Application value of cystic plate approach for extrahepatic right hepatic pedicle dissection in minimally invasive anatomic liver resection / 中华消化外科杂志

Objective:To investigate the application value of cystic plate approach (CPA) for extrahepatic right hepatic pedicle dissection in minimally invasive anatomical hepatectomy (MIALR).Methods:The retrospective cohort study was conducted. The clinicopathological data of 42 patients with primary liver cancer who underwent laparoscopic right hemi-hepatectomy in Nanfang Hospital of Southern Medical University from August 2020 to August 2022 were collected. There were 36 males and 6 females, aged (55±13)years. Of the 42 patients, 25 cases undergoing CPA for extrahepatic right hepatic pedicle dissection were divided into the CPA group, and 17 cases undergoing traditional approach for extrahepatic right hepatic pedicle dissection were divided into the traditional approach group. Observation indicators: (1) surgical situations; (2) postoperative situations. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the t test. Measurement data with skewed distribution were represented as M( IQR), and comparison between groups was conducted using the Mann-Whitney U test. Count data were described as absolute numbers, and comparison between groups was conducted using the chi-square test or Fisher exact probability. Comparison of ordinal data was conducted using the non‐parameter rank sum test. Results:(1) Surgical situations. All patients in the two groups underwent laparos-copic right hemi-hepatectomy successfully, with the surgical margin as negative. The operation time, volume of intraoperative blood loss, time of dissection of the targeted hepatic pedicle, cases under-going dissection of the trunk of right anterior hepatic pedicle and its operation time, cases under-going dissection of the trunk of right posterior hepatic pedicle and its operation time, cases with hepatic pedicle injury, cases with hepatic tissue injury, cases with dissection space as large and small were 150.00(130.00)minutes, 100.00(100.00)mL, 472.00(201.00)seconds, 10 and 366.00(94.75)seconds, 9 and 564.00(138.50)seconds, 2, 2, 25, 0 in patients of the CPA group, versus 140.00(113.00)minutes, 100.00(125.00)mL, 670.00(107.00)seconds, 8 and 663.00(136.00)seconds, 7 and 783.00(189.00)seconds, 8, 5, 2, 19 in patients of the traditional approach group. There were significant differences in the time of dissection of the targeted hepatic pedicle, time of dissection of the trunk of right anterior hepatic pedicle, time of dissection of the trunk of right posterior hepatic pedicle, hepatic pedicle injury, dissection space between the two groups ( Z=-4.809, -3.254, -3.188, χ2=6.493, 34.314, P<0.05) and there was no significant difference in the operation time, volume of intraoperative blood loss, dissection of the trunk of right anterior hepatic pedicle, dissection of the trunk of right posterior hepatic pedicle, hepatic tissue injury between the two groups ( Z=-0.282, -0.412, χ2=0.095, 0.002, 1.976, P>0.05). (2) Postoperative situations. There was no patient under-going postoperative hemorrhage in both of the two groups. The alanine transaminase (ALT), aspartate transaminase (AST), total bilirubin (TBil) and prothrombin time (PT) at postoperative day 3, cases with postoperative biliary fistula, pathological type of tumor (hepatocellular carcinoma, intrahepatic cholangiocarcinoma) were 68.00(48.50)U/L, 52.00(35.50)U/L, 28.30(12.35)mmol/L, 12.40(2.40)seconds, 2, 21, 4 in patients of the CPA group. The above indicators were 58.00(25.00)U/L, 41.00(19.50)U/L, 26.80(14.25)mmol/L, 12.50(2.95)seconds, 5, 15, 2 in patients of the traditional approach group. There was no significant difference in the ALT, AST, TBil, PT at postoperative day 3, postoperative biliary fistula between the two groups ( Z=-1.218, -1.488, -0.205, -0.320, χ2=1.976, P>0.05), and there was no significant difference in the pathological type of tumor between the two groups ( P>0.05). Conclusion:Application of CPA for extrahepatic right hepatic pedicle dissection in MIALR is safe and feasible.

Safety of minimally invasive liver resection for resectable hepatocellular carcinoma complica-ted with portal hypertension: a multicenter study / 中华消化外科杂志

Objective:To investigate the safety of minimally invasive liver resection for resectable hepatocellular carcinoma (HCC) complicated with portal hypertension.Methods:The propensity score matching and retrospective cohort study was conducted. The clinicopathological data of 807 patients with resectable HCC who underwent minimally invasive liver resection in 8 medical centers, including Sir Run Run Shaw Hospital, Affiliated with the Zhejiang University School of Medicine et al, from June 2011 to November 2022 were collected. There were 670 males and 137 females, aged 58(50,66)years. Of the 807 patients, 173 cases with portal hypertension were divided into the portal hypertension group, and 634 cases without portal hypertension were divided into the non-portal hypertension group. Observation indicators: (1) propensity score matching and comparison of general data of patients between the two groups after matching; (2) intraoperative and post-operative situations; (3) subgroup analysis. Propensity score matching was done by the 1:1 nearest neighbor matching method, with the caliper setting as 0.001. Measurement data with skewed distribution were represented as M( Q1, Q3), and comparison between groups was conducted using the rank sum test. Count data were described as absolute numbers, and comparison between groups was conducted using the chi-square test or Fisher exact probability. Comparison of ordinal data was constructed using the non-parameter rank sun test. Results:(1) Propensity score matching and comparison of general data of patients between the two groups after matching. Of the 807 patients, 268 cases were successfully matched, including 134 cases in the portal hypertension group and 134 cases in the non-portal hypertension group. The elimination of the tumor diameter and robot-assisted surgery confounding bias ensured comparability between the two groups after propensity score matching. (2) Intraoperative and postoperative situations. The occlusion time of porta hepatis, cases with intraoperative blood transfusion, cases with postoperative complication, cases with complication >Ⅱ grade of Clavien-Dindo classification, cases of Clavien-Dindo classification as Ⅰ grade, Ⅱ grade, Ⅲ grade, Ⅳ grade, cases with liver related complication were 27.0(15.0,43.0)minutes, 33, 55, 15, 13, 29, 14, 1, 37 in the portal hypertension group, versus 35.0(22.0,60.0)minutes, 17, 25, 5, 14, 9, 4, 1, 13 in the non-portal hypertension group, showing significant differences in the above indicators between the two groups ( Z=-2.15, χ2=6.30, 16.39, 4.38, 20.72, 14.16, P<0.05). (3) Subgroup analysis. Results of subgroups analysis showed that in cases with major live resection, the operation time, volume of intraoperative blood loss, duration of postoperative hospital stay were 243.5(174.6,296.3)minutes, 200.0(150.0,600.0)mL, 7.5(6.0,13.0)days in the portal hypertension group, versus 270.0(180.0,314.5)minutes, 200.0 (75.0,450.0)mL, 7.0(5.5,10.0)days in the non-portal hypertension group, showing no significant difference in the above indicators between the two groups ( Z=-0.54, -1.73, -0.92, P>0.05). In cases with non-major live resection, the operation time, volume of intraoperative blood loss, duration of postoperative hospital stay were 170.0(120.0,227.5)minutes, 100.0(50.0,200.0)mL, 8.0(5.0,10.0)days in the portal hypertension group, versus 170.0(120.0,227.5)minutes, 100.0(50.0,200.0)mL, 7.0(5.5,9.0)days in the non-portal hypertension group, showing no significant difference in the above indicators between the two groups ( Z=-1.39, -0.10, 1.05, P>0.05). In cases with anatomical liver resection, the operation time, volume of intraoperative blood loss, duration of postoperative hospital stay were 210.0(150.0,285.0)minutes, 150.0(50.0,200.0)mL, 8.0(6.0,9.3)days in the portal hypertension group, versus 225.5(146.3,306.8)minutes, 100.0(50.0,250.0)mL, 7.0(6.0,9.0)days in the non-portal hypertension group, showing no significant difference in the above indica-tors between the two groups ( Z=-0.75, -0.26, -0.91, P>0.05). In cases with non-anatomical liver resection, the operation time, volume of intraoperative blood loss, duration of postoperative hospital stay were 173.5(120.0,231.5)minutes, 175.0(50.0,300.0)mL, 7.0(5.0,11.0)days in the portal hyper-tension group, versus 186.0(123.0,262.5)minutes, 100.0(50.0,200.0)mL, 7.0(5.0,9.5)days in the non-portal hypertension group, showing no significant difference in the above indicators between the two groups ( Z=-0.97, -1.12, -0.98, P>0.05). Conclusion:Minimally invasive liver resection or even major liver resection is safe and feasible for screened HCC patients complicated with portal hyper-tension, but attention should be paid to the prevention and treatment of postoperative complications.

Application value of cystic plate approach for extrahepatic right hepatic pedicle dissection in minimally invasive anatomic liver resection / 中华消化外科杂志

Objective:To investigate the application value of cystic plate approach (CPA) for extrahepatic right hepatic pedicle dissection in minimally invasive anatomical hepatectomy (MIALR).Methods:The retrospective cohort study was conducted. The clinicopathological data of 42 patients with primary liver cancer who underwent laparoscopic right hemi-hepatectomy in Nanfang Hospital of Southern Medical University from August 2020 to August 2022 were collected. There were 36 males and 6 females, aged (55±13)years. Of the 42 patients, 25 cases undergoing CPA for extrahepatic right hepatic pedicle dissection were divided into the CPA group, and 17 cases undergoing traditional approach for extrahepatic right hepatic pedicle dissection were divided into the traditional approach group. Observation indicators: (1) surgical situations; (2) postoperative situations. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the t test. Measurement data with skewed distribution were represented as M( IQR), and comparison between groups was conducted using the Mann?Whitney U test. Count data were described as absolute numbers, and comparison between groups was conducted using the chi?square test or Fisher exact probability. Comparison of ordinal data was conducted using the non‐parameter rank sum test. Results:(1) Surgical situations. All patients in the two groups underwent laparoscopic right hemi-hepatectomy successfully, with the surgical margin as negative. The operative time, volume of intraoperative blood loss, time of dissection of the targeted hepatic pedicle, cases undergoing dissection of the trunk of right anterior hepatic pedicle and its operation time, cases undergoing dissection of the trunk of right posterior hepatic pedicle and its operation time, cases with hepatic pedicle injury, cases with hepatic tissue injury, cases with dissection space as large and small were 150.00(130.00)minutes, 100.00(100.00)mL, 472.00(201.00)seconds, 10 and 366.00(94.75)seconds, 9 and 564.00(138.50)seconds, 2, 2, 25, 0 in patients of the CPA group, versus 140.00(113.00)minutes, 100.00(125.00)mL, 670.00(107.00)seconds, 8 and 663.00(136.00)seconds, 7 and 783.00(189.00)seconds, 8, 5, 2, 19 in patients of the traditional approach group. There were significant differences in the time of dissection of the targeted hepatic pedicle, time of dissection of the trunk of right anterior hepatic pedicle, time of dissection of the trunk of right posterior hepatic pedicle, hepatic tissue injury, dissection space between the two groups ( Z=-4.809, -3.254, -3.188, χ2=6.493, 34.314, P<0.05) and there was no significant difference in the operation time, volume of intraoperative blood loss, dissection of the trunk of right anterior hepatic pedicle, dissection of the trunk of right posterior hepatic pedicle, hepatic tissue injury between the two groups ( Z=-0.282, -0.412, χ2=0.095, 0.002, 1.976, P>0.05). (2) Postoperative situations. There was no patient undergoing postoperative hemorrhage in both of the two groups. The alanine transaminase (ALT), aspartate transaminase (AST), total bilirubin (TBil) and prothrombin time (PT) at postoperative day 3, cases with postoperative biliary fistula, pathological type of tumor (hepatocellular carcinoma, intrahepatic cholangiocarcinoma) were 68.00(48.50)U/L, 52.00(35.50)U/L, 28.30(12.35)mmol/L, 12.40(2.40)seconds, 2, 21, 4 in patients of the CPA group. The above indicators were 58.00(25.00)U/L, 41.00(19.50)U/L, 26.80(14.25)mmol/L, 12.50(2.95)seconds, 5, 15, 2 in patients of the traditional approach group. There was no significant difference in the ALT, AST, TBil, PT at postoperative day 3, cases with postoperative biliary fistula between the two groups ( Z=-1.218, -1.488, -0.205, -0.320, χ2=1.976, P>0.05), and there was no significant difference in the pathological type of tumor between the two groups ( P>0.05). Conclusion:Application of CPA for extrahepatic right hepatic pedicle dissection in MIALR is safe and feasible.

Classification and evolution of the surgical approach of laparoscopic hepatectomy / 中华消化外科杂志

In the past 30 years, laparoscopic hepatectomy has developed rapidly, which multi-dimensionally promoted the innovation of hepatectomy technology and strategy. This is mainly attributed to the key factors such as the improvement of domestic and foreign scholars′ under-standing of liver anatomy, the conversion and application of laparotomy technology, the expansion of laparoscopic vision and the feedback in surgery related fields. The authors summarize the enlighten-ment, development, promotion and sublimation of laparoscopic hepatectomy, and discuss the classi-fication and evolution of the surgical approach of laparoscopic hepatectomy.

Comparision between laparoscopic hepatectomy and open hepatectomy for recurrent hepatocellular carcinoma / 中华肝胆外科杂志

Objective To compare the safety and short-term efficacy of laparoscopic repeat hepatectomy (LRH) with open repeat hepatectomy (ORH) for recurrent hepatocellular carcinoma (rHCC).Methods The clinical data of 33 patients with rHCC who underwent hepatectomy at Nanfang Hospital,Southern Medical University from August 2015 to November 2017 were retrospectively analyzed.There were 24 males and 9 females.The patients were divided into LRH group (n=15) and ORH group (n=18).The preoperative clinical data,operative and postoperative data of the two groups were compared.Results No significant differences were observed in the preoperative clinical data of the two groups,including the extent of the previous hepatectomy,the interval between the two surgeries,the number of tumors,and the maximum diameter of tumors.No significant differences were observed in the liver resection method,portal occlusion time and operation duration between the two groups.Blood loss was significantly lower in the LRH group [(66.7±86.1) ml vs.(251.1±75.6) ml,P＜0.05].The total hospitalization expenses,first postoperative white blood cell count,and hepatic insufficiency in the two groups were not significantly different (P＞0.05).The postoperative diet recovery was significantly shorter (1.2±0.4) days vs.(2.9± 1.4) days,the inflammation indicator NEU％ was significantly decreased (83.6±4.8)％ vs.(88.2±3.7)％,and the length of postoperative hospital stay (6.3±2.9) days vs.(9.8± 3.7)days was significantly shorter in the LRH group (P＜0.05).Conclusions LRH was safe and effective in the treatment of rHCC,LRH was superior in reducing intraoperative blood loss,promoting postoperative recovery and shortening hospital stay when compared to ORH.

Risk factors analysis and prognosis of the microvascular invasion of hepatocellular carcinoma / 中华消化外科杂志

Objective To explore the risk factors and prognosis of the microvascular invasion of hepatocellular carcinoma (HCC).Methods The retrospective case-control study was conducted.The clinicopathological data of 220 patients with HCC who were admitted to the Nanfang Hospital of Southern Medical University from July 2012 to July 2015 were collected.Among 220 patients,63 were confirmed with microvascular invasion of HCC by postoperative pathological examination after radical resection of HCC and 157 were not confirmed with microvascular invasion of HCC.Observation indicators:(1) univariate and multivariate analyses affecting microvascular invasion of HCC;(2) follow-up and survival situations.Follow-up using outpatient examination and telephone interview was performed to detect patients' survival and tumor recurrence up to July 2016.The univariate and multivariate analyses were done using the Logistic regression model.The survival curve and survival rate were respectively drawn and calculated by the Kaplan-Meier method,and the Log-rank test was used for survival analysis.Results (1) Univariate and multivariate analyses affecting microvascular invasion of HCC:the results of univariate analysis showed that maximum diameter of tumor,preoperative alpha-fetoprotein (AFP) and preoperative platelet (PLT) were related factors affecting microvascular invasion of HCC [OR =4.542,1.576,3.655,95％ confidence interval (CI):2.433-8.470,1.084-2.292,1.985-6.831,P＜0.05].The results of multivariate analysis showed that maximum diameter of tumor,preoperative AFP and preoperative PLT were independent factors affecting microvascular invasion of HCC (RR=3.386,1.563,2.247,95％CI:1.703-6.729,1.054-2.318,1.135-4.451,P＜0.05).(2) Follow-up and survival situations:220 patients were followed up for 12-48 months,with a median time of 26 months.The postoperative overall 1-and 2-year survival rates,postoperative 1-and 2-year tumor-free survival rates were 77.3％,50.0％,47.3％,38.0％ in 63 patients with microvascular invasion of HCC and 92.4％,77.2％,74.5％,69.4％ in 157 patients without microvascular invasion of HCC,with statistically significant differences (x2 =10.480,19.605,14.677,18.461,P＜ 0.05).Conclusion The maximum diameter of tumor,preoperative AFP and preoperative PLT are independent factors affecting microvascular invasion of HCC,and patients with microvascular invasion of HCC have poor clinical prognosis.

Precise hepatectomy and irregularity hepatectomy in treatment of primary liver cancer:a comparative study / 实用医学杂志

Objective To evaluate the value of precise hepatectomy in treatment of early-stage primary liver cancer after radical resection. Methods Between June 2012 and July 2014,174 patients undergoing radical resection of hepatocellular carcinoma were enrolled in this comparative study at Nan fang Hospital. 118 patients with liver resection under precise hepatectomy were assigned to precise resection group and 56 patients with liver resection under Pringle maneuver were assigned to occlusion group. The two groups were compared in terms of preoprational clinical pathological and laboratory data ,volume of intraoperative bleeding and blood transfusion , postoperative hepatic function recovery,hospitalization days,and postoperative tumor-free survival rate of 1,2 years. Results There was no significant difference between the two groups in the sex,age,liver disease,preo-pration albumin,ALT,AST,alcohol intake and liver cirrhosis(P>0.05). No differences between the two groups were found about the volume of intraoperative bleeding and blood transfusion as well as surgery cost (P > 0.05). The recovery of hepatic function was accelerated and the incidence of complications ,hospitalization days and peri-od of drainage were significantly reduced in the precise resection group compared with the occlusion group (P <0.05). The 1,2-years postoperative tumor-free survival rate was 79.7%(94/118),60.9%(46/118)in the precise group and 50.0%(28/56),46.4%(26/56) in the occlusion group ,with significant difference between them (χ2=4.741,8.722,P<0.05). Conclusions For early-stage liver cancer patients,the precise hepatectomy during radical resection results in quick recovery and fewer complications ,thus it should be the first choice of clinical operation.

Risk factors analysis and prognosis of the microvascular invasion of hepatocellular carcinoma / 中华消化外科杂志

Objective To explore the risk factors and prognosis of the microvascular invasion of hepatocellular carcinoma (HCC).Methods The retrospective case-control study was conducted.The clinicopathological data of 220 patients with HCC who were admitted to the Nanfang Hospital of Southern Medical University from July 2012 to July 2015 were collected.Among 220 patients,63 were confirmed with microvascular invasion of HCC by postoperative pathological examination after radical resection of HCC and 157 were not confirmed with microvascular invasion of HCC.Observation indicators:(1) univariate and multivariate analyses affecting microvascular invasion of HCC;(2) follow-up and survival situations.Follow-up using outpatient examination and telephone interview was performed to detect patients' survival and tumor recurrence up to July 2016.The univariate and multivariate analyses were done using the Logistic regression model.The survival curve and survival rate were respectively drawn and calculated by the Kaplan-Meier method,and the Log-rank test was used for survival analysis.Results (1) Univariate and multivariate analyses affecting microvascular invasion of HCC:the results of univariate analysis showed that maximum diameter of tumor,preoperative alpha-fetoprotein (AFP) and preoperative platelet (PLT) were related factors affecting microvascular invasion of HCC [OR =4.542,1.576,3.655,95％ confidence interval (CI):2.433-8.470,1.084-2.292,1.985-6.831,P＜0.05].The results of multivariate analysis showed that maximum diameter of tumor,preoperative AFP and preoperative PLT were independent factors affecting microvascular invasion of HCC (RR=3.386,1.563,2.247,95％CI:1.703-6.729,1.054-2.318,1.135-4.451,P＜0.05).(2) Follow-up and survival situations:220 patients were followed up for 12-48 months,with a median time of 26 months.The postoperative overall 1-and 2-year survival rates,postoperative 1-and 2-year tumor-free survival rates were 77.3％,50.0％,47.3％,38.0％ in 63 patients with microvascular invasion of HCC and 92.4％,77.2％,74.5％,69.4％ in 157 patients without microvascular invasion of HCC,with statistically significant differences (x2 =10.480,19.605,14.677,18.461,P＜ 0.05).Conclusion The maximum diameter of tumor,preoperative AFP and preoperative PLT are independent factors affecting microvascular invasion of HCC,and patients with microvascular invasion of HCC have poor clinical prognosis.

Precise hepatectomy and irregularity hepatectomy in treatment of primary liver cancer:a comparative study / 实用医学杂志

Objective To evaluate the value of precise hepatectomy in treatment of early-stage primary liver cancer after radical resection. Methods Between June 2012 and July 2014,174 patients undergoing radical resection of hepatocellular carcinoma were enrolled in this comparative study at Nan fang Hospital. 118 patients with liver resection under precise hepatectomy were assigned to precise resection group and 56 patients with liver resection under Pringle maneuver were assigned to occlusion group. The two groups were compared in terms of preoprational clinical pathological and laboratory data ,volume of intraoperative bleeding and blood transfusion , postoperative hepatic function recovery,hospitalization days,and postoperative tumor-free survival rate of 1,2 years. Results There was no significant difference between the two groups in the sex,age,liver disease,preo-pration albumin,ALT,AST,alcohol intake and liver cirrhosis(P>0.05). No differences between the two groups were found about the volume of intraoperative bleeding and blood transfusion as well as surgery cost (P > 0.05). The recovery of hepatic function was accelerated and the incidence of complications ,hospitalization days and peri-od of drainage were significantly reduced in the precise resection group compared with the occlusion group (P <0.05). The 1,2-years postoperative tumor-free survival rate was 79.7%(94/118),60.9%(46/118)in the precise group and 50.0%(28/56),46.4%(26/56) in the occlusion group ,with significant difference between them (χ2=4.741,8.722,P<0.05). Conclusions For early-stage liver cancer patients,the precise hepatectomy during radical resection results in quick recovery and fewer complications ,thus it should be the first choice of clinical operation.

Related factors of liver cancer recurrence associated with hyperglycemia after radical resection of liver cancer / 中华消化外科杂志

Objective To investigate the related factors of early liver cancer recurrence associated with elevated fasting glucose levels after radical resection of liver cancer.Methods The retrospective cohort study was adopted.The clinical data of 145 patients with liver cancer who were admitted to the Nanfang Hospital of Southern Medical University from October 2009 to June 2013 werc collected.After radical resection of liver cancer, 111 patients with average level of fasting blood glucose (FBG) ＜ 6.1 mmol/L and 34 patients with level of FBG ≥ 6.1 mmol/L were divided into the normal group and the hyperglycemic group, respectively.The blood glucose levels of patients during the period of hospital stay and follow-up were observed.The status of early recurrence and risk factors affecting recurrence in the 2 groups were analyzed.Follow-up of outpatient examination was applied to patients up to July 1, 2015 with the first recurrence as the end point.Patients had reexaminations once every month within postoperative month 6 and once every 3 months after 6 months.The general information [gender, age, FBG, underlying hepatopathy, preoperative AFP, alanine transaminase (ALT), aspartate aminotransferase (AST), Child-Pugh stage, Barcelona Clinic Liver Cancer (BCLC) stage, history of alcohol drinking], surgical data (surgical method, operation time, number of blood transfusion, volume of intraoperative blood loss), pathological data (histopathological differentiation, number of tumor nodules, diameter of maximal tumor, liver cirrhosis) and follow-up data (postoperative AFP, imaging findings, recurrence time, preventive chemotherapy) were collected.Measurement data with normal distribution were presented as-x ± s and analyzed by the t test.Measurement data with skewed distribution were presented as M (range) and analyzed by the non-parametric test.Count data were analyzed using the chi-square test.With the first recurrence as the end point, the tumor-free survival rate was drawn using the Kaplan-Meier method, and the comparison was analyzed by the logrank test.The risk factors affecting recurrence were analyzed using the Kaplan-Meier method for proportional hazards assumption test firstly, and then eligible factors were done using Log-rank test in the univariate analysis.The multivariate analysis was done using the COX model.Results The postoperative 1-, 2-year overall recurrence rates of liver cancer were 28.3％ (41/145) and 45.5％ (66/145).And 1-, 2-year recurrence rates of liver cancer were 21.6％ (24/111) and 36.9％ (41/111) in the normal group and 50.0％ (17/34) and 73.5％ (25/34) in the hyperglycemic group, respectively, showing significant differences between the 2 groups (x2=10.335, 14.053, P ＜ 0.05).The univariate analysis showed that FBG, Child-Pugh stage, volume of intraoperative blood transfusion and postoperative AFP were risk factors affecting tumor-free survival rate after radical resection of liver cancer (x2 =17.591,6.492, 10.690,12.820, P ＜ 0.05).The tumor-free survival rates at postoperative month 24 in the normal group and hyperglycemic group were 63.1％ and 26.5％ respectively, showing significant difference between the 2 groups (x2=17.591, P ＜ 0.05).The results of multivariate analysis showed that level of FBG ≥6.1 mmol/L, volume of intraoperative blood transfusion ＞ 200 mL and postoperative level of AFP ＞ 8.1 pg/L were independent risk factors affecting tumor-free survival rate after radical resection of liver cancer (RR =2.542, 2.028, 2.724, 95 ％ condifence interval : 1.529-4.225,1.183-3.479,1.635-4.538, P ＜ 0.05).Conclusions Elevated FBG level has a stimulative effect on early recurrence of tumor after radical resection of liver cancer.As a result, monitoring and controlling of blood glucose after operation is helpful in decreasing the early recurrence rate of patients with liver cancer.

Searching of journal club and lab meeting jointly applied to academic postgraduate training of obstetrics and gynecology / 中华医学教育探索杂志

Academic medical postgraduate recruitment and training is facing a new dilemma due to the overall implementation of resident standardization training and the combination of postgraduate education in professional master degree of clinical medicine and resident standardization training.We optimize and marry together journal club and lab meeting education methods in academic medical postgraduate training of obstetrics and gynecology on the basis of its teaching characteristics, and develop a new form of academic graduate student training of obstetrics and gynecology.This new method is expected to effectively improve the academic postgraduates' research interests, research capacity and the teaching quality of obstetrics and gynecology for academic postgraduates.

Diagnosis, treatment, and nutritional support strategy of malignant bowel obstruction induced by peritoneal metastasis of gastric cancer / 中国肿瘤临床

Gastric cancer is one of the most common types of cancer worldwide. In China, approximately 42%of new cancer cas-es are documented. However, the prognosis of advanced gastric cancer remains poor because of high recurrence and metastatic rates. In gastric cancer patients with peritoneal metastasis, malignant bowel obstruction (MBO) is often detected. Many of these patients endure excruciating pain because of ineffective diagnosis and treatment. In recent years, the symptoms of many patients with MBO have been effectively relieved after somatostatin and other drugs have been administered. Other patients with MBO have been provided the chance to undergo chemotherapy, and their survival time has been prolonged. Hence, the diagnosis and treatment of these patients could be im-proved by further advancements in basic and clinical research in cancer therapy.

Early prognosis judgment in adult recipients after first liver transplantation / 中华消化外科杂志

Objective To judge the prognosis of adult recipients after first liver transplantation by stepwise discriminant analysis,and screen out the main influencing factors.Methods The clinical data of 221 patients who received liver transplantation at the Nanfang Hospital of Southern Medical University were retrospectively analyzed.A total of 218 patients who met the criteria were divided into the training samples (188 patients admitted from August 2004 to June 2010) and checking samples (30 patients admitted from July 2010 to February 2011),and then all patients were re-divided into dead group (survival time ≤ 90 days,34 patients) and surviving group (survival time ＞ 90 days,184 patients).Factors which had significant difference after the univariate analysis was further analyzed by the stepwise discriminant analysis method.All data were analyzed by the t test,rank sum test,chi-square test or Fisher exact probability test.Results The ages of the recipients in the dead group and the living group were (54 ± 11)years and (51 ± 11)years,respectively,with no significant difference between the 2 groups (t =-1.681,P ＞ 0.05).The preoperative levels of hemoglobin in the dead group and the living group were 106.7 g/L and 119.2 g/L,respectively,with a significant difference between the 2 groups (t =2.809,P ＜ 0.05).There were significant differences in the levels of serum creatinine,urea nitrogen,albumin,total bilirubin,indirect bilirubin,Na+,prothrombin time,activated partial thromboplastin time,international normalized ratio,fibrinogen,prothrombin activity,platelet,nutrition risk index,model for end-stage liver disease score,number of patients with preoperative hepatic encephalopathy (HE),preoperative hepatorenal syndrome (HRS),preoperative digestive tract bleeding,preoperative infection,preoperative diabetes,Child-Turcotte-Pugh score,cardiac function classification and anesthesia risk rating operation time,anhepatic time,volume of intraoperative blood transfusion,volume of peritoneal effusion ; intraoperative urine output,between the 2 groups (Z =-2.277,-2.595,-3.290,-3.486,-2.562,-2.577,-3.670,-3.882,-3.625,-3.557,-3.837,-1.974,-3.693,-3.815,x2 =19.632,9.756,28.143,Z =-4.175,-3.905,-4.865,-3.564,-5.822,P ＜ 0.05).Preoperative HE,preoperative HRS,duration of operation,intraoperative blood transfusion and intraoperative volume of urine were the independent influencing factors of early prognosis after liver transplantation.The standardized partial regression coefficients were 0.146,0.188,0.257,0.181,-0.340,89.9％ (169/188) of the training samples and 90.0％ (27/30) of the checking samples were correctly classified.Conclusion Based on factors including HRS,HE,intraoperative blood transfusion,intraoperative volume of urine and duration of operation,the early prognosis can be judged in adult recipients after first liver transplantation.

Effects of Survivin Antisense RNA on Apoptosis and Reversing Drug Resistance of SGC7901 Cells / 中国普外基础与临床杂志

Objective To study the effects of survivin antisense RNA on SGC7901 cell’s apoptosis and chemosensitivity to taxotere, and to investigate its effect on the expression of multi-drug resistance gene-1 (MDR-1). Methods Survivin antisense eukaryotic vector anti-pcDNA3-svv was transfected into SGC7901 cell lines by lipofectamine and positive clones were screened out then. Survivin protein and MDR-1 mRNA were measured by western blot and RT-PCR, respectively. Apoptosis that was induced by anti-pcDNA3-svv was observed by electronic microscope, and the sensitivity of SGC7901 cell to taxotere was examined by MTT. Results The expressions of survivin protein and MDR-1 mRNA in transfected SGC7901 cells both decreased more significantly than that of non-transfected cells (P

Analysis of comparative genomic hybridization and loss of heterozygosity in 43 primary gastric carcinomas / 中华医学杂志(英文版)

<p><b>OBJECTIVE</b>To investigate common chromosomal changes and the LOH frequency of microsatellite loci in primary gastric cancer samples in order to locate the deleted regions in which human gastric cancer related genes might exist.</p><p><b>METHODS</b>Comparative genomic hybridization (CGH) was used to define global chromosomal aberrations in 43 primary gastric tumors. Based on the results of CGH, analysis of loss of heterozygosity (LOH) was performed in chromosome 19 in which the loss was first discovered in the gastric cancers. The PCR-based approach was used to investigate 22 loci, which are spaced at 1.1 - 10.9 cM intervals throughout chromosome 19. The amplified PCR fragments were subjected to electrophoresis in PAGE gel and analyzed with Genescan trade mark and Genotyper trade mark.</p><p><b>RESULTS</b>CGH analysis revealed gains in chromosome 3p (8/43), 8q (8/43), 20 [20 (9/43), 20p (7/43), 20q (4/43)], 12q (16/43), 13q (12/43) and losses in 19 [19 (15/43)], 7 [17 (8/43), 17p (10/43)], 16 (10/43) and 1p (11/43). Among the 43 evaluated samples, the most frequent LOH was detected at locus D19S571 (27.81%).</p><p><b>CONCLUSIONS</b>The tumorigenesis of gastric cancer includes several chromosomal changes. The aberration of chromosome 19 was the first common change founded in gastric cancer. The region near the D19S571 might harbor potential genes related to the tumorigenesis of gastric cancer.</p>

Adenovirus mediated PML growth suppressor induces apoptosis of gastric cancer cells / 中国普通外科杂志

Objective To investigate the apoptosis induced by adenovirus mediated PML growth suppressor in SGC-7901 gastric cancer cells. Methods Human full-length PML cDNA was cloned into shuttle plasmid pSGCMV, the constructed plasmid containing PML gene was co-transfected into 293 cells together with backbone plasmid pPE3 to obtain recombinant adenovirus Ad-pml. Ad-pml was used to infect SGC-7901 cells. The expression of p53 and bcl-2 in SGC-7901 cells and qualitative, quantitative index of cell apoptosis were detected with MTT, flow cytometry and immunohistochemical method. Results The growth of SGC-7901 cells was inhibited and the apoptosis rate was increased by adenovirus mediated PML in a MOI- dependent manner. The expression of p53 protein was increased and that of bcl-2 protein was unchanged in SGC-7901 cells after treated with adenovirus mediated PML. Conclusions Adenovirus mediated PML exerts its cytotoxic effect on SGC-7901 cells by inducing apoptosis. The increase of p53 protein expression is the mechanism inducing gastric cancer cell apoptosis.

Apoptosis-inducing effect of vp3 gene on human breast carcinoma / 中国普通外科杂志

Objective To construct recombinant plasmid pcDvp3 and observe the apoptosis-inducing effect of vp3 gene on human breast cancer cell line-435. Methods (1) vp3 gene was cloned into the plasmid pcDNA3.1 to form the recombinant plasmid pcDvp3. Then the nucleotides sequencing was processed. (2) 48h after transfection of pcDvp3 and pcDNA3.1 into breast cancer cell lines-435,optical microscopy, electric-microscopy, agarose electrophoresis and flow cytometry were used to verify apoptosis of tumor cells.(3)Nude mouse model of human breast cancer cells -435 was established to observe the tumor-inhibiting rate and TUNEL was adopted to identify apoptosis. Results (1) Sequence analysis justified the recombination of plasmid pcDvp3. (2) 48h after transfection into breast cancer cells-435, distinct morphological transformation and typical apoptosis bodies were observed, agarose electrophoresis of genomic DNA showed typical ladder-like pattern and flow cytometry analysis showed apoptosis peaks with the percentage of 14.42%. (3) Tumor-inhibiting rates in pcDvp3 groups were 65.52% and 68.23%, much higher than that in pcDNA3.1 group(t=4.06,P

The expression of MMR、p53、Bax、PCNA and microsatellite instability in multiple primary colorectal cancer / 中国普通外科杂志

Objective To study microsatellite instability(MSI) in multiple primary colorectal carcinoma(MPCC) and solitary colorectal tumor(SCT), and to explore the relationship between the expression of mismatch repair(MMR)、p53、Bax、PCNA and MSI. Methods The expression of MMR、p53、Bax、 PCNAwere detected by immunohistochemical staining, and MSI at five microsatellite loci were examined by PCR-SSLP in 51 tumors from 38 MPCC patients and 35 SCT cases. Results The replication errors positive phenotype was observed in 27 of 51(53%) tumor foci from MPCC cases, and in 6 of 35(17%) SCT cases. There was an inverse correlation between replication errors (RER) positive and expression of p53; the PCNA labeling index of RER positive tumors were significantly lower than of RER negative tumors; RER positive related strongly with poor differentiation, the proclivity for proximal colon. Conclusions MSI may play an important role in the development of MPCC and may be used as a tumor marker of MPCC.