi- croscopic examination. Results: For the expression of stress genes, both the heat shock genes (HSP 70A and HSC 70) and acute phase genes (TNF-α and interleukin-6) were detec- ted simultaneously in the patients with or without in- termittent Pringle manoeuvre. The patients under in- termittent Pringle manoeuvre had relatively higher mRNA levels of heat shock gene 70 family, which is related to intracellular repair and protection. Induc- tion of TNF-α and interleukin-6 genes, which con- tributed to ischaemia-reperfusion injury and posto- perative complication, was not found in the patients under intermittent Pringle manoeuvre. Under the e- lectron microscopy, the hepatic ultrastructure was well maintained under intermittent Pringle manoeu- vre whatever the liver status, even when the accumu- lated ischaemic duration was extended to 120 min. Conclusion: Intermittent Pringle manoeuvre induced relatively higher expression of heat shock genes, which are related to intracellular homeostasis, and is consistent with the well maintenance of liver ultra- structure.