Objective To investigate the clinical value of independently-designed three-demensional printed navigation templates for hepatectomy in hepatic surgical oncology.Methods A retrospective study was conducted on 45 patients (including 36 males and 9 females,aged from 40 to 70 years) with hepatocelluar carcinoma treated by hepatoctomy from Department of Hepatobiliary and Intestinal Surgery of Hunan Cancer Hospital from June 2016 to June 2018.These patients were divided into observation group (patients conducted with the 3D navigation-template-aided operation,n =25) and control group (patients conducted with regular operation,n =20) according to operation approach.Virtual liver resection volume and actual liver resection volume were calculated in the observation group,and the correlationship between the volume of virtual liver resection and actual liver resection was analyzed by Pearson correlation analysis.The operative time,intraoperative blood loss,intraoperative intrahepatic duct injury and postoperative hospital stay were compared between the two groups.Results In the observation group,3D modeling was successfully completed and intrahepatic and extrahepatic duct reconstruction was successful,surgical simulation.There were no statistically significant difference between the virtual and actual resected liver volume in the observation group (P ＞ 0.05).The virtual resected liver volume was positively correlated with the actual resected liver volume (r =0.991,P ＜ 0.05).Volume of intraoperative blood loss in the observation group was lower than that in the control group [(245.1 ±22.3) ml vs.(308.6 ± 19.9) ml],and the length of hospital stay was shorter than that in the control group [(7.4 ±0.2) d vs.(8.6 ±0.4) d],the difference was statistically significant (P ＜ 0.05).There was no accidental injury of intrahepatic duct in the observation group,1 case of accidental injury of middle hepatic vein and 1 case of accidental injury of secondary branch of right hepatic vein in the control group.The AST of the observation group was significantly reduced compared with that of the control group on the 4 th and 7th days after the operation,and the difference was statistically significant (P ＜ 0.05).Conclusions 3D reconstruction of liver based on high quality MR images,can facilitate restoring the adjoint relationship between hepatic duct system and liver tumor.3D printed navigation templates effectively guide certain kinds of hepatectomy,ensure that the cutting edge at the same time protect the rest of the liver tissue,reduce bleeding and accidental damage,realize accurate tumor resection.

[目的]探讨增强现实技术(AR)联合腹腔镜在切除原发性肝癌中的应用价值.[方法]术前通过核磁共振(MRI)得到的数据进行肝癌患者3D虚拟模型的构建,将构建的3D影像与腹腔镜采集到的图像传送到工作站视频采集卡,通过工作站处理将合成视频投送到手术室视频显示器,最终完成AR构建,应用AR进行切除肝脏肿瘤.[结果]术前构建的肝癌3D影像与腹腔镜术中采集到的肝脏图像,经过工作站的处理,达到精准融合.肝肿瘤位于右肝后叶,约5cm×5cm,质地较硬,边界欠清楚,腹腔及盆腔未见明显转移性肿瘤.手术时间约180min,术中分次阻断肝门共4次,每次15min,间隔5min,出血量约300mL.患者术后d1拔出胃管、进流质饮食,d2下床活动并有排气,d5拔除腹腔引流管,术后d7顺利出院.[结论]AR与腹腔镜的结合,可以术中实时地将腹腔镜得到的图像与术前3D模型准确融合,从而可引导腹腔镜实施精准切除肝脏肿瘤.

OBJECTIVE To establish the preoperative three dimensional (3D) model of liver cancer, and to precisely match the preoperative planning with the target organs during the operation.
 Methods: The 3D model reconstruction based on magnetic resonance data, which was combined with virtual reality technology via HoloLens glasses, was applied in the operation of liver cancer to achieve preoperative 3D modeling and surgical planning, and to directly match it with the operative target organs during operation.
 Results: The 3D model reconstruction of liver cancer based on magnetic resonance data was completed. The exact match with the target organ was performed during the operation via HoloLens glasses leaded by the 3D model.
 Conclusion: Magnetic resonance data can be used for the 3D model reconstruction to improve preoperative assessment and accurate match during the operation.

[Objective] To analyze prognosis and related influencing factors of hepatocellular carcinoma (HCC).[Methods] Clinical and follow-up data of 1838 patients with HCC admitted in our hospital from 1989 to 2007 were retrospectively reviewed.The survival and the related influencing factors were analyzed.[Results] The 1-,3-,5-and 10-year overall survival was 52％,26％,17％ and 8％,respectively with a median survival of 14 months and the maximal survival of 190 months.Cox proportional hazard regression model indicated that gender,AFP,clinical stage,gross type,histological type,treatment were the independent risk factors influencing the prognosis of hepatocellular carcinoma.[Conclusions] Gender,AFP,clinical stage,gross type,histological type,treatment are major influencing factors of the survival time of HCC patients.

MicroRNAs (miRNAs) are a family of small, non-coding RNA molecules that are highly conserved across species and function as regulators of gene expression. In the present study, we revealed that miR-138 expression was at a low level while sirtuin type 1 (Sirtl) mRNA expression was at high level in hepatocellular carcinoma tissues and cell lines by using real-time PCR and western blot assays, and the functions of miR-138 were achieved via targeting of Sirtl using luciferase reporter gene vector and RNA immunoprecipitation assays. Overexpression of miR-138 attenuated Sirtl expression and inhibited cell proliferation by using CCK-8 and BrdU assays. The inhibitory effect of miR-138 could be partially restored by forced expression of Sirtl in cells. Our data revealed a crucial role and mechanism of miR-138 in the regulation of hepatocellular carcinoma cell growth via the miR-138/Sirtl axis, and miR-138 could be an important potential target for the clinical management of hepatocellular carcinoma in the future.

Objective To investigate the effects of knockdown of TGFA on the proliferation of hepatocellular carcinoma cells. Methods We selected TGFA as the candidate target gene. TGFA-siRNA was transfected into L02 and HepG2 cells. The expression efficiency of TGFA mRNA was detected by Real-time PCR, and the expression level of TGFA protein was detected by Western blot. Then MTT and BrdU methods were used to detect the effects of down-regulation of TGFA-siRNA on proliferation of L02 and HepG2 cells. Western blot assay was applied to detect the TGFA/EGFR pathway activity. TGFA over expression was achieved to verify the correlation between TGFA and EGFR expression in hepatocellular carcinoma. Results TGFA-siRNA down-regulated the expression of TGFA, inhibited proliferation of human hepatoma cells but had no obvious effects on normal cell line L02. It also inhibited the activity of TGFA/EGFR pathways. The mRNA expression levels of TGFA and EGFR were specifically high in the hepatocellular carcinoma tissue and were positively correlated. Conclusion Knockdown of TGFA inhibited the proliferation of HepG2 hepatocellular carcinoma cells.

目的 探讨数字3D技术在复杂腹部外科手术中的应用方法 .方法 整群选取该院2014年1月—2015年2月收治的复杂外科手术患者为研究对象,3D系统完成手术42例为3D组,常规完成手术39例为对照组,分析两组患者手术相关指标和术后并发症情况.结果 3D组患者手术时间显著短于对照组(P<0.05),3D组患者住院时间、消化道术后恢复时间显著短于对照组(P<0.05),手术并发症发生率显著低于对照组(P<0.05).结论 应用数字3D技术进行复杂腹部外科手术术前评估及规划,能够有效的改善患者近期疗效.

目的:分析手术切除大肝癌的临床效果,为临床治疗提供参考.方法:回归性分析我院收治大肝癌患者162例临床资料,患者均采取手术治疗,分析患者术后并发症、生存期等.结果:患者肿瘤完整切除,手术时间(130±67) min,术中出血量300～6500mL,平均出血量(900±126) mL,平均输血量(600±168) mL.围术期死亡2例,1例上消化道出血,1例肝功能衰竭.术后1周ALT、TBIL水平显著增高,阻断组患者ALT、TBIL治疗改善情况显著优于对照组(P＜0.05).62术后例出现并发症,并发症发生率为38.3％,一期切除和二期切除患者生存率无明显差异(P＞0.05),平均5年生存率为45.1％.结论:手术是治疗大肝癌有效治疗方法,治疗中需要根据患者病情采取最佳手术方法,合理使用阻断法,提高治疗效果.

[Objective]To explore the clinical outcomes of colorectal cancer patients with liver metastasis after surgery .[Methods]A total of 50 cases of colorectal cancer patients with liver metastasis are analyzed .Simultaneous liver & colorectal resection and colorectal resection followed by liver resection ( n =25) were performed .And their outcomes were analyzed .[Results]Statistical significance existed between 2 groups in overall survival (OS) ,complica‐tion incidence and re‐resectable rate .[Conclusion]Simultaneous surgery offers a better OS and prognosis for colorectal patients with liver metastasis .A surgeon should strive to perform simultaneous surgery as much as possible .

Objective To analyze the effect of middle pancreatectomy for benign or low-grade malignant pancreatic tumor. Methods 24 cases of patients with benign or low-grade malignant pancreatic tumor underwent middle pancreatectomy were selected as the subjects, and their clinical data were analyzed retrospectively. Results The surgery of all the patients was completed successfully. And no operative deaths occurred. Various complications occurred postoperatively, including 1 case of pancreatic fistula, 2cases of gastrointestinal bleeding, 1 case of pyoperitoneum, 2 cases of new-onset diabetes. The patients are followed up for a period of three years, all of them are alive, and have good physical condition. Conclusion Middle pancreatectomy is a very effective way for the treatment of benign or low-grade tumor of the neck and body of the pancreas, which can improve the safety and effectiveness of surgery, reduce the incidence of complications, and is worthy of promotion in clinical practice.

[目的]探讨原发性肝癌合并肝硬化患者采用不阻断入肝血流的肝叶切除术的临床效果.[方法]本院2007年9月至2012年9月收治原发性肝癌合并肝硬化患者286例,随机分为观察组和对照组各143例,对照组采用分支入肝血流阻断切除术,观察组采用不阻断入肝血流切除术.[结果]两组术中出血量、手术时间无明显差异(P＞0.05).术前及术后1d两组谷丙转氨酶(ALT)及总胆红素水平(TB)无明显差异(P＞0.05),术后7d对照组均显著高于观察组,差异有统计学意义(P＜0.05).术后切口感染、腹水、上消化道出血、肺部感染、胆漏为主要并发症,对照组并发症发生率为19.6％,观察组为7.7％,观察组显著少于对照组(P ＜0.05).[结论]采用不阻断入肝血流的肝叶切除术治疗原发性肝癌合并肝硬化具有一定的安全性和可行性,降低了并发症发生率,对肝功能影响较小,值得在临床推广应用.

Objective To study the expression of MyD88 and STAT3 in hepatocellular cancer(HCC) tissues and its signicficance.Methods S-P immunohistological assay was applied to detect the expression of MyD88 and STAT3 protein in specimens from hepatocellular carcinoma tissues and adjacent liver tissues of 82 HCC cases.Correlation analysis was used to determine the relation of MyD88 and STAT3 with the clinicopathological data.Results The positive rate of MyD88 and STAT3 expression was 67.1% and 69.5% respectively in 82 hepatocellular carcinoma tissues,which were significantly higher than the positive rate(11% and 8.5% respectively) in adjacent tissues(P0.05).STAT3 expression was positively correlated with MyD88(r=0.578,P=0.002).MyD88 and STAT3 expression were correlated with patient′s gender,differitiation of HCC,HBV infection and cirrhosis(P0.05),but not with lumor size,venous invasion(P0.05).Conclusions MyD88 and STAT3 genes are significantly over expressed in HCC tissues and may promote the initiation and development of HCC by cell proliferation and immune escape.

Objective To observe the effect of early enteral nutrition in postoperative gastric cancer patients.Methods There were 117 cases of postoperative gastic cancer patients who were divided randomly into enteral nutrition group(EN) or parenteral nutrition group(PN).Nutrition support was started 24 hours after the operation.Nutritional condition,immunological level and variables of clinical recovery were measured and compared after the operation.Results EN group showed better immunological level and clinical recovery than the PN group(P0.05);and the hostal stay of EN group was also shorter than that of PN group(P0.05).Conclusions Early enteral nutrition in postoperative gastric cancer patients can improve the patients immunological level and enhance the restoration of gastrointestinal function.

目的 探讨胰十二指肠切除治疗的胰头癌、十二脂肠乳状癌等疾病的治疗效果及并发症的发生的原因.方法 回顾性分析胰十二指肠切除94例患者的临床资料,分析临床各并发症的可能原因及术中、术后处理措施.结果 共23例发生并发症,并发症发生率为24.5%.其中胰瘘并腹腔感染9例,胆瘘并腹腔感染2例,消化道出血7例,肺部感染2例,胸腔积液1例,粘连性肠梗阻1例,胃排空障碍1例;死亡4例,病死率4.3%.其中3例死于胰瘘并腹腔严重感染,1例死于人造血管置换术后血栓形成.结论 胰十二指肠切除仍有一定并发症发生率及病死率,正确评估患者病期的手术耐受力,规范术中操作,积极处理并发症是获得满意疗效的关键.

[目的]探讨乳腺癌外科不同治疗方法的得失,进一步规范完善乳腺癌的外科临床治疗.[方法]回顾性分析了869例乳腺癌患者的临床特点、治疗情况及近、远期疗效,分析并发症发生原因,探讨术前新辅助化疗对预后的影响.[结果]城市乳腺癌患者就诊病期早于农村患者(P<0.05);术前新辅助化疗将导致术后近期并发症发生率增高;术前新辅助化疗无助于提高Ⅰ、Ⅱ期乳腺癌患者术后生存率,但能延长Ⅲ期患者术后生存时间;把握严格指征的保乳手术配合综合治疗能达到根治性乳房切除手术同等疗效.[结论]早期发现能改善乳腺癌患者的预后,乳腺癌的治疗应当是多学科综合治疗,应当根据患者具体情况恰当的选用个体化治疗方案.

Objective To investigate the treatment of recurrent small hepatocellular carcinoma(HCC).Methods The clinical data of 47 patients with recurrent small HCC after initial operation and treated in our haspital from January 2003 to December 2008 were retrospectively analyzed.The patients were divided into reoperation group and radiofrequency ablation group,and the 3-year survival and recurrences between the two groups were compared.Results Twenty-four patients in the reoperation group underwent local resection and chemoembolization with an implanted chemotherapy pump via hepatic artery.Twenty-three patients in the radiofrequency ablation group underwent local radiofrequency ablation and chemoembolization with a catheter introduced into the hepatic artery via femoral artery.The 3-year tumor-free survival rate of the reoperation group was higher than that of the radiofrequency ablation group [66.7%(16/24) vs.47.8%(11/23),P0.05],and the local recurrence in reoperation group was lower than that of the radiofrequency ablation group [25.0%(6/24) vs.34.8%(8/23),P0.05].However,the 3-year survival and recurrence rate showed no statistical difference between the treatment of reoperation and radiofrequency ablation among the patients with recurrent tumor size less than 3 cm(P0.05),but the treatment by reoperation had a high 3-year survival rate and a low recurrence rate compared with treatment of radiofrequency ablation among the patients with the recurrent tumor size between 3 to 5 cm(both P0.05).Conclusions For small(3 cm) recurrent HCC,surgeons should give full consideration to the wishes of the patients as well as the specific condition of the patients in selection of reoperation or rediofrequency ablation.However,reoperation is the preferential treatment for patients whose recurrent tumor sizes are between 3 to 5 cm.

[目的]探讨术中结肠灌洗对左侧梗阻性结直肠癌术后感染的影响.[方法]将作者所在的两所医院收治的78例能行I期吻合的左侧梗阻性结直肠癌患者,按是否术中结肠灌洗随机分成A、B两组.A组39例术中结肠灌洗后行I期吻合,B组39例术中仅放空近段结肠内贮留粪便后行I期吻合.两组分别于术前及术后第1,2,3天行血细菌培养,记录两组术后感染性并发症发生情况.[结果]A组术后三次血培养阳性率均显著高于B组,感染性并发症发生率亦高于B组.[结论]术中结肠灌洗有可能损伤患者的肠屏障功能,增加了左侧梗阻性大肠癌患者的肠道细菌移位,有增加感染性并发症发生的趋势.

Objective To investigate the feasibility and significance of the re-operation for patients with recurrent primary liver cancer.Methods The clinical data of 58 patients with post-operative recurrence after initial operation for primary liver cancer in our hospital from January 2003 to December 2008 were analyzed.They were divided into re-operation group and the other treatment group,and the 1-and 3-year survival rates were compared.Results The 23 cases of re-operation group were all treated by local radical resection plus hepatic arterial chemotherapy pump implantation,and postoperative chemotherapy was given via hepatic artery chemoembolization pump line.The 35 patients of the other treatment group underwent radiofrequency ablation plus transcatheter hepatic arterial chemoembolization via femoral artery.The 1-and 3-year survival rates in re-operation group was 100% and 82.6% respectively,which was significantly higher than that of the other treatment group(82.9% and 45.7% respectively).Conclusions Re-operation is the treatment of choice for patients with tumor recrrrencr after radical resection of primary liver cancer,provided that the conditions are suitable and the timing of operation is appropriate.

Objective To investigate the approaches for diagnosis and treatment of intrahepatic cholangiocarcinoma(ICC)and asgess its prognosis factors.Methods The clinical data of 86 patients with ICC in our hospital from January 1995 to December2005 were retrospeetively analyzed.All patients were divided into two groups according to the treatment method,including hepatectomy and lymphatic clearance group(Group A,n=42)and hepateetomy group(Group B,n=44),and their clinicopathological variables were analyzed.Resuits The 1-,3-and 5-year survival rates were 77.81%and 35.21%,20.93%and 19.82%,2.31%and 0%respectively between group A and group B.There was significantly difference between these two groups(P＜0.01).The analysis showed that resection and lymphatic clearance were correlated to prognosis.The 1-,3-and 5-year survival rates were 59.21%,26.21%,and 20.11% respectively in 47 patients who were found no lymph node metastasis,and the 1-,3-and 5-year survival rates were 19.82%,2.31%and 0% respectively in 39 patients who were found lymph node metastasis.There was significantly difference in survival rate between group A and group B(P＜0.01).Condusions Reseetability and lymphatic clearance are two significant factors correlated to survival of the patients with ICC.Aggresgive treatment of lymph node metastasis in hepatoduodenal ligament is an important strategy to improve survival rates and strengthen patient's life quality.

约15%～25%的结直肠癌患者在临床确诊时就发生同期肝转移[1].本文对湖南省肿瘤医院1998年1月至2007年12月收治的264例结直肠癌合并肝转移的手术病例资料进行回顾性分析并报道如下.