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Objective:To investigate the classification of main pancreatic duct and treatment strategy after linear stapler closure of pancreatic neck in laparoscopic pancreaticoduodenectomy (LPD).Methods:The records of 51 consecutive patients with LPD who were treated by linear staple closure technique of pancreatic neck from February to December 2022 from Binzhou Second People′s Hospital, Shijingshan Campus, Beijing Chaoyang Hospital, Capital Medical University, Rizhao Hepatobiliary-Pancreatic-Splenic Surgery Research Institute, Chaoyang Central Hospital, Shandong Juxian People′s Hospital, Weihai Municipal Hospital, Binzhou Central Hospital, and Affiliated Hospital of Chifeng University were retrospectively reviewed. According to the visibility, position and diameter of the main pancreatic duct at the stump of the pancreas, the type of main pancreatic duct was divided into type I, type Ⅱ, type Ⅲa and type Ⅲb. The number of cases in each main pancreatic duct classification and the corresponding treatment strategies were examined.Results:A total of 51 cases of LPD were successfully completed. Of these patients, the males comprised 56.9%(29/51), and females comprised 43.1%(22/51), with age ranging from 31 to 88 years old. The type of the main pancreatic duct at the stump of the pancreas included 7 cases (13.7%) of type Ⅰ, 39 cases (76.5%) of type Ⅱ, 2 cases (3.9%) of type Ⅲa, and 3 cases (5.9%) of type Ⅲb. Corresponding treatment strategies were adopted according to different main pancreatic duct types, the main pancreatic duct was successfully found, and a support drainage tube was inserted.Conclusion:After linear stapler closure of pancreatic neck, corresponding treatment strategies should be adopted according to the classification of the main pancreatic duct, which would help to improve the success rate of finding the main pancreatic duct and placing a support drainage tube.
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Objective:To evaluate the value of conventional ultrasound, shear wave elastic parameters and immunohistochemistry in predicting axillary lymph node metastasis of breast cancer.Methods:The ultrasonographic features and pathological results of 172 masses in 152 breast cancer patients who underwent surgery in the First Affiliated Hospital of Shihezi University Medical College from May to October 2020 were analyzed retrospectively. The patients were divided into metastatic group and non-metastatic group according to the status of axillary lymph nodes. The conventional ultrasound characteristics, shear wave velocity (SWV) and immunohistochemical indexes (ER, PR, HER-2, Ki-67) of 2 groups of breast cancer masses were analyzed. Finally, the parameters with statistically significant difference between groups were selected and the Logistic regression model was established.Results:There were significant differences in the aspect ratio, calcification, SWVmean and HER-2 expression between metastatic group and non-metastatic group (all P<0.05). A prediction model was constructed with aspect ratio >1, calcification, high SWVmean and HER-2(+ ). The area under receiver operating characteristic curve (AUC) of the subjects was 0.891, which was larger than the single parameter (all P<0.05), and was in good agreement with pathological results (Kappa=0.731). Conclusions:The joint prediction model can be used to predict the status of lymph nodes, and the axillary lymph node metastasis is more likely to occur in breast cancer with the aspect ratio >1, calcification, high SWVmean and HER-2(+ ).
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Objective:To retrospectively analyze the impact of adjuvant iodine-125( 125I)brachytherapy on postoperative recurrence and survival for patients with hepatocellular carcinoma (HCC) treated with partial hepatectomy with narrow resection margins. Methods:The data of 72 HCC patients who underwent partial hepatectomy with narrow resection margins from January 2011 to June 2015 at Weihai Municipal Hospital were analyzed retrospectively. The patients were divided into the adjuvant 125I brachytherapy group ( 125I group) ( n=36) and the control group ( n=36). The data of the two groups of patients were compared to study the factors influencing long-term survival outcomes and recurrence. Results:The follow-up time was (45.0±18.4) months. There were no deaths relating to 125I brachytherapy. The median recurrent free survival (RFS) was significantly longer in the 125I group than the control group (41.0 months vs 21.5 months, P<0.05). The 1-, 3- and 5-year RFS rates of the 125I group and the control group were 94.4%, 58.3%, 41.6% versus 86.1%, 33.3%, 25.0%, respectively ( P<0.05). The 1-, 3- and 5-year overall survival (OS) rates of the 125I group versus the control group were 97.2%, 69.4%, 52.8% versus 94.4%, 52.8%, 27.8%, respectively ( P<0.05). On multivariate analysis, 125I implantation was an independent factor affecting RFS and OS ( HR=2.112, 95% CI: 1.155-3.860, P<0.05; HR=2.492, 95% CI: 1.272-4.693, P<0.05). Conclusion:Adjuvant 125I brachytherapy was safe and effective for HCC patients with narrow resection margins after hepatectomy. It obviously reduced the tumor recurrence rate and prolonged the long-term RFS and OS.
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Objective To investigate the correlation between ultrasound findings and clinical pathological types of adrenal cortical tumors(ACT).Methods The clinical data and ultrasonographic finding of 138 ACT patients undergoing surgical treatment in Affiliated Hospital of Qingdao University from January 2006 to December 2015 were retrospectively reviewed.The correlation between ultrasonic signs and pathological types of ACT was analyzed with Spearman method.Results There were 65 males and 73 females aged 18-71 years old.Among 138 cases,90 patients were characterized by hypertension,Cushing signs,Coon signs and abnormal sexual character, with the clinical diagnosis of adrenal cortical hyperplasia or adenoma;while 48 asymptomatic patients were first detected by ultrasonography.The coincidence rate of ultrasound and clinical pathological diagnosis was 92.0%(127/138),and 11 cases were misdiagnosed.The coincidence rate of ultrasound and surgical diagnosis was 94.2%(130/138), and 8 cases were misdiagnosed.The coincidence rate for no functional adenoma was 95.8%(46/48), for cortisol cortical adenoma was 94.1%(32/34),for aldosterone cortical adenoma was 93.6%(29/31),for cortical cysts was 9/10,for no functional adenocarcinoma was 5/6,for sexual abnormal cortical adenocarcinoma was 3/4,for cortisol cortical adenocarcinoma was 2/3,for mucous cortical adenoma was 1/2.The diameter of ACT was 0.6-11.5 cm.The low echo nodules of the adrenal region with a diameter <2.0 cm were associated with aldosterone cortical adenomas(r=0.485, P=0.01); the low echo or isoechoic nodules with a diameter 2.0-5.0 cm were associated with cortical adenomas or non-functional adenomas(r=0.567,0.452,P=0.01),and the circular non-echo nodules were associated with cortical cysts(r=0.483, P=0.01); the irregular nodules with a diameter >5.0 cm were associated with cortical adenocarcinoma(r=0.595, P=0.01).Conclusion The ultrasound image of ACT is related to different clinical pathological types,which can provide important information for clinical diagnosis and selection of surgical modalities.
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Objective:To explore clinical application value of color Doppler ultrasound (CDU) assigned to diagnose triple-negative breast cancer (TNBC) and axillary lymph node metastasis (ALNM).Methods:A retrospectively analyzed of proved of clinical data on the 863 patients breast cancer in women by CDU inspection,operation and pathology.According results will be divided into TNBC group and non negative breast cancer (NTNBC) group via clinical pathological and immunohistochemical detection.Using multi-factor unconditioned Logistic regression analysis the CDU supposed the diagnosis and the correlation of TNBC.Results:The coincidence rate of CDU and pathological diagnosis was 90.96％ (785/863),78 cases (9.04％) remove breast masses,105 patients TNBC group and NTNBC group 680 patients.The mass circular or elliptic (48.57％ vsl0.70 ％),the tumor maximum diameter 5.0 cm (21.90％ vs 15.30 ％),micro calcifications (87.62％ vs 74.12 ％),state clearly (56.19％ vs 41.47 ％),no burr edge character (74.29％ vs 41.62 ％),peripheral hyperechoic halo ring (74.29％ vs46.76 ％),rear echo attenuation (72.38％ vs 46.76 ％),no ALNM (61.90％ vs 37.35％) comparing the two groups exists significant difference (P＜ 0.05),while the mass number,and vertical and horizontal diameter ratio,degree of echo,echo distribution and blood flow classification comparing the two groups were no significant difference (P＞ 0.05).The CDU fu points ＞ 10 divided into NTNBC and pathological coincidence rate 93.93％ (680/724),8 ～ 10 points TNBC suspected diagnosis coincidence rate 11.51％ (16/139),＜ 8 points TNBC tendency diagnosis coincidence rate 64.03％ (89/139),TNBC total diagnostic coincidence rate was 75.54％ (105/139).In CDU diagnosed 785 cases of breast cancer,the ALN enlargement in 319 cases (40.64％),with TNBC group was 61.90％ (65/105),NTNBC group was 37.35％ (254/680).Logistic regression analysis results:tumor assumes the circular or elliptic,edge without burr,peripheral hyperechoic halo ring,rear echo attenuation and ALNM with TNBC has certain correlation (P＜0.05).Conclusion:The seemingly benign breast diseases and axillary lymph node enlargement,the CDU,supposed less than 8 points,age 50 or less or not at the same time,menopause or having a history of breast cancer susceptibility to family,important reference index,clinical value has high of CDU diagnostic of TNBC and ALNM.
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Objective To investigate the occurrence of postoperative healthcare-associated infection(HAI)in pa-tients with hepatobiliary malignant tumor,explore the related risk factors,so as to provide the basis for taking ef-fective prevention and control measures.Methods The occurrence of postoperative HAI in patients with hepatobili-ary malignant tumor in a hospital from January 2012 to December 2014 were retrospectively analyzed,risk factors for postoperative HAI were analyzed through reviewing and collecting patients’medical data.Results A total of 302 patients were investigated,42 (13.91 %)developed postoperative HAI,no multiple site infection occurred,the main infection site was deep surgical site (n=10,23.81 %),followed by lower respiratory tract (n=9,21 .43%) and digestive system (n=7,16.67%).Of 42 infection cases,38(90.48%)were sent specimens for pathogenic cul-ture,36 pathogenic strains were isolated,31 (86.11 %)of which were gram-negative bacteria,and 5 (13.89%) were gram-positive bacteria.Multivariate logistic analysis showed that operation duration≥2 hours (OR =1 .48), overweight (or obesity)(OR=1 .40),and preoperative radiotherapy (OR=2.98)were independent risk factors for postoperative HAI in patients with hepatobiliary malignant tumor (all P <0.05).Conclusion Incidence of postoper-ative HAI is high in patients with hepatobiliary malignant tumor,risk factors are long length of operation,over-weight (or obesity),and preoperative radiotherapy,effective prevention and control measures against risk factors should be taken.
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Background:14 C-urea breath test(14 C-UBT)is widely used for diagnosis of Helicobacter pylori(Hp)infection owing to its noninvasiveness and high sensitivity and specificity. Nevertheless,the presence of false-negative result can influence the diagnostic accuracy. Aims:To investigate the possible causes of false-negative 14 C-UBT for improving the accuracy of diagnosis. Methods:Eight-two cases with confirmed false-negative 14 C-UBT and 813 controls with true-positive 14 C-UBT at the People’s Hospital of Xinjiang Uygur Autonomous Region from Jan. 2014 to Aug. 2014 were enrolled. Patients in both groups were diagnosed as positive for Hp infection by Warthin-Starry silver staining combined with Hp stool antigen test. Univariate and multivariate analysis were performed to screen the factors related with false-negative 14 C-UBT. Results:In univariate analysis,5 variables were significantly different between case group and control group(P ﹤ 0. 05),and were taken into the multivariate analysis. Logistic stepwise regression analysis revealed that bile reflux( OR = 3. 961,P ﹤0. 001),post subtotal gastrectomy(OR = 9. 734,P ﹤ 0. 001),type Ⅱ Hp infection(OR = 1. 892,P = 0. 012)and upper gastrointestinal bleeding( OR = 4. 979,P ﹤ 0. 001 ) were the independent risk factors for false-negative 14 C-UBT. Conclusions:Bile reflux,upper gastrointestinal bleeding,post subtotal gastrectomy and type Ⅱ Hp infection might be the influential factors for false-negative 14 C-UBT. Combined tests for Hp infection should be suggested in patients with negative 14 C-UBT who had undergone subtotal gastrectomy or complicated with bile reflux or upper gastrointestinal bleeding.
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Background:The incidence of duodenal Brunner’s gland hyperplasia is low and the etiology and pathogenesis has not yet been clarified. Aims:To investigate the relationship between duodenal Brunner’s gland hyperplasia and Helicobacter pylori( Hp ) infection. Methods:A total of 96 patients with duodenal Brunner ’s gland hyperplasia diagnosed by pathological examination from October 2005 to December 2013 at People’s Hospital of Xinjiang Uygur Autonomous Region were enrolled in this study,and 270 cases without duodenal Brunner’s gland hyperplasia were served as controls. Hp infection was detected by 14 C-urea breath test( 14 C-UBT). The relationship between duodenal Brunner’s gland hyperplasia and Hp infection was analyzed. Results:In the duodenal Brunner ’s gland hyperplasia group,75 patients were Hp positive,the proportion of Hp infection was 3. 57( 75/21 ). In the control group,110 cases were Hp positive,the proportion of Hp infection was 1. 45(160/110). The difference between the two groups was statistically significant(χ2 =10. 97,P=0. 001). Hp infection was a risk factor of the genesis of duodenal Brunner’s gland hyperplasia( OR=2. 46, 95% CI:1. 44-4. 19). Conclusions:Hp infection may be related with the genesis of duodenal Brunner’s gland hyperplasia.