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Objective:To explore prognostic factors of intraductal papillary mucinous neoplasm of the bile duct (IPMN-B) patients.Methods:Clinical data on 227 patients with IPMN-B between 2004 and 2015 were retrospectively collected from the surveillance, epidemiology, and end results (SEER) database. There were 126 male and 101 female patients with the age at diagnosis of 69(58, 77) years old. IPMN-B patients were divided into two groups based on whether surgical treatment was performed. There were 129 patients in the surgery group and 98 patients in the non-surgery group. The survival analyses were assessed by Kaplan-Meier analyses and log-rank test was used to compared survival rate. The univariate and multivariate Cox analyses were applied to find independent prognostic factors of the survival in IPMN-B patients.Results:The tumor size of 227 IPMN-B patients from the SEER database was 25(18.5, 45.0) mm. The differences of tumor size, grade of defferentiation, American Joint Committee on Cancer (AJCC) stage, T stage, M stage chemotherapy were statistically significant respectively in surgery group and non-surgery group (all P<0.05). The median overall survival time (OS) of patients with IPMN-B was 14 months and the overall 1-year survival was 53.4%. The median overall survival time of IPMN-B patients in surgery group was 27 months, which was better than 5 months of patients in non-surgery group, and the difference was statistically significant ( P<0.001). Univariate Cox analysis found AJCC stage, T stage, N stage, M stage and surgery were prognostic factors in patients with IPMN-B. Multivariate Cox analysis showed that M1 stage ( HR=2.125, 95% CI: 1.472-3.066, P<0.001) was independent risk factor of prognosis while surgery ( HR=2.983, 95% CI: 2.106-4.224, P<0.001) was independent protective factor of prognosis. Conclusion:The AJCC staging system is an important predictor for evaluating the prognosis of IPMN-B patients. Surgery could significantly improve the prognosis of patients with IPMN-B.
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Objective:To study the predictive value of Barcelona clinic liver cancer (BCLC) staging system combined with albumin-indocyanine green (ALICE) score (ALICE-BCLC) in hepatectomy for hepatocellular carcinoma, and compare it with BCLC staging system combined with Child-Pugh score (CP-BCLC).Methods:The clinical data of 311 patients with hepatocellular carcinoma who underwent hepatectomy at Jinhua Hospital Affiliated to Zhejiang University from April 2012 to June 2021 were analyzed retrospectively. There were 271 males and 40 females, with a median age of 59 years old (range 26 to 92 years old). These patients were divided into two groups based on the ALICE-BCLC: the ALICE-BCLC grade 0 group ( n=63) and the ALICE-BCLC grade A group ( n=248); and another two groups based on the CP-BCLC: the CP-BCLC grade 0 group ( n=58) and the CP-BCLC grade A group ( n=253). The clinical data, including indocyanine green retention rate at 15 min, and albumin were collected and the scores were calculated. Follow-up was conducted by combining outpatient visits with telephone calls. The survival rate was calculated by the life method, and survival curves were drawn by the Kaplan-Meier method. The multivariate Cox regression model was used to determine the main factors affecting prognosis. Weighted Kappa was used to compare consistency of the two staging systems. Results:Multivariate analysis showed that a maximum tumor diameter >5 cm, total bilirubin >18 μmol/L, major hepatectomy, CP-BCLC grade A and ALICE-BCLC grade A to be independent risk factors affecting overall survival of patients with hepatocellular carcinoma after liver resection with curative intent (all P<0.05). The median survival of patients in the CP-BCLC grade 0 group and the CP-BCLC grade A group were 43.0 and 28.0 months, respectively. There was a significant difference between the two groups ( P=0.017). The median survival of patients in the ALICE-BCLC grade 0 group and the ALICE-BCLC grade A group were 41.4 and 28.1 months, respectively. There was a significant difference between the two groups ( P=0.035). The weighted Kappa coefficient of ALICE-BCLC and CP-BCLC was 0.949, showing a strong consistency ( P<0.001). Conclusion:ALICE-BCLC showed a good predictive value for prognosis of hepatocellular carcinoma after liver resection, and it had a similar overall prognostic discrimination ability as CP-BCLC.
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Objective:To compare the clinical outcomes of a double purse-string and bridging technique versus duct-to-mucosal pancreaticojejunostomy in laparoscopic pancreaticoduodenectomy.Methods:The clinical data of patients who underwent laparoscopic pancreaticoduodenectomy using the double purse-string and bridging pancreaticojejunostomy technique versus those who underwent duct-to-mucosa pancreaticojejunostomy at the Affiliated Jinhua Hospital of Zhejiang University School of Medicine from January 2016 to August 2021 were retrospectively analyzed. Of the 93 patients who underwent laparoscopic pancreaticoduodenectomy, there were 48 males and 45 females, with age of (62±10) years old. These patients were divided into two groups: patients who underwent double purse-string and bridging pancreaticojejunostomy (the double purse-string group, n=51), and patients who underwent duct-to-mucosa pancreaticojejunostomy (the duct-to-mucosa group, n=42). The clinical data of the two groups were compared. Results:All the 93 patients underwent laparoscopic pancreaticoduodenectomy successfully, and there were no deaths within 3 months of operation. Compared with the duct-to-mucosa group, the double purse-string group had significantly shorter time of pancreaticojejunal anastomosis [(32.41±8.75) vs. (47.62±8.90) min] and time of operation [(365.75±43.74) vs. (389.07±45.31) min] (all P<0.05). The postoperative pancreatic fistula rates were 9.8% (5/51) in the double purse-string group and 7.1% (3/42) in the duct-to-mucosa group. There was no significant difference between the two groups ( P>0.05). In the double purse-string group, there were 18 patients with a pancreatic duct diameter >3 mm, and 3 of these patients developed grade B pancreatic fistula, giving a grade B pancreatic fistula rate of 16.6% (3/18). In the duct-to-mucosa group, there were 11 patients with a pancreatic duct diameter >3 mm, and no patients developed grade B pancreatic fistula, giving a pancreatic fistula rate of 0(0/11). Conclusion:Compared with the duct-to-mucosa anastomosis, the double purse string and bridging pancreaticojejunostomy was technically simpler. It shortened the time of pancreaticojejunostomy in laparoscopic pancreaticoduodenectomy, especially for patients with a non-dilated pancreatic duct.
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Objective:To investiagte the ability of albumin-indocyanine green (ALICE) score, albumin-bilirubin (ALBI) score and Child-Pugh score in predicting postoperative liver failure (PHLF) in patients with hepatocellular carcinoma, and to determine the clinical value of ALICE score.Methods:The clinical data of 397 patients with hepatocellular carcinoma who underwent hepatectomy in the Department of Hepatobiliary and Pancreatic Surgery, Jinhua Hospital Affiliated to Zhejiang University from June 2015 to June 2021 were retrospectively analyzed, including 350 males and 47 females, aged (58.9±11.2) years. Univariate and multivariate logistic regression were used to analyze the risk factors of PHLF. The predictive ability of ALICE score for PHLF was evaluated by receiver operating characteristic (ROC) curve, and compared with ALBI score and Child-Pugh score.Results:There were 74 patients with PHLF and 323 patients without PHLF. Multivariate logistic regression analysis showed that Child-Pugh score ( OR=1.630, 95% CI: 1.251-2.486, P=0.034), ALBI score ( OR=1.863, 95% CI: 1.028-3.119, P=0.049) and ALICE score ( OR=1.759, 95% CI: 1.216-3.078, P=0.038) were independent risk factors for PHLF in patients with hepatocellular carcinoma, and the risk of PHLF increased with the increase of grade. The area under the ROC curve of ALICE score predicting PHLF in patients with hepatocellular carcinoma was 0.613 (95% CI: 0.564-0.662), the area under the ALBI score was 0.612 (95% CI: 0.563-0.661), and the area under the Child-Pugh score was 0.555 (95% CI: 0.505-0.605). The ALICE score was better than the Child-Pugh score, and the difference was statistically significant ( z=2.04, P=0.041). In small liver resection patients, ALICE score was better than Child-Pugh score ( z=2.61, P=0.009). There was no significant difference betwenn ALICE score and ALBI score ( z=0.06, P=0.954). Conclusion:ALICE score can predict the occurrence of PHLF in patients with hepatocellular carcinoma, especially in patients with small liver resection, its value is similar to ALBI score, but better than Child-Pugh score.
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Objective:To study the feasibility, safety and efficacy using transperitoneal approach guided by puncture catheter on laparoscopic treatment of infectious necrotizing pancreatitis.Methods:The clinical data of 7 patients who underwent laparoscopic treatment of infectious necrotizing pancreatitis using the transperitoneal approach at Jin Hua Jinhua Hospital of Zhe Jiang Zhejiang University from June 2018 to March 2021 were retrospectively analyzed. There were 3 males and 4 females, with age of (49.6±9.4) years old (range 32-65 years old). The general data, operation time, intraoperative blood loss and other clinical data were collected. Hepatobiliary and pancreatic CT was reviewed 1 week after the operation to study the changes in size of lesion, double cannula position and effect of necrotic tissue removal.Results:All patients were treated with percutaneous puncture and drainage under ultrasonic guidance before surgery. The course of the disease before operation was 42-58 days. All patients successfully completed surgery, and 5 patients underwent cholecystectomy. No patients required conversion to open surgery. The operation time was 140-195 min, the intraoperative blood loss was 30-100 ml, the postoperative hospital stay was 28-42 days, the postoperative time to first passed flatus was 2-4 days. Routine hepatobiliary and pancreatic CT 1 week after the operation showed that the degrees of necrosis and infection of pancreas were significantly improved and the lesion cavity was reduced compared with those before the operation. One patient suffered from abdominal hemorrhage after operation. There were no other serious complications. All patients recovered well after 6 to 12 months follow-up.Conclusion:Laparoscopic treatment of infectious necrotizing pancreatitis by using the transperitoneal approach guided by puncture catheter was safe and feasible. The treatment had the advantages of less trauma and fast recovery, and it was especially suitable for patients with biliary pancreatitis.
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Objective:To explore the clinical value of three-dimensional visualization combined with 3D laparoscopy in the resection of middle segment pancreatectomy.Methods:The clinical data of 11 patients who underwent middle segment pancreatectomy by 3D laparoscopy admitted in the Department of General Surgery of Jinhua Hospital affiliated with Zhejiang University from December 2016 to March 2020 were retrospectively analyzed. The 3D visualization software was used to reconstruct the image data collected from 2D CT images of the patients before operation, showing the three-dimensional location of the tumor, the extent of pancreatic tumor involvement, the relationship between tumor and surrounding vessels and the status of peripheral enlarged lymph nodes; according to the reconstructed figure, the specific surgical approach and procedures were determined. All the middle segment pancreatectomy was performed under 3D laparoscopy.Results:Three-dimensional visualization clearly displayed the middle pancreatic tumor and the adjacent organs, especially showing the distinct relationship between the tumor and the artery, vein and common bile duct. All the surgery had been successfully completed because of the good depth of field and sterescopic image of 3D laparoscopy, and no patient was transferred to open surgery and Roux-Y pancreaticojejunostomy was performed in all the patients. The average operation time was (264±98)min, and the intraoperative blood loss was (105±82)ml. The average hospital stay ranged from 6 to 17 days after operation. There were 3 cases of grade B pancreatic fistula after operation, which were cured by active drainage and conservative treatment. All the patients recovered and discharged without death.Conclusions:Three-dimensional visualization can accurately evaluate the pancreatic tumor before operation, and it combined with 3D laparoscopic middle segment pancreatectomy was safe and feasible.
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Objective:To study the feasibility and safety of combining liver suspension with 3D laparoscopy in resection of liver tumors in segments 7 and 8.Methods:The data of 26 patients who underwent liver tumor resection in segments 7 and 8 with 3D laparoscopy at Jinhua Hospital of Zhejiang University from January 2018 to December 2019 were retrospectively analyzed. There were 20 males and 6 females, with an average age of 58.7 years. All patients underwent liver tumor resection in segments 7 and 8 with liver suspension combining with 3D laparoscopy. The operative data was analysed.Results:For 25 patients underwent successful operations, and 1 patient was converted to open surgery. The mean operating time was 153 (65-350) min. The Pringle's maneuver was used in 15 patients. The mean blood loss was 155 (30-1 200) ml. Postoperative ascites developed in 4 patients (16.0%), and pleural effusion in 2 patients (8.0%). There was no bile leakage or incisional infection. The mean postoperative hospital stay was 6.2 (4-10) days.Conclusion:The liver suspension technique combing with 3D laparoscopy is safe and effective for resection of liver tumors in segments 7 and 8.
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Objective To investigate the safety and feasibility of laparoscopic resection of hepatic caudate lobe tumor.Methods The clinical data of six patients who underwent laparoscopic hepatic caudate lobe tumor resection in Jinhua Municipal Central Hospital were retrospectively analyzed.Results Laparoscopic procedures were successful in all the 6 patients.Four patients underwent partial caudate lobe resection,1 patient did combined left hemihepatectomy with partial eaudate lobe resection,and 1 patient underwent combined left lateral lobectomy.The operation time ranged from 130 to 240 minutes with a mean of 190 minutes.The intraoperative blood loss ranged from 60 to 480 ml with a mean of 185 ml.Postoperative bile leakage occured in 1 case.The primary diseases were hepatic haemangioma (n =4) and hepatocellular carcinoma(n =2),margin negtiveness achieved.The follow-up period was from 4 to 48 months,the patients recovered well and no recurrence was found.Conclusions Laparoscopic resection of hepatic caudate lobe tumor was safe and feasible in appropriately selected patients with skilled laparoscopic techniques.
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Objective@#To investigate the safety and feasibility of laparoscopic resection of hepatic caudate lobe tumor.@*Methods@#The clinical data of six patients who underwent laparoscopic hepatic caudate lobe tumor resection in Jinhua Municipal Central Hospital were retrospectively analyzed.@*Results@#Laparoscopic procedures were successful in all the 6 patients. Four patients underwent partial caudate lobe resection, 1 patient did combined left hemihepatectomy with partial caudate lobe resection, and 1 patient underwent combined left lateral lobectomy.The operation time ranged from 130 to 240 minutes with a mean of 190 minutes.The intraoperative blood loss ranged from 60 to 480 ml with a mean of 185 ml. Postoperative bile leakage occured in 1 case. The primary diseases were hepatic haemangioma (n=4) and hepatocellular carcinoma(n=2), margin negtiveness achieved. The follow-up period was from 4 to 48 months, the patients recovered well and no recurrence was found.@*Conclusions@#Laparoscopic resection of hepatic caudate lobe tumor was safe and feasible in appropriately selected patients with skilled laparoscopic techniques.
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Objective@#To study the feasibility of using a double purse-string bridging pancreaticojejunostomy in total laparoscopic pancreaticoduodenectomy (TLPD).@*Methods@#A database of 35 patients who underwent TLPD using a double purse-string bridging pancreaticojejunostomy from January 2016 to January 2019 in Jinhua Hospital of Zhejiang University was retrospectively reviewed. The perioperative outcomes were analyzed.@*Results@#All the 35 patients underwent TLPD successfully. The surgery time was (370.2±33.5) min, and the time of constructing the pancreaticojejunostomy was (28.4±12.6) min. The hospital stay after surgery was (14.2±6.9) days. Five patients developed postoperative complications, including pancreatic fistula in 3 patients, bile leakage in 1 patient, gastroparesis (complicated with abdominal infection) in 1 patient, and abdominal infection in 3 patients (2 patients with pancreatic fistula, and 1 patient with gastroparesis). All the patients with complications responded well to conservative treatment.@*Conclusions@#A double purse-string bridging pancreaticojejunostomy was simple and widely applicable. It is safe and feasible in total laparoscopic pancreaticoduodenectomy and should be promoted in clinical practice.
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Objective To study the feasibility of using a double purse-string bridging pancreaticoje-junostomy in total laparoscopic pancreaticoduodenectomy ( TLPD ) . Methods A database of 35 patients who underwent TLPD using a double purse-string bridging pancreaticojejunostomy from January 2016 to Janu-ary 2019 in Jinhua Hospital of Zhejiang University was retrospectively reviewed. The perioperative outcomes were analyzed. Results All the 35 patients underwent TLPD successfully. The surgery time was (370. 2 ± 33. 5) min, and the time of constructing the pancreaticojejunostomy was (28. 4 ± 12. 6) min. The hospital stay after surgery was (14. 2 ± 6. 9) days. Five patients developed postoperative complications, including pancreatic fistula in 3 patients, bile leakage in 1 patient, gastroparesis ( complicated with abdominal infec-tion) in 1 patient, and abdominal infection in 3 patients ( 2 patients with pancreatic fistula, and 1 patient with gastroparesis) . All the patients with complications responded well to conservative treatment. Conclu-sions A double purse-string bridging pancreaticojejunostomy was simple and widely applicable. It is safe and feasible in total laparoscopic pancreaticoduodenectomy and should be promoted in clinical practice.
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Objective To study the safety and feasibility of laparoscopic spleen-preserving distal pancreatectomy (LSPDP) in the treatment of pancreatic benign and borderline tumors.Methods The clinical data of 15 patients with preoperative diagnoses of pancreatic benign or borderline tumors who underwent LSPDP in the Jinhua Hospital,Zhejiang University from March 2013 to March 2017 were retrospectively analyzed.The diameter of tumors ranged from 2.6 to 6.8 cm,with an average of 4.4 cm.Results 15 patients were successfully treated with LSPDP.Twelve patients underwent splenic vessels preservation and 3 without splenic vessels preservation.The average operation time was 215 min (160 ～ 270 min).The mean intraoperative blood loss was 340 ml (180 ～700 ml),and the average postoperative hospital stay was 10.5 days (7 ～ 16 days).There was no patient with postoperative abdominal hemorrhage.Three patients developed postoperative pancreatic fistula and they were treated successfully with conservative therapy.Two patients developed splenic infarction,and the splenic infarction improved markedly after two months on CT.The pathological diagnoses showed 9 patients with serous cystadenoma,4 patients with mucinous cystadenoma,1 patient with a pancreatic neuroendocrine tumor and 1 patient with a solid pseudopapillary tumor.There was no recurrence on follow-up which ranged from 6 to 24 months.Conclusions Laparoscopic spleen-preserving distal pancreatectomy was safe and feasible in the treatment of pancreatic benign or borderline tumors.The Kimura procedure should be performed in preference to the Warshaw procedure.
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Pancreatic duct stone is a sequel of chronic pancreatitis and may be found in the main ducts,side branches or parenchyma.These stones obstruct the pancreatic ducts and produce ductal hypertension,which leads to pain,the cardinal feature of CP.Surgical operation has been the preferred treatment of pancreatic duct stones in many domestic and external pancreatic medical centers.Lithotomy by longitudinal pancreatic duct incision and Roux-en-Y anastomosis of pancreatic duct to jejunum is the main and effective surgical procedure,while micro-surgery was also rational for the treatment of pancreatic duct stones.However,further studies with a larger sample size and longer follow-up duration are needed to improve the surgical technique and verify our initial results.
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ObjectiveTo investigate the feasibility and efficacy of using the hepatoduodenal ligament tension-reduced operation (tension-reduced operation in short) for iatrogenic bile duct injury where the bile duct was severely defective. MethodsBetween March 2006 and May 2009, the authors treated 6 patients with iatrogenic bile duct injury (Bismuth type Ⅱ : 5 patients and type Ⅲ : 1 patient). A no. 7 black silk thread was used to hold the hilar plate tissues and the seromuscular layer of the bulbous part of the duodenum closer together and knots were tied. This method brought the porta hepatis and the duodenal bulb closer together and the hepatoduodenal ligament was shortened. An end to end anastomosis could then be made between the two broken ends of the defective bile duct without tension. ResultsSix patients suffered from bile duct injury and they recovered fully after the tensionreduced operation. There was no complication on follow-up. ConclusionsThe tension-reduced operation was efficacious in the treatment of iatrogenic bile duct injury. This technique should be popularized and more widely used.
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Objective To evaluate surgical management of pancreatic duct stones.Methods From 1997 to 2007, 24 cases of pancreatic duct stones underwent surgical treatment, the clinical data were retrospectively analyzed. Results In this study, 17 cases underwent lithotomy by longitudinal pancreatic duct incision, Roux-en-Y anastomosis(side-to-side) of pancreatic duct to jejunum, extra drainageof the main pancreatic duct was done in two cases, hepaticojejunostomy in three cases, pancreaticcystojejunostomy in one case. One case suffered from postoperative bleeding at pancreatic ojejunostomy, one from stress ulcer, and both were cured by conservative treatment. Three cases underwent pancreaticeduodenectomy, anastomosis bleeding occurred in one patient, and was cured by conservative method. One case underwent duodenum-preserving resection of the head of the pancreas, 2 cases underwent distal pancreatectomy, one case underwent lithotomy by pancreatic duct incision and primary closure, no postoperative complications occurred among those patients. 21 cases were followed up, results were excellentin 17 patients. Conclusions Lithotomy by longitudinal pancreatic duct incision, Roux-en-Y anastomosisof pancreatic duct to jejunum is the main and effective surgical procedure, while duodenum preserving pancreatic head resection and lithotomy by pancreatic duct incision and primary closure are also rational for the treatment of pancreatic duct stones.