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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.
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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.
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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.
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ObjectiveInvestigate the value of partial hepatectomy combined radiofrequency ablation in the treatment of medium-term liver cancer.MethodsThe 19 cases were retrospectively analyzed which admitted by Anhui Provinical Hospital due to hepatocellular carcinoma from October 2008 to November 2011.Liver function in patients before surgery was assessed by Child-Pugh score and indocyanine green.The complications 7 days after surgery were evaluated by liver function.The short-term effect 4 weeks after surgery was evaluated by radiofrequency ablation,contrast enhanced CT and contrast enhanced ultrasound.The inspection per month was lined by radiofrequency ablation,contrast enhanced CT and contrast enhanced ultrasound 6 months after surgery.After then referral was done once every 2-3 months.ResultsAll patients had liver function damage 7 days after surgery,but there were no hepatic encephalopathy and death cases.Residual tumor and incomplete ablation accounted for 10.1％ (2/19)of all cases.For 1 year and 2 year survival rates were 83.2％ and 46.4％.The average survival time was 22.23 months and the median survival time was 24.87 months.ConclusionsPartial hepatectomy combined radiofrequency ablation has important application value in the treatment of medium-term liver cancer,expanding the indications of surgical exploration in hver cancer,especially medium-term liver cancer,and it can matimaly kill visible lesions.
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Objective To investigate the impact of different hepatic vascular inflow occlusion methods on hepatic parenchymal function in partial hepatectomy.Methods Between 2009 and 2010,62 hepatocellular carcinoma (HCC) patients underwent partial hepatectomy.In 13 patients,partial hepatectomy was carried out without using any inflow occlusion (group A).In 29 patients intermittent Pringle's maneuver (group B) while in 20 patients selective hepatic inflow occlusion (group C) were used.Intraoperative indocyanine green retention rate at 15 minutes (ICGR15) was measured using pulse spectrophotometry before and during hepatectomy. Results (1) Blood loss in group A was greater than group B and C (P=0.016,P=0.001).(2) There was no significant difference in the preoperative ICGR15 values among group A,B and C.The intraoperative ICGR15 for group B was significantly higher than group A and C (P=0.011,P=0.030).(3) A significant correlation was found between the level of ICGR15 and total inflow clamp time (r =0.484,P =0.001) and blood loss (r=0.349,P=0.005),respectively.(4) Compared with group A and B,postoperative liver function recovered significantly faster in group C.Conclusion Selective hepatic inflow occlusion was useful in controlling blood loss and it was beneficial to the hepatic functional reserve in the liver remnant.
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Objective To investigate the expression of patterned matrix vasculogenic mimicry in hepatocellular carcinoma (HCC) and its prognostic significance. Methods HCC tissues from 151 patients undergoing curative resection in Anhui Provincial Hospital from January 2003 to December 2008 were studied.Postoperative follow-up and clinicopathologic data were reviewed.Immunohistochemical staining of laminin,CD34 and transmission electron microscopy were used to identify patterned matrix VM in HCC.The relations between clinicopathologic features, prognosis and patterned matrix VM were analyzed.Results Patterned matrix VM was positive in 31 out of 151 cases (20.5％ ).The expression of patterned matrix VM was positively correlated with tumor size ( x2 =4.132,P =0.042),vascular invasion ( x2 =5.825,P=0.016),high Edmondson grade (x2 =5.256,P=0.022),and late pTNM stage (x2 =6.218,P =0.013).Kaplan-Meier survival analysis revealed that cases of the VM positive group had poor overall 1,3 and 5 year survival (OS) and disease-free survival (DFS) than that of the VM negative group (67.7％,34.6％,11.5％ and 86.7％,64.7％,40.3％,respectively,x2 =14.852,P ＜ 0.001 ; and 41.9％,19.4％,6.5％ and 63.3％,40.6％,19.6％,respectively,x2 =10.065,P =0.002).Univariate and multivariate analyses revealed that multiple tumor nodules,vascular invasion and VM were independent prognostic factors for overall survival,while vascular invasion and VM were independent prognostic factors for disease-free survival. Conclusions Patterned matrix VM exists in HCC. The expression of patternedmatrix VM is associated with tumor size,Edmondson grade,pTNM stage and vascular invasion,and it might serve as an unfavorable prognostic factor for HCC patients.
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Objective To assess the value of indocyanine green excretion test in predicting hepatic failure after hepatectomy. Methods The retention rate of indocyanine green at 15 minutes (ICG R15), effective hepatic blood flow (EHBF) and clinical and biochemical parameters of 128 patients who received hepatectomy at the Affiliated Provincial Hospital of Anhui Medical University from June 2007 to June 2008 were detected by pulse dye densitometry. All patients were divided into non-hepatic failure group (n = 110) and hepatic failure group (n =18). ICG R15, EHBF, Child's score, histology activity index (HAI) score, clinical and biochemical parameters and other indexes were analyzed to predict hepatic failure by the t test, chi-square test, linear regression analysis or regression model. The relationship between positive predictive indexes and HAI score was studied. Results Eighteen patients suffered from hepatic failure after operation. ICG R15, Child's score, HAI score of patients without hepatic failure were 9% ±4%, 5.6 ±0.7, 3.8 ±0.5, which were significantly lower than 15% ±6%,6.1 ± 0. 8, 5.0 ± 0. 8 of patients with hepatic failure (t = 11. 121,2. 356, 3. 915, P ＜ 0.05). EHBF of patients without hepatic failure was (1.2 ±0.2) L/min, which was significantly higher than (1.0 ±0.2) L/min of patients with hepatic failure (t = 2. 802, P ＜ 0. 05). In a logistic regression model, age ≥ 65 years, ICG R15 ≥ 14% and EHBF ＜ 1.0 L/min were risk factors of postoperative hepatic failure (x2 = 4. 758, 9.709, 5. 362, P ＜ 0.05).ICG R15 was negatively correlated with EHBF (r =-0. 527, P ＜0.05). HAI score was positively correlated with ICG R15 (r =0. 638, P ＜0.05), while it was negatively correlated with EHBF (r =-0. 445, P ＜0. 05).Conclusions ICG R15 and EHBF are good predictive indicators for hepatic failure after hepatectomy. Patients with ICG R15≥14% and EHBF ＜ 1.0 L/min are prone to have postoperative hepatic failure.
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Objective To investigate the expressions of extracellular matrix protein 1 (ECM1)and matrix metalloproteinase-9 (MMP-9) in hepatocellular carcinoma (HCC) and to explore their correlations with metastasis and recurrence.Methods Immunohistochemisty was employed to determine the expressions of ECM1 and MMP-9 in 120 HCC and 17 normal liver tissues.Results The positive rates of ECM1 and MMP-9 expression in HCC tissues were 73.3％ (88/120) and 65.0％ (78/120),respectively.They were significantly higher than that in normal liver tissues.The expression of ECM1 in HCC tissues was significantly correlated with vascular invasion and TNM stage.The expression of MMP-9 in HCC tissues was significantly correlated with tumor size,number of tumor nodules,differentiation of tumor and degree of cirrhosis.They were not correlated with age,gender,serum AFP level,HBsAg,Child-Pugh class and capsulated tumor.Patients with ECM1 and MMP-9 positivity had significantly poorer overall and disease-free survival rates.There was a significant positive correlation between ECM1 and MMP-9 (r=0.585,P＜0.001).Conclusion Both ECM1 and MMP-9 were significantly related to invasion and metastasis.Over-expression of both ECM1 and MMP-9 had predictive values for prognosis and recurrence of HCC after surgery.
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AIM To investigate the inhibitory effect of extract of fu ng i of huaier (EFH) on neovascularization formed by human umbilical vein endotheli al cells (HUVECs) in vitro. METHODS Using MTT assay, flow cytomet ry and Matrigel assay, the effect of EFH on the proliferation and differentiatio n of HUVECs stimulated by vascular endothelial growth factor (VEGF) were evaluat ed in vitro. RESULTS EFH inhibited proliferation of HUVECs stimul ated by VEGF at the concentration of 0 1 to 10 g?L -1 . The antiproliferat itive effect occurred in a dose-dependent manner. Flow cytometry analyses revea led that EFH treatment delayed S-phase progression. A remarkable inhibition of tube formation was observed in the presence of 1 g?L -1 EFH and complete i nhibition was obtained at 10 g? L -1 EFH. CONCLUSION EFH is able to inhibit neovascularization formed by HUVECs. Its mechanism might be rela ted to S-phase progression.