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Objective:To study the impact of repeat hepatectomy for patients with post-hepatectomy recurrent hepatocellular carcinoma (HCC).Methods:The data of patients who developed post-hepatecotmy recurrent HCC and underwent repeat hepatectomy at the General Surgery Department of Beijing Tongren Hospital from May 2013 to May 2016 (the Recurrence Group), were retrospectively compared with the data from patients who underwent initial hepatectomy for HCC during the same study period (the Primary Group). The general data, perioperative data, postoperative complications and survival of the two groups were compared.Results:The primary group included 179 patients, consisting of 133 males and 46 females, aged (57.3±11.7) years, with a range from 14.0 to 84.0 years. The recurrence group included 36 patients, consisting of 30 males and 6 females, aged (55.9±11.4) years, with a range from 40.0 to 77.0 years. There were no statistically significant differences between the two groups in gender, age, hepatitis virus infection status, preoperative alpha fetoprotein, Child-Pugh score and indocyanine green retention rate at 15 min ( P>0.05). However, there were statistically significant differences ( P<0.05) between the two groups in operative time [(244.2±84.3)min vs. (283.4±66.8)min], intraoperative blood loss[(428.5±151.6)ml vs. (756.2±187.4)ml], anatomic or nonanatomic hepatectomy, single tumor or multiple tumors, and maximum tumor diameter[(5.81±2.24)cm vs. (3.69±1.55)cm]. There were no statistically significant differences between the two groups in incidences of tumor capsular invasion, tumor thrombus and degrees of tumor differentiation ( P>0.05). There were no statistically significant differences in surgical complication rates ( P>0.05), and in 1-year and 3-year overall and disease free survival rates between the two groups ( P>0.05). Conclusions:Repeat hepatectomy for recurrent HCC after hepatectomy was safe and effective. Its long-term survival outcomes were similar to first hepatectomy for HCC.
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Objective To evaluate the application value of focused assessment with sonography for trauma (FAST) in treatment of emergency thoracic and abdominal closed injury.Methods FAST examination was performed in 85 patients with thoracic and abdominal closed injury,to determine whether the thoracic and abdominal cavity,pericardial free effusion and abdominal parenchyma organ injury,and the results were compared with conventional ultrasonography,CT scan and operation results.Results FAST was (2.85 ± 1.15) min,conventional ultrasonography was (15.48 ±5.17) min,there was statistically significant difference (t =21.99,P ＜ 0.05).In 85 patients,10 cases were FAST positive,5 cases of abdominal cavity in that amount or a large number of free effusion,underwent emergency operation,postoperative intra abdominal parenchymal organs were confirmed as rupture and hemoperitoneum; 2 cases of renal rupture with perirenal hematoma,confirmed by the whole abdominal CT examination; 2 cases of thoracic free pneumatosis,effusion,confirmed by thoracic CT examination or closed thoracic drainage; 1 case of prompt hemopericardium,confirmed by the pericardium puncture.Conventional ultrasonography was positive in 11 patients,no statistically significant difference between them (P ＞ 0.05).The sensitivity,specificity,accuracy rate of FAST screening thoracic and abdominal closed injury was 10/12,100.0％ (73/73),97.6％ (83/85).Conclusions FAST has high sensitivity and specificity for thoracic and abdominal cavity,pericardial free effusion,check with short time,low environmental requirements,without moving the trauma patients,and may be out of sync with the fluid resuscitation and other emergency measures.For large quantities of trauma patients and patients with severe multiple trauma,FAST can quickly,accurately determine the existence of thoracic and abdominal closed injury,and provide guidance for clinical treatment,which has good application value.
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Objective To compare the effects of limited fluid resuscitation and aggressive fluid resuscitation in treatment of uncontrolled hemorrhagic traumatic shock,and to improve the cure rate.Methods One hundred and twenty patients with hemorrhagic traumatic shock on the basis of outpatient registration number of single and double were divided into limited fluid resuscitation group(limited group,56 cases) and aggressive fluid resuscitation group (positive group,64 cases),respectively.The preoperative blood lactic acid,base excess,prothrombin time,hemoglobin was compared and the preoperative infusion and the number of patients with death was recorded.Results The preoperative infusion in limited group was significantly less than that in positive group [(1 050 ± 212) ml vs.(2 120 ± 186) ml],the difference was statistically significant (P ＜ 0.01).The mortality rate in limited group was significantly lower than that in positive group [12.50％(7/56) vs.28.12％(18/64)],the difference was statistically significant (P＜ 0.05).The preoperative blood lactic acid,base excess,prothrombin time in limited group were significantly lower than those in positive group [(3.31 ± 0.29) mmol/L vs.(5.78 ± 0.15) mmol/L,(5.42 ± 1.13) mmol/L vs.(9.86 ± 1.21) mmol/L,(11.7 ± 1.9) s vs.(18.1 ± 1.7) s],and the hemoglobin in limited group was significantly higher than that in positive group [(96 ± 18) g/L vs.(83 ± 20) g/L],the differences were statistically significant (P ＜0.01).Conclusions If hemorrhage is not controlled,early limited fluid resuscitation can maintain blood perfusion of vital organs,alleviate acidosis,reduce mortality and creat good conditions for advanced treatment.Limited fluid resuscitation is superior to aggressive fluid resuscitation in operative intervention for patients with uncomtrolled hemorrhagic traumatic shock.