Recurrencia en echinococcosis quística hepática

El tratamiento quirúrgico de la equinococosis quística hepática se asocia (entre otras), con una tasa de recurrencia actual de hasta 27%, aunque es infrecuente la recurrencia después de la exéresis total de un quiste intacto. Por lo general, la recurrencia ocurre producto del derrame de estructuras parasitarias vivas a alguna cavidad, o de dejar residuos de germinal, vesículas hijas o protoescólices durante la cirugía. La recurrencia suele ser asintomática, por lo que el diagnóstico depende, casi exclusivamente, de un seguimiento riguroso y prolongado en el tiempo, con controles clínicos, determinaciones serológicas, e imágenes. El tratamiento puede incluir el uso de albendazol, asociado a técnicas de radiología intervencionista o cirugía. El objetivo de este manuscrito fue generar un documento de lectura referente a la recurrencia de la equinococosis quística hepática.

Surgical treatment of hepatic cystic echinococcosis is associated (among others), with a current recurrence rate of up to 27%; although recurrence after total resection of an intact cyst is rare. In general, recurrence occurs as a result of the spillage of living parasitic structures into a cavity, or of leaving germinal residues, daughter vesicles, or protoscolices during surgery. Recurrence is usually asymptomatic, so the diagnosis depends almost exclusively on a rigorous and prolonged follow-up, with clinical controls, serological determinations, and images. Treatment may include the use of albendazole, followed by interventional radiology techniques or surgery. The aim of this manuscript was to generate a reading document regarding the recurrence of hepatic cystic echinococcosis.

Application of concept of enhanced recovery after surgery in the training of hepatic surgery specialists / 中华医学教育探索杂志

Objective:To investigate the application effect of the concept of enhanced recovery after surgery (ERAS) in the training of hepatic surgery specialists.Methods:Sixty attending physicians who had received 6 months of specialist training in the Hepatopancreatobiliary Surgery of the First Affiliated Hospital, School of Medicine, Zhejiang University, China in 2017-2019 were randomly divided into the control group and research group. The control group adopted the traditional training mode of hepatic surgery specialists, and the research group adopted the training mode of hepatic surgery specialists integrating the concept of ERAS. At the end of the training, the two groups were evaluated through theoretical examination and clinical practice. SPSS 25.0 was used for t test and Chi-square test. Results:The scores in theoretical knowledge [(91.70±2.87) vs. (89.60±2.88), P = 0.006], clinical thinking [(93.17±2.78) vs. (86.33±3.70), P < 0.001], and surgical simulation [(92.83±2.84) vs. (89.50±3.31), P = 0.013] were significantly better in the research group than in the control group. The questionnaire results showed that the satisfaction of specialists in the research group was better than that in the control group [(91.50±3.26) vs. (84.67±3.46), P < 0.001]. The results of clinical practice assessment showed that the patients managed by the specialist in the research group had faster postoperative recovery compared with the control group (length of stay: 6.10±1.80 vs. 9.90±1.60, P < 0.001). Conclusion:The training mode of hepatic surgery specialists integrating the concept of ERAS enables specialists to better master the theoretical knowledge and practical operation skills of hepatic surgery, and ultimately benefits patients.

Resección laparoscópica de tumor hepático / Laparoscopic Resection of Hepatic Tumor

Introducción: La cirugía laparoscópica desde su introducción en 1987 ha experimentado un enorme desarrollo. La cirugía hepática laparoscópica de los tumores hepáticos plantea diversas controversias: los cirujanos deben estar formados en cirugía hepática y cirugía laparoscópica, la técnica laparoscópica más adecuada no está bien definida (totalmente laparoscópica o asistida con la mano), el abordaje o disección de grandes vasos entraña riesgos importantes, los métodos de sección parenquimatosa están menos desarrollados que en la cirugía hepática abierta entre otros retos. A pesar de estos criterios existen situaciones en que la cirugía puede llevarse a cabo con seguridad, sobre todo en tumores benignos y malignos cuando las lesiones se localizan principalmente en segmentos anteriores del hígado. Objetivo: Presentar una paciente portadora de una lesión hepática intervenida quirúrgicamente por videolaparoscopía con buenos resultados y evolución excelente. Caso clínico: Paciente femenina de 42 años de edad; antecedentes de salud con presencia de dolor abdominal de tres meses de evolución en región de hipocondrio derecho y trastornos dispépticos esporádicos. Se confirmó imaginológicamente un tumor de 5 cm de diámetro en segmento III, de aspecto hemangiomatoso con componente mixto y sospecha de malignidad. Se realizó resección laparoscópica, el diagnóstico anatomopatológico fue nódulo regenerativo, tipo nódulo cirrótico con hemangioma cavernoso de localización periférica en hígado sano, sin evidencias de malignidad en los estudios realizados. Conclusiones: Las resecciones quirúrgicas de lesiones hepáticas abordables por vía laparoscópica son una opción terapéutica segura y muy válida en pacientes con indicaciones específicas(AU)

Introduction: Laparoscopic surgery, since its introduction in 1987, has undergone enormous development. Laparoscopic hepatic surgery of liver tumors raises several controversies: surgeons must be trained in hepatic surgery and laparoscopic surgery, the most appropriate laparoscopic technique is not well defined (totally laparoscopic or hand-assisted), the approach to or dissection of large vessels involves significant risks, the methods for parenchymal section are less developed than in open hepatic surgery, among other challenges. Despite these criterions, there are situations in which the surgery can be performed safely, above all in benign and malignant tumors when the lesions are located mainly in anterior segments of the liver. Objective: To present the case of a patient with a hepatic lesion and operated on by videolaparoscopy with good outcomes and excellent evolution. Clinical case: A 42-year-old female patient with a family history of disease presented abdominal pain of three months of evolution in the right hypochondrium and sporadic dyspeptic disorders. Imaging confirmed a tumor of 5 cm of diameter in segment III, with hemangiomatous aspect, mixed component and suspicion of malignancy. Laparoscopic resection was performed; the anatomopathological diagnosis was regenerative nodule, similar to a cirrhotic nodule with cavernous hemangioma of peripheral location in healthy liver, with no evidence of malignancy in the performed studies. Conclusions: Surgical resections of hepatic lesions that can be laparoscopically approached are a safe and very valid therapeutic option in patients with specific indications(AU)

Nuevos avances en cirugía hepática: evaluación y planificación preoperatoria (Parte 1) / New advances in liver surgery: evaluation and preoperative planning

Resumen Los avances en la cirugía hepática de los últimos años han permitido resecciones hepáticas más extensa y complejas para el tratamiento de diferentes patologías del hígado sin un aumento excesivo de la morbimortalidad perioperatoria. El desarrollo de diferentes técnicas, tecnologías y herramientas para la evaluación preoperatoria han mejorado la planificación quirúrgica con el uso por ejemplo de las tecnologías audiovisuales e impresión de modelos en 3 dimensiones (3D) de alta fidelidad. Otros avances, han permitido realizar una mejor evaluación funcional del parénquima hepático y una caracterización más precisa de las lesiones con el uso por ejemplo de verde de indocianina, cintigrafía hepática y resonancia magnética con contraste hepatoespecífico. Este artículo describe algunos de los nuevos avances en la evaluación y planificación preoperatoria en cirugía hepática.

Advances in liver surgery in recent years have made it possible to achieve more extensive and complex liver resections for the treatment of different liver diseases without an excessive increase in perioperative morbidity and mortality. The development of different techniques, technologies and tools for preoperative evaluation have improved surgical planning with the use, for example, of audiovisual technologies and printing of high-fidelity 3-dimensional (3D) models. Other advances have allowed a better functional evaluation of the liver parenchyma and a more precise characterization of the lesions with the use, for example of indocyanine green or liver scintigraphy and magnetic resonance with hepatospecific contrast. This article describes some of the new advances in preoperative evaluation and planning in liver surgery.

Application of flipped classroom model from the perspective of POA theory in the training of students during standardized residency training in department of hepatic surgery / 中华医学教育探索杂志

Objective:To explore the application of flipped classroom teaching in the standardized residency training of students in department of hepatic surgery from the perspective of production-oriented approach (POA) theory.Methods:Based on the implementation time of flipped classroom teaching (January 2017) from the perspective of POA theory in West China Hospital, 51 nursing students who were routinely trained in department of hepatic surgery before the implementation (January 2015 to January 2017) were included in the control group. After the implementation (January 2017 to January 2019), 51 nursing students under the residency training were included in the observation group. The changes of test scores, independent learning ability and professional awareness of the two groups of nursing students before and 6 months after the training were compared, and the teaching satisfaction after the training was recorded. SPSS 19.0 was performed for t test and chi-square test. Results:The total scores of the theoretical examination scores of the two groups of nursing students, the total scores of the clinical practice assessment scores, and the self-learning ability assessment scale for nursing college students (learning motivation, self-management ability, learning cooperation ability, information literacy) scores and total scores in each dimension were significantly higher than those before training, and the observation group was significantly higher than the control group ( P<0.05); the two groups of professional maturity scales (career goals, professional self-confidence, professional autonomy, professional value, dependence on relatives and friends, occupation reference) scores of all dimensions were significantly improved compared with those before the training, and the scores of the observation group (career goals, professional self-confidence, professional autonomy, professional value) were significantly higher than those of the control group during the same period ( P<0.05). There was no statistical significance in the comparison between the two groups' dependence on relatives and friends and occupational reference scores ( P>0.05); the teaching satisfaction rate of nursing students in the observation group was 96.08%, which was significantly higher than that of the control group (82.35%). Conclusion:The application of flipped classroom teaching from the perspective of POA theory in the standardized residency training of department of hepatic surgery can significantly improve the autonomous learning ability of nursing students, which is conducive to the improvement of test scores and professional awareness, with high teaching satisfaction.

Application and efficacy evaluation of clinical pathway in clinical practice teaching in the department of liver surgery / 中华医学教育探索杂志

Objective@#To investigate the application and effect of clinical pathway in practice teaching of hepatic surgery.@*Methods@#The 64 clinical interns who had an internship in our department between February 2018 and May 2019 were divided randomly into two groups: the experimental group (n=32) and the control group (n=32). The clinical pathway teaching method was used in the experimental group and the traditional teaching method was used in the control group. At the end of their internship, the examination and the satisfaction survey were requested to finish in the both groups. The statistical software SPSS 17.0 was used. Continuous variables were analyzed through the t-test. Categorical data were compared through Pearson chi-square.@*Results@#The examination results included theoretical knowledge (P=0.033), operating skill (P=0.021), case analysis (P=0.006) and medical record writing (P=0.017), which were significantly better in the experimental group than in the control group, and the satisfaction of interns was also significantly better in the experimental than in the control group (P<0.05).@*Conclusion@#The clinical pathway teaching method is effective in practice teaching of hepatic surgery, and can improve the results of practice teaching quality obviously.

Application and efficacy evaluation of clinical pathway in clinical practice teaching in the department of liver surgery / 中华医学教育探索杂志

Objective To investigate the application and effect of clinical pathway in practice teaching of hepatic surgery.Methods The 64 clinical interns who had an internship in our department between February 2018 and May 2019 were divided randomly into two groups: the experimental group(n=32)and the control group(n=32).The clinical pathway teaching method was used in the experimental group and the traditional teaching method was used in the control group.At the end of their internship,the examination and the satisfaction survey were requested to finish in the both groups.The statistical software SPSS 17.0 was used.Continuous variables were analyzed through the t-test.Categorical data were compared through Pearson chi-square.Results The examination results included theoretical knowledge(P=0.033),operating skill(P=0.021),case analysis(P=0.006)and medical record writing(P=0.017),which were significantly better in the experimental group than in the control group,and the satisfaction of interns was also significantly better in the experimental than in the control group(P＜0.05).Conclusion The clinical pathway teaching method is effective in practice teaching of hepatic surgery,and can improve the results of practice teaching quality obviously.

Treatment experience and efficacy of precise surgery for hepatic caudate lobe involved lesions / 中华消化外科杂志

Objective To explore the treatment experience and efficacy of precise surgery for hepatic caudate lobe involved lesions.Methods The retrospective cross-sectional study was conducted.The clinicopathological data of 127 patients with hepatic caudate lobe involved lesions who were admitted to Hunan Provincial People's Hospital between January 2012 and December 2016 were collected,including 71 of malignant tumors,52 of benign lesions and 4 of other diseases.Anatomical hepatectomy was performed in patients via left approach,right approach,anterior approach,left combined with right approach,left and right combined with anterior approach,left and right combined with para-liver hanging tape approach,anterior combined with left approach,retrograde approach according to their conditions.Observation indicators:(1) intraoperative and postoperative recovery situations;(2) follow-up and survival situations.Follow-up using outpatient examination and telephone interview was done to detect postoperative survival of patients up to February 2018.Measurement data with normal distribution were represented as (x)±s.Measurement data with skewed distribution were described as M (range).Kaplain-Meier method was used to calculate survival rate.Results (1) Intraoperative and postoperative recovery situations:all the 127 patients underwent successful operation without perioperative death,including 111 of open surgery and 16 of laparoscopic surgery.Of 127 patients,single total caudate lobectomy and partial caudate lobectomy were performed in 2 and 13 patients,single hepatic segmentectomy combined with total caudate lobectomy,double hepatic segmentectomy combined with total caudate lobectomy,hepatic trisegmentectomy combined with total caudate lobectomy,left hemitectomy combined with total caudate lobectomy,left hepatic trilobectomy combined with total caudate lobectomy,right hemitectomy combined with total caudate lobectomy,right hepatic trilobectomy combined with total caudate lobectomy were performed in 6,4,5,1,1,30,3 patients respectively,single hepatic segmentectomy combined with partial caudate lobectomy,double hepatic segmentectomy combined with partial caudate lobectomy,left hemitectomy combined with partial caudate lobectomy,left hepatic trilobectomy combined with partial caudate lobectomy,right hemitectomy combined with partial caudate lobectomy,right hepatic trilobectomy combined with partial caudate lobectomy were performed in 3,3,41,2,5,8 patients respectively,including 78 via left approach,29 via right approach,2 via anterior approach,7 via left combined with right approach,2 via left and right combined with anterior approach,6 via left and right combined with para-liver hanging tape approach,1 via anterior combined with left approach,2 via retrograde approach.The operation time,time of first hepatic hilum occlusion,volume of intraoperative blood loss and duration of postoperative hospital stay were 285 minutes (range,188-670 minutes),47 minutes(range,30-150 minutes),294 mL(range,20-2 500 mL) and 10 days (range,6-27 days) respectively.Thirty-four patients had postoperative complications,including 21 with abdominal ascites,20 with pleural effusion,6 with incisional infection,5 with hemorrhage,4 with bile leakage,2 with pulmonary infection (1 patient combined with multiple complications).One patient underwent reoperation after ineffective conservative treatment for hemorrhage within postoperative 24 hours and other 33 were cured by conservative treatment.(2) Follow-up and survival situations:of 127 patients,124 including 68 of malignant tumors and 56 of non-malignant tumors were followed up for 2-71 months with a median time of 33 months.During the follow-up,1-,3-,5-year overall survival rates were 83.1％,63.4％,22.5％ in 68 patients with malignant tumors,89.3％,71.4％,57.1％ in 28 patients with hilar cholangiocarcinoma and 76.9％,46.2％,23.1％ in 26 with hepatocellular carcinoma.All the 56 patients with non-malignant tumors survived well.Conclusions Anatomical hepatectomy using precise surgery is safe and feasible.Preoperative precise evaluation and surgical procedure design,intraoperative vascular control and surgical plane mastering are keys to success.

Advances in the 8th Japan-China Hepato-Pancreato-Biliary Symposium / 中华消化外科杂志

The 8th Japan-China Hepato-Pancreato-Biliary Symposium was held in Tokyo,Japan from 22nd to 23rd November 2018.The meeting was convened coincidently with the 80th Annual Congress of Japanese Surgical Association,which attracted the participation of Chinese and Japanese hepatobiliary and pancreatic surgeons.The symposium aimed to explore the latest achievements and clinical issues of diagnosis and treatment for hepato-pancreato-biliary diseases.In this article,authors reviewed the up-to-date research information in order to share the experience,achievements and new information in the field of hepatobiliary and pancreatic diseases with colleagues.

Early and late outcomes of surgery of non-complicated liver hydatid / Resultados precoces y tardíos de la cirugía de la hidatidosis hepática no complicada

Hepatic echinococcosis (HE) is a prevalent health problem, and there is limited published information regarding HE surgery. On the other hand, postoperative morbidity (POM) has not varied significantly. The aim of this study was to describe early and late outcomes in terms of POM of a series of patients with non-complicated liver hydatid cysts (NLHC) treated surgically. Prospective cohort. We included patients undergoing surgery for NLHC in the Hospital Regional and Clínica in Temuco, between 2000 and 2015. The main outcome variable was the development of early and late POM. Other variables of interest were hospital stay, mortality and recurrence. Surgical techniques used were total or subtotal pericystectomy and liver resection. Percentages, measures of central tendency and dispersion, and incidence were calculated. We studied 136 patients with a median age of 41 years and 60.3 % female The median ultrasound diameter of the cysts was 15.0 cm. The median surgical time was 95 minutes. The incidence of POM was 9.6 %, 92.3 % of whose cases were Grade I or II Dindo & Clavien. The aetiology was 5.9 % and 3.7 % medical complications of surgical complications. There was no mortality and with a median follow up of 115 months, recurrence was observed in one patient, representing an incidence of 0.7 %. POM was determined in a cohort of patients with NLHC throughout an extended follow-up period, and the incidence and gravity of POM is smaller and of lower gravity than those previously published.

Siendo una equinococosis hepática (EH) un problema de salud prevalente, la información publicada respecto a la cirugía de EH no es abundante. Por otro lado, la morbilidad postoperatoria (MPO) no ha variado de forma muy significativa. El objetivo de este estudio fue describir los resultados tempranos y tardíos en términos de MPO de una serie de pacientes con quistes hidatídicos hepáticos no complicados (QHHN) tratados quirúrgicamente. Estudio de cohorte prospectiva. Se incluyeron pacientes sometidos a cirugía para QHHN en el Hospital Regional y Clínica en Temuco, entre 2000 y 2015. La variable resultado principal fue desarrollo de MPO temprana y tardía. Otras variables de interés fueron estancia hospitalaria, mortalidad y recurrencia. Las técnicas quirúrgicas utilizadas fueron periquistectomía total o subtotal y resección hepática. Se calcularon porcentajes, medidas de tendencia central y dispersión, e incidencia. Se estudiaron 136 pacientes con una mediana de edad de 41 años; 60,3 % de los cuales son mujeres. La mediana del diámetro de los quistes y del tiempo quirúrgico fue de 15,0 cm y 95 min. Respectivamente. La incidencia de MPO fue 9,6 %, de los cuales 92,3 % fueron Grado I o II de Dindo y Clavien. La etiología fue: 5,9 % de complicaciones médicas y 3,7 % de complicaciones quirúrgicas. No hubo mortalidad; y con una mediana de seguimiento de 115 meses, se determinó una incidencia de recidiva de 0,7 % (1 paciente, en el período estudiado). Se describe la MPO de una cohorte de pacientes con QHHN. La morbilidad observada es inferior a la publicada y de bajo nivel de gravedad.

Cirugía hepática: algunas consideraciones más allá de la técnica quirúrgica / Liver surgery: Considerations beyond the surgical technique

La mortalidad de la cirugía resectiva hepática es de 1-2%. Mejorar esto requerirá optimizar detalles que involucran a todos los encargados del cuidado de estos pacientes. El primero de estos puntos es la evaluación de la función hepática postoperatoria. Diversos métodos han sido utilizados para tratar de estimarla, sin resultados concluyentes respecto a cuál es el más adecuado. Estudios que evalúan la cantidad de parénquima residual y su relación con el desarrollo de falla hepática postoperatoria recomiendan que en presencia de un hígado sano debería quedar 20-25% del volumen hepático, 30-60% en casos de condiciones que deterioran la funcionalidad, y 40-70% en casos de cirrosis. El aporte de volumen y su relación con la morbilidad, el sangrado y el desarrollo de insuficiencia renal han sido muy estudiados. La restricción del volumen y el mantenimiento de presiones venosas bajas aparecen como estrategias recomendadas, pero no deben comprometer la perfusión sistémica. A diferencia de lo observado en pacientes críticos, especialmente sépticos, el uso de almidones aparece como una alternativa segura en pacientes sanos sometidos a procedimientos resectivos o trasplante hepático. Las alteraciones de exámenes de coagulación deben ser evaluadas y corregidas cuando corresponda, idealmente a través de métodos que permitan identificar la causa. El tromboelastograma aparece como una alternativa adecuada. La administración profiláctica de hemocomponentes no está indicada, pudiendo ser origen de morbilidad. La analgesia debe ser optimizada, siendo la peridural una buena alternativa en presencia de hígado sano y en procedimientos no mayores de una lobectomía.

The mortality of liver resection surgery is 1-2%. Improve this will require optimizing details involving all caregivers of these patients. The first of these points is the evaluation of postoperative liver function. Various methods have been used to estimate it, without conclusive results regarding what is the most appropriate. Several studies evaluating the amount of residual parenchyma and its relationship to the development of postoperative liver failure recommend that in the presence of a healthy liver should be 20-25% of liver volume, 30-60% in cases of conditions that impair the functionality and 40-70% in cases of cirrhosis. The contribution of fluids administration and its relationship with morbidity, bleeding and development of renal failure have been studied. The volume restriction, maintenance of low central venous pressures appear as recommended strategies but must not compromise systemic perfusion that can determine organ dysfunction. Unlike what was observed in critically ill patients, the use of starches appears as a safe alternative in healthy patients and those undergoing liver transplantation. Alterations in coagulation tests should be evaluated, ideally through methods that allow to identify the cause. The thromboelastography appears as a suitable alternative. Prophylactic administration of blood components is not indicated and can be a source of morbidity. Analgesia should be optimized, being epidural analgesia a good alternative in the presence of healthy liver and procedures involving no more than a lobectomy.

Clinical efficacy of precise liver resection of liver tumors adjacent to the main pipeline / 中华消化外科杂志

Objective To investigate the clinical efficacy of precise liver resection of liver tumors adjacent to the main pipeline.Methods The retrospective and descriptive study was conducted.The clinical data of 22 patients who underwent precise resection of liver tumors adjacent to the main pipeline in the Affiliated Tumor Hospital of Zhengzhou University between December 2014 and June 2016 were collected.According to preoperative precise evaluation and fully intraoperative exposed tumors,different methods of blood flow occlusion were choosed timely,and then precise resection of the liver was evaluated based on tumor location and size,relationship between tumor and blood vessels and the degree of liver cirrhosis.The operation procedures,operation time,time of liver resection,volume of intraoperative blood loss,number of patients with perioperative blood transfusion,postoperative complications,duration of postoperative hospital stay and follow-up were observed.The follow-up was performed by outpatient examination and telephone interview up to September 2016.Tumor recurrence of patients with hepatocellular carcinoma (HCC) was monthly detected by alpha-fetoprotein retest and color Doppler ultrasound of the liver or computed tomography (CT) within 3 months postoperatively.Tumor recurrence of patients with cholangiocarcinoma was monthly detected by tumor marker retests,color Doppler ultrasound of the liver or CT,and then patients without tumor recurrence received reexamination once every 2 months after 3 months.Patients with liver hemangioma were followed up once every 2-3 months and once every 6 months after half a year,and follow-up included the liver function,ultrasound and other imaging examinations to detect the tumor recurrence.Measurement data with normal distribution were represented as-x±s.Results All the 22 patients underwent successful precise resection of liver tumors.Twenty patients received intraoperative ultrasound localization.Blood flow occlusion of 22 patients:Pringle was conducted in 6 patients,treatment of the corresponding hepatic pedicle in 3 patients,selective hepatic blood flow occlusion in 8 patients,total hepatic blood flow occlusion in 2 patients and non-hepatic portal occlusion in 3 patients.Precise resection of the liver of 22 patients:1 patient underwent right trisegrnentectomy,2 underwent left hepatectomy,2 underwent segment Ⅳ a resection of the liver,2 underwent segment Ⅳ resection of the liver,3 underwent segment Ⅴ resection of the liver,3 underwent segment Ⅷ resection of the liver,1 underwent middle lobe resection of the liver and 8 underwent partial resection of the liver.Operation time,time of liver resection,volume of intraoperative blood loss and number of patients with perioperative blood transfusion were (213±39) minutes,(57± 19) minutes,(518± 98) mL and 3,respectively.Of 22 patients,5 with postoperative complications were improved after symptomatic treatment,including 2 with effusion at surgical site,2 with right pleural effusion and 1 with bile leakage.The duration of postoperative hospital stay of 22 patients was (8.9± 1.6)days.Twenty-one patients were followed up for 3-20 months,with a median time of 12 months.Two of 22 patients had recurrence during the follow-up,and no recurrence at surgical site was detected.Conclusion Precise resection of liver tumors adjacent to the first and second hepatic hilum is safe and feasible,with the advantages of less intraoperative bleeding and low incidence of postoperative complications.

Application of tissue-specific magnetic resonance imaging contrast agent gadolinium ethoxybenzyl dimeglumine on precision hepatic surgery / 中华消化外科杂志

Gadolinium ethoxybenzyl dimeglumine (Gd-EOB-DTPA),a newly applicable hepatocyte-specific contrast agent,can provide both dynamic and hepatobiliary images and has been rapidly accepted by clinicians for the diagnosis of liver lesions and preoperative evaluation.Gd-EOB-DTPA can fulfill hepatic perfusion imaging,detection and characterization of focal liver lesions,evaluation of liver function,and predict biological behaviors of hepatocellular carcinoma (HCC) within the same examination in a relatively short time window.A large number of domestic and foreign studies have confirmed that hepatobiliaryspecific enhanced magnetic resonance imaging (MRI) was significantly superior to MRI scan,enhanced CT and ultrasound in diagnosing HCC.With the help of the advanced imaging techniques,surgeons can accurately diagnose and assess the situation of patients to implement individualized treatment plans,and therefore these will promote the development of precision hepatic surgery.

Problems of precision hepatic surgery in nowadays / 中华消化外科杂志

With the era of precision hepatic surgery coming,the hepatic surgery has been promoted to brand-new level,which would be more accurate and meticulous.However,all those advances,such as super-thin computed tomography scan,three-dimensional imaging and the technology of threedimensional printing,have not promoted the clinic results for patients overtly.The optimal curative effect could be attained,if there is a perfect combination of operators' experience and those advanced imaging.For two issues,the time of vascular inflow occlusion and residual hepatic volume,operators could flexiblely use of clinic existing researches with surgical team and instruments according to the medical condition of patients.Precision hepatic surgery could be promoted to a higher level through constantly clinical research and innovations.

Impact of precision medicine, evidence-based medicine and precision surgery on the multimodality therapy for hepatocellular carcinoma / 中华消化外科杂志

Precision medicine significantly promotes the diagnosis and treatment of various diseases,which also induces the revolution of evidence-based clinical practice guidelines,as well as multimodality therapy for hepatocellular carcinoma (HCC).In the application of the concept of precision medicine and evidence-based medicine,surgeons will concretize the precise surgery,establish an improved multimodality therapy for HCC,and ultimately achieve the goal of overall benefit.This is also a new task of surgeons in the precision medicine era.

Surgical alternatives used in the treatment of liver hydatid cyst: a systematized approach based on evidence (an overview) / Alternativas quirúrgicas utilizadas en el tratamiento del quiste hidatídico hepático: revisión global de la evidencia

Echinococcosis is an endemic zoonosis in the south of Chile; we therefore have occasion to treat a large number of patients, particularly in the liver. Hepatic echinococcosis (HE) has its own morbidity and mortality due to evolutionary complications, to which the risk of complications related to the surgical procedures is added, the morbidity which has been reported up to 80 %. This is associated with a history of previous surgeries for HE, evolutionary complications of the cyst, the need for additional procedures such as the treatment of the disease in other simultaneous locations, etc. Moreover, reported mortality is up to 10 %, a situation that remains unchanged despite technological and therapeutic advances. The surgical treatment of HE can be divided into four phases: isolation of the surgical area, evacuation of the cyst, treatment of the complications of the cyst and treatment of the residual cavity. HE surgical procedures can be classified as conservative (marsupialization, cystostomy, Posadas technique and cystojejunostomy) and radical (pericystectomy and hepatic resections). Finally, the role of laparoscopic surgery, which is still under evaluation, is also worthy of note. The aim of this article is to present a general evidence-based overview of some surgical aspects of interest in the treatment of HE. In this article issues of the different surgical options utilized for HE treatment and their results are discussed, based on published evidence.

La equinococosis es una zoonosis endémica en el sur de Chile; por lo tanto, tenemos la oportunidad de tratar un gran número de pacientes, particularmente en el hígado. La equinococosis hepática (EH) tiene su propia morbilidad y mortalidad debido a complicaciones evolutivas, a lo que se añade el riesgo de complicaciones relacionadas con los procedimientos quirúrgicos. Se ha informado una morbilidad hasta del 80 %. Esto se asocia con antecedentes de cirugías previas para EH, complicaciones evolutivas del quiste, la necesidad de procedimientos adicionales, tales como el tratamiento de la enfermedad en otros lugares en forma simultánea, etc. Por otra parte, la mortalidad reportada alcanza el 10 %, una situación que se mantiene sin cambios a pesar de los avances tecnológicos y terapéuticos. El tratamiento quirúrgico de la EH se puede dividir en cuatro fases: aislamiento de la zona quirúrgica, evacuación del quiste, tratamiento de las complicaciones del quiste y tratamiento de la cavidad residual. Los procedimientos quirúrgicos de la EH se pueden clasificar en conservador (marsupialización, cistostomía, técnica y cistoyeyunostomía de Posadas) y radical (periquistectomía y resecciones hepáticas). Por último, el papel de la cirugía laparoscópica, que todavía está en proceso de evaluación, también es digno de mención. El objetivo de este artículo es presentar una visión general basada en la evidencia de algunos aspectos quirúrgicos de interés en el tratamiento de la EH. Se discuten los temas desde las diferentes opciones quirúrgicas utilizadas para el tratamiento de la EH y sus resultados, sobre la base de la evidencia publicada.

Progress in the research of anatomic segmental hepatectomy / 中华消化外科杂志

Anatomic segmental hepatectomy,as an important part ofprecision surgery,has been accepted and widely applied as the promotion of precision hepatectomy.Anatomic segmental hepatectomy is superior to non-anatomical hepatectomy in clinical efficacy,application scope and operation techniques.There are many operation techniques developed by surgeons to accomplish segmental hepatectomy,and it is worthy for spreading in clinical practice.

Role-playing with the practice teaching and thinking in liver surgery / 中华医学教育探索杂志

There are many kinds of diseases in hepatic surgery department including hepatitis,hepatic cirrhosis, liver cancer etl. Most of them are very ditficult to diagnose and treat, so it's necessary to change our traditional clinical practice teaching mode.Role-playing mode increases the interaction between students and teachers, which can achieve the desired effect with entertainment. So role-playing is a new model of clinical teaching as a meaningful innovation.

Development of hepatopancreatobiliary surgery in China and the challenges and opportunities in synchronizing itself with the world / 中华消化外科杂志

This article traced how western medicine and surgery were introduced into China, described where Chinese surgery stands currently at the international scene, and proposed future strategies as to how Chinese surgery can go internationally. Surgery, a major component of western medicine,was first introduced into China in the late 19th and early 20th centuries through the missionaries and the merchants of the East Indian Company. Surgical centers were soon established in the big cities along the coastal region, then spread inland along the Yellow River, the Yangtze River and the Pearl River. The establishment of general surgery centers soon led to the development of the subspecialty in hepatopancreatobiliary surgery because of high prevalence of hepatitis B related hepatocellular carcinoma, intrahepatic stones, portal hypertension caused by schistosomiasis and pancreatic disease. For historical reasons,Chinese surgery was cut off from the outside world in the 1960s.This led to the development of Chinese surgery along a different path from that taken internationally. With the opening up of China in the 1980s, and the recent economic developments,Chinese surgery needs to merge with surgery in the rest of the world. Suggested proposal for future strategies for Chinese surgery to go internationally include undergraduate medical reform, introduction of structured surgical training and examination for the whole country, life long continuing medical education for all surgeons, academic exchanges with internationally renowned centers, publication in international peer-review journals, active involvement in international surgical societies and conferences.

Evaluación hepática con TC multidetector. Angiotomografía, determinación volumétrica y hepatectomía virtual / Liver evaluation with multidetector CT. Angiotomography, volume determination and virtual hepatectomy

Objetivo: mostrar una nueva técnica de evaluación prequirúrgica del hígado utilizando tomografía computada multidetector (TCMD), determinando la utilidad de las reconstrucciones angiográficas, la volumetría hepática y la hepatectomía virtual, en correlación con los hallazgos quirúrgicos. Métodos: veinte pacientes con tumores hepáticos primarios o secundarios fueron evaluados con TCMD y luego operados. Las TC se efectuaron con técnica de doble fase (arterial y venosa) con un tomógrafo de 4 filas de detectores (Mx8000; Philips Medical Systems) luego de la inyección de 120ml de contraste endovenoso con una bomba inyectora. La adquisición se realizó con una colimación de 4x2.5mm. Las imágenes se evaluaron en conjunto con los cirujanos. Se calcularon los volúmenes hepáticos, se realizaron reconstrucciones vasculares y se efectuó la hepatectomía virtual. Se determinó la correlación del volumen de hígado a resecar establecido por la hepatectomía virtual y el de la pieza quirúrgica mediante el método de Bland y Altman. Resultados: la hepatectomía virtual permitió planificar y realizar en todos los pacientes la cirugía en un solo tiempo quirúrgico. No se produjeron complicaciones. El coeficiente de correlación fue 0.83 (IC 95%: -132.08- 159.78). Conclusiones: la hepatectomía virtual prequirúrgica es una nueva herramienta diagnóstica de la TCMD que, junto con las reconstrucciones vasculares, es útil para determinar la técnica quirúrgica a realizar en cada paciente y para estimar si el volumen hepático remanente será suficiente para evitar el desarrollo de una insuficiencia hepática post-quirúrgica.

Aim: to show a new technique of presurgical liver tumor evaluation using multidetector computed tomography (MDCT), determining the usefulness of angiographic reconstructions, presurgical virtual hepatectomy and 3D liver volume determination, in correlation with surgery findings. Methods: twenty patients with primary or secondary liver tumors were evaluated with MDCT and then operated on. Dualphase CT was performed in all patients on a 4-row multidetector CT scanner (Mx8000; Philips Medical Systems) after mechanical injection of 120ml of iodinated contrast medium. Scanning was performed using a detector configuration of 4x2.5mm. Images were sent to a workstation and they were analysed with the surgeons. The 3D volumes of each lesion, of the total liver and of the segments to be resected were calculated. Vascular reconstructions and virtual hepatectomy were also performed. Correlation of the liver volume between MDCT and surgery was calculated using the Bland and Altman method. Results: virtual liver segmentation allowed to perform the surgery in 100 % of the patients in one time and there were no complications. The correlation coefficient was 0.83 (CI 95%: -132.08, 159.78). Conclusions: presurgical liver hepatectomy is a new application tool of MDCT. The angiographic findings and the volume determination are useful to determine the surgical technique for each patient and this information allows the surgeons to know if the remnant liver will be enough for the patients to avoid a post-surgical liver insufficiency.