ABSTRACT
Objective To evaluate the preoperative liver function and prognosis of laparoscopic cholecystectomy (LC) in patients with cirrhosis,using the Child-Turcotte-Pugh classification and the model for end-stage liver disease(MELD) score.Methods From January 2009 to June 2013,973 patients who were admitted to the Department of General Surgery of our hospital and the HuiZhou Municipal Central Hosptial were studied.Of the 373 patients with cirrhosis,38 patients were excluded because of Child C,MELD ＞ 30,or laparotomy.The remaining 335 patients who received laparoscopic cholecystectomy were randomly divided into two groups The Child grade and MELD score were retrospectively analyzed.Results There was no significant difference in intraoperative hemorrhage between the Child A group [(106 ± 11) ml] and the Child B group [(109 ± 11) ml] (P ＞ 0.05).The R ＜ 14 scores in the MELD group [(58 ± 15) ml] was significantly lower than that in the R≥ 14 group [(120 ± 28) ml] (P ＜ 0.01).There was no significant difference in postoperative complications between the Child group A (10 cases,12％) and the Child group B (17 cases,21％) (P ＞0.05).There was a significantly lower incidence in the R ＜ 14 scores in the MELD group (10 cases,12％) than the R ≥ 14 group (27 cases,33％) (P ＜ 0.05).There was also no significant difference in the hospital stay between the Child A group (9 ± 1) and the Child B group (10 ± 2)(P ＞0.05) ; the R ＜ 14 score of the MELD group (7 ± 1) was significantly less than that of the R≥ 14 group (11 ±2) (P ＜0.01).There was no significant difference in the cost of hospitalization between the Child A group (1.337 ± 0.063) and the Child B group (1.359 ± 0.089) (P ＞ 0.05) ; the R ＜ 14 group (MELD score 1.108 ± 0.123) was significantly less than that of the R ≥ 14 group (1.568-± 0.117)(P ＜ 0.01).Conclusion Compared with the Child-Turcotte-Pugh classification,the MELD score was more scientific,objective and accurate in judging the preoperative liver function.It helped to predict the amount of intraoperative hemorrhage and postoperative morbidity,reduced hospital stay and hospitalization expenses.Therefore,the MELD scoring system more objectively guided the treatment of patients with cholecystitis with cirrhosis.
ABSTRACT
<p><b>OBJECTIVE</b>To assess the value of protective hepatectomy based on three-dimensional (3D) reconstruction technique in the treatment of hepatolithiasis.</p><p><b>METHODS</b>The image data of 64-slice spiral CT scan were obtained from 21 patients with hepatolithiasis and processed using the MI-3DVS software for 3D reconstruction and visible simulation surgery of protective hepatectomy. The actual protective hepatectomy for hepatolithiasis was performed based on the preoperative surgical plan according to the 3D model and the simulation hepatectomy. The consistency between the actual hepatectomy and the simulation surgery was evaluated, and the operating time, lengths of postoperative hospital stay, estimated blood loss, calculus depletion rate and intra- and postoperative complications were recorded.</p><p><b>RESULTS</b>The consistency rate between the actual procedures of hepatectomy were carried out with a total consistency with the preoperative surgical simulation, and the normal functioning liver tissues were retained in all the 21 patients. The operating time of the procedures was 215.2∓51.3 min, the average postoperative hospital stay was 10.7∓4.3 days, estimated blood loss was 301.4∓60.7 ml, and the calculus depletion rate was 95.2%. The procedure was associated with an incidence of intra- and postoperative complications of 19.0%.</p><p><b>CONCLUSION</b>Protective hepatectomy for hepatolithiasis based on 3D technique allows efficient calculus depletion, lesion removal, elimination of strictures, and total bile drainage, and also protects the maximum functional liver tissue and reduces the surgical complications.</p>
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Bile Ducts , Cholelithiasis , Diagnostic Imaging , General Surgery , Hepatectomy , Methods , Image Processing, Computer-Assisted , Software , Tomography, Spiral Computed , Treatment OutcomeABSTRACT
<p><b>OBJECTIVE</b>To investigate the degradation process of collagens and identify the key unit operation during manufacturing process of E'jiao.</p><p><b>METHOD</b>Samples in different unit operations were withdrawn, and their amino acid compositions and the molecular weight ranges were determined. The peptide composition was analyzed by high-performance liquid chromatography/mass spectrometry.</p><p><b>RESULT</b>The content of sample during atmospheric condensation unit increased by 16.8% compared to the thermal extraction unit. Gel filtration chromatographic analysis indicated that the degradation process of collagen primarily occurred during the atmospheric condensation unit. The peptides in samples mainly resulted from the degradation of collagens and cytoskeleton proteins such as tubulin, actinin, and so on. The relative abundance of degraded collagens increased with the decrease of no-collagen proteins.</p><p><b>CONCLUSION</b>Collagen degradation mainly occurred during the atmospheric condensation unit, which was the key process affecting the composition of E-jiao.</p>