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Hepatectomy guided by the diseased bile duct and hepatic vein for hepatolithiasis

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hepatobiliary surgery and Nutrition 2024年第3期13卷 566-568页

作者： Jianwei Li Xingru Wang Shuguo Zheng the institute of hepatobiliary surgery of the army Southwest HospitalArmy Medical UniversityChongqingChina Department of hepatobiliary surgery Qujing Central Hospital of Yunnan Regional Medical CenterQujingChina

Hepatolithiasis(HL)is a common and serious disease with high incidence in Southeast Asian countries(1),especially in Southwest China,South China,and Southeast coastal areas of *** on the pathological characteristics of the segmented stone distribution and atrophy of the hepatic parenchyma,resection of the atrophied liver involving the diseased bile duct is the most effective and common surgical treatment for *** proposed by Shindoh et al.,hepatobiliary surgeons have used anatomic liver resection(AR)for hepatocellular carcinoma(HCC),which involves complete resection of the anatomic area supplied by the portal vein of the Glissonean branch(2).However,factors such as changes in bile fluid dynamics,stone compression,and chronic inflammation associated with HL lead to portal vein and hepatic artery stenosis and occlusion in some diseased areas,resulting in the diseased bile duct and hepatic vein(HV)becoming significant characteristic anatomical *** such cases,the effect and success rate of indocyanine green fluorescence staining are poor for navigation during HL *** imaging techniques such as 3D visualization,3D printing,and artificial intelligence can facilitate preoperative evaluation but not accurate evaluation of all real anatomical structures and guidance of the transection *** such patients with HL,the lack of effective intrahepatic anatomic landmarks used during AR results in residual stones and diseased bile ducts and recurrence of *** necessitates repeated surgeries and affects postoperative recovery and patients’quality of ***,to allow for standardized and more accurate hepatectomy for HL and provide a theoretical basis for formulating corresponding treatment norms,we proposed and applied hepatectomy guided by the bile duct and HV(H-BV),that is by using the diseased bile duct tree and HV as anatomic landmarks.

关键词： Hepatolithiasis(HL) minimally invasive hepatectomy bile duct-HV space(BV space)

Laparoscopic partial splenectomy in the treatment of splenic ectopic pregnancy

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hepatobiliary surgery and Nutrition 2024年第3期13卷 569-572页

作者： Ke-Xi Liao Li Cao Yan-Zhou Wang Bao-Lin Wang Shu-Guo Zheng Jian-Wei Li institute of hepatobiliary surgery First Affiliated HospitalArmy Medical UniversityChongqingChina Department of Gynecology and Obstetrics First Affiliated HospitalArmy Medical UniversityChongqingChina

Ectopic pregnancy is a pregnancy that occurred outside the uterus,usually in the fallopian tube,followed by other abdominal *** pregnancy could not develop normally to term and requires sufficient evaluation and intervention with medication or surgery in most cases(1).As a rare form of abdominal pregnancy(2),splenic ectopic pregnancy could be treated by drug treatment(3)or surgical interventions,including laparotomy and laparoscopy,which focused on total splenectomy(4,5).A previous study(6)indicated that laparoscopic partial splenectomy for selected patients was safe and *** to the fragile texture of the spleen,the suture method during laparoscopic partial splenectomy was technically demanding since it might encounter higher risk of splenic vascular hemorrhage than total ***,few reports focused on the treatment of splenic ectopic pregnancy via laparoscopic partial splenectomy(7).In order to avoid the potential severe complications such as hemoperitoneum(8)caused by drug treatment alone,and to avert impaired hematopoietic and immune function caused by total splenectomy,we herein presented a case(Video 1)of a 30-year-old woman(gravida 2,para 1)undergoing laparoscopic partial splenectomy performed by hepatobiliary surgeons to treat splenic ectopic pregnancy.

关键词： pregnancy splenectomy impaired

The emerging tumor microbe microenvironment: From delineation to multidisciplinary approach-based interventions

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Acta Pharmaceutica Sinica B 2024年第4期14卷 1560-1591页

作者： Yu Fu Jia Li Wenyun Cai Yulan Huang Xinlong Liu Zhongyi Ma Zhongjie Tang Xufei Bian Ji Zheng Jiayun Jiang Chong Li Medical Research institute College of Pharmaceutical SciencesSouthwest UniversityChongqing 400715China institute of hepatobiliary surgery Southwest HospitalThird Military Medical University(Army Medical University)Chongqing 400038China Department of Urology Urologic Surgery CenterXinqiao HospitalThird Military Medical University(Army Medical University)Chongqing 400037China

Intratumoral microbiota has become research hotspots,and emerges as a non-negligent new component of tumor microenvironments(TME),due to its powerful infuence on tumor initiation,metas-tasis,immunosurveillance and prognosis despite in *** accumulations of microbes,and their related components and metabolites within tumor tissues,endow TME with additional pluralistic features which are distinct from the conventional ***,it's definitely necessary to comprehen-sively delineate the sophisticated landscapes of tumor microbe microenvironment,as well as their func-tions and related underlying ***,in this review,we focused on the fields of tumor microbe microenvironment,including the heterogeneity of intratumor microbiota in different types of tu-mors,the controversial roles of intratumoral microbiota,the basic features of tumor microbe microenvi-ronment(i.e.,pathogen-associated molecular patterns(PAMPs),typical microbial metabolites,autophagy,infammation,multi-faceted immunomodulation and chemoresistance),as well as the multi-disciplinary approach-based intervention of tumor microbiome for cancer therapy by applying wild-type or engineered live microbes,microbiota metabolites,antibiotics,synthetic biology and rationally de-signed *** hope our work will provide valuable insight to deeply understand the interplay of cancer-immune-microbial,and facilitate the development of microbes-based tumor-specific treatments.

关键词： Tumor microbe microenvironment Microbiota metabolites Immunomodulation Chemoresistance Multidisciplinary approach Genetically engineered microbiota Autophagy Outer membrane vesicles

3D laparoscopic anatomical hepatectomy guided by 2D real-time indocyanine green fluorescence imaging for hepatocellular carcinoma

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hepatobiliary surgery and Nutrition 2024年第3期13卷 494-499,I0015页

作者： Feng Tian Li Cao Jian Chen Shuguo Zheng Jianwei Li Department of hepatobiliary surgery Southwest HospitalArmy Medical University(Third Military Medical University)ChongqingChina

Laparoscopic anatomical hepatectomy(LAH)for patients with hepatocellular carcinoma(HCC)has been advocated by many surgeons in the hope of producing better oncological *** recent techniques,3D laparoscopic system and 2D real-time indocyanine green fluorescence imaging(r-ICG)guidance,are benefit for improving the operative precision of LAH in different ***,these two techniques cannot be applied concomitantly because of the technical *** a new modern laparoscopic system with both 3D and indocyanine green(ICG)imaging mode has been designed,it has not been listed in many countries including ***,we design a new procedure to perform the 3D LAH with 2D r-ICG guidance for HCCs with conventional laparoscopic *** this procedure,both 3D and 2D laparoscopic systems were used.A total of 11 patients with HCC received 3D laparoscopic right posterior sectionectomy(LRPS)with 2D r-ICG *** right posterior Glissonian pedicle was clamped under the 3D *** ICG solution was then intravenously *** liver parenchyma was transected under the 3D vision and guided by 2D ICG vision *** was no severe complications(Clavien-Dindo≥III)and operation related *** 90-day mortality was also *** using this procedure,the advantages of two techniques,3D laparoscopic system and 2D r-ICG guidance,were combined so that LAH could be performed with more ***,it should be validated in more studies.

关键词： Laparoscopic anatomical hepatectomy(LAH) indocyanine green fluorescence imaging(ICG fluorescence imaging) 3D laparoscopy 2D laparoscopic ICG fluorescence imaging

Robotic versus laparoscopic surgery for sporadic benign insulinoma:Short-and long-term outcomes

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hepatobiliary & Pancreatic Diseases International 2024年第4期23卷 399-405页

作者： Zhu-Zeng Yin Yuan-Xing Gao Zhi-Ming Zhao Ming-Gen Hu Wen-Bo Tang Rong Liu Faculty of Hepato-Pancreato-Biliary surgery The First Medical CenterChinese PLA General HospitalBeijing 100853China institute of hepatobiliary surgery of Chinese PLA Beijing 100853China Key Laboratory of Digital hepatobiliary surgery of Chinese PLA Beijing 100853China

Background:Minimally invasive surgery is the optimal treatment for *** present study aimed to compare short-and long-term outcomes of laparoscopic and robotic surgery for sporadic benign ***:A retrospective analysis of patients who underwent laparoscopic or robotic surgery for insulinoma at our center between September 2007 and December 2019 was *** demographic,perioperative and postoperative follow-up results were compared between the laparoscopic and robotic ***:A total of 85 patients were enrolled,including 36 with laparoscopic approach and 49 with robotic *** was the preferred surgical ***-nine patients(69.4%)underwent enucleation;among them,26 and 33 patients underwent laparoscopic and robotic surgery,*** enucleation had a lower conversion rate to laparotomy(0 vs.19.2%,P=0.013),shorter operative time(102.0 vs.145.5 min,P=0.008)and shorter postoperative hospital stay(6.0 vs.8.5 d,P=0.002)than laparoscopic *** were no differences between the groups in terms of intraoperative blood loss,the rates of postoperative pancreatic fistula and *** a median follow-up of 65 months,two patients in the laparoscopic group developed a functional recurrence and none of the patients in the robotic group had a ***:Robotic enucleation can reduce the conversion rate to laparotomy and shorten operative time,which might lead to a reduction in postoperative hospital stay.

关键词： Robotic surgical procedures Laparoscopy Insulinoma Enucleation Pancreatectomy

Ex vivo liver resection and auto-transplantation as an alternative for the treatment of liver malignancies: Progress and challenges

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hepatobiliary & Pancreatic Diseases International 2024年第2期23卷 117-122页

作者： Xin Yang Lu Lu Wen-Wei Zhu Yi-Feng Tao Cong-Huan Shen Jin-Hong Chen Zheng-Xin Wang Lun-Xiu Qin hepatobiliary surgery and Liver Transplantation Centers Department of General SurgeryHuashan Hospital&Cancer Metastasis InstituteFudan UniversityShanghai 200040China

Hepatectomy is still the major curative treatment for patients with liver ***,it is still a big challenge to remove the tumors in the central posterior area,especially if their location involves the retrohepatic inferior vena cava and hepatic *** vivo liver resection and auto-transplantation(ELRA),a hybrid technique of the traditional liver resection and transplantation,has brought new hope to these patients and therefore becomes a valid alternative to liver *** to its technical difficulty,ELRA is still concentrated in a few hepatobiliary centers that have experienced surgeons in both liver resection and liver *** efficacy and safety of this technique has already been demonstrated in the treatment of benign liver diseases,especially in the advanced alveolar ***,the application of ELRA for liver malignances has gained more ***,standardization of clinical practice norms and international consensus are still *** prognostic impact in these oncologic patients also needs further *** this review,we summarized the principles and recent progresses on ELRA.

关键词： Ex vivo liver resection Liver auto-transplantation Oncology Liver malignancies

Laparoscopic left hemihepatectomy guided by indocyanine green fluorescence: A cranial-dorsal approach

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World Journal of Gastrointestinal surgery 2024年第2期16卷 409-418页

作者： Xing-Ru Wang Xiao-Ju Li Dan-Dan Wan Qian Zhang Tian-Xi Liu Zong-Wen Shen Hong-Xing Tong Yan Li Jian-Wei Li institute of hepatobiliary surgery First Affiliated HospitalArmy Medical UniversityChongqing 400038China Department of hepatobiliary surgery Qujing Central Hospital of Yunnan Regional Medical CenterQujing 655000Yunnan ProvinceChina School of Clinical Medicine Qujing Medical CollegeQujing 655000Yunnan ProvinceChina

BACKGROUND Advancements in laparoscopic technology and a deeper understanding of intra-hepatic anatomy have led to the establishment of more precise laparoscopic hepatectomy(LH)*** indocyanine green(ICG)fluorescence navi-gation technique has emerged as the most effective method for identifying hepatic regions,potentially overcoming the limitations of *** laparoscopic left hemihepatectomy(LLH)is a standardized procedure,there is a need for innova-tive strategies to enhance its *** anatomical markers,surgical skills,and ICG staining *** Thirty-seven patients who underwent ICG fluorescence-guided LLH at Qujing Second People's Hospital between January 2019 and February 2022 were retrospectively *** cranial-dorsal approach was performed which involves dissecting the left hepatic vein cephalad,isolating the Arantius ligament,exposing the middle hepatic vein,and dissecting the parenchyma from the dorsal to the foot in order to complete the anatomical *** surgical methods,as well as intra-and post-surgical data,were recorded and *** hospital’s Medical Ethics Committee approved this study(Ethical review:2022-019-01).RESULTS Intraoperative blood loss during LLH was 335.68±99.869 mL and the rates of transfusion and conversion to laparotomy were 13.5%and 0%,*** overall incidence of complications throughout the follow-up(median of 18 months;range 1-36 months)was 21.6%.No mortality or severe complications(level IV)were *** LLH has the potential to become a novel,standardized approach that can effectively,safely,and simply expose the middle hepatic vein and meet the requirements of precision surgery.

关键词： Laparoscopic left hemihepatectomy Indocyanine green Cranial-dorsal approach Laparoscopic hepatectomy Arantius ligament Glissonean pedicle

Inhibiting HMGCR represses stemness and metastasis of hepatocellular carcinoma via Hedgehog signaling

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Genes & Diseases 2024年第5期11卷 470-483页

作者： Zhirong Zhang Jiayao Yang Rui Liu Jing Ma Kai Wang Xiaojun Wang Ni Tang Key Laboratory of Molecular Biology for Infectious Diseases(Ministry of Education) Institute for Viral HepatitisDepartment of Infectious DiseasesThe Second Affiliated HospitalChongqing Medical UniversityChongqing 400016China institute of hepatobiliary surgery Southwest HospitalThird Military Medical University(Army Medical University)Chongqing 400038China

Cancer stem cells(CSCs)play a crucial role in tumor initiation,recurrence,metastasis,and drug ***,the current understanding of CSCs in hepatocellular carcinoma(HCC)remains *** a comprehensive analysis of the database,it has been observed that 3-hydroxy-3-methylglutaryl-coenzyme A reductase(HMGCR),a critical enzyme involved in cholesterol synthesis,is up-regulated in HCC tissues and liver ***,high expression of HMGCR is associated with a poor prognosis in patients with ***,HMGCR promotes the stemness and metastasis of HCC both in vitro and in *** screening various signaling pathway inhibitors,we have determined that HMGCR regulates stemness and metastasis by activating the Hedgehog signaling in ***,HMGCR positively correlates with the expression of the Smoothened receptor and facilitates the nuclear translocation of the transcriptional activator GLI family zinc finger *** of the Hedgehog pathway can reverse the stimulatory effects of HMGCR on stemness and metastasis in ***,simvastatin,an FDA-approved cholesterol-lowering drug,has been shown to inhibit stemness and metastasis of HCC by targeting *** together,our findings suggest that HMGCR promotes the regeneration and metastasis of HCC through the activation of Hedgehog signaling,and simvastatin holds the potential for clinical suppression of HCC metastasis.

关键词： Cancer stem cells Hedgehog Hepatocellular carcinoma Metastasis Statin

Endoscopic-ultrasound-guided biliary drainage with placement of electrocautery-enhanced lumen-apposing metal stent for palliation of malignant biliary obstruction:Updated meta-analysis

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World Journal of Gastrointestinal surgery 2024年第3期16卷 907-920页

作者： Zu-Xiang Peng Fang-Fang Chen Wen Tang Xu Zeng Hong-Juan Du Ru-Xian Pi Hong-Ming Liu Xiao-Xiao Lu Department of hepatobiliary surgery Daping HospitalArmy Medical UniversityChongqing 400042China Department of Oncology Chongqing General HospitalChongqing UniversityChongqing 401147China Department of Gastroenterology and hepatobiliary surgery People’s Hospital of Fenggang CountyGuizhou 564200Guizhou ProvinceChina hepatobiliary and Pancreatic Tumor Center Chongqing University Cancer HospitalChongqing 400030China

BACKGROUND Endoscopic ultrasound-guided biliary drainage using electrocautery-enhanced(ECE)delivery of lumen-apposing metal stent(LAMS)is gradually being re-cognized as a viable palliative technique for malignant biliary obstruction after endoscopic retrograde cholangiopancreatography(ERCP)***,most of the studies that have assessed its efficacy and safety were small and *** meta-analyses of six or fewer studies that were published 2 years ago were therefore underpowered to yield convincing *** To update the efficacy and safety of ECE-LAMS for treatment of biliary ob-struction after ERCP *** We searched PubMed,EMBASE,and Scopus databases from the inception of the ECE technique to May 13,*** outcome measure was pooled technical success rate,and secondary outcomes were pooled rates of clinical success,re-intervention,and adverse ***-analysis was performed using a random-effects model following Freeman-Tukey double-arcsine transformation in R soft-ware(version 4.1.3).RESULTS Fourteen eligible studies involving 620 participants were ultimately *** pooled rate of technical success was 96.7%,and clinical success was 91.0%.Adverse events were reported in 17.5%of *** reinter-vention rate was 7.3%.Subgroup analyses showed results were generally *** ECE-LAMS has favorable success with acceptable adverse events in relieving biliary obstruction when ERCP is *** consistency of results across most subgroups suggested that this is a generalizable approach.

关键词： Biliary obstruction Biliary drainage Electrocautery-enhanced lumen-apposing metal stents Endoscopic ultrasound Endoscopic retrograde cholangiopancreatography failure