Hepatectomy is the treatment of choice for huge ( ＞ 10 cm) hepatocellular carcinoma.However,the resection is more difficult and risky due to a huge space occupied by the tumor and vascular invasion.Precise hepatectomy is a new concept of liver surgery in the 21st century.The goal of which is the least invasive,most parenchymal preserving and optimal recovery.A male patient with a huge hepatocellular carcinoma (diameter =22.5 cm) received precise hepatectomy in the Department of Hepatobiliary Surgery of Fuzhou General Hospital of Nanjing Military Area.By using the digital medical technology and procedure of liver surgery planning system,the tumor and the whole structure of the liver were three dimensionally reconstructed,and the planning of resection was made.During surgery,the right liver artery and the right.porta hepatis were ligated and the right hemihepatic vessels were occluded.We accomplished right hepatectomy by accurate resection according the precisely planned preoperation,with less bleeding or no bleeding surgical field and rapid recovery.

Objective To investigate whether Ki-67 and DNA topoisomerase Ⅱ α (Topo Ⅱ α) are effective prognostic markers in patients with primary hepatocellular carcinoma (HCC) after liver transplantation.Methods This retrospective cohort study included 105 patients with HCC who underwent liver transplantation in a single center from 2001 to 2012.The demographic features,clinicopathological data,expressions of Topo I c and Ki-67 as detected by immunohistochemistry.The long-term survival and the potential prognostic factors,together with standard histologic parameters,were analyzed by univariate and multivariate analyses.Results A positive correlation was found between Topo II α and Ki-67 levels in HCC (r ＝ 0.469,P ＜ 0.01).Multivariate analyses showed that Ki-67 was an independent prognostic risk factor of recurrencefree survival (HR ＝ 2.296,P ＜ 0.05).The 5-year overall survival rate was related to tumor size (HR ＝ 1.743,P ＜ 0.05),AFP (HR ＝ 2.291,P ＜ 0.05),histological grade (HR ＝ 0.283,P ＜ 0.01),and high expressions of Ki-67 (HR ＝ 1.977,P ＜ 0.05) and Topo Ⅱ α levels (HR ＝ 1.883,P ＜ 0.05).The KaplanMeier analysis showed that there was a significant difference in the 5-year recurrence-free survival rate (40.4％ vs.57.6％) between patients with high and low expressions of Ki-67,which were significantly lower in the high Topo Ⅱ α expression patients (13.5％ vs.63.8％) (P ＜0.01).The 5-year overall survival rates were significantly lower in the high Ki-67 expression patients (12.7％ vs.61.1％,P ＜0.01) when compared with the low Ki-67 expression patients,which were significantly lower in the high Topo Ⅱ α-and Ki-67 expression patients (10.7％ vs.54.5％,P ＜0.01) than the low Topo Ⅱ α-or Ki-67 patients.Conclusions Ki-67 was associated with recurrence and metastasis in patients with primary hepatic carcinoma after liver transplantation.High expression of both Ki-67 and Topo Ⅱ α were associated with poor prognosis in these patients.

Objective To investigate the effect of rehabilitation nursing in perioperative period of elderly patients with femoral neck fractures undergone supercapsular percutaneously assisted total hip (SuperPATH) arthroplasty.Methods A retrospective cohort analysis was made on 30 patients treated by total hip arthroplasty through the SuperPATH approach from January 2016 to July 2016.There were seven males and 23 females,aged 75-91 years (mean,77 years).Nursing methods contained application of pluralistic education before operation,application of body position management,psychologic support joint pain and sleep multidimensional strengthening nursing intervention and dislocation nursing after operation,and recovery training.Self-rating anxiety scale (SAS),self-rating scale of sleep (SRSS),Barthel index and Harris hip score were used to compare clinical manifestations before and after treatment.Results SAS score was 42.5-66.3 points [(50.0 ± 6.2) points] one day before operation,compared to 33.8-53.8 points [(41.5 ± 5.2) points] five day after operation (P ＜ 0.05).SRSS score was 24-37 points [(29.9 ±3.1) points] one day before operation,compared to 14-34 points [(23.2 ± 5.3) points] five day after operation (P ＜ 0.05).Barthel index was 20-40 points [(38.5 ± 4.4) points] one day before operation,was 35-55 points [(49.7 ± 6.3)points] two day after operation and was 55-70 points [(63.5 ± 5.1)] points five day after operation,showing significant differences (P ＜ 0.05).Harris hip score was 4-25 points [(14.8 ±4.2)points] one day after operation,was 59-75 points[(67.3 ± 5.1) points] two day after operation and was 66-85 points [(79.2 ± 4.3) points] two weeks after operation,showing significant differences (P ＜ 0.05).All incision healed primarily.No complications occurred.Conclusion Perioperative rehabilitation nursing of minimally invasive SuperPATH arthroplasty is effective in alleviating patients' anxiety,improving sleep status and self-care ability,enhancing postoperative rehabilitation effect and reducing risk of in-hospital complications.

Objective To compare the efficacies of hepatectomy and liver transplantation for patients with hepatocellular carcinoma (HCC) fulfilling the Milan criteria.Methods From July 2002 to February 2009,121 patients with HCC combined with hepatic cirrhosis fulfilling the Milan criteria were admitted to the Fuzhou General Hospital.Eighty-nine patients who received hepatectomy were in the hepatectomy group,and 32 patients who received liver transplantation were in the liver transplantation group.There were no significant difference in the age,gender,etiology of liver disease,the size of the largest tumor,number of tumors,microscopic venous invasion,microsatellite lesion and tumor differentiation between the 2 groups.The clinical data of the patients in the 2 groups were retrospectively analyzed.The overall survival and disease-free survival were evaluated by Kaplan-Meier method,and differences in survival rates between the 2 groups were determined by Log-rank test.COX proportional hazard was used for univariate and multivariate analysis to evaluate the risk factors for prognosis.Results The median period of follow-up was 37 months.The 1-,3-,5-year survival rates were 86％,63％ and 44％ in the hepatectomy group,and 87％,70％ and 62％ in the liver transplantation group.There was no significant difference in the overall survival rate between the 2 groups (x2 =1.092,P ＞ 0.05).The 1-,3-,5-year disease-free survival rates were 68％,44％ and 26％ in the hepatectomy group,and 80％,65％ and 52％ in the liver transplantation group.There was a significant difference in the disease-free survival rate between the 2 groups (x2 =4.712,P ＜ 0.05).The result of univariate analysis revealed that microscopic venous invasion and microsatellite lesion were significantly correlated with the survival (Wald =9.625,7.340,P ＜ 0.05),and the result of multivariate analysis indicated that microscopic venous invasion was the independent risk factor influencing the survival (Wald =5.008,P ＜ 0.05).Conclusions As for patients with HCC fulfilling the Milan criteria,the overall survival rate of patients who received hepatectomy is not different from those who received liver transplantation,but the disease-free survival rate of patients who received liver transplantation is higher than those who received hepatectomy.Microscopic venous invasion is an independent risk factor influencing the survival.

BACKGROUND: The affected liver can be completely removed by liver transplantation,long-term efficacy is superior to liver resection,the 5-year survival rate reaches 70% H1.In addition,liver transplantation can avoid a serious risk for incomplete liver function caused by hepatic resection in the case of liver dysfunction.OBJECTIVE: To retrospectively analyze the treatment effects and importance of orthotoplc liver transplantation for primary hepatic cancer patients.METHODS: A total of 75 patients with primary hepatic cancer treated by orthotopic liver transplantation in Department of Hepatobiliary Surgery,Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA from March 1980 to December 2008 were involved in the analysis for the postoperative survival rates and recurrence of tumors.RESULTS AND CONCLUSION: For all the patients,the total postoperative survival rate in the 1st,2nd and 3rd year was 86.6%,66.7% and 53.3% respectively,the disease free survival rate was 65.2%,53.9%,34.1%.Their mean survival time is 25 months.For the patients in line with Milan standard,the postoperative survival rate in the 1st,2nd and 3rd year was 88.4%,72.5% and57.9% respectively,the disease free survival rate was 77.6%,62.3%,51.8%.Their mean survival time is 39 months.Tumor recurrence occurred within one year in all six patients who were beyond Milan standard.Two patients died in one year after operation,the survival rate at postoperative one year was 66.7% and the remanent four patients all died in the 2nd year after operation.Orthotopic liver transplantation was one of the effective treatments for pdmary hepatic cancer patients.The patients which were measured up to Milan standard would have the best curative effects.

Objective To investigate the clinical effect of cryosurgery in the preoperative preparation of liver transplantation in treating liver cancer.Method This study reviewed retrospectively clinical data from 74 patients who underwent cryosurgery of liver cancer before liver transplantation.According to the differences between transplantation programs,74 patients were divided into 2 groups:26 patients in Argon-helium cryoablation group (AHC group) and 48 patients in transcatheter arterial chemoembolization group (TACE group).Whether the patients in two groups met the standard of Milan after treatment,as well as the incidence rate of complication,waiting time for transplantation and MELD score before transplantation were compared between two groups after preoperative therapy.What's more,operation time,no liver time,amount of bleeding,PT and serum level of aminotransferase at 1st,3rd,and 5th day after transplantation were analyzed.Abdominal drainage fluid volume,the incidence of infection,acute rejection,kidney failure,biliary complication,and vascular complication in two groups were also compared.Disease free survival rate was counted after two years by outpatient follow-up.Result Only 3 cases in two groups exceeded Milan standard after treatment,one in AHC group and two in TACE group.The complication incidence and waiting time in two groups had no statistically significant differences.The MELD score in AHC group was significantly lower than in TACE group before transplantation.The operation time,amount of bleeding and transfusion requirements in AHC group were also significantly lower than in TACE group.The time without liver in two groups had no statistically significant difference.The speed of liver function recover was faster in ACH group,and the abdominal drainage fluid volume was less.There were no significant differences in incidence of postoperative complications between two groups (P＞0.05).Conclusion Cryosurgery therapy has little effect on liver functions after treatment.It is a good therapy for liver cancer patients before liver transplantation.

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.

ObjectiveTo investigate the value of cold laser combined with choledochoscopy in the treatment of residual stones after biliary surgery. MethodsA retrospective analysis was performed for the clinical data of 79 patients with residual stones after biliary surgery who were admitted to Fuzhou General Hospital of Nanjing Military Area Command from January 2015 to June 2016. All the patients underwent cold laser combined with choledochoscopy at 6 weeks after surgery. The cure rate and complications were observed. ResultsAll the patients underwent successful lithotripsy, and the cure rate was 100%. Of all the patients, 68 did not experience any postoperative complication, 7 experienced abdominal distension, abdominal pain, and diarrhea, which achieved spontaneous remission after observation, and 4 experienced fear of cold and chill, which were improved after symptomatic treatment. No patients experienced serious complications, such as bile duct injury, biliary tract perforation, bile leakage, and hematobilia. ConclusionCold laser combined with choledochoscopy has a good effect, a high level of safety, and good repeatability in the treatment of residual stones after biliary surgery; therefore, it holds promise for clinical application.

Objective To investigate the efficacy and safety of different course duration of rivaroxaban for deep venous thrombosis (DVT) in elderly patients with femoral neck fractures after artificial femoral head replacement.Methods A prospective case control study was conducted on 95 elderly cases of femoral neck fractures treated from February 2015 to July 2017.There were 18 males and 77 females,with average age of 80.8 years (range,70-98 years).There were 85 patients at stage Ⅲ and 10 at stage Ⅳ according to Garden classification.All patients received artificial femoral head replacement and were randomly divided into 3 groups (Group A:34 cases,rivaroxaban treatment for 2 weeks;Group B:31 cases,rivaroxaban treatment for 3 weeks;Group C:30 cases,rivaroxaban treatment for 5 weeks).At 2,3 and 5 weeks after operation,the patients were given 10 mg oral rivaroxaban once daily.General information,blood transfusion rate,hemoglobin volume,platelet count and DVT rate were recorded before and 6 weeks after operation.Results No significant difference among the groups in terms of division,age,body mass index,fracture classification,time interval from injury,intraoperative blood loss,quantity of drainage fluid after operation,and associated underlying diseases was observed (P ＞ 0.05).The blood transfusion rate of Groups A,B and C within 2 weeks after operation was 9％ (3/34),3％ (1/31) and 3％ (1/30) (P ＞ 0.05) respectively.The comparative difference in hemoglobin and platelet count had no statistical significance (P ＞ 0.05).The DTV rate after operation of Groups A,B and C was 21％ (7/34),13％ (4/31) and 0,respectively.There was no significant difference between Groups B and C (P ＞ 0.05),but the difference between Groups A and C was statistically significant (P ＜ 0.05).Conclusions For elderly patients with femoral neck fracture who underwent the artificial femoral head replacement,it is effective to prevent the occurrence of DVT by extending the course of rivaroxaban treatment to 5 weeks.In addition,it does not increase the risk of bleeding.

Objective To investigate the relationship between contactin (CNTN)-1 and vascular endothelial growth factor (VEGF)-C expression levels and the recurrence,metastasis and prognosis of hepatocellular carcinoma(HCC) patients after liver transplantation.Methods Clinical data and pathological specimen of 105 patients diagnosed with primary HCC undergoing orthotopic liver transplantation were collected.The expression levels of CNTN-1 and VEGF-C in the cancerous and para-cancerous liver tissues were quantitatively measured by immunohistochemical staining.The relationship between the CNTN-1 and VEGF-C expression levels and clinicopathological characteristics,postoperative recurrence,metastasis and prognosis was statistically analyzed.Results The high expression rate of CNTN-1 and VEGF-C in liver cancerous tissues was 46.7％ and 39.0％,significantly higher compared with 11.4％ and 19.0％ in the para-cancerous tissues (both P＜0.05).Spearman correlation analysis revealed that the expression level of CNTN-1 was positively correlated with that of VEGF-C (P＜0.005).X2 test demonstrated that the expression of CNTN-1 protein was positively correlated with the level of alpha fetoprotein (AFP) (P=0.017),tumor,node,metastasis (TNM) staging(all P＜0.001),and negatively correlated with the degree of differentiation (P＜0.001).High expression of VEGF-C was positively correlated with TNM staging (P＜0.001).Cox multivariate analysis revealed that overall survival rate was significantly correlated with gender,AFP,degree of tumor differentiation,microvascular invasion,tumor diameter and high expression of CNTN-1 (P＜0.05-0.001).The recurrence-free survival was correlated with TNM staging,envelope integrity and high CNTN-1 expression (P＜0.05-0.001).Kaplan-Meier survival analysis revealed that postoperative overall survival curve and recurrence-free survival curve significantly differed between patients with high and low expression levels of CNTN-1 (both P＜0.01).Recurrence-free survival curve significantly differed between patients with high and low expression levels of VEGF-C (P=0.005).Conclusions CNTN-1 protein is highly expressed in HCC tissues and correlated with the expression of VEGF-C.It is associated with postoperative recurrence and metastasis of HCC after liver transplantation and affects the clinical prognosis of patients.