A case-control study of minimally invasive transforaminal interbody fusion with the assistance of robot and traditional fluoroscopy in the treatment of single-space lumbar disc herniation / 中国骨伤

OBJECTIVE@#To compare the safety and nail placement accuracy of fluoroscopy-assisted and robot-assisted minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) in the treatment of single-space lumbar disc herniation.@*METHODS@#The clinical data of 52 patients with single-space lumbar disc herniation treated by MIS-TLIF from March 2019 to February 2020 were retrospectively analyzed. Among them, 24 patients were treated by robot-assisted MIS-TLIF(group A) and 28 patients were treated by fluoroscopy-assisted MIS-TLIF (group B). The intraoperative blood loss, operation time, intraoperative fluoroscopy times, preoperative and postoperative visual analogue scale(VAS), Japanese Orthopaedic Association(JOA) scores and operation-related complications were recorded in two groups. Gertzbein-Robbins grade according to CT scan was used to evaluate the nail placement after operation. Grade A and B were evaluated as satisfactory nail placement, and grade C, D, and E were evaluated as error placement. Babu's method was used to evaluate the screw's invasion to the superior articular process.@*RESULTS@#The operation time, intraoperative blood loss and intraoperative fluoroscopy times in group A were less than those in group B(P<0.05).VAS and JOA scores of all patients at the final follow-up were significantly improved compared with those before operation(P<0.05), but there was no statistically significant difference between the groups(P>0.05). There were 96 and 112 screws in group A and group B, respectively. Three days after operation, according to the Gertzbein-Robbins grade to evaluate the nail placement accuracy, there were 90 screws of grade A, 5 of grade B, 1 of grade C, no grade D and E in group A;there were 84 screws of grade A, 16 of grade B, 8 of grade C, 4 of grade D, no grade E in group B;the difference between two groups was statistically significant(Z=-3.709, P=0.000). The satisfactory rate of screw placement in group A was 98.96% (95/96), and that of group B was 89.29% (100/112), the difference between two groups was statistically significant (χ2=8.254, P=0.004). Three days after operation, the invasion of superior facet joints by pedicle screws was evaluated according to Babu's method, including 90 screws in grade 0, 4 in grade 1, 2 in grade 2, and 0 in grade 3 in group A;86 in grade 0, 12 in grade 1, 10 in grade 2 and 4 in grade 3 in group B, and the difference was statistically significant(Z=-3.433, P=0.001). There were no serious spinal cord, nerve and vascular injuries and other operation-related complications caused by screw implantation failure in both groups. All patients were followed up from 6 to 12(9.06±1.60) months. The neurological symptoms improved well after operation. During the follow-up period, there was no recurrence of symptoms, loosening or breakage of the internal fixation.@*CONCLUSION@#Compared with the traditional fluoroscopy-assisted MIS-TLIF, the spinal robot-assisted MIS-TLIF not only has more minimally invasive and safer, but also has higher accuracy in nail placement, lower incidence of upper articular process invasion, and more accurate decompression targets, which can be used for minimally invasive treatment of single-space lumbar disc herniation.

Effect of Zhenzhu Tiaozhi Capsule on HbA1c in Patient with Type 2 Diabetes Mellitus： A Real-world Study / 中国实验方剂学杂志

Objective:To explore the long-term effect of Zhenzhu Tiaozhi capsule（FTZ） on hemoglobin A1c（HbA1c）in patients with type 2 diabetes mellitus （T2DM） based on real-world data. Method:T2DM patients who were provided with FTZ （FTZ group） and those receiving conventional hypoglycemic drugs （control group） were extracted from the hospital information system （HIS） of the First Affiliated Hospital of Guangdong Pharmaceutical University， followed by propensity score matching （PSM） for balancing the confounding factors between groups. With HbA1c as the efficacy evaluation index， the difference in efficacy between the two groups was compared using <italic>t</italic>-test and <italic>χ</italic>² test. For repeated measurement data of the same patient， the difference in efficacy and the stability of FTZ against HbA1c were analyzed by generalized estimating equation （GEE）. The factors that might affect the efficacy of FTZ against HbA1c were subjected to multivariate linear regression analysis （MLRA）， and the subgroup analyses were then conducted after the stratification of relevant factors. Result:There were 46 patients included in the FTZ group and 1 208 patients in the control group. PSM yielded 42 pairs of samples with balanced covariates between groups. As revealed by one-year observation， ① HbA1c in the FTZ group after treatment was 6.51%±1.09%. No significant difference was observed either in pre- and post-treatment comparison in the FTZ group or in its comparison with the control group. At the same time， the HbA1c compliance rate in the FTZ group was 73.8% after treatment. No significant difference was observed either in pre- and post-treatment comparison in the FTZ group or in its comparison with the control group. ② The GEE results showed that the post-treatment HbA1c levels in the two groups were not significantly different from each other. Moreover， the HbA1c level remained stable over treatment time. ③ MLRA and subgroup analyses results demonstrated that FTZ was more effective in patients with high baseline HbA1c ［<italic>β</italic>=-0.530，95% confidence interval（CI） -0.850～-0.209，<italic>P</italic><0.01］ or those who were complicated with hypertension （<italic>β</italic>=-0.918，95%CI -1.614～-0.222，<italic>P</italic><0.05）. Conclusion:In the real world， FTZ is able to control the blood sugar， and its effect is similar to those of conventional hypoglycemic drugs. Besides， it is capable of stabilizing the blood sugar for a long time.

Effect of fucoxanthin on insulin resistance in obese mice induced by high fat diet / 中国中药杂志

The aim of this paper was to study the effect and mechanism of fucoxanthin on insulin resistance of obese mice induced by high-fat diet. Fifty C57 BL/6 J male mice were randomly divided into control group and high-fat diet group. The insulin resistance model was induced with high-fat diet for 12 weeks, and model mice were randomly divided into model group, fucoxanthin-0.2% group, fucoxanthin-0.4% group and metformin group. After dietary treatment for 6 weeks, the body weight and epididymal fat weight in each group were measured. Fasting blood glucose(FBG), fasting insulin(FINS), total cholesterol(TC), triglyceride(TG), low-density lipoprotein(LDL-C) and high-density lipoprotein(HDL-C) were measured, and insulin resistance index(HOMA-IR) was calcula-ted. The pathological morphology in liver was observed by hematoxylin eosin staining, and the expressions of some key proteins in insulin receptor substrate 1(IRS-1)/posphoinositide 3-kinase(PI3 K)/serine-threonine kinase(Akt) and peroxisome proliferators-activated receptor-γ(PPARγ)/sterol regulatory element binding protein-1(SREBP-1)/fatty acid synthetase(FAS) pathways in liver were detected by Western blot. According to the findings, compared with the model group, levels of body weight, epididymal fat weight, FBG, FINS, TC, TG, LDL-C and HOMA-IR, as well as protein expressions of PPARγ, SREBP-1 and FAS in liver were significantly reduced(P<0.05 or P<0.01), while level of HDL-C and protein expressions of p-IRS-1, IRS-1, PI3 K and p-Akt in liver were signi-ficantly increased after treatment with fucoxanthin(P<0.05 or P<0.01). And the pathological changes of liver tissue in fucoxanthin-treated mice were also improved obviously. The results showed that fucoxanthin could improve obesity, hyperglycemia and hyperlipidemia, and alleviate insulin resistance in obese mice, and its mechanism is possibly related to the regulation of IRS-1/PI3 K/Akt and PPARγ/SREBP-1/FAS pathways.

Development of a cell-based peroxisome proliferator-activated receptors (PPARs) screening model and its application for evaluation of triterpenoids isolate from Alismatis Rhizoma / 中国中药杂志

Peroxisome proliferators activated receptors (PPARs) are closely related to human chronic disease, such as diabetes mellitus and the other metabolic diseases. In this study, a cell-based PPARs (PPAR α/β/γ) model was developed for the screening of PPARs agonists from Alismatis Rhizoma (AR). Firstly, 293T cells were transfected with the reconstructed plasmid pBind-PPAR (α, β, or γ)-LBD and reporter gene pGL4.35, and the known PPARs agonists were used as the positive control (fenofibrate for PPARα, L165041 for PPARβ, and rosiglitazone for PPARγ). The ability of activation for PPARs was evaluated by analyzing the expression value of luciferase. Afterward, the 14 pure triterpenoids isolate from AR were analyzed on the developed PPARα, PPARβ and PPARγ screening assay method. The results showed that the compounds 5, 6, 7, 8, 13 and 14 from AR have the ability of activation for PPARα. The compounds 5 and 7 from AR have the ability of activation for PPARβ. The compounds 6, 7, 8 and 12 from RA have the ability of activation for PPARγ.In this study, the compound 12 from AR were found to display significant activation on PPARγ for the first time. AR triterpenoids extracts had the ability of activation for PPARα, PPARβ and PPARγ. The results suggested that triterpenoids extracts from AR were PPARα, PPARβ and PPARγ agonists. The results will help to provide reference for clinical application of AR, and establish a model for PPARs on 293T cell, which can be used to screen and evaluate PPARs natural agonists.

Exposure to heat-inactivated Trichophyton rubrum resulting in a limited immune response of human keratinocytes / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Trichophyton rubrum (T. rubrum) represents the most important agent of dermatophytosis in humans. T. rubrum infection causes slight inflammation, and tends to be chronic and recurrent. It is suggested that it may result from the failure of epithelial cells to recognize T. rubrum effectively and initiate effective immune responses. The C-type lectin receptors (CLR) and toll-like receptors (TLR) are the two major pattern recognition receptors (PRRs) that recognize fungal components. Therefore, the purpose of the study was to analyze the expression of those PRRs and the cytokines in HaCaT cells stimulated with heat-inactivated T. rubrum conidia and hyphae, respectively.</p><p><b>METHODS</b>HaCaT cells were unstimulated or stimulated with heat-inactivated T. rubrum conidia and hyphae (1×10(6) and 1.5×10(5) colony-forming unit (CFU) in 2 ml medium, respectively) for 6, 12 and 24 hours. The mRNA expression of PRRs involved in recognizing fungal pathogen-associated molecular patterns (PAMPs) and signaling molecules were measured by quantitative reverse transcription polymerase chain reaction (RT-PCR). Meanwhile, surface toll-like receptor (TLR) 2, TLR4 and Dectin-1 were analyzed by fluorescence-activated cell sorter (FACS) 24 hours after treatment. The cytokines were detected in cell culture supernatants of HaCaT cells in 12 and 24 hours after treatment.</p><p><b>RESULTS</b>HaCaT cells constitutively expressed mRNA of membrane-bound TLR1, 2, 4 and 6, Dectin1 and DC-SIGN, but not Dectin-2 or Mincle. Heat-killed T. rubrum did not significantly upregulate gene transcriptions of the PRRs of HaCaT cells. Heat-inactivated T. rubrum conidia significantly reduced the surface expression of TLR2 and Dectin-1, and suppressed the secretions of interferon-inducible protein-10 (IP-10) and monocyte chemotactic protein-1 (MCP-1) of HaCaT cells, while heat-killed T. rubrum hyphae significantly induced the secretions of IP-10 and MCP-1.</p><p><b>CONCLUSION</b>The cell-wall antigens of T. rubrum fail to activate transcriptional expression of PRRs and induce a lower immune response of HaCaT cells by limited cytokines secretion.</p>

Surgical management and outcome of solid-pseudopapillary tumor of pancreas: a series of 58 cases / 中华外科杂志

<p><b>OBJECTIVE</b>To study the surgical management of solid-pseudopapillary tumor of the pancreas (SPTP) and its characteristics of outcome.</p><p><b>METHODS</b>Fifty-eight patients with SPTP of the pancreas admitted from January 2001 to December 2010 were retrospectively analyzed. There were 7 male and 51 female patients, with an average age of 30 years (ranging 9 to 70 years). Most patients were symptomatic before admission; the most common symptom was abdominal pain. Of the 58 patients, 21 patients underwent pancreaticoduodenectomy, 30 patients underwent distal pancreatectomy, 6 patients underwent central pancreatectomy, 1 patient underwent simple tumor enucleation, and 1 patients underwent duodenum-preserving pancreatic head resection.</p><p><b>RESULTS</b>The average length of stay in hospital was 23.8 days (ranging 12 to 64 days). Thirteen patients (22.4%) developed postoperative complications, including grade A postoperative pancreatic fistula of 8 cases, gastrointestinal tract bleeding of 1 case, pleural effusion of 2 cases, wound infection and fat liquefaction of 2 cases. Two patients underwent reoperation due to gastrointestinal tract bleeding or wound infection. There was no hospital death. Forty-four patients were followed-up for 7 to 136 months with an average of 41 months. All the 44 patients were alive, while 8 patients developed dyspepsia and 4 patients developed diabetes mellitus. There were no tumor recurrences or metastasis.</p><p><b>CONCLUSIONS</b>SPTP is found primarily in young women. Excellent prognosis would be achieved with surgical resection.</p>

Intrahepatic biliary cystadenoma: experience with 10 consecutive cases at a single center / 南方医科大学学报

<p><b>OBJECTIVE</b>To summarize the clinical experience with diagnosis and treatment of intrahepatic biliary cystadenoma (IBCA).</p><p><b>METHODS</b>We retrospectively analyzed the data of 10 consecutive IBCA cases treated in our department in light of the characteristics of the epidemiology, radiology, lab tests, pathology and prognostic.</p><p><b>RESULTS</b>The patients are all female with an average age of 48.9 (16-73) years. The number of asymptomatic, slightly symptomatic and severe symptomatic patients was 4, 4 and 2, respectively. Radiological examination showed segmented cystic lesions in all the cases with an average diameter is 13.3∓4.9 cm. The incidence of segmentation, papillary or nodular hyperplasia, and calcification within the lesions was 90%, 60% and 20%, respectively. Macroscopic examination of the specimen showed compartmentation in the lesions, and microscopically, the lesions all showed lining of cubic or columnar epithelium on the inner wall with ovary-like or fibrous stroma. Complete resection of the tumor was achieved in 8 cases and partial resection was performed in 2 cases. The patients were followed up for a mean of 55.3 (12-164) months, and none of the patients with complete tumor resection showed recurrence, while both of the two patients with partial resection had postoperative recurrence.</p><p><b>CONCLUSION</b>IBCA is a rare cystic lesion occurring primarily in middle-aged women. The preoperative diagnosis of this disease relies primarily on radiological evidences, and a complete resection of IBCA may prolong the patient survival.</p>

Effect of arterioportal shunting in radical resection of hilar cholangiocarcinoma / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The resection and reconstruction of the hepatic artery is often required in radical surgery for hilar cholangiocarcinoma. In this study, we report our experience in performing arterioportal shunting as an alternative for the arterial reconstruction.</p><p><b>METHODS</b>Four patients with hilar cholangiocarcinoma underwent extended left hepatectomy and caudate lobectomy combined with en bloc resection of the hepatic artery and arterioportal shunting with restriction of the arterial caliber. The efficacy of arterioportal shunting was assessed by computed tomography angiography (CTA).</p><p><b>RESULTS</b>All the four patients recovered uneventfully without any complications. CTA showed a patent shunt and normal liver regeneration. No signs of portal hypertension were found at one year of follow-up.</p><p><b>CONCLUSIONS</b>Arterioportal shunting with restriction of the arterial caliber appears to be a feasible and safe alternative for the microvascular reconstruction after hepatic artery resection in radical surgery for hilar cholangiocarcinoma.</p>

Experience from surgical resection for 48 cases of hilar cholangiocarcinoma / 中华外科杂志

<p><b>OBJECTIVE</b>To summarize the methods, safety and efficiency of surgical resection for hilar cholangiocarcinoma.</p><p><b>METHODS</b>The clinical and follow-up data of 48 patients with hilar cholangiocarcinoma underwent surgical resection from January 2003 to December 2007 were analyzed retrospectively. There were 26 male and 22 female, aged from 38 to 72 years old with a mean of 63.6 years old.</p><p><b>RESULTS</b>Perioperative management including percutaneous transhepatic biliary drainage applied in 19 cases and portal vein embolization applied in 2 cases. Eight patients were treated with extrahepatic bile duct resection with or without parital hepatic segment II resection, 10 cases with perihilar hepatic resection (segment IVB, partial V, partial VIII, I), 28 cases with extended hemihepatectomy and 2 cases with central hepatic resection (segment IVB, V, VIII, I). R0 resection rate was 89.5% and the operative mortality was 2.1%. The 1-, 3- and 5-year survival rate were 93.5%, 51.8% and 36.5%, respectively. Patients undergoing extended hepatic resection survived significantly longer than those undergoing partial hepatic resection (P = 0.034).</p><p><b>CONCLUSIONS</b>Extended hepatic resection for hilar cholangiocarcinoma offers good outcomes with an acceptable mortality rate.</p>

Clinical application of precise liver resection techniques in patients with complicated liver space-occupying lesions / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the early results of precise liver resection.</p><p><b>METHODS</b>Between May 2006 and June 2009, 65 patients with complicated liver space-occupying lesions were included in the study. Fifty-one patients underwent curative liver resection. Liver resections performed included 16 trisectionectomies, 11 hemihepatectomy, 5 meso hepatectomies, 3 combined segmentectomies, 5 caudate lobectomies and 11 irregular local resections.</p><p><b>RESULTS</b>Patients undergoing resection had no mortality with a major morbidity of 9.8%. Nineteen vascular repairs and reconstructions were patent at last follow-up. The postoperative 1-year survival rate was 100% in 10 patients with benign lesions and 92.7% in 41 patients with malignant tumors. The 1-year survival rate was zero in patients with malignant tumors, who underwent no liver resection.</p><p><b>CONCLUSIONS</b>Precise liver resection, as an aggressive surgical approach, offers hope for these patients, who would otherwise have a dismal prognosis.</p>

Hepatic resection: an analysis of the impact of operative and perioperative factors on morbidity and mortality rates in 2008 consecutive hepatectomy cases / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Hepatectomy is a standard hepatic surgical technique. The safety of hepatectomy has been improved in line with improvements in surgical techniques. This study analyzed the operative and perioperative factors associated with hepatectomy.</p><p><b>METHODS</b>A total of 2008 patients who underwent consecutive hepatectomies between January 1986 and December 2005 were investigated retrospectively. Diagnoses were made based on pathological findings.</p><p><b>RESULTS</b>Malignant and benign liver diseases accounted for 58.5% and 41.2%, respectively, of the conditions requiring resections. Primary liver cancers accounted for 76.1% of the malignant tumors, while hilar cholangiocarcinomas accounted for 6.7%. Hemangiomas (41.7%) and hepatolithiasis (29.6%) were the most common of the benign conditions. Microwave in-line coagulation was used in 236 of our liver resection cases. The overall postoperative complication rate was 14.44%, of which 12.54% of resections were performed for primary liver cancer, 16.40% for secondary liver cancer, and 16.32% for hepatolithiasis. The overall hospital mortality was 0.55%, and that for malignant liver disease was 0.51%. A high mortality (2.53%) was associated with extensive liver resections for hilar cholangiocarcinomas (two deaths in 79 cases). Microwave in-line pre-coagulation resection, Child-Pugh grading, operating time, postoperative length of stay, and preoperative serum albumin level were independent predictors of morbidity. Blood loss, Child-Pugh grading, operating time and preoperative serum albumin level were independent predictors of mortality.</p><p><b>CONCLUSIONS</b>Hepatectomy can be performed safely with low morbidity and mortality, provided that it is carried out with optimal perioperative management and innovative surgical techniques.</p>

Effects of portal venous arterialization on acute occlusion of hepatic artery in rats / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>A fatal complication after liver transplantation is anastomotic embolization of the hepatic artery. In order to solve this problem, the portal venous arterialization (PVA) is used to reconstruct the hepatic arterial blood flow. The purpose of this study was to investigate the influence of PVA on rats with acute occlusion of hepatic artery.</p><p><b>METHODS</b>Rat PVA models were established and then randomly divided into Group 1 (control group), Group 2 (jaundice group), Group 3 (bile duct recanalization group), and Group 4 (portal vein arterilization group). Recanalization of the common bile duct and PVA were performed 5 days after bile duct ligation in the rats. The influence of the PVA on general conditions, hepatic changes of structure and function, portal vein pressure and hepatic micrangium were observed for one month.</p><p><b>RESULTS</b>Five days after common bile duct ligation the serum bilirubin, transaminase and alkaline phosphatase levels were significantly increased. Compared with group 1, there was a statistically significant difference (P < 0.01). These rats then underwent bile duct recanalization and PVA. After a month, the liver functions and microscopic structures completely returned to normal and, compared with group 1, there was no statistically significant difference in portal vein pressure (P > 0.05). Vascular casting samples showed that hepatic sinusoids were slightly thicker and more filled than normal ones and although they had some deformations, the hepatic sinusoids were still distributed around the central vein in radial form.</p><p><b>CONCLUSION</b>Within a month after operation, bile duct recanalization and PVA do not show obvious adverse effects on liver hemodynamics and hepatic micrangium, and the liver function and microscopic structure can return to normal.</p>

Liver resection: single center experiences of 2008 consecutive resections in 20 years / 中华外科杂志

<p><b>OBJECTIVE</b>To analyze operative and perioperative factors associated with hepatectomy.</p><p><b>METHODS</b>2008 consecutive patients undergoing hepatectomy from January 1986 to December 2005 at Chinese People's Liberation Army General Hospital were investigated retrospectively according to their medical documentation. Diagnoses were made on basis of pathological results.</p><p><b>RESULTS</b>Malignant and benign liver diseases accounted for 58.5% and 41.2%, respectively. In the former, primary liver cancer accounted for 76.1% and hilar cholangiocarcinoma for 6.7%. Hemangioma (41.7%) and hepatolithiasis (29.6%) were listed in the first two in the latter group with relatively more patient ratios. Isolated caudate lobe resection was performed in 25 patients and micro-wave inline coagulation was induced in 236 cases of liver resection. In all cases, those with blood loss less than 200 ml accounted for 50.5% (1015/2008), whereas those with more than 400 ml accounted for 28.4% (570/2008). In patients performed micro-wave inline coagulation liver resection, those with blood loss less than 200 ml and more than 400 ml accounted for 60.6% (143/236) and 19.9% (47/236), respectively, which differed significantly from the average level (P < 0.05). The postoperative complication incidence was 14.44% for all cases, 12.54% for primary liver cancer, 16.40% for secondary liver cancer, and 16.32% for hepatolithiasis. Complication incidence of primary liver cancer with tumor size smaller than 5 cm was 11.65% and that with tumor larger than 10 cm was 14.69%. There was no significant difference between the two groups. All-case hospital mortality was 0.55% and that for liver malignant disease was 0.60%, hilar cholangiocarcinoma 2.53%.</p><p><b>CONCLUSION</b>Hepatectomy can be performed safely with low mortality and low complication incidence, provided that it is carried out with optimized perioperative management and innovative surgical technique.</p>

Liver resection in hepatolithiasis: 20-year's evolution / 中华外科杂志

<p><b>OBJECTIVE</b>To analyze operative and perioperative factors associated with hepatectomy in hepatolithiasis.</p><p><b>METHODS</b>245 consecutive hepatolithiasis patients undergoing hepatectomy from January 1986 to December 2005 at Chinese People's Liberation Army General Hospital were investigated retrospectively according to medical documentation.</p><p><b>RESULTS</b>Hepatolithiasis accounted for 29.6% (245/827) in all benign liver diseases treated with hepatectomy during this time period. There were 88 cases in male and 157 cases in female, the average age was (46.9 +/- 11.3) years. Cases of right liver resection and hepatic segments resection were much more than that in 1963 - 1985. Blood transfusion during operation was given in 45.3% of cases. Complication incidence was 16.3%, with infection 3.3% and bile leakage 2.4%. Length of stay after operation was (15.7 +/- 9.2) days. Perioperative mortality rate was 0.4% (1/245).</p><p><b>CONCLUSIONS</b>Individualized hepatectomy is the important surgical treatment of hepatolithiasis. Hepatectomy can be performed safely with low mortality and low complication incidence, provided that it is carried out with optimized perioperative management and innovative surgical technique.</p>

Impact of surgical operation-related factors on long-term survival of patients with hepatocellular carcinoma after hepatectomy / 中国医学科学院学报

<p><b>OBJECTIVE</b>To evaluate the prognostic value of surgical operation-related factors in patients with hepatocellular carcinoma (HCC).</p><p><b>METHODS</b>The clinical data of 234 patients after hepatic resection (214 men and 20 women) were retrospectively studied. Univariate and multivariate COX regression analyses were performed for surgical operation-related prognostic factors including age, gender, intraoperative blood loss, iatrogenic tumour rupture, transfusion, operation duration, hepatectomy extent, Pringle manoeuvre, with or without devarscularization, and complications (e.g. postoperative ascites, biliary leakage, incision infection, and pleural effusion). Kaplan-Meier and log-rank tests were used to compare survival rates. Kendall's tau bivariate analyses were used to examine the correlations of these surgical operation-related factors.</p><p><b>RESULTS</b>Univariate COX regression analysis revealed that iatrogenic blood loss (chi2 = 19.721, P < 0.001), transfusion (chi2 = 7.769, P = 0.005), tumour rupture (chi2 = 6.401, P = 0.011), operation duration (chi2 = 4.793, P = 0.029), and postoperative ascites (chi2 = 4.452, P = 0.035) were statistically significant predictors in patients with HCC after hepatic resection. Multivariate COX regression analysis revealed that pathological factors, such as blood loss (RR: 2.138, 95% CI: 1.556-2.939), tumour rupture (RR: 2.260, 95% CI: 1.182-4.321), and postoperative ascites (RR: 1.648, 95% CI: 1.088-2.469), independently influenced the HCC prognosis. Blood loss correlated with transfusion (Kendall's tau = 0.416, P < 0.001). There was no correlation between hepatectomy extent and blood loss (Kendall's tau = 0.057, P = 0.383), while transfusion closely correlated with the hepatectomy extent (Kendall's tau = 0.185, P = 0.004). The postoperative ascites closely correlated with Child classification (Kendall's tau = 0.151, P = 0.024).</p><p><b>CONCLUSIONS</b>The long-term survival of patients with HCC after hepatectomy may be improved by avoiding blood loss and iatrogenic tumour rupture. The indications of blood transfusion may not be strictly obeyed in some severe cases. Child class B and C cirrhotic patients may experience postoperative ascites and a worse prognosis, and therefore may be candidates for liver transplantation.</p>

Clinical analysis of 110 patients with primary gallbladder carcinoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the clinical characteristics of primary gallbladder carcinoma.</p><p><b>METHODS</b>The data of clinical manifestations, image characteristics, diagnosis and treatment of 110 patients with primary gallbladder carcinoma were analyzed.</p><p><b>RESULTS</b>The rate of diagnosis as early primary gallbladder carcinoma was only 8.2% (9/110) in this series. The majority of the patients were females (63/110) with an age ranging from 31 to 80 years. Clinical manifestations were not specific, and diagnosis was made mainly on image examination. Radical resection was performed for 57 patients, palliative resection for 41, the rest 12 patients failed to receive operation on reasons of distant metastasis, age or other reasons. Only 88 patients were followed with a mean survival time of 196 days ranging from 15 days to 5 years and 11 months.</p><p><b>CONCLUSION</b>The primary gallbladder carcinoma is quite difficult to diagnose at the early stage, and its prognosis is usually poor. The diagnosis is made mainly depending on the medical history and image examinations.</p>

Surgical treatment of 402 consecutive cases for hilar cholangiocarcinoma: Chinese single center experience / 中华外科杂志

<p><b>OBJECTIVE</b>To analyze clinical typing, pathologic characteristics of hilar cholangiocarcinoma (HCCA) and surgical strategies and their effects on HCCA, and to explore the factors that influence the surgical outcomes and long-term survival.</p><p><b>METHODS</b>The data of the 402 patients with HCCA admitted between January 1993 and December 2004 was investigated retrospectively. Primary outcomes examined included clinical typing, pathologic characteristics, surgical procedures and follow-up results. On the basis of Bismuth-Corlette typing, we defined the tumor originated from intrahepatic large bile duct (LBD) as type V (type Va and Vb).</p><p><b>RESULTS</b>Among the 402 patients with HCCA, 198 cases accepted curative resection, 102 (51.5%) for radical resection and 96 (48.5%) for palliative resection. Of the rest patients, 8 received orthotopic liver transplantation (OLT), 161 received simple drainage and 35 were not operated on. The resection rates for type I, II, IIIa, IIIb, IV, Va and Vb were 69.4%, 55.5%, 57.4%, 71.7%, 19.6%, 100% and 34.6%, respectively. The one-year survival rates for radical resection, palliative resection, simple drainage and untreated were 80.3%, 53.2%, 26.7% and 9.8%, respectively. And the three-year and five-year survival rates in the four groups were 41.9% and 33.3%, 19.6% and 14.7%, 3.3% and 0, 0 and 0, respectively. Significant difference was found in survival rates between the radical and palliative resection. In the patients who received tumor resection, the ones without lymph nodes metastasis (LNM) survived much longer than those with LNM (P < 0.05). Complications were found in 36.1% of the patients and the mortality rate was 0.3%.</p><p><b>CONCLUSIONS</b>HCCA type V originated from intrahepatic LBD has higher resection rate and better prognosis. The tumor differentiation is significantly correlated with the prognosis after operation. With HCCA, resection is still the major treatment selection. Curative resection carries the best effect. Extended radical resection of liver lobes, blood vessels, lymph nodes can prolong survive. The problem of high recurrence rate after OLT for HCCA has not been solved yet.</p>

Protective effects of lidocaine injected into the hepatoduodenal ligament on warm ischemia-reperfusion injury to the rat liver / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Ischemia-reperfusion (IR) injury to the liver is still a critical and daunting problem in the field of hepatobiliary surgery. Ischemic preconditioning (IP) of the liver serves as an effective approach against IR injury. This study was to develop a novel procedure that could mimic IP, but might be more feasible than IP during surgery.</p><p><b>METHODS</b>Eighty-two SD rats were randomly divided into 5 groups. L group (n = 21): 0.4% lidocaine (10 mg/kg) was injected into the hepatoduodenal ligament 10 minutes before a 40-minute hepatic IR. IP group (n = 16): a 5-minute ischemia was followed by a 10-minute reperfusion prior to a 40-minute hepatic IR. ILR group (n = 15): after a 40-minute ischemia of the liver, 0.4% lidocaine (10 mg/kg) was injected into the hepatoduodenal ligament 10 minutes prior to a 40-minute reperfusion of the liver. IR group (n = 15): the liver of the rat was subjected to a 40-minute IR. Control group (n = 15): 0.9% sodium chloride was injected into the hepatoduodenal ligament without other treatments. The levels of plasma alanine transaminase (ALT) and aspartate transaminase (AST) were determined for each group after treatment.</p><p><b>RESULTS</b>The mean concentrations of ALT and AST were (379.80 +/- 141.69) U/L and (606.05 +/- 220.26) U/L for the L group, (334.64 +/- 141.94) U/L and (625.68 +/- 267.06) U/L for the IP group, (523.36 +/- 170.35) U/L and (765.47 +/- 238.45) U/L for the ILP group, (524.29 +/- 163.59) U/L and (764.63 +/- 246.79) U/L for the IR group, and (150.90 +/- 27.05) U/L and (298.15 +/- 47.68) U/L for the control group (standard error of the mean).</p><p><b>CONCLUSION</b>A significant decrease in ALT and AST levels was observed in the L and IP groups when compared to the ILR and IR groups (P < 0.05), but no significant difference in ALT and AST levels was observed in the L group when compared to the IP group (P > 0.05). These results suggest that pretreatment with lidocaine injected into the hepatoduodenal ligament prior to IR provides effective protection against subsequent IR injury to the liver. The novel approach of blocking innervation with lidocaine mimics hepatic IP, but is more convenient than IP at the time of liver surgery.</p>