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Objective:To assess the safety and feasibility of hepatic pedicle-first approach laparoscopic anatomical hepatectomy for central segments.Methods:The clinical data of 19 patients with hepatocellular carcinoma who underwent hepatic pedicle-first approach laparoscopic anatomical hepatectomy for the central segments in the Faculty of Hepato-Pancreato-Biliary Surgery, Chinese PLA General Hospital from September 2020 to January 2023 were retrospectively analyzed. In this procedure, hepatic pedicles of the central segments were divided first to delineate the ischemic demarcation and guide the liver parenchymal transection. The methods of operation, operation time, intraoperative blood loss, postoperative complications and hospital-stay were analyzed.Results:Hepatic pedicle-first approach laparoscopic anatomical hepatectomy for the central segments was successfully performed in all patients, including 5 cases of segment Ⅳ, 2 cases of segment Ⅳ+ Ⅷ, 3 cases of segment Ⅳ+ ventral segment Ⅷ, 3 cases of segment Ⅳa+ Ⅴ+ Ⅷ and 6 cases of segment Ⅴ+ Ⅷ. The mean operation time, intraoperative blood loss and postoperative hospital stay was (253.1±86.1) min, [ M( Q1, Q3)] 100.0(100.0, 250.0) ml, and (5.1±1.2) d respectively. There was no intraoperative blood transfusion and postoperative complications. Conclusion:Hepatic pedicle-first approach can help delineate the segemental demarcation in laparoscopic anatomical hepatectomy for the central segments, which is technically feasible and worth more practice.
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With the continuous development of laparoscopic hepatectomy for the treatment of hepatocellular carcinoma in recent years, laparoscopic anatomical hepatic segmentectomy has become increasingly improved, including anatomical segmentectomy, subsegmentectomy and combined segmentectomy. The above surgical procedures involve a variety of technical means, requiring the surgeon to be familiar with intrahepatic anatomy and possess extensive experience in ultrasound technology and laparoscopic surgery. This article discussed the key techniques of laparoscopic anatomical hepatic segmentectomy for hepatocellular carcinoma based on our clinical practice.
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Objective:To study the use of trans gastric sinus stent placement and drainage in management of persistent external pancreatic fistula.Methods:The clinical data of 12 patients who developed persistent external pancreatic fistulae after severe acute pancreatitis, pancreatic trauma or pancreatic surgery who were treated at the First Medical Center of Chinese PLA General Hospital from August 2018 to December 2020 were retrospectively analyzed. There were 10 males and 2 females, aged 30 to 65 years, median 43.5 years. These patients underwent trans gastric sinus stent placement and drainage, and were followed-up to study persistence of pancreatic fistula, new pancreatic fluid accumulation, complications and death.Results:In this study, there were 9 patients who developed persistent external pancreatic fistulae after severe acute pancreatitis, 2 patients after pancreatic trauma, and 1 patient after pancreatic surgery. The median operation time was 47 min (range 38-54 min). The technical success rate was 100.0% (12/12). The median follow-up was 22.5 months (range 2-29 months). Seven days after stenting, the percutaneous drainage tubes (urinary catheters) of all the patients were removed. One patient (8.3%) developed recurrence of pancreatic fistula 17 days after treatment. The same procedure of placing another stent was done and the patient recovered. Six months after treatment, 2 patients (16.7%) lost their stents, and 1 patient developed a pseudocyst (recurrence of pancreatic fistula). The maximum diameter of this pseudocyst increased gradually to 7cm after 9 months. A double pigtail drainage tube was placed under endoscopy in this patient, and the patients recovered. All the other patients did not develop recurrence of pancreatic fistula or pseudocyst. During the follow-up period, no patient developed any new complications including pancreatic fluid accumulation, fever, bleeding, infection and organ dysfunction, and no patients died.Conclusion:It was safe and efficacious to use trans gastric sinus stent placement for treatment of persistent external pancreatic fistula. However, the long-term outcomes require further studies.
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Objective:To study the use of left renal vein as a graft vessel in reconstruction after portal vein/superior mesenteric vein (PV-SMV) resection in pancreaticoduodenectomy.Methods:A retrospective study was conducted on 5 of these patients who underwent surgery from July 2008 to December 2017 at Chinese PLA General Hospital. The operative, complication and follow-up data were analysed.Results:There were 4 males and 1 female, with an average age of 57 (33-72) years. The mean operative time was 6.8 (5.4-9.1) h and the mean tumor size was 3.8 (2.8-4.8) cm. The average length of the PV-SMV defect left after resection was 3.8 (3.2-4.6) cm. The average length of the left renal vein used was 3.4 (3.0-4.1) cm. The operations were carried out in 3 patients with pancreatic cancer and in 2 patients with colon cancer pancreatic metastasis. The average postoperative hospital stay was 12 (10-25) days. Perioperative complications included 1 patient each with ascites, diarrhea and delayed gastric emptying. The creatinine levels ranged from 70-98 μmol/L preoperatively, with a transient creatinine rise to 80-156 μmol/L after operation and became 62-107 μmol/L upon discharge from hospital. The follow-up time was 4.3-17.8 months. Two patients died of recurrence/metastasis at 14.2 and 17.8 months after surgery.Conclusions:The left renal vein has the appropriate diameter and rich collateral branches. It has a sufficient length and it is conveniently located in the surgical field. This study showed that there was a minimal effect on renal function after its excision, and it can be used as a graft vessel for reconstruction in pancreaticoduodenectomy after PV-SMV resection.
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Objective:To explore the strategy and efficacy using minimally invasive treatment for grade Ⅲ&Ⅳ blunt pancreatic injuries.Methods:Retrospective data retrieved from medical records of 13 patients with grade Ⅲ&Ⅳ blunt pancreatic injuries who underwent minimally invasive treatment at the Chinese PLA General Hospital from July 2011 to June 2019 were analysed. There were 10 males and 3 females, aged (38±9) years. Minimally invasive treatment included percutaneous catheter drainage (PCD) and minimal-access retroperitoneal pancreatic necrosectomy (MARPN). Date from enrolled patients were anylsed.Results:There were 9 patients suffering from grade Ⅲ injuries and 4 patients suffering from grade Ⅳ injuries. On initial conservative treatment of these 13 patients, all developed local complications. The local complications were treated using minimally invasive treatment strategies: 13 patients underwent PCD. The median intervention time for PCD was 25 days after trauma; 10 patients were further treated with MARPN, and the median intervention time of MARPN was 41 days after trauma. Twelve patients recovered well and were discharged home. One patient died. The mortality rate was 7.7% (1/13). The median postoperative hospital stay was 19 days.Conclusion:For patients with pancreatic grade Ⅲ&Ⅳ injuries who were hemodynamically stable and had no other associated gastrointestinal injuries, initial conservative treatment, followed by subsequent minimally invasive treatment based on MARPN technology could be used to treat local complications.
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Objective: To evaluate the degree of microvascular perfusion in hypertension patients with carotid artery hypoechoic plaques with semi-quantitative and quantitative CEUS under different blood pressure conditions. Methods: Totally 27 hypertension patients with carotid artery hypoechoic plaques were collected, 24 h ambulatory blood pressure was monitored to observe the highest and lowest blood pressure within 24 h, and the differences of plaque enhancement grade and enhancement intensity were compared between the two blood pressure states. The correlation between systolic blood pressure, diastolic blood pressure and enhancement intensity was analyzed. Results: There was no significant difference in the enhancement grade of hypoechoic plaques between the highest and lowest blood pressure (Z=0.36, P>0.05), but there was significant difference of intra-plaque enhancement intensity (t=2.44, P=0.02). The enhancement intensity in plaques was positively correlated with systolic blood pressure and diastolic blood pressure. Conclusion: Blood pressure should be taken into account when CEUS of carotid plaques are performed in hypertension patients. The enhancement intensity of hypoechoic plaques is different under different blood pressure conditions.
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Objective@#To examine the effectiveness of non-operative of colonic fistula following acute pancreatitis.@*Methods@#Retrospective analysis of 354 patients with acute pancreatitis who were admitted to Department of Hepatobiliary Surgery of Chinese People′s Liberation Army General Hospital from January 2013 to December 2018. Age of the patients was (46±14) years (range: 14-85 years); 249 cases (70.3%) were males. There were 41 cases of acute edematous pancreatitis and 313 cases of acute necrotising pancreatitis. Two hundred and fifteen cases were diagnosed as moderate severe acute pancreatitis and 139 were diagnosed as severe acute pancreatitis. Among 313 cases of acute necrotising pancreatitis, 62 cases underwent non-surgical treatment, 251 cases underwent surgical treatment in which 218 of minimal access retroperitoneal pancreatic necrosectomy underwent percutaneous nephroliguectomy with peripancreatic necrotic tissue removal technique.@*Results@#There were 15 cases of colon fistula following acute necrotising pancreatitis, and the incidence rate was 4.2%(15/354). There were 7 males and 8 females, with age of (39±8) years (range: 27 to 50 years). The median interval between acute pancreatitis onset and diagnosis of colonic fistula was 71 days(27-134) days. Two cases occurred at the hepatic flexure of the colon, 4 cases at transverse colon, and 9 cases at splenic flexure of colon. Of the 354 patients, 39 cases died and the mortality was 11.0%. Two patients underwent laparotomy, and one of them died. The remaining 13 patients underwent non-surgical treatment and were discharged.@*Conclusion@#Acute pancreatitis with colonic fistula can be treated with non-surgical treatment and can achieve good prognosis.
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<p><b>OBJECTIVE</b>To compared the efficacy of laparoscopy- assisted radiofrequency ablation (LRFA) and percutaneous radiofrequency ablation (PRFA) for the treatment of hepatocellular carcinoma (HCC).</p><p><b>METHODS</b>Between September, 2013 and September, 2016, a total of 60 HCC patients with 78 tumor nodules underwent LRFA (30 cases with 46 tumor nodules) and PRFA (30 cases with 32 tumor nodules) in our hospital. The patients were followed up for 3 years to compare the complete ablation rate, serious complications, recurrence rate and long-term survival rate between the two groups.</p><p><b>RESULTS</b>The patients receiving LRFA had a complete ablation rate of 95.65% (44/46), significantly higher than the rate of 93.75% (30/32) in PRFA group ( > 0.05). Significant differences were found between LRFA and PRFA groups in the incidence of serious complications [0 6.7% (2/30), < 0.05] and recurrence rate [13.33% (4/30) 23.33% (7/30), < 0.05]. The 1-and 3-year overall survival rates of the patients were 96.15% and 55.12% in LRFA group and 93.73% and 48.54% in PRFA group, respectively ( > 0.05).</p><p><b>CONCLUSIONS</b>Both LRFA and PRFA are effective for HCC treatment, but is associated with a lower recurrence rate, fewer serious complications, a better treatment safety and a better applicability for tumor in difficult locations.</p>
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Objective Surgical resection is the primary form of curative treatment for hepatocellular carcinoma.Recent reports suggested that when compared to non-anatomical resection,anatomical liver resection improved prognosis of HCC patients.Whether anatomical liver resection should be the preferred routine procedure remains controversial.Methods The data of 236 HCC patients who underwent curative hepatectomy at the PLA General Hospital from January 2008 to July 2013 were reviewed.The data included basic information,procedure,tumor related information and follow-up data.Factors influencing overall survival and tumor-free survival rates were analyzed by multivariate analysis.Multivariate analysis and stratification analysis were also used to evaluate the long-term efficacy of the different procedures.Results The 5-year survival rate of anatomical liver resection was 75％,which was significantly better than that of non-anatomical resection (65 ％) (P ＜ 0.05).The tumor-free survival rate was 51％,which was significantly better than that of non-anatomical resection (34％) P ＜ 0.05).Antiviral therapy prolonged survival time and tumor-free survival time of HbsAg-positive patients.Surgical procedure,tumor diameter,tumor staging,antiviral therapy were influencing factors of overall survival.Surgical procedure,tumor staging,antiviral therapy were influencing factors of tumor-free survival.Anatomical resection improved the tumor-free survival for patients with tumor diameters less than 5 cm (P =0.098),improved tumor-free survival for patients with TNM stage T1 and T2 (P =0.059),and significantly improved the overall survival and tumor-free survivals for patients with T3,T4 (P ＜ 0.05).Conclusion Anatomical resection is recommended for treatment of patients with hepatocellular carcinoma.
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Objective To investigate the effects of structured triglyceride (STG) and physical mixed medium chain/long chain triglycerides (MCT/LCT) on hepatic and renal function and lipometabolism of patients with acute necrotizing pancreatitis (ANP).Methods The clinical data of 30 patients with ANP who were admitted to the PLA General Hospital between January 2012 and June 2014 were prospectively analyzed.A double-blind,randomized,controlled study was performed in 30 patients who were allocated into the experimental group (15 patients received STG) and the control group (15 patients received physical mixed MCT/LCT).All the patients received isometrical nitrogen and isocaloric parenteral nutrition more than 5 days.The levels of alanine transaminase (ALT),aspartate transaminase (AST),glutamyl-transpeptidase (GGT),alkaline phosphatase (ALP),creatinine (Cr),blood urea nitrogen (BUN),triglyceride (TG) and total cholesterol (TC) were assayed before nutritional support treatment and at day 1,3 and 5 after nutritional support therapy.The measurement data with normal distribution was presented as (x) ± s.The skew distribution data were described as M (range).The comparison between groups were evaluated with an independent sample t test or one-way ANOVA.The count data were analyzed using the chi-square test.Results A total of 30 patients were screened for eligibility.The levels of ALT,AST,GGT,ALP,Cr,BUN,TG and TC were changed within a certain range at day 1,3 and 5 after nutritional support treatment.The levels of ALT,AST,GGT,ALP,Cr,BUN and TC before treatment and at day 5after treatment were changed from 29.0 U/L,25.4 U/L,83.2 U/L,(193 ± 115) U/L,(124 ± 97) μmol/L,(8±6)mmol/L and (2.4±1.1)mmol/L to 29.4 U/L,33.0 U/L,77.7 U/L,(172±74)U/L,(117 ±103)μmol/L,(8 ± 5) mmol/L and (2.3 ± 1.0) mmol/L in the experimental group,and from 23.8 U/L,22.9 U/L,96.2 U/L,(148 ± 108) U/L,(82 ± 57) μmol/L,(9 ± 7) mmol/L and (2.5 ± 0.7) mmol/L to 21.3 U/L,24.5 U/L,127.4 U/L,(179 ± 126) U/L,(80 ± 54) μmol/L,(10 ± 6) mmol/L and (2.4 ±0.8) mmol/L in the control group,respectively.There were no significant differences in the changing trends of the levels of ALT,AST,GGT,ALP,Cr,BUN and TC between the 2 groups (F =0.647,1.186,0.282,0.553,0.862,0.182,0.369,P＞0.05).The level of TG in the experimental group from pre-treatment to day 5 after treatment was changed from (1.5 ± 0.6) mmol/L to (1.5 ± 0.7) mmol/L,with increasing trend from pre-treatment to day 1 after treatment and reaching the normal level at day 3 and 5 after treatment.The level of TG in the control group from pre-treatment to day 5 after treatment was changed from (1.5 ± 0.6) mmol/L to (2.4 ± 0.6) mmol/L,with increasing trend from pre-treatment to day 1,3 and 5 after treatments.There were significant differences in the changing trends of TG before and after nutritional support therapy between the 2 groups (F =7.940,P ＜ 0.05).Conclusion STG and physical mixed MCT/LCT don't influence the hepatic and renal function of patients with ANP undergoing parenteral nutritional support therapy,while STG has a better effect of lipometabolism compared with physical mixed MCT/LCT.Registry This study was registered with the UMIN Clinical Trial Registry with the registry number of UMIN000016958
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<p><b>OBJECTIVE</b>To investigate the predictors for recurrence of carcinoma ampulla of Vater following pancreatico- duodenectomy.</p><p><b>METHODS</b>We reviewed the clinical data of 77 patients with carcinoma of the ampulla of Vater who received surgical intervention with pancreaticoduodenectomy. Independent t-test and χ(2) test were used for statistical comparison, and logistic regression was used for multivariate analysis to investigate the predictors for tumor recurrence following pancreaticoduodenectomy.</p><p><b>RESULTS</b>The tumor recurred in 30 patients following the surgery. Univariate analysis showed that tumor size (P=0.008), tumor invasion depth (P=0.003), lymph node metastasis status (P=0.039), TNM staging (P=0.027), and grade of cell differentiation (P=0.019) were significant prognostic factors of carcinoma of the ampulla of Vater. Multivariate analysis identified tumor size (P=0.032) and grade of cell differentiation (P=0.027) as independent prognostic factors of the carcinoma.</p><p><b>CONCLUSION</b>Distant failure is the predominant recurrence pattern of carcinoma of the ampulla of Vater after curative resections, and tumor size and grade of cell differentiation are the most important factors influencing the outcome of the patients.</p>
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Adult , Aged , Female , Humans , Male , Middle Aged , Ampulla of Vater , Common Bile Duct Neoplasms , Pathology , General Surgery , Lymphatic Metastasis , Multivariate Analysis , Neoplasm Recurrence, Local , Diagnosis , Pathology , Neoplasm Staging , Pancreaticoduodenectomy , Postoperative Period , Prognosis , Retrospective StudiesABSTRACT
ObjectiveTo evaluate a computer-assisted operation planning system in curative hepatectomy for complex hilar cholangiocarcinoma.MethodsThe clinical data of 15 patients with complex hilar cholangiocarcinoma who were admitted to the Chinese PLA General Hospital from January 2008 to December 2009 were retrospectively analyzed.Based on triple-phase contrast-enhanced computed tomography inages,a computer-assisted operative planning system was used to evaluate the anatomic relationship between the tumor and its adjacent vessels,liver volume,operative feasibility,and the potential surgical approaches.The accuracy of three-dimensional reconstruction was tested by comparison to actual intraoperative findings.The correlation between actual liver resection volumes and predicted liver resection volumes was analyzed by calculating a Pearson correlation coefficient.Differences in liver volumes calculated by two-dimensional techniques versus three-dimensional reconstruction were analyzed using the paired t test,and the error rate was compared using the chi-squarc test. Results Fifteen patients received curative hepatectomy,including extended hemihepatectomy in 8 patients and trisectionectony in 7 patients.Preoperative evaluation of the hepatic anatomy based on three-dimensional reconstruction imaging was confirmed with operative findings.The sensitivity,specificity and accuracy rates were 100.0％,72.7％ and 72.7％ for patients with portal invasion and 100.0％,78.6％ and 78.6％ for patients with hepatic arterial invasion,respectively.The actual liver resection volume was positively correlated with the predicted liver resection volume ( r =0.974,P ＜ 0.05 ).The mean liver volumes calculated by the three-dimensional reconstruction and the two-dimen-sional techniques were (458 ±86)ml and (491 ± 103 )ml,respectively,with no significant difference (t =-1.911,P ＞0.05 ).The error rates of the three-dimensional reconstruction and the two-dimensional techniques were 4.7％ and 7.2％,respectively,with no significant differnece ( x2 =2.381,P ＞ 0.05 ).Five patients had postoperative complications,and each was cured with conservative or interventional management. Conclusion The application of a computer-assisted operation planning system may improve the safety and accuracy of curative resection for complex hilar cholangiocarcinoma.
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Objective To confirm whether or not let-7b and miR-199a were significantly associated with malignant melanoma growth and proliferation. Methods An over -expression plasmid and an inhibitor, which targeted on let-7b and miR-199a, was constructed. B16F10 cells were divided into seven groups: control group, let-7b plasmid group, miR-199a plasmid group, empty plasmid group, let-7b inhibitor group, miR-199a inhibitor group, inhibitor control group. Foreign gene was transfected into B16F10 cells, let-7b and miR-199a expression were validated from RNA level, protein level and cell level. Results The relative let-7b or miR-199a gene expression of the let-7b plasmid group (3.8776±0.1372)and miR-199a plasmid group (2.8660±0.2821)were significantly higher than control group (P＜0.05), the relative let-7b or miR-199a gene expression of the let-7b inhibitor group (0.2057±0.0263) and miR-199a inhibitor group(0.2656±0.0253) were significantly lower than control group(P＜0.05). The cyclinD1 expression of the let-7b plasmid group(2.023±0.315) and let-7b inhibitor group (1.857±0.377) were significantly higher than control group (0.997±0.041) (P＜0.05), whereas, the Met expression of themiR-199a plasmid group (5.19±0.309) and miR-199a inhibitor group (4.87±0.044) were significantly higher than control group (2.2±0.198) (P＜0.05). The let-7b plasmid group and miR-199a plasmid group B16F10 cell growth rate were slower than control group, especially on the third day after transfection, the growth rate gradually dropped to the lowest value (P＜0.05). In addition, the apoptosis rates of the let-7b plasmid group and miR-199a plasmid group reach to (11.8±1.19)% and (11.3±1.59)%,which were significantly higher than control group (P＜0.05). Conclusions let-7b and miR-199a may be a negative regulator on the B16F10 cell growth and proliferation.
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Objective To investigate the expression pattern of Nrf2 in the lung of septic rat and preliminary analysis of the role of Nrf2 in the development of sepsis. Methods Wistar rats were used in this study, it was divided into 4 groups, including normal control group, pure burn group, burn with staphylococcus sepsis group, burn with pseudomonas sepsis group. According to the different time intervals such as 2 hours, 8 hours, and 24 hours, it was divided into three sub-group after injection of bacteria. The expression of Nrf2 in the lung at different time intervals was determined. Results Nrf2 mRNA in the lungs of normal rats was high expression （74.0±7.0）, Nrf2 mRNA in the lungs of pure burns rats obviously down-regulated, respectively as 34.5±1.9,50.4±2.2,32.1±1.4, （t＝5.69～14.63,P＜0.01）. Nrf2 mRNA in burn sepsis caused by Staphylococcus aureus in lung tissue of rats down-regulated expression, respectively as 53.1±5.0,14.4±1.6,48.5±1.9,and reached peak at 8 h（t＝5.59～29.3,P＜0.01）. Pseudomonas aeruginosa burn sepsis didn't induced Nrf2 mRNA in the lung tissue, but it showed a downward trend at 2h（71.0±8.1,P＞0.05）and markedly reduced after 8, 24 h（24.8±2.1,4.1±2.0,t＝21.33,68.1,P＜0.01）.Conclusions The distribution of Nrf2 mainly localized in immune organ, and it directly took part in the post burn immune response.
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Objective To establish an animal model of hepatic inflow occlusion with meso-caval shunt in Bama swines so as to evaluate the tolerance limit of normothermic hepatic inflow occlusion.Methods Eighteen Bama swines were divided into group A in which the hepatic blood inflow was occluded for 90 min and group B in which the hepatic blood inflow was blocked for 100 min.The animal survival rate,the changes of liver function and histopathology were observed.Results The animal survival rate was significantly higher in group A than group B(100% vs 44.4%,P