Application of indocyanine green fluorescence navigation in laparoscopic cholecystectomy after percutaneous transhepatic gallbladder drainage in elderly patients with acute cholecystitis / 临床肝胆病杂志

Objective To investigate the clinical value of indocyanine green (ICG) fluorescence navigation in laparoscopic cholecystectomy (LC) after percutaneous transhepatic gallbladder drainage (PTGBD) in elderly patients with acute cholecystitis. Methods A retrospective analysis was performed for the perioperative clinical data of the elderly patients with acute cholecystitis who underwent LC after PTGBD in Zhengzhou Central Hospital Affiliated to Zhengzhou University from June 2021 to February 2022. The 36 patients who underwent ICG fluorescence navigation were enrolled as experimental group, and the 26 patients who did not undergo ICG fluorescence navigation during the same period of time were enrolled as control group. Preoperative general information was analyzed for both groups, as well as time to identify the biliary system during surgery, time of operation, intraoperative blood loss, bile tract injury, conversion to laparotomy, time to first flatus after surgery, time to ambulation, time to removing abdominal drainage tube, time to return to normal diet, and length of postoperative hospital stay. The group t -test or the Mann-Whitney U test was used for comparison of continuous data between two groups, and the chi-square test was used for comparison of categorical data between groups. Results Compared with the control group, the experimental group had a significantly shorter time to identify the biliary system during surgery (19.9±3.7 min vs 36.5±5.9 min, t =13.56, P < 0.05), a significantly shorter time of operation (50.6±8.5 min vs 80.9±10.6 min, t =12.48, P < 0.05), and a significantly lower amount of intraoperative blood loss ( χ 2 =6.91, P < 0.05). No patient was converted to laparotomy in the experimental group, while 2 patients in the control group were converted to laparotomy, and no bile duct injury was observed in either group. Compared with the control group, the experimental group had significantly shorter time to ambulation (10.2±2.4 hours vs 16.6±3.2 hours, t =8.92, P < 0.05), time to removing abdominal drainage tube (20.1±3.4 hours vs 30.7±4.7 hours, t =10.2, P < 0.05), time to return to normal diet (20.3±3.8 hours vs 31.2±6.0 hours, t =8.68, P < 0.05), and length of postoperative hospital stay [3.3 (3.0-4.3) days vs 5.3 (5.0-6.2) days, Z =5.91, P < 0.05]. Conclusion ICG fluorescence navigation can visualize the extrahepatic biliary system during LC after PTGBD in elderly patients with acute cholecystitis, which may help to achieve accurate operation, reduce the risk of surgery, shorten the time of operation, and accelerate postoperative recovery.

Current status of the treatment of common bile duct stones after Billroth Ⅱ subtotal gastrectomy / 临床肝胆病杂志

Common bile duct stones are a common of digestive system disease, and as one of the long-term complications after Billroth II subtotal gastrectomy, it has attracted more and more attention from clinicians. Common bile duct stones after Billroth II subtotal gastrectomy have a complex pathogenesis, including neurological, humoral, and mechanical factors. Even though there are many methods to remove stones, there are still controversies over the selection of digestive endoscopy, surgical operation, or percutaneous transhepatic approach. Clinicians should fully evaluate the specific conditions of patients and formulate individualized treatment regimens to achieve the best treatment outcome.

Clinical effect of laparoscopic splenectomy and pericardial devascularization in portal hypertension patients with Child-Pugh A/B liver function / 临床肝胆病杂志

ObjectiveTo investigate the clinical effect of laparoscopic splenectomy and pericardial devascularization (LSPD) in patients with portal hypertension and the long-term effect of LSPD. MethodsA total of 40 portal hypertension patients with Child-Pugh A/B liver function who received LSPD in The First Hospital of Jilin University from August to December 2017 were enrolled as surgical group, and 44 portal hypertension patients with Child-Pugh A/B liver function who received conservative treatment during the same period of time was enrolled as internal medicine group. The patients were followed up to June 30, 2019, and liver function parameters, upper gastrointestinal bleeding, and portal vein thrombosis were recorded for all patients at each time point. The t-test was used for comparison of normally distributed continuous data between two groups; an analysis of variance was used for comparison between multiple groups, and the Bonferroni test was used for further comparison between two groups. The Kruskal-Wallis H test was used for comparison of continuous data with skewed distribution; between multiple groups, and the Mann-Whitney U test was used for further comparison between two groups. The chi-square test was used for comparison of categorical data between groups. ResultsAt 6, 12, and 24 months after discharge, compared with the internal medicine group, the surgical group had a significantly higher level of cholinesterase (t=3.527, 3.849, and 5.555, all P＜0.05) and a significantly lower Child-Pugh score (t=2.498, 2.138, and 2.081, all P＜0.05). Compared with the internal medicine group at 12 and 24 months after discharge, the surgical group had a significantly higher level of albumin (t=3.120 and 2.587, both P＜0.05) and a significantly lower incidence rate of upper gastrointestinal bleeding (χ2=4.947 and 5.155, both P＜0.05). At 24 months after discharge, the surgical group had a significantly lower number of patients who had a significant increase in alpha-fetoprotein level than the internal medicine group (χ2=4.648, P=0.031). At 12 months after discharge, the surgical group had a significantly higher incidence rate of portal vein thrombosis than the internal medicine group (χ2=4.395, P=0.036). The surgical group had significant improvements in albumin (F=2.959, P=0.013), cholinesterase (F=11.022, P＜0001), prothrombin time (H=94.100, P＜0.001), and Child-Pugh score (F=3.742, P=0.003) from admission to 12 and 24 months after surgery. ConclusionIn portal hypertension patients with Child-Pugh A/B liver function, LSPD can improve liver function and reduce the incidence rate of upper gastrointestinal bleeding, and the high incidence rate of portal vein thrombosis can be effectively reduced by oral aspirin and rivaroxaban.

Association between Toll-like receptor 4 and pancreatic cancer / 临床肝胆病杂志

Toll-like receptor 4 (TLR4) is a key regulator of innate and adaptive immune response. The role of TLR4 in pancreatic diseases is a research hotspot in recent years, and a large number of studies have shown that TLR4 is closely associated with pancreatic cancer. This article mainly discusses the abnormal expression and regulation mechanism of TLR4 in pancreatic cancer and its potential in cancer treatment, so as to provide new ideas for the pathogenesis and treatment of pancreatic cancer.

Risk factors for pancreatic fistula after laparoscopic pancreaticoduodenectomy / 中华普通外科杂志

Objective:To investigate the preoperative and intraoperative risk factors of clinical pancreatic fistula after laparoscopic pancreaticoduodenectomy (LPD).Methods:Clinical data of 100 patients undergoing LPD at the Second Department of Hepatobiliary and Pancreatic Surgery of the First Hospital of Jilin University from Jan 2019 to May 2019 were studied.Results:The total incidence of pancreatic fistula was 8%, and the incidence of clinical pancreatic fistula (grade B, C) was 6%. Univariate analysis found that gender (male), preoperative pancreatic plain CT value <33HU, soft texture of the pancreas, long operation time, alcoholic consuming history may be risk factors for pancreatic fistula after LPD( P<0.05), and further multivariate analysis found gender (male), preoperative pancreatic plain CT value <33 HU, soft texture of the pancreas were independent risk factors for clinical pancreatic fistula after LPD( P<0.05). Conclusions:Male patients, preoperative pancreatic plain CT value <33HU, soft texture of the pancreas were respectively independent risk factors predicting post-LPD clinical pancreatic fistula.

Management of patients with gallstones and acute cholecystitis during the epidemic of coronavirus disease 2019 / 临床肝胆病杂志

At present, the epidemic of coronavirus disease 2019 is still serious, and the prevention and control of this epidemic is taken seriously throughout the country. As one of the most common acute abdominal diseases in hepatobiliary surgery, gallstones with acute cholecystitis has sudden onset and rapid progression and thus requires early diagnosis and timely and effective treatment. During the prevention and control of the epidemic, patients should be admitted properly to reduce nosocomial infection. Gallstones with acute cholecystitis is often accompanied by pyrexia, and therefore, the presence or absence of severe acute respiratory syndrome coronavirus 2 infection should be clarified. Treatment regimen should be selected appropriately and individualized treatment measures should be developed. While ensuring that patients receive timely and effective diagnosis and treatment, hospitals should adopt prevention and control measures for patients and their caregivers to reduce nosocomial infection. The personal protection of medical personnel should also be taken seriously, and scientific measures should be implemented to guarantee their safety.