RESUMO
Objective@#To compare the clinical effects between laparoscopic cholecystectomy and choledochotomy versus traditional open cholecystectomy plus choledochotomy.@*Methods@#One hundred and sixty-eight elderly patients with gallbladder and choledocholithiasis were divided into a laparoscopy group(n=75, receiving laparoscopic cholecystectomy and choledochotomy)and an open abdominal group(n=93, undergoing traditional open cholecystectomy and common bile duct exploration). The surgical incision length, operation time, intraoperative blood loss, anal exhaust time, hospital stay and postoperative complications were compared between the two groups.@*Results@#The surgical incision length, operation time, intraoperative blood loss, anal exhaust time, hospital stay were lower in the laparoscopic group than in the open abdominal group(P<0.05). The incidence of postoperative complications was lower in the laparoscopic group than in the open group(P<0.05).@*Conclusions@#Laparoscopic cholecystectomy and choledochotomy can obviously improve the clinical efficacy and reduce complications in elderly patients with gallbladder and choledocholithiasis, and it is worthy of clinical application.
RESUMO
Objective To compare the clinical effects between laparoscopic cholecystectomy and choledochotomy versus traditional open cholecystectomy plus choledochotomy.Methods One hundred and sixty-eight elderly patients with gallbladder and choledocholithiasis were divided into a laparoscopy group(n=75,receiving laparoscopic cholecystectomy and choledochotomy)and an open abdominal group (n =93,undergoing traditional open cholecystectomy and common bile duct exploration).The surgical incision length,operation time,intraoperative blood loss,anal exhaust time,hospital stay and postoperative complications were compared between the two groups.Results The surgical incision length,operation time,intraoperative blood loss,anal exhaust time,hospital stay were lower in the laparoscopic group than in the open abdominal group (P ＜ 0.05).The incidence of postoperative complications was lower in the laparoscopic group than in the open group(P＜0.05).Conclusions Laparoscopic cholecystectomy and choledochotomy can obviously improve the clinical efficacy and reduce complications in elderly patients with gallbladder and choledocholithiasis,and it is worthy of clinical application.
RESUMO
Objective To analyze the clinical efficacy and outcomes of adult patients who underwent ABO-incompatible living donor liver transplantation.Methods The clinical data of 7 patients who underwent ABO-incompatible living donor liver transplantation at the Henan Provincial People's Hospital and Zhengzhou People's Hospital from January 2013 to December 2015 were analyzed retrospectively.Age,gender,primary disease,blood type antibody level,graft volume/standard liver volume (GV/SLV),postoperative complications and prognosis were analyzed.Results The recipients' average GV/SLV was 52.0％.There were 4 recipients who underwent splenectomy,including 3 patients who underwent the procedure concurrently,and one patient who underwent the procedure a few years before,the liver transplantation.Seven recipients were treated with plasmapheresis,Rituximab and Basiliximab.No patients experienced acute rejection during the perioperative period,and the 1-year survival rate was 85.7％ (6/7).Conclusion ABOincompatible liver transplantation in adult living donor can have favorable clinical outcomes using appropriate preoperative evaluation for recipients,optimized surgical procedures,pretransplant plasmapheresis,and perioperative Rituximab,Basiliximab injection and intravenous immunoglobulin administration.
RESUMO
Objective To evaluate the outcome of patients with alcoholic liver disease (ALD) after orthotopic liver transplantation (OLT) and to study the prognostic factors.Methods The data of 17 patients who underwent OLT for ALD from January 2010 to March 2013 were analyzed retrospectively.The data on age,gender,history of gastrointestinal bleeding,history of splenectomy,Child-Pugh score,Maddrey' s discriminant function and MELD score were evaluated using the Kaplan-Meier method for univariate analysis.The log-rank test was applied to compare the survival rates.Results The overall survival rate at 100 weeks in patients less than 55 years old was 90％ (9/10),while that in patients more than 55 years old was 28.57％ (2/7).There was a significant difference between the two groups (P ＜ 0.05).There were no statistically significant differences between female and male patients,between patients with or without a history of gastrointestinal bleeding or splenectomy (P ＞ 0.05).There was no significant difference on survival rates after liver transplantation between patients with Child-Pugh B and Child-Pugh C,patients with Maddrey' s scores ＜ 70 and ≥70,and patients with a MELD score ＜ 30 and ≥ 30 (P ＞ 0.05).Conclusions Better survival rates were observed in ALD patients who were ＜ 55 years old after liver transplantation.The Child-Pugh score,Maddrey' s discriminant function and MELD score were of no prognostic significance.These findings still need to be verified by prospective large-scale studies.
RESUMO
BACKGROUND:The incidence of intestinal necrosis during liver transplantation is low, and most of them abandon transplantation and thus leading to death. OBJECTIVE:To retrospectively analyze the reasons which result in smal intestinal necrosis during liver transplantation, and to explore the viable treatment options. METHODS:The clinical data of 207 patients were reviewed, two patients complicated with smal intestinal necrosis during liver transplantation. Case 1 underwent liver transplantation combined with necrotic smal bowel resection. Case 2 abandoned liver transplantation, and received conservative treatment. RESULTS AND CONCLUSION:Both of the two patients had preoperative portal system thrombosis. In Case 1, there was upper gastrointestinal bleeding before transplantation, and repeated application of hemostatic drugs could increase the thrombosis and thus resulting smal intestinal necrosis. At 10 days after liver transplantation, the patients complicated with intestinal fistula and were treated with fistulation. After fistulation, the patient suffered from abdominal cavity and lung infections. At 7 days after anti-infection treatment and immunosuppressant stopped, the infections were cured. At 40 days after fistulation, the intestinal fistula was healed and the patient was discharged after rehabilitation. After fol owed-up for 2 years, the patient was stil healthy living. The Case 2 suffered with mass ascites which lead to abdominal compartment syndrome, the intestinal venous disorders lead to extensive smal bowel necrosis. At 2 days after abandon the liver transplantation, the patient was dead because of multiple organ failure. The patients who waiting for liver transplantation had preoperative portal system thrombosis, abdominal pain and abdominal distention, should be pay attention to intestinal necrosis. Patients with smal bowel necrosis during liver transplantation can be cured with liver transplantation combined with necrotic smal bowel resection.
RESUMO
Objective To study the relationship between polymorphisms of NQO1 and hepatocellular carcinoma (HCC) in Zhengzhou and Guilin area.Methods The Zhengzhou group was a hospital-based case-control study which included 146 cases of HCC and 151 cases of controls with nontumor seen in the People's Hospital of Zhengzhou.The Guilin group was a hospital-based case-control study which included 136 cases of HCC and 123 cases of controls with non-tumor seen in the Guilin Medical University Hospital.NQO1 polymorphisms were determined by polymerase chain restriction with TaqMan MGB probe.All data were analyzed by conditional logistic multiple factor regression analysis with SPSS 18.0 statistical package.Results The frequency with mutation allele (T) in the case group was significantly different between the Zhengzhou and Guilin groups (x2=23.307,P＜ 0.05).The odds risk of NQO1 mutation homozygote and mutation heterozygote to wild homozygote were significantly increased (OR=2.476,CI:1.518～4.038).Conclusions NQO1 mutation genotype is the predisposing gene with relatively different susceptibility to the development of HCC in the Zhengzhou and Guilin regions.There are synergistic effects between the NQO1 predisposing genotype,drinking and smoking.