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At present, surgical treatment is the most effective method for the treatment of hepatobiliary malignant tumor. However, due to the complex anatomical structure of hepatobiliary region, accompanied by vascular variation, and with the continuous update of medical concepts, the requirements for surgery are more strict. Traditional imaging examination has reached a bottleneck in the support of surgical treatment, while 3D printing technology is compared with the former. It showed strong advantages in preoperative program planning and improving the effect of intraoperative precise resection. At the same time, it also shows great potential for medical assistance and disease treatment in the production of bioactive models, and 3D printing technology has obviously enhanced the understanding of surgery for young doctors, and medical staff can create a variety of highly practical 3D printing models under the existing conditions. In the future, it is expected to overcome the limitations of materials and technology and bring higher therapeutic benefits for the majority of patients.
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The global incidence of liver cancer has remained elevated for a long time. As a high-risk country for hepatitis B, China has one of the highest rates of liver cancer in the world. Historically, surgical excision has been the recommended method of treatment for early-stage liver cancer. With the advancement of imaging technology and the growing use of physical treatment in clinics in recent years, microwave ablation has emerged as a new treatment option for patients with small hepatocellular carcinoma and those who have missed the chance for surgery. It is less traumatic, requires less time in the hospital, and is less expensive than the traditional surgery. However, due to several current indication limits and the inability to totally avoid postoperative sequelae, microwave ablation is not appropriate for all patients with liver cancer. This article examines the use, combined therapy, and postoperative consequences of microwave ablation in the treatment of hepatocellular carcinoma, as well as the potential future direction of development in the treatment of hepatocellular carcinoma.
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Objective:To explore the association of miRNA-146a (miR-146a), miRNA-196a2 (miR-196a2), and miRNA-499 (miR-499) single nucleotide polymorphisms with genetic susceptibility in hepatocellular carcinoma.Methods:A case-control study was designed. A total of 175 patients (hepatocellular carcinoma group) in Affiliated Hospital of Yangzhou University from April 2015 to March 2019 and 302 healthy people undergoing physical examination during the same period (the control group) were selected. The genotype distribution of miR-146a, miR-196a2 and miR-499 in the peripheral blood of the two groups were detected by using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). Logistic regression model was used to analyze the association of 3 genotypes of miRNA, genotypes of hepatitis virus infectors with genetic susceptibility in hepatocellular carcinoma. The relationship between miR-146a gene polymorphism and demography factor as well as the clinical characteristics was also analyzed by using Spearman correlation analysis.Results:In hepatocellular carcinoma group, miR-146a single nucleotide polymorphism of CC, CG, GG site genotypes had 52 (29.7%) cases, 86 (49.1%) cases, 37 (21.1%) cases, respectively; in the control group, the corresponding genotypes had 137 (45.4%) cases, 135 (44.7%) cases and 30 (9.9%) cases, respectively, and the difference in genotype distribution of both groups was statistically significant ( χ2 = 17.23, P < 0.05). There were no statistical differences in genotype distribution of miR-196a2 and miR-499 ( χ2 = 0.51, P = 0.776; χ2 = 0.05, P = 0.976). Single factor logistic regression analysis showed that in the co-dominant model of miR-146a genotype, genotypes of CG ( OR = 1.96, 95% CI 1.13-3.41, P = 0.017) and GG ( OR = 3.30, 95% CI 1.85-5.89, P<0.01) had elevated risk of hepatocellular carcinoma compared with CC genotype. In the dominant model, the risk of hepatocellular carcinoma in CG+GG genotypes was increased compared with that in CC genotype ( OR=1.97, 95% CI 1.33-2.93, P = 0.001); in the recessive model, the risk of hepatocellular carcinoma in GG genotype was increased compared with that in CG+ GG genotype ( OR=2.43, 95% CI 1.44-4.11, P = 0.001). Single factor logistic regression analysis showed that there was no significant difference in the risk of hepatocellular carcinoma in the co-dominant, dominant and recessive models between miR-196a2 and miR-499 genotypes (all P > 0.05). For hepatocellular carcinoma patients with positive hepatitis B virus (HBV), CG genotype had a 2.02-fold (95% CI 1.06-5.07) risk of hepatocellular carcinoma compared with CC genotype, and GG genotype had a 3.12-fold (95% CI 1.66-10.07) risk of hepatocellular carcinoma compared with CC genotype; CG+GG genotype had a 1.91-fold (95% CI 1.85-3.38) compared with CC genotype, GG genotype had a 1.54-fold (95% CI 1.15-6.08) compared with CG+GG genotype. The increasing risk of hepatocellular carcinoma by miR-146a gene polymorphisms was not found in hepatocellular carcinoma patients with hepatitis C virus (HCV) infection or without HBV and HCV infection. Spearman correlation analysis showed that miR-146a gene polymorphisms was not related with age, gender, smoking, drinking, family history of cancer, alanine transaminase and aspartate aminotransferase (all P>0.05). Conclusions:GG and CG genotypes of miR-146a increase the risk of genetic susceptibility in hepatocellular carcinoma, especially for patients with HBV infection. miR-196a2 and miR-499 single nucleotide polymorphisms don't increase the risk of hepatocellular carcinoma.
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The scalpel is the most practical tool for surgeons. The traditional scalpel is a blade with a split handle, but the length of the blade cannot be adjusted, and it is easy to scratch medical staff. In order to solve the above problems, a retractable scalpel handle was designed by the medical staffs of department of general surgery, Affiliated Hospital of Yangzhou University (Clinical Teaching Hospital of Dalian Medical University), and obtained the National Utility Model Patent of China (ZL 2019 2 0203154.9). The telescopic scalpel adopted the design of rotary telescopic sleeve and threaded column handle to achieve the purpose of built-in blade. By rotating the handle at one end of the handle, the length of the surgical blade extending out of the sleeve could be adjusted according to the actual needs. The structure of the device is simple and easy to operate. The adjustable blade length could also achieve the purpose of accurate operation while effectively avoiding the injury of medical personnel during the operation.
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Objective@#To evaluate hepatectomy by anterior approach combined with liver hanging maneuver against conventional right hepatectomy in patients with large hepatocellular carcinoma (HCC).@*Methods@#Of the 62 cases, 29 patients underwent anterior approach hepatectomy and 33 did conventional hepatectomy.@*Results@#The overall operative time (t=1.815, P=0.037) and parenchymal transsection time (t=4.591, P=0.000) were longer in the anterior approach group than in the conventional group. More cases got radical resection in the anterior group (χ2=7.280, P=0.007). Log-rank test showed that 1, 3 and 5-year overall survival rate (OS) in the anterior approach group and the conventional group was 86.1%, 50.1%, 32.6% vs 75.8%, 30.3%, 18.9%, respectively (χ2=5.24, P=0.022), 1, 3 and 5-year disease free survival rate (DFS) were 75.3%, 42.1%, 31.0% vs 66.1%, 24.4%, 10.1%, respectively (χ2=4.38, P=0.037), and recurrence rate were 23.6%, 49.5%, 64.8% vs 36.7%, 63.7%, 82.5%, respectively (χ2=5.61, P=0.018).@*Conclusion@#Long term survival of patients with large sized HCC undergoing hepatectomy through the anterior approach combined with liver hanging maneuver is better than that of conventional approach.
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Objective To evaluate hepatectomy by anterior approach combined with liver hanging maneuver against conventional right hepatectomy in patients with large hepatocellular carcinoma (HCC).Methods Of the 62 cases,29 patients underwent anterior approach hepatectomy and 33 did conventional hepatectomy.Results The overall operative time (t =1.815,P =0.037) and parenchymal transsection time (t =4.591,P=0.000) were longer in the anterior approach group than in the conventional group.More cases got radical resection in the anterior group (x2 =7.280,P =0.007).Log-rank test showed that 1,3 and 5-year overall survival rate (OS) in the anterior approach group and the conventional group was 86.1％,50.1％,32.6％ vs 75.8％,30.3％,18.9％,respectively (x2 =5.24,P=0.022),1,3 and 5-year disease free survival rate (DFS) were 75.3％,42.1％,31.0％ vs 66.1％,24.4％,10.1％,respectively (x2 =4.38,P =0.037),and recurrence rate were 23.6％,49.5％,64.8％ vs 36.7％,63.7％,82.5％,respectively (x2 =5.61,P =0.018).Conclusion Long term survival of patients with large sized HCC undergoing hepatectomy through the anterior approach combined with liver hanging maneuver is better than that of conventional approach.
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Objective To explore the protective effect of astilbin in hepatic ischemia-reperfusion injury (HIRI).Methods SD rats were divided into Sham group (control group),HIRI group (ischemia-reperfusion group),astilbe (low dose group,middle dose group,high dose group),and estabilished the model of rat HIRI.After liver were reperfused with blood (in 4 h,8 h,16 h),collecting the specimens of blood and liver tissues.Detection of serum alanine aminotransferase (ALT),aspertate aminotransferase (AST);Then observed the changes of liver cell microstructure;Western blot analysised the expression of HMGB1,TLR4,NF-kB,TNF-α in liver tissue.Results The serum ALT levels of Sham group in 4 h,8 h,16 h were (58.11 ±4.81) U/L,(57.12 ± 5.33) U/L,(57.63 ±4.54) U/L,the serum ALT levels of HIRI group in 4 h,8 h,16 h were (540.38 ± 21.41) U/L,(831.21 ± 20.11) U/L,(191.95 ± 15.35) U/L.Compared with Sham group,the serum ALT levels of HIRI group were significantly increased(P ＜ 0.01).Compared with HIRI group,The serum ALT levels of three dose groups in 4 h,8 h,16 h were significantly declined,including high dose group lower the most obvious (The serum ALT levels of high dose group in 4 h,8 h,16 h were (223.75 ± 10.53) U/L,(412.14 ±23.59) U/L,(205.25 ± 15.48) U/L (P ＜0.01).The results of light microscope indicated that drug groups significantly reduce the liver cell damage.The results of Western blot displayed that High dose group of HMGB1,TLR4 protein expression in 4 h,8 h,16 h drop significantly than HIRI group(P ＜0.05).High dose group of NFkB,TNF-α protein expression in postoperative 8 h,16 h decrease significantly than HIRI group (P ＜ 0.05),but in postoperative 8 h,there was no statistically significant difference compared with group HIRI (P＞0.05).Conclusion Astilbe pretreatment can reduce HIRI and its mechanism may be associated with downregulating the axis of HMGB1/TLR4/NF-kB/TNF-α,proceed to the next inhibiting the inflammatory response.
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Objective To investigate the causes of pancreatic injury after autologous liver transplantation in rats. Methods Forty-two SD rats were randomly divided into post autologons liver transplantation 1-hour group, 6-hour group, 12-hour group, 24-hour group, 48-hour group, 72-hour group and sham group (6 rats per group). The plasma concentrations of amylase and lipase were measured to assess pancreatic exocrine function. The histomorphological changes of pancreatic tissue were studied under optical and electron microscopes. All data were analyzed via one-way ANOVA. Results The plasma concentrations of amylase and lipnse in post autologous liver transplantation 1-hour group were significantly higher than those in sham group, and they gradually increased as time passed by. The plasma concentrations of amylase and lipase reached peak at hour 48, after which they decreased gradually. There was a significant difference in the plasma concentration of amylase and lipase among the 7 groups (F = 538.622,489.417, P < 0.05). Acute edematous pancreatitis was observed 1 hour after autolognus liver transplantation, and acute hemorrhagic necrotic pancreatitis was observed 6 hours after transplantation. The degree of injury reached a peak 48 hours after transplantation. The number of mitochondria was increased, and endoplasmic reticulum and Golgi apparatus were swollen 1 hour after transplantation, and the area, perimeter, specific surface area and mean gray value of mitochondria were (312±40) mm~2, (80.3±3.8)mm, 0.332±0.039 and 113±11, respectively. As time passed by, the injury of the pancreatic cells was aggravated and autophagosomes were observed. The injury was most severe 48 hours after transplantation, and the area, perimeter, specific surface area and mean gray value of mitochondria were (466±7) mm~2, (108.8±3.7) mm, 0.298±0.009 and 195±12, respectively. There were significant differences in the specific surface area and mean gray value among all the groups (F = 9.322, 76.560, P < 0.05). Conclusion The pancreatic injury after autologous liver transplantation is related to the energy metabolism of the pancreatic cells induced by hypoxia.