Objective To evaluate the safety and effect of seromuscular layer anastomosis in small intestinal suture. Methods Forty patients with hepatobiliary and pancreatic diseases undergoing biliojejunostomy or cystojejunostomy were randomly divided into seromuscular layer anastomosis group (n=20) and two-layer anastomosis group (n=20) before operation， which received Roux-en-Y end-to-side jejunal seromuscular layer anastomosis and two-layer anastomosis, respectively. Intestinal anastomotic complications and other indexes such as anus venting time were recorded in each group. Results Neither group had intestinal anastomotic complications such as leakage, stricture, obstruction and hemorrhage. Time of venting to normal were (3.6±0.9) d and (3.6±0.8) d in seromuscular layer and two-layer anastomosis group respectively, there was no significant difference between them (Pgt;0.05). Conclusion Seromuscular layer anastomosis is a safe and effective method of small intestinal anastomsis.
Objective To assess the value of precise hepatectomy in treatment of primary hepatocellular carcinoma. Methods Three-dimensional (3D) models from MR image were reconstructed by 3D-Doctor software in 32 patients with primary hepatocellular carcinoma scheduled for liver resection between July 2007 and Sept 2009. From these 3D models, the vena cava, portal vein, hepatic vein, and short hepatic vein images were reconstructed, total liver volume, tumor volume, functional liver volume and ratio of functional liver volume to standard liver volume (SFLVR) were calculated. The patients were followed-up for 1-27 months, with an average of 12 months. Results The anatomic detail of liver veins and its relationship with the tumor could be displayed clearly in liver 3D models. By the 3D models, total liver volume was calculated as （1 353±419）ml, tumor volume as （287±248） ml, functional liver volume as （830±289） ml, and SFLVR as （71±22）%. Of 32 patients with hepatocellular carcinoma, right hemihepatectomy was performed in 8 cases, left hemihepatectomy in 2, and segmental or limited resection in 22. All operations were completed successfully. Postoperative complications included pulmonary infection in 1 case, bile leak in 1, moderate ascites (500-3 000 ml) in 8, and massive ascites (gt;3 000 ml) in 2 including one patient developed hepatic failure. Six and 12-month survival rates were 100% and 87%. Three, 6, and 12-month disease-free survival rates were 78%, 72%, and 72%. Conclusions Precise hepatectomy technique provides an accurate picture of liver veins anatomy and its relationship with the tumor， and allows the procedure to be simulated preoperatively for adequate and safe hepatectomy.