Surgical management of incidental gallbladder cancer discovered during or after laparoscopic cholecystectomy / 中华外科杂志

<p><b>OBJECTIVE</b>To analyze the surgical management of incidental gallbladder cancer (IGBC) discovered during or after laparoscopic cholecystectomy (LC) and to evaluate the associated factors of survival.</p><p><b>METHODS</b>A retrospective analysis of patients with IGBC between January 2002 and December 2013 was performed. A total of 10 080 consecutive patients underwent LC operation for presumed gallbladder benign disease in Chinese People's Liberation Army General hospital. And among them, 83 patients were histologically diagnosed as IGBC. Data covering clinical characteristics, surgery records, local pathological stage, histological features and factors for long term survival were reviewed. The survival analysis was performed using Kaplan-Meier method, and the results were examined using the log-rank test.For multivariate statistical analyses of prognostic factors, a Cox proportional hazards model was carried out.</p><p><b>RESULTS</b>A total of 83 patients with IGBC:68.7% females (57/83), median age of 61 years (range 34-83 years). There were 47 cases accepted the initial simple LC, 18 cases converted to open extended radical cholecystectomy, 16 cases with radical second resection, and 2 cases with re-laparotomy; the 5-year survival rates for each group were 89.4%, 38.9%, 87.5%, and 0, respectively. The 5-year survival rates in T1a, T1b, T2, and T3 stage patients were 95.7% (22/23), 90.0% (18/20), 75.0% (15/20), and 40.0% (8/20), respectively. Univariate analysis for prognostic factors associated with cancer-specific death showed that depth of invasion, lymph-node status, vascular or neural invasion, tumor differentiation, extent of resection, bile spillage during prior LC and type of surgery were statistically significant.In multivariate analysis, depth of invasion, extent of resection and bile spillage were the most important prognostic factors related to both cancer-specific mortality and disease relapse (P < 0.05).</p><p><b>CONCLUSIONS</b>Simple LC is appropriate for T1a patients with clear margin and unbroken gallbladder. An extended radical resection in patients with T1b or more is highly recommended, and provided as a potentially curative R0 resection only if it is necessary.</p>

Risk factors of delayed gastric emptying after pancreaticoduodenectomy / 中华肝胆外科杂志

Objective To study the risk factors of delayed gastric emptying (DGE) after pancreaticoduodenectomy (PD).Methods Between Ja(n)uary 1st 2013 and December 31st 2013,data from 196 consecutive patients who underwent PD at the Chinese PLA General Hospital were studied retrospectively.17 factors were examined.Univariate analysis and multivariate logistic regression analysis were used to determine the relative risks.Results DGE occurred in 71 patients (36.2％).The incidences of grade A,grade B and grade C DGE were 22.4％ (44/196),6.1％ (12/196) and 7.7％ (15/196) respectively.There were three postoperative deaths.The overall mortality rate was 1.5％.BMI,Braun anastomosis,clinically relevant postoperative pancreatic fistula (CR-POPF) and intra-abdominal collection were significantly correlated with DGE on univariate analyses.BMI ≥25 kg/m2,CR-POPF,and intra-abdominal collection were independent risk factors on univariate and multivariate regression analyses.Conclusions Post-operative complications were associated with DGE.Early diagnosis and timely treatment for pancreatic fistula and abdominal collection were helpful to decrease morbidity and to promote recovery of DGE.

Variations in serum level of cytokines associated with vascular endothelial cells before and after treatment with either TACE or liver resection in patients with hepatocellular carcinoma / 中华肝胆外科杂志

ObjectiveTo determine the serum levels of cytokines associated with vascular endothelial cells before and after treatment with either transcatheter arterial chemoembolization (TACE) or partial hepatectomy in patients with hepatocellular carcinoma (HCC).MethodsThere were 30 patients who received partial hepatectomy (the operation group) and 30 patients who received TACE (the TACE group).Cytokines were measured before and after treatment.ResultsThe serum levels of IL-1β,IL-6,IL-8,VEGF and EGF of the post-TACE patients were significantly lower than the pre-TACE patients.The serum levels of IL-10,IFNγ and TNFα of the post-TACE patients were significantly higher than the pre-TACE patients.The serum levels of IL-1β,IL-6.IL-8,VEGF and EGF in the postoperative patients were significantly lower than the post-TACE patients.The serum levels of IL-10,IFNγ and TNFα of the postoperative patients were significantly higher than the post-TACE patients.ConclusionThe results suggested that the serum levels of angiogenic factors in the postTACE patients were significantly higher than the postoperative patients.The serum levels of the inhibitors of vascular endothelial cells of the post-TACE patients were significantly lower than the postoperative patients.

Choledochoplasty for major bile duct defect in Mirizzi syndrome / 中华肝胆外科杂志

ObjectiveTo evaluate the various methods of choledochoplasty in the repair of major bile duct defects in Mirizzi syndrome.MethodsThis is a retrospective study on 3 patient with Mirizzi syndrome with a large bile duct defect.These defects were repaired by using a vascular gastric pedicle patch in our department from July 2008 to November 2011.The authors searched the domestic medical literature on surgical repair for Mirizzi syndrome in the past ten years.The patients were treated by various surgical methods,and they were analyzed according to the Csendes Classification.ResultsThere were no surgical complications in our three patients.There was one patient with a Csendes type Ⅲ,while the remaining 2 patients were with Csendes type Ⅳ.At a median follow- up of 2.5 years,no patient developed signs of chronic cholangitis.In the medical literature,there were 93 patients who were with Csendes type Ⅰ ; and 58 patients were treated by cholecystectomy only,while 35 patients were treated by partial cholecystectomy plus mucosal ablation.Of the 40 patients with type Ⅱ,29 patients were treated by direct fistula repair,9 patients by pedicle gallbladder flap and 2 patients by pedicle round ligament.Of the 20 patients with type Ⅲ,9 patients were treated by pedicle gallbladder flap.1 patient by pedicle round ligament,3 patients by pedicle gastric flap and 7 patients by Rouxen- Y hepaticojejunostomy.For the 5 patients with type Ⅳ,they were treated by Roux-en- Y hepaticojejunostomy.Of these 159 patients,postoperative complications included biliary fistula (n=1 ),upper gastrointestinal bleeding (n=1),and biliary stricture (n=1).All the remaining patients were cured.ConclusionIn patients with Mirizzi Syndrome,the choice of treatment depends on the size of the fistula.For patient with a major tissue defect in the common hepatic duct,a pedicle vascular gastric flap is a good treatment.

The serum levels of cytokines associated with vascular endothelial cells in preoperative and postoperative patients with hepatocarcinoma / 中华肝胆外科杂志

Objective To determine the serum levels of cytokine IL-1α, IL-1β, IL-2, IL-4, IL-6, IL-8, IL-10, VEGF, IFNγ, EGF, MCP-1 and TNFα in preoperative and postoperative patients with hepatocarcinoma(HCC). Methods 30 patients with hepatocirrhosis were taken as hepatocirrho-sis group; 30 normal health examiners were taken as the normal control group. 30 patients with hepatocarcinoma were taken as HCC group; 30 patients with hepatic hemangioma were taken as the control group. Cytokines had been measured by biochips methods in evidence 180 automatic biochips analyze.Results The serum levels of IL-1β, IL-6, IL-8, VEGF and EGF of the patient with HCC and cirrhosis were significantly higher than those in normal control group. The serum levels of IL-10, IFNγand TNFα of the patient with HCC and cirrhosis were significantly lower than those in normal control group. The serum levels of IL-1β, IL-6, IL-8, VEGF and EGF of the preoperative patient with HCC were significantly higher than those in the postoperative patient with HCC. The serum levels of IL-10,IFNγ and TNFa of the preoperative patient with HCC were significantly lower than those in the postoperative patient with HCC. Conclusions These results suggest that the serum levels of angiogenic factors in HCC were increased. The serum levels of the inhibitors of vascular endothelial cells in HCC were decreased. The serum levels of angiogenic factors in the postoperative patient with HCC were decreased. The serum levels of inhibitors of vascular endothelial cells in the postoperative patient with HCC were increased.

Targeting~(131)I labeled monoclonal antibody against vascular endothelial cells for treatment of hepatocarcinoma / 解放军医学杂志

Objective To study the possibility of targeting endothelial cells with the 131I labeled monoclonal antibody (mAb) for the treatment of hepatocarcinoma. Methods An animal model of human hepatocarcinoma in nude mice was reproduced, and tumor inhibiting activity of the 131I labeled mAb was tested. 30 nude mice with hepatocarcinoma were randomly divided into 3 groups: in group A the mice were treated with mAb 200?g/200?l twice a week; group B mice were treated with the 131I labeled mAb 200?g/200?l twice a week; control group mice were given normal saline in equal volume. Tumor growth in mice was observed. After the mice were sacrificed, the tumor was histologically examined and the intra-tumor microvessel density (TMVD) recorded. Results The tumor growth inhibition effect in mice treated with mAb was 74.55%. This effect was enhanced when treated with the 131I labeled mAb, as evidenced by an increase of tumor growth inhibition rate to 86.36%. Pathologically, Massive necrosis of tumor cells around the degenerated vessels was observed in the mAb treated mice. TMVD was significantly lower in the mAb treated mice than that in the untreated mice (P

Laparoscopic anatomical resection of left lateral liver / 中国普通外科杂志

Objective To evaluate the feasibility of and indications for laparoscopic left lateral hepatectomy. Methods The candidates for laparoscopic left lateral lobectomy were 7 cases with liver lesions including 2 cases of primary liver cancer,5 cases of liver hemangioma. Results These patients underwent laparoscopic hepatectomy uneventfully. The operation time averaged at 210 min. The blood loss in operation averaged at 700 ml. The postoperative hospital stay averaged at 5.7 days. No complications occurred. Conclusion Based on these preliminary results, we conclude that laparoscopic anatomical left lateral lobectomy can be carried out safely and effectively by a surgeon with the sufficient expertise of laparoscopy and hepatobiliary surgery.