ObjectiveTo investigate the effect of the round ligament fissure approach in re-hepatectomy.MethodsA total of 40 patients with recurrence of hepatocellular carcinoma (HCC) who underwent re-hepatectomy in the Department of Hepatopancreatobiliary Surgery of Leshan People’s Hospital from June 2017 to August 2020 were collected and divided into two groups according to different surgical approaches: study group (transhepatic round ligament fissure approach) and control group (conventional surgical approach), 20 cases in each group. The perioperative general indicators, peripheral blood laboratory indicators, and complications of the two groups were compared.ResultsCompared with the control group, the operation time, postoperative drainage tube removal time, and postoperative hospital stay of study group were shortened, and intraoperative blood loss was reduced (P<0.05). Compared with preoperatively in the same group, postoperative TBIL and ALT levels of the two groups decreased, and HGF levels increased (P<0.05). There was no significant difference in the levels of TBIL, ALT, and HGF between the two groups before surgery (P>0.05); at 1 month after surgery, there was no significant difference in the levels of TBIL and ALT between the two groups (P>0.05), but the HGF level of the study group was higher than that of the control group at1 month after operation, the difference was statistically significant (P<0.05). The changes before and after operation of TBIL and ALT were similar between the two groups (P>0.05), but the rising value of HGF in the study group was higher than that of the control group (P<0.001). There was no death in the two groups during the perioperative period, and the total postoperative complications were not statistically different (P=0.677). There was no statistically significant difference in the postoperative follow-up results between the two groups in recurrence, metastasis, and death (P>0.05).ConclusionRe-hepatectomy through the round ligament fissure approach can reduce the amount of intraoperative blood loss, shorten the operation time, and reduce the damage to the residual liver, which has high safety.
ObjectiveTo evaluate the short-term effectiveness of robotic distal pancreatectomy (RDP) and laparoscopic distal pancreatectomy (LDP) by meta-analysis.MethodsWe searched for manuscripts about RDP versus LDP form PubMed, The Cochrane Library, EMbase, CKNI, CBM, and WanFang Databases. The parallel quality assessment was selected according to the literature inclusion and exclusion criteria. Relevant data were extracted and meta-analysis was performed by using Revman 5.3 software.ResultsA total of 23 articles were included, and a total of3 487 patients enrolled who underwent pancreatic body resection. Meta-analysis results showed that compared with the LDP group, the RDP group had a longer operation time [MD=15.52, 95%CI was (0.60, 30.45), P=0.04], but the intraoperative blood loss was less [MD=–59.18, 95%CI was (–111.62, –6.73), P=0.03], the intraoperative spleen preservation rate was higher [OR=1.74, 95%CI was (1.02, 2.96), P=0.04], the intraoperative conversion to open rate was lower [ OR=0.45, 95%CI was (0.34, 0.60), P<0.000 01], and postoperative hospital stay was shorter [MD=–0.90, 95%CI was (–1.70, –0.10), P=0.03], while there were no significant differences in intraoperative blood transfusion rate [OR=0.88, 95%CI was (0.60, 1.30), P=0.52], incidence of postoperative overall complication [OR=0.88, 95%CI was (0.68, 1.13), P=0.32] and pancreatic leakage [OR=0.91, 95%CI was (0.72, 1.14), P=0.41], 90-day readmission rate [OR=1.32, 95%CI was (0.95, 1.83), P=0.10], and 90-day reoperation rate [OR=0.73, 95%CI was (0.40, 1.33), P=0.30].ConclusionsRDP has the advantages of less bleeding, low turnover rate, and short postoperative hospital stay. However, due to the quality limitations of the included studies, the above conclusions still need to be verified by more high-quality studies.
ObjectiveThis meta-analysis aimed to systematically evaluate the feasibility and the safety of total laparoscopic pancreatoduodenectomy (TLPD) by comparing it with open pancreatoduodenectomy (OPD).MethodsWe searched the relative domestic and international data bases systematically, such as the Cochrane Library, Medline Database, SCI, CBM, VIP-data, CNKI-data, and WanFang Data. We selected case control studies or cohort studies, and used the Review Manager 5.3 to perform statistical analysis.ResultsIn total, thirteen single-center retrospective case-control studies were included, totally 808 patients involved, and there were 401 cases in the TLPD group and 407 cases in the OPD group. There were no significant difference in terms of the cumulative morbidity, incidence of the Clavien Ⅲ-Ⅴ complication, pancreatic fistula, B/C pancreatic fistula, biliary fistula, postoperative hemorrhage, pulmonary infection, and gastric emptying delay, as well as the ratio of secondary operation, mortality of perioperative period, the ration of R0 resection, and the number of lymph nodes dissected between the 2 groups (P>0.05). Although the operative time was significant longer, TLPD had significant superiority in terms of the amount of bleeding and blood transfusion during operation, the hospital stays after operation, the bowel function recovery time, the time to restart eating, and the time to reactivate (P<0.05).ConclusionIn terms of the relative complications and the parameters of oncology such as the ration of R0 resection, the number of lymph nodes dissected, both of the procedures are safe and feasible, while TLPD is more favorable to control operative bleeding and accelerate rehabilitation.
ObjectiveTo investigate the clinical value of laparoscopic cholecystectomy following “A-B-D” approach applied in the operation of acute suppurative or gangrenous cholecystitis.MethodsWe sought out 45 patients diagnosed as acute suppurative or gangrenous cholecystitis and treated by laparoscopic cholecystectomy following the “A-B-D” approach in People’s Hospital of Leshan from Sep. 2019 to Dec. 2020 as the observation group (ABD observation group), and sought out 50 patients with the same diseases but treated by conventional laparoscopic cholecystectomy from Jun. 2018 to Aug. 2019 as the matched group (conventional matched group). We analyzed and compared the parameters related to safety and efficacy of the two groups retrospectively.ResultsA total of 95 patients were included, including 45 patients in the ABD observation group (26 cases of acute suppurative cholecystitis, 19 cases of acute gangrenous cholecystitis) and 50 patients in the conventional matched group (24 cases of acute suppurative cholecystitis, 26 cases of acute gangrenous cholecystitis). There were no significant differences in age, gender, body mass index, disease composition, gallbladder condition, and preoperative complications between the two groups (P>0.05). There was no bile duct injury case in the ABD observation group (0), while there were 4 cases (8.0%) in the conventional matched group, but the statistical results showed no statistical significance between the two groups (P=0.054). One case (2.2%) in the ABD observation group converted to laparotomy, which was significantly lower than the 10 cases (20.0%) in the conventional matched group, and the difference was statistically significant (P=0.017). In addition, there were no significant differences for other parameters including operative time, postoperative hospital stay, incidences of intraoperative bleeding and postoperative bleeding between the two groups (P>0.05).ConclusionsThe laparoscopic cholecystectomy following the “A-B-D” approach can help distinguish the anatomical structure of cystic duct and extrahepatic bile duct clearly, and it can help prevent biliary tract injury effectively and reduce the probability of conversion to laparotomy. It is worthy of clinical application and promotion, especially in the majority of county hospitals.
ObjectiveTo investigate safety and effectiveness of laparoscopic pancreaticoduodenectomy (LPD) in municipal hospitals.MethodsThe clinic data of patients underwent pancreatoduodenectomy in the Leshan People’s Hospital from November 2017 to January 2020 were retrospectively analyzed. The patients were divided into LPD group and open pancreaticoduodenectomy (OPD) group according to the operation methods, and the indicators of perioperative safety and effectiveness of the two groups were compared.ResultsA total of 72 patients were enrolled in this study, including 30 patients in the LPD group and 42 patients in the OPD group. There were no significant differences in the age, gender, and other baseline indicators between the two groups (P>0.05). Although the operative time of the LPD group was longer than that of the OPD group (P<0.05), the intraoperative blood loss in the LPD group was significantly less than that in the OPD group (P<0.05), the postoperative hospital stay, postoperative exhaust time, and postoperative ambulation time in the LPD group were shorter than those in the OPD group (P<0.05). And there were no significant differences in the terms of intraoperative red blood cell transfusion, intraoperative blood transfusion rate, postoperative ICU hospitalization time, hospitalization expenses, overall complications and specific complications (except incision infection rate of LPD group was significantly lower than OPD group, P=0.031) between the two groups (P>0.05). There were no significant differences in the positive rate of resection margin, number of lymph node dissection, and positive rate of lymph node between the two groups (P>0.05).ConclusionLPD has the same safety and effectiveness as OPD in the perioperative period in municipal hospitals, and is more conducive to postoperative recovery of patients.
ObjectiveTo evaluate the safety and efficacy of extra-sheath dissection via the Laennec membrane space combined with indocyanine green (ICG) fluorescence navigation in laparoscopic anatomic hepatectomy. MethodsA retrospective analysis was conducted on the clinical data of hepatocellular carcinoma patients who underwent laparoscopic anatomic hepatectomy at Leshan People’s Hospital between January 2022 and September 2025. The study group comprised patients who underwent the extra-sheath anatomical approach via the Laennec’s capsule space combined with ICG fluorescence navigation, while the control group consisted of patients who underwent the conventional intra-sheath Glissonean pedicle transection approach combined with intraoperative ultrasound. ResultsA total of 113 patients were included in this study, including 54 cases in the study group and 59 cases in the control group. Intraoperative blood loss [MD=–139.88 mL, 95%CI (–229.51, –50.25) mL], number of drainage tubes × drainage tube indwelling time [MD=–2.00 (tubes×d), 95%CI (–4.00, 0.00) (tubes×d)], postoperative ambulation time [MD=–0.58 d, 95%CI (–0.94, –0.22) d], alanine aminotransferase level on postoperative day 1 [MD=–129.83 U/L, 95%CI (–259.96, –5.71) U/L], aspartate aminotransferase level on postoperative day 1 [MD=–131.09 U/L, 95%CI (–259.12, –3.06) U/L], albumin level on postoperative day 1 [MD=1.64 g/L, 95%CI (0.21, 3.06) g/L], and hospitalization cost [MD=–5 523.10 yuan, 95%CI (–10 572.42, –471.77) yuan] of the study group were all better than those in the control group (P< 0.05). ConclusionExtra-sheath dissection via the Laennec membrane space combined with ICG fluorescence navigation can improve the safety and efficacy of laparoscopic anatomical hepatectomy, and is worthy to explore further its clinical application value.
ObjectiveTo investigate the prognostic value of the alkaline phosphatase + gamma-glutamyl transpeptidase / platelet (AGPR) in predicting overall survival in patients with hepatocellular carcinoma (HCC) after curative hepatectomy, and to develop an AGPR-based nomogram prediction model to enhance the accuracy of prognostic risk stratification and individualized treatment decision-making. MethodsThis multicenter retrospective study included patients who underwent radical resection for HCC at the Affiliated Hospital of Southwest Medical University (2013–2023) as the training and internal validation sets, and at Leshan People’s Hospital (2018–2024) as the external validation set. Baseline characteristics, preoperative laboratory tests, surgical details, and pathological findings were collected. Optimal cutoff values for AGPR and the pan-immune-inflammation value (PIV) were determined using receiver operating characteristic (ROC) curves. Independent prognostic factors for overall survival were identified using univariate and multivariate Cox regression, then a nomogram was developed. Model performance was assessed using the area under the ROC curve (AUC), concordance index (C-index), calibration, and decision curve analysis for clinical utility assessment. Patients were stratified into low- and high-risk groups based on the median nomogram score, and overall survival was compared. ResultsA total of 618 patients were included: 250 in the training set, 167 in the internal validation set, and 201 in the external validation set. Optimal cutoff values were 1.06 for AGPR and 316.79 for PIV. Multivariate Cox regression identified alpha-fetoprotein (AFP), AGPR, PIV, and tumor diameter as independent prognostic factors (P＜0.05). The nomogram predicting 1-, 3-, and 5-year overall survival rates achieved AUCs of 0.820, 0.734, and 0.727 in the training set; 0.784, 0.722, and 0.705 in the internal validation set; and 0.789, 0.703, and 0.702 in the external validation set. C-indices were 0.748, 0.701, and 0.692, respectively. The Hosmer-Lemeshow test indicated good calibration (P>0.05), and calibration curves aligned closely with the ideal diagonal. Decision curve analysis demonstrated clinical net benefit across all datasets. Low-risk patients had significantly better overall survival than high-risk patients (P＜0.05). ConclusionsAGPR is an independent prognostic factor for overall survival in HCC patients after radical resection. The nomogram incorporating AGPR, AFP, PIV, and tumor diameter exhibits favorable discrimination, calibration, and clinical utility, supporting its use for postoperative risk stratification and individualized treatment planning.