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Objective To study the clinical use of microwave scalpel in hepatectomy for hepatocellular carcinoma without hepatic vascular inflow occlusion.Methods A retrospective study was conducted on the clinical data of 126 consecutive patients with hepatocellular carcinoma who were treated at the Department of Hepatobiliary Surgery of the Third Affiliated Hospital of Sun Yat-sen University from December 2015 to August 2018.The patients included 111 males and 15 females,with ages which ranged from 25 to 75 years.These patients were divided into two groups by the different surgical resection methods:the microwave scalpel hepatectomy (MSH) group which employed microwave scalpels to perform hepatectomy (n =42),and the ultrasound scalpel hepatectomy (USH) group which employed ultrasound scalpels (n =84).The perioperative conditions which included baseline data,amount of intraoperative bleeding,liver function after operation,and morbidity of postoperative complications were compared.Results There were no significant differences in the preoperative indexes which included tumor diameter,number of tumors,levels of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) between the 2 groups (all P ＞ 0.05).In the MSH group,the amount of intraoperative bleeding was 100.0 (100.0,200.0) ml,which was significantly lower than the 300.0 (100.0,400.0) ml in the USH group (P ＜ 0.05).Compared with the USH group,the levels of AST and ALT on postoperative day 1,3,7 after operation in the MSH group were significantly lower (all P ＜ 0.05),and the corresponding albumin levels were significantly higher than the USH group (P ＜0.05).The incidence of complications was 4.8％ (2/42) in the MSH group which was significantly lower than that of 20.2％ (17/84) in the USH group (P ＜ 0.05).Conclusion Microwave scalpel significantly reduced intraoperative bleeding and postoperative complications,and led to less liver functional injury.
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Objective:To investigate the teaching mode of laparoscopic surgery skills for medical interns and its effect.Method:s New interns were randomly divided into experimental group and control group. The experimental group received the laparoscopic surgery skill training by learning Pick and Place (PP), Scrip Shear (SS), Suture and Knot tying (SK) and Tissue Isolation (TI), and they also received additional training of basic surgery skills before the training of laparoscopic surgery skills, while the control group did not receive the pre-training. Examines and questionnaires were conducted after the training.Result:s There were no significant differences in laparoscopic skills between the two groups at the beginning of the training, but they all had obvious improvement after training ( P<0.01). Compared with the control group, the experimental group did better in PP and SK ( P<0.01), but no differences in SS and TI. The satisfaction rate of training model and skill improvement was 95% and 85% in the experimental group and control group. Conclusion:Short-term program of laparoscopic surgery skill training could effectively improve intern's laparoscopic surgery skills, and the master of basic surgery skills is conducive to the learning of laparoscopic surgery skills.
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Objective To investigate the effect of occult HBV infection (OBI) on carcinogenesis of cryptogenic hepatocellular carcinoma.Methods Samples of hepatocellular carcinoma (HCC) and pericarcinomatous tissues obtained after hepatectomy from January 2011 to November 2013 at the Third Affiliated Hospital of Sun Yat-Sen University were collected.They were divided into two groups:the cryptogenic HCC group (the CH group,n =26) and the HBV related HCC group (the HH group,n =40).These samples were compared with the normal liver tissues obtained in 30 patients.HBV DNA was identified by the nested polymerase chain reaction and the immunohistochemical method was taken to examine the hepatitis B virus X protein (HBx) and Yes-associated protein (YAP) expressions.Results OBI was identified in 20 (77.8％) cryptogenic HCC patients and 8 (26.7％) in the control group.There was a significant difference between the two groups (x2 =14.072,P ＜ 0.05).HBV DNA was detected in all the HBV-related HCC patients.The HBx protein expression was mainly located in the cytoplasm of liver cells and liver cancer cells,but YAP was expressed in the nucleus.Both of them showed diffuse brown or tan particles.In the HH group and the CH group,the positive expression rates of HBx protein in the tumorous tissues were 80.0％ and 90.0％,respectively,and 85.0％ and 82.5％ in the nontumorous tissues,but only in 40.0％ in the control group.The positive expression rates of YAP in the tumorous tissues were 65.0％ and 67.5％,respectively,15.0％ and 20.0％ in the nontumorous tissues,respectively,but only in 12.5％ in the control group.The HBx expression in the cancerous tissues and para-cancerous tissues of the HH group and the CH group showed no significant difference (P ＞ 0.05),but the YAP expression in the tumor tissues was significantly higher than that in the nontumorous tissues (P ＜ 0.05).The HBx and YAP expressions in the HH group were comparable to the CH group (P ＞ 0.05).However,their expressions in the cancerous tissue of the HH group and the CH group were significantly higher than in the normal liver tissues (P ＜ 0.05).Conclusion A high prevalence of HBV infection was observed in HBsAg-negative HCC and the high expressions of HBx and YAP might be involved in the process of cryptogenic hepatocellular carcinoma.
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BACKGROUND:Previous studies have confirmed that bone marrow mesenchymal stem cells in vitro can promote hepatic stel ate cellapoptosis and inhibit its activity, in which the mechanism of action remains unknown. OBJECTIVE:To screen out apoptosis-related genes during hepatic stel ate cellapoptosis regulated by bone marrow mesenchymal stem cells using gene chip technology. METHODS:Purified human bone marrow mesenchymal stem cells were seeded in 6-wel Transwel plate and cocultured with hepatic stel ate cells. Cultured human bone marrow mesenchymal stem cells alone served as control group, and cultured for 72 hours. The alterations in apoptosis-related genes were analyzed between culture alone group and coculture group using gene chip technology. The genes strongly associated with regulation of hepatic stel ate cells were selected. RESULTS AND CONCLUSION:By the functional classification of second-generation SABiosciences Gene chips, apoptotic gene screening found that after coculture, significantly upregulated genes in bone marrow mesenchymal stem cells contained:AKT1, PIK3R2, DAPK1, DHCR24, NOTCH2 and BDNF. Combined with previous findings, we hypothesized that NOTCH may play a key role in the regulation of hepatic stel ate cells by bone marrow mesenchymal stem cells.
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Objective To evaluate HCC family history on recurrence and survival of HCC patients after curative hepatectomy. Methods The family history,postoperative recurrence rate,1,2 and 5 year survival rate of 79 HCC patients who received surgical resection were collected.Patients were divided into two groups:34 cases in familial aggregation HCC group (FH group ) and 45 cases in non- familial aggregation HCC group (NH group).All these HCC patients were followed up for 3 months to10 years after surgery,and the median follow-up period was 48.5 months.We analyzed the survival rate of HCC patients by Kaplan -Meier survival curve to compare the postoperative recurrence rate and survival rate between two groups. Results 34 cases of HCC probands came from 33 families,and there were 104 cases of HCC patients in these families,an average of 3.2 cases per family.There were 6 families in which 3 or more cases developed HCC,and there were 13 families in which father or (and) mother had HCC accounting for 39.4％.The six months,1 year,2 year posthepatectomy recurrence rate in FH group was 15.1％,22.3％,40.1％,significantly higher than NH group of 10.3％,17.4％,25.6％ (x2 =5.762,6.434,5.987,P ＜0.05),and 1,2,5 year's survival rate in FH group was 57％,46％,40.3％,much lower than NH group of 85.3％,75.2％ and61.5％ (x2 =8.986,9.765,7.634,P＜0.05). Conclusions Family history of HCC affects the prognosis of HCC patients after surgery. Patients with HCC family history have higher postoperative recurrence rate and worse prognosis than that of patients who do not have HCC family history.
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Objective To evaluate the effect and safety of combined treatment by laparoscopic cholecystectomy and subsequent ablation in patients with HCC adjacent to the gallbladder. Methods From June 2005 to June 2009,13 patients with HCC nodules( less than 3 cm) adjacent to the gallbladder were treated by ablation after laparoscopic cholecystectomy. The rate of complete necrosis as well as postoperative complications were also analyzed. Results All the patients showed complete necrosis of their tumor lesions after treatment by ablation subsequence of laparoscopic cholecystectomy. During the follow-up period( nearly 2 years), recurrent nodules appeared in other subsegments but not at the original site treated by ablation. Of note, no fatal complications were observed in all the ablation treated patients. Conclusion Combined treatment by laparoscopic cholecystectomy and subsequent PMCT was an effective and safe method for patients with small HCC which was adjacent to gallhladder.
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BACKGROUND: There is no accepted treatment for liver fibrosis recently. Bone marrow meaenchymal stern cells (BMSCs) used in the treatment of liver fibrosis has been reported as an effectively treatment, but the mechanism is unclear.OBJECTIVE: To study the regulation of hepatic stellate cells mediated by human BMSCs in vitro.DESIGN, TIME AND SETTING: The cytological in vitro study was performed at the Center for Stem Cells and Tissue Engineering of Sun Yat-sen University and the Central Laboratory of Third Affiliated Hospital of Sun Yat-sen University from June to December 2008.MATERIALS: Human bone marrow masenchymal stem cells were collected from normal youth volunteers; Human hepatic stellate cells and normal liver call line L-O2 were supplied by the Animal Experimental Center of Sun Yat-sen University.METHODS: The purified human BMSCs and hepatic stellate calls were set up in Transwell co-culture system. The incubation density was 2×104cells/well. L-O2 was set up instead of human BMSCs as negative control. Hepatic stellate cells cultured alone served as blank control group. The culture was performed for 72 hours.MAIN OUTCOME MEASURES: Morphology of hepatic stellate cells and results of immunocytochemical staining. Apoptosis of hepatic stellte calls was determined by flow cytometry. Western blot were used to assay the expression of α-actin.RESULTS: Activated hepatic stellate cells presented fiat and thin shape under an inverted microscope. Fat drop was lack in cytoplasm, a -actin located in hepatic stellate calls, with the presence of high tension fibers. Compared with the L-O2 + hepatic stellate cell and hepatic stellate call groups, the apoptotic rate of hepatic stellate cells was significantly increased in the BMSC + hepatic stellate cell group (P < 0.05). α -actin expression was significantly down-regulated.CONCLUSION: Human BMSCs can inhibit activation of hepatic stellate ceils and promote them apoptosis, which may be the anti-hepatic fibrosis mechanism of BMSCs.
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Objective To evaluate a thrombolytic system of portal vein port-catheter kit (PC) in the treatment of portal vein thrombosis (PVT). Methods In this study, 42 PVT patients with liver cirrhosis and portal hypertension after splenectomy from 2005 to 2007 were divided into two groups. In group A (20 eases) thrombolysis was administered through the PC device. Urokinase at the dosage of 1000 U?kg-1?h-1 was given for a consecutive 3 -6 days through the PC, and then the therapy was converted to 100 AxaIU/kg of low molecular heparin twice a day for 7 days subcutaneously. In group B, the thrombolysis was performed on 22 patients through peripheral veins. The therapy was same as in group A except for that the urokinase dosage was doubled. The complete thrombolysis rate, the effective thrombolysis rate, the time of thrombolysis, the long-term recurrence rate and the incidence of complication were compared between the two groups. Results The complete thrombolysis rate and the effective thrombolysis rate in group A were 75%, 90% respectively, compared with that of 41%, 59% respectively in group B. The significant differences in the complete thrombolysis rate, the effective thrombolysis rate, the time of thrombolysis and the incidence of complication were found between the two groups, while the thrombolysis recurrence rate had no significant difference between the two groups. Conclusion PC regime is an effective and safe method for the treatment of portal vein thrombosis.
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We arranged for experienced doctors to carry out the programme of short-term strengthening training in obstetrics,gynecology and pediatrics to trainees before the end of their clinical practice,aiming at assisting trainees to systematize and categorize skill and knowledge that they had gained confusedly and disorderly during obstetrics,gynecology and pediatrics practice.It demonstrated that such programme was beneficial to their comprehensive examination of graduation and future clinical practice.
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Objective To evaluate the effect of combination splenectomy and endoscopic varices ligation in comparison with Hassab procedure in the treatment of portal hypertension. A prospective, controlled study was carried out on Splenectomy with EVL in comparision with portoazygous disconnection--the Hassab procedure to assess whether SEVL can achieve better results in the treatment of portal hypertension. Methods From Jan 1999 to June 2002, 103 cirrhotic patients with portal hypertension were admitted. These patients were randomized into two groups. Group A were treated by splenectomy combined with EVL(53 cases) , and group B were treated with Hassab procedure(50 cases). Results In both groups, there was a significant postoperative decrease in free portal pressure, the velocity and volume of portal flow (all P0.05). Portal vein thrombosis developed in 7 cases (13%) in group A, and in 14 cases (28%) in group B, P
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ObjectiveTo study growth hormone activated regulation of growth hormone receptors (GHR) in cirrhotic hepatocytes. MethodsPrimary cultures of hepatocytes from cirrhotic rat were exposed to recombinant human growth hormone (rhGH) at different concentrations of 0, 13.3, 133.3,and 1?333?ng/ml, respectively. Thereafter the binding sites of hepatocytes were detected with radio-ligand binding assay. ResultsAfter culture with different rhGH concentrations, the binding sites (10 4/cell) of receptors on cirrhotic liver cells were respectively 0.73?0.13, 1.14?0.17, 1.23?0.21, and 0.68?0.10(P