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Large hepatocellular carcinoma (HCC) is one of the most common malignancies and was mistaked as "advanced and unresectable" . Liver resection is still the best curable treatment for HCC.The resection of large HCC is very difficult, which seriously restrict the progress of liver surgery.Our study proved that solitary large HCC (SLHCC) has unique clinicopathological and molecular biological characteristics.No matter how big the tumor size is, it belongs to early stage if there is no vascular invasion.Liver resection should be aggressively recommended for the patients with SLHCC, in which they can obtain good outcome, with 40% 5-year survival rate.We has also defined the borderline resectable hepatocellular carcinoma, and suggested that strictly master and correctly judge the surgical indications, syntheticly evaluate the surgical safety and patient′s tolerability for liver resection.After that, with hands of experienced surgeons, liver resection for SLHCC can be safely and reliablely performed.
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Portal hypertension caused by liver cirrhosis is common and severely threatens the patients' health.The dominant position of the conventional surgical treatment was strongly challenged by the pharmacological,endoscopic esophageal variceal ligation (EVL),transjugular intrahepatic portosystemic shunt (TIPS) and liver transplantation.So,what the prospect of surgical treatment is and whether it has disappeared? In fact,the surgical treatment is not only far from disappearing,but also play a unique and indispensable role,and could not be displaced by other treatments.Nowadays,the laparoscopic pericardial devascularization is widespread used,shows the increasingly prominent and distinct advantages of less injury and bleeding,fewer complications and faster recovery.The generalizing of multidisciplinary treatment (MDT) will combine advantages of varies subjects then provide the individual and precise diagnosis and treatment plan to patients.Authors should pay attention to the problems and then organize the clinical multicenter RCT studies,provide high level evidences,explore new surgical procedures,compose new clinical guidelines and consensuses which consistent with our national situations,thus to guide the clinical practice and will further improve the treatment of portal hypertension and raise our country'voice in this subject.
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Objective To analyze the clinicopathological characteristics and prognostic factors of combined hepatocellular-cholangiocarcinoma (cHCC-CC).Methods The retrospective cohort study was conducted.The clinicopathological data of 72 patients with primary hepatocellular carcinoma (HCC) who were admitted to the Xiangya Hospital of Central South University between January 2005 and December 2014 were collected.Thirty-two patients who were diagnosed with cHCC-CC by postoperative pathological examination were allocated into the cHCC-CC group and 40 patients who were diagnosed with HCC by postoperative pathological examination were allocated into the HCC group.Observation indicators:(1) clinicopathological characteristics:male,age ＞ 60 years,positive hepatitis B surface antigen (HBsAg),positive alpha-fetoprotein (AFP),positive CA19-9,positive carcinoembryonic antigen (CEA),liver cirrhosis,Child-Pugh grade A,tumor diameter ＞ 5 cm,tumor with capsule,solitary tumor,portal vein tumor thrombus (PVTT),cancer thrombus of the bile duct,positive lymph node metastasis,stage Ⅰ-Ⅱ of TNM stage,Edmondson-Steiner stage Ⅰ-Ⅱ;(2) pathological features of surgical incision specimens;(3) follow-up situations:median survival time,1-,3-,5-year survival rates and tumor-free survival rate;(4) prognostic factors analysis of patients with cHCC-CC:AFP,CA19-9,liver cirrhosis,tumor diameter,tumor capsule,number of tumor,PVTT,cancer thrombus of the bile duct,lymph node metastasis,Edmondson-Steiner stage,volume of intraoperative blood loss,intraoperative blood transfusion,distant from surgical margin.Follow-up using outpatient examination and telephone interview was performed to detect survival of patients and tumor recurrence or metastasis up to October 2015.Comparison of count data was analyzed using the chi-square test.The survival curve was drawn by the Kaplan-Meier method,and the survival analysis was done using the Log-rank test.The prognostic analysis was done using the COX regression model.Results (1) Clinicopathological characteristics:positive CA19-9,tumor with capsule,cancer thrombus of the bile duct and positive lymph node metastasis were detected in 16,4,12,6 patients in the cHCC-CC group and 5,17,1,1 patients in the HCC group,respectively,with statistically significant differences between the 2 groups (x2=10.471,9.723,13.005,4.009,P ＜ 0.05).(2) Pathological features of surgical incision specimens:pathological results showed that surgical incision specimens in the cHCC-CC group had characteristics of HCC tissues and cholangiocarcinoma tissues.The antigenic activity of hepatic cells in paraffin sections,Cytokeratin 7,Cytokeratin 19 and progenitor cell markers were positive by immunohistochemical staining detection.Patients in the HCC group had characteristics of HCC tissues,with positive AFP using immunohistochemical staining detection.(3) Follow-up situations:all the 72 patients were followed up for 5.0-74.0 months with a median time of 41.0 months.The median survival time,1-,3-,5-year survival rates,1-,3-,5-year tumor-free survival rates were 14.5 months,62.3％,38.9％,19.1％,50.0％,23.9％,4.0％ in the cHCC-CC group and 46.8 months,82.3％,57.4％,38.6％,72.9％,35.6％,17.6％ in the HCC group,respectively,with statistically significant differences in overall survival and tumor-free survival between the 2 groups (x2=4.231,3.881,P ＜ 0.05).(4) Prognostic factors analysis of patients with cHCC-CC:results of univariate analysis showed that CA19-9,tumor capsule,number of tumor,cancer thrombus of the bile duct,lymph node metastasis and Edmondson-Steiner stage were related factors affecting prognosis of patients with cHCC-CC [HR =1.824,0.227,0.441,1.421,1.887,2.745,95％ confidence interval (CI):1.126-2.172,0.118-0.654,0.318-0.764,1.071-4.231,1.017-5.643,1.223-6.421,P ＜ 0.05].Results of multivariate analysis showed that lymph node metastasis and stage Ⅲ-Ⅳ of Edmondson-Steiner stage were independent risk factors affecting prognosis of patients with cHCC-CC (RR =1.658,2.912,95％ CI:1.027-7.542,1.143-6.582,P ＜0.05).Conclusions The positive CA19-9,tumor without capsule,cancer thrombus of the bile duct and positive lymph node metastasis can partly predict cHCC-CC.The prognosis of patients with cHCC-CC is worse than that with HCC.The positive lymph node metastasis and stage Ⅲ-Ⅳof Edmondson-Steiner stage are independent risk factors affecting prognosis of patients with cHCC-CC.
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Esophagogastric variceal hemorrhage caused by portal hypertension is common and severely threatens the patients' health.The conventional surgical treatment plays an important role in portal hypertension.Although surgical treatment is strongly challenged by the pharmacological treatments,endoscopic treatments and radioactive intervention therapies,the role in portal hypertension treatment is still unshakable and irreplaceable,and is also not the disappearing surgery.The multidisciplinary treatment modalities have also brought new impetus for the individualization and precision treatment of portal hypertension.The developments of new clinical guidelines and consensuses,new techniques and novel conceptions have promoted the treatment of portal hypertension to a standard procedure.
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Objective To summarize the diagnosis and treatment experiences of focal nodular hyperplasia (FNH).Methods The clinical data of 48 patients with FNH who were admitted to the Xiangya Hospital from February 2010 to August 2014 were retrospectively analyzed.All the patients received complete serologic tests,abdomen B ultrasound,computed tomography (CT) and magnetic resonance imaging (MRI) examinations.The pathological examinations were done on the patients undergoing surgical treatment.The surgical treatment was done on the unconfirmed FNH patients according to location of space-occupying lesions.The conservative treatment was done on the confirmed FNH patients without clinical symptoms.All the patients were followed up via outpatient examination and telephone interview up to September 2014,and the follow-up included the history review,clinical symptoms and medical examinations.Results Forty-seven patients had normal liver function and 1 had high level of total bilirubin (TBil).The serum tumor markers including AFP,CEA and CA19-9 in all the patients were negative.Fifty-five foci were detected by imaging examination,41 foci were single mass and 7 foci were multifocality.Forty-eight patients were definitively unconfirmed with FNH by B ultrasound.The results of CT examinations in 38 patients showed as follows:low density was in 31 patients and isodensity in 7 patients,including striped and radiated low density showing in the center of tumor in 20 patients and 3 patients with the confirmed FNH.The results of MRI examinations in 10 patients showed as follows:3 patients were confirmed as with FNH; all the 10 patients showed rather homogeneous enhancement in arterial phase; 5 patients were accompanied with radiated foci in the center of tumor,and showed high signal on T2WI,no enhancement in early arterial phase and enhancement in delayed arterial phase.The central scar showed low signal on T1WI and high signal on T2WI.Two patients were confirmed as with FNH by percutaneous trans-hepatic histopathological examinations.Forty patients without the confirmed FNH underwent surgical treatment,including 31 undergoing open hepatectomy and 9 undergoing laparoscopic hepatectomy.No patients had cirrhosis of liver.During operation,47 foci were detected,16 of which located at the left lobe of liver and 31 of which located at the right lobe of liver.Local tumor resection of liver was carried out on 30 patients,right hemihepatectomy or extended right hepatectomy on 7 patients,left hemihepatectomy on 3 patients and combined treatment of cholecystectomy on 12 patients.The operation time,volume of blood loss and diameter of foci were (78-255) minutes,(80-720) mL and (4.6 ± 1.6) cm (range,1.5-11.5 cm).Forty patients were confirmed as with FNH by pathological examination,and 8 patients were cured by conservative treatment.All the 48 patients were followed up for 21 months (range,1-56 months) and survived well without recurrence and complications.Conclusions The clinical symptoms of FNH are atypical and unobvious.The preoperative enhanced CT and MRI examinations can help improve the diagnosis and differential diagnosis of FNH.The surgical treatment could be performed on the patients with significant clinical symptoms and without definitive diagnosis,and the patients with definitive diagnosis should be treated by conservative treatment with the good prognosis.
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Objective To explore the expression levels of RAS-interacting protein 1 (RASIP1) mRNA and protein in hepatocellular carcinoma (HCC) tissues and its cell lines,and to analyze the relationship between RASIP1 and tumorigenesis and progression of hepatocellular carcinoma.Methods The expression levels of RASIP1 mRNA and protein in 29 hepatocellular carcinoma tissues and the corresponding adjacent non-cancer liver tissues (ANLTs),as well as those in the HCC cell lines such as LO2,HEPG2,MHCC97-H and HCCLM3 were detected using real-time PCR and western blot.Results The RASIP1 expression levels decreased significantly in HCC tissues when compared with the corresponding ANLTs; The expression levels of RASIP1 mRNA and protein in LO2 were significantly higher than those in other HCC cell lines (P ＜ 0.05) ; The expression levels of RASIP1 mRNA and protein in MHCC97-H and HCCLM3 were significantly lower than those in HepG2 (P ＜ 0.05).Conclusions HCC tissues had lower expression than those in ANLTs.On analyzing the RASIP1 levels of HCC tissues and its cell lines,we speculated that RASIP1 might suppress recurrence and metastasis of HCC.
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OBJECTIVE@#To explore the diagnosis and surgical treatment for pancreatic vasoactive intestine polypeptide tumor (VIPoma).@*METHODS@#Clinical data of 7 patients with VIPoma from Xiangya Hospital, Central South University between January 1990 and July 2011 were collected and analyzed retrospectively.@*RESULTS@#The different operation modes were selected according to the location of VIPomas, and the postoperative symptoms of all 7 patients were gradually relieved and cured. The follow up showed that life spans of the above-mentioned patients were 3-6 years.@*CONCLUSION@#The incidence of pancreatic VIPoma is low but it is easy to misdiagnose. The excision for the tumor is the most effective therapy. Combining with somatostatin, intervention and other effective strategies, the life quality of patients can be improved and long-term survival may be achieved.
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Humans , Pancreatic Neoplasms , Diagnosis , General Surgery , Retrospective Studies , Somatostatin , Vipoma , Diagnosis , General SurgeryABSTRACT
Objective To evaluate the safety and efficacy of mesohepatectomy for large and centrally located hepatocellular carcinoma.Methods A retrospective study was carried out on 136 pa tients who underwent mesohepatectomy for large and centrally located hepatocellular carcinoma at Xiangya Hospital,Central South University,from 2001 to 2007.Intraoperative/post operative data and long-term survivals were analyzed.Results Vascular occlusion time,operative time,intraoperative blood loss,intraoperative blood transfusion and hospital stay were (13.3 ± 9.1) min,(173.1 ±41.1)min,(548.7±320.5)ml,(511.4±231.7)ml and (18.6±8.8)d,respectively.Four patients developed major complications.There was no in-hospital death.The 1-,3-,and 5-year overall survival rates and disease-free survival rates were 71％,46％,29％ and 65％,40％,24％,respectively.Conclusions Mesohepatectomy for large and centrally located hepatocellular carcinoma preserved the maximum amount of functional liver parenchyma.It is safe and reliable and may be used as the treatment of choice.
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Objective To investigate the expression of Semaphorin 3F (SEMA3F) protein in hepatocellular carcinoma (HCC) and to demonstrate its relationship with clinicopathological features and prognosis of HCC. Methods Western Blotting was carried out in 32 hepatocellular carcinoma samples and matched perineoplastic tissues to detect the expression of SEMA3F protein. The relationship between SEMA3F protein expression and clinicopathological features as well as prognosis of HCC patients was analyzed. Immunohistochemistry was used to show the location of SEMA3F in HCC cells and its relationship with microvessel density (MVD). Results The expression of SEMA3F protein in HCC tissues was significantly higher than in the perineoplastic tissues (447.78± 48.26 vs 618.93 ±61.23, P＜0. 05) and it was correlated closely with tumor capsulation and tumor nodular number (P＜0.05). Based on the Western Blotting and clinical follow-up data, we found that the survival time of HCC patients with a higher SEMA3F expression level was longer than those with a lower level, and the recurrent/metastatic time of HCC patients was significantly different between these two groups (P＜0.01). Immunohistochemistry demonstrated that SEMA3F protein localized in the cytoplasm of HCC cells and its expression correlated with HCC MVD. MVD in the low-level group was higher than the high-level group (115.6±30.38 vs 86. 56±17.94, P＜0.01). Conclusions SEMA3F expression in HCC was significantly down-regulated and correlated closely with tumor-capsulation, nodular number, and MVD, implicating SEMA3F may play an important role in recurrence and metastasis of HCC. It can be regarded as a prognostic marker in HCC patients.
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ObjectiveTo study the effect of age on the perioperative and long-term outcome of hepatic resection for hepatocellular carcinoma. MethodsFifty two cases of elderly patients with hepatic resection for hepatocellular carcinoma were analysised retrospectively. ResultsThe morbidity rate and in-hospital duration in elderly group were 32.7% and (29.94.3)d respectively, higher than 18.6% and (24.76.1)d in non-elderly group (P
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<p><b>OBJECTIVE</b>To investigate the correlation between epidermal growth factor (EGF) and overexpression of vascular endothelial growth factor (VEGF) in hepatocellular carcinoma (HCC).</p><p><b>METHODS</b>Expressions of EGF, VEGF and microvessel density were studied through immunohistochemical SABC method in 36 HCC specimens, their paraneoplastic liver tissues and 6 normal liver tissues with the correlation between these parameters analyzed. Recombinant human EGF was used to stimulate HepG(2) cells and semi-quantitative reverse transcription PCR was adopted to detect the expression of VEGF in HepG(2) cells.</p><p><b>RESULTS</b>The positive rates of EGF and VEGF expression in HCC tissue were 75.0% and 88.9%. There was positive correlation between EGF and VEGF expression (P < 0.01, r = 0.462). Recombinant human EGF could induce the expression of VEGF in HepG(2) cells in a dose and time dependent manner.</p><p><b>CONCLUSION</b>The expression of EGF in HCC underlies the overexpression of VEGF in HCC.</p>
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Adult , Aged , Female , Humans , Male , Middle Aged , Carcinoma, Hepatocellular , Metabolism , Endothelial Growth Factors , Epidermal Growth Factor , Intercellular Signaling Peptides and Proteins , Liver Neoplasms , Metabolism , Lymphokines , Neovascularization, Pathologic , Statistics as Topic , Vascular Endothelial Growth Factor A , Vascular Endothelial Growth FactorsABSTRACT
Objective To determine whether the important apoptosis-related genes of p53 and bcl-2 participate in the regulation of apoptosis of human liver cancer cells by establishing the model of apoptosis of human liver cancer cells induced by mitomycin C (MMC). Methods The selected human liver cancer cell line HepG2 was treated with 8mg/ml MMC. The morphological changes of the cells were observed using fluorescent and electron transmission microscopy and the DNA fragments of the cells analyzed by agarose gel electrophoresis to testify cell apoptosis. The expression of p53 and bcl-2 genes was detected by flow cytometry. Results The morphological observation and biochemical examination showed that MMC induced the HepG2 cells to undergo apoptosis. After administration of MMC, the expression of p53 gene changed obviously while that of bcl-2 gene was not apparent. Conclusion p53 plays an important role in the regulation of apoptosis induced by MMC in HepG2 cells. This regulation may be an early event in apoptotic signal pathway. Meanwhile, the apoptosis of the cells is p53-dependent. However, bcl-2 gene may not participate in the control of this apoptosis.
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ObjectiveTo investigate the expression of RhoC gene in primary hepatocellular carcinoma and to evaluate the relationship between RhoC gene expression and invasion and metastasis of primary hepatocellular carcinoma.MethodsThe mRNA expression of RhoC gene was examined by polymerase chain reation after reverse transcription (RT-PCR) in 25 cases of primary hepatocellular carcinoma (HCC) and adjacent non-cancerous tissuse. In addition, the mutation of RhoC gene was examined by polymerase chain reaction-single strand conformational polymorphism(PCR-SSCP)ResultsThe mRNA expression of RhoC in tumor tissue were higher than that in adjacent liver tissue,1.8?1.1 vs. 1.0?0.7( P
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Objective To summrize the effects of various treatment methods,including operation,transcatheter arterial embolization(TAE),and percutaneous ethanol injection(PEI) on hepatic cavernous hemangioma(HCH),in order to select an optimal therapy strategy for HCH.MethodsClinic data of 47 patients with 58 hepatic hemangiomas treated in our hospital in recent 10 years were analyzed retrospectively.Results There were 26 males and 21 females with mean age 42?2 5 years(10～72 years old)in this series.The diameters of these lesions were 3～21 5cm(mean diameter 8 5?1 8cm).Of them,obvious symptoms appeared in 39 patients,malignancy could not excluded in 6,and the size of HCH increased rapidly in 2.Operations were performed in 40 patients,including 2 patients failed to PEI;TAE was conducted in 7cases.There was no mortality or major morbidity occurred in the operative patients,except right pleual effusion in one case and subdiaphragmatic fluid collections in another case(2/40).Neither is mortality nor morbidity seen in the TAE treated case.Conclusions Operation is an effective procedure for HCH.But for more diffuse lesions or lesions located in special region,TAE is a more favorable alterative selection.Because PEI has risk of hemorrhage and hardener injection under ultrasonography guide has uncertain outcome,so it should be chosen cautiously.
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ObjectiveTo investigate the relationship between metabolic abnormalies of thyroid hormone and intestinal barrier disfunction and the potential protective effects of exogenous thyroid hormone in sepsis. MethodsMurine septic model was established through cecal ligation puncture. Triiodothyronine (15??g/kg) was given to the septic rats to correct the low T 3 syndrome. ResultsThere was significant negative correlation between the seral concentration of free T 3 or free T 4 and MDA concentration in the tissues of small intestines. The insulting degree of the intestinal barrier in the treatment group were much milder than that of the sepsis group. ConclusionsThere were significant correlation between the metabolic abnormalies of thyroid hormone and the oxic insults of the intestinal barriers in sepsis. Providing the thyroid hormone for the septic rats could protect the intestinal barriers and improve the prognosis of sepsis.
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Objective To study the expression of integrin ?v subunit(?v) in hepatocellular carcinoma(HCC )and its effect. Methods With the method of immunohistochemistry, specimens from 43 HCC patients and 6 control patients were studied. The relationship between the ?v expression and pathological features,microvessel density(MVD) was evaluated.Results The difference of the expression of ?v in tumor cells between HCC with satellite lesions and without it was significant(H=9 008, P =0 003).The MVD of HCC with positive and negative expression of ?v in endothelia was 151?54 and 115?39 respectively,difference of which was significant( t =2 503, P =0 016).Conclusions Integrin ?v subunit may play an important role in the angiogenesis, invasiveness and metastasis of hepatocellular carcinoma.
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Objective To investigate the protective role of Ulinastatin UTI on gut barrier of septic rats. Methods Twenty-two SD rats were divided into three groups: sham laparatomy(S), cecal ligation and punture(CLP), and CLP plus UTI. Septic rat model was estabilished through CLP method. Fluorescence spectrometry was used to measure FITC-dextran concentration from bowel lumen to portal vein. Ultrastructure of intestinal mucosa was observed under transmission eletron microscope (TEM). Results Twenty-one hrs after CLP septic symptoms in CLP plus UTI group were milder than those in CLP group. Portal concentration of FITC-dextran in CLP group was higher than that of S group[S (1.22?0.21) ?g/ml vs. CLP (2.51?0.56) ?g/ml, P
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Objective To investigate the expressions of vascular endothelial growth factor (VEGF) , hypoxia inducible factor 1 alpha (HIF 1?) and epidermal growth factor (EGF) in hepatocellular carcinoma (HCC) and their clinical significance. Methods The expressions of VEGF, HIF 1? and EGF in 36 cases of HCC and corresponding paraneoplastic tissues and normal liver tissues (6 cases) were studied by immunohistochemistry assay. ResultsThe expression rate of VEGF, HIF 1? and EGF in HCC tissue was 89%, 67% and 75% respectively, higher than those in paraneoplastic tissues and normal liver tissues ( P
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Objective To explore the methods of decreasing pancreatic fistula rates after pancreaticoduodenectomy. Methods This paper was made on the review of recent literatures about preventing pancreatic fistula after pancreaticoduodenectomy. Results Pancreatic fistula is still one of the main common complications of pancreaticoduodenectomy. Pancreatic stamp is managed mostly by pancreato enteric or pancreato gastric anastomosis. Ligation of the pancreatic duct and total pancreatectomy have reduced gradully. It is still undertermined that perioperative somatostatin can prevent pancreatic fistula. Conclusions The key point of deteasing pancreatic fistula rate of pancreaticoduodenectomy is to master all sorts of ways in managing the pancreatic stump.
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Objective This study was to investigate the effect of exogenous thyroid hormone on serum NO and iNOS activity of intestinal mucosa in septic rats. Methods Septic model was established by cecal ligation puncture(CLP) in male SD rats. Triiodothyronine(T 3) was administered intraperitoneally to correct the low T 3 syndrome of septic rats. Blood was collected to examine serum NO and thyroid hormone concentration. Intestinal mucosa iNOS activity was assayed using immunochemical stain. Results Mortality rate in the prevention group was significantly lower than the septic group(Log rank=3.85, P