With the wide application of liver transplantation techniques,rapid development of digital imaging medicine and continuous update of surgical implements,the theory of precision hepatectomy still keeps optimizing.Precision hepatectomy is not a surgical implement or surgical technique,but a concept of liver surgery emphasizing less bleeding,minimal invasion,fast recovery and long-term curative effect,which is updating and improving with the development of modern science.Much less intraoperative bleeding,shorter operation time,better postoperative recovery and long-term survival should be the chief pursuit and principle of precision hepatectomy.

Radical pancreaticoduodenectomy is extremely important for patients who suffered from pancreatic head cancer achieving long-term survival.Accurate understanding on composition of resection margin of pancreaticoduodenectomy specimens is pivotal for standardized labeling and testing.Standardization of pathological examination and accurate diagnosis of surgical margin status play an important role in prognosis of patients.Currently,different centers have a different definition of surgical margins for pancreatic head cancer.In this paper,based on the related literature,the authors discuss issues related to surgical margins of pancreatic head cancer.

Humans ; Liver Abscess

Hydatid is a common pathogen found in human and animals,incidence of hepatic echinococcosis is high in the west China.In recent years,operation and chemotherapy are basic treatment.Faced with varieties of operational manner,a proper choice is very important.5 operational manners are compared in this article,furthermore,problems in the selection of operational manner is analysed.

Objective To investigate the factors affecting the recovery of immunological function after bilirubin decreasing interventional therapy in patients with obstructive jaundice.Methods 67 patients with malignant obstructive jaundice were investigated.The patients were randomly divided into the enteral nutrition (EN) group (n =34)and the parenteral nutrition (PN) group (n =33).TBIL,DBIL,TSP,ALB,PA,TF,CD3 +,CD4 +,CD8 +,CD4 +/CD8 + were determined before PTCD and at the 7th day after the procedure.Results Except for 20 patients,the levels of TBIL,DBIL,CD8 + significantly declined,and the levels of TSP,ALB,PA,TF,CD3+,CD4+,CD4+/CD8 + significantly increased in the 2 groups of patients.There was no significant difference in the recovery of liver function and immunological status between the PN and the EN groups.Conclusions The recovery of immunological function was significantly associated with reduction of serum bilirubin in patients with malignant obstructive jaundice.There was no relationship with the ways of nutrition support.

Objective To explored vascular epithelium growth factor (VEGF) and transforming growth factor-β1 (TGF-β1) expression profiles in rat liver regeneration after selective portal vein embolization (SPVE).Methods The SPVE model was constructed by embolization of the left portal vein and regenerative liver tissues were collected in postoperative days 1-9.Fifty of the SD rats were divided into the SPVE group (45 rats) and control group (5 rats).The expressions of VEGF and TGF-β1 in regenerative rat liver tissues were detected with immunohistochemistry and Western blot.The relationship between VEGF/TGF-β1 and time-phased rat liver regeneration was analyzed.Results In the SPVE group compared to the control group,the expression of VEGF increased from post operative day 1 to 5,peaking at day 5.The expression of TGF-β1 increased from post operative day 3 to 7,peaking at day 7.Conclusions The results suggest that after SPVE,VEGF fluctuation may correlate with the start of hepatic regeneration,and TGF-β1 fluctuation may correlate with the termination of hepatic regeneration.

Objective To evaluate the safety and efficacy of ligasure vessel sealing system (LVSS) and conventional ligation haemostasis in thyroidectomy.Methods Pubmed,EMBASE,Medline,and CNKI were performed to search for randomized controlled trial.Literature selection and data collection were completed by 2 researchers independently.The assessment of methodological quality was conducted with Cochrane Handbook 5.1.The Review Manager software 5.2 was used for Meta analysis.Results A total of 11 studies (934 patients) were involved.Meta-analysis indicated that the operation time was shorter in LVSS group [WMD=-12.47,95％ CI (-18.33,-6.61),P＜0.0001].No significant difference was found in intra-operative blood loss,incidence of hypocalcaemia,recurrent laryngeal nerve (RLN) injury,or hospitalization time between the 2 groups (P＞0.05).Conclusion LVSS can reduce the operation time without increasing intra-operative blood loss,incidence of hypocalcemia,RLN injury,or hospitalization time,which is a safe and effective haemostasis method.

For patients with poor liver function as a result of the final stage of liver disease,liver transplantation is the best way to prevent them from death.Recently,liver transplantation in China get a rapid development,however,patients who need liver transplantation are much more than livers that can be transplanted,that is a bottleneck problem for liver transplantation,adoption of brain death must be a useful way to deal with this problem.More than a hundred countries have adopted brain death and their liver transplantation developed much better than China.Thus,we should pay more attention to brain death and corresponding legislation to promote the development of liver transplantation.

Pancreatic cancer is a highly lethal disease in gastrointestinal malignant tumors.The mortality of pancreatic cancer closely parallels its incidence.Most patients with pancreatic cancer remain asymptomatic until the disease reaches an advanced stage.There is no program for screening patients at high risk of pancreatic cancer.Although CT,MRI,positron emission tomography,endoscopic ultrasonography,and endoscopic ultrasonography-guided fine-needle aspiration offer high diagnostic ability for pancreatic cancer,it cannot be found at the early stage easily.Surgical resection is regarded as the only potentially curative treatment and adjuvant chemotherapy is given after surgery.This article reviews epidemiology,risk factors,diagnosis and treatment for pancreatic cancer by summarizing relevant literature.

Objective To compare the efficacies of early intensive and moderate insulin therapy on the prognosis of patients with severe acute pancreatitis (SAP).Methods The clinical data of 78 patients with SAP complicated by hyperglycemia who were admitted to the Second Hospital of Lanzhou University from January 2005 to December 2009 were retrospectively analyzed.All patients were divided into the intensive insulin therapy (IIT)group (31 patients) and moderate insulin therapy (MIT) group (47 patients).The target levels of blood glucose were 0.80-1.10 g/L(4.4-6.1 mmol/L) in the IIT group and 1.44-1.80 g/L(8.0-10.0 mmol/L) in the MIT group,respectively.The effects of the 2 therapies on the prognosis of the patients were compared.All data were analyzed by the t test or chi-square test.Results The daily intravenous insulin dosage,fasting glucose level and incidence of severe hypoglycemia were ( 35 ± 11 ) u,( 1.02 ± 0.13 ) g/L[ (5.7 ± 0.7 ) mmol/L] and 10％ (3/31 )in the IIT group,and ( 24 ± 15 ) u,( 1.58 ± 0.21 ) g/L[ ( 8.8 ± 1.2 ) mmol/L] and 2％ ( 1/47 ) in the MIT group.A significant difference was detected in the daily intravenous insulin dosage between the 2 groups( t =12.76,P ＜=0.05),but no significant difference was detected in the incidence of severe hypoglycemia between the 2 groups (x2 =0.91,P ＞ 0.05 ).The levels of albumin and prealbumin on the 14th day were ( 34 ± 6) g/L and (231 ± 31 ) mg/L in the IIT group,and (35 ± 5)g/L and (241 ± 29)mg/L in the MIT group,respectively,with no significant difference between the 2 groups( t =-1.94,-1.68,P ＞ 0.05).The incidences of abdominal infection,circulatory dysfunction,respiratory dysfunction and acquired kidney injury were 23％ (7/31),32％ (10/31),26％ (8/31)and 13％ (4/31) in the lIT group,and 26％ (12/47),36％ ( 17/47),30％ (14/47) and 23％ (11/47) in the MIT group,with no significant difference between the 2 groups(x2 =0.09,0.13,0.15,1.33,P ＞ 0.05).The scores of APPACHE Ⅱ on the 14th day were 9 ± 4 in the IIT group and 9 ± 3 in the MIT group,respectively,with no significant difference between the 2 groups ( t =- 0.60,P ＞ 0.05 ).There were 4 ( 13％ ) patients in the IIT group and 7( 15％ ) patients in the MIT group died of multi-organ dysfunction syndrome,including 2 patients in the IIT group and 6 patients in the MIT group complicated with sepsis.There was no significant difference in the mortality between the 2 groups ( x2 =0,P ＞ 0.05 ).Conclusions Compared with MIT,early IIT could not improve the prognosis of the patients with SAP.MIT is appropriate for SAP patients complicated with hyperglycemia.