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The APR triangle:A practical zone in the Glissonean approach to laparoscopic anatomical right hepatectomy

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iLIVER 2022年第3期1卷 176-180页

作者： Jie chen Ziyu Zhang Rui Zhou Anzhi Wang Jun Cao yajin chen Department of Hepatobiliary Surgery Sun Yat-sen Memorial HospitalSun Yat-Sen UniversityGuangzhouChina Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation Medical Research CenterSun Yat-sen Memorial HospitalSun Yat-sen UniversityGuangzhouChina

Background:An understanding of vascular anatomy is crucial for the safe performance of laparoscopic anatomical liver *** discovered a triangular zone during the laparoscopic right liver surgery and termed this zone the APR *** purpose of this study was to determine the probability of the existence of the APR triangle and elucidate its various ***:Analyzed three-dimensional image reconstructions of 66 individuals who underwent liver surgery and calculated the statistics for various types of APR triangles under various grouping ***:The APR triangle was present in the majority of cases,with right hepatic vein trunk type in 68%and right hepatic vein branch type in 21%,*** angle between the right anterior and right posterior hepatic pedicles(AP&PP)was at most between 45 and 90°(74%).There was a 35%chance that at least one of the AP&PP was longer than 2 cm,and a 39%chance that both *** right posterior pedicle first branch would appear at the bifurcation of AP&PP in 13%***:The APR triangle is objectively present and may represent a practical zone for performing laparoscopic right hepatic anatomical resection more simply and safely.

关键词： Laparoscopic anatomical liver resection Vascular anatomy ARP triangle

Splenic autotransplantation and oesophageal transection anastomosis in patients with portal hypertension (26 years clinical observation)

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Frontiers of Medicine 2007年第1期1卷 30-35页

作者： chen Jisheng HUO Jinshan ZHANG Hongwei SHANG Changzhen chen Rufu ZHANG Jie Obetien Mapudengo chen yajin ZHANG Lei Department of General Surgery the Second Affiliated HospitalZhong Shan UniversityGuangzhou 510120China

The surgical treatment methods for cirrhosis patients complicated with portal hypertension are *** this study,we evaluated the effectiveness of a new treatment strategy:splenic auto-transplantation and oesophageal transection anastomosis on 274 patients from three aspects:clinical observation,splenic immunology and portal *** 1979 to 2005,274 cirrhosis patients with portal hypertension who underwent the new treatment strategy were followed up to observe different clinical indexes,which were then compared with those of the traditional surgery *** 1999 to 2002,a randomized control trial(RCT)was performed on 40 patients to compare their immune function after *** 1994 to 2004,another RCT was carried out on 28 patients to compare the portal dynamics through three-dimensional dynamic contrast enhanced MR angiography(3D DEC MRA)investigation after *** 274 patients(mean age 41.8 years),the emergency operative mortality(4.4%),selective operative mortality(2.2%),complication rate(17.9%),morbidity of hepatic encephalopathy(<1%),bleeding rate of portal hypertension gastritis(PHG)(9.1%),and morbidity of hepatic carcinoma(8%)were similar to those under traditional operation;the spleen immunology function(Tuftsin,IgM)decreased among the groups 2 months after *** 3D DCE MRA,the cross section area,the velocity and volume of blood flow of main portal vein decrease significantly after operation in both groups,the auto transplantation group was significantly lower in velocity and volume of blood flow than in the control *** auto transplantation and esophageal transection anastomosis are a safe,effective,and reasonable treatment strategy for portal hypertension with varicial *** can not only correct hypersplenism but also completely stanch blood,and auto transplanted spleen in the retroperitoneal space can preserve immune function and establish abroad collateral circulation.

关键词： spleen immunology function spleen transplantation oesophageal transection anastomosis portal hypertension

中肝叶联合尾状叶切除术在肝门部胆管癌中的应用

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中华消化外科杂志 2021年第1期20卷 52-58页

作者：陈亚进周睿中山大学孙逸仙纪念医院肝胆外科广州510120

肝门部胆管癌是常见胆道恶性肿瘤,其外科治疗的核心是达到R0切除,包括切除病变胆管、受肿瘤浸润肝组织及区域淋巴结。在精准外科及多学科治疗时代,肝门部胆管癌的手术治疗应遵循可视化、可量化、可控化和多学科治疗原则。基于精准肝门... 详细信息

肝门部胆管癌是常见胆道恶性肿瘤,其外科治疗的核心是达到R0切除,包括切除病变胆管、受肿瘤浸润肝组织及区域淋巴结。在精准外科及多学科治疗时代,肝门部胆管癌的手术治疗应遵循可视化、可量化、可控化和多学科治疗原则。基于精准肝门部胆管癌董氏分型,包括Ⅰ+Ⅳ+Ⅴ+Ⅷ段、Ⅰ+Ⅴ+Ⅷ段及Ⅰ+Ⅳ段的中肝叶联合尾状叶切除术,在获得R0切除的同时可最大限度保留更多肝实质,使部分病人避免术前进行减轻黄疸治疗和分期手术。然而,在获得良好围术期效果的同时,还需随访评价病人的长期生存情况。笔者结合团队开展中肝叶联合尾状叶切除术的临床经验,探讨其在肝门部胆管癌中的应用。

关键词：胆道肿瘤肝门部中肝叶切除 R0切除肝实质保留

Chinese expert consensus on clinical application of molecularly targeted drugs for hepatocellular carcinoma (2022 edition)

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中华医学杂志(英文版) 2024年第21期137卷 2630页

作者： Sun Juxian Li Qiu Bai Xueli Cai Jianqiang chen yajin chen Minshan Dai Chaoliu Fang Chihua Jia Weidong Li Xiangcheng Wen Tianfu Xia Jinglin Ying Mingang Zhang Zhiwei Zhang Xuewen Zeng Zhaochong cheng Shuqun Department of Hepatic Surgery VI Eastern Hepatobiliary Surgery Hospital Naval Medical University Shanghai China Department of Medical Oncology Cancer Center West China Hospital Sichuan University Chengdu Sichuan China Department of Hepatobiliary and Pancreatic Surgery The First Affiliated Hospital Zhejiang University School of Medicine Hangzhou Zhejiang China Department of Hepatobiliary Surgery Cancer Hospital Chinese Academy of Medical Sciences Beijing China Department of Hepatobiliopancreatic Surgery Sun Yat-Sen Memorial Hospital Sun Yat-Sen University Guangzhou Guangdong China Department of Hepatobiliary Surgery Sun Yat-sen University Cancer Center Guangzhou Guangdong China Department of Hepatobiliary and Spleenary Surgery The Affiliated Shengjing Hospital China Medical University Shenyang Liaoning China Department of Hepatobiliary Surgery Zhujiang Hospital First Military Medical University Guangzhou Guangdong China Department of General Surgery Anhui Key Laboratory of Hepatopancreatobiliary Surgery Anhui Provincial Hospital The First Affiliated Hospital of USTC University of Science and Technology of China Hefei Anhui China Hepatobiliary Center The First Affiliated Hospital of Nanjing Medical University Key Laboratory of Living Donor Liver Transplantation Nanjing Jiangsu China Department of Liver Surgery West China Hospital of Sichuan University Chengdu Sichuan China The First Affiliated Hospital of Wenzhou Medical University Wenzhou Zhejiang China Liver Cancer Institute & Zhongshan Hospital Fudan University Shanghai China Department of Gastrointestinal Oncological Surgery Fujian Provincial Cancer Hospital Fujian Medical University Teaching Hospital Fuzhou Fujian China Department of Surgery Hepatic Surgery Center Institute of HBP Surgery Tongji Hospital Tongji Medical College Huazhong University of Science and Technology Wuhan Hubei China Department of Hepatobiliary and Pancreas Surgery The Second Hospital of Jilin University Changc

[3] Many targeted drugs have been developed for different treatment purposes and for different patient populations, and the way in which these therapies are selected to achieve a maximum benefit has been left up to individual clinicians due to the absence of authoritative guidelines.After progression is observed by imaging during treatment with first-line targeted drugs, a timely comprehensive evaluation should be performed to determine the appropriate second-line treatment (IIb, B).Many clinical studies have demonstrated that molecularly targeted drugs are effective treatments for advanced HCC, as they have good objective response rate (ORRs) and obvious survival benefits.Funding This work is supported by grants from the State Key Project of the National Natural Science Foundation of China (No. 81730097), the Clinical Science and Technology Innovation Project of Shanghai Shenkang Hospital Development Center (Joint Project of Emerging Frontier Technology) (No.

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腹腔镜下定构流程化解剖性肝中叶切除治疗肝细胞癌的临床效果

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中华外科杂志 2021年第10期59卷 836-841页

作者：曹君陈亚进中山大学孙逸仙纪念医院肝胆外科广州510000

目的探讨腹腔镜下定构流程化解剖性肝中叶切除治疗肝细胞癌的可行性和有效性。方法回顾性分析2017年4月至2021年4月中山大学孙逸仙纪念医院肝胆外科连续行腹腔镜下定构流程化解剖性肝中叶切除治疗的65例肝细胞癌患者的病例资料。男性39... 详细信息

目的探讨腹腔镜下定构流程化解剖性肝中叶切除治疗肝细胞癌的可行性和有效性。方法回顾性分析2017年4月至2021年4月中山大学孙逸仙纪念医院肝胆外科连续行腹腔镜下定构流程化解剖性肝中叶切除治疗的65例肝细胞癌患者的病例资料。男性39例,女性26例,年龄[M(QR)]61.2(29.5)岁(范围:25~80岁);体重指数(24.2±3.8)kg/m^(2)(范围:19.5~26.1 kg/m^(2))。腹部CT检查结果显示,肿瘤最大径为(6.7±2.9)cm(范围:3.4~10.5 cm)。以显露矢状部、肝中静脉、肝右静脉等标志性脉管为目标实施定构流程化切除,并对围手术期结果和近期肿瘤学疗效进行分析。结果65例患者均行腹腔镜下定构流程化解剖性肝中叶切除。手术时间为(190.5±70.4)min(范围:90~280 min),出血量为(370.6±120.8)ml(范围:100~1050 ml)。65例患者术中均未输血,无中转开腹。术后出现并发症8例(12.3%)。术后住院时间为(7.5±2.5)d(范围:5~18 d);无住院期间死亡病例及30 d内再住院病例。术后病理学检查结果显示均为R0切缘,最小切缘为(2.4±1.9)cm(范围:0.5~3.1 cm)。术后随访结果显示,1年内肿瘤复发率为12.3%(8/65)。结论腹腔镜下定构流程化解剖性肝中叶切除可用于治疗肝细胞癌患者,可获得较好的临床效果。

关键词：腹腔镜检查肝肿瘤肝中叶切除定构切除流程化

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开展腹腔镜胆囊癌根治术的启示与思考

中华消化外科杂志 2020年第1期19卷 46-49页

作者：张磊陈亚进中山大学孙逸仙纪念医院肝胆外科广州510120

胆囊癌是一种早期诊断困难、恶性程度高、预后差的胆道恶性肿瘤,根治性切除术是改善患者预后最有效的手段。随着微创设备的更新及外科医师经验的积累,腹腔镜手术在多种消化道恶性肿瘤疾病的治疗中已取得令人满意的效果,但是在胆囊癌治... 详细信息

胆囊癌是一种早期诊断困难、恶性程度高、预后差的胆道恶性肿瘤,根治性切除术是改善患者预后最有效的手段。随着微创设备的更新及外科医师经验的积累,腹腔镜手术在多种消化道恶性肿瘤疾病的治疗中已取得令人满意的效果,但是在胆囊癌治疗的应用中仍存在争议,主要原因是缺乏改善生存预后的可靠证据。腹腔镜手术可以使部分早期胆囊癌患者围术期及生存获益。对于进展期胆囊癌患者,尽管对切除范围仍未达成共识,但通过分期腹腔镜手术可以让患者避免不必要的扩大切除。胆囊癌的微创化进程需要通过高质量的诊断与治疗流程规范化推动,唯有如此才能得到有实际意义的临床证据指导最佳临床实践。

关键词：胆管肿瘤治疗胆囊癌根治术腹腔镜检查

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浅谈腹腔镜肝切除之入路

中华外科杂志 2019年第7期57卷 503-507页

作者：曹君陈亚进中山大学孙逸仙纪念医院肝胆外科广州510120

腹腔镜肝切除为肝切除研究领域带来了新的技术和理念。相对于传统开腹术式的固有视角和入路,腹腔镜肝切除的入路设计与之存在很大差异,并具有自身优势。本文着重归纳叙述各种腹腔镜肝切除入路的特点、选择和应用,结合目前具有代表意义... 详细信息

腹腔镜肝切除为肝切除研究领域带来了新的技术和理念。相对于传统开腹术式的固有视角和入路,腹腔镜肝切除的入路设计与之存在很大差异,并具有自身优势。本文着重归纳叙述各种腹腔镜肝切除入路的特点、选择和应用,结合目前具有代表意义的主流术式加以阐述。不同的手术策略造就了不同的入路方式,各种入路的选择并非固定和独立存在。对各种入路方法进行合理的选择和组合,利用优势,规避劣势,方能最大限度保障腹腔镜肝切除术式的安全性和有效性。

关键词：肝肿瘤肝切除术腹腔镜手术入路

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微创外科技术在胆道恶性肿瘤治疗中的应用展望

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中华消化外科杂志 2023年第7期22卷 843-847页

作者：陈亚进曹君中山大学孙逸仙纪念医院肝胆外科广州510120

胆道恶性肿瘤固有的疾病特点和手术难度导致其在微创外科领域的发展遭遇更多困难和争议。作为现代精准外科的代表性领域之一和多学科系统治疗的重要组成部分,微创外科在胆道恶性肿瘤治疗体系中的价值和应用亟待进一步阐述和规范。微创... 详细信息

胆道恶性肿瘤固有的疾病特点和手术难度导致其在微创外科领域的发展遭遇更多困难和争议。作为现代精准外科的代表性领域之一和多学科系统治疗的重要组成部分,微创外科在胆道恶性肿瘤治疗体系中的价值和应用亟待进一步阐述和规范。微创外科技术应在合理的规范和监管下进行探索和研究,在保证患者最大获益伦理原则前提下获取更多更高级别循证医学证据,最终促进领域的整体进步。

关键词：胆道肿瘤微创外科精准外科多学科治疗应用

程序性细胞死亡蛋白-1及其配体抑制剂在胆道肿瘤治疗中的现状与前景

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中华消化外科杂志 2018年第3期17卷 219-224页

作者：陈亚进陈贤清中山大学孙逸仙纪念医院肝胆外科广州510120

胆道肿瘤是一种预后极差的疾病。目前，仅有小部分的早期患者可以接受根治性切除术，而传统放疗、化疗、靶向治疗等对胆道肿瘤作用有限。免疫系统在胆道肿瘤的发病机理中扮演重要角色。因此，以程序性细胞死亡蛋白-1及其配体（PD-1／PD... 详细信息

胆道肿瘤是一种预后极差的疾病。目前，仅有小部分的早期患者可以接受根治性切除术，而传统放疗、化疗、靶向治疗等对胆道肿瘤作用有限。免疫系统在胆道肿瘤的发病机理中扮演重要角色。因此，以程序性细胞死亡蛋白-1及其配体（PD-1／PD-L1）抑制剂为代表的免疫检查点抑制剂在胆道肿瘤的治疗中具有巨大潜在价值。笔者分析国内外最新研究进展，结合自身治疗经验与当前临床热点问题，深入探讨PD-1／PD-L1抑制剂在胆道肿瘤治疗中的现状及前景。

关键词：胆道肿瘤程序性细胞死亡蛋白-1抑制剂程序性细胞死亡配体-1抑制剂免疫治疗