Laparoscopic splenectomy and azygoportal disconnection with intraoperative endoscopic variceal ligation in the prevention of postoperative recurrent bleeding / 中华普通外科杂志

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.

Application of vagus nerve-guided robotic splenectomy and azygoportal disconnection / 中华肝胆外科杂志

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.

The value of liver fibrosis serum markers in predicting esophagogastric variceal re-bleeding after laparoscopic splenectomy and azygoportal disconnection: a prospective study / 中华消化外科杂志

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.

Clinical efficacy of Da Vinci robotic assisted vagus nerve-preserving splenectomy and azygo-portal disconnection / 中华消化外科杂志

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.

Current status and progress in diagnosis and treatment of intrahepatic cholangiocarcinoma / 国际外科学杂志

Intrahepatic cholangiocarcinoma is a malignant tumor that originates from the bile duct above the confluence of left and right hepatic ducts, and is one of the commonest types of primary liver cancer. The early symptoms of intrahepatic cholangiocarcinoma are not obvious, most patients with non-specific abdominal symptoms in the advanced stage. CT, MRI, etc. are helpful for diagnosis, but most patients are in advanced stage when they are diagnosed. Hepatectomy is the main treatment, radiotherapy, chemotherapy are significant adjuvant treatment, and the overall prognosis is poor. This article reviews the current status and progress in diagnosis and treatment of intrahepatic cholangiocarcinoma.

Diagnosis and surgical treatment of intrahepatic cholangiocarcinoma / 国际外科学杂志

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.

Advances in the role of HECT-type E3 ubiquitin ligases in tumors / 国际外科学杂志

The occurrence and development of tumors is a complex process with multiple factors and multiple steps.Ubiquitination refers to a multi-step cascade of protein modification processes including ubiquitin,ubiquitin-activating enzyme,ubiquitin-binding enzyme,ubiquitin ligase and proteasome,which is important for maintaining eukaryotic homeostasis.mechanism.The E3 ubiquitin ligases family is an important component of the ubiquitin-proteasome system.This family includes many proteins that catalyze the ubiquitination of various protein substrates and promote their degradation by the proteasome system.Up to date,E3 ubiquitin ligases has played an important role in a variety of tumor cell biology processes,including cell proliferation,apoptosis and cycle regulation.HECT-type E3 ubiquitin ligases,one of the earliest studies of E3 ubiquitin ligases,is involved in the ubiquitination of transcriptional regulation of protein translation.This article reviews the recent research progress of HECT-type E3 ubiquitin ligases and its role in tumors.

Advances in the role of HECT-type E3 ubiquitin ligases in tumors / 国际外科学杂志

The occurrence and development of tumors is a complex process with multiple factors and multiple steps. Ubiquitination refers to a multi-step cascade of protein modification processes including ubiquitin, ubiquitin-activating enzyme, ubiquitin-binding enzyme, ubiquitin ligase and proteasome, which is important for maintaining eukaryotic homeostasis. mechanism. The E3 ubiquitin ligases family is an important component of the ubiquitin-proteasome system. This family includes many proteins that catalyze the ubiquitination of various protein substrates and promote their degradation by the proteasome system. Up to date, E3 ubiquitin ligases has played an important role in a variety of tumor cell biology processes, including cell proliferation, apoptosis and cycle regulation. HECT-type E3 ubiquitin ligases, one of the earliest studies of E3 ubiquitin ligases, is involved in the ubiquitination of transcriptional regulation of protein translation. This article reviews the recent research progress of HECT-type E3 ubiquitin ligases and its role in tumors.

Clinical efficacy of laparoscopic splenectomy combined with pericardial devascularization in the treatment of cirrhotic portal hypertension: a report of 425 cases / 中华消化外科杂志

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.

Clinical efficacy of laparoscopic splenectomy combined with pericardial devascularization in the treatment of cirrhotic portal hypertension: a report of 425 cases / 中华消化外科杂志

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.

Application and clinical significance of exosomes in hepatocellular carcinoma / 国际外科学杂志

Exosomes are produced by multivesicular bodies,they are extracellular lipid nano-vesicles carrying a variety off bioactive substances,containing lipids,RNA,DNA and proteins.Exosomes produced by tumor cells carry important information about tumor cells.Exosomes produced by hepatocellular carcinoma can participate in the formation of a microenvironment suitable for the proliferation,growth,invasion,metastasis and drug resistance of tumor cells.Meanwhile,circulating exosomes can be used as non-invasive biomarkers for early diagnosis of tumors and as drug delivery vectors for treatment.This review summarizes the characteristics of exosomes in the growth,invasion and metastasis,immune escape,and drug resistance biology of hepatocellular carcinoma,as well as the potential clinical application of early detection and treatment.

Glutamine 1 regulates the chemosensitivity of intrahepatic cholangiocarcinoma cells to 5-FU by targeting major vault protein / 中华普通外科杂志

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.

Research status and progress of the mechanism of intestinal microecology in thrombosis / 国际外科学杂志

Thrombosis is a multifactorial process with complex mechanisms and thrombosis-related diseases are extremely risky.At present, traditional or new types of anticoagulant drugs cannot completely reduce the risk of thrombosis, and these anticoagulant drugs have certain limitations and cannot meet clinical needs.In recent years, studies have found that intestinal microecology is closely related to many diseases, and The results show that it is involved in the regulation of thrombosis as the largest and most complex microecological system in the human body.In this review, we retrospect the current status and progress about the mechanism of intestinal microecology in thrombosis.Therefore, it provides a new idea and theoretical basis for the clinical application of intestinal microecology-based diagnosis and treatment in thrombosis-related diseases.

Research status and progress of the mechanism of intestinal microecology in thrombosis / 国际外科学杂志

Thrombosis is a multifactorial process with complex mechanisms and thrombosis-related diseases are extremely risky.At present,traditional or new types of anticoagulant drugs cannot completely reduce the risk of thrombosis,and these anticoagulant drugs have certain limitations and cannot meet clinical needs.In recent years,studies have found that intestinal microecology is closely related to many diseases,and The results show that it is involved in the regulation of thrombosis as the largest and most complex microecological system in the human body.In this review,we retrospect the current status and progress about the mechanism of intestinal microecology in thrombosis.Therefore,it provides a new idea and theoretical basis for the clinical application of intestinal microecology-based diagnosis and treatment in thrombosis-related diseases.

Relationship of CRIM1 and epithelial-mesenchymal transition in hepatocellular carcinoma / 国际外科学杂志

Objective To study the expression and the clinical significance of cysteine rich transmembrane BMP regulator 1 (CRIM1) in hepatocellular carcinoma (HCC) and discuss the association between CRIM1 and epithelial-mesenchymal transition (EMT).Methods The cases were came from the Subei People's Hospital Affilated Hospital of Yangzhou University from January 2013 to December 2017.CRIM1 and EMT related proteins (E-cadherin,Vimentin) in parts of HCC tissues and their paired peritumoural tissues were tested by Western blotting.The gray value was test by t test.The observation indicators:(1) expression of CRIM1 protein and EMT-related protein (E-cadherin,Vimentin) in liver cancer tissues and paracancerous tissues.(2) The relationship between CRIM1 protein expression and clinicopathological factors in patients with liver cancer.The expression ofCRIM1 in HCC tissues and adjacent tissues was detected by immunohistochemistry(IHC),which was divided into high expression group and low expression group according to the histochemical score,and the relation between the expression of CRIM1 and the clinicopathological factors of the patients was analyzed by chi-square test and Spearman correlation analysis.Finally,the relation between CRIM1 and overall survival of HCC patients was analyzed by Kaplan Meier Plotter database.Results The expression of CRIM1 in tumor and matched paratumor specimens were 0.15 ± 0.03,0.8 ± 0.04,and E-cadherinin tumor and matched paratumor specimenswere 0.20 ±0.05,0.56 ± 0.06,their expression in paracancerous tissues was higher than HCC tissues (t =14.21,4.69,P ＜ 0.05),while the expression of Vimentin in tumor and matched paratumor specimens were 0.74 ± 0.08,0.45 ± 0.06,the expression in tumor tissues were significantly higher than adjacent tissues (t =2.87,P ＜ 0.05).The expression of CRIM1 in HCC tissues was further verified by immunohistochemistry,which shows that CRIM1 was overexpressed in paracancerous tissues.In 114 patients,46 cases of CRIM1 protein were highly expressed in liver cancer tissues,and 68 cases of CRIM1 protein were low expressed.The expression of CRIM1 obviously related with the level of αt-fetoprotein (AFP),tumor size and symptom(r =-0.43,-0.34,-0.24,x2 =9.381,5.248,8.117,P ＜ 0.05).However,other clinicopathological features were not correlated with CRIM 1 expression,including age,tumour differentiation,tumor number.Finally,the overall survival was different between CRIM1 high expression and low expression according to the Kaplan Meier Plotter database.Conclusions The expression of CRIM1 is negatively correlated with the EMT process in HCC.CRIM1 might be a potential molecular marker for prognosis.

Sequential laparoscopic splenectomy plus azygoportal disconnection and postoperative endoscopic variceal ligation for portal hypertensive variceal bleeding / 中华普通外科杂志

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.

Enhanced recovery after surgery in radical resection of primary liver cancer / 中华普通外科杂志

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.

Vagus nerve-preserving laparoscopic splenectomy and azygoportal disconnection / 中华普通外科杂志

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.

Research progress on heterogeneity and epigenetics of hepatocellular CarCinoma / 国际外科学杂志

Tumor heterogeneity is one of the common phenomena of malignant tumors, and the heterogeneity of hepatocellular carcinoma is significant. Despite some treatments such as surgical resection, chemotherapy and radiotherapy in the primary phage of hepatocellular carcinoma have been used, the prognosis of patients remains poor, which is closely related to the heterogeneity of hepatocellular carcinoma. Therefore, exploring the heterogeneity of hepatocellular carcinoma has important clinical significance for improving the therapeutic effect of hepatocellular carcinoma. This article reviews the heterogeneity of hepatocellular carcinoma from an epigenetic perspective and explores the possible intrinsic epigenetic molecular mechanisms underlying the heterogeneity of hepatocellular carcinoma.

Influence of enhanced recovery after surgery in liver perioperative metabolism / 国际外科学杂志

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.