The clinical data were retrospectively analyzed for 21 cases of liver neoplasms undergoing laparoscopic hepatectomy from December 2007 to October 2012.Among 11 cases of borderline hepatocellular carcinoma (HCC) (1.0-9.0 cm),6 of them were of micro hepatocellular carcinoma (MHCC) with a diameter ≤2 cm.There were 10 cases of borderline hepatic benign tumor,including liver hemangioma (n =7),hepatic adenoma (n =1),liver lymphoma (n =1) and liver focal necrosis (n =1).According to Couinaud's liver segmentation method,neoplasm was located on segment Ⅲ (n =13),segment Ⅳ (n =6),segment Ⅴ (n =1) and segment Ⅵ (n =1).Laparoscopic hepatectomy was successful in all patients.There was neither conversion into open approach nor postoperative complications of bile leakage,air embolism or perioperative mortality,etc.The mean operative duration was (120 ± 30) minutes,average hemorrhagic volume (165-±79) ml and normal diet & ambulation at Day 1-2 post-operation.The average postoperative hospitalization stay was (16 ± 10)days and l-year survival rate 100％.The parameters of leucocyte,liver enzymes,albumin and bilirubin returned to normal at Week 1 post-operation.Once a reasonable surgical indication is selected,laparoscopic resection is both safe and effective for peripheral micro hepatocellular carcinoma.

Objective:To investigate the effect of laparoscopic sleeve gastrectomy (LSG) on weight loss in patients with different degrees of obesity.Methods:A retrospective analysis was performed on 152 patients with obesity who underwent LSG in Affiliated Huaian No.1 People′s Hospital of Nanjing Medical University from March 2019 to May 2022, including 119 females (78.3%) and 33 males (21.7%), with a mean age of (30.9±7.9) years (ranging from 18 to 58 years). The body mass index (BMI) was 30.0-34.9 kg/m 2, 35.0-39.9 kg/m 2 and ≥40.0 kg/m 2 in Ⅰ, Ⅱ and Ⅲ objesity groups respectively ( n=38, 57, 57). The body measurements, biochemical indexes, percentage of excess weight loss (%EWL) and percentage of total weight loss (%TWL) were collected and analyzed before and after surgery at 1, 3, 6, 12 months. Statistical analysis was conducted using SPSS 22.0 software. Results:LSG was successfully implemented in 152 patients. Body weight, BMI, waist circumference, hip circumference, waist-to-hip ratio, liver function, blood glucose and lipid parameters all decreased at each time point of postoperative follow-up, while uric acid increased at 1 month and decreased at 3, 6 and 12 months after surgery and then gradually decreased. At 12 months after surgery, the body weight was (75.9±17.0) kg ( t=15.14, P<0.001), BMI (26.2±3.7) kg/m 2 ( t=14.44, P<0.001), waist circumference (89.0±10.7) cm ( t=9.20, P<0.001), hip circumference 100.6±7.6 cm ( t=12.67, P<0.001), alanine aminotransferase (18.2±16.6) μ/L ( t=2.83, P=0.018), aspartate aminotransferase (15.2±14.2) μ/L ( t=2.84, P=0.018), fasting plasma glucose (4.6±0.5) mmol/L ( t=2.01, P=0.026), triglyceride 1.1±0.5 mmol/L ( t=3.71, P=0.005) and uric acid 340.2±102.7 μmol/L ( t=4.46, P=0.001), all were lower than those before surgery with statistical significance. At 6 months after surgery, the %EWL in Ⅰ, Ⅱ and Ⅲ obesity groups was (92.7±35.5) %, (86.1±16.0) % and (67.5±14.0) % respectively, with statistical significance among the 3 groups ( F=5.38, P=0.010). The %TWL was (20.5±7.4) %, (28.5±5.2) % and (28.9±6.1) % in the three groups respectively, and the overall difference was statistically significant ( F=3.50, P=0.043). At 1 year after surgery, there was no significant difference in %EWL and %TWL among the 3 groups. Conclusions:LSG was effective in treating simple obesity, with improvements of body weight, waist circumference, hip circumference, liver function, blood glucose and lipid and uric acid. In the first 6 months after surgery, %EWL in patients with class Ⅰ obesity was higher than that in patients with class Ⅲ obesity, achieving relatively better weight loss. However patients with class Ⅲ obesity also experienced significant weight loss until 1 year after surgery.

Objective:To investigate the short-term efficacy and safety of Donafenib as postoperative adjuvant therapy for patients with high risk of recurrence after radical resection of hepatocellular carcinoma (HCC).Methods:The propensity score matching (PSM) and retrospective cohort study was conducted. The clinicopathological data of 157 HCC patients with high risk of recurrence after radical resection who were admitted to 6 medical centers, including The First Affiliated Hospital of Nanjing Medical University et al, from June 2021 to February 2023 were collected. There were 128 males and 29 females, aged (59±10)years. Of 157 patients, 101 cases undergoing Donafenib as postoperative adjuvant therapy were divided into the the Donafenib group, and 56 cases under-going no systemic postoperative adjuvant therapy were divided into the control group. Observation indicators: (1) PSM and comparison of general data of patients between the two groups after matching; (2) postoperative treatment; (3) follow-up and survival of patients; (4) analysis of risk factors affecting recurrence-free survival of patients. PSM was done based on the principle of optimal perfect matching, with the clamp value of 0.5, and the Donafenib group and the control group were matched at a ratio of 1.25∶1. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the t test. Measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers and/or percentages, and comparison between groups was conducted using the chi-square test. Comparison of ordinal data between groups was conducted using the Kruskal-Wallis H test. The Kaplan-Meier method was used to calculate survival rates and draw survival curves, and the Log-Rank test was used for survival analysis. The COX proportional hazard model was used for univariate and multivariate analyses. Results:(1) PSM and comparison of general data of patients between the two groups after matching. Of 157 patients, 126 cases were successfully matched, including 70 cases in the Donafenib group and 56 cases in the control group, respectively. The elimination of tumor number confounding bias ensured comparability between the two groups after PSM. (2) Postoperative treatment. After PSM, of 70 patients in the Donafenib group, there were 23 cases receiving Donafenib monotherapy, 26 cases combined with transcatheter arterial chemoembolization (TACE), 14 cases combined with immunotherapy, and 7 cases combined with TACE+immunotherapy. Of 56 patients in the control group, there were 37 cases receiving postoperative follow-up alone and 19 cases combined with TACE. (3) Follow-up and survival of patients. All 157 patients were followed up, and the follow-up time of the 101 patients in Donafenib group and the 56 patients in control group were 10.1(range, 6.3-14.6)months and 22.2(range, 15.1-25.5)months, respectively. During the follow-up period, 70 patients in the Donafenib group experienced treatment-related adverse reactions, inclu-ding 8 cases of grade 3 adverse reactions, 23 cases of grade 2 and 39 cases of grade 1 adverse reactions, respectively. After PSM, the postoperative 12-, 18-month recurrence-free survival rates were 83.7%, 83.7% in the 70 patients of Donafenib group and 67.8%, 58.9% in the 56 patients of control group, respectively, showing a significant difference in the postoperative recurrence-free survival time between the two groups ( hazard ratio=0.395, 95% confidence interval as 0.176-0.888, P<0.05). (4) Analysis of risk factors affecting recurrence free survival of patients. Results of multivariate ana-lysis showed that microvascular invasion, vascular thrombus, clinical stage as ⅢA were independent risk factors affecting recurrence-free survival in patients with high risk of recurrence after radical resection of HCC ( hazard ratio=2.181, 2.612, 2.612, 95% confidence interval as 1.028-4.629, 1.128-6.047, 1.128-6.047, P<0.05), Donafenib as postoperative adjuvant therapy was an independent protective factor affecting recurrence-free survival in patients with high risk of recurrence after radical resection of HCC ( hazard ratio=0.457, 95% confidence interval as 0.227-0.920, P<0.05). Results of further analysis showed that after PSM, there were significant differences in the postoperative recurrence-free survival time in patients with different clinical factors, including male, age ≥60 years, tumor diameter >5 cm, positive microvascular invasion, positive hepatitis B virus infection, alpha fetoprotein <200 μg/L, between the Donafenib group and the control group ( hazard ratio=0.283, 0.202, 0.174, 0.345, 0.273, 0.180, 95% confidence interval as 0.114-0.707, 0.044-0.937, 0.038-0.794, 0.128-0.929, 0.091-0.819, 0.052-0.620, P<0.05). Conclusion:Donafenib as postoperative adjuvant therapy can effectively reduce the short-term recurrence rate in patients with high risk of recurrence after radical resection of HCC, with good safety and tolerance.