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Liver cancer is one of the common malignant tumors in the digestive system,which has a high incidence and mortality.With the development and innovation of laparoscopy,laparoscopic hepatectomy has shown great advantages in the treatment of liver malignant tumors.In this paper,the indications and contraindications of laparoscopic hepatectomy,surgical methods,key points of operation technology,feasibility and safety,postoperative complications and prevention were reviewed.
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Objective:To explore the safety of clinical application of liver cysts under the mode of ambulatory surgery.Methods:Retrospective analysis of the data of 84 patients with liver cysts admitted to the Huainan First People′s Hospital, the Fourth Affiliated Hospital of Bengbu Medical College from January 2017 to December 2019, they were divided into study group ( n=42) and control group according to the random number table method ( n=42). The control group adopted the traditional perioperative management method, and the research group adopted the day surgery treatment mode. The two groups of patients were evaluated for their hospitalization days, total cost, satisfaction, activity of daily living (ADL) score of 7 days after surgery, temporary cancellation rate, unplanned readmission rate, total postoperative complications and other indicators. Normally distributed measurement data were expressed as mean±standard deviation ( Mean± SD), and independent sample t test was used for comparison between groups. Enumeration data was expressed as a percentage (%), and comparison between groups was performed by chi-square test. Results:The length of stay in the study group and the total cost of hospitalization were (1.76±0.82) d and (0.55±0.10) ten thousand yuan, respectively. The control group were (5.33±1.69) d and (0.90±0.22) ten thousand yuan, respectively. The study group was lesser than In the control group, the differences between the two groups were statistically significant ( P<0.001). The patient satisfaction score of the study group was (4.20±0.64) points, and the control group was (3.20±0.92) points. The study group was higher than the control group. The difference between the two groups was statistically significant ( P<0.001). The postoperative ADL score, temporary cancellation rate, unplanned readmission rate, and total postoperative complication rate in the study group were (46.45±9.75) points, 4.76%, 7.14% and 9.52%, respectively. The control group were (45.57±7.02) points, 2.38%, 4.76% and 7.14%, there was no significant difference between the two groups ( P>0.05). Conclusions:Ambulatory laparoscopic fenestration of liver cysts is safe and effective for the treatment of patients with liver cysts. Compared with traditional in-patient surgery, it can reduce the length of stay and the cost of hospitalization and increase the satisfaction of patients.
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Objective@#To investigate the role of bone marrow mesenchymal stem cells (BMSCs) with CTLA4Ig and CD40LIg gene modification in rejection reaction after liver transplantation in rats and possible mechanisms.@*Methods@#The modified Kamada’s two-cuff technique was used to establish a Lewis-BN rat model of orthotopic liver transplantation, and a total of 75 rats were randomly divided into groups A, B, C, D, and E, with 15 rats in each group. The rats in group A (control group) were given infusion of isotonic saline via the portal vein during liver transplantation, those in group B (BMSC group) were given infusion of BMSCs via the portal vein during liver transplantation, those in group C (BMSCs with CTLA4Ig gene modification) were given infusion of BMSCs carrying the CTLA4Ig gene via the portal vein during liver transplantation, those in group D (BMSCs with CD40LIg gene modification) were given infusion of BMSCs carrying the CD40LIg gene via the portal vein during liver transplantation, and those in group E (BMSCs with CTLA4Ig and CD40LIg gene modification) were given infusion of BMSCs carrying CTLA4Ig and CD40LIg gene modification via the portal vein during liver transplantation. Postoperative survival and change in liver function were observed. HE staining was used to observe the pathomorphological changes of the graft liver, and ELISA was used to measure the levels of interleukin-2 (IL-2), interleukin-4 (IL-4), interleukin-10 (IL-10), and interferon-γ (IFN-γ) in peripheral blood. A one-way analysis of variance was used for comparison of means of multiple samples, and the Kaplan-Meier survival curve analysis was used for comparison of survival rates between multiple groups.@*Results@#Group E had a significantly longer survival time after surgery than groups A, B, C, and D (P < 0.05), groups C and D had a significantly longer survival time than groups A and B (P < 0.05), and there was no significant difference between groups C and D (P > 0.05). On day 10 after surgery, group A had significantly higher levels of alanine aminotransferase and total bilirubin than the other four groups (P < 0.05). HE staining showed severe rejection reaction in group A, moderate rejection reaction in group B, and mild rejection reaction in groups C and D; pathological examination showed no marked rejection reaction in group E. Group A had significant increases in the levels of IL-2 and IFN-γ and significant reductions in the levels of IL-4 and IL-10 after surgery compared with the other four groups (all P < 0.05).@*Conclusion@#Infusion of BMSCs with modification of both CTLA4Ig and CD40LIg genes can significantly inhibit acute rejection reaction after liver transplantation in rats and effectively prolong the survival time of the graft liver, with a better effect than infusion of BMSCs alone or BMSCs with modification of CTLA4Ig or CD40LIg gene.
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Objective To explore the experience of diagnosis and treatment of laparoscopic abdominal inci-sion hernia repair.Methods The clinical data of 15 patients treated with laparoscopic incision hernia repair were ret-rospectively analyzed.Results All 15 cases were successful in operation by laparoscopy.The operation time was 60~180 mins,and the mean operation time was (117 ±30.46) mins,the post-operation aerofluxus time was 1~2 days and the mean time of post-operation hospital stay was (16.53 ±3.46) days.During the operation no association with serosal layer damage or massive hemorrhage occurred;no postoperative seroma infection,intestinal fistula,infec-tion of incision,patches or deaths occurred.Ten patients(66.67%) had abdominal wall nail regional pain to different degree.2~11 months′postoperative follow-up indicated no recurrent cases.Conclusion Laparoscopic adoption of stapler or stapler with sutures through abdominal wall to repair incisional hernia is safe and effective.Compared with the open surgery,laparoscopic incisional hernia repair has the advantage of minor injury,quicker recovery,and lower recurrence rate.
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Objective To summarize the effect of tension-free hernioplasty for inguinal hernia .Methods Retrospective analysis of 619 cases of adult inguinal hernia underwent tension-free hernioplasty clinical data , curative effect and complications were observed .Results Patients could all get up 1 day after operation .Incisional pain was disappeared within 1-2days.Postoperative scrotal hematoma was found with 3 cases,no postoperative incision infec-tion,rejection.574 cases were followed up for 3 months to 4 years, there was no recurrence .Conclusion Adopting the method of Tension-free herniorrhaphy in treatment for inguinal hernia has the advantages of less trauma , faster postoperative recovery ,less complications and low recurrence rate etc .
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Objective To explore the ultrasound images features of breast infiltrating ductal carcinoma. Methods Retrospective analysis of operation pathology ,55 patients diagnosed preoperatively infiltrating ductal carcinoma of color Doppler ultrasound diagnostic information. Results Before operation, 55 patients with breast tumors had color Doppler shows in 49 cases,no color doppler showed 6 cases,color Doppler shows with pathologic diagnosis is 89.1%. An infiltrating ductal carcinoma ultrasound image characteristics:the larger mass was irregular form,no coated, posterior acoustic attenuation,burr levy ,and crabs foot shape more inside,bump such change for not uniformity hypoechoic,with tiny clusters of calcified or irregular flare,shadow,blood flow distribution after silent for AlderⅡmore performance level Ⅲ,axillary lymph node enlargement,a different level hilus structure was clear,the peak systolic velocity in 12-80cm/s (average 35.1 cm/s ) , resistance index in 0.62-0.92 (average for 0.79 + 0.10). Conclusion Color doppler ultrasonography had important value in early diagnosis of infiltrating ductal carcinoma.
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Objective To summarize the clinical experience of laparoseopie chdeeystectomy(LC).Methods Clinical records of 276 cases treated by LC were retrospectively reviewed.Results LC Was successfully accomplished in 265 cases and conversion to open surgery was required in 11 eases;The success rate of operation was 96%;and conversion rate of opening surgery was 4%;In the study,no severe complications occurred.Conclusion selecting fitable inpatients;With perfect technique and highly responsibility,LC could be performed safely.