CHANGES OF INTERLEUKIN-6 AND RELATED FACTORS AS WELL AS GASTRIC INTRAMUCOSAL pH DURING COLORECTAL AND ORTHOPAEDIC SURGICAL PROCEDURES

Objective To investigate the changes of perioperative serum levels of interleukin-6(IL-6), C-reactive protein (CRP), and cortisol, as well as gastric intramucosal pH (pHi) and plasma lactate, aiming to compare systemic changes and tissue perfusion during colorectal and orthopaedic surgical procedures. Methods Twenty patients were randomly assigned to two groups, 10 cases of operation on vertebral canal, 10 cases of colorectal radical operation.Venous blood was drawn at 1 day before operation, 2, 4, and 6 hours following skin incision, and 1 day after operation, in order to measure serum IL-6, CRP, and cortisol.pHi and plasma lactate were also measured at the same time points.Results Serum concentrations of IL-6 and cortisol increased gradually following operation, reaching the peak value at 6 hours from the beginning of operation.CRP was not detectable until the first day after operation.Peak concentration of IL-6 had positive relationship with CRP.These variables changed more significantly in colorectal group than that in orthopaedic group (P<0.05).pHi decreased gradually, reaching the lowest level at 4 hours from the beginning of operation, and to more extent in colorectal group than that in orthopaedic group (P<0.05).Conclusion IL-6 may reflect tissue damage more sensitively than CRP.Colorectal surgery might induce systemic disorder to more extent, in terms of immuno-endocrinal aspect as well as tissue perfusion, reflected with pHi.

What is the best surgical procedure of transverse colon cancer?An evidence map and minireview

Colorectal cancers comprise a large percentage of tumors worldwide,and transverse colon cancer(TCC)is defined as tumors located between hepatic and splenic flexures.Due to the anatomy and embryology complexity,and lack of large randomized controlled trials,it is a challenge to standardize TCC surgery.In this study,the current situation of transverse/extended colectomy,robotic/laparoscopic/open surgery and complete mesocolic excision(CME)concept in TCC operations is discussed and a heatmap is conducted to show the evidence level and gap.In summary,transverse colectomy challenges the dogma of traditional extended colectomy,with similar oncological and prognostic outcomes.Compared with conventional open resection,laparoscopic and robotic surgery plays a more important role in both transverse colectomy and extended colectomy.The CME concept may contribute to the radical resection of TCC and adequate harvested lymph nodes.According to published studies,laparoscopic or robotic transverse colectomy based on the CME concept was the appropriate surgical procedure for TCC patients.

Cancellation Causes of Elective Surgical Procedures in a Major Pediatric Surgery Department

Introduction: Cancellation of surgical operation is a surgical operation registered in the official schedule the day before or added to the list after and not carried out on the operating day. The purpose of this work was to determine the causes of cancellation of elective surgical operations in a major pediatric surgery department in Senegal. Patients and methods: It was a prospective and descriptive study of 278 patients scheduled during a period of 13 weeks. The study took place between April 3rd, 2017, and January 31st, 2018. Mean age was 2.9 years with extremes of 3 days and 15 years. The age group of 29 days to 30 months was the most represented (62.2%). Sex ratio was 1.41. Causes of cancellation were categorized into administrative and organizational causes, patient-related causes and staff-related causes. Results: Cancellation rate was 29.4%. Patient-related causes were most common (51.2%). Upper Respiratory tract infection (URTI) was commonest reason within this category (57.5%). Organizational causes (28.1%) came second and were mainly represented by the unavailability of the operating room (60.8%) related to breakdowns of anesthesia equipment. Finally, staff-related causes (20.7%) were due for most to the unavailability of the anesthesiologist (12 cases/17). Conclusion: Majority of causes that led to cancellation of elective surgical operations in our Pediatric surgery department are related to intercurrent illnesses affecting the patient, in particular URTI.

Application of Plan-Do-Check-Action cycle and fishbone diagram analysis in optimizing surgical procedures to improve satisfaction degree of doctor-nurse-patient

Background:To study the application of management tools such as Plan-Do-Check-Action(PDCA)cycle and fishbone diagram in optimizing surgical procedures to improve the satisfaction of doctor-nurse-patient.Methods:The fundus surgery nursing team of our hospital began to implement the PDCA cycle management mode to optimize the surgical procedure from July 2017,set up a project activity improvement team,unified the surgical labeling processing plan,and made the fundus surgery procedure,and established the preoperative health education for surgical patients,and standardized the training content of post-rotating doctors and interns.Results:The satisfaction degree to surgical procedure after implementation of doctors and nurses was higher than that before implementation.Conclusions:Using PDCA cycle and fishbone diagram analysis tools to manage the surgical procedure optimization can better integrate doctor-nurse medical care,improve the efficiency and accuracy of the surgical procedure delivery and operation,and optimize the satisfaction of the three parties of doctor-nurse-patient.

Comparison of the Efficacy of Ultrasound-Guided Microwave Ablation of Parathyroid Adenoma with Surgical Procedures

Objective: To compare the clinical efficacy and safety of ultrasound-guided microwave ablation with surgery for the treatment of primary parathyroid adenoma. Methods: The clinical data of patients with primary parathyroid adenoma admitted to the First Hospital of Yangtze University from January 2010 to May 2020 were retrospectively analyzed, and they were divided into 43 cases in the microwave ablation group (MWA) and 39 cases in the surgical procedure group (SR) according to the different treatment methods. The surgical condition, postoperative complications, and changes in serum parathyroid hormone (PTH) and serum calcium and phosphorus levels were analyzed in both groups. Results: The hospital stay and operation time of patients in the microwave ablation group were shorter than those in the surgical group, and the intraoperative bleeding was significantly less than that in the surgical group (P < 0.05);the serum parathyroid hormone (PTH), blood calcium and blood phosphorus levels of patients in both groups were significantly lower than those before treatment (P < 0.05) after surgery of 1, 3 and 6 months respectively, and the differences between groups were not statistically significant (P > 0.05). There was no statistically significant difference in the incidence of postoperative complications between the two groups (P > 0.05). Conclusion: Microwave ablation can achieve the same therapeutic effect as surgery. It is a safe and feasible clinical technique worthy of clinical promotion with its short hospitalization time, less bleeding and less trauma.

Surgical procedures of thoracic ossification of the ligamentum flavum

Objective To investigate different surgical procedures for treatment of thoracic ossification of ligamentum flavum.Methods From January 1994 to June 2008,56 cases of thoracic ossification of ligamentum flavum underwent

Comparison of Surgical Techniques Used in Treating Acromioclavicular Dislocation in Patients Participating in Sports: A Systematic Review

Introduction: The acromioclavicular joint is a superficial diarthrodial joint that surrounds the medial articular facet of the acromion and the distal portion of the clavicle. Due to its anatomy and biomechanics, it is highly susceptible to trauma and in young men who play contact sports, acromioclavicular dislocation is common. This article aimed to systematically review the literature and compare the surgical techniques used in the treatment of acromioclavicular dislocation in patients who practice sports. Methods: This systematic review was conducted according to the International Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. Eligible studies for this systematic review included articles in English or Spanish published between 2013 and 2023, which mention the occurrence of acromioclavicular dislocation during sports practices. Additionally, only studies that addressed the surgical treatment of acromion-clavicular dislocation and contained original data on the topic were included. Results: We found 144 eligible studies after searching the LILACS and PubMed databases. Based on the inclusion and exclusion criteria and the reviewers’ consensus, we selected four studies for the systematic review. 133 patients with AC joint displacement were evaluated. Mean Age: approximately 31.90 years. 81.92 of these injuries occurred during sports practice. Surgical Procedures Used: titanium plates fixation (49 patients), arthroscopy (24), single tunnel technique (30) and coracoid sling technique (30). The results of the visual analog scale and Constant-Murley scores varied between the techniques used. Twenty-two complications after surgical treatment were identified. Conclusion: A significant variability of operative techniques can be used in the surgical approach of acromioclavicular dislocation, such as arthroscopy, single tunnel, coracoid sling and titanium plates. Although it presented excellent functional results compared to the other three techniques evaluated by this review, using titanium plates is not the gold standard since other techniques not assessed by this work may be more effective.

低温等离子治疗儿童鼻咽部第二鳃裂囊肿分析

目的探讨儿童鼻咽部第二鳃裂囊肿的临床特征和治疗方式,提高诊治能力。方法回顾性分析河北省儿童医院收治的4例儿童鼻咽部第二鳃裂囊肿的临床资料,包括年龄、性别、症状、影像学资料和治疗过程。总结分析病变部位特点,B超、CT或MRI特征,术后病理结果及治疗方式。结果4例鼻咽部第二鳃裂囊肿患儿均表现为鼻咽侧壁咽鼓管咽口与腭咽弓后上方连线上的囊性肿物,囊壁较厚,影像学检查结果均为囊性病变。4例患儿选择内镜下低温等离子病变切除术,其中2例为内侧囊壁大部分切除术,将囊腔充分敞开,2例为囊肿全部切除术。术后病理提示衬覆纤毛柱状上皮或复层上皮,周围淋巴组织增生。术后随访1.5~3年无复发。结论儿童鼻咽部第二鳃裂囊肿临床罕见,诊断主要依靠病变部位及术后病理结果,内镜下低温等离子切除病变组织是微创、安全、有效的治疗方式。

Feasibility and safety of minimally invasive multivisceral resection for T4b rectal cancer:A 9-year review

BACKGROUND Colorectal cancer is the third most common cancer and the second highest cause of cancer-related mortality worldwide.About 5%-10%of patients are diagnosed with locally advanced rectal cancer(LARC)on presentation.For LARC invading into other structures(i.e.T4b),multivisceral resection(MVR)and/or pelvic ex-enteration(PE)remains the only potential curative surgical treatment.MVR and/or PE is a major and complex surgery with high post-operative morbidity.Minimally invasive surgery(MIS)has been shown to improve short-term post-operative outcomes in other gastrointestinal malignancies,but there is little evi-dence on its use in MVR,especially so for robotic MVR.This is a single-center retrospective cohort study from 1st January 2015 to 31st March 2023.Inclusion criteria were patients diagnosed with cT4b rectal cancer and underwent MVR,or stage 4 disease with resectable systemic metastases.Pa-tients who underwent curative MVR for locally recurrent rectal cancer,or me-tachronous rectal cancer were also included.Exclusion criteria were patients with systemic metastases with non-resectable disease.All patients planned for elective surgery were enrolled into the standard enhanced recovery after surgery pathway with standard peri-operative management for colorectal surgery.Complex sur-gery was defined based on technical difficulty of surgery(i.e.total PE,bladder-sparing prostatectomy,pelvic lymph node dissection or need for flap creation).Our primary outcomes were the margin status,and complication rates.Cate-gorical values were described as percentages and analysed by the chi-square test.Continuous variables were expressed as median(range)and analysed by Mann-Whitney U test.Cumulative overall survival(OS)and recurrence-free survival(RFS)were analysed using Kaplan-Meier estimates with life table analysis.Log-rank test was performed to determine statistical significance between cumulative estimates.Statistical significance was defined as P<0.05.Meier estimates with life table analysis.Log-rank test was performed to determine statistical significance between cumulative estimates.Statistical significance was defined as P<0.05.RESULTS A total of 46 patients were included in this study[open MVR(oMVR):12(26.1%),miMVR:36(73.9%)].Patients’American Society of Anesthesiologists score,body mass index and co-morbidities were comparable between oMVR and miMVR.There is an increasing trend towards robotic MVR from 2015 to 2023.MiMVR was associated with lower estimated blood loss(EBL)(median 450 vs 1200 mL,P=0.008),major morbidity(14.7%vs 50.0%,P=0.014),post-operative intra-abdominal collections(11.8%vs 50.0%,P=0.006),post-operative ileus(32.4%vs 66.7%,P=0.04)and surgical site infection(11.8%vs 50.0%,P=0.006)compared with oMVR.Length of stay was also shorter for miMVR compared with oMVR(median 10 vs 30 d,P=0.001).Oncological outcomes-R0 resection,recurrence,OS and RFS were comparable between miMVR and oMVR.There was no 30-d mortality.More patients underwent robotic compared with laparoscopic MVR for complex cases(robotic 57.1%vs laparoscopic 7.7%,P=0.004).The operating time was longer for robotic compared with laparoscopic MVR[robotic:602(400-900)min,laparoscopic:Median 455(275-675)min,P<0.001].Incidence of R0 resection was similar(laparoscopic:84.6%vs robotic:76.2%,P=0.555).Overall complication rates,major morbidity rates and 30-d readmission rates were similar between la-paroscopic and robotic MVR.Interestingly,3-year OS(robotic 83.1%vs 58.6%,P=0.008)and RFS(robotic 72.9%vs 34.3%,P=0.002)was superior for robotic compared with laparoscopic MVR.CONCLUSION MiMVR had lower post-operative complications compared to oMVR.Robotic MVR was also safe,with acceptable post-operative complication rates.Prospective studies should be conducted to compare short-term and long-term outcomes between robotic vs laparoscopic MVR.

低温等离子射频消融联合下鼻甲骨折外移术治疗阻塞性睡眠呼吸暂停低通气综合征的疗效观察

目的探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者接受低温等离子射频消融联合下鼻甲骨折外移术后睡眠及经鼻持续气道正压通气(nasal continuous positive airway pressure,nCPAP)治疗耐受性的改善情况。方法选择40例OSAHS合并双侧下鼻甲肥大的患者作为研究对象,均在局麻下接受下鼻甲低温等离子射频消融联合骨折外移术。术前及术后2周分别采用多导睡眠监测(PSG)、鼻阻力仪、autoCPAP呼吸机及视觉模拟量表(VAS)测定睡眠呼吸暂停低通气指数(AHI)、最低血氧饱和度(lowest oxygen saturation,LSaO_(2))、鼻气道阻力及nCPAP治疗耐受性。结果与术前比较,术后2周时患者AHI降低至(35.17±9.72)次/h,LSaO_(2)提高至(83.21±6.58)%,鼻气道阻力降低至(0.55±0.09)kPa·s/cm^(3),VAS评分升高至8.32±1.17,差异比较均有统计学意义(P均<0.05)。结论低温等离子射频消融联合下鼻甲骨折外移术能有效降低OSAHS患者的鼻阻力,提高nCPAP治疗的耐受性,改善OSAHS患者的睡眠情况。

Reconstruction of cervical necrotizing fasciitis defect with the modified keystone flap technique:Two case reports

BACKGROUND Cervical necrotizing fasciitis(CNF)is a rare,aggressive form of deep neck space infection with significant morbidity and mortality rates.Serial surgical debridement acts as the cornerstone of CNF treatment;however,it often results in defects requiring complex reconstructions.CASE SUMMARY We report two cases in which the keystone flap(KF)was used for CNF defect coverage:Case 1,an 85-year-old patient with CNF in the anterior neck,and Case 2,a 54-year-old patient with CNF in the posterior neck.Both patients received empirical intravenous antibiotic therapy and underwent serial debridement,enabling adequate wound preparation and stabilization.The final defect size measured 5.5 cm×12 cm in Case 1 and 6 cm×11 cm in Case 2.For defect coverage,we employed an 8 cm×19 cm type II KF based on perforators from the superior thyroid artery in Case 1 and a 9 cm×18 cm type II KF based on perforators from the transverse cervical artery in Case 2.Both flaps showed complete survival.No postoperative complications occurred in both cases,and favorable outcomes were observed at 7-and 6-month follow-ups in case 1 and 2,respectively.CONCLUSION We effectively treated CNF-associated defects using the KF technique;KF is viable for covering CNF defects in carefully selected cases.

In-Hospital Outcomes in Minimally Invasive Mitral Valve Surgery: First Results in a Brazilian Single Center

Introduction: Treatments for cardiovascular diseases have increasingly evolved with the tendency to offer minimally invasive or transcatheter procedures instead of conventional sternotomy surgery. In this context, we highlight minimally invasive mitral valve surgery (MIMVS), which has been shown to be an increasingly solid option with some superior results when compared to the conventional technique: better pain control, shorter hospital stays, shorter recovery time, shorter readmission rate in the first postoperative year, better aesthetic results, and lower overall cost. Aim: This study aims to evaluate the stages of MIMVS, by primary mitral valve consultation, in our service and compare these results with data from the literature. Methods: All electronic medical records of patients who underwent MIMVS for primary mitral valve injury in the Encore Hospital from January 2020 to February 2023 were analyzed. Tabulation and statistical analysis were performed using the Microsoft Excel® program. Quantitative variables were presented as means, standard deviations. Results: 46 patients were enrolled in our study (Age: 59.1 ± 12.4 years old;60.8% Female, BMI: 26 ± 4.4 Kg/m2, Low risk STS score: 82.6%). The observed 30-day mortality was 2.1%, plastic rate of 23.9%, blood transfusion rate of 41.3%, length of stay in an intensive care bed (ICB) of 3.3 ± 3.3 days and hospital stay of 6.4 ± 5.1 days. Conclusions: We noticed that the MIMVS results carried out in our service agree with data from national and international literature with approximately 1.3 days more hospitalization in ICB.

Surgical spacer placement and proton radiotherapy for unresectable hepatocellular carcinoma

Few potentially curative treatment options exist apart from hepatic resection for patients with huge hepatocellular carcinoma (HCC). Proton radiotherapy is a promising new modality which has an inherent antitumor effect against HCC. However, the application of proton radiotherapy for tumors adjacent to the gastrointestinal tract is restricted because the tolerance dose of the intestine is extremely low. A novel two-step treatment was developed with surgical spacer placement and subsequent proton radiotherapy to administer proton radiotherapy with curative intent. This report presents a case of a patient with a huge unresectable HCC treated by this method who achieved disease-free survival of more than 2 years. This new strategy may potentially be an innovative and standard therapy for unresectable HCC in the near future.

Safety and efficacy of wireless capsule endoscopy in patients with surgically altered upper gastrointestinal anatomy

Background:Wireless capsule endoscopy(WCE)is an effective,minimally invasive tool used for evaluation of the small intestine.To date,there are no studies evaluating the diagnostic yield of WCE in patients with surgically altered upper gastrointestinal anatomy.Aim:To evaluate the diagnostic yield,technical success and safety of WCE in patients with surgically altered upper gastrointestinal anatomy.Methods:Retrospective chart review of all patients with surgically altered upper GI anatomy who underwent WCE between 2006 and 2016 at the Medical University of South Carolina.Technical success,diagnostic yield,adverse events and therapeutic yield data was collected.Results:Thirty-one cases met inclusion criteria.Two were excluded as they did not undergo WCE due to failed patency capsule.The mean age was 58(69%female).The capsule was ingested in 18 cases and endoscopically placed in 11.The most common surgical anatomy was Roux-en-Y gastric bypass(n=13).Technical success,defined as the capsule reaching the cecum,was achieved in 89.7%of cases.The diagnostic yield was 44.8%,with the most common finding being angioectasia.No intra-or postprocedural adverse events were noted.Discussion:Capsule endoscopy in patients with surgically altered upper GI anatomy appears to show no elevated risk of adverse events and shows similar technical success and diagnostic yield as in patients with native anatomy.

头颈部髓外浆细胞瘤3例

髓外浆细胞瘤(extramedullry plasmcytoma,EMP)是来源于B淋巴细胞的肿瘤,由单克隆细胞异常增生形成的一种较为罕见的疾病[1]。EMP在临床和影像学表现不典型,早期难以诊断,往往术后经病理检查才得以确诊。由于EMP病例罕见,目前尚无治疗指南,治疗方式仍存在争议。1临床资料病例1。患者,女,60岁,于2009-12-29因右侧鼻塞、流涕就诊,鼻窦CT检查示右侧鼻腔外侧壁软组织块状影(图1A),遂入院治疗并完善相关检查后行鼻内镜下右侧鼻腔肿物切除术,术后病理结果考虑EMP。

33例耳廓化脓性软骨膜炎诊治经验

目的总结分析33例不同病因引起的耳廓化脓性软骨膜炎的治疗体会。方法回顾性分析南昌大学第一附属医院耳鼻咽喉头颈外科2015年1月~2020年6月收治的不同病因的耳廓化脓性软骨膜炎患者33例,分析总结病因及诊治经验。结果33例患者中行药物保守治疗者9例,治疗后9例均痊愈,未出现耳廓畸形等并发症;行局麻下脓肿切开引流治疗者4例,治疗后4例均痊愈,未出现耳廓畸形等并发症;行全麻下耳廓软骨清创缝合术者20例,术后痊愈20例,出现耳廓“菜花样”畸形1例。33例患者,取得脓液样本细菌培养及药敏者24例,微生物检出者20例,4例培养后未见微生物生长,检出金黄色葡萄球菌9例,检出率45%,检出铜绿假单胞菌12例,检出率60%,真菌均未检出。检出微生物舒普深均敏感。结论耳廓化脓性软骨膜炎病因较多,诊断相对简单,治疗上首选针对铜绿假单胞菌及金黄色葡萄球菌敏感的抗生素,病情较轻的可行药物保守治疗,病变严重时则应切开引流及清除病变的软骨,同时超短波辅助治疗也是十分有效的治疗手段。

颈部多间隙感染12例临床分析

目的总结颈部多间隙感染患者的临床特点和治疗经验。方法回顾性分析吉林市人民医院耳鼻咽喉头颈外科收治的12例颈部多间隙感染患者的详细临床资料,对其感染来源、实验室结果、影像学检查、治疗方式、疗效等进行总结和分析。结果男10例,女2例,2例牙源性感染,白细胞及C反应蛋白均不同程度升高,颈部增强CT可见局部软组织肿胀、密度不均,部分患者可见气体影或边缘及分隔样强化。6例保守治疗,6例手术治疗,所有患者均治愈出院,无死亡病例。结论颈部多间隙感染患者根据病情轻重选择保守或手术治疗,手术治疗的关键在于彻底清创引流,合理应用抗生素和规律控制血糖,必要时多科联合治疗以提高治愈率。

颈交感链神经鞘瘤的诊断和治疗

目的探讨术中是否保留颈交感链对颈交感链神经鞘瘤(cervical sympathetic chain neurilemmoma,CSCL)患者预后的影响。方法回顾性分析2018年4月~2022年5月首都医科大学附属北京友谊医院诊治的5例CSCL患者病例资料,分析临床表现、诊断要点、手术经验、术后并发症及转归情况。结果5例CSCL患者术中均先试行包膜内核除术,4例成功保留颈交感链,术后4~14 d出现霍纳综合征(Horner syndrome,HS),术后1~3个月恢复正常,患者未有第一口综合征(first bite syndrome,FBS)并发症;1例切断颈交感链,术后3 d出现HS,随访21个月未恢复,患者出现严重的FBS并发症,随访21个月无明显减轻。所有患者中位随访时间14个月,未发现复发。结论CSCL手术时应首先尝试包膜内核除,如果能成功保留颈交感链,可以避免FBS并发症,尽管术后会出现HS,但仍可恢复。

成人鳃裂畸形患者临床分析

目的探讨成人鳃裂畸形的临床特征、检查手段及疗效。方法回顾性分析2011年11月~2021年12月宁波大学附属第一医院手术的25例成人鳃裂畸形患者,分析治疗疗效及术后并发症情况。结果成人鳃裂畸形男女比例为7∶18,病程(113.92±154.20)个月。囊肿型16例,瘘管型9例。第一鳃裂来源5例,第二鳃裂来源17例,第三鳃裂来源3例。就诊于耳鼻咽喉头颈外科18例、口腔科6例、甲状腺外科1例。MRI检查可显示病变及走行。术后复发7例(28%),其中囊肿型者1例,瘘管型者6例。3例累及腮腺、面神经;2例累及同侧甲状腺、颈鞘、喉返神经。所有患者均手术治愈,无面瘫、声嘶等并发症。结论成人鳃裂畸形就诊科室分布广,涉及解剖复杂,相关科室提高对该病的认知程度和外科处理能力,避免漏诊误诊,减少疾病复发及相关并发症的出现。

The “No-touch” technique improves the survival of patients with advanced hepatocellular carcinomas treated by liver transplantation: A single-center prospective randomized controlled trial

Background:Liver transplantation(LT)is the best treatment for patients with hepatocellular carcinoma(HCC).However,the surgical technique needs to be improved.The present study aimed to evaluate the“no-touch”technique in LT.Methods:From January 2018 to December 2019,we performed a prospective randomized controlled trial on HCC patients who underwent LT.The patients were randomized into two groups:a no-touch technique LT group(NT group,n=38)and a conventional LT technique group(CT group,n=46).Operative outcomes and survival in the two groups were analyzed.Results:The perioperative parameters were comparable between the two groups(P>0.05).There was no significant difference between the two groups in disease-free survival(DFS)(P=0.732)or overall survival(OS)(P=0.891).Of 36 patients who were beyond the Hangzhou criteria for LT,the DFS of the patients in the NT group was significantly longer than that in the CT group(median 402 vs.126 days,P=0.025).In 31 patients who had portal vein tumor thrombosis(PVTT),DFS and OS in the NT group were significantly better than those in the CT group(median DFS 420 vs.167 days,P=0.022;2-year OS rate 93.8%vs.66.7%,P=0.043).In 14 patients who had diffuse-type HCCs,DFS and OS were significantly better in the NT group than those in the CT group(median DFS 141 vs.56 days,P=0.008;2-year OS rate 75.0%vs.33.3%,P=0.034).Multivariate analysis showed that for patients with PVTT and diffusetype HCCs,the no-touch technique was an independent favorable factor for OS(PVTT:HR=0.018,95%CI:0.001-0.408,P=0.012;diffuse-type HCCs:HR=0.034,95%CI:0.002-0.634,P=0.024).Conclusions:The no-touch technique improved the survival of patients with advanced HCC compared with the conventional technique.The no-touch technique may provide a new and effective LT technique for advanced HCCs.