ABSTRACT
Objective:To investigate the clinical application value of enhanced recovery after surgery using the LEER model in patients subjected to laparoscopic cholecystectomy in basic hospitals of Yi nationality area.Methods:Twenty-six patients who underwent laparoscopic cholecystectomy based on the concept of enhancing recovery after surgery using the LEER model in People's Hospital of Jinkouhe District of Leshan from January to October 2021 were included in the observation group. An additional 20 patients who concurrently underwent laparoscopic cholecystectomy and conventional intervention were included in the control group. Clinical efficacy, postoperative complications and postoperative pain were compared between the two groups.Results:Postoperative fasting time, length of hospital stay, and total hospital days in the observation group were 6 (6, 6) hours, 2 (2, 3) days and 4 (4, 6) days respectively, which were significantly shorter than 24 (24, 36) hours, 5 (5, 6) days, 7 (7, 9) days in the control group ( H = 351.00, 407.50, 458.00, all P < 0.05). Hospitalization cost in the observation group was 5 454.58 (5 014.11, 6 016.58) yuan, which was significantly lower than 6 611.91 (6 192.68, 7 841.73) yuan in the control group ( H = 420.00, P < 0.05). There were no significant differences in operative time and postoperative complications between the two groups (both P > 0.05). At postoperative 6 hours, Visual Analogue Scale score in the observation group was 3 (3, 4) points, and patients with mild pain accounted for 73.07% (19/26). At postoperative 24 hours, Visual Analogue Scale score in the observation group was 2 (2, 3) points, and patients with mild pain accounted for 92.31% (24/26). Overall pain was well controlled after surgery. Patient satisfaction rate in the observation was 96.15% (25/26). All patients recovered and were discharged. Conclusion:Application of enhanced recovery after surgery using the LEER model in patients subjected to laparoscopic cholecystectomy in basic hospitals of Yi nationality area can promote postoperative recovery, contribute to changing the theory of diagnosis and treatment, and improve overall medical quality. The enhanced recovery after surgery protocol using the LEER model has a good application value.
ABSTRACT
Objective:To compare the clinical outcomes of treatment using non-selective versus highly selective partial splenic embolization in patients with hypersplenism secondary to liver cirrhosis.Methods:The clinical data of patients with hypersplenism secondary to hepatitis B cirrhosis who underwent splenic embolization at the Department of Hepatobiliary and Pancreatic Surgery of Leshan People's Hospital from July 2017 to July 2020 were analyzed retrospectively. Of 65 patients with hypersplenism, there were 42 males and 23 females, with age of (58.5±9.8) years. Twenty-six patients underwent splenic artery non-selective partial splenic embolization (the non-selective group) and 39 patients underwent partial splenic embolization using highly selective intubation (the highly selective group). The postoperative peripheral hematological indexes, liver function, operation-related complications and portal vein color Doppler ultrasonography were compared between the two groups.Results:The white blood cell count and platelet count of patients in the 2 groups were significantly higher than those before operation. The white blood cell count at 4, 12 and 24 weeks after operation and the platelet count at 12 and 24 weeks after operation in the highly selective group were significantly higher than those in the non-selective group ( P<0.05). Compared with the non-selective group, the total bilirubin, ICG-R15, portal vein diameter and portal vein blood flow in the highly-selective group significantly lower ( P<0.05). The incidences of 0/Ⅰ/Ⅱ/Ⅲ pain in the non-selected group was significantly higher when compared with that in the highly selected group (5/10/11/1 vs. 12/22/7/0), ( P<0.05). There were no significant differences in the incidences of postoperative complication between the two groups ( P>0.05). Conclusion:Compared with non-selective partial splenic embolization, highly selective partial splenic embolization gave more stable and lasting treatment outcomes in patients with hypersplenism caused by liver cirrhosis with better recovery of blood-related indicators, better improvement in postoperative liver function and relief of portal hypertension symptoms.
ABSTRACT
BACKGROUND@#Hepatectomy for hepatocellular carcinoma (HCC) beyond the Milan criteria is shown to be beneficial. However, a high rate of post-operative HCC recurrence hinders the long-term survival of the patients. This study aimed to investigate and compare the impacts of tenofovir (TDF) and entecavir (ETV) on the recurrence of hepatitis B viral (HBV)-related HCC beyond the Milan criteria.@*METHODS@#Data pertaining to 1532 patients who underwent hepatectomy and received antiviral therapy between January 2014 and January 2019 were collected from five centers. Recurrence-free survival (RFS) analysis was performed using the Kaplan-Meier method. Cox proportional hazards regression analysis was performed to determine prognostic factors for HCC recurrence.@*RESULTS@#The analysis incorporates 595 HBV-related HCC patients. The overall 5-year RFS was 21.3%. Among them, 533 and 62 patients received ETV and TDF treatment, respectively. The 1-, 3-, and 5-year RFS rates were 46.3%, 27.4%, and 19.6%, respectively, in the ETV group compared with 65.1%, 41.8%, and 37.2%, respectively, in the TDF group (P < 0.001). Multivariate analysis showed that TDF treatment (hazard ratio [HR]: 0.604, P = 0.005), cirrhosis (HR: 1.557, P = 0.004), tumor size (HR: 1.037, P = 0.008), microvascular invasion (MVI) (HR: 1.403, P = 0.002), portal vein tumor thrombus (PVTT) (HR: 1.358, P = 0.012), capsular invasion (HR: 1.228, P = 0.040), and creatinine levels (CREA) (HR: 0.993, P = 0.031) were statistically significant prognostic factors associated with RFS.@*CONCLUSIONS@#Patients with HCC beyond the Milan criteria exhibited a high rate of HCC recurrence after hepatectomy. Compared to the ETV therapy, TDF administration significantly lowered the risk of HCC recurrence.
Subject(s)
Humans , Antiviral Agents/therapeutic use , Carcinoma, Hepatocellular/surgery , Guanine/analogs & derivatives , Hepatectomy , Hepatitis B virus , Hepatitis B, Chronic/drug therapy , Liver Neoplasms/surgery , Retrospective Studies , Tenofovir/therapeutic useABSTRACT
Objective To investigate the opportunity and skill of surgery for pancreatic sinistral portal hypertension.Methods Clinical data were retrospectively analyzed on 15 cases of pancreatic sinistral portal hypertension admired from Dec 2015 to Dec 2017.Results All fiften cases underwent surgical treatment,among them three cases were initially treated conservatively in the early stage and treated surgically for gastrointestinal bleeding,12 cases with definite pancreatic disease and pancreatic sinistral portal hypertension treated in the first stage.Three patients underwent second surgery for recurrent gastrointestinal bleeding.The patients were followed up for 6 to 18 months with symptoms significantly impioved without deaths.Conclusions Splenectomy combined with esophagogastric devascularization is the basic surgical treatment for pancreatic sinistral portal hypertension.
ABSTRACT
<p><b>OBJECTIVE</b>To compare the safety and effectiveness of DPPHR with PPPD/PD for treating chronic pancreatitis with an inflammatory mass in the head of pancreas.</p><p><b>METHODS</b>The relative data bases such as Medline, EMBase, Biosis, COCHRANE Library, Science Citation Index, SinoMed, Chinese Journal Full-text Database, Wangfang, CNKI were searched systematically, researchers selected randomized controlled trials (RCT) and prospective clinical controlled trials (CCT) . The assessment of the bias risk of the included trials was according to the assessing tools suggested by Cochrane Handbook 5.1. The Review Manage 5.2 was used to perform the statistical analysis.</p><p><b>RESULTS</b>In total, 5 RCTs and 2 CCTs were included, 381 patients involved. Comparing with PPPD/PD procedure, DPPHR has no significant difference in terms of the mortality of perioperative period (RD = 0.01, P = 0.51), the incidence of bleeding (RD = -0.01, P = 0.72), pancreatic fistula(RD = -0.01, P = 0.59) and delayed gastric emptying (RD = -0.15, P = 0.10), the ration of complete pain relief after operation (RR = 1.06, P = 0.32) and the score of global quality of life (WMD = 10.31, P = 0.19).While DPPHR had significant superiorities in terms of the total morbidity of perioperative period (RR = 0.60, P = 0.008), the duration of the operations(WMD = -71.60, P = 0.03), the postoperative hospitalization duration(WMD = -3.95, P < 0.01), weight gain(WMD = 3.68, P < 0.01), occupational rehabilitation after the operations (RR = 1.38, P = 0.008).</p><p><b>CONCLUSIONS</b>In terms of reducing the morbidity of perioperative period, shortening the duration of the operations and the postoperative hospitalization duration, weight gain, occupational rehabilitation after the operations, the DPPHR is more favorable for improving patients' life qualities comparing with PPPD/PD.</p>