Objectives Early recurrence after surgical resection adversely affects long-term survival of hepatocellular carcinoma (HCC) patients. This study aims to develop and validate a novel predictive model for early recurrence of HCC after curative resection. Methods A retrospective study included 132 HCC patients who underwent surgical resection at the Second Affiliated Hospital of Anhui Medical University between October 2018 and May 2021. Clinical and pathological features were evaluated to assess parameters independently linked with early recurrence. Associations between possible risk factors and early recurrence were evaluated using multivariate logistic regression models. Results Of the 132 individuals, 48 (36.36 %) had early recurrence. Multivariate analysis identified AFP level >= 400 ng/mL (OR=2.603, 95 % CI: 1.056-6.587, p=0.039), portal hypertension (OR=3.556, 95 % CI: 1.195-11.049, p=0.024), tumor size>10 cm (OR=5.036, 95 % CI: 1.264-23.237, p=0.027), albumin<35 g/L (OR=0.127, 95 % CI: 0.041-0.353, p<0.001), and GGT >= 50 U/L (OR=2.172, 95 % CI: 0.863-5.612, p=0.042) were independently predictive of early recurrence. Conclusions Early recurrence after HCC resection is associated with high AFP levels, presence of portal hypertension, larger tumor size, reduced serum albumin, and elevated GGT levels. Monitoring of these signs after surgery may help identify patients at a higher risk more quickly, allowing for earlier intervention and potentially better long-term outcomes.

Background The advantages of laparoscopic left-sided hepatectomy (LLH) for treating hepatolithiasis in terms of the time to postoperative length of hospital stay (LOS), morbidity, long-term abdominal wall hernias, hospital costs, residual stone rate, and recurrence of calculus have not been confirmed by a randomized controlled trial. The aim of this trial is to compare the safety and effectiveness of LLH with open left-sided hepatectomy (OLH) for the treatment of hepatolithiasis. Methods Patients with hepatolithiasis eligible for left-sided hepatectomy will be recruited. The experimental design will produce two randomized arms (laparoscopic and open hepatectomy) at a 1:1 ratio and a prospective registry. All patients will undergo surgery in the setting of an enhanced recovery after surgery (ERAS) programme. The prospective registry will be based on patients who cannot be randomized because of the explicit treatment preference of the patient or surgeon or because of ineligibility (not meeting the inclusion and exclusion criteria) for randomization in this trial. The primary outcome is the LOS. The secondary outcomes are percentage readmission, morbidity, mortality, hospital costs, long-term incidence of incisional hernias, residual stone rate, and recurrence of calculus. It will be assumed that, in patients undergoing LLH, the length of hospital stay will be reduced by 1 day. A sample size of 86 patients in each randomization arm has been calculated as sufficient to detect a 1-day reduction in LOS [90% power and α = 0.05 (two-tailed)]. The trial is a randomized controlled trial that will provide evidence for the merits of laparoscopic surgery in patients undergoing liver resection within an ERAS programme. Conclusions Although the outcomes of LLH have been proven to be comparable to those of OLH in retrospective studies, the use of LLH remains restricted, partly due to the lack of short- and long-term informative RCTs pertaining to patients with hepatolithiasis in ERAS programmes. To evaluate the surgical and long-term outcomes of LLH, we will perform a prospective RCT to compare LLH with OLH for hepatolithiasis within an ERAS programme. Trial registration ClinicalTrials.gov NCT03958825. Registered on 21 May 2019.

目的 探讨三维可视化技术在腹膜后肿瘤手术中的应用价值.方法 回顾性分析2020年5月至2023年5月安徽医科大学第二附属医院收治的9例腹膜后肿瘤患者的临床资料.结果 9例患者术前均完成肿瘤三维可视化模型,清晰显示肿瘤部位、立体解剖形态及其与周围血管的位置关系.9例患者均成功接受手术,切除的肿瘤中位最大径为7.28(4.45,20.75)cm,中位手术时间为261(191,347)min,中位术中出血量约100(50,300)mL,中位术后住院时间为11(6.5,16.5)d.术后病理检查结果:脂肪肉瘤2例、上皮样间皮瘤1例、支气管源囊肿1例、囊性畸胎瘤1例、平滑肌肉瘤1例、神经源性肿瘤3例.术后1例患者因术后出血需再次外科手术干预,无围手术期死亡病例.中位随访时间为21个月(15.5,25.5),无失访病例,无肿瘤局部复发或远处转移病例.结论 三维可视化技术可精准显示腹膜后肿瘤与其周围脏器的复杂解剖关系,并可在术前进行模拟手术,有助于术前制定个体化的手术策略,可提高腹膜后肿瘤手术治疗的安全性和有效性.

原发性肝细胞癌(简称肝癌)是我国常见的消化道恶性肿瘤之一,据统计,肝癌为2018年全球第六大癌症和第四大癌症死因,每年约有841000例新病例和782000例死亡;主要包括肝细胞癌(占病例的80％)和肝内胆管癌(占病例的20％)以及其他罕见类型.

To study whether laparoscopic liver resection (LLR) is able to alleviate the postoperative liver function impairment for hepatocellular carcinoma patients, the clinical data of 103 patients were retrospectively analyzed, including 42 patients who underwent LLR and 61 patients who underwent open liver resection (OLR), during the period spanning from 2012 to 2017. The postoperative peak aspartate aminotransferase and alanine aminotransferase levels in the LLR group were significantly lower than those of the OLR group (209.76±189.516 vs. 262.55±181.19, P=0.046; 250.56±200.944 vs. 411.01±412.51, P=0.005, for aspartate aminotransferase and alanine aminotransferase, respectively). The recovering of postoperative total protein and albumin in the LLR group was faster than that in the OLR group, and the total protein and albumin levels on the postoperative day-5 were significantly higher in the LLR group than in the OLR group (62.528±9.427 vs. 57.87±6.101, P=0.019; 36.456±4.875 vs. 33.653±4.112, P=0.012, respectively). In conclusion, these data show that LLR alleviates postoperative liver function impairment and increases liver function recovery.

目的 比较单层胰管-空肠黏膜吻合与双层胰管-空肠黏膜吻合对胰十二指肠切除术后发生临床性胰瘘的影响.方法 回顾性分析2015年8月至2020年9月安徽医科大学第二附属医院肝胆胰外科和安徽医科大学第一附属医院器官移植中心同一手术组医师实施的303例胰十二指肠切除术病人的病例资料.根据胰肠吻合方式分成单层胰管-空肠黏膜吻合组(单层组,116例)和双层胰管-空肠黏膜吻合组(双层组,187例).结果 两组病人进行1:1匹配后,各103例,年龄分别为(62.1±9.3)岁(范围:39～76岁)和(62.5±10.2)岁(范围:39～76岁).在胰肠吻合时间方面,单层组中位时间为12min,明显短于双层组的25 min,差异有统计学意义(Z=-3.683,P=0.002).在术后住院天数方面,单层组为(13.7±2.7)d,短于双层组的(15.3±3.7)d,差异有统计学意义(t=-3.001,P=0.003).在临床相关性胰瘘发生率方面,单层组为4.9％,明显低于双层组的19.4％,差异有统计学意义(x2=10.243,P=0.001).在严重并发症发生率方面,单层组为6.8％,低于双层组的17.5％,差异有统计学意义(x2=5.509,P=O.019).多因素分析显示,双层胰管-空肠黏膜(95％CI 1.086-11.230,P=0.036)和胰管直径细(95％CI1.719-12.946,P=O.003)是术后临床相关性胰瘘的独立危险因素.结论 与双层胰管-空肠黏膜相比,单层胰管-空肠黏膜胰肠吻合技术可缩短胰肠吻合时间、减少术后住院天数、降低临床相关性胰瘘发生率和严重并发症发生率,是一种安全、简单、有效的胰肠吻合方式.

1 病例资料 患者,男,50 岁,因"右上腹部隐痛不适5 月余"入院.腹部CT 示:肝右叶巨块占位,伴卫星灶,最大肿瘤直径约17 cm(图1).肠镜检查发现乙状结肠腺癌.初步诊断为"结肠癌伴肝转移"收入院.CEA164.80 ng/mL,CA19-9506.20 ng/mL,AFP 正常.血常规及血液生化分析未见明显异常.

1 前言 扩大的右肝切除术(切除肝段≥4段)是肝脏外科目前面临的巨大挑战,围手术期致死性肝衰的发生率高达6％～8％[1].残余肝体积常用于术前评估患者对肝切除的耐受能力.而极量肝切除,是指患者所能耐受的最大切除肝体积,不同的肝脏基础疾病,所能耐受的肝切除量不同.正常肝可耐受80％的切除量而肝硬化患者一般不能超过40％[2].

Objective To evaluate preoperative three dimensional(3D)reconstruction techniques in perioperative patients of hepatocellular carcinoma (HCC) undergoing hepatectomy.Methods Fifty-eight HCC patients who had undergone hepatectomy between 2015 and 2017 were enrolled.Twenty-three patients underwent hepatectomy based on preoperative 3D reconstruction techniques,while other thirty-five patients were without using it.Results No significant statistical difference was found in clincopathological parameters of patients preoperatively.The patients who underwent hepatectomy based on 3D reconstruction techniques had less operation time (Z =-2.213,P =0.028),hepatic inflow occlusion rate,time (x2 =3.966,P =0.046;Z =-2.371,P =0.018) and blood loss (Z =-2.140,P =0.032) during operation.Totally 23 postoperative complications occurred which were Clavien-Dindo classification grade Ⅰ or Ⅱ.More complications occurred in the not using 3D technique group (x2 =6.061,P =0.014).Conclusion Preoperative 3D reconstruction technique improves the perioperative prognosis of hepatectomy in patients with hepatocellular carcinoma.

分析腹腔镜与开腹在肝左外叶切除术中的临床疗效.回顾性分析2014年10月—2018年3月收治的75例左肝占位患者,根据手术治疗方式分为腹腔镜组和开腹组,腹腔镜组35例,开腹组40例,记录手术时间、术中出血量、术后住院时间、术后肝功能指标(ALT、AST、PT、TBIL、CRP等)并进行对比分析.腹腔镜组术中出血量及手术时间少/短于开腹组(P<0.05).两组术后第1天肝功能差异无统计学意义(P>0.05);术后第3天,腹腔镜组CRP优于开腹组;术后第5天,ALT、AST、CRP两组差异均有统计学意义(P<0.05).腹腔镜组住院时间较开腹组缩短(P<0.05).腹腔镜组未出现明显手术并发症;但开腹组出现6例,包括胆瘘1例,腹腔积液1例,胸腔积液2例,肺部感染2例.腹腔镜肝左叶切除术是安全有效的,且具有手术创伤小、恢复快、住院时间短等优势.

To investigate the clinical application ofthe "three lines and one plane" concept as the anatomic landmarks during laparoscopic common bile duct exploration (LCBDE).From January 2014 to February 2017, 148 cases of LCBDE performed in the General Surgery Department of the 2nd affiliated Hospital of Anhui Medical University were recruited, and analyzed in this study. "Three lines and one plane" was applied as anatomical landmarks during LCBDE, and the perioperative clinical outcomes were analyzed.No serious operational complications occurred in all the patients in this study. Two cases (1.4%) was converted to open operation. Two other cases (1.4%) suffered post-operative bile leakage and were cured by conservative treatment. All patients recovered uneventfully.Anatomical landmarks of "three lines and one plane" is benefit in helping surgeons to build a three-dimensional (3D) anatomical construction, and avoiding the operative injury of the bile duct, and vessels.

Objective To compare the perioperative outcomes of laparoscopic liver resection (LLR) versus open liver resection (OLR) for hepatocellular carcinoma (HCC).Methods A total of 89 HCC patients undergoing liver resection between January 2012 and November 2016 were enrolled.Nonparametric tests were employed to compare the clinicalpathological characters and preoperative outcomes.Results No significant difference was observed in clinicalpathological features and postoperative morbidity.LLR group had shorter hospital stay (Z =4.642,P ＜0.01),lower serum ALT level in 1st,3rd and 5 day (Z =2.157,3.089,2.384,all P ＜0.05) and AST level in 1st-and 3rd-day postoperatively (Z =2.688,2.566,all P ＜0.05).The growth rate in serum total protein (TP) and albumin (ALB) postoperatively is higher for LLR group (y =2.348 4x + 51.696 vs.y =0.902 9 + 35.532),(y =1.539 9x + 29.68 vs.y =0.732 9x + 30.406).Conclusion LLR allows quicker liver function recovery and shortens patients' postoperative hospital stay.

A comprehensive meta-analysis was performed to investigate whether the combination of high-/low-dose of aspirin and various intensities of warfarin (W) offer greater benefit than aspirin (ASA) alone. A total of 14 randomized clinical trials (RCTs) having 26,916 patients with acute coronary syndrome (ACS) met inclusion criteria. The efficacy and safety of all outcomes which included myocardial infarction (MI), all-cause death, stroke, and bleeding were calculated. The overall outcomes analysis showed there was no significant difference in the risk of MI (relative ratio [RR] 0.959, 95 % confidence interval [CI] 0.78–1.04, P = 0.308), stroke (RR 0.789, 95 % CI 0.57–1.09, P = 0.145), and all-cause death (RR 1.007, 95 % CI 0.93–1.09, P = 0.87) between the combination group and ASA group. The subgroup analysis suggested that ASA (≤100 mg/day) plus W (mean international normalized ratio [INR] 2.0–3.0) decreased the risk rate of stroke (RR 0.660, 95 % CI 0.50–0.87, P = 0.003). There was a lower risk of MI (RR 0.605, 95 % CI 0.47–0.77, P < 0.0001) as well as stroke (RR 0.594, 95 % CI 0.45–0.79, P < 0.0001) between W (INR 2.0–3.0) combined with ASA (mean dose ≥100 mg/day) and ASA. However, the risk of major bleeding (RR 1.738, 95 % CI 1.45–2.08, P < 0.0001) and minor bleeding (RR 2.767, 95 % CI 2.12–3.61, P < 0.0001) was almost doubled in the combined groups. Compared with ASA, high-dose aspirin with moderate-intensity warfarin (INR 2.0–3.0) may better reduce the risk of MI and stroke but confer an increased risk of bleeding.

Objective: To investigate the application value of using “three lines and one plane” as landmarks for extrahepatic bile ducts in laparoscopic surgery for bile duct stones. <br> Methods: From January 2014 to December 2015, 445 cases of laparoscopic cholecystectomy and 70 cases of laparoscopic common bile duct exploration consecutively performed in the First Department of General Surgery of the Second Affliated Hospital of Anhui Medical University. “hTree lines and one plane” which refers to the upper curve of the duodenal bulb, the arc incisure curve of the hepatic pedicle of the right posterior lobe, the middle line between the common hepatic duct and the common bile duct and the plane of the hilar plate, were used as anatomical landmarks for extrahepatic bile ducts during operation in all patients. <br> Results: No bile duct injury or surgical death occurred in any of the entire group of patients. No open surgical conversion was needed in patients undergoing laparoscopic cholecystectomy, while in those undergoing laparoscopic common bile duct exploration, one case (1.4%) was converted to open operation and 2 cases (2.9%) developed postoperative bile leakage that was cured by conservative treatment. All patients recovered uneventfully.&nbsp;Conclusion: Using “three lines and one plane” as guidance for dissection of the extrahepatic bile ducts can avoid bile duct and vascular injury during laparoscopic surgery for bile duct stones. So, it is recommended to be used.

目的:探讨腰背痛症状对胰腺癌胰外神经侵犯的预测价值.方法:回顾性分析130例胰腺癌患者的临床及影像学资料.所有患者通过CT判断有无胰外神经侵犯,分析腰背痛症状预测胰腺癌胰外神经侵犯与CT判断结果的差异.结果:CT判断77例(59.2％)患者有胰外神经侵犯,其中胰头癌38例(50.7％,38/75),胰体尾癌39例(70.9％,39/55),后者比例明显高于前者(x2=78.999,P=0.000);87.0％的可见腹腔干周围神经丛受侵表现,高于左侧腹腔神经节(57.1％)和右侧腹腔神经节受侵率(45.5％)(x2=30.415,P=0.000).48例腰背痛患者中,有47例(97.9％) CT判断有胰外神经侵犯.与CT判断结果比较,本组中腰背痛预测胰腺癌胰外神经侵犯的灵敏度为61.0％,特异性为98.1％,阳性预测值97.9％.一致性检验结果显示,两者有中等一致性(κ=0.545,P=0.000).结论:腰背痛症状与胰腺癌胰外神经侵犯有关,腰背痛症状和CT影像学特征性改变对于术前预测胰腺癌胰外神经侵犯有互补作用.

Cecropin-P17 is a peptide derived from Cecropin B. In this study, we investigated the effects and relative mechanisms of Cecropin-P17 in a human liver cancer cell line (HepG-2) in vitro and in vivo. A cell viability assay, Annexin V/propidium iodide assay, western blot, flow cytometry, quantitative real-time polymerase chain reaction, and a tumor-xenograft model were applied to elucidate the mechanism exerted by Cecropin-P17 on HepG-2 cells. Cecropin-P17 significantly inhibited the proliferation of HepG-2 cells and demonstrated low cytotoxicity to normal liver cells in vitro. The apoptotic rate of HepG-2 cells was increased after Cecropin-P17 treatment together with increased production of reactive oxygen species. Moreover, Cecropin-P17 stimulated caspase-3, caspase-9, and Bax and inhibited Bcl-2 on both the transcriptional and translational levels. Finally, Cecropin-P17 significantly suppressed tumor growth in a HepG-2-bearing nude mouse model. All of these results indicated that Cecropin-P17 could be a potential agent for the treatment of liver cancer.

目的总结跟腱撕裂的MRI表现。方法采用意大利百盛公司生产的0.2T永磁型专用关节磁共振扫描仪,分析7例经手术证实的跟腱损伤临床表现及MRI征象。结果 7例中,完全撕裂6例,MRI表现为跟腱连续性中断,断端回抽,其间有脂肪组织充填并可见腱周积液。部分撕裂1例,MRI表现为跟腱粗细不均匀,横断位跟腱内见小片状高信号区并见低信号腱束影。结论 MRI是诊断跟腱损伤的首选检查方法。

肝细胞癌是恶性程度最高的消化道肿瘤之一,虽然已有多种治疗方法和手段,但其高复发和转移性使患者预后差,生存率低。如何及早预测、诊断及治疗肝细胞癌,成为研究的重点和难点。分子生物学的迅速发展和检测技术的进步,为肿瘤分子生物学的研究提供了有利的条件。KAI1/CD82基因蛋白与多种恶性肿瘤的复发和转移相关。本文综述了KAI1/CD82的特点及其与肝细胞癌转移相关性的研究进展。

DNA methylation is a normal modification mode of eukaryon, there is an intimate relationship between aberrant promoter methylation of tumor-related genes and the generation or development of neo- plasms,emerging significantly biological effectiveness. Aberrant promoter methylation of tumor-related genes as the epigenetic markers, maybe play a very important role in the incidence, diagnosis, therapeutic effects, prognosis judgements and other aspects in gallbladder carcinoma.