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Objective:To develop and validate a nomogram model for predicting microvascular invasion (MVI) in hepatocellular carcinoma (HCC) based on preoperative enhanced computed tomography imaging features and clinical data.Methods:The clinical data of 210 patients with HCC undergoing surgery in the Second Affiliated Hospital of Anhui Medical University from May 2018 to May 2022 were retrospectively analyzed, including 172 males and 38 females, aged (59±10) years old. Patients were randomly divided into the training group ( n=147) and validation group ( n=63) by systematic sampling at a ratio of 7∶3. Preoperative enhanced computed tomography imaging features and clinical data of the patients were collected. Logistic regression was conducted to analyze the risk factors for HCC with MVI, and a nomogram model containing the risk factors was established and validated. The diagnostic efficacy of predicting MVI status in patients with HCC was assessed by receiver operating characteristic (ROC) curve, calibration curves, decision curve analysis (DCA), and clinical impact curve (CIC) of the subjects in the training and validation groups. Results:The results of multifactorial analysis showed that alpha fetoprotein ≥400 μg/ml, intra-tumor necrosis, tumor length diameter ≥3 cm, unclear tumor border, and subfoci around the tumor were independent risk factors predicting MVI in HCC. A nomogram model was established based on the above factors, in which the area under the curve (AUC) of ROC were 0.866 (95% CI: 0.807-0.924) and 0.834 (95% CI: 0.729-0.939) in the training and validation groups, respectively. The DCA results showed that the predictive model thresholds when the net return is >0 ranging from 7% to 93% and 12% to 87% in the training and validation groups, respectively. The CIC results showed that the group of patients with predictive MVI by the nomogram model are highly matched with the group of patients with confirmed MVI. Conclusion:The nomogram model based on the imaging features and clinical data could predict the MVI in HCC patients prior to surgery.
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Objective To evaluate preoperative three dimensional(3D)reconstruction techniques in perioperative patients of hepatocellular carcinoma (HCC) undergoing hepatectomy.Methods Fifty-eight HCC patients who had undergone hepatectomy between 2015 and 2017 were enrolled.Twenty-three patients underwent hepatectomy based on preoperative 3D reconstruction techniques,while other thirty-five patients were without using it.Results No significant statistical difference was found in clincopathological parameters of patients preoperatively.The patients who underwent hepatectomy based on 3D reconstruction techniques had less operation time (Z =-2.213,P =0.028),hepatic inflow occlusion rate,time (x2 =3.966,P =0.046;Z =-2.371,P =0.018) and blood loss (Z =-2.140,P =0.032) during operation.Totally 23 postoperative complications occurred which were Clavien-Dindo classification grade Ⅰ or Ⅱ.More complications occurred in the not using 3D technique group (x2 =6.061,P =0.014).Conclusion Preoperative 3D reconstruction technique improves the perioperative prognosis of hepatectomy in patients with hepatocellular carcinoma.
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Objective To compare the perioperative outcomes of laparoscopic liver resection (LLR) versus open liver resection (OLR) for hepatocellular carcinoma (HCC).Methods A total of 89 HCC patients undergoing liver resection between January 2012 and November 2016 were enrolled.Nonparametric tests were employed to compare the clinicalpathological characters and preoperative outcomes.Results No significant difference was observed in clinicalpathological features and postoperative morbidity.LLR group had shorter hospital stay (Z =4.642,P ＜0.01),lower serum ALT level in 1st,3rd and 5 day (Z =2.157,3.089,2.384,all P ＜0.05) and AST level in 1st-and 3rd-day postoperatively (Z =2.688,2.566,all P ＜0.05).The growth rate in serum total protein (TP) and albumin (ALB) postoperatively is higher for LLR group (y =2.348 4x + 51.696 vs.y =0.902 9 + 35.532),(y =1.539 9x + 29.68 vs.y =0.732 9x + 30.406).Conclusion LLR allows quicker liver function recovery and shortens patients' postoperative hospital stay.
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Objective To analyze the surgical treatment of pancreatic duct stones.Methods The clinical data of 46 patients with pancreatic duct stones treated in our hospital from January 2008 to January 2013 were retrospectively analyzed.Results The most common symptoms were abdominal pain in 42 patients,diarrhea in 4 patients,diabetes in 6 patients,increased level of amylase in 4 patients,high level of CA19-9 in 9 patients and concomitant pancreatic cancer in 5 patients.4 patients had history of acute pancreatitis.All patients were diagnosed with pancreatic duct stones by preoperative imaging.The stones were located in the head of the pancreas in 21 cases,in pancreatic body and tail in 17 cases,and in the whole length of the pancreas in 8 cases.7 cases had single stone,28 cases had 2 to 3 stones,and 11 cases had more than three stones.21 cases had stones with a maximum diameter more than 1.0 cm,and 25 cases with a maximum diameter less than 1.0 cm.Pancreatic lithotomy plus pancreaticojejunostomy was performed in 33 cases,pancreatoduodenectomy in 8 and resection of the body and tail of pancreas plus splenectomy in 5 cases.6(13.0％) patients had postoperative complications,and there was no mortality.3(6.5％) patients had postoperative residual stones.39 cases were followed up with follow-up time ranging from 3 months to 57 months.Pain relief rate was 85.7％,Stone occurred in 2 (4.3％) patients.Conclusions Surgery is an important treatment for pancreatic duct stones,and treatments should be adopted based on the situations of individual patients.
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Objective To compare the complication and long-term efficacy of standard and extended pancreaticoduodenectomy for carcinoma of the head of pancreas by meta-analysis.Methods A literature search was performed of PubMed,Web of Science,Springer,WanFang,CNKI and CBMDisc databases from January 1990 to August 2014.Qualitative analysis of these literatures was conducted using Jadad evaluation.Patients with pancreatic head carcinoma undergoing extended radical resection and standard radical resection were divided into treatment group (extended pancreaticoduodenectomy group,EPD) and control group (standard pancreaticoduodenectomy group,SPD),respectively.Based on the heterogeneity test,meta-analysis of a fixed-or random-effect model were used.Results A total of 5 studies suitable for the selection criteria were chosen,involving 597 patients (299 in EPDs and 298 in SPDs).The results of meta-analysis showed that the EPDs have significantly longer operative time (MD =64.36,95％ CI =23.88-104.85,P =0.002) and more dissected lymph nodes (MD =16.45,95％ CI =9.61-23.29,P ＜ 0.000 01) than SPDs.There was no statistical difference (OR =1.76,95 ％ CI =0.66-4.65,P =0.26) in postoperative complications (46.3％ vs 36.0％) mortality (OR =1.31,95％ CI =0.47-3.69,P =0.61),1-year survival rate (OR =0.70,95 ％ CI =0.49-0.99,P =0.05),3-year survival rate (OR =0.79,95％ CI =0.55-1.15,P =0.22),and 5-year survival rate (OR =-0.02,95％ CI =-0.17-0.12,P =0.77).Conclusions Compared with standard radical resection,extended radical resection for pancreatic head carcinoma does not prolong the postoperative 1-,3-,and 5-year survival rates with comparable postoperative mortality and morbidity and prolonged operative time.
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Objective To study 18F-FDG PET/CT and enhanced CT in the evaluation of resectability of pancreatic cancer.Methods The 18F-FDG PET/CT and enhanced CT images of patients with pancreatic cancer were analyzed and the results in assessing resectability were compared.The diagnosis of pancreatic cancer and resectability were confirmed by intraoperative findings and histopathology.Results 31 patients with pancreatic cancer underwent surgery.Complete resection of the tumor was successfully carried out in 18 patients.Palliative operations were performed in the remaining 13 patients because the tumors were unresectable.The sensitivity,specificity and accuracy for unresectabilitywere 94.4％,15.3％,61.2％ using enhanced CT,94.4％,38.4％,70.9％ using 18F-FDG PET/CT,and 88.8％,53.8％,71.3％ using a combination of these two examinations,respectively.There was no significant difference between enhanced CT and 18 F-FDG PET/CT.A combination of these two examinations was significantly better than either one of these examinations.Conclusions Either enhanced CT or 18F-FDG PET/CT was useful,and they complemented each other in assessing resectability of pancreatic tumor.A combination of these two examinations was more evaluable than either one of these examinations.
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Objective To observe the changes of peptide YY (PYY) and its receptors in rats with ulcerative colitis (UC) by detecting both the serum level of PYY and jejunum epithelial cells in UC rats. Methods Rats were randomly divided into UC group, diarrhea-irritable bowel syndrome (D-IBS) group and control group. We measured the serum level of PYY by radioimmunoassay and made radioligand analysis of two basic parameters reflecting the characteristics of PYY receptors: dissociation constant (Kd) and maximum binding capacity (Bmax). Results The serum level of PYY was higher in UC and D-IBS groups than in normal group (P<0.001), and it was higher in UC group than in D-IBS group (P<0.001). However, the values of Kd and Bmax in UC group did not differ significantly from those in D-IBS and normal groups (P>0.05). Conclusion The serum level of PYY in UC group was significantly higher than that in normal group and D-IBS group; therefore, we assume that the change of serum PYY level may be related to not only the symptom of diarrhea but also inflammation. Kd and Bmax in neither UC group nor D-IBS group were significantly different from those in normal group, which indicates that the symptom and inflammation in UC may have nothing to do with the changes of PYY receptors.
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0.05). Conclusion IBS may be related to the changes of the serum level of PYY,but not to the changes of PYY receptor.