The impact of resection margin status within 1 mm clearance of portal and superior mesenteric vasculature on the prognosis of patients of pancreatic head adenocarcinoma undergoing pancreatoduodenectomy / 中华普通外科杂志

Objective:To evaluate the impact of resection margin status within a cut-off 1 mm clearance of cancer on the groove of portal/superior mesenteric vein and/or the top end of the uncinate process bordering on the superior mesenteric artery in pancreatic head adenocarcinoma patients after pancreatoduodenectomy.Methods:The clinical, pathological and followup data of 113 pancreatic head adenocarcinoma patients undergoing pancreatoduodenectomy with or without vascular graft replacement were retrospectively analyzed.Results:Univariate analysis showed that resection margin 1mm clearance, postoperative adjuvant chemotherapy, T staging, N staging, TNM staging (AJCC), gender, and maximum tumor diameter were risk factors for survival . Multivariate analysis showed that surgical margin 1mm clearance, postoperative adjuvant chemotherapy, and gender were independent prognostic factors. In resection margin >1 mm group(83 cases), the mean survival time was 19.04 months, and the 1-year, 2-year, and 3-year survival rates were 78%, 50%, and 25%, respectively. In resection margin ≤1 mm group(30 cases), the mean survival time was 9.42 months, and the 1-year, 2-year and 3-year survival rates were 61%, 20% and 0, respectively. There was statistical significance between the two groups in survival time ( P=0.018). Conclusion:Resection margins 1 mm clearance of cancer off portal vein/superior mesenteric vein and superior mesenteric artery is independent prognostic factors in pancreatic head adenocarcinoma patients undergoing pancreatoduodenectomy.

Prevention of bile leakage after laparoscopic primary suturing of common bile duct by transabdominal placement of nasal bile duct / 中华肝胆外科杂志

Objective To study the advantages of laparoscopic primary suturing of common bile duct plus transabdominal nasobiliary drainage in reducing the rate of bile leakage.Methods The clinical data of laparoscopic primary suturing of common bile duct with or without nasal bile duct drainage in Second People's Hospital of Chengdu were analyzed retrospectively.Results During laparoscopic common bile duct exploration,286 patients were treated by primary suturing without nasobiliary drainage (group without drainage),including 32 (11.2％) patients with bile leakage;350 patients were treated by primary suturing with transabdominal nasobihary drainage (group with drainage),including 11 (3.1％) patients with bile leakage.The incidences of bile leakage of the two groups were significantly different (P ＜ 0.05).When the diameter of the common bile duct was less than 11.0 mm,the incidence of bile leakage in the non-drainage group and the drainage group were 18.5％ (20/108) and 2.1％ (3/143),respectively.The incidence in the drainage group was significantly lower than that in the non-drainage group,and the difference was statistically significant (P ＜ 0.05).When the diameter of common bile duct was larger than 11.0 mm,there was no significant difference in the incidences of bile leakage between the two groups (P ＞ 0.05).Conclusions The choice after laparoscopic primary suturing of common bile duct between with or without nasobiliary drainage should be determined according to the diameter of common bile duct.When a common bile duct diameter of less than 11.0 mm,nasobiliary drainage is recommended to reduce the rate of bile leakage.

Primary closure of common bile duct after laparoscopic bile duct exploration: a report of 2 740 patients / 中华肝胆外科杂志

Objective To analyze our experience in primary closure of common bile duct after laparoscopic bile duct exploration.Methods From June 1992 to March 2018,2 740 patients underwent primary closure of common bile duct after laparoscopic common bile duct exploration in the Second People's Hospital of Chengdu.Results The operations were successfully carried out in 2 534 (92.4％) out of 2 740 patients,of whom 15 patients (0.6％) were converted to open common bile duct exploration.Bile leakage occurred in 113 patients (4.1％).Residual stones were found in 29 patients (1.1％).One patient (0.1％) who had a pancreatic carcinoma died on postoperation day 15.48 patients (1.8％) developed other complications.The total postoperative complication rate was 7.0％ (191/2 740).Conclusion In suitable patients,laparoscopic bile duct exploration with primary closure was feasible,safe and effective.

Clinical efficacy of primary closure in laparoscopic common bile duct exploration (A report of 2 429 cases) / 中华消化外科杂志

Objective To investigate the clinical efficacy of primary closure in laparoscopic common bile duct exploration (LCBDE).Methods The retrospective cross-sectional study was conducted.The clinicopathological data of 2 429 patients who underwent primary closure in LCBDE in the Second Hospital of Chengdu City from March 1992 to December 2017 were collected.Patients underwent laparoscopic cholecystectomy (LC) + stone extraction using LCBDE or extracorporeal shock wave lithotripsy (ESWL),laparoscopic endoscopic sphincteropapillotomy (LEST) was performed selectively,then underwent laparoscopic endoscopic nasobiliary drainage (LENBD) or laparoscopic transabdominal antegrade-guide common bile duct stent implantation,finally underwent primary closure of common bile duct.Observation indicators:(1) surgical situations;(2) postoperative recovery;(3) postoperative short-term complications;(4) follow-up situation.Follow-up using outpatient examination and telephone interview was performed to observe long-term surgical complications once every 3 months up to 1 year postoperatively.Measurement data with normal distribution were represented as (x) ± s.Measurement data with skewed distribution were described as M (range).Results (1) Surgical situations:of 2 429 patients,2 251 underwent successful stone extraction using LCBDE,relief of the obstruction and primary closure of common bile duct,with depletion of stones;15 underwent stone extraction using conversion to open surgery,with depletion of stones;163 had residual stones or surgery-related complications.Of 2 429 patients,1 144,898,223,110 and 54 were respectively detected in grade N or 0,1,2,3 and 4 of laparoscopic distal of the common bile duct smooth classification (LDSC);599 underwent LEST,367 underwent LENBD,207 indwelled urinary catheter through cystic duct stump,125 underwent laparoscopic transabdominal antegrade-guide common bile duct stent implantation and 1 131 underwent primary closure in LCBDE only.Number of removing the stones,diameter of common bile duct,volume of intraoperative blood loss and operation time was (2.5±0.2)per case,(0.7±0.4)cm,(22.4±2.6)mL and (100±12) minutes,respectively.(2) Postoperative recovery:time of postoperative gastrointestinal function recovery,duration of hospital stay and treatment expenses were respectively (2.5±0.5) days,(7.3± 1.2) days and (2.7±0.3) × 104 yuan.Of 2 429 patients,367 removed nasobiliary catheter at 3-7 days postoperatively,207 removed urinary catheter at 3-6 weeks postoperatively,and 125 removed common bile duct stent through duodenoscope port at 1-4 months postoperatively.(3) Postoperative short-term complications:incidence of postoperative short-term complications in 2 429 patients was 6.711％ (163/2 429).① Ninety-four patients with bile leakage were cured after drainage and symptomatic and supportive treatment.② Of 29 patients with residual stones:25 with residual stones of common bile duct were cured by stone extraction using endoscopic sphincterotomy of duodenal papilla,and 4 with residual stones of intrahepatic bile duct didn't receive treatment.③ One patient died at 15 days after surgery for pancreatic cancer.④ Of 39 with postoperative other complications:2 with postoperative hemorrhage were cured by laparoscopic reoperation;12,19 and 3 were respectively complicated with postoperative inflammatory stenosis of duodenal papilla induced to short-term obstructive jaundice,mild acute pancreatitis and stress ulcer bleeding of upper digestive tract,and they were improved by endoscopy or non-operation treatment;2 with stenosis of bile duct didn't receive treatment;1 had a miss ligation at bending section of front zone of nasobiliary catheter,and ligation was removed by endoscopic retrograde cannulation of the pancreatic at 19 days postoperatively.(4) Follow-up situation:of 2 429 patients,1 749 were followed up for 3-12 months,with a median time of 6 months.During the follow-up,of 1 749 patients,2 had mild stenosis in the primary closure area of common bile duct incision and 1 had stenosis of duodenal papilla,they were not treated,and other patients didn't have related complications.Conclusion Controlling strictly the operative indication,primary closure of common bile duct in LCBDE is safe and feasible,with satisfactory clinical outcomes.

Endoscopic papillotomy and nasobiliary drainage during the course of common bile duct exploration: a report of 219 cases / 中华肝胆外科杂志

To explore the operation methods and indications of the duodenoscopic papillotomy (IEST) with endoscopic nasobiliary drainage (IENBD) for the treatment of duodenal papilla stenosis during the course of common bile duct operation.The clinical data of 219 cases of cholecystolithiasis with choledocholith and the stenosis of papillary underwent endoscopic sphincterotomy (IEST) plus endoscopic nasobiliary drainage (IENBD) in the Second People's Hospital of Chengdu were retrospectively analyzed.It was successful in 198 cases who had the gallbladder and common bile duct stones removed,and endoscopic papillary dissection was performed and the nasobiliary tube was successfully inserted.Nasobiliary drainage was successful in 186 cases (93.9％) of 198 cases.No liquid outflow was observed in nasobiliary drainage in 7 cases (3.5％).Nasal bile duct slipped early in 5 case (2.5％).Primary closure of bile duct incision was completed in 198 cases.It failed in 4 cases (2.0％) who had the bile leakage with primary closure of duct incision.Mild pancreatitis after operation occurred in 3 cases (1.5％).Nose bile duct ligation was performed in 1 case (0.5％).The overall postoperative complication rate was 4.0％ (8/198).IEST + IENBD in open laparotomy was successful in 21 cases.No perforation of intestine and bile duct,bleeding,severe pancreatitis and other complications and death were detected postoperatively in two groups.During the course of laparoscopy and open laparotomy,IEST + IENBD in treating cholecystolithiasis with choledocholith and the stenosis of papillary and primary closure of duct incision after the endoscopic nasobiliary drainage is safe and effective.

Application of fast track surgery strategy in perioperative period of primary suture of laparoscopic choledocholithotomy / 临床肝胆病杂志

ObjectiveTo investigate the clinical application value of fast track surgery strategy (EARS) in the perioperative period of primary suture of laparoscopy in the treatment of common bile duct stones. MethodsA total of 64 patients with gallstones complicated by common bile duct stones who were hospitalized in Department of Hepatobiliary Surgery in The Second People′s Hospital of Chengdu from October 2015 to February 2016 were enrolled, and according to the treatment in the perioperative period, the patients were divided into EARS group (32 patients) and control group (32 patients). Clinical indices and complications were compared between the two groups. The t-test was used for comparison of continuous data between groups, and the chi-square test was used for comparison of categorical data between groups. ResultsCompared with the control group, the ERAS group had significantly shortened time of extraction of drainage tube (1.6±0.9 d vs 2.7±1.0 d, t=-5.675, P＜0.01) and length of hospital stay (5.1±1.0 d vs 6.8±1.1 d, t=-5.910, P＜0.01), significantly shorter time to first ambulation (1.0±0.3 d vs 1.6±0.7 d, t=-4.313, P＜0.01) and time to intestinal functional recovery (1.1±0.4 d vs 1.8±0.6 d, t=-4.842, P＜0.01), a significantly shortened time to stopping infusion after surgery (3.8±1.0 d vs 4.9±1.2 d, t=-3.923, P＜0.01), significantly reduced total hospital costs (17 433.5±1411.3 ten thousand yuan vs 26 651.6±2945.8 ten thousand yuan, t=-15.942, P＜0.001), a significantly lower proportion of patients who experienced pain after surgery ［4 (12.5%) vs 13 (406%), χ2=6.490, P=0.011］, and significantly lower levels of alanine aminotransferase (105.25±35.34 U/L vs 179.00±48.64 U/L, t=-5.973, P＜0.05) and total bilirubin (50.78±12.60 μmol/L vs 79.70±18.56 μmol/L, t=-7.090, P＜0.05) after surgery. ConclusionEARS is highly practical in the perioperative period of laparoscopic surgery and can promote patients′ rapid recovery. Therefore, it holds promise for clinical application.

A comparative study using the transabdominal route versus the transoral route in establishing nasobiliary drainage in laparoscopic surgery / 中华肝胆外科杂志

Objective To compare using the transabdominal route versus the transoral route in establishing naso-biliary drainage in laparoscopic surgery.Methods The combined use of laparoscopy with choledochoscopy and duodenoscopy to establish naso-biliary drainage was carried out in 204 patients with gallbladder and common bile duct calculi.In 162 patients,the naso-biliary drainage was established transabdominally and in 42 patients it was established transorally.The success and the complication rates in the two groups were compared.Results Of 162 patients using the transabdominal route,4 patients failed.There were 6 patients (3.7％) who had no output from the nasobiliary drain.There were 3 patients (1.8％) who had only intestinal juice outflow from the nasobiliary drain.Primary closure failed in 3 patients (1.8％),all resulting in bile leak.Pancreatitis occurred in 2 patients (1.2％) after the operation.There was 1 patient (0.6％) whose nasobiliary drain was wrongly ligated.Of 42 patients with nasobiliary drainage using the transoral route,6 patients failed.There was 1 patient (2.4％) who had no output from the nasobiliary drain.There was 1 patient (2.4％) who had intestinal juice output from the nasobiliary drain.Primary closure failed in 1 patient (2.4％) with resultant bile leakage.Pancreatitis occurred in 4 patients (9.5％) after the operation.The success rate of establishing a nasobiliary drainage in the transabdominal group was significantly higher than that in the transoral group,but the complications were less.Conclusions Nasobiliary drainage established through the transabdominal route in laparoscopy surgery for patients with gallbladder and common bile duct calculi was technically easier and had a high success rate.It had less complications.

The experimentation about the expression of Lin28b and its clinical relevance in Pancreatic cancer / 中国医师杂志

Objective Through detected the expression degree of Lin28b in three different malig-nant degree pancreatic cancer cell lines and human pancreatic cell line to study the relationship of pancreatic cancer and the express of Lin28b.Methods The RT-PCR was used to detect the expression degree of mR-NA in Lin28b in cell lines of PANC-1,BxPC-3,AsPC-1,HPC-Y5 and Western-blot was used to detect the expression degree of protein in Lin28b in cell lines of PANC-1,BxPC-3,AsPC-1,HPC-Y5,then discovering the differential expression.Results The Lin28b was high expression in three pancreatic cancer cell lines, also higher than human pancreatic cell lines,and the expression of difference had statistical significance. Conclusions The results suggested that Lin28b may play a role in the pathogenesis of pancreatic cancer, and there is a certain relationship between the expression of Lin28b and malignant degree of tumor cells.