ObjectiveTo investigate the clinical application of laparoscopic right hemihepatectomy via anterior approach. MethodThe clinical data of 32 patients underwent laparoscopic right hemihepatectomy via anterior approach from June 2017 to May 2019 were retrospectively analyzed.ResultsThe laparoscopic right hemihepatectomies via anterior approach were successfully completed in the 32 patients, no one converted to laparotomy. The operation time was (315.5±36.7) min, the intraoperative bleeding was (340.8±105.4) mL, and the postoperative hospital stay was (8.9±1.7) d. The postoperative complications occurred in 6 cases, including 1 case of peritoneal effusion, 1 case of intraabdominal infection, 2 cases of bile leakage and 2 cases of pleural effusion combined with pulmonary infection, who were discharged after receiving the conservative treatment according to the symptoms. The results of postoperative pathology: 13 cases of hepatocellular carcinoma, 6 cases of intrahepatic cholangiocarcinoma, 7 cases of hepatic angioleiomyoma, 6 cases of intrahepatic bile duct stones. The average follow-up time was 12 months (range 1 to 24 months). During the follow-up period, 7 cases of hepatic angioleiomyoma and 6 cases of hepatolithiasis survived after operation. The intrahepatic metastases were found in 1 patient with hepatocellular carcinoma at 12 months and 2 cases of intrahepatic cholangiocarcinoma at 9 months and 11 months, respectively. The rest patients survived free tumor.ConclusionLaparoscopic right hemihepatectomy via anterior approach is safe and feasible, and has a satisfactory short-term efficacy.
ObjectiveTo evaluate the effects of indocyanine green (ICG) fluorescence imaging in laparoscopic anatomic hepatectomy. MethodsThe clinical data of 26 patients who underwent ICG fluorescence-guided laparoscopic anatomic hepatectomy in the Department of Hepatobiliary Surgery at Affiliated Hospital of North Sichuan Medical College from March 2019 to May 2023 were retrospectively analyzed. ICG staining methods included combined lipiodol-ICG (SHIFT&nanoICG) hepatic artery embolization (anterograde staining) and (or) portal vein retrograde staining. Patient demographics, pathological characteristics, intraoperative outcomes (ICG staining method and results, operation time, intraoperative blood loss, transfusion rate, conversion to open surgery), and postoperative outcomes [alanine aminotransferase (ALT), aspartate aminotransferase (AST), albumin (ALB), total bilirubin (TB) levels on postoperative day 3, hospital stay, complications] were analyzed. Quantitative data conforming to a normal distribution were described as mean ± standard deviation, while skewed distributions were described as median (interquartile range). The significance level was set at α=0.05. ResultsAmong 26 patients, 6 received combined anterograde (SHIFT&nanoICG) + retrograde staining (referred to as the “dual-staining group”), while 20 received retrograde staining alone (referred to as the “single-staining group”). One case (3.8%) in the single-staining group required conversion to open surgery. All resection margins were negative. No statistically significant differences were observed between the dual-staining group and the single-staining group for the following parameters: Tumor diameter [5.0 (4.4) cm vs. 4.0 (4.2) cm, P=0.483], operative time [307.0 (146.0) min vs. 250.0 (137.5) min, P=0.831], intraoperative blood loss [250.0 (225.0) mL vs. 225.0 (338.0) mL, P=0.756], postoperative hospital stay [(12.3±2.1) d vs. (10.9±2.7) d, P=0.232]. Furthermore, no significant differences were found in ALT, AST, ALB, and TB levels on postoperative day 3 (P>0.05). Regarding postoperative complications (classified according to the Clavien-Dindo system): One patient with grade Ⅰ complication was recorded in the dual-staining group, 3 with grade Ⅰ and 3 with grade Ⅱ complications were recorded in the single-staining group, no grade Ⅲ or higher complications occurred in either group. Comparison of complication rate between the two groups showed no statistically significant difference (P=0.600). ConclusionsBoth conventional ICG and SHIFT&nanoICG provide effective fluorescence guidance for laparoscopic anatomic hepatectomy. For patients with hepatocellular carcinoma who are ineligible for primary radical resection or have lost the opportunity for initial curative surgery, SHIFT&nanoICG provides superior intraoperative fluorescence visualization following transarterial embolization-assisted conversion therapy.
Objective To clarify incidence and risk factors of hepatitis B reactivation during short term (one month) in hepatitis B virus (HBV) related hepatocellular carcinoma (HCC) patients receiving partial hepatectomy. Methods From January 2015 to December 2015, 214 consecutive patients with HBV-related HCC who underwent partial hepatectomy were retrospectively enrolled in this study. The risk factors affecting incidence of hepatitis B reactivation were analyzed. Results Hepatitis B reactivation happened in 7.0% (15/214) of patients within 1 month after partial hepatectomy. By univariate analysis, the preoperative HBV-DNA negativity and hepatitis B e antigen (HBeAg) positivity were significantly correlated with the occurrence of hepatitis B reactivation (P=0.023 and P=0.001, respectively). By multivariate analysis, the preoperative HBV-DNA negativity 〔OR=9.21, 95% CI (2.40, 35.45), P=0.001〕 and HBeAg positivity 〔OR=20.51, 95% CI (5.41, 77.73), P<0.001〕 were the independent risk factors for hepatitis B reactivation. Conclusions Hepatitis B reactivation is common after partial hepatectomy for HBV-related HCC during short term, especially in patients whose preoperative HBV-DNA negativity and HBeAg positivity. A close monitoring of HBV-DNA during short term after partial hepatectomy is necessary, once hepatitis B is reactivated, antiviral therapy should be given.
ObjectiveTo investigate the clinical value of three-dimensional reconstruction of liver and resection of hepatocellular carcinoma with indocyanine green (ICG) fluorescence staining. MethodsClinical data of a patient with hepatocellular carcinoma admitted to the Department of Liver Surgery of West China Hospital of Sichuan University in May 2021 were retrospectively collected. In this patient, intrahepatic vascular reconstruction was performed by SYNAPSE 3D software of Japan before operation, and the portal vein and hepatic vein corresponding to the tumor were analyzed to simulate the resection range. Intraoperative ICG fluorescence staining was used to perform laparoscopic resection of segment Ⅳ of the liver.ResultsIn this patient, the fluorescence boundary on the liver surface was clear after staining, and the intrahepatic segment fluorescence interface could still be maintained in the hepatic parenchyma dissociation, and the resection of the liver segment was consistent with the preoperative three-dimensional reconstruction plan. The operation took 230 min in total, and the bleeding was about 200 mL. On the first day after the operation, blood biochemical test showed that the plasma albumin was slightly low, and no obvious abnormalities were observed in transaminase, bilirubin, etc. After the infusion of human albumin, the indexes returned to normal, and the patient recovered and was discharged on the fourth day after the operation. No complications occurred after the operation, and no tumor recurrence and metastasis were observed during follow-up period. Conclusion3D reconstruction and ICG fluorescence guidance are safe and feasible for the treatment of hepatocellular carcinoma after laparoscopic anatomic segment Ⅳ resection, and the positive staining method of ICG fluorescence segment is recommended.
In order to investigater the effect of nutritional support on nutrients metabolism after liver resection,we researched into the hepatectomy and total parenteral nutrition model in rats.The features of the model were no fasting before surgery,10% glucose subcutaneous injection prior to operation avoiding of blood loss and shortening of the surgical process.The 7-day mortality was markedly decreased.Anesthetized with phenobarbital(25mg/kg) injection in combination of ether inhalation,the rats recovered quickly from anesthesia and developed almost no infection of the respiratory tract after hepatectomy.The rats were supplied parenterally energy of 573kJ/kg and a marked improvement in survival was achieved after liver resection.By applying dual preventive rotation equipment of protective spring and IN-Stopper,nutrient solution could be safely infused.
The global incidence of benign biliary tract diseases is high. Not only its anatomical variations are complex and the disease heterogeneity is strong, but also its preoperative assessment methods, surgical techniques and diagnostic and treatment strategies need to be improved. Consequently, patients have many perioperative complications and a poor long-term prognosis. According to the anatomical characteristics of the biliary tract and the pathophysiological characteristics of benign biliary diseases, we propose the surgical treatment concept of benign biliary tract diseases with the removal of the diseased bile duct tree drainage as the core, which is different from the traditional biliary surgery that takes “patency and obstruction” as the focus of treatment, and “alleviates symptoms” as the treatment goal. Through a series of improvements such as preoperative evaluation, surgical planning, surgical operations, and postoperative management, we have designed a series of innovative diagnosis and treatment strategies and procedures with the goal of curing biliary diseases, with a view to changing the diagnosis and treatment status of biliary surgery. We hope that can change the current the diagnosis and treatment status of biliary surgery.
ObjectiveTo explore the clinical value and experience of enhanced recovery after surgery (ERAS) of “LEER” model with “less pain” “early move” “early eat” and “reassuring” as its ultimate goal in perioperative period of laparoscopic anatomical hepatectomy of patients with primary liver cancer.MethodsThe basic clinical data of 98 patients treated in our department from May 2017 to March 2020 who were diagnosed as primary liver cancer and underwent laparoscopic anatomical hepatectomy were retrospectively analyzed. The incidence of postoperative complications, postoperative recovery and patients’ satisfaction were compared between 40 patients managed with traditional model (traditional group) and 58 patients managed with measures of ERAS of “LEER” model (“LEER”-ERAS group).ResultsCompared with the traditional group, the “LEER”-ERAS group had lower postoperative pain scores (t=2.925, P=0.004), earlier postoperative anal exhaustion, bowel movement and normal diet (t=3.071, t=3.770, t=3.232, all P<0.005) , shorter time to postoperative off-bed activity (t=5.025, P<0.001) and earlier postoperative removal time of drainage tube (t=3.232, P=0.001). Postoperative hospital stay was shorter (t=4.831, P<0.001), the cost of hospitalization was lower (t=3.062, P=0.003), and the patient’s satisfaction with medical treatment was higher (χ2=9.267, P=0.002). There were no statistical difference in the operative time, intraoperative blood loss, rate of conversion to laparotomy, blocking time of porta hepatis, postoperative complications and postoperative adverse events between the two groups (P>0.05).ConclusionsCompared with the traditional model, the measures of ERAS of “LEER” model that applied to laparoscopic anatomical hepatectomy of patients with primary liver cancer, is safe and effective, and can relieve postoperative pain, accelerate postoperative rehabilitation, improve satisfaction of patients, shorten hospital stay, and reduce medical costs. It has further promotion and research value.
Objective To evaluate effects of three-dimensional (3D) visualized reconstruction technology on short-term benefits of different extent of resection in treating hepatic alveolar echinococcosis (HAE) as well as some disadvantages. Methods One hundred and fifty-two patients with HAE from January 2014 to December 2016 in the Department Liver Surgery, West China Hospital of Sichuan University were collected, there were 80 patients with ≥4 segments and 72 patients with ≤3 segments of liver resection among these patients, which were designed to 3D reconstruction group and non-3D reconstruction group according to the preference of patients. The imaging data, intraoperative and postoperative indicators were recorded and compared. Results The 3D visualized reconstructions were performed in the 79 patients with HAE, the average time of 3D visualized reconstruction was 19 min, of which 13 cases took more than 30 min and the longest reached 150 min. The preoperative predicted liver resection volume of the 79 patients underwent the 3D visualized reconstruction was (583.6±374.7) mL, the volume of intraoperative actual liver resection was (573.8±406.3) mL, the comparison of preoperative and intraoperative data indicated that both agreed reasonably well (P=0.640). Forty-one cases and 38 cases in the 80 patients with ≥4 segments and 72 patients with ≤3 segments of liverresection respectively were selected for the 3D visualized reconstruction. For the patients with ≥4 segments of liver resection, the operative time was shorter (P=0.021) and the blood loss was less (P=0.047) in the 3D reconstruction group as compared with the non-3D reconstruction group, the status of intraoperative blood transfusion had no significant difference between the 3D reconstruction group and the non-3D reconstruction group (P=0.766). For the patients with ≤3 segments of liver resection, the operative time, the blood loss, and the status of intraoperative blood transfusion had no significant differences between the 3D reconstruction group and the non-3D reconstruction group (P>0.05). For the patients with ≥4 segments or ≤3 segments of liver resection, the laboratory examination results within postoperative 3 d, complications within postoperative 90 d, and the postoperative hospitalization time had no significant differences between the 3D reconstruction group and the non-3D reconstruction group (P>0.05). Conclusion 3D visualized reconstruction technology contributes to patients with HAE ≥4 segments of liver resection, it could reduce intraoperative blood loss and shorten operation time, but it displays no remarkable benefits for ≤3 segments of liver resection.
Objective To investigate the technique and feasibility of hepatic pedicle vascular control in laparoscopic hepatectomy. Methods From May 2005 to June 2011, 95 cases of hepatectomies were performed by laparoscopy in the Department of Minimally Invasive Surgery, The First Affiliated Hospital, Guangxi Medical University.The characteristics of these cases were analyzed. Results Left lateral segmentectomy were required in 21 patients, left hepatectomy in 13 patients, right hepatectomy in 4 patients, segmentectomy in 17 patients, tumor resection in 24 patients,hemangioma resection in 5 patients, and conversions to laparotomy in 11 patients. The intermittent Pringle maneuver were performed in 39 patients. The mean vascular clamping time in Pringle maneuver was （30.84±9.51） min. The selective vascular control of inflow were performed in 56 patients， the technique included intrahepatic Glisson approach in 14 patients and controlling hepatic artery and portal vein separately in 42 patients. Pre-parenchymal transection control of hepatic outflow were performed in 12 patients, included the left hepatic vein were controlled by suturing or separating in 11 patients and right hepatic vein was controlled by separating in 1 patient. Others were controlled intraparenchymally during transection. The mean operative time was （236.80±95.97） min，mean operative blood loss was（ 551.55±497.41） ml， concentrate red blood cells transfusion volume was（ 2.60±2.23） U， and plasma transfusion volume was （211.90±179.29） ml. The postoperative complications included bleeding in 4 patients, pleural effusion in 4 patients, pneumonia in 3 patients, ascites in 7 patients, and biliary fistula in 2 patients, and dead in 1 patient. The mean hospitalization time was（ 12.47±4.18） days. At the deadline（ February 2012）, 72 cases with liver cancer were followup. The follow-up time ranged from 5 to 81 months and the mean time was（ 24.14±16.62） months， where survival rate was 68.4%（ 54/79） of 1-year and 21.5%（ 17/79） of 3-year. Conclusions The application of hepatic pedicle vascular control in laparoscopic hepatectomy is feasible.