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Objective:To investigate the techniques used in blood flow control of Kimura laparoscopic spleen-preserving pancreatectomy (LSPDP).Methods:Forty·five patients with benign or low-grade malignant pancreatic diseases undergoing LSPDP at Huzhou Central Hospital from May 2014 to Oct 2021 were analyzed retrospectively. Patients were divided into splenic vascular flow control group ( n=22) and routine management group ( n=23). Results:There was no significant difference in gender, age, BMI, accompanying symptoms, hypertension, diabetes, lesion size and pathological diagnosis between the two groups (all P>0.05). A higher overall spleen preservation rate (90.9% vs. 52.2%, χ2=8.213, P=0.004), lower incidence of morbidity with Clavien grade ≥ Ⅱ (22.7% vs. 73.9%, χ2=9.911, P=0.002) and shorter postoperative hospital stay [(9.6±4.5) d vs. (14.3±6.6) d, t=2.447, P=0.008] were achieved in the vascular flow control group compared with those in the routine group. Conclusion:Splenic vascular flow control techniques improve the success rate of spleen preservation in laparoscopic distal pancreatectomy, reduce the postoperative complications and shorten the postoperative hospital stay.
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Objective To explore the risk factors and prognosis of the microvascular invasion of hepatocellular carcinoma (HCC).Methods The retrospective case-control study was conducted.The clinicopathological data of 220 patients with HCC who were admitted to the Nanfang Hospital of Southern Medical University from July 2012 to July 2015 were collected.Among 220 patients,63 were confirmed with microvascular invasion of HCC by postoperative pathological examination after radical resection of HCC and 157 were not confirmed with microvascular invasion of HCC.Observation indicators:(1) univariate and multivariate analyses affecting microvascular invasion of HCC;(2) follow-up and survival situations.Follow-up using outpatient examination and telephone interview was performed to detect patients' survival and tumor recurrence up to July 2016.The univariate and multivariate analyses were done using the Logistic regression model.The survival curve and survival rate were respectively drawn and calculated by the Kaplan-Meier method,and the Log-rank test was used for survival analysis.Results (1) Univariate and multivariate analyses affecting microvascular invasion of HCC:the results of univariate analysis showed that maximum diameter of tumor,preoperative alpha-fetoprotein (AFP) and preoperative platelet (PLT) were related factors affecting microvascular invasion of HCC [OR =4.542,1.576,3.655,95％ confidence interval (CI):2.433-8.470,1.084-2.292,1.985-6.831,P＜0.05].The results of multivariate analysis showed that maximum diameter of tumor,preoperative AFP and preoperative PLT were independent factors affecting microvascular invasion of HCC (RR=3.386,1.563,2.247,95％CI:1.703-6.729,1.054-2.318,1.135-4.451,P＜0.05).(2) Follow-up and survival situations:220 patients were followed up for 12-48 months,with a median time of 26 months.The postoperative overall 1-and 2-year survival rates,postoperative 1-and 2-year tumor-free survival rates were 77.3％,50.0％,47.3％,38.0％ in 63 patients with microvascular invasion of HCC and 92.4％,77.2％,74.5％,69.4％ in 157 patients without microvascular invasion of HCC,with statistically significant differences (x2 =10.480,19.605,14.677,18.461,P＜ 0.05).Conclusion The maximum diameter of tumor,preoperative AFP and preoperative PLT are independent factors affecting microvascular invasion of HCC,and patients with microvascular invasion of HCC have poor clinical prognosis.
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Objective To evaluate the value of precise hepatectomy in treatment of early-stage primary liver cancer after radical resection. Methods Between June 2012 and July 2014,174 patients undergoing radical resection of hepatocellular carcinoma were enrolled in this comparative study at Nan fang Hospital. 118 patients with liver resection under precise hepatectomy were assigned to precise resection group and 56 patients with liver resection under Pringle maneuver were assigned to occlusion group. The two groups were compared in terms of preoprational clinical pathological and laboratory data ,volume of intraoperative bleeding and blood transfusion , postoperative hepatic function recovery,hospitalization days,and postoperative tumor-free survival rate of 1,2 years. Results There was no significant difference between the two groups in the sex,age,liver disease,preo-pration albumin,ALT,AST,alcohol intake and liver cirrhosis(P>0.05). No differences between the two groups were found about the volume of intraoperative bleeding and blood transfusion as well as surgery cost (P > 0.05). The recovery of hepatic function was accelerated and the incidence of complications ,hospitalization days and peri-od of drainage were significantly reduced in the precise resection group compared with the occlusion group (P <0.05). The 1,2-years postoperative tumor-free survival rate was 79.7%(94/118),60.9%(46/118)in the precise group and 50.0%(28/56),46.4%(26/56) in the occlusion group ,with significant difference between them (χ2=4.741,8.722,P<0.05). Conclusions For early-stage liver cancer patients,the precise hepatectomy during radical resection results in quick recovery and fewer complications ,thus it should be the first choice of clinical operation.
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Objective To explore the risk factors and prognosis of the microvascular invasion of hepatocellular carcinoma (HCC).Methods The retrospective case-control study was conducted.The clinicopathological data of 220 patients with HCC who were admitted to the Nanfang Hospital of Southern Medical University from July 2012 to July 2015 were collected.Among 220 patients,63 were confirmed with microvascular invasion of HCC by postoperative pathological examination after radical resection of HCC and 157 were not confirmed with microvascular invasion of HCC.Observation indicators:(1) univariate and multivariate analyses affecting microvascular invasion of HCC;(2) follow-up and survival situations.Follow-up using outpatient examination and telephone interview was performed to detect patients' survival and tumor recurrence up to July 2016.The univariate and multivariate analyses were done using the Logistic regression model.The survival curve and survival rate were respectively drawn and calculated by the Kaplan-Meier method,and the Log-rank test was used for survival analysis.Results (1) Univariate and multivariate analyses affecting microvascular invasion of HCC:the results of univariate analysis showed that maximum diameter of tumor,preoperative alpha-fetoprotein (AFP) and preoperative platelet (PLT) were related factors affecting microvascular invasion of HCC [OR =4.542,1.576,3.655,95％ confidence interval (CI):2.433-8.470,1.084-2.292,1.985-6.831,P＜0.05].The results of multivariate analysis showed that maximum diameter of tumor,preoperative AFP and preoperative PLT were independent factors affecting microvascular invasion of HCC (RR=3.386,1.563,2.247,95％CI:1.703-6.729,1.054-2.318,1.135-4.451,P＜0.05).(2) Follow-up and survival situations:220 patients were followed up for 12-48 months,with a median time of 26 months.The postoperative overall 1-and 2-year survival rates,postoperative 1-and 2-year tumor-free survival rates were 77.3％,50.0％,47.3％,38.0％ in 63 patients with microvascular invasion of HCC and 92.4％,77.2％,74.5％,69.4％ in 157 patients without microvascular invasion of HCC,with statistically significant differences (x2 =10.480,19.605,14.677,18.461,P＜ 0.05).Conclusion The maximum diameter of tumor,preoperative AFP and preoperative PLT are independent factors affecting microvascular invasion of HCC,and patients with microvascular invasion of HCC have poor clinical prognosis.
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Objective To evaluate the value of precise hepatectomy in treatment of early-stage primary liver cancer after radical resection. Methods Between June 2012 and July 2014,174 patients undergoing radical resection of hepatocellular carcinoma were enrolled in this comparative study at Nan fang Hospital. 118 patients with liver resection under precise hepatectomy were assigned to precise resection group and 56 patients with liver resection under Pringle maneuver were assigned to occlusion group. The two groups were compared in terms of preoprational clinical pathological and laboratory data ,volume of intraoperative bleeding and blood transfusion , postoperative hepatic function recovery,hospitalization days,and postoperative tumor-free survival rate of 1,2 years. Results There was no significant difference between the two groups in the sex,age,liver disease,preo-pration albumin,ALT,AST,alcohol intake and liver cirrhosis(P>0.05). No differences between the two groups were found about the volume of intraoperative bleeding and blood transfusion as well as surgery cost (P > 0.05). The recovery of hepatic function was accelerated and the incidence of complications ,hospitalization days and peri-od of drainage were significantly reduced in the precise resection group compared with the occlusion group (P <0.05). The 1,2-years postoperative tumor-free survival rate was 79.7%(94/118),60.9%(46/118)in the precise group and 50.0%(28/56),46.4%(26/56) in the occlusion group ,with significant difference between them (χ2=4.741,8.722,P<0.05). Conclusions For early-stage liver cancer patients,the precise hepatectomy during radical resection results in quick recovery and fewer complications ,thus it should be the first choice of clinical operation.
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<p><b>OBJECTIVE</b>To observe the serum expression of miR-181b in atherosclerotic patients and the in vitro effects of miR-181b on vascular smooth muscle cell growth and migration.</p><p><b>METHODS</b>Fifty patients (mean age: (78.1 ± 8.9) years old) with carotid ultrasound examination evidenced atherosclerotic plaque were enrolled as the atherosclerosis group and 50 healthy (mean age: (72.5 ± 10.7) years old) subjects serve as control group. Stem-loop real time RT-PCR was used to detect the serum expression of miR-181b. Importin-α3 was predicted to be a direct target of miR-181b by Targetscan and Pictar. Western-blot was employed to detect the in vitro effects of miR-181b on the expression of Importin-α3 in endothelial cells. Luciferase reporter assay was employed to testify the prediction. The effects of miR-181b on vascular smooth muscle cell growth, migration abilities were respectively examined by CCK8 assay and Matrigel migration assay.</p><p><b>RESULTS</b>Compared with healthy controls, serum expression of miR-181b was significantly down-regulated in patients with atherosclerosis (31.69 ± 0.96 vs. 82.28 ± 5.95, P < 0.05); Importin-α3 was predicted and proved to be a direct target of miR-181b by Western-blot and luciferase reporter assay. The proliferation and migration of vascular smooth muscle cell were significantly downregulated by forced expression of miR-181b (1.57 ± 0.18 vs. 2.66 ± 0.16, P < 0.05; 8.7 ± 1.1 vs. 21.4 ± 2.3, P < 0.05), while these effects could be abolished by inhibition of miR-181b (2.88 ± 0.09 vs. 2.04 ± 0.11, P < 0.05; 15.2 ± 1.5 vs. 8.4 ± 1.3, P < 0.05).</p><p><b>CONCLUSION</b>The serum miR-181b level was significantly reduced in patients with atherosclerosis. miR-181b may function as an atherosclerosis suppressor by interupting the NF-κB pathway in endothelial cells and inhibiting the proliferation and migration of vascular smooth muscle cells.</p>