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Objective:To study the correlation between systemic immune inflammation index (SII) and prognosis of patients with hilar cholangiocarcinoma after surgical treatment.Methods:The clinical data of 181 patients with hilar cholangiocarcinoma treated by surgery at the First Affiliated Hospital of Zhengzhou University from January 2012 to December 2016 were retrospectively analyzed. There were 119 men and 62 women, with an average age of 62.4 years. SII was calculated using preoperative routine blood tests. Receiver operating characteristic (ROC) curve was used to obtain the optimal cutoff value of SII. The Kaplan-Meier method was used to draw survival curves and survival rates were compared by log-rank test. The Cox proportional risk model was used to analyze single and multiple factors.Results:The SII area under the ROC curve in predicting postoperative survival was 0.749(95% CI: 0.641-0.858), the optimal threshold was 412.6. Using this threshold, patients were divided into the low SII group (SII≤412.6, n=80) and the high SII group (SII>412.6, n=101). The 1, 3, and 5-year cumulative survival rates of patients in the low SII group were 87.5%, 57.5%, and 26.3%, which were significantly better than those of the high SII group of 71.3%, 39.6%, and 9.9% respectively ( P<0.05). Multivariate analysis showed that SII>412.6 ( HR=2.887, 95% CI: 2.256-7.903, P<0.05) was an independent risk factor for overall survival of patients with hilar cholangiocarcinoma. Conclusion:Preoperative SII had predictive values for postoperative survival of patients with hilar cholangiocarcinoma, SII>412.6 was an independent risk factor for postoperative survival.
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Objective:To analyze the clinical and imaging features, and treatment and curative effects of primary splenic angiosarcoma.Methods:A retrospective study was conducted on 6 patients with primary splenic angiosarcoma diagnosed histopathologically at the First Affiliated Hospital of Zhengzhou University from January 2012 to December 2019. The clinical characteristics, CT and ultrasound imaging findings, treatment methods and survival outcomes of these patients were analyzed.Results:There were 4 males and 2 females, with an average age of 52.6 years. These 6 patients with primary splenic angiosarcoma had no specific clinical manifestations, and the diagnoses were all confirmed histopathologically after surgery. CT examination of these 6 patients showed that the spleen volume was increased, with splenic space-occupying lesions. The lesions were single in 1 patient and multiple in 5 patients. Some lesions fused with each other. There were multiple intrahepatic metastases in 1 patient. Ultrasound in 3 patients showed enlarged solid hypoechoic spleens, and rich blood flow at the edges. Five patients underwent splenectomy with complete removal of tumors. For the patient with multiple lesions in the spleen and multiple space-occupying lesions in the liver who could not be treated radically, only splenectomy was done. This patient developed significantly more liver lesions 2 months after surgery, and survived for 3 months. Two patients who underwent postoperative adjuvant chemotherapy relapsed at 9 months and 13 months after surgery. They survived for 16 months and 19 months, respectively. A patient who received postoperative adjuvant chemotherapy survived for 27 months without any obvious signs of recurrence. A patient who underwent targeted therapy relapsed after 10 months, and survived for 14 months after surgery. The remaining patient who underwent simple surgery relapsed 4 months after surgery and died 6 months later.Conclusions:Primary splenic angiosarcoma is a highly malignant tumor. In this study, it lacked specific clinical manifestations and imaging features and its diagnosis required histopathological examination. Surgical resection is the main treatment for this disease. Whether surgery combined with postoperative adjuvant therapy is a more effective treatment than surgery alone for splenic angiosarcoma requires more studies in the future to determine.
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Objective@#To investigate the clinical characteristics, treatment and curative effect of primary hepatic angiosarcoma.@*Methods@#A retrospective study was conducted on 10 patients with primary hepatic angiosarcoma who were treated in the Department of Hepatobiliary Surgery, the First Affiliated Hospital of Zhengzhou University from April 2012 to July 2018. There were 6 males and 4 females, with an average age of 55.1 (range 39.0 to 71.0) years. The clinical features, imaging findings, treatment methods and survival time of the patients were analyzed.@*Results@#The clinical manifestations of 10 patients with primary hepatic angiosarcoma were non-specific and all were confirmed by pathology. Three cases had diffuse liver echo changes on ultrasound, and 7 cases had hypoechoic lesions with blurred borders. Space occupying lesions were found in 10 cases by CT. A total of five patients underwent partial hepatectomy, 1 case received chemotherapy, 1 case received transcatheter arterial chemoembolization (TACE), 2 case received molecular targeted therapy, and 1 case was untreated. From diagnosis to the last follow-up, the survival time of the 5 patients receiving surgical resection were 9 months, 15 months, 19 months, 21 months and 26 months. The survival time of the patient receiving chemotherapy was 7 months. The survival time of the patient receiving TACE was 3 months. Two patients were targeted for treatment, one survived for 32 months, another had been targeted for 15 months, and treatment was continuing. One patient survived for 1 month without treatment.@*Conclusions@#Primary hepatic angiosarcoma has a high degree of malignancy and a poor prognosis. No specific clinical manifestations and imaging findings, confirmed by pathological examination. Patients with partial hepatectomy have a better survival. Targeted therapy may be the most effective treatment for primary hepatic angiosarcoma in the future.
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Objective To investigate the clinical characteristics,treatment and curative effect of primary hepatic angiosarcoma.Methods A retrospective study was conducted on 10 patients with primary hepatic angiosarcoma who were treated in the Department of Hepatobiliary Surgery,the First Affiliated Hospital of Zhengzhou University from April 2012 to July 2018.There were 6 males and 4 females,with an average age of 55.1(range 39.0 to 71.0)years.The clinical features,imaging findings,treatment methods and survival time of the patients were analyzed.Results The clinical manifestations of 10 patients with primary hepatic angiosarcoma were non-specific and all were confirmed by pathology.Three cases had diffuse liver echo changes on ultrasound,and 7 cases had hypoechoic lesions with blurred borders.Space occupying lesions were found in 10 cases by CT.A total of five patients underwent partial hepatectomy,1 case received chemotherapy,1 case received transcatheter arterial chemoembolization(TACE),2 case received molecular targeted therapy,and 1 case was untreated.From diagnosis to the last follow-up,the survival time of the 5 patients receiving surgical resection were 9 months,15 months,19 months,21 months and 26 months.The survival time of the patient receiving chemotherapy was 7 months.The survival time of the patient receiving TACE was 3 months.Two patients were targeted for treatment,one survived for 32 months,another had been targeted for 15 months,and treatment was continuing.One patient survived for 1 month without treat-ment.Conclusions Primary hepatic angiosarcoma has a high degree of malignancy and a poor prognosis.No specific clinical manifestations and imaging findings,confirmed by pathological examination.Patients with partial hepatectomy have a better survival.Targeted therapy may be the most effective treatment for primary hepatic angiosarcoma in the future.
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Objective To investigate the role and implication of Engrailed-2 (EN2) in human hepatocellular carcinoma (HCC) and the effect of silencing EN2 genes on the proliferation and invasion of HepG2 cells by RNA interference.Methods Immunohistochemistry was used to detect the expression of EN2 in the HCC tissues and corresponding non-cancerous adjacent liver tissues in 126 patients with HCC.The expressions of EN2 and the relationship between EN2 expression and clinicopathological features and prognosis were analyzed using the Chi-square test.The survival curve was drawn using the Kaplan-Meier method and the survival was analyzed using the log-rank test.EN2-small interfering RNA (siRNA) was transfected into HepG2 cell lines mediated by LipofectamineTM 2000,and the expression of EN2 were detected by Western blotting assay.The cell proliferation and invasion were measured by methyl thiazol tetrazolium (MTT) and Transwell assays.Results EN2 positive expression rate was high (62.7％) in HCC tissue but low in the corresponding peritumoral tissue (23.5％,P ＜ 0.01).The high expression of EN2 was strongly correlated with tumor size,metastasis and AJCC TNM stage.The cumulative 5-year survival rate was 33.9％ in the low EN2 expression group,whereas it was 5.1％ in the high EN2 expression group (P ＜ 0.01).Expression of EN2 in EN2 siRNA group was significantly lower than that in control siRNA group and control group (P ＜ 0.05),respectively.The cell proliferation and invasion ability were significantly reduced in the EN2 siRNA group.Conclusion The expression of EN2 is highly up-regulated in HCC tissues and down-regulation of EN2 could inhibit proliferation and invasion of HepG2 cells,which indicating that EN2 is involved in the process of HCC carcinogenesis and progression and may serve as a biomarker for predicting prognosis of HCC patients.
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Objective To evaluate covered stent placement in the treatment of iliac artery rupture in the process of iliac artery angioplasty.Methods Clinical data of 9 patients' iliac artery rupture in the process of iliac artery angioplasty were retrospectively reviewed.Results Covered stent was successfully placed in all cases.The patency of involved iliac artery was identified in 8 cases by angiography and there was no contrast extravasation.Type Ⅰ endoleak occurred in one patient in the proximal end of the stent graft and iliac artery graft replacement was done by open surgery immediately.Postoperatively clinical symptoms were relieved in all these 9 patients.One case lost to follow up.8 patients were followed up for 14 to 45 months,average (22 ±9) months.Stenosis on the distal end of the covered stent (external iliac artery)was found in one patient who underwent external iliac artery balloon-expandable stent angioplasty.One patient with artificial vessel placement was symptoms free with patency of the involved artery as reviewed by ultrasonography on 18 month followed up.Conclusions When iliac artery rupture in the process of iliac artery angioplasty should develop,the first choice is immediately covered stent placement therapy,while open surgery remains as the last resort.
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Objective To evaluate interventional therapy in the treatment of interposition graft stenosis or occlusion after mesocaval shunts.Methods The clinical data of 19 cases of artificial vessel stenosis or occlusion after mesocaval shunts for portal hypertension at our department from march 2009 to march 2012 were retrospectively analyzed.Results In the 19 cases with artificial vessels stenosis or occlusion developed after mesocaval interposition shunts for portal hypertension,there were 5 cases in which acute thrombosis occurred within a week after the surgery.Catheter directed thrombolysis was successfully conducted.In 6 cases in which shunt stenosis developing 1 to 8 years after surgery were managed by balloon dilatation or stent angioplasty successfully.The shunt graft occlusion occurred in 8 cases after 1 to 4 years of surgery was successfully managed and the shunt was reopened by balloon dilatation or stent angioplasty in 6 cases,and in 2 the procedure was failed for the guide wire can't go through the anastomotic site of artificial vessel-superior mesenteric vein.In 11 cases embolization of the esophagogastric varices was successfully carried out for postoperative standard anticoagulation.During a period of 3 months to 3 years follow-up,stenosis recurred 1 year after balloon dilatation in one case,and stenosis was managed by angioplasty successfully.Conclusions Interventional radiological techniques by percutaneous puncture through femoral vein-inferior vena cava-artificial vessel-portal vein (including catheter directed thrombolysis,balloon dilatation,stent placement,etc) are less traumatic,highly successful in the treatment of shunt stenosis or occlusion after mesocaval shunts in portal hypertension.
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Hepatic nodules in patients with Budd-Chiari syndrome (B-CS) are identified in clinical work and the differentiating diagnosis is very important for making the treatment strategy.Most B-CS patients with hepatic nodules have nonspecific clinical manifestations.Ultrasonography,computed tomography and magnetic resonance imaging are often used for differentiating diagnosis.According to the results of retrospective study on clinical and imaging data of 51 B-CS patients with hepatic nodules,we draw a conclusion that the differentiating diagnosis of hepatic nodules in patients with B-CS depends on imaging characteristics.Different treatment strategies are adopted according to the comprehensive analysis of these imaging data and satisfactory results can be achieved.
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Objective To set up a standard for surgical classification of cavernous transformation of the portal vein (CTPV) and their management strategy according to the classification.Methods The clinical data of 63 CTPV cases were analyzed retrospectively,the classification and the corresponding treatment strategy were evaluated.Results According to the imaging examination,surgical treatment and long-term follow-up,CTPV was classified into four types:Type Ⅰ:cavernous transformation involving main trunk of the portal vein and intrahepatic branches.Portasystemic shunt (mesocaval and splenocaval shunt)(or plus port-azygous devascularization) were used for this type;Type Ⅱ:cavernous transformation in the main trunk and proximal SV or SMV.Portasystemic shunt (mesocaval and splenocaval shunt) or plus portazygous devascularization were applied;Type Ⅲ:cavernous transformation involving the whole portal system.Portopulmonary shunt (splenopneumopexy) or inferior mesenteric-caval shunt plus port-azygous devascularization were suggested;Type Ⅳ:any types aforementioned accompanied by biliary and /or pancreatic abnormalities.The treatment should focus on main symptoms and two-stage operation.Conclusions Doppler ultrasound and multi-slice spiral CT (MSCT) three dimensional (3D) reconstruction are the mainstay for the diagnosis of CTPV;Correct diagnosis,classification as well as individualized management are of great importance in the treatment of adult CTPV.
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Objective To investigate the indication,feasibility and clinical effectiveness of stage management of Budd-Chiari syndrome(B-CS). Methods From Feb 2007 to June 2009,32 cases of Budd-Chiari syndrome(9 cases of type Ⅰ,17 cases of type Ⅲa,6 cases of type Ⅲ b)were admitted.Inferior vena cava hypertension(IVCHT)and portal hypertension(PHT)co-existed in all the patients.According to the clinicopathologic classification and hemodynamic compensation,these patients underwent single stage treatment(snrglcal procedure or radioactive intervention)or two-stage management(one.stagesurgical procedure/radioactive intervention plus two-stage surgical procedure/radioactive intervemion).Results Recovery was achieved in all patients without mortality.The main complications were Dleural effusion in 3 cases,acute heart failure in 2 cases and celiac lymphatic leakage in 1 case respectively.which were cured after medical treatment.In 4 months to 2 years follow-up,no recurrent cases were identified and all the patients were in good condition. Condusions Stage management of Budd.Chiari svndrome canalleviate the perioperative risk and clinical effectiveness can be achieved.The hemodynamic compensation is the basis on which stage management is adopted.
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Objective To study the effect of small diameter graft (0.8 cm) splenocaval or mesocaval shunts combined with pericardial devascularization in the treatment of portal hypertensive variceal bleeding. Methods Splenocaval shunts were performed in 14 patients and mesocaval shunts were done in 24 patients, in combination with pericardial devascularization. Results The average decrease of free portal pressure was 6.6±1.2 cm. There was no significant changes in liver function postoperatively (P>0.05). Platelet counts and leukocyte counts were back to normal in splenocaval shunt patients postoperatively (P< 0.05). Operative mortality was 3%. Pyrexia developed in 4 patients, intractable ascites in 1 patient, chylons ascites in 1 patient, hepatic encephalopathy in 1 patient, intraabdominal infection in 1 patient and stress ulceration in 1 patient. All patients recovered after expectant treatment except one who died from severe intraabdominal infection. 35 patients received follow-up between 6 months and 3 years, total effective rate was 89%, 2 patients died from recurrent variceal bleeding, the shunt potency rate was 80% in 1 year and 75% in 3 years. Esophagogastric varices disappeared or alleviated as shown by endoscopy in 25 patients on 6 months postoperatively. Conclusions Small diameter portosystemic graft shunts combined with poricardial devascularization is an effective therapy for bleeding esophagogastric varices with a low rate of hepatic encephalopathy. Splenocaval shunt alleviates hypersplenism concurrently.
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model control group. CONCLUSION: Both heterologous bone marrow stem cell transplantation and vascular endothelial growth factor injection can promote the formation of retroperitoneal blood vessel in rats with portal hypertension, and the conbination of them can effectively relieve portal venous pressure.
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Objective To investigate the diagnosis and treatment of obstructive jaundice (OJ) caused by hepatocellular cacinoma (HCC) invasion to bile duct. Methods The diagnosis and treatment of 16 cases of OJ caused by HCC in our hospital from January 1989 to December 1998 were retrospectively analysed. Results Correct diagnosis was made in 2 cases and misdiagnosis in 14 cases preoperatively. 14 cases were operated on, including hepatectomy, enucleation of the tumor in the common bile duct (CBD) and T tube drainage in 2 cases; enucleation of the tumor in CBD and internal stent of T tube drainage in 11 cases; tumor biopsy and T tube drainage in 2 cases; one case died without operation. 15 cases were followed-up for 1 to 14 months postoperatively. The results demonstrated that 14 patients died within 6 months, and only 1 case remained alive for 14 months after operation. Conclusions The correct diagnosis of this disease could be made for the patients with jaundice accompanied with positive of HbsAg and AFP, local lesions in the liver and the dilated bile duct. B-US, CT, PTC and ERCP are the main examination methods for the diagnosis. The best treatment of this kind of HCC is to remove the hepatic tumor and to recanalize the affected bile ducts.
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Objective To study the mechanism and management of abdominal compartment syndrome (ACS) in patients with Budd Chiari Syndrome (BCS).Methods 42 patients with BCS complicated with ACS were diagnosed by venography and intraabdominal pressure measurement. All patients were treated with ascities dialysis and influsion before operation. Portosystemic shunt was performed on 36 patients, and interventional procedures were conducted to recanalize the occluded main hepatic vein(MHV) on 6 patients. Results In this series, 2 patients died postoperatively and 2 patients had no good results in long term follow-up; the clinical features disappeared or markedly alleviated in the others. Conclusions MHV occlusion is the primary pathologic change of BCS complicated with ACS. Portosystemic shunt operation or MHV recanalization by interventional therapy can relieve the symptoms of BCS with ACS.
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Objective To set up CEAP system for the diagnosis of portal hypertention.Methods Based on CEAP system from American Venous Forum,the clinical and pathologic classification of Budd-Chiari syndrome from Xu,the clinical and pathologic data of 251 cases of portal hypertension were analyzed retrospectively.Results According to the results of imaging examination [(Doppler ultrasound,percutaneous splenoportography,selective angiography of mesenteric artery,multi-slice spiral CT(MSCT) three dimensional(3D) reconstruction],clinical and pathological data,CEAP system for the diagnosis of portal hypertention was defined as follows: Clinical manifestation(C) including mild and severe types;Etiology(E)(congenital,primary,secondary);Anatomy(A) consists of liver,inferior vena cava,hepatic veins,and portal vein system;Pathophysiology(P) could have liver fibrosis/cirrhosis,obstruction,thrombosis,intrahepatic collateral circulation and tumors.Conclusions CEAP system for correct diagnosis,classification as well as the individual treatment is of great practical importance,and could be wide application.
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Objective To investigate the diagnosis and treatment of portal hypertension caused by cavernous transformation of the portal vein (CTPV) in adults Methods A retrospective study was made on clinical data of 31 adult upper GI bleeding patients with CTPV The diagnosis of CTPV in all cases were confirmed by B ultrasonography or ultrasonic Doppler and by percutaneous splenoportography or selective arteriography Splenic artery and coronary vein ligation plus C graft mesocaval shunt was performed in 12 cases Splenorenal graft shunt was performed in 1 In 8 post splenectomy rebleeding, cases 6 underwent C graft mesocaval shunt, one inferior meso caval shunt and one jejunectomy due to ictopic variceal hemorrhage Six cases received splenocaval shunt 2 splenopneumopexy 1 splenorenal shunt 1 portocaval shunt 1 pericardial devascularization ResultsPostoperativelly varices disappeared or ameliorated in all patients There was no rebleeding and hepatoencephalopathy occurred in follow up of 6 months to 4 years Conclusion Ultrasonic Doppler and percutaneous splenoportography are diagnostic for CTPV in adults Portasystemic shunt plus porta azygous devascularization is the choice of treatment
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AIM: To investigate how brain-dead state affects the heart structure and function and the effect of PKC-? in BA-Ma mini pigs.METHODS: Ten Ba-Ma mini pigs were randomized into 2 groups: brain-dead group(n=5),and control group(n=5).The brain-dead model was made by increasing intracranial pressure,while the control group was maintained anesthesia for 24 h.The concentrations of cTnT,TNF-?,IL-1? and IL-6 in serum were determined at 6,12 and 24 h after brain death.At 24 h,heart tissues were observed by HE staining and electron microscope.The expression of PKC-? was detected by immunohistochemistry and RT-PCR.RESULTS:(1) Histological changes of myocardium: flaky bleeding under endocardium and dissolution of myocardium were found in optical microscope.In electron microscope dropsical mitochondria and confluent muscle fiber were found.(2) Changes of serum cTnT: serum cTnT for brain-dead group began to increase gradually since 6 h,and were significantly higher at each time point than those in control group(P
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Objective To investigate the causes,prevention and management principles of postoperative recurrence of Budd Chiari syndrome(BCS).Methods The clinical data of 223 postoperative recurrence BCS patients were analyzed retrospectively,including type Ia in 66 cases,type Ib in 48 cases,type II in 57 cases , type IIIa in 28 cases,and type IIIb in 24 cases. Of them,36 patients underwent two or more operations .Results Secondary operations were all successful.No patient died in the perioperative period. One hundred and eighty two patients were followed up for 6 months to 10 years.In 89.6% of the patients,the results were successful,but the recurrence rate after the reoperation was 6.0%,and 8 patients died postoperatively .Conclusions The main recurrent causes are that indications are not correctly selected and the operative technique is not correct. Correct classification,reasonable selection of the operation method, and adopting an interruptive,matress,and eversive suture for blood vessels anastomosis in the operation are important to prevent the recurrence of BCS.
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Objective To explore the causes of upper gastrointestinal rebleeding after devascularization operation for portal hypertension and the therapeutic effect of shunt operation.Methods The clinical data of 56 cases of upper gastrointestinal rebleeding after devascularization operation for portal hypertension in our hospital from 1996 to 2006 were retrospectively analyzed.Shunt operation was done in 54 ceses including emergency operation shunt in 5 cases,and elective operation in 49 cases.C-type Mesocaval shunt was done in 45 cases,inferior mesenteric vein-cava shunt in 4 cases,H-type and portacaval in 5 cases.Results Chylorrhea occurred in 13 cases after operation and all recovered;hepatic encephalopathy occurred in 5 cases,and 4 cases recovered,1 died;and 1 case died of liver function failure on the third day after operation.Fifty-two cases were followed-up from 6 months to 9 years,and none had recurrence of upper gastrointestinal bleeding,but 7 died(2 cases died of primary hepatic carcinoma,3 cases died of liver function failure and hepatic encephalopathy,and 2 cases died of non-correlated disease).Conclusions Patients with upper gastrointestinal rebleeding after devascularization operation for portal hypertension should undergo non-operative treatment at first,and elective surgery is done later.If aggressive non-operative treatment for 48h is not successful,then emergency operation should be performed.In elective cases,the operation of first choice is mesocaval interposition synthetic graft shunt,which is particularly applicable in patients with portal vein thrombosis or portal hypertensive gastropathy.
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Objective To investigate the indications for interventional therapy of Budd-Chiari syndrome((B-CS)) and surgical treatment after stent failure. Methods A retrospective analysis of the clinical data of 21 patients with mistakes in treatment of B-CS by stent placement in inferior vena cava(IVC).Results (Among) the 21 cases with mistakes, the indications were inappropriately selected in 6 cases, the main hepatic vein was obstructed by the stent in 1 case, dilated accessory veins were occluded in 10 cases, the stent was (displaced) in 3 cases, and the stent failed to unfold in 1 case. Nineteen cases were converted to operation; of these patients, a shunt was performed in 18 cases, and radical excision of diaphragmatic web of IVC was done in 1 case. Operation was successful in all 19 cases. After shunt procedure in the 18 cases, the free portal pressure significantly decreased(P