Hepatocellular carcinoma (HCC) is one of the most common malignant tumors, and its features of insidious onset, rapid development, and high recurrence bring great challenges to the long-term survival of HCC patients. Molecular-targeted drugs and immune checkpoint inhibitors have become the research hotspots in the treatment of HCC, and a large number of clinical trials have found that combined therapy has achieved a good clinical effect. This article mainly introduces the application of combined therapy with molecular-targeted drugs and immune checkpoint inhibitors and other combined therapies in HCC and points out that combined therapy related to systemic therapy or local therapy has become the latest research hotspot in HCC treatment.

Objective:To investigate the application value of a new internal cold circula-tion bipolar radio frequency device in open hepatectomy.Methods:The retrospective cohort study was conducted. The clinical data of 85 patients with hepatocellular carcinoma who underwent open hepatectomy at the Affiliated Tumor Hospital of Zhengzhou University from February 2017 to January 2020 were collected. There were 48 males and 37 females, aged from 32 to 74 years, with a median age of 52 years. Of 85 patients, 45 cases undergoing hepatectomy assisted by the new internal cold circulation bipolar radio frequency device were allocated into new internal cold circulation bipolar radio frequency device group, and 40 cases undergoing hepatectomy assisted by Habib-4X bipolar radio frequency device were allocated into Habib-4X group, respectively. Observation indicators: (1) intraoperative situations; (2) postoperative situations; (3) follow-up. Follow-up was conducted by outpatient, inpatient reexamination and telephone interview to detect the postoperative complications and death of patient within postoperative 30 days up to May 2020. Measurement data with normal distribution were represented as Mean± SD, and independent sample t test was used for comparison between groups. Measurement data with skewed distribution were expressed as M(range), and nonparametric Mann-Whitney U test was used for comparison between groups. Count data were represented as absolute numbers, and comparison between groups was analyzed using the chi-square test or Fisher exact probability. Repeated measurement data were anlyzed by the repeated ANOVA. Results:(1) Intraoperative situations: the time of crosscutting process for liver parenchyma, average area transection speed, coagulation tissue width, cases with needle bleeding rate and electrode needle charring were (55±16)minutes, (4.8±1.2)cm 2/minute, (1.4±0.2)cm, 6, 10 for the new internal cold circulation bipolar radio frequency device group, versus (64±15)minutes, (3.6±1.0)cm 2/minute, (1.8±0.2)cm, 14, 25 for the Habib-4X group, respectively, showing significant differences in the above indicators between the two groups ( t=2.665, 4.973, 9.204, χ2=5.525, 14.184, P<0.05). (2) Postoperative situations: for the new internal cold circulation bipolar radio frequency device group, the total bilirubin (TBil) was (20±12)μmol/L, (25±12)μmol/L, (20±14)μmol/L at postoperative 1, 3, 7 days, the prothrombin time (PT) was (15.4±2.2)seconds, (14.2±2.1)seconds, (12.7±0.8)seconds, the alanine aminotransferase (ALT) was (288±248)IU/L, (132±61)IU/L, (67±32)IU/L, the aspartate aminotransferase (AST) was (279±114)IU/L, (50±22)IU/L, (30±13)IU/L. For the Habib-4X group, the TBil was 1(22±15)μmol/L, (23±10)μmol/L, (19±8)μmol/L at postoperative 1, 3, 7 days, PT was (15.8±2.8)seconds, (14.3±2.0)seconds, (13.6±1.3)seconds, the ALT was (369±269)IU/L, (133±99)IU/L, (54±30)IU/L, the AST was (345±125)IU/L, (60±36)IU/L, (32±11)IU/L. There were significant differences in the time effect of PT, ALT, AST between the two groups ( F=18.364, 23.020, 93.786, P<0.05). There was no significant difference in the time effect, between-group effect, interaction effect of TBil or between-group effect, interaction effect of PT, ALT, AST between the two groups ( F=2.421, 1.424, 0.522, 1.593, 0.312, 0.121, 0.267, 1.027, 0.600, P>0.05). (3) Follow-up: 85 patients were followed up for 4 to 39 months, with a median follow-up time of 16 months. There were 5 patients in the new internal cooling circulation bipolar radiofrequency device group and 8 patients in the Habib-4X group with complications, respectively, showing no significant difference in overall complications between the two groups ( χ2=1.292, P>0.05). The number of deaths in the new internal cooling circulation bipolar radio frequency device group and Habib-4X group was 0 and 1, respectively, showing no significant difference between the two groups ( P>0.05). Conclusion:The new internal cold-circulating bipolar radio frequency device for open hepatectomy is safe and effective, which cuts the liver parenchyma faster, has lower carbonization rate at the tip of electrode needle, and has more accurate coagulation range.

Objective:To compare the clinical outcomes between the new cold-circulation bipolar radiofrequency assisted versus Habib-4X bipolar radiofrequency assisted open hemihepatectomy.Methods:A retrospective study was conducted on 45 patients who underwent bipolar radiofrequency assisted open hemihepatectomy at the Affiliated Tumor Hospital of Zhengzhou University from October 2016 to January 2020. There were 28 males and 17 females, with an average age of 52.2 years. These patients were divided into the experimental group ( n=20) who underwent the new cold-circulation bipolar radiofrequency assisted open liver resection, and the control group ( n=25) who underwent the Habib 4X bipolar radiofrequency assisted open liver resection. The postoperative alanine aminotransferase (ALT), postoperative aspartate aminotransferase (AST), liver coagulative necrosis plane width, speed of liver parenchymal transection, electrode needle carbonization rate, and postoperative complications were compared between groups. Results:In the experimental group, the speed of liver parenchymal transection was (5.0±2.0) cm 2/min, the width of the coagulative necrosis plane was (1.36±0.21) cm, the AST on the first postoperative day was (177.0±79.3) U/L, the ALT on the first postoperative day was (200.2±78.5) U/L, and the electrode needle tip carbonization rate was 20.0% (4/20). These figures were significantly better than the control group with (3.6±1.7) cm 2/min, (1.93±0.16) cm, (233.2±66.6) U/L, (249.2±62.9) U/L, and 56.0% (14/25), respectively (all P<0.05). The postoperative complication rate was 15.0% (3/20) in the experimental group and 24.0% (6/25) in the control group ( P>0.05). Conclusion:Cold-circulation bipolar radiofrequency assisted hemihepatectomy was safe and feasible. It had the advantages of rapid transection of liver parenchyma, a low electrode tip carbonization rate, and a more accurate coagulation range.

Objective:To study the safety and efficacy of liquid isolation assisted technology in ultrasound-guided percutaneous radiofrequency ablation for hepatocellular carcinoma adjacent to liver surfaces.Methods:A retrospective study was conducted on 246 patients with hepatocellular carcinoma near liver surfaces treated by radiofrequency ablation from November 2016 to November 2019 at the Department of Hepatobiliary and Pancreatic Surgery, Affiliated Tumor Hospital of Zhengzhou University. There were 182 males and 64 females, aged (56.7±9.2) years. The patients were divided into the liquid isolation group with liquid isolation assisted technology for radiofrequency ablation ( n=131) and the conventional treatment group with conventional radiofrequency ablation ( n=115). The complication, one-time complete ablation and progression-free survival rates were compared between the two groups. Results:The incidence of intraoperative complications in the liquid isolation group was 21.4% (28/131), versus 20.9% (24/115) in the conventional treatment group. There was no significant difference between the two groups ( P>0.05). The incidence of postoperative complications in the liquid isolation group was 20.6% (27/131), which was significantly lower than that in the conventional treatment group 33.9% (39/115) ( P<0.05). The incidence of postoperative pain in the liquid isolation group was 6.1% (8/131), which was significantly lower than that in the conventional treatment group 15.7% (18/115) ( P<0.05). For the 131 patients in the liquid isolation group, there were 183 tumors near to liver surfaces. For the 115 patients in the conventional treatment group, there were 142 lesions near to liver surfaces. The one-time complete ablation rate in the liquid isolation group was 94.0% (172/183), which was significantly higher than the 75.4% (107/142) in the conventional treatment group ( P<0.05). The progression-free survival rate in the liquid isolation group was significantly better than that in the conventional treatment group ( P<0.05). Conclusion:The liquid isolation technique increased the one-time complete ablation rate of liver cancer adjacent to liver surfaces, reduced the incidence of postoperative complications and improved prognosis.