CT guided percutaneous transhepatic microwave ablation for primary liver cancer in segment 9 / 中华肝胆外科杂志

Objective:To study the efficacy and safety of CT guided percutaneous transhepatic microwave ablation (PTPMWA) for primary liver cancer (PLC) in liver segment 9.Methods:A retrospective study was conducted on PLC patients between October 2013 and March 2019 at Dongguan People’s Hospital, Southern Medical University. Of 41 patients who entered into the study, there were 36 males and 5 females, with an average age of 59.1 years. These patients were diagnosed to have PLC in segment 9. The surgical related data and follow-up results were collected and analyzed.Results:All patients enrolled in the study completed the treatment procedure. CT scan was performed immediately after ablation which showed that the tumor areas to be completely covered by ablation. The duration of operation ranged from 45 to 260 (mean 91) min. The amount of bleeding during treatment was 1.0 to 5.0 (mean 1.4) ml. The complete response rate was 97.6% (40 patients) and the partial response rate was 2.4% (1 patient). The cumulative survival rates at 1, 2, 3, 4 and 5 years were 95.1%, 85.4%, 75.3%, 45.2% and 45.2%, respectively. Only 4 patients (9.8%) developed recurrence after treatment. The timings of recurrence were 1, 6, 13 and 67 months after treatment, respectively. The recurrent lesions were ablated again and complete response was obtained in all patients. There were no serious problems related to complications from ablation. The rate of postoperative complication was 7.3% (3 patients).Conclusion:PTPMWA is a novel treatment for patients with PLC in liver segment 9, the advantages of this treatment include good safety, high efficacy, low complications and local recurrence. The treatment is worthy of further future studies.

A mathematical calculation model of replacement fluid and citric acid infusion in continuous veno-venous hemofiltration / 中华危重病急救医学

Objective To design a mathematical calculation model for better understanding and grasping the logical problem of replacement fluid and citric acid anticoagulant infusion in continuous veno-venous hemofiltration (CVVH). Methods ① Parameter definition: A, B, and T were respectively called the main part of pre-replacement fluid, 5% sodium bicarbonate solution, and 4% sodium citrate infused before filter. And a and b were respectively called the main part of post-replacement fluid, and 5% sodium bicarbonate solution infused after filter. ② Logic conversion:The liquid in back terminal (Z) was artificially divided into two parts. One (X) was the original residual plasma after filtration. The second (Y) was the part excluding the plasma, including the left part of pre-replacement fluid with sodium citrate, and the post-replacement fluid. ③The mathematical formulas of liquid volume and electrolyte concentration at X, Y and Z in unit time were listed according to the principle of CVVH and the screening coefficient of filter for different substances. ④The calculation formulas were entered into Excel form, and a mathematical calculation model was made, and a simulation calculation with examples was carried out. Results An Excel model was established by inserting the calculation formulas of volume, electrolyte, and total calcium at X, Y and Z. And it was found that the concentration of Na+, K+, Cl-, HCO3- at Y point remained unchanged only when A, B and (or) a, b was kept in same side and proportion even with the change of blood flow and other parameters without sodium citrate as anticoagulant. Once any of the parameters (such as blood flow, replacement fluid volume, etc.) were adjusted in other infusion methods (such as different ratios, different directions of the same year, etc.), the calculation results at Y would vary, and the electrolyte concentration at Z would change accordingly. A change of dilution model or parameter would result in the change of the electrolyte concentration at Y and Z with sodium citrate as anticoagulant. The concentration of total calcium scarcely changed no matter in what model and parameters. Conclusions All kinds of infusion ways could be included in the Excel model. The infusion results of all kinds of infusion matching could be intuitively evaluated. It is helpful for the medical staff to make a logical analysis and risk prediction in CVVH.

Experience of pancreaticoduodenectomy and the diagnosis of carcinoma of the papilla of Vater / 中华肝胆外科杂志

Objective To summarize our experience in the diagnosis and treatment of carcinoma of the papilla of Vater (CPV).Methods From April 2005 to May 2012,21 consecutive patients were enrolled in Dongguan Affiliated Hospital of Southern Medical University.The clinical characteristics,diagnosis,surgical data and follow-up results of these patients were retrospectively analyzed.Results Painless jaundice was the primary symptom in 18 patients.An elevated CEA level was observed in 3 patients preoperatively,while CA19-9 was increased in 10 patients.17 patients with periampullary tumors were detected by MRCP or CT,and in 12 patients,they were detected by ultrasound examination.Gastroscopy was performed in 16 patients,among whom 8 patients were diagnosed with neoplasm of the duodenal papilla initially,and 5 patients were ultimately diagnosed with CPV by pathological examination after biopsy.All the 21 patients were successfully treated with pancreaticoduodenectomy.8 patients developed postoperative complications.No death occurred in the perioperative period.The complications included pancreatic fistula (2 patients),gastroparesis (2 patients),incisional infection (2 patients),gastrointestinal hemorrhage (1 patient) and concurrent gastrointestinal and intraperitoneal haemorrhage (1 patient).A reoperation consisting of pancreaticoduodenal repair and drainage was performed in 1 patient.3 patients underwent adjuvant chemotherapy.Long-term follow up was obtained in 18 patients.The 1-year,3-year and 5-year survival rates were 80.9％,66.7％ and 47.6％,respectively.The longest overall survival was 152 months.Conclusions Early diagnosis of CPV was feasible.Pancreaticoduodenectomy as a treatment strategy for this cancer was safe and effective.

Preoperative evaluation of multi-slice spiral computed tomography angiography in laparoscopic radical operation for colorectal carcinoma / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the clinical application of 256 multi-slice spiral computed tomography angiography (MSCTA) technique in the preoperative evaluation of mesenteric angiography in order to provide a reference to vessel anatomy and dissociation in laparoscopic radical operation for colorectal carcinoma.</p><p><b>METHODS</b>Clinical data of 50 patients with colorectal cancer who underwent preoperative MSCTA+FDCT and laparoscopic curative operation at our hospital from October 2013 to March 2015 were collected (MSCTA group). The evaluation item was visualization of mesenteric artery, which was compared with the findings under laparoscopic surgery. Meanwhile, another 50 colorectal cancer patients undergoing laparoscopic radical operation by the same surgeon team without preoperative MSCTA examination were used as control(control group). Clinical data were compared between the two groups.</p><p><b>RESULTS</b>MSCTA precisely and correctly demonstrated anatomy and variations of the mesenteric artery and relative nutrient vessel in carcinoma. The angiography reconstruction images were consistent with the visual anatomy and variation from laparoscopic findings, whose diagnostic conformity rate of 100%. As compared to control group, operative time was shorter [(195.0±23.2) minutes vs.(218.0±19.6) minutes, t=8.326, P=0.015], and blood loss was less[(168.1±18.8) ml vs. (206.5±14.3) ml, t=-19.369, P=0.002] in MSCTA group. Differences of number of harvested lymph node, postoperative complication morbidity, postoperative hospital stay and hospitalization cost were not significant between two groups(all P>0.05).</p><p><b>CONCLUSION</b>Preoperative MSCTA can demonstrate anatomy and variations of the mesenteric artery precisely and correctly, thus it is beneficial to shorten the operation time and to reduce blood loss.</p>

Distribution of 5-FU in rat hepatoma, liver tissue and plasma after locoregional infusion / 中国癌症杂志

Background and purpose: Locoregional infusion chemotherapy such as hepatic artery, or hepaticportal vein infusion is one of the most important treatments for hepatocelluar carcinoma. This study was aimed to investigate the distribution of fluorouracil(5-FU) in rat hepatoma, liver tissue and plasma after administrated by caudal vein or locoregional routes of hepatic artery, hepaticportal vein, and hepaticportal vein with ligated hepatic artery. Methods:Twenty-four tumor-bearing rats were divided into 4 groups randomly, and they were infused with 5-FU through peripheral vein(caudal vein), hepatic artery, hepaticportal vein or hepaticportal vein with ligated hepatic artery, which dose was 20 mg/kg. High performance liquid chromatography was adopted to measure the content of 5-FU in hepatoma, liver tissue and plasma, and the drug penetration rate among them were calculated. Results:The group of hepaticportal vein with ligated hepatic artery reached the highest concentrations of 5-FU in live tissue and hepatoma, which concentrations were (22.1±9.5)μg/g and (16.4±7.2)μg/g. Then was the hepatic artery group, and the concentration of the hepaticportal vein group in the hepatoma focus was much smaller than the former 2 groups, which was (8.9±3.7)μg/g. The peripheral vein group got the lowest concentrations both in the liver tissue and hepatoma, which were (9.4±3.7) and (4.3±2.2)μg/g. The concentrations of 5-FU in the plasma in the peripheral vein group, the hepatic artery group, the group of hepaticportal vein with ligated hepatic artery and the hepaticportal vein group were (26.8±12.5), (16.4±9.7), (15.9±10.1) and (14.9±8.5)μg/mL, which indicated that the drug concentrations of the latter 3 groups were much lower than the former group. The hepatoma/plasma penetration rate of 5-FU in the group of hepaticportal vein with ligated hepatic artery, the hepatic artery group, the hepaticportal vein group and the peripheral vein group were 103.47%, 92.94%, 59.58% and 16.08%. Conclusion: Compared to the peripheral venous bolus injection, locoregional infusion could significantly increase the concentrations of chemotherapy agent in hepatoma focus and liver tissue, and decrease the drug distributions in peripheral blood. And the infusion through hepaticportal vein with ligated hepatic artery and through hepatic artery reaches higher concentrations in the hepatoma focuses, which indicate that they are 2 practical and promising routes for the locoregional chemotherapy of hepatoma.

Experimental study on concentrations and pharmacokinetics of antibiotics in bile and evaluation of their microbicidal potential / 中华外科杂志

<p><b>OBJECTIVE</b>To study the concentrations and pharmacokinetics of 6 different kinds of antibiotics in rabbit bile, and evaluate their microbicidal potential.</p><p><b>METHODS</b>Thirty-six health rabbits were randomly divided into 6 groups, and each group was 6 rabbits. After anaesthesia, the common bile duct of rabbit was isolated and cumulated with a silicone tube. The rabbits were administered intravenously with the equal-effect dose of antibiotics. Bile (1.5 ml) was collected at different time points after administration, and the concentration of antibiotics of bile was assayed by high performance liquid chromatography. The bile drug concentration-time data were processed by software to figure out the pharmacokinetic parameters such as maximum concentration (C(max)), peak time (T(max)), half-life time (T(1/2)), clearance (CL) and apparent volume of distribution (VD). The bile antibiotics concentration contrasted to the minimum inhibitory concentration (MIC), and attained the bactericidal index (C(max)/MIC) and the time when the drug concentration exceeded the MIC (T(>MIC)).</p><p><b>RESULTS</b>The C(max) and T1/2 of each antibiotic were as the followings: piperacillin (7 950 ± 3 023) mg/L and (1.97 ± 1.23) h, ceftriaxone (1 104 ± 248) mg/L and (3.14 ± 0.57) h, cefoperazone (5 215 ± 2 225) mg/L and (0.89 ± 0.13) h, meropenem (31.97 ± 12.44) mg/L and (0.36 ± 0.11) h, levofloxacin (66.3 ± 36.9) mg/L and (3.32 ± 2.57) h, metronidazole (28.2 ± 10.2) mg/L and (0.81 ± 0.33) h, respectively. Piperacillin/tazobactam and cefoperazone/sulbactam had the largest bactericidal index and the longest T(>MIC), and their bactericidal indexes were (62.1 ± 23.6) - (993.8 ± 377.9) and (164.8 ± 69.0) - (659.3 ± 275.9), their T(>MIC) were (6.00 ± 2.53) - (8.00 ± 0.00) h and (6.33 ± 1.97) - (8.00 ± 0.00) h. The bactericidal index and T(>MIC) of levofloxacin were the smallest, which were (2.1 ± 1.2) - (8.3 ± 4.6) and (0.54 ± 0.25) - (2.67 ± 1.03) h . Ceftriaxone and meropenem were as the medium, and their bactericidal indexes and T(>MIC) were (4.3 ± 1.0) - (69.2 ± 15.5) , (1.42 ± 0.65) - (8.00 ± 0.00) h and (2.0 ± 0.8) - (1 031.3 ± 401.4) , (0.29 ± 0.10) - (1.83 ± 0.26) h. The bactericidal index of metronidazole to anaerobic ranged from 7.4 to 294.9, and the T(>MIC) ranged from 1.88 to 5.00 h.</p><p><b>CONCLUSIONS</b>The bile concentrations of six antibiotics all exceed their effective bactericidal concentrations. The concentration-time curves of piperacillin, cefoperazone, meropenem and metronidazole conformed to one-compartment model, and ceftriaxone and levofloxacin are conformed to two-compartment model. Piperacillin/tazobactam and cefoperazone/sulbactam have the largest bactericidal index and the longest T(>MIC), so they can be chosen as the first choice for the therapy of hepatobiliary infection.For the anaerobic, the microbicidal potential of metronidazole is high.</p>

Surgical therapy for hepatocellular carcinoma with right diaphragmatic invasion / 中华肝胆外科杂志

Objective To review the indications,surgical methods,and matters which need attention in partial right diaphragmatic resection,and to summarize our experience of surgical therapy for hepatocellular carcinoma with right diaphragmatic invasion.Methods The clinical data of 27 patients with hepatocellular carcinoma which had invaded the diaphragm and had received partial right diaphragmatic resection and partial hepatectomy in our hospital from September 2008 to September 2012 were retrospectively analyzed.Results The operations were all performed successfully.The tumor diameter ranged from 5.0 to 15.0 cm (average 8.5 cm).The area of right diaphragm which was resected ranged from 9.0 to 50.0 cm2 (average 28.5 cm2).The operation time was 110～250 min (average 165 min),and blood loss was 450～2600 ml (average 870 ml).Diaphragmatic invasion was confirmed by postoperative histopathology in 9 patients (33.3％).A small quantity of right thoracic effusion was detected in all the cases postoperatively.Other complications included hepatic insufficiency in 4 patients and early postoperative bleeding,upper gastrointestinal bleeding,biliary fistula,and infection under the diaphragm in 1 case each.All patients recovered after conservative treatment.There was no perioperative death.19 patients received other postoperative adjuvant treatment while 6 patients refused further treatment and 2 patients were lost to follow-up.The 0.5-,1-,2,and 3 year survival rates after operation were 92.6％,81.5％,51.9％ and 33.3％ respectively.Conclusions Right diaphragmatic invasion is not a contraindication to surgery.Right diaphragmatic resection was safe and feasible,and postoperative long-term survival was satisfactory.

Management of main hepatic vein injury in hepatectomy for hepatic neoplasm of segment Ⅷ / 中华肝胆外科杂志

Objective To summarize the experience in management of main hepatic vein injury due to hepatectomy for hepatic neoplasm of segment Ⅷ. Methods Clinical data of 64 patients suffering from main hepatic vein injury due to hepatectomy of hepatic neoplasm of segment Ⅷ in our hospital from October 1996 to October 2008 were retrospectively analyzed. Results Both the main trunks of the middle and right hepatic vein were injured in 34 patients, single right hepatic vein in 13 and middle hepatic vein in 17. In these patients with hepatic vein injury, the main trunk of the hepatic vein was repaired in 39, vessels ligated in 12 and direct liver wound surfaces sutured in 12. The hepatectomy and hemostasis were successfully performed during operation in all patients. After operation, 3 patients had active bleeding and 2 patients were reoperated on to sew up the bleeding points by wadding with the gelatin sponge and discharged after rehabilitation. One patient gave up treatment and was discharged automatically. Conclusion Main hepatic vein injury in hepatectomy of hepatic neoplasm of segment Ⅷ can be managed effectively by hepatic vein repair, hepatic vein ligation and suture of the liver section that can be chosen to control the bleeding of hepatic vein injury according to the actual conditions.

Assessment of Biliary Excretion of Ceftriaxone Sodium in Humans / 医学研究杂志

Objective To study biliary excretion of ceftriaxone sodium in humans. Methods Twelve biliary calculi patients were infused with a single dose of 2.0g ceftriaxone half an hour before operation and the common bile duct bile and gallbladder bile samples were coUected in the operations. The bile drug concentrations were assayed by HPLC. Results The results of clinical study on the bile drug showed that the concentrations (C) of ceftriaxone in common bile duct and gallbladder were (264.43±166.46) μg/ml and (85.39 ±48.16) μg/ml, respectively. Conclusion Ceftriaxone reaches high concentrations in humans' bile, and it could be chosen as a good antibiotics for the treament of biliary infection.

The nursing of implantable drug delivery system ofter operation of liver cancer / 中国实用护理杂志

Objective To study the method and nursing measurements of the detection of portal venous pressure. Method The implantable drug delivery system was performed during the operation in 31 patients with liver cancer. The direct dynamic observation was performed by using the system and the corresponding nursing measurement was given. Result The measurement of portal venous pressure was successful performed 251 times in 31 cases with liver cancer and no complications were taken place. Conclusions The dynamic observation of portal venous of pressure by using the implantable drug delivery system was simple. Safety and could be repeated and could easily be receipted by the cases, the nurses skilled measured the key points of nursing and actively prevented the complications was taken implant role in increasing the rate of success of detection .

Treatment of liver cancer located in the first porta hepatis with percutaneous radiofrequency ablation combined with ethanol injection / 中国医师杂志

Objective To investigate the feasibility,curative effect and problems of combined ultrasound-guided percutaneous radiofrequency ablation and ethanol injection(PRFA+EI) on small liver cancer located in first porta hepatis.Methods Twenty-six patients,who diagnosed as primary and metastatic liver cancer that located in first porta hepatis and was less than 5 cm in diameter by clinical evidence or pathology,were performed PRFA+EI between Jan 2001 and Oct 2004.The necrosis of the tumors was determined by MRI,Doppler ultrasound or CT after the treatment for one month and the regular examinations were tested every 3 months.The primary tumor recurrence rate and cumulative survival rate were calculated.Results The seroconversion rate of AFP was 76.9%(10/13).The complete necrosis rate of liver cancer in first porta hepatis was 84.6%(22/26) by MRI and CT.The primary tumor recurrence rate of 6 months and 1 year were 23.1%(6/26) and 26.9%(7/26),respectively.The 1-,2-,3-year cumulative survival rate were 92.3%(24/26),82.3% (14/17),75.0%(9/12),respectively.There was no occurrence of bile ducts stenosis.Conclusion The small live cancer located in first porta hepatis is not the contraindication of PRFA+EI.If the puncture point and route is selected properly,electrodes deployed exactly using ultrasound guidance and the size of heating area controlled appropriately,the PRFA+EI is an effective treatment for small liver cancer located in first porta hepatis.

Standardization of Perioperative Prophylactic Use of Antibiotics for TypeⅠand ⅡOperative Incision Wounds and Monitoring the Efficacy / 中国药房

0.05),the average costs of antibiotics,all other drugs and hospitalization in trial group were lower than those in control group(P