Objective To investigate the effectiveness of autologous nano-fat mixed granule fat transplantation in the treatment of facial soft tissue dysplasia in children with mild hemifacial microsomia (HFM). Methods A total of 24 children with Pruzansky-Kaban type Ⅰ HFM were admitted between July 2016 and December 2020. Among them, 12 children were treated with autologous nano-fat mixed granule fat (1∶1) transplantation as study group and 12 with autologous granule fat transplantation as control group. There was no significant difference in gender, age, and affected side between groups (P>0.05). The child’s face was divided into region Ⅰ(mental point-mandibular angle-oral angle), region Ⅱ (mandibular angle-earlobe-lateral border of the nasal alar-oral angle), region Ⅲ (earlobe-lateral border of the nasal alar-inner canthus-foot of ear wheel). Based on the preoperative maxillofacial CT scan+three-dimensional reconstruction data, the differences of soft tissue volume between the healthy and affected sides in the 3 regions were calculated by Mimics software to determine the amount of autologous fat extraction or grafting. The distances between mandibular angle and oral angle (mandibular angle-oral angle), between mandibular angle and outer canthus (mandibular angle-outer canthus), and between earlobe and lateral border of the nasal alar (earlobe-lateral border of the nasal alar), and the soft tissue volumes in regions Ⅰ, Ⅱ, and Ⅲ of healthy and affected sides were measured at 1 day before operation and 1 year after operation. The differences between healthy and affected sides of the above indicators were calculated as the evaluation indexes for statistical analysis. At 1 year after operation, the parents, the surgeons, and the nurses in the operation group made a self-assessment of satisfaction according to the frontal photos of the children before and after operation. Results The study group and the control group were injected with (28.61±8.59) and (29.33±8.08) mL of fat respectively, with no significant difference (t=0.204, P=0.840). After injection, 1 child in the control group had a little subcutaneous induration, and no related complications occurred in the others. All children in both groups were followed up 1 year to 1 year and 6 months, with an average of 1 year and 4 months in the study group and 1 year and 3 months in the control group. At 1 year after operation, the asymmetry of the healthy and affected sides improved in both groups; the satisfactions of parents, surgeons, and nurses in the study group were all 100% (12/12), while those of the control group were 100% (12/12), 83% (10/12), and 92% (11/12), respectively. The differences between healthy and affected sides in mandibular angle-oral angle, mandibular angle-outer canthus, earlobe-lateral border of the nasal alar, and the soft tissue volume in 3 regions of the two groups after operation were significantly smaller than those before operation (P<0.05). There was no significant difference in the above indexes between the two groups before operation (P>0.05). After operation, all indexes were significantly lower in study group than in control group (P<0.05). Conclusion Autologous nano-fat mixed granule fat transplantation and autologous granule fat transplantation can both improve the facial soft tissue dysplasia in children with mild HFM, and the former is better than the latter.
ObjectiveTo summarize the progress of associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) and evolution of surgical procedure improvement, so as to summarize experience in selecting appropriate surgical method for patients. MethodThe domestic and foreign literature on the evolution of ALPPS surgical procedure improvement in recent years was reviewed. ResultsIn the decade since the emergence of ALPPS, the ALPPS had been rapidly developed in the hepatobiliary surgery. The ALPPS promoted a rapid increase in future liver remnant during a relatively shorter period to contribute to resectability of liver tumors and reduce the rate of postoperative liver failure, the patients with intermediate to advanced and huge liver cancer could obtain the surgical radical resection. In recent years, the domestic and foreign experts had refined the ALPPS procedure, which mainly focused on the operation of hepatic section separation and hepatic artery flow restriction in stage Ⅰ surgery, including partial ALPPS, radiofrequency ablation ALPPS, tourniquet ALPPS, transcatheter arterial embolization ALPPS, hepatic artery ringed and operation ALPPS, as well as laparoscopic ALPPS and robotic ALPPS with minimally invasive approach. ConclusionsDespite the ongoing controversy over ALPPS, with the continuous progress and innovation of improved procedures and the utilization of laparoscope and robot in surgery, the trauma of ALPPS surgery has a further reduction, and the morbidity and mortality have gradually been decreased. It is believed that with the continuous advancement and improvement of ALPPS surgery technology, the indications and safety of ALPPS will be further enhanced, bringing hope to more patients with intermediate to advanced liver cancer with huge tumors.
ObjectiveTo summarize experiences of diagnosis and treatment of intraperitoneal mass after associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) in treatment of hepatocellular carcinoma (HCC).MethodThe clinicopathologic data of a 40 years old case of HCC with intraperitoneal mass after ALPPS in the First Affiliated Hospital of Guangxi Medical University were retrospectively analyzed.ResultsThe patient was admitted to this hospital because of abdominal pain and abdominal distension for 5 d. The intraperitoneal mass was found and its nature was not clear on year 1 after ALPPS on admission. After discussion of multidisciplinary team (MDT), the exploratory laparotomy and abdominal tumor resection were planned to perform. The intraperitoneal mass and appendix were removed, the resected tissues were diagnosed as chronic inflammation and retroperitoneal abscess caused by perforation of suppurative appendicitis, respectively. The anti-infection and symptomatic support treatment were strengthened to perform after operation, the patient discharged after recovery. The patient was followed up so far, the general condition was good, and there was no clinical recurrence.ConclusionsFor patient underwent ALPPS, regular follow-up should be paid attention to. If intraperitoneal mass is found and nature is not clear, MDT discussion should be performed so as to make a more reasonable treatment plan. After exclusion of contraindications, surgical treatment should be carried out to furthest benefit patients.
ObjectiveTo explore the influencing factors of cancer-specific survival of patients with large hepatocellular carcinoma, and draw a nomogram to predict the cancer-specific survival rate of large hepatocellular carcinoma patients.MethodsThe clinicopathological data of patients with large hepatocellular carcinoma during the period from 1975 to 2017 in the Surveillance, Epidemiology, and End Results (SEER) database were searched and randomly divided into training group and validation group at 1∶1. Using the training data, the Cox proportional hazard regression model was used to explore the influencing factors of cancer-specific survival and construct the nomogram; finally, the receiver operating characteristic curve (ROC curve) and the calibration curve were drawn to verify the nomogram internally and externally.ResultsThe results of the multivariate Cox proportional hazard regression model showed that the degree of liver cirrhosis, tumor differentiation, tumor diameter, T stage, M stage, surgery, and chemotherapy were independent influencing factors that affect the specific survival of patients with large hepatocellular carcinoma (P<0.05), and then these factors were enrolled into the nomogram of the prediction model. The areas under the 1, 3, and 5-year curves of the training group were 0.800, 0.827, and 0.814, respectively; the areas under the 1, 3, and 5-year curves of the validation group were 0.800, 0.824, and 0.801, respectively. The C index of the training group was 0.779, and the verification group was 0.777. The calibration curve of the training group and the verification group was close to the ideal curve of the actual situation.ConclusionThe nomogram of the prediction model drawn in this study can be used to predict the specific survival of patients with large hepatocellular carcinoma in the clinic.