Objective:To investigate the effect of high glucose on invasion and migration of colorectal cancer（CRC）through hepatocyte growth factor（HGF）/c-met pathway.Methods:Forty CRC patients from January 2022 to December 2022 were selected and divided into hyperglycemic group（blood glucose ≥6.1 mmol/L，n=22）and normal blood glucose group（blood glucose 3.96.1 mmol/L，n=18）according to fasting blood glucose. The clinicopathological features and high expression rates of HGF and c-met were compared between the two groups. HCT116 cells were divided into control group（n=5），high glucose group（n=5）and high glucose +sull274 group（n=5）. The proliferation，invasion，migration，HGF and c-met protein expression levels of the three groups were compared. SPSS 20.0 statistical software was used to process the data. The measurement data were expressed as（xˉ±s）. One-way ANOVA analysis of variance was used for multi-group comparison，and LSD-t test was used for pin-group comparison. The comparison of counting data between the two groups was performed using the χ2 test. P < 0.05 was considered statistically significant.Results:The proportion of CRC differentiation and lymph node metastasis in hyperglycemia group were higher than those in normal glycemia group（P < 0.05）. The high expression rates of HGF and c-met in hyperglycemia group were higher than those in normal blood glucose group（P < 0.05）. Compared with the control group，the proliferation activity，invasion，migration，HGF and c-met protein expression levels of HCT116 cells in high glucose group were increased，with statistical significance（P < 0.05）. Compared with the high sugar group，the above indexes in the high sugar +sull274 group were lower，and the difference was statistically significant （P < 0.05）.Conclusion:High glucose can promote CRC invasion and migration by upregulating HGF/c-met pathway.
Objective:To investigate the application of perioperative comprehensive management in patients with choledocholithiasis combined with acute cholangitis by endoscopic retrograde cholangiopancreatography (ERCP) and laparoscopic cholecystectomy (LC).Methods:Eighty patients with choledocholithiasis complicated with acute cholangitis who received ERCP+LC were randomly divided into two groups. The control group was given perioperative routine management, and the observation group was given perioperative comprehensive management. SPSS 25.0 software was used to analyze the data. Perioperative indexes, hemodynamic indexes, inflammatory emergency indexes and myocardial injury markers were presented with (), independent t test was used for comparison between groups; The statistical data such as complication rate were compared by χ2 test. P<0.05 was considered statistically significant.Results:The length of hospital stay in the observation group was better than that in the control group (P<0.05). After induction of anesthesia (T1), immediately after intubation (T2), 5?min after pneumoperitoneum (T3), and at the end of operation (T4), the fluctuation of heart rate (HR) and mean arterial pressure (MAP) in the observation group was smaller than that in the control group (P<0.05). One day after operation, the inflammatory stress indexes in the observation group were lower than those in the control group(P<0.05). 3 days after operation, the myocardial injury indexes in the observation group were lower than those in the control group(P<0.05). There was no significant difference in the total complication rate between the two groups (P>0.05).Conclusion:Perioperative comprehensive management intervention for choledocholithiasis patients with acute cholangitis treated with ERCP+LC can effectively maintain the hemodynamic stability of patients, reduce postoperative inflammatory stress response and myocardial damage, which is conducive to postoperative rehabilitation of patients, and is safe and feasible.
Liver regeneration (LR) is a complex set of mechanisms between liver cells and molecules in which the initiation, proliferation, and termination processes of liver repair are regulated. In the face of various liver diseases and treatment measures, the liver's regenerative capacity is significantly affected. In addition, whether liver diseases can be alleviated or even cured depends to a large extent on the regenerative ability of liver cells to achieve the recovery of liver function. Exploring the pathogenesis of LR and the related cell sources is of great significance for accelerating the recovery of liver function under different pathological modes and formulating therapeutic strategies. Although LR has been extensively studied, many challenges remain to fully understand it. This article reviews the mechanism of liver regeneration in order to have a new understanding of the changes of liver diseases and provide a new direction for the treatment of liver diseases.
Objective:To analyze the short-term and long-term prognosis and influencing factors of primary liver cancer (PLC) with spontaneous ruptured hemorrhage after emergency transcatheter arterial chemoembolization (TACE) surgery.Methods:Clinical data of 96 PLC patients with spontaneous ruptured hemorrhage underwent emergency TACE surgery from January 2017 to December 2019 were retrospectively analyzed, and they were included in this study and divided into poor prognosis group (n=45) and good prognosis group (n=51) based on one-year survival status after surgery. Statistical analysis were performed by using SPSS 25.0 software. Count data were expressed as [Example (%)] and were examined by using χ2 test ; Measurement data exhibiting a normal distribution, were represented by (), and were exmined by using independent sample t test. By using multiple factor COX regression analysis was performed to identify independent prognostic factors of patients. Furthermore, the area under the curve (AUC) of the receiver operating characteristic (ROC) curve were used to evaluate the predictive value of the mortality of patients within 1 year after surgery. P <0.05 was considered as a statistically significant difference.Results:All patients completed emergency TACE surgery, with a short-term hemostasis success rate of 91.7%. The median survival time of all patients was 10.9 months, and the one-year survival rate after surgery was 46.9% (45/96). Age, the proportions of Child Pugh grade C, TNM stage IV, portal vein tumor thrombus, the maximum diameter of cancer focus, blood levels of prothrombin time, total bilirubin, glutamic transaminase, creatinine and alpha-fetoprotein in poor prognosis group were significantly higher than those in the good prognosis group, and the blood level of hemoglobin (HB) and prognostic nutritional index (PNI) were significantly lower than those in the good prognosis group (P<0.05). The multivariate COX regression analysis result showed that Child Pugh grade, TNM stage, preoperative Hb and PNI were the independent influencing factors for the prognosis of patients after emergency TACE surgery (P<0.05). The ROC curve analysis result indicated that Hb and PNI before emergency TACE have high predictive value for mortality within one-year after surgery (P<0.05).Conclusion:The short-term hemostatic effect of emergency TACE for PLC patients with spontaneous ruptured hemorrhage is good, and Child Pugh grade, TNM stage, preoperative Hb and PNI were the independent influencing factors for postoperative prognosis of patients.
Objective:To investigate the ability of preoperative urea-creatinine ratio (UCR) to predict long-term postoperative prognosis and to validate the relationship between UCR and muscle mass in patients with colorectal cancer.Methods:Clinical data of 221 colorectal cancer patients from January 2015 to January 2019 were retrospectively analyzed. The patients were divided into two groups according to the UCR optimal cut-off value of 2.65 to explore the relationship between UCR and 3-year prognosis of the patients. Kaplan-Meier plotting of survival curves was done and compared by Log-Rank test. Correlation analysis was performed between patients' preoperative UCR and muscle parameters. Independent t test and nonparametric rank-sum test were used for normally and non-normally data, respectively. Categorical variables were tested using the χ2 test. P<0.05 was statistically significant.Results:There were 22 deaths and 29 recurrences within 3 years. Multivariate analysis showed that UCR and tumor stage were significantly associated with postoperative overall survival (OS) and recurrence-free survival (RFS) （P<0.05）. In all patients, the ROC area predicting 3-year overall survival and recurrence was 0.789 （P<0.001） and 0.739 （P<0.001）, respectively; the risk of death and recurrence was more significant in the high UCR group compared with the low UCR group （P<0.007）. In addition, UCR level was significantly associated with skeletal muscle mass （P<0.01）.Conclusion:UCR levels are effective in predicting the long-term prognosis of colorectal cancer patients after surgery. Patients with a higher UCR have an increased risk of death and tumor recurrence. In addition, UCR is positively correlated with skeletal muscle mass.
Objective:To explore the clinical application of retrosheath approach through umbilical single-port laparoscopy in totally extraperitoneal inguinal hernia repair (TEP).Methods:80 patients with inguinal hernia treated in our hospital from January 2022 to July 2023 were randomly divided into experimental group (40 cases) and control group (40 cases). The clinical effects of the two groups were compared and analyzed by t test and χ2 test.Results:There was no significant difference in operation time between the two groups, but the patients in the experimental group had less blood loss, shorter incision length, shorter hospitalization days, lower VAS pain score, higher incision satisfaction rate and fewer postoperative complications(P<0.05).Conclusion:Transumbilical single-port laparoscopic retrosheath approach for total extraperitoneal inguinal hernia repair is safe and effective, with the advantages of shorter hospitalization time, less injury and fewer complications, which is worthy of wide clinical application.
Objective:To investigate the relationship between the expression of thymidine kinase 1(TK1) and cell proliferation antigen 67(Ki67) protein in cancer tissues and the prognosis of patients with differentiated thyroid carcinoma (DTC) treated by endoscopic assisted thyroidectomy via areola approach.Methods:In a case control study, 40 DTC patients with poor prognosis who received endoscopic resection via areola from June 2012 to June 2016 were included in the poor prognosis group. At the same time, 40 patients with DTC with good prognosis who received endoscopic resection via areola approach were included in the good prognosis group. All patients were followed up for 5 years. SPSS 23.0 software was used for data processing. The enumeration data were expressed as [cases (%)], and χ2 test was used. Rank sum test was used for grade data; all measurement data were tested by Shapiro-Wilk normality test, and the normal distribution was expressed as (). Independent sample t test was used for comparison between groups. Measurement data with skewed distribution were expressed as [M(P25, P75)], and Mann-Whitney U test was used for comparison between groups. The receiver operating curve (ROC) was drawn to analyze the relationship between the expression of TK1 and Ki67 protein and the prognosis of DTC patients after endoscopic resection via areola approach. P<0.05 was considered statistically significant.Results:The positive expression rate of TK1 and Ki67 protein in DTC cancerous tissues (66.25%, 71.25%) was higher than that in adjacent tissues (21.25%, 23.75%) (P<0.05); the levels of thyroglobulin (Tg) and thyroid stimulating hormone (TSH) in patients with poor prognosis were higher than those in patients with good prognosis, and the positive expression rates of TK1 and Ki67 protein were higher than those in patients with good prognosis (P<0.05). The ROC curve was drawn. The results showed that the AUC of TK1 and Ki67 protein expression predicting the poor prognosis of endoscopic resection via areola approach were 0.825 (95% CI: 0.728-0.922) and 0.863 (95% CI: 0.775-0.950), respectively, which had certain predictive value.Conclusion:The prognosis of DTC patients may be related to the expression of TK1 and Ki67 proteins in cancer tissues, and TK1 and Ki67 proteins can be used as prognostic indicators of DTC patients.
Objective:To study the overall efficacy and postoperative complications of "one-step" and sequential "two-step" laparoscopic surgery for cholecystolithiasis combined with choledocholithiasis.Methods:A total of 103 patients with calculi admitted from May 2020 to May 2022 were included and divided into one-step group (n=48) and two-step group (n=55) according to treatment methods. The one-step group was treated with laparoscopic choledochotomy (LCBDE) combined with laparoscopic cholecystectomy (LC). In the two-step group, endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic duodenal papillary sphincterotomy (EST) combined with LC were performed. All patients' data were scored by propensity matching (caliper value: 0.02) to exclude the influence of confounding factors of baseline data, and 46 patients with comparable baseline data were obtained in each group. The data were analyzed using SSPS 24.0 software, and the statistical data were expressed as [n (%)] and χ2 test was used. Measurement data were expressed as () using paired t test or LSD-t test. P<0.05 indicated that the difference was statistically significant.Results:There was no significant difference in one-time stone clearance rate (93.5% vs. 91.3%), conversion to laparotomy rate (0.0% vs. 2.2%), stone residual rate (6.5% vs. 8.7%) and gastrointestinal function between the two groups during operation (P>0.05). There was no significant difference in the improvement time of gastrointestinal function between the two groups (P>0.05). The rate of sedative use and length of hospital stay in one-step group were significantly lower than those in two-step group (P<0.05). There was no significant difference in the incidence of complications during operation between the two groups (8.7% vs. 10.9%) (P>0.05).Conclusion:LCBDE combined with LC in the treatment of cholecystolithiasis combined with choledocholithiasis has a faster postoperative recovery, which is suitable for young patients or patients with large stones, but ERCP/EST+LC can be selected for elderly patients or patients with severe obstructive gangrene. Therefore, the appropriate minimally invasive treatment plan should be selected according to the actual situation of patients.
Objective:To investigate the relationship between energy metabolism and sex hormone levels in patients with polycystic ovary syndrome after 3D laparoscopic sleeve gastrectomy（LSG）.Methods:A total of 68 patients with PCOS from June 2021 to June 2022 were selected as the study objects and divided into operation group and non-operation group according to different treatment methods，with 34 patients in each group. All patients were treated with letrozole，and patients in operation group were treated with 3D LSG on this basis. SPSS 20.0 software was used for statistical analysis. Measurement data such as sex hormone level and metabolic index were expressed as（xˉ±s），and independent sample t test was performed. Rank Sum test was used for treatment effect，χ2 test was used for other statistical data. Spearman correlation was used to analyze the correlation between postoperative metabolic indexes and sex hormone levels. P<0.05 was considered to be statistically significant.Results:The total effective rate of operation group（88.2%）was significantly higher than that of non-operation group（67.6%），and the difference was statistically significant（P=0.041）. After treatment，the levels of luteinizing hormone（LH），testosterone（T），follicle-stimulating hormone（FSH），estradiol（E2）and progesterone（P）in 2 groups were significantly decreased（P<0.05），but the levels of LH，T，FSH，E2 and P in surgery group were significantly lower than those in non-surgery group（P<0.05）. After treatment，the body mass index，abdominal circumference，hip circumference，fat content，weight without fat，respiratory quotient and resting energy metabolism of patients in the surgery group were significantly lower than those in the non-surgery group（P<0.05），and the above indexes were positively correlated with LH，T，FSH，E2 and P.Conclusion:There was a significant correlation between the body energy metabolism after 3D LSG and the sex hormone levels in PCOS patients.
Objective:To analyze the clinical effects of orthostomy preperitoneal repair and laparoscopic Sugarbaker in the treatment of parastostomy hernia.Methods:Sixty patients who underwent parastostomy hernia repair from January 2017 to April 2022 were retrospectively analyzed and divided into two groups with 30 cases each according to different operation methods. The observation group underwent in situ preperitoneal repair and the control group underwent laparoscopic Sugarbaker operation. All data were analyzed using SPSS 22.0 software. Measurement data of perioperative indexes，pain scores and ostomy function scores were represented by（xˉ±s），and independent t test was performed for comparison between groups. The number of postoperative complications and recurrence rate were compared among the data groups by χ2 test. P<0.05 was considered statistically significant.Results:The first exhaust time and hospitalization cost of the observation group were better than those of the control group，but the intraoperative blood loss and drainage tube removal time of the control group were better than those of the observation group，the difference was statistically significant（P<0.05）. The pain scores of the observation group were significantly lower than those of the control group at 1 d and 3 d after surgery，and the ostomy function scores at 7 d after surgery were significantly higher than those of the control group（P<0.05）. There was no significant difference in the total complication rate and recurrence rate between the two groups（P>0.05）.Conclusion:Compared with laparoscopic Sugarbaker，the treatment of parastostomy hernia with orthostomy preperitoneal repair results in less postoperative pain，faster recovery of intestinal function，better ostomy function，and less financial burden for patients.
Objective:To compare the effect of two prophylactic ileostomy methods in laparoscopic ISR for ultra-low rectal cancer.Methods:The clinical data of 52 patients with LARC from June 2019 to June 2022 were retrospectively analyzed. All patients received neoadjuvant radiochemotherapy（nCRT）before receiving ISR and were divided into group A（distal margin distance <1 cm，n=24）and group B（distal margin distance ≥1 cm，n=28）according to the distance of distal margin. All data were processed by SPSS 22.0 software. Perioperative indicators and other measurement data were expressed by（xˉ±s），and independent t test was performed for inter-group comparison. The statistical data of postoperative complications were represented by［cases（%）］and χ2 test was performed. Kaplan-Meier method and Log-Rank test were used for survival analysis. P<0.05 indicated that the difference was statistically significant.Results:There were no significant differences in operation time，intraoperative blood loss，number of lymph node dissection，postoperative exhaust time and postoperative hospital stay between the two groups（P>0.05）. There were no significant differences in incision infection，anastomotic leakage，anastomotic hemorrhage，pelvic infection，intestinal obstruction and total complications between the two groups（P>0.05）. The median follow-up time was 30 months（11~47 months）. Kaplan-Meier analysis showed that cumulative overall survival（70.8%vs.78.6%）and disease-free survival（62.5%vs.75.0%）were not significantly different between the two groups（Log-Rank χ2=0.256，1.360，P=0.613，0.244）.Conclusion:Patients with LARC with a distance of ≥1 cm and a distance of <1 cm at the distal incisional margin during ISR can achieve the same efficacy after nCRT，and the overall survival and disease-free survival of patients are not significantly affected.
Laparoscopic technology has been developed in colorectal surgery in China for 30 years. The key to the success of this technology is standardized technical practice and standardized technical promotion. The incidence of rectal cancer，especially mid and lower rectal cancer，is relatively high in China，and because of the special anatomical position，it is more involved in functional preservation. Therefore，the standardization of laparoscopic surgery is more important for radical resection of rectal cancer. This article elaborates on the standardized development of laparoscopic surgery for rectal cancer in China from the aspects of surgical indications，standardized promotion of technology，systematic training，and further standardization of technological innovation.
Laparoscopic techniques have become popular for the surgical treatment of gastric cancer and are used for many procedures. However，intracorporeal esophagojejunostomy during laparoscopic total gastrectomy is technically challenging. Various methods of intracorporeal anastomosis for esophagojejunostomy have been applied. However，anastomosis with a circular stapler is troublesome and requires special equipment for purse-string suture and anvil insertion. However，anastomosis methods using linear staplers require advanced techniques and numerous staplers. Totally，π-shape reconstruction（3-in-1 procedure for esophagojejunostomy）is widely used.
Objective:To investigate the effect of peritoneal peritoneal hernia repair（TAPP）in the treatment of incarcerated inguinal hernia.Methods:A total of 76 patients with incarcerated inguinal hernia from June 2018 to March 2022 were selected and divided into control group（receiving open tension-free hernia repair）and TAPP group（receiving TAPP）by random number table method，with 38 patients in each group. SPSS 25.0 software was used for data processing. Measurement data such as perioperative indicators，visual analogue scale（VAS）score 24 hours after surgery，inflammation indicators were expressed as（xˉ±s），and independent sample t test was performed. The statistical data of postoperative complications were expressed by［n（%）］using χ2 test. P < 0.05 was considered statistically significant.Results:The intraoperative blood loss，length of hospital stay，postoperative gastrointestinal function recovery time，time to get out of bed and 24h VAS scores in TAPP group were lower than those in control group（P < 0.05）. Immediately after surgery，the levels of procalcitonin（PCT）and C-reactive protein（CRP）in 2 groups were higher than those before surgery，but those in TAPP group were lower than those in control group（P < 0.05）. There was no significant difference in the incidence of postoperative complications between the two groups（P > 0.05）.Conclusion:TAPP is effective in the treatment of incarcerated inguinal hernias，with faster postoperative recovery，less pain and no increase in postoperative complications.
Objective:To investigate the effect of two “half pocket” suture embedding method in strengthening duodenal stump during radical gastrectomy of gastric cancer.Methods:The clinical data of 194 patients with gastric cancer who underwent radical gastrectomy from December 2018 to March 2021 were retrospectively analyzed. According to different methods of strengthening duodenal stump during the operation，two “half-bag” suture embedding method were used in the observation group（110 cases），and sarcomuscular suture embedding method was used in the control group（84 cases）. SPSS 25.0 software was used for statistical analysis，and the perioperative indicators（xˉ±s）of the two groups were compared by independent sample t test，and postoperative complications（%）were compared by χ2 test. P < 0.05 was considered to be statistically significant.Results:None of the patients died. The incidence of duodenal stump leakage in the observation group was significantly lower than that in the control group（0% vs. 3.6%， P = 0.046）. The ratio of duodenal stump length ≤0.5 cm in observation group was significantly higher than that in control group（27.3% vs. 13.1%，P = 0.016）. Duodenal embedding time in the observation group was significantly shorter than that in the control group［（2.5 ± 0.8）vs.（4.7 ± 0.9）min，P < 0.001］.Conclusion:The occurrence of duodenal stump leakage can be significantly reduced by using two “half pocket” suture embedding method to strengthen duodenal stump during radical gastrectomy. The embedding time of the method is short，the operation is simple，and the embedding difficulty caused by the short duodenal stump can be solved. Therefore，this method is worth popularizing and applying in gastric cancer surgery.
At present，radical total gastrectomy is still the main treatment method for esophagogastric junction adenocarcinoma（AEG）. However，due to the low rate of distal lymph node metastasis in early AEG，total gastrectomy without any choice may lead to unnecessary lymph node dissection in some patients，increase surgical trauma，and seriously affect the postoperative quality of life of patients. Therefore，how early AEG can minimize surgical trauma，preserve part of gastric function and improve patients’quality of life on the premise of ensuring the radical treatment of tumors has gradually become the focus of scholars. In recent years，more and more scholars at home and abroad recommend proximal gastrectomy，which has the advantages of better postoperative quality of life，and the disadvantages of higher gastroesophageal reflux and anastomotic stenosis rate. Therefore，in order to improve this deficiency，Many new anastomotic methods，including Side-overlap，double muscle flap anastomosis，jejunal interposition and double channel anastomosis，emerged. However，there is no consensus or guideline on how to choose the best proximal gastro-digestive reconstruction. Therefore，this article reviews the progress of digestive tract reconstruction after proximal gastrectomy，hoping to provide reference for the selection of the best anastomotic method.
Objective:A meta-analysis was performed to evaluate the effects of preserving and removing denonvilliers fascia（DVF）during laparoscopic radical surgery on urination and sexual function in male patients with rectal cancer.Methods:By searching large literature databases such as Pubmed，FMRS Library，Wanfang，Weipu，CNKI，etc.，the literature search started and ended from the establishment of the database to August 2022. Meta-analysis was performed using Revman 5.3 software，and Begg's test was performed using STATA14.0 to evaluate publication bias among studies.Results:A total of 915 patients in 9 literatures were included. The experimental group retained DVF（n=457 cases）and the control group did not retain DVF（n=458 cases）. The incidence of urinary dysfunction，sexual dysfunction and ejaculatory dysfunction in the experimental group was significantly lower than that in the control group，and the difference was statistically significant（Z=5.92，2.82，5.69； P<0.05），the experimental group had higher maximum urinary flow and international erectile function questionnaire scores，and the differences were statistically significant（Z=12.32，5.34； P<0.05）. Sensitivity analysis was carried out after the relevant literatures were excluded one by one，and there was no significant change in the comparison of the final statistical results. The funnel plot of Begg's test indicating ejaculatory dysfunction showed no publication bias（P=0.315）.Conclusion:Retention of DVF during laparoscopic radical resection of rectal cancer can effectively protect the function of pelvic autonomic nerve in male patients，so as to more effectively avoid the occurrence of postoperative urination function and sexual dysfunction.
Objective:To investigate the application value of needle aspiration cell block technique in preoperative molecular classification of breast cancer.Methods:Seventy-five patients with breast cancer from March 2020 to July 2022 were selected as research objects. All patients were examined by needle aspiration cell block technique before surgery，and the application value of needle aspiration cell block technique in preoperative molecular typing of breast cancer was evaluated based on postoperative histopathological and immunohistochemical results. SPSS20.0 software was used to process the data. The measurement data conforming to normal distribution was represented by（xˉ±s），and the count data was represented by［n（%）］，using χ2 test. P<0.05 indicated statistically significant difference.Results:75 female patients diagnosed with highly suspicious breast cancer and breast cancer by needle aspiration cell block technique before surgery were all confirmed to be breast cancer by postoperative histopathological examination. The accuracy of needle aspiration cell block technique for breast cancer diagnosis was 100%. The comparison of preoperative needle aspiration and postoperative histopathological immunohistochemical results showed that，The coincidence rates of progesterone receptor（PR），estrogen receptor（ER），human epidermal growth factor receptor 2（Her-2）and nuclear proliferation antigen（Ki-67）were 97.3%（73/75），98.7%（74/75），97.3%（73/75）and 94.7%（71/75），respectively. There was no significant difference in the expression of each molecular marker between the breast cancer cell block and the corresponding tissue（P>0.05），and the total coincidence rate of preoperative needle aspiration cell block technique and postoperative histopathological molecular typing reached 96.0%.Conclusion:Needle aspiration cell block technique is an accurate and easy method in preoperative diagnosis of breast cancer. It not only improves the accuracy of breast cancer diagnosis，further defines the molecular classification of breast cancer，and helps clinicians to grasp more accurate biological characteristics of breast cancer before surgery.
Objective:To investigate the efficacy of indocyanine green（ICG）fluorescence imaging in hepatectomy of complex and difficult hepatocellular carcinoma（HCC）.Methods:A total of 80 HCC patients who underwent complex and difficult hepatectomy from January 2018 to October 2022 were retrospectively selected as subjects. According to different tumor localization and hepatectomy plane determination scheme，the patients were divided into conventional group and ICG fluorescence group，with 40 cases in each group. Conventional group：Routine laparoscopic hepatectomy（LH）；ICG fluorescence group：LH was completed under the guidance of ICG fluorescence development. Data was processed by SPSS 22.0. Perioperative relevant indicators，liver function indicators and other measurement data were represented by（xˉ±s），independent t test；Statistical data such as postoperative complications were represented by［cases（%）］，χ2 test was performed. P<0.05 was considered statistically significant.Results:Operation time，intraoperative blood loss，hilar occlusion time and postoperative hospital stay in ICG fluorescence group were significantly lower than those in conventional group，and R0 margin rate was significantly higher than that in conventional group，with statistical significance（P<0.05）. There was no significant difference in postoperative anal exhaust time，postoperative extubation time and postoperative complication incidence between the two groups（P>0.05）. There was no interaction between time and method at the levels of ALB，TBIL，AST and ALT（P>0.05），while the main effect of time and method was significant at the levels of ALB，TBIL，AST and ALT（P<0.05）.Conclusion:The application of ICG fluorescence imaging in hepatectomy of complex and difficult hepatocellular carcinoma is safe and effective. It can not only effectively shorten the operation time and hilar occlusion time，reduce intraoperative injury and improve R0 resection rate，but also benefit the postoperative recovery of patients and the recovery of liver function，which is worthy of widespread clinical application.
