Objective To state operative details of lip-shaped hepatectomy (LSH) and evaluate its advantage in treatment of primary liver cancer (PLC).Methods LSH is one of the irregular hepatectomies. The key lies in the following five operative kinks: ①adequately mobilizing perihepatic ligaments; ②designing lip-shaped hepatic incision; ③laying sutures on both sides of the hepatic incision for traction; ④wedge-shapedly resecting the tumor and the surrounding liver; ⑤closely sewing up the hepatic cutting surface.Results Two hundreds and thirty three patients with PLC were treated by LSH between Oct. 1991 and Dec. 1997 in Zhongshan hospital, Shanghai medical university. Among them 8 cases underwent initial hepatectomy and resection for recurrence of the tumor. The operative mortality rate was 1.2%, 2 died of hepatic failure and 1 renal failure. In addition to bile leakage in 3 cases and hydropsy at the operative area in one case, no severe postoperative complications were found, such as intraperitoneal bleeding, subphrenic abscess and so on. The 1-,3-,5-year survival rates were 89.8%, 64.3% and 55.9% respectively, in 233 patients with 241 LSHs. 25 patients survived more than 5 years. The result indicated that the most advantage of LSH was to increase operative safety on the basis of guarantee of radical resection of PLC, especially to decrease some complications from hepatic cutting surface.Conclusion LSH is a relatively simple, safe, reasonable and recommendable hepatectomic modality.
Objective To investigate the preventive measures for bleeding in laparoscopic hepatectomy. Methods The candidates for laparoscopic hepatectomy were 22 patients with live lesions， including 5 patients with primary liver cancer， 16 patients with liver hemangioma， and 1 patient with metastatic liver cancer. The tumors locatedthe left lateral lobe in 15 cases， caudate lobe in 1 case， segmentⅣin 2 cases， and segmentⅥ in 4 cases. The meandiameter of tumors was 4cm （2-10cm）. The surgical approaches included the left lateral lobectomy （15 cases）， leftlateral lobectomy of caudate （1 case）， and nonanatomic and wedge resection were performed in 6 cases. Results Twenty-two cases underwent laparoscopic liver resection， there were no conversion to open and operative death. The mean operative time was 115min （65-142min）， the mean blood loss was 450mL （270-780mL）， the mean length of hospital stay after operation was 6.5 days （3-11 days）. Conclusion Control liver section hemorrhage is a key technique in laparoscopic hepatectomy.
Objective To study the effect of recombinant growth hormone (rhGH) on improvement of liver function and liver regeneration in animal and patients after hepatectomy. Methods The liver cirrhosis model of SD species mouse was set up, then the mouse were randomly divided into experiment group and control group, then 30%-40% liver of all the models were resected, rhGH was used by hypodermic injection (0.2-0.4ml/100g) in experimental group, and the equal dose of N.S. were given in control group every day. Then liver function, arterial blood ketone body ratio(AKBR), and the regenerated liver/body weight ratio (RL/W) were determined, histopathology of the cirrhosis with microscope and electron microscope and the mitotic index (MI) of liver cell on 7, 14 and 28th day after operation were observed. Clinically,39 hepatectomized patients were randomly divided into experiment group and control group, liver function, PA， Glu, RI and AKBR were measured preoperatively and on 1, 7,14th day after operation. Postoperative clinical course were also compared between the two groups. Results In the animal experiment group, as compared with the control group, AKBR was obviously higher (P＜0.01), seruim level of total protein and PA were increased faster (P＜0.05), and RL/W was higher. The mitotic index of liver cell was increased faster on 14th day, the numbers of regenerated liver cell with double nucleus and rough endoplasmic reticulum were higher in 14 and 28th day. In the clinical experiment group, as compared with the control group, serum total bilirubin, alanine aminotransferase and aspartate aminotransferase were lower on 7 and 14th postoperative day (P＜0.05). Serum albumin, PA, Glu, RI and AKBR were higher on 7, 14th postoperative day (P＜0.05). Conclusion Both experimental and clinical study show that the rhGH can promote liver regeneration and improve liver function after hepatectomy.
ObjectiveTo analyze the clinical effects and hospitalization costs of the enhanced recovery after surgery (ERAS) mode for patients underwent radical resection of hepatocellular carcinoma (HCC). MethodThe clinicopathologic data of adult patients who underwent radical resection of HCC in the West China Hospital of Sichuan University from January 2017 to December 2019 were collected retrospectively. ResultsA total of 1 082 patients were collected according to inclusion and exclusion criteria in this study, including 469 patients in the ERAS mode group and 613 patients in the traditional mode group. There were no significant differences in baseline data such as gender, age, body mass index, preoperative complications, operation type, and medical group between the two groups (P>0.05). Compared with the traditional mode group, the total hospitalization cost, medical service fee, examination fee, bed fee, and cooling and heating fee in the ERAS mode group were lower (P<0.05), the average total hospitalization time was shortened by about 1.2 d (P<0.01), the preoperative hospitalization time was shortened by about 0.3 d (P=0.03), and the postoperative hospitalization time was shortened by about 0.8 d (P<0.01) in the EARS mode group. There were no significant differences in the incidences of specific complications and total complications between the two groups (P>0.05). ConclusionERAS for patients with HCC might play a role in improving rehabilitation efficiency and reducing hospitalization costs.
ObjectiveTo study clinical practical value of multimode imaging technique in precise hepatectomy for huge hepatocellular carcinoma (HCC). MethodsThe clinicopathologic data of patients with huge HCC who underwent precise hepatectomy in Yuebei People’s Hospital from Jan. 2018 to Dec. 2020 were collected. The three-dimensional (3D) reconstruction, 3D visualization, 3D printing, and augmented reality (AR) were used to guide preoperative evaluation, surgical planning, and surgical navigation. The liver function indexes, surgical mode, operative time, intraoperative bleeding, volume of resected liver, postoperative hospitalization, and complications were analyzed. ResultsThere were 23 patients in this study, including 18 males and 5 females, with (56.8±8.1) years old. The virtual tumor volume assessed by multimodal imaging technology was (865.2±165.6) mL and the virtual resected liver volume was (1 628.8±144.4) mL. The planned operations were anatomical hepatectomy in 19 patients and non-anatomical hepatectomy in 4 patients. The actual operation included 17 cases of anatomical hepatectomy and 6 cases of non-anatomical hepatectomy, which was basically consistent with the results of AR. The operative time was (298.4±74.5) min, the median hepatic blood flow blocking time was 20 min, and the intraoperative bleeding was (330.4±152.8) mL. Compared with preoperative levels, the levels of hemoglobin and albumin decreased temporarily on the first day after operation (P<0.05), and then which began to rise on the third day and basically rose to the normal range; prothrombintime, total bilirubin, alanine aminotransferase, and aspartate aminotransferase increased transiently on the first day after operation (P<0.05), then which began to decline to the normal levels. There were no serious operative complications and no perioperative death. The median follow-up time was 18 months, the tumor recurrence and metastasis occurred in 3 cases. ConclusionFrom preliminary results of this study, it could improve surgical safety and precision of hepatectomy for huge HCC by preoperative precise assessment and operation navigation in good time of multimode imaging technology.
目的 探讨白试验在肝切除手术中检测漏胆的价值。方法 笔者所在医院2008年1月至2013年1月期间在肝切除手术中采用白试验联合干纱布擦拭法检测漏胆56例。即在肝切除手术操作末期，用干纱布擦拭法确认无漏胆后，经胆囊管或左右肝管插管注入5%无菌脂肪乳剂10～30mL，同时用手阻断远端胆总管。观察肝切除手术创面的白色液体渗出情况，对渗出白色液体处予以间断缝合。重复操作，至断面无白色液体渗出为止。结果 56例患者经术中检测，发现漏胆17例（漏胆检出率为30.4%），每例发现漏胆1～6处（平均2.9处），术中均予以确切缝合以关闭漏胆处，且重复试验操作，证实均再无漏胆。术后发生漏胆2例（3.6%），经相应治疗后痊愈出院。全部患者出院后均随访3～6个月（平均3.8个月），无膈下积液或膈下感染病例发生。结论 术中白试验能够发现漏胆的精确部位，不会污染肝切除手术创面，并能够无限次地重复试验，值得临床推广。
ObjectiveTo investigate the expression of Lgr5 protein in regeneration tissue of remnant liver after associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) and its significance.MethodsA total of 120 male SD rats (200–240 g) were randomly equally divided into sham operation (SO) group, portal vein ligation (PVL) group, and ALPPS group using random number table method. The liver regeneration rate (LRR), liver function (AST and ALT), and the expressions of Ki-67 and Lgr5 in the right middle lobe of the liver were observed at day 1, 2, 4, and 7 after surgery.ResultsCompared with SO group, the LRRs and the Ki-67 protein expression positive rates and Lgr5 related protein expression levels in the right middle lobe of liver tissue were increased in the PVL group and ALPPS group at day 1, 2, and 4 after surgery (P<0.05), and the LRR was still increased at day 7 after surgery (P<0.05). The LRRs at day 4 and 7 after surgery in the ALPPS group were higher than those in the PVL group (P<0.05), the Ki-67 protein expression positive rates and Lgr5 related protein expression levels at day 2 and 4 after surgery in the ALPPS group were higher than those in the PVL group (P<0.05). The AST and ALT levels at day 1 and 2 after surgery in the ALPPS group and PVL group were higher than those in the SO group (P<0.05), which at day 1 after surgery in the ALPPS group were higher than those in the PVL group (P<0.05), but which returned to normal on day 4 after surgery.ConclusionsALPPS could promote liver regeneration better. Lgr5 is closely related to liver regeneration after ALPPS. Liver stem cells might be involved in liver regeneration after ALPPS.
ObjectiveTo explore the application of the technique of liver venous deprivation (LVD) for two-stage radical hepatectomy in patient with liver cancer underlying hepatitis B virus infection.MethodsA 53 years old patient diagnosed with central primary liver cancer (Ⅴ/Ⅷ segment) could not receive standard right hepatectomy since his future liver remnant was insufficient, so the LVD was performed to induce FLR growth. The general condition and CT scan were repeated at 1-, 2- and 3-week after LVD, the FLR and FLR weigh/ body weight ratio were calculated.ResultsThe FLR and FLR weight/body weight ratio before LVD were 24.2% and 0.459%, the FLR at 1-, 2- and 3-week after LVD were 29.5%, 38.3% and 44.4% respectively, the FLR weight/body weight were 0.545%, 0.707% and 0.820% at 1-, 2- and 3-week after LVD. The standard right hepatectomy was undertaken successfully at 25 days after LVD and discharged safely.ConclusionThe LVD technique could induce a rapid and large FLR volume and offer opportunity for patients with insufficient FLR to receive two-stage radical hepatectomy, is a novel method to induce FLR growth effectively.
【Abstract】ObjectiveTo explore the appropriate surgical management of the primary hepatocellular carcinoma with hypersplenism. MethodsOf 67 patients who has primary hepatocellular carcinoma with hypersplenism, 17 cases had hepatectomy combined with splenectomy, 7 cases had hepatectomy only, and the other 43 patients were treated with hepatic artery embolization and splenic artery embolization. ResultsThe symptoms of hypersplenism disappeared and the hemogram became normal 30 d after operation in 17 patients who had hepatectomy combined with splenectomy, but worsened in 7 patients who only had simple hepatectomy and 6 cases of those patients were treated with splenic artery embolization 3-7 months after operation. In 43 patients treated with hepatic artery embolization and splenic artery embolization, 79%（34/43）had improved hypersplenism symptoms and the hemogram became normal. ConclusionThe treatment of primary hepatocellular carcinoma with hypersplenism should be strived for hepatectomy combined with splenectomy. If the liver mass cannot be resected, hepatic artery embolization and splenic artery embolization should be chosen.
Objective To compare therapeutic effects of associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) and transcatheter arterial chemoembolization (TACE) on patients with advanced hepatocellular carcinoma. Methods Thirty-five patients with advanced hepatocellular carcinoma admitted in the Department of Hepatobiliary and Pancreatic Surgery of Shiyan Taihe Hospital Affiliated to Hubei University of Medicine from August 1, 2014 to August 1, 2015 were randomly divided into ALPPS group and TACE group, in which 17 cases treated by the ALPPS and 18 cases treated by the TACE. The survival, changes of liver function and life quality, postoperative complications and mortality were compared in these two groups. The follow-up was performed by the telephone and the outpatient. Results ① The baselines such as the age, gender, diameter of tumor, complications had no significant differences in these two groups (P>0.05). ② The changes of liver function and life quality after operation in the ALPPS group were significantly better than those in the TACE group (P<0.05). ③ The complications after operation were observed in 5 cases (there were 2 cases of bile leakage, 1 case of intraabdominal bleeding, 1 case of peritoneal effusion, and 1 case of pulmonary infection) in the ALPPS group, which in 13 cases (there were 6 cases of nausea and vomiting, 4 cases of liver function damage, 2 cases of granulocytopenia, 1 case of fever) in the TACE group. The rate of the overall complications in the ALPPS group was significantly lower than that in the TACE group (5/17versus 13/18, P=0.018). ④ The overall survival in the the ALPPS group was significantly better than that in the TACE group (P=0.024). During follow-up period, the deaths happened in 3 cases duo to hepatocellular carcinoma and 1 case duo to traffic accident, 1 case was lost on month 8, 12 cases were still alive in the ALPPS group; the deaths happened in 10 cases duo to hepatocellular carcinoma, 1 case duo to coronary disease, and 1 case duo to cerebral infarction, 6 cases were still alive in the TACE group. Conclusion Preliminary results of limited cases in this study show that ALPPS has a better effect than TACE on patients with advanced hepatocellular carcinoma.