Objective To explore the methods， clinical effects， and application value of laparoscopic splenectomy combined with pericardial devascularization. Methods The clinical data of 23 patients with liver cirrhosis and portal hypertension who performed laparoscopic splenectomy combined with pericardial devascularization between july 2009 and july 2012 in our hospital were analyzed retrospectivly. Results In 23 cases， 2 cases were converted laparotomy due to bleeding， 21 cases were successfully performed laparoscopic splenectomy combined with pericardial devascularization. The operative time was 230-380 minutes （average 290 minutes）. The intraoperative blood loss was 300-1 500 mL （average 620 mL）. The postoperative fasting time was 1-3 days （average 2 days）. The postoperative hospital stay was 8-14 days （average 10 days）. Conclusion Laparoscopic splenectomy combined with pericardial devascularization is a feasible， effective， and safe procedure as well as minimally invasive hence is applicable for patients with portal hypertension and hypersplenism．
ObjectiveTo explore the predictive value of preoperative serum heat shock protein 90α (HSP90α) level in combination with the prognostic nutritional index (PNI) for patients with hepatocellular carcinoma (HCC) after transcatheter arterial chemoembolization (TACE). MethodsThe HCC patients confirmed by histopathological examination and underwent TAC at Guigang People’s Hospital from January 2022 to June 2023 were as the observation group, the healthy individuals who underwent physical examinations during the same period and same hospital as the control group. The blood before treatment and on the day of the physical examination was collected to detected the HSP90α and albumin levels, as well as lymphocyte count. The PNI was calculated [PNI=albumin (g/L)+5×lymphocyte count (×109/L)]. The clinical outcome (tumor progression or death) was observed within one year after TACE treatment, those without tumor progression or death were defined as a good prognosis, while those with tumor progression or death were defined as a poor prognosis. Using the multivariate unconditional logistic regression analysis to identify the risk factors affecting the poor prognosis for HCC patients, and the receive operating characteristic (ROC) curve to evaluate the predictive value of serum HSP90α level in combination with PNI in distinguishing prognosis after TACE treatment. ResultsIn this study, there were 178 cases in the observation group and 100 cases in the control group. The serum HSP90α level (μg/L) in the observation group was higher than that in the control group (96.40±33.57 vs. 52.19±22.13, t=3.191, P<0.001), and the PNI value was lower than that in the control group (43.70±5.24 vs. 56.46±6.86, t=–16.144, P<0.001); Within one year after TACE, there were 70 patients with poor prognosis and 108 patients with good prognosis. The serum HSP90α (μg/L) level in the patients with poor prognosis was higher than that in the patients with good prognosis (117.33±29.48 vs. 82.83±28.84, t=7.726, P<0.001), and the PNI was lower than that in the control group (40.49±4.18 vs. 45.78±4.80, t=–7.548, P<0.001). The multivariate unconditional logistic regression analysis found that the probabilities of incidence of poor prognosis after TACE treatment were higher in the patients with Chinese liver cancer staging Ⅲa–Ⅲb stage [reference: Ⅰ–Ⅱa stage [OR (95%CI)=5.332 (1.058, 26.875), P=0.043] and increased age and HSP90α level [OR (95%CI)=1.100 (1.025, 1.180), P=0.008; OR (95%CI)=1.049 (1.029, 1.070), P<0.001] , as well as decreased PNI value [OR (95%CI)=0.772 (0.686, 0.869), P<0.001]. The area under the ROC curve after TACE in the HCC patients by serum HSP90α level in combination with PNI was 0.878 [95% CI (0.820, 0.922)] in differentiating poor prognosis or not. ConclusionThe analysis results of this study suggest that preoperative serum HSP90α level in combination with PNI has a higher predictive value for prognosis of HCC patients after TACE.
Objective To explore the value of laparoscopic hepatectomy for small hepatocellular carcinoma (HCC) of non-peripheral type. Methods The clinical data of 34 patients with small HCC of non-peripheral type underwent laparoscopic liver resection from March 2008 to April 2011 in our hospital were analyzed retrospectively. Results Thirty-two patients received successful total laparoscopic hepatectomy without blockage of liver blood flow，and 2 were converted to open surgery. The operative time was （162±65） min （100-220 min） and the blood loss was （295±166） ml （100-750 ml）. There were postoperative complications in 4 patients， included cross-section bleeding in 2 cases and ascites in 2 cases. There were no complications such as biliary fistula， infection， carbon dioxide gas embolism， and so on. The mortality of perioperative period was 0. The postoperative hospital stay was （6±2） d （4-9 d）. The follow-up time was （23±7） months （5-42 months）. Thirteen patients developed intrahepatic tumor recurrence during follow-up. The overall and recurrence-free survival rate one year after operation was 90.6% （29/32）and 75.0% （24/32）， respectively. Conclusions Laparoscopic hepatectomy is a safe， feasible， and minimal invasive approach for small HCC of non-peripheral type，and it can be considered as a alternative treatment of HCC.