ABSTRACT
Primary liver cancer is the sixth most commonly diagnosed cancer and the third leading cause of cancer death worldwide, and hepatocellular carcinoma is the main type of primary liver cancer. HCC is insidious and asymptomatic at an early stage, and when clinically relevant, the disease is often in the middle to late stages. As a result, most patients miss out on radical treatment at the time of diagnosis, leading to high recurrence and metastasis rates and poor prognosis. At present, there are more and more methods in the treatment of hepatocellular carcinoma. Photothermal therapy, as an emerging cancer treatment, has attracted widespread attention due to its minimally invasive, low-cost, high efficiency, low side effects and strong targeting. Research progress of photothermal therapy and its synergistic therapy in the treatment of hepatocellular carcinoma were reviewed in this paper, aiming to explore new ideas and strategies for the treatment of hepatocellular carcinoma.
ABSTRACT
Objective To systematically evaluate the safety and feasibility of enhanced recovery after surgery (ERAS) in perioperative management of pancreatectomy.Methods Literatures were researched using CNKI,Wanfang database,VIP database,PubMed,Cochrane Library,Embase from January 1990 to March 2018 with the key words including "快速康复外科,加速康复外科,胰腺切除术,胰十二指肠切除术,惠普而术,ERAS,enhanced recovery,fast track,pancreatic surgery,pancreatectomy,Whipple,pancreatoduodenectomy,pancreatoduodenal resection".The cohort study about ERAS in elective pancreatic surgery or pancreaticoduodenectomy were received and enrolled.The patients using ERAS in perioperative management and using traditional perioperative management were respectively allocated into the ERAS group and control group.Two reviewers independently screened literatures,extracted data and assessed the risk of bias.Count data were described as odds ratio (OR) and 95％ confidence interval (CI).Weighted Mean Difference (WMD) was used as a consolidated statistics for measurement data that were measured using the same tool,and standardized mean difference (SMD) was used as a consolidated statistics for measurement data that were measured using the different tools.The heterogeneity of the studied was analyzed using the I2 test.Results Nineteen retrospective cohort studies were enrolled in the Meta analysis,and total sample size was 3 699 patients,including 1 823 in the ERAS group and 1 876 in the control group.The results of Meta analysis showed that there were statistically significant differences in the time of postoperative nasogastric tube removal,time for postoperative solid diet intake,time of postoperative defecation recovery,incidence of postoperative overall complications,incidence of postoperative delayed gastric emptying,incidence of postoperative intra-abdominal infection,duration of postoperative hospital stay and hospital expenses between ERAS group and control group (WMD=-1.70,-3.61,-0.86,OR =0.65,0.60,0.70,WMD=-4.64,SMD=-0.48,95％CI:-2.97--0.42,-4.70--2.53,-1.01--0.71,0.52-0.81,0.45-0.80,0.54-0.91,-5.91--3.38,-0.77--0.18,P ＜ 0.05).There was no statistically significant difference in the operation time,volume of intraoperative blood loss,incidence of postoperative pancreatic fistula,incidence of postoperative wound infection,readmission rate,reoperation rate and mortality between ERAS group and control group (WMD=-9.73,-14.39,OR=0.85,0.72,1.05,0.81,0.74,95％CI:-34.24-14.78,-116.96-88.17,0.72-1.01,0.46-1.14,0.83-1.32,0.58-1.13,0.53-1.02,P＞0.05).The results of subgroup analysis showed that heterogeneity of data was from eastern and western countries.Conclusion ERAS in the perioperative management of pancreatectomy is safe and feasible,it can also promote postoperative recovery of patients and reduce incidence of complications and financial burden.
ABSTRACT
ObjectiveTo evaluate the effect of preoperative percutaneous transhepatic biliary drainage (PTBD) on postoperative outcomes after pancreaticoduodenectomy.MethodsThe clinical data of 115 patients undergoing pancreatoduodenectomy between 2001 and 2009 were retrospectively analyzed.The diagnosis of periampullary cancer or cancer of the pancreatic head was confirmed histologically.The preoperative total bilirubin level was more than 100 μmol/L and there was no concomitant cholangitis.Forty-two patients underwent PTBD (PTBD group),and 73 were not drained (early operation group).The following parameters were analyzed:wound infection,intra-abdominal abscess,intra-abdominal or gastrointestinal bleeding,biliary or pancreatic leakage,gastroparesis,morbidity and mortality.The length of hospital stay and cost were also assessed.ResultsThe perioperative mortality and morbidity were 2.38％/54.76％ in the PTBD group and 2.74％/50.68％ in the early operative group,respectively.There were no significantly differences between these two groups.Similar results were obtained in biliary leak,pancreatic leak,intra-abdominal infection,wound infection and gastroparesis.The length of hospital stay and cost were significantly less in the early operation group than the PTBD group.ConclusionsPTBD had no beneficial effects on postoperative outcomes following pancreaticoduodenectomy.For distal biliary obstruction,PTBD should not be carried out routinely.
ABSTRACT
Objective To investigate the value of Habib 4X in hepatic resection. Methods The clinical outcome of 21 patients with liver disease who received liver resection at the Tianjin Third Central Hospital from November 2009 to April 2010 were retrospectively evaluated. All the operations were carried out by using Habib 4X. Results All patients received hepatectomy, including right hepatectomy in three patients, left hepatectomy in one patient, multiple segmentectomy in nine patients, single segmentectomy in seven patients and partial liver resection in one patient. All tumors were reseeted completely. The mean operation time was (50±25) minutes and the mean blood loss was(129±117)ml. No patient was transferred to ICU. Three patients were complicated with bile leakage, one with lymphatic leakage and four with pleural effusion, and they were cured by non-surgical treatment. There were no patients with postoperative hemorrhage, incision infection or hepatic failure. No mortality was observed. The mean postoperative hospital stay was(19±14)days. Conclusions Radiofrequency energy was applied along the margins of the tumor to create zones of necrosis before resection with a scalpel, offering hepatobiliary surgeons an additional method for performing liver resections with minimal blood loss, low morbidity and mortality rates. As for malignant tumors, minor or major liver resection assisted by Habib 4X is safe, and it can reduce the chance of positive incisal margin.
ABSTRACT
Objective To analyze the features of clinical diagnosis and treatment of duodenal gastrointestinal stromal tumors(GIST).Methods Retrospective analysis was performed on clinical data of 5 cases of duodenal GIST treated in our hospital between April 2002 and May 2009.Results The duodenal GIST was mainly located in the 2nd(3/5)and 3rd portion of duodenum(2/5).Clinical diagnosis of the disease mainly depended on barium meal examination, gastrointestinal endoscopy, and CT scanning.Two patients were treated with pancreaticoduodenectomy, 1 with segmental duodenectomy and 2 with local resection.After operation, 2 patients had recurrence and 1 of them underwent adjuvant therapy with Gleevec.Conclusion Surgical resection is the only effective therapeutic method for duodenal GIST.Various surgical procedures are mainly determined by the location and size of the tumors.For patients with a high degree of pathologic grade, adjuvant therapy with Gleevec is necessary.
ABSTRACT
Objective To study the value of transcatheter arterial chemoembolization (TACE)in combination with portal vein chemotherapy (PVC) after resection of hepatocellular carcinoma to prolong survival. Methods From January 2000 to July 2007, 168 patients with hepatocellular carcinoma (HCC) underwent tumor resection in our hospital. After operation, TACE in combination with PVC was performed in 48 patients (combined group), TACE alone in 26 (TACE group), PVC alone in 50 (PVC group) and none of the above in 44 (control group). All the patients were followed up for 17-96 months. The 1-, 3-and 5-year survival rates were compared among the 4 groups. Results Accumulative 1-, 3-and 5-year survival rates were higher in the combined and TACE groups than in PVC and control groups. Conclusion After resection of HCC, combined use of TACE and PVC is the same as TACE in prolonging patient survival. However, it is better than PVC alone and non-surgical procedure.
ABSTRACT
In this paper, we address the preparation of the EPC and HEPC sterically stabilized doxorubicin liposomes and report the data collected from further studies on pharmacokinetics in blood for choosing a better carrier in delivering the drugs. The pharmacokinetics of EPC and HEPC sterically stabilized liposomes (EPC-SSL, and HEPC-SSL) in Wistar rats were investigated by HPLC. The results showed that the mean residence time of HEPC-SSL in blood is 23.3 h, while that of EPC-SSL is 12.0 h. In conclusion, HEPC-SSL is a better carrier in delivering the drugs to the extravascular sites when compared with EPC-SSL.
Subject(s)
Animals , Rats , Antibiotics, Antineoplastic , Pharmacokinetics , Delayed-Action Preparations , Pharmacokinetics , Doxorubicin , Pharmacokinetics , Drug Carriers , Chemistry , Hydrogenation , Liposomes , Phosphatidylcholines , Chemistry , PharmacologyABSTRACT
This article presents the design of a bioreactor using hollow fiber membrane and, isolated hepatocytes of suckling pigs, and the experimental study of its efficacy in vitro. Liver cells were harvested from suckling pigs with collagenase perfusion in situ, and parenchymal and non-parenchymal hepatocytes were cocultured in a hollow fiber module which was rotated sporadically. Bioartificial liver(BAL) was developed using this bioreactor,and the BAL was perfused with ascites of patients suffering from liver cirrhosis. The yield of viable hepatocytes was (6.29 +/- 0.37) x 10(8) cells, and cell viability was greater than 84%. Hepatocytes aggregated to multi-cells spheroids after being rotated every thirty minutes for three hours. The hepatocytes in the bioreactor could synthesize urea. Total billirubin was decreased, and AST was significantly increased in the group of bioreactor, as compared with that in the control group. Glucose decreased in the group of bioreactor,whereas there was no significant descent in the control group; and the difference between the two groups was significant. The above results demonstrate that this bioreactor is effective for decreasing total bilirubin and glucose.
Subject(s)
Animals , Animals, Newborn , Bioreactors , Cell Separation , Cells, Cultured , Hepatocytes , Cell Biology , Liver, Artificial , SwineABSTRACT
Objective: To study the possibility of liposomes to ta rget hepatocytes af ter being linked with asialofetuin(AF). Methods: The biodistribu tions in differen t cells in liver as well as in blood, in various organs such as heart, spleen, l ung and kidney of mice, of traditional sterically stabilized liposomes(SSL) , AF-linked normal liposomes(AF-NL) and AF-linked sterically stabilized lipos ome s(AF-SSL) were studied by radioisotopic labeling. Results: The half-live s of SSL, AF-NL and AF-SSL were 14.44, 4.73 and 11.49 h， respectively. The di strib ution of liposomes in liver was AF-NL>AF-SSL>SSL. There was significant differenc e among these three formulations. In hepatocytes and non-hepatocytes, the conce ntr ations of the liposomes were both in line with the sequence AF-NL>AF-SSL>SSL( P <0.05). However, the ra tios of the concentrations in hepatocytes to that of non-hepatocytes were AF-N L≈AF -SSLSSL( P <0.05). Conclusion: After being labeled with asi alofetuin, liposomes can target hepatocytes very we ll， whether in long-circulation or not.