ABSTRACT
Objective:To study the predictive value of the systemic immune inflammation index (SII) on the overall survival rate of patients after Whipple surgery for pancreatic ductal adenocarcinoma (PDAC).Methods:The clinical data of patients with PDAC who underwent Whipple surgery at the First Affiliated Hospital of Zhengzhou University from January 1, 2010 to December 31, 2017 were retrospectively analyzed, and the SII value was calculated. The best cut-off value of SII was 900, and all patients were divided into the low SII group (SII≤900) and the high SII group (SII>900) using 900 as the dividing point. The Kaplan-Meier method was used to draw survival curves and the log-rank test was used. The overall survival of the two groups of patients were analyzed. The Cox risk regression model was used to perform univariate analysis of the various clinicopathological parameters, and multivariate analysis for the statistically significant indicators.Results:Of 135 patients enrolled into this study, there were 78 males and 57 females, aged 28.0-76.0 (56.6±8.8) years. There were 92 patients in the low SII group, aged (56.9±9.2) years with 53 males and 39 females; and 43 patients in the high SII group, aged (56.1±7.9) years, with 25 males and 18 females. The median survival of the low SII group and the high SII group were 32.7 months (95% CI: 28.4-37.0) and 24.4 months (95% CI: 21.4-27.4), respectively. The survival of patients with PDAC in the low SII group was significantly higher than that in the high SII group ( P<0.05). On univariate survival analysis, postoperative overall survival of patients with PDAC was significantly associated with high SII ( HR=2.047, 95% CI: 1.354-3.096), R 1 margin ( HR=2.595, 95% CI: 1.663-4.048), a positive rate of lymph node>20% ( HR=3.244, 95% CI: 1.888-5.573), and positive regional lymph node (N1) ( HR=3.061, 95% CI: 1.993-4.702), all P<0.05. Multivariate Cox regression analysis showed that high SII ( HR=1.672, 95% CI: 1.094-2.555), R 1 resection margin ( HR=2.167, 95% CI: 1.274-3.685), and a positive rate of lymph node>20% ( HR=2.631, 95% CI: 1.309-5.285) to be independent risk factors affecting overall survival ( P<0.05). Conclusion:SII was an independent prognostic factor available before surgery for patients with PDAC. It has some guiding significance in predicting overall survival in patients after Whipple surgery for PDAC.
ABSTRACT
Objective To compare endoscopic stenting with surgery for pyloric obstruction caused by unresectable gastric cancer.Methods Between June 2002 and June 2012,6 patients underwent endoscopic stenting and 70 did surgery for gastric outlet obstruction caused by gastric cancer.Results There were no significant difference in technical success rate and clinical success rate between the stenting and surgery groups (P ＞ 0.05).The stenting group had shorter time to oral intake,and shorter length of hospital stay [(2.5-± 3.1) d vs.(6.6 ± 3.5) d,t =-7.0,P ＜ 0.001].The incidence of early complications was significantly higher in the surgery group.However,the rates of late complications were significantly lower in the surgery group.Moreover,the surgery group was significantly associated with a longer patency duration [(295.8 d,95％ CI:260.7-330.8) vs.(168.2 d,95％ CI:134.7-201.7 d),P ＜0.001] and overall survival [(307.6 d,95％ CI:272.4-342.8 d) vs.(229.6 d,95％ CI:195.1-264.3 d),P =0.003].Conclusions Both endoscopic stenting and surgery are effective palliative therapy for gastric outlet obstruction caused by gastric cancer.Endoscopic stenting is associated with better shortterm outcomes.Surgery is preferable to ES in longer patency duration.
ABSTRACT
Objective To explore the clinical application of indocyanine green (ICG) fluorescence imaging in patients with hepatocellular carcinoma.Methods 65 hepatocellular carcinoma patients,all were with single lesion,were divided into two groups:preoperative ICG administration group (n =28) and intraoperative ICG administration group (n =37).In preoperative ICG administration group ICG was given 2 to 14 days before surgery,while in the intraoperative ICG administration group it was given during surgery.ICG mediated near-infrared imaging system was used to observe the tumor and determine surgical margin.Results In the preoperative group,tumors were bright fluorescent imaging,in 6 cases 10 new small lesions were found,with cancer diagnosed in 4 patients,cirrhotic liver nodule in 5 patients,fatty degeneration in 1 patient.In the intraoperative group,tumors were clearly demarcated shadow,12 new small lesions were found in 8 cases,with cancer being diagnosed in 5 patients,cirrhotic liver nodule in 4 patients,fatty degeneration in 2 patients,hemangioma in 1 patient.Conclusion Both methods can find small lesions,preoperative administration group was better in identifying the nature of the tumor,while the intraoperative administration group was more valuable in determining the boundaries of the tumor.
ABSTRACT
Objective To investigate the expression of CYP2W1 in gastric cancer and its effect on proliferation and invasion.Methods CYP2W1 protein expression in 326 gastric cancertissues and in the corresponding normal gastric mucosa was measured by immunohistochemstry.The expression of CYP2W1 mRNA in 10 randomly chosen gastric cancer tissues and its corresponding normal gastric mucosa was tested by semi-quantitative RT-PCR.4 groups pairs of gastric cancer and normal gastric mucosa cell lines were constructed.CYP2W1 expression in each of the cell line was tested.The effect of CYP2W1 expression on the proliferation and invasion capacity of the gastric cancer cells was studied by MTT experiment and transwell cell experiment.Results Expression of CYP2W1 protein in the gastric cancer tissues is higher than that in normal gastric mucosa (26.7％ vs.0,x2 =100.396,P ＜ 0.05).CYP2W1 mRNA in the gastric cancer tissues is higher than that in normal gastric mucosa [(0.413 ± 0.026) vs.(0.074 ± 0.005),t =28.115,P ＜ 0.05].CYP2W1 protein expression in the gastric cancer cell lines is higher than that in normal gastric mucosa cell lines [(0.481 ± 0.024) vs.0,t =49.097,P ＜ 0.05].The growth capacity of CYP2W1 positive gastric cancer cell is stronger than that of CYP2W1 negative cells (P ＜ 0.05),and CYP2W1 positive gastric cancer cells are also more of invasiveness,[(63 ±8) vs.(18 ±3),t =24.134,P ＜0.05].Conclusions CYP2W1 is only expressed in the gastric cancer tissues,hence it is closely related to the growth multiplication,and invasiveness of gastric cancer cells.
ABSTRACT
Objective To summarize the experience in diagnosis and treatment for solid-pseudopapillary tumors of the pancreas (SPT). Methods A retrospective clinical analysis about clinical, imaging and pathologic data was made on 16 cases of SPT admitted from January 2005 to December 2009. Results Five had SPT in the head of the pancreas, 5 in the body of the pancreas, 6 in the tail of the pancreas. The first symptom was intermittent epigastric pain ( n = 7), abdominal aponia mass ( n = 3), Pancreatic tumor found by chance (n =4), weight loss (n =2). Solid and Solid-cystic masses of low echo were found in US. Masses of low density in pancreas were found on CT scan, while irregular enhancement appeared in the circumference of all tumors in enhanced CT scan sequences. Tumor markers in patients' erum were all negative.9 patients underwent distal pancreatectomy and spleen resection, including 1 patient also underwent left hemicolectomy. Local excision of tumor was performed in 4 cases. Pancreatic local excision and pancreaticojejunostomy were performed in 3 cases. 14 cases were followed up with an period of from 3 to 48 months. No evidence of relapses and metastasis in these cases was found. Conclusion SPT primarily affects young women, and it may be located in any part of pancreas. Surgical resection is recommended as the treatment of choice. The prognosis is good.
ABSTRACT
Objective To set up a standard for surgical classification of cavernous transformation of the portal vein (CTPV) and their management strategy according to the classification.Methods The clinical data of 63 CTPV cases were analyzed retrospectively,the classification and the corresponding treatment strategy were evaluated.Results According to the imaging examination,surgical treatment and long-term follow-up,CTPV was classified into four types:Type Ⅰ:cavernous transformation involving main trunk of the portal vein and intrahepatic branches.Portasystemic shunt (mesocaval and splenocaval shunt)(or plus port-azygous devascularization) were used for this type;Type Ⅱ:cavernous transformation in the main trunk and proximal SV or SMV.Portasystemic shunt (mesocaval and splenocaval shunt) or plus portazygous devascularization were applied;Type Ⅲ:cavernous transformation involving the whole portal system.Portopulmonary shunt (splenopneumopexy) or inferior mesenteric-caval shunt plus port-azygous devascularization were suggested;Type Ⅳ:any types aforementioned accompanied by biliary and /or pancreatic abnormalities.The treatment should focus on main symptoms and two-stage operation.Conclusions Doppler ultrasound and multi-slice spiral CT (MSCT) three dimensional (3D) reconstruction are the mainstay for the diagnosis of CTPV;Correct diagnosis,classification as well as individualized management are of great importance in the treatment of adult CTPV.
ABSTRACT
Objective To explore the clinical efficacy of artificial blood vessel sheath around re-nal vein for the treatment of left renal vein entrapment syndrome. Methods Eight cases with left re-nal vein entrapment syndrome (7 males and 1 female, mean age, 16 years) with history of gross hema-turia for 6 to 36 months were reviewed. Doppler ultrasound reports suggested compression of the left renal vein at mesenteric angle in all eases. CT scan showed the abnormal angle between aorta and su-perior mesenterie artery in 5 cases. Cystscopy showed hematuria from the left ureteral orifice in 5 ca-ses. All cases with left renal vein entrapment syndrome were treated ,with the method of putting artifi-cial blood vessel as a sheath around left renal vein. Results The operations were all successful. The average operation time was 150 min, the average blood loss was 50 ml, and the average hospital stay after operation was 9 d. No surgical complications occurred. The gross hcmaturia disappeared in 6 ca-ses and Doppler ultrasound showed that left renal vein outflow was normal in 7 when the patients dis-charged from the hospital. The gross hematuria disappeared during 2-24 months' follow-up in 7 pa-tients. Conclusions The surgical aim of renal vein entrapment syndrome is to reduce the compres-sion of renal vein. The method of putting artificial blood vessel around renal vein could be a simple, safe and effective method.
ABSTRACT
Objective To summarize the experience in the diagnosis and management of insulinoma. Methods From January 1966 to December 2007, the clinical data of 131 patients with insulinoma were retrospectively analyzed. Results All the 131 cases had Whipple triad syndrome and 64 eases suffered from psychoneurosis symptoms. The fasting blood glucose or insultus blood glucose concentration of all the cases was lower than 2.8 mmol/L. The ratios of serum insulin to glucose were all higher than 0.3. Before operation, tumor was detected in 8 of 75 patients by B-us scan, and in 17 of 68 by CT, and in 5 of 10 by MRI. The intraoperative ultrasonography(IOUS) was applied in 44 eases, and tumor was found in 43 cases. Surgery included enucleation of insulinoma (88 cases), resection of the corpus and eauda of the pancreas (40 cases), duodenopancreatectomy (2 cases), and biopsy (1 case). The low blood glucose symptoms disappeared postoperatively in 130 cases. Pancreatic fistulae occurred in 20 cases, acute pancreatitis occurred in 32 cases. Conclusions Insulinoma can be diagnosed based on symptoms of Whipple triad and the ratio of serum insulin to glucose. Exploration and IOUS are the simple and effective methods to localize insulinoma.
ABSTRACT
Objective To investigate the diagnosis and treatment of obstructive jaundice (OJ) caused by hepatocellular cacinoma (HCC) invasion to bile duct. Methods The diagnosis and treatment of 16 cases of OJ caused by HCC in our hospital from January 1989 to December 1998 were retrospectively analysed. Results Correct diagnosis was made in 2 cases and misdiagnosis in 14 cases preoperatively. 14 cases were operated on, including hepatectomy, enucleation of the tumor in the common bile duct (CBD) and T tube drainage in 2 cases; enucleation of the tumor in CBD and internal stent of T tube drainage in 11 cases; tumor biopsy and T tube drainage in 2 cases; one case died without operation. 15 cases were followed-up for 1 to 14 months postoperatively. The results demonstrated that 14 patients died within 6 months, and only 1 case remained alive for 14 months after operation. Conclusions The correct diagnosis of this disease could be made for the patients with jaundice accompanied with positive of HbsAg and AFP, local lesions in the liver and the dilated bile duct. B-US, CT, PTC and ERCP are the main examination methods for the diagnosis. The best treatment of this kind of HCC is to remove the hepatic tumor and to recanalize the affected bile ducts.
ABSTRACT
AIM: To investigate how brain-dead state affects the heart structure and function and the effect of PKC-? in BA-Ma mini pigs.METHODS: Ten Ba-Ma mini pigs were randomized into 2 groups: brain-dead group(n=5),and control group(n=5).The brain-dead model was made by increasing intracranial pressure,while the control group was maintained anesthesia for 24 h.The concentrations of cTnT,TNF-?,IL-1? and IL-6 in serum were determined at 6,12 and 24 h after brain death.At 24 h,heart tissues were observed by HE staining and electron microscope.The expression of PKC-? was detected by immunohistochemistry and RT-PCR.RESULTS:(1) Histological changes of myocardium: flaky bleeding under endocardium and dissolution of myocardium were found in optical microscope.In electron microscope dropsical mitochondria and confluent muscle fiber were found.(2) Changes of serum cTnT: serum cTnT for brain-dead group began to increase gradually since 6 h,and were significantly higher at each time point than those in control group(P
ABSTRACT
Objective To explore the causes of upper gastrointestinal rebleeding after devascularization operation for portal hypertension and the therapeutic effect of shunt operation.Methods The clinical data of 56 cases of upper gastrointestinal rebleeding after devascularization operation for portal hypertension in our hospital from 1996 to 2006 were retrospectively analyzed.Shunt operation was done in 54 ceses including emergency operation shunt in 5 cases,and elective operation in 49 cases.C-type Mesocaval shunt was done in 45 cases,inferior mesenteric vein-cava shunt in 4 cases,H-type and portacaval in 5 cases.Results Chylorrhea occurred in 13 cases after operation and all recovered;hepatic encephalopathy occurred in 5 cases,and 4 cases recovered,1 died;and 1 case died of liver function failure on the third day after operation.Fifty-two cases were followed-up from 6 months to 9 years,and none had recurrence of upper gastrointestinal bleeding,but 7 died(2 cases died of primary hepatic carcinoma,3 cases died of liver function failure and hepatic encephalopathy,and 2 cases died of non-correlated disease).Conclusions Patients with upper gastrointestinal rebleeding after devascularization operation for portal hypertension should undergo non-operative treatment at first,and elective surgery is done later.If aggressive non-operative treatment for 48h is not successful,then emergency operation should be performed.In elective cases,the operation of first choice is mesocaval interposition synthetic graft shunt,which is particularly applicable in patients with portal vein thrombosis or portal hypertensive gastropathy.
ABSTRACT
Objective To investigate the causes,prevention and management principles of postoperative recurrence of Budd Chiari syndrome(BCS).Methods The clinical data of 223 postoperative recurrence BCS patients were analyzed retrospectively,including type Ia in 66 cases,type Ib in 48 cases,type II in 57 cases , type IIIa in 28 cases,and type IIIb in 24 cases. Of them,36 patients underwent two or more operations .Results Secondary operations were all successful.No patient died in the perioperative period. One hundred and eighty two patients were followed up for 6 months to 10 years.In 89.6% of the patients,the results were successful,but the recurrence rate after the reoperation was 6.0%,and 8 patients died postoperatively .Conclusions The main recurrent causes are that indications are not correctly selected and the operative technique is not correct. Correct classification,reasonable selection of the operation method, and adopting an interruptive,matress,and eversive suture for blood vessels anastomosis in the operation are important to prevent the recurrence of BCS.
ABSTRACT
Objective To study the methods for diagnosis and treatment of insulinoma.Methods The clinical data of 120 patients with insulinoma who had been admitted to our hospital in the last 40 years were retrospectively reviewed.Results Fasting blood glucose values were less than 2.75 mmol/L in all the patients.Fasting serum insulin values in 75 patients were higher than 25 ?U/mL,and the average was (65 ?6.0)?U/mL.Before operation,tumor was detected in 2 of 60 patients by ultrasound scan,and in 10 of 50 by CT. Among 18 patients who had intra-operative B-ultrasound examination, 16 positive cases were verified by intraoperative exploration; and one case the tumor was not palpable but was found by intraoperative B-ultrasound examination.The operations included enucleation of insulinoma(70 patients),insulinoma resection and distal resection of the pancreas(44),distal resection of the pancreas(4),and biopsy(2).The low blood glucose symptoms disappeared after the first operation in 111 of the 112 patients who had benign tumor.One case with benign tumor was cured by a second operation.Twenty patients developed pancreatic fistula after tumor enacleation, of them,14 healed uneventfully after drainage,5 were cured by operation,and 1 died of peritoneal infection.Conclusions Preoperative localization of insulinomas is difficult. Intraoperative exploration and ultrasound scan are the chief methods for the localization of insulinoma.Enucleation of insulinoma should be selected for benign tumor. Resections of the pancreatic body and tail is required for large,deep or multiple tumors.
ABSTRACT
Objective To investigate the treatment of severe Budd-Chiari syndrome (BCS) . Methods The clinical data of 95 patients with severe BCS from November 1994 to June 1999 were retrospectively analyzed . Results Mesocaval C shunt with artificial graft was performed in 51 cases , splenojugular shunt with artificial graft in 23 cases ,mesojuglar shunt with artificial graft in l case , percutaneous transhepatic recanalization and dilation and/or stent placement of main hepatic vein (MHV) in 10 case, and combined PTA and stent placement of inferior vena cava (IVC) and mesocaval shunt in 10 cases . 5～60 months follow-up showed excellent result in 65 patients , good results in 25 and 5 cases dead. Conclusions Good results could be obtained by most of the severe BCS patients treated by different procedures according to the pathological changes of IVC and main hepatic vein.
ABSTRACT
Objective To investigate the diagnosis and treatment of obstructive jaundice (OJ) caused by hepatocellular cacinoma (HCC) invasion to bile duct. Methods The diagnosis and treatment of 16 cases of OJ caused by HCC in our hospital from January 1989 to December 1998 were retrospectively analysed. Results Correct diagnosis was made in 2 cases and misdiagnosis in 14 cases preoperatively. 14 cases were operated on, including hepatectomy, enucleation of the tumor in the common bile duct (CBD) and T tube drainage in 2 cases; enucleation of the tumor in CBD and internal stent of T tube drainage in 11 cases; tumor biopsy and T tube drainage in 2 cases; one case died without operation. 15 cases were followed-up for 1 to 14 months postoperatively. The results demonstrated that 14 patients died within 6 months, and only 1 case remained alive for 14 months after operation. Conclusions The correct diagnosis of this disease could be made for the patients with jaundice accompanied with positive of HbsAg and AFP, local lesions in the liver and the dilated bile duct. B-US, CT, PTC and ERCP are the main examination methods for the diagnosis. The best treatment of this kind of HCC is to remove the hepatic tumor and to recanalize the affected bile ducts.
ABSTRACT
Objective To investigate the effect of interventional therapy for Budd Chiari Syndrome(BCS). Methods 355 patients with BCS were examined with phlebography of inferior vena cava(PIVC) and percutaneous transhepatic hepatovenography(PTHV).The interventional procedures were based on the pathological changes of inferior vena cava(IVC) and main hepatic veins(MHVs).The procedures included PTA and/or stent placement of IVC,percutaneous transhepatic recanalization and dilation (PTHRD)of MHVs ,and percutaneous transjugular or transinferior vena cava recanalization and dilation with stent placement of MHVs(PTJRD and PTIRD ), percutaneous transhepatic recanalization or transinferior vena cava recanalization and dilation with stent placement of associated hepatic veins(AHVs). Results The success rate and recurrence rate were 96.0%(240/250) and 10.0 %(24/240), respectively, in PTA; the success rate was 91.4%(32/35 ) in PTHRD of MHVs; 90.0%(18/20 ) in PTJRD and PTIRD of MHVs , 100.0%(10/10) in PTJRD and PTIRD of AHVs; 90.0 %( 9/10 ) in PTA and stent placement plus PTHRD of AHVs. Severe complications occurred in 10 cases (2.8%). Conclusions Interventional therapy is simple, safe and effective for patients with some types of Budd Chiari Syndrome.