2019年 · 第57卷第06期

At present, many international articles have reported prostate cancer^[1]kidney cancer^[2]urothelial carcinoma,^[3]The related data of gene mutation profiles, based on the detection of gene mutations in urinary system tumors in Chinese people, have also been reported in relevant literatures^[4,5,6]。 The results of gene mutation detection in the real world and how it affects the actual clinical operation are the problems that clinicians are concerned about. We summarized and analyzed the single-center gene mutation information collected by the urology department of our hospital in the past 1 year, and the results are reported below.

Lung transplantation is one of the effective methods for the treatment of end-stage lung disease. Due to the limitation of cold preservation time and marginal donor lung application, lung transplantation is far less developed than liver and kidney transplantation. The application of ex vivo lung perfusion (EVLP) can make the donor lung under physiological conditions, which is beneficial to alleviate the cold ischemic injury of the donor lung, and at the same time, it can evaluate and repair the lung function. In foreign countries, isolated normal temperature perfusion is widely used before transplantation of liver, lung and other organs, and has achieved good results^[1,2]。 In China, EVLP has not been carried out systematically. In order to provide a system platform for future research, we used the self-designed lung isolated normal temperature perfusion system to perform EVLP on the donor lung after cold preservation.

Postoperative infection is the most common nosocomial infectious disease in China^[1]。 Common postoperative infections include surgical site infection (SSI), catheter-related bloodstream infection, pneumonia and urinary tract infection, among which SSI has the highest incidence. SSI includes incisional superficial SSI, incisional deep SSI and organ and lacunar SSI.

The patient was a 56-year-old male whose right liver occupied space for 1 month on physical examination. Forty years ago, the patient suffered from hepatitis B and was treated regularly. Laboratory tests: HBsAg (+); Alpha-fetoprotein 816.59 μ g/L. Preoperative enhanced abdominal CT scan and MRI showed that the 4th, 5th and 8th segments of the liver occupied space, which was considered as malignant tumor. Preoperative liver function Child-P μ gh grade A, indocyanine green 15 min retention rate 10.5%. Preoperative diagnosis: 1. Right liver occupation: primary liver cancer (BCLC stage: A1); 2. Chronic hepatitis B virus. Laparoscopic fluorescence-guided resection of 4+5 and 8 ventral subsegments of the liver is proposed. Fluorescent masses (indocyanine green clearance test and tumor development 48 h before surgery) were observed in the 4th, 5th and 8th segments of the liver, with a size of about 5.0 cm ×4.0 cm. During the operation, the liver was free, the hepatic hilum was intermittently blocked (15+5 mode), the liver parenchyma was incised on the right side of the sagittal part of the left Glisson sheath, and four segments of Glisson branches were ligated and severed. This incision was extended to the right side, close to the ventral side of the hepatic hilum plate, and the ventral side of the right anterior Glisson sheath was incised. 2 ml (2.5 g/L) of indocyanine green dilution was injected into the peripheral vein to counter-stain the liver, and the resection plane was drawn on the liver according to the staining boundary. Four left plane cuts were performed along the fluorescence staining plane from caudal to cephalic to the second hepatic hilum, at the entry point of the anterior cleft vein of the second hepatic hilum, away from the severed middle hepatic vein. Fifth and eighth ventral subsegments were cut from cephalic side to caudal side along the anterior fissured vein, and the whole course of anterior fissured vein was exposed. After the specimen was dissected, the liver section was examined for bile leakage under fluorescence laparoscopy and sutured. Fluorescence imaging showed the tumor well, the effect of reverse staining of the diaphragm surface was better than that of the dirty surface, and the bile leakage test was positive. The patient got out of bed 2 days after surgery, removed the abdominal drainage tube 5 days after surgery, and was discharged 6 days after surgery. Pathological results: (1) Massive-beam-cord hepatocellular carcinoma grade III, the mass size is 5.0 cm ×4.0 cm ×1.6 cm, the carcinoma tissue invades the liver capsule, no satellite nodules are seen, and the liver resection margin is clear; (2) Microvascular invasion of M1; (3) Grade and stage of chronic liver disease: G2/S2; (4) Chronic cholecystitis; (5) Pathological stage IIIA (T3N0M0IIIa).