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Objective To investigate the application of liver three-dimensional (3D) visualized reconstruction technique in hepatectomy for children with complicated hepatoblastoma. Methods A retrospective analysis was performed for the clinical data of 30 children with hepatoblastoma who underwent hepatectomy for radical resection in PLA Rocket Force Characteristic Medical Center from January 2018 to October 2020, and according to whether liver 3D visualization with IQQA-Liver system was performed before surgery, the children were divided into 3D reconstruction group with 15 children and control group with 15 children. The two groups were compared in terms of perioperative parameters, short-term prognosis, and follow-up conditions. The independent samples t -test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups; the Fisher's exact test was used for comparison of categorical data between two groups. Results Compared with the control group, the 3D reconstruction group had a significantly higher mean age (55.7±10.2 years vs 28.2±2.7 years, P 0.05). The median follow-up after surgery was 9.5 months. In the 3D reconstruction group, 2 children experienced recurrence and were diagnosed at 10 and 12 months, respectively, after surgery, and they were treated with chemotherapy at the moment; in the control group, 4 children experienced recurrence, which was higher than that in the 3D reconstruction group ( P =0.651), and among these 4 children, 2 had recurrence at 7 months after surgery, received liver transplantation, and survived up to now, and the other 2 children died shortly after recurrence. Conclusion 3D visualized reconstruction technique helps to perform hepatectomy for children with complicated hepatoblastoma more safely and accurately, especially extended hepatectomy for patients with stage POST TEXT III/IV hepatoblastoma, thereby avoiding liver transplantation.
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ObjectiveTo investigate the change in the serum level of complement C5a after obstruction removal and its correlation with the serum levels of liver fibrosis markers in patients with obstructive jaundice. MethodsA total of 164 patients with obstructive jaundice who underwent endoscopic retrograde cholangiopancreatography and obstruction removal in our hospital from June 2012 to June 2014 were enrolled, and 20 healthy adults were enrolled as the control group. The serum levels of complement C5a and four liver fibrosis markers, type Ⅳ collagen (ⅣP), pre-type Ⅲ collagen (PⅢP), laminin (LN), and hyaluronic acid (HA), were measured. The t-test was applied for comparison between groups, and linear correlation analysis was applied for correlation analysis. ResultsCompared with the healthy controls, the patients with obstructive jaundice had a significantly higher serum level of complement C5a (89.7±30.2 vs 62.2±21.1 ng/L; t=2.213, P=0.016), and the serum level of complement C5a was closely related to the course of obstruction (r=0.954, P=0003). The serum level of complement C5a decreased significantly after obstruction removal (66.2±26.3 ng/L; t=1.998, P=0.021). Before obstruction removal, the serum level of complement C5a increased synchronously with those of ⅣP (r=0.976, P＜0.001), PⅢP (r=0972, P＜0.001), LN (r=0.915, P=0.039), and HA (r=0.962, P=0.002); after obstruction removal, the serum level of complement C5a decreased synchronously with those of ⅣP (r=0.965, P=0.001), PⅢP (r=0.912, P=0.003), and HA (r=0.875, P=0023). ConclusionComplement C5a may be involved in the development of liver fibrosis induced by obstructive jaundice.
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The pathogenesis of pancreatic sinistral portal hypertension (PSPH)is quite different from that of cirrhotic portal hypertension, and PSPH is the only curable type of portal hypertension.Gastric variceal bleeding is a less common manifestation of PSPH;however,it probably exacerbates the patient’s condition and leads to critical illness,and inappropriate management would result in death.Therefore,it is necessary to develop the optimal management of upper gastrointestinal bleeding in PSPH patients.Splenectomy is considered as a definitive procedure,together with surgical procedures to treat underlying pancreatic diseases.For patients in poor conditions or ineligible for surgery, splenic artery coil embolization is a preferable and effective method to stop bleeding before second-stage operation.The therapeutic decision should be made individually,and the further multi-center study to optimize the management of upper gastrointestinal bleeding from PSPH is warranted.
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ObjectiveTo explore the value of expanded radical resection for gallbladder cancer located respectively at body and bottom of the gallbladder and at the neck.MethodsIn this study,91 cases of gallbladder cancer were macropathologically divided into two groups, one with the lesion at the body and bottom of the gallbladder and the other at the neck, survival analysis was made accordingly. Three different kinds of resection were performed: the expanded radical resection, the standard radical resection and palliative operation.ResultsThe overall median survival rate of patients undergoing expanded radical operation was significantly longer than that of the cases doing other two procedures, that was 27. 1 ± 2. 4,10. 7 ±2. 2,4. 7 ±2.2 (months) respectively for body and bottom cancer, and 8.5 ±2. 1,6. 7 ± 1.9,3.1 ± 1.1 (months) respectively for neck cancer. For cancer at the body and bottom RO was achieved by expanded radical resection in 16/18(88％ ) cases and by standard radical resection in 7/12(58％ ) cases, while for cancer at the neck it was in 6/16(38％ ) cases, and in 3/13 (23％)cases only.ConclusionsThe median survival time is longer and RO resection rate is higher in patients with the cancer at the body and bottom than these at the neck of the gallbladder.
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Objective To explore the cultivated methods of dendritic cells (DC) and the killing effect of DC stimulated by CpG ODN1826 on gastritic cancer cells MKN45 in vitro. Methods DC was induced from peripheral blood monocytes stimulated by A group ( GM- CSF + IL-4 ), B group ( GM- CSF + IL-4 + TNF- α), C group(nonCpG ODN) and D group( CpG ODN 1826). The surface markers of DC was analyzed via flow cytometry, and the abilities to stimulate proliferation of allogenic lymphocyte by DC and antitumor experiment were detected by MTT assay. Results On day 10, a majority of cells showed typical morphology of DC in D group and B group with visible branching-like and pseudopod-like structures under microscope. The results of flow cytometry showed that there are significantly high expressed co-stimulated molecules such as CD40, CD1a,CD80, CD86 and MHC- Ⅱ in D group compared to other experimental groups ( P ＜ 0.05 ), which dramatically stimulate the proliferation of allogenic lymphocytes and enhance the killing activity of DC on gastric cancer cells. Conclusion This method can acquire relatively high purified DC, and CpG ODN can significantly induce the differentiation and maturation of DC isolated from peripheral blood and enhance the killing activity of DC on MKN45 by stimulating PBMC in vitro.
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Objective To summarize the clinical experience in Da Vinci surgical system-assisted hepatopancreatobiliary surgery.Methods From January to December in 2009,94 patients with hepatopancreatobiliary diseases were treated at General Hospital of Second Artillery of PLA.The surgical procedure and postoperative recovery of patients were analysed.Results A total of 90 patients had successfully undergone robotic surgery,and 4 patients were converted to open surgery with the conversion rate of 4%(4/94).Sixteen patients received surgeries for hepatic diseases,and 1 patient with a giant hemangioma in the right posterior hepatic lobe was converted to open surgery,because a very close relationship between the hemangioma and inferior vena cava was observed;27 patients received surgeries for hilar diseases;19 patients underwent surgeries for pancreatic diseases,and 3 patients were converted to open surgery,including 2 with poor exposure of the giant pancreatic head carcinoma and 1 with tumors in the distal common bile duct:32 patients received other surgeries,including 6 with choledochojejunostomy and 11 with laparoscopic common bile duct exploration.Conclusions Almost all kinds of operations for hepatopanereatobiliary diseases could be performed by Da Vinci surgical system.Da Vinci surgical system expands the indications for laparoscopic surgery.
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Objective To summarize the clinical experience of operations with Da Vinci surgical system in 27 patients with previous abdominal surgery.Methods The clinical data of 27 patients with previous abdominal surgery who had received reoperation using Da Vinci surgical system at General Hospital of Second Artillery of PLA from January to December 2009 were retrospectively analysed.The distribution of trocars was designed according to the surgical sites and previous surgical incision sites.The operation was divided into 2 steps:firstly,intraabdominal adhesion was dissected and the robotic arms were set up;secondly,the lesions were resected.Experience in trocars placement,surgical approach and management of complications were summarized.Results Six approaches were designed according to previous incision sites.Of all patients,22 were with severe intraabdominal and hepatic hilar band adhesion,and 5 with strip adhesion.One patient who underwent intraabdominal radiotherapy and chemotherapy abandoned robotic surgery because of the failure in trocar placement and pneumoperitoneum establishment.Twenty-six patients had successfully undergone robotic surgery and the success rate was 96%(26/27).Of the 26 patients,1 was complicated with enterorrhexis intraoperatively and received repairment.No postoperative complication was observed.Conclusions Previous abdominal surgery has little influence on robotic surgery with Da Vinci system. Pneumoperitoneum establishment,insertion point of the first trocar and dissection of the intraabdominal adhesions are key points for success of operation.
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objective To summarize the clinical experience of pancreatoduodenectomy using Da Vinci surgical system,and to investigate the methods to improve its efficacy.Methods Sixteen patients who received pancreatoduodenectomy from January to December 2009 at the General Hospital of Second Artillery of PLA were divided into robotic group(n=8)and open group(n=8).Data on the surgical procedure,perioperative management and postoperative recovery between the 2 groups were retrospectively analysed using t test and chi-square test.Result The radical resection rates of robotic group and open group were 7/8 and 8/8,respectively,with no significant difference between the 2 groups(χ~2=1.067,P＞0.05).The operation time of robotic group was (718±186)minutes,which was significantly longer than(420±127)minutes of open group(t=3.714,P＜0.05＝.The blood loss of robotic group was(153±43)ml,which was significantly less than(210±53)ml of open group(t=2.318,P＜0.05＝.The postoperative ambulation time and length of hospital stay of robotic group were(28±7)hours and(16±4)days,which were significantly shorter than(96±18)hours and(24±7)days of open group(t=9.939,2.714,P＜0.05＝.The incidences of postoperative complications of robotic group and open group were 2/8 and 6/8,respectively,with significant difference between the 2 groups(χ~2=6.349,P＜0.05＝.The incidences of anastomotic leakage of robotic group and open group were 2/8 and 3/8,respectively,with no significant difference between the 2 groups(χ~2=0.291,P＞0.05).Conclusion Pancreatoduodenectomy performed by Da Vinci surgical system is feasible and safe,and with the advantages of less trauma and rapid recovery of patients.
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Objective To summarize the clinical experiences in partial splenectomy for the treatment of splenic injuries Methods The indications, surgical procedures and surgical outcomes of a total of 105 cases undergoing partial splenectomy for splenic injuries in Southwest Hospital in the past 16 years were analyzed retrospectively Results Sixty seven cases(63 8%) suffered from isolated splenic injury According to splenic injury scale, grade Ⅰ (13, 11 4%), grade Ⅱ (56, 53 3%), gradeⅢ (28, 26 7%) and grade Ⅳ(8, 7 6%) were found in 105 cases of splenic injuries Surgical procedures included segmental splenectomy in 41 cases, hemi splenectomy in 35 cases, subtotal splenectomy in 29 cases and autotransplantation of splenic tissue in 21 cases of splenic injury in children There was no in hospital death in all cases Severe complications of subdiaphragmatic fluid collection and infection occurred in 3 cases, but the patients were cured by conservative treatment Conclusion Partial splenectomy is a safe and reasonable choice for selected patients with splenic injury
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Objective To investigate the clinical advantages of enteral nutrition (EN) for acute pancreatitis(AP)comparing with parenteral nutrition (PN) and its prospect. Methods Literatures using MESH Browser in Medline were collected and reviewed. Results Being of much higher cost and complications, total parenteral nutrition (TPN) ever regarded as most importantly for AP nutritional support, is now challenged by EN. Clinical evidence suggests enteral (jejunal) nutrition may diminish intestinal permeability to endotoxin and diminish bacterial translocation, thus reducing the cytokine drive to the generalized inflammatory response and preventing organ dysfunction, as well as achieving “pancreatic rest” equivalent to the TPN. Conclusion Early enteral nutrition should be used preferentially for patients with severe acute pancreatitis without paralytic ileus.
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Objective To summarize the experience of diagnosis and management of regional portal hypertension. Methods The clinical manifestations, diagnostic methods and therapeutic modalities of 16 cases of regional portal hypertension were analyzed retrospectively. Results Among 16 patients with ~regional portal hypertension, 12 cases resulted from pancreatic diseases, and 4 cases were complicated with non-pancreatic diseases. The main clinical findings were splenomegaly in 16(100%), abdominal pain ~in 10(63%) , gastrointestinal bleeding in 7(44%) and abdominal masses in 3(19%). All had normal liver function test. The main diagnostic methods were ultrasonography(US), computerized tomography (CT) and endoscopy. Splenic vein thrombosis could be detected by color Doppler ultrasonography (7/7). ~Enhanced CT could demonstrate enlarged and tortuous short gastric veins, gastroepiploic veins, and ~coll- ~ateral vessels around splenic hilum(16/16). Isolated gastric varices (4/5) were revealed mainly by ~gastro- ~scopy . Splenectomy was effective for controlling gastrointestinal bleeding, and its complication of portal vein thrombosis occurred in 1 case. Conclusions It is not difficult to diagnose regional portal ~hyper- ~tension based on findings of US and CT, together with special clinical characteristics. Therapeutic options should be ~individualized according to underlying diseases, however, splenectomy should be performed in the ~patients with gastrointestinal bleeding.
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Objective To investigate the possible contributing risk factors, diagnosis and treatment of gastroparesis after abdominal surgery. Methods Potential risk factors, clinical manifestations and therapeutic approaches of 22 cases of gastroparesis after abdominal operation were analyzed retrospectively. Results In this series, gastroparesis more frequently occured in those patients having a long-term preoperative gastric outlet obstruction, malignant tumor, O type blood group pancreaticoduodenectomy or simple gastrojejunostomy without gastric resection. Endoscopy, upper gastrointestinal radiography and radioisotope scintigraphy were effective methods in the diagnosis of gastroparesis, and normal gastrointestinal movement was achieved mostly in 5 weeks postoperatively by conservative treatments.Conclusions Postoperative gastroparesis can recover spontaneously after a longer period of supportive treatment combined with prokinetic drugs, and reoperation should be avoided.
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Objective To investigate the clinicopathological characteristics, diagnosis and treatment of primary duodenal malignant tumors (PDMTs). Methods The clinical data of 47 PDMTs confirmed by pathology were retrospectively analyzed. Results Pathological types were adenocarcinoma in 42 cases, leiomyosarcoma in 4, and carcinoid in 1.The most common location of the tumor was the descending portion (35), especially the peri-papillary region (28) of the duodenum. The most common symptoms and signs were abdominal pain, jaundice, upper gastrointestinal hemorrhage, obstruction ,and weight loss. The main diagnostic modalities were gastroduodenoscopy, GI barium meal, ERCP, ultrasound (US) and CT. US together with ERCP was the most useful in improving the diagnosis of peripapilla tumors in the duodenum. Panceraticoduodenectomy and some palliative procedures were performed for 25 and 20 cases, respectively.Surgical mortality and postoperative morbidity were 2.2% (1/45) and 20% (9/45),retrospectively. The 3-year and 5-year survival for those adenocarcinoma without distant metastasis undergoing pancreaticoduodenectomy were 50% and 32%. No long survival was found after the palliative operation. Conclusions Adenocarcinoma is the most common pathological type of PDMTs.No specific symptoms were shown in the early stage of PDMTs, US, CT and ERCP are the main diagnostic procedures. Radical pancraticoduodenectomy can prolong survival time and should be attempted for those without systemic dissemination.Palliative operations should be considered for tumors in advanced stage.