ABSTRACT
Purpose@#Pancreatic duct decompression relieves pancreatic duct stone (PDS)-associated abdominal pain, though a consensus indication for the drainage procedure of the main pancreatic duct (MPD) is lacking. Moreover, major prognostic factors for postsurgical long-term pain relief and recurrence are largely unknown. @*Methods@#The clinical outcomes of 65 consecutive PDS patients undergoing surgery from 2008–2012 with 3+ years of follow-up were assessed. @*Results@#At postsurgical follow-up (median, 4.5 years; range, 3–7 years; procedure: Partington, n = 32; Frey, n = 27; pancreatoduodenectomy, n = 3; distal pancreatectomy, n = 3), the early complication and complete stone clearance rates were 29.2% and 97%, respectively. Long-term, complete and partial pain relief were 93.9%, 83.1%, and 10.8%, respectively. The risk of pancreatic fistula was higher in the 8 mm group (P < 0.05), and 80% of the pancreatic fistula cases occurred in the <8 mm group. A shorter pain duration (P = 0.007), smaller MPD diameter (P = 0.04), and lower Izbicki pain score (P < 0.001) predicted long-term pain relief. Pain recurrence after initial remission occurred in 5 patients and was only related to pain duration (P = 0.02). Stone recurrence and pancreatic exocrine functional and endocrine functional deterioration occurred in 2, 5, and 11 patients, respectively. @*Conclusion@#Surgery provides excellent stone clearance, long-term pain relief, and acceptable postoperative morbidity. Using 8 mm as the criterion for drainage surgery can minimize the postoperative pancreatic fistula risk. Individualized and timely surgical treatment may improve the effect of surgery.
ABSTRACT
Objective:To report on 3 patients who presented with rupture of hepatic artery pseudoaneurysm after liver transplantation.Methods:From April 2010 to April 2019, 3 patients with hepatic artery pseudoaneurysm rupture after liver transplantation treated at the Department of Hepatobiliary and Pancreatic Surgery, Henan Provincial People's Hospital were studied. The possible causes, clinical manifestations, diagnosis and treatment were retrospectively analyzed.Results:Rupture of hepatic artery pseudoaneurysm occurred on the19th, 28th and 63th days after transplantation. The 3 patients all presented with hematochezia and abdominal pain, while 2 patients presented with hematemesis. Two patients had bile leakage and abdominal infection. All the 3 patients presented with fever. Patient 1 who was diagnosed by laparotomy died of liver failure. Patient 2 underwent interventional embolization of hepatic artery and died of liver failure also. Patient 3 underwent surgical resection of the pseudoaneurysm followed by hepatic artery reconstruction, but died of repeat abdominal hemorrhage.Conclusion:Hepatic artery pseudoaneurysm after liver transplantation has a long latent period and is difficult to diagnose at an early stage. Early detection of this life-threatening complication is the key to improve survival. Early treatment of biliary leakage, abdominal infection and other complications help to prevent development of pseudoaneurysms.
ABSTRACT
Objective To compare the clinical effects between laparoscopic cholecystectomy and choledochotomy versus traditional open cholecystectomy plus choledochotomy.Methods One hundred and sixty-eight elderly patients with gallbladder and choledocholithiasis were divided into a laparoscopy group(n=75,receiving laparoscopic cholecystectomy and choledochotomy)and an open abdominal group (n =93,undergoing traditional open cholecystectomy and common bile duct exploration).The surgical incision length,operation time,intraoperative blood loss,anal exhaust time,hospital stay and postoperative complications were compared between the two groups.Results The surgical incision length,operation time,intraoperative blood loss,anal exhaust time,hospital stay were lower in the laparoscopic group than in the open abdominal group (P ＜ 0.05).The incidence of postoperative complications was lower in the laparoscopic group than in the open group(P＜0.05).Conclusions Laparoscopic cholecystectomy and choledochotomy can obviously improve the clinical efficacy and reduce complications in elderly patients with gallbladder and choledocholithiasis,and it is worthy of clinical application.
ABSTRACT
Objective@#To compare the clinical effects between laparoscopic cholecystectomy and choledochotomy versus traditional open cholecystectomy plus choledochotomy.@*Methods@#One hundred and sixty-eight elderly patients with gallbladder and choledocholithiasis were divided into a laparoscopy group(n=75, receiving laparoscopic cholecystectomy and choledochotomy)and an open abdominal group(n=93, undergoing traditional open cholecystectomy and common bile duct exploration). The surgical incision length, operation time, intraoperative blood loss, anal exhaust time, hospital stay and postoperative complications were compared between the two groups.@*Results@#The surgical incision length, operation time, intraoperative blood loss, anal exhaust time, hospital stay were lower in the laparoscopic group than in the open abdominal group(P<0.05). The incidence of postoperative complications was lower in the laparoscopic group than in the open group(P<0.05).@*Conclusions@#Laparoscopic cholecystectomy and choledochotomy can obviously improve the clinical efficacy and reduce complications in elderly patients with gallbladder and choledocholithiasis, and it is worthy of clinical application.
ABSTRACT
Objective To analyze the clinical efficacy and outcomes of adult patients who underwent ABO-incompatible living donor liver transplantation.Methods The clinical data of 7 patients who underwent ABO-incompatible living donor liver transplantation at the Henan Provincial People's Hospital and Zhengzhou People's Hospital from January 2013 to December 2015 were analyzed retrospectively.Age,gender,primary disease,blood type antibody level,graft volume/standard liver volume (GV/SLV),postoperative complications and prognosis were analyzed.Results The recipients' average GV/SLV was 52.0％.There were 4 recipients who underwent splenectomy,including 3 patients who underwent the procedure concurrently,and one patient who underwent the procedure a few years before,the liver transplantation.Seven recipients were treated with plasmapheresis,Rituximab and Basiliximab.No patients experienced acute rejection during the perioperative period,and the 1-year survival rate was 85.7％ (6/7).Conclusion ABOincompatible liver transplantation in adult living donor can have favorable clinical outcomes using appropriate preoperative evaluation for recipients,optimized surgical procedures,pretransplant plasmapheresis,and perioperative Rituximab,Basiliximab injection and intravenous immunoglobulin administration.
ABSTRACT
Objective To evaluate the outcome of patients with alcoholic liver disease (ALD) after orthotopic liver transplantation (OLT) and to study the prognostic factors.Methods The data of 17 patients who underwent OLT for ALD from January 2010 to March 2013 were analyzed retrospectively.The data on age,gender,history of gastrointestinal bleeding,history of splenectomy,Child-Pugh score,Maddrey' s discriminant function and MELD score were evaluated using the Kaplan-Meier method for univariate analysis.The log-rank test was applied to compare the survival rates.Results The overall survival rate at 100 weeks in patients less than 55 years old was 90％ (9/10),while that in patients more than 55 years old was 28.57％ (2/7).There was a significant difference between the two groups (P ＜ 0.05).There were no statistically significant differences between female and male patients,between patients with or without a history of gastrointestinal bleeding or splenectomy (P ＞ 0.05).There was no significant difference on survival rates after liver transplantation between patients with Child-Pugh B and Child-Pugh C,patients with Maddrey' s scores ＜ 70 and ≥70,and patients with a MELD score ＜ 30 and ≥ 30 (P ＞ 0.05).Conclusions Better survival rates were observed in ALD patients who were ＜ 55 years old after liver transplantation.The Child-Pugh score,Maddrey' s discriminant function and MELD score were of no prognostic significance.These findings still need to be verified by prospective large-scale studies.
ABSTRACT
Objective To explore the histopathological manifestations of various complications after transplantation,the patients in our hospital after liver transplantation liver puncturebiopsy pathology data were analyzed,and then provide a reliable clinical diagnosis and treatment for the patients scheme.Methods A retrospective analysis of our hospital 198 cases of liver transplantation in 249 cases diagnosis of liver puncture biopsy pathology data,HE staining method to analyze the pathological morphological changes,using rejectionpathological criteria,according to clinical examination and treatment effect of international unified Banff.Results All biopsy materials,acute rejection rate is the highest,a total of 71 cases(28.5％),biliary complications occurred in 39 cases (15.7％),hepatitis B virusinfection and recurrence in 28 cases (11.2％),34 cases of drug-induceddamage (13.7％),reperfusion injury in 35 cases (14.1％),CMV infection of 14cases (5.6％),tumor recurrence in 7 cases (2.8％),chronic rejection in 16cases (6.4％),primary graft non function in 2 cases (0.8％),it is difficult to determine in 3 cases (1.2％).Conclusion Transplantation of liver biopsy can provide correct cause for abnormal liver function,and to guide the clinical treatment of accurate,effective treatment,suggested that thetransplantation center will transhepatic listed for liver transplantationpostoperative routine inspections,periodic biopsies,the survival of the state to better protect the graft.
ABSTRACT
Objective To investigate the expression of Foxp3+ Treg in liver cancer patients receiving liver transplant after immunosuppressive protocols FK506 or Rapamycin and evaluate the rejection prevention.Methods Liver transplant patients were randomly divided into FK506 group (10 cases),and Rapamycin group (10 cases).Real time quantitatve PCR was used to examine Foxp3 mRNA expression of patients' PBMC starting the 2nd month for consecutively 10 months.Foxp3 mRNA and incidences of acute rejection were compared between the two groups.Results Foxp3 mRNA expression was significantly lower in the FK506 group (0.1032 ±0.0943) as compared to that in the Rapamycin group (1.2136 ±0.6738)(t =5.1610,P ＜ 0.01) ;The incidences of acute rejection was significantly lower in the Rapamycin group as compared to that in the FK506 group after operation in the same period (x2 =2.2222,P ＜ 0.05).Conclusions FK506 may suppress the induction of immune tolerance after liver transplantation,while Rapamycin may play an important role in inducing and maintaining graft immune tolerance.Rapamycin is better than FK506 in preventing rejection reaction in liver cancer patients receiving liver transplant.
ABSTRACT
BACKGROUND:The incidence of intestinal necrosis during liver transplantation is low, and most of them abandon transplantation and thus leading to death. OBJECTIVE:To retrospectively analyze the reasons which result in smal intestinal necrosis during liver transplantation, and to explore the viable treatment options. METHODS:The clinical data of 207 patients were reviewed, two patients complicated with smal intestinal necrosis during liver transplantation. Case 1 underwent liver transplantation combined with necrotic smal bowel resection. Case 2 abandoned liver transplantation, and received conservative treatment. RESULTS AND CONCLUSION:Both of the two patients had preoperative portal system thrombosis. In Case 1, there was upper gastrointestinal bleeding before transplantation, and repeated application of hemostatic drugs could increase the thrombosis and thus resulting smal intestinal necrosis. At 10 days after liver transplantation, the patients complicated with intestinal fistula and were treated with fistulation. After fistulation, the patient suffered from abdominal cavity and lung infections. At 7 days after anti-infection treatment and immunosuppressant stopped, the infections were cured. At 40 days after fistulation, the intestinal fistula was healed and the patient was discharged after rehabilitation. After fol owed-up for 2 years, the patient was stil healthy living. The Case 2 suffered with mass ascites which lead to abdominal compartment syndrome, the intestinal venous disorders lead to extensive smal bowel necrosis. At 2 days after abandon the liver transplantation, the patient was dead because of multiple organ failure. The patients who waiting for liver transplantation had preoperative portal system thrombosis, abdominal pain and abdominal distention, should be pay attention to intestinal necrosis. Patients with smal bowel necrosis during liver transplantation can be cured with liver transplantation combined with necrotic smal bowel resection.