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Objective: To investigate the feasibility and oncological efficacy of structuring process approach to laparoscopic anatomical liver central lobectomy for hepatocellular carcinoma. Methods: The clinical data of 65 patients with hepatocellular carcinoma who underwent laparoscopic anatomical liver central lobectomy at the Department of Hepatobiliary Surgery, Sun Yat-sen Memorial Hospital from April 2017 to April 2021 was retrospectively analyzed. There were 39 males and 26 females,aged ( M ( Q R )) 61.2 (29.5) years (range:25 to 80 years).The body mass index was (24.2±3.8) kg/m 2 (range:19.5 to 26.1 kg/m 2 ) and the tumor diameter was (6.7±2.9)cm(range:3.4 to 10.5 cm).This structuring process approach was designed using a series of main vessels as the plane markers, along which liver transection was carried out. The perioperative indicators and early oncological efficacy were then analyzed. Results: All the procedures were successfully carried out laparoscopically. The operative time was (190.5±70.4) minutes (range:90 to 280 minutes). The blood loss was (370.6±120.8)ml(range:100 to 1 050 ml). No patient received blood transfusion or converted to laparotomy. Postoperative complications occurred in 8 cases(12.3%). Postoperative hospital stay was (7.5±2.5) days(range:5 to 18 days).There was no perioperative death and rehospitalization within 30 days. Pathological study showed all the operations to be R0 resections, the average surgical margin was (2.4±1.9)cm(range:0.5 to 3.1 cm).The tumor recurrence rate was 12.3% after 1 year follow-up. Conclusion: Structuring process approach to laparoscopic anatomical liver central lobectomy could be used to treat patients with hepatocellular carcinoma.

Laparoscopic hepatectomy has brought new techniques and concepts to the liver surgery.Compared with the traditional laparotomic resection, the approaches of laparoscopic hepatectomy are quite different and have advantages.In this article, the characteristics, selection and application of various laparoscopic hepatectomy approaches are summarized and described.Different surgical strategies lead to different approaches, and the choice of each approach is not fixed and independent.The safety and effectiveness of laparoscopic hepatectomy can be guaranteed to the greatest extent by reasonable selection and combination of various approaches.

Objective: To summarize the experience in surgical treatment of patients with intracranial aneurysms., Methods: The measures used in the treatment of 500 patients with intracranial aneurysms were retrospectively reviewed with regard to timing of surgery, induced-hypotensive anesthesia, brain protection combined with temporal occlusion of the feeding artery, dynamically monitoring of transcranial Doppler ultrasound, antivasospasm treatment, techniques of direct surgery, and endovascular embolization., Results: In 465 patients undergoing surgery, intraoperative rupture was observed in 27(6.2%), postoperative death in 13 (2.7%), hemipalsy in 8(2.2%), and vegetative state in 2 (5.0%). The operative mortality was 3.8% in 210 patients before 1990, while 1.9% in 255 patients after 1990., Conclusion: The outcome of patients with intracranial aneurysms can be markedly improved by comprehensive measures.

Objective: Transjugular intrahepatic portosystemic shunts (TIPS), a modified Sugiura procedure and TIPS plus a modified Sugiura procedure were compared to evaluate their clinical results in treatment of portal hypertension., Methods: Ninety patients with portal hypertension respectively underwen TIPS (group I, n = 30), a modified Sugiura procedure (group II, n = 30) and TIPS plus a modified Sugiura procedure (group III, n = 30). The rates of rebleeding and encephalopathy, and the mortality of patients with portal hypertension were observed., Results: The early postoperative complications were observed in 23.33% of the patients in group I, in 30.0% of those in group II, and in 20.0% of those in group III. The early postoperative rates of rebleeding were 6.67% in group I, 10% in group II, and 0% in group III. Hepatic encephalopathy was seen in 16.67% of the patients in group I, 0% in group II and 13.33% in group III. The early mortality was 3.33% in group I. During follow-up for 1 - 36 months, the rates of rebleeding were 34.48% in group I, 33.33% in group II, and 3.33% in group III. The rates of encephalopathy and mortality were respectively 17.20% and 20.69% in group I, 3.33% and 13.33% in group II, 3.33% and 3.33% in group III. The shunt patency in group III was higher than that in group I., Conclusion: Combination of TIPS and a modified Sugiura procedure can be effective to prevent and treat variceal bleeding.

Objectives: To observe the changes in the anatomic variation and the hepatofugal flow of coronary vein and to evaluate the clinical significance of these changes in patients with portal hypertension., Methods: The anatomic variations and the retrograde flow of the coronary vein, and the portal antegrade flow and the portal pressure were observed by direct and indirect portography, direct measurement of portal pressure and Doppler sonography in 200 cirrhotic patients with portal hypertension., Results: Single branch and two branches of the coronary vein were noted in 79.46% and 20.54% of the patients with portal hypertension respectively by direct portography. The sites of coronary vein arising from the portal vein, splenic vein or portosplenic junction were found in 62.33%, 27.35% or 8.07% respectively. The confluence of coronary vein and portal vein was found in most patients with variceal bleeding and recurrent bleeding after devascularization. The confluence of the coronary vein and splenic vein was observed in most patients with refractory ascites without variceal bleeding. Arterial portography demonstrated retrograde opacification of the coronary vein in 26.19% (grade II portal venous pattern), 56.64% (grade III portal venous pattern), 100% (portal thrombosis and action bleeding) 47.79% (controuing periods of bleeding), and 19.05% (refractory ascites)., Conclusions: The anatomic variation of the coronary vein may be related to variceal bleeding in cirrhotic patients with portal hypertension and the retrograde opacification of the coronary vein is a significant sign of variceal bleeding.

Objective: To evaluate the clinical results of combined TIPSS with modified Sugiura operation for portal hypertension., Methods: 24 patients with portal hypertension associated with variceal bleeding and ascites were treated with TIPSS and then modified Sugiura operation two weeks later., Results: After combined TIPSS with modified Sugiura operation, variceal bleeding ceased and ascites subsided. The portal pressure significantly decreased (P < 0.01) and the portal blood flowed quickly (P < 0.01). The blood velocity of intrahepatic shunts was (132.64 +/- 41.42) cm/s. Direct portal venography showed that coronary vein had disappeared. No rebleeding was noted in varices and stenosis in intrahepatic shunts., Conclusions: Combined TIPSS with modified Sugiura operation not only can reduce portal pressure and improve portal circulation, but also completely interrupt coronary vein and maintain liver function.

Objective: To determine the influence of transjugular intrahepatic portosystemic stent shunts (TIPSS) on portal and systemic hemodynamics of patients with portal hypertension., Methods: Fifteen patients who had undergone TIPSS with 10 mm stents were studied. The parameters of portal, systemic and pulmonary hemodynamics were measured with Doppler sonography, direct portal pressure measurement, blood-gas analysis and Swan-Ganz catheter before and 30 min and 2 weeks after TIPSS., Result: Portal pressure decreased by 34% and 55.4%, and PO(2), SatO(2) increased by 67.7%, 21.3% and 68%, 20.4% respectively 30 min and 2 weeks after TIPSS. Portal blood velocity increased by 1.4 times 2 weeks after TIPSS. CO, CI, SI increased (P < 0.01) and SVR, PVR decreased (P < 0.01) after TIPSS. Also, RAP, PAP increased (P < 0.05). Renal blood flow increased (P < 0.01) and renal function significantly improved., Conclusion: TIPSS can not only decrease portal pressure and improve renal function, but also worsen portal and systemic hemodynamics. Cardiac and liver function should be monitored before and after TIPSS.

Most meningiomas have typical clinical and CT features. But some meningiomas which have an atypical clinical and CT findings can lead to a wrong diagnosis. The authors have reviewed 123 hospitalized patients with meningiomas which had been pathologically diagnosed. Nine of them had atypical meningiomas according to their histories, symptoms, signs and CT findings. All of these patients were mis diagnosed as having gliomas or metastatic tumors. The authors analyed these cases carefully and find the clues that may help to do an accurate preoperative diagnosis.

Expandable venous stents is a new method for treatment of Budd-Chiari syndrome (BCS). Ten cases of BCS underwent expandable venous stents in inferior cava vein or/and in hepatic vein, or/and intrahepatic portosystemic shunt according to the location and the extent of lesion. Expandable venous stents were successful in all patients. No serious procedure-related complications were observed. The symptoms and signs disappeared. Portal pressure and inferior cava vein pressure gradient reduced immediately after treatment. The blood in stents flowed quickly. During follow-up of 1-21 months, rebleeding was observed in one case. The stenoses of intrahepatic shunts and inferior vena vein respectively occurred in two cases requiring repeat intervention. Therefore, expandable venous stent is safe and effective in patients with BCS, and will be of great value in wide application and further study.

To improve preoperative diagnosis of gastric cancer, we applied DSA in clinical diagnosis. 36 patients with gastric cancer were observed. Preoperative DSA and postoperative pathological analysis revealed the following results. With DSA, the accuracy of diagnosis of invasion depth of gastric cancer reached 72.2%. We summarised the criteria for diagnosis of gastric cancer. If subsidiary anastomotic channels narrow or obliterate in DSA, the case may be early cancer. If parietal branches narrow or obliterate in DSA, the cancer may invade the muscle of the stomach. If arcade of this lesser curvature narrows in DSA, the cancer may invade the serosa of the stomach. If the roots of main vascular vessels, such as the left gastric artery, and vascular vessels of other organs narrow or obliterate in DSA, the cancer may directly invade other organs as well. Two-thirds of gastric cancer could be identified through DSA with their shapes and characteristics. The varied shapes of vascular vessels caused by invasion of gastric cancer could reveal growing mode of the cancer.

14 cases of mannitol-induced acute renal failure were reported. The dosage of mannitol used varied widely. In all cases serum Na+, HCO3- were decreased, K+ and BUN increased significantly. Serum osmolality was measured in 5 cases. The osmolal gap was increased greatly, 77.4mOsm/kg. H2O in average. The increase of osmolal gap may play an important role in acute renal failure by causing intensive renal vasocontraction. Monitoring of serum osmolality or osmolal gap can help to prevent mannitol intoxication. The decrease of serum Na+ may be a warning sign of increased osmolal gap. Hemodialysis is the best way for the treatment of mannitol-induced acute renal failure.

To study the clinical results and hemodynamic changes of portal venous system after TIPSS we created a transjugular intrahepatic portosystemic stent shunt in 140 patients with advanced cirrhosis and portal hypertension, meanwhile we used Doppler sonography, direct portography and measurement of portal pressure to assess the blood hemodynamic changes of portal venous system in 100 patients with TIPSS. The technical success rate of TIPSS was 94.62% in 130 patients except for 10 patients with portal venous occlusion. The complication rate related to TIPSS procedure was 4.62%. Slight encephalopathy was observed in 9.03% of patients with TIPSS. The early mortality within 30 days of treatment was 3.08%. Follow-up for 1 to 24 months showed that the stenosis or occlusion of shunt and variceal rebleeding or ascites were observed respectively in 12% and 9% of patients. Six percent of the patients with TIPSS died. The portal venous pressure and the inflow of collateral circulation remarkably decreased and the portal flow velocity increased by 2.4 times after TIPSS. The flow velocity of shunt and portal vein decreased by 11.39% and 20.14% respectively in the patients with shunt patency, while the flow velocity continued to decrease in the patients with shunt stenosis or occlusion during the follow-up. TIPSS is an effective method for treating the patients with portal hypertension due to cirrhosis. The observation of trends in the hemodynamic changes of portal venous and shunt can early diagnose and treat the shunt stenosis or occlusion.

Transjugular intrahepatic portosystemic shunt (TIPS) was carried out in 140 cases of advanced cirrhosis with portal hypertension. The success rate of TIPS was 94.62%. The complication rate of TIPS was 16.15%, of which, 4.62% was TIPS procedure related including intraabdominal or intratheoracic bleeding and rebleeding of esophageal varices. The complication rate related to portosystemic shunt was 11.54% and the complications included encephalopathy and acute hepatic failure. The mortality of TIPS was 3.08% within one month following TIPS. 2.31% of patients died of hepatic failure and 0.77% died of rebleeding of varices.

Management of Labbé's vein in operations of cerebellar pons angle (CPA) and clivus regions was reported. Ligation of the Labbé's vein in the left side resulted in hematoma in the temporal lobe or aphasia. In preservation of Labbé's vein, either on the left or right side, only one case of intracerebral hematoma occurred. The reason for this difference was discussed. In protecting Labbé's vein, continuous ventricular draining and removal of the inferior temporal gyrus if necessary was effective.