Chinese expert guidance on overall application of lenvatinib in hepatocellular carcinoma / 中华消化外科杂志

Lenvatinib mesylate is an oral receptor tyrosine kinase inhibitor against targets of vascular endothelial growth factor receptors 1-3, fibroblast growth factor receptors 1-4, platelet-derived growth factor receptor α, stem cell growth factor receptor, and rearranged during transfection, et al. Lenvatinib has been approved by the National Medical Products Administration of China on September 4,2018, for the first-line treatment of patients with unresectable hepatocellular carcinoma who have not received systematic treatment before. Up to February 2023, Lenvatinib has been listed in China for more than 4 years, accumulating a series of post-marketing clinical research evidences. Based on the clinical practice before and after the launch of lenvatinib and referring to the clinical experience of other anti-angiogenesis inhibitors, domestic multidisciplinary experts and scholars adopt the Delphi method to formulate the Chinese Expert Guidance on Overall Application of Lenvatinib in Hepatocellular Carcinoma after repeated discussions and revisions, in order to provide reference for reasonable and effective clinical application of lenvatinib for clinicians.

Discussion on enhanced recovery after surgery of hilar cholangiocarcinoma after operation / 国际外科学杂志

The concept of enhanced recovery after surgery has been widely accepted and applied by clinical medical staff, and has made good progress in the field of hepatobiliary pancreatic surgery in recent years. Hilar cholangiocarcinoma is one of the more complicated operations in hepatobiliary pancreatic surgery. The traditional perioperative management mode is not conducive to the early rehabilitation of patients, and the relative operation risk and the probability of postoperative complications are high. In order to promote the application of enhanced recovery after surgery in patients with hilar cholangiocarcinoma after operation, this paper systematically introduces the measures and experience of accelerated rehabilitation after operation of hilar cholangiocarcinoma from the aspects of postoperative multimodal analgesia, early activity, diet, drainage tube management, discharge and follow-up, based on the relevant literature and combined with own work experience. These measures can reduce the postoperative complications of patients with hilar cholangiocarcinoma and promote their early rehabilitation.

Application of minimally invasive technique in the treatment of acute obstructive suppurative cholangitis / 国际外科学杂志

Acute obstructive suppurative cholangitis (AOSC) is one of the common surgical acute abdomen. It often causes the increase of intrabiliary pressure due to biliary obstruction, resulting in various clinical symptoms. The onset is urgent and the disease progresses quickly. It is the primary cause of death of benign biliary diseases. Timely biliary decompression and bile drainage are the key to treat AOSC and save the lives of patients. With the continuous progress of the concept of enhanced recovery after surgery and minimally invasive technical means, minimally invasive technical means such as endoscopic retrograde cholangiopancreatography, ppercutaneous transhepatic catheterizde drainage and endoscopic ultrasound guided biliary drainage have gradually become the preferred treatment for AOSC, playing a more and more important role in the treatment of AOSC. Combined with relevant research literature and the author′s personal experience in the treatment of AOSC with these technologies, this paper introduces the application value, advantages and disadvantages of the above three minimally invasive technologies in the treatment of AOSC.

Progress in surgical treatment of hilar cholangiocarcinoma / 国际外科学杂志

Hilar cholangiocarcinoma is a dread disease for humankind due to its high level of malignant,quick metastatic,and high mortality rate.Some patients get treated at the stage of obstructive jaundice,when the intestines are mostly or even completely obstructed,whom can not be radically treated since it can only lead to many complications and a low level of life quality.Despite the various ways of curing this disease,we will talk about the latest progress of surgical excision,palliative treatment,as well as liver transplantation in the eyes of surgical skills.This essay aims to summarize the latest treatment for hilar cholangiocarcinoma in the area of surgery,updating our knowledges,as a way of upgrading our skills and transforming our minds,so as to raise the life quality of our patients by avoiding complications.At the same time,it can provide some ideas for further research in this area.Besides,the paper sheds light on the current treatment of the disease by pointing out some questions on clinical works,which also focuses on lowering the death rate and raising the life quality of our patients.

Inhibition of Indoleamine 2,3-Dioxygenase Enhances the Therapeutic Efficacy of Immunogenic Chemotherapeutics in Breast Cancer / 한국유방암학회지

PURPOSE: Breast cancer has become a major public health threat in the current society. Anthracycline doxorubicin (DOX) is a widely used drug in breast cancer chemotherapy. We aimed to investigate the immunogenic death of breast tumor cells caused by DOX, and detect the effects of combination of DOX and a small molecule inhibitor in tumor engrafted mouse model. METHODS: We used 4T1 breast cancer cells to examine the anthracycline DOX-mediated immunogenic death of breast tumor cells by assessing the calreticulin exposure and adenosine triphosphate and high mobility group box 1 release. Using 4T1 tumor cell-engrafted mouse model, we also detected the expression of indoleamine 2,3-dioxygenase (IDO) in tumor tissues after DOX treatment and further explored whether the specific small molecule IDO1 inhibitor NLG919 combined with DOX, can exhibit better therapeutic effects on breast cancer. RESULTS: DOX induced immunogenic cell death of murine breast cancer cells 4T1 as well as the upregulation of IDO1. We also found that treatment with NLG919 enhanced kynurenine inhibition in a dose-dependent manner. IDO1 inhibition reversed CD8+ T cell suppression mediated by IDO-expressing 4T1 murine breast cancer cells. Compared to the single agent or control, combination of DOX and NLG919 significantly inhibited the tumor growth, indicating that the 2 drugs exhibit synergistic effect. The combination therapy also increased the expression of transforming growth factor-β, while lowering the expressions of interleukin-12p70 and interferon-γ. CONCLUSION: Compared to single agent therapy, combination of NLG919 with DOX demonstrated better therapeutic effects in 4T1 murine breast tumor model. IDO inhibition by NLG919 enhanced the therapeutic efficacy of DOX in breast cancer, achieving synergistic effect.

Efficacy and safety of enhanced recovery after surgery concept combined with precise hepatectomy for the treatment of hepatocellular carcinoma / 中华普通外科杂志

Objective To investigate the safety and efficiency of enhanced recovery after surgery (ERAS) concept combined with precise hepatectomy (EP) in the treatment of hepatocellular carcinoma (HCC).Methods 393 HCC patients admitted to the Affiliated Provincia Hospital of Anhui Medical University were divided into group EP (n =73),precise hepatectomy group P (n =55),group ERAS (n =118) and conventional hepatectomy group C (n =147).Outcome measures were postoperative length of stay (LOS),hospital charges,postoperative complication,numerical rating scale (NRS) on postoperative 24 h,48 h,time to ambulation and first passage of flatus,readmission rate,mortality.Results Compared to group P,patients in group EP had significantly shorter postoperative LOS (F =4.573,P ＜ 0.05),less hospital charges(F =3.090,P ＜ 0.05),lower NRS on postoperative 24 h,48 h (F =5.235,7.456,P ＜ 0.05),shorter time to ambulation (x2 =41.387,P ＜ 0.05) and first passage of flatus (F =0.387,P ＜ 0.05).Compared with the group ERAS,the group EP had significantly lower general postoperative complications (x2 =2.967,P ＜ 0.05).Conclusion ERAS concept combined with precise hepatectomy could optimize surgical treatment of patients with hepatocellular carcinoma.

Influential factors for failure of enhanced recovery after surgery from hepatectomy for hepatocellular carcinoma and the establishment of risk prediction model / 中华外科杂志

Objective@#To investigate the influential factors for failure of enhanced recovery after surgery(ERAS) from hepatectomy for hepatocellular carcinoma(HCC) patients and then to establish a risk prediction model.@*Methods@#The relevant clinical data of 180 patients with HCC undergoing hepatectomy at Department of Hepatic Surgery, Affiliated Provincial Hospital, Anhui Medical University from January 2016 to June 2017 were analyzed retrospectively.There were 149 male patients and 31 female patients aging of (56.5±11.0)years(from 33 to 84 years old). The factors affecting postoperative failure of ERAS of HCC patients were identified by univariate and multivariate analyses, and then, all the obtained factors and their statistical values were used to establish the risk prediction model.@*Results@#A total of 23 patients failed in the ERAS protocol(12.8%). The preoperative total bilirubin (TBIL), alanine aminotransferase(ALT) and amount of intraoperative bleeding were independent risk factors for failure of ERAS from hepatectomy(all P<0.05). The obtained risk prediction model was presented as follows: risk coefficient(R)=0.114×(TBIL)+ 0.082×(ALT)+ 0.008×(amount of intraoperative bleeding). At the cut of value of R=7.90, the area under the ROC curve of this model for predicting failure of ERAS was 0.866(95%CI: 0.788-0.945, P<0.01), with the sensitivity and specificity of 69.6% and 91.1%, respectively.External validation results indicated that the scoring system had good differential ability(area under the ROC curve=0.889, 95%CI: 0.811-0.967, P<0.01).@*Conclusions@#Higher level of preoperative TBIL(>21 μmol/L) and ALT(>50 U/L) and the larger amount of intraoperative bleeding (more than 400 ml) are independent risk factors for failure of ERAS inpatients undergoing hepatectomy for HCC and the established prediction model may have certain value for risk assessment.

Multidisciplinary team building in enhanced recovery after surgery / 中华外科杂志

There has been 10 years to explore the road in line with China′s actual enhanced recovery after surgery(ERAS) since Academician Li Jieshou introduced the view of ERAS into China. ERAS has been widely carried out in the field of surgery, and gradually formed with Chinese characteristics of ERAS clinical pathway.The clinical implementation of ERAS relies on the effective integration of a series of perioperative methods, and any single technique or method can′t completely reduce the perioperative physiological and psychological traumatic stress of the patient, so as to achieve the patient′s rapid rehabilitation patient-centered multidisciplinary team(MDT)collaboration is an inevitable trend in ERAS development. On the basis of drawing lessons from foreign experience, the establishment of ERAS-MDT model in line with China′s national conditions is a new subject that needs to be studied at present. The construction of ERAS-MDT might promote the development of new ERAS services, new technologies, and ultimately promote the improvement of surgical treatment, and bring the greatest clinical benefit to the society and patients.

Clinical efficacy of anatomic liver resection in the treatment of hepatocellular carcinoma with microvascular invasion / 中华消化外科杂志

Objective To explore the clinical efficacy of anatomic liver resection in treatment of hepatocellular carcinoma (HCC) with microvascular invasion (MVI).Methods The retrospective cohort and case-control study was conducted.The clinical data of 150 HCC patients with MVI who were admitted to the Anhui Medical University Affiliated Provincial Hospital from June 2007 to June 2012 were collected.Sixty patients undergoing anatomic liver resection were allocated into the AR group and 90 undergoing non-anatomic liver resection in the NR group.Patients in the AR group underwent anatomic liver resection according to results of preoperative ICG R15 test,and patients in the NR group underwent non-anatomic liver resection.Observation indicators:(1) operation situations:operation time,volume of intraoperative blood loss,number of patients with blood transfusion;(2) postoperative recovery situations:time of drainage-tube removal,duration of hospital stay,Clavein grade of complication within 30 days postoperatively,number of patients with hepatic failure within 30 days postoperatively and number of death within 30 days postoperatively;(3) follow-up:postoperative median survival time,5-year overall survival rate and 5-year tumor-free survival rate;(4) prognostic factors analysis of 150 HCC patients with MVI.Measurement data with normal distribution were represented as-x±s and comparison between groups was analyzed using the independent-sample t test.Count data were represented as the chi-square test or Fisher exact probability.The survival rate was calculated using the Kaplan-Meier method and survival analysis was done using Log-rank test.The univariate analysis and multivariate analysis were done using the COX regression model.Results (1) Operation situations:all the 150 patients received successful radical resection of HCC.Operation time,numbers of patients with volume of intraoperative blood loss ≥ 500 mL and with volume of intraoperative blood loss ＜ 500 mL and number of patients with blood transfusion were (165±39) minutes,12,48,15 in the AR group and (136±30)minutes,34,56,38 in the NR group,respectively,with statistically significant differences between the 2 groups (t =29.172,x2=5.351,4.673,P＜0.05).(2) Postoperative recovery situations:time of drainage-tube removal and duration of hospital stay were (2.7± 1.1)days and (5.2± 1.3) days in the AR group,(3.8±1.6)days and (7.1±2.3)days in the NR group,respectively,with statistically significant differences between the 2 groups (t =4.641,5.812,P＜0.05).Numbers of patients with grade Ⅰ-Ⅱ of Clavein grade and with grade Ⅲ-Ⅳ and number of death within 30 days postoperatively were 45,15,1 in the AR group and 61,29,2 in the NR group,respectively,with no statistically significant difference between the 2 groups (x2 =0.906,P＞0.05).Number of patients with hepatic failure within 30 days postoperatively in the AR and NR group were respectively 4 and 17,with a statistically significant difference (x2=4.467,P＜0.05).(3) Follow-up:all the 150 patients were followed up for 1-106 months,with a median time of 26 months.The postoperative median survival time,5-year overall survival rate and 5-year tumor-free survival rate were 46 months,33.3％,21.7％ in the AR group and 18 months,15.6％,2.2％ in the NR group,respectively,with statistically significant differences in overall survival and tumor-free survival between the 2 groups (x2=23.718,63.932,P＜ 0.05).(4) Prognostic factors analysis of 150 HCC patients with MVI:result of univariate analysis showed that maximum diameter of tumor,tumor capsule,TNM stage,Edmondson grade and surgical procedures were relative factors affecting overall survival and tumor-free survival of HCC patients with MVI,with statistically significant differences (x2=5.519,2.790,13.639,8.321,42.470,31.057,15.963,19.594,23.718,63.932,P＜ 0.05).Result of multivariate analysis showed that missing tumor capsule,stage Ⅲ-Ⅳ of TNM stage,grade Ⅲ-Ⅳ of Edmondson grade and non-anatomic liver resection were independent factors affecting poor overall survival and tumor-free survival of HCC patients with MVI,and maximum diameter of tumor ＞5 cm was an independent factor affecting poor overall survival of HCC patients with MVI,with a statistically significant difference [HR =0.527,0.683,0.333,0.522,0.576,0.514,0.523,0.268,95％ confidence interval (CI):0.355-0.782,0.475-0.983,0.219-0.504,0.361-0.755,0.389-0.852,0.358-0.737,0.342-0.800,0.174-0.413;HR=0.559,95％CI:0.370-0.845,P＜0.05].Conclusions Anatomic liver resection in the treatment of HCC patients with MVI is safe and effective,with good short-term and long-term outcomes,and it can also improve prognosis of patients.Missing tumor capsule,stage Ⅲ-Ⅳ of TNM stage,grade Ⅲ-Ⅳ of Edmondson grade and non-anatomic liver resection are independent factors affecting poor overall survival and tumor-free survival of HCC patients with MVI,and maximum diameter of tumor ＞5 cm is an independent factor affecting poor overall survival of HCC patients with MVI.

Clinical values of multimodal preventive analgesia in patients with partial hepatectomy for liver cancer / 中华外科杂志

Objective@#To investigate the clinical values of multimodal preventive analgesia in patients with partial hepatectomy for liver cancer.@*Methods@#A perspective study was conducted to collect data of patients with liver cancer who underwent partial hepatectomy from March 2014 to March 2015.The 90 patients involved in the study were randomly divided into two groups as multimodal analgesia and control groups, and each group had 45 cases. In multimodal analgesia group, 40 mg parecoxib sodium was injected intravenously 30 minutes before anesthetic induction, and 0.375% ropivacaine 150 mg combined with dexamethasone 5 mg were applied to transversus abdominis plane block before closing abdomen.The patients in control group without above treatment. Patient controlled intravenous analgesia was used in all patients. Three days after surgery, 40 mg parecoxib sodium was injected intravenously, twice a day for all patients.Visual analogue scales (VAS) was used to evaluate postoperative pain, and postoperative adverse events were observed.The number of cases of postoperative ambulation (>6 h for every day), time of flatus and defecation, and duration of hospital stay were recorded in two groups.Pearson chi-square test was used to compare the rate or constituent ratio between two groups.Independent sample t test or Mann-Whitney U was used to analyzed the measurement data between two groups.@*Results@#There were no difference between two groups in aging, gender, weight, body mass index, ASA classification, blood loss volume, time of operation(all P>0.05). The scores of VAS in multimodal analgesia group was significantly lower than that in control group(3.0±0.8 vs. 4.6±1.1, t=7.814, P<0.01 for day 1; 2.2±1.0 vs. 3.6±1.2, t=5.825, P<0.01 for day 2; 1.6±0.8 vs. 2.4±1.2, t=3.894, P<0.01 for day 3). The number of cases of postoperative ambulation(>6 h) in multimodal analgesia group was significantly more than that in control group (10 cases vs. 0 case, χ2=11.250, P<0.01 for day 1; 21 cases vs. 5 cases, χ2=13.846, P<0.01 for day 2; 28 cases vs. 17 cases, χ2=5.378, P =0.020 for day 3). The time of flatus and defecation, and duration of hospital stay were significantly shorter than that in control group((30.2±7.3) hours vs. (36.4±7.0)hours, t=4.115, P<0.01 for flatus; (50.9±5.2)hours vs. (60.7±7.3)hours, t=7.346, P<0.01 for defecation; (6.2±0.8)days vs. (9.6±1.1)days, t=16.615, P<0.01 for hospital stay).@*Conclusion@#Multimodal preventive analgesia effectively alleviate the postoperative pain, benefits early ambulation, improves recovery of gastrointestinal function, and shortens duration of hospital stay in patients with partial hepatectomy for liver cancer.

Application of functional exercise pathway in a enhanced recovery after surgery in patients undergoing hepatectomy / 国际外科学杂志

Objective To investigate the application value of functional exercise pathway in enhanced recovery of patients undergoing hepatectomy.Methods Fifty primary hepatic carcinoma patients who had undergone liver resection in Anhui Province Hospital from December 2014 to August 2015 were randomly divided into experimental group (n =25) and control group (n =25).Postoperative length of hospital stay,hospitalization charges,complications,postoperative pain score,postoperative ambulation and intestinal ventilation time were compared between these groups.Measurement data with normal distribution were represented as ((x) ± s) and comprison between groups was analyzed using the t test.Comparisons of count data were analyzed by the x2 test.Results Postoperative length of hospital stay of the experimental group [(7.00 ± 2.27) days] were shorter than control group [(9.36 ± 4.58) days] (t =3.090,P =0.003),and hospitalization expense was lower in the experimental group [(28 184.57 ± 8 675.65) yuan] (t =2.281,P =0.025).Compared with control group (40％),the experimental group (20％) had lower overall complication incidence (t =4.286,P =4.286),and general complications incidence (8％) is lower than that in control group (24％),however,the incidence of operation characteristic complications had not statistical significance in two groups.Besides,the intestinal recovery time in the experimental group was shorter than control group (experimental group 36.56 hours,control group 45.24 hours,t =2.390,P =0.019).Conclusion The application of functional exercise pathway in postoperative enhanced recovery exercise of patients undergoing hepatectomy is safe and effective,which can reduce the patients' postoperative hospital stay,hospital costs,and the general incidence of complications incidence,and be helpful for the intestinal function recovery.

Effects of parecoxib sodium and fentanyl multimodal analgesia on immune functions in patients undergoing hepatectomy for hepatocellular carcinoma / 中华普通外科杂志

Objective To investigate the effects of multimodal analgesia of parecoxib and fentanyl on perioperative immune functions in patients of hepatocellular carcinoma (HCC).Methods Eighty HCC patients scheduled for hepatectomy were randomly divided into two groups:parecoxib sodium combined with fentanyl group (group P,40 cases) and fentanyl group (group C,40 cases).The percentages of CD3 +,CD4+,CD8+,CD4+/CD8+ T cells,CD3-CD16+ CD56+ (NK),interleukin-4 (IL-4),interferon-γ (IFN-γ) and the ratio of IFN-γ/IL-4 were detected at the following time points:30 minutes before induction of anesthesia (T0),at the end of the surgery (T1),24 h after surgery (T2) and 72 h after surgery (T3).The analgesic effects were estimated by visual analogue scale (VAS) after surgery.Total fentanyl consumption and adverse effects were also recorded.Results The percentages of CD3 + T cells were significantly lower in group C than that in group P at T2 (t =2.155,P ＜0.05).The percentages of NK in group P were recovered nearly to baseline (T0) at T2,which was higher than that of group C (t =2.791,P ＜0.05).In group C,the percentages of CD3 + T cells and NK has not recovered to baseline at T3 (respectively t =3.065,3.231,P ＜ 0.05).In group P,IL-4 serum levels were significantly lower than those in group C,while IFN-γ serum levels were significantly higher than those in group C at T2 (respectively t =2.173,2.100,P ＜0.05).From T2 to T3,the ratio of IFN-γ/IL-4 significantly increased in group P than those in group C (respectively t =3.259,2.203,P ＜ 0.05).VAS scores at rest and on cough in group P were significantly lower than those in group C at 2 h,6 h,12 h and 24 h after operation (respectively t =8.661,9.726,9.147,7.109,P＜0.05;t =8.569,9.614,9.144,8.509,P＜0.05).The total fentanyl consumption in group P was lower than that in group C (t =2.636,P ＜ 0.05).There were no significant differences regarding the incidence of adverse effects between the two groups.Conclusions Perioperative multimodal analgesia of parecoxib sodium combined with fentanyl enhances the analgesic efficacy,and reduces the dosage of opioid consumption,helps recover the cell immunity function of HCC patients after hepatectomy.

Surgical treatment of hepatocellular carcinoma with portal vein tumor thrombus / 临床肝胆病杂志

Portal vein tumor thrombus (PVTT) is one of the important biological characteristics of hepatocellular carcinoma (HCC), and also a serious complication and a metastatic mode. Surgical treatment is still the most effective therapy for HCC with PVTT. This article describes the history and present situation of surgical treatment of HCC with PVTT, the anatomical basis for PVTT formation, classification of PVTT, indications for surgery, selection of surgical approaches, and evaluation of the surgical outcome of PVTT. Individualized multidisciplinary treatment should be developed based on evidence-based medicine, which might be the right direction for the treatment of HCC with PVTT.

Application of selective devascularization for the treatment of portal hypertension / 局解手术学杂志

Objective To determine efficacy of selective devascularization in management of portal hypertension. Methods The clini-cal data of 86 patients of portal hypertension in our hospital from Jan. 2010 to Aug. 2013 were retrospectively analyzed. The patients were divided into the selective group and the nonselectove devascularization group according to the different devascularization ways. The postopera-tive liver function index and complications were analyzed. Results In selective devascularization group, the surgery time was prolonged (P0. 05). The postoperative peak value of ALT and AST and postoperative pomplications in the selective devascularization group were low-er than those in the nonselectove devascularization group (P<0. 05). And patients in the selective devascularization group have a shorter hospital stay compared to the nonselectove devascularization group (P<0. 05). Conclusion Selective devascularization can lower free portal pressure more effectively, reduce incidence rates of postoperative early complications, and it is worthy of clinical promotion.

Application of enhanced recovery after surgery in the precision liver surgery / 中华消化外科杂志

The application of enhanced recovery after surgery (ERAS) in hepatectomy is safe and feasible.The related researches of the clinical strategies of ERAS involved in colonic surgery instead of management of basic diseases of liver,and the influence of portal hypertension and hepatitis B virus infection on the ERAS has not been emphasized.According to the clinical strategies of ERAS in colon surgery,the basic diseases and the characteristics of liver were focused,and the clinical strategies of ERAS in the era of precision liver surgery were proposed.Through concerted efforts of the multidisciplinary team and a joint of surgeons,nurses and patients,the establishment of multicentre clinical studies under guidance of evidence-based medicine (EBM) will show clearly a development direction of the clinical strategies of ERAS in the era of precision liver surgery.

Analysis of postoperative pain of hepatectomy / 中华普通外科杂志

Objective To investigate the occurrence of postoperative pain of hepatectomy and its possible related factors.Methods The clinical data of 555 cases undergoing hepatectomy was analyzed retrospectively,and the related influencing factors on postoperative pain of hepatectomy were analyzed by univariate analysis and multivariate logistic regression.Results Moderate postoperative pain was reported in 255 cases among 555 patients who underwent hepatic resection (with an incidence of 45.95％).Incision pain which was often sharp was most common,followed by postoperative complication caused pain.According to whether the postoperative pain occurred or not,all cases were divided into postoperative pain group (n =255) and non-postoperative pain group (n =300),univariate analysis showed that age (P ＜0.01),surgical history (P ＜ 0.01),surgical approach (P ＜ 0.01),incision length (P ＜ 0.01),xiphoid removal(P ＜ 0.01),the final outcome of incision (P ＜ 0.01),complications (P ＜ 0.01) were significantly different between the two groups.Logistic multiple regression analysis showed that the independent influencing factors of postoperative pain included surgical history (P =0.001),surgical approach (P =0.005),incision length (P =0.000),xiphoid process removal (P =0.001),complications (P =0.000).Conclusions The postoperative pain of hepatectomy has a high incidence.Surgical history,surgical approach,incision length,xiphoid process,removal and postoperative complications are the independent impact factors of postoperative pain.

Surgical treatment of primary liver cancer with diaphragmatic muscle invasion / 中华普通外科杂志

Objective To explore the way and the effect of surgical treatment of primary hepatic carcinoma with diaphragmatic invasion.Method Clinical data of 37 primary hepatic carcinoma patients with diaphragmatic muscle invasion undergoing enbloc liver resection in Anhui Provincial Hospital between January 2008 and January 2014 were retrospectively analyzed.Control group comprised 54 liver cancer patients without diaphragm involvement.Results All cases underwent surgery successfully,no significant statistical differences were found between pre-operation clinical data of two groups.The operation time of the group with diaphragmatic invasion is slightly longer than that of the group without (149.4 ± 23.4 min vs 137.9 ±24.6 min,t =2.228,P =0.028);meanwhile,there was no obvious difference between blood loss of the two groups (449.5 ±304.1 ml vs 304.1 ±222.3 ml,t =0.678,P =0.499).There were no significantly statistical differences in other aspects between the two groups such as postoperative pulmonary infection,pleural effusion,infection of the incision,mortality and hospitalization time.Based on Kaplan Meier-log-rank test analysis,it is found that the two groups had no significant differences in disease-free survival and overall survival (P1 =0.982,P2 =0.906).Conclusions Hepatic carcinoma patients with diaphragmatic invasion are still indicated for liver resection with a favorable prognosis.

Clinical efficacy of laparoscopic surgery for acute intestinal obstruction / 国际外科学杂志

Objective To investigate the feasibility,safety and clinical efficacy of acute iutestinal obstruction by laparoscopic surgery.Methods We selected 47 patients with acute intestinal obstruction implementation from August 2012 to August 2014,and used laparoscopic surgery on these cases.Results Forty-one cases of laparoscopic surgery were successfully completed,the successful implementation of the enterolysis;due to severe adhesions,laparotomy cannot be separated in three cases;two cases due to intraoperative exploration found in the tumor;one case due to surgery bleeding and laparotomy cannot be completed;no cases with serious complications and no deaths.Conclusion Laparoscopic surgery for acute intestinal obstruction is feasible and safe,with less trauma,quicker recovery,especial ly in the abdominal exploration in significant advantage,it is worthy of further promotion in clinic.

Expression of Nodal in hepatocellular carcinoma and its relationship with angiogenesis and epithelial-mesenchymal transition / 中华外科杂志

<p><b>OBJECTIVE</b>To detect the expression of Nodal in hepatocellular carcinoma (HCC), and explore its relationship with angiogenesis and epithelial-mesenchymal transition (EMT).</p><p><b>METHODS</b>From September 2006 to June 2010, the 16 self-paired frozen HCC specimens were collected and the expression of Nodal was detected by qPCR and Western blot. The 10 normal liver tissues and 96 cases of HCC tumor and paracarcinomatous tissues were collected. The expression of Nodal and relationship among Nodal, clinicopathological characteristics of HCC and patients' prognosis were detected and analyzed using immunohistochemistry. The expressions of Nodal, Vimentin and CD34 in 96 HCC tumor tissues were detected by immunohistochemistry, and then judgment relationship between the expression of Nodal, EMT and angiogenesis.</p><p><b>RESULTS</b>Immunohistochemistry showed that Nodal mainly expressed in the cytoplasm. The high expression rate of Nodal in HCC tumor tissues was 72.9% (70/96), which was remarkably higher than that in paracarcinomatous tissues (8.3%) and normal liver tissues (0) (χ(2) = 83.001 and 24.470, both P < 0.001). qPCR and Western blot analysis showed that the expression level of Nodal in HCC was significantly higher than that in paracarcinomatous and normal tissues (P < 0.05). The high expression of Nodal in HCC was correlated with tumor size (χ(2) = 15.318, P = 0.000), alpha-fetoprotein (χ(2) = 3.850, P = 0.049), indocyanine green retention rate at 15 minutes (χ(2) = 6.590, P = 0.010), and invasion and metastasis (χ(2) = 17.824, P = 0.000). High expression of Nodal was positively correlated with high microvascular density in HCC (t = 3.070, P = 0.006), but not with Vimentin (r = 0.198, P = 0.053). Survival analysis showed that accumulated survival rate of patients with high expression of Nodal was significantly less than that the low expression (χ(2) = 487.053, P < 0.001). The Cox multivariate analysis demonstrated that high expression of Nodal was independent risk factors for cumulative survival in patients with hepatocellular carcinoma after a curative resection (RR = 2.757, 95%CI: 1.450-5.240, P = 0.002).</p><p><b>CONCLUSIONS</b>Nodal does not participate in EMT of HCC, but can promote angiogenesis, and it could be used as a predictor of poor prognosis.</p>

Advancement in researches of the effects of perioperative analgesia on immune function of cancer patients / 国际外科学杂志

Perioperative immunosuppression exists in cancer patients are as a result of their own disease,and postoperative pain inhibit immunological function.The effective postoperative analgesia can relieve the suppression of cell-mediated immunity,as well as reducing tumor recurrence and metastasis.However,diverse range of analgesic agents and techniques have a different impact on immune function.This article reviews the influence of various analgesic agents and techniques on the perioperative immune function of cancer patients so as to provide more suitable analgesia techniques,which is beneficial for regulating of immune balance,lessening tumor recurrence and improving prognosis.