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ObjectiveTo investigate the feasibility and effectiveness of low central venous pressure (LCVP) in the operation of major hepatic resection.MethodsFourty-eight patients underwent major hepatic resection were randomized into two groups: LCVP and control group.In the LCVP group,CVP was maintained ≤5 cm H2O during the hepatic resection and then returned to normal after resection.In the control group,CVP was maintained normal between 6 -12 cm H20.The duration of hepatectomy,volume of blood loss,volume of blood transfused and renal function were compared between the two groups.ResultsFor the LCVP and control group,the time for hepatectomy was (45 ± 8 ) and ( 35 ± 5 ) min,respectively; the volumes of blood loss were ( 850 ± 160) and (436 ±280)ml,respectively; the blood loss during operation was (490 ± 130) and (270 ± 105 ) ml respectively.The differences were statistically significant (t values were 15.53,7.69 and 17.89 separately,P ＜0.05 ).No significant difference in the renal function was observed before and after the operation ( P ＞ 0.05 ).Conclusion Using LCVP technique during liver resection significantly reduced the operation time,blood loss and blood infusion.And there wa.s no obvious adverse effect on renal function.
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Objective To analyze the cause of the syndrome recurrences of postcholecystectomy.Methods Clinical data of 98 patients with syndrome recurrences of postcholecystectomy were retrospectively reviewed.Results Among 98 cases,95 cases were found with organic lesions.The recurrences included residual or recurrent calculi in extra or intrahepatic bile ducts,stricture of common bile duct,cystic duct remnant,chronic pancreatitis,cholangioduodenal fistula,cancer of biliary ducts,periampullary cancer.Conclusion MRCP and B ultra sound should be conducted before operations to localize the lesion sites.Detailed detection or cholangiography during operation may avoid the injury and incomplete surgery and reduce the recurrence.
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Objective To investigate the efficacy and safety of laparoscopic radiofrequency ablation (RFA) therapy for hepatocellular carcinoma.Methods Clinical data of 78 hepatocellular carcinoma patients undergoing laparoscopic radiofrequency in Beijing China-Japan Friendship Hospital from May.2008 to July.2010 were reviewed retrospectively.Age ranged from 31 to 87 years,41 were male and 37 were female.Intraoperative ultrasound-guided needle biopsy was performed and diagnosis of hepatocellular carcinoma was established in all cases before RFA was carried out.Data analysis was performed using software SPSS or OriginPro7.Necrosis,local recurrence of the tumor and the cumulative survival rate were analyzed by Kaplan-Meier test and x2 test.Results The median follow-up time was 16 months after RFA treatment.Tumor size,proximity to intrahepatic vessels and combination with TACE were factors that influence local recurrence.The complete ablation (CA) rate was remarkably higher in tumors ＜ 3 cm than in tumors ＞ 3 -5 cm (90.5％ vs 71.4％,x2 =4.291,P =0.038 ).Tumors adjacent to major vessels had a significantly lower CA rate as compared with those not adjacent to them (63.6％ vs 91.9％,x2 =6.351,P =0.012).The CA rate were 88.9％ in the TACE ± RFA group and 75.0％ in the RFA group ( x2 =1.567,P =0.211 ).The mean overall survival were 48.7 ± 2.4 months,the cumulative survival rate was 86.1％ at 1 year、76.9％ at 2 years、60.3％ at 3 years、51.8％ at4 years and 33.1％ at 5 years.Conclusions Laparoscopic RFA is safe,mini-invasive and effective for unresectable hepatic carcinoma with a favorable long term survival.
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Objective The purpose of this study was to assess the value of serial sectioning and immunohistoehemistry(IHC)for the diagnosis of senfinel lymph node(SLNs)metastases in patients with breast cancer,and to evaluate the significance of mierometastases and isolated tunlor cells(ITCs)in the SLNs. Methods Eighty pailents with clinically node-negative breast cancer underwent SLN biopsy with both99mTc-labeled sulfur colloid and iBosulfan blue dye for SLN identification.All SLNS and non-SLNs were evalnated with standard H&E stain and IHC analysis. Results SLNs were successfully identified in 78 of 80 patients(97.5%),the isotope/blue dye concordanee rate was 76.5%for all SLNs.Thirty two patients (41%)had histologically positive SLNs,and 13(40.6%)of these patients hod SLNS with micrometastatic disease.In 14(43.8%)of these patients,the SLNs were the only nodes involved.The sensitivity,specificity and accuracy of SLN biopsy in predicting axillary node stams were 96.9%,100%and 98.7%,reslaeetively.Patients with positive SLNs metastasis had a markedly higher proportion of non-SLNs metastases compared with those with only micrometastasis in the SLNS(78.9% vs 23.1%). Conclusions Serial sectioning and IHC ale sensitive methods for detecting breast cancer metastases in SLNS.The incidence of non-SLNs metastases is rather low in patients with SLNs that contain only micrometsstatic foci and ITCs.The prognostic significance and effect on surgical management of these occult disease have yet to be determined.
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Objective To assess the clinical efficacy of percutaneous transhepatic portal embolization (PTPE) before the extended right hemihepatectomy for the treatment of hilar cholangiocarcinoma. Methods We successfully carried out a percutaneous transhepatic portal embolization in a patient with hilar cholangiocarcinoma and liver cirrhosis. Hepatic hemodynamics, liver volume,liver functions, and pathological changes were recorded after the procedure. Results After PTPE, the patient developed an inflammatory response manifested by a transient fever (39.2 ℃ at peak on the 5th postoperative day) and a mild abdominal pain. There were no other complications such as nausea, vomitting, hemorrhage, or bile leakage. The volume of the left lobe increased from 417.0 ml to 522.4 ml (enlargement rate, 125.2%); the volume of the right lobe decreased from 1041.3 ml to 1017.4 ml (diminishment rate, 97.7%). The ratio of the left lobe to the whole liver increased from 28.6% to 33.9%. The velocity of blood flow of the left portal vein increased by 100% and 39% on the day of operation and the 6th day after operation, respectively (from 12.8 ml/s preoperatively to 23.2 ml/s and 17.1 ml/s). The values of ICG R15 and ICG-K returned to normal levels. On the 17th day after PTPE, the quantity of bile drainage from the left lobe exceeded that from the right lobe. The extended right hemihepatectomy was performed 34 days after PTPE. During operation, an obvious hypertrophy of the left lobe and a distinct demarcation line between the segment 5, 6, and 7 (S5,6,7) and other segments were observed. Postoperative recovery was uneventful. The pathological examination found stenosis and embolization of the portal vein, as well as the degeneration, necrosis, and apotosis of the liver cells in the embolized lobe. Conclusions Portal vein embolization can effectively induce the hypertrophy of the unembolized lobe, which increases the safety level of following extended hemihepatectomy in patients with impared liver functions.