ObjectiveTo investigate feasibility and safety of laparoscopic liver resection with vascular variation.MethodsThe clinical data of one patient with preoperative diagnosis of primary liver cancer, who was admitted into the Department of Hepatobiliary Surgery of the Second Affiliated Hospital of Army Military University in October 2017, were analyzed retrospectively. The three-dimensional (3D) reconstruction was completed basing on the preoperative CT data, then the liver volume was calculated and the preoperative planning was made, finally the subsequent surgery was performed.ResultsThe results of the 3D reconstruction suggested that the tumor was situated in the central of the right liver, including the segment Ⅴ, Ⅵ, Ⅶ, and Ⅷ. There was a type Ⅱ portal vein variation, the right anterior branch of the portal vein divided a branch into the left medial lobe. The right hepatic vein was divided into the ventral and dorsal branches. There was a thick right posterior inferior vein in this case. The preoperative planning was that the right posterior lobectomy or right anterior lobectomy could not completely remove the tumor. According to the standard right hemihepatectomy, the remaining liver volume accounted for 27% of the standard liver volume. If preserving the right anterior branch of the portal vein for the right hemihepatectomy, the remaining liver volume accounted for 41% of the standard liver volume. According to the concept of precise hepatectomy, the laparoscopic partial right hepatectomy with preservation of the main branch of the right anterior portal vein was performed smoothly. The liver function recovered well after the surgery. The right pleural effusion appeared after the surgery, then was relieved by the thoracentesis.ConclusionFor primary liver cancer patient with vascular variation, laparoscopic liver resection is feasible and safe basing on guide of 3D reconstruction technology.
ObjectiveTo investigate the clinical application value of laparoscopic anatomical resection of liver segment 8 via a hepatic parenchymal transection-first approach guided by the middle hepatic vein.MethodsClinical data of 8 patients who underwent laparoscopic anatomical resection of liver segment 8 via a hepatic parenchymal transection-first approach guided by the middle hepatic vein in Xinqiao Hospital from May 2017 to December 2019 were retrospectively analyzed. The operation time, intraoperative blood loss, postoperative complications, and hospitalization duration were observed.ResultsAll patients were confirmed by pathology, the postoperative pathological results showed that: hepatocellular carcinoma was found in 6 patients, mixed hepatocellular carcinoma and cholangiocarcinoma was found in 2 patients. All patients completed the operation successfully without conversion to open surgery. The median operation time was 220 min (190-240 min), median blood loss was 230 mL (200-280 mL), and blood transfusion was not needed. The postoperative median hospital stay was 8 d (7–12 d). All the patients recovered well without severe complications. Eight patients were followed up for 10.5 to 31.7 months, with a median follow-up time of 16.9 months. During the follow-up period, none of them developed hemorrhage, bile leakage, and other complications. There was no reoperation or perioperative mortality during the follow-up.ConclusionsThe method of laparoscopic anatomical resection of liver segment 8 via a hepatic parenchymal transection-first approach guided by the middle hepatic vein is safe and effective. This method can shorten the operation time, improve the safety, and reduce the difficulty of operation.
The in-vivo electron paramagnetic resonance (EPR) method can be used for on-site, rapid, and non-invasive detection of radiation dose to casualties after nuclear and radiation emergencies. For in-vivo EPR spectrum analysis, manual labeling of peaks and calculation of signal intensity are often used, which have problems such as large workload and interference by subjective factors. In this study, a method for automatic classification and identification of in-vivo EPR spectra was established using support vector machine (SVM) technology, which can in-batch and automatically identify and screen out invalid spectra due to vibration and dental surface water interference during in-vivo EPR measurements. In this study, a spectrum analysis method based on genetic algorithm optimization neural network (GA-BPNN) was established, which can automatically identify the radiation-induced signals in in-vivo EPR spectra and predict the radiation doses received by the injured. The experimental results showed that the SVM and GA-BPNN spectrum processing methods established in this study could effectively accomplish the automatic spectra classification and radiation dose prediction, and could meet the needs of dose assessment in nuclear emergency. This study explored the application of machine learning methods in EPR spectrum processing, improved the intelligence level of EPR spectrum processing, and would help to enhance the efficiency of mass EPR spectra processing.