BACKGROUND: Significant hemorrhage together with blood transfusion increases postoperative morbidity and mortality of hepatic resection. Hepatic vascular occlusion is effective in minimizing bleeding during hepatic pa...BACKGROUND: Significant hemorrhage together with blood transfusion increases postoperative morbidity and mortality of hepatic resection. Hepatic vascular occlusion is effective in minimizing bleeding during hepatic parenchymal transection. This article aimed to review the current role and status of various techniques of hepatic vascular occlusion during hepatic resection. DATA SOURCES: The relevant manuscripts were identified by searching MEDLINE, and PubMed for articles published between January 1980 and April 2010 using the keywords 'vascular control', 'vascular clamping', 'vascular exclusion' and 'hepatectomy'. Additional papers were identified by a manual search of the references from the key articles. RESULTS: One randomized controlled trial (RCT) and 5 RCTs showed intermittent Pringle maneuver and ischemic preconditioning followed by continuous Pringle maneuver were superior to continuous Pringle maneuver alone, respectively. Two RCTs compared the outcomes of hepatectomy with and without intermittent Pringle maneuver. One showed Pringle maneuver to be beneficial, while the other failed to show any benefit. One RCT showed that ischemic preconditioning had significantly less blood loss than using intermittent Pringle maneuver. Four RCTs evaluated the use of hemihepatic vascular occlusion. One RCT showed it had significantly less blood loss than Pringle maneuver, while the other 3 showed no significant difference. Only 1 RCT showed it had significantly less liver ischemic injury. No RCT had been carried out to assess segmental vascular occlusion. Two RCTs compared the outcomes of total hepatic vascular exclusion (THVE) and Pringle maneuver. One RCT showed THVE resulted in similar blood loss, but a higher postoperative complication. The other RCT showed less blood loss using THVE but the postoperative complication rate was similar. Both studies showed similar degree of liver ischemic injury. Only one RCT showed that selective hepatic vascular exclusion (SHVE) had less blood loss and liver ischemic injury than Pringle maneuver. CONCLUSION: Due to the great variations in these studies, it is difficult to draw a definitive conclusion on the best technique of hepatic vascular control.展开更多
INTRODUCTIONIn China,primary liver cancer (PLC) ranks secondin cancer mortality since the 1990s.In the field ofPLC treatment,surgical resection remains the best,which includes large PLC resection,small PLCresection,re...INTRODUCTIONIn China,primary liver cancer (PLC) ranks secondin cancer mortality since the 1990s.In the field ofPLC treatment,surgical resection remains the best,which includes large PLC resection,small PLCresection,re-resection of subclinical recurrence,aswell as cytoreduction and sequential resection forunresectable PLC.However,recurrence展开更多
BACKGROUND： With advances in technology, laparoscopic liver resection is widely accepted. Laparoscopic liver resection under hemihepatic vascular inflow occlusion has advantages over the conventional total hepatic in...BACKGROUND： With advances in technology, laparoscopic liver resection is widely accepted. Laparoscopic liver resection under hemihepatic vascular inflow occlusion has advantages over the conventional total hepatic inflow occlusion using the Pringle＇s maneuver, especially in patients with cirrhosis.METHOD： From November 2011 to August 2012, eight consecutive patients underwent laparoscopic liver resection under hemihepatic vascular inflow occlusion using the lowering of hilar plate approach with biliary bougie assistance.RESULTS： The types of liver resection included right hepatectomy（n1）, right posterior sectionectomy（n1）, left hepatectomy and common bile duct exploration（n1）, segment 4b resection（n1）, left lateral sectionectomy（n2）, and wedge resection（n2）. Four patients underwent right and 4 left hemihepatic vascular inflow occlusion. Four patients had cirrhosis. The mean operation time was 176.3 minutes. The mean time taken to achieve hemihepatic vascular inflow occlusion was 24.3minutes. The mean duration of vascular inflow occlusion was54.5 minutes. The mean intraoperative blood loss was 361 mL.No patient required blood transfusion. Postoperatively, one patient developed bile leak which healed with conservative treatment. No postoperative liver failure and mortality occurred. The mean hospital stay of the patients was 7 days.CONCLUSION： Our technique of hemihepatic vascular inflow vascular occlusion using the lowering of hilar plate approachwas safe, and it improved laparoscopic liver resection by minimizing blood loss during liver parenchymal transection.展开更多
BACKGROUND In recent years,neoadjuvant chemotherapy(NAC)has been increasingly used in patients with resectable colorectal liver metastases.However,the efficacy and safety of NAC in the treatment of resectable colorect...BACKGROUND In recent years,neoadjuvant chemotherapy(NAC)has been increasingly used in patients with resectable colorectal liver metastases.However,the efficacy and safety of NAC in the treatment of resectable colorectal liver metastases(CRLM)are still controversial.AIM To assess the efficacy and application value of NAC in patients with resectable CRLM.METHODS We searched PubMed,Embase,Web of Science,and the Cochrane Library from inception to December 2020 to collect clinical studies comparing NAC with non-NAC.Data processing and statistical analyses were performed using Stata V.15.0 and Review Manager 5.0 software.RESULTS In total,32 studies involving 11236 patients were included in this analysis.We divided the patients into two groups,the NAC group(that received neoadjuvant chemotherapy)and the non-NAC group(that received no neoadjuvant chemotherapy).The meta-analysis outcome showed a statistically significant difference in the 5-year overall survival and 5-year disease-free survival between the two groups.The hazard ratio(HR)and 95%confidence interval(CI)were HR=0.49,95%CI:0.39-0.61,P=0.000 and HR=0.4895%CI:0.36-0.63,P=0.000.The duration of surgery in the NAC group was longer than that of the non-NAC group[standardized mean difference(SMD)=0.41,95%CI:0.01-0.82,P=0.044)].The meta-analysis showed that the number of liver metastases in the NAC group was significantly higher than that in the non-NAC group(SMD=0.73,95%CI:0.02-1.43,P=0.043).The lymph node metastasis in the NAC group was significantly higher than that in the non-NAC group(SMD=1.24,95%CI:1.07-1.43,P=0.004).CONCLUSION We found that NAC could improve the long-term prognosis of patients with resectable CRLM.At the same time,the NAC group did not increase the risk of any adverse event compared to the non-NAC group.展开更多
目的探讨双源CT单能谱成像对提高肝脏占位病变图像质量的价值。资料与方法收集经手术或临床确诊为肝脏占位病变的72例患者,共90个病灶。行上腹部双源CT扫描,门静脉期双能数据经双能量Monoenergetic软件处理,获得最佳CNR单能量点及图像,...目的探讨双源CT单能谱成像对提高肝脏占位病变图像质量的价值。资料与方法收集经手术或临床确诊为肝脏占位病变的72例患者,共90个病灶。行上腹部双源CT扫描,门静脉期双能数据经双能量Monoenergetic软件处理,获得最佳CNR单能量点及图像,双能量扫描后自动重建获得融合图像。比较两组对比噪声比（CNR）、信噪比（SNR）、图像质量评分及病灶的检出率。结果 72例患者90个病灶中,肝脏占位病变平均最佳CNR单能量点为74 ke V。两组CNR、SNR、图像质量评分比较,差异有统计学意义（t=4.034、5.071、3.483,P〈0.001）,图像噪声差异无统计学意义（t=1.734,P〉0.05）。2名医师对图像质量评分的一致性较好（Kappa=0.634）。最佳CNR组与融合组的病灶检出率分别为100.0%（90/90）和97.8%（88/90）,差异无统计学意义（χ～2=1.32,P〉0.05）。结论与融合组图像比较,最佳CNR组单能量图像具有更高的CNR、SNR、图像质量,有利于提高肝脏占位病变的检出。展开更多
目的探讨能谱CT在去除肝癌经导管动脉化疗栓塞术（TACE）治疗后碘油硬化伪影的应用价值,寻求图像质量最佳的单能量成像点。资料与方法回顾性分析23例肝癌TACE治疗后行能谱CT检查患者的图像。采用能谱软件处理后可获得Mono图像（40-140 k...目的探讨能谱CT在去除肝癌经导管动脉化疗栓塞术（TACE）治疗后碘油硬化伪影的应用价值,寻求图像质量最佳的单能量成像点。资料与方法回顾性分析23例肝癌TACE治疗后行能谱CT检查患者的图像。采用能谱软件处理后可获得Mono图像（40-140 keV,间隔10 keV）和QC图像（140 kVp）。对11组Mono图像进行主观评分,并对其结果进行优化。选取主观评分较高的Mono图像及QC图像,测量伪影最多层面感兴趣区的CT值（ROI1）、同层面无伪影或伪影较少感兴趣区的CT值（ROI2）,比较两者CT值的差异。计算并比较去除伪影最佳的Mono图像及QC图像的信噪比（SNR）。结果 70-120 ke V时Mono图像的主观评分较高;110 keV Mono图像的ROI1为（60.18±12.48）HU,ROI2为（60.89±12.12）HU,差异无统计学意义（P〉0.05）,其余5组Mono图像及混合能量图像的ROI1、ROI2比较,差异有统计学意义（P〈0.05）。110 ke V Mono图像的SNR为8.47±1.59,QC图像的SNR为7.31±1.24,两者差异无统计学意义（P〉0.05）。结论选择能谱CT110 keV的Mono图像可以在不影响整体图像质量的前提下有效去除肝癌TACE治疗后碘油的硬化伪影。展开更多
文摘BACKGROUND: Significant hemorrhage together with blood transfusion increases postoperative morbidity and mortality of hepatic resection. Hepatic vascular occlusion is effective in minimizing bleeding during hepatic parenchymal transection. This article aimed to review the current role and status of various techniques of hepatic vascular occlusion during hepatic resection. DATA SOURCES: The relevant manuscripts were identified by searching MEDLINE, and PubMed for articles published between January 1980 and April 2010 using the keywords 'vascular control', 'vascular clamping', 'vascular exclusion' and 'hepatectomy'. Additional papers were identified by a manual search of the references from the key articles. RESULTS: One randomized controlled trial (RCT) and 5 RCTs showed intermittent Pringle maneuver and ischemic preconditioning followed by continuous Pringle maneuver were superior to continuous Pringle maneuver alone, respectively. Two RCTs compared the outcomes of hepatectomy with and without intermittent Pringle maneuver. One showed Pringle maneuver to be beneficial, while the other failed to show any benefit. One RCT showed that ischemic preconditioning had significantly less blood loss than using intermittent Pringle maneuver. Four RCTs evaluated the use of hemihepatic vascular occlusion. One RCT showed it had significantly less blood loss than Pringle maneuver, while the other 3 showed no significant difference. Only 1 RCT showed it had significantly less liver ischemic injury. No RCT had been carried out to assess segmental vascular occlusion. Two RCTs compared the outcomes of total hepatic vascular exclusion (THVE) and Pringle maneuver. One RCT showed THVE resulted in similar blood loss, but a higher postoperative complication. The other RCT showed less blood loss using THVE but the postoperative complication rate was similar. Both studies showed similar degree of liver ischemic injury. Only one RCT showed that selective hepatic vascular exclusion (SHVE) had less blood loss and liver ischemic injury than Pringle maneuver. CONCLUSION: Due to the great variations in these studies, it is difficult to draw a definitive conclusion on the best technique of hepatic vascular control.
文摘INTRODUCTIONIn China,primary liver cancer (PLC) ranks secondin cancer mortality since the 1990s.In the field ofPLC treatment,surgical resection remains the best,which includes large PLC resection,small PLCresection,re-resection of subclinical recurrence,aswell as cytoreduction and sequential resection forunresectable PLC.However,recurrence
文摘BACKGROUND： With advances in technology, laparoscopic liver resection is widely accepted. Laparoscopic liver resection under hemihepatic vascular inflow occlusion has advantages over the conventional total hepatic inflow occlusion using the Pringle＇s maneuver, especially in patients with cirrhosis.METHOD： From November 2011 to August 2012, eight consecutive patients underwent laparoscopic liver resection under hemihepatic vascular inflow occlusion using the lowering of hilar plate approach with biliary bougie assistance.RESULTS： The types of liver resection included right hepatectomy（n1）, right posterior sectionectomy（n1）, left hepatectomy and common bile duct exploration（n1）, segment 4b resection（n1）, left lateral sectionectomy（n2）, and wedge resection（n2）. Four patients underwent right and 4 left hemihepatic vascular inflow occlusion. Four patients had cirrhosis. The mean operation time was 176.3 minutes. The mean time taken to achieve hemihepatic vascular inflow occlusion was 24.3minutes. The mean duration of vascular inflow occlusion was54.5 minutes. The mean intraoperative blood loss was 361 mL.No patient required blood transfusion. Postoperatively, one patient developed bile leak which healed with conservative treatment. No postoperative liver failure and mortality occurred. The mean hospital stay of the patients was 7 days.CONCLUSION： Our technique of hemihepatic vascular inflow vascular occlusion using the lowering of hilar plate approachwas safe, and it improved laparoscopic liver resection by minimizing blood loss during liver parenchymal transection.
基金Supported by the Natural Science Foundation of Gansu Province,China,No.18JR3RA052the Gansu Province Da Vinci Robot High End Diagnosis and Treatment Personnel Training Project+1 种基金the National Key Research and Development Program Task Book,No.2018YFC1311506the Lanzhou Talent Innovation and Entrepreneurship Project Task Contract,No.2016-RC-56.
文摘BACKGROUND In recent years,neoadjuvant chemotherapy(NAC)has been increasingly used in patients with resectable colorectal liver metastases.However,the efficacy and safety of NAC in the treatment of resectable colorectal liver metastases(CRLM)are still controversial.AIM To assess the efficacy and application value of NAC in patients with resectable CRLM.METHODS We searched PubMed,Embase,Web of Science,and the Cochrane Library from inception to December 2020 to collect clinical studies comparing NAC with non-NAC.Data processing and statistical analyses were performed using Stata V.15.0 and Review Manager 5.0 software.RESULTS In total,32 studies involving 11236 patients were included in this analysis.We divided the patients into two groups,the NAC group(that received neoadjuvant chemotherapy)and the non-NAC group(that received no neoadjuvant chemotherapy).The meta-analysis outcome showed a statistically significant difference in the 5-year overall survival and 5-year disease-free survival between the two groups.The hazard ratio(HR)and 95%confidence interval(CI)were HR=0.49,95%CI:0.39-0.61,P=0.000 and HR=0.4895%CI:0.36-0.63,P=0.000.The duration of surgery in the NAC group was longer than that of the non-NAC group[standardized mean difference(SMD)=0.41,95%CI:0.01-0.82,P=0.044)].The meta-analysis showed that the number of liver metastases in the NAC group was significantly higher than that in the non-NAC group(SMD=0.73,95%CI:0.02-1.43,P=0.043).The lymph node metastasis in the NAC group was significantly higher than that in the non-NAC group(SMD=1.24,95%CI:1.07-1.43,P=0.004).CONCLUSION We found that NAC could improve the long-term prognosis of patients with resectable CRLM.At the same time,the NAC group did not increase the risk of any adverse event compared to the non-NAC group.
文摘目的探讨双源CT单能谱成像对提高肝脏占位病变图像质量的价值。资料与方法收集经手术或临床确诊为肝脏占位病变的72例患者,共90个病灶。行上腹部双源CT扫描,门静脉期双能数据经双能量Monoenergetic软件处理,获得最佳CNR单能量点及图像,双能量扫描后自动重建获得融合图像。比较两组对比噪声比（CNR）、信噪比（SNR）、图像质量评分及病灶的检出率。结果 72例患者90个病灶中,肝脏占位病变平均最佳CNR单能量点为74 ke V。两组CNR、SNR、图像质量评分比较,差异有统计学意义（t=4.034、5.071、3.483,P〈0.001）,图像噪声差异无统计学意义（t=1.734,P〉0.05）。2名医师对图像质量评分的一致性较好（Kappa=0.634）。最佳CNR组与融合组的病灶检出率分别为100.0%（90/90）和97.8%（88/90）,差异无统计学意义（χ～2=1.32,P〉0.05）。结论与融合组图像比较,最佳CNR组单能量图像具有更高的CNR、SNR、图像质量,有利于提高肝脏占位病变的检出。
文摘目的探讨能谱CT在去除肝癌经导管动脉化疗栓塞术（TACE）治疗后碘油硬化伪影的应用价值,寻求图像质量最佳的单能量成像点。资料与方法回顾性分析23例肝癌TACE治疗后行能谱CT检查患者的图像。采用能谱软件处理后可获得Mono图像（40-140 keV,间隔10 keV）和QC图像（140 kVp）。对11组Mono图像进行主观评分,并对其结果进行优化。选取主观评分较高的Mono图像及QC图像,测量伪影最多层面感兴趣区的CT值（ROI1）、同层面无伪影或伪影较少感兴趣区的CT值（ROI2）,比较两者CT值的差异。计算并比较去除伪影最佳的Mono图像及QC图像的信噪比（SNR）。结果 70-120 ke V时Mono图像的主观评分较高;110 keV Mono图像的ROI1为（60.18±12.48）HU,ROI2为（60.89±12.12）HU,差异无统计学意义（P〉0.05）,其余5组Mono图像及混合能量图像的ROI1、ROI2比较,差异有统计学意义（P〈0.05）。110 ke V Mono图像的SNR为8.47±1.59,QC图像的SNR为7.31±1.24,两者差异无统计学意义（P〉0.05）。结论选择能谱CT110 keV的Mono图像可以在不影响整体图像质量的前提下有效去除肝癌TACE治疗后碘油的硬化伪影。
