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Lenvatinib mesylate is an oral receptor tyrosine kinase inhibitor against targets of vascular endothelial growth factor receptors 1-3, fibroblast growth factor receptors 1-4, platelet-derived growth factor receptor α, stem cell growth factor receptor, and rearranged during transfection, et al. Lenvatinib has been approved by the National Medical Products Administration of China on September 4,2018, for the first-line treatment of patients with unresectable hepatocellular carcinoma who have not received systematic treatment before. Up to February 2023, Lenvatinib has been listed in China for more than 4 years, accumulating a series of post-marketing clinical research evidences. Based on the clinical practice before and after the launch of lenvatinib and referring to the clinical experience of other anti-angiogenesis inhibitors, domestic multidisciplinary experts and scholars adopt the Delphi method to formulate the Chinese Expert Guidance on Overall Application of Lenvatinib in Hepatocellular Carcinoma after repeated discussions and revisions, in order to provide reference for reasonable and effective clinical application of lenvatinib for clinicians.
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The literatures on indocyanine green fluorescent imaging in hepatectomy,especially in laparoscopic hepatectomy were reviewed by retriving Web of science,Pubmed,China National Knowledge Infrastructure (CNKI) and Wanfang database.To view the progress and limitations of indocyanine green fluorescent imaging in laparoscopic hepatectomy.Indocyanine green fluorescent imaging can:(1) effectively detect and differentiate tumor;(2) visualize the staining of liver segment and differentiate bile duct;(3) detect bile leakage.However,high false positive rate and limitation in depth in tumor detectation are still the major disadvantages of indocyanine green fluorescent imaging.Also,the best dose and interval of indocyanine green are unknown.Indocyanine green fluorescent imaging will be very usefull in laparoscopic hepatectomy in future,also need to be explored in details,especially in oncology effect.
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Objective:To investigate the value of indocyanine green retention rate at 15 minutes (ICG R15) on postoperative day 3 combined with standard remnant liver volume (SRLV) in predicting the occurrence of liver dysfunction after hepatectomyin hepatocellular carcinoma (HCC).Methods:The clinical data of 61 HCC patients undergone hepatectomy in Xiangya Hospital of Central South University from January 2015 to February 2016 were collected and analyzed.The patients were divided into 2 groups:a normal liver function group (n=40) and a liver dysfunction group (n=21).Univariate analysis was used to evaluate the risk factors for postoperative liver dysfunction.Logistic regression was used to assess the independent risk factors for postoperative liver dysfunction,and the regression equation between independent risk factors and postoperative liver dysfunction was established,The receiver operating characteristic (ROC) curve was used to examine the regression equation and compare the value difference in predicting postoperative liver dysfunction between single and combined independent risk factors.Results:Postoperative liver dysfunction occurred in 21 of the 61 patients,with an incidence rate at 34.4％.There was no significant difference in the time of operation,time of hepatic portal occlusion,volume of tumor and volume of resected liver between the 2 groups (all P＞0.05),but there were significant differences in the ICG R15 on postoperative day 3,intraoperative blood loss and SRLV between the 2 groups (all P＜0.05).The ICG R15 on postoperative day 3,intraoperative blood loss,SRLV were the risk factors for postoperative liver dysfunction.Logistic regression analysis showed ICG R15 on postoperative day 3 and SRLV were the independent risk factors for postoperative liver dysfunction,and the regression equation between independent risk factors and postoperative liver dysfunction was as follows:logit(P)=1.277+0.140×ICG R15 on postoperative day 3-5.125×SRLV.The area under the ROC curve ofICG R15 on postoperative day 3 combined with SRLV was more than that of single ICG R15 and single SRLV.Conclusion:ICG R15 on postoperative day 3 and SRLV are the independent risk factors for postoperative liver dysfunction.The regression equation,which is established by combination of ICG R15 with SRLV,can predict the occurrence of postoperative liver dysfunction.The accuracy of ICG R15 on postoperative day 3 combined with SRLV is better than that of single ICG R15 or single SRLV.
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OBJECTIVE@#To investigate the application of identification techniques of the recurrent laryngeal nerve (RLN) in endothyroidectomies.@*METHODS@#Routine identification of the RLN was performed in a series of 20 consecutive endothyroidectomies, and the clinical data were reviewed.@*RESULTS@#Totally 20 RLNs were dissected. Neither transient nor permanent RLN injury occurred.@*CONCLUSION@#To expose RLN, both sharp and blunt dissection should be applied skillfully. Thorough liberation of the thyroid lobe is essential for the identification of RLN. It is safe and feasible to remove the thyroid and identify the RLN simultaneously.
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Endoscopy , Methods , Intraoperative Complications , Recurrent Laryngeal Nerve , Recurrent Laryngeal Nerve Injuries , Thyroid Neoplasms , General Surgery , Thyroid Nodule , General Surgery , Thyroidectomy , Methods , Vocal Cord ParalysisABSTRACT
Objective To investigate the relationship of postoperative complications of thyroid surgery with primary thyroid disease, operation procedures and operative manipulation. Methods The clinical data of 1805 cases of thyroid diseases treated by surgery in our department between 1990～2001 were analyzed retrospectively . Results There were 67 complications occurred in 1805 cases (3.7%). The postoperative complications rate in Hashimoto′s disease and thyroid carcinoma were 6 (16.2%) and 27 (12.2%) respectively ,which were obviously higher than that in other primary thyroid disease( P
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Objective To sum up the effect and experience in radiofrequency ablation(RFA) for liver cancer(LC). Methods The clinical data of 102 patients with LC treated by percutaneous and intraoperative RFA were analysed retrospectively. Results RFA was used to treat 195 tumors (median diameter 5.6 cm,ranging from 1.5 to 9.5 cm) in 102 patients.Of them, primary liver cancer was found in 80 patients( 78.4%),and metastatic liver tumor was in 22 patients(21.6%). Percutaneous RFA(PRFA) and intraoperative RFA(IRFA) was performed in 77 patients(75.5%) and 25 patients(24.5%) respectively. There was no severe complications after RFA in this series. All of the 102 cases had been followed up for 3～24months,AFP positive returned to negative in 70.3%(52/74)of the patients.The rate of concreted necrosis of liver cancer showed by CT was 88.2%(90/102). The 1 year survival rate was 93.8%.Conclusions RFA is a safe and effective treatment for patients with LC. Patients with small and readily accessible tumor are the indications of PRFA;while the patients with large,multiple,perivascular or otherwise inaccessible liver tumor are also the indications for IRFA.The adoption of the TACE and other methods to occlude the vascular inflow can improve the efficacy of RFA.
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Objective To investigate the gene expression of nuclear factor-kappa B(NF-?B) and its (biological) significance in liver cancer tissue.Methods The samples from hepatic cancer tissue and(corresponding) adjacent tissues were collected in thirty-two patients with primary liver cancer.The mRNA and protein levels of NF-?B were determined by reverse-transcription PCR and Western bolt,respectively.(Immunochemistry) was employed to determine the localization of NF-?B protein in liver tissues.Results As shown by RT-PCR and Western blot,both mRNA and protein expressions of NF-?B in liver cancer tissues were significantly higher than those in corresponding adjacent liver tissues(P
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Objective To investigate the effect and the prognostic factors of radiofrequency ablation(RFA) for primary liver cancer(PLC).Methods RFA was performed in 195 patients with PLC,and the efficency was evaluated with univariate analysis.Cox′s regression analysis model was used to analyze the factors affecting the prognosis.Results In the whole group of patients,the 1,2,3 and 5-year overall survival rate was 80.5%,67.4%,49.1% and 32.7% respectively,and in the patients with small PLC(the size≤3 cm),the 1,2,3 and 5-year overall survival rate was 91.7%,81.2%,60.5% and 40.4% respectively.The Cox regression models indicated that the independent factors in determining the prognosis were: Liver function of Child-Pugh stage,tumor size and occlusion of hepatic inflow during RFA.Conclusions RFA is an effective mini-invasive treatment for patients with PLC,and especially for the patients with small PLC.The efficency of RFA for small PLC has the same outcome as that of surgical resection of the tumor.Liver function of Child-Pugh stage,tumor size and occlusion of hepatic inflow during RFA are the independent prognostic factors.
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Objective To explore the methods and outcome of comprehensive therapeatic for primary liver cancer. Methods Various therapeutic methods and outcome of 265 patients with primary liver cancer admitted in the last five years, were analyzed retrospectively .The group consisted of 238 male, and 27 female patients. The average age 47.5 years. Operation was performed in 215 cases and non-operative treatment is 50 cases. Operative treatment included resection of hepatic cancer and/or adjuvant therapy. Non-operative therapy included transcatheter hepatic chemo-embolization(TACE),percutaneous ethanol injection (PEI)、drug delivery system(DDS)、cryosurgery、radiofrequency ablation(RFA). Results The resection rate, and mortality and morbidity rates were 57%(215/377), 74.9%(161/215), 0.5%(1/215), and 19% respectively. The overall 1-,2-,3-year survival rate were 78.9 %,59.3%,33.5%, respectively, in patients who received comprehensive treatment centered around surgical resection, and 62.3%,32.3%,22.8%, respectively, in 45 patients who received non-surgical resection treatment. Conclusions Liver resection combined with other nonoperative modalities are ideal ways to treat primary liver cancer at the present time, and for different stages of primary liver cancer different treatment modalities are used.
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Objective To evaluate the results of liver carcinoma treated by radiofrequency ablation(RFA) with color Doppler ultrasonography(CDU). Methods Hemodynamic changes of the interior and periphery of 212 nodules of liver carcinoma in 152 patients were investigated by CDU one week before and one month after RFA. Results Blood flow signals were found in 187 cancerous nodules before RFA, and were chiefly from mixed arterio-venous blood supply. After RFA, the blood flow signals of these 187 cancerous nodules completely disappeared in 133, were reduced in 40 and did not change in 14. Peripherar blood flow did not change in 51.2% of the tumors. Conclusions CDU is useful in evaluating the therapeutic effect of RFA in patients with liver carcinoma and may provide information for further treatment.
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Objective To investigate the feasibility of autogenous vein graft as a connector to repair recurrent laryngeal nerve(RLN) defect. Methods 20 healthy dogs were randomly devided into 4 groups: group 1(n=6), 2(n=6), 3(n=5) and control group(n=3). Left RLN of dogs in group 1,2,3 were resected for 1,2,3 centimetres respectively and followed by repairment with autogenous vein graft, while RLNS of dogs in control group were resected but not conducted by autogenous vein graft. Six months after operation, the vocal fold movement, phonation and induced action potensial as well as morphologic observation of the aryngeal muslces were studied. Results In group 1, phonation of dogs was all restored to normal. The vocal fold of RLN resected side showed no atrophy symmetrical to the normal side and adducted apparently when phonating. Furthermore thyroarythenoid muscle and posterior cricoarytenoid muscle both could generate induced action potentially. Regenerated nerves in verin graft and distal nerve were observed by light microscope and electron microscope. In group 2,3 and control group hoarseness improved six months after op eration, the vocal fold of RLN resected side was atrophied apparently and fixed paramedianly. Fissure existed in glottis when vocal fold closed, and compensative movement of opposite vocal fold across over the median line was found. Thyoarthenoid muscle and posterior cricoarytenoid muscle unable to generate an action was found. Regenerated nerves were not observed in vein graft or distal nerve by light microscope and electron microscope. Conclusions It is feasible to repair RLN defect in certain length by autogenous vein graft.
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Objective To investigate the diagnosis and treatment of Hashimoto's disease. Method The clinical data of 51cases of Hashimoto's disease admitted to our department from 1986 to 2001 were collected and analyzed. Result The preoperative misdiagnosis rate is 78.4%. 37 of 51 cases undergone surgical treatment and the results were satisfied. Follow up data, which were collected from 30 patients, showed that 6 patients(16.2%) developed hypothyroidism . Conclusion The examination of antithyroglobulin (TGA) and antimicrosomal (TMA) and the frozen section examination during operation are helpful to the diagnosis. Appropriate operation is a safe and effective treatment for patients with Hashimoto's disease who have received effectiveless thyroxine treatment.
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Objective To investigate the diagnosis, surgical treatment of thyroid cancer and prevention of the surgical complications. Methods Clinical data of 246 cases of thyroid cancer were analysed retrospectively from March 1990 to April 2001. Results 135 and 80 patients were diagnosed before and during operation, and all patients were diagnosed after operation; Reoperation was performed in 57 patients and residual carcinoma tissue was found in 30 patients; 1, 3 and 5 years surviving rate of thyroid cancer after operation were 99.2% , 96.3% and 91.5% respectively; No death occurred in the 246 cases after operation, 4 cases of whom showed temporary vocal cord paralysis and 3 cases showed tic due to hypocalcemia. Conclusions Intraoperative frozen section is helpful for the diagnosis and the choice of operative methods; The extention of thyroidectomy and whether to perform lymph dissection vary with the pathology types and risk factors. Patients should take thyroid tablets all their lives.