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Objective:To discuss the surgical approach and the clinical effect of laparoscopic enucleation for hepatic hemangioma(HH).Methods:Forty HH patients admitted in the Third Affiliated Hospital of Soochow University between Aug 2018 and Dec 2019 were analyzed. The technical knowhow involved is to make a good explosure of the pseudocapsular HH from underneath. Herewith a process of HH enucleatoin started.Results:All the 40 patients undergone total laparoscopic hepatectomy successfully.The operative time was (90.3±32.3)min, the intraoperative blood loss was (50±500)ml, the time of hepatic block was (12.5±35.4) min. The volume of postoperative drainage was 10-150 ml on the first postoperative day, and was gradually reduced to <30 ml on the third day after the operation. All patients were up and about from post-op day 2. The length of stay after operation was (5.5±2.7)d. There were significant differences in ALT、AST、TBIL and prealbumin in 1 and 3 days after surgery (seperately, t=-5.481, -4.182, -2.235, 9.722, all P<0.05), before back to normal on day 7 (seperately t=0.167, -1.392, 1.000, -2.531, all P>0.05). Liver function recovered to normal in 7 days after surgery. Conclusion:New approach breaks the traditional stripping method and makes the procedure simple, safe, lessly disturb the liver function.
ABSTRACT
Objective@#To evaluate the clinical significance of C-reactive protein/albumin ratio in predicting the postoperative prognosis of pancreatic cancer patients.@*Methods@#The clinical date of 97 patients with resectable pancreatic cancers who treated at Department of Hepatobiliary and Pancreatic Surgery, the third Affiliated Hospital of Soochow University from January 2005 to December 2015 were analyzed retrospectively. The cut-off value of CRP/Alb ratio was determined by the receiver operating characteristic(ROC) curve. According to the CRP/Alb ratio, patients were respectively divided into two groups: the high group(CRP/Alb ratio≥0.109) and the low group(CRP/Alb<0.109). The relationships between CRP/Alb ratio and clinical characteristics were analyzed by χ2 test. Median survival and 1-year overall survival rate(OS) was calculated by Kaplan-Meier method.The risk factors of patients with poor prognosis were analyzed by univariate and multivariate Cox regression analysis model.@*Results@#Tumor TNM stage(χ2=4.280, P=0.039) and differentiation(χ2=6.635, P=0.010) had significant relationship with CRP/Alb ratio. The median survival of higher CRP/Alb ratio group and lower CRP/Alb ratio group was 15 months and 23 months respectively. Compared with lower CRP/Alb ratio group, the 1-year OS of higher CRP/Alb ratio group decreased remarkablely, and the difference was statistically(χ2=10.207, P=0.001). Moreover, median survival and OS were decreased in patients with advanced age(≥65 years old: χ2 =5.338, P=0.021), high TNM stage(ⅡB-Ⅲ: χ2 =10.529, P=0.001), poor tumor differentiation(χ2=5.380, P=0.020), vascular invasion(χ2 =7.856, P=0.005) and positive surgical margin(χ2=9.059, P=0.003). A high CRP/Alb ratio was identified as an independent risk factor of poor prognosis for patients with pancreatic cancer(HR=1.832, 95% CI: 1.067-3.144, P=0.028). Besides, old age(HR=1.684, P=0.014), high TNM stage(HR=1.666, P=0.031), vascular invasion(HR=1.834, P=0.024) and positive surgical margin(HR=2.205, P=0.023) were also included.@*Conclusion@#Preoperative CRP/Alb ratio can be an important clinical factor for assessing the prognosis of patients with resectable pancreatic cancers, and high CRP/Alb ratio suggests poor prognosis.