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Objective:To investigate the clinical efficacy of pancreaticoduodenectomy with TRIANGLE operation in the treatment of pancreatic head cancer.Methods:The retrospective cohort study was conducted. The clinicopathological data of 51 patients with pancreatic head cancer who were admitted to the Sichuan Provincial People′s Hospital, Affiliated Hospital of School of Medicine of University of Electronic Science and Technology of China from January 2017 to July 2018 were collected. There were 33 males and 18 females, aged from 42 to 74 years, with a median age of 56 years. Of the 51 patients, 24 cases undergoing standard pancreaticoduodenectomy, in which No.12, 13 and 17 lymph nodes were dissected, combined with transcatheter arterial infusion chemo-therapy (TAI) were allocated into the standard group, and 27 cases undergoing pancreaticoduo-denectomy with TRIANGLE operation, in which No.7, 8, 9, 12, 13, 16, 17 lymph nodes were dissected, combined with TAI were allocated into the TRIANGLE group, respectively. Observation indicators: (1) intraoperative conditions of the two groups; (2) postoperative conditions of the two groups; (3) follow-up and survival. Follow-up was conducted using outpatient examination and telephone interview once three months to detect tumor recurrence and metastasis and survival of patients up to July 2021 or the death of patient. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was analyzed using the t test. Measurement data with skewed distribution were represented as M(range), and comparison between groups was analyzed using the chi-square test or the Fisher exact probability. Comparison of ordinal data was analyzed using the rank sum test. Kaplan‐Meier method was used to calculate the survival rate and median survival time and draw survival curve. Log‐Rank test was used for survival analysis. Results:(1) Comparison of intraoperative conditions between the two groups. The operation time, volume of intraoperative blood loss, cases with intraoperative blood transfusion were (501±61)minutes, (563±278)mL, 4 in the standard group, versus (556±46)minutes, (489±234)mL, 6 in the TRIANGLE group, respectively. There was a significant difference in the operation time between the two groups ( t=3.62, P<0.05) but there was no significant difference in the volume of intraoperative blood loss or cases with intraoperative blood transfusion between the two groups ( t=1.03, χ2=0.25, P>0.05). (2) Comparison of postoperative conditions between the two groups. Of the 51 patients, 30 had 50 times of postoperative complications, including 18 times of grade Ⅰ complications of Clavien-Dindo classification, 29 times of grade Ⅱ complications of Clavien-Dindo classification, 2 times of grade Ⅲa complications of Clavien-Dindo classification, 1 time of grade Ⅲb complications of Clavien-Dindo classification, respectively. Cases with postoperative complications, cases with delayed gastric emptying, cases without or with pancreatic fistula as class A or class B, cases with biliary fistula, cases with bleeding, cases with diarrhea were 15, 4, 13, 7, 4, 4, 2, 2 in the standard group, versus 15, 6, 14, 10, 3, 4, 1, 3 in the TRIANGLE group, respectively. There was no significant difference in cases with postoperative complications, cases with delayed gastric emptying, cases with pancreatic fistula between the two groups ( χ2=0.16, 0.02, Z=-0.04, P>0.05) and there was no significant difference in cases with biliary fistula, cases with bleeding, cases with diarrhea between the two groups ( P>0.05). Cases with complications as Clavien-Dindo grade Ⅰ, grade Ⅱ, grade Ⅲ were 10, 11, 2 in the standard group, versus 8, 18, 1 in the TRIANGLE group, showing no significant difference between the two groups ( Z=-0.67, P>0.05). The duration of postoperative hospital stay was (23±8)days in both of the standard group and the TRIANGLE group, showing no significant difference between the two groups ( t=0.31, P>0.05). (3) Follow-up and survival. All the 51 patients were followed-up for 6 to 54 months, with a median follow-up time of 17 months. The postoperative 1-year overall survival rate was 75.0% and 81.5% in the standard group and the TRIANGLE group, respectively. The postoperative 3-year overall survival rate was 12.5% and 22.2% in the standard group and the TRIANGLE group, respectively. The median postoperative survival time was 15.00 months (95% confidence interval as 12.63 to 17.37 months) and 21.00 months (95% confidence interval as 15.91 to 19.62 months) in the standard group and the TRIANGLE group, respectively. There was a significant difference in survival of patients between the two groups ( χ2=4.30, P<0.05). Cases with tumor recurrence during post-operative 1 year and 3 year were 9 and 20 in the standard group, versus 6 and 15 in the TRIANGLE group, respectively. There was no significant difference in cases with tumor recurrence during postoperative 1 year between the two groups ( P>0.05) and there was a significant difference in cases with tumor recurrence during postoperative 3 year between the two groups ( P<0.05). Conclusion:Compared with standard pancreaticoduodenectomy, pancreaticoduodenectomy with TRIANGLE operation can prolong the median survival time of patients with pancreatic head cancer without increasing surgical related complications.
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Objective:To evaluate the clinical efficacy of different treatment methods for chronic pancreatitis based on M-ANNHEIM system.Methods:The retrospective cross-sectional study was conducted. The clinicopathological data of 177 patients with chronic pancreatitis from two medical centers between July 2008 and July 2018 were collected, including 95 in the Sichuan Provincial People′s Hospital and 82 in the West China Hospital of Sichuan University. There were 100 males and 77 females, aged (49±5)years, with a range from 29 to 72 years. The M-ANNHEIM system was used to decide clinical stages of chronic pancreatitis. Patients in different clinical stages received drug, endoscopic or surgical treatment. Observation indicators: (1) general data and follow-up of patients; (2) treatment of patients in asymptomatic stage; (3) treatment of patients in stage Ⅰ; (4)treatment of patients in stage Ⅱ; (5) treatment of patients in stage Ⅲ; (6) treatment of patients in stage Ⅳ; (7) aggravation and new-onset of diabetes; (8) complications. Follow-up using outpatient examination, telephone, mail, and Sojump was performed to collect data for M-ANNHEIM system up to December 2018. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was analyzed by the AVONA. Repeated measurement data were analyzed using repeated ANOVA. Count data were described as absolute numbers, and comparison between groups was conducted using the chi-square test. Results:(1) General data and follow-up of patients: there were 11, 72, 55, 31, and 8 patients with chronic pancreatitis classified as asymptomatic stage, stage Ⅰ, stage Ⅱ, stage Ⅲ, stage Ⅳ of M-ANNHEIM system before treatment. Of the 177 patients, 49, 49, and 79 patients underwent drug, endoscopic and surgical treatment, respectively. All the 177 patients were followed up for (2.4±0.5)years. (2) Treatment of patients in asymptomatic stage: 11 patients in asymptomatic stage underwent drug treatment. The M-ANNHEIM score was 1.91±0.21 before treatment, and 1.27±0.14, 1.73±0.19, 2.09±0.16 at 1 month, 12 months, 24 months after treatment, respectively. (3) Treatment of patients in stage Ⅰ: of the 72 patients in stage Ⅰ, 13 underwent drug treatment, 26 underwent endoscopic treatment, and 33 underwent surgical treatment. The M-ANNHEIM score of patients undergoing drug treatment was 8.11±1.05 before treatment, and 6.31±0.31, 7.69±0.24, 10.00±0.23 at 1 month, 12 months, 24 months after treatment, respectively. The M-ANNHEIM score of patients undergoing endoscopic treatment was 8.42±0.93 before treatment, and 5.13±0.25, 6.89±0.20, 8.27±0.24 at 1 month, 12 months, 24 months after treatment, respectively. The M-ANNHEIM score of patients undergoing surgical treatment was 8.13±0.77 before treatment, and 4.79±0.15, 5.42±0.22, 7.76±0.20 at 1 month, 12 months, 24 months after treatment, respectively. There was no significant difference in M-ANNHEIM score before treatment between patients receiving different treatments ( F=1.23, P>0.05). For patients in M-ANNHEIM stage Ⅰ, at 1 month after treatment, there was a significant difference in M-ANNHEIM score between patients receiving drug treatment and patients receiving endoscopic treatment, between patients receiving drug treatment and patients receiving surgical treatment ( F=2.94, 4.98, P<0.05); there was no significant difference in M-ANNHEIM score between patients receiving endoscopic treatment and patients receiving surgical treatment ( F=1.26, P>0.05). At 12 months after treatment, there was a significant difference in M-ANNHEIM score between patients receiving drug treatment and patients receiving endoscopic treatment, between patients receiving drug treatment and patients receiving surgical treatment, between patients receiving endoscopic treatment and patients receiving surgical treatment ( F=2.43, 5.99, 4.80, P<0.05). At 24 months after treatment, there was a significant difference in M-ANNHEIM score between patients receiving drug treatment and patients receiving endoscopic treatment, between patients receiving drug treatment and patients receiving surgical treatment ( F=4.61, 6.29, P<0.05); there was no significant difference in M-ANNHEIM score between patients receiving endoscopic treatment and patients receiving surgical treatment ( F=1.63, P>0.05). (4) Treatment of patients in stage Ⅱ: of the 55 patients in stage Ⅱ, 8 underwent drug treatment, 15 underwent endoscopic treatment, and 32 underwent surgical treatment. The M-ANNHEIM score of patients undergoing drug treatment was 12.61±1.16 before treatment, and 11.63±0.26, 12.57±0.30, 14.50±0.27 at 1 month, 12 months, 24 months after treatment, respectively. The above indicators of patients undergoing endoscopic treatment was 12.42±1.43, 8.47±0.24, 11.07±0.21, 11.93±0.30, respectively. The above indicators of patients undergoing surgical treatment was 12.53±1.22, 8.78±0.15, 9.94±0.21, 11.00±0.24, respectively. There was no significant difference in M-ANNHEIM score before treatment between patients receiving different treatments ( F=1.38, P>0.05). For patients in M-ANNHEIM stage Ⅱ, at 1 month after treatment, there was a significant difference in M-ANNHEIM score between patients receiving drug treatment and patients receiving endoscopic treatment, between patients receiving drug treatment and patients receiving surgical treatment ( F=8.37, 8.48, P<0.05); there was no significant difference in M-ANNHEIM score between patients receiving endoscopic treatment and patients receiving surgical treatment ( F=1.13, P>0.05). At 12 months after treatment, there was a significant difference in M-ANNHEIM score between patients receiving drug treatment and patients receiving endoscopic treatment, between patients receiving drug treatment and patients receiving surgical treatment, between patients receiving endoscopic treatment and patients receiving surgical treatment ( F=4.13, 8.48, 3.33, P<0.05). At 24 months after treatment, there was a significant difference in M-ANNHEIM score between patients receiving drug treatment and patients receiving endoscopic treatment, between patients receiving drug treatment and patients receiving surgical treatment, between patients receiving endoscopic treatment and patients receiving surgical treatment ( F=5.61, 6.83, 2.26, P<0.05). (5) Treatment of patients in stage Ⅲ: of the 31 patients in stage Ⅲ, 9 underwent drug treatment, 8 underwent endoscopic treatment, and 14 underwent surgical treatment. The M-ANNHEIM score of patients undergoing drug treatment was 17.25±0.89 before treatment, and 17.11±0.35, 18.44±0.41, 17.33±0.44 at 1 month, 12 months, 24 months after treatment, respectively. The above indicators of patients undergoing endoscopic treatment was 17.38±1.06, 15.00±0.53, 16.50±0.33, 16.88±0.44, respectively. The above indicators of patients undergoing surgical treatment was 17.63±1.06, 14.64±0.34, 16.00±0.35, 16.57±0.33, respectively. There was no significant difference in M-ANNHEIM score before treatment between patients receiving different treatments ( F=1.19, P>0.05). For patients in M-ANNHEIM stage Ⅲ, at 1 month after treatment, there was a significant difference in M-ANNHEIM score between patients receiving drug treatment and patients receiving endoscopic treatment, between patients receiving drug treatment and patients receiving surgical treatment ( F=3.37, 4.82, P<0.05); there was no significant difference in M-ANNHEIM score between patients receiving endoscopic treatment and patients receiving surgical treatment ( F=0.59, P>0.05). At 12 months after treatment, there was a significant difference in M-ANNHEIM score between patients receiving drug treatment and patients receiving endoscopic treatment, between patients receiving drug treatment and patients receiving surgical treatment ( F=3.63, 4.48, P<0.05); there was no significant difference in M-ANNHEIM score between patients receiving endoscopic treatment and patients receiving surgical treatment ( F=0.95, P>0.05). At 24 months after treatment, there was no significant difference in M-ANNHEIM score between patients receiving drug treatment and patients receiving endoscopic treatment, between patients receiving drug treatment and patients receiving surgical treatment, between patients receiving endoscopic treatment and patients receiving surgical treatment ( F=0.73, 1.41, 0.55, P>0.05). (6) Treatment of patients in stage Ⅳ: 8 patients in stage Ⅳ underwent drug treatment. The M-ANNHEIM score of patients was 17.94±0.59 before treatment, and 18.01±0.34, 17.54±0.19, 17.34±0.26, 17.88±0.43 at 1 month, 6 months, 12 months, 24 months after treatment, respectively. (7) Aggravation and new-onset of diabetes: of 49 patients undergoing endoscopic treatment, 17 had diabetes before treatment, 5 had aggravated diabetes and 11 had new-onset of diabetes after treatment. Of 79 patients undergoing surgical treatment, 31 had diabetes before treatment, 21 had aggravated diabetes and 7 had new-onset of diabetes after treatment. There were significant differences in the aggravation and new-onset of diabetes between the two groups ( χ2=2.07, 2.04, P<0.05). (8) Complications: 49 patients undergoing drug treatment had no treatment related complications. Of 49 patients undergoing endoscopic treatment, 4 patients with stent related complications were cured after replacing stent under endoscopy, 6 patients had acute pancreatitis, 2 had gastrointestinal bleeding including 1 patient was cured after endoscopic hemostasis, other patients with complications were improved after symptomatic and supportive treatment. Of 79 patients undergoing surgical treatment, 17 had pancreatic leakage (including 11 of biochemical leakage, 5 of grade B pancreatic leakage, and 1 of grade C pancreatic leakage), 3 had postoperative gastroparesis, 3 had intraabdominal infection, 1 had deep venous thrombosis, 2 had hemorrhage of which 1 combined with grade C pancreatic leakage was improved after open hemostasis and 1 was improved after interventional treatment, other patients with complications were improved after symptomatic and supportive treatment. Conclusions:For chronic pancreatitis, individualized treatment should be formulated according to the different stages. M-ANNHEIM score system can be used the evaluate clinical efficacies of drug treatment, endoscopic treatment, and surgical treatment.
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The mortality rate of liver cancer patients in China is increasing constantly, which greatly threatens human health, and therefore, it is urgent to explore more effective treatment methods to prolong the survival time of patients. Because of its special physiological structure, the liver plays an immunoregulatory role, and thus immunotherapy for liver cancer gradually shows its clinical advantages and has become the fourth-generation therapy for liver cancer after surgical resection, chemotherapy, and radiotherapy. Adoptive cell transfer immunotherapy has been developed rapidly in the treatment of hepatocellular carcinoma (HCC) in recent years. CIK, NK, DC-CIK, TIL, and CAR-T cells are immune cells used for adoptive cell transfer immunotherapy. This article briefly summarizes the research advances in these immune cells in the treatment of HCC.
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Objective@#To further observe the efficacy of combined transplantation of islet and bone marrow mesenchymal stem cells (BMSC) in diabetic rats, PET-CT was used to trace cells in vivo to determine the homing and distribution of cells in vivo.@*Methods@#Streptozotocin (STZ)was used to construct a rat model of diabetes mellitus. BMSC could be isolated and cultured by full adherence method; islets were isolated by collagenase; Islets and BMSC were labeled with 18F-FDG in vitro. Diabetic rats were randomly divided into 4 groups, 15 rats in each group: A, Control group; B, Stem cell transplantation group; C, Islet Transplantation group; D, Combined transplantation group, a total of four groups, all transplanted through portal vein, PET-CT tracing the distribution of cells transplanted into the body.7 days after transplantation, the livers of each group were taken, and the homing and distribution of transplanted cells were detected by immunofluorescent staining.The SUV was calculated by the analysis of variance of random block, and the difference between groups was compared by t-test.@*Results@#PET-CT results showed that BMSC were mainly distributed uniformly in the right liver, and the islets of the pancreas were mainly clustered in terminal branches of hepatic portal vein, and BMSC were around the islets of pancreas, but there was no obvious development in the liver of the control group.@*Conclusions@#PET-CT can directly reveal the distribution of islets and BMSC in liver after transplantation through portal vein.
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Objective To further observe the efficacy of combined transplantation of islet and bone marrow mesenchymal stem cells (BMSC) in diabetic rats ,PET-CT was used to trace cells in vivo to determine the homing and distribution of cells in vivo .Methods Streptozotocin (STZ)was used to construct a rat model of diabetes mellitus .BMSC could be isolated and cultured by full adherence method;islets were isolated by collagenase ;Islets and BMSC were labeled with 18F-FDG in vitro . Diabetic rats were randomly divided into 4 groups ,15 rats in each group :A ,Control group;B ,Stem cell transplantation group ;C ,Islet Transplantation group ;D ,Combined transplantation group ,a total of four groups ,all transplanted through portal vein ,PET-CT tracing the distribution of cells transplanted into the body .7 days after transplantation ,the livers of each group were taken ,and the homing and distribution of transplanted cells were detected by immunofluorescent staining .The SUV was calculated by the analysis of variance of random block , and the difference between groups was compared by t-test .Results PET-CT results showed that BMSC were mainly distributed uniformly in the right liver ,and the islets of the pancreas were mainly clustered in terminal branches of hepatic portal vein ,and BMSC were around the islets of pancreas ,but there was no obvious development in the liver of the control group .Conclusions PET-CT can directly reveal the distribution of islets and BMSC in liver after transplantation through portal vein .
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Objective To evaluate the effects of interferon therapy after curative surgical intervention on improving prognosis of patients with hepatitis C-related hepatocellular carcinoma (HCC).Methods We searched randomized clinical trials from 1990 to 2015 on interferon therapy after curative surgical intervention in patients with hepatitis C-related HCC from the Cochrane Library,the Cochrane Database of Systematic Reviews,MEDLINE and Embase.A Meta-analysis was carried out using Revman 5.Results There were 7 studies included in this research.The results showed that interferon therapy after curative surgical intervention in patients with hepatitis C-related HCC reduced the recurrence rate of HCC at 3 years (RR =0.84,95％ CI 0.73 ～0.97,P ＜0.05).The therapy could not improve the 3-year survival rate in these patients (RR =1.04,95％ CI 0.90 ～ 1.21,P ＞ 0.05).Stratified subgroup analyses showed interferon therapy after liver resection reduced the recurrence rate (RR =0.62,95 ％ CI 0.39 ～ 1.00,P =0.05).For patients with tumors less than 3 cm,interferon therapy reduced the recurrence rate (RR =0.82,95％ CI 0.69 ～ 0.98,P ＜ 0.05).Conclusion Interferon therapy after curative surgical intervention improved prognosis in patients with hepatitis C-related HCC.
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<p><b>OBJECTIVE</b>To investigate whether transplantation of autologous peripheral blood CD34+ stem cells is a viable approach for treating patients with advanced cirrhosis,which is currently hindered by a shortage in liver donors.</p><p><b>METHODS</b>A total of 100 patients with advanced cirrhosis and who had failed to respond to conservative therapy were recruited for transplantation of autologous peripheral blood CD34+ stem cells.The success of transplantation was investigated 6-and 12-months later by measuring markers of liver biosynthesis function (coagulation,albumin level,indocyanine green clearance,Child-Pugh score) and assessing pathological changes (Knodell score) and morphologic changes in the liver tissue.Complications were also recorded during follow-up.</p><p><b>RESULTS</b>The 1-year cumulative survival rate was 100%. Fifty-two patients with massive ascites showed gradual reduction and disappearance of the ascites.Four patients experienced upper gastrointestinal bleeding and three patients developed with hepatic encephalopathy (I-II degree) at 3 months post-transplantation.All patients showed significantly improved liver biosynthesis function,liver elasticity and Knodell score after transplantation (P less than 0.05).</p><p><b>CONCLUSION</b>Autologous peripheral blood CD34+ stem cell transplantation is a safe and effective treatment for advanced cirrhosis,and has high cost-benefit since it improves liver function,liver histology,and quality of life.</p>
Subject(s)
Humans , Ascites , Liver Cirrhosis , Therapeutics , Quality of Life , Stem Cell Transplantation , Transplantation, Autologous , Treatment OutcomeABSTRACT
Hepatocyte transplantation is an additional effective treatment for liver failure subsequent to liver transplantation.It can also be used to as a bridge to orthotopic liver transplantation for patients with acute liver failure.Compared with liver transplantation,hepatocyte transplantation is less invasive and rejective.However,the development of both treatment is impeded by the shortage of organ donors.The quality and quantity of the liver cells and their routes of transplantation should be the substantial factors if hepatocyte transplantation is to be a treatment extended to large numbers of patients.This review discusses the latest bench-to-bedside developments in hepatocyte transplantation with the aim of drawing the attention of our domestic colleagues.
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Objective To investigate the impact of cavoplasty on the piggy back liver transplantation and on the prevention of hepatic outflow block. Methods Three patients received modified piggy back liver transplantation with venacavoplasty under single veno venous bypass. Results All the recipients had stability of dynamic circulation, short anhepatic phase and decreased hemorrhage during operation. Postoperatively all the patients recovered quickly with good liver function without any complications. Conclusions Venacavoplasty may overcome outflow block in piggy back liver transplantation and the technique can shorten anhepatic phase and decrease complications.