Recent studies indicate that the activation of peroxisome proliferator-activated receptor gamma (PPARγ) can inhibit the invasion and metastasis of hepatocellular carcinoma (HCC) by inhibiting proliferation and adhesion of HCC cells,degradation of extracellular matrix and angiogenesis.Therefore,the mechanisms that PPARγsignaling pathway inhibits the invasion and metastasis of HCC may provide help for the clinical treatment,and is expected to improve the survival rate of HCC patient.

Objective To investigate the efficiency and safety of laparoscopic hepatectomy (LH) and open hepatectomy (OH) in patients with hepatocellular carcinoma (HCC). Methods A total of 45 HCC cases undergoing hepatectomy from January 2008 to December 2010 in our hospital were divided into LH group ( n =21 ) and OH group ( n =24 ).Their clinical efficiency and safety were compared and analyzed. Results The amount of intraoperative blood loss and blood transfusion in LH group were significantly higher than that of OH ( respectively x2 =3.973,x2 =4.862,all P ＜ 0.05 ).LH is associated with less postoperative complications and duration of hospital stay,compared with OH ( respectively x2 =4.746,t =-2.717,all P ＜0.05).Cumulative survival rates in both groups were not statistically significant ( x2 =0.172,P ＞ 0.05 ).However tumor-free survival rate in LH was significantly higher,superior to that of OH (x2 =4.543,P ＜ 0.05). Conclusions LH and OH are all safe and effective hepatectomy for HCC.LH has the advantage of less complication and shorter hospital stay.

Objective This retrospective study was to explore the efficacy and determine the risk factors of survival for recurrent hepatocellular carcinoma ( HCC) treated by repeat hepatectomy. Methods From January 1995 till December 2010, 60 patients with recurrent HCCs, were treated by repeat hepatectomy.The significance of seventeen clinical or pathological variables in the risk factors of overall survival were assessed. Results The overall survival 1,3, and 5-year survival rates were 76. 3% , 40.7% and 25. 0% (from repeat hepatectomy), and 95. 0% , 62. 6% and 43. 3% ( from initial hepatectomy) , respectively.Univariate analysis indicated that tumor size at initial hepatectomy, recurrence interval from initial hepatectomy, serum albumin(ALB) level, resection margin, diameter of largest recurrence tumor and rumor vascular invasion were significant prognostic factors(P <0. 05, Kaplan-Meier Log-rank test). Multivariate analysis showed recurrence interval from initial hepatectomy, resection margin, diameter of largest recurrence tumor and rumor vascular invasion were significant prognostic factors(P<0.05, Cox proportional hazards model).Conclusion Repeat hepatectomy is effective for recurrent HCC. Recurrence interval from initial hepatectomy, resection margin, diameter of largest recurrence tumor and rumor vascular invasion were significant prognostic factors.

Objective To investigate the efficacy and safety of endoscopic radiofrequency ablation on patients with advanced stage unresectable cholangiocarcinoma. Methods Clinical data of 45 cases with unresectable cholangiocarcinoma who underwent endoscopic retrograde cholangiopancreatography from October 2011 to October 2014 were collected. The patients were divided into two groups: the group A included 23 cases undergoing radiofrequency ablation, and the group B included 22 cases without ablation. The occurrence of complications, the postoperative levels of CA19-9 and total bilirubin ( TBIL) in blood plasma, the patency of stents, and survival period were compared between the two groups. Results All of the 45 patients completed treatment, and no perforation, bleeding and bile leakage occurred. In the group A, 2 patients got fever and 5 patients got pancreatitis after operation, and the number in the group B was 3 and 4, respectively. Their symptoms disappeared after suitable treatment. The postoperative pain rate in group A ( 21. 7％, 5/23) was significantly lower than that of group B ( 54. 5％, 12/22,χ2=5. 148, P=0. 023) . At 7th day of post-operation, the levels of CA19-9 in the two groups were 960. 5 ± 362. 7 U/mL and 979. 3 ± 378. 1 U/mL, respectively, and the levels of TBIL were 95. 25±28. 36μmol/L and 98. 75±20. 76μmol/L, respectively, which were not significantly different between the two groups( P>0. 05) , but were significantly decreased compared with the levels of pre-operation ( P<0. 05) . The patency of self-expandable metal stent in group A ( 60. 0％, 6/10) was significantly higher than that of group B ( 10. 0％, 1/10,χ2=5. 495, P=0. 019) 9 months after operation. Kaplan-Meier analysis showed that the median survival time in the two groups had no statistical difference [ 271. 0 days ( 95％CI: 168. 4-373. 4days ) VS 245. 0 days ( 95％CI:200. 3-289. 7 days), χ2=1. 380, P=0. 258]. Conclusion For the patients with advanced unresectable cholangiocarcinoma, endoscopic radiofrequency ablation is able to relieve cancer pain, prolong the patency of stents, and improve the life quality, which deserves clinical applications.

Objective:To compare the results of operative versus interventional treatments in patients presenting with sentinel hemorrhage after hepatobiliary and pancreatic surgery.Methods:The clinical data of patients presenting with sentinel hemorrhage after hepatobiliary and pancreatic surgery at the Department of Hepatobiliary Surgery, the Second Affiliated Hospital of Guangzhou Medical University from August 2017 to July 2022 were retrospectively analyzed. Of 82 patients who were enrolled in this study, there were 50 males and 32 females, aged (59.0±7.7) years. The patients were divided into the interventional group ( n=42) and the surgical group ( n=40) based on the treatment they received for sentinel hemorrhage. The vascular injury rate, the first operation time for sentinel bleeding, the rate of successful hemostasis in a single operation, the number of deaths and other indicators were compared between groups. Results:In both the two groups of patients who underwent percutaneous transhepatic cholangial drainage, hepatectomy, endoscopic retrograde cholangiopancreatography, hilar cholangiocarcinoma resection and cholecystectomy were mainly performed hepatic artery injury, pancreaticoduodenectomy with gastroduodenal artery injury, and splenectomy with splenic artery injury. In the intervention group, 36 patients (85.7%) were successfully hemostasis after single treatment, and 32 patients (80.0%) in the operation group, and there was no significant difference between the two groups (χ 2=0.47, P=0.492). The first operation time for the intervention group was (40.5±8.5) min and the mortality rate was 2.4% (1/42), which were significantly better than that of the operation group (90.6±20.8) min and 15.0% (6/40) (all P<0.05). Conclusion:Interventional therapy can be used as the first-line diagnosis and treatment for sentinel bleeding after hepatobiliary and pancreatic surgery. It has the advantages of a lower mortality rate in treating these patients.

Objective:To evaluate the effect of controlled low central venous pressure with milrinone on laparoscopic hepatectomy in the patients.Methods:Fifty American Society of Anesthesiologists physical statusⅠ-Ⅲ patients of both sexes, aged 18-64 yr, with body mass index of 18-30 kg/m 2, of Child-Pugh grade A or B, undergoing elective laparoscopic hepatectomy, were divided into 2 groups ( n=25 each) using a random number table method: milrinone group (group M) and nitroglycerin group (group NG). After the start of surgery, milrinone 0.5 μg·kg -1·min -1 was continuously infused in group M, and nitroglycerin was continuously infused with the initial dose of 0.5 μg·kg -1·min -1 to maintain central venous pressure (CVP)≤5 mmHg in group NG.Mean arterial pressure and heart rate were recorded on admission to the operation room (T 0), at skin incision (T 1), at the beginning of liver resection (T 2), at completion of liver resection (T 3), at the end of operation (T 4), and CVP, cardiac index and stroke volume variation were recorded at T 1-4.Internal jugular vein blood samples were collected to determine the concentrations of hemogloblin, blood lactate at T 1 and T 4, and serum alanine aminotransferase, aspartate aminotransferase and creatinine concentrations at 1, 3 and 7 days after surgery.The score of blood oozing in hepatic surgical field, amount of norepinephrine used, blood loss, postoperative recovery and occurrence of complications within 7 days after operation were recorded. Results:Compared with group NG, cardiac index was significantly increased at T 2, 3, the CVP was decreased at T 2, the blood oozing score, blood loss, consumption of norepinephrine, and concentrations of blood lactate were decreased, and the postoperative drainage indwelling time was shortened in group M ( P<0.05). There was no significant difference in the serum alanine aminotransferase, aspartate aminotransferase and creatinine concentrations and incidence of postoperative complications at 1, 3 and 7 days after operation between the two groups ( P>0.05). Conclusions:Milrinone is better than nitroglycerin in decreasing central venous pressure, reducing blood loss, maintaining stable circulatory function and tissue perfusion in laparoscopic hepatectomy.

Objective To explore the application value of preoperative bedside ultrasound in the surgical operation of primary liver cancer (PLC).Methods Clinical data of 23 patients with PLC in the Second Affiliated Hospital of Guangzhou Medical University from October 2016 to May 2017 were retrospectively analyzed.The informed consents of all patients were obtained and the local ethical committee approval was received.Among 23 patients,15 cases were male and 8 female,aged from 27 to 73 years with a median age of 53 years.Bedside ultrasound examination was performed in the patients.The liver was scanned and examined by Doppler ultrasound via the xiphoid process,the right costal margin and the intercostal space,and the results were compared with the preoperative imaging data.Results All the patients received bedside ultrasound examination within preoprative 24 h.The left,middle and right hepatic venous structures of the second porta could be displayed clearly by the scaning from xiphoid process,and the left hepatic segment where the lesions located could be further displayed.The scan form right costal margin showed the anatomical relationship of primary porta and the anatomy of portal vein.The scan from intercostal space could identify the position of lesions in the right lobe and determine the intrahepatic distribution of middle and right hepatic veins and right portal vein,and their relationship with lesions.The lesions located in segment Ⅱ and Ⅲ of 6 cases,segment Ⅳ of 5 cases,segment Ⅴ of 2 cases,segment Ⅴ and Ⅷ of 3 cases and segment Ⅵ of 7 cases.The findings of preoperative bedside ultrasound was inconsistent with that of preoperative CT and MRI.The operation was aborted in 1 case and operative plan was changed in 1 case.Conclusions Preoperative bedside ultrasound can provide more anatomical information and lesion distribution for liver surgery,which can shorten the intraoperative exploration time and adjust the surgical plan timely.