Radical hepatectomy in patients with initially unresectable liver cancer after conversion therapy / 中华普通外科杂志

Objective:To explore the clinical efficacy of radical surgery after successful conversion therapy for liver cancer.Methods:We retrospectively analyzed the clinical data of 10 patients with liver cancer who underwent successful conversion therapy and subsequent radical surgery in Peking University People's Hospital from Nov 2019 to Dec 2021.Results:The median age of the 10 patients was 64 (51.25,68.50) years. The median number of conversion therapy cycles was 11 (4.75,25.00). No serious adverse reactions were found in the patients during conversion therapy. After conversion therapy, 8 patients underwent partial hepatectomy, and 2 patients underwent radiofrequency ablation. Postoperative complications occurred in 4 patients. All complications were classified as Clavien-Dindo grade Ⅰ or Ⅱ. The median follow-up time was 13 (9.75,49.75) weeks. Three patients had tumor recurrence after surgery. Among the patients with tumor recurrence, 1 patient died of liver failure.Conclusions:Conversion therapy is an effective treatment for patients with clinically unresectable liver cancer. The incidence of serious adverse reactions in conversion therapy for liver cancer is low. The radical surgery can be safely performed in patients with good general condition and liver function. Radical surgery after conversion therapy can prolong the survival time of patients for unresectable liver cancer.

Subspecialty Variation in Academic Citations of Orthopedic Surgery Publications

Background@#The objective of this study was to assess the variation in academic citation and social media mentions across orthopedic subspecialties in general orthopedic surgery journals. @*Methods@#An internet-based study was performed of 666 articles from four orthopedic journals published from January 2018 to February 2019. Each publication was categorized by its subspecialty within orthopedics: arthroplasty, hand and upper extremity, foot and ankle, orthopedic oncology, pediatric orthopedics, shoulder, spine, sports medicine, orthopedic trauma, basic science, and miscellaneous. For each publication, academic citations were quantified using Google Scholar and Web of Science, and social media mentions were quantified using Twitter. Comparisons of continuous data among various subspecialties were performed using analysis of variance. @*Results@#The average number of citations per publication was 7.4 ± 9.0 on Google Scholar, 4.5 ± 5.3 on Web of Science, and 2.8 ± 8.7 on Twitter. The number of academic citations differed significantly by subspecialty on Google Scholar (p < 0.001) and Web of Science (p < 0.001). There was no difference in social media mentions on Twitter by subspecialty (p = 0.8). The most highly cited subspecialties, adjusted for number of publications, were arthroplasty, orthopedic oncology, and sports medicine, while the least highly cited subspecialties were hand and upper extremity, pediatric orthopedics, and orthopedic basic science. @*Conclusions@#There is significant baseline variation in the citation of orthopedic publications among various subspecialties. Our findings argue against the use of a uniform threshold to gauge scholarly success in orthopedic surgery. The variation in citation of orthopedic publications across subspecialties support the use of subspecialty-specific benchmarks to gauge academic productivity.

A comparison between microwave ablation and surgical resection for small hepatocellular carcinoma / 中华普通外科杂志

Objective:To compare the clinical effects of microwave ablation (MWA) and surgical resection in the treatment of small hepatocellular carcinoma(SHCC).Methods:Sixty five SHCC patients with intact clinical data, treated in the Center of Hepatobiliary Surgery, Peking University People's Hospital between Feb 2005 and Aug 2012, were enrolled in this study. Among them, 30 patients were treated by MWA, and the other 35 by hepatectomy. Follow-up was conducted from Mar 2013 to Feb 2021. The differences in long-term survival, intraoperative blood loss, operative time, postoperative complications, performance status (PS), and postoperative hospital stay were compared between the two groups.Results:The survival probability at 1, 3, 5 and 10 years was 93.2%, 82.5%, 55.6% and 41.2%, respectively, in the MWA group, and 97.1%, 82.6%, 67.2% and 48.3%, in the resection group ( P=0.347). The MWA group had less perioperative complications, less blood loss, shorter operation time, better PS score and better hospital stay than the surgical resection group (all P<0.001).There was no statistically significant difference in the survival rate between BCLC stage 0~A1 and A2~A4 patients( P=0.773, 0.536). Conclusions:Microwave ablation in the treatment of small hepatocellular carcinoma can achieve similar results as hepatectomy with less traumatic,better postoperative PS score and shorter postoperative hospital stay.

Roux-en-Y hilar-jejunum anastomosis for biliary tract reconstruction after radical resection of hilar cholangiocarcinoma / 中华普通外科杂志

Objective To investigate the effect of Roux-en-Y hilar-jejunum anastomosis in surgical resection of hilar cholangiocarcinoma.Methods The clinical data of 31 patients with hilar cholangiocarcinoma admitted from Feb 2009 to Feb 2017 who underwent Roux-en-Y hilar-jejunum anastomosis after resection were retrospectively analyzed.Results According to Bismuth-Corlette classification there were 6 cases of Ⅲ a,6 cases of Ⅲ b and 19 cases of type Ⅳ.These patients all successfully underwent Roux-en-Y hilar-jejunum anastomosis,with intraoperative blood loss of 50-4 000 ml [on average of (1 146 ± 1 082) ml].The average operation time was (346 ± 118) min,and the average hilar-jejunum anastomosis time was (35 ± 13) min.The average postoperative hospital stay was (20 ± 11)days.There were 25 cases of R0 resection (80.6％).The postoperative complication rate was 25.8％(8/31).The overall median survival time was 21 months,and the 1-,3-,and 5-year survival rates were 68.8％,14.6％ and 3.6％,respectively.During the follow-up period,7 cases of reflux cholangitis,5 cases of biliary anastomotic stenosis,and 1 case of adhesive intestinal obstruction were found.Conclusion The hilar-jejunum anastomosis is simple,safe,widely applicable prcedure,which is easy to perform.

Combined caudate lobectomy radical resection and lymph node dissection for hilar cholangiocarcinoma / 中华普通外科杂志

Objective To investigate the clinical efficacy and prognostic factors for combined caudate lobectomy radical resection plus broad lymph node dissection in patients of hilar cholangiocarcinoma.Methods The clinical data and follow-up results of patients with hilar cholangiocarcinoma surgically treated from Feb 2008 to Feb 2017 were retrospectively analyzed.Result The R0 resection rate[72.2％ (13/18) vs 43.9％ (18/41)],operation time [(433 ± 136) min vs (302 ± 122) min],intraoperative blood loss [(1 789 ± 1 091) ml vs (776 ± 755) ml] and postoperative complication rate [66.7％ (12/18) vs 36.6％ (15/41)]were significantly higher in the hepatic lobe combined with caudate lobe resection group than that without caudate lobe resection group (P ＜ 0.05).The median survival time of patients with enlarged lymph node dissection was longer than that of patients with regional lymph node dissection (33 months vs 13 months,P ＜0.05).Univariate and multivariate analysis showed that the preoperative serum CA199 level ＞ 1 000 U/ml,the degree of microscopic margin and tumor TNM stage were significantly correlated with the prognosis of the patients (P ＜ 0.05).Conclusion Combined with caudate lobe resection can improve R0 resection rate.Targeted lymph node dissection helps prolong survival.The degree of microscopic margin,preoperative CA199 and TNM staging are independent risk factors for the prognosis of patients with hilar cholangiocarcinoma.

Diagnosis and treatment of upper gastrointestinal hemorrhage caused by pancreatic segmental portal hypertension / 中华普通外科杂志

Objective To investigate the diagnosis and treatment of upper gastrointestinal hemorrhage caused by pancreatic segmental portal hypertension.Methods The clinical diagnosis and follow-up data of 13 patients with upper gastrointestinal hemorrhage caused by pancreatic segmental portal hypertension from Jan 2010 to Dec 2017 were retrospectively analyzed.Results Of the 13 patients,5 had pancreatic pseudocysts and 8 had chronic pancreatitis.All of them had a history of hematemesis or (and) tarry feces,and 2 of them had a history of hemorrhagic shock.13 patients had isolated gastric varices,and 5 of them had varicose veins in the lower esophagus.13 patients had splenomegaly and hypersplenism,and all patients underwent splenectomy.All patients were followed up,and the varicose veins were significantly improved or disappeared.During 1 year to 8 years of follow-up,there was no rebleeding.Conclusion Splenectomy cures upper gastrointestinal hemorrhage caused by rupture of the varicose veins in patients of pancreatic segmental portal hypertension.Preoperative interventional spleen artery embolization can reduce the difficulty of spleen resection.

Risk factors for pancreaticoduodenectomy in elderly patients / 中华普通外科杂志

Objective To investigate the complication and risk factors in elderly patients undergoing pancreaticoduodenectomy (PD).Methods From Jan 2005 to Dec 2016,358 consecutive patients undergoing PD were divided into ≥ 70 years group (98 cases) and ＜ 70 years group (260patients).Perioperative complications were compared and risk factors explored between the two groups.Results There were differences in coronary heart disease between the two groups in the preoperative medical comorbidities (P =0.008),and that of albumin,alanine aminotransferase,alkaline phosphatase and creatinine (all P ＜ 0.05).Perioperative mortality was higher in the elderly group than in the younger group (P =0.038),probably related to higher systemic complications (P =0.001).The independent risk factors influencing the postoperative medical complications were preoperative total bilirubin ≥ 171 μmol/L and intraoperative blood loss ≥ 1 000 ml.Conclusions Patients over 70 years old have a comparatively higher perioperative mortality rate after pancreaticoduodenectomy,which were probably derived from a higher postoperative vital organ dysfunction.

Therapeutic effect and safety of selective paraesophagogastric devascularization with or without splenectomy for treatment of esophagogastric variceal hemorrhage / 中华普通外科杂志

Objective To evaluate the therapeutic effect or safety of selective paraesophagogastric devascularization with or without splenectomy for treatment of esophagogastric variceal hemorrhage.Methods The clinical data of 70 patients with a history of esophagogastric variceal hemorrhage from 2009 to 2015 were analyzed.29 cases received spleen preserving paraesophagogastric devascularization and 41 were given portoazygous devascularization plus splenectomy.Results Postoperative portal pressure in spleenpreserving group decreased 14％,that in splenectomy group decreased 23％ (t =2.87,P =0.01).The average blood loss in without splenectomy group was (829 ± 720) ml in contrast to (1 400 ± 1 329) ml in splenectomy group (t =2.311,P =0.024).Postoperative WBC and platelet count in without splenectomy group were lower (t =-5.379,t =-4.924,all P ＜0.01).The postoperative complication rate (24％ vs.39％),and portal venous thrombosis (10％ vs.31％) were all in favour of splenectomy free group (x2 =0.036,P ＜0.05).The 1-and 3-year's recurrent bleeding rate were 4％ and 8％ compared with 4％ and 8％ (all P ＞ 0.05).Conclusion Paraesophagogastric devascularization without splenectomy has less blood loss during the surgery,lower rate of PVT and comparable effect against post-op recurrent bleeding in contrast to devascularization plus splenectomy.

CEA, CA19-9 in predicting the clinicopathologic characteristics and prognosis of primary duodenal carcinoma / 中华普通外科杂志

Objective To investigate the significance of tumor markers CEA and CA19-9 in predicting the clinicopathologic characteristics and prognosis of primary duodenal carcinoma.Methods A retrospective analysis of 110 cases with primary duodenal carcinoma treated in our hospital from January 1999 to December 2016 was conducted.ROC analysis,univariate and multivariate analysiswere performed to investigate the relationship between CEA,CA19-9 and the clinicopathologic characteristics of primary duodenal carcinoma.Kaplain-Meier method was used to analyze the relationship between CEA and CA19-9 and the prognosis of primary duodenal carcinoma.Results CEA level was of value for predicting the depth of infiltration,lymphatic involvement,metastasis and TNM stage.The receiver operating characteristic was 0.629,0.672,0.749,0.692 respectively.Univariate analysis showed serum CA19-9 lever was related to the depth of infiltration and serum CEA lever were related to tumor differentiation,lymphatic invasion,metastasis and TNM stage.Logistic analysis showed that CEA value was only associated with metastasis (OR:9.853,P ＜ 0.01).Patients with elevated serum CEA level had a significant worse prognosis than patients with normal serum CEA level (P ＜ 0.05).Conclusion Serum CEA level was closely associated with the clinicopathologic characteristics and prognosis of primary duodenal carcinoma.

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

Objective To analyze the risk factors for pancreatic fistula after pancreaticoduodenectomy.Methods Clinical data of 351 patients who underwent pancreaticoduodenectomy in our hospital from Jan 2001 to Dec 2015 were retrospectively analyzed.Results The overall incidence of pancreatic fistula was 20.2％ (71/351),with grade A in 34 (9.7％) patients,grade B in 25 (7.1％),and grade C in 12 (3.4％).Postoperative hospital stay was significantly prolonged in patients with grade B and C pancreatic fistula.Multivariate analysis using Logistic regression identified three variables as independent factors associated with pancreatic fistula,namely,BMI (OR =2.281),preoperative total bilirubin level (OR =2.180) and soft pancreatic texture (OR =3.653).Preoperative total bilirubin level (OR =2.684),soft pancreatic texture (OR =5.128) and postoperative hemorrhage (OR =9.030) were independent risk factors of grade B and C pancreatic fistula after pancreaticoduodenectomy.Conclusions The incidence of pancreatic fistula after pancreaticoduodenectomy is still high.Pancreatic fistula prolongs the postoperative hospital stay significantly.The incidence of grade B and C pancreatic fistula could be reduced by avoiding postoperative hemorrhage.

Protective effect of Shenfu soup on myocardial ischemia in rats and expression of apelin / 中国药理学通报

Aim To study the effects of Shenfu soup onthe ISO -induced myocardial ischemia injury model ofrats and the influence of apelin level changes on myocardial ischemia.Methods The myocardial ischemiainjury model of rats was established by the subcutaneous injection of ISO.For 1 5 days,rats in Shenfugroups were given by gavage 3,6 and 1 2 g · kg -1Shenfu soup and rats in SF injection group were given6.67 g·kg -1 Shenfu injection,rats in sham group andmodel group were given the same volume of distilledwater.Rats were subcutaneously multipoint injectedISO for 5 days on the eleventh administrating day.Theeffects of Shenfu soup on myocardial morphology,serum myocardial enzyme levels,apelin mRNA level inserum and apelin protein level in myocardial tissue,and relationship between myocardial enzyme and apelinexpression were evaluated. Results Shenfu soupcould reduce the degree of myocardial tissue necrosisand compared with model group,CK values and LDHvalues of rats in middleand highdose groups were significantly lower (P <0.05 or P <0.01 ).However,the apelin mRNA level in myocardial tissue and apelinprotein level in serum of the rats in middleand highdose groups compared with model group had increased(P <0.05,P <0.01 ).Meanwhile,serum levels ofapelin and the expression of myocardial enzyme CK andLDH were negatively correlated.Conclusion Shenfusoup has a protective effect on myocardial ischemia injury in rats induced by ISO and the mechanism is involved with the promotion of apelin mRNA and proteinexpression,the inhibition of myocardial enzyme production and the improvement of myocardial ischemia.

Inhibition of primary liver cancer by oral javanica oil emulsion / 中国肿瘤临床

Objective: This study aimed to investigate the inhibitory effects of Brucea javanica oil oral emulsion (BJOOE) on primary liver cancer induced by diethylnitrosamine (DEN). Methods:Rats were randomly divided into the control group, model group, and BJOOE group. Rats were given free access to water. DEN was administered intragastrically to induce liver cancer in rats. Five weeks later, rats were intragastrically administered with BJOOE for five times per week. The rats were killed after 14 weeks. Abdominal aortic blood samples were collected. The contents of ALT, AST, ALP, γ-GT, and AFP of serum were detected by an automatic biochemical analyzer. The liver index, spleen index, thymus index, and changes in liver cancer nodules of the surface were observed in rats. Changes in the number of liver cancer nodules of the surface were detected by imaging. Results:Compared with the control group, the liver index, spleen index, and number of nodules of the model group significantly increased, whereas the thymus index significantly decreased (P<0.01). The levels of ALT, AFP, AST, ALP, andγ-GT of serum in the model group were significantly higher than those in the control group (P<0.01). Compared with the model group, BJOOE significantly reduced the liver index, spleen index, and number of cancer nodules, but increased the thymus index in the liver of rats with cancer (P<0.01). The levels of ALT, AFP, AST, ALP, andγ-GT of serum in rats with hepatic carcinoma significantly improved (P<0.01 or P<0.05). Conclusion:BJOOE could inhibit primary liver cancer, and the underlying mechanisms are complex.

Risk factors for delayed gastric emptying after pancreaticoduodenectomy / 中华普通外科杂志

Objective To analyze the risk factors for delayed gastric emptying (DGE) after pancreaticoduodenectomy.Methods Clinical data of 213 patients who underwent pancreaticoduodenectomy at our hospital from January 1996 to December 2011 was retrospectively analyzed.Results The overall incidence of DGE was 40.8％ (87/213).The incidence of grade A,grade B and grade C DGE was 14.1％ (30/213),14.5 ％ (31/213) and 12.2％ (31/213) respectively.Median postoperative hospital stay was significantly prolonged in patients with DGE:30.5,32 and 61 days for grade A,B and C respectively versus 21 days in patients without DGE (x2 =66.171,P =0.000).Univariate analysis showed that operation time (≥420 min),intraoperative blood loss (≥ 1000 ml),Child alimentary reconstruction and pancreatic fistula were risk factors for postoperative DGE.Multivariate analysis using Logistic regression identified three variables as independent risk factors associated with postoperative DGE,namely,Child alimentary reconstruction (OR =2.098),intraoperative blood loss (≥ 1000 ml) (OR =2.525) and pancreatic fistula (OR =4.821).Grade C DGE was more frequently seen in patients suffering from postoperative pancreatic fistula.Conclusions The incidence of DGE after pancreaticoduodenectomy is still high.DGE prolongs the postoperative hospital stay significantly.The incidence of DGE could be reduced by Roux-en-Y reconstruction and reducing intraoperative blood loss.Postoperative pancreatic fistula is significantly associated with DGE,especially grade C DGE.

Cause and treatment of gastrointestinal hemorrhage after pancreaticoduodenectomy / 中国综合临床

Objective To analyze the cause and treatment of the postoperative gastrointestinal hemorrhage after pancreaticoduodenectomy(PD).Methods Clinical data of 213 patients who underwent PD in our hospital from January 1996 to December 2011 and 2 patients who suffered from gastrointestinal hemorrhage after PD transferred to our hospital from other hospitals were retrospectively analyzed.Results The incidence of postoperative gastrointestinal hemorrhage was 8.5％ (18/213),the mortality rate of which was 22.2％ (4/18).Among the twenty patients with postoperative gastrointestinal hemorrhage (including the 2 patients transferred from other hospitals),stress ulcer was the most common reason of gastrointestinal hemorrhage (11/20,55 ％).There were 8 patients suffering from mild hemorrhage who were treated by medications.Seven of 12 patients who suffered from severe hemorrhage underwent reoperation.Univariate analysis showed that duration of operation above 420 min (x2 =3.976,P =0.046) and volume of intraoperative blood loss above 1200 ml (x2 =6.753,P =0.009) were significantly associated with postoperative stress ulcer bleeding.Multivariate logistic regression analysis showed that intraoperative blood loss was the only independent factor associated with postoperative stress ulcer bleeding (OR =5.677,P =0.035).Conclusion Gastrointestinal hemorrhage is one of the common complications after PD.The incidence of stress ulcer bleeding could be reduced by skillful operation and decreasing intraoperative blood loss.Operation should be used properly according to the cause and location of bleeding if hemorrhage could not be stopped by medications.

Prevention and treatment of hemorrhage after pancreaticoduodenectomy / 中华普通外科杂志

Objective To analyze the prevention and treatment of postoperative hemorrhage after pancreaticoduodenectomy. Methods The clinical data of 142 patients undergoing pancreaticoduedenectomy from Jan 1995 to Dec 2008 were retrospectively analyzed. Results The incidence of postoperative hemorrhage was 14.1% (20/142), the mortality caused by this complication was 35% (7/20). Among these patients, intra-abdominal hemorrhage occurred in seven cases, and gastrointestinal hemorrhage occurred in 14 cases, with one case suffering both. There were three and four cases of early and delayed intra-abdominal hemorrhage respectively. Early and delayed gastrointestinal hemorrhage occurred in three and eleven cases respectively. Univariate analysis showed that operative blood loss, blood transfusion, infection and pancreatic fistula were significantly associated with postoperative hemorrhage. Multivariate analysis using Logistic regression identified two variables as independent factors associated with postoperative hemorrhage, namely, infection(OR=6.918) and pancreatic fistula(OR=3.948). Conclusions The incidence and mortality of hemorrhage after pancreaticoduodenectomy is still high. Skillful operation and prevention of pancreatic fistula, infection and stress ulcer are the key paints for reducing postoperative hemorrhage. Proper treatments should be used according to the site, onset and severity of hemorrhage.

Microwave ablation in combination with TACE for the treatment of primary hepatic carcinoma / 中华普通外科杂志

Objective To evaluate the therapeutic effect of microwave ablation in combination with TACE for the treatment of primary liver carcinoma (PLC). Methods From Jan. 2004 to Dec. 2008, 63 PLC patients underwent ultrasound-guided microwave ablation (percutaneous or open) under general anesthesia. Repeated microwave ablation or TACE was used when an incompleted ablation or recurrence was found during postoperative regular follow-up. Results These 63 PLC patients have received a total of 82 sessions of microwave ablation procedure (1 to 5 sessions for each patient). There were 2 early postoperative deaths with a procedure-related mortality of 3.2%. At the end of the follow-up, 22 patients were alive and 38 died,and the other one was lost to follow-up. The survival rates in 1,2 and 3 years were 63.3%,42.1% and 26.5%, respectively, with a median survival of 20 months for all patients. The survival for PLC patients with early stage (TNM Ⅰ and Ⅱ) was significantly longer than that of advanced stage (TNM Ⅲ and Ⅳ). The 1,2 and 3 year's cumulative survival rate was 93.3%,86.7% and 65.0% respectively in those 15 cases with only single tumor and the diameter≤3 cm, which were significantly longer than that of other PLC patients. Of 23 patients with recurrence,9 had solitary tumor without lymphnode and distal metastases, for which the survival rates in 1,2 and 3 years were 100%,88.9%, and 35.6%, respectively, whereas in other recurrent patients the survival rates in 1,2 and 3 years were 21.4%, 10.7% and 0%, respectively(P< 0.01). Conclusions Ultrasound-guided microwave ablation in combination with TACE is effective for PLC patients with early stage. In recurrent PLC patients after ablation therapy with solitary tumor and no lymphnode and distal metastases the survival is significantly longer than that of the others.