Laparoscopic hepatectomy is routinely used in the surgical treatment of hepatocellular carcinoma, and has formed a standardized operating procedure. Tumors located in the segments Ⅶ and Ⅷ of liver as well as the paracaval subsegment of caudate lobe are considered to be difficult sites for laparoscopic hepatectomy due to the deep anatomical location, proximity to important vascular structures, difficulty in exposing the visual field under laparoscopy, and limited operating space. Based on the experience of our team and related research reports, the authors analyzed and summarized countermeasures for the difficulties of laparoscopic hepatectomy in the treatment of hepatocellular carcinoma in difficult sites. Adhering to the tumor-centered and margin-based principles, accurate preoperative assessment, selection of the correct surgical approach, designing liver resection plane guided by hepatic vena while taking into account portal vein territory, and giving preference to ananatomical hepatectomy while preserving functional liver parenchyma as much as possible are the prerequisites for ensuring minimally invasive and oncology benefits for patients with hepatocellular carcinoma in difficult sites.
Objective To provide experimental evidence for the clinical application of ischemia therapy to treating pancreatic cancer. Methods After the model of pancreatic transplanted cancer was established in nude mice with orthotransplantation of human pancreatic cancer cell line into the pancreas, the ischemia of the right lobe of the pancreas was induced with ligation of the gastroduodenal, inferior pancreaticoduodenal and dorsal pancreatic arteries. Effects of regional ischemia on the growth of transplanted cancer and the pathomorphology of the transplanted cancer and pericancerous tissue were investigated. Results The transplanted cancer grew slower and its doubling time was longer in the ischemic group than in the control. On the 3rd, 7th and 14th day after operation, the size of transplanted cancer, the proliferative index and protein content of the cancer cells were significantly lower in the ischemic group than in the control (Ｐ＜0.01). Optical microscopy revealed large areas of coagulation necrosis, necrobiotic cells and the infiltration of inflammatory cells. The atrophy of acini, fibrosis and the infiltration of lymphocyte cells were found in pericancerous tissue. Conclusion Regional ischemia can destroy and inhibit the pancreatic transplanted cancer in nude mice effectively. The ischemia changes of pericancerous tissue may be unfavourable for the growth of the pancreatic transplanted cancer.
【Abstract】Objective To establish animal model of orthotopic liver transplantation(OLT) in miniature pigs with high standardization, reproducibility and stability. Methods OLTs were performed without venovenous bypass in Bama miniature pigs. The survival rates and the changes of hemodynamics and metabolism were investigated. Results Twenty OLTs were performed between pairs of miniature pigs. The mean operative time and anhepatic phase were (181±25.8) min and (28.4±3.2) min respectively. During the anhepatic phase, dramatic hemodynamics and metabolism changes accompanied hyperkalemia identified. MAP and CVP decreased from (14.59±1.68) kPa and (0.66±0.11) kPa to (5.87±0.91) kPa and (0.27±0.10) kPa respectively, while temperature, pH, BE and HCO3- were significantly reduced (P＜0.05) and HR and K+ in serum were remarkable increased. After reperfusion, the disorder of hemodynamics and metabolism described above recovered gradually. 1week survival rate was 90%. Sixteen animals survived more than 2 weeks. AST, ALT and TBIL were significantly increased and reached the peak level on postoperative 1 day. From postoperative 2 day, AST, ALT and TBIL began to decrease and reached postanaesthesia level on postoperative 7 day. Conclusion The animal model of OLT without venovenous bypass in miniature pig, with its high standardization, reproducibility and stability, is an ideal one for series studies related to liver transplantation.
ObjectiveTo investigate indications,technical points,and outcomes of laparoscopic liver resection in treatment for hepatic hemangioma. MethodThe clinical data of 78 patients with hepatic hemangioma underwent laparoscopic liver resection in our institute from January 2014 to December 2014 were analyzed retrospectively. ResultsSeventy-seven patients were underwent laparoscopic liver resection successfully,1 patient was conversed to open procedure.Operation method:laparoscopic anatomical liver resections were performed in 35 patients including 23 patients with left lateral segmentectomy,4 patients with left hemihepatectomy,3 patients with right hemihepatectomy,1 patient with Ⅲ segmentectomy,1 patient with Ⅵ segmentectomy,2 patients with Ⅵ and Ⅶ segmentectomy,1 patient with left lateral segmentectomy combined with Ⅵ and Ⅶ segmentectomy.Laparoscopic non-anatomical liver resection were performed in 43 patients.The operation time was (163.6 ±62.3) min,the intraoperative blood loss was (273.6±282.4) mL.No operative death occurred.One patient with postoperative functional bowel obstruction and 3 patients with pleural effusion had been recorded.All the patients recovered well.The postoperative hospital stay was (7.2±2.5) d.The results of postoperative pathology confirmed that all the tumors were hepatic cavernous hemangiomas. ConclusionsLaparoscopic liver resection for hepatic cavernous hemangioma is a safe and feasible method with small trauma,rapid recovery,cosmetic incision.Key of this technology is to strictly select surgical indications,to transect liver parenchyma along right plane,effective control of hepatic blood inflow,and properly management of cutting surface of liver.