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Objective:To investigate the influencing factors of textbook outcomes in liver surgery (TOLS) after radical resection of gallbladder carcinoma.Methods:The retrospective case-control study was conducted. The clinicopathological data of 530 patients who underwent radical resection of gallbladder carcinoma in 15 medical centers, including the First Affiliated Hospital of Army Medical University et al, from January 2014 to January 2020 were collected. There were 209 males and 321 females, aged (61±10)years. Patients underwent radical resection of gallbladder carcinoma, including cholecystectomy, hepatectomy, invasive bile duct resection, and lymph node dissection. Observation indicators: (1) situations of TOLS; (2) influencing factors of TOLS. Measure-ment data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the independent sample t test. Measurement data with skewed distribution were represented as M( Q1, Q3), and comparison between groups was conducted using the Mann-Whitney U test. Count data were described as absolute numbers or percentages, and comparison between groups was conducted using the chi-square test. Comparison of ordinal data between groups was conducted using the Mann-Whitney U test. The univariate analysis was conducted using the corresponding statistical methods based on data type, and variables with P<0.10 were included in multivariate analysis. Multivariate analysis was conducted using the Logistic stepwise regression model. Results:(1) Situations of TOLS. All 530 patients underwent radical resection of gallbladder carcinoma, and there were 498 cases achieving R 0 resection, 508 cases without ≥grade 2 intra-operative adverse events, 456 cases without postoperative grade B and grade C biliary leakage, 513 cases without postoperative grade B and grade C liver failure, 395 cases without severe com-plications within postoperative 90 days, 501 cases did not being re-admission caused by severe com-plications within postoperative 90 days. Of the 530 patients, 54.53%(289/530) of patients achieved postoperative TOLS, while 45.47%(241/530) of patients did not achieve postoperative TOLS. (2) Influencing factors of TOLS. Results of multivariate analysis showed that American Society of Anesthesiologists classification >grade Ⅱ, preoperative jaundice, T staging as T3?T4 stage, N staging as N2 stage, liver resection as right hemi-hepatectomy, and neoadjuvant therapy were independent factors influencing TOLS in patients undergoing radical resection of gallbladder carcinoma ( odds ratio=2.65, 1.87, 5.67, 5.65, 2.55, 3.34, 95% confidence interval as 1.22?5.72, 1.18?2.95, 2.51?12.82, 2.83?11.27, 1.41?4.63, 1.88?5.92, P<0.05). Conclusion:American Society of Anesthesiologists classification >grade Ⅱ, preoperative jaundice, T staging as T3?T4 stage, N staging as N2 stage, liver resection as right hemi-hepatectomy, and neoadjuvant therapy are independent factors influencing TOLS in patients undergoing radical resection of gallbladder carcinoma.
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Objective:To investigate the risk factors for posthepatectomy liver failure (PHLF) in patients with hepatocellular carcinoma and construction of prediction model.Methods:The retrospective case-control study was conducted. The clinicopathological data of 116 patients with hepatocellular carcinoma who underwent hepatectomy in the First Affiliated Hospital of University of Science and Technology of China from January 2019 to January 2022 were collected. There were 99 males and 17 females, aged (59±10)years. Observation indicators: (1) occurrence of PHLF; (2) analysis of factors influencing the occurrence of PHLF; (3) construction and evaluation of prediction model for PHLF. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the t test. Measurement data with skewed distri-bution were represented as M( Q1, Q3), and comparison between groups was conducted using the rank sum test. Count data were described as absolute numbers, and comparison between groups was conducted using the chi-square test or Fisher exact probability. The univariate analysis was conducted using the corresponding statistical methods based on data type. Multivariate analysis was conducted using the Logistic regression model with forward method. The regression coefficient was used to construct the prediction model. The receiver operating characteristic curve was drawn, and the area under curve (AUC) was used to evaluate the predictive ability of prediction model. Results:(1) Occurrence of PHLF. Of the 116 patients, there were 27 cases with PHLF and 89 cases without PHLF, respectively. Of the 27 patients with PHLF, 13 cases underwent laparoscopic hepatectomy and 14 cases underwent open hepatectomy. (2) Analysis of factors influencing the occurrence of PHLF. Results of multivariate analysis showed preoperative portal vein tumor thrombus and preoperative indocyanine green retention at 15 minutes (ICG R15) ≥10% were independent risk factors influencing the occurrence of PHLF ( odds ratio=13.463, 4.702, 95% confidence interval as 3.140-57.650, 1.600-13.800, P<0.05). (3) Construction and evaluation of prediction model for PHLF. According to the multivariate analysis, preoperative portal vein tumor thrombus and preoperative ICG R15 were included to construct the prediction model for predicting the occurrence of PHLF in patients with hepatocellular carcinoma. The AUC, sensitivity, specificity of prediction model was 0.750 (95% confidence interval as 0.654-0.846, P<0.05), 0.551, 0.852, respectively. Conclusions:Preoperative portal vein tumor thrombus and preoperative ICG R15 ≥10% are independent risk factors influen-cing the occurrence of PHLF. The prediction model based on these two factors has good efficacy in predicting PHLF of patients with hepatocellular carcinoma.
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Objective:To investigate the safety of minimally invasive liver resection for resectable hepatocellular carcinoma (HCC) complicated with portal hypertension.Methods:The propensity score matching and retrospective cohort study was conducted. The clinicopathological data of 807 patients with resectable HCC who underwent minimally invasive liver resection in 8 medical centers, including Sir Run Run Shaw Hospital, Affiliated with the Zhejiang University School of Medicine et al, from June 2011 to November 2022 were collected. There were 670 males and 137 females, aged 58(50,66)years. Of the 807 patients, 173 cases with portal hypertension were divided into the portal hypertension group, and 634 cases without portal hypertension were divided into the non-portal hypertension group. Observation indicators: (1) propensity score matching and comparison of general data of patients between the two groups after matching; (2) intraoperative and post-operative situations; (3) subgroup analysis. Propensity score matching was done by the 1:1 nearest neighbor matching method, with the caliper setting as 0.001. Measurement data with skewed distribution were represented as M( Q1, Q3), and comparison between groups was conducted using the rank sum test. Count data were described as absolute numbers, and comparison between groups was conducted using the chi-square test or Fisher exact probability. Comparison of ordinal data was constructed using the non-parameter rank sun test. Results:(1) Propensity score matching and comparison of general data of patients between the two groups after matching. Of the 807 patients, 268 cases were successfully matched, including 134 cases in the portal hypertension group and 134 cases in the non-portal hypertension group. The elimination of the tumor diameter and robot-assisted surgery confounding bias ensured comparability between the two groups after propensity score matching. (2) Intraoperative and postoperative situations. The occlusion time of porta hepatis, cases with intraoperative blood transfusion, cases with postoperative complication, cases with complication >Ⅱ grade of Clavien-Dindo classification, cases of Clavien-Dindo classification as Ⅰ grade, Ⅱ grade, Ⅲ grade, Ⅳ grade, cases with liver related complication were 27.0(15.0,43.0)minutes, 33, 55, 15, 13, 29, 14, 1, 37 in the portal hypertension group, versus 35.0(22.0,60.0)minutes, 17, 25, 5, 14, 9, 4, 1, 13 in the non-portal hypertension group, showing significant differences in the above indicators between the two groups ( Z=-2.15, χ2=6.30, 16.39, 4.38, 20.72, 14.16, P<0.05). (3) Subgroup analysis. Results of subgroups analysis showed that in cases with major live resection, the operation time, volume of intraoperative blood loss, duration of postoperative hospital stay were 243.5(174.6,296.3)minutes, 200.0(150.0,600.0)mL, 7.5(6.0,13.0)days in the portal hypertension group, versus 270.0(180.0,314.5)minutes, 200.0 (75.0,450.0)mL, 7.0(5.5,10.0)days in the non-portal hypertension group, showing no significant difference in the above indicators between the two groups ( Z=-0.54, -1.73, -0.92, P>0.05). In cases with non-major live resection, the operation time, volume of intraoperative blood loss, duration of postoperative hospital stay were 170.0(120.0,227.5)minutes, 100.0(50.0,200.0)mL, 8.0(5.0,10.0)days in the portal hypertension group, versus 170.0(120.0,227.5)minutes, 100.0(50.0,200.0)mL, 7.0(5.5,9.0)days in the non-portal hypertension group, showing no significant difference in the above indicators between the two groups ( Z=-1.39, -0.10, 1.05, P>0.05). In cases with anatomical liver resection, the operation time, volume of intraoperative blood loss, duration of postoperative hospital stay were 210.0(150.0,285.0)minutes, 150.0(50.0,200.0)mL, 8.0(6.0,9.3)days in the portal hypertension group, versus 225.5(146.3,306.8)minutes, 100.0(50.0,250.0)mL, 7.0(6.0,9.0)days in the non-portal hypertension group, showing no significant difference in the above indica-tors between the two groups ( Z=-0.75, -0.26, -0.91, P>0.05). In cases with non-anatomical liver resection, the operation time, volume of intraoperative blood loss, duration of postoperative hospital stay were 173.5(120.0,231.5)minutes, 175.0(50.0,300.0)mL, 7.0(5.0,11.0)days in the portal hyper-tension group, versus 186.0(123.0,262.5)minutes, 100.0(50.0,200.0)mL, 7.0(5.0,9.5)days in the non-portal hypertension group, showing no significant difference in the above indicators between the two groups ( Z=-0.97, -1.12, -0.98, P>0.05). Conclusion:Minimally invasive liver resection or even major liver resection is safe and feasible for screened HCC patients complicated with portal hyper-tension, but attention should be paid to the prevention and treatment of postoperative complications.
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Objective:To investigate the application value of donor liver autologous portal venous blood rinse in orthotopic liver transplantation (OLT).Methods:The retrospective cohort study was conducted. The clinicopathological data of 35 pairs of donors and recipients who underwent OLT in the First Affiliated Hospital of University of Science and Technology of China from May 2018 to June 2019 were collected. Of the 35 donors, there were 31 males and 4 females, aged (48±9)years. Of the 35 recipients, there were 25 males and 10 females, aged (47±9)years. Of the 35 recipients, 16 recipients undergoing donor liver autologous portal venous blood rinse were allocated into the portal vein group, and 19 recipients undergoing donor liver albumin water rinse were allocated into the albumin group. Observation indicators: (1) surgical situations; (2) postoperative situations; (3) follow-up. Measurement data with normal distribution were represented as Mean± SD, and compari-son between groups was analyzed using the t test. Measurement data of skewed distribution were represented as M(range). Count data were descried as absolute numbers, and comparison between groups was analyzed using the Fisher exact probability. Results:(1) Surgical situations. The anhepatic phase time and arterial blood Ca 2+ concentration within 5 minutes after reperfusion of the recipients were (52±12)minutes and (0.99±0.10)mmol/L in the portal vein group, versus (64±12)minutes and (1.05±0.07)mmol/L in the albumin group, showing significant differences in the above indicators between the two groups ( t=2.94, 2.22, P<0.05). The mean arterial pressure, arterial blood K +concentration and arterial blood pH within 5 minutes after reperfusion of the recipients were (70±24)mmHg (1 mmHg=0.133 kPa), (4.7±1.3)mmol/L and 7.27±0.06 in the portal vein group, versus (71±28)mmHg, (4.6±1.1)mmol/L and 7.30±0.07 in the albumin group, showing no significant difference in the above indicators between the two groups ( t=0.14, 0.30, 1.22, P>0.05). (2) Post-operative situations. Cases with post-reperfusion syndrome (PRS), cases with severe PRS of cardiac arrest, cases with primary graft nonfunction of the recipients were 6, 0, 2 in the portal vein group, versus 8, 1, 1 in the albumin group, showing no significant difference in the above indicators between the two groups ( P>0.05). Total bilirubin on postoperative day 7 of the recipients was (90±52)μmol/L in the portal vein group, versus (166±112)μmol/L in the albumin group, showing a significant difference between the two groups ( t=2.66, P<0.05). International normalized ratio on postoperative day 7, the highest alanine aminotransferase and aspartate aminotransferase within 7 days after operation of the recipients were 2.1±2.0, (1 952±2 813)IU/L and (3 944±6 673)IU/L in the portal vein group, versus 1.8±0.6, (1 023±1 014) IU/L and (2 005±2 910)IU/L in the albumin group, showing no significant difference in the above indicators between the two groups ( t=0.66, 1.23, 1.08, P>0.05). Recipients with hepatic artery complication and biliary complication were 1 and 2 in the portal vein group, versus 0 and 4 in the albumin group, showing no significant difference in the above indicators between the two groups ( P>0.05). There were 3 cases and 2 cases died during the perioperative period in the portal vein group and the albumin group, respectively. (3) Follow-up. Of the 35 recipients, 30 recipients were followed up for 534(range, 28?776)days after operation. During the follow-up, there were 3 patients with postoperative complications in the portal vein group including 2 cases died and 1 case recovered after sympto-matic treatment. There were 5 patients with postoperative complications in the albumin group including 1 case died and 4 cases recovered after symptomatic treatment. Up to the follow-up date, 11 patients in the portal vein group and 16 patients in the albumin group were in good condition. Conclusion:Rinse of the donor liver with autologous portal venous blood during liver transplantation can shorten the time of anhepatic phase, without increasing the occurrence of post-reperfusion syndrome, ischemia re-perfusion injury and biliary tract complications.
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Caroli disease is a relatively rare genetic disease, also known as congenital intrahepatic cystic cholangiectasis, which is mainly manifested as non-obstructive segmental dilation of large, intrahepatic bile ducts, which is manifested as cysts in imaging and histopathological examination. The pathogenesis of Caroli disease is still unclear, and it is mainly believed to be related to PKHD1 gene mutation. Mutations in this gene often lead to autosomal recessive polycystic kidney disease (ARPKD), so Caroli disease is commonly associated with polycystic kidney disease. Caroli disease usually develops during adolescence and is characterized by recurrent cholangitis, which is diagnosed mainly by imaging. This article reviews the progress of diagnosis and treatment of Caroli disease by reading related literature.
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Objective:Through the statistics and comparison of SCI papers jointly published by the hospital investigators and university scholars, this paper aims to provide a reference for the next step of interdisciplinary research cooperation in ″medicine, science, engineering and liberal art″.Methods:The collaborative SCI papers were searched from the Science Citation Index expanded (SCIE) database, basic information of the cooperative papers were collected. Taking into consideration of the time spots that 3 years before (2015-2017) and after (2018-2020) when the hospital became affiliated to the university. The number of the paper, paper quality, author's basic information, hospital disciplines and the distribution of department/unit in the university were analyzed.Results:The number of the collaborative papers has increased from 23 to 131. There are statistical significance in both the personnel situations and the qualifications to supervise postgraduate students of the authors. The number of the related hospital departments has increased from 7 to 22, and the number of the universities′ unit increased from 3 to 10.Conclusions:After becoming the university affiliated hospital, the interdisciplinary collaborations in medicine, science, engineering and liberal art have already made some achievements, the breadth and depth of cooperation have been continuously expanded, which is related to the various policies implemented by the hospital and the advantages of interdisciplinary collaboration in resource sharing.
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Near infrared region Ⅱ (NIR-Ⅱ) fluorescence imaging has made progress in clinical application in recent years and has shown a higher image quality, tumor sensitivity and deeper tissue imaging capability compared to near infrared region Ⅰ imaging in liver neoplasms and biliary tract system. As a real-time intraoperative imaging technology, which can provide high signal to background ratio and deeper tissue penetration, NIR-Ⅱ is able to shorten the duration of operation while improve the safety and therapeutic effect of surgery. It has a great prospect and expanding ability. With the development of a bunch of novel NIR-Ⅱ fluorophores, it is expected to play more important roles in hepatocellular carcinoma targeted imaging, evaluation of bile duct perfusion, distal choledochal imaging and so on. The authors review the progress in the application of NIR-Ⅱ fluorescence imaging in hepatobiliary surgery.
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Pyogenic liver abscess(PLC) is a common infectious disease in the hepatobiliary system. For people with high risk factors such as diabetes mellitus and cardiovascular diseases, the presence of this disease should be warned when clinical manifestations including fever and abdominal pain occur. In recent years, great changes were observed in the characteristics, high risk factors, pathogenic bacteria and treatment strategy of PLC. The most common pathogens of liver abscess are so-called Gram-negative bacteria such as Escherichia coli and Klebsiella pneumoniae and Klebsiella. pneumoniae has replaced Escherichia coli as the most common microorganism isolated from PLA infections. As liver abscesses caused by Klebsiella. pneumoniae can produce invasion syndromes, including endophthalmitis, central nervous system infection, other extrahepatic infections. The most common laboratory abnormality among included items was increased C-reactive protein and white blood cell levels. Pyogenic liver abscess can be diagnosed differently via ultrasound or CT scan from other liver lesions. Once recognized, percutaneous drainage guided by ultrasound and CT and antibiotic treatment are the mainstay of management for PLA. The aim of this article is to review clinical characteristics and treatment changing in recent years.
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Eukaryotes inhibit the translation of mRNA under stress conditions and form particles-stress granules (stress granules). At present, stress granules have been proved to be related to the occurrence and development of a variety of diseases, including tumors. The production of stress granules is promoted by microenvironment such as hypoxia and hyperactive oxygen in tumor cells, while stress granules-related proteins such as G3BP1, RACK1, YB-1 and mammalian target of rapamycin (mTOR) can promote the occurrence and metastasis of tumors, but the mechanism is not yet clear. In addition, studies have linked the formation of stress granules to the survival of tumor cells during chemotherapy, and believe that stress granules play a role in the treatment of tumors by different anti-tumor drugs. This review introduces the biological characteristics of stress granules and their relationship with tumors.
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Hepatic cellular carcinoma is the third most common cause of cancer deaths in China.Partial hepatectomy is still the most effective treatment for hepatic cellular carcinoma.The liver is an organ with strong regenerative ability,and its regenerative mechanism is very complex.Majority of patients with hepatic cellular carcinoma are accompanied by cirrhosis,and cirrhosis is an important factor affecting the regeneration of the remaining liver after surgery.Liver regeneration is obviously impaired under this condition.However,the anti-liver fibrosis mechanisms behind these processes have not been completely elucidated,the current treatment of fibrosis is merely supportive care,and thus further definition of the antiliver fibrosis related factors such as keratinocyte growth factor,hepatocyte growth factor,milk fat globule epidermal growth factor 8,collagen-binding vascular endothelial growth factor,ex vivo expansion of circulating CD34+ cells has far-reaching significance for improving their prognosis.This article mainly introduces some relevant factors associated with anti liver fibrosis,for later use of single factor or a combination of multifarious factors to resist liver fibrosis,to provide reference for improving the ability of remained liver regeneration after partial hepatectomy.
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To improve standardization and consensus regarding interpreting,and reporting CT and MRI scans of the liver in patients with high-risk HCC,Liver Imaging Reporting and Data System (LI-RADS) was launched in 2011 and subsequently modified in 2013 and 2014,respectively.Major diagnostic imaging features for HCC are hyper-enhancement in the arterial phase,rapid dissection in the portal vein phase and balance phase,capsule presence and appearance,interval threshold tumor growth and tumor diameter.LI-RADS categorizes nodules recognized at CT or MRI as LR-1 (definitively benign),LI-RADS is a system of standardized criteria for interpreting liver CT and MR images of patients at risk of hepatocellular carcinoma in higher interobserver reliability and faster categorization while maintaining diagnostic accuracy.LR-2 (probably benign),LR-3 (intermediate probability of being HCC),LR-4 (probably HCC) and LR-5 (definitively HCC).According to diagnostic classification,different options for treatment recommendations are adopted by surgeons including continue standard surveillance,regular follow-up,alternative imaging method,multidisciplinary discussion,liver resection or transplantation.LI-RADS is a system of standardized criteria for interpreting liver CT and MR images of patients at risk of hepatocellular carcinoma in higher interobserver reliability and faster categorization while maintaining diagnostic accuracy.
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The surgical treatment of hepatocellular carcinoma have advanced greatly in recent years: associating liver partition and portal vein ligation for staged hepatectomy can bring hope and relief to patients with advanced liver cancer and less future liver remnant; the application range of laparoscopic hepatectomy and robotic hepatectomy were amplified; hepatectomy following anatomic or non-anatomic direction should be decided by particular situations; the precise preoperative assessment of liver reserve function ensured the success of extended hepatectomy; the further discussion of United Network for Organ Sharing criteria for liver transplantation made the appearance of University of California at San Francisco, Up-to-seven and Hangzhou criteria; bridge therapy can decrease tumor progression and the dropout rate from the liver transplantation waiting list; downstaging treatment is used in selected patients with more advanced liver cancer who are beyond the accepted transplant criteria to acquire the chance of liver transplantation and increase survival rates.
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Humanos , Carcinoma Hepatocelular , Cirugía General , Hepatectomía , Ligadura , Neoplasias Hepáticas , Cirugía General , Trasplante de Hígado , Vena Porta , Cirugía General , Tasa de Supervivencia , Resultado del TratamientoRESUMEN
Objective To explore the hotspots and developing direction of splenic surgery in China.Methods The biliometric analysis was adopted.Database including Chinese Database of Literature on Biomedicine were searched with “脾,外科,移植”.The time for retrieving was from January 1984 to December 2013.Chinese articles on splenic surgery which were published by academic journals were retrieved,and data were analyzed and evaluated by 2 independent researchers,including published year,distribution of journals,key words,authors and publication type.The P-value was calculated according to P =2Ln(eE × Y),and Euler's number =0.577 2 and Y was maximum amount of published articles in each journal.Results (1) Published year:1 977 articles were retrieved.There were 168 articles from 1984 to 1993,and number of articles in every year was less than 30.There were 562 articles from 1994 to 2003 and increasing number of articles in every year,with a maximum number of 88.There were 1 247 articles from 2004 to 2013,and average number of articles in every year was 125,with a maximum number of 165 in 2009.(2) Distribution of journals:all the articles have been published in 489 journals,including 9 surgical journals in the core journal such as Chinese Journal of Hepatobiliary Surgery and 7 journals from Chinese Science Citation Database.The maximum number of published articles of each journal was 54,and literature number in the core journals P≈9.(3) Distribution of key words:occurrence frequencies of “脾破裂”and“脾切除术”were very high in 3 periods (from 1984 to 1993,from 1994 to 2003,from 2004 to 2013) and percentages of occurrence frequencies were respectively 9.524％,24.911％,51.163％ and 12.500％,19.217％,38.813％,showing an increasing trend.Occurrence frequencies of“回顾性研究”“手术后期间”“胰腺切除术”and“脾动脉”reached the top 20 of key words from 1994 to 2003 and then continued to increase from 2004 to 2013,and occurrence frequency of“回顾性研究”was significantly increased witha growth rate of 23.742％.The percentages of occurrence frequencies of“回顾性研究”“手术后期间”“胰腺切除术”and“脾动脉”were respectively 3.203％,8.185％,4.448％,3.559％ from 1994 to 2003 and 26.945％,16.279％,7.939％,6.496％ from 2004 to 2013.“创伤和损伤”and“腹腔镜”first appeared on the top 20 of key words from 2004 to 2013,with percentages of occurrence frequencies of 15.958％ and 11.307％.Occurrence frequencies of“胰腺”and“肝”were gradually increased in 3 periods,with the percentages of 2.976％,3.915％,10.906％ and l.786％,4.804％,6.496％.The percentage of occurrence frequency of“移植,自体”in 3 periods was respectively 15.476％,20.107％,8.821％.Conclusions The Chinese articles of splenic surgery are rising obviously in the past 30 years.The splenic injury and splenectomy have always been research hotspots in splenic surgery.The preservation of spleen function and minimal invasive surgery are the developing direction of splenic surgery.
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ObjectiveTo compare the efficacy of laparoscopic and open left lobectomy.MethodsThe clinical data of 92 patients who received left lobectomy at the First Affiliated Hospital of Harbin Medical University from May 2010 to June 2011 were retrospectively analyzed.Of the 92 patients,42 received laparoscopic left lobectomy (laparoscopic group ) and 50 received open left lobectomy (open group ). The advantages and disadvantages between laparoscopic and open left lobectomy were compared. All data were analyzed using the t test,chi-square test or by calculating the Fisher exact probability.ResultsTwenty-nine patients received left lateral lobectomy and 13 patients received left hemihepatectomy in the laparoscopic group. One patient was converted to the open group becaused of the injury of the middle hepatic vein.Thirty-three patients nnderwent left lateral lobectomy and 17 underwent left hemihepatectomy in the open group.The tumor-free resection margin of the laparoscopic group was ( 1.6 ± 0.6 ) cm,which was significantly longer than ( 1.2 ± 0.4 ) cm of the open group (t=3.81,P＜0.05).The volume of operative blood loss of the laparoscopic group was (158 ±89)ml,which was significantly smaller than (292 ± 172)ml of the open group (t =4.56,P ＜ 0.05 ).The time of postoperative pain control,time to bowel function recovery and duration of hospital stay were ( 1.2 ± 0.3 )days,(23 ± 4)hours,( 7.5 ± 2.8 ) days in the laparoscopic group,which were significantly shorter than ( 2.0 ± 1.1 ) days,(4.9 ± 7 ) hours,( 11.3 ± 4.2 ) days in the open group,respectively ( t =4.57,21.31,5.00,P ＜ 0.05 ).The levels of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) at postoperative day 1 were increased,while the increase of AST and ALT in the open group were greater than that in the laparoscopic group (t =6.73,5.03,P ＜0.05).The postoperative prothrombin time in the open group was significantly longer than that before operation (t =2.32,P ＜ 0.05 ).The incidence of postoperative complications and total hospital costs were 7％ (3/41) and (2.5 ±0.7) ×104 yuan in the laparoscopic group,which were lower than 8％ (4/50) and (2.6 ±0.6) × 104 yuan in the open group,but no significant difference was observed (t =0.74,P ＞0.05).One patient in the open group died of multi-organ dysfunction syndrome caused by acute hepatic failure.ConclusionLaparoscopic left lobectomy is safe and effective,and it has the advantages of small trauma,quick recovery of patients and significant overall efficacy when compared with open left lobectomy.
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ObjectiveTo explore the efficacy of an antibiotic ertapenem for the treatment of bacterial liver abscess. MethodThe clinical data of 134 hospitalized bacterial liver abscess patients were retrospectively analyzed to evaluate the clinical and bacteriological efficacy of ertapenem from March 2009-2011in our hospital. ResultFever was present in 122 (91％)cases,abdominal pain was complained in 70 (52.2％ ) cases and rigor in 66 (49.3％ ) cases.In 92(68.7％ ) cases the abscess was located in the right lobe of the liver.Leukocytosis and liver dysfunction were found in 73 cases(54.8％ ) and 84 cases (62.7％ ),respectively.Ultrasonography was the most effective diagnostic means for liver abscess.Fortyone cases(30.6％ )were treated conservatively with ertapenem and 82(61.2％ )were treated with ertapenem associated with percutaneous liver puncture aspiration and 11cases (8.2％ )were treated with ertapenem associated with surgery.The clinical success rate was respectively 89％,87.8％,90.9％.The average duration of medication and length of stay were respectively ( 7.0 ± 2.4 ) d and 14.2 d.Ninety-seven pathogens were isolated from samples and predominant strains were Klebsiella species.Bacterial eradication rate was 92.8％.The sensitivities of isolated bacteria to ertapenem were 94.8％.ConclusionsErtapenem administration is effective therapy for bacterial liver abscess.
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Mechanical stapling devices have been widely applied in the gastrointestinal surgery since the 1950s because of its advantages of easy manipulation,less time consumption and low incidence of postoperative complications.With modification of these devices and technical proficiency,mechanical staplers have been introduced into several surgical procedures in hepatopancreatobiliary surgery including pancreatoduodenectomy,hepatectomy,cholecystojejunostomy,gastroenterostomy,cystogastrostomy and enteroenterostomy.Currently,there are no guidelines or consensus in China concerning the use of mechanical stapling devices. Current advances in mechanical stapling devices and complications in the clinical practice are discussed in this article.
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ObjectiveTo compare the efficacy and safety of sequential intravenous moxifloxacin treatment against cefoperazone/sulbactam in patients with acute biliary tract infection. MethodsA prospective, randomized, non-blind, multi-centric study was performed to compare the efficacy and safety of moxifloxacin 400 mg Ⅳ once daily to cefoperazone-sulbactam (2 g q12 hours) and metronidazole 250 ml once daily to treat patients, from March- December 2009 in 13 hospitals, with acute biliary tract infection.The primary efficacy variable was clinical cure rate after the end of a 5 - 14 day treatment period,bacteriologic outcomes and adverse reaction effects were also determined.ResultsA total of 319 subjects were enrolled, 282 of whom were eligible for protocol efficacy analyses ( 138 moxifloxacin, 144 comparator).Demographic and baseline medical characteristics were similar between the 2 groups. Clinical success rates were 86.2％ for moxifloxacin and 84. 7％ for the comparator(P =0. 7192). Pathogens (55 moxifloxacin, 61 comparator) were isolated from bile or blood cultures and the predominant strains were E. coli, Klebsiella species and Enterococcus species. Bacterial eradication rates were 85.4％ ( 37 of 55 ) with moxifloxacin versus 82. 0％ (50 of 61 ) in the comparator group ( x2 = 0. 2568, P = 0. 6123 ). Both treatments were safe and well tolerated. ConclusionsE. coli, Klebsiella species and Enterococcus species were the most common bacteria isolated from bile or blood from patients with acute biliary tract infection. Moxifloxacin monotherapy has high clinical and bacteriological efficacies and safety for the treatment of acute biliary tract infection.