Mesohepatectomy is considered a feasible option for patients with centrally located hepatocellular carcinoma (HCC). However, mesohepatectomy is a technically demanding and less frequently used procedure. In this study, we summarized the surgical experience and evaluated the clinical outcomes of mesohepatectomy in 24 patients with centrally located HCC. Of these patients, 9 were treated with hepatectomy of Couinaud's segments IV, V and VIII with concurrent cholecystectomy; 8 underwent resection of segments IVb, V and VIII, including 7 patients who also received a cholecystectomy; 4 underwent hepatectomy of segments IVa, V and VIII; and 3 patients were treated with hepatectomy of segments I, IV, V and VIII, with concurrent cholecystectomy. The Pringle maneuver was used on 17 patients during hepatectomy. Total hepatic vascular exclusion (HVE) was performed on 3 patients and HVE was not used on 4 patients. The average mesohepatectomy operative time was 238 min and the average intraoperative blood loss was 480 ml (200-2,200 ml). There was no intraoperative mortality and the postoperative morbidity rate was 25% (6/24). The 1- and 3-year overall survival rates were 76 and 46%, respectively. Therefore, mesohepatectomy is a safe and effective surgical procedure for the treatment of centrally located HCC and HVE during mesohepatectomy for centrally located HCC is crucial to the success of the operation and postoperative patient recovery.

Objective:To investigate the methods of surgical treatment for large primary liver cancer(LPLC).Methods:The clinical data of 180 patients with large LPLC admitted to our hospital from January 2002 to December 2009 were retrospectively reviewed.The presence of cirrhosis,tumor size,lesion location,clinical stage and comorbidities were analyzed.Results:All the 180 patients underwent surgical treatment,of whom 170 cases were hepatocellular carcinoma,7 cases were cholangiocarcinoma and 3 cases were mixed hepatic carcinoma.The average size(maximum diameter) of the tumors was 9(5.3-26.3) cm and 150 cases were accompanied with cirrhosis.Of the patients,anatomic hepatectomy was performed in 112 cases and non-anatomic hepatectomy was performed in 68 cases;the procedures were performed with pringle maneuver in 88 cases,selective hemihepatic vascular clamping in 62 cases,total hepatic vascular exclusion in 10 cases and without hepatic vascular occlusion in 20 cases,respectively.The incidence of postoperative complications was 13.89%(25/180) and the mortality was rate 1.61%(3/180).The 1-3-and 5-year overall survival rate of these patients was 76.11%,48.89% and 30.0%,respectively.Conclusion:Surgical resection-based comprehensive therapy is the main treatment method for large LPLC,and second-stage resection should be strived for after transcatheter arterial chemoembolization(TACE) for those presenting with formidable large LPLC.The rational choice of hepatic blood flow occlusion is a key to ensure operative success and smooth postoperative recovery.

OBJECTIVE:To explore and evaluate the therapeutic efficacy of surgical treatment for cancer of the pancreatic head.METHODS:The clinical data of 96 patients with cancer of the pancreatic head admitted in our hospital from January 2002 to December 2009 were retrospectively analyzed. pancreatoduodenectomy was performed in 48 cases, extended pancreatoduodenectomy in 30 cases, and Roux-Y cholangiojejunostomy in 18 cases.RESULTS:The 1, 2 and 3-year survival rates were 59.2%, 41.8% and 13.2%, respectively, in the patients treated with pancreatoduodenectomy, and 73.2%, 58.2% and 24.1%, respectively, in the patients treated with extended pancreatoduodenectomy. The 1, 2 and 3-year survival rates were 36.8%, 15.8% and 5.3%, respectively, in the patients with unresectable tumor who received radiotherapy and (or) chemotherapy in Roux-Y cholangiojejunostomy. The postoperative morbidity was 29.2%, 30.0% and 27.8% in the patients treated with pancreatoduodenectomy, extended pancreatoduodenectomy and Roux-Y cholangiojejunostomy, respectively.CONCLUSIONS:Pancreatoduodenectomy is the most effective treatment. Extended pancreatoduodenectomy can improve the surgical resection rate, reduce the recurrence rate and improve the survival rate. Internal drainage is an important palliative measure.

外科手术技术的改进及围手术期处理的不断完善,使原发性肝癌(简称肝癌,Primary liver cancer,PLC)术后近期疗效有了明显提高,但肝癌手术切除后复发率仍然很高.Ochiai等[1]报道肝癌术后2年内复发率约为70%,国内吴孟超等[2]报道术后3年复发率可高达57%～81%.由于术后高复发率影响手术切除后的远期疗效,目前复发性肝癌的治疗有多种方法,选择混乱,选择恰当的治疗方法,可提高复发性肝癌的疗效.本文对我院199年1月至2006年12月收治的84例复发性肝癌的临床资料进回顾性分析,现报告如下.

Objective To evaluate the therapeutic effects of the surgical treatment for primary retroperitoneal malignant tumor.Methods The clinical data of 120 primary retroperitoneal malignant patients were analyzed retrospectively.All the cases were examined by ultrasound,CT/MRI,and 8 cases of DSA,28 cases of IVP.The surgical treatments were achieved in 88 cases of radical excision,18 of palliated excision,and 14 of biopsy only.Results The 1-,3-,and 5-year overall survival rates of 88 cases with curative resection were 100.0%,91.2% and 25.1% respectively,and the 1-,3-,and 5-year overall survival rates of 18 cases with palliative resection were 34.1%,27.7% and 7.2% respectively.There were significant differences between the two groups(P0.05).Conclusions It is important of B-ultrasonography,CT,MRI and DSA for the preoperative evaluation in primary retroperitoneal malignant tumor.Surgical resection is an effective way for primary retroperitoneal malignant tumor,and multiple organs combined resection increases the success rate of tumor resection.Excellent surgical technique is the key to improve the tumor resection rate.

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.

Objective To investigate the effect of surgical treatment for liver metastasis from rectal cancer.Methods Clinical data of 186 cases with hepatic metastasis from rectal cancer were analyzed retrospectively with regard to surgical methods and survival rates.There were 96 cases of hepatectomy group received radical resection of rectal carcinoma and hepatectomy simultaneouly,in whom 83 received FOLFOX chemotherapy or TPVCE interventional therapy.There were 90 cases of non-hepatectomy group underwent radical resection of rectal carcinoma only,and 58 cases were treated by FOLFOX chemotherapy or TPVCE interventional therapy,20 by combined anhydrous alcoho intratumoral injection,and 12 by combined radiotherapy.Results The 1-and 3-year overall survival rate of the hepatectomy group was 79.8% and 44.2% respectively.The 1-and 3-year overall survival rate of the non-hepatectomy group was 55.1% and 20.1% respectively.The meso-survival time was 19(5～38) months and 14(3～37) months respectively in the hepatectomy group and the non-hepatectomy group.The survival rates and the meso-survival time between the two groups had significant differences(P0.05).Conclusion Hepatectomy can achieve best therapeutic effect for hepatic metastasis from rectal cancer.The surgical treatment combined with the chemotherapy can improve the survival rate and prevent the tumor recurrence.

Objective To investigate the change of immune function and liver function in cases of hepatocellular carcinoma(HCC) with hypersplenism after concomitant splenectomy and liver resection.Methods The clinical data of 126 cases of HCC with hypersplenism were analyzed retrospectively.They were divided into two groups according to the different treatment: 58 cases underwent concomitant splenectomy and hepatectomy(group A),68 cases underwent hepatectomy only(group B).The total serum bilirubin and aminotransferase levels and immune function were compared between the two groups.Results At 7 days after operation,the total serum bilirubin(TBIL) concentration was(25±6)μmol/L and(38±12)μmol/L respectively in group A and group B(P0.05);The alanine aminotransferase(ALT) and the aspartate aminotransferase(AST) were(49.8±35.8)u/L and(71.8±57.4)u/L,(45.6±39.3)u/L and(61.4±41.2)u/L respectively,in group A and group B on the 12th postoperative day(all P0.05).The levels of CD4 and CD4/CD8 were(41.7±4.2) and(32.6±3.5),(1.9±0.21) and(1.1±0.18),respeetively in group A and group B(all P0.05).The postoperative morbidity was 7.24 %(10/58) and 16.18(11/68),respectively,in group A and group B(P0.05).The 3-and 5-year disease-free survival rates in group A were 50.0 %(14/28) and 77.50 %(3/8) respectively,which were significantly higher than those of group B[32.26 %(10/31) and 20.0 %(2/10),P0.05].Conclusions Concomitant splenectomy and hepatectomy for HCC with hypersplenism may promote the recovery of balance in the subgroup of T-cell,and improve the patient′s antitumor immune function.It can alleviate the bilirubin metabolism burden,and promote recovery of liver function.The 3-and 5-year tumor-free survival rates were improved significantly with no increase of postoperative morbidity.

[Objective] To evaluate the clinical effect of implanting 5-Fluorouracil(5Fu)Sustained-release(SR)in preventing local recurrence after operation of rectal cancer.[Methods] Ninety six patients with rectal cancer undergoing total mesorectal excision were randomly divided into 2 groups.The patients in experiment group were implanted with 5Fu Sustained-release to dissected regions at the time of operation of total mesorectal excision(51 cases,including Miles 13 cases and Dixon 38 cases).45 patients,as control group,underwent operation alone(including Miles 10 cases and Dixon 35 cases).[Results]All patients were examined routinely blood after two weeks,and the results were normal.Complications of anastomotic fistula were in 2 cases of the two groups respectively.In the experiment group,the 6-,12-,24-month local recurrence rates were 0%,3.9% and 11.8%,compared with 11.1%,20.0% and 35.6% in control group(all P0.05).[Conclusion]The implanting 5Fu-SR might become a new hopeful method to prevent postoperative local recurrence of rectal cancer.

目的 探讨肝门部胆管癌的诊断及根治性切除方法.方法 回顾性分析45例肝门部胆管癌的临床特点、根治性切除方法及治疗效果.结果 本组术前均明确诊断.根治性切除45例,手术死亡5例(11.1%),胆漏5例(11.1%),其中2例并膈下脓肿,均经引流或再次手术引流治愈,右胸腔积液4例(8.9%),均经保守治疗治愈,切口裂开3例(6.7%),经再次缝合治愈.本组45例中,有36例(90.0%)获得随访,1,3年生存率,分别为91.7%,36.1%,无5年生存者.结论肝门部胆管癌早期诊断困难,联合应用影像学检查可明确诊断.本组根治性切除率仍较低,术后易复发和转移,鲜有长期生存者,手术死亡率仍较高.说明手术切除和清扫范围不够,手术技术有待进一步改进。

原发性肝癌（以下简称肝癌）是我国常见恶性肿瘤，手术切除是治疗肝癌首选和最有效的方法。部分肝癌合并活动性肝炎患者，手术会加重对全身脏器的损害，术后极易出现肝功能衰竭，而长时间的护肝治疗，易延误手术时机。因此，把握好手术指征和加强围手术期的治疗，是治疗该类肝癌的关键。我院1995年至2003年收治肝癌452例，其中98例伴活动性肝炎，现将治疗结果报告如下。

【objective】To explore clinical therapeutic effects of regional chemotherapy by portal vein infusion to prevent hepatic metastasis after resection of colon cancer.【Methods】After radical resection,100 patients of Dukes A,B and C with colon cancer were randomly divided into two groups: 50 cases were treated by radical resection combined 5-FU regional chemotherapy by portal vein infusion;50 cases were treated by radical resection only for contrast in the same time.Hepatic metastasis and survival time were observed.【Results】The rate of hepatic metastasis in the treated group was 34.0%(17/50),and the 1,3,5-and 10-year survival rates were 95.61%,82.21%,73.89% and 25.11%,respectively.The rate of hepatic metastasis in the control group was 72.0%(36/50),and the 1,3,5-and 10-year survival rates were 92.28%,79.91%,52.16% and 13.11%.There were significantly differences in 5-and 10-year Survival rates(P0.01).There were not significant differences about survival rates in stage Dukes A and B(P0.05).【Conclusion】Regional chemotherapy by portal vein infusion after resection of colon cancer can decrease the hepatic metastasis rate,and raise the 5-and 10-year survival rate.Thus it improves the patients quality of life.

Objective To investigate COX-2 expression in HCC and its clinical application. Methods The COX-2 expression was examined in 38 matched sets of HCC specimens and adjacent liver, and seven normal liver tissues using immunohistochemistry and reverse transcription-polymerase chain reaction(RT-PCR). Results The COX-2 expression was significantly higher in well differentiated HCC than moderated HCC and poor differentiated HCC (P 0.01 respectively), and adjacent non-tumoral liver tissues(P 0.01). The COX-2 was not expressed in normal liver tissues. There was no significant difference among adjacent nontumors tissues, moderated HCC and poor differentiated HCC (P 0.05, respectively). Conclusions The overexpression of COX-2 may involve in carcinogensis of well differentiated HCC, it may play a role in the early stages of hepatocarcinogensis.

Objective To investigate the effect of surgical treatment on hepatic metastasis from gastric cancer. Method 25 cases of hepatic metastasis from gastric cancer underwent surgical treatment from January 1996 to December 2003, including synchronous metastasis in 17 cases, metachronous metastasis in 8 cases. Metastases were solitary in 15 cases, multiple in 10 cases. Resection included irregular hepatectomy in 16 cases, left lateral lobectomy in 4 cases, left lobectomy in 3 cases, right lobectomy in 2 cases. Adjuvant therapy included postoperative hepatic arterial perfusion and chemotherapy in 9 cases, hepatic chemotherapy and embolization in 16 cases. Result 24 cases were followed up with 7 to 60 months (mean 25 months) except 1 case died of adult respiratory distress syndrome after hepatectomy. The 1- and 3-year survival rate was 68.5% and 29.8%, respectively. Less tumor infiltration, fewer lymphatic metastasis, solitary metastasis, metachronous metastasis, and well-capsule metastasis were the factors which positively correlated with a favorable survival. Conclusions Synchronous and metachronous metastasis from gastric cancer is amenable to resection, prognosis can be improved when the indication is strictly determined.

环氧合酶-2(cyclooxygenase-2)是前列腺素合成的限速酶,在许多恶性肿瘤中均有表达,并参与肿瘤的形成和复发转移.本文就COX-2的结构、在肝细胞癌中的表达及其抑制剂对肝细胞癌的作用作一综述.

探讨伴脾功能亢进的原发性肝癌治疗.结果表明,A和B两组术中出血及术后并发症的发生率无显著性差异(P＞0.05),但术后血小板、白细胞的回升,A组优于B组(P＜0.01).A和B两组1、3和5年的生存率分别为84.12%、50.34%、36.51%及80.50%、31.21%、19.81%,两组3年和5年的生存率统计学有差异性(P＜0.01).肝脾联合切除治疗原发性肝癌没有危险性,是安全有效的治疗措施,可为肝癌的进一步治疗创造了条件.

Objective To assess the outcome of hepatectomy with regional lymphadenectomy for hilar cholangiocarcinoma. Methods The clinical data of 60 patients who underwent radical resection for hilar cholangiocarcinoma from January 1990 to December 2004 were analyzed retrospectively. All patients were divided into two groups: group A underwent hepatectomy (n=38) and group B did not receive hepatectomy (n=22). All patients underwent extrahepatic bile duct resection and regional lymphadenectomy. Results The postoperative morbidity and mortality in group A and B were 31.58% , 5.26% and 9.09%, 4.55% respectively. There was significant difference in terms of postoperative morbidity between two groups (P0.05),but not in terms of mortality(P0.05). The 1-,2- and 3-year overall survival rates in group A and group B were 84.21%,60.53%, 39.47% and 72.73%, 31.82%,13.64% respectively. There were significant difference in survival rates between two groups of the 2- and 3-year survival (P0.05). Conclusions Hepatectomy with regional lymphadenectomy for hilar cholangiocarcinoma are critical to improve the survival. Skeletonization of the hepatoduodenal ligament should be comprised by any means in the procedure.

Objective To investigate the therapeutic eff ec t of different treatment for primary hepatic cancer (PHC) with portal vein tumor emboli. Methods 132 cases of PHC with portal vein tumor emboli admitted from January 1995 to December 2003 were retrospectively reviewe d, which were divided into four groups according to the different treatment: con servative treatment group (Group A, n=19), chemotherapy group (Group B, n=38), s urgical resection group (Group C, n=20), and surgical resection combined with ch emotherapy group (Group D, n=55). Results The me dian survival periods group A, B, C and D were 3.3, 6.8, 10.0 and 13.8 mon ths respectively. The 0.5, 1-, 2-, 3-year survival rate in Group D was 52.7%, 3 6.4%, 30.9% and 12.7% respectively, which were significantly higher than those of the other three groups ( P 0.05). Tumor size, resection mar gin and chemotherapy times significantly associated with the therapeutic effect. Median survival period remarkably increased with the increasing of chemotherapy times. Conclusions Aggressively hepatecto my and tumor embolectomy are recommendable for PHC patient with portal vein tumo r emboli who can endure operation. The surgical effect can be further improved w hen followed with chemotherapy.

Objective To assess the diagnosis and treatment of primary retroperaitoneal tumor (PRT). Methods Eighty two cases of PRT admitted from January 1996 to December 2001 were retrospectively analyzed in clinical manifestations, imaging findings and surgical managements. Results The diagnostic rate of CT was 93.9%. The total resection rate was 50%(41/82). After the total resection, 21 relapsed, then 20 cases received reoperation and 12 cases got total resection again. Conclusions Abdominal mass without other symptom is the major feature of PRT. CT is the most important method for diagnosis. Total resection is the best way for treatment. The recurrence tumor should be treated with reoperation if possible.