Application of digitalized minimally invasive technique in treatment of hepatolithiasis based on MI-3DVS / 南方医科大学学报

<p><b>OBJECTIVE</b>To assess the clinical value of digitalized minimally invasive technique in the treatment of the hepatolithiasis.</p><p><b>METHODS</b>The 64-slice spiral CT data were acquired from 4 hepatolithiasis patients for three-dimensional reconstruction and simulation operation using abdominal medical image-3D visualization system (MI-3DVS). Three-dimensional reconstruction was performed for the liver, hepatic arteries, hepatic veins, portal veins, intrahepatic bile ducts and calculi. Based on the size and position of the calculi and the distribution of the dilated or stenotic biliary ducts, several simulation operations such as partial hepatectomy and hepaticojejunstomy were performed. With guidance by the findings in the simulation operation, the actual minimally invasive operation was performed.</p><p><b>RESULTS</b>The three-dimensional models of the liver, hepatic arteries, hepatic veins, portal veins, intrahepatic bile ducts and calculi were reconstructed successfully, which clearly visualized the site and the number of calculi and the condition of the involved intrahepatic bile ducts. Guided by the three-dimensional models and the simulation operations, partial hepatectomy and hepaticojejunstomy were performed and the calculi were removed completely in all the 4 cases with maximum preservation of the residual liver volume.</p><p><b>CONCLUSION</b>Three-dimensional reconstruction and simulation operation allows digital minimally invasive treatment of hepatolithiasis, which can be a new approach to hepatobiliary surgery.</p>

Application of three-dimensional visualization technology in precise diagnosis and treatment for hepatolithiasis / 南方医科大学学报

<p><b>OBJECTIVE</b>To assess the value of three-dimensional (3D) visualization technique in preoperative diagnosis, preoperative evaluation and surgical guidance for hepatolithiasis.</p><p><b>METHODS</b>The 64-slice spiral CT data of 30 hepatolithiasis cases were imported in a self-designed medical image processing system for 3D reconstruction of the intrahepatic bile duct. The preoperative diagnosis and pathological classification were derived from the reconstructed model, with which the feasibility and safety of the surgical plan were assessed by simulation of the surgical procedures. The consistency between the simulated procedure and the actual operation was evaluated, and the residual stones were detected using cholangiography with a T-shaped tube.</p><p><b>RESULTS</b>When the model setting was configured to render the liver translucent, the system clearly displayed the site and number of the bile duct calculi as well as the expansion or narrowing of the intrahepatic bile duct. A total consistency (100%) was found between the surgical findings and the preoperative findings based on the 3D model, and also between the actual surgical procedures and the preoperative simulation in 30 cases. The consistency rate between the actual surgical protocols and the preoperative surgical plan was 90%. Follow-up of 27 of the patients for 6 months showed a recurrence rate of 7.4% (2/27) after the operation.</p><p><b>CONCLUSION</b>The 3D visualization system allows accurate preoperative diagnosis and precise surgical operation to reduce the postoperative recurrence rate, and can be of value as a new diagnostic and treatment modality in biliary surgery.</p>

Application of the medical image three-dimensional visualization system of abdomen in diagnosis and evaluating resectability of pancreatic tumors / 中华外科杂志

<p><b>OBJECTIVE</b>To study the value and the clinical application of the Medical Image three-dimensional Visualization System of Abdomen (MI-3DVS) in diagnosis and evaluating resectability of pancreatic tumor.</p><p><b>METHODS</b>Twelve patients with pancreatic tumor were tested with 64-slice helical CT (64-MSCT) angiography, and the CT data was reconstructed with MI-3DVS from November 2008 to August 2009. The 3D findings were adopted in diagnosis and evaluating resectability, and the results were compared with surgical operation and the pathological finding. There were 7 male and 5 female, aged from 14 to 83 years. Within the 12 cases, there were 4 cases with pancreatic carcinoma, 5 cases with pancreatic solid pseudopapillary tumor, 2 cases with pancreatic serous cystadenoma, 1 case with pancreatic cyst (ductal epithelial papillary hyperplasia).</p><p><b>RESULTS</b>Nine tumors which had been regarded as removable pre-operatively with MI-3DVS were removed successfully. Three patients who were considered unresectable by other hospitals with CT were operated successfully with MI-3DVS. The other 3 patients' tumors were actually not able to be removed as pre-operative evaluation.</p><p><b>CONCLUSION</b>MI-3DVS plays an important role in diagnosis and assessment of resectability of pancreatic tumor.</p>

Minimally invasive surgical treatment with per-pancreat region for sever acute pancreatitis / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the clinical effect of the minimally invasive surgical treatment with per-pancreat region for sever acute pancreatitis (SAP).</p><p><b>METHODS</b>Fify-four cases of SAP were divided into two groups, patients of group A (n = 28) were given minimally invasive surgical treatments (step 1: under local anesthesia, patients were put the home-made double cannula in the abdominal around the region of pancreas.step 2:patients with biliary stone were performed by laparoscopical operations). Patients of group B (n = 26) were treatment by open operations including biliary decompression, gastrostomy, jejunostomy, removing necrotic pancreatic organizations and puting the double cannula around the region of pancreas. Through double cannula around the pancreas area, all patient's cavity were persistently douched using 0.5% 5-FU saline solution.</p><p><b>RESULTS</b>Washed after one week, two groups patient's drainage fluid amylase concentration were decreased significantly (t = 2.68, P = 0.013; t = 2.41, P = 0.028), patient's white cell count, body temperature, heart rate of Groups A were also decreased significantly (t = 2.32, P = 0.035; t = 2.39, P = 0.021; t = 2.38, P = 0.023). Compared with group B, the mortality, the incidence of complications, hospitalization time and total cost of treatment of group A patients were significantly lower than that of group B (chi(2) = 8.62, P = 0.001; chi(2) = 6.35, P = 0.014; t = 2.22, P = 0.034; t = 2.67, P = 0.010), but the cure rate was significantly higher than that of group B (chi(2) = 3.89, P = 0.045).</p><p><b>CONCLUSIONS</b>Minimally invasive surgical treatment of per-pancreatic region for SAP can not only remove the causes, but also fully drainage and timely block the pathological vicious cycle of SAP. What is more, it is simple, minimally invasive and have few complications and significant effect.</p>

Study on the application of value of digital medical technology in the operation on primary liver cancer / 中华外科杂志

<p><b>OBJECTIVE</b>To study the clinical application of digital medical in the operation on primary liver cancer.</p><p><b>METHODS</b>The patients (n=11) with primary hepatic carcinoma treated between February and July 2008, including 9 cases of hepatocellular carcinoma, 2 cases of cholangiocellular carcinoma, were scanned using 64 slices helicon computerized tomography (CT) and the datasets was collected. Segment and three-dimensional (3D) reconstruction of the CT image was carried out by the medical image processing system which was developed. And the 3D moulds were imported to the FreeForm Modeling System for smoothing. Then the hepatectomy in treatment of hepatoma and implanting of catheter were simulated with the force-feedback equipment (PHANToM). Finally, 3D models and results of simulation surgery were used for choosing mode of operation and comparing with the findings during the operation.</p><p><b>RESULTS</b>The reconstructed models were true to life, and their spatial disposition and correlation were shown clearly; Blood supply of primary liver cancer could be seen easily. In the simulation surgery system, the process of virtual partial hepatectomy and implanting of catheter using simulation scalpel and catheter on 3D moulds with PHANToM was consistent with the clinical course of surgery. Life-like could be felt and power feeling can be touched during simulation operation.</p><p><b>CONCLUSIONS</b>Digital medical benefited knowing the relationship between primary liver cancer and the intrahepatic pipe. It gave an advantage to complete primary liver cancer resection with more liver volume remained. It can improve the surgical effect and decrease the surgical risk and reduce the complication through demonstrating visualized operation before surgery.</p>

Detection of multidrug resistance-associated proteins MRP2, MRP3, and MRP5 mRNA expressions in hepatocarcinoma cells using SYBR real-time PCR / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the differential expression of genes encoding multidrug resistance-associated protein 2 (MRP2), MRP3 and MRP5 in human normal liver cell line L-02, hepatocarcinoma cell line BEL and its adriamycin-resistant counterpart BEL/ADM cell line.</p><p><b>METHODS</b>The total RNA was extracted from L-02, BEL and BEL/ADM cells, respectively, and the mRNAs were reversely transcribed into cDNA. The expression levels of MRP2, MRP3, MRP5 mRNAs were detected according to the standard curve using real-time fluorescence quantitative PCR.</p><p><b>RESULTS</b>The expression of MRP2 mRNA in BEL/ADM cell line was significantly higher than that in L-02 and BEL cells (P=0.000), and the latter two cells showed similar expression levels of MRP2 mRNA (P=0.468). The expressions of MRP3 and MRP5 mRNA showed statistically significant difference between the 3 cell lines (P=0.000).</p><p><b>CONCLUSION</b>MRP2 might play a role in the intrinsic drug resistance, and MRP3 and MRP5 are related to the acquired drug resistance of hepatocellular carcinoma.</p>

Intraoperative argon cryosurgery in surgical resection of advanced hepatic carcinoma: safety and efficacy / 南方医科大学学报

<p><b>OBJECTIVE</b>To evaluate the safety and efficacy of intraoperative argon/helium cryosurgery in surgical resection of advanced hepatic carcinoma.</p><p><b>METHODS</b>Eighty-six surgical patients with advanced hepatic carcinoma were enrolled in this study, including 14 undergoing argon cryosurgery for tumor removal and 72 receiving cryosurgery in addition to surgical tumor reduction. Portal vein or hepatic arterial pump placement was performed in 15 patients for chemotherapy.</p><p><b>RESULTS</b>No death occurred in the operation or during the postoperative hospitalization period in these patients. Improvement of the clinical symptoms was observed in 66 cases (76.74%) and 43 (78.18%) patients showed significantly decreased blood AFP levels after the surgeries. Postoperative CT demonstrated obviously reduced tumor size in 58 cases (67.44%). Of the 70 patients available for the follow-up, 28 survived with a survival rate of 40%. The 0.5-, 1-, 3 and 5-year survival rates were 44/48 (91.67%), 35/48 (72.92%), 28/48 (58.33%), and 20/48(41.67%) in the patients with primary hepatic carcinoma (PHC), respectively, as compared with those of 21/22 (95.45%), 18/22 (81.82%), 13/22 (50.09%), and 8/22 (36.36%) in patients with metastasis hepatic carcinoma (MHC). The 1-, 3- and 5-year survival rates of the patients undergoing surgical tumor resection and cryosurgery were 65/72 (90.27%), 47/60 (78.33%) and 24/58 (41.38%), respectively, significantly higher than the rates of 10/14 (71.43%), 8/12 (66.67%) and 4/12 (33.33%) in the patients receiving cryosurgery only (P<0.05).</p><p><b>CONCLUSIONS</b>Argon cryosurgery offers an effective and safe option for management of advanced hepatic carcinoma, and its combination with other therapeutic approaches may achieve better clinical effects.</p>

The value of three-dimensional 64-multi-slices helical computer tomography on the diagnosis of diseases of digestive system / 中华外科杂志

<p><b>OBJECTIVE</b>To study the value of three-dimensional 64-slice helical computer tomography (64-MSCT) in diagnosis and surgical treatment on diseases of digestive system.</p><p><b>METHODS</b>From November 2005 to August 2006, 64-MSCT was performed on 102 patients suspected of digestive diseases to display foci of infection, hepatic conduit, biliary-pancreatic duct and portal venous system, followed by three-dimensional reconstruction of those targets. The reconstructed images as well as the data obtained from the reconstruction were compared with the surgical results.</p><p><b>RESULTS</b>Twenty-five of 27 patients with portal hypertension (PHT) showed blur-free imaging of main portal vein (MPV) while the other 2 cases showed congenital cavernous transformation or thrombogenesis of MPV. Compensatory circulation of portal venous system was displayed satisfactorily in 27 cases. The three-dimensionally reconstructed images of 34 cases of hepatocellular carcinoma (HCC) demonstrated no invasion of tumors into the tissues and blood vessels of 23 cases, visible invasion into portal vein and hepatic veins of 9 cases, tumor embolus in portal veins of 1 case, and arterio-venous fistula in only one case. The 3D imaging of biliary passages displayed total concretion, tumor and constrictive or dilated biliary-pancreatic duct and bile duct around amphi-obstruction, which complied with the operations research of calculus of bile duct in 25 cases, cholangiocarcinoma in 5 cases, and cancer of pancreas in 5 cases. Operations research in accordance with the 3D reconstructed imaging accorded with imaging diagnosis in respect of PHT, HCC and diseases of biliary-pancreatic system at the rates of 100%, 97% and 100%, respectively.</p><p><b>CONCLUSIONS</b>Three-dimensional 64-MSCT displays foci of infection and constructions of biliary-pancreatic duct and hepatic conduit stereoscopically.</p>

The research of virtual hepatectomy / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the methodology of mimic resection system on liver.</p><p><b>METHODS</b>Hepatic arteries, portal vein, inferior cava vein, hepatic veins and biliary ducts of liver with integrate hepatic portal were perfused with filling materials in different colors. And then the sample was embedded, frozen and slice-cut to obtain serial sectional images. After image registration and segmentation, the 3D reconstruction model which contained the liver's surface and its internal structures was constructed with MIMICS 9.0. Based on the freeform modeling system and its accessories (the software GHOST and the force-feedback equipment PHANTOM), the virtual hepatectomy system was established which could manipulate the virtual scalpel to perform optional resection on virtual liver model.</p><p><b>RESULTS</b>After slice-cutting the cast liver, 910 serial cross-section images were obtained sharply and clearly. The 3D reconstructed liver model looked like the liver sample exactly, and could be magnified, contracted and rotated. In the virtual surgery system with good interaction, powerful immersion and great imagination, the virtual scalpel could be manipulated to perform optional resection on 3D liver model with the haptic device (PHANTOM).</p><p><b>CONCLUSIONS</b>The 3D visualized liver and the virtual hepatectomy system has been satisfactorily developed using the hepatic serial sectional images. The process of simulation operation was consistent with clinical practice.</p>

Adenovirus mediated double suicide gene under controlling by KDR promoter selectively kills vascular endothelial cells and colorectal tumor cells / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the selectively killing effect of adenovirus (Ad) mediated double suicide gene under the regulation of KDR promoter on vascular endothelial cells and colorectal tumor cells.</p><p><b>METHODS</b>293 packaging cells were transfected with the plasmids of pAdEasy- KDR- CDglyTK and pAdEasy- CMV- CDglyTK and the infectious viruses were generated. The KDR expressive cells of ECV304,SW620 and the KDR inexpressive cells of LS174T were infected by two Ads. The infection rate was observed and the expression of CDglyTK was detected by RT- PCR. After treatment with different concentrations of 5- FC and GCV,the killing effect and bystander effect on ECV304,SW620 and LS174T were examined.</p><p><b>RESULTS</b>The titers of these two purified Ads were 2.0 x 10(12 ) pfu/ml. There was no significant difference in infection rate between two recombinant Ads infecting various cells,and the infection rate increased in accordance with the enhancing titers of Ads. RT- PCR demonstrated that there existed the product of CDglyTK gene in all the cells infected by Ad- CMV- CDglyTK and the cells infected by Ad- KDR- CDglyTK except in the SL174T. The curative effect in this system on various cells was shown as follows: (1) All cells infected with Ad- CMV- CDglyTK and some cells of ECV304 and SW620 infected with Ad- KDR- CDglyTK were highly sensitive to the prodrugs,but there was no significant differences among them (P > 0.05); compared with ECV304 and SW620 cells,LS174T cells were not sensitive to the two prodrugs (P< 0.001). (2) The efficacy of double suicide gene was better than that of single suicide gene (P< 0.001). (3) The system had considerable bystander effect.</p><p><b>CONCLUSION</b>The double suicide gene under the regulation of KDR promoter has specific killing effect on the KDR- expressing endothelial cells and colorectal tumor cells.</p>