Objective To investigate the clinical value of enhanced recovery after surgery (ERAS) in radical resection of hepatocellular carcinoma (HCC).Methods The propensity score matching (PSM) and retrospective cohort study were conducted.The clinicopathological data of 116 patients with HCC who were admitted to the Fuzhou General Hospital of Nanjing Command of PLA from June 2014 to January 2016 were collected.Fifty-eight patients using pre-,intra-and post-operative ERAS managements were allocated into the ERAS group and 58 using traditional perioperative managements were allocated into the control group.Observation indicators:(1) operation situations;(2) postoperative recovery:postoperative recovery time of bowel sound,time to initial anal exsufflation,time of drainage-tube removal,levels of alanine transaminase (ALT),total bilirubin (TBil),C-reactive protein (CRP) at 1,3 and 7 days postoperatively,postoperative complications (vomiting,abdominal distension,wound infection,intra-abdominal infection and pulmonary infection),duration of postoperative hospital stay,hospital expenses and satisfaction degree of patients;(3) follow-up situation.Followup using outpatient examination and telephone interview was performed to detect survival of patients up to March 2016.Measurement data with normal distribution were described as x±s.The comparison between groups was analyzed using the t test.Measurement data with skewed distribution were described as M (range).The comparison between groups was analyzed using the paried rank sum test.Repeated measurement data were evaluated by the repeated measures ANOVA.Results (1) Operation situations:all the patients underwent successful operations,without perioperative death.(2) Postoperative recovery:postoperative recovery time of bowel sound,time to initial anal exsufflation,time of drainage-tube removal,levels of ALT,TBil and CRP at 1,3 and 7 days postoperatively,duration of postoperative hospital stay,hospital expenses and satisfaction degree of patients were (49±10)hours,(60±10)hours,(3.3±0.7)days,(379±99)U/L,(222±65)U/L,(98±16)U/L,(20.4±4.7)μmol/L,(15.5±2.1)μmol/L,(13.4±1.8)μmol/L,(49±10)mg/L,(124±21)mg/L,(30± 5)mg/L,(9.7±0.9)days,(4.1±0.6) ×104 yuan,8.6±0.9 in the ERAS group and (53±5)hours,(64±7)hours,(6.2±1.6)days,(445± 114)U/L,(278±79) U/L,(116± 25) U/L,(18.6± 3.5) μmol/L,(17.0±2.7) μmol/L,(14.2±1.9)μmol/L,(53±11)mg/L,(135±35)mg/L,(34±6)mg/L,(10.0± 1.0) days,(4.3±0.5)x104 yuan,8.2±1.0 in the control group,respectively,with statistically significant differences between the 2 groups (t=2.537,2.479,2.065,F=20.075,14.357,13.460,t=2.060,2.197,2.370,P＜0.05).Number of patients with postoperative vomiting,abdominal distension,wound infection,intra-abdominal infection and pulmonary infection were 5,3,2,1,1 in the ERAS group and 6,6,7,5,3 in the control group,respectively,with no statistically significant difference between the 2 groups (x2=0.100,1.084,3.011,0.206,0.618,P＞ 0.05).(3) Follow-up situation:all the 116 patients were followed up for 1-20 months,with a median time of 11 months.During the follow-up,2 patients in the ERAS group died (1 dying of tumor recurrence and 1 dying of respiratory failure) and 3 in the control group died (1 dying of multiple organs metastasis,1 dying of lung metastasis of HCC and 1 dying of myocardial infarction).Conclusion ERAS in the perioperative management after radical resection of HCC is safe and effective,and it can quickly improve postoperative recovery of patients.

Objective:To investigate the application value of three-dimensional (3D) visualization combined with indocyanine green (ICG) fluorescence imaging in anatomical hepatectomy for hepatocellular carcinoma (HCC).Methods:Clinical data of 45 patients with HCC who underwent anatomical hepatectomy in the Department of Hepatobiliary Surgery, the 900th Hospital of Joint Logistic Support Force of People′s Liberation Army from September 2019 to December 2020 were retrospectively analyzed. Among them, 27 patients were males and 18 were females, aged from 28 to 73 years, aged (57.76±10.95) years on average. According to the different surgical methods, all patients were randomly divided into ICG group ( n=24) and control group ( n=21). In ICG group, 15 patients were males and 9 females, aged (58.21±11.81) years on average. Anatomical hepatectomy was performed using 3D visualization combined with ICG fluorescence imaging. In control group, 12 patients were male and 9 female, aged (57.24±11.35) years on average. Conventional anatomical hepatectomy was performed. The operation duration, bleeding volume, the numbers of cases underwent blood transfusion, occlusion durations, days of hospitalization, highest postoperative serum ALT and TBiL, duration of recovery of postoperative serum ALT and TBiL, and incidence of complications were observed. Measurement data with approximately normal distribution were represented by ( Mean± SD) and groups were compared using t test. Measurement data with skewed or uneven distribution were represented by M (rang) and groups were compared using Man-Whitney U test. Count date were compared using Fisher exact test. Results:All the patients underwent successful operations, without perioperative death. In ICG group, the operation duration was 110.50 (44.00-145.00) min and the occlusion durations was (15.17±2.14) min respectively, shorter than 122.00(80.00-255.00) min and (17.29±4.35) min in control group, the difference between the two groups were statistically significant ( Z=-2.002, -2.115; P<0.05). In ICG group, the numbers of cases underwent blood transfusion was 2 cases, less than 8 cases in control group, the difference between the two groups was statistically significant ( χ2=4.147, P<0.05). The bleeding volume, days of hospitalization, highest postoperative serum ALT and TBiL, duration of recovery of postoperative serum ALT and TBiL, postoperative complications between the two groups were not statistically different ( P>0.05). Conclusions:3D visualization combined with indocyanine green fluorescence imaging technique is a feasible surgical method for anatomical hepatectomy. It is helpful for liver surgeons to visualize and recognize the boundary between hepatic segments and improve the safety of anatomic hepatectomy.

Objective To explore the prevention and treatment of early pulmonary infection after liver(transplant).Methods A retrospective analysis was carried out on the clinical data of 34 cases suffered from post-transplant pulmonary infection among 62 cases of liver transplant.Results Among the 34 cases,27 cases recovered and 7 cases died.The sputum of 27 cases was cultured positive for bacteria and fungus(including) Gram-negative bacteria(51.9%),Gram-positive bacteria(29.6%) and fungus(18.5%),cytomegalovirus 1 case,EB virus in 1 case,and pathogens unknown in 5 cases.Conclusions (Gram-negative) bacteria are the main pathogens of pulmonary infection after liver transplant.The critical stage of pulmonary infection is the first week after operation.The perioperative management of respiratory tract and rational use of antibiotics are important for prevention and treatment of post-transplant pulmonary infection.

Objective To investigate the methods for reconstructing portal vein in liver transplantation patients with grade Ⅳ portal vein thrombosis.Methods Clinical data of 6 patients with grade Ⅳ portal vein thrombosis who underwent liver transplantations were analyzed retrospectively.Different portal vein reconstructing approaches were applied: 4 patients underwent portal vein anastomosis with internal organ varicosis vein (group A),and 2 patients underwent portal vein arterialization (group B). Portal venous flow was monitored by intraoperative ultrasound and postoperative liver function was tested periodically during follow-up.Results In group A,one patient died of celiac infection 2 months post-transplantation.The remaining three patients were followed up for 14-17 months,and their portal veins remained smooth without thrombosis and with mitigated esophageal varicosity.In group B,one patient,with recurrent upper gastrointestinal bleeding,died of celiac infection 47 days after liver transplantation.The patient was followed up for 33 months with satisfactory liver and kidney functions although stomach esophagus varicosity was aggravated.Portal vein blood flow in groups A and B was 1258 ± 345 and 2275 ± 247 ml/min respectively after anastomosis by intraoperative color Dopplar ultrasound monitoring. Aspertate aminotransferase (AST) in group B was significantly lower on the fourth day after liver transplantation,and alanine aminotransferase (ALT) in group B was significantly lower on the 3rd,4th,5th and 6th day after liver transplantation than in group A (all P＜0.05).Serum total bilirubin (TBIL) had no statistically significant difference during the 10 days post-operation (P＞0.05).Conclusion Patients with grade Ⅳ portal vein thrombosis may achieve a satisfactory clinical effect by reconstructing portal vein through anastomosis of donor portal vein with internal organ? varicosis vein.PVA may be associated with early recovery of graft function and may be an effective remedial measure for patients with grade Ⅳ portal vein thrombosis who undergo liver transplantation.

Objective To study the clinical value of the conventional liver function tests in liver reserve function assessment for large hepatocellular carcinoma.Methods The clinicopathological data of 113 patients with ChildPugh A hepatocellular carcinoma who underwent radical resection with large hepatocellular carcinoma in the Department of Hepatobiliary Surgery of Fuzhou General Hospital of People's Liberation Army from January 2014 to December 2016 were retrospectively analyzed.The patients were divided into two groups according to the recovery of postoperative liver function,which 105 patients recovered well and 8 patients had hepatic decompensation among them.The liver function index of two groups were analyzed.Measurement data with approximately normal distribution were represented by and groups were compared using t test;measurement data with skewed or uneven disstribution were represented by M (range)and group werecompared using Man-Whitney U test;count data were compared using Fisher exact test;risk factors for postoperative liver dysfunction were analyzed using Logistic single factor and multivariate and ROC curve were drawn.Results Preoperative prothrombin time,international standardization ratio,platelet,prealbumin,total bilirubin,alkaline phosphatase,γ-glutamyl transpeptidase comparison between the two groups were statistically significant (Z =-1.983,-2.180,-2.608,-2.007,-3.577,-2.228,-2.575,P ＜ 0.05).Logistic univariate analysis showed that platelet,total bilirubin and prealbumin were the risk factors for the recovery of liver function of radical resection hepatic decompensation with large hepatocellular carcinoma.Logistic multivariate regression analysis showed that preoperative high total bilirubin and low preabumin were independent risk factors of radical resection hepatic decompensation with large hepatocellular carcinoma.Logistic univariate analysis showed that preoperative high total bilirubin and low prealbumin were not risk factors of radical resection liver failure with large hepatocellular carcinoma.The area under the curve of total bilirubin was 0.880,P =0.000,95％ CI:0.808-0.953,the sensitivity was 87.5％,specificity was 84.8％ and the area under prealbumin curve was 0.769,P =0.011,95％ CI:0.648-0.891,sensitivity was 75.2％,specificity was 77.5％ by the ROC curve.The best threshold of total bilirubin and prealbumin after radical resection with large hepatocellular carcinoma were 17.55 μmol/L and 0.18 g/L respectively by the ROC curve.Conclusion The Child-Pugh A patients in radical resection hepatic decompensation with large hepatocellular carcinoma recover well when the preoperative liver function is as follows:total bilirubin ＜ 17.55 μmol/L and prealbumin ≥0.18 g/L.

Hilar cholangiocarcinoma(HCCA) is a hotpot and a difficult point in the field of hepatobiliary surgery. HCCA is the most common type of cholangiocarcinoma and is characterized by atypical early clinical manifestations, rapid progression and poor prognosis. There is no specific marker for HCCA and its preoperative diagnosis and evaluation mainly relies on imaging examination. Surgical treatment is still the main treatment, but most patients have lost the opportunity of surgical resection by the time of treatment. In recent years, a large number of studies have been conducted on the diagnosis and treatment of HCCA at home and abroad, and the efficacy of HCCA has been improved. Perioperative management, including the selection of preoperative drainage and perioperative chemoradiotherapy and others, improved postoperative survival. Among them, the application of preoperative radiotherapy and chemotherapy in the field of liver transplantation has achieved quite good results. Targeted therapy and immunotherapy have provided new treatment methods for HCCA. This paper reviews the diagnosis and multimodal treatment of HCCA.

Objective:To evaluate the effects of pegylated interferon (Peg-IFN) alfa-2b combined with nucleotide analogues (NAs) on the recurrence of hepatitis B-related liver cancer after resection, and to explore the changes of HBsAg and HBV DNA in patients with chronic hepatitis B liver cancer during postoperative treatment.Methods:The prospective study was conducted. Clinical data of 43 patients with hepatitis B-related liver cancer who underwent radical resection treated in 900th Hospital of People′s Liberation Army were prospectively analyzed from January 2020 to December 2021. Among 43 patients, there were 39 males and 4 females, the age was 30-76 years. According to different treatment methods they were divided into two groups, the patients treated by Peg-IFN alfa-2b combined with NAs were devided into the IFN group( n=10), and those treated by NAs alone into the NAs group( n=33). Two-pair semi-quantitative were collected every 3 months after operation. The recurrence-free survival rate, recurrence time after 2 years in the two groups, the clearance rate and the negative rate of HBsAg and HBV DNA in the two groups. Peg-IFN alfa-2b was evaluated in improving the prognosis of hepatitis B-related liver cancer. The measurement data of normal distribution were expressed by mean±standard deviation ( ± s), and t-test was used for comparison between the two groups. Chi-square test was used for comparison between the two groups of count data. Repeated analysis of measurement variance was used for analysis HBsAg and HBV DNA changes of the interferon group overall survival time and recurrence-free surrival time of patients was estimated using Kaplan-Meier method and the difference between groups was assessed using Log-rank test. Results:HBsAg and HBV DNA: The HBsAg clearance rate at 24 weeks and that at 48 weeks in the IFN group were 24.6% and 59.0% respectively. The HBsAg negative rate at 48 weeks was 16.7%. The HBV DNA clearance rate at 24 weeks and that at 48 weeks were 33.9% and 53.8% respectively. The HBV DNA negative rate was 0 at 48 weeks. The levels of HBsAg and HBV DNA in the IFN group decreased gradually with time. There were statistically differences between the levels of HBsAg and HBV DNA at 0 weeks, 24 weeks and 48 weeks( P<0.05). The 2-year overall survival rates of IFN group and NAs group were 100% and 90.9% respectively. The 2-year recurrence-free survival rates were 90.0% and 63.6% respectively. There were no significant statistical differences in the overall survival rate and recurrence-free survival rate between the groups ( P>0.05). The postoperative recurrence time of the IFN group and the NAs group were (15.00±7.07) months and (5.78±3.39) months respectively. The difference between the two groups was statistically significant ( t=3.160, P<0.01). Conclusion:Long-term antiviral therapy of Peg-IFN alfa-2b combined with NAs can prolong the recurrence time of liver cancer, reduce the levels of HBsAg and HBV DNA in serum, and potentially improve the survival rate of the patients compared with therapy of NAs alone.

Objective To discuss the health education effect of a self-made health education video for patients with hepatic carcinoma who are receiving transcatheter arterial chemoembolization (TACE)therapy.Methods Based on the needs of patients,a TACE health education video was designed and produced,which was input into the tablet personal computer,such as iPad,to let patients watch.A total of 451 patients with liver cancer,who were admitted to the Department of Intervention,First Affiliated Hospital of Henan University of Technology and Science,China,to receive TACE during the period from June 2014 to June 2016,were included in this study.By using the random number table method,the patients were divided into the observation group (n=226) and the control group (n=225).The self-made health education video together with regular education was used to educate the patients of the observation group,while routine oral and written education was executed for the patients of the control group.The cognition to TACE-related knowledge,the compliance with postoperative treatment and nursing,and the patient's satisfaction were assessed and the results were compared between the two groups.Results The cognition in the following three aspects,including TACE-related knowledge,perioperative education and discharge education,in the patients of the observation group was significantly higher than that in the patients of the control group (P＜0.05).The compliance with postoperative treatment and nursing in the patients of the observation group was remarkably higher than that in the patients of the control group (P＜0.01).The patient's satisfaction in the patients of the observation group was strikingly higher than that in the patients of the control group (P＜0.01).Conclusion Health education by using a self-made health education video can improve liver cancer patient's cognition to TACE as well as the patient's compliance with postoperative treatment and nursing.The health education in the form of watching video can significantly improve health education effect and the satisfaction of the patients.Thus,it is worthy of clinical application.

Objective To evaluate the efficacy and safety of 125I seed implantation combined with transcatheter arterial chemoembolization (TACE) in the treatment of primary hepatocellular carcinoma (PHC).Methods 156 patients who had unresectable PHC seen from January 2012 to December 2015 in our unit were randomly assigned into the study group (76 patients) and the control group (80 patients).The study group of patients were treated with intra-hepatic implantation of 125I seed + TACE,and the control group of patients were treated with three dimensional conformal radiotherapy (3DCRT) + TACE.After ra diotherapy the two groups of patients underwent 2 to 3 times TACE treatment.The biomarker levels were compared between the two groups before and after treatment,and the short-term efficacy,clinical safety and 1 year survival rates were assessed.Results The success rates of the treatment for the two groups were both 100％.Patients in the study group were implanted with 1 016 125I seeds,with an average of (13.7 ± 2.5) seeds per patient.The two groups had no significant difference on short-term efficacy (P ＞ 0.05).The DCR,ORR and 1 year survival rates in the study group were 63.2％,92.1％,55.5％,and they were 61.3％,90.0％,58.1％ in the control group,respectively.There were no significant differences between these 2 groups (P ＞ 0.05).At 1 month after treatment,the two groups had no significant differences onAFP,IGF-Ⅱ and IGFBP-2 [(5.08±0.85) μg/L vs.(5.12 ±0.79) μg/L,(4.77 ±0.58) μg/L vs.(4.86 ±0.53) μg/L,(4.98 ±0.67) μg/L vs.(5.04 ±0.71) μg/L] (P＞0.05).There were no signif-icant differences on chemotherapy drug toxicities between the two groups (P ＞ 0.05).The incidence of radi-ation hepatitis in the study group was 1.3％,while the incidences of radiation dermatitis,hepatitis,gastriculcer in the control group were 5.0％,8.8％,2.5％,respectively.The radiation dermatitis incidence inthe study group was significantly lower than that of the control group (P ＜ 0.05).In the study group,2 pa-tients (2.6％) had their 125I seed slightly moved.Conclusion The short-term efficacy of 125I seed implan-tation plus TACE in the treatment of PHC is no less than the 3DCRT + TACE regimen,but with less radia-tion side effects.

Objective To investigate the feasibility of liver transplantation in the treatment of inoperable hilar cholangiocarcinoma. Methods The clinical data for 3 patients with unresectable hilar cholangiocarcinoma who underwent liver transplantation in the Department of Hepatobiliary Surgery of Fuzhou General Hospital of People's Liberation Army from January 2006 to December 2012 were retrospectively analyzed. The patients were followed up by phone, outpatient service, and hospitalization. The starting point of the follow-up was the operation date. The patients death was the end point. The clinical and pathological features, postoperative survival, tumor recurrence, and prognostic factors were observed. The follow-up deadline was December 2017. Results All 3 patients underwent classical orthotopic liver transplantation using retrograde perfusion through inferior vena cava and no perioperative deaths occurred. All 3 patients were followed up for 10 to 132 months. During the follow-up period, of 1 patient who died of tumor recurrence, the pathological TNM stage was T4a N1 M0, and both had Union for International Cancer Control stage Ⅳa, and the tumor-free survival time was 3 months, and the survival time was12 months. Of 1 patient who died of other causes, the pathological TNM stage was T3N1 M0, and both had Union for International Cancer Control stage Ⅲ, and the tumor-free survival time was 12 months, and the survival time was12 months. One case as of the end of follow-up, the patient has survived for 132 months, the pathological TNM staging was T2a NOM0, and both had Union for International Cancer Control stage Ⅱ. Conclusions Lymph node positive and high pathological TNM stage were poor prognosis factor for hilar cholangiocarcinoma who underwent liver transplantation. Patients with early hilar cholangiocarcinoma who don't have lymph node metastasis are expected to benefit from liver transplantation.