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Objective To evaluate the effect of application of combined hemihepatic inflow and hepatic veins occlusion in major liver resection.Methods The clinical data of 46 cases of large hepatic carcinoma who underwent liver resection were surveyed retrospectively.The hepatic pedicle of affected side and hepatic veins were dissected and controlled initially,then hepatectomy was performed under the condition of vascular exclusion of the affected side of liver.Results All the 46 cases suffered from hepatocellular carcinoma.The average size of the tumors was 8.3 cm(6-15 cm) in diameter.One main hepatic vein was invaded by tumor in 20 cases and 2 main hepatic veins were invaded by tumor in 14 cases.Among the 46 hepatectomies,right hemihepatectomy was performed in 16,right posterior lobe hepatectomy in 14,and left hemihepatectomy in 16 cases.The mean occlusion time of the hemihepatic pedicle was 30 min(10-45 min),and occlusion time of the hepatic veins was 20 min(10-30 min).The average blood loss was 540 ml(300-1 500 mL).Postoperative complications occurred in 14 cases,and all recovered after treatment.There was no mortality in this series.Conclusions Combined hemihepatic inflow and hepatic veins occlusion in major hepatectomy is a safe,effective and practical vascular exclusion method which can effectively reduce the blood loss and the incidence of the liver function failure.
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Objective To evaluate the clinical values of selective hemihepatic vascular occlusion in hepatectomy for large hepatocellular carcinomas.Methods Forty patients with large hepatocellular carcinomas who underwent hepatectomy with selective hepatic inflow and outflow occlusion of tumor-bearing liver were retrospectively analyzed.Results All the 40 patients underwent hepatectomy successfully.The blood losts during the operation was 100-800 mL(average 360 mL).The operation time was 90-150 min(average 116 min).Intraoperative blood transfusion was not performed in twenty-five patients.All patients recovered completely and were discharged without liver function failure or other severe complications.There was no perioperative death.Conclusions Selective hemihepatic vascular occlusion in hepatectomy for large hepatocellular carcinomas is a safe and effective method with advantages of controlling hemorrhage,decreasing liver damage and gut barrier injury,avoiding air embolism and preventing metastasis.
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0.05).Compared with non-SRHCC matched selective operation group(group),second stage hepatectomy(group C)had similar rate of complications and mortality,but the long-term survival was worse(P
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Objective To improve the recognition of intrahepatic biliary cystadenoma.Methods The clinical manifestations,radiologic features,diagnosis and surgical treatment of 18 patients with intrahepatic biliary cystadenomaadmitted in our hospital during the recent 8 years were retrospectively analyzed.Results Four cases were discovered by general medical examination,while the other 14 patients had varying symptoms that included right upper abdominal discomfort or pain in 11 cases,abdominal mass in 3 cases,and jaundice accompaniedby fever in 2 cases.B ultrasound and CT scan showed intrahepatic cystic occupying lesions consistingof multilocular or single cyst,and usually with papillary structures in the cyst wall.All of 18 cases received surgical resection.The patholgic dingnosis was intrahepatic biliary cystadenoma in all the 18 cases,and 6 of them showed malignant change.The average survival time of maligmant patients was 35(27-58)months.Conclusions Preoperative diagnosis of intrahepatic biliary cystadenoma is difficult.Intrahepatic biliarycystadenoma is easy to develop into cystadenocarcinoma.Early surgical resection is necessary,and can effectively prevent recurrence or malignant transformation.
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Objective To investigate the feasibility and significance of the re-operation for patients with recurrent primary liver cancer.Methods The clinical data of 58 patients with post-operative recurrence after initial operation for primary liver cancer in our hospital from January 2003 to December 2008 were analyzed.They were divided into re-operation group and the other treatment group,and the 1-and 3-year survival rates were compared.Results The 23 cases of re-operation group were all treated by local radical resection plus hepatic arterial chemotherapy pump implantation,and postoperative chemotherapy was given via hepatic artery chemoembolization pump line.The 35 patients of the other treatment group underwent radiofrequency ablation plus transcatheter hepatic arterial chemoembolization via femoral artery.The 1-and 3-year survival rates in re-operation group was 100% and 82.6% respectively,which was significantly higher than that of the other treatment group(82.9% and 45.7% respectively).Conclusions Re-operation is the treatment of choice for patients with tumor recrrrencr after radical resection of primary liver cancer,provided that the conditions are suitable and the timing of operation is appropriate.
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Objective To explore the clinical value of B ultrasound-guided psychro-circulation percutaneous microwave coagulation therapy(PMCT) in the treatment of liver cancer.Methods One hundred and sixteen liver cancer patients with 154 lesions were selected to receive psychro-circulation PMCT in our department from July 2004 to December 2007.The pre-and postoperative alpha fetoprotein(AFP) levels were detected.The diameters and blood flow state of the tumors were measured and compared by use of B ultrasound and computerized tomographic scanning(CT).The postoperative 1,2 and 3 y survival rate of those patients was followed up and recorded.Results No mortality or severe complications occurred in this series.Preoperative serum AFP level of the patients was(421.6?36.5)?g/L and decreased obviously to(232.5?25.6)?g/L at 1 month after psychro-circulation PMCT(P
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Objective To study the method,effect and safety of percutaneous targeted argon-helium (cryoablation) for liver cancer. Methods Retrospective analysis of the clinical data was made on the 52 (patients) with primary liver cancer who were treated with argon-helium cryoablation. Results Following the treatment of the 52 (patients), there were no operative mortality or complications, such as rupture of liver,bleeding,biliary fistula,frostbite of skin,and metastatic implantalion or infection at the injection site.(Postoperatively), 5 patients developed pneumothorax and reactive pleural effusion, and 43 patients had a low-grade fever. The 1- and 2-year survival rates were 63.5 %( 33/52) and 36.5 %( 19/52)(respectively).After treatment, the AFP levels were significantly lower. Conclusions CT guided percutaneous targeted argon-helium cryoablation is a reasonable, safe, effcctive and mimimally invasive new therapeutic method for the treatment of liver cancer.
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0.05).(2)Serum ALT,AST and LDH:After reperfusion,the values of ALT,AST,and LDH in IP group were significantly lower than those in I-R group(P
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Objective To explore the effect of surgical comprehensive treatment(SCT) in treating primary liver cancer(PLC).Methods The clinical data of 108 patients with PLC undergoing SCT in XiangYa Hospital from January 1999 to September 2002 were reviewed retrospectively. The SCT including surgical resection ,radiofrequency ablation(RFA),transcatheter hepatic chemo-embolization(TACE),percutaneous ethanol injection(PEI),TACE via drug delivery system(DDS),cryosurgery,biological treatment,etc.Results The postoperative mortality was 0.9%, and the postoperative complications was 18.7%,intrahepatic recurrent rate and remote metastasis within 1 year after SCT were 56.1%,17.9%.The 1-,2-,3-year survival rate after SCT were 79.46%,61.83%,36.61%,respectively.Conclusions Liver resection combined with other treatment methods can cut down the rate of intrahepatic recurrence and remote metastasis, and can improve the tumor-free survival rate and long-term survival.
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Objective To study the clinical characteristics, diagnosis and treatment of extrahepatic growing hepatocellular carcinoma(HCC). Methods The clinical data of 11 patients with extrahepatic growing HCC were analysed retrospectively. Results The mean diameter of the tumors was (12.4?4.3)cm.All the tumors in the 11 patients had complete capsule formation. The numbers of tumors located in the left, right and caudate lobe of the liver were 6,3 and 2 respectively. Surgical treatment included segmentectomy in 6 cases , lobectomy in 4 cases, and unresectable in 1 case. The 1-, 2-, and 3-year survival rates were 80.1%,62.3%, and 47.6% respectively. Conclusions Although the size of extrahepatic growing HCC is large,the resection rate is high and prognosis is good. The resection of hepatic segments or lobes containing the lesion should be done in radical operation of this tumors.
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Objective To study the feasibility and invasiveness of hand-assisted laparoscopic hepatectomy(HALH) for liver cancer.Methods Forty patients undergoing hepatectomy for liver cancer were randomly divided into HALH group and open hepatectomy(OH) group.Data of patients of two groups,Which included operating time,intraoperative blood loss,length of incision,postoperative flatus time,hospital stay,complications and C-reactive protein(CRP) were compared.Results The mean intraoperative blood loss,length of incision,postoperative flatus time,hospital stay and CRP in HALH group were significantly less than that in OH group;but there was no significant difference in operating time,or complication and recurrence rate.Conclusions HALH for liver cancer is less traumatic,and achieves faster patient recovery.It is feasible and safe in selected patients.
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Objective To investigate the proper selection of methods of hepatic vascular control during(resection) of liver carcinoma.Methods Ninety-foury cases of liver carcinoma underwent hepatectomy using 4 different types of hapatic vascular control in our hospital.The operative time,amount of intraoperative blood loss,transfusion,and postoperative drainage,changes of postoperative liver function and complications were analyzed and compared between the 4 groups.Results Of the 94 cases,38(40.4%) underwent routine Pringle′s maneuver,34(36.2%) had selective hemihepatic vascular exclusion,18(19,1%) without(hepatic) inflow occlasion and 4(4.3%) had total vascular exclusion during hepatectomies.All tumors were entirely removed and operations were performed smoothly.Postoperative complications occurred 24 case-times and 2 patients(2.1%) died.Conclusions The selection of method of hepatic vascular control during(hepatectomy) for massive liver carcinoma should be comprehensively determined,based on the size and location of tumor,preoperative liver function,diffculty of hepatectomy and findings at intraoperative exploration.Proper method manner of hepatic vascular control is crucial for successful operation and uneventful recovery of the(patient).
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Objective To investigate an effective method of treating primary hepatic cancer(PHC) with portal venous tumor thrombosis (PVTT). Methods The clinical data Of 23 patients with PHC and PVTT were retrospectivly analysed. Results Of the 23 patieats after hepatoma resection and PVTT extraction, continuous micro dose infusion chemotherapy or perfusion chemotherapy by DDS was adopted. In 8 patients with main portal vein tumor thrombus, 2 died, 4 recured in 6 months. In 8 patients with the first class branch of portal vein tumor thrombus, 2 recurrd in 6 months and 6 recurred in 12 months. In 4 patients with secondary class branch of portal vein tumor thrombus, l recurred in 12 months (P
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Objective To define the factors that influence the safety of hepatectomy for hepatocellular carcinoma (HCC) associated with cirrhosis. Methods Based on the patients treated before and after February 1997,229 cases of HCC associated with cirrhosis were divided into two groups, Group A and Group B, respectively. The patients′ general condition, operative procedure, morbidity and mortality rates were compared between the two groups. The factors that influenced surgical morbidity were analysed. Results In group B, patients′ average age was higher (P
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Objective To discuss the experiences of surgical treatment of hepatic cavernous hemangioma in a peculiar position. Methods We retrospectively analyzed the clinical data of 32 cases of cavernous hemangioma in the central area of the liver. Results All of the hepatic cavernous hemangiomas were resected successfully by extracapsular dissection. Intraoperative hemorrhage volume varied from 50ml to 10000ml, and in 12 patients the amount of blood transfusion was 400ml to 4000ml. 5 cases (15.6%) had postoperative complications, including right pleural effusion(3 cases), bile leakage(1 case), and subdiaphragmatic fluid collection(1 case). The mortality rate was 3.1%(1/32). 26 cases were followed up for a median of(3.09?0.93)yrs, and there was no recurrence of hemangioma. Conclusions Familiarity with the liver anatomy and proficient operative methods are the key get to successful surgical treatment of these hemangiomas and reduce complications. Extracapsular dissection is a safe and effective way to treat hepatic cavernous hemangioma .
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Objective To investigate the long-term effect of recombinate human growth hormone(rhGH) on the immune function in patients with liver cancer. Methods Fifty patients with hepatoma who underwent hepatectomy were randomly divided into two groups:(1)Control group;(2)rhGH treatment(GH) group. All patients were treated with TPN for five days postoperatively,and additionally the patients in the GH group received rhGH(8U/d IH) in the evening for seven days. Results IgG,IgM,CD3,CD4 in the control group and CD8 in the GH group were significantly lower on day 10 postoperatively than that on preoperative days. IgG in the GH group significantly increased on day 15. The 1 year and 3 year survival rate and recurrent rate were not different between the two groups. Conclusions rhGH therapy can improve the immune function of patients with hepatoma who underwent hepatectomy and has no side effect on the long term survival and recurrence.
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Objective To evaluate the feasibility and safety of resection of tumors in hepatic centric area. Methods The clinical data of 36 patients with tumors in hepatic centric area treated by resection in our hospital from Jan 1996 to Dec 2001 were retrospectively analyzed. In this series,there were 26 cases of liver cancer and 10 cases of benign tumor. Of the 36 patients,the tumor involved the first porta hepatis in 13 cases, involved the second porta hepatis in 10 , involved the third porta hepatis in 5 , involved both the first and second porta hepatis in 3, and involved both the second and third porta hepatis in 5 cases. Results During the operation, massive hemorrhage occurred in 4 cases(11.1%). Postoperative complications occurred in 11 patients(30.5%),including liver function failure in 1 case (2.7%), biliary fistula in 2 cases (5.5%), pleural effusion in 6 cases (16.7%), subphrenic infection in 1 case (2.7%),and abdominal incisional hernia in 1 case (2.7%). All patients recovered except that one died of acute hepatic failure after the operation. Conclusions Although the surgery for this tumor is quite difficult and risky, if enough attention is paid to the choice of the patient,and the meticulous surgical technique,the operation safety and therapeutic result of the operation could be improved.
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Objective To study the applicable value of resection of segment VIII after cryotherapy for hepatocarcinoma. Methods As for 8 patients with hepatocarcinoma in segment VIII, the turnor was dealt with cryotherapy before resected. Results All the tumors were resected smoothly after cryotherapy with less bleeding (mean 430*!ml), less time (mean 138*!min) and without severe complications or postoperative death in this series. Conclusions Resection of segment VIII after cryotherapy for hepatocarcinoma is proved safe and feasible, whitch can decrease blood loss, save time, reduce tissue injury, and decrease postoperative recurrence.
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Objective To study the effect of HAI and/or PVI after radical resection of hepatocellular carcinoma (HCC) for preventing recurrence.Methods From Jun. 1995 to Apr. 2000, 49 patients with HCC were undergone radical tumor resection. They were divided into 4 group: the treatment combined with HAI and PVI was given in group I(12 cases), HAV alone in group II (8 cases); PVI alone in group III (15 cases); nothing in group IV (14 cases). All patients were followed up for 6 months to 5 years. Results Recurrence rate at one year didn't show significantly lower in group I, II and III than that in grou IV. Survival rate in one year showed no significant difference in 4 groups. Recurrence rate in three years was significantly lower in group I and II than that in group IV. Survival rate in three years was significantly higher in group I and II than that in group IV. Recurrence rate and survival rate in five years showed no significante difference in four groups. Conclusions The treatment of radical resection of HCC combined with HAI and/or PVI is simple and safe. It is an useful method for preventing tumor recurrence.
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Objective To explore the clinical efficacy of hepatic segmentectomy under segmental staining and intraoperative chemoembolization for primary liver cancer(PLC).Methods Twenty cases of liver cancer underwent hepatic segmentectomy under segmental staining and intraoperative chemoembolization(observed group),the results were compared with 22 cases of PLC after treated by routine hepatectomy(control group).AFP,CT and MRI were regularly used after hepatectomy to evaluate the outcome.Results In observed group,the operative blood loss was(295?105)mL,blood transfusion was(280?85)mL,liver function levels were in the normal range accounted for 15%(3/20) one week postoperatively,the incidence of postoperative complications was 40%(8/20),the postoperative 3-year survival rate was 60%,and the postoperative local recurrence rate was 35%;while in the control group,these parameters were(490?140)mL,(370?105)mL,40.9%(9/22),45.5%(10/22),40.91% and 68.18% respectively.In observed group,the operative blood loss,blood transfusion,cases with liver function levels in the normal range,the incidence of postoperative complications,postoperative 3-year survival rate,and postoperative local recurrence rate were significantly lower than those in the control group(P0.05).Conclusions The hepatic segmentectomy under segmental staining and intraoperative chemoembolization for PLC may reduce postoperative complications,lower postoperative relapse rate and improve survival rate.