Effect of hepatitis B virus infection on patients with hepatic alveolar echinococcoisis after surgical resection / 中华肝胆外科杂志

Objective:To investigate the effect of hepatitis B virus (HBV) infection in patients with hepatic alveolar echinococcoisis after surgical resection and determine the differences of liver function between patients with different HBV-DNA levels.Methods:Patients were selected from January 2014 to July 2018 in the Affiliated Hospital of Qinghai University. Twenty-eight patients with hepatitis B and hepatic alveolar echinococcoisis were included in the experimental group, and 20 patients with hepatic alveolar echinococcoisis but without hepatitis B virus were included in the control group. Based on HBV-DNA level, the experimental group was divided into low-level group (HBV-DNA level<200 IU/ml, n=6), intermediate-level group (HBV-DNA level 200-20 000 IU/ml, n=15) and high level group (HBV-DNA level>20 000 IU/ml, n=7). Comparison of complications and liver function after liver resection in two groups.Univariate and multivariate logistic regression were used to analyze the influential factors of postoperative complications in patients.Comparison of postoperative liver function indexes in patients with different HBV-DNA levels. Results:In the control group, postoperative total bilirubin 10.6(8.3, 16.9) μmol/L, direct bilirubin 5.3(3.4, 10.0) μmol/L, prothrombin time 13.6(13.0, 15.8)s, and the incidence of complications 25.0%(5/20), were better than the experimental group 12.6(8.4, 46.9) μmol/L, 6.7(3.1, 26.4) μmol/L, 15.4(13.5, 18.1)s, 78.6% (22/28), the differences were statistically significant significance (all P<0.05). Multivariate logistic analysis showed that patients with HBV infection ( OR=4.593, 95% CI: 1.128-18.708) and intraoperative blood loss ≥1 000 ml ( OR=2.200, 95% CI: 1.106-4.378) were the hepatic alveolar echinococcoisis independent risk factors for postoperative complications. There were no significant differences in total bilirubin and albumin between the three groups of patients with different HBV-DNA levels ( P>0.05). Conclusion:Patients with HBV and hepatic alveolar echinococcoisis have worse liver function and are more prone to complications after surgical resection, but there is no significant difference in liver function among patients with different HBV-DNA levels.

A nomogram prediction of bile leakage in patients undergoing cystic echinococcosis surgery / 中华肝胆外科杂志

Objective:To analyze the risk factors for bile leakage in patients undergoing cystic echinococcosis surgery to establish a nomogram model to predict the risk of bile leakage.Methods:The clinical data were retrospectively analyzed that 203 patients with cystic echinococcosis treated in Qinghai University Affiliated Hospital from January 2015 to October 2018. Logistic regression was used to screen out independent risk factors of biliary leakage in patients undergoing cystic hydatid surgery. Then the R software was used to establish a predictive nomogram model. Bootstrap method was used to validate the nomogram model and ROC curve was used to explore the predictive efficacy of the model in predicting the bile leakage.Results:There were 54 cases of biliary leakage in 203 patients with cystic echinococcosis, the incidence was 26.1%. ALP ( OR=11.193, 95% CI 5.066-24.731), GGT ( OR=2.728, 95% CI 1.246-5.975), cyst diameter ( OR=3.491, 95% CI 1.550-7.861), hilar cyst ( OR=2.503, 95% CI 1.176-5.329) were all independent risk factors for biliary leakage of cystic echinococcosis. The consistency index was 0.835 for predicting PPC risk, and the area was 0.823 (95% CI 0.754-0.892) under the curve for predicting the risk of cystic echinococcal bile leakage. Conclusions:ALP, GGT, cyst diameter and hepatic hilar cyst are independent risk factors for cystic echinococcal bile leakage. Nomogram model can evaluate the risk of cystic echinococcal bile leakage more intuitively, with potentially high clinical application value.

Influence of HBV DNA load on surgical outcome of hepatitis B-associated liver cancer / 临床肝胆病杂志

HBV infection is highly prevalent in China, and patients with a high HBV-DNA load for a long time may progress to liver cirrhosis, which may lead to liver cancer. At present, surgery is still the main method for the treatment of hepatitis B-related liver cancer. Many studies have shown that HBV DNA load is an important influencing factor for the recovery of liver function after surgery, postoperative complications, recurrence of liver cancer, and the success of liver transplantation in patients with hepatitis B-related liver cancer. Its mechanism may be associated with high HBV DNA load and HBV reactivation. Maintaining a low HBV DNA load by antiviral therapy can improve the prognosis of patients with hepatitis B-related liver cancer. This article reviews the influence of HBV DNA load before and after surgery on the surgical outcome of hepatitis B-related liver cancer, in order to provide a reference for research on the treatment of patients with liver cancer.