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Objective:To investigate the role and mechanism of pancreatic stellate cells (PSCs) and pancreatic cancer cells (PCCs) in the angiogenesis of pancreatic cancer.Methods:The experimental study was conducted. The human PSCs and PCCs and human umbilical vein endothelial cells (HUVECs) were cultured in vitro. HUVECs was treated with PSCs/PCCs supernatants and matrix metalloproteinase (MMP) inhibitor of different types and concentrations. As controls, HUVECs treated with complete endoprime medium (C/E) and DMEM/Ham's F12 medium (D/F) were set as the C/E group and the D/F group, respectively. Observation indicators: (1) proliferation of HUVECs under different conditions; (2) tube formation of HUVECs under different conditions; (3) migration of HUVECs under different conditions; (4) expression of MMP-2 in the supernatants of PSCs and PCCs; (5) effect of MMP inhibitor GM6001 on migration of HUVECs. Measurement data with normal distribution were represented as Mean± SD, comparison among groups was conducted using the one way ANOVA and comparison between groups was conducted using the LSD- t test. Results:(1) Proliferation of HUVECs under different conditions. Results of HUVECs proliferation assay using 5-ethynyl-2′-deoxyuridine (EdU) labeling showed that the binding rate of EdU in the HUVECs of D/F group and HUVECs treated with supernatants of different concentration (25%, 50%, 75%, 95%) of PSCs was 12.4%±1.0%, 24.5%±2.9%, 25.3%±3.0%, 22.8%±2.0%, 22.9%±2.8%, respectively, showing a significant difference among them ( F=8.60, P<0.05). There were significant differences in the binding rate of EdU between HUVECs in the D/F group and HUVECs treated with supernatants of different concentration (25%, 50%, 75%, 95%) of PSCs, respectively ( P<0.05). The binding rate of EdU between HUVECs in the D/F group and HUVECs treated with supernatants of different concentration (25%, 50%, 75%, 95%) of PCCs was 12.4%±1.0%, 30.0%±3.2%, 32.1%±1.0%, 32.3%±3.5%, 26.2%±5.6%, respectively, showing a significant difference among them ( F=11.93, P<0.05). There were significant differences in the binding rate of EdU between HUVECs in the D/F group and HUVECs treated with supernatants of different concentration (25%, 50%, 75%, 95%) of PSCs, respectively ( P<0.05). (2) Tube formation of HUVECs under different conditions. Number of tube formation, length of tube in the HUVECs of D/F group and HUVECs treated with PSCs supernatants was 15.2±2.3, (12.1±1.5)mm and 49.7±3.2, (39.8±2.3)mm, respectively, showing significant differences between the two groups of HUVECs ( P<0.05). (3) Migration of HUVECs under different conditions. Results of single cell tracing experiment showed that the migration rate of HUVECs treated with supernatants of different ratio of PSCs and PCCs was faster than that of HUVECs in the D/F group, and the enhancement effect of supernatants of PSCs and PCCs was dose-dependent. The migration rate of HUVECs treated with mix supernatants of different concentration of PSCs and PCCs and supernatants of co-cultured PSCs and PCCs was faster than that of HUVECs in the D/F group. The migration rate of HUVECs treated supernatants of co-cultured PSCs and PCCs was faster than that of HUVECs treated with mix supernatants of different concentration of PSCs and PCCs, showing a synergistic effect in the HUVECs treated supernatants of co-cultured PSCs and PCCs. (4) Expression of MMP-2 in the supernatants of PSCs and PCCs. Results of gelatine zymography showed that the MMP-2 expression levels decreased sequentially in super-natants of co-cultured PSCs and PCCs, supernatants of PSCs, mix supernatants of PSCs and PCCs and supernatants PCCs. (5) Effect of MMP inhibitor GM6001 on migration of HUVECs. Results of single cell tracing experiment showed that the migration rate of HUVECs treated with PSCs supernatants combined with different concentration of GM6001 (0, 1, 10, 25 μmol/L) was (25.70±2.06)μm/h, (18.37±1.61)μm/h, (16.20±0.26)μm/h, (15.99±0.58)μm/h, respectively, showing a significant difference among them ( F=11.39, P<0.05). There were significant differences in the migration rate between HUVECs treated with PSCs supernatants combined with 1, 10, 25 μmol/L GM6001 and HUVECs treated with PSCs supernatants ( P<0.05). The migration rate of HUVECs treated with mix super-natants of PSCs and PCCs combined with different concentration of GM6001 (0, 1, 10, 25 μmol/L) was (30.06±3.70)μm/h, (22.76±1.56)μm/h, (23.87±2.84)μm/h, (22.10±2.35)μm/h, respectively, showing a significant difference among them ( F=4.06, P<0.05). There were significant differences in the migration rate between HUVECs treated with mix supernatants of PSCs and PCCs combined with 1, 10, 25 μmol/L GM6001 and HUVECs treated with mix supernatants of PSCs and PCCs ( P<0.05). Conclusions:Both PSCs and PCCs can promote the proliferation, migration and angiogenesis of HUVECs in vitro experiment. Releasing of MMP-2 by interaction between PSCs and PCCs is an important factor to stimulate endothelial cell migration, which increases the stimulating activity of angiogenesis, especially the migration ability of HUVECs.
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Objective To summarize clinical experience of transabdominal pericardial anastomosis of suprahepatic vena cava of the donor and right atrium of the recipient in liver transplantation for Budd-Chiari syndrome (BCS) complicated with liver cancer. Methods Clinical data of a BCS patient complicated with liver cancer undergoing transabdominal pericardial anastomosis of suprahepatic vena cava and right atrium in liver transplantation were retrospectively analyzed. Results The hepatic vein and suprahepatic vena cava were partially occluded in the patient. Liver transplantation was completed by transabdominal pericardial anastomosis of suprahepatic vena cava and right atrium with beating-heart. In addition, due to pathological changes of the recipient's hepatic artery, splenic artery of the recipient was cut off, distal ligation was performed, and the proximal end was reversed and anastomosed with the common hepatic artery of the donor liver, and the reconstruction of hepatic artery was completed. The surgery was successfully performed. At approximately postoperative 1 week, the function of the liver allograft was gradually restored to normal, and no major complications occurred. The patient was discharged at postoperative 25 d. No signs of BCS recurrence was reported after 8-month follow-up. Conclusions It is safe and feasible to treat BCS by liver transplantation with transabdominal pericardial anastomosis of suprahepatic vena cava and right atrium. BCS patients complicated with liver cancer obtain favorable prognosis.
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Objective To evaluate the effect of different techniques of hepatic artery reconstruction on postoperative hepatic artery complications and clinical prognosis in liver transplantation. Methods Clinical data of 140 liver transplant recipients were retrospectively analyzed. All recipients were divided into the conventional hepatic artery reconstruction group (n=123) and special hepatic artery reconstruction group (n=17) according to hepatic artery reconstruction methods. Intraoperative and postoperative clinical indexes, the incidence of postoperative hepatic artery complications and survival rate were compared between two groups. Results The alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels at postoperative 1 d, total bilirubin (TB) at postoperative 7 d and prothrombin time international normalized ratio (PT-INR) at postoperative 30 d in special hepatic artery reconstruction group were higher than those in conventional hepatic artery reconstruction group, and the differences were statistically significant (all P < 0.05). There were no significant differences in the operation time, anhepatic phase, intraoperative blood loss, intraoperative transfusion volume of red blood cells, cold or warm ischemia time, the length of intensive care unit (ICU) stay, the length of hospital stay and postoperative blood flow of liver allograft between two groups (all P > 0.05). In the conventional hepatic artery reconstruction group, 5 recipients developed hepatic artery complications, whereas no hepatic artery complications occurred in the special hepatic artery reconstruction group, with no significant difference between two groups (P > 0.05). In the special hepatic artery reconstruction group, the 1-, 3- and 5-year cumulative survival rates were equally 82.4%, compared with 85.0%, 78.9% and 75.6% in the conventional hepatic artery reconstruction group, respectively. There was no significant difference between two groups (all P > 0.05). Conclusions When hepatic artery variations and (or) lesions are detected in donors and recipients, use of special hepatic artery reconstruction may effectively restore the hepatic arterial blood flow of liver allograft after liver transplantation, and will not affect the incidence of hepatic artery complications and survival rate of the recipients following liver transplantation.
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Objective:To investigate the clinical efficacy of precise hepatectomy for the treatment of recurrent unilateral hepatolithiasis and prognostic factors.Methods:The retrospec-tive case-control study was conducted. The clinicopathological data of 166 patients with recurrent unilateral hepatolithiasis who were treated by precise hepatectomy in the First Affiliated Hospital of Anhui Medical University from January 2015 to January 2021 were collected. There were 51 males and 115 females, aged (58±12)years. Observation indicators: (1)diagnosis and classification; (2) surgical and intraoperative situations; (3) postoperative situations; (4) follow-up; (5) analysis of prognostic factors. Follow-up was conducted using the outpatient examination and telephone inter-view to detect final stone clearance or recurrence and survival of patients up to August 2021. Patients with T-tube were performed T-tube cholangiography or choledochoscopy to evaluate the final stone clearance rate at postoperative week 8. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers or percentages. Univariate and multi-variate analyses were conducted using the Logistic regression model. Results:(1) Diagnosis and classifica-tion: 166 patients were diagnosed as hepatolithiasis by preoperative imaging examination and intraoperative evaluation, including 134 cases with common bile duct stones. Of the 166 patients, 115 cases had stones located in the left lobe of liver and 51 cases had stones located in the right lobe of liver. There were 111 cases with bile pigment stones, 31 cases with cholesterol stones, 24 cases with mixed type of stones. There were 9 cases classified as Tsunoda type Ⅰ, 89 cases as Tsunoda type Ⅱ, 65 cases as Tsunoda type Ⅲ, 3 cases as Tsunoda type Ⅳ. There were 12 cases classified as type Ⅰ, 99 cases as type Ⅱ, 47 cases as type Ⅲ, 8 cases as type Ⅳ according to Japanese classification in 2001. All the 166 patients were classified as type Ⅰ based on Chinese classification. According to the classification of author team, 166 patients were classified as type Ⅱ. (2) Surgical and intra-operative situations: 119 of 166 patients had liver lobe or segment atrophy. All the 166 patients underwent precise hepatectomy combined with different methods of drainage, of which 28 cases underwent left hemihepatectomy, 11 cases underwent right hemihepatectomy, 1 case underwent liver resection of segment Ⅰ, 5 cases underwent liver resection of segment Ⅱ, 5 cases underwent liver resection of segment Ⅲ, 8 cases underwent liver resection of segment Ⅳ (left medial lobe), 3 cases underwent liver resection of segment Ⅴ, 2 cases underwent liver resection of segment Ⅵ, 2 cases underwent liver resection of segment Ⅷ, 68 cases underwent liver resection of segment Ⅱ and Ⅲ (left lateral lobe), 3 cases underwent liver resection of segment Ⅴ and Ⅵ, 6 cases underwent liver resection of segment Ⅴ and Ⅷ (right anterior lobe), 21 cases underwent liver resection of segment Ⅵ and Ⅶ (right posterior lobe), 1 case underwent liver resection of segment Ⅱ, Ⅲ and Ⅳa, 1 case underwent liver resection of segment Ⅴ, Ⅵ and Ⅶ, 1 case underwent liver resection of segment Ⅰ, Ⅱ, Ⅲ and Ⅳ. For biliary drainage methods of 166 patients, 120 patients received T-tube external drainage, 23 cases received choledochojejunostomy, 23 cases received choledochojejunostomy combined with T-tube external drainage. The original cholangiojejunal anastomotic stenosis was found and reconstructed in 10 patients. The operation time was (258±87)minutes and intraopera-tive blood transfusion rate was 16.87%(28/166) of 166 patients. All the 166 patients underwent fiber choledochoscopy, showing 77 cases with normal function of Oddi sphincter, 38 cases with disorder, 40 cases with dysfunction. There were 11 patients undergoing choledochojejunostomy who were not evaluate the function of Oddi sphincter. There were 21.69%(36/166)of patients with intra-hepatic biliary stricture. One hundred and forty-nine of 166 patients were conducted bile culture, showing the positive rate as 75.17%(112/149). There were 22 cases cultured multiple kinds of bacteria. The most common bacterium was Escherichia coli (43 cases), followed by Pseudomonas aeruginosa (12 cases), Klebsiella pneumoniae (9 cases), Klebsiella oxytoca (7 cases), Enterococcus faecium (7 cases). (3) Postoperative situations. The postoperative complication rate of 166 patients was 16.87%(28/166). In the 8 patients with serious complications of Clavien-Dindo grade Ⅲ, 6 cases were performed thoracocentesis or abdominocentesis for effusion, 1 case was stopped bleeding under gastroscopy for stress ulcerbleeding, 1 case was performed surgery for adhesive intestinal obstruction. Two patients with septic shock of Clavien-Dindo grade Ⅳ were converted to intensive care unit for treatment and discharged after recovery. There were 13 patients with biliary leakage, 10 patients with pulmonary infection, 6 cases with incision infection, which were improved after conservative treatments. There was no perioperative death. The instant stone clearance rate of 166 patients was 81.93%(136/166). The duration of postoperative hospital stay of 166 patients was (11±6)days. (4) Follow-up: 166 patients were followed up for (37±17)months. The final stone clearance rate and stone recurrence rate of 166 patients were 94.58%(157/166) and 16.87%(28/166), respectively. According to Terblanche classification of prognosis, there were 91, 36, 25, 14 cases of grade Ⅰ, Ⅱ, Ⅲ, Ⅳ in 166 patients, respectively. Five of the 166 patients underwent intrahepatic secondary malignancy in which 4 cases died. (5) Analysis of prognostic factors: results of univariate analysis showed that biliary culture, the number of previous surgeries, immediate stone clearance, final stone clearance were related factors affecting the prognosis of precise hepatectomy in patients with recurrent unilateral hepatolithiasis ( odds ratio=2.29, 7.48, 2.69, 4.52, 95% confidence interval as 1.09?4.85, 2.80?19.93, 1.16?6.25, 1.15?17.77, P<0.05). Results of multivariate analysis showed that the number of previous surgeries ≥3 was an independent risk factor affecting the prognosis of precise hepatectomy in patients with recurrent unilateral hepato-lithiasis ( odds ratio=6.05, 95% confidence interval as 2.20?16.62, P<0.05). Conclusions:Precise hepatectomy is safe and effective for the treatment of patients with recurrent unilateral hepato-lithiasis. The number of previous surgeries ≥3 is an independent risk factor affecting the prognosis of precise hepatectomy in patients with recurren t unilateral hepatolithiasis.
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Objective:To investigate the clinical outcomes of patients with intrahepatic cholangiocarcinoma (ICC) undergoing surgical resection.Methods:Patients who undergoing radical surgical resection for ICC from Jan 2015 to Apr 2021 at the Department of General Surgery, the First Affiliated Hospital of Anhui Medical University were included in this retrospective cohort study.Results:There were 67 patients in the final analysis, The median follow-up duration was 14 months (range: 1-60 months). Firty three patients (79.1%) had tumor recurrence, 52 patients (77.6%) died, Among them, 49 patients (73.1%) died from tumor recurrence. The 1-、2-、and 3-year accumulated disease-free and overall survival rate were 35.6%, 19.6%, 16.8% and 53.7%, 32.4%, 20.8%. respectively. The overall survival rate of the group without microvascular invasion was significantly better than those of the group with microvascular invasion ( χ2=5.916, P=0.015). CA19-9≥1 000 U/ml was the only independent risk factor for the disease-free survival. CA19-9≥1 000 U/ml、blood loss≥600 ml、microvascular invasion and tumor recurrence were the independent risk factors for the overall survival. Conclusion:For ICC patients with single tumor, when the tumor diameter is less than 5 cm and has no microvascular invasion, surgical resection is recommended, and a satisfactory prognosis could be achieved.
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Objective:To explore the postoperative biliary leakage and severe complication rate and its related risk factors of hepaticojejunostomy (HJ) for biliary disease.Methods:The clinical data of patients undergoing HJ for benign biliary diseases at the First Affiliated Hospital of Anhui Medical University from Jan 2003 to Dec 2017 were retrospectively analyzed. Multi-factor analysis was used to find a risk factor for postoperative bile leakage and severe complications.Results:Two hundred and eighty-three patients received HJ. The median age was 39 years.The short-term complication rate after surgery was 19.1% ( n=54), and the biliary leakage rate was 11.7% ( n=33), and the severe complication rate was 15.2% ( n=43). By multi-factor analysis: preoperative sepsis[ OR=3.875, 95% CI (1.583, 9.485), P=0.003], liver cirrhosis [ OR=3.212, 95% CI (1.001, 10.307), P=0.050], intraoperative blood loss≥400 ml [ OR=6.054, 95% CI (1.231, 29.781), P=0.027],postoperative hospitalization ≥9 days [ OR=6.738, 95% CI (2.287, 19.855), P=0.001] are the independent risk factors for postoperative bile leakage. Main bile duct stone[ OR=2.764, 95% CI (1.174, 6.510), P=0.020], preoperative sepsis [ OR=4.310, 95% CI (1.666, 11.149), P=0.003], intraoperative bleeding ≥400 ml [ OR=5.944, 95% CI (1.231, 29.781), P=0.022] and postoperative hospitalization ≥ 9 days [ OR=11.422, 95% CI (1.317, 49.859), P=0.001] are the independent risk factors for serious complications. Conclusions:HJ should be conducted when the sepsis was under control and sufficient bile drainage.The patients' condition should be comprehensively and accurately assessed before operation. The indications for partial hepatectomy need to be strictly defined.
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Objective:To investigate the effect of optimizing perioperative measures on reducing postoperative gastric emptying disorder in gastrointestinal reconstruction after pancreaticoduodenectomy.Methods:The clinical data of 146 patients who underwent pancreaticoduodenectomy from Jan 2019 to Dec 2020 at the Department of Hepatobiliary and Pancreatic Surgery,the First Affiliated Hospital ,Anhui Medical University were analyzed retrospectively. Among them, 78 cases underwent traditional Billroth Ⅱ gastrojejunal anastomosis for gastrointestinal reconstruction, and 68 cases in the improvement group took optimization measures. The time to first postoperative flatus, time to oral intake, postoperative hospital stay and complications were observed.Results:The operation time in the control group was (351.4±71.6) min, less than that in the improved group (368.8±97.6) min, while the time [(9.9±6.5)d vs. (7.6±6.0)d] to first oral take and postoperative hospital stay [(20.7±8.6)d vs. (17.9±7.0)d] were significantly longer than those in the improved group. The incidence of postoperative gastric emptying disorder (19.2% vs. 7.4%) was significantly higher than that in the improved group ( P<0.05). There was no significant difference in postoperative time to first flatus and postoperative gastrointestinal bleeding between the two groups (all P>0.05). Conclusions:The measures of optimizing gastrointestinal reconstruction in the perioperative period of pancreaticoduodenectomy have obvious advantages in reducing gastric emptying disorder, promoting the recovery of gastrointestinal function and shortening the length of hospital stay.
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Objective:To study the efficacy and safety of early abdominal puncture drainage (APD) in severe acute pancreatitis (SAP).Methods:A retrospective study was conducted on 189 patients with SAP who were managed at the Department of Intensive Medicine of the Second Affiliated Hospital of Anhui Medical University from January 2013 to May 2020. According to whether ultrasound-guided APD was performed within one week after admission to ICU, these patients were divided into 2 groups: patients treated with APD (the APD group) and patients treated without APD (the non-APD group). Clinical data, including the acute physiological and chronic health status (APACHE) Ⅱ score, modified Marshall score, sequential organ failure evaluation (SOFA) score, and prognostic indicators including the retroperitoneal percutaneous drainage (PCD) rate and length of hospital stay, were compared between the two groups before and 1 week after surgery.Results:Of the 189 SAP patients in this study, there were 110 males and 79 females, aged (52.5±17.4) years old. On admission to ICU, the blood amylase, C-reactive protein, procalcalonin, interleukin-6, APACHE II score, modified Marshall score and SOFA score in the APD group were significantly higher than those in the non-APD group. After 1 week of treatment, most clinical indicators in the 2 groups were significantly improved, and there were no significant differences between these indicators (all P>0.05). There were no significant differences in the abdominal infection, retroperitoneal PCD and mortality rates between the APD group and the non-APD group ( P>0.05). The length of hospital stay [29 (18, 45) vs 21 (15, 32) d] and ICU stay [5 (3, 11) vs. 7 (5, 17) d] in the APD group were significantly higher than those in the non-APD group ( P<0.05). Conclusion:For patients with SAP with peritoneal effusion, early APD effectively improved the condition and prognosis without increasing the peritoneal infection and mortality rates.
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Objective:To investigate the risk factors for delayed gastrointestinal hemorrhage after pancreaticoduodenectomy (PD).Methods:The retrospective case-control study was conducted. The clinicopathological data of 173 patients who underwent PD in the First Affiliated Hospital of Anhui Medical University from November 2017 to May 2020 were collected. There were 107 males and 66 females, aged (61±11)years. All patients underwent PD and patients with gastrointestinal hemorrhage after surgery were treated with non-surgical or surgical treatments. Observation indicators: (1) gastrointestinal hemorrhage after PD and treatment situations; (2) influencing factors for delayed gastrointestinal hemorrhage after PD. Measurement data with normal distribution were expressed by Mean±SD, and count data were expressed by absolute numbers or percentages. Univariate analysis was performed using the chi-square test, and multivariate analysis was performed using the Logistic regression model. Results:(1) Gastrointestinal hemorrhage after PD and treatment situations: of 173 patients, 15 cases had gastrointestinal hemorrhage after PD, including 2 cases with early gastrointestinal hemorrhage and 13 cases with delayed gastrointestinal hemorrhage. Among the 13 cases with delayed gastrointestinal hemorrhage, 3 cases were mild hemorrhage, 10 cases were severe hemorrhage, 4 cases were gastric mucosal hemorrhage, 3 cases were gastric ulcer hemorrhage, 3 cases were gastrointestinal anastomotic hemorrhage, 2 cases were cholangio-jejunal anastomotic hemorrhage, 1 case was biliary arteriovenous fistula hemorrhage. Of the 13 patients with delayed gastrointestinal hemorrhage, 4 cases were treated only with conservative treatment, 4 cases were treated with interventional treatment, 3 cases were treated with endoscopic treatment and 2 cases were treated with surgical treatment. Of the 13 patients with delayed gastrointestinal hemorrhage, 12 were cured and 1 died. (2) Influencing factors for delayed gastrointestinal hemorrhage after PD: results of univariate analysis showed that albumin, total bilirubin, pancreatic fistula and history of gastric ulcer were the influencing factors for delayed gastrointestinal hemorrhage after PD ( χ2=7.888, 6.555, 4.252, 6.253, P<0.05). Results of multivariate analysis showed that total bilirubin >200 μmol/ L, pancreatic fistula and history of gastric ulcer were independent risk factors for delayed gastrointestinal hemorrhage after PD ( odds ratio=4.122, 4.290, 5.267, 95% confidence interval as 1.009-16.844, 1.149-16.022, 1.195-23.221, P<0.05). Conclusion:Total bilirubin >200 μmol/L, pancreatic fistula and history of gastric ulcer are independent risk factors for delayed gastrointestinal hemorrhage after PD.
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Objective To analyze the risk factors of multi-drug resistant organism (MDRO) infection after liver transplantation. Methods The clinical data of 77 recipients undergoing liver transplantation were retrospectively analyzed. According to the incidence of MDRO infection, all recipients were divided into the non-MDRO infection group (n=51) and MDRO infection group (n=26). The infection rate and strain distribution of MDRO in liver transplant recipients were summarized. The risk factors of MDRO infection in liver transplant recipients were identified. Clinical prognosis of all recipients was statistically compared between two groups. Results The infection rate of MDRO after liver transplantation was 34% (26/77), mainly carbapenem-resistant MDRO infection. The main sites of infection included lung, abdominal cavity and incision. Univariate analysis showed that postoperative tracheal intubation ≥48 h, length of intensive care unit (ICU) stay ≥72 h, length of hospital stay ≥30 d, re-operation, continuous renal replacement therapy (CRRT) and tacrolimus (Tac) blood concentration ≥15 ng/mL were the risk factors for MDRO infection after liver transplantation. Cox regression analysis indicated that postoperative tracheal intubation≥48 h, re-operation, CRRT and Tac blood concentration ≥15 ng/mL were the independent risk factors for MDRO infection after liver transplantation. The fatality in the MDRO infection group was significantly higher than that in the non-MDRO infection group [31%(8/26) vs. 10%(5/51), P=0.01]. Conclusions Postoperative tracheal intubation ≥48 h, re-operation, CRRT and Tac blood concentration ≥15 ng/mL may increase the risk of MDRO infection after liver transplantation and affect clinical prognosis of the recipients.
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Objective:To analyze the risk factors for postoperative pancreatic fistula after pancreaticoduodenectomy (PD).Methods:The clinical data of 185 patients undergoing PD who were admitted to the Hepatobiliary and Pancreatic Surgery Center of First Affiliated Hospital of Anhui Medical University from January 2014 to December 2018 were retrospectively analyzed. Risk factors for pancreatic fistula after PD were investigated using univariate and multivariate logistic regression analyses.Results:Among 185 patients, pancreatic fistula occurred in 37 patients after PD, and the incidence was 20.0%. Of 34 patients (18.4%) developed grade B pancreatic fistula, and 3 patients (1.6%) developed grade C pancreatic fistula. There were two deaths directly related to postoperative pancreatic fistula (5.4%). Patients with grade B and C postoperative pancreatic fistula had significantly increased hospitalization time and medical expenses. Univariate analysis identified that pancreatic duct diameter ≤3 mm, soft pancreas and serum albumin ≤30 g/L(χ 2=7.236, 6.948, 8.063, all P<0.05) were risk factors for pancreatic fistula after PD. Multivariate logistic regression analysis identified that pancreatic duct diameter≤3mm, soft pancreatic texture and serum albumin ≤30 g/L ( OR=0.401, 0.629, 0.326, 95% CI 0.167-0.968, 0.411-0.963, 0.150-0.711, all P<0.05) were independent risk factors for pancreatic fistula after PD. Postoperative pancreatic fistula patients had a median survival time of 827.0 days, 1-year survival rate was 94.7%, and a 3-year survival rate was 35.8%. There was no significant correlation between postoperative pancreatic fistula and postoperative survival(χ 2=1.367, P=0.242). Conclusions:Patients with a smaller pancreatic duct diameter (≤3 mm), soft pancreatic texture, and low postoperative albumin(≤30 g/L) may have a high incidence of pancreatic fistula after PD. Postoperative pancreatic fistula did not significantly affect the patients′ long-term survival.
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Hepatolithiasis is a common biliary disease in China. Even though there was a great development in the treatment for hepatolithiasis over the past 70 years, its therapeutic effect is frustrating. At present, there is still no recognized and widely accepted guidelines for its diagnosis and treatment. Based on the 40 years of experience and recent advances in the treatment of hepatolithiasis, the author′s team developed a new classification of hepatolithiasis with four types: primary type, inflammatory type, space occupying type, and terminal type. This new classification is a benefit for treatment strategy selection which is consistent with the traditional Chinese medicine theory of "the same disease with different treatment" . This new classification may be helpful to select surgical methods and time individually, in order to improve the therapeutic effect of hepatolithiasis.
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Intrahepatic cholangiocarcinoma (ICC) is a group of adenocarcinoma that derives from epithelium of the subbranches of intrahepatic bile ducts, which is characterized by difficulty in early diagnosis, high malignancy and poor prognosis. ICC is relatively rare, but it is the second most common in primary liver cancer, and its incidence has gradually increased worldwide. Radical resection is recognized as the only treatment that can bring better long-term survival currently. However, many surgery-related problems, such as lymph node dissection and major vascular resection and reconstruction, are still controversial. Adjuvant therapy, including chemotherapy, regional therapy, targeted therapy and immunotherapy, has received increasing attention in recent years. Although there is no uniform standard, a large number of related studies have supported its efficacy. In this article, the authors have reviewed the molecular pathogenesis of ICC and advances in treatment.
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Objective:To explore the clinicopathological characteristics of the primary hepatic adenosquamous carcinoma(ASC).Methods:A retrospective analysis was performed on the clinical data of 5 ASC patients admitted to the First Affiliated Hospital of Anhui Medical University from 2006 to 2019 who underwent surgical resection and were pathologically confirmed.Results:Among the 5 ASC cases, there were 4 males and 1 female. The age ranged from 48 to 73 years. As for the initial symptoms, there were 5 cases complaining upper abdominal pain, 2 cases presenting fever, 1 case presenting weight loss and 1 case presenting jaundice. CA19-9 was significantly higher than normal in 4 cases, while AFP was normal in all. None had definite preoperative diagnosis.All the 5 patients underwent surgical resection with pathology proved primary hepatic ASC. Lymph node metastasis was found in 4 cases and nerve invasion in 2 cases. There were 4 cases at TNM stage ⅣA, one at stage ⅠB. The median disease-free survival (DFS) was 5 months and the overall survival (OS) was 9 months.Conclusions:Primary hepatic adenosquamous carcinoma is a rare type of liver malignant tumor with an extremely poor prognosis. Surgical resection helps little in improving the prognosis.
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Objective:To investigate the incidence and related risk factors related to early postoperative complications after hepaticojejunostomy surgery for iatrogenic bile duct injury.Methods:A retrospective analysis was made on the data of 110 cases undergoing a hepaticojejunostomy at the First Affiliated Hospital of Anhui Medical University and Anhui Provincial Hospital from January 2001 to December 2018. The univariate and multivariate analyses were performed to explore the impact risk factors on the short-term complications.Results:Patients′ median age was 44 years old. The short-term postoperative complication rate was 35.5% and the serious complication rate was 17.3%. Univariate analysis showed that male, a failed repair was attempted before referral, intraoperative bleeding>400 ml, and duration of surgery were significantly related to the occurrence of early postoperative complications (all P<0.05). Multivariate analysis showed that male, pre-referral failed surgical repair, preoperative bile leakage, initially combined with hepatectomy, and intraoperative bleeding>400 ml were independent risk factors for postoperative short term complications (all P<0.05). Univariate and multivariate analysis of early postoperative severe complications(Clavien-Dindo≥Ⅲ) revealed that pre-referral surgical repair, combined liver resection, and intraoperative bleeding>400 ml can significantly affect the occurrence of early postoperative severe complications (all P<0.05) . There was no significant correlation between the timing of biliary repair and the occurrence of complications ( P>0.05). Conclusions:Upon the occurrence of iatrogenic bile duct injury, the surgeon is advised to refrain from doing a repair instead sending the patient to a referral hospital. If bile leakage persists before surgery, sufficient bile drainage should be given priority to control infection.
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Many clinicians have the following 4 misconceptions about the incidence and epedemil trend of gallbladder cancer.(1) The incidence of gallbladder cancer and extrahepatic bile duct carcinoma is considered as the incidence of gallbladder cancer.(2) The gallbladder cancer is the common malignant tumor of the digestive system.(3) The gallbladder cancer is the most common malignant tumor of biliary tract system.(4) The incidence of gallbladder cancer is increasing year by year.Based on the latest annual report of the 2016 Chinese Cancer Registry Annual Report,published by the National Cancer Center (NCCR),combined with previous annual reports and the data of the incidence of gallbladder and extrahepatic bile duct cancer in the related articles,supplemented by clinical data,the author points out that the incidence of gallbladder cancer in China is about 1.00-1.30 per 100 000.It is pointed out that gallbladder cancer is not the most common cancer in the digestive and biliary systems.The incidence of gallbladder cancer has not been significantly increased in recent years,and its 5-year relative survival rate has been reduced by 0.9％ since 2003.Although the incidence of gallbladder cancer is low,the malignant degree is high and the prognosis is poor.It highlights the lack of effective treatment for the disease,and further hints that we should strengthen the necessity of early diagnosis and treatment of gallbladder cancer.
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Objective To summarize the experience of complex hepatic artery reconstruction in orthotopic liver transplantation. Methods Clinical data of 7 liver transplantation recipients who underwent complex hepatic artery reconstruction from January 2015 to March 2019 were retrospectively analyzed. Among them, 4 recipients received classical liver transplantation and 3 cases underwent piggyback liver transplantation. Intraoperative general conditions including anhepatic phase, intraoperative blood loss, hepatic artery anastomosis time and operation time of the recipients were recorded. The clinical prognosis and complications were observed. Results In two donors, variant right hepatic artery was used for vascular reconstruction. The celiac trunk or the common hepatic artery of the donors was anastomosed with the common hepatic artery of the recipients. Iliac artery bypass was employed in 2 cases, and then the hepatic artery of the donors was anastomosed with the abdominal aorta of the recipients. The superior mesenteric artery of 1 donor was end-to-end anastomosed with the common hepatic artery of the recipient. The celiac trunk of 1 donor was anastomosed with the splenic artery of the recipient. Only 1 case was required to undergo secondary liver transplantation due to acute hepatic artery thrombosis after hepatic artery anastomosis. All the 6 recipients successfully completed the liver transplantation. No perioperative death was observed. The anhepatic phase endured from 49 to 77 min. The intraoperative blood loss was ranged from 300 to 1 500 mL. The anastomosis time of hepatic artery was 23-56 min. The operation time was ranged from 5.3 to 11.1 h. The length of postoperative hospital stay was 23-56 d. Neither hepatic artery thrombosis nor stenosis occurred. The liver function of all recipients was basically restored to normal within postoperative 2 weeks. No severe surgical complications occurred. The liver graft achieved excellent function. Conclusions Appropriate identification of the hepatic artery variation, proper management of liver artery of the donors and recipients and reconstructing the blood supply of liver graft are the crucial procedures of liver transplantation.
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Objective To evaluate 3D visualization technology in the preoperative planning of hepatic malignancy surgery.Methods The clinical data of 42 patients with hepatic malignancy undergoing radical resection after 3D reconstruction assessment from Feb 2015 to Feb 2018 in our center was retrospectively studied.The predicted resected liver volume were compared with that of resected specimen.Results Surgery was successful in all the 42 patients,and there were no operative deaths.The average operation time was (303 ± 109) minutes,the average intraoperative blood loss was (510 ±482) ml,and 28 patients had intraoperative hepatic inflew occlusion.Postoperative Clavien Ⅲ complications occurred in 4 cases.In terms of the resection liver volume,there was no significant difference between the predicted results (PELV) and actual results [resection liver volume (AELV):(1 143 ± 584) ml vs.(1 091 ± 570) ml,t =0.414,P ＞ 0.05].There is a strong positive correlation between AELV and PELV (r =0.996,P ＜ 0.01).PELV was highly consistent with AELV data (ICC =0.998).Conclusion Three-dimensional visualization technology can accurately reflect the anatomic relationship between intrahepatic tumors and vessels,and correctly assess liver volume,guide surgical resection,thus,it can instruct radical resection of liver malignancy.
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With the development of diagnostic and screening technologies,the incidence of hepatocellular carcinoma (HCC) with extrahepatic metastasis is increasing and surgical rate is also increasing.There is currently no standard of treatment.Four famous experts and their teams in hepatic surgery discussed reasonability of surgical treatment for HCC with extrahepatic metastasis based on clinical experiences.Professor Geng Xiaoping suggested that HCC with extrahepatic metastasis was classified as advanced HCC,however,under the premise of strict control of indications,selective patients undergoing comprehensive treatment combined with surgical procedures could achieve good prognosis.For some rare liver malignancies,active surgical treatment for extrahepatic metastasis based on comprehensive treatment was recommended.Professor Zhou Jian proposed that resection of intrahepatic lesions in HCC with extrahepatic metastasis should be based on the premise of whether to prolong the survival of patients.He advocated choice of individualized treatment and comprehensive treatment of multiple methods to benefit patients' survival.The necessary intrahepatic lesion resection was a positive and feasible treatment strategy.Professor Wang Jie shared the diagnosis and treatment of 2 patients with HCC and extrahepatic metastasis,suggested that primary tumor resection might have a favorable impact on the prognosis of these patients with resectable primary tumors.Therefore,surgical treatment was important for HCC patients with extrahepatic metastasis,and surgical therapy combined with personalized systemic treatment showed survival benefit for selected patients.Professor Zhou Weiping recommended that choosing surgery for HCC with extrahepatic metastasis should be extraordinarily cautious.Priority should be given to improving the survival rate of patients.In the case of effective control or complete necrosis of extrahepatic metastases,hepatic primary tumor resection was still the current mainstream opinion.
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Retrospective analysis of clinical data was conducted in the patients with secondary hyperparathyroidism( SHPT) undergone parathyroidectomy ( PTX ) in our department from September 2015 to September 2016. Uni- and multivariate analyses were conducted to define independent influencing factors for persistent severe hypocalcemia. The results showed that 27 cases(31％ ) suffered from persistent severe hypocalcemia in a total of 87 patients. Univariate analysis revealed that age, weight, hospitalization time after operation, the year of increased serum creatinine, preoperative alkaline phosphatase ( ALP), preoperative intact parathyroid hormone (iPTH), preoperative albumin, postoperative 1 d serum calcium and phosphorus level, renal hypertension, and degeneration of bone were risk factors of persistent severe hypocalcemia. Multivariate analysis revealed that the year of increased serum creatinine, preoperative ALP, and preoperative albumin were the independent influence factors for persistent severe hypocalcemia.