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Objective To compare the lung injury in thoracoscopic cardiac surgery with one-lung ventilation (OLV) and thoracotomy cardiac surgery.Methods A total of 60 patients underwent thoracotomy cardiac surgery (control group) or thoracoscopic cardiac surgery with OLV (observation group) in our hospital from May 2013 to December 2015 were enrolled,30 patients in each group.Two-lung ventilation was performed with a single-lumen endotracheal tube in the control group.In observation group,left lung ventilation was performed with a double-lumen endotracheal tube.Arterial blood gas analysis parameters,levels of intercellular adhesion molecule-1 (ICAM-1) and surfactant protein A (SP-A) were detected after the induction of anesthesia (T1),before cardiopulmonary bypass (CPB)(T2),immediately after the onset of the CPB (T3),30 min after CPB (T,) and 60 min after CPB (T5),and the respiratory index (RI) was calculated at the above time points,as well.Lung tissues were collected during operation for nuclear factor-κB (NF-κB) detection and pathological analysis.Results Compared with the control group,arterial partial pressures of oxygen (PaO2) were decreased at T3,T4 and T5,and RI values were increased at T2,T3,T4 and T5 in the observation group(P＜ 0.05).After surgery,the serum levels of ICAM-1 and expression levels of NF-κB in both two groups were increased,and serum levels of SP-A in both two groups were decreased;moreover,the levels of ICAM-1 and NF-κB in the observation group were significantly higher than those in the control group (P＜0.05),and the level of SP-A in the observation group was significantly lower than that in the control group (P＜0.05).The lung histopathological changes showed alveolar swelling,neutrophil infiltration and interstitial exudation in the observation group,and inflammation in the observation group was more obvious than that in the control group.Conclusion Comparing with thoracotomy cardiac surgery,lung injury is more serious in thoracoscopic cardiac surgery with OLV.
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Objective To compare the lung injury in thoracoscopic cardiac surgery with one-lung ventilation (OLV) and thoracotomy cardiac surgery.Methods A total of 60 patients underwent thoracotomy cardiac surgery (control group) or thoracoscopic cardiac surgery with OLV (observation group) in our hospital from May 2013 to December 2015 were enrolled,30 patients in each group.Two-lung ventilation was performed with a single-lumen endotracheal tube in the control group.In observation group,left lung ventilation was performed with a double-lumen endotracheal tube.Arterial blood gas analysis parameters,levels of intercellular adhesion molecule-1 (ICAM-1) and surfactant protein A (SP-A) were detected after the induction of anesthesia (T1),before cardiopulmonary bypass (CPB)(T2),immediately after the onset of the CPB (T3),30 min after CPB (T,) and 60 min after CPB (T5),and the respiratory index (RI) was calculated at the above time points,as well.Lung tissues were collected during operation for nuclear factor-κB (NF-κB) detection and pathological analysis.Results Compared with the control group,arterial partial pressures of oxygen (PaO2) were decreased at T3,T4 and T5,and RI values were increased at T2,T3,T4 and T5 in the observation group(P＜ 0.05).After surgery,the serum levels of ICAM-1 and expression levels of NF-κB in both two groups were increased,and serum levels of SP-A in both two groups were decreased;moreover,the levels of ICAM-1 and NF-κB in the observation group were significantly higher than those in the control group (P＜0.05),and the level of SP-A in the observation group was significantly lower than that in the control group (P＜0.05).The lung histopathological changes showed alveolar swelling,neutrophil infiltration and interstitial exudation in the observation group,and inflammation in the observation group was more obvious than that in the control group.Conclusion Comparing with thoracotomy cardiac surgery,lung injury is more serious in thoracoscopic cardiac surgery with OLV.
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Combined hepatocellular and cholangiocarcinoma (HCC-CC) is a unique primary epithelial tumor of the liver classified by the WorldHealth Organization (WHO) as a tumor containing elements of both hepatocellular carcinoma (HCC) and cholangiocarcinoma (CC).The clinical diagnosis is established by histopathology and a firm pathological diagnosis from definitive evidence of HCC and CC differentiation.HCC-CC's clinical features tend to resemble hepatocellular carcinoma in regards to venous infiltration and like cholangiocarcinoma with respect to lymph node metastasis.To date,the biological behavior of HCC-CC remains ill-defined; however its prognosis seems to be worse than just HCC.Conversely,it is unclear whether the prognosis of HCC-CC is better than that of only ICC.This paper reviews recent studies on the clinicopathological behavior of HCC-CC.
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<p><b>OBJECTIVE</b>To evaluate the efficacy of transarterial embolization (TAE) for intraperitoneal hemorrhage due to spontaneous rupture in hepatocellular carcinoma (HCC).</p><p><b>METHODS</b>Fourty-two patients with ruptured HCC were divided into 4 groups according to the type of their previous treatment: Group A-TAE followed by elective hepatectomy 15, Group B- TAE alone 11, Group C-emergency operation 6 and group D-medical conservative management 10.</p><p><b>RESULTS</b>Celiac arteriography done before the present treatment showed extravasation of contrast material in 7 (26.9%) of the 26 patients in group A and B, and hypervascular tumor was observed in the rest. The hemostasis success rate of group A, B and C were 100%, which were much higher than that of group D (40%) (P < 0.05). The in-hospital mortality rates of group A, B and C were 0, 3.8% and 16.7% (P > 0.05), which were much lower than that of group D (80%) (P < 0.01). The 1-year survival rate of group A (76.3%) was higher than those in groups B (47.5%) and C (43.7%) (P < 0.05). There was no 1-year survivor in group D.</p><p><b>CONCLUSION</b>Transarterial embolization is safe and effective for hemorrhage due to spontaneous rupture in hepatocellular carcinoma. For resectable lesions, TAE is a preferential treatment to be given first, then followed by elective hepatectomy.</p>
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Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Carcinoma Hepatocelular , Cirurgia Geral , Embolização Terapêutica , Hemorragia , Terapêutica , Neoplasias Hepáticas , Cirurgia Geral , Ruptura EspontâneaRESUMO
Objective To investigate the clinicopathological features of primary hepatic lymphoma (PHL).Methods Data of 5 PHL cases treated at our hospital between 1998 and 2002 were retrospectively analyzed. Results The patients were all male with a mean age of 43 6 years. Abdominal pain and fever were the most frequent presenting symptoms. Four (80%) were positive for the hepatitis B virus antigen. Tumors were all removed surgically in the 5 patients. Pathologic examination revealed B cell lymphoma, T cell lymphoma and Hodgkin′s disease in 2, 2 and 1 patients, respectively. Moreover, coexistent tumors were incidentally discovered by histology in 2 cases. ConclusionThere seems to be a close relationship between hepatitis B virus infection and the development of PHL; PHL should always be considered in the differential diagnosis for patients presenting with mass lesions in the liver; Surgical resection whenever feasible should be attempted as a part of combination modalities.
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We used retroviral vector pLXSN to construct recombinant retroviral vectors with the human apoptosis gene, interleukin-l? converting enzyme (ICE). The vectors were introduced into packaging cell line PA317 by electroporation method. The G418 resistant colonies were selected, and the supematants of the colonies were used to infect the human hepatocellular carcinoma cell line SMMC7721. G418 resistant colonies of SMMC7721 were named SMMC7721-MCE and SMMC7721-neo. The results of RT-PCR analysis showed that exogenous hICE gene had successfully integrated into the genome of SMMC7721-hICE cells. The proliferation rate and tumorigenicity of cells in nude mice were examined. Our data showed that the growth rate and the tumorigenicity of SMMC7721-hICE cells in nude mice were considerablely decreased comparing with parent SMMC7721 and SMMC7721-neo. These results suggested that the retroviral vector expressing hICE gene was successfully constructed and could suppress the growth ability and tumorigenicity of human hepatocellular carcinoma cells, which provided a basis for further investigation of hICE gene therapy.
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This paper reported 65 cases of hepatectomy on patients with intrahepatic cholelithiasis, among which 62 were left lateral lobectomy, 2 left hemihepatectomy and 1, right hemihepatectomy. The incidence of postoperative complication was 21.5%: incision infection (8 cases), subphrenic abscess (3 cases), biliary fistula (1 case), and septicemia and duodenal fistula which caused the death of the patients (one each). The complications are related to the number of previous operations, the biliary infection and the improper drainage. Attention should be paid to the following aspects to prevent complications: (1) strict observation of indications for hepatectomy; (2) correct management of the raw surface; (3) adequate maintenance of bile drainage; (4) proper choice of drains.
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The purpose of this study was to retrospectively analyse the results of 1102 primary liver cancer (PLC) patients underwent liver resection in the past thirty years and to search some effective approaches for improving the longterm effect or PLC treatment. 95% were with hepatocellular carcinoma (HCC), 85.2% with cirrhosis of hepatitis and 25.6% with tumor equal to or smaller than 5 cm in diameter. The mortality rate (MR) within 1 month after operation was 1.8%, the operative MR was 8.8% before 1977 and only 0.4% after that. The total 5-year survival rate (SR) was 28.2% while in the group of small tumor (≤5cm), it was 75.0%. Our experience was as follows: (1) Early diagnosis and early resection of PLC is the key point for improving the operative result of longterm survival. In 282 cases of small cancer, tumor resection rate was 90.0%. Of 48 cases of tumor equal to or smaller than 3 cm in diameter, the 5-year SR was 83.3%. (2) .Rehepatectomy for recurrent liver cancer is an important approach for improving the surgical result. In our series, recurrent rate within 5 years postoperation was 72.3% in larger tumor group and 34.5% in small tumors. There were 78 cases undergoing reoperation in a total number of 170 times of rehepatectomy with 54.7% of 5-year SR after the 1st operation and 34.6% after the 2nd one. (3) For unresectable large tumors, two-stage operation is an important development in liver surgery. We had 26 cases of such patients with 60.0% of 5-year SR. (4) Improvement of operating techniques plays an important role in reducing postoperative complications, lowering operative mor- tality and obtaining better operative result. (5) Postoperative comprehensive treatments are also important for solidating operative effect and preventing tumor recurrence.