RESUMEN
OBJECTIVE: To preliminarily explore the application value of two-dimensional image technology and three-dimensional visualization technology in hepatocellular carcinoma(HCC) treated by associating liver partition and portal vein ligation for staged hepatectomy(ALPPS). METHODS: Clinical data of nineteen HCC patients treated by ALPPS were retrospectively analyzed in Sun-Yat-Sen Memorial Hospital of Sun Yat-Sen University from August 2013 to May 2015.Preoperative assessment, surgical planning and intraoperative guidance were assisted by traditional two-dimensional imaging technology(group 2D) in 15 cases, and the rest 4 cases were assisted by three-dimensional visualization technology(group 3D). RESULTS: Three-dimensional visualization technology offered precise, visual, and distinct images, calculated the liver volume precisely, achieved virtual simulation operations, and assisted the formulation of intraoperative decisions.The mean operation time of the first stage were(331.3±61.7)minutes and (261.3±21.4)minutes in group 2D and group 3D, and the mean volume of intraoperative bleedings were (360.7±51.9)ml and (300.0±40.8)ml, respectively.The mean operation time of the second stage were (199.3±41.0)minutes and (170.0±29.4)minutes in group 2D and group 3D, and the mean volume of intraoperative bleedings were (285.3±132.6)ml and (257.5±99.5)ml, respectively.The mean interval time between two stages of operations were (15.3±6.5)d and (13.8±5.1)d in group 2D and group 3D, and the mean hospital stays were (39.3±5.8)d and (31.5±7.5)d, respectively.There were 4 cases and 12 cases who accepted the second stage operation in group 2D and group 3D respectively.There were 7 cases(4 with grade A, 2 with grade B, 1 with grade C) and 2 cases(1 with grade A, 1 with grade B) with post-hepatectomy liver failure and 9 cases(4 with grade â , 2 with grade â ¡, 1 with grade â ¢, 2 with grade â £) and 3 cases (1 with grade â , 1 with grade â ¡, 1 with grade â ¢)with postoperative complications in group 2D and group 3D respectively.There were 2 cases and 0 case died after operation in group 2D and group 3D respectively.There were 3 cases and 1 case who were recurrent and 4 cases and 1 case died 6 months after surgery in group 2D and group 3D respectively. CONCLUSION: Three-dimensional visualization technology assisted the formulation of preoperative assessments and surgical planning individually and precisely, which displayed potential application value in HCC treated by ALPPS.
Asunto(s)
Carcinoma Hepatocelular/diagnóstico por imagen , Hepatectomía , Imagenología Tridimensional , Neoplasias Hepáticas/diagnóstico por imagen , Carcinoma Hepatocelular/cirugía , Humanos , Ligadura , Neoplasias Hepáticas/cirugía , Vena Porta , Complicaciones Posoperatorias , Estudios Retrospectivos , Procedimientos Quirúrgicos VascularesRESUMEN
The purpose of the present work is to study whether the analgesia of "Zusanli" EA was mainly produced by its noxious effect. The antidromic C waves on N. peroneus communis innervating the area of "Zusanli" point were recorded. When "Zusanli" point was stimulated by trains of stimuli, the amplitude of the antidromic C wave was obviously decreased due to collision with the orthodromic stimulation. It was suggested that EA of "Zusanli" could excite some C fibers. It was observed that when the stimulation intensity reached the threshold of C fiber, the NRM neurons were obviously activated, and when it reached or exceeded the intensity for producing the maximal C wave, the NRM neurons were highly activated. Therefore, EA analgesia is probably produced mainly by its noxious stimulus component, especially carried by C fibers, via a negative feedback mechanism in modulating pain.