【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 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.
ObjectiveTo evaluate the safety and feasibility of laparoscopic hepatectomy. Methods A total of 25 patients with hepatocellular carcinoma or liver hemangioma received laparoscopic hepatectomy, and perioperative results were analyzed. ResultsOnly one patient was converted to open hepatectomy because of massive hemorrhage. Blood loss of all patients during operation ranged from 100-1 200 ml with an average of 400 ml. The total blood volume of transfusion was 200-1 000 ml (mean 400 ml) in 14 patients. The operative time was 0.8-4.0 h (mean 2.3 h). All patients had no complications such as bile leakage and infection, and discharged from hospital in 5-10 d (mean 8 d) after operation. ConclusionLaparoscopic hepatectomy is safe and feasible to some liver diseases, but should be used with caution for the patients with tumor diameter over 9 cm and hepatic large vessels invaded by cancer.
One hundred and five hepatic resection were performed from 1984 to 1994. Six of these patients complicated with subphrenic infection after hepatectomy, of whom two patients died of liver failure. Subphrenic dropsy occureeed in nine cases. Subphrenic infection is easy to occur in: right or extend lobectomy, massive blood loss at operation, and in postoperative bleeding which subjects to laparotomy for lemostasis. Seecure hemostasis, avoidence of hepatic tissue devitalization during operation and effective subphenic drainage aree essential to reduce the incidencee of subphrenic infection, and routine bacterial culture of subphrenic drainage fluid will help to select propre antibiotic.
ObjectiveTo explore clinical value of 3D printing technology in hepatic resection. MethodsFrom March to May 2015, multidetector-row computed tomography images of 12 patients, including hepatic carcinoma in 6, hepatic hemangioma in 3, intra-and extra-hepatic bile duct stones in 3, were used for 3D hepatic reconstruction, the final segmentation data were converted to stereolithography files for 3D printing, 50%-70% scale of the full-sized liver model was fabricated by polylactic acid to be used to analyze its anatomical structure, design surgical planning, select the optimal operative route and simulate hepatic resection. Hepatic resection was performed by referring to the 3D printing model. ResultsThe hepatic resections were successful without complications by referring to the preoperative 3D printing models, the average blood loss was 340(100-1000) mL. ConclusionHepatic resection is more accurate and safe by 3D printing technology.
ObjectiveTo investigate the protective effect of SadenosylLmethionine on liver regeneration and liver function in cirrhotic rats after hepatectomy. MethodsCirrhosis was successfully induced by injection of 40% CCl4.Then,partial hepatectomy (about 30%) was performed in all rats. Cirrhotic rats were divided into 3 groups,namely,cirrhotic group (normal saline 5 ml/d,for 15 postoperative days，n=20),treatment group 1 〔S adenosylLmethionine 10 mg/(kg·d),for 15 postoperative days,n=16〕 and treatment group 2 〔SadenosylL methionine 20 mg/(kg·d),15 postoperative days,n=16〕,and normal control group was also established. Animals were sacrificed at the 15th postoperative day and 30th postoperative day to take samples for detection of liver function (Alb,ALT,TB,TBA) and serum TNFα.Liver tissues were also observed under light microscope and electron microscope. ResultsIn two treatment groups,at the time point (15 postoperative days or 30 postoperative days),concentrations of ALT,TB,TBA,Alb and TNFα were decreased significantly as compared with cirrhotic group (P ＜0.01),and concentration of Alb was increased significantly (P＜0.01).In contrast, there were no obvious difference in the same time point of different dosetreatment groups (Pgt;0.05),but the decrease of ALT,TB,TBA,TNFα and the increase of Alb were more significant at the second time point (30th postoperative day) than the first time point (15th postoperative day) when treated with same dose (P＜0.01).At the same time,concentration between TNF α and ALT,TB,TBA showed a positive correlation (P＜0.01),and the concentration between TNFα and Alb showed a negative correlation (P＜0.01).In addition, the histopathology showed SadenosylLmethionine had effects of protecting liver function and enhancing liver regeneration. ConclusionThe study suggests that SadenosylL methionine has the efficacy of enhancing liver regeneration and improving liver function.
ObjectiveTo discuss the feasibility, safety, and superiority of da Vinci surgery system (DVSS) in liver tumor resection. MethodThe clinical data of 21 patients who underwent DVSS in the liver tumor resection were analyzed retrospectively. ResultsThere were 12 patients with hepatocellular carcinoma (HCC), 1 patient with cholang-iocellular carcinoma, 1 patient with hepatic cirrhosis regenerative nodule, 2 patients with metastatic adenocarcinoma, 2 patients with leiomyosarcoma, and 3 patients with cavernous hemangioma.The operative time was (156.67±92.19) min (60-480 min), the intraoperative blood loss was (585.71±1 076.12) mL (50-5 000 mL), the time of diet recovery was (3.23±1.26) d (2-6 d), and the hospital stay was (10.10±9.02) d (5-47 d).The hospital mortality and morbidity rates were 0(0/21) and 9.52%(2/21) respectively including 1 patient with biliary leakage and 1 patient with abdominal infection. ConclusionThis study demonstrates the feasibility and safety of DVSS in the liver tumor resection and the system has a wide range of application for patients who are suffering from liver tumor.
Objective To explore the curative effect of surgical treatment for primary liver cancer with portal vein tumor thrombus（PVTT）. Methods The clinical data of 227 patients who were performed surgical treatment because of primary liver cancer with PVTT were analyzed retrospectively. Results Two hundreds and seventeen cases were performed surgical resection, 14 cases died from postoperative complications. The median survival time was 17.7 months, and the l-, 2-, 3-, and 5-year survival rates were 61.9%, 37.2%, 21.7%, and 4.0% respectively. There were 40 cases with PVTT ofⅠtype, the l-, 2-, 3-, and 5-year survival rates were 82.3% , 61.7%, 38.6%, and 6.6% respectively，which was obviously higher than those with PVTT of Ⅱ type （n=129, 61.1%, 34.3%, 20.8%, and 5.3%） and PVTT of Ⅲ type （n=48, 46.8%, 24.0%, 9.6%, and 0）, P＜0.05. There were 84 cases whose PVTT and tumor were resected together, the l-, 2-, 3-, and 5-year survival rates were 67.3%, 43.2%, 28.1%, and 7.9% respectively，which were obviously higher than those patients whose PVTT were removed from cross-section of liver （n= 85, 65.1%, 38.8%, 22.3%, and 3.4%） and patients whose PVTT were removed by cutting the portal vein （n=48, 46.8%, 24.0%, 9.6%, and 0）, P＜0.05. The l-, 2-, 3-, and 5-year survival rates of 76 cases who received postoperative therapy of TACE/TAI were 75.3%, 53.2%, 33.1%, and 5.7% respectively, which were obviously higher than those patients who were not received any postoperative therapy （n=141, 54.8%, 29.1%, 15.9%, and 3.2%）, P＜0.05. Conclusions Surgical treatment is an effective treatment for primary liver cancer with PVTT. Surgery should strive for resecting the tumor and PVTT together, and postoperative therapy of TACE/TAI may have a favorable effect on the long term survival rate.
Objective To approach the indications， techniques features， and efficacy of laparoscopic hepatectomy for liver tumor. Methods The clinical data and follow-up results of 61 patients who received laparoscopic hepatectomy at our institute from January， 2007 to December， 2012 were retrospectively analyzed. Results Of the 61 patients， 16 cases were with primary liver cancer， 1 case with liver adenocarcinoma， 2 cases with metastatic liver cancer， 31 cases with hepatic hemangioma， and 11 cases with other benign liver diseases （including hepatocellular adenoma， focal nodular hyperplasia， hepatic cysts， and mucinous cystadenoma）. The average tumor diameter was 5.6 cm （2-15 cm）. The surgical approaches includes laparoscopic hepatic left lateral lobectomy （42 cases）， right posterior lobectomy （2 cases）， hepatectomy of segmentⅥ （3 cases）， hepatectomy of segmentsⅦ/Ⅷ， Ⅳa， and caudate lobe （one respectively）. Non-anntomic and wedge resection were performed on 11 patients. The mean operating time， blood loss， postoperative hospital stay， and postoperative complication rate were （124±65） min （50-200min）， （251±145） mL （50-1 000mL），（7.3±3.6） d （4-11d）， and 16.3% （10/61）， respectively. In 19 cases with malignant liver lesions， 15 cases were followed up mean for 26 months （1-48 months）. One of them died in 1 year after operation for multiple organ dysfunction， others were survival. Conclusions Experienced laparoscopic surgery doctors selected appropriate cases， used proper blood inflow oclussion and liver resction methods， and cared for tumor-free principle， the laparoscopic hepatectomy for malignant and benign tumors of liver could be safe and effective to carry out.
In order to observe the effect of hepatocyte growth promoting factor (pHGF) on liver regeneration of rat with cirrhosis after hepatectomy, IBAS Ⅱ auto image analysis technology was used to measure the variety of DNA ploid rate of hepatocytes and OPTDM of enzymes by liver histochemistry after hepatectomy; serum levels of the glutamicpyruvic transaminase (SGPT) and indocyanine green retention rate in 15 minute (ICG15) were tested to measure the function of the remanent liver. The results revealed that tetraploid hepatocytes lowered greatly and diploid, quintploid and ＞quintploid hepatocytes increased apparently in group A. OPTDM of enzymes by liver histochemistry showed no significant difference at the first day after operation in each group (Ｐ＞0.05); SDH and LDH of group A were significantly higher than those of group B and AkP, AcP were significantly lower at the second or fifth day after hepatectomy. Serum tests showed that SGPT, ICG15 of group A decreased apparently at the fifth day after operation. The results demonstrate that pHGF not only stimulates the regeneration of the remanent liver but also accelerates the functional mature of the regenerative hepatocytes and the functional recovery of the remanent liver after resection of cirrhotic liver of rats.