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Modifications of ALPPS–from complex to more complex or from complex to less complex operations

Hepatobiliary & Pancreatic Diseases International 2017年第4期16卷 346-352页

作者： Wan Yee Lau Eric ch lai Faculty of Medicine The Chinese University of Hong KongShatinNew TerritoriesHong Kong SARChina Department of Surgery Pamela Youde Nethersole Eastern HospitalHong Kong SARChina

BACKGROUND: Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) has recently been developed to induce rapid liver hypertrophy to reduce the chance of post-hepatectomy liver failure in patients with borderline or insufficient future liver remnant. ALPPS is still in an early developmental stage and its techniques have not been standardized. This study aimed to review the technical modifications of the conventional ALPPS procedure. DATA SOURCES: Studies were identified by searching MEDLINE and PubMed for articles published from January 2007 to December 2016 using the keywords 'associating liver partition and portal vein ligation for staged hepatectomy' and 'ALPPS'. Additional articles were identified by a manual search of references from key articles. RESULTS: There have been a lot of modifications of the conventional ALPPS. These are classified as: (1) modifications aiming to improve surgical results; (2) modifications aiming to expand surgical indications; (3) salvage ALPPS; (4) ALPPS using the minimally invasive approach. Some of these modifications have made the conventional ALPPS procedure to become even more complex, although there have also been other attempts to make the procedure less complex. The results of most of these modifications have been reported in small case series or case reports. We need better well-designed studies to establish the true roles of these modifications. However, it is interesting to see how this conventional ALPPS procedure has evolved since its introduction. CONCLUSIONS: There is a trend for the use of minimally invasive procedure in the phase 1 or 2 of the conventional ALPPS procedure. Some of these modifications have expanded the use of ALPPS in patients who have been considered to have unresectable liver tumors. The long-term oncological outcomes of these modifications are still unknown.

关键词： associating liver partition and portal vein ligation for stage hepatectomy hepatocellular carcinoma hepatectomy liver metastasis portal vein embolization

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Hemodynamics and oxygen transport dynamics during hepatic resection at different central venous pressures in a pig model

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Hepatobiliary & Pancreatic Diseases International 2011年第5期10卷 516-520页

作者： Wan-Yee Lau Eric ch lai Department of Hepatic and Biliary Surgery First Affiliated Hospital Guangxi Medical University Faculty of Medicine the Chinese University of Hong Kong Shatin New Territories Hongkong SAR China

BACKGROUND: Although low central venous pressure (CVP) has been used to minimize blood loss during hepatectomy the impact of variations of CVP on the rate of blood loss and on the perfusion of end-organs has not been evaluated This animal study aimed to evaluate the hemodynamics and oxygen transport changes during hepatic resection at different CVP levels. METHODS: Forty-eight anesthetized Bama miniature pigs were divided into 8 groups with CVP during hepatic resection controlled at 0 to <1, 1 to <2, 2 to <3, 3 to <4, 4 to <5, 5 to <6, 6 to <7, and 7 to <8 cmH 2 O. Intergroup comparisons were made for hemodynamic parameters, oxygen transport dynamics, and the rate of blood loss. RESULTS: The rate of blood loss and the hepatic venous pressure during hepatic resection were almost linearly related to the CVP. A significant drop in the mean arterial pressure cardiac output, and cardiac index occurred between CVP ≥2 and <2 cmH 2 O. Oxygen delivery (DO 2 ), oxygen consumption (VO 2 ) and oxygen extraction ratio (ERO 2 ) remained relatively constant between CVPs of 2 to <8 cmH 2 O. There was a significant drop in DO 2 when the CVP was <2 cmH 2 O. There was also a significant drop in VO 2 and ExO 2 when the CVP was <1 cmH 2 ***: The optimal CVP for hepatic resection is 2to 3 cmH2O.

关键词： hepatectomy hemorrhage central venous pressure tissue oxygenation hemodynamics

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Associating liver partition and portal vein ligation for staged hepatectomy： the current role and development

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Hepatobiliary & Pancreatic Diseases International 2017年第1期16卷 17-26页

作者： Wan Yee Lau Eric ch lai Stephanie HY Lau Faculty of Medicine The Chinese University of Hong Kong Shatin New Territories Department of Surgery Pamela Youde Nethersole Eastern Hospital Department of Surgery Queen Elizabeth Hospital Hong Kong China

BACKGROUND： Associating liver partition and portal vein ligation for staged hepatectomy （ALPPS） has recently been developed to induce rapid liver hypertrophy and reduce posthepatectomy liver failure in patients with insufficient future liver remnant （FLR）. ALPPS is still considered to be in an early developmental phase because surgical indications and techniques have not been standardized. This article aimed to review the current role and future developments of ALPPS. DATA SOURCES： Studies were identified by searching MED- LINE and PubMed for articles from January 2007 to October 2016 using the keywords ＂associating liver partition and portal vein ligation for staged hepatectomy＂ and ＂ALPPS＂ Addi- tional papers were identified by a manual search of references from key articles. RESULTS： ALPPS induces more hypertrophy of the FLR in less time than portal vein embolization or portal vein ligation. The benefits of ALPPS include rapid hypertrophy 47%-110% of the liver over a median of 6-16.4 days, and 95%-100% com- pletion rate of the second stage of ALPPS. The main criticisms of ALPPS are centered on its high morbidity and mortality rates. Morbidity rates after ALPPS have been reported to be 15.3%-100%, with ≥ the Clavien-Dindo grade III morbidity of 13.6%-44%. Mortality rates have been reported to be 0%-29%. The important questions to ask even if oncologic long-term results are acceptable are： whether the gain in quality and quantity of life can be off balance by the substantial risks of morbidity and mortality, and whether stimulation of rapid liver hypertrophy also accelerates rapid tumor progression and spread. Up till now, the documentations of the ALPPS procedure come mainly from case series, and most of these series include heterogeneous groups of malignancies. The numbers are also too small to separately evaluate survival for different tumor etiologies. CONCLUSIONS： Currently, knowledge on ALPPS is limited, and prospective randomized studies are lacking. From th

关键词： associating liver partition and portal vein ligation for staged hepatectomy portal vein embolization laparoscopy colorectal liver metastases hepatocellular carcinoma

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Optimal central venous pressure during partial hepatectomy for hepatocellular carcinoma

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Hepatobiliary & Pancreatic Diseases International 2013年第5期12卷 520-524页

作者： cheng-Xin Lin Ya Guo Wan Yee Lau Guang-Ying Zhang Yi-Ting Huang Wen-Zheng He Eric ch lai Department of Anesthesiology First Affiliated Hospital of Guangxi Medical University Department of Hepatic and Biliary Surgery First Affiliated Hospital of Guangxi Medical University Faculty of Medicine The Chinese University of Hong Kong

BACKGROUND:Low central venous pressure(CVP) affects hemodynamic stability and tissue *** prospective study aimed to evaluate the optimal CVP during partial hepatectomy for hepatocellular carcinoma(HCC).METHODS:Ninety-seven patients who underwent partial hepatectomy for HCC had their CVP controlled at a level of 0 to 5 mmHg during hepatic parenchymal *** systolic blood pressure(SBP) was maintained,if possible,at 90 mmHg or *** B surface antigen was positive in 90 patients(92.8%) and cirrhosis in 84 patients(86.6%).Pringle maneuver was used routinely in these patients with clamp/unclamp cycles of 15/5 *** average clamp time was 21.4±8.0 *** patients were divided into 5 groups based on the CVP:group A:0-1 mmHg;B:1.1-2 mmHg;C:2.1-3 mmHg;D:3.1-4 mmHg and E:4.1-5 *** blood loss per transection area during hepatic parenchymal transection and the arterial blood gas before and after liver transection were ***:With active fluid load,a constant SBP ≥90 mmHg which was considered as optimal was maintained in 18.6% in group A(95% CI:10.8%-26.3%);39.2% in group B(95% CI:29.5%-48.9%);72.2% in group C(95% CI:63.2%-81.1%);89.7% in group D(95% CI:83.6%-95.7%);and 100% in group E(95% CI:100%-100%).The blood loss per transection area during hepatic parenchymal transection decreased with a decrease in *** to groups D and E,blood loss in groups A,B and C was significantly less(analysis of variance test,P<0.05).Compared with the baseline,the blood oxygenation decreased significantly when the CVP was *** excess and HCO 3-in groups A and B were significantly decreased compared with those in groups C,D and E(P<0.05).CONCLUSION:In consideration of blood loss,SBP,base excess and HCO 3-,a CVP of 2.1-3 mmHg was optimal in patients undergoing partial hepatectomy for HCC.

关键词： central venous pressure hepatectomy blood loss

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

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Hepatobiliary & Pancreatic Diseases International 2014年第5期13卷 508-512页

作者： Ying-Jun chen Zuo-Jun Zhen Huan-Wei chen Eric ch lai Fei-Wen Deng Qing-Han Li Wan Yee Lau Department of Liver Surgery The First People's Hospital of Foshan Faculty of Medicine The Chinese University of Hong Kong

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 ***： 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 ***： 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 *** 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 ***： 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.

关键词： laparoscopic liver resection hepatectomy vascular control liver neoplasm hilar plate

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What are the ten new commandments in severe polytrauma management？

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World Journal of Emergency Medicine 2010年第2期1卷 85-92页

作者： CW Kam ch lai SK Lam FL So CL Lau KH cheung Accident ＆ Emergency Department Tuen Mun Hospital Hong Kong China

This review aims to provide a concise overview of the trauma management evolution in the past decade. 1） Trauma care priorities have incorporated staff protection against infection and early decision making in addition to the conventional ABCDE. 2） Five stratified levels for DAM have replaced the non-specific conventional Plans A ＆ B. 3） CT scanning can be the tunnel to death for the hemodynamically unstable patient. 4） DPL has virtually been replaced by the FAST USG. 5） Direct whole-body MDCT provides rapid imaging diagnosis ＆ expedites the definitive treatment but carries high radiation hazards. 6） The dynamic shock assessment by fluid resuscitation response provides more outcome-specific evaluation than the static blood volume loss model. 7） DCR comprising of permissive hypotension, hemostatic resuscitation ＆ DCS aims to overcome the lethal triad of trauma. Early transfusion of blood components of FFP ＆ platelet concentrates improves the outcome in massive blood transfusion. 8） DCS aims to rectify the deranged physiology and not to fully restore the damaged anatomy. 9） A pre-defined protocol for major pelvic fracture can be life-saving and the novel Pre-PPP （pre-peritoneal pelvic packing） may further reduce mortality coupled with the necessary TCAE. 10） Injury prevention is equally important if not more than the trauma resuscitation ＆ operation.

关键词： Polytrauma Priorities DAM CT MDCT DPL FAST Fluid resuscitation responder DCR DCS Pre-PPP Injury prevention

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让步式评价构式“不是NP,胜似NP”——兼谈边缘范畴及其成员的实现路径

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汉语学习 2024年第6期 37-47页

作者：赵彧陈昌来上海对外经贸大学/上海师范大学中国语言文学博士后流动站上海201620 上海师范大学上海200234

“不是NP,胜似NP”作为让步式评价构式,表达主体对陈述对象的范畴归属做出了边缘成员的断言。构式的语用功能可以表达言者的态度立场和认识立场。研究发现,边缘范畴的存在既有心理现实性,也有语言表现性。除了构式层面,语言中的词缀、... 详细信息

“不是NP,胜似NP”作为让步式评价构式,表达主体对陈述对象的范畴归属做出了边缘成员的断言。构式的语用功能可以表达言者的态度立场和认识立场。研究发现,边缘范畴的存在既有心理现实性,也有语言表现性。除了构式层面,语言中的词缀、词汇、话语标记等多个层面都有表征边缘范畴的形式。边缘成员的实现路径有两条:下行路径和上行路径。

关键词： “不是NP,胜似NP” 让步式评价边缘范畴实现路径

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FOS/NOS前庭神经元参与前庭代偿的意义

FOS/NOS前庭神经元参与前庭代偿的意义

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中华医学会第十次全国耳鼻咽喉-头颈外科学术会议

作者：蒋子栋 YS chAN ch lai 北京协和医院耳鼻咽喉科香港大学生理系

目的在人和动物,一侧内耳损伤后所表现的平衡障碍,经过一段时间,可逐渐消失,称为前庭代偿,是中枢神经系统可塑性的表现。其机制未明,对参与前庭代偿过程的神经递质的研究,不仅是一项探求未知的过程,而且为,治疗由于损伤引起的前庭疾病,...

目的在人和动物,一侧内耳损伤后所表现的平衡障碍,经过一段时间,可逐渐消失,称为前庭代偿,是中枢神经系统可塑性的表现。其机制未明,对参与前庭代偿过程的神经递质的研究,不仅是一项探求未知的过程,而且为,治疗由于损伤引起的前庭疾病,有着重要意义,尤其对于鼓室注入庆大霉素进行化学性迷路切除或前庭神经切断术治疗顽固性梅尼埃病。我们在早期的研究中,分别探讨单侧前庭损伤后,FOS(蒋子栋2006)和 NOS(蒋子栋2003)的改变,随着 CONFOCUS 技术的成熟,我们将探讨 FOS/NOS 前庭神经元参与前庭代偿

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梅尼埃病发病电生理机制的实验研究

梅尼埃病发病电生理机制的实验研究

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中华医学会第十次全国耳鼻咽喉-头颈外科学术会议

作者：蒋子栋 YS chAN ch lai 北京协和医院耳鼻咽喉科香港大学生理系

目的梅尼埃病的典型病理变化为膜迷路积水,许多年来,人们一直采用 Kimura 的方法,建立豚鼠单耳膜迷路积水模型。由于需要开颅,建立模型后,无法进行近场电生理变化的描记。梅尼埃病发病电生理机制推测与异常放电有关,到目前为止,仅为推测...

目的梅尼埃病的典型病理变化为膜迷路积水,许多年来,人们一直采用 Kimura 的方法,建立豚鼠单耳膜迷路积水模型。由于需要开颅,建立模型后,无法进行近场电生理变化的描记。梅尼埃病发病电生理机制推测与异常放电有关,到目前为止,仅为推测,无相关资料提供。我们用醛固酮成功的诱发建立豚鼠双耳膜迷路积水模型(蒋子栋2002,李琦2007),利用胞外记录技术,分别研究在正常状态、积水状态、内耳损伤状

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Pathogenesis, diagnosis, and treatment of epilepsy: electromagnetic stimulation-mediated neuromodulation therapy and new technologies

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Neural Regeneration Research 2025年第4期20卷 917-935页

作者： Dian Jiao lai Xu Zhen Gu Hua Yan Dingding Shen Xiaosong Gu Academy of Medical Engineering and Translational Medicine Tianjin UniversityTianjinChina Key Laboratory of Advanced Drug Delivery Systems of Zhejiang Province College of Pharmaceutical SciencesZhejiang UniversityHangzhouZhejiang ProvinceChina Affiliated Hospital of Nantong University NantongJiangsu ProvinceChina

Epilepsy is a severe,relapsing,and multifactorial neurological *** regarding the accurate diagnosis,prognosis,and in-depth pathogenesis are crucial for the precise and effective treatment of *** pathogenesis of epilepsy is complex and involves alterations in variables such as gene expression,protein expression,ion channel activity,energy metabolites,and gut microbiota *** results are lacking for conventional treatments for *** resection of lesions,drug therapy,and non-drug interventions are mainly used in clinical practice to treat pain associated with ***-pharmacological treatments,such as a ketogenic diet,gene therapy for nerve regeneration,and neural regulation,are currently areas of research *** review provides a comprehensive overview of the pathogenesis,diagnostic methods,and treatments of *** also elaborates on the theoretical basis,treatment modes,and effects of invasive nerve stimulation in neurotherapy,including percutaneous vagus nerve stimulation,deep brain electrical stimulation,repetitive nerve electrical stimulation,in addition to non-invasive transcranial magnetic stimulation and transcranial direct current *** studies have shown that electromagnetic stimulation-mediated neuromodulation therapy can markedly improve neurological function and reduce the frequency of epileptic ***,many new technologies for the diagnosis and treatment of epilepsy are being ***,current research is mainly focused on analyzing patients’clinical manifestations and exploring relevant diagnostic and treatment methods to study the pathogenesis at a molecular level,which has led to a lack of consensus regarding the mechanisms related to the disease.

关键词： diagnosis drug treatment electroencephalography epilepsy monitoring epilepsy nerve regeneration neurostimulation non-drug interventions pathogenesis prediction

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