Hepatectomy for huge hepatocellular carcinoma (HCC) is difficult due to its huge size and the compression and invasion to the surrounding tissues as well as the important vascular systems.Surgical resection of huge carcinoma in the caudate lobe is a big challenge for hepatobiliary surgeons because of its special location and complex anatomical structure.As the improvement of surgical techniques in recent years,especially the promotion of the concept of precision liver surgery,many surgeons begin to take the challenge of resection of huge HCC in the caudate lobe in a variety of ways.In April 2014,a male patient aged 58 years with huge HCC in the caudate lobe was admitted to the Anhui Provincial Hospital.Precision right hemihepatectomy combined with caudate lobectomy was performed on this patient without occlusion of the hepatic inflow,and the efficacy was satisfactory.The key techniques involved in this procedure were discussed in this article.

Objective To investigate the effects of multimodal analgesia of parecoxib and fentanyl on perioperative immune functions in patients of hepatocellular carcinoma (HCC).Methods Eighty HCC patients scheduled for hepatectomy were randomly divided into two groups:parecoxib sodium combined with fentanyl group (group P,40 cases) and fentanyl group (group C,40 cases).The percentages of CD3 +,CD4+,CD8+,CD4+/CD8+ T cells,CD3-CD16+ CD56+ (NK),interleukin-4 (IL-4),interferon-γ (IFN-γ) and the ratio of IFN-γ/IL-4 were detected at the following time points:30 minutes before induction of anesthesia (T0),at the end of the surgery (T1),24 h after surgery (T2) and 72 h after surgery (T3).The analgesic effects were estimated by visual analogue scale (VAS) after surgery.Total fentanyl consumption and adverse effects were also recorded.Results The percentages of CD3 + T cells were significantly lower in group C than that in group P at T2 (t =2.155,P ＜0.05).The percentages of NK in group P were recovered nearly to baseline (T0) at T2,which was higher than that of group C (t =2.791,P ＜0.05).In group C,the percentages of CD3 + T cells and NK has not recovered to baseline at T3 (respectively t =3.065,3.231,P ＜ 0.05).In group P,IL-4 serum levels were significantly lower than those in group C,while IFN-γ serum levels were significantly higher than those in group C at T2 (respectively t =2.173,2.100,P ＜0.05).From T2 to T3,the ratio of IFN-γ/IL-4 significantly increased in group P than those in group C (respectively t =3.259,2.203,P ＜ 0.05).VAS scores at rest and on cough in group P were significantly lower than those in group C at 2 h,6 h,12 h and 24 h after operation (respectively t =8.661,9.726,9.147,7.109,P＜0.05;t =8.569,9.614,9.144,8.509,P＜0.05).The total fentanyl consumption in group P was lower than that in group C (t =2.636,P ＜ 0.05).There were no significant differences regarding the incidence of adverse effects between the two groups.Conclusions Perioperative multimodal analgesia of parecoxib sodium combined with fentanyl enhances the analgesic efficacy,and reduces the dosage of opioid consumption,helps recover the cell immunity function of HCC patients after hepatectomy.

Objective To evaluate the prognosis-related factors of severe trauma in Intensive Care Unit,and to provide clinical reference for the diagnosis and treatment of severe trauma.Methods The clinical data of all 408 patients with severe trauma and ISS score ≥ 25 admitting to our ICU and from January 2011 to December 2015 were retrospectively analyzed.To summarize the epidemiological characteristics and compare gender,age,site of injury,cause of injury,duration,complications,treatment,ISS score and APACHE Ⅱ score between the improved group and the death or deterioration group.Results There were 332 people who were improved and 76 people who died or deteriorated.The patients of death and deterioration groups were older,has a higher proportion of self falls,environment disorder,shock,ARF,ARDS and MODS,more complications,and are more likely to accept mechanical ventilation,blood purification,CPR and lower GCS score and higher APACHE Ⅱ score.The improvement group has more sites of injury higher proportion of chest,limbs and pelvis injury,and is more likely to accept surgical operation and the longer hospital stay.Binary Logistic regression analysis shows that age ＞ 55,self falls,MODS,APACHE Ⅱ ＞ 20 and CPR are risk factors of death and deterioration for the severe trauma in ICU.Conclusion It's essential to pay more attention to the overall situation of patients,preventing complications,and protecting the function of organs during the treatment of severe trauma in ICU.

Critical care medicine is the last line of defense for people′s lives and health, and it is necessary to attach great importance to the development of critical care medicine and the construction of treatment capabilities. This study analyzed the development effect of critical care medicine and critical care capacity in China, analyzed the shortcomings of the current shortage of talent and treatment capacity reserves in the field of critical care medicine, combed the experience of foreign countries in attaching importance to the reserve of critical care resources, the mechanism of combining peacetime and wartime, and the construction of critical care database. Targeted suggestions were proposed to strengthen development planning, optimize investment mechanism, improve talent cultivation and growth, and build critical care database, so as to provide reference for promoting the development of critical care medicine and improving the ability of critical care in China.