ABSTRACT
Objective To investigate the risk factors for rebleeding after emergency esophageal variceal ligation (EVL) in patients with liver cirrhosis. Methods A retrospective analysis was performed for the clinical and laboratory data of 290 patients with liver cirrhosis who underwent emergency EVL in The Fifth Medical Center of Chinese PLA General Hospital from January 2016 to December 2019, and according to the presence or absence of rebleeding within 1-year follow-up, they were divided into rebleeding group and non-rebleeding group. The t -test was used for comparison of normally distributed continuous data between two groups, and the Wilcoxon rank sum test was used for comparison of non-normally distributed continuous data between two groups; the chi-square test was used for comparison of categorical data between two groups. A multivariate logistic regression analysis was performed with the statistically significant factors as independent variables to screen out the independent risk factors for rebleeding after emergency EVL, and the receiver operating characteristic (ROC) curve was plotted to obtain the indices for predicting the probability of rebleeding and establish a predictive model. Results The univariate analysis showed that there were significant differences between the two groups in platelet count ( t =-1.888, P =0.047), Child-Pugh score ( χ 2 =5.975, P =0.049), albumin level ( t =-2.229, P =0.029), and splenic vein diameter ( t =3.808, P =0.001). The multivariate logistic regression analysis showed that Child-Pugh score (odds ratio [ OR ]=0.280, 95% confidence interval [ CI ]: 0.108-0.729, P =0.009), splenic vein diameter ( OR =1.549, 95% CI : 1.197-2.005, P =0.001) and albumin level ( OR =0.832, 95% CI : 0.729-0.949, P =0.006) were independent influencing factors for rebleeding after EVL. The predictive model based on these three factors had an area under the ROC curve of 0.796, with a sensitivity of 83.7% and a specificity of 74.5% at the cut-off value of -0.086. Conclusion Child-Pugh score, albumin level, and splenic vein diameter are independent risk factors for rebleeding after emergency EVL, and the combination of the three indices has the highest sensitivity and specificity in predicting rebleeding.
ABSTRACT
Objective To confirm the noninferiority of mesorectal excision (ME) alone to ME combined with lateral lymph node dissection (LLND) in terms of efficacy. Methods Eligibility criteria included histologically proven rectal cancer at clinical stageⅡ/Ⅲ; main lesion located in the rectum. Patients were intra-operatively allocated to undergo ME combined with LLND or ME alone in a randomized manner. The primary endpoint was relapse-free survival, with a noninferiority margin for the hazard ratio of 1.34. Secondary end points included overall survival and local-recurrence-free survival. Results In total, 502 patients from November 11, 2010 to October 1, 2017 were randomized to the ME combined with LLND (252 patients) and ME alone (250 patients) groups. The 5-year relapse-free survival in the ME combined with LLND and ME alone groups were 73.4% and 73.3%, respectively (hazard ratio:1.07, 90.9% CI 0.84— 1.36), with one sided P value for noninferiority of 0.0547. The 5-year overall survival, and 5-year local-recurrence-free survival in the ME combined with LLND and ME alone groups were 92.6% and 90.2% , and 87.7% and 82.4% , respectively. The numbers of patients with local recurrence were 21 cases (8.3%) and 43 cases (17.2%) in the ME combined with LLND group and ME alone group (P=0.024). Conclusions The noninferiority of ME alone to ME combined with LLND is not confirmed in the intent-to-treat analysis. ME combined with LLND has a lower local recurrence, especially in the lateral pelvis, compared to ME alone.
ABSTRACT
Objective To compare the advantages and disadvantages between the Mammotome ( MMT ) and conventional resection operation in the diagnosis and treatment of breast tumors . Methods A total of 288 patients during the period from February to July of 2014 were divided into MMT group ( 137 cases ) and control group ( 151 cases ) according to patient ’ s willingness .The surgical and post-operative results , postoperative complications and burden of disease were compared between the two groups . Results As compared to the control group, the MMT group had shorter operation time [(28.3 ±9.1) min vs.(37.5 ±14.2) min, t =-6.472, P=0.000], larger amount of tissue cut [(29.2 ±8.1) g vs.(16.5 ±7.9) g, t=13.462, P=0.000], lower visual analogue scales at one day after surgery [(4.2 ±3.6) points vs.(4.9 ±1.5) points, t=-2.189, P=0.029], lower incidence of postoperative breast shape change [10.2% (14/137) vs.55.0% (83/151), χ2 =64.392, P =0.000], and higher patient satisfaction scores [(7.2 ±1.8) points vs.(5.3 ±2.9) points, t=6.601, P=0.000], but more intraoperative bleeding [(22.3 ± 4.3) ml vs.(12.6 ±5.9) ml, t=15.807, P=0.000], higher incidence of postoperative breast hematoma [9.5% (13/137) vs. 2.6%(4/151),χ2 =6.050, P=0.014], and higher total costs [(5.12 ±1.97) ×103 yuan vs.(3.18 ±2.01) ×103 yuan, t=8.258, P=0.000]. Conclusion The MMT operation has advantages of short time , more cut tissue volume, mild postoperative pain, good postoperative breast shape , and high patient satisfaction , but disadvantages of easy development of hematoma and high total costs.