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Objective:To explore whether CT image post-processing software can accurately measure (associating liver partition and portal vein ligation for staged hepatectomy, ALPPS) related (future liver remnant, FLR).Methods:Clinical data of 9 liver cancer patients undergoing ALPPS were retrospectively analyzed in the Second Affiliated Hospital of Air Force Military Medical University from Mar 2015 to May 2019. All cases were divided into 2 groups by measurement: CT′s image post-processing software, or Myrian software. Two groups were compared with each other by paired t-test. Results:FLR from group CT′s image post-processing software was larger than that by Myrian software, there was statistical difference ( t=2.512, P=0.019). The mistakes of FLR measurements by the radiologist using CT′s image post-processing software couldbe caused by: (1)Lacking theoretical knowledge of liver surgery; (2) Adding devitalized tissue of hepatic section into future liver remnant; (3) Concept confusion about liver anatomy; (4) Lack of precision measurement. Conclusions:The inaccuracies generated during the ALPPS related future liver remnant measurements in CT′s image post-processing technique are all caused by human factors. These problems could be solved if the radiologist who operates 3D reconstruction receives liver surgery training or works with liver surgeons.
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Objective To evaluate the laparoscopic splenectomy and pericardial devascularization in patients with portal hypertension.Methods In this study,205 patients who underwent splenectomy and pericardial devascularization in the Second Hospital of Air Force Medical University between Jan 2013 and Jan 2018 were divided into 135 patients undergoing laparoscopic surgery(LSD group) and 70 patients undergoing open surgery (OSD group).Results Operation time,intraoperative blood loss,intraoperative blood infusion,time of postoperative abdominal drainage-tube removal,time of gastrointestinal function recovery and duration of hospital stay were respectively (150 ± 37) min,(223 ± 129) ml,(91 ± 138) ml,(4.0 ± 1.0)d,(33 ±9)h,(5.6 ± 1.0)d in the LSD group,(183 ±42) min,(346 ± 131) ml,(214 ± 182) ml,(5.5 ± 1.3)d,(42 ± 14)h,(7.5 ± 1.4)d in the OSD group,with statistically significant differences between groups(t =-2.203,-4.980,-2.830,-5.553,-2.307,-6.635,all P ＜ 0.05).The main complications included pancreatic fistula,intra-abdominal bleeding,intra-abdominal infection,pulmonary infection,refractory ascites,portal vein system thrombosis and incision infection,and there were respectively 0,1,2,2,3,13,0 in the LSD group and 3,4,6,6,7,14,3 in the OSD group,with statistically significant differences between groups (x2 =5.872,4.792,6.179,6.179,6.010,4.335,5.872,all P ＜ 0.05).All the 205 patients received follow-up for a median time of 38 months (12-72 months).Gastroscopy showed improvement of esophageal and gastric varices in postoperative 6 months.Conclusion Laparoscopic splenectomy and pericardial devascularization for the treatment of portal hypertension is safe,feasible and effective.
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ObjectiveTo investigate the role of radionuclide hepatobiliary scintigraphy in the evaluation of gallbladder contraction function, and to provide a theoretical basis for preoperative evaluation of gallbladder contraction function in patients undergoing laparoscopic-hard endoscopic gallbladder-preserving cholecystolithotomy. MethodsA total of 47 patients with gallstones who were admitted to The Second Affiliated Hospital of Air Force Medical University from June to December, 2016, and underwent 99mTc-EHIDA hepatobiliary imaging to evaluate gallbladder contraction function were enrolled. The radioactive count of the gallbladder was measured after fat meal and gallbladder contraction function was evaluated. A comparative analysis was performed based on intraoperative exploration and gallbladder-preserving outcome. ResultsA total of 26 patients with negative results of the EHIDA gallbladder contraction test underwent a successful gallbladder-preserving surgery, and some of them had no recurrence of stones after 24 months of follow-up. Among the 12 patients with impaired gallbladder contraction function shown by EHIDA, 1 underwent cholecystectomy due to roughness of the gallbladder wall and deposition of a large amount of cholesterol crystal, and 11 underwent gallbladder-preserving cholecystolithotomy. Among the 9 patients without the image of the gallbladder, 1 was found to have stones with a diameter of 2 cm embedded in the neck of the gallbladder by intraoperative exploration and underwent gallbladder-preservation surgery, and no recurrence of gallbladder stones was observed after 24 months of follow-up; the remaining 8 patients underwent cholecystectomy. Conclusion99mTc-EHIDA hepatobiliary scintigraphy has a certain value in evaluating gallbladder contraction function, but it cannot be used as the only evidence for the selection of surgical approach. Laparoscopic-hard endoscopic intraoperative exploration is a strong evidence for the selection of gallbladder-preserving surgery, and formal industry standards can be developed.
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Objective To analyze the application value of high risk human papillomavirus (HR HPV) DNA and thinprep cytolo-gy test(TCT ) detection in screening cervical cancer and to evaluate the clinical significance of their combined detection .Methods A total of 402 cases conducting cervical cancer screening in our hospital from March to May 2016 were selected and performed the HR HPV DNA and TCT detection .Those of suspected cervical lesions were performed the histopathological examination .Then the effects of HR HPV DNA and TCT combined detection were compared according to the pathological results .Results The detection positive rate of female HR HPV DNA was 27 .1% (109/402);abnormal and benign inflammation reaction were detected out in 46 cases of female TCT ,the positive rate was 11 .4% (46/402);in 123 cases of suspected cervical malignant lesion ,32 .5% females(40/123) appeared CIN Ⅰgrade or more lesions by histopathological examination ;the sensitivity of HR HPV DNA and TCT combined detection was higher than that of single detection ,the difference was statistically significant (P0 .05) .Conclusion The detection of HR HPV DNA and TCT is a good method for screening of cervical cancer ,the combined detection of HR HPV DNA and TCT can improve the detection rate of cervical precancerous lesion .
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Objective To explore the prognosis of patients with BCLC-B hepatocellular carcinoma (HCC) receiving LR + MCT vs TACE.Methods BCLC-B HCC patients undergoing LR + MCT (107 cases) and TACE (65 cases) were retrospectively evaluated,in terms of 30-day mortality rate,the median survival,early and long term survival rate and complications.Results The hospital mortality rate was similar between the two groups (x2 =0.285,P =0.593).However,the LR + MCT group were with a significantly higher postoperative complication rate than the TACE group (x2 =4.694,P =0.03).At the same time,the LR + MCT group had significantly higher median Survival rates (x2 =9.135,P =0.003),but,there was no statistical difference for five-year survival (x2 =4.767,P =0.434).Conclusions LR + MCT are as safe as TACE for patients with BCLC-B HCC,and it provides longer median survival rates.
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In recent years, with the development of in-depth basic and clinical research on hepatocellular carcinoma (HCC), the heterogeneity, biological characteristics, molecular subtyping, and individualized treatment of HCC have gradually become the basic guiding principles for the clinical treatment of HCC in the modern era. Multinodular HCC is a form of gross specimens of HCC, and new achievements have been made in the molecular origin and guidelines for clinical typing of HCC, which guide the diagnosis and treatment of HCC. However, new controversies have also appeared. This article reviews the advances in basic and clinical research on multinodular HCC, hoping to provide a reference for clinical prevention and treatment of HCC and contribute to patients' survival benefit.
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Seen from the development of the treatment for hepatocellular carcinoma (HCC),although great progress has been made on the optimization of the treatment,the patients' overall survival (OS) has not been greatly improved compared with other tumors of digestive system such as colorectal cancer.That is mainly because of the early microvascular invasion (MIV) and portal vein tumor thrombus (PVTT) which are among the most important reasons for poor prognosis in HCC.Thus we overviewed the recent research findings on the treatment of HCC with PVTT,which might help the clinicians select the optimal therapeutic strategy.
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Magnetic compression anastomosis can compress tissues together and restore the continuity. Magnetic compression anastomosis mainly experienced three stages: magnetic ring, magnetic ring and column, and smart self-assembling magnets for endoscopy (SAMSEN). Nowadays, the magnetic compression anastomosis has been applied in vascular and different digestive tract surgeries, especially for complex surgery, such as anastomotic stenosis of biliary ducts after liver transplantation or congenital esophageal stenosis. Although only case reports are available at present, the advantages of the magnetic compression anastomosis includes lower cost, simplicity, individualization, good efficacy, safety, and minimally invasiveness. We are building a better technical platform to make magnetic compression anastomosis more advanced and popularized.
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Humans , Anastomosis, Surgical , Methods , Digestive System Surgical Procedures , Methods , MagneticsABSTRACT
Objective To evaluate radiofrequency ablation in anatomical hepatectomy.Methods The clinical data of 57 patients undergoing anatomical hepatectomy with radiofrequency ablation (radiofrequency ablation group) from Jul 2010 to May 2013 in Tangdu Hospital were compared with those 57 cases using traditional clamp crushing resection during the same period.Results There was no mortality perioperatively.Intraoperative duration of liver dissection,haemorrhage volume of liver dissection,blood transfusion volume,Pringle manoeuvre,postoperative alanine aminotransferase (ALT) in the third and fifth day in the radiofrequency ablation group were (65 ±30) min,(195 ± 107) ml,(150 ±80) ml,7 cases (12.3％),(309 ±226) U/L and (164 ±82) U/L respectively,which were statistically different from those of (50 ±40) min,(255 ± 180) ml,(205 ± 120) ml,45 (78.9％),(388 ± 174) U/L and (220 ± 156) U/L in clamp crushing resection group (seperately t =2.266,-2.158,-2.880,x2 =51.060,t =-2.090,-2.403,all P ＜ 0.05).Large branches of hepatic vein (caliber ≥ 7 mm) were injuried by mistake 7 times in radiofrequency group,there was no massive blood loss.Postoperative biliary fistula developed in two cases.There was no ablation included thrombus.In radiofrequency group,and Pringle manoeuvre was used in hemihepatic resection in 7 patients.Conclusions Radiofrequency ablation is not recommended to dissecting large caliber vessels (≥ 7 mm) for fear of causing thrombus.Radiofrequency ablation in anatomical hepatectomy,when used properly,is safe and effective.
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Objective To study the results of repeat hepatectomy,followed by transcatheter arterial chemoembolization (TACE) and percutaneous microwave coagulation therapy (PMCT),but with or without portal vein chemotherapy (PVC) in patients with recurrence of hepatocelluar carcinoma (HCC) after partial hepatectomy.Methods The data of 33 patients were analyzed retrospectively.All these patients received repeat hepatectomy.They were then divided into two groups:the PVC group (n =19) was treated with PVC + TACE + PMCT,and the non-PVC group (n =14) with TACE + PMCT.Results For the 33 patients,13 (39.4％) developed tumor recurrence ＞2 years from the initial resection while 20 patients (60.6％) developed recurrence within ≤ 2 years.The tumor recurrence consisted of local recurrence in 14 patients (42.4％),and heterochronous recurrence in 19 patients (57.6％).There was a significantly difference in the cumulative survival rates between the two groups (x2 =4.319; P =0.038).The 1y,3y,5y survival rates were 84.2％,42.1％,31.6％ in the PVC Group,and 71.4％,28.6％,14.3％ in the Non-PVC Group respectively.28 sessions of PMCT and 97 sessions of TACE were performed postoperatively (the medians were 1,0.5; 3,3 respectively,the mean ranks were 17.68,16.07; 15.05,19.64 respectively,and the P values were 0.612,0.163 respectively between the two groups).Conclusions For patients with recurrence of HCC after hepatic resection,after repeat hepatectomy PVC + TACE + PMCT gave better survival than those with TACE + PMCT but without PVC.
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Objective To investigate the expression of ligands of DNAM-1 and NKG2D in the colonic cancer.Methods The colonic cancer tissue and adjacent normal colonic tissues were collected from 42 colonic cancer patients who were admitted to the Tangdu Hospital of Fourth Military Medical University from June 2010 to January 2011 were retrospectively analyzed.The expressions of CD155,CD112 and MICA/B in the colonic cancer tissues and the normal colonic tissues were detected by immunohistochemistry.The expressions of CD155,CD112 and MICA/B in the colonic cell line SWll6,SW480,SW620 and Colo205 in the Duke's A,B,C and D phases were detected by cell cytometry.The relationship of the expressions of the 3 ligands and the clinicopathological parameters was analyzed using the Mann-Whitney U test,chi-square test and Fisher exact probobility.Results Week expression of CD155 was found in the normal colonic tissues,while the expressions of CD112 and MICA/B were not found.In the colonic cancer tissues,the expressions of CD155,CD112 and MICA/B were 81.0％,52.4％ and 47.6％,which were significantly increased.The expressions of CD155,CD112 and MICA/B were not correlated with the gender,tumor differentiation,lymph node metastasis and Duke's staging (P ＞ 0.05).The overall expression rates of CD155,CD112 and MICA/B in the colonic cancer cell line SWll6,SW480,SW620 and Colo205 were 88.9％,67.4％ and 42.3％,respectively.The overall expression of CD155 was significantly higher than CD112 and MICA/B (F =23.17,P ＜ 0.05).Conclusion CD155,CD112 and MICA/B express in the colonic cancer tissues and colonic cancer cell line SW116,SW480,SW620 and Colo205,and the expression of CD155 is the highest.
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BACKGROUND: Kadsurenone is characterized by obvious anti-oxidation and calcium ion resistant effect and can effectively clear oxygen-derived free radicals, decrease activity of pancreatic enzyme, and relieve self-digestion of pancreatic tissue.OBJECTIVE: To observe the effects of kadsurenone on the splanchnic blood flow in rats with severe acute pancreatitis (SAP), especially the mechanism of pancreatic blood flow.DESIGN: Contrast observational animal study.SETTING:Laboratory of General Surgery and Central Laboratory of Tangdu Hospital, the Fourth Military Medical University of Chinese PLA.MATERIALS: A total of 40 male Sprague-Dawiey (SD) rats, of clean grade and weighing 200-280 g, were selected in this study. Kadsurenone (150 mg) was provided by Pharmacological College of Peking University (batch number: 20050347); sodium taurocholate by Sigma Company (batch number: 86339); amylase reagent by Roche Company (batch number: irp 170505); Imexlab9100 Doppler ultrasound diagnostic meter by Imex Company; 8 mHz probe privated by Doppler ultrasound diagnostic meter by Imex Company, USA (number: X1-M0008).METHODS: The experiment was carried out in the Laboratory of General Surgery, Tangdu Hospital, Fourth Military Medical University of Chinese PLA from April to October 2006. Eight rats were randomly selected as sham operation group, and other rats were used to establish SAP models at 12 hours after fasting. Continuously, 32 SAP rats were randomly divided into two subgroups after model establishment, including kadsurenone group (n =16) and model group (n =16). In addition, all rats in the two subgroups were observed at 12 and 24 hours after operation with 8 rats at each time point. However, rats in the sham operation group did not give any treatment. At 3 hours after operation, rats in kadsurenone group were given 10 mg/kg kadsurenone through jejunum fistula once every 6 hours for one or two times in total. Kadsurenone was dissolved in 25 g/L dimethyl sulfoxide. In addition, rats in model group were given the same dosage of dimethyl sulfoxide through jejunum fistula; furthermore, rats in sham operation group were only opened their abdomens. Blood starch was respectively measured in sham operation group at 12 hours after abdominal operation, model group at 12 hours and kadsurenone group at 24 hours after acute pancreatic operation; meanwhile, Doppler ultrasound was used to detect local artery of pancreas (relative to the crossed site between head and body of pancreas), blood flow of portal vein, splenic artery and blood flow of superior mesenteric artery.MAIN OUTCOME MEASURES: Changes of plasma amylase and blood flow at various time points.RESULTS : All 40 SD rats were involved in the final analysis.①Measuring results of plasma amylase: Level of plasma amylase was increased in both model group and kadsurenone group at various time points as compared with that in sham operation group (P＜0.01 ). With the time passing by, level of plasma amylase was still increased in model group, and there was significant difference from that at 12 hours after operation (P＜0.05). ②Blood flow of local pancreatic artery: At 12 and 24 hours after operation, blood flow was lower in kadsurenone group and model group than that in sham operation group (P＜0.01). With the development of illness course, blood flow was still decreased in kadsurenone group (P＜0.05); however, blood flow was obviously higher than that in model group at various time points (P＜0.01 ). ③ Blood flow of superior mesenteric arterial root, portal vein and splenic artery: Blood flow was lower in kadsurenone group and model group than that in sham operation group at 12 and 24 hours after operation, respectively (P＜0.01). In addition, blood flow was remarkably increased in kadsurenone group as compared with that in model group at various time points (P＜0.01).CONCLUSION: Kadsurenone can increase the pancreatic blood flow and relieve pathological injury in SAP rats.
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Objective To observe the effects of telramethylpyrazine(TMP)on the splanchnic blood flow in severe acute pancreatitis(SAP)rats and to elucidate the underlying mechanism.Methods Thirty-two rats were randomly divided into 2 groups:telramethylpyrazine group(TMP group,n=16)and SAP group(n=16).At 12,24 hours after the induction of SAP,serum amylase was measured.The regional pancreatic blood flow was measured by Doppler ultrasound;the blood flow of portal vein,spleen artery and superior mesenteric artery were also measured.Results The level of the serum amylase was lower in the TMP group than that in the SAP group(P
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Objective To investigate the value of quantitative assessment of hepatic fibrosis and indocyanine green measurement in predicting hepatic functional reserve in rats with liver cirrhosis.Methods Female Wister rats were divided into normal control and cirrhotic group,and cirrhotic models were established.Quantitative assessment of hepatic fibrosis was done by use of computer-assisted digital image analysis,and R15ICG was measured.Results Differences of R15ICG and quantitative assessment of hepatic fibrosis between the two groups at 8 and 10 weers after hepatic fibrosis model was established were statistically significant(P
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Objective To explore the changes of IL-6, IL-8 and TNF-? levels before and after pericardial(devascularization) associated with proximal spleno-renal shunt(combined operation) in cirrhotic patients with portal hypertension. Methods Plasma levels of IL-6, IL-8 and TNF-? in combined(operation ) patients at 1d before(operation),and 7d after operation were measured and compared with control group. Results Preoperatively, the(plasma) levels of IL-6[ (230.4?10.3) ng/L], IL-8 [ (201.5?7.8) ng/L]and TNF-?[ (261.5?28.3) ng/L]in(combined) operation patients were significantly higher than those in control group (P
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Objective To investigate the changes of the levels of TNF and IL 8 in blood and in gastric mucosa and their mRNA expression after liver ischemia reperfusion (I/R). Methods 130 rats were randomly divided into 3 groups: (1) sham operation group(control group, n=10);(2)liver ischemia reperfusion group (n=60), including ischemia for 20min and 40min, and reperfusion for 1h, 24h and 72h respectively; (3) liver I/R rats treated with famotidine group (n=60). ALT and AST were detected after operation, pathomorphological changes of gastric mucosa were studied by light microscope and transmission electronic microscope, the concentrations of TNF and IL 8 in blood and gastric mucosa were measured by radioimmunoassay (RIA), TNF mRNA and IL 8 mRNA were detected by in situ hybridization. Results After liver I/R,inflammatory damage appeared in gastric mucosa, TNF and IL 8 concertrations increased significantly(P
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Objective To compare prospectively the features and effects of combined operation(splenorenal shunt plus portal-azygous devascularization) and portal-azygous devascularization only(PCDV)on portal(hypertension)(PH).Methods We summarized 360 cases of PH admitted from 1984 to 2004.All patients were randomly divided into two groups,one was combined operative group(250 patients) and the other was PCDV group(110 patients).The therapeutic effects and changes of portal hemodynamics were studied with doppler flowmeter(DCFI),free portal pressure(FPP) and digital subtraction angiography(DSA) pre-and post-operatively,and were measured directly during the course of the procedure.Results(1)Postoperative bleeding:Of all the patients who underwent combined operation,no case of rebleeding occurred in the short period after operation,and the rebleeding rate was 8.0% in the long period of follow-up.In the patients who underwent PCDV,the rebleeding rate was 5.5% in the short period after operation,and 17.6% at long-term follow up(P0.05).(3)There was a significant decrease in the diameter of portal vein,and FPP postoperatively in the combined operation group compared to PCDV group.There was a significant decreases of PVF in the PCDV group.But the decrease of PVF in the two groups had no significant difference.Conclusions The combined procedure has merits of greater decrease of FPP,and alleviation of the condition of hyperdynamic blood flow in the portal vein.The clinical effect is also better than that of portal-azygous devascularization only.
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Objective To observe the effect of iodized oil on radiofrequency thermal ablation (RFA) of hepatic neoplasms by using a cluster array of ten separate electrodes. Methods The patients were divided into 2 groups, group A with transcatheter hepatic artery embolization, group B without transcatheter hepatic artery embolization. All patients were undergone radiofrequency ablation of hepatic neoplasms. Results The time of RFA for group A was (9?2.1) minutes, showing the diameter of necrosis of (5.3?1.4)cm. The time of RFA for group B was (1.6?4.6) minutes demonstrating the diameter of necrosis of (3.5?1.8)cm (P