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Objective To investigate the safety and effectiveness during perioperative period in patients undergoing laparoscopic hepatectomy under ERAS program.Methods A retrospective study was carried out,in 40 patients under ERAS programs from Sep 2016 to Aug 2017 compared with 40 patients in control group from Sep 2015 to Aug 2016 in intraoperative central vein pressure,blood loss,postoperative stress indicators,the incidence of moderate to severe pain,exhaust time,oral feeding time,ambulation time,complications,hospital stays and costs and patient satisfaction.Results Compared with control group,the intraoperative blood loss was decreased by controlling central venous pressure (t =2.556,P =0.013),earlier exhaust,oral intake of food and ambulation (P ＜0.001),lower incidence rate of moderate to severe pain (x2 =11.314,P ＜ 0.001),and higher patient satisfaction (t =6.816,P ＜ 0.001) in ERAS group,though there were no significant differences in extubation time (t =0.336,P =0.738).The average hospital stays were 2.8 days shorter (16.6 ± 3.0 vs.19.4 ± 6.4,t =2.514,P =0.015),and hospital expenses were (￥)6 000 less than control group (5.4 ±0.7 vs.6.0± 1.5,t =2.338,P =0.023).Conclusion ERAS programs applied to patients undergoing laparoscopic hepatectomy can safely and effectively accelerate patient recovery.
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Objective@#To investigate the effect of adipose tissue-derived mesenchymal stem cell (ADSC) transplantation in the treatment of liver fibrosis rats and possible mechanism.@*Methods@#Subcutaneous adipose tissue in the inguinal region of rats was collected to isolate ADSCs. The rats with liver fibrosis induced by intraperitoneally injected carbon tetrachloride were divided into cell transplantation group and phosphate buffer saline (PBS) injection group, and the rats which were fed normally were enrolled as negative control group. The rats in the cell transplantation group were given tail vein injection of ADSCs, and those in the PBS injection group were given injection of 0.5 ml PBS. At 7 days after transplantation, blood samples were collected from the inferior vena cava to evaluate liver function; liver tissue was collected to measure the protein expression of hepatocyte growth factor (HGF) and alpha-smooth muscle actin (α-SMA); Masson trichrome staining was used to evaluate intrahepatic collagen deposition. Hepatic stellate cells (HSCs) were collected from the rats with liver fibrosis, and indirect co-culture of HSCs and ADSCs was performed in vitro to analyze the influence of ADSCs on the proliferation and apoptosis of HSCs. The independent samples t-test was used for comparison between groups, and an analysis of variance was used for comparison of means between multiple samples.@*Results@#ADSCs were found in liver tissue in the transplantation group, and compared with the PBS injection group, the transplantation group had significant alleviation in hepatocyte necrosis, vacuolization, and area of fibrosis and significant reductions in the serum levels of aminotransferases, while there was no significant difference in the level of albumin between the two groups. Compared with the PBS injection group, the transplantation group had significant upregulation in the protein expression of HGF and significant downregulation in the protein expression of α-SMA (both P < 0.05). In vitro co-culture for 72 hours showed that ADSCs inhibited the proliferation of HSCs, and there was a significant difference between the co-culture group and the control group with HSCs cultured alone. Caspase-3 immunostaining showed that after co-culture for 72 hours, there was a significant difference in the apoptosis rate of HSCs between the co-culture group and the control group with HSCs cultured alone (23.42% ± 3.02% vs 14.82% ± 3.93%).@*Conclusion@#ADSC transplantation can upregulate the expression of HGF in the liver, promote the apoptosis of HSCs, and thus alleviate liver fibrosis.
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Objective To evaluate the feasibility,safety and effectiveness of modified associating liver partition and portal vein ligation for staged hepatectomy (ALPPS).Methods The published literatures associated with modified ALPPS were pooled from Embase,Pubmed,Medline,Google Scholar databases.The studies were included or excluded depends on our predetermined criteria.We selected data and performd descriptive analysis from the included studies.Results Five articles were included and reviewed.A total of 62 patients underwent five modified procedures,including monosegment ALPPS (m-ALPPS),anterior approach ALPPS,partial-ALPPS,radiofrequency-assisted liver partition with portal vein ligation (RALPP) and associating liver tourniquet and portal ligation for staged hepatectomy (ALTPS).There were 50 (80.6％) patients diagnosed liver metastatic colorectal cancer.The average operation interval of modified ALPPS was between 8 ～ 22 days and growth rate of future liver remnant (FLR) ranged from 48.7％ to 62.3％,the feasibility to perform ALPPS stage 2 was 98.4％.The incidence of severe postoperative complications were between 11.8％ ～33.3％.The 90-day mortality for monosegment ALPPS,partial-ALPPS and RALPP was 0,while the figure was 8.3％ in ALTPS.The in-hospital morbidities were 5.9％ and 8.3％ for anterior approach ALPPS and ALTPS,respectively,which were 0 in the other three modified groups.Clinical response evaluation,including R0 resection rate,overall survival rate,disease-free and recurrence rates were merely presented 83.3％,80％,50％,50％ in m-ALPPS group,while 100％,100％,95％,5％ in modified ALTPS group.Conclusion Modified ALPPS with improved safety is feasible in clinical practice.However,the effectiveness still needs further studies.
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Objective To evaluate the effect of enteral nutritional support for the liver cancer patients with precise hepatetomy under fast track process model. Methods 82 patients were prospectively randomized into enteral nutrition group (n = 41) and parenteral nutrition (n = 41). The hemoglobin (HB), total protein (TP), albumin (ALB) and total lymphocyte count (TLC) were measured on 3 days before operation and 7 days after operation respectively. The two groups were compared in terms of time for anal exhaust and defecation after surgery , the postoperative hospital stay, the gastrointestinal adverse reactions and complications after surgery. Results The nutrition and immunity indicators on day 7 after operation were significantly poorer and lower than on day 3 before operation in the parenteral nutrition group (P0.05). Conclusion Enteral nutritional support under fast track process model for the liver cancer patients undergoing precise resection could improve clinical outcome.