Research progress of liquid biopsy in the diagnosis and treatment of hepatocellular carcinoma / 国际外科学杂志

Liver cancer is the second largest cancer in China, with the majority being hepatocellular carcinoma(HCC), which has a significant adverse impact on the lives and health of the Chinese people. Liquid biopsy is a new type of examination method with peripheral blood as the main examination subject. Compared with conventional tumor tissue pathology, liquid biopsy has less trauma, and the detection items can more accurately represent a certain tumor tissue group, more directly reflect the biological behavior of tumor tissue in the patient′s body. It is widely used in tumor screening, staging and grading, tumor individualized treatment monitoring, and prognosis evaluation. The following is mainly about the diagnosis, therapeutic effect evaluation and prognosis prediction of liquid biopsy in HCC from three aspects: circulating tumor DNA (ctDNA), exosome and circulating tumor cells (CTC), and the challenges faced by liquid biopsy technology at present are briefly described and its future development is prospected.

Progress in the diagnosis and treatment of pancreatic duct stones / 中华肝胆外科杂志

Pancreatic duct stones are one of the benign pancreatic diseases. It is often combined with chronic pancreatitis. The disease will progress to pancreatic cancer without timely treatment, thus reducing the quality of life of patients and seriously affecting their physical and psychological health. In recent years, with the development of imaging technology, the detection rate of pancreatic duct stones has been increasing year by year. This article reviewed the etiology, diagnosis and treatment strategies for pancreatic duct stones in recent years.

Selection of surgical treatment for Bismuth-Corlette type III and IV hilar cholangiocarcinoma / 中华肝胆外科杂志

Objective:To analyze the efficacy and prognosis of different surgical treatments for Bismuth-Corlette type III and IV hilar cholangiocarcinoma (HCCA).Methods:The clinical data of 86 Bismuth-Corlette type III and IV HCCA patients treated at the First Affiliated Hospital of Anhui Medical University from January 2010 to December 2016 were retrospectively analyzed. There were 45 males and 41 females with age of (59.5±10.5) years old. According to the operative method, 57 patients were included into the extended hepatectomy group, and 29 patients into the perihilar hepatectomy group. The perioperative clinical data and survival rates were compared between the two groups. Through inpatient interviews, regular outpatient or telephone follow-up, factors affecting prognosis were analyzed by univariate and multifactorial Cox regression.Results:The operative time and intraoperative blood loss in the extended hepatectomy group were significantly higher than those in the perihilar hepatectomy group, [320(270, 380) min vs. 270(210, 300) min, P<0.001; 300(200, 400) ml vs. 100(100, 150) ml, respectively P<0.001]. The incidences of ≥ Clavien-Dindo grade III complications and ISGLS grade C liver failure in the extended hepatectomy group were significantly higher than those in the perihilar hepatectomy group [36.4%(20/57) vs. 13.8% (4/29), P=0.037; 13.8% (7/57) vs. 0(0/29), respectively P=0.047]. The cumulative 1-, 3- and 5-year survival rates of the extended hepatectomy group were 89.5%, 38.6% and 19.3%, respectively. The cumulative 1-, 3- and 5-year survival rates of perihilar hepatectomy group were 86.2%, 20.7% and 10.3%, respectively. The difference between the two groups was statistically significant ( P=0.048). Multivariate analysis showed that perihilar hepatectomy ( HR=1.958, 95% CI: 1.174-3.268, P=0.010), non-R 0 resection ( HR=6.040, 95% CI: 2.915-12.513, P<0.001) and TNM stage III/IV( HR=2.144, 95% CI: 1.257-3.654, P=0.005) were independent risk factors for overall survival after surgery for HCCA patients ( P<0.01). Conclusions:Patients with Bismuth-Corlette type III and IV HCCA who received extended hepatectomy had significantly better overall survival than those patients who underwent perihilar hepatectomy. However, the incidences of surgical complications and liver failure in the extended hepatectomy group were also significantly higher.

Safety and efficacy of the controlled first hepaticportal blood flow occlusion in hepatectomy / 中华肝胆外科杂志

Objective:To determine the safety and efficacy of controlled first hepaticportal blood flow occlusion in hepatectomy.Methods:Patients who underwent hepatectomy from 1 September 2018 to 1 September 2020 at the Department of Hepatobiliary Surgery of the First Affiliated Hospital of Anhui Medical University were studied. There were 133 males and 70 females, with age of (52.9±19.2) years old. They were prospectively randomized into three groups: the intermittent Pringle’s maneuver group ( n=72), the controlled first hepaticportal blood flow occlusion group ( n=66) and the selective portal vein occlusion group ( n=65). The clinical data of these three groups before, during and after operation were analysed. Results:The amount of intraoperative bleeding in the selective portal vein occlusion group was significantly more than the intermittent Pringle’s maneuver group [(226.7±117.9) vs. (115.7±84.2) ml, P<0.05] and the controlled first hepaticportal blood flow occlusion group [(226.7±117.9) vs. (128.1±103.6) ml, P<0.05]. The total duration of operation in the selective portal vein occlusion group was significantly longer than the intermittent Pringle’s maneuver group [(173.6±51.7) vs. (128.4±36.5) min, P<0.05] and the controlled first hepaticportal blood flow occlusion group [(173.6±51.7) vs. (136.1±40.7) min, P<0.05]. The postoperative data showed the AST indexes on day 1 after surgery to be significantly different between the intermittent Pringle’s maneuver group with the controlled first hepaticportal blood flow occlusion group [(587.5±189.2) vs. (361.2±158.3) U/L, P<0.05], and the selective portal vein occlusion group [(587.5±189.2) vs. (358.2±162.7) U/L, P<0.05]. The ALT indexes on day 1 after surgery were significantly different between the intermittent Pringle’s maneuver group with the controlled first hepaticportal blood flow occlusion group [(609.4±172.5) vs. (414.8±162.2) U/L, P<0.05], and the selective portal vein occlusion group[(609.4±172.5) vs. (395.6±158.7) U/L, P<0.05]. The AST and ALT indexes on day 3 after surgery were significantly different between the intermittent Pringle’s maneuver group the controlled first hepaticportal blood flow occlusion group, and the selective portal vein occlusion group. Other liver functions, postoperative complications and recovery indexes showed no significantly differences among the three groups. Conclusions:All the three methods of hepatic blood flow occlusion were safe and efficacious. The controlled first hepaticportal blood flow occlusion method was simple to use and it provided some protective effect in alleviating hepatic ischemia reperfusion injury.

Progress in diagnosis and treatment of locally advanced pancreatic cancer / 中华肝胆外科杂志

Pancreatic cancer,one of the common malignant tumors of the digestive system,is secretive in incidence and morbidity.Eighty percent of pancreatic cancer patients have already missed the opportunity of eradicative resection surgery when they were diagnosed,among whom,thirty to fifty percent of patients are in locally advanced tumor stage (specifically signifying the local extensive infiltration of tumor with serious vascular invasion and without distant metastasis) with a five-year survival rate of five to ten percent after excision.The pathogenesis of pancreatic cancer is still unclear,with a low rate of early diagnosis due to its lack of characteristic clinical manifestations.This paper reviewed the relevant studies on the clinical therapy of pancreatic cancer patients in locally advanced tumor stage,which is the key to improve the prognosis of pancreatic cancer.

A clinical treatment strategy for ruptured hepatocellular carcinoma / 中华肝胆外科杂志

Objective To investigate the prognoses of patients with ruptured hepatocellular carcinoma (HCC) after resection combined with interventional therapy.Methods This retrospective study was conducted on 50 consecutive patients with ruptured hepatocellular carcinoma treated from March 2013 to December 2016 in the First Affiliated Hospital,Anhui Medical University.The patients were divided into two groups according to the different therapies,they underwent:Group A resection after interventional therapy (n =20) and Group B interventional therapy after resection (n =40).The COX regression multivariate analysis was performed and the 1-year,2-year,3-year overall survival rates (OS) were calculated.Results The 3-year OS rates were significantly different (OS:34％ vs.0％,P =0.044).Multivariate survival analysis showed that age (HR 1.376,P ＜0.001,95％ CI 1.191 ～ 1.589) and blood transfusion (HR 1.001,P ＜ 0.05,95％ CI 1.000 ～ 1.003) were the two prognostic factors which affected OS rates of patients.Conclusions Combined surgical resection and interventional therapy was effective in treating patients with ruptured hepatocellular carcinoma.Resection after interventional therapy gave a better overall survival rate than interventional therapy after resection.

Surgical treatment of chronic pancreatitis / 中华肝胆外科杂志

Objective To investigate the clinical manifestations of chronic pancreatitis(CP)and choice of the surgical therapy. Methods The clinicopathological and follpw-up data in 91 cases surgically treated in our hospital from January 1980 to January 2006 were retrospectively analyzed.Resuits The causes for CP were biliogenic one in 34 patients(37.4%),alcohol in 14(15.3%),iniury in 8(8.8%),acute pancreatitis in 14(15.3%)and idiopathic one in 20(22%).RelaPsing upper abdominal pain was the major symptom of CP.There were only two patients that were up with endoscopic sphincterotomy(EST)and the others were operated on.The operative morbiditv was 6.6%(n=6),and mortality 1.1%(n=1).Mean hospital stay was 17.7d.For the 9l patients with preoperative pain,the pain was relieved in 88.Conclusion The best operative procedure should be chosen for treatment of CP according to causes,clinical findings,imaging records and pathological examination.

Effects of lipoxygenase inhibitor NDGA on expression of 5-LOX and its apoptosis related genes in HepG2 cell line / 国际外科学杂志

Objective To investigate the effects of lipoxygenase inhibitor NDGA on expression of 5-LOX and its apoptosis related genes in HepG2 cell line.Methods The expression of 5-LOX and apoptosis related genes hTERT,bcl-2 and bax mRNA was determined by reverse transcriptasepolymerase chain reaction (RT-PCR).Results After 25,50,100,200 μmol/L NDGA treatment for24,48 h,the expression of 5-LOX of HepG2 cell decreased,but the expression of bax was up-regulated and the expressions of bcl-2 and hTERT mRNA were down-regulated,(P＜0.05 compared with the control group).The decrease in the expression of 5-LOX,hTERT and bcl-2 in HepG2 cell was negtively correlated with the dose duration of action of NDGA.Conclusion In vitro,5-LOX is expressed highly in HepG2 cell.Overexpression of 5-LOX may be related to the progression of hepatocellular carcinoma,NDGA can significantly decrease the expression of 5-LOX,up-regulate of bax and downregulation of bcl-2 and telomerse.Lipoxygenase might be a novel therapeutic target for the hepatocellular carinoma.

Hepatectomy in the treatment of bleeding of spontaneous rupture of hepatocellular carcinoma / 中国普通外科杂志

ObjectiveTo investigate the clinical results of hepatectomy for bleeding of spontaneous rupture of hepatocellular carcinoma (HCC). MethodsThe clinical data of 24 cases admitted to our hospital from Jan 1990 to Mar 2004 was analyzed retrospectively.ResultsSurgical hemostasis was achieved successfully in 100.0% (24/24) of patients. The postoperative mortality rate was 4.1% (1/24), and the (complication) rate 12.5%(4/24). Liver function recovered within two weeks after operation. The length of hospital stay was 14.756.25 days.Twenty-one patients were followed-up from 6 month to 36 months. 8 patients died from recurrence within 10 months postoperatively; 10 patients survived over 1 year, 1 patient over 2 years and 1 over 3 years. The overall 1-year survival rate was 58.3%(13/24).ConclusionsIn the management of bleeding of spontaneous rupture of HCC, hepatectomy can effectively stop the bleeding and excise the tumor at the same operation. In some patients, a radical excision can be achieved, and, if the (patient)s condition permits it, hepatectomy should be the treatment of choice.