Diagnosis and treatment of Budd-Chiari syndrome accompanied with hepatic nodules / 中华肝胆外科杂志

Objective:To summarize our experience in diagnosis and treatment of Budd-Chiari syndrome(BCS) accompanied with hepatic nodules.Methods:The clinical data of 33 patients with BCS accompanied with hepatic nodules who were treated at Henan Provincial People's Hospital from January 2012 to December 2018 were retrospectively analysed. A total of 33 patients were enrolled, including 17 males and 16 females, with an average age of 51 years. Analyze the treatment and prognosis of different types of nodules.Results:Of 33 patients, 27 were diagnosed to have hepatocellular carcinoma and 6 benign proliferative nodules. Treatment of patients with hepatocellular carcinoma included, transcatheter arterial chemoembolization ( n=1) and hepatectomy ( n=26). The survival time of these patients with hepatocellular carcinoma ranged from 10.0 to 78.0 months (mean 37.8 months). For the remaining 6 patients with benign nodules, the nodules were multiple and no malignant changes were observed on follow-up. Conclusion:For patients with BCS associated with benign nodules, no specific treatment was required. Hepatocellular carcinoma assocated with BCS had good prognosis. An aggressive surgical resectional approach is recommended to treat and to relieve the hepatic outflow obstruction.

Entrapped duct-to-mucosa pancreaticojejunostomy in pancreaticoduodenectomy / 中华肝胆外科杂志

Objective:To study the safety and efficacy of using entrapped duct-to-mucosa pancreaticojejunostomy for patients with small pancreatic ducts of less than 3 mm in diameter.Methods:The clinical data of patients who underwent entrapped duct-to-mucosa pancreaticojejunostomy at Henan Province People's Hospital from January 2017 to December 2019 were retrospectively analyzed. The incidences of complication including pancreatic fistula and abdominal hemorrhage were studied. The duration to carry out the pancreaticojejunostomy and postoperative hospital study were also analyzed.Results:Of 98 patients included in this study, there were 58 males and 40 females, with an average age of 62.3 (aged 24 to 73) years. The average time of completing the pancreaticoenterostomy was (10.2±3.1) min. There were 10 patients (10.2%) who developed grade A pancreatic fistulae. There were no grade B or C pancreatic fistulae, no portoperative bleeding and no perioperative deaths. The postoperative hospital stay was (13.4±4.6) days.Conclusion:Entrapped duct-to-mucosa pancreaticojejunostomy was simple, quick, safe and effective in patients with small pancreatic ducts.

Associating liver partition and portal vein ligation for staged hepatectomy combined with hepatic artery reconstruction in the treatment of hilar cholangiocarcinoma / 中华肝胆外科杂志

Objective To study the combined use of ALPPS (associating liver partition and portal vein ligation for staged hepatectomy) with hepatic artery reconstruction in the treatment of hilar cholangiocarcinoma with hepatic arterial involvement.Methods The clinical data of 7 patients with hilar cholangiocarcinoma who underwent ALPPS combined with hepatic arterial resection and reconstruction were analyzed retrospectively.The technical points and the perioperative management were analyzed.Methods At the first stage,the relationship between the tumor and the vessels were explored,the portal vein of the part of the liver to be resected was ligated and the liver was transected with a CUSA (Cavitron Ultrasound Surgical Aspirator).Then the bile duct was cut and a hepaticojejunostomy was completed.Finally,under ultrasound guidance,a bile duct drainage tube was inserted transhepatically into the part of the liver which was to be resected.Two to three weeks later,and after enough hypertrophy of the liver remnant size was confirmed,tumor resection was completed with reconstruction of the hepatic artery.Results Seven patients underwent the second stage operation,with no perioperative death.Six patients developed pulmonary infection and were treated successfully with conservative treatment.Two patients developed postoperative bile leak with secondary abdominal infection.One patient developed postoperative hepatic artery thrombosis secondary to biliary tract infection.Conclusion ALPPS combined with hepatic artery reconstruction was safe and feasible in the treatment of hilar cholangiocarcinoma with hepatic arterial involvement.

Clinical analysis of 37 patients with pancreatic portal hypertension / 中华肝胆外科杂志

Objective To study the pathogenesis,diagnosis and treatment of pancreatic portal hypertension (PPH).Methods The clinical data of 37 patients with PPH treated in Henan Province People's Hospital from January 2008 to January 2016 were retrospectively analyzed.Result Nine patients underwent conservative treatment and 28 patients underwent surgical treatment.No deaths were observed in the perioperative and follow-up periods.One patient underwent a second operation becausc of gastrointestinal bleeding.The clinical symptoms of the remaining patients were significantly relieved after surgery.Conclusions Treatment should be individualized and directed at the underlying cause.The anatomy of the coronary vein and the location of obstruction of the splenic vein determined the degree of the variceal veins and the surgical methods.Splenectomy was the basic treatment for PPH.Subcapsular splenectomy was effective in some challenging cases.

Use of a saline-coupled bipolar sealer (Aquamantys(R)) in liver resection for primary hepatic malignancy: a retrospective cohort study / 中华肝胆外科杂志

Objective To evaluate the efficacy and outcomes with the use of a saline-coupled bipolar sealer during liver resection.Methods 101 patients underwent liver resection for primary hepatic carcinoma at the People's Hospital Affiliated to Zhengzhou University from August 2015 to December 2016.The patients were divided into two groups according to whether the Aquamantys(R) system was used or not.In group A (n =62) the clamp crushing technique was used for liver parenchymal transection.In group B (n =39) the Aquamantys(R) system was used.The intraoperative and postoperative complication rates were compared.Results The operation time in group B was significantly longer than group A (216.4 min vs.253.5 min,P ＜ 0.05).The intraoperaitve blood loss in group B was significantly less than group A (381.1 ml vs.257.2 ml,P ＜ 0.05),and less blood transfusion was required (211.3 ml vs.90.9 ml,P ＜ 0.05).The volume of abdominal drainage fluid in group B in the first and the 5th day was significantly less than group A (242.6 ml vs.199.2 ml,P＜0.05;84.3 ml vs.70.4 ml,P＜0.05,respectively).The drainage tube in group B was taken off earlier than in group A (8.1 d vs.7.0 d,P ＜ 0.05).The average hospitalization stay after surgery in group B was also significantly shorter (13.4 d vs.11.6 d,P ＜ 0.05).There was no significant difference in the overall postoperative complication rate (P ＞ 0.05) between the 2 groups,and no death was observed.Conclusion The use of a saline-coupled bipolar sealer (Aquamantys(R)) in liver resection for hepatocellular carcinoma was associated with less intraoperative blood loss and was better for the patients' postoperative recovery.

Diagnosis and surgical treatment of solid pseudopapillary tumor of the pancreatic head / 中华肝胆外科杂志

Objective To discuss the diagnosis and surgical treatment of solid pseudopapillary tumor (SPTP) of the pancreatic head.Methods From January 2008 to August 2013,the clinicopathological data of 12 patients who were diagnosed and surgically treated in our hospital for this condition were analyzed retrospectively.Results There were 11 women and 1 man,the mean age was 28.7 years,with a range from 11 to 43.The mean diameter of the tumor was 7.5 cm(2 ～ 15 cm),6 of 12 of these tumors were more than 10 cm.Seven patients underwent pancreaticoduodenectomy,2 duodenum-preserving pancreatic head resection,2 local resection of tumor,1 palliative resection,1 pancreaticoduodenectomy combined with resection of part of the portal vein.All the diagnoses were confirmed by postoperative histopathology.In a follow-up which ranged from 3 to 65 months,all the patients were alive with no evidence of disease recurrence.Conclusions Most of the SPTPs of the pancreatic head were huge.The diagnosis was difficult.Complete tumor resection is the best treatment.

Diagnosis and treatment of abdominal compartment syndrome secondary to fulminant acute pancreatitis / 中华肝胆外科杂志

Objective To study the treatment of abdominal compartment syndrome(ACS) secondary to fulminant acute pancreatitis (FAP).Method A retrospective study was conducted from Jan.2009 to Dec.2011 to analyze the therapeutic results of 18 patients with ACS secondary to FAP.Results Three out of 7 patients who received non-operative therapy died (mortality rate 42.9％).Three out of 11 patients treated with early surgery died (mortality rate 27.3％),which was significantly better than those patients treated conservatively.Conclusion A reduction in intra-abdominal pressure improved the function of the viscera in the treatment of ACS secondary to FAP.The decompressive effects of early surgery was efficacious,and it reduced the mortality rate.

Duodenum-preserving pancreatic head resection (DPPHR) in treating patients with benign lesions in the head of the pancreas / 中华普通外科杂志

Objective To evaluate the procedure and the therapeutic efficacy of duodenumpreserving pancreatic head resection (DPPHR) in treating benign lesions in the head of the pancreas.Methods From February 2003 to August 2011,DPPHR was performed in 21 patients with benign lesions in the head of the pancreas.Thirteen patients were male and eight were female.Age ranged from 30 to 48 years,and the lesions ranged from 2.0 cm to 5.6 cm in diameter.Posterior superior pancreaticoduodenal artery was conserved in all patients.Results There was no hospital death.Pancreatic fistula was the main and the most often morbidity,occurring in 33.3％.After operation all patients with preoperative abdominal pain were completely pain free.Preoperative hypoglycemia in 2 patients turned to eugycemia.There was no recurrences report during following up.Concl~ions DPPHR was safe and effective in treating benign lesion in the head of pancreas.It was important in preserving blood supply to the duodenum by posterior superior pancreaticoduodenal artery.