Laparoscopic liver resection under hemihepatic vascular inflow occlusion using the lowering of hilar plate approach

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.

VEGF、VEGFR与头颈部肿瘤研究进展

血管内皮生长因子（Vascular endothelial growth factor,VEGF）是一种分子质量约为2000～23000具有肝素结合活性的同源二聚体多肽，VEGF的生物学效应是通过其特异性受体VEGFR介导实现的。VEGF是一种内皮细胞的特异性有丝分裂原，可以促进内皮细胞增殖，提高血管通透性，改变细胞外基质，对组织器官的发生、正常状态的维持以及肿瘤的发生、发展起重要的作用，更为重要的是VEGF能促进肿瘤血管形成与肿瘤的生长、浸润及转移也有着密切的关系。本文就VEGF、VEGFR的结构和生物学功能及其在头颈部肿瘤研究方面的新进展做一介绍。