ABSTRACT
Objective: To examine the clinical value of fluorescence-guided indocyanine green (ICG) laparoscopic anatomical hepatectomy in the treatment of primary hepatocellular carcinoma. Methods: Data from patients diagnosed with hepatocellular carcinoma and who underwent laparoscopic hepatectomy with ICG fluorescence navigation in the Department of Liver Surgery and Liver Transplantation Center of West China Hospital between September 2020 and May 2022 were retrospectively collected. There were 53 males and 19 females, with an age of (55.5±12.9)years(range:42.6 to 68.4 years). Among them, 13 of the cases underwent laparoscopic anatomical liver resection(LALR) guided by tans-arterial ICG,43 of the cases received LAIR guided by portal vein negative ICG, and 16 of the cases received LALR positive by portal vein. Comparison among the three groups was performed by one-way ANOVA; and the rank sum test was used for comparison between groups. The counting data was expressed as percentage,and the χ2 test or Fisher's exact probability method was used for comparison between groups. Results: (1) Postoperative pathology: Resection R0 was achieved in all operations. The maximum tumor diameter of the patients in the arterial staining group, the reverse staining group, and the positive staining group(M (IQR)) was 2.5 (2.4) cm, 3.0 (2.5) cm and 3.0(2.4) cm,respectively. There were no statistically significant differences in the maximum tumor diameter between the three groups (P=0.364). The minimum tumor margin was 1.1 (1.1) cm, 1.0 (1.0) cm, 1.1 (1.6) cm in the the arterial staining group, reverse staining group and the positive staining group, respectively. There was no significant difference in the margin among the three groups (P=0.878). (2) Operation conditions: the operation time of the arterial staining group, the negative staining group, and the positive portal staining group was (348±93)minutes,(277±112)minutes,and (295±116)minutes,respectively. There were no significant differences in operation time among the three groups (P=0.134). The intraoperative blood loss of the three groups was 80(150)ml,200(350)ml,and 100(150)ml,respectively. There was no statistically significant difference in intraoperative bleeding volume between the three groups(P=0.743). All cases were not transfused during the operation and were not converted to laparotomy. ALT in the arterial staining group was higher than in the negative staining group in the first two days after the operation ((559±398)IU/L307(257) IU/L, q=235.5,P=0.004;(611±389)IU/L(331±242) IU/L, q=265.2, P=0.002). There was only one case of a grade III complication (Clavien-Dindo grading system) postoperative complication in the negative and positive staining group of the portal vein, respectively. Tumor markers in all patients decreased to the normal range after 2 months of operation. Conclusion: Laparoscopic anatomical hepatectomy guided by ICG fluorescence through arterial staining and portal vein staining is safe and feasible for primary hepatocellular carcinoma treatment.
ABSTRACT
Objective To compare the stability of injectable pedicle screw with different lateral holes augmented with different volume of polymethylmethacrylate (PMMA) in synthetic bone block used for patients with osteoporosis,and analyze the relationship between screw stability and injected volume and distribution pattern of PMMA.Methods The synthetic bone blocks used for patients with osteoporosis were randomly divided into groups A,B,C and D according to the screw difference,and the blocks in each group were then randomly divided again into subgroups 0,1,2 and 3 according to the difference of PMMA volume.A pilot hole was prepared in advance using the same method in all samples.Pedicle screws of type A-C were directly inserted into vertebrae of groups A-C respectively,and then different volumes of PMMA (0,1.0,1.5 and 2.0ml) were injected through screw into the blocks of subgroups 0,1,2 and 3 respectively.The pilot hole was filled with different volumes of PMMA (0,1.0,1.5 and 2.0ml) followed by insertion of screw in groups D0,D1,D2 and D3 respectively.X-ray examination was performed to evaluate the screw position and PMMA distribution,and axial pull-out test was performed to measure the maximum axial pullout strength (Fmax).Results X-ray examination revealed that PMMA wrapt the anterior 1/3 part of screw in groups A1-A3,wrapt the middle 1/3 part of screw in groups B1-B3 and groups C1-C3,and evenly wrapt the full length of screw in groups D1-D3.Two factor ANOVA showed that both volume and distribution of PMMA significantly influenced Fmax (P＜0.05),but no marked interaction existed between the two factors (P=0.877).Among groups with the same screw,no significant difference of Fmax was found between the groups injected of 1.0ml and 1.5ml PMMA and those of 1.5ml and 2.0ml PMMA (P＞0.05),but the Fmax was significantly higher in groups with injection of 2.0ml PMMA than that in groups with injection of 1.0ml PMMA (P＜0.05).Among the groups injected with same volume of PMMA,no significant differences on Fmax were found among the groups A0-D0,A2-D2 and A3-D3 (P＞0.05).The Fmax was significantly lower in group A1 than in group DI (P=0.026),and no significant differences existed between the other two groups injected with the same volume of PMMA (P＞0.05).Conclusion PMMA can significantly enhance the stability of different injectable pedicle screws in synthetic bone block used for patients with osteoporosis,and the stability is significantly correlated with injected volume and distribution pattern of PMMA.