Segment-orientated anatomical liver resection for the treatment of hepatic alveolar echinococcosis in the middle lobe of the liver / 中华消化外科杂志

Objective To investigate the efficacy and feasibility of segment-orientated anatomical liver resection for the treatment of hepatic alveolar echinococcosis (HAE) in the middle lobe of the liver.Methods The clinical data of a female patient with HAE in the middle lobe of the liver who was admitted to the First Affiliated Hospital of Xi'an Jiaotong University in September 2013 were retrospectively analyzed.Before operation,various surgical plannings were facilitated by a three-dimensional reconstruction system,and then the surgical planning was determined with the assistance of the multivariate analysis (volume measurement of liver,resectability of remnant functional liver,evaluation of vascular resection and reconstruction,Child-Pugh score and indocyanine green retention at 15 minutes).Segment-orientated anatomical liver resection(segment Ⅴ,Ⅷ and Ⅳb) was performed on the patient.There was a close relationship between the HAE and the first and the second hepatic portal during operation,and the anatomical liver resection of segment Ⅴ,Ⅷ and Ⅳb was precisely carried out.The patient was followed up by outpatient examination and telephone interview every month up to April 2014.The condition of the liver was observed by B ultrasound and computed tomography examinations.Results The three-dimensional reconstruction of the CT data of the patient clearly displayed the anatomical structure and adjacent relationship between the tumor,abdominal organs and major abdominal vessels.The preoperative evaluation of the anatomy of tumor based on three-dimensional images was confirmed with operative findings.The operation time and volume of blood loss were 410 minutes and 1 000 mL,respectively.The patient did not receive blood transfusion.The intraoperative vital signs of the patient were stable.There were no complications such as hepatic insufficiency.The duration of postoperative hospital stay was 15 days.Surgical incision was healed at discharge.The results of blood routine and blood biochemistry test,daily diet and basic self-care ability were in normal condition.HAE was diagnosed based on the result of pathological examination.Albendazole was administered with 1 200 mg/d after operation.The patient was followed up for 6 months and returned to work.The weight of the patient increased by 5 kilograms than that at discharge,without complaint of discomfort.There was no recurrence of HAE and hepatic echinococcosis of organs.Conclusions Segment-orientated anatomical liver resection is not only a method for complete resection,but also maximizes the functional remnant of liver on the basis of intraoperative three-dimensional reconstruction system together with selective hepatic inflow occlusion and vessel reconstruction technique.The patient gets a full recovery with satisfactory outcome.

Three-dimensional reconstruction of rabbit eye vessels based on X-ray phase contrast imaging technique / 医用生物力学

Objective To establish a three-dimensional (3D) visualization model for the vessel system of rabbit eyes using X-ray phase contrast imaging（XPCI）technique, and observe the morphological characteristics of iris vessels of the rabbit eyes. Methods Angiography on vessels of the New Zealand rabbit eyes was conducted using Barium sulfate as the contrast medium. The projected images of in vitro rabbit eye samples with high precision were obtained by XPCI technique, and then converted to tomography images by filter back projection. The 3D reconstruction of the rabbit eyes was completed by commercial visualization software Amira 5.2.2. Results The main blood vessels of the rabbit eyes were clear and coherent in the projection images, and the distribution and trend of some small vessels could be observed, with the smallest distinguishable blood vessel diameter being about 10 μm. The 3D model for vessel network of the rabbit eyes was built after 3D reconstruction of CT scan images. The major arterial circle of the iris could be observed at level 4 branch structure of vessels in the fundus, and the minimum diameter of vessels that could be identified was 40 μm. Conclusions The vessels of the rabbit eyes can be clearly observed and 3D visualization of vessel network can be constructed by using XPCI technique, which would provide basis for the analysis on hemodynamics of blood vessels in the eye and reference for the clinical study of glaucoma.

Resection and reconstruction of mediastinal great vessels in invasive thymoma.

Objective : To evaluate the safety, feasibility, and outcome following radical excision of thymoma with resection and reconstruction of invaded mediastinal vessels. Study Design : A retrospective study. Patients and Methods : Six patients with thymoma invading the superior vena cava (SVC) and/or the brachiocephalic veins (BCVs) were reviewed in this study. All the patients underwent radical excision of the tumor along with invaded mediastinal vessels followed by vessel reconstruction or repair. The clinical presentation, operative details, postoperative course, and follow-up were reviewed and analyzed. Results : Three patients presented with features suggestive of SVC syndrome. Contrast-enhanced computed tomography of the chest was the primary imaging modality, which detected a tumor with invasion of major mediastinal veins. WHO type B2 was the commonest histologic type, which was seen in 4 cases. Intraoperatively, SVC invasion, SVC and BCV invasion, and BCV invasions alone were seen in 1, 2, and 3 cases, respectively. The vessels were reconstructed with a prosthetic graft in 3 patients, and autologous pericardial tube graft was used in 1 patient. Two patients had primary repair of the wall of the involved vessel. Postoperative course was complicated by ventilator support requirement in 2, graft thrombosis in 2, acute renal failure in 1 and pneumonia in 1 patient. All patients are alive at the end of follow-up period ranging between 18 and 24 months. Conclusion: Thymoma excision with the reconstruction of SVC or BCV is safe and feasible in experienced hands.

Surgical treatment for patients with chest cancers invading the superior vena cava / 中国医师进修杂志

Objective To summarize the experiences in clinical diagnosis and surgical treatment of chest cancers invading the superior vena cava (SVC). Method Retrospective study of 12 cases with chest cancers invading the SVC, SVC and innominate vein were reconstructed with prosthesis in 3 cases, the side wall of the SVC was excised and repaired in 9 cases. Results Complete resection was performed in 10cases,2 cases had incomplete resection. There was no death associated with operation in these patients. All patients were followed up for 1 - 7 years after operation,and 3 cases were lost to follow up,5 of remaining 9cases were dead because of relapse and metastasis, their median survival time was 8 months,other 4 cases lived, their median survival time was 42 months. Conclusions Patients with chest cancers invading the SVC should have surgical treatment of not only tumor resection but also the vessel reconstruction,the prognosis would be better than without surgical treatment. These patients have a high quality of life and live with long-term survival.

Combination hemihepatectomy and hilar blood vessel resection plus reconstruction for hilar cholangiocarcinoma / 中华普通外科杂志

Objective To evaluate a combination hemihepatectomy and hilar blood vessel resection plus reconstruction for hilar cholangiocarcinoma. Methods Ten cases of hilar cholangiocarcinoma at the stage of Ⅲa, Ⅲb, and Ⅳ, underwent this surgical procedure including right - hemihepatectomy + pancreatoduodenectomy + right portal vein branch resection and reconstruction (1case), right - hemihepatectomy + right portal vein branch resection and reconstruction (5cases), left - hemihepatectomy + left caudectomy + left portal vein branch resection and reconstruction + left hepatic artery resection (1case), and left - hemihepatectomy + left caudectomy + left portal vein branch resection plus and reconstruction (3cases). Results There was no postoperative mortality and severe complications. All the 10 cases were followed up with 1,2,3-year survival rate of 50%,30%and 20%, respectively. Conclusion Hepatectomy plus hilar blood vessel resection and reconstruction helps to increase the resection rate in cases of hilar cholangiocarcinoma and prolong patients' survival.