Recurrence after gallbladder-preserving cholecystolithotomy for sand-like and non-sand-like gallstones: a comparative analysis / 临床肝胆病杂志

ObjectiveTo investigate the recurrence at 1-3 years after laparoscopic cholecystolithotomy in patients with sand-like and non-sand-like gallstones. MethodsA retrospective analysis was performed for the clinical data of 155 patients with gallstones who underwent gallbladder-preserving cholecystolithotomy in Air Force General Hospital, PLA from October 2012 to December 2014, and these patients were divided into sand-like stone group (29 patients) and non-sand-like stone group (126 patients). The recurrence of stones was observed at 1-3 years after surgery. The t-test was used for comparison of continuous data between groups, and the chi-square test was used for comparison of categorical data between groups. ResultsThe time of operation showed a significant difference between the sand-like stone group and the non-sand-like stone group (126.13±20.52 min vs 75.64±16.58 min, t=7.709, P＜0.001). At 1-3 years after surgery, 6 patients in the sand-like stone group and 8 in the non-sand-like stone group experienced recurrence, and the 2- and 3-year recurrence rates showed significant differences between the two groups (2-year recurrence rate: 20.69% vs 6.35%, χ2=4284, P=0038; 3-year recurrence rate: 20.69% vs 6.35%, χ2=4284, P=0.038). ConclusionThe patients with sand-like gallstones have a significantly higher recurrence rate and a significantly longer time of operation than those with non-sand-like gallstones, and therefore, they should avoid gallbladder-preserving cholecystolithotomy.

The role of hepatic arteriography before precise hepatectomy in primary liver cancer / 中华肝胆外科杂志

ObjectiveTo study the role of hepatic arteriography before precise hepatectomy in primary liver cancer,Methods207 patients with primary liver cancers resected from 2005 to 2010 at Air Force General Hospital of Chinese PLA were studied retrospectively.There were 81 patients who received routine hepatectomy and 126 who received precise hepatectomy with hepatic arteriography before surgery.ResultsAnalysis showed that precise hepatectomy was superior to routine hepatectomy for lesions less than 1.0 cm (81.48％ vs 18.18％),with less operative time (168.20±35.81 min vs 221.75±30.33 min),volume of resection,blood loss (168.20±35.81 min vs 221.75±30.33 min),transfusion rate (256.13±185.24 ml vs 436.97±590.12 ml),and hospital stay (20.53± 12.41 d vs 25.72±17.27 d),(all P＜0.05).Hepatic arteriography did not affect liver function before precise hepatectomy.ConclusionsHepatic arteriography was significantly better in showing blood vessels of the primary liver cancer,and in detecting liver metastases or satellite lesions of less than 1.0 cm before surgery.

Comparative studies of perioperative period correlation factor of hepatectomy treatment for liver malignant tumor / 中华肝胆外科杂志

Objective To compare superiorities of liver malignant tumors underwent regular and irregular hepatectomies through approaching perioperative factors.Methods 1019 consecutive hepatectomies of liver malignant tumor from 1986 to 2009 at Air Force General Hospital and General Hospital of Chinese PLA were investigated retrospectively according to their medical documentation.Results Multivariate analysis showed that liver malignant tumors on which regular hepatectomy and irregular hepatectomy were performed,there was no significant difference in the blood loss,complications,mortality related to operation,hospital stay,and so on.But the operating time of regular hepatectomy was obvious more than that of irregular hepatectomy (P＜ 0.001,OR=1.004).Conclusions Although for liver malignant tumor,regular hepatectomy seems to be superior to irregular hepatectomy based on oncological theory,in clinical practice,there were no significant difference between the perioperative risk of regular hepatectomy and that of irregular hepatectomy.

Efficacy of precise sequential therapy for primary liver cancer / 中华消化外科杂志

Objective To investigate the construction and implementation of the concept of precise sequential therapy for primary liver cancer.Methods The clinical data of 207 patients with resectable liver cancer who were admitted to the Air Force General Hospital from May 2005 to June 2010 were retrospectively analyzed.Of all the patients,81 received conventional therapy (conventional therapy group),and the other 126 patients received precise sequential therapy (precise sequential therapy group).The conditions of the patients in perioperative phase,during postoperative sequential treatment and the period of follow-up between the 2 groups were compared.All data were analyzed by using the covariance analysis,analysis of variance,chi-square test or rank sum test.Results The detection rates of lesions with a diameter less than 1 cm,operation time,liver resection volume,intraoperative blood loss,rate of perioperative blood transfusion,duration of postoperative hospital stay,incidences of postoperative complications were 81％ (22/27),( 186 ± 36) minutes,(75 ± 29) ml,( 189 ± 60) ml,24％(30/126),(21 ± 12)days and 13％ (17/126) in the precise sequential therapy group,and 18％ (2/11),(222 ± 30)minutes,(133 ±88)ml,(327 ±46)ml,51％ (41/81),(26 ± 17)days and 20％ (16/81) in the conventional therapy group,respectively,with significant differences between the 2 groups (F =10.876,7.390,46.996,31.025,14.556,6.315,4.017,P ＜ 0.05).No significant difference was observed on the levels of alanine transaminase,albumin and the Child-Pugh score before and after the intervention in the precise sequential therapy group,but significant differences were observed in the conventional therapy group.The 1-,2-,3-year tumor recurrence rates and the 1-,2-,3-year survival rates were 17％ (21/126),22％ (17/76),26％ (8/31) and 87％ (110/126),87％ (66/76),84％ (26/31) in the precise sequential therapy group,and 31％ (25/81),38％ (27/71),48％(31/65 ) and 77％ (62/81),75％ (53/71 ) and 60％ (39/65) in the conventional therapy group,respectively.There were significant differences in the prognosis of the patients in the 2 groups ( x2 =4.958,4.292,4.168,4.062,3.640,5.470,P ＜ 0.05 ).Conclusion Through accurate assessment of the patients' condition before surgery,precise hepatectomy and precise postoperative intervention,the goal of effective control of tumor recurrence,maximum protection of the liver function and improvement of the survival rate can be achieved.

Study of liver function factors and cytokines following crashing liver injury / 中国现代普通外科进展

Objective: To explore the parameters used for the clinical evaluation of post-trau- matic hepatic function crashing down to the ground. Methods: By establishing the animal model of liver impact injury in simulation of parachuter,blood were sampled before injuries and 15 min, 30 min,45 min,1 h, 3 h, 6 h ,9 h after injuries. Cytokines including TNF?、IL-2 and liver function parameters including ALT,AST,LD-L,GGT,ALP were measured and analyzed statistically. Results: TNF? increased after 15 min- utes, and IL-2 increased after 30 minutes(P0.05). These two pa- rameters were significantly increased all the time after injuries(P

Diagnosis and clinical treatment of unexpected gallbladder carcinoma / 中国现代普通外科进展

Objective: To investigate the cinlical features and therapeutic methods of unex-pected gallbladder carcinoma. Methods: A retrospective analysis was performed in 19 cases of unexpected gallbladder carcinoma treated in our hospital from April 2002 to April 2008. Results: Ten cases in early stage were perfomed gallbaldder resection and local lymph node removal, and the average survival time was 18.7 months; 4 cases were perfomed extend radical resection, and the average survival time was 12.3 months; 5 cases were performed palliative resection, and the survival time was less than 6 months. Conclusions: Frozen section examination during opera-tion is key to diagnose unexpected gallbladder carcinoma. Radical resection is the first option once the diagnosis is confirmed, and the method can be decided according to Nevin classification and B ultrosound scaning during opreation.

Antagonistic action on the progression of experimental liver fibrosis of Kunming mice by transferring antisense-Smad_4 gene / 中国普通外科杂志

ObjectiveTo study the effect of TGF-? 1 signal transduction blocked by antisense-Smad 4 gene on progression of experimental liver fibrosis of Kunming mice.MethodsWe transfered retrovirus-mediated antisense Smad 4cDNA into the CCl4/ethanol induced cirrhotic liver of Kunming mouse model to investigate the antisense-Smad 4 gene integration by Southern blot. The expression of Smad 4 in cirrhotic liver was observed by Northern blot, RT-PCR, and Western blot. The fibrotic degree of the livers among the three groups were compared.ResultsThe antisense-Smad 4 gene was confirmed to integrate into the liver of the retrovirus-treated mouse .In the non-treated cirrhotic liver, the expression of Smad 4 mRNA was significantly increased than normal liver, the antisense Smad 4 gene could decrease the expression of Smad 4. Compared with the non-treated liver, the fibrotic septa of the liver in the retrovirus-treated mouse were fewer,narrow, and incomplete,and their fibrotic degree of the treated-liver was reduced.ConclusionThese results indicate that antisense-Smad 4 gene can reduce the expression of Smad 4,inhibit the progression of liver fibrosis.