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Objective:To study the safety and feasibility of anatomic left hemihepatectomy via cranial-dorsal approach in the treatment of left hepatolithiasis.Methods:Clinical data of 47 patients with left intrahepatic bile duct stones who underwent cranial-dorsal approach laparoscopic anatomic left hemihepatectomy in Hunan People's Hospital from October 2016 to June 2022 were retrospectively analyzed, including 15 males and 32 females, aged (56.45±1.37) years old. The operative time, intraoperative blood loss, postoperative liver function and complications were analyzed. Patients were followed up by telephone and outpatient review.Results:All 47 patients successfully underwent laparoscopic surgery without conversion. The median operative time was 260 (range, 160-440) min. The median intraoperative blood loss was 100 ml (range, 20-400 ml). The total bilirubin, alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels were 15.7 (11.7, 21.9) μmol/L, 126.6 (91.7, 168.5) U/L, and 151.1 (98.0, 212.4) U/L on postoperative day (POD) 1, respectively, and decreased to 12.6 (9.6, 16.2) μmol/L, 97.9 (60.7, 156.9) U/L, 54.2 (40.0, 104.1) U/L on POD 3, respectively. The median postoperative hospital stay was 7 (range, 4-24) d. Postoperative abdominal effusion and infection occurred in one patient, and the complication rate was 2.1% (1/47). Postoperative CT review found residual stones in common bile duct in one patient [2.1% (1/47)]. No stone recurrence or death occurred during postoperative follow-up.Conclusion:Anatomic left hemihepatectomy via cranial-dorsal approach is a safe and feasible surgery for the treatment of left hepatolithiasis.
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Objective:To study the efficacy and safety of laparoscopic surgery in treatment of recurrent hepatocellular carcinoma.Methods:The clinical data of 58 patients with recurrent hepatocellular carcinoma who underwent surgical treatment from January 2010 to January 2018 at Hunan Provincial People’s Hospital were retrospectively analyzed. There were 50 males and 8 females, ranging in age from 28 to 78 (53.0±10.8) years old. Patients were divided into laparoscopic group ( n=27) and laparotomy group ( n=31) according to different surgical procedures. The differences in operative time, intraoperative blood loss, hospital stay, postoperative anal exhaustion time, postoperative complications and prognosis between the two groups were compared. Results:The intraoperative blood loss of laparoscopy group and laparotomy group were 100.0(50.0, 400.0) ml vs 300.0(100.0, 500.0) ml, the postoperative anal exhaustion time were (2.7±0.6) d vs (3.3±0.6) d, the hospital stay were (14.8±3.8) d vs (21.4±6.3) d, and these differences were statistically significant (all P<0.05). The operative time of the two groups were (243.4±27.2) min vs (217.5±34.7) min, with no statistical significance ( t=0.59, P=0.344). There were no significant differences between the two groups in postoperative complications (bile leakage, abdominal infection, hemorrhage, pleural effusion and hepatic encephalopathy) (all P>0.05); thetumor free survival, 1-year, and 3-year overall survival rates of the two groups were also not significantly different (both P>0.05). Conclusion:Laparoscopic surgery is safe and effective in the treatment of recurrent hepatocellular carcinoma, and its prognosis is similar to laparotomy, its complications are not significantly increased, which is worthy of promotion in clinic.
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Objective:To analyze the causes of postoperative stricture of biliary-enteric anastomotic for congenital choledochal cysts.Methods:These 28 patients underwent salvage operation on an average 15 years (0.2-25 years) after initial surgeries at the Department of Hepatobiliary Surgery, Hunan Provincial People's Hospital from Jan 2014 to Jun 2018.Results:In 26 patients the biliary-enteric anastomotic stenosis was benign, and in 2 the stricture was caused by cancerration. In 26 cases the Roux-en-Y hepaticojejunostomy was redone,among them 8 cases underwent concurrent hepatectomy for a better exposure of the intrahepatic bile duct. In 2 cases the anastomotic stenosis was found to be caused by canceration with extensive intraabdominal metastasis ,an external drainage was adopted. There were no inhospital deaths, and no serious complications. The postoperative follow-up time was 6-67 months. Two cancerated patients died within half a year, and the remaining patients had no long-term complications.Conclusions:Biliary-enteric anastomotic stenosis is one of the serious complications in postoperative patients for congenital choledochal cysts. Hence a wide, tension free biliary-enteric anastomosis performed by a experienced hand is necessary.
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Objective:To compare between laparoscopic and open pancreaticoduodenectomy in the treatment of distal cholangiocarcinoma.Methods:The clinical data of laparoscopic pancreaticoduodenectomy (LPD group, n=101) and open pancreaticoduodenectomy (OPD group, n=99) in patients with distal cholangiocarcinoma who underwent pancreaticoduodenectomy at Hunan people's Hospital from Jan 2015 to Dec 2019 were analyzed retrospectively. The operation time, intraoperative blood loss, number of lymph node dissection, R 0 resection rate, postoperative hospital stay, postoperative complications and overall survival rate were compared between the two groups. Results:The operation time was (475.0±90.7) min and (444.8±63.3) min, the intraoperative blood loss was (350.9±397.9) ml and (546.7±642.9) ml, the postoperative hospital stay was (11.5±4.7) d and (13.3±5.1) d, the differences were statistically significant ( P<0.05).The number of lymph node dissection was 14.8±3.0 and 15.4±2.4, the R 0 resection rate was 93.1% and 96.0%, respectively, and there was no significant difference ( P>0.05). There was no significant difference in the incidence of residual complications ( P>0.05). During the follow-up of 5-64 months, the OS of 1, 3 and 5 years in the two groups were 90.4%, 41.3%, 20.6% and 94.3%, 50.8% and 24.7%, respectively. ( P>0.05). Conclusions:LPD is safe and feasible in the treatment of distal cholangiocarcinoma, and its short-term curative effect, curative effect and long-term overall survival rate are similar to those of OPD.
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Objective:To compare the safety and efficacy of laparoscopic versus open pancreaticoduodenectomy.Methods:The clinical data of 989 patients who underwent pancreaticoduodenectomy at Hunan People's Hospital from January 2015 to December 2019 were analyzed retrospectively. There were 349 patients in the laparoscopic pancreaticoduodenectomy (LPD) group and 640 patients in the open pancreaticoduodenectomy (OPD) group. Propensity score matching (PSM) was used to match the baseline data of the two groups at a 1: 1 ratio. Data including operation time, intraoperative bleeding, postoperative hospital stay, bile leakage, pancreatic fistula and wound infection were compared between the two groups.Results:After PSM, there were 345 patients in each of the 2 groups. When the LPD group was compared with the OPD group, there were no significant differences in postoperative mortality, reoperation, intraoperative blood transfusion, pancreatic fistula, bile leakage, abdominal hemorrhage, abdominal abscess, severe complications, and pulmonary complication rates. The number of lymph node dissected, R 0 resection and overall survival rates between the two groups were also not significantly different ( P>0.05). However, the operation time of the LPD group (478.2±91.3) min was significantly longer than that of the OPD group (410.8±62.0) min ( P<0.05). On the other hand, the postoperative hospitalization time (10.8±4.3) d, intraoperative bleeding (322.0±362.6) ml, wound infection rate 1.2% (4/345) in the LPD group were significantly better than those in the OPD group [postoperative hospitalization time (12.5±7.9) d, intraoperative bleeding (478.8±570.2) ml, and wound infection rate 5.8% (20/345)] ( P<0.05) . Conclusion:LPD was safe and feasible, and it achieved similar curative effect as OPD.
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Objective To investigate the causes and countermeasures of reoperation following laparoscopic pancreatoduodenectomy.Methods The causes,approaches and outcome of reoperation were retrospectively analyzed in 10(4.0％,10/250) patients undergoing reoperations following pancreaticoduodenectomy with various complications in Hunan Provincial People's Hospital from April 2014 to April 2018.Results The causes of the 10 patients including intra-abdominal bleeding of seven cases (2 cases combined with pancreatic fistula,1 case with pancreatic and biliary fistula),1 patient with gastrointestinal anastomosis output perforation,1 patient with intra-abdominal abscess,and 1 case with postoperative pancreatitis.The time of reoperation was one day to 82 day after the first operation.The main methods of reoperation including suture and hemostasis,rebuilding the digestive tract,gastrostomy and enterostomy combined with abdominal cavity drainage.The mortality of reoperation following laparoscopic pancreatoduodenectomy was 20.0％ (2/10).Conclusions Intra-abdominal hemorrhage,pancreatic fistula and intra-abdominal abscess are the major causes of reoperation after laparoscopic pancreatoduodenectomy.Timely and decisive reoperation is an effective means to reduce postoperative morbidity and mortality after LPD.
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Objective To investigate the clinical effects of laparoscopic pancreaticoduodenectomy (LPD) for distal cholangiocarcinoma.Methods The retrospective cross-sectional study was conducted.The clinicopathological data of 37 patients who underwent LPD for distal cholangiocarcinoma in the Hunan Provincial People's Hospital between January 2013 and November 2016 were collected.LPD for distal cholangiocarcinoma was performed using the "en-block" procedure.According to the principle of "one axis,two planes and four zones",anatomy used posterior approach,anterior approach and medial approach,lymph node dissection was performed from carotid sheath outside,and en bloc specimens were resected.Observation indicators:(1) surgical and postoperative recovery situations;(2) postoperative pathological examination;(3) follow-up and survival situations.Follow-up using outpatient examination was performed to detect the patients' recurrence-free survival up to November 2017.Measurement data with normal distribution were represented as (x)±s.The survival curve and rate were drawn and calculated by the Kaplan-Meier method.Results (1) Surgical and postoperative recovery situations:all the 37 patients underwent successful LPD,without conversion to open surgery and perioperative death.The operation time,volume of blood loss and case with intraoperative blood transfusion were (326 ± 55) minutes,(176± 39)mL and 1,respectively.The time to initial exsufflation and time for diet intake were respectively (4.5± 1.6)days and (5.3±2.7)days.Of 37 patients,14 had postoperative complications,including 8 with pancreatic fistula (6 with biochemical fistula and 2 with grade B pancreatic fistula),1 with biliary fistula,3 with postoperative bleeding (2 with intra-abdominal bleeding and 1 with gastrointestinal anastomosis bleeding),2 with delayed gastric emptying (grage A),2 with intra-abdominal infection and 2 with pulmonary infection;the same patients can merge multiple complications.Three patients were in Clavien-Dindo classification ≥ Ⅲ.One patient received reoperation and other patients were improved by symptomatic treatment.Duration of hospital stay of 37 patients was 13.5 days (range,8.0-33.0 days).Eight patients underwent adjuvant chemotherapy of 4-6 cycles by taking orally tegafur or gemcitabine with cisplatin.(2) Postoperative pathological examination:tumor diameter and pancreatic duct diameter of 37 patients were (2.1±1.1)cm and (2.5±1.2) mm,respectively.Of 37 patients,9,13 and 15 were respectively detected in high-differentiated,moderate-differentiated and lowdifferentiated adenocarcinoma.Surgical margins:35 patients received R0 resection and 2 received R1 resection.Number of lymph node dissected,cases with lymph node metastasis and number of positive lymph nodes were respectively 18.5±4.9,16 and 1.7± 1.4.Analysis of lymph node metastasis location showed that the positive rates in 8a,12,13,14 and 17 groups lymph nodes were respectively 5.4％ (2/37),18.9％ (7/37),21.6％ (8/37),8.1％ (3/37) and 10.8％ (4/37);Perineural invasion (PNI),lymphovascular invasion (LVI),pancreatic invasion and duodenal invasion were identified in 14,9,16 and 6 patients,respectively.TNM stage:stage 0,Ⅰ A,Ⅰ B,ⅡA and Ⅱ B were respectively detected in 1,3,5,12 and 16 patients.(3) Follow-up situation:of 37 patients,36 were followed up for 6-45 months,with a median time of 26 months.The median recurrence-free survival time,1-and 3-year recurrence-free survival rates were respectively 28 months,80.6％ and 42.2％.Conclusion LPD is safe and effective for distal cholangiocarcinoma,and "en-block" resection not only helps to optimize the process of LPD for distal cholangiocarcinoma,but also has a significant effect on R0 resection and lymph node dissection.
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Objective To compare the efficacies of anatomic and nonanatomic mesohepatectomy for central type hepatocellular carcinoma.Methods The clinical data of 85 patients with central type hepatocellular carcinoma undergoing hepatectomies were retrospectively analysed.36 patients underwent anatomic mesohepatectomy and the other 49 patients did nonanatomic mesohepatectomy.The operative time,intraoperative blood loss,incidence of postoperative complications,postoperative drainage volume,time to flatus and length of postoperative stay between the two groups were compared.Results There were no significant differences in the general condition,organ function,tumor size and location between the two groups before operation (P ＞ 0.05).The intraoperative blood loss,incidence of postoperative complications,drainage volume were significantly less but the operative time longer in anatomic mesohepatectomy group than nonanatomic hepatectomy group (P ＜ 0.05).No differences between the two groups were found in regard to the time for flatus and length of postoperative hospital stay (P ＞ 0.05).Tumor recurrence developed in 7 cases in group A and 20 cases in group B (P ＜ 0.05).Conclusions Anatomic mesohepatectomy has the advantages of less surgical trauma,less exudation and complications in patients with central type hepatocellular carcinoma.
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BACKGROUND:Severe abdominal infection after liver transplantation is the serious perioperative complications in liver transplant recipients, and it is one of the major reasons of death or loss of liver function. OBJECTIVE:To investigate the etiology, diagnosis and treatment of severe abdominal infection after orthotopic liver transplantation. METHODS:The clinical data of 186 cases of abdominal infection that received orthotopic liver transplantation between March 2004 and November 2011 were retrospectively analyzed. RESULTS AND CONCLUSION:Among the 186 patients, 16 patients had severe abdominal infection. Among the 16 patients, five patients had the infection due to the biliary anastomotic leakage caused large effusion in the gap under liver;10 patients had infection due to the peripheral liver massive hematocele caused by liver transplant surgery wounds extensive bleeding;one patient had injection due to left subphrenic large effusion caused by lower esophagus fistula after transplantation. Twelve patients had second operation within 3 days after diagnose, and there was no death;four patients had second operation after diagnosed for 3 days, one patient dead due to multiple organ failure at 21 days after liver transplantation and 5 days after second surgery. The results show that severe abdominal infection after liver transplantation is one of the serious perioperative complications in liver transplant recipients, and active recovery, multiple organ support and removal of infected lesions with control ing surgery as wel as the adequate drainage and other comprehensive treatment measures are the key points for the treatment of severe abdominal infection after liver transplantation.
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Objective To explore the classification and surgical management of pancreatic duct stones.Methods The clinical data of 54 patients with pancreatic duct stones who were admitted to the People's Hospital of Hunan Province from June 1994 to November 2009 were retrospectively analyzed. Stones were found in the head of the pancreas (type Ⅰ ) in 31 patients, in the body and tail of the pancreas (type Ⅱ ) in 7 patients, and in all the pancreas (type Ⅲ ) in 16 patients. According to the types of the pancreatic duct stones, ten patients (6 with type Ⅰ , two with type Ⅱ and two with type Ⅲ pancreatic duct stones) received opening of the main pancreatic duct + pancreaticojejunostomy or pancreaticogastrostomy ( group A). Twenty-four patients ( 16 with type Ⅰ and eight with type Ⅲ pancreatic duct stones) received pancreaticoduodenectomy (group B). Fifteen patients (nine with type Ⅰ and six with type Ⅱ pancreatic duct stones) received subtotal resection of pancreatic head preserving duodenum (group C). Five patients with type Ⅱ pancreatic duct stones received resection of the body and tail of the pancreas and the spleen (group D). All data were analyzed using the t test. Results The mean operation time, blood loss, length of postoperative stay and hospital charges of group A were (2.2 ± 1.2)hours,( 127 ±24)ml,( 11.4 ±4.3) days and (3.24 ± 1.15 ) × 104 yuan, respectively. Five out of nine patients who were followed up had stone recurrence. The mean operation time, blood loss, length of postoperative stay and hospital charges of group B were (7.6 ± 1.1 ) hours, (409 ± 37 ) ml, ( 18.9 ± 2.5 ) days and (7.93 ± 1.35 ) × 104 yuan, respectively.No stone recurrence was detected in the 21 patients who were followed up. The mean operation time, blood loss,length of postoperative stay and hospital charges of group C were (4. 1 ± 0.7 ) hours, ( 156 ± 63 ) ml, ( 10.3 ±2.1 )days and (4. 12 ± 1.22) × 104 yuan, respectively. No stone recurrence was detected in the 15 patients who were followed up. The mean operation time, blood loss, length of postoperative stay and hospital charges of group D were (3.3 ± 1.4) hours, ( 185 ± 36 ) ml, ( 9.3 ± 2.0) days and ( 3.22 ± 1.05 ) × 104 yuan, respectively. No complication was detected after the operation, and no stone recurrence was detected in the three patients who were followed up. There were significant differences in the mean operation time, blood loss, length of postoperative stay and hospital charges between patients with type Ⅰ and Ⅲ pancreatic duct stones who received pancreaticoduodenectomy and subtotal resection of pancreatic head preserving duodenum (t = 12. 143, 14. 099, 11. 550, 9. 103,P < 0.05 ). Conclusions Classification of the pancreatic duct stones is important for choosing the proper surgical procedure. Subtotal resection of pancreatic head preserving duodenum is ideal for the treatment of patients with type Ⅰ or Ⅱ pancreatic duct stones.
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Objective To explore the surgical treatment of bile duct necrosis.Methods Clinical data of 94 cases of bile duct necrosis treated in this hospital from May1990 to December 2008 were retrospectively analyzed.Results There were no death or severe complications such as biliary fistula and massive hemorrhage in these patients.Conclusion Bile duct necrosis should be treated with a proper surgical approach based on its features.
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Objective To investigate therapeutic effect and mechanism of hyperbaric oxygen and ulinastatin respectively or combinatively used to treat acute necrotizing pancreatitis (ANP). Methods One hundred and twenty SD rats were divided into 6 groups randomly: group of normal control, group receiving sham operation, group of untreated acute necrotizing pancreatitis (ANP group), group of acute necrotizing pancreatitis treated with hyperbaric oxygen (HBO group), group of acute necrotizing pancreatitis treated with ulinastatin (ULT group), and group of acute necrotizing pancreatitis treated with combined hyperbaric oxygen and ulinastatin (HBO+ULT group). The rat model of acute necrotizing pancreatitis was established according to Aho HJ et al. Concentrations of amylase, TNF?, TXB-2 and 6-keto-PGF- 1? in blood were measured through ELISA or radioimmunoassay. Changes of pancreatic histopathology were investigated. SPSS 10.0 was used in statistical analysis. Results The concentrations of amylase, TNF?, TXB-2 in the ANP-treated groups were significantly lower than those of ANP group (P
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OBJECTIVE:To observe the pharmacological effect of Ulinastatin on acute necrotizing pancreatitis in rats.METHODS:Animal models were divided into3groups:group A,sham operation;group B,acute necrotic pancreatitis given no treatment;group C,acute necrotic pancreatitis treated with Ulinastatin.The changes of AMS and TNF-?were compared at different time among3groups.RESULTS:AMS and TNF-?in group C were significantly different from those in group A and in group B.CONCLUSION:Ulinastatin could remarkably improve the prognosis of acute necrotic pancreatitis.
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9scores). Results Fifty-five of fifty-seven cases with CT between 0～6 scores,which considered to be resected,underwent tumor resection . The accuracy of prediction of CT was 96.5%. Conclusions Preoperative CT scord could accurately predict the resectability and difficulty of pancreatic cancer.
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Objective To evaluate different surgical repairments for iatrogenic bile duct injury Methods Clinical data of 145 patients with iatrogenic bile duct injury surgically treated in our department from Mar 1990 to Sep 2002 were retrospectively analyzed Results Bile duct end to end anastomosis、 or bile duct repair using the patient′s own tissues and medical glue, or Roux en Y bile duct jejunostomy were used in these 145 cases The average follow up time was 3 6 years (3 months to 11 years) in 130 cases The eutherapeutic rate was 94 6% Conclusion With good surgical expertise iatrogenic bile duct injury could be repaired by a variety of methods with a satisfactory results