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Background: Indocyanine green fluorescence-guided laparoscopic hepatectomy (ICG-guided LH) is increasingly used for the treatment of hepatocellular carcinoma (HCC). However, whether ICG-guided LH can improve surgical outcomes remains unclear. This study aimed to investigate the short-term outcomes and survival outcomes of ICG-guided LH versus common laparoscopic hepatectomy (CLH) for HCC. Methods: We conducted a retrospective analysis of 104 ICG-guided LH and 158 CLH patients from 2014 to 2020 at our center. To avoid selection bias, 81 ICG-guided LH and 81 CLH cases were analyzed after 1:1 propensity score matching (PSM). The baseline data and results were compared between the two groups. Results: The baseline characteristics of both groups were comparable after matching. There was a significant difference in operative time: longer in the ICG-guided LH group than in the CLH group (p=0.004). However, there was no significant difference in operative time in anatomical resection between the two groups (p=0.987). There was a significant difference in operative time in non-anatomical resection: longer in the ICG-guided LH group than in the CLH group (p=0.001). There were no significant differences in positive surgery margin, blood loss, blood transfusion rate, postoperative complication rate, postoperative length of hospital stay, mortality within 30 days, and mortality within 90 days. The ICG-guided LH group appeared to have a trend towards better overall survival (OS), but there was no significant difference in OS (P=0.168) and recurrence-free survival (RFS) (P=0.322) between the two groups. Conclusions: Although ICG fluorescence-guided LH is a timelier procedure to perform, it is a safe and effective technique with the advantages of intraoperative positioning, low postoperative complication rates, and potential to improve OS.
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Hepatocellular carcinoma (HCC) is one of the most common types of malignancies in the world, and most HCC patients undergoing liver resection relapse within five years. Microvascular invasion (MVI) is an independent factor for both the disease-free survival and overall survival of HCC patients. At present, the definition of MVI is still controversial, and a global consensus on how to evaluate MVI precisely is needed. Moreover, this review summarizes the current knowledge and clinical significance of MVI for HCC patients. In terms of management, antiviral therapy, wide surgical margins, and postoperative transcatheter arterial chemoembolization (TACE) could effectively reduce the incidence of MVI or improve the disease-free survival and overall survival of HCC patients with MVI. However, other perioperative management practices, such as anatomical resection, radiotherapy, targeted therapy and immune therapy, should be clarified in future investigations.
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Objective To discuss features of angiogenesis in degenerative intervertebral disc and related factors.Methods In this case-control study,52 patients undergoing single level posterior lumbar interbody fusion during October 2012 to December 2013 were selected as research objects.Annulus fibrosus,nucleus pulposus and cartilage end plate of responsible level were collected in surgery for frozen section and HE staining.Angiogenesis in the intervertebral disc was identified according to the morphological characteristics of vascular endothelial cells,i.e.typical lumen structure and blue stained nucleus.These intervertebral disc specimens were divided into two groups according to the angiogenesis phenomenon.All specimens with angiogenesis were evaluated by blood micro-vessel density (MVD) counting.Related factors of angiogenesis including gender,age,VAS score,JOA lumbar score,classification of lumbar intervertebral disc degeneration,intervertebral disc calcification rate and classification of intervertebral disc herniation were compared between the two groups.Logistic regression analysis was further conducted on indicators with differences of statistical significance.Results In our group of 52 patients,28 patients had obvious angiogenesis:12 patients in annulus fibrosus,7 patients in cartilage endplate and 9 patients in annulus fibrosus and nucleus pulposus.Angiogenesis rate was 53.8% (28/52).The mean value of MVD was 12.5±3.1.24 patients did not have obvious angiogenesis.Intervertebral disc calcification rate (75.0% vs.37.5%),VAS score (6.79±2.06 vs.5.25±2.23) and JOA lumbar score (16.32±3.89 vs.19.08±4.24) were significant differences between two groups (P=0.006,0.013,0.018).Multi-factor regression analysis showed that VAS score (OR=7.248,P=0.011) and intervertebral disc calcification (OR=8.881,P=0.006) were important factors associated with intervertebral disc angiogenesis.JOA lumbar score (OR=3.739,P=0.070) was not associated with intervertebral disc angiogenesis.Conclusion Degeneration of the intervertebral disc is accompanied by angiogenesis.Intervertebral disc calcification and VAS score are important factors associated with angiogenesis in intervertebral disc.
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Objective To evaluate the effectiveness of one-stage debridement for cervical tuberculosis at different segments.Methods Clinical data of 54 patients (male 20,female 34) with cervical tuberculosis treated by one-stage debridement from Jan 1998 to Dec 2011 were reviewed retrospectively.The average age of these patients was 45.4 years (range,26-75 years).Among them,12 cases were involved in single level (C2 1 case,C4 2 cases,C5 3 cases,C6 4 cases,C7 2 cases); 36 cases in the adjacent two levels (C1,2 3 cases,C2,3 2 cases,C3,4 5 cases,C4,5 6 cases,C5,6 14 cases,C6,7 5 cases,C7T1 1 case); 5 cases in three levels(C4 6 2 cases,C5-7 2 cases,C3,5,6 1 case)and 1 case in four levels (C4-7).Five cases were involved in other spinal levels (T6 1 case,T 3 cases,L3,4 1 case).Comorbidity of cervical ossification of the posterior longitudinal ligament was found in 1 case.Before surgery,the mean VAS and JOA scores were 5.9 (range,4-9) and 10.5 (range,7-12) respectively and the mean Cobb angle of lesion segment was 26.7°± 9.1°.All cases underwent regular anti-TB treatment preoperatively,and surgical treatment were performed when blood sedimentation (ESR) was lower than 50 mm/1 h.According to the segmental involvement,different surgical approaches were performed including anterior debridement with anterior or anterior-posterior internal fixation and fusion,submandibular approach debridement with posterior occipital cervical fusion or atlantoaxial fusion.Results Mean follow-up duration was 27.3 months (range,13-52 months).Symptoms were improved significantly in all cases.Mean time of union was 3.2 months (range,2-4 months).At the last follow-up,the mean VAS and JOA scores were 5.9 (range,4-9)and 10.5 (range,7-12) respectively,and the mean Cobb angle of lesion segment was 6.8°.Regular anti-TB treatment was performed postoperatively for 18 to 20 months.Intraoperative esophageal injury was found in one case of upper cervical tuberculosis which was cured uneventfully after gastrointestinal tubation for 1 week.No cervical tuberculosis recurrence,graft loosening or pseudarthrosis was found in follow-up.Conclusion With preoperative anti-TB treatment,cervical tuberculosis can be treated by one-stage foci debridement according to the segmental involvement and deformity.Postoperative regular anti-TB treatment is a crucial factor for the final recovery of cervical tuberculosis.
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Objective: To explore the effect of CO 2 pneumoperitoneum in laparoscopic surgery on the cardiovascular function of the geriatric cholelithiasis.Methods:Sixty aged patients undergone laparoscopic surgery were selected.During various stage of CO 2 insufflation,the heart rate(HR),blood pressure,oxygen saturation ,electrocardiogram(ECG),and myocardial enzymes were dected,and the clinical values of these changes were analyzed.Results: when CO 2 pneumoperitoneum established ,the HR and blood pressure were increased obviously .The incidence of arrhythmia was 36% and the incidence of changes of ST segment was 30%,10 minutes after pneumoperitoneum eliminated,these changes were restored. The myocardial enzymes and the oxygon saturation of blood had no distinct changes. Conclusion: The procedure of CO 2 pneumoperitoneum caused temporany changes of the HR ,SBP/DSP and ECG.The laparoscopic surgery is effective and safe for geriatric cholelithiasis.It suggests that the dynamic monitoring of electrocardiogram is necessary,especially for those with abnormal heart function.