Abstract:

Abstract:

肝切除是一项需由有经验的外科医生完成的高风险手术。肝切除术在治疗肝恶性疾病中的地位在过去100年里随着并发症、病死率不断地减少及生存率的提高而发生了改变。对肝解剖新的认识，不断提高的围手术期治疗，麻醉技术和技术上的进步已使患者的治疗效果得到改善。随着技术的进步，从前被认为肿块不可切除的患者有了接受根治性手术的机会。该篇综述描述了针对肝切除的不同方法及技巧。文中对肝切除相关解剖、手术命名，解剖肝切除与非解剖肝切除的地位进行了讨论。分析了不同血管控制方法及对不同的肝实质横断策略进行了对比，同时涉及到了微创手术技术。最后，介绍了作者对肝切除的有关技术经验。

Abstract:

尽管近来在化疗药上取的了很多进步，但是对于转移性的结直肠癌治疗预后仍然很差，就过去20年而言，肝脏转移灶切除术已作为一种有希望的术式，它能改善结直肠癌肝转移患者的生存率，而且该技术在某些案例中显示出长期的治愈效果。为了扩大转移灶切除术的安全性及功效，合适的术前影像是必须的。CT，MRI，PET方面的进步已经改善了隐蔽病灶的探测而且获得更为清晰解剖形态。而CT，PET，MRI在探查大的肝转移瘤上有相似的敏感性，相对于CT及FDG-PET而言，MRI更擅于探知厘米级以下的肝转移灶，特别是与弥散加权成像（DWI）及肝细胞特异性对比剂结合时效果更显著，CT或许可用来作为一种筛选模式或术前计划制定如剩余肝体积的计算或显露肝动脉灌注分布的动脉解剖情况，而技术进步已经带来了史无前例的高画质与高清晰度的图片，但它仍然无法取代专业的，娴熟的具有丰富经验的影像学专家的角色。

Abstract:Objective: To compare the therapeutic efficacies between radiofrequency ablation (RFA) and hepatic resection for solitary colorectal liver metastasis. Methods: The controlled clinical trials concerning RFA and hepatic resection for treatment of solitary colorectal liver metastasis were collected through literature retrieval from several native and foreign online databases. The quality of the include studies was assessed according to the Cochrane systematic review method, and data analysis was conducted by using RevMan 5.0 software. Results: Nine studies were finally included, with a total of 1 259 patients, of whom, 440 cases underwent RFA and 819 cases were subjected to surgical resection. The results of Meta-analysis demonstrated that the 5-year overall survival rate was lower, and the overall recurrence and local recurrence rate was higher in patients undergoing RFA than that in patients receiving surgical resection (P=0.02, P=0.01, P=0.003); there was no obvious difference in 5-year overall survival rate after operation between patients undergoing RFA and hepatic resection when the tumor diameter was less than 3 cm (P=0.43). Conclusion: Hepatic resection has a better efficacy than that of RFA for solitary colorectal liver metastasis, but RFA could be considered when tumor diameter is less than 3 cm.

Abstract:Objective: To investigate the proper options for different hepatic blood flow occlusion methods during liver cancer resection. Methods: The data of 124 patients undergoing liver cancer resection were respectively analyzed. According to the method of blood flow occlusion, patients were divided into group A (51 cases undergoing total hepatic inflow occlusion), group B (38 cases undergoing selective inflow occlusion), group C (24 cases undergoing selective inflow and outflow occlusion) and group D (11 cases undergoing complete hemihepatic vascular occlusion). The operative time, duration of hepatic ischemia, intraoperative blood loss, blood infusion requirement, postoperative liver function recovery and incidence of postoperative complications as well as mortality among the 4 groups were compared. Results: The general conditions among groups showed no significant differences before operation (all P>0.05). There were no significant differences among the 4 groups with regard to the duration of hepatic ischemia, incidence of postoperative complications and mortality (all P>0.05). The operative time in both group C and group D were significantly prolonged versus group A (both P<0.05), but their intraoperative blood loss and infusion requirements were less than those in group A or group B (all P<0.05). The postoperative levels of alanine aminotransferase (ALT) and total bilirubin (TBIL) in group A were increased relatively higher than those of other groups, as the former showed significant difference versus all other groups, and the latter versus group B reached a statistical significance (all P<0.05). Conclusion: Proper selection of method of hepatic blood flow occlusion is based on overall consideration of several factors such as the size and location of the tumor, preoperative liver function, underlying liver disease, and function of cardio-cerebral vascular system. It also, greatly depends on the surgeon’s judgment and experience.

Abstract:Objective: To evaluate the efficacy of ex vivo hypothermic liver resection with caval preservation for irresectable Bismuth type IV hilar cholangiocarcinoma. Methods: The clinical records of two patients with Bismuth type IV hilar cholangiocarcinoma were reviewed. One of the two patients underwent in situ hypothermic extended right hepatectomy with of caval flow preservation, and the other one received complete ex vivo extended right liver resection with vena cava preservation. Results: The surgical duration of in situ hypothermic extended right hepatectomy lasted 14 h, and the intraoperative blood transfusion was 3 000 mL, however, the patient died due to multiple organ failure on the first day after surgery. The surgical procedure for ex vivo extended right liver resection took 15 h, and the blood transfusion requirement was 2 000 mL, with a cold ischemic time of 195 min, and a warm ischemic time of 20 min. This patient was discharged on postoperative day 30 with no occurrence of liver failure or other major complications, and was still alive with no evidence of vascular or biliary complications and no tumor recurrence or metastases during the 11-month follow-up period. Conclusion: Based on the premise of having wide experience in performing complex liver resection and living donation liver transplantation, the operation of ex vivo hypothermic extended right hepatectomy with caval preservation is safe, and it may be a therapeutic option for highly selected irresectable Bismuth type IV hilar cholangiocarcinoma.

Abstract:Objective: To investigate the feasibility and safety of liver resection with liver hanging maneuver for tumors adjacent to the second porta hepatis. Methods: The clinical data of 7 patients with liver neoplasms near the second porta hepatis admitted from August 2011 to August 2012 were analyzed retrospectively. Results: The liver hanging tape was positioned as planned and operation was successfully performed in all the 7 patients. Of the patients, 2 cases underwent right hemihepatectomy, one case underwent right hemihepatectomy plus perirenal fatty capsule resection, one case underwent right hemihepatectomy plus removeal of two haemangiomas in the left medial and lateral lobes, one case underwent right hemihepatectomy plus partial segment IV resection, one case underwent left hemihepatectomy plus segment VIII resection and right diaphragmatic peritoneal stripping, and 1 case underwent anatomical segment VI and VII resection. Inadvertent inferior vena cava injuries during parenchymal transection did not occur in any of the cases, and one case underwent fascial repair of the right diaphragm. The median operative time was 375 (295–460) min, median intraoperative blood loss was 2 000 (750–8 000) mL, and median blood transfusion requirement was 1 000 (0–4 000) mL. Two patients developed postoperative pleural effusion that resolved by puncture and aspiration. No bile leakage or abdominal infection occurred; all patients were cured and discharged from hospital, and the average length of postoperative hospital stay was 20 d. Patients were followed up for 1 to 12 months, and one case developed local recurrence of hepatocellular carcinoma. Conclusion: Hepatectomy using liver hanging maneuver for tumors adjacent to the second porta hepatis is safe and feasible.

Abstract:Objective: To investigate the safety of intraoperative warm water bath during liver cancer (HCC) resection and its influence on therapeutic effects. Methods: The clinical data of 35 HCC patients undergoing intraoperative warm water bath (hepatectomy followed by warm water bath of the remaining liver for 1 h) over the past 3 years were reviewed (warm water bath group), which were compared with the data of the selected HCC patients, who underwent liver resection alone (hepatectomy group) or liver resection plus interventional therapy (interventional group) during the same period, with the same number of cases. Results: The levels of immunoglobulin and soluble interleukin 2 receptor (sIL-2R) were significantly elevated in warm water bath group after surgery compared with those before surgery (all P<0.05), while no such changes were noted in the other two groups. As for the postoperative recurrence and survival, there were no significant differences between water bath group and interventional group (both P>0.05), but both of which were better than those in hepatectomy group (all P<0.05). The hospitalization costs and postoperative pain were increased in interventional group compared with water bath group and hepatectomy group. There were no significant differences in incidence of postoperative complications among groups (P>0.05). Conclusion: Liver resection plus intraoperative warm water bath is a safe and effective method for treatment of HCC, which can provide the patients with enhanced postoperative immune function, reduced recurrence and improved quality of life.

Abstract:Objective: To compare the short term efficacies between laparoscopic liver resection and open liver resection in treatment of small hepatocellular carcinoma. Methods: The clinical data of 52 patients with small hepatocellular carcinoma treated between August 2011 and November 2012 were reviewed. Of the patients, 20 cases underwent laparoscopic liver resection (laparoscopic group), while the other 32 cases were subjected to open liver resection (laparotomy group). The pre-, intra- and postoperative conditions between the two groups were compared. Results: The data between the two groups before surgery were comparable (all P>0.05). The difference in operative time between the two groups did not reach a statistical significance (P>0.05), but the intraoperative blood loss in laparoscopic group was significantly lower than that in laparotomy group (t=5.568, P=0.003). Comparison of the postoperative outcomes between the two groups showed that the liver function parameters in laparoscopic group were all better than those in laparotomy group (all P<0.05), the levels of white blood cells, neutrophils and C-reactive protein in laparoscopic group were all significantly lower than those in laparotomy group (t=0.727, 2.191, 5.691, all P<0.05), and the time to eating and ambulation as well as the length of hospital stay in laparoscopic group were all shorter than those in laparotomy group (t=15.838, 3.896, 7.638, 3.663, all P<0.01). Post-procedure complications occurred in none of the patients in laparoscopic group, but in 8 cases in laparotomy group (χ2=5.909, P=0.017). Conclusion: Laparoscopic liver resection for small hepatocellular carcinoma is safe, feasible, and is better than traditional open surgery in terms of short-term efficacy.

Abstract:Objective: To evaluate the efficacy of radiofrequency ablation (RFA) combined with transarterial chemoembolization (TACE) for hepatocelluar carcinoma (HCC) with intrahepatic arteriovenous shunts (AVS). Methods: The clinical data of 45 HCC patients with intrahepatic AVS were retrospectively analyzed. In all patients, the AVS were identified by angiography or enhanced CT scan before operation. Patients underwent RFA first, followed by TACE two weeks later. At one month after operation, the patients received re-examination of the enhanced CT scan and AFP level to assess the degree of AVS occlusion and tumor ablation. Results: Operations were successfully performed in all patients. The overall disappearance and effective occlusion rate of the AVS was 28.9% and 77.8%, and the overall complete and effective ablation rate of tumor was 68.9% and 80%, respectively. In the 37 α-fetoprotein (AFP)-positive patients, AFP turned to be negative in 28 cases and AFP level declined in 9 cases. No serious complications occurred in any of the patients. Conclusion: RFA combined with TACE is an effective and safe approach for HCC with AVS.

Abstract:Objective: To compare the efficacy of microwave ablation and hepatic arterial embolization for hepatic hemangioma. Methods: Seventy patients with liver hemangioma admitted between January 2009 and April 2012 were randomly assigned to ablation group (37 cases undergoing microwave ablation of the liver hemangioma by ultrasonography guided percutaneous approach under local anesthesia or laparoscopic puncture under general anesthesia) and embolization group (33 cases undergoing super-selective embolization of the liver hemangioma with pingyangmycin-lipiodol emulsion). The therapeutic effects between the two treatment methods were compared. Results: Six months after treatment, 9 patients (24.32%) in ablation group had residual blood supply to the lesions, and underwent a second microwave ablation treatment, while 18 patients (54.55%) in embolization group had residual blood supply to the lesions and received a second treatment (13 cases underwent hepatic artery embolization and 5 cases underwent microwave ablation). At follow-up of 12 months after treatment, in ablation group, 31 patients (83.78%) had reduction in tumor size by more than 75%, with complete disappearance of blood supply to the tumor and 6 patients (16.22%) whose reduction of tumor size was less than 75% showed that most of the blood supply to the tumor had disappeared; in embolization group, tumor size in 15 patients was reduced by more than 75%, and blood supply to the tumor had completely disappeared, whereas the 18 patients (54.55%) who underwent the second treatment had less than 75% reduction of tumor size, and most of the blood supply to the tumor had disappeared. The difference between the two groups had statistical significance (P<0.01). Conclusion: Microwave ablation has reliable efficacy for hepatic hemangioma, which is better than hepatic arterial embolization in reducing tumor size and blood supply to the lesion.

Abstract:Objective: To investigate the clinical efficacy of transarterial chemoembolization (TACE) therapy combined with autologous cytokine-induced killer (CIK) cells adoptive immunotherapy for primary hepatic carcinoma (HCC). Methods: Thirty-eight HCC patients were designated to observational group (20 cases undergoing TACE plus CIK cells treatment) and control group (18 cases undergoing TACE only). The quality of life (QOF), immunity function alterations, progression-free survival (PFS) and overall survival (OS) between the two groups after operation were compared. Results: The improvement rate of QOL in observational group was significantly higher than that in control group after operation (P<0.05). Compared with the status before operation, the percentage of CD3+ and CD4+ cells and CD4+/CD8+ ratio were significantly increased while the percentage of CD8+ cells was significantly decreased after operation in observational group (all P<0.05), but these indices showed no obvious difference in control group (all P>0.05). The average PFS and OS in observational group was 12 and 34 months, and in control group was 7 and 13 months respectively, and the differences between the two groups had statistical significance (both P<0.05). Conclusion: The adjuvant CIK cells adoptive immunotherapy can increase the efficacy of TACE for HCC, and improve the patients’ QOL.

Abstract:Objective: To assess the significance of antiviral therapy in liver cancer patients infected with hepatitis B virus (HBV) undergoing radical resection. Methods: Sixty patients undergoing radical resection for liver cancer were divided into high-level viral replication group (load level of HBV-DNA≥105 copies/mL) and low-level viral replication group (load level of HBV-DNA<105 copies/mL), according to their HBV-DNA levels. The postoperative liver function, HBV-DNA levels and incidence of complications as well as length of hospital stay and costs between patients receiving antiviral therapy with adefovir dipivoxil and those who did not were compared within each group. Results: In either high-level viral replication group or low-level viral replication group, patients with antiviral treatment had better recovery of liver function and lower HBV-DNA levels than those without antiviral treatment, and all differences reached a statistical significance (all P<0.05); in either group, the incidence of postoperative complications was decreased and length of hospital stay and costs was reduced in patients who received antiviral treatment compared with those without antiviral treatment, and difference in incidence of postoperative complications in low-level viral replication group reached statistical significance while difference in length of hospital stay and costs in high-level viral replication group achieved statistical significance (all P<0.05). Conclusion: Antiviral therapy can effectively improve the postoperative liver function and virological indexes of liver cancer patients, so it has certain value in clinical practice.

Abstract:

Objective: To investigate the role of hypoxia inducible factor 1α (HIF-1α) in epithelial-mesenchymal transition (EMT) process of hepatocellular carcinoma. Methods: HIF-1α inducible liver cancer cell line HepG2Tet-on-HIF-1α cells were used. First, the mRNA and protein expressions of EMT-related molecules (E-cadherin, vimentin and FSP-1) and HIF-1α in HepG2Tet-on-HIF-1α cells under hypoxia were determined by real-time PCR and Western blot analysis, respectively. Then, under normoxia condition, the expressions of above molecules were determined in HepG2Tet-on-HIF-1α cells with HIF-1α overexpression induced by doxycycline (Dox), and HepG2Tet-on-HIF-1α cells transfected with HIF-1α siRNA after Dox treatment. Results: After hypoxia treatment, the mRNA and protein expressions of EMT-related molecules and HIF-1α in HepG2Tet-on-HIF-1α cells were all significantly increased compared with normoxia status (all P<0.05). Under normoxia condition, HIF-1α was overexpressed, and the EMT-related molecules expressions were simultaneously increased significantly in HepG2Tet-on-HIF-1α by Dox exposure (all P<0.05), but the above effect of Dox was abolished by HIF-1α siRNA transfection. Conclusion: HIF-1α can promote EMT process in HepG2 cells, and probably may be an effective target for liver cancer gene therapy.

Abstract:Objective: To investigate the effects of rapamycin on the growth and apoptosis as well as DDAH2 expression in hepatocellular carcinoma cells. Methods: Human liver cancer HepG2 cells were exposed to different concentrations of rapamycin (0, 4, 20 and 100 nmol/L) for 48 h, and then the cell cycle and apoptosis were determined by flow cytometry, and DDAH2 expression was measured by Western blot analysis. Results: Compared with HepG2 cells in control group (0 nmol/L rapamycin), the HepG2 cells treated with various concentrations of rapamycin showed significant G1 phase arrest and increased apoptotic rate along with reduced DDAH2 protein expression (all P<0.05), with a certain concentration-dependent manner. Conclusion: Rapamycin can inhibit proliferation and promote apoptosis of liver cancer cells, and the mechanism may be associated with its down-regulaton of DDAH2 expression.

Abstract:Objective: To investigate the microRNA-497(miR-497) expression in hepatocellular carcinoma (HCC) tissues and its significance. Methods: Forty HCC and their adjacent tissue specimens were collected, and the miR-497 expression in these specimens were measured by qRT-PCR method. Human HCC SMMC-7721 cells were transfected with miR-497 mimic, and then their proliferation ability and apoptosis level were determined by MTT assay and flow cytometry technique, and the mRNA and protein expressions of Bcl-w as a potential target of miR-497 were detected by qRT-PCR and Western blot analysis, respectively. Results: The expression level of miR-497 in HCC tissues was significantly lower than that in the adjacent tissues (1.181±0.779 vs. 14.599±5.266, P<0.05). In SMMC-7721 cells transfected with miR-497 mimic, the cell proliferation was decreased while cell apoptosis was increased, and both mRNA and protein expressions of Bcl-w were reduced significantly (all P<0.05 vs. untransfected SMMC-7721 cells). Conclusion: The miR-497 expression is down-regulated in HCC tissues, which may probably result in the increased expression of its target gene Bcl-w and then promote the occurrence and development of the tumor.

Abstract:Objective: To investigate the death inducing protein (DIP) expression in hepatocellular carcinoma (HCC) and its relations with the clinicopathological features of HCC. Methods: The mRNA and protein expressions of DIP in 40 HCC and their adjacent normal tissues were measured by RT-PCT and immunohistochemical staining respectively, and the relations of DIP protein expression with the clinicopathological features of HCC were analyzed. The DIP mRNA expressions in normal human liver cell line (LO2) and various human HCC cell lines (HepG2, Hep3B and SMMC-7721) were determined by RT-PCR method. Results: Both mRNA and protein expressions of DIP in HCC tissues were significantly higher than those in their adjacent tissues (both P<0.05), and high DIP expression was associated with larger tumor size, high Edmonson-Steiner’s classification and advanced TNM stage (r=0.419, 0.414, 0.531; all P<0.05). The DIP mRNA expressions in all HCC cell lines (HepG2, Hep3B, and SMMC-7721) were significantly higher than that in LO2 (all P<0.05). Conclusion: The DIP expression is up-regulated in HCC tissue, and the high DIP expression is associated with the unfavorable clinicopathological profiles of HCC.

Abstract:

Objective: To observe the expression of the glucose-regulated protein 78 (GRP78), an endoplasmic reticulum stress (ERS) related molecule, in the rat liver tissues injured by ischemia-reperfusion. Methods: Twenty-four healthy male SD rats were equally randomized into sham operation group, hepatic ischemia alone group (30 min hepatic ischemic followed by no reperfusion), 6-h reperfusion group (30 min hepatic ischemic followed by 6-h reperfusion) and 12-h reperfusion group (30 min hepatic ischemic followed by 12-h reperfusion). The serum levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) of each group of rats were measured, and the pathological changes, apoptosis and GRP78 mRNA expression in rats’ liver tissues were also determined. Results: Compared with control group, all the experimental groups presented obvious hepatic tissue injuries after ischemia, and the injuries were exacerbated with the prolongation of reperfusion period, as evidenced by the increased serum levels of ALT and AST, remarkable pathological changes in the hepatic tissues, and elevated apoptotic rates, with all the differences for the quantitative parameters among groups reaching statistical significance (all P<0.05). The GRP78 mRNA expression in rats’ liver tissues, similar to the patterns of the above parameters, was significantly increased after hepatic ischemia and aggravated as reperfusion time went on, with the differences reaching statistical significance among groups (all P<0.05). Conclusion: The GRP78 expression is up-regulated in the liver tissue injured by ischemia-reperfusion, however, its exact role in this process remains to be verified.

Abstract:Objective: To investigate the relationship between intestinal endotoxin (ET) and liver expression of Toll-like receptor 4 (TLR4) in liver injury induced by severe acute pancreatitis (SAP). Methods: Forty-eight Wistar rats were equally randomized into model group and control group. Rats in model group were subjected to retrograde cholangiopancreatic duct injection of 5% sodium taurocholate to induce SAP, while rats in control group underwent sham operation. At 3, 6 and 12 h after surgery, 8 rats at each time point were randomly taken from each group, and their pancreatic and liver tissues as well as peripheral arterial blood samples were collected. Pathological examinations were performed, and the blood levels of amylase (AMY), alanine transaminase (ALT) and ET, as well as the TLR4 expression in liver were determined. Results: Compared with control group, the pathological scores for pancreatic and liver injury, blood levels of AMY, ALT and ET, and liver expression level of TLR4 protein in model group were all increased significantly (all P<0.05), and all above parameters were increased in a time-dependent manner. All the parameters in control group showed no significant alteration across time points (all P>0.05). In model group, there was a significant positive correlationship between liver TLR4 expression and blood ET level (r=0.863, P<0.01). Conclusion: Blood ET level increase is correlated with liver TLR4 up-regulation during SAP, and the interaction between ET and TLR4 may be involved in the mechanism of SAP-induced liver damage.

Abstract:Objective: To investigate the clinical efficacy of endoscopic retrograde cholangiopancreatography (ERCP) in management of biliary complications after liver transplantation. Methods: The clinical data of 8 patients undergoing ERCP for biliary complications after liver transplantation between August 2002 and December 2012 were retrospectively analyzed. Of the patients, 5 cases had biliary stricture (4 cases of anastomotic biliary stricture and one case of intrahepatic biliary stricture), one case had developed bile leakage, and 2 cases had biliary calculi and biliary sludge. ERCP was performed 21 times in the 8 patients, and was combined with endoscopic sphincterotomy, dilation of the bile duct, nasobiliary drainage and stent placement for those with biliary stricture, with endoscopic nasobiliary drainage and placement of plastic stent for the one with bile leakage, and with endoscopic sphincterotomy, nasobiliary drainage and stone extraction via basket for the two cases with bile duct stones. Results: ERCP was successfully carried out 21 times (100% success rate). The 4 patients with anastomotic biliary stricture, one patient with bile leakage and 2 patients with bile duct stones were all cured after ERCP, but there was one treatment failure in the patient with intrahepatic biliary stricture, for whom a second liver transplantation was recommended. The incidence of biliary tract infection and pancreatitis after ERCP was 14.3% (3/21) and 19.0% (4/21) respectively, which were all resolved after symptomatic treatments. Conclusion: ERCP is a minimally invasive, safe and effective treatment modality for biliary complications following liver transplantation.

Abstract:Objective: To assess the clinical value of selective hepatic arterial embolization in the management of liver rupture and hemorrhage due to blunt hepatic injury. Methods: The clinical data of 61 patients with blunt liver rupture and hemorrhage treated during August 2009 to February 2012 were retrospectively analyzed. Of the patients, 30 cases received medical therapy only (drug treatment group), while the other 31 cases underwent medication and selective hepatic arterial embolization (interventional group). The opertion conversion rate, average red blood cell transfusion per patient, average length of hospital stay and incidence of complications between the two groups were compared. Results: The differences in gender, age and degree of severity of liver injury between the two groups showed no statistical significance at admission (all P>0.05). Compared with drug treatment group, the operation conversion rate (12.9% vs. 30%), average red blood cell transfusion requirement [(4.2±0.88) U vs. (6.6±1.47) U] and length of hospital stay [(7.2±5.2) d vs. (22.6±4.9)d] in interventional group were decreased significantly (all P<0.05). No significant difference in incidence of complications between the two groups was noted (19.4% vs. 23.3%) (P>0.05). Conclusion: Selective hepatic arterial embolization is a safe and effective treatment modality for liver rupture caused by blunt trauma, with the advantages of stable efficacy, minimal invasiveness and quick recovery.

Abstract:Objective: To investigate the methods and efficacy of laparoscopic Roux-en-Y diversion for intractable gastroesophageal reflux and respiratory symptoms following gastroesophageal surgery. Methods: The data from 5 patients with this disorder, which included the surgical history, clinical manifestations and Roux-en-Y diversion procedures as well as the results during the follow-up period of 12 to 22 months, were studied. Results: All the patients underwent a 40-cm jejunal Roux-en-Y diversion, and no operative death or postoperative complications occurred. The reflux and respiratory symptoms were completely relieved in 4 patients, and were significantly improved in one patient. Use of antireflux drugs was discontinued in all patients. Conclusion: Laparoscopic Roux-en-Y diversion can effectively correct the intractable gastroesophageal reflux and associated digestive and respiratory symptoms following esophagectomy or subtotal gastrectomy.

Abstract:Objective: To compare the efficacies between laparoscopic and open radical gastrectomy and their impacts on immune function of patients. Methods: The clinical data of 114 gastric cancer patients admitted over the past 3 years were retrospectively analyzed. Of the patients, 55 cases underwent laparoscopic gastrectomy (laparoscopy group) while 59 cases were subjected to open gastrectomy (laparotomy group). The postoperative immune function alterations, and intra- and postoperative conditions between the two groups of patients were compared. Results: The determination results for immune function parameters at 24 and 72 h after operation showed the levels of IL-2 and IL-6 in both groups were increased significantly compared with those before operation (all P<0.01), but the increasing degrees of both factors in laparotomy group were greater than those in laparoscopy group (all P<0.05); the peripheral blood levels of CD3+, CD4+, and CD8+ cells in laparotomy group were decreased significantly versus those before operation (all P<0.05), while no significant changes in above T cell subsets were noted in laparoscopy group (all P>0.05). Compared with laparotomy group, the intraoperative blood loss, frequency in analgesic use and postoperative complications in laparoscopy group were significantly reduced, and times to first flatus passage, liquid diet and ambulation as well as length of postoperative hospital stay were significantly shortened (all P<0.05). Conclusion: The efficacy of laparoscopic gastrectomy is better than that of open surgery, because it exerts less impact on immune function and with little systemic damage on the patients.

Abstract:Objective: To investigate the approach for the preservation of the intercostobrachial nerve (ICBN) during endoscopic axillary lymph node dissection (EALND) for breast cancer and its significance. Methods: The clinical data of 98 patients with stage I or II breast cancer undergoing EALND procedures during May 2010 to September 2012 were collected, and then the data from 52 patients with ICBN preservation (preservation group) were compared historically to those from 46 previously treated patients without ICBN preservation (non-preservation group). Results: The post-mastectomy incidence of abnormal skin sensation (numbness and/or pain) in the upper arm in preservation group was 7.69% (4/52) and in non-preservation group was 82.61% (38/46) respectively, and difference between them had a statistical significance (P<0.05). The symptoms of abnormal skin sensation in the upper arm lasted for more than one year in the 38 cases in non-preservation group, and were considerably milder in the 4 cases in preservation group, among whom the symptoms were completely relieved in 3 cases within 3 months and within 6 months in 1 case. Conclusion: Sufficient liposuction is the key for preserving ICBN during EALND for breast cancer, and ICBN preservation can reduce the occurrence of upper arm numbness and/or pain after surgery and improve the patients’ quality of life.

Abstract:

Imaging examination techniques play very important roles in diagnosis of liver diseases, among which CT or MRI imaging has the most practical value, and has become a routine examination for diagnosis and differential diagnosis of liver diseases. The application value of MRI imaging becomes increasingly important in diagnosis of liver diseases, due to its excellent tissue discrimination and a variety of contrast agents for use. Here, the authors address the application of Primovist, a liver-specific contrast agent for MRI, in diagnosis of liver diseases.