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With the accelerated aging society in China, the incidence of biliary surgical diseases in the elderly has increased significantly. The clinical characteristics of these patients indicate that improving treatment outcomes and realizing healthy aging are worthy of attention. How to effectively improve the treatment effect of geriatric biliary surgical diseases has attracted widespread attention. This paper reviews and comments on the hotspots and difficulties of biliary surgery in older patients from six aspects: (1) higher morbidity associated with an aging society, (2) prevention and control of pre-operative risks, (3) extending the indications of laparoscopic surgery, (4) urgent standardization of minimally invasive surgery, (5) precise technological progress in hepatobiliary surgery, and (6) guarantee of peri-operative safety. It is of great significance to fully understand the focus of controversy, actively make use of its favorable factors, and effectively avoid its unfavorable factors, for further improving the therapeutic effects of geriatric biliary surgical diseases, and thus benefits the vast older patients with biliary surgical diseases. Accordingly, a historical record with the highest age of 93 years for laparoscopic transcystic common bile duct exploration has been created by us recently.
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Humans , Aged , Aged, 80 and over , Biliary Tract Surgical Procedures , Gallstones , Laparoscopy , Treatment Outcome , Aging , Retrospective StudiesABSTRACT
Objective:To evaluate the effect of anatomic resection (AR) and nonanatomic resection (NAR) on the prognosis of hepatocellular carcinoma (HCC) patients of China Liver Cancer Staging (CNLC) Ⅰa.Methods:PubMed, Embase and Cochrane Library databases were searched for articles on AR and NAR of CNLC Ⅰa stage HCC from January 2000 to March 2021. A meta-analysis was performed on patient characteristics, tumor characteristics, surgical procedures, postoperative pathological characteristics and long-term prognosis.Results:Of 9 case-control studies were included in this study, there were 2761 patients, with 1727 cases in the AR group and 1034 cases in the NAR group. When compared with the NAR group, the AR group had lower proportion of liver cirrhosis, lower ICG R15 value, higher proportion of Child-Pugh A grade, larger tumor diameter, higher proportion of microvascular invasion, longer operation time and higher intraoperative blood loss. The AR group had a better postoperative 5-year disease-free survival rate [ OR=1.54, 95% CI: 1.30-1.82, P<0.001] and a higher postoperative 5-year overall survival rate [ OR=1.27, 95% CI: 1.04-1.55, P=0.018]. Conclusion:AR is significantly better than NAR for preventing long-term recurrence and improving long-term survival in patients with CNLC Ⅰa stage HCC.
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Objective:To investigate the prognostic value of preoperative inflammatory indicators for hepatocellular carcinoma (HCC).Methods:The retrospective cohort study was conducted. The clinicopathological data of 73 patients with primary HCC who underwent radical partial hepatectomy in the Beijing Tsinghua Changgung Hospital of Tsinghua University from December 2014 to July 2019 were collected. There were 57 males and 16 females, aged from 33 to 81 years, with a median age of 58 years. Results of blood examination indicators at the first time in hospital were determined for patients. Observation indicators: (1) the best cut-off values of?? preoperative inflammatory indicators calculated by the maximally selected rank statistics; (2) follow-up; (3) influencing factors for prognosis of HCC patients; (4) comparison of clinicopathological parameters of HCC patients; (5) comparison of predictive value for overall survival. Follow-up was conducted using outpatient examination and telephone interview to determine postoperative survival of patients up to September 2019. Measurement data with normal distribution were represented as Mean±SD, and comparison between groups was analyzed using the t test. Measurement data with skewed distribution were represented as M (range). The best cut-off values ??for continuous variables were obtained using the maximally selected rank statistics based on survival at endpoint of follow-up. Count data were represented as absolute numbers, and comparison between groups was analyzed using the chi-square test or Fisher exact probability. Kaplan-Meier method was used to calculate survival rates, and Log-rank test was used for survival analysis. Univariate analysis was performed using the Log-rank test. Multivariate analysis was performed using the COX proportional hazard model. The time-dependent receiver operating characteristic curve (ROC) was used to compare the predictive value of independent prognostic factors. Results:(1) The best cut-off values of?? preoperative inflammatory indicators calculated by the maximally selected rank statistics: the best cut-off values of neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and prognostic nutrition index (PNI) were 3.46, 131.05, and 45.65. (2) Follow-up: 73 patients were followed up for 31 months (range, 2-57 months). Twenty patients died during the follow-up. (3) Influencing factors for prognosis of HCC patients: results of univariate analysis showed that NLR, PNI, tumor diameter, and tumor differentiation degree were related factors affecting prognosis of patients ( χ2=10.213, 4.434, 5.174, 4.306, P<0.05). Results of multivariate analysis showed that NLR and tumor differentiation degree were independent factors affecting prognosis of patients ( hazzard ratio=4.429, 13.278, 95% confidence interval as 1.662-11.779, 1.056-10.169, P<0.05). (4) Comparison of clinicopathological parameters of HCC patients: of 73 patients, 64 cases had NLR<3.46 and 9 cases had NLR≥3.46. Cases with tumor length >5 cm or ≤5 cm, neutrophils, lymphocytes were 23, 41, (2.9±1.2)×10 9/L, (1.7±0.6)×10 9/L for 64 patients with NLR<3.46, versus 8, 1, (5.8±2.9)×10 9/L, (1.0±0.3)×10 9/L for 9 patients with NLR≥3.46; there were significant differences in above indicators between the two groups ( χ2=7.017, t=2.982, -3.168, P<0.05). (5) Comparison of predictive value for overall survival: time-dependent ROC curves of NLR and tumor differentiation degree for 1-, 2-, 3-, 4-year survival rates had the area under curve of 0.735,0.611, 0.596, 0.574 and 0.554, 0.583, 0.572, 0.556, respectively. NLR had better predictive value for overall survival of patients than tumor differentiation degree. Conclusion:Preoperative NLR is an independent factor affecting prognosis patients, and its predictive efficacy is better than tumor differentiation degree.
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Objective:To evaluate the efficacy of erector spinae plane block (ESPB) for transforaminal endoscopic surgery.Methods:Sixty patients of both sexed, aged 20-45 yr, with body mass index of 17.5-29.0 kg/m 2, of American Society of Anesthesiologists physical status ⅠorⅡ, undergoing percutaneous transforaminal endoscopic lumbar discectomy, were divided into 2 groups ( n=30 each) by using a random number table method: ESPB group (E group) and local infiltration anesthesia group (L group). Group E received the ultrasound-guided ESPB, group L received layer-by-layer-assisted local infiltration anesthesia (including subcutaneous layer and fascia, muscular layer and superior articular process) according to the location of operation, and 0.5% ropivacaine 20 ml was used as local anesthetic in both groups.Operation time and C-arm X-ray localization time were recorded.Visual analogue scale score and Ramsay sedation score were recorded at skin incision (T 1), muscle separation (T 2), foraminoplasty (T 3), nerve root decompression (T 4) and skin suture (T 5). The effective analgesia and satisfaction with sedation were recorded.Patients were followed up postoperatively for patient satisfaction, lower extremity motor block, development of nausea and vomiting, dizziness, hematoma at puncture site, nerve damage and etc.Functional status was assessed using the Oswestry Disability Index. Results:Compared with group L, visual analogue scale scores were significantly decreased at T 2-4, Ramsay sedation scores were increased at T 3, 4, patient′s satisfaction was increased, operation time and C-arm X-ray localization time were shortened ( P<0.05), and no significant change was found in Oswestry Disability Index score or rate of satisfactory analgesia in group E ( P>0.05). No motor block, nausea and vomiting, dizziness, hematoma at puncture site and nerve damage was found in both groups. Conclusion:ESPB can provide satisfactory analgesia with a higher safety when used for trasforaminal endoscopic surgery.
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The current epidemic of Corona Virus Disease 2019 (COVID-19) poses a serious threat to people′s health and lives. Following the national policies and deployment, medical community in China invests large amounts of medical resources to help Hubei. However, some hospitals nationwide have suspended outpatient and inpatient services. The authors analyze the underlying causes of suspension of medical services and its harm to patients, and summarize the optimization of disease diagnosis and treatment during the COVID-19 outbreak. In further, they propose reasonable suggestions on safe medical management in general hospitals outside the epidemic area, in order to attract the attention of medical institutions and medical colleagues.
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The invasion,metastasis and drug resistance of hepatocellular carcinoma are the main factors affecting the prognosis of patients.Recent studies have shown that the interaction between tumor cells and the tumor microenvironment is critical for tumor cell survival,proliferation,stem cell characteristics acquisition,invasion,metastasis and drug resistance.This article discussed the progress of hepatocellular carcinoma tumor microenvironment from the contribution of hepatitis virus,liver fibrosis to microenvironment,and microenvironmental cell components and non-cellular components.
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Objective To investigate the preoperative plus postoperative neutrophil-lymphocyte ratio (PP-NLR) predicts the outcomes of hepatocellular carcinoma after hepatectomy.Methods The clinical data of 44 patients with partial hepatectomy in the Hepatobiliary Surgery,Beijing Tsinghua Changgung Hospital,Tsinghua University,from December 2014 to March 2018 were retrospectively analyzed.According to the cut-off value,the high NLR is assigned a value of 1 before and after surgery,and the low NLR is assigned a value of 0.Preoperative NLR plus postoperative NLR =0/1/2.The preoperative NLR plus postoperative NLR=0/1 was assigned to one group,and the preoperative NLR plus postoperative NLR=2 was attributed to one group.Recurrence-free survival (RFS) and overall survival (OS) were evaluated by the Kaplan-Meier method,with comparisons using the log-rank test.The Cox proportional hazard model is used for univariate and multivariate analysis.Results Comparison of clinical and pathological data of different PP-NLR,the preoperative and postoperative NLR was higher in the PP-NLR=2 group than in the PP-NLR=l/0 group,and the difference was significant (P＜0.05).Univariate analysis showed that PP-NLR (HR=3.495,95％CI:1.054 ～ 11.589,P ＜ 0.05) and degree of differentiation (HR =3.995,95％ CI:1.050 ～15.198,P＜0.05) were risk factors for OS after liver resection,while preoperative NLR and postoperative NLR alone were not risk factors for overall survival.Multivariate analysis showed that PP-NLR (HR=4.733,95％CI:1.320～16.966,P＜0.05) and degree of differentiation (HR=6.310,95％CI:1.456～27.344,P＜0.05) were independent risk factors for OS after liver resection.Conclusion PP-NLR considers the systemic immune status of preoperative and postoperative,predicts prognosis better than preoperative or postoperative NLR.
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Objective To investigate the effect of B-guided brachial plexus block anesthesia on postoperative cognitive function and serum neurotrophic factor (NGF) and transforming growth factor-β (TGF-β) levels in children with ulnar and radius fractures.Methods From February 2014 to January 2017,we selected 78 children with ulnar radius fractures in our hospital randomly and divided them into observation group and control group,each group 39 cases.The control group was given brachial plexus block anesthesia under the position of nerve stimulation,and the observation group was subjected to B-guided brachial plexus block anesthesia.Anesthesia-related indicators,anesthetic effects and complications were observed and analyzed between the two groups,and hemodynamics parameters of brachial plexus block after 0.5h,cognitive function and serum NGF and TGF-β levels before and after operation were compared.Results Compared with the control group,anesthesia onset,recovery room stay time in the observation group were shorter and the duration of analgesia was longer (P ＜ 0.05).The excellent and good rate of anesthesia in the observation group 97.44％ (38/39) was higher than that in the control group (76.92％,30/39).The incidence of complications in the observation group 5.12％ (2/39) was much lower than that of the control group (23.08％,9/39,P ＜ 0.05).There was no significant difference in systolic peak velocity between the two groups (P ＞ 0.05).Compared with the control group,the end of the diastolic velocity and blood flow of brachial plexus block after 0.5h were higher,resistance and pulsatility index were lower (P ＜ 0.05).There was no significant difference in preoperative cognitive function,serum NGF and TGF-β levels between the two groups before operation (P ＞ 0.05).After operation,compared with the control group,the cognitive function,serum NGF and TGF-β levels were higher in the observation group (P ＜ 0.05).Conclusion Anesthesia effect of B-guided brachial plexus block anesthesia is significant in children with ulnar radius fractures.The incidence of complications is low,which can significantly improve the ulnar arterial hemodynamics,significantly increased serum NGF,TGF-β levels,contribute to postoperative fracture healing,and will not affect the cognitive function of children after surgery.
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For unresectable advanced hepatocellular carcinoma (HCC),besides sorafenib,alternative drugs and treatment modalities are required.Clinical studies of hepatic arterial infusion chemotherapy (HAIC),transcatheter arterial chemoembolization (TACE),and system chemotherapy have shown favorable efficacy and tolerance in advanced HCC patients.In addition,the potential efficacy of sorafenib combined with focal treatment is also an interesting issue.As more therapies become available,decision-making for treating advanced HCC becomes increasingly complex.In our opinion,diverse treatment modalities should be utilized for the best interest of patients.Based on predictive biomarkers,we should develop a precise patient stratification system to select suitable candidates for each treatment modality in future studies,as is useful for improving prognosis of patients with advanced HCC.
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Congenital bile duct dilatation may occur in any part of the biliary tree,and the diagnosis and treatment of lesions involving the intrahepatic bile duct is the most challenging issue.Surgical operation plays a dominant role in the management of congenital bile duct dilatation,with the purposes of relieving symptoms and preventing disease progression and malignant transformation.Surgical principles are radical resection of lesions and reconstruction of unobstructed bile drainage.Hepatectomy is the main surgical procedure for congenital bile duct dilatation with involvement of the intrahepatic bile duct,and liver transplantation can be used for diffuse lesions.Therefore,we believe that hepatectomy and early intervention will maximize patients' benefits.
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Objective To investigate the effect of remifentanil combined with dezocine or fentanyl on analgesia in patients with cholecystectomy. Methods A total of 98 patients with cholecystectomy from our hospital were collected, patients were randomly divided into the experimental group and control group with 49 cases in each group.Patients in the control group were treated by remifentanyl combined with fentanyl intravenous injection and patients in the experimental group were treated by remifentanyl combined with dezocine intravenous injection.The analgesia and sedation score and vital signs changes at recovery time (T1), after recovery 1h (T2), 2 h (T3), and the revival time, extubation time and adverse reactions were compared between two groups.Results The visual analogue scale score in experimental group at T1 , T2 , T3 and Ramsay sedation scale ( RSS) at T2 , T3 were lower than control group, the revival time and extubation time in experimental group were lower than control group, with significant difference (P<0.05). There was no significant difference at T0 ,T1 ,T2 and T3 between two groups.There was no respiratory depression happened in two groups, and there was no significant difference in adverse drug reaction between control group and experimental group (16.33% vs.10.20%).Conclusion The remifentanil combined with dezocine has a good inhibitory effect on postoperative hyperpathia with less adverse reactions.
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Objective To study the effect of preemptive analgesia with tramadol on ovarian cancer patients with stress reaction.Methods 80 cases with ovarian cancer undergoing elective surgery under general anesthesia were divided into the observation group and the control group according to the computer randomly generated control table,40 cases in each group.Patients in the observation group with PECA were pumped into tramadol after anesthesia induction,while the control group was in the same conditions of pumping tramadol after operation.Patients were all treated with intravenous patient -controlled analgesia with sufentanil after waking up.The blood concentrations of cortisol (COR),adrenal cortical hormone (ACTH),angiotensin Ⅱ (AT Ⅱ)were determined by radioimmunoassay, and the blood concentrations C reactive protein (CRP)was determined by immune turbidity method.The adverse reactions and the VAS score of patients after 2h,6h,12h,24h,48h were recorded.Results The COR,ACTH,AT Ⅱ, CRP concentrations of the two groups had no significant differences (all P >0.05)before operation.After each time point,COR[(208.5 ±31.6)ng/mL vs (446.3 ±19.8)ng/mL],ACTH[(35.7 ±8.2)pg/mL vs (63.5 ±9.1)pg/mL],AT Ⅱ[(46.8 ±10.9)pg/mL vs (75.9 ±12.5)pg/mL],CRP[(3.9 ±0.7)mg/mL vs (40.5 ±2.9)mg/mL] concentrations were significantly higher than those of pre -operation (all P 0.05);At the time of coughing,the two groups were significantly differ-ent only at the 6h[(2.5 ±0.6)vs (3.1 ±0.8)]and 12h[(2.1 ±0.6)vs (2.9 ±0.4)]time point (t =13.406, P =0.012;t =12.625,P =0.025).Conclusion Preemptive analgesia with tramadol and sufentanil for postoperative analgesia can effectively reduce the radical resection of postoperative pain and the stress reaction after surgery.It is a safe and effective analgesic method.
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Objective To examine the role of c-Src activation in hepatitis B virus X (HBx) protein induced epithelial-mesenchymal transition (EMT) in liver cancer.Methods SMMC-7721 liver cancer cells were transfected with HBx gene to induce EMT and the activated c-Src expression was evaluated by Western blot.Both the morphological changes and the epithelial and mesenchymal markers expression (real-time PCR,western blot and immunocytochemistry) of HBx-transfected SMMC-7721 cell treated by c-Src kinase inhibitor PP2 and negative control PP3 were observed and compared,respectively.Results The activated c-Src expression in HBx gene transfected SMMC-7721 cells was significantly increased compared to that in mock transfected cells,c-Src kinase inhibitor PP2 could enable the HBx-transfected SMMC-7721 cells to transmit from spindle-like shape to original epithelial morphology.Western blot and immunocytochemistry confirmed that the expression of epithelial markers and mesenchymal markers almost returned to the levels of parental cells,indicating the mesenchymal-epithelial transition.Conclusions c-Src activation plays a key role in the process of EMT induced by HBx protein in SMMC-7721 cells.
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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 evaluate three-dimentional (3D) reconstruction technique and methylene blue staining in precise anatomic hepatectomy.Methods The clinical data of 12 patients with hepatocellular carcinoma who were admitted to the Chinese PLA General Hospital from February 2009 to August 2011 were retrospectively analyzed.The 3D reconstruction of the liver tumor and intrahepatic vessels were done based on the computed tomography data and magnetic resonance imaging data.The portal vein supplying the tumor and its anatomic relationship with adjacent vessels were evaluated.Precise anatomic hepatectomy was performed guided by sustained methylene blue staining.Results The accurate rate of 3D model of the portal triad was 12/12.The shape of target segments observed after methylene blue staining was consistent with the results of 3D evaluation.Two patients received hemihepatectomy,3 received lobectomy,5 received monosegmentectomy or subsegmentectomy,2 received multisegmentectomy.The mean tumor diameter,operation time,blood loss,postoperative hospital stay and complication rate were 5.6cm (2.5-16.0 cm),(150±24)minutes,(236±25)ml,(10±3)days and 2/12,respectively.After a median follow-up of 14 months,tumor recurrence was found in 2 patients,and 1 of them died of tumor progression.Conclusions The 3D reconstruction may contribute to precise evaluation of the anatomic relationship between the tumor and its adjacent vessels.The 3D technique combined with sustained methylene blue staining may significantly improve the accuracy of anatomic hepatectomy.
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Objective To evaluate the role of computer-assisted surgical planning system in liver resection for patients with hepatocellular carcinoma (HCC).Methods Between January 2010 and January 2012,21 patients with HCC who underwent liver resection were included in this study.Computer assisted operative planning was performed before surgery.Results Computer-assisted surgical planning was performed successfully in all the 21 patients.The three dimensional anatomic evaluation was precise and quantitative.The predicted liver resection volume showed a significant correlation with the actual volume,with a mean difference of 3.5％.The types of liver resection included anatomic liver resection (15 patients) and local resection (6 patients).There was a 0％ mortality and a 14.3％ morbidity (3/21).Conclusions The computer-assisted surgical planning system reliably analyzed the 3D vascular structures and predicted accurately liver resection volumes.It can help to promote precise and safe liver resection.
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Microbial lipopeptides play an important role in apoptosis induction of tumor cells. However, there is little knowledge about the relationship between apoptosis induction and membrane fatty acids. The present study focused on the effects of lipopeptides produced by Bacillus subtilis HSO121 on Bcap-37 cell lines. 3-(4, 5-dimethylthiazol-2-yl)-2, 5-diphenyl (MTT) colorimetric assay and surface tension measurements, showed that the critical micelle concentration (CMC) was a critical level for the inhibitory activity of lipopeptides on the growth of Bcap-37 cells. Under the CMC, the order of least to greatest cytotoxicity effect on cancer cell lines by lipopeptides is C(13)-lipopeptide < C(14)-lipopepitde < C(15)-lipopeptide. Above CMC, all lipopeptides directly exert cytolytic activity. The flow cytometric analysis and Hoechst33258 staining experiments confirmed the apoptosis of Bcap-37 cell lines induced by lipopeptides in a dose-dependent manner. This apoptosis was associated with a significant decrease of the unsaturated degree of the cellular fatty acids of Bcap-37 cell lines due to the changes in the cellular fatty acids composition induced by the lipopeptide treatment. These results indicated that disturbance of the cellular fatty acid composition of breast cancer cell lines were related to in the cell apoptosis. Furthermore, significant difference in IC(50) values of tumor cells and normal cell showed that the lipopeptide exerted selective cytotoxicity on the cancer cells. Thus HSO121 lipopeptides may have potential applications as an anticancer leads.
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Humans , Antineoplastic Agents , Chemistry , Pharmacology , Apoptosis , Bacillus subtilis , Cell Cycle , Cell Membrane , Chemistry , Metabolism , Cell Survival , Fatty Acids , Chemistry , Metabolism , HeLa Cells , Lipopeptides , Chemistry , Pharmacology , Ploidies , Tumor Cells, CulturedABSTRACT
Objective To investigate the clinical value of lasting methylene blue staining in precise hepatectomy.Methods The clinical data of 21 patients with liver cancer who received precise hepatectomy after methylene blue staining at General Hospital of PLA from February to August in 2009 were retrospectively analyzed.After the hepatic pedicle Was dissected,methylene blue WaS injected into the portal vein,and then the hepatic pedicle was ligated.Parenchymal division is initiated along the line of devascularization demarcated on Glisson capsule.Results The success rate of methylene blue staining Was 100%.Methylene blue retained in the parenchyma for(80±23)minutes.Right hepatectomy was performed on 2 patients,left hepatectomy on 1,right posterior lobectomy on 2,right anterior lobectomy on 3,left lateral lobectomy on 1,segmentectomy of segment Ⅷon 2,segmentectomy of segment Ⅶ on 3,segmentectomy of segment Ⅵ on 1,segmentectomy of segment Ⅳ on 2 and combined segmentectomy on 4.The mean volume of blood loss,incidence of postoperative complications and postoperative hospital stay were(236±6)ml,14%(3/21)and(12±3)days.Conclusions Ligation of hepatic pedicle after methylene blue injection has the advantages of high success rate and lasting staining of parenchyma of liver.Especially,this staining method contributes to improve the precision of hepatectomy by guiding the segment selection during parenchyma transection.
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Objective To investigate the clinical value of computer-assisted operation planning system for precise hepatectomy.Methods The clinical data of 45 patients who had undergone precise hepatectomy at General Hospital of PLA from November 2006 to November 2009 were retrospectively analyzed.The 3-dimensional imaging of liver was constructed by computer-assisted operation planning system,and the anatomic relationship between hepatic vasculature and tumor Was analyzed.Volume of hepatic segments,total liver volume,tumor volume,predicted resection volume and the remnant liver volume were calculated before operation.Virtual liver resection was performed in order to select the best operative procedure.The predicted resection volume Was compared with the hepatic segment resected.All data were analyzed by t test,Pearson rank correlation analysis and chi-square test.Results The predicted resection volume calculated based on the 2-dimensional imaging was similar to that calculated based on the 3-dimensional imaging(t=2.125,P>0.05).The three-grade branches of the hepatic artery,portal vein and hepatic vein were clearly shown in the computer-assisted operation planning system.The anatomic relationship between tumor and adjacent vessels was quantitatively analyzed.There was a positive correlation between the predicted resection volume and the resected liver volume(r=0.999,P<0.05),and the error rate Was 5.1%.All patients received anatomical hepatectomy,and the incidence of postoperative complications was 20%(9/45).No liver failure or perioperative mortality was observed.Conclusion Computer-assisted operation planning system may facilitate and promote precise hepatectomy.
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Objective To investigate the existence of epithelial-mesenchymal transition(EMT)and its relation to the expression of HBx protein in hepatocellular carcinoma(HCC).Methods The expression of HBx protein,E-cadherin,β-catenin,N-cadherin and fibronectin were detected by immumnohistochemistry technique in 76 cases of HCC.Results Among 76 HCC samples,the loss of expressions of E-cadherin and β-catenin were 34%(26/76)and 20%(15/76),respectively.The positive expressions of HBx protein,N-cadherin and frbronectin were observed in 68%(52/76),55%(42/76),46%(35/76)of HCC samples,respectively.The loss of expression of E-cadherin significantly correlated with the positive expression of N-cadherin and HBx protein (P＜0.01).The positive expression of N-cadherin and fibronectin significantly correlated with the loss of expression of β-catenin and the positive expression of HBx protein(P＜0.05).Conclusions EMT exists in hepatocellular carcinoma,and the expression of HBx is significantly associated with EMT.