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Objective:To evaluate the clinical efficacy of laparoscopic splenectomy and azygoportal disconnection (LSD) with intraoperative endoscopic variceal ligation (LSDL) in the treatment of esophagogastric variceal bleeding (EVR).Method:In this study,90 cirrhotic patients with esophagogastric variceal bleeding (EVB) were divided to receive either LSD ( n=45) or LSDL ( n=45) from Jan 2020 and Dec 2021. Results:There were no significant differences in estimated blood loss, incidence of blood transfusion, time to first flatus, off-bed activity and postoperative hospital stay between the two groups (all P>0.05). Compared with LSD group, operation time was longer in LSDL group[ (140±21) min vs. (150±19) min, t=2.420, P=0.018]. LSDL was associated with significantly decreased EVR rate in one year follow-up (2% vs. 18%, P=0.030). Univariate analysis and multivariate logistic regression revealed that LSDL was a significant independent protective factor for EVR as compared with LSD ( P<0.05). Conclusion:LSDL procedure is not only technically feasible and safe, it also contributed to lower postoperative EVR risk than single LSD.
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Objective:To evaluate whether vagus nerve-guided robotic splenectomy and azygoportal disconnection (VNRSD) is feasible and safe and to determine whether VNRSD can be competent for well protecting vagus nerve.Methods:In this prospective clinical study, 12 cirrhotic patients with portal hypertension, hypersplenism and esophagogastric variceal bleeding (EVB) who accepted VNRSD at the Clinical School of Medicine of Yangzhou University between January 2022 and March 2022 were included, including 5 females and 7 males, aged (56.6±11.6) years old. Clinical data such as visual analog scale (VAS) pain score, conversion to laparotomy, esophagogastric variceal bleeding, and death were collected. The patients were asked to reexamine in the outpatient department 1 month after the operation, and the diarrhea, delayed gastric emptying and epigastric fullness were followed up.Results:VNRSD was successfully performed in all patients. There was no conversion to open or laparoscopic operations. The operation time was (170.0±16.8) min, blood loss was (60.8±11.3) ml, VAS pain score on the first day was (2.2±0.9) scores, and the postoperative hospital stay was (7.7±0.7) d, the four patients had main portal vein system thrombosis on the 7th day after operation. At the first day after operation, all patients were mange to take semi-fluid and off-bed activity. There were no incisional complications, pneumonia, gastric fistula, pancreatic fistula, and abdominal infection. No patients suffered from diarrhea, delayed gastric emptying, and epigastric fullness. None of the patients suffered from esophagogastric variceal bleeding, hepatic encephalopathy or death after operation and one month after operation, and the esophagogastric variceal were significantly improved. And no patient complained of abdominal distension or diarrhea.Conclusion:VNRSD procedure is not only technically feasible and safe, but also effectively protects anterior and posterior vagal trunks and all their branches, completely eradicating digestive system complications.
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Objective:To investigate the value of liver fibrosis serum markers in predicting esophagogastric variceal re-bleeding (EGVR) after laparoscopic splenectomy and azygoportal discon-nection (LSD).Methods:The prospective study was conducted. The clinical data of 155 cirrhotic portal hypertension patients with EGVR after LSD in the Clinical Medical College of Yangzhou University from September 2014 to January 2017 were selected. Observation indicators: (1) grouping situations of the enrolled patients; (2) risk factors analysis for postoperative EGVR; (3) prediction of postoperative EGVR; (4) follow-up. Follow-up was conducted using telephone interview, outpatient examination and hospitalization. Patients were followed up once every 3 months after operation to detect occurrence of EGVR and survival of patient up to January 2018. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the t test. Measurement data wite skewed distribution were represented as M(range), and comparison between groups was conducted using the non-parameter test. Count data were described as absolute numbers, and comparison between groups were conducted using the chi-square test or Fisher exact probability. Logistic regression model was used for multivariate analysis. The area under curve (AUC) of receiver operating characteristic (ROC) curve was used to estimate the diagnostic efficiency. The Youden index was used to determine the optimal cut-off point. Results:(1) Grouping situations of the enrolled patients. A total of 155 patients were selected for eligibility. There were 106 males and 49 females, aged (53±11)years. Of the 155 patients, there were 21 cases with EGVR in the postoperative 1 year and 134 cases without EGVR in the postoperative 1 year. The protein expression of laminin and collagen Ⅳ were 100.3(range, 16.1?712.2)μg/L and 68.4(range, 35.0?198.8)μg/L in patients with EGVR, vs 35.5(range, 2.0?521.2)μg/L and 43.5(range, 4.3?150.4)μg/L in patients without EGVR, showing significant differences between them ( Z=?4.55, ?4.52, P<0.05). (2) Risk factors analysis for postoperative EGVR. According to the Youden index, the optimal cut-off point of protein expression of laminin and collagen Ⅳ were 64.0 μg/L and 65.0 μg/L, respec-tively. Results of multivariate analysis showed that the protein expression of laminin ≥64.0 μg/L and the protein expression of collagen Ⅳ ≥65.0 μg/L were independent risk factors for postoperative EGVR ( odds ratio=9.69, 8.16, 95 confidence intervals as 3.05?30.82, 2.65?25.15, P<0.05). (3) Prediction of postoperative EGVR. Results of ROC curve showed that the AUC of laminin and collagen Ⅳ in predicting postoperative EGVR was 0.79 (95% confidence interval as 0.66?0.92), with sensi-tivity as 0.62 and specificity as 0.96. (4) Follow-up. All the 155 patients were followed up for 12(range, 1?12)months. During the follow-up, there were 21 of the 155 patients (13.55%) with post-operative EGVR, including 3 cases died of EGVR. Of the 21 patients with postoperative EGVR, there were 6 cases with postoperative EGVR during the first month after operation including 2 cases died, 5 cases with postoperative EGVR at postoperative 1?3 month, 6 cases with postoperative EGVR more than 3 month and less than 6 month after operation and 4 cases with postoperative EGVR at postoperative 6?12 months including 1 case died at postoperative 12 month. Conclusions:Laminin and collagen Ⅳ show satisfactory ability to predict EGVR after LSD.
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Objective:To investigate the clinical efficacy of Da Vinci robotic assisted vagus nerve-preserving splenectomy and azygoportal disconnection.Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 10 cirrhotic portal hypertension patients with esophagogastric variceal bleeding and hypersplenism who were admitted to Clinical Medical College of Yangzhou University from February to May 2021 were collected. There were 4 males and 6 females, aged from 43 to 64 years, with a median age of 55 years. All 10 patients underwent Da Vinci robotic assisted vagus nerve-preserving splenectomy and azygoportal discon-nection. Observation indicators: surgical situations, intraoperative autologous blood transfusion, conversion to open laparotomy, allogeneic blood transfusion, the operation time, volume of intra-operative blood loss, time to initial diet intake, time for out-of-bed activity, postoperative complica-tion, duration of postoperative hospital stay and follow-up. Follow-up was conducted using out-patient examination and telephone interview to detect recurrent gastrointestinal hemorrhage and gastric retention up to July 2021. 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. Results:All 10 patients underwent Da Vinci robotic assisted nerve-preserving splenectomy and azygoportal disconnection successfully, with intraopera-tive autologous blood transfusion and without conversion to open laparotomy or allogeneic blood transfusion. The operation time, volume of intraoperative blood loss, time to initial diet intake and time for out-of-bed activity of 10 patients were (180±14)minutes, (111±28)mL, (1.5±0.5)days and (2.5±0.7)days, respectively. Of the 10 patients, 1 case underwent mild pancreatic leakage, 1 case underwent pneumonia, 2 cases underwent portal vein thrombosis and 3 cases underwent splenic vein thrombosis. Patients with postoperative complications was cured after conservative treatment. The duration of postoperative hospital stay of 10 patients was (8.9±0.9)days. All 10 patients were discharged without perioperative death and followed up for 1 to 4 months, with a median follow-up time of 3 months. There was no patient undergoing gastrointestinal hemorrhage and gastric reten-tion.Conclusion:Da Vinci robotic assisted vagus nerve-preserving splenectomy and azygoportal disconnection is safe and feasible for the treatment of cirrhotic portal hypertension patients with esophagogastric variceal bleeding and hypersplenism.
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Intrahepatic cholangiocarcinoma(ICC) is a malignant tumor that originates in the epithelium of the proximal proximal to the second-degree bile ducts and has a high degree of malignancy. The causes of ICC are widely geographically diverse. Pathogenesis of ICC involves multiple molecular alterations at the level of genome, epigenome and stromal environment resulting in several deregulated signal transduction pathways. There are three types of pathological classification: mass-forming, periductal infiltrating, and intraductal growth. The mixed type of mass-forming + periductal infiltrating has the highest degree of malignancy. Early diagnosis of ICC is not easy, and tumor biomarkers such as CA19-9, CEA and so on, have some reference values, and multiple imaging examinations are needed to confirm each other. The effect of surgery mainly depends on the characteristics of the tumor, the vascular invasion of the tumor, the resection margin of the tumor and lymphatic metastasis. Lymph node dissection is controversial. If local lymphatic metastasis is identified, standardized lymph node dissection can improve ICC prognosis. Some ICC patients benefit from laparoscopic staging. In experienced centers, minimally invasive treatment can provide oncological outcomes similar to open resection for specific ICC patients. Liver transplantation is feasible in early ICC patients, but further clinical validation is needed.
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Objective To study the functions and mechanisms of glutamine 1 (GLS1) in intrahepatic cholangiocarcinoma (ICC) cell to 5-fluorouraeil (5-FU) chemosensitivity.Methods The expression and relation between GLS1 and major vault protein (MVP) in cholangiocarcinoma were analyzed by bioinformatics database.Western blot and immunohistochemistry were used to detect the expression of GLS1 and MVP in 42 ICC tissues,and the correlation between GLS1 and MVP was studied by statistics.The regulation of GLS1 in ICC cell were evaluated by siRNA interference and pcDNA overexpression,and then tested the interference and overexpression efficiency of GLS1 by Western blotting.The chemosensitivity to 5-Fu was tested by cell counting kit-8 (CCK-8).Results The expression of GLS1 and MVP in ICC tissues was significantly up-regulated (tGLSI =3.963;tMVP =3.131,P ＜ 0.05),and the expression of GLS1 was positively correlated with MVP(r2 =0.351 7,P ＜ 0.05).Knockdown of GLS1 in QBC939 cells enhanced chemosensitivity of QBC939 cells to 5-Fu and notably downregulated MVP expression,while enforced expression of GLS1 in RBE cells promoted MVP expression and reduce cell sensitivity to 5-fluorouracil chemosensitivity.Conclusions GLS1 regulates the chemosensitivity of ICC cells to 5-Fu,and its mechanism may relates to the regulation of MVP.
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Objective@#To investigate the clinical efficacy of laparoscopic splenectomy combined with pericardial devascularization in the treatment of cirrhotic patients with cirrhotic portal hypertension.@*Methods@#The retrospective and descriptive study was conducted. The clinicopathological data of 425 patients with cirrhotic portal hypertension who were admitted to Northern Jiangsu People′s Hospital Affiliated to Yangzhou University were collected. There were 289 males and 136 females, aged (53±11)years, with a range from 21 to 79 years. All the patients were allocated into 3 periods according to the operation time, including 100 patients of early period from February 2012 to March 2014, 156 patients of mature technology period from April 2014 to August 2016, and 169 patients of technology innovation period from september 2016 to December 2018. The patients of early period and mature technology period underwent laparoscopic splenectomy combined with pericardial devascularization, and the patients of technology innovation period underwent vagus nerve-preserving laparoscopic splenectomy combined with pericardial devascularization. Observation indicators: (1) surgical situations; (2) postoperative situations; (3) follow-up. Patients were followed up by outpatient examination to detect the upper digestive rebleeding, gastric retention, and diarrhea up to March 2019. Sequential therapy of endoscopic variceal ligation (EVL) was slectively performed on patients based on results of gastroscopy. Measurement data with normal distribution were represented as Mean±SD, and comparison between groups was analyzed using ANOVA, and paired comparison was analyzed using the t test. Measurement data with skewed distribution were represented as M (range), and comparison between groups was anlyzed using the Kruskal-Wallis rank sum test, and paired comparison was analyzed using the rank sum test. Count data were described as absolute numbers or percentages, and comparison between groups was analyzed using the chi-square test and Fisher exact probability.@*Results@#(1) Surgical situations: the operation time, volume of intraoperative blood loss, cases with intraoperative blood transfusion, cases with conversion to open surgery, and cases with emergency operation for bleeding were (187±46)minutes, 150 mL (range, 50-1 300 mL), 2, 2 , 1 for patients of early period, (164±22)minutes, 50 mL (range, 30-100 mL), 1, 1, 1 for patients of mature technology period, and (150±18)minutes, 50 mL (range, 10-300 mL), 0 , 0 , 0 for patients of technology innovation period, respectively. There were significant differences in the operation time and volume of intraoperative blood loss between the three groups (F=55.482, χ2=94.620, P<0.05). There was no significant difference in the cases with intraoperative blood transfusion, cases with conversion to open surgery, or cases with emergency operation between the three groups (P>0.05). (2) Postoperative situations: 425 patients had oral aspirin enteric-coated tablets for prevention of thrombus, with no perioperative death. Duration of postoperative hospital stay, cases with portal vein thrombosis at postoperative 7 days, cases with pancreatic fistula, cases with pulmonary infection, and cases with abdominal infection were (11.0±2.9)days, 46, 2, 1, 0 for patients of early period, (9.9±1.7)days, 81, 3, 0, 0 for patients of mature technology period, and (8.8±1.3)days, 83, 2, 1, 1 for patients of technology innovation period, respectively. There was a significant difference in the duration of postoperative hospital stay between the three groups (F=39.836, P<0.05), between patients of mature technology and patients of early period (t=3.329, P<0.05), between patients of mature technology period and patients of technology innovation (t=6.502, P<0.05). There was no significant difference in the cases with portal vein thrombosis at postoperative 7 days between the three groups (χ2=0.865, P>0.05) and no significant difference in the cases with pancreatic fistula, cases with pulmonary infection, or cases with abdominal infection between the three groups (P>0.05). Patients with portal vein thrombosis at postoperative 7 days had oral aspirin enteric-coated tablets or warfarin for treatment. Patients with pancreatic fistula, pulmonary infection, and abdominal infection were cured and discharged after conservative treatment. (3) Follow-up: all the 425 patients were followed up for 1-72 months, with a median follow-up of 36 months. Of the 425 patients, 261 underwent postoperative sequential therapy of EVL, including 133 patients of mature technology period and 128 patients of technology innovation period. The incidence rate of upper digestive rebleeding was 3.83%(10/261) of the 261 patients undergoing postoperative sequential therapy of EVL and 17.68%(29/164) of 164 patients without postoperative sequential therapy of EVL, showing a significant difference between them (χ2=23.185, P<0.05). The incidence rates of gastric retention and diarrhea were 96.24%(128/133) and 61.65%(82/133) for 133 patients undergoing sequential therapy of EVL in mature technology period, and 1.56%(2/128) and 3.91%(5/128) for 128 patients undergoing sequential therapy of EVL in technology innovation period, showing significant differences between them (χ2=233.876, 97.883, P<0.05).@*Conclusions@#It is safe and feasible of laparoscopic splenectomy combined with pericardial devascularization for patients with cirrhotic portal hypertension, and intraoperative vagus nerve-preserving can reduce volume of intraoperative blood loss and incidence of postoperative complications.
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Objective To investigate the clinical efficacy of laparoscopic splenectomy combined with pericardial devascularization in the treatment of cirrhotic patients with cirrhotic portal hypertension.Methods The retrospective and descriptive study was conducted.The clinicopathological data of 425 patients with cirrhotic portal hypertension who were admitted to Northern Jiangsu People's Hospital Affiliated to Yangzhou University were collected.There were 289 males and 136 females,aged (53±11)years,with a range from 21 to 79 years.All the patients were allocated into 3 periods according to the operation time,including 100 patients of early period from February 2012 to March 2014,156 patients of mature technology period from April 2014 to August 2016,and 169 patients of technology innovation period from september 2016 to December 2018.The patients of early period and mature technology period underwent laparoscopic splenectomy combined with pericardial devascularization,and the patients of technology innovation period underwent vagus nerve-preserving laparoscopic splenectomy combined with pericardial devascularization.Observation indicators:(1) surgical situations;(2) postoperative situations;(3) follow-up.Patients were followed up by outpatient examination to detect the upper digestive rebleeding,gastric retention,and diarrhea up to March 2019.Sequential therapy of endoscopic variceal ligation (EVL) was slectively performed on patients based on results of gastroscopy.Measurement data with normal distribution were represented as Mean±SD,and comparison between groups was analyzed using ANOVA,and paired comparison was analyzed using the t test.Measurement data with skewed distribution were represented as M (range),and comparison between groups was anlyzed using the Kruskal-Wallis rank sum test,and paired comparison was analyzed using the rank sum test.Count data were described as absolute numbers or percentages,and comparison between groups was analyzed using the chi-square test and Fisher exact probability.Results (1) Surgical situations:the operation time,volume of intraoperative blood loss,cases with intraoperative blood transfusion,cases with conversion to open surgery,and cases with emergency operation for bleeding were (187±46) minutes,150 mL (range,50-1 300 mL),2,2,1 for patients of early period,(164±22)minutes,50 mL (range,30-100 mL),1,1,1 for patients of mature technology period,and (150± 18)minutes,50 mL (range,10-300 mL),0,0,0 for patients of technology innovation period,respectively.There were significant differences in the operation time and volume of intraoperative blood loss between the three groups (F=55.482,x2 =94.620,P＜0.05).There was no significant difference in the cases with intraoperative blood transfusion,cases with conversion to open surgery,or cases with emergency operation between the three groups (P＞0.05).(2) Postoperative situations:425 patients had oral aspirin enteric-coated tablets for prevention of thrombus,with no perioperative death.Duration of postoperative hospital stay,cases with portal vein thrombosis at postoperative 7 days,cases with pancreatic fistula,cases with pulmonary infection,and cases with abdominal infection were (11.0±2.9) days,46,2,1,0 for patients of early period,(9.9±.1.7)days,81,3,0,0 for patients of mature technology period,and (8.8±1.3)days,83,2,1,1 for patients of technology innovation period,respectively.There was a significant difference in the duration of postoperative hospital stay between the three groups (F =39.836,P ＜ 0.05),between patients of mature technology and patients of early period (t =3.329,P＜0.05),between patients of mature technology period and patients of technology innovation (t =6.502,P＜0.05).There was no significant difference in the cases with portal vein thrombosis at postoperative 7 days between the three groups (x2 =0.865,P ＞ 0.05) and no significant difference in the cases with pancreatic fistula,cases with pulmonary infection,or cases with abdominal infection between the three groups (P＞0.05).Patients with portal vein thrombosis at postoperative 7 days had oral aspirin enteric-coated tablets or warfarin for treatment.Patients with pancreatic fistula,pulmonary infection,and abdominal infection were cured and discharged after conservative treatment.(3) Follow-up:all the 425 patients were followed up for 1-72 months,with a median follow-up of 36 months.Of the 425 patients,261 underwent postoperative sequential therapy of EVL,including 133 patients of mature technology period and 128 patients of technology innovation period.The incidence rate of upper digestive rebleeding was 3.83％ (10/261) of the 261 patients undergoing postoperative sequential therapy of EVL and 17.68％ (29/164) of 164 patients without postoperative sequential therapy of EVL,showing a significant difference between them (x2 =23.185,P＜0.05).The incidence rates of gastric retention and diarrhea were 96.24％ (128/133) and 61.65％ (82/133) for 133 patients undergoing sequential therapy of EVL in mature technology period,and 1.56％ (2/128) and 3.91％(5/128) for 128 patients undergoing sequential therapy of EVL in technology innovation period,showing significant differences between them (x2 =233.876,97.883,P＜0.05).Conclusions It is safe and feasible of laparoscopic splenectomy combined with pericardial devascularization for patients with cirrhotic portal hypertension,and intraoperative vagus nerve-preserving can reduce volume of intraoperative blood loss and incidence of postoperative complications.
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Objective To investigate the clinical safety and value of sequential therapy combining laparoscopic splenectomy and azygoportal disconnection with postoperative endoscopic variceal ligation (EVL) for portal hypertensive variceal bleeding.Methods From February 2012 to March 2016,114 patients underwent sequential laparoscopic splenectomy plus azygoportal disconnection and periodical postoperative endoscopic variceal ligation.Results were compared with those who underwent laparoscopic splenectomy and azygoportal disconnection without postoperative endoscopic variceal ligation in a group of 105 cases.Results Between the two groups oesophageal variceal re-bleeding (EVR) rates during first postoperative 3 months was not significantly different (P ＞ 0.05),however,sequential therapy group was associated with lower EVR rates during the periods ranging from 1 to 12 months,and 4 to 12 months compared with non-sequential therapy group (all P ＜ 0.05).Dynamic changes in the diameter of oesophageal varices and EVL rates in sequential therapy group both decreased gradually and significantly over the 12-month follow-up period (all P ＜0.01).No one in sequential therapy group suffered EVR from 6th month onward.No patient required EVL at the 12th month in sequential therapy group.Conclusion Sequential laparoscopic splenectomy plus azygoportal disconnection and postoperative EVL for portal hypertensive variceal bleeding is safe,feasible and effective in decreasing postoperative EVR rates.
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Objective To investigate the clinical value of enhanced recoverv after surgery (ERAS) in radical resection of primary liver cancer.Methods In this study 68 patients were randomly assigned into the ERAS group (n =35),and control group (n =33).Results Comparing with control group,there was significant differences in ERAS group with less volume of intraoperative intravenous fluid (t =2.812,P ＜0.05),lower visual analogue scale (VAS) scores (t =2.023,P ＜ 0.05),the shorter time to flatus (t =2.354,P ＜ 0.05),shorter postoperative hospital stay (t =2.056,P ＜ 0.05),and higher satisfaction degree of patients (t =2.227,P ＜ 0.05),while there was no significant differences between the two groups in postoperative complications (x2 =0.032,P ＞ 0.05).Conclusion ERAS was safe and effective for patients undergoing radical resection of primary liver cancer.
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Objective To investigate the clinical safety and value of vagus nerve-preserving versus conventional laparoscopic splenectomy and azygoportal disconnection.Methods A total of 60 cirrhotic patients with bleeding portal hypertension undergoing modified laparoscopic splenectomy and azygoportal disconnection between Apr 2015 and Sep 2016 were retrospectively analyzed.Patients were divided into nonvagus nerve-preserving (n =37) and vagus nerve-preserving group (n =23).Results Operative time (169 ± 42) min,and incidences of postoperative complications (102/370),delayed gastric emptying (35/37),epigastric fullness (22/37),diarrhea (26/37) in non-vagus nerve-preserving group were all more than those in vagus nerve-preserving group [(147 ± 21) min,(21/230),(2/23),(2/23),(2/23)] (t =2.684,x2 =29.583,44.272,15.229,21.606,all P ＜ 0.05).There was no significant between-group difference in body weight at admission and on postoperative day 7 (POD 7) between the two groups.However,body weight in vagus nerve-preserving group was significantly higher on postoperative 6 month (POM) compared with that in non-vagus nerve-preserving group [(63 ± 10) kg vs.(70 ± 12) kg,t =2.546,P ＜ 0.05].There was no significant between-group difference in ALB levels at admission and on POD 7 between the two groups.However,ALB levels in vagus nerve-preserving group at POM 6 were significantly higher than those in non-vagus nerve-preserving group [(42 ±6) g/L vs.(46 ±5) g/L,t =-2.607,P ＜ 0.05].Conclusion Vagus nerve-preserving laparoscopic splenectomy and azygoportal disconnection for cirrhotic portal hypertension is safe,feasible and with good therapeutic effect.
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The Enhanced recovery after surgery applies a series of evidence-based perioperative measures to accelerate patients recovery by reducing acute injury and complication.It is easy to lead to metabolic disturbance during perioperative period of hepatectomy which usually brings some serious trauma and is assiociated with strong and lasting surgical stress.In order to enhance recovery,enhanced recovery after surgery applies a series of key measures to easy the inflammatory reaction,relieve surgical physical and mental stress,keep homeostasis,reduce the rate of postoperative complications and readmission,save medical expenses at the same time.
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Objective To evaluate the feasibility and safety of modified laparoscopic pyloroplasty (LP) during laparoscopic splenectomy and azygoportal disconnection (LSD) for the prevention of postoperative gastroparesis.Methods A total of 31 cirrhotic patients with bleeding portal hypertension admitted to our department between Jan 2015 and Aug 2015 were retrospectively reviewed.Patients were divided into LP group (n =14) and non-LP group (n =17).Results One month postoperatively,the incidence of bloating was significantly lower in the LP group than in the non-LP group [21％ vs.88％,P ＜0.05].Three months postoperatively,the LP group had significantly lower incidences of nausea (0 vs.35％,P ＜ 0.05) and bloating (14 ％ vs.76％,P ＜ 0.05) than the non-LP group.The incidence of gastric retention confirmed by electronic gastroscopy at 3 and 6 months postoperatively in the LP group was significantly lower than that in the non-LP group (14％ vs.94％,P ＜ 0.01;14％ vs.88％,P ＜ 0.01,respectively).Conclusion It is safe,feasible and with good therapeutic effect for modified laparoscopic pyloroplasty during laparoscopic splenectomy and azygoportal disconnection for the prevention of postoperative gastroparesis.
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Objective To investigate the risk factors of portal venous thrombosis ( PVST) following laparoscopic splenectomy ( LS) in cirrhotic patients with hypersplenism .Methods The clinical data of 62 patients with secondary hypersplenism due to cirrhotic portal hypertension admitted to the Clinical Medical College of Yangzhou University were retrospectively analyzed .These patients underwent LS from January 2013 to April 2014.Based on whether the patients had PVST on postoperative day (POD) 7 or not, the pa-tients were categorized into the non-PVST and PVST groups .Fifteen perioperative variables were analyzed in these two groups .Results On univariate analysis , age and portal vein diameter in the PVST group were significantly higher and velocity of portal blood flow in the PVST group were significantly lower than those in the non-PVST group, (all P50 years, portal vein diameter >13 mm and velocity of portal blood flow >18 cm/s were significantly correlated .Multivariate logistic regression showed that age >50 years and portal vein diameter >13 mm were significantly independent risk factors of PVST, and velocity of portal blood flow >18 cm/s was an independent protective factor .Conclusion Age>50 years and portal vein diameter >13 mm were independent risk factors , while velocity of portal blood flow >18 cm/s was an independent protective factor of postoperative PVST .
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Objective To investigate the feasibility and safety,and short-term therapeutic effect of laparoscopic azygoportal disconnection without splenectomy for cirrhotic portal hypertension (PLT count ＞ 50 × 109/L).Methods Clinical data of 48 patients with bleeding portal hypertension and secondary hypersplenism (PLT count ＞ 50 × 109/L) undergoing laparoscopic splenectomy and azygoportal disconnection (LSD,n =26) vs.laparoscopic azygoportal disconnection (LD,n =22) between January 2014 and August 2015 were analyzed.Results Operative time (82 ± 29) min,intraoperative blood loss 20(10-50) ml,days of postoperative fever 0(0-3) d,rate of postoperative fever 10/22,postoperative hospital stay (7.0 ± 1.3) d,and WBC counts (3.8 ± 1.6) × 109/L,PLT counts 64 (49-88) × 109/L,and the incidence of portal vein thrombosis on POD 7 (14％),were significantly less in LD group than in LSD group [(180±41) min,80(20-500) ml,2(0-4) d,(22/26),(10.8 ±3.0) d,(9.1 ±3.1) × 109/L,156 (78-630) × 109/L,(42％)],(t =9.637,Z =-4.746,Z =-2.314,x2 =8.224,t =5.794,t =7.785,Z=-5.508,x2 =4.742,all P ＜ 0.05).Immune function was better in LD group than in splenectomy group at postoperative month 3.The serum proportion of CD4 + (58 ± 11) and the CD4 +/CD8 + ratio (1.9 ±0.7) at postoperative month 3 were significantly higher after LD than after LSD [(43 ± 14),(1.2 ± 0.9)],(t =-3.755,t =-2.509,all P ＜ 0.05).Conclusion Laparoscopic azygoportal disconnection without splenectomy is safe and effective for esophagogastric variceal hemorrhage and moderate hypersplenism (PLT ＞ 50 × 109/L) secondary to portal hypertension.
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Objective To investigate the short-term therapeutic effect of warfarin in preventing portal vein thrombosis (PVT) after modified laparoscopic splenectomy combined with pericardial devascularization.Methods The retrospective cohort study was used to analyze the clinical data of 32 patients with cirrhotic portal hypertension who were admitted to the Clinical Medical College of Yangzhou University between January 2014 and August 2014.The characteristics of warfarin and aspirin regimens were introduced to the patients before operation for choosing postoperative therapeutic regimen.Based on the decisions, 17 and 15 patients receiving warfarin regimen and aspirin regimen were divided into the warfarin group and the aspirin group, respectively.All the patients underwent successful modified laparoscopic splenectomy and pericardial devascularization with intraoperative autologous blood salvage.The treatments were as follows : from postoperative day 3, patients in the warfarin group received 2.5 mg of oral warfarin once daily with titration of the dose to maintain a target international normalized ratio (INR) of 2.0-3.0 for 1 year;patients in the aspirin group received 100 mg aspirin enteric coated tablets for 1 year;and both groups received 50 mg of oral dipyridamole three times daily for 3 months and subcutaneous injection of 4 100 U of low-molecular-weight heparin (LMWH) once daily for 5 days.Blood cell analysis, liver function, coagulation function and Doppler ultrasound screening for the occurrence of PVT were performed at the first and third months.Postoperative electronic gastroscopy was performed at 3 months postoperatively for observing the change of the esophageal and gastric-fundus varices.The patients were followed up till February 2015.The incidences of PVT and the level of INR at the first week, the first month and the third month after operation were observed.Measurement data with normal distribution were presented as (x) ± s and analyzed by t test, and measurement data with skewed distribution were presented as M(range) and analyzed by the rank-sum test.Comparison of the mean INR at different time points between the 2 groups was analyzed by the repeated measures ANOVA.Comparison of count data was analyzed by the Fisher's Exact Probility.Results There were no gastrointestinal hemorrhage or perioperative death in the 2 groups.(1) The overall incidences of PVT at postoperative week 1 were 9/17 and 6/15 in the warfarin and the aspirin groups, respectively, with no significant difference (P ＞ 0.05).However, the overall incidences of PVT at postoperative month 1 and 3 were 7/17 and 3/17 in the warfarin group, which was significantly different from 12/15 and 12/15 in the aspirin group (P ＜ 0.05).(2)The incidences of main portal vein thrombosis (MPVT) at postoperative week 1 and postoperative month 1 were 5/17 and 6/17 in the warfarin group, 4/15 and 5/15 in the aspirin group, showing no significant difference (P ＞ 0.05).The incidence of MPVT at postoperative month 3 was 3/17 in the warfarin group, which was significantly different from 9/15 in the aspirin group (P ＜ 0.05).(3) The INR was changed from 1.30 ± 0.17 before operation to 1.55 ± 0.38 at postoperative month 3 in the warfarin group, and from 1.33 ±0.14 before operation to 1.21 ±0.11 at postoperative month 3 in the aspirin group, showing significant difference in the changing trend between the 2 groups (F =713.908, P ＜ 0.05).(4) All the 32 patients were followed up for a median time of 7 months (range, 3-11 months).The results of electronic gastroscopy at postoperative month 3 showed that the esophageal and gastric-fundus varices were obviously improved or disappeared.Conclusion Warfarin in preventing PVT after modified laparoscopic splenectomy combined with pericardial devascularization is safe and feasible, with a good short-term outcome.
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Objective To investigate the safety and clinical efficacies of synchronous laparoscopic hepatectomy combined with splenectomy for the treatment of hepatocellular carcinoma (HCC) associated with cirrhotic portal hypertensive hypersplenism.Methods The clinical data of 5 patients with HCC associated with cirrhotic portal hypertensive hypersplenism who were admitted to the Clinical Medical College of Yangzhou University between January 2015 and April 2015 were retrospectively analyzed.Five patients underwent synchronous laparoscopic hepatectomy combined with splenectomy and intraoperative autologous blood transfusion.The operation time,volume of intraoperative blood loss,time for diet intake,postoperative drainage tube removal time,duration of hospital stay and occurrence of complications were observed.Patients were followed up by outpatient examination and telephone interview till June 2015.Measurement data with normal distribution were presented as x ± s.Results Of the 5 patients without conversion to open surgery,3 patients underwent synchronous laparoscopic hepatectomy combined with splenectomy,1 patient underwent laparoscopic hepatectomy + splenectomy + cholecystectomy and 1 patient underwent laparoscopic hepatectomy + splenectomy + devascularization.The operation time and volume of blood loss were (225 ± 41)minutes and (221 ± 81)mL.All the patients received intraoperative autologous blood transfusion without homologous blood transfusion.Two patients were complicated with abdominal effusion including 1 patient associated with pleural effusion,and symptoms of 2 patients disappeared after conservative treatment.All the patients took fluid diet at postoperative day 1 and out-of-bed activity at postoperative day 2,and drainage tubes were removed at postoperative day 3,with good recovery and without perioperative death.The duration of postoperative hospital stay was (7.8 ±0.8)days.All the 5 patients were followed up and survived well up to the end of follow-up.Conclusion Synchronous laparoscopic hepatectomy combined with splenectomy is safe and feasible for the treatment of HCC associated with cirrhotic portal hypertensive hypersplenism with an exact curative effect.
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Objective To evaluate modified laparoscopic hepatic hemangioma extraction methods during laparoscopic hepatectomy.Methods From May 2009 to June 2013, 25 hepatic hemangioma patients were admitted for laparoscopic hepatectomy.Patients were divided into modified laparoscopic group with modified laparoscopic hepatic hemangioma extraction methods (MLH, n =11) and traditional laparoscopic group (TLH, n =14).Perioperative clinical parameters were compared between the two groups.Results Operative time (148.6 ± 18.0) min, time to removal of the HCH (15.7 ±4.6) min, visual analog scale pain score on the first postoperative day (2.3 ± 0.9), time to off-bed activity (2.5 ± 0.8) d, and postoperative hospital stay (8.5 ± 2.6)d in the MLH group were all less than those in the TLH group [(163.9±13.2)min, (33.9±3.1)min, (3.4±0.9), (3.1±0.8)d, (10.6±1.9)d] (t=-2.451,t =-11.800, t =-2.931, t =-2.156, t =-2.338,P ＜ 0.05).There were one in the MLH group and two cases in the TLH group developing postoperative complications (P =1.000).Conclusions Modified laparoscopic hepatic hemangioma extraction methods during laparoscopic hepatectomy for hepatic hemangioma is safe, feasible and of good therapeutic effect.
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Objective To investigate the feasibility and safety of elective synchronous laparoscopic splenectomy plus portaazygous disconnection and hepatectomy for cirrhotic portal hypertension patients with hypersplenism, esophageal and gastric variceal bleeding and hepatocellular carcinoma.Methods Two hepatocellular carcinoma patients with a history of upper gastrointestinal hemorrhage and secondary hypersplenism underwent one stage, non-emergency laparoscopic splenectomy plus portaazygous disconnection and hepatectomy between April 2015 and May 2015 in our department.Autologous red cell salvage was used during the operation.Liver resection was performed after splenectomy, portaazygous disconnection and the use of cell saver.Results The two operations were performed successfully.The operative time was 190 min and 205 min respectively, Volume of intraoperative bleeding was 180 ml and 260 ml.There was no intraoperative homologous blood transfusion.The two patients recovered smoothly, without major complications and postoperative hospital stay was 8 d and 9 d.Conclusions The procedure of synchronous laparoscopic splenectomy and azygoportal disconnection with hepatectomy for cirrhotic patients with hepatocellular carcinoma, hypersplenism and esophageal and gastric variceal bleeding is safe and feasible.
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Objective To explore the feasibility and effect of spleen-preserving distal pancreatectomy in patients with distal pancreatic injures and its outcome.Methods Retrospectively analysed the follow up results of 18 patients undergoing spleen-preserving distal pancreatectomy in Clinical Medical College of Yangzhou University from March 2008 to November 2012.Results The operations were successful in all of these 18 patients,B-mode ultrasonography and CT scan follow-up revealed that there were no significant changes in the size and structure of the spleens.The operation time was 152 to 188 minutes (mean,172 minutes),and the intraoperative blood loss was 155 to 356 mL (mean,191 mL).The length of postoperative hospital stay was 13 to 19 days (mean,15 days).No bleeding after operation,no pancreatic leakage,and no intraabdominal infection occurred.Conclusions Distal pancreatectomy with spleen and supply vessel preserving is effective and feasible methods for the patients with distal