Influential factors for failure of enhanced recovery after surgery from hepatectomy for hepatocellular carcinoma and the establishment of risk prediction model / 中华外科杂志

Objective@#To investigate the influential factors for failure of enhanced recovery after surgery(ERAS) from hepatectomy for hepatocellular carcinoma(HCC) patients and then to establish a risk prediction model.@*Methods@#The relevant clinical data of 180 patients with HCC undergoing hepatectomy at Department of Hepatic Surgery, Affiliated Provincial Hospital, Anhui Medical University from January 2016 to June 2017 were analyzed retrospectively.There were 149 male patients and 31 female patients aging of (56.5±11.0)years(from 33 to 84 years old). The factors affecting postoperative failure of ERAS of HCC patients were identified by univariate and multivariate analyses, and then, all the obtained factors and their statistical values were used to establish the risk prediction model.@*Results@#A total of 23 patients failed in the ERAS protocol(12.8%). The preoperative total bilirubin (TBIL), alanine aminotransferase(ALT) and amount of intraoperative bleeding were independent risk factors for failure of ERAS from hepatectomy(all P<0.05). The obtained risk prediction model was presented as follows: risk coefficient(R)=0.114×(TBIL)+ 0.082×(ALT)+ 0.008×(amount of intraoperative bleeding). At the cut of value of R=7.90, the area under the ROC curve of this model for predicting failure of ERAS was 0.866(95%CI: 0.788-0.945, P<0.01), with the sensitivity and specificity of 69.6% and 91.1%, respectively.External validation results indicated that the scoring system had good differential ability(area under the ROC curve=0.889, 95%CI: 0.811-0.967, P<0.01).@*Conclusions@#Higher level of preoperative TBIL(>21 μmol/L) and ALT(>50 U/L) and the larger amount of intraoperative bleeding (more than 400 ml) are independent risk factors for failure of ERAS inpatients undergoing hepatectomy for HCC and the established prediction model may have certain value for risk assessment.

Clinical efficacy of anatomic liver resection in the treatment of hepatocellular carcinoma with microvascular invasion / 中华消化外科杂志

Objective To explore the clinical efficacy of anatomic liver resection in treatment of hepatocellular carcinoma (HCC) with microvascular invasion (MVI).Methods The retrospective cohort and case-control study was conducted.The clinical data of 150 HCC patients with MVI who were admitted to the Anhui Medical University Affiliated Provincial Hospital from June 2007 to June 2012 were collected.Sixty patients undergoing anatomic liver resection were allocated into the AR group and 90 undergoing non-anatomic liver resection in the NR group.Patients in the AR group underwent anatomic liver resection according to results of preoperative ICG R15 test,and patients in the NR group underwent non-anatomic liver resection.Observation indicators:(1) operation situations:operation time,volume of intraoperative blood loss,number of patients with blood transfusion;(2) postoperative recovery situations:time of drainage-tube removal,duration of hospital stay,Clavein grade of complication within 30 days postoperatively,number of patients with hepatic failure within 30 days postoperatively and number of death within 30 days postoperatively;(3) follow-up:postoperative median survival time,5-year overall survival rate and 5-year tumor-free survival rate;(4) prognostic factors analysis of 150 HCC patients with MVI.Measurement data with normal distribution were represented as-x±s and comparison between groups was analyzed using the independent-sample t test.Count data were represented as the chi-square test or Fisher exact probability.The survival rate was calculated using the Kaplan-Meier method and survival analysis was done using Log-rank test.The univariate analysis and multivariate analysis were done using the COX regression model.Results (1) Operation situations:all the 150 patients received successful radical resection of HCC.Operation time,numbers of patients with volume of intraoperative blood loss ≥ 500 mL and with volume of intraoperative blood loss ＜ 500 mL and number of patients with blood transfusion were (165±39) minutes,12,48,15 in the AR group and (136±30)minutes,34,56,38 in the NR group,respectively,with statistically significant differences between the 2 groups (t =29.172,x2=5.351,4.673,P＜0.05).(2) Postoperative recovery situations:time of drainage-tube removal and duration of hospital stay were (2.7± 1.1)days and (5.2± 1.3) days in the AR group,(3.8±1.6)days and (7.1±2.3)days in the NR group,respectively,with statistically significant differences between the 2 groups (t =4.641,5.812,P＜0.05).Numbers of patients with grade Ⅰ-Ⅱ of Clavein grade and with grade Ⅲ-Ⅳ and number of death within 30 days postoperatively were 45,15,1 in the AR group and 61,29,2 in the NR group,respectively,with no statistically significant difference between the 2 groups (x2 =0.906,P＞0.05).Number of patients with hepatic failure within 30 days postoperatively in the AR and NR group were respectively 4 and 17,with a statistically significant difference (x2=4.467,P＜0.05).(3) Follow-up:all the 150 patients were followed up for 1-106 months,with a median time of 26 months.The postoperative median survival time,5-year overall survival rate and 5-year tumor-free survival rate were 46 months,33.3％,21.7％ in the AR group and 18 months,15.6％,2.2％ in the NR group,respectively,with statistically significant differences in overall survival and tumor-free survival between the 2 groups (x2=23.718,63.932,P＜ 0.05).(4) Prognostic factors analysis of 150 HCC patients with MVI:result of univariate analysis showed that maximum diameter of tumor,tumor capsule,TNM stage,Edmondson grade and surgical procedures were relative factors affecting overall survival and tumor-free survival of HCC patients with MVI,with statistically significant differences (x2=5.519,2.790,13.639,8.321,42.470,31.057,15.963,19.594,23.718,63.932,P＜ 0.05).Result of multivariate analysis showed that missing tumor capsule,stage Ⅲ-Ⅳ of TNM stage,grade Ⅲ-Ⅳ of Edmondson grade and non-anatomic liver resection were independent factors affecting poor overall survival and tumor-free survival of HCC patients with MVI,and maximum diameter of tumor ＞5 cm was an independent factor affecting poor overall survival of HCC patients with MVI,with a statistically significant difference [HR =0.527,0.683,0.333,0.522,0.576,0.514,0.523,0.268,95％ confidence interval (CI):0.355-0.782,0.475-0.983,0.219-0.504,0.361-0.755,0.389-0.852,0.358-0.737,0.342-0.800,0.174-0.413;HR=0.559,95％CI:0.370-0.845,P＜0.05].Conclusions Anatomic liver resection in the treatment of HCC patients with MVI is safe and effective,with good short-term and long-term outcomes,and it can also improve prognosis of patients.Missing tumor capsule,stage Ⅲ-Ⅳ of TNM stage,grade Ⅲ-Ⅳ of Edmondson grade and non-anatomic liver resection are independent factors affecting poor overall survival and tumor-free survival of HCC patients with MVI,and maximum diameter of tumor ＞5 cm is an independent factor affecting poor overall survival of HCC patients with MVI.

Effects of parecoxib sodium and fentanyl multimodal analgesia on immune functions in patients undergoing hepatectomy for hepatocellular carcinoma / 中华普通外科杂志

Objective To investigate the effects of multimodal analgesia of parecoxib and fentanyl on perioperative immune functions in patients of hepatocellular carcinoma (HCC).Methods Eighty HCC patients scheduled for hepatectomy were randomly divided into two groups:parecoxib sodium combined with fentanyl group (group P,40 cases) and fentanyl group (group C,40 cases).The percentages of CD3 +,CD4+,CD8+,CD4+/CD8+ T cells,CD3-CD16+ CD56+ (NK),interleukin-4 (IL-4),interferon-γ (IFN-γ) and the ratio of IFN-γ/IL-4 were detected at the following time points:30 minutes before induction of anesthesia (T0),at the end of the surgery (T1),24 h after surgery (T2) and 72 h after surgery (T3).The analgesic effects were estimated by visual analogue scale (VAS) after surgery.Total fentanyl consumption and adverse effects were also recorded.Results The percentages of CD3 + T cells were significantly lower in group C than that in group P at T2 (t =2.155,P ＜0.05).The percentages of NK in group P were recovered nearly to baseline (T0) at T2,which was higher than that of group C (t =2.791,P ＜0.05).In group C,the percentages of CD3 + T cells and NK has not recovered to baseline at T3 (respectively t =3.065,3.231,P ＜ 0.05).In group P,IL-4 serum levels were significantly lower than those in group C,while IFN-γ serum levels were significantly higher than those in group C at T2 (respectively t =2.173,2.100,P ＜0.05).From T2 to T3,the ratio of IFN-γ/IL-4 significantly increased in group P than those in group C (respectively t =3.259,2.203,P ＜ 0.05).VAS scores at rest and on cough in group P were significantly lower than those in group C at 2 h,6 h,12 h and 24 h after operation (respectively t =8.661,9.726,9.147,7.109,P＜0.05;t =8.569,9.614,9.144,8.509,P＜0.05).The total fentanyl consumption in group P was lower than that in group C (t =2.636,P ＜ 0.05).There were no significant differences regarding the incidence of adverse effects between the two groups.Conclusions Perioperative multimodal analgesia of parecoxib sodium combined with fentanyl enhances the analgesic efficacy,and reduces the dosage of opioid consumption,helps recover the cell immunity function of HCC patients after hepatectomy.

Prognostic significance and clinicopathological features of hypoxic inducible factor-2alpha expression in hepatocellular carcinoma

To assess the association between hypoxic inducible factor-2alpha [HIF- alpha] and hepatocellular carcinoma [HCC] by meta-analysis. This study was carried out at Anhui Province Hospital, Hefei, Anhui, China in February 2014. We searched various databases for studies published in English or Chinese up to February 28, 2014. The hazard ratio for overall survival and analyzed odds ratio were combined to evaluate the clinicopathological features of HIF-2 alpha expression in HCC. A total of 7 eligible studies comprising 1066 patients with HCC were identified after our full assessment according to inclusion criteria. All of the patients came from China. The results indicated that the association between HIF-2 alpha expression and prognostic values in HCC was inconspicuous, while the expression of HIF-2 alpha was significantly associated with capsule infiltration, vein invasion, and histological grade. Expression of HIF-2 alpha was associated with invasion and metastasis in HCC, but did not have a distinct significance in prognosis, according to the limited evidence. However, high quality, large sample size, and controlled trials are required

Application of selective devascularization for the treatment of portal hypertension / 局解手术学杂志

Objective To determine efficacy of selective devascularization in management of portal hypertension. Methods The clini-cal data of 86 patients of portal hypertension in our hospital from Jan. 2010 to Aug. 2013 were retrospectively analyzed. The patients were divided into the selective group and the nonselectove devascularization group according to the different devascularization ways. The postopera-tive liver function index and complications were analyzed. Results In selective devascularization group, the surgery time was prolonged (P0. 05). The postoperative peak value of ALT and AST and postoperative pomplications in the selective devascularization group were low-er than those in the nonselectove devascularization group (P<0. 05). And patients in the selective devascularization group have a shorter hospital stay compared to the nonselectove devascularization group (P<0. 05). Conclusion Selective devascularization can lower free portal pressure more effectively, reduce incidence rates of postoperative early complications, and it is worthy of clinical promotion.

Role of liver cancer stem cells in the metastasis and recurrence of liver cancer / 中华消化外科杂志

Liver cancer is one of the most common cancers worldwide and the third leading cause of cancer death.Partial hepatectomy and liver transplantation are the most effective therapies.However, postoperative tumor metastasis and recurrence are the main obstacles in the long-term survival.Liver cancer stem cells (LCSCs) within cancer tissues are associated with tumor occurrence, proliferation and tolerance to current therapy and are regarded as the major root of metastasis and recurrence.Eradication of LCSCs is a novel therapy of liver cancer.In this review, surface markers of LCSCs and mechanisms of pro-metastasis and recurrence, circulating LCSCs,microenvironment of LCSCs and their roles in the metastasis and relapse are summarized.

The diagnosis and management of penetrating abdominal injury with large vessels damage in 18 cases / 中华普通外科杂志

Objective To investigate the experience of diagnosis and treatment of abdominal penetrating injury with large vessels damage.Methods The clinical data of 18 patients with abdominal large vessels injuries in our hospital from Jan 2003 to oct 2014 were analyzed retrospectively.Results 18 cases of large vessels injuries,accounting for 16.21％ during the same period of all penetrating wounds (18/111),emergency laparotomy was performed.There were 8 cases of arterial injury,4 cases of concurrent arteriovenous injury,6 cases of venous injury,Arterial and venous broken walls were repaired,splenic artery and venous ligation and splenectomy were performed.Vascular repair success rate was 100％,Intraoperative blood loss was 500-6 000 ml,average (3 750 ±670) ml.Operating time varied from 2.5 to 7 h,average (3.9 ±0.8) h.All patients were cured.12 cases were followed-up for 2-36 months,mean follow-up time was (15 ± 7) months,ultrasonography showed normal blood flow without complications.Conclusions Emergency surgical exploration and limited fluid resuscitation is the most effective therapy in abdominal penetrating injury involving large vessels.

Analysis of postoperative pain of hepatectomy / 中华普通外科杂志

Objective To investigate the occurrence of postoperative pain of hepatectomy and its possible related factors.Methods The clinical data of 555 cases undergoing hepatectomy was analyzed retrospectively,and the related influencing factors on postoperative pain of hepatectomy were analyzed by univariate analysis and multivariate logistic regression.Results Moderate postoperative pain was reported in 255 cases among 555 patients who underwent hepatic resection (with an incidence of 45.95％).Incision pain which was often sharp was most common,followed by postoperative complication caused pain.According to whether the postoperative pain occurred or not,all cases were divided into postoperative pain group (n =255) and non-postoperative pain group (n =300),univariate analysis showed that age (P ＜0.01),surgical history (P ＜ 0.01),surgical approach (P ＜ 0.01),incision length (P ＜ 0.01),xiphoid removal(P ＜ 0.01),the final outcome of incision (P ＜ 0.01),complications (P ＜ 0.01) were significantly different between the two groups.Logistic multiple regression analysis showed that the independent influencing factors of postoperative pain included surgical history (P =0.001),surgical approach (P =0.005),incision length (P =0.000),xiphoid process removal (P =0.001),complications (P =0.000).Conclusions The postoperative pain of hepatectomy has a high incidence.Surgical history,surgical approach,incision length,xiphoid process,removal and postoperative complications are the independent impact factors of postoperative pain.

Surgical treatment of primary liver cancer with diaphragmatic muscle invasion / 中华普通外科杂志

Objective To explore the way and the effect of surgical treatment of primary hepatic carcinoma with diaphragmatic invasion.Method Clinical data of 37 primary hepatic carcinoma patients with diaphragmatic muscle invasion undergoing enbloc liver resection in Anhui Provincial Hospital between January 2008 and January 2014 were retrospectively analyzed.Control group comprised 54 liver cancer patients without diaphragm involvement.Results All cases underwent surgery successfully,no significant statistical differences were found between pre-operation clinical data of two groups.The operation time of the group with diaphragmatic invasion is slightly longer than that of the group without (149.4 ± 23.4 min vs 137.9 ±24.6 min,t =2.228,P =0.028);meanwhile,there was no obvious difference between blood loss of the two groups (449.5 ±304.1 ml vs 304.1 ±222.3 ml,t =0.678,P =0.499).There were no significantly statistical differences in other aspects between the two groups such as postoperative pulmonary infection,pleural effusion,infection of the incision,mortality and hospitalization time.Based on Kaplan Meier-log-rank test analysis,it is found that the two groups had no significant differences in disease-free survival and overall survival (P1 =0.982,P2 =0.906).Conclusions Hepatic carcinoma patients with diaphragmatic invasion are still indicated for liver resection with a favorable prognosis.

Damage control surgery in diagnosis and treatment of sharp abdominal injury combined with multiple trauma / 中华创伤杂志

Objective To evaluate the role of damage control surgery (DCS) in the diagnosis and treatment of sharp abdominal injury combined with multiple trauma.Methods Sixty patients with sharp abdominal injury accompanied by multiple trauma treated from January 2005 to August 2014 were reviewed retrospectively.There were 55 males and 5 females,aged at 15-79 years (mean,32.08 years).Thirty patients underwent definite operative treatment (control group),and 30 patients had DCS (DCS group).Between-group differences were examined in pre-and post-operative hemodynamic changes,function recovery,cure rate and complication incidence.Results All patients showed improved hemodynamic parameters after operation.The cure rate was 97％ (29/30) in DCS group versus 50％ (15/30) in control group (P ＜ 0.05).Complications were reported in 17％ (5) of the patients in DCS group versus 40％ (12) of the patients in control group (P ＜ 0.05).Conclusion DCS is associated with decreased rate of complications and increased cure rate in the treatment of sharp abdominal injury combined with multiple trauma.

Recent advances in surgical treatment of complex hilar cholangiocarcinoma / 临床肝胆病杂志

Complex hilar cholangiocarcinoma is a great challenge to surgeons in hepatic surgery,not only because of its great degree of oper-ation difficulty,but also the high surgical risk and low R0 resection rate.Noticeably,R0 resection,lymph node infringement,and vessel re-section are regarded as three independent prognostic factors for complex hilar cholangiocarcinoma.In recent years,with the advancement of surgical techniques such as precise liver resection using preoperative 3D imaging,application of radical tumor resection while preserving nor-mal liver parenchyma for patients who are suitable for this surgical process,combined hepatic resection and vascular resection,and perform-ance of reasonable extent of lymph node dissection,it is hoped to increase the curative resection rate for patients with Bismuth typeⅢandⅣcomplex hilar cholangiocarcinoma,improve their quality of life,and prolong their survival time.

Expression of Nodal in hepatocellular carcinoma and its relationship with angiogenesis and epithelial-mesenchymal transition / 中华外科杂志

<p><b>OBJECTIVE</b>To detect the expression of Nodal in hepatocellular carcinoma (HCC), and explore its relationship with angiogenesis and epithelial-mesenchymal transition (EMT).</p><p><b>METHODS</b>From September 2006 to June 2010, the 16 self-paired frozen HCC specimens were collected and the expression of Nodal was detected by qPCR and Western blot. The 10 normal liver tissues and 96 cases of HCC tumor and paracarcinomatous tissues were collected. The expression of Nodal and relationship among Nodal, clinicopathological characteristics of HCC and patients' prognosis were detected and analyzed using immunohistochemistry. The expressions of Nodal, Vimentin and CD34 in 96 HCC tumor tissues were detected by immunohistochemistry, and then judgment relationship between the expression of Nodal, EMT and angiogenesis.</p><p><b>RESULTS</b>Immunohistochemistry showed that Nodal mainly expressed in the cytoplasm. The high expression rate of Nodal in HCC tumor tissues was 72.9% (70/96), which was remarkably higher than that in paracarcinomatous tissues (8.3%) and normal liver tissues (0) (χ(2) = 83.001 and 24.470, both P < 0.001). qPCR and Western blot analysis showed that the expression level of Nodal in HCC was significantly higher than that in paracarcinomatous and normal tissues (P < 0.05). The high expression of Nodal in HCC was correlated with tumor size (χ(2) = 15.318, P = 0.000), alpha-fetoprotein (χ(2) = 3.850, P = 0.049), indocyanine green retention rate at 15 minutes (χ(2) = 6.590, P = 0.010), and invasion and metastasis (χ(2) = 17.824, P = 0.000). High expression of Nodal was positively correlated with high microvascular density in HCC (t = 3.070, P = 0.006), but not with Vimentin (r = 0.198, P = 0.053). Survival analysis showed that accumulated survival rate of patients with high expression of Nodal was significantly less than that the low expression (χ(2) = 487.053, P < 0.001). The Cox multivariate analysis demonstrated that high expression of Nodal was independent risk factors for cumulative survival in patients with hepatocellular carcinoma after a curative resection (RR = 2.757, 95%CI: 1.450-5.240, P = 0.002).</p><p><b>CONCLUSIONS</b>Nodal does not participate in EMT of HCC, but can promote angiogenesis, and it could be used as a predictor of poor prognosis.</p>

Precision right hemihepatectomy combined with caudate lobectomy for the treatment of huge carcinoma in the caudate lobe / 中华消化外科杂志

Hepatectomy for huge hepatocellular carcinoma (HCC) is difficult due to its huge size and the compression and invasion to the surrounding tissues as well as the important vascular systems.Surgical resection of huge carcinoma in the caudate lobe is a big challenge for hepatobiliary surgeons because of its special location and complex anatomical structure.As the improvement of surgical techniques in recent years,especially the promotion of the concept of precision liver surgery,many surgeons begin to take the challenge of resection of huge HCC in the caudate lobe in a variety of ways.In April 2014,a male patient aged 58 years with huge HCC in the caudate lobe was admitted to the Anhui Provincial Hospital.Precision right hemihepatectomy combined with caudate lobectomy was performed on this patient without occlusion of the hepatic inflow,and the efficacy was satisfactory.The key techniques involved in this procedure were discussed in this article.

Expression of Mortalin in human hepatoma-derived cell lines and its role in epithelial-mesenchymal transition / 中华肝胆外科杂志

Objective To detect the expression of Mortalin in human hepatoma-derived cell lines and explore its effect on epithelial-mesenchymal transition in hepatocellular carcinoma (HCC) cell lines.Methods Six HCC cell lines and 1 normal liver cell line (L02) were chosen.The expression of Mortalin was detected using Western blot and real-time quantitative PCR (qPCR).The endogenous gene expression of Mortalin was inhibited by RNA interference (shRNA).Cell viability was detected using MTT assay and flow cytometry.The expression of Mortalin,E-cadherin and Vimentin were detected by Western blot and qPCR.The experiment was divided into three groups; blank,control,and shRNA.Results Mortalin was detected in Hep3B,MHCC97H,HepG2,and HCCLM3,but not in MHCC97L and L02.After 24 h transfection,GFP fluorescence showed that plasmid Mortalin shRNA was successfully transfected into MHCC97H cells.MTT assay indicated that cytotoxicity was 0％,2.5％,and 3.5％ in the blank,control,and shRNA group respectively.Similarly,flow cytometric showed that early apoptosis rates were 0.8％,4.5％,and 9.2％ in the blank,control,and shRNA group respectively.These results indicated that transfection did not cause severe cell damage.After 48 h of interference,Western blot and qPCR analysis showed that shRNA significantly inhibited the expression of Mortalin.Moreover,cells were collected after 24 h,48 h,72 h and 96 h of interference and analyzed for the relationship between Mortalin,E-cadherin and Vimentin by Western blot and qPCR.It was found that decreased expression of Mortalin was accompanied by elevated E-cadherin expression and reduced Vimentin expression.Conclusion Overexpression of Mortalin correlated with the metastatic phenotype of HCC cells and could promote epithelial-mesenchymal transition.

Advances in the mechanism and prevention of liver ischemia reperfusion injury / 国际外科学杂志

Ischemia reperfusion injury is an important factor which has been affected the recuperation of hepatic function after hepatectomy and liver transplantation,and is a complex course in pathophysiology with many factors.With the development of research on ischemia reperfusion injury,effective prevention measures of ischemia reperfusion injury also have made new progress.And this will greatly improve the prognosis of hepatic surgery.The mechanism and its prevention measure of hepatic ischemia reperfusion injury were reviewed in this paper.

99mTc-GSA SPECT imaging in liver diseases / 中华肝胆外科杂志

Asialogycoprotein receptor (ASGPR) is a specific receptor of mammalian hepatocytes,exclusively up-take the glycoprotein in the blood.The number of ASGPR correlates significantly with liver function,and the reduction of the number of ASGPR suggest liver dysfunction.Decreased ASGPR in patients with liver cirrhosis or portal hypertension or hepatocellar carcinoma,lead to varying degrees of liver dysfunction,which made it more susceptible to post operative complications.liver ASGPR scintigraphy with Technetium-99 m DTPA-galactosyl human serum albumin (99m Tc-GSA),combinating with single photon emission computed tomography (SPECT) technology can assess the functional reserve of remnant liver and predict incidence of postoperative complications,then assist to evaluate the use fulness for clinically surgical decisions.Current situation and progress of 99mTc-GSA SPECT imaging in hepatic surgery were reviewed in the paper.

Research progress of proteomics and prediction of metastasis and recurrence in hepatocellular carcinoma / 国际外科学杂志

Tumor metastasis and recurrence had become a key to curative effect and long-term survival,and it's hotspot of current clinical oncology research.Differential expression of proteomics between cancer and normal tissue can be used for discovering new tumor markers.Clinical detection of liver cancer-related protein molecules was useful to monitor and assess early diagnosis,recurrence and prognosis of hepatocellular carcinoma.Herein,this article reviewed the research progression of protein molecules in hepatocellular carcinoma.

Causes and managements of complications after precise hepatectomy for primary liver cancer / 国际外科学杂志

ObjectiveTo summarize the complications after precise hepatectomy for primary liver cancer and explore the prevention experiences.MethodsThe clinical data of 120 primary liver cancer patients who underwent precise hepatectomy in Anhui Provincial Hospital from August 2008 to October 2011 were retrospectively analyzed.The common complications after hepatectomy and the management measures of the complications were studied.Results Related complications were found in 19 cases,including 7 cases of pleuraI effusion,3 cases of pneumonia,1 case of intra- abdominal hemorrhage,2 cases of up gastrointestinal bleeding,1 case of abdominal abscess,1 case of hepatic failure,1 case of bile leakage,2 cases of would infection,1 case of urinary tract infection.ConclusionsPrecise hepatectomy has characteristics of preoperative accurate assessment,intraoperative fine operation and postoperative excellent management,which reduce the incidence of postoperative complications.

The prognostic significance of preoperative serum levels of extracellular matrix protein 1 in patients with hepatocellular carcinoma / 中华普通外科杂志

Objective To evaluate the prtognostic significance of preoperative serum extracellular matrix protein 1 ( ECM1 ) levels in patients with hepatocellular carcinoma (HCC).Methods Preoperative serum levels of ECM1 were detected by enzyme-linked immunosorbent assay (ELISA) in 117 HCC patients and 53 healthy volunteers.Corrrlations to the clinicopathological characteristics and patients survival were analyzed.Results ECM1 were detected in all the samples of 117 HCC patients and 53 healthy volunteers,the median serum ECM1 level in HCC patients was significantly higher than that in healthy volunteers ( 166.39 vs 108.06 pg/ml,Z =- 7.805,P ＜ 0.001 ).Median serum ECM 1 levels were significantly higher in patients with invasive phenotypes,such as larger tumor size (Z =- 3.454,P =0.001 ),multiple nodule ( Z =- 2.201,P =0.028 ),vascular invasion ( Z =- 4.685,P ＜ 0.001 ),and advanced TN M stage ( Z =-4.610,P ＜ 0.001 ).Patients with lower serum ECM1 level (≤ 180 pg/ml ) have significantly better overall and disease free survival thanthose with higher levels ( ＞ 180 pg/ml).By Cox proportional-hazard model multivariate analysis,high serum ECM1 level ( ＞ 180 pg/ml) was an independent factor for OS and DFS in HCC patients.Conclusions Serum ECM1 levels are significantly correhted to the invasive phenotypes and survival rate.Serum ECM1 level could be used as a predictive marker for HCC recurrence and prognostic factor of HCC patients after surgery.

Research progression of tumor-associated macrophage and hepa-tocellular carcinoma / 国际外科学杂志

Chronic inflammation has been demonstrated closely related to the tumor progression.Tumorassociated macrophage,as the most abundant immune cells in the tumor microenvironment,is a key element that links inflammation and cancer.Recently,studies found that the phenomenon and function of tumor-associated macrophage almost tend to M2 type macrophage.As an important indicator,tumor-associated macrophage usually predicts the poor progress with the cancer development.In China,Most of patients with hepatocellular carcinoma are associated with chronic viral infection.A large number of macrophages in the liver infiltrated in chronic inflammation,which are differentiated by variety of mechanisms under the chronic inflammatory stimulation,promote the development of liver cancer.In this paper,we will review the tumor-associated macrophages and the development of liver cancer.