ObjectiveTo evaluate whether radiofrequency-assisted associating liver partition and portal vein ligation for staged hepatectomy (RALPPS) is a safer and more effective modified treatment for patients with cirrhosis-related hepatocellular carcinoma (HCC). MethodsRALPPS were performed in patients with HCC and insufficient volume of future liver remnant (FLR<40%). Data of the patients during perioperative period such as operative morbidity, mortality, operative time, blood loss, percent increase in FLR, and interval between operations, were analyzed to assess the effectiveness and safety of the operation. ResultsA total of 8 patients were performed the RALPPS operation, and 6 cases completed both stages, 2 cases of postoperative complications or tumor metastasis did not complete the two phase of surgery. The average first and second stages operative time was (214.3±35.7) min, (266.7±46.0) min, respectively, and the average two stages blood loss during the operation was (218.8±113.2) mL,(501.7±224.5) mL, respectively. The mean preoperative FLR was (26.4±7.1)%, and the mean FLR before the second stage was (46.2±4.6)%. The average percentage increase in FLR during the interval time was 35%-113%, and the mean time interval between operations were (22.2±6.4) days. One case died of renal failure and severe pulmonary infection after two operation. Seven patients were followed-up (11.6+2.0) months (8-15 months). Two patients who had not completed the two-stage operation died within 3 months after discharge. Three patients who had completed the two-stage operation were tumor recurrence in 3-9 months after discharged from hospital and supplemented interventional therapy, 1 of them died,and 2 patients were followed-up to now without recurrence. ConclusionsRALPPS is equivalent to ALPPS for treating patients with cirrhosis-related HCC and insufficient FLR volume.
ObjectiveTo asses the clinical result of left ventrical total artery revascularization with "T"-type anastomosis of left internal mammary artery (LIMA) and radial artery on pump. MethodsWe retrospectively analyzed the clinical data of 40 patients who underwent left ventrical total artery revascularization with "T"-type anasmtomosis of LIMA and radial artery on pump in our hospital between December 2013 and December 2015 year. There were 27 males and 13 females at age of 46-70 (55.0±10.2) years. The radial artery anastomosis was made sequentially to the left obtuse artery, intermediate artery, diagonal artery and left anterior descending artery. LIMA anastomosis was made to the radial artery closed to the left anterior descending artery. Saphenous vein (SV) anastomosis was made to right coronary artery. LIMA blood flow was measured with coronary artery Butterfly Flowmeter when LIMA was in suit and after operation. cTnI was measured at different time points. Complications after operation were studied. ResultsThe blood flow of LIMA after operation was significantly different from that in suit (P < 0.05). The plasm cTnI postoperation was higher than that preoperation, but the difference was not significant. All the patients were survival. Atrial fibrillation occurred in 2 patients and low cardiac output occurred in 1 patient after operation, but they recovered quickly after proper treatment. There was no myocardial infraction or hand ischemia during postoperation. There was no recurrence of mycardial infarction within 6 months to 1 year follow-up. Graft patency was assessed using 128-slice CT coronary angiography in 25 patients. Cumulative graft patency rates were 96.0% in LIMA and 90.4% in SV grafts. ConclusionLeft ventrical total artery revascularization with "T"-type anasmtomosis of LIMA and radial artery on pump is safe and effective.