Forty-five patients with peritonsillar abscesses(PA) were treated by needle aspiration. Pus was drawn in 89%(40/45) of the cases at the first aspiration and repeated aspiration was necessary in 33%(15/45) of the patients. All of the patients were cured by needle aspiration without further invasive therapy and no serious complication was observed. 32 out of 45 patients were available for follow-up. Among them, three had another recurrent PA in situ and the other ten(31%) had recurrent tonsillitis. However, analysis showed that the patients under 35 years of age had higher recurreuce rate of PA of recurrent tonsillitis than those over 35 years old(P

Objective To compare anatomic resection (AR) and non-anatomic resection (NAR)for hepatocellular carcinoma (HCC) as a factor in preventing intra-hepatic recurrence and local recurrence after the initial surgical procedure.Methods A systematic review and Meta-analysis of nonrandomized trials comparing anatomic resection with non-anatomic resection for HCC published from 1990to 2010 in PubMed and Medline,Coehrane Library,Embase,and Science Citation Index were searched.Intra-hepatic recurrence,including early and late recurrence,and local recurrence were primary outcomes.5-year survival and 5-year disease-free survival were secondary outcomes.Pooled effect was calculated by utilizing either fixed effects model or random effects model.Result Eleven nonrandomized studies including 1576 patients were identified and analyzed.810 patients were in the AR group and 766 were in the NAR group.Patients in the AR group were characterized by lower prevalence of cirrhosis,more favorable hepatic function,and larger tumor size and higher prevalence of macrovascular invasion compared with patients in the NAR group.Anatomic resection significantly reduced the risks of local recurrence (OR,0.27; 95％ CI,-0.17～0.43; P＜0.001) and achieved a better 5-year disease-free survival (OR,2.10; 95％ CI,-1.41 ～3.12; P=0.001) in HCC patients.Also,anatomic resection was marginally effective in decreasing early intra-hepatic recurrence.However,anatomic resection was not advantageous in preventing late intra-hepatic recurrence.No significant differences were found between the AR and NAR groups with respect to postoperative morbidity,mortality,and length of hospitalization.Conclusion Anatomic resection was recommended to be superior to non-anatomic resection in reducing the risks of local recurrence,early intra-hepatic recurrence and achieving a better 5-year disease-free survival in HCC patients.

Primary liver cancer is one of the most common malignant tumors in the world, and hepatocellular carcinoma accounts for the majority of liver cancer. Hepatectomy is one of the most important treatment methods, but the high postoperative recurrence rate is the leading cause of treatment failure, which seriously reduces the long-term survival rate and reduces quality of life. Therefore, preventing the recurrence of liver cancer is an important part of treatment. At present, there is no standard program for the treatment of hepatocellular carcinoma to prevent recurrence after surgery, most of the treatment programs include transarterial chemoembolization, antiviral therapy, traditional Chinese medicine treatment, targeted therapy, immunity therapy, etc., which has certain clinical significance in preventing recurrence. This paper reviewed the research progress on preventing recurrence of hepatocellular carcinoma after surgery, which may provide guidance for the clinical study.

Objective To explore the association between ratio index of gamma glutamyl transpeptidase/platelet (GPRI) and the prognosis of patients with hepatitis B virus (HBV) related hepatocellular carcinoma (HCC) before liver resection. Methods A total of 368 patients underwent liver resection for HBV-related HCC were retrospectively analyzed in this study. Patients were divided into high GPRI group (n=184, GPRI≥0.38) and low GPRI group (n=184, GPRI<0.38). Clinicopathologic characteristics including overall survival (OS) and disease-free survival (DFS) were compared between the two groups. Independent risk factors influencing DFS and OS were determined by Cox multivariate analysis. Results Compared to low GPRI group, there were higher levels of serum total bilirubin and alanine aminotransferase, higher proportions of tumor diameter larger than 10 cm, amount of tumou more than 3, and patients with macrovascular invasion and intermediate or advanced HCC in high GPRI group (all P<0.05). Values of DFS at 1, 3, and 5 years were significantly lower in high GPRI group (50.8%, 16.9%and 5.7%) than those in low GPRI group (69.0%, 33.3%, 10.7%;P=0.001). Values of OS at 1, 3, and 5 years were also significantly lower in high GPRI group (75.0%, 51.8%and 36.0%) than those in low GPRI group (89.8%, 72.8%and 63.2%;P<0.05). Cox multivariate analysis also demonstrated that GPRI ≥0.38 was an independent risk factor for DFS and OS in patients with HBV-related HCC after liver resection. Conclusion Preoperative GPRI can predict tumor recurrence and long-term survival in patients with HBV-related HCC after liver resection.

ObjectiveTo study the chromosome genetic changes in hepatocellular carcinoma (HCC) with double exposure to hepatitis B virus/aflatoxin B1 (HBV/AFB1) in Guangxi.Method Differences in genomic alterations in 32 patients with HCC were analyzed using comparative genomic hybridization(CGH).Results(1) The majority of chromosome copy number in the 32 HCC samples had varying degrees of change.The amplification of chromosome regions were 1q,7q,8q,with the high frequency regions being 1q,8q.The deletion of chromosome regions were 1p,4q,8p,9p,13q,14q,16p,16q,17p,18q,19p,Y,with the high frequency regions being 1p,4q,8p,16q,17p,19p;(2) There were also some high copy number amplification or deletion of small regions,such as 2p25.1-p25.2,3q22.3-q23,7p14.1-p14.3,and 9p13.2-9p21; (3) Hierarchical clustering analysis showed that the rate of deletion of chromosome 13q decreased progressively in the following 4 groups:-HBsAg(+)/AFB1 (+),HBsAg(+)/AFB1 (-),HBsAg( - )/AFB1 ( + ),and HBsAg( - )/AFB1 (-) (x2=6.452,P＜0.05).4p was found mainly to be amplified in the HBsAg(+)/AFB1(-)group,but it was mainly deleted in the HBsAg(-)/AFB1(+),and HBsAg( - )/AFB1(-) groups.19q was found mainly to be amplified in the HBsAg(+)/AFB1(+) group,but it was mainly deleted in the HBsAg(-)/AFB1(+),and HBsAg(-)/AFB1(-) groups.ConclusionThe chromosome genetic changes of HCC in Guangxi showed multiplicity.The deletion of chromosome 19p,2p25.1-25.2,3q22.3-q23,7p14.1-p14.3 and amplification of chromosome 9p13.2-9p21 are probably unique genetic characteristics of HCC in this region.The combined effects of Hepatitis B virus and aflatoxin B1 may contribute to deletion of chromosome 13q of HCC in Guangxi.

Objective To identify potential serum biomarkers specific for hepatocellular carcinoma (HCC).Methods Eighty-one patients wilh hepatitis B-related HCC and 80 healthy controls were randomly divided into a training set (48 HCC,47 controls) and a testing set (33 HCC,33 controls).Serum proteomic profiles were measured using surface-enhanced laser desorption/ionization time-offlight mass spectroscopy (SELDI-TOF-MS).A classification tree was established by the Biomarker Pattern Software.Candidate biomarkcrs were separated by HPLC and identified by MA1DI-MS/MS and database searching.Forty-eight patients with HCC,54 cirrhotic patients and 42 healthy subjects were clinically validated using candidate biomarkers by SELDI-Immunoassay.Real-time reverse transcriptase-polymerase chain reaction was performed to observe GRO-1 and Thrombin in 55 HCC tissues and 13 normal hepatolage tissues.Results Two up-regulated protein peaks were automatically chosen as a classification tree in the training set.These biomarkers were identified as thrombin light chain and CXC chemokines ligand 1 (GRO-1).The sensitivity and specificity of this classification tree were 89.6％.The multivariate model using the two biomarkers and alpha-fetoprotein (AFP) resulted in a sensitivity of 91.7％ and specificity of 92.7％,which was significantly better than AFP alone.The mRNA expression of GRO-1 and Thrombin were found in all HCC tissues.There were significant associations between GRO-1 gene expression and some clinical and pathological findings such as metastasis and recurrence (P＜0.05).Significant differences of 5-year survival rates wee observed among subgroups according to the expression of GRO-1 (P＜0.05).There were significant associations between Thrombin gene expression and some clinical and pathological findings such as recurrence and AFP (P＜0.05).Significant differences of 5-year survival rates were observed among the subgroups according to the expression of THROMBIN (P＜0.05).A positive correlation was found between GRO-1 and Thrombin (r=0.73,P＜0.01).Conclusion Thrombin light chain and GRO-1 are potential biomarkers of HCC.The expression of GRO-1 in HCC tissues was a valuable indicator in estimating metastasis and recurrence in HCC patients.

Objective To investigate the efficacy of laparoscopic hepatectomy for the treatment of hepatocellular carcinoma (HCC).Methods The clinical data of 30 HCC patients who were admitted to the Affiliated Cancer Hospital of Guangxi Medical University from January 2011 to December 2011 were retrospectively analyzed.All patients were divided into the laparoscopic hepatectomy (LH) group (10 patients) and open hepatectomy (OH) group (20 patients) according to the operation patterns and at the ratio of 1 ∶ 2.The degree of cirrhosis,size and location of tumor of the 2 groups were analyzed using the covariance analysis.The student t test was used for analysing the difference of the 2 groups.Results In the LH group,7 patients received laparoscopic nonanatomical liver resection,3 received anatomical resection of the left lateral lobe,no patient was converted to the hand assisted laparoscopic surgery or open surgery.In the OH group,14 patients received non-anatomical liver resection,and 6 received anatomical liver resection.The volume of blood loss of the LH group was (247 ± 235) ml,which was significantly lower than (408 ± 191)ml of the OH group (t =2.199,P ＜ 0.05).The mean postoperative fasting time,postoperative abdominal drainage time and duration of hospital stay of the LH group were (1.9 ±0.6) days,(3.2 ± 1.2) days and (8.9 ± 2.3) days,which were significantly shorter than (3.0 ± 1.6) days,(4.9±1.6)daysand (11.5±2.3)days of the OH group (t=2.149,2.917,2.921,P＜0.05).The levels of alanine aminotransferase (ALT) of the LH group at day 1,3,5 were (228 ± 100)U/L,(143 ± 51)U/L,(85 ±24) U/L,and the levels of aspartate aminotransferase (AST) of the LH group at day 1,3,5 were (196 ± 67)U/L,(90 ± 35) U/L,(46 ± 10) U/L.The levels of ALT of the OH group at day 1,3,5 were (557 ± 401) U/L,(414 ±397)U/L,(217 ± 199)U/L,and the levels of AST of the OH group at day 1,3,5 were (506 ±317)U/L,(178 ± 122) U/L,(71 ± 33) U/L.The time for hepatic function recovery of the LH group was significantly shorter than that of the OH group (t =3.675,3.001,2.073 ; 4.196,2.223,2.272,P ＜ 0.05).All the 30 patients were followed up for 3-15 months.The level of alpha fetoprotein of 1 patient in the LH group was increased at postoperative month 4,and the results of computed tomography showed multiple intrahepatic lesions.The patient was cured by intervention treatment.One patient of the OH group was diagnosed as with tumor recurrence at the resection margins and adjacent hepatic segments.The patient was cured by radiofrequency ablation,with no tumor recurrence.No tumor recurrence or metastasis was observed in the other patients.Conclusion Laparoscopic hepatectomy is a feasible,safe and minimally invasive approach for patients with HCC.

Objective To evaluate the impact of different treatment strategies on patients with hepatocellular carcinoma (HCC) of less than 10 cm but with portal vein tumor thrombus (PVTT),and to investigate the prognostic factors.Methods Between 2003 and 2008,338 HCC patients with PVTT from the Affiliated Tumor Hospital,Guangxi Medical University,were retrospectively studied.These patients were divided into four groups:the conservative treatment group (n =75),the transarterial chemoembolization (TACE) group (n=86),the surgical resection group (n =90) and the surgical resection with postoperative TACE group (n=87).Survival rates were analyzed by the Kaplan-Meier method and differences among groups were compared using the log-rank analysis.The Cox' s proportional hazards model was performed to explore the risk factors of survival.Results The mean survival periods of patients in the four groups were 3.8,7,8.2,15.1 months respectively.There were significant differences in survival rate among the 4 groups.The survival rates at 1-,2-,and 3-year in the surgical resection with postoperative TACE group were 49％,37％ and 19％,which were significantly higher than the other 3 groups (P＜0.05).The 1-,2-,and 3-year survival rates in the surgical resection group were 28％,20％ and 15％ compared with 17.5％,0％ and 0％ in the TACE group.The survival rates were significantly higher after surgical resection than TACE (P＜0.05).The 1-,2-,and 3-year survival rates in the conservative treatment group were 0％.These were the lowest among the four groups (P＜0.05).Univariate analysis indicated that portal vein occlusion by tumor thrombus was a significant predictor of poor prognosis.Multivariate analysis revealed that the strategy of treatment (TACE) and the number of TACE cycles were independent survival predictors for HCC patients with PVTT.Conclusions Surgical resection is the most effective therapeutic strategy for HCC patients with PVTT and with good liver functional reserve.Postoperative TACE is necessary in preventing recurrence and prolonging survival in patients who could tolerate chemoembolization.TACE should be recommended as an effective and safe treatment for unresectable HCC patients with PVTT.The treatment provided a significantly better survival than conservative treatment.

Objective To explore the effect of preoperative antiviral therapy on hepatitis B virus ( HBV ) reactivation and postoperative liver function in perioperative patients with HBV-DNA-negative hepatocellular carcinoma(HCC).Methods 74 patients with preoperative HBV-DNA-negative scheduled which were analyzed.Patients were divided into two groups according to antiviral therapy or not:20 cases in antiviral treatment group received antiviral therapy for three days, 54 cases in non-antiviral teatment group did not receive antiviral therapy, and both groups received antiviral therapy after post-operative resuming to diets.The indicators of liver function and HBV-DNA levels were detected on pre-operative, post-operative 3rd and 7th day in two groups, and HBV-DNA-positive ( HBV-DNA>500 IU/mL) was defined as reactivation, conversely as inactivation.The indicators of liver function on pre-operative, post-operative 3rd and 7th day were compared between reactivation group and inactivation group.Results The reactivative rate was 21.6%(16/74) in all patients;27.7%(15/54) in pre-operative non-antiviral teatment group, 5.0%(1/20) in antiviral teatment group, and there was significant differences in reactivative rate between two groups ( P=0.035 ).The results of Logistic regression showed that pre-operative nonantiviral therapy was an independent risk factor of post-operative HBV reactivation (OR=13.952,95% confidence interval[CI]:1.358-143.379,P=0.027).The recovery of albumin (ALB) on post-operative 3rd, 7th days in antiviral treatment group was faster than those in nonantiviral treatment group, respectively (P=0.035,0.043).The recovery of ALB and alanine aminotransferase (ALT) on post-operative 7th day in reactivation group were slower than those in inactivation group, respectively (P=0.016, 0.048).Conclusion The pre-operative nonantiviral therapy is an independent risk factor of post-operative HBV reactivation in patients with HBV-DNA-negative HCC.The pre-operative antiviral therapy could inhibit post-operative HBV reactivation effectively and accelerate the post-operative recovery of liver function.

Objective To evaluate the prognostic significance of preoperative serum gamma glutamyl transpeptidase (GGT) level in patients with hepatocellular carcinoma (HCC) after liver resection.Methods A total of 432 patients undergoing hepatectomy for HCC were divided into normal GGT group (175 patients with GGT ≤ 50 U/L) and high GGT group (257 patients with GGT ＞ 50 U/L).After balancing baseline characteristics by propensity score analysis,disease-free survival (DFS) and overall survival (OS) were compared between the two groups.Independent risk factors influencing DFS and OS were identified by Cox multivariate analyses.Results Propensity score analysis identified 124 matched pairs of patients from each group.In the propensity-matched cohort,DFS at 1,3,and 5 years in normal GGT group (69.3％,36.1％,12.8％) was significantly higher than that in high GGT group (60.6％,18.7％,7.5％;P=0.039).OSat1,3,and5 years innommlGGTgroup (90.7％,73.7％,66.1％) was also significantly higher than that in high GGT group (89.2％,63.6％,43.3％;P =0.024).COX multivariate analyses revealed that alpha-fetoprotein ≥400 ng/ml,GGT ＞ 50 U/L,macrovascular invasion,tumor size ≥ 10 cm,and tumor number ≥3 were independent risk factors for DFS in patients with HCC after liver resection.Albumin ＜ 35 g/L,GGT ＞ 50 U/L,macrovascular invasion,tumor size ≥ 10 cm,and tumor number ≥ 3 were identified as independent risk factors for OS.Conclusions Preoperative serum GGT level is an independent factor predicting tumor recurrence and long-term survival in HCC patients after liver resection.