ObjectiveTo explore the curative effect of precise hepatectomy techniques in hepatolithus. MethodsTotally 132 patients underwent precise hepatectomy and 52 patients underwent irregular hepatectomy were retrospectively analyzed, and the intraoperative and postoperative indexes such as operation time, blood loss, postoperative complications, hospitalization time, clearance rate of calculus, and cost of hospitalization were analyzed. ResultsCompared with the patients in irregular hepatectomy group, although the operative time was longer in precise hepatectomy group 〔(364.6±57.8) min vs. (292.9±44.7) min, Plt;0.001〕, but the patients in precise hepatectomy group had less blood loss 〔(558.3±90.6) ml vs. (726.7±88.7) ml, Plt;0.001〕, less postoperative complications (11.4% vs. 23.1%，P=0.004 3), and higher clearance rate of calculus (89.4% vs. 73.1%, P=0.005 5). Thus, the patients in precise hepatectomy group had shorter hospital stay 〔(22.9±4.4) d vs. (28.8±3.5) d, Plt;0.001〕 and less cost of hospitalization 〔(1.8±0.7)×104 yuan vs. (2.1±0.9)×104 yuan, P=0.016 5〕. Conclusion Precise hepatectomy is better than irregular hepatectomy in treatment for hepatolithus.
Objective To explore the safety and feasibility of using modified Glisson pedicle transection methodin the precise hepatectomy of hepatocellular carcinoma （HCC）. Methods Sixty patients with HCC， which confirmed by postoperational pathology were admitted in the study. During the surgery of experimental group （Glisson group）， the segment pedicle were transected firstly using modified Glisson pedicle transection method. Then， the liver parenchyma was split follow the hepatic vein guided by intraoperative ultrasound. During the surgery of contrast group （Prigle group），the liver parenchyma was split using ultracision harmonic scalpel under intermittent pringle clamping of hilar. Results There were no significant difference in the amount of intraoperative bleeding， blood transfusion， as well as duration of surgery， serum alanine aminotransferase， total bilirubin， and length of hospital stay between the two groups （P＞0.05）. However， the incidence of postoperative complication was lower in Glisson group （23.3% vs. 50.0%， P＜0.05）. In addition， the length of tumor margin was more favorable in Glisson group 〔（2.3±0.7） cm vs. （1.5±0.6） cm， P＜0.05〕. The recurrence rate of Glisson group was lower than that Prigle group， but was not different significantly （P＞0.05）. Conclusions The modified Glisson pedicle transection method has the same safety as traditional method in the precise hepatectomy of HCC. And it has the advantages in lower postoperative complication and more favorable tumor margin， which may reduce the recurrence rate theoretically.
ObjectiveTo evaluate the feasibility and accuracy of a novel three dimensional (3D) preoperative simulation software in a clinical setting for patients undergoing precise hepatectomy. MethodsThe clinical data of 85 patients with hepatocellular carcinoma underwent precise hepatectomy were retrospectively studied. All the patients received CT screening and subsequent evaluation on the liver resection volume and margin and the percentage of resected tumor by 3D preoperative simulation software, which compared with the actual resection liver values. The operation plan was optimized by virtual hepatectomy. ResultsThe liver, tumor as well as blood vessel could be clearly showed and reconstructed by 3D preoperative simulation software. All the patients underwent precise hepatectomy. After operation ascites occurred in 3 patients on 2 d, moderate pleural effusion occurred in 2 patients on 2 d, and bile leakage appeared in 4 patients on 5 d, which were improved by conservative treatment. The length of stay in all patients ranged from 6 to 88 d (mean 23 d), and no recurrence and death occurred within 30 d of operation. The predicted resection liver volume was significantly correlated with the actual resection volume (r=0.960, Plt;0.001), and the difference between the mean volume of predicted and actual resection liver was not significant (896.7 ml vs. 819.1 ml， t=1.851, P=0.068). In addition, the predicted resection margin was also correlated with the actual resection margin (r=0.972, Plt;0.001), with the difference in the mean resection margin was not significant too (12.2 mm vs. 11.9 mm， t=1.143, P=0.256). No patients suffered from severe postoperative complications. ConclusionsThe 3D preoperative simulation software is able to evaluate and simulate liver resection accurately, which may contribute to a safe precise hepatectomy plan.
Objective To assess the value of precise hepatectomy in treatment of primary hepatocellular carcinoma. Methods Three-dimensional (3D) models from MR image were reconstructed by 3D-Doctor software in 32 patients with primary hepatocellular carcinoma scheduled for liver resection between July 2007 and Sept 2009. From these 3D models, the vena cava, portal vein, hepatic vein, and short hepatic vein images were reconstructed, total liver volume, tumor volume, functional liver volume and ratio of functional liver volume to standard liver volume (SFLVR) were calculated. The patients were followed-up for 1-27 months, with an average of 12 months. Results The anatomic detail of liver veins and its relationship with the tumor could be displayed clearly in liver 3D models. By the 3D models, total liver volume was calculated as （1 353±419）ml, tumor volume as （287±248） ml, functional liver volume as （830±289） ml, and SFLVR as （71±22）%. Of 32 patients with hepatocellular carcinoma, right hemihepatectomy was performed in 8 cases, left hemihepatectomy in 2, and segmental or limited resection in 22. All operations were completed successfully. Postoperative complications included pulmonary infection in 1 case, bile leak in 1, moderate ascites (500-3 000 ml) in 8, and massive ascites (gt;3 000 ml) in 2 including one patient developed hepatic failure. Six and 12-month survival rates were 100% and 87%. Three, 6, and 12-month disease-free survival rates were 78%, 72%, and 72%. Conclusions Precise hepatectomy technique provides an accurate picture of liver veins anatomy and its relationship with the tumor， and allows the procedure to be simulated preoperatively for adequate and safe hepatectomy.
ObjectiveTo investigate the value of computer assisted radiology and surgery solutions system (IQQA-Liver) in surgical planning for precise hepatectomy. MethodsThe clinical data of 95 cases performed precise hepatec-tomy from January 1, 2012 to June 30, 2013 in our hospital were retrospectively analyzed, and the computer assisted radiology and surgery solutions system was used for three dimensional quantitative analysis, volume measurement and designing for liver resection in all the cases before operation. ResultsThe intuitive and clear three dimensional images of all the 95 cases were obtained by using the computer assisted radiology and surgery solutions system, which could show the precise anatomical relationship of the liver, tumor, and main hepatic vascular.The three dimensional images could be observed at any angle and rotated freely, and could show the involved and needed to be resected vascular away from the tumor margin for 2 mm, 5 mm, 10 mm, and 20 mm and the liver volume dominated by this vascular.Of all the 95 cases, the total liver volume was (1 776.4±998.5) cm3, the proposed removed liver volume was (1 026.2±811.5) cm3, the functional residual liver volume was (795.3±522.6) cm3.The ratio of functional residual liver volume to the standard total liver volume was (58.2±25.1)%, which the ratio of patients without cirrhosis was > 30% and with cirrhosis was > 40%.All the 95 cases were implemented precise operation.The operation plan was designed based on a combination of factors such as the amount of functional residual liver volume and function.The surgery programs were changed for 13 cases, in which 9 cases were narrowed the scope of resection and 4 cases were expanded the scope of resection.No patients died perioperation. ConclusionBy using the computer assisted radiology and surgery solutions system (IQQA-Liver), we could precisely locate liver tumor, calculate the functional residual liver volume, identify the relationship between tumor and adjacent vascular, and ultimately help to design the optimal surgical plan.
Objective To summarize the development of process and clinical practice for radiomics. Methods Relevant literatures about the development of process and clinical practice of radiomics were collected to make a review. Results Radiomics, which resulting from big data, had been used in diagnosis, assessment of prognosis, and predictionof therapy response for neoplasm. Conclusion Radiomics is an important part of precision medical imaging in the eraof big data.
Abstract Precision medicine is an ideal medical paradigm which combines modern scientific methods with traditional medical methods to diagnose, treat and evaluate the physical function and nature of diseases more precisely, and to maximize health benefits and minimize the risk of individuals and society with the most effective, safest, and the most economical medical service. Evidence-based medicine is necessary to verify the precision of diagnosis and treatment. In this review, we clarified the conception of precision medicine and the relation between precision medicine and evidence-based medicine. Moreover, we reviewed the application of precision medicine in the field of cerebrovascular disease. We pointed out that such new technologies as genetics, bioinformatics, molecular imaging and management provided tools to realize the idea of precision medicine, and high-quality evidence-based studies provided a guarantee for the clinical practice of precision medicine. In summary, precision medicine is an individualized medical mode that based on the context of a patient's genetic information, living environment and clinical data, etc. to provide precise treatment strategies for the prevention and treatment of disease, but still the promotion of precision medicine should be based on clinical validation under the guidance of evidence-based medicine. Thus, long-term exploration and unremitting efforts are required to achieve the idea of precision medicine.
ObjectiveTo summarize current patient-derived organoids as preclinical cancer models, and its potential clinical application prospects. MethodsCurrent patient-derived organoids as preclinical cancer models were reviewed according to the results searched from PubMed database. In addition, how cancer-derived human tumor organoids of pancreatic cancer could facilitate the precision cancer medicine were discussed. ResultsThe cancer-derived human tumor organoids show great promise as a tool for precision medicine of pancreatic cancer, with potential applications for oncogene modeling, gene discovery and chemosensitivity studies. ConclusionThe cancer-derived human tumor organoids can be used as a tool for precision medicine of pancreatic cancer.
Objective To explore the feasibility and the effectiveness of the accurate placement of lumbar pedicle screws using three-dimensional (3D) printing navigational templates in Quadrant minimally invasive system. Methods The L1-5 spines of 12 adult cadavers were scanned using CT. The 3D models of the lumbar spines were established. The screw trajectory was designed to pass through the central axis of the pedicle by using Mimics software. The navigational template was designed and 3D-printed according to the bony surface where the soft tissues could be removed. The placed screws were scanned using CT to create the 3D model again after operation. The 3D models of the designed trajectory and the placed screws were registered to evaluate the placed screws coincidence rate. Between November 2014 and November 2015, 31 patients with lumbar instability accepted surgery assisted with 3D-printing navigation module under Quadrant minimally invasive system. There were 14 males and 17 females, aged from 42 to 60 years, with an average of 45.2 years. The disease duration was 6-13 months (mean, 8.8 months). Single segment was involved in 15 cases, two segments in 13 cases, and three segments in 3 cases. Preoperative visual analogue scale (VAS) was 7.59±1.04; Oswestry disability index (ODI) was 76.21±5.82; and the Japanese Orthopaedic Association (JOA) score was 9.21±1.64. Results A total of 120 screws were placed in 12 cadavers specimens. The coincidence rate of placed screw was 100%. A total of 162 screws were implanted in 31 patients. The operation time was 65-147 minutes (mean, 102.23 minutes); the intraoperative blood loss was 50-116 mL (mean, 78.20 mL); and the intraoperative radiation exposure time was 8-54 seconds (mean, 42 seconds). At 3-7 days after operation, CT showed that the coincidence rate of the placed screws was 98.15% (159/162). At 4 weeks after operation, VAS, ODI, and JOA score were 2.24±0.80, 29.17±2.50, and 23.43±1.14 respectively, showing significant differences when compared with preoperative ones (t=14.842,P=0.006;t=36.927,P=0.002;t=–36.031,P=0.001). Thirty-one patients were followed up 8-24 months (mean, 18.7 months). All incision healed by first intention, and no complication occurred. During the follow-up, X-ray film and CT showed that pedicle screw was accurately placed without loosening or breakage, and with good fusion of intervertebral bone graft. Conclusion 3D-printing navigational templates in Quadrant minimally invasive system can help lumbar surgery gain minimal invasion, less radiation, and accurate placement.