In order to protect the integrity and function of the digestive system, duodenum-preserving total pancreatic head resection is becoming the surgical method which was chosen by more and more doctors for benign lesions or low-grade malignant tumors of the pancreatic head. With the development of minimally invasive concepts and techniques, laparoscopic technology has brought unique advantages to this surgery. In this paper, a series of problems such as the development process and indications of laparoscopic duodenum-preserving total pancreatic head resection were discussed, and the core techniques of surgery and how to reduce the occurrence of complications were emphasized. The aim is to improve the therapeutic effect and quality of life of patients through reasonable surgical methods and treatment strategies.
ObjectiveTo summarize the research progress of near infra-red fluorescence imaging (NIRFI) in biliary tract surgery, and to provide protection for improvements of therapeutic effect and safety of biliary tract surgery.MethodThe relevant literatures about studies on NIRFI in the biliary tract surgery in recent years were reviewed.ResultsThe NIRFI had been preliminarily used in the surgical treatment of benign and malignant biliary diseases, and had shown its unique value in cholangiography. It provided a new method for effectively avoiding surgical complications, shortening operation time, reducing the rate of conversion to open surgery, evaluating blood supply of bile duct and improving the safety of operation.ConclusionsNIRFI has achieved notable successes in treatment of biliary tract diseases. With future application of fluorescence imaging in near infra-red Ⅱ window and new specific fluorescence targeting molecules, this technique will highlight its more important values in biliary surgery.
Immuno-fluorescence technique can qualitatively determine certain nuclear translocation, of which NF-κB/p65 implicates the activation of NF-κB signal pathways. Immuno-fluorescence analysis software with independent property rights is able to quantitatively analyze dynamic location of NF-κB/p65 by computing relative fluorescence units in nuclei and cytoplasm. We verified the quantitative analysis by Western Blot. When we applied the software to analysis of nuclear translocation in lipopolysaccharide (LPS) induced (0.5 h, 1 h, 2 h, 4 h) primary human umbilical vein endothelial cells (HUVECs), we found that nuclear translocation peak showed up at 2h as with calculated Western blot verification results, indicating that the inventive immuno-fluorescence analysis software can be applied to the quantitative analysis of immuno-fluorescence.
ObjectiveTo investigate the effectiveness of probe-based near infrared autofluorescence (AF) technology in the identification and functional protection of parathyroid gland (PG) during endoscopic total thyroidectomy. MethodsWe retrospectively collected the clinical data of 160 patients who underwent total thyroidectomy with bilateral central compartment lymph node dissection due to papillary thyroid carcinoma in Chongqing General Hospital from 1 July 2023 to 31 January 2024. Among them, 80 patients who used probe-based near infrared AF technology to identify the PGs were categorized as the AF group, 80 patients who used naked eye (NE) to identify the PGs were categorized as the NE group. The number of PGs identified, inadvertently removed, preserved in situ and autotransplanted, the incidence of postoperative hypoparathyroidism, and operative time were compared between the two groups. ResultsThe incidence of transient hypoparathyroidism was significantly lower in the AF group than that of the NE group [21.25% (17/80) vs. 43.75% (35/80), χ2=9.231, P=0.002], with no cases of permanent hypoparathyroidism in either group. The AF group had significantly more PGs identified and preserved in situ than the NE group (P<0.05) , but had significantly fewer PGs inadvertently removed and autotransplanted than the NE group (P<0.05). The AF group identified the first PG earlier than the NE group (4 min vs. 5 min, P<0.001). But there was no statistically difference in the operative time between the two groups (90 min vs. 94 min, P=0.052). ConclusionThe probe-based near infrared AF technology can help surgeons better identify and protect PGs during surgery, reducing the incidence of postoperative transient hypoparathyroidism.
Objective To explore the accuracy and efficiency of indocyanine green fluorescence (ICGF) imaging in evaluating blood perfusion of parathyroid gland (PG) during total thyroidectomy. Methods Seventy patients who underwent total thyroidectomy and bilateral central lymph node dissection for papillary thyroid carcinoma (PTC) from March 2021 to December 2021 were enrolled and randomly divided into experimental group (ICGF imaging, n=35) and control group (normal treatment, n=35). Blood perfusion of PGs was evaluated by ICGF imaging and naked eye in each group respectively. The perfusion of PGs, incidence of hypoparathyroidism, and number of autotransplanted PGs were analyzed between the two groups. Results There was no difference between two groups in the incidence of transient hypoparathyroidism (P=0.339), and no one occurred permanent hypoparathyroidism. More PGs were autotransplanted in the experimental group compared to the control group (P＜0.001). At least one PG with good perfusion in the experimental group predicted an extremely high rate of normal parathyroid hormone levels of the patients postoperatively than the control group (P=0.003). Conclusion ICGF imaging can evaluate the blood perfusion of PGs accurately and guide their autotransplantation.
This consensus aims to introduce the applications of 4K high-definition technology and fluorescence technology in thoracic surgery, summarize and categorize the technical support for pulmonary segment surgery, and innovatively propose technical support for precise sleeve resection of pulmonary segments. It provides a reference for clinical use, points out the direction for the research and innovation of domestically produced high-end endoscopes, promotes the widespread application of excellent domestically produced medical endoscopes, and facilitates the development of domestically produced medical equipment.
Objective To investigate the relationships between circulating tumor cells (CTCs), circulating tumor endothelial cells (CTECs) and treatment methods in patients with nasopharyngeal carcinoma (NPC) at different stages of treatment. Methods The data of NPC patients at different treatment periods in West China Hospital of Sichuan University from March 2016 to November 2019 were retrospectively collected. The patients received CTCs test and part of those patients received CTECs test, by subtraction enrichment-immunostaining-fluorescence in situ hybridization. The relationships of CTCs and CTECs with radiotherapy and chemotherapy, and the correlations between CTCs and CTECs in NPC patients were analyzed. Results A total of 191 patients were included. Among them, there were 66 cases before initial treatment, 38 cases after induction chemotherapy, and 87 cases after concurrent chemoradiotherapy. A total of 127 patients received CTECs test, including 41 cases before initial treatment, 29 cases after induction chemotherapy, and 57 cases after concurrent chemoradiotherapy. The positive rates of CTCs were 89.4%, 81.6% and 69.0% respectively in the three stages of treatment, and the difference was statistically significant only between the pre-treatment group and the post-concurrent chemoradiotherapy group (P=0.003). The number of CTCs in the post-concurrent chemoradiotherapy group was lower than that in the pre-treatment group and the post-induction chemotherapy group (P<0.001, P=0.002). The number of triploid CTCs in the post-concurrent chemoradiotherapy group was significantly different from that in the pre-treatment group and the post-induction chemotherapy group (P=0.009, P=0.013). The number of tetraploid CTCs in the post-concurrent chemoradiotherapy group was significantly different from that in the post-induction chemotherapy group (P=0.007). The number of polyploidy (pentaploid or > 5 copies of chromosome 8) CTCs in the post-concurrent chemoradiotherapy group was significantly different from that in the pre-treatment group (P<0.001). The positive rates of CTECs were 70.7%, 82.8% and 64.9% respectively in the three stages of treatment, and the difference was not statistically significant (P>0.05). The number of CTECs in the post-concurrent chemoradiotherapy group was only lower than that in the post-induction chemotherapy group (P=0.009). There was no significant difference in the number of triploid or tetraploid CTECs among the three groups (P=0.265, P=0.088). The number of polyploid CTECs was statistically different only between the post-concurrent chemoradiotherapy group and the post-induction chemotherapy group (P=0.007). Spearman correlation analysis showed that there was a significant positive correlation between CTCs and CTECs (rs=0.437, P<0.001). Conclusions Concurrent chemoradiotherapy plays a decisive role in reducing the number of CTCs in the blood of NPC patients, while induction chemotherapy does not appear to directly cause changes in the number of CTCs. In NPC patients, different types of CTCs have different responses to different treatments. There is a significant positive correlation between CTECs level and CTCs level in NPC.
ObjectiveTo investigate the application value of indocyanine green (ICG) fluorescence imaging technology for determining the blood supply of parathyroid in thyroid surgery.MethodsThe patients who underwent total thyroidectomy and bilateral central lymph node dissection for papillary thyroid carcinoma (PTC) from June 1, 2017 to January 1, 2018 were prospectively enrolled and then divided into a study group and control group randomly. The study group used the ICG fluorescence imaging technology to evaluate the blood supply of the parathyroid glands, while the control group assessed the blood supply by naked eyes, then determined that whether the parathyroid glands were retained in situ or autotransplanted. The incidence of hypoparathyroidism, length of hospital stay, and parathyroid hormone (PTH) were compared between the two groups.Results① A total of 60 patients with PTC were included in the study, and 30 patients in each group. There were no significant differences in the baseline informations of the two groups such as the gender, age, comorbidities, and preoperative PTH, Ca2+ levels, etc. (P>0.05). ② The ICG score of type A parathyroid glands (except type A3) was lower than that of type B parathyroid glands (0.99±0.38 versus 1.45±0.58, t=–2.395, P<0.05). ③ The length of postoperative hospital stay was shorter in the study group than in the control group (t=–2.159, P=0.035). ④ The ICG fluorescence imaging could significantly reduce the incidence of temporary hypoparathyroidism (χ2=5.079, P=0.024). The incidence of permanent hypoparathyroidism was not statistically different between the two groups (χ2=1.000, P=0.317), and only 1 case appeared in the control group. ⑤ There were no statistically significant differences in the PTH and serum Ca2+ levels at day 1, month 1, month 3, and month 6 after the surgery between the two groups (P>0.05). ConclusionICG fluorescence imaging technology could be used to determine blood supply of parathyroid in situ in real time during operation. Further studies are needed to confirm this conclusion.
ObjectiveTo evaluate efficacy and safety of laparoscopic Glissonean pedicle transection anatomic hepatectomy using indocyanine green (ICG) fluorescence imaging.MethodThe retrospective analysis was made on the preoperative clinical data, surgical treatment and postoperative status of a patient with hepatocellular carcinoma who underwent the laparoscopic Glissonean pedicle transection anatomic hepatectomy using the ICG fluorescence imaging technology in the Department of Liver Surgery, West China Hospital of Sichuan University.ResultsAccording to the preoperative history, imaging and laboratory examinations, the diagnosis of hepatocellular carcinoma was considered. The intraoperative exploration revealed that there was only one tumor located in the segment Ⅳ and was superficial. The ICG fluorescence imaging was used to perform the Glissonean pedicle transection anatomic hepatectomy. The postoperative pathological diagnosis was consistent with hepatocellular carcinoma without serious complications. The patient recovered well. No recurrence was found in the follow-up period up to 6 months.ConclusionsLaparoscopic Glissonean pedicle transection anatomic hepatectomy using ICG fluorescence technology can be used as a safe and precise treatment to solve problems such as bleeding during operation, difficult determination of tumor boundary, and whether having residual tumor in surgical margin.
ObjectiveTo observe the detection of circulating tumor cells (CTCs) in peripheral blood of patients with gastric cancer, and to investigate the relationship between the CTCs and clinicalpathological features of gastric cancer. MethodsSixty cases of gastric cancer from September 2011 to September 2013 of our hospital were as the research object, and compared with 40 cases of benign gastric disease over the same period. These patients' venous blood were collected, the CTCs counts were determined by using the CellTracks AutoPrep fluorescence scaning system, and the relationship between CTCs and clinicopathological features of gastric cancer was analyzed. ResultsThe detection rate of CTCs in gastric cancer patients was 70.0% (42/60), in control group was 7.5% (3/40). The positive rate of CTCs in peripheral blood of patients with gastric cancer was significantly higher than that of benign gastric disease (P<0.05). The positive rate of CTCs in peripheral blood were no correlated with gender, age, N staging, distant metastasis, tumor size, and vascular invasion (P>0.05), but were correlated with the TNM staging of tumor and degree of differentiation (P<0.05). The cumulative survival rates of 12 months and 18 months after operation in CTCs negtive patients with gastric cancer were higher than that CTCs positive patients (P<0.05). ConclusionsThe detection of CTCs is easy to manage and repeatable. The positive rate of CTCs in gastric patients is higher, which can reflect the progression of tumor and serve as the prognostic index in gastric cance patients.