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Objective:To explore the effect of repetitive transcranial magnetic stimulation (rTMS) combined with cognitive behavioral therapies (CBT) on the cognitive function and alcohol craving in patients with alcohol dependence.Methods:From March 2019 to September 2021, a total of 150 patients with alcohol dependence were enrolled and randomly divided into rTMS treatment group (rTMS+ sham CBT, n=41), CBT treatment group (CBT+ sham rTMS, n=34), rTMS+ CBT treatment group( n=36) and control group (sham rTMS+ sham CBT, n=39). At baseline (before treatment), 2nd week, 8th week, 12th week and 24th week, alcohol dependence scale (ADS) was used to evaluate the degree of alcohol dependence, the obsessive compulsive drinking scale (OCDS) was used to assess patients' drinking craving, and Montreal cognitive assessment scale (MoCA) was used to assess the overall cognitive level of patients.SPSS 23.0 statistical software was used to compare the differences of ADS, OCDS and MoCA scale scores of the four groups by repeated measure ANOVA and simple effect analysis. Results:(1)The patients in the four groups were evaluated with ADS scale at baseline, 12th week and 24th week respectively.The interaction of group×time( F=1.279, P=0.279) and the main effect of group were not significant ( F=0.882, P=0.454), and the main effect of time was significant ( F=12.925, P<0.001) .Further simple effect analysis showed that the ADS score of rTMS+ CBT group was lower than that of baseline(14.48±5.70, 10.00±6.51) ( P=0.01) at 24th week.(2)Patients in the four groups were assessed with OCDs scale at baseline, 2nd week, 8th week, 12th week and 24th week, and the interaction of group×time was significant ( F=2.015, P=0.042). Further simple effect analysis showed that the OCDs scores of rTMS group and rTMS+ CBT group at each follow-up time node were lower than those at baseline period (all P<0.05). (3)Patients in the four groups were assessed with MoCA scale at baseline, 8th week, 12th week and 24th week, and the interaction of group×time was not significant ( F=1.660, P=0.106), and the main effect of group and the main effect of time were significant ( F=2.964, P=0.038; F=14.239, P<0.001). Further simple effect analysis showed that the score of MoCA scale in CBT group at the 24th week was higher than that at baseline (21.73±5.81, 24.60±3.98)( P=0.029), the score of MoCA scale in rTMS+ CBT group at the 24th week was higher than that at the 8th week (23.50±6.01, 25.95±2.87) ( P=0.006), and the score of MoCA scale in rTMS group at the 12th week was higher than that in control group (22.08±6.64, 26.64±2.46)( P=0.009). Conclusion:rTMS combined with CBT can be effective in improving alcohol craving and cognitive function in patients with alcohol dependence, and has a good long-term effect.
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Objective To analyze the curative effect and prognosis of pancreatic ductal stone treated by pancreatectomy,pancreatic duct drainage or combined procedures.Methods The clinical data of 296 pancreatic ductal stone patients who received surgical treatment in First Affiliated Hospital of the Army Medical University between January 2008 and June 2017 were retrospectively analyzed.The cases were divided into pancreatectomy group (162 cases),pancreatic duct drainage group (104 cases) and combined procedures group (30 cases) according to their surgical procedures.The clinical characteristics and short-term and longterm outcomes of surgical treatment between the three groups were analyzed.Kaplan-Meier method was used to estimate the survival rate of no recurrence of pain after operation.Log-rank test and Cox-proportional hazard model were used to analyze the influencing factors on the recurrent pain free survival after surgery.Results The ratio of male patients was highest in pancreatectomy group,and the incidence of pancreatic exocrine insufficiency was highest in pancreatic duct drainage group.Of 296 patients,Ⅰ type pancreatic stone was most in pancreatectomy group and combined procedures group (80.2％,70.0％),and Ⅲ type pancreatic stone was most in pancreatic duct drainage group (46.2％).Medium size pancreatic stone was most in pancreatectomy group (52.5％),and medium and large size pancreatic stone was most in pancreatic duct drainage group (80.8％).Obvious pancreatic atrophy was most in pancreatic duct drainage group.Pancreatic head swelling,bile ductal dilation or compression,combined with pancreatic or surrounding organ complications were most in pancreatectomy,and all the differences were statistically significant (all P ＜ 0.05).In the short-term effect,the overall rate of pain relief was 99.3％,and there was no statistical difference among three groups.Pancreatic duct drainage group was superior to the other two groups in terms of operative time,bleeding volume,postoperative hospitalization days and postoperative complications (all P ＜0.05),but the total incidence of residual stones after operation in drainage group (64.8％) was higher than that in the other two groups,and the difference was statistically significant (all P ＜ 0.05).In the long-term effect,there were no significant differences in pain recurrence,stone recurrence reoperation,postoperative pancreatic function,body weight and quality of life recovery among the three groups.The 1-year,3-year and 5-year no recurrent pain after operation was 89.0％,79.2％ and 68.9％,respectively.Univariate and multivariate analysis showed that the course of CP ≥5 years(HR =2.113,95％ CI 1.160-3.848,P=0.014) and postoperative long-term alcohol consumption (HR =1.971,95％ CI 1.073-3.620,P =0.029) were independent risk factors affecting pain recurrence after surgery.Conclusions Surgery is still an important means for the treatment of pancreatic ductal stone.The short-term and long-term effect of pancreatectomy,pancreatic duct drainage and combined procedures for pancreatic ductal stones are definitely effective.However,none of the three methods can prevent the continued loss of pancreatic function in some patients.According to the preoperative clinical features,surgery strategy should be formulated individually,and the postoperative health guidance and follow-up should be emphasized,which can help to improve the prognosis of the patients with pancreatic ductal stones.
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Objective To investigate the risk factors of pancreatic ductal stones (PDS) combined with malignant tumor beside stones.Methods The retrospective case control study was conducted.The clinicopathological data of 190 patients with PDS who underwent surgical treatment at the First Affiliated Hospital of Army Medical University (Third Military Medical University) between January 2008 and June 2017 were collected.Of 190 patients,175 and 15 were detected PDS complicated with chronic pancreatitis and malignant tumor beside stones respectively.Observation indicators:(1) risk factors analysis of PDS combined with malignant tumor beside stones;(2) follow-up and survival situations.Follow-up using outpatient examination and telephone interview was done to detect treatment of patients who had PDS combined with malignant tumor beside stones and postoperative survival up to December 2017.Univariate analysis was done by chi-square test,Fisher exact probability or rank sum test,and multivariate analysis was done using Logistic regression model.The survival curve was drawn and survival rate was calculated by Kaplan-Meier method.Results (1) Risk factors analysis of PDS combined with malignant tumor beside stones:results of univariate analysis showed that increased serum tumor markers,diameter of PDS,common bile duct dilation or compression,pancreatic parenchymatous atrophy were related factors affecting PDS combined with malignant tumor beside stones (x2 =12.501,Z =-2.508,x2 =12.230,5.863,P＜0.05).Results of multivariate analysis showed that increased serum tumor markers,common bile duct dilation or compression,pancreatic parenchymatous atrophy were independent risk factors affecting PDS combined with malignant tumor beside stones (odds ratio:5.482,8.062,4.993,95％ confidence interval:1.556-19.313,1.620-40.107,1.188-20.977,P＜0.05).(2) Follow-up and survival situations:162 of 190 patients were followed up for 2-111 months with a median time of 20 months,including 149 of PDS complicated with chronic pancreatitis and 13 of PDS combined with malignant tumor beside stones.During the follow-up,the 1-,3-,5-year overall survival rates after operation were 46.7％,6.7％ and 0 in 13 patients of PDS combined with malignant tumor beside stones,and 3 patients received postoperative chemotherapy.The 1-,3-,5-year overall survival rates of the 149 patients who had PDS combined with chronic pancreatitis were 97.0％,93.5％,91.6％.Conclusion Increased serum tumor markers,common bile duct dilation or compression,pancreatic parenchymatous atrophy are independent risk factors affecting PDS combined with malignant tumor beside stones.
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As for the surgeons,surgical treatment of pancreatic cancer promises to be very challenging.The concept of borderline resectable pancreatic cancer has further improved diagnostic and treatment systems of pancreatic cancer recently,but there is no verdict on the controversial problems of borderline resectable pancreatic cancer,such as the significance and indications combined with vascular resection,feasibility combined with artery resection and effect of neoadjuvant treatment.This article will go into in-depth discussions concerning the hot issues of borderline resectable pancreatic cancer in order to further improve the standardized diagnosis and surgical treatment for pancreatic cancer.
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Objective To investigate the clinical application value of pancreatoduodenectomy combined with vascular resection and reconstruction for pancreatic head carcinoma.Methods The clinical data of a patient with pancreatic head carcinoma who underwent pancreatoduodenectomy combined with vascular resection and reconstruction at the Southwest Hospital in March 2014 were retrospectively analyzed.Preoperative imaging examination showed no gap between vascular wall of portal vein (PV) and pancreatic head space-occupying lesion,vascular compression and stenosis at intersection of PV,splenic vein (SV) and superior mesenteric vein (SMV),but not excluding adjacent main PV invasion.During the operation,it was difficult to separate pancreatic head carcinoma from PV,indicating vascular wall invasion at intersection of PV,SV and SMV.Therefore,the pancreatic head,bile ducts,duodenum,partial jejunum,invasive vein vessels,lymphatic and nerve tissues were radically resected,then PV,SMV and SV were reconstructed.The patient was followed up by outpatient examination and telephone interview after surgery till April 2015.Results The patient underwent pancreatoduodenectomy combined with vascular resection and reconstruction successfully without blood transfusion.The operation time was 285 minutes and volume of intraoperative blood loss was 300 mL.The patient had a smooth postoperative recovery,resuming diet at postoperative day 5.The abdominal drainage tube and stitches were removed at postoperative day 6 and day 12,and the patient was discharged from hospital at postoperative day 15.Computed tomography reexamination showed clear vascular anastomose.The patient was not complicated with pancreatic fistula,biliary fistula,intra-abdominal hemorrhage and vascular embolism.The postoperative pathological examination confirmed the diagnosis of pancreatic head moderately differentiated adenocarcinoma accompanied by PV invasion and lymph node metastasis,with a negative margin.The patient began a course of single drug common chemotherapy using gemcitabine at postoperative day 40.No cancer recurrence was detected during the one-year follow-up.Conclusion Pancreatoduodenectomy combined with vascular resection and reconstruction is safe and feasible for the treatment of pancreatic head carcinoma with good surgical effects.
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<p><b>OBJECTIVE</b>To explore the application value of the MI-3DVS in patients with hepatic artery variation receiving duodenopancreatectomy.</p><p><b>METHODS</b>A total of 114 patients who had undergone pancreatoduodenectomy were retrospectively summarized and analyzed during January 2010 to July 2012. The clinical data of 64-slice multidetector CT angiography (64-MDCTA) scanning was introduced into MI-3DVS for procedural segmentation, registration and 3-dimensional reconstruction. Based on the reconstructed 3-dimensional model, the origination and bifurcations of variant hepatic artery was observed. And its anatomical relationships with abdominal organs and vessels were also observed. Thereafter, preoperative procedures planning was formulated. The findings were compared to those found during the operation and by postoperative digital subtraction angiography (DSA) of coeliac artery.</p><p><b>RESULTS</b>The abdominal 3D models can clearly display the size and shape of tumor, the origin and course of the blood vessels, as well as the 3D anatomic relationship between tumors and organs, blood vessels. A total of 14 cases (12.3%, 14/114) were found with variant, including 9 cases (7.9%) with replaced right hepatic artery arising from superior mesenteric artery, 3 cases (2.6%) with replaced common hepatic artery arising from superior mesenteric artery, 2 cases (1.8%) with replaced left hepatic artery arising from left gastric artery. The 14 patients all received standard procedures of duodenopancreatectomy. Compared to the intraoperative findings and postoperative DSA examination, the sensitivity, specificity and accuracy of MI-3DVS to variant hepatic artery is 100%. The preoperative planning guided by MI-3DVS is in line with the intraoperative findings.No postoperative complications occurred in all 14 patients, including hepatic abscesses, biliary fistula and liver failure.</p><p><b>CONCLUSIONS</b>MI-3DVS can accurately diagnose hepatic artery variation before duodenopancreatectomy. Therefore, it contributes to the formulation of preoperative surgical plans.It also increases the success rate of the surgical operations and decreases the occurrence of postoperative complications.</p>
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Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Young Adult , Hepatic Artery , Congenital Abnormalities , Imaging, Three-Dimensional , Pancreaticoduodenectomy , Retrospective Studies , Tomography, Spiral ComputedABSTRACT
Objective To investigate the significance of combined vascular resection and reconstruction in surgery for pancreatic cancer.Methods The clinical data of 231 patients with pancreatic canccr who received pancreaticoduodenectomy at the Southwest Hospital from January 2006 to December 2011 were retrospectively analyzed.All the patients were divided into the combined vascular resection and reconstruction group (97patients) and non-vascular resection and reconstruction group (134 patients).Effects of operation,results of pathological examination,prognosis and lymph node metastasis on the prognosis of the patients in the 2 groups were compared.Two independent samples t test was used to analyze the measurement data,and the count data were analyzed using the chi-square test.The survival curve was drawn by the Kaplan-Meier method,and the survival was analyzed using the Log-rank test.Results The operation time and intraoperative volume of blood loss were (554 ± 136)minutes and (1110 ± 939)rnl in the combined vascular resection and reconstruction group,and (445 ±106)minutes and (623 ±349)ml in the non-vascular resection and reconstruction group,with significant difference between the 2 groups (t =6.552,4.873,P ＜ 0.05).The mortality,morbidity and positive rate of lymph node metastasis of were 8.2％ (8/97),20.6％ (20/97) and 32.0％ (31/97) in the combined vascular resection and reconstruction group and 3.0％ (4/134),8.2％ (11 / 134) and 16.4％ (22/134) in the non-vascular resection and reconstruction group.There was no significant difference in the mortality between the 2 groups (x2=3.164,P ＞ 0.05),while significant differences in the morbidity and positive rate of lymph node metastasis were detected between the 2 groups (x2 =7.458,7.687,P ＜ 0.05).A total of 223 patients were followed up till September 2012,53 patients were with lymph node metastasis,and their median survival time was 8.4 months (range,6.9-10.0 months) ; 170 patients were with negative lymph node metastasis,and their median survival time was 18.6 months (range,15.8-21.5 months),which was significantly longer than that of patients with positive lymph node metastasis (x2=17.045,P ＜ 0.05).Of the 53 patients with lymph node metastasis,31 were in the combined vascular resection and reconstruction group,and their median survival time was 8.5 months (range,6.3-10.7 months) ; 22 were in the non-vascular resection and reconstruction group,and their median survival time was 8.3 months (range,6.1-10.5 months),with no significant difference between the 2 groups (x2 =0.022,P ＞ 0.05).Of the 178 patients with negative lymph node metastasis,64 were in the combined vascular resection and reconstruction group,and their median survival time was 13.2 months (range,9.2-17.1 months) ; 106 were in the non-vascular resection and reconstruction group,and their median survival time was 21.7 months (range,18.1-25.3 months),with significant difference between the 2 groups (x2 =11.908,P ＜ 0.05).Conclusions Although pancreaticoduodenectomy combined with vascular resection and reconstruction increases the incidence of postoperative complications,it could achieve the complete removal of tumors without significantly increasing the mortality rate.For patients with lymph node metastasis,pancreaticoduodenectomy combined with vascular resection and reconstruction has no influence on the postoperative survival time,while it might have influence on the patients without lymph node metastasis.
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Pancreatic cancer is malignant with a poor prognosis,and its incidence is rising worldwide in recent years.Multiple slices spiral computed tomography and computed angiography are the first choice for the diagnosis of pancreatic cancer,while misdiagnosis of pancreatic cancer still exists.From August 2009 to October 2011,80 patients with pancreatic or periampullary cancer were diagnosed using the medical image three dimensional visualization system (MI-3DVS).The threedimensional models of the liver,pancreas,vascular system and tumors were reconstructed successfully based on the 64-slice spiral computed tomography data.According to the analysis of the three dimensional models,4 patients underwent standard pancreaticoduodenectomy,1 received palliative surgery.MI3DVS plays an important role in the diagnosis and assessement of resectability of pancreatic and periampullary cancer.
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The majority of the pancreatic cancer was diagnosed at advanced stage.The tumor may invade portal vein and/or superior mesenteric vein.Moore et al.firstly reported pancreaticoduodenectomy combined with portal vein and superior mesenteric vein resection and reconstruction in 1951.This procedure has improved the resection rate of pancreatic cancer.A 72-year-old man suffered from pancreatic cancer was admitted to the Southwest Hospital in September 2011.Because the tumor invaded the confluence of portal vein and superior mesenteric vein,thus the patient underwent a pancreaticoduodenectomy combined with portal vein and superior mesenteric vein resection and reconstruction.The patient recovered smoothly without any complication,and he had a normal liver function and CA19-9 value,and no local and remote metastasis was detected during the follow-up.
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Objective To investigate the efficacy of pancreaticoduodenectomy (PD) combined with vascular resection and reconstruction.Methods The clinical data of 56 patients who received PD combined with vascular resection and reconstruction at the Southwest Hospital of Third Military Medical University from January 2007 to May 2011 were retrospectively analyzed.The incidence of perioperative complications,mortality and postoperative conditions were also analyzed.Results The mean operation time and intraoperative blood transfusion were 473 minutes (range,234-853 minutes) and 781 ml (range,0-900 ml),respectively.Seven patients did not receive blood transfusion.The median period of hospital stay was 25.9 days (range,17-100 days).A total of 43 patients underwent PD combined with vascular reconstruction.The incidence of perioperative complications and mortality rate were 34％ (19/56) and 7％ (4/56),respectively.There were 42 patients with pancreatic ductal adenocarcinoma,5 with ampullary carcinoma,3 with distal bile duct carcinoma,4 with papillary carcinoma of duodenum,1 with pancreatic neuroendocrine carcinoma and 1 with pancreatic serous cystadenoma.All patients were followed up till August 2011,and the 1-year survival rate was 57％ (32/56).The mean survival time was 13.5 months.The weight of 32 surviving patients increased and no abdominal pain occurred.Within 3 months after the operation,5 patients had slight diarrhea and were administered antidiarrheal; thrombosis in the artificial blood vessels and peritoneal effusion were found in 1 patient,while 6 months later,collateral circulation was formed and the peritoneal effusion was diminished.Conclusion PD combined with vascular resection and reconstruction can improve the quality of life for patients with pancreatic cancer and with blood vessels involvement.
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Objective To investigate the effect of the teaching modes based on problem-based learning (PBL) and lecture-based learning (LBL) in clinical practice of hepatobiliary surgery.Methods 166 5-year program students were divided into 2 groups:PBL group (n=83)and LBL group (n=83).The performance in interrogation,physical examination,medical records and theoretical tests were analyzed.Results PBL group had better performance in all the above aspects compared to LBL group (P<0.05).Conclusions The teaching mode based on PBL is a good method,which Can inspire the students and improve their ability to solve problems in clinical practice of hepatobiliary surgery.
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Objective To investigate the diagnosis and treatment of functional pancreatic endocrine tumors (PETs). Methods The clinical data of 45 patients with functional PETs who were admitted to the Southwest Hospital from January 1998 to December 2008 were retrospectively analyzed. Etiologic and localization diagnosis were made preoperatively according to the manifestation and the results of color doppler ultrasound and computed tomography, respectively. Eight patients received resection of the body and tail of the pancreas and spleen, 32 received tumor enucleation, one received resection of the pancreaticobiliary junction and four received pancreaticoduodenectomy. All patients received chemotherapy after the operation. Results Thirty-four cases of the PETs were benign and the rest eleven cases were malignant. Eight cases of the PETs were in the head of the pancreas,26 in the tail of the pancreas, seven in the body of the pancreas and four cases were with multiple PETs. The diameters of the PETs were 0. 3-5.0 cm, and the diameters of the PETs in 19 cases were above 2.0 cm. Eight patients were complicated with pancreatic leakage, two with incision infection and one with abdominal infection. Of the 33 patients with insulinoma, the blood glucose of five patients with multiple PETs was still abnormal after the operation, three patients underwent reoperation and the other two were treated by diazoxide to control the blood glucose in the normal range. The clinical symptoms of the seven patients with gastrinoma disappeared after the operation, and the gastric ulcer was healed, the 12-hour gastric juice volume and the level of the gastric acid were in the normal range after a continuous treatment with proton pump inhibition agents for 6 months. Necrotizing or migratory rash and diabetes of the four patients with glucagonoma were cured three weeks later, and the level of the amino acid was back to normal. Diarrhea and electronic disturbance of one patient with vasoactive intestinal peptide tumor were alleviated after the operation. Thirty-nine patients were followed up for 20-120 months. Of the 32 patients with benign PETs, two patients had tumor recurrence, and three patients died of other diseases. Of the seven patients with malignant PETs, two patients survived, and three patients died of hepatic metastasis or tumor recurrence, two patients died of other diseases. Conclusions Surgical treatment is effective for the treatment of functional PETs. Palliative resection of the tumor also can obviously improve the life quality of patients with fuctional PETs.
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In the process of the introduction of classical problem based learning,the combination of PBL teaching method and current teaching method was found to be abstract and difficult to operate. PBL gradual teaching was brought forward through qestionnaires and analysis. Improved PBL teaching is more suitable for clinical teaching of hepatobiliary surgery in China and helping the interns to get good learning habits. Thus ,it is an effective PBL teahcing method of hepatobiliary surgery.
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Objective To clone ORF of DcR3 gene and insert it into eukaryotic expression vector and express it in COS-7 cells. Methods Encoding sequence of human DcR3 gene was cloned by PCR and sequenced. The sequenced ORF was cloned into eukaryotic expression vector pAAV-IRES-hrGFP to construct recombinant plasmid. COS-7 cells were transfected with recombinant plasmid by lipofectamine2000. Expression of recombinant DcR3 gene was verified by Western blotting and confocal microscopy. Results A 1 000-bp gene segment was obtained by PCR and inserted into pAAV-IRES-hrGFP to construct recombinant plasmid. The gene segment was proved to be encoding sequence of human DcR3 gene by sequencing. DcR3 expression in COS-7 cells was verified by Western blotting and confocal microscopy. Conclusion DcR3 gene was successfully cloned and expressed in COS-7 cells.
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<p><b>OBJECTIVE</b>To summarize the vascular and bile duct reconstruction experience in 40 cases of orthotopic liver transplantation in the southwest hepatobiliary surgery hospital.</p><p><b>METHODS</b>The clinical data of 40 cases of liver transplantation were analyzed retrospectively from Jan. 1999 to Nov. 2001.</p><p><b>RESULTS</b>Mortality rate of this group was 15.0%. Complications included: pulmonary infection (18 cases), MOSF (5 cases), intraperitoneal bleeding (4 cases), ARDS (8 cases), thrombus of hepatic artery (1 case), bile leakage (1 case), and cerebral hemorrhage (1 case). The longest survival time was 31 moths (1 case). There were 15 cases whose survival time was more than 1 year.</p><p><b>CONCLUSIONS</b>The key point of success of liver transplantation relies on excellent vascular and bile duct reconstruction technique.</p>
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Adult , Female , Humans , Male , Middle Aged , Biliary Tract , Blood Vessels , Liver Transplantation , Methods , Mortality , Postoperative Complications , Mortality , Plastic Surgery Procedures , Methods , Survival RateABSTRACT
Objective To study the effect of portal vein blocking on the permeability of the intestinal mucosa in pigs. Methods Healthy Rongchang pigs were divided into 3 groups: ① sham operation group(SO), ② portal vein clamping for 45 min group (PVC-45'), ③ portal vein clamping for 60 min group (PVC-60'). Urine lactulose/mannitol(L/M) ratio was measured after portal vein blocking. Results The L/M ratio was increased significantly (P<0.05) in PVC-45' and 60' groups than in SO group, with that of PVC-60' higher than that of PVC-45' group, but not significantly. Conclusion The increase of intestinal mucosal permeability after portal vein blocking is an early and important index for the damage of the intestinal mucosa barrier.
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Objective To summarize our experience in performing modified hepatic outflow tract reconstruction in liver transplantation. Methods The clinical data of 142 cases of liver transplantation from Jan 1999 to Aug 2003 were analyzed retrospectively. Results Sixteen patients died postoperatively, mortality rate of this group was 11.27%. No hepatic outflow obstruction developed in this group. Two postoperative recipients have survived for more than four years, five recipients have survived for more than three years, thirty four for more than two years, thirty eight for more than one year. Conclusion This procedure has the advantage of less technique-related complications and time-saving.
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Objective To explore the evolution of HBV polymerase gene as a result of adefovir dipivoxil treatment in liver transplant patients with lamivudine resistance. Methods Eight patients with HBV reinfection which was lamivudine resistance received adefovir therapy (10mg/day). Sequential serum samples were obtained from 2 consecutive patients with adefovir failure, and the polymerase gene of HBV was amplified by PCR and TA cloned, and sequencing and analysis were performed in 10 random clones. Results Neither rtN236T nor A181V/T mutation, which were associated with adefovir (ADV) resistance, was found. The rtL180M mutation associated with lamivudine resistance presented before ADV treatment, and several previously unreported amino acid substitutions were observed in the reverse transcriptase domain. Conclusion Possibly, the rtL180M mutation in the B domain of HBV polymerase reduced the susceptibility to ADV. ADV resistance mutation may occur in other sites besides rtN236T and A181V/T amino acid substitutions or do not happen early after treatment.