Strategy of long-term anti-HBV treatment after liver transplantation for patients with HBV related liver disease / 中华普通外科杂志

Objective:To evaluate the risk of HBV recurrence after liver transplantation in patients with end-stage hepatitis B related liver disease, and to explore the indications for antiviral therapy withdrawal.Methods:The data of HBV DNA, cccDNA in liver puncture tissues and peripheral blood in 31 patients after liver transplantation was retrospectively analyzed.Results:Among the 31 patients, 15 (48%) had detectable and quantified HBV DNA in liver biopsy tissue, while their HBV related serological indicators were negative, suggesting an occult HBV infection in some patients. The study found 15 out of 19 cases who were taking Entecavir were cccDNA negative (78.9%), compared to 5 out of 12 cases (41.6%) in Lamivudine regiment ( P=0.03). Conclusions:Hidden HBV infection can be detected by amplifying cccDNA and HBV DNA in liver puncture tissue by using ddPCR. Entecavir is superior to lamivudine in the clearance of cccDNA.

ARID1A expression in intrahepatic cholangiocarcinoma and its relationship with tumor recurrence,metastasis and tumor-specific immunomarkers / 中华普通外科杂志

Objective:To investigate the expression level between AT-Rich Interaction Domain 1A(ARID1A) in intrahepatic cholangiocarcinoma (ICC) and the correlation with tumor microenvironment.Methods:The clinicopathological and survival data of 110 ICC patients undergoing radical hepatectomy in Peking University People's Hospital from Jan 2015 to May 2021 were retrospectively analyzed. Immunohistochemical staining was used to detect the expressions of ARID1A , programmed cell death 1 ligand 1( PD-L1) in tumor tissues , programmed cell death protein 1(PD-1) and cluster of differentiation 8(CD8) in the microenvironment. The relationship between ARID1A expression and PD-L1, PD-1, CD8 protein expression was analyzed.Results:Twenty seven patients did not express ARID1A, absence of ARID1A was associated with high PD-L1, PD-1 and CD8 expression ( P<0.05). Multivariate analysis showed ARID1A expression, preoperative CEA level,preoperative CA19-9 level, lymph node metastasis and tumor number were independent risk factors. Conclusion:Absent expression of ARID1A suggests poor prognosis of ICC patients, high expression of PD-L1,PD-1 and CD8 protein in ICC tumor microenvironment with ARID1A-deficient expression suggests a possible prognosis benefit by using anti-PD-1, anti-PD-L1 and other immunotherapy regimens.

Liver transplantation for liver cancer in the era of immunotherapy / 临床肝胆病杂志

Most patients with liver cancer in China cannot get radical surgical treatment at the time of diagnosis, and the breakthrough of immunotherapy for liver cancer in recent years has brought new hope to the patients with advanced liver cancer. In the field of liver transplantation for liver cancer, immunotherapy has attracted much attention because of its dual role in tumor immunity and transplantation immunity. There are also innovative applications of immunotherapy in preoperative down-staging treatment and the treatment of tumor recurrence after transplantation. In the era of immunotherapy, how to apply the thinking of transplant oncology to benefit liver cancer patients undergoing liver transplantation is a brand-new topic, and this requires multidisciplinary collaboration in clinical practice to explore the best treatment strategies for liver cancer patients undergoing liver transplantation and finally improve the prognosis of patients with advanced liver cancer.

Surgery for cirrhotic portal hypertension in the era of liver transplantation / 中华肝胆外科杂志

Liver transplantation is the only curative treatment for cirrhotic portal hypertension, especially for the patients with end-stage liver failure. In the era of liver transplantation, when drugs, endoscopy and interventional treatments fail, surgery (not including liver transplantation) is an irreplaceable treatment option for esophagogastric variceal bleeding, which should be individualized, in order not to increase the risk and difficulty of liver transplantation in the future.

Clinical characteristics and prognosis of 26 cases of combined hepatocellular carcinoma and cholangiocarcinoma / 中华普通外科杂志

Objective To investigate the clinical manifestations,imaging features and prognosis of mixed liver cancer.Methods The clinical and pathological data of 26 patients with combined hepatocellular carcinoma and cholangiocarcinoma (cHCC-CC) pathologically diagnosed after liver resection were retrospectively analyzed,and the relevant factors affecting the prognosis were statistically analyzed.Results Of the 26 cHCC-CC patients,19 were on background of chronic viral hepatitis,including 17 chronic viral hepatitis B and 2 chronic viral hepatitis C.There were 18 cases having AFP≥20ng/ml,9 cases were with carbohydrate antigen 199 (CA199) ≥ 37U/ml,and 5 cases with carcinoembryonic antigen (CEA) ≥5ng/ml.The 1-,3-,and 5-year postoperative survival rates were 68.8％,34.4％,and 17.4％.Multivariate analysis showed that serum CA199≥37U/ ml(x2 =5.687,P =0.019) was an independent risk factor for patients' survival.Conclusion Most cHCC-CC is found in association with chronic viral hepatitis.Serum CA199 ≥37U/ml is an independent risk factor affecting patients survival.

Diagnosis and treatment of rare types of hepatic benign space occupying lesions / 中华普通外科杂志

Objective To summarize the experience of diagnosis and treatment of rare type of hepatic benign space occupying lesions.Methods The clinical data of 113 patients with rare type of hepatic benign space occupying lesions confirmed by surgery and pathology from Jan 2009 to Dec 2018 were retrospectively analyzed.Results There were 51 males and 62 females,age ranging from 12 to 83 years,with an average of 44.3 years.91.2％ of the 113 cases were single lesions and 8.8％ were multiple lesions.Surgical methods included hepatectomy in 98 cases,ablation therapy in 12 cases and hepatectomy combined with ablation in 3 cases.There were 21 types of pathology in 113 patients.The top five types were focal nodular hyperplasia (30 cases),hepatocellular adenoma (16 cases),dysplasia nodules (14 cases),perivascular epithelioid cell tumors (12 cases),and mucinous cystic neoplasms (11 cases),accounting for 73.5％ cases.All the patients were alive in the follow-up period ranging from 6 to 120 months.Conclusion Preoperative diagnosis of rare benign space-occupying lesions of the liver is very difficult.Preoperative MRI is helpful for diagnosis.Conservative treatment or follow-up observation can be considered for the type malignancy have never been reported.For the borderline types or those with difficulty in definite diagnosis,surgical removal is recommended.

Roux-en-Y hilar-jejunum anastomosis for biliary tract reconstruction after radical resection of hilar cholangiocarcinoma / 中华普通外科杂志

Objective To investigate the effect of Roux-en-Y hilar-jejunum anastomosis in surgical resection of hilar cholangiocarcinoma.Methods The clinical data of 31 patients with hilar cholangiocarcinoma admitted from Feb 2009 to Feb 2017 who underwent Roux-en-Y hilar-jejunum anastomosis after resection were retrospectively analyzed.Results According to Bismuth-Corlette classification there were 6 cases of Ⅲ a,6 cases of Ⅲ b and 19 cases of type Ⅳ.These patients all successfully underwent Roux-en-Y hilar-jejunum anastomosis,with intraoperative blood loss of 50-4 000 ml [on average of (1 146 ± 1 082) ml].The average operation time was (346 ± 118) min,and the average hilar-jejunum anastomosis time was (35 ± 13) min.The average postoperative hospital stay was (20 ± 11)days.There were 25 cases of R0 resection (80.6％).The postoperative complication rate was 25.8％(8/31).The overall median survival time was 21 months,and the 1-,3-,and 5-year survival rates were 68.8％,14.6％ and 3.6％,respectively.During the follow-up period,7 cases of reflux cholangitis,5 cases of biliary anastomotic stenosis,and 1 case of adhesive intestinal obstruction were found.Conclusion The hilar-jejunum anastomosis is simple,safe,widely applicable prcedure,which is easy to perform.

Complications in patients surviving over ten years after liver transplantation / 中华全科医师杂志

Objective To analyze the complicationsin patients surviving over ten years after liver transplantation.MethodsTotal 397 patients underwent liver transplantation from May 2000 to May 2008 at Department of Hepatobiliary Surgery,Peking University People's Hospital,among whom 217 patients survived for ≥10years;after 12 cases with incomplete data were excluded,205 cases were enrolled in the study.The complications of patients after liver transplantation were analyzed.Results The survival rate of patients over 10 years after liver transplantation was 51.6％ (205/397).In 205 patients surviving ≥10years after liver transplantation,the incidence of de novo neoplasms was 3.9％ (n=8);the prevalence of hyperuricemia,obesity,hyperlipidemia,metabolic syndrome,hypertension,and diabetes was 54.1％ (n=111),52.2％ (n=107),48.3％ (n=99),46.8％ (n=96),42.9％ (n=88),and 18.5％ (n=38),respectively.The recurrence rate of hepatitis B and the incidence of newly infected hepatitis B were 2.0％ (n=4) and 1.0％ (n=2),respectively.The incidence of cardiovascular and cerebrovascular events,renal insufficiency and biliary complications were 2.0％ (n=4),4.9％ (n=10) and 12.2％ (n=25),respectively.Fourteen patients dies 10 years after liver transplantation,the causes of death were cancer (n=4),biliary complications (n=4),recurrence of hepatitis B (n=2),cardio-cerebrovascular disease (n=2),renal insufficiency (n=1),and secondary liver transplantation (n=1).Conclusion Liver transplantation may prolong survival of patients with terminal liver diseases.The neoplasms,metabolic diseases,cardiovascular and cerebrovascular diseases,hepatitis B recurrence and chronic renal damage would affect the long-term survival of patients after liver transplantation.

Diagnosis and treatment of upper gastrointestinal hemorrhage caused by pancreatic segmental portal hypertension / 中华普通外科杂志

Objective To investigate the diagnosis and treatment of upper gastrointestinal hemorrhage caused by pancreatic segmental portal hypertension.Methods The clinical diagnosis and follow-up data of 13 patients with upper gastrointestinal hemorrhage caused by pancreatic segmental portal hypertension from Jan 2010 to Dec 2017 were retrospectively analyzed.Results Of the 13 patients,5 had pancreatic pseudocysts and 8 had chronic pancreatitis.All of them had a history of hematemesis or (and) tarry feces,and 2 of them had a history of hemorrhagic shock.13 patients had isolated gastric varices,and 5 of them had varicose veins in the lower esophagus.13 patients had splenomegaly and hypersplenism,and all patients underwent splenectomy.All patients were followed up,and the varicose veins were significantly improved or disappeared.During 1 year to 8 years of follow-up,there was no rebleeding.Conclusion Splenectomy cures upper gastrointestinal hemorrhage caused by rupture of the varicose veins in patients of pancreatic segmental portal hypertension.Preoperative interventional spleen artery embolization can reduce the difficulty of spleen resection.

The relationship between cholecystolithiasis or cholecystectomy and the risk of colorectal cancer: a Meta-analysis / 中华肝胆外科杂志

Objective To analyze the correlations between cholecystolithiasis or cholecystectomy and the risk of colorectal cancer,and make a brief summary combining with the present study.Methods Qualified studies about the correlations between cholecystolithiasis or cholecystectomy and the risk of colorectal cancer published in English and Chinese before April 2018 were retrieved from PubMed,Cochrane Library,China National Knowledge Infrastructure(CNKI),Wan Fang Data,and VIP.Case-control and cohort studies were selected according to the inclusion and exclusion criteria and assessed by the Newcastle-Ottowa Scale,then we chose the high-quality literature to extract the data and analyze those data by RevMan 5.3software.Publication bias was analyzed by Stata 12.1 software.Results A total of 28 articles were finally included in the systematic review,including 23 case-control studies and 5 cohort studies.The results showed that there is a significant relationship between cholecystolithiasis and the risk of colorectal cancer (OR =1.70,95 ％ CI:1.39 ～ 2.08,P ＜ 0.05)、colon cancer (OR =1.74,95 ％ CI:1.36 ～ 2.23,P ＜ 0.05)、rectal cancer (OR =1.35,95 ％ CI:1.02 ～ 1.80,P ＜ 0.05).The results showed a risk of colorectal cancer (OR =1.31,95 ％ CI:1.14 ～ 1.51,P ＜ 0.05) and colon cancer (OR =1.20,95％ CI:1.05 ～ 1.36,P ＜ 0.05)after cholecystectomy,but the risk is significantly less than the risk in patients with gallstone.And there is no relevance between cholecystectomy and the risk of rectal cancer(OR =0.89,95％ CI:0.73 ～ 1.08,P ＞0.05).Conclusion There is a positive association between cholecystolithiasis and colorectal cancer,but cholecystectomy itself may be not the risk of rectal cancer.

Combined caudate lobectomy radical resection and lymph node dissection for hilar cholangiocarcinoma / 中华普通外科杂志

Objective To investigate the clinical efficacy and prognostic factors for combined caudate lobectomy radical resection plus broad lymph node dissection in patients of hilar cholangiocarcinoma.Methods The clinical data and follow-up results of patients with hilar cholangiocarcinoma surgically treated from Feb 2008 to Feb 2017 were retrospectively analyzed.Result The R0 resection rate[72.2％ (13/18) vs 43.9％ (18/41)],operation time [(433 ± 136) min vs (302 ± 122) min],intraoperative blood loss [(1 789 ± 1 091) ml vs (776 ± 755) ml] and postoperative complication rate [66.7％ (12/18) vs 36.6％ (15/41)]were significantly higher in the hepatic lobe combined with caudate lobe resection group than that without caudate lobe resection group (P ＜ 0.05).The median survival time of patients with enlarged lymph node dissection was longer than that of patients with regional lymph node dissection (33 months vs 13 months,P ＜0.05).Univariate and multivariate analysis showed that the preoperative serum CA199 level ＞ 1 000 U/ml,the degree of microscopic margin and tumor TNM stage were significantly correlated with the prognosis of the patients (P ＜ 0.05).Conclusion Combined with caudate lobe resection can improve R0 resection rate.Targeted lymph node dissection helps prolong survival.The degree of microscopic margin,preoperative CA199 and TNM staging are independent risk factors for the prognosis of patients with hilar cholangiocarcinoma.

The relationship between cholecystolithiasis or cholecystectomy and the risk of colorectal cancer: a Meta-analysis / 中华肝胆外科杂志

Objective@#To analyze the correlations between cholecystolithiasis or cholecystectomy and the risk of colorectal cancer, and make a brief summary combining with the present study.@*Methods@#Qualified studies about the correlations between cholecystolithiasis or cholecystectomy and the risk of colorectal cancer published in English and Chinese before April 2018 were retrieved from PubMed, Cochrane Library, China National Knowledge Infrastructure(CNKI), Wan Fang Data, and VIP. Case-control and cohort studies were selected according to the inclusion and exclusion criteria and assessed by the Newcastle-Ottowa Scale, then we chose the high-quality literature to extract the data and analyze those data by RevMan 5.3 software. Publication bias was analyzed by Stata 12.1 software.@*Results@#A total of 28 articles were finally included in the systematic review, including 23 case-control studies and 5 cohort studies. The results showed that there is a significant relationship between cholecystolithiasis and the risk of colorectal cancer(OR=1.70, 95%CI: 1.39~2.08, P<0.05)、colon cancer(OR=1.74, 95%CI: 1.36~2.23, P<0.05)、rectal cancer (OR=1.35, 95%CI: 1.02~1.80, P<0.05). The results showed a risk of colorectal cancer(OR=1.31, 95%CI: 1.14~1.51, P<0.05) and colon cancer (OR=1.20, 95%CI: 1.05~1.36, P<0.05) after cholecystectomy, but the risk is significantly less than the risk in patients with gallstone. And there is no relevance between cholecystectomy and the risk of rectal cancer(OR=0.89, 95%CI: 0.73~1.08, P>0.05).@*Conclusion@#There is a positive association between cholecystolithiasis and colorectal cancer, but cholecystectomy itself may be not the risk of rectal cancer.

Value of the preoperative Child-Pugh score and albumin-bilirubin score predicting posthepatectomy liver failure and prognosis of patients with hepatocellular carcinoma / 中华消化外科杂志

Objective To investigate the value of the preoperative Child-Pugh score and albuminbilirubin (ALBI) score predicting posthepatectomy liver failure (PHLF) and prognosis of patients with hepatocellular carcinona (HCC).Methods The retrospective cohort study was conducted.The clinical data of 226 HCC patients who were admitted into the People's Hospital of Peking University between January 2010 and October 2014 were collected.After preoperative related examinations,feasibility and extent of liver resection were discussed according to patients' conditions by muhidisciplinary team,and then surgery was performed.Observation indicators:(1) surgical situations;(2) factors analysis affecting PHLF of HCC patients;(3) receiver operating characteristic (ROC) curve analysis of Child-Pugh and ALBI scores predicting PHLF;(4) follow-up and survival situations;(5) prognosis analysis of HCC patients after hepatectomy.Follow-up using outpatient examination and telephone interview was performed to detect postoperative survival up to August 2016.Measurement data with normal distribution were represented as-±s.Measurement data with skewed distribution were described as M (P25,P75).The survival curve was drawn by the Kaplan-Meier method,and the Log-rank test was used for survival analysis.The influencing factors of PHLF were analyzed using the logistic regression model.The prognostic factors were analyzed by the COX regression model.ROC analysis was used for predictive value of Child-Pugh and ALBI scores.Results (1) Surgical situations:226 patients underwent successful surgery,including 171 receiving localized liver resection (＜ 3 Couinaud hepatic segments resection) and 55 receiving extensive liver resection (≥ 3 Couinaud hepatic segments resection).Volume of intraoperative blood loss of 226 patients was 1-22 550 mL,with a median of 800 mL.Of 226 patients,89,9,4,4,3 and 1 were complicated with liver failure,pulmonary infection,bile leakage,gastrointestinal henorrhage,incision infection and infectious shock,respectively,they were cured and discharged from hospital by life-sustaining treatment and symptomatic treatment.Duration of hospital stay was 2-49 days,with a median of 12 days.(2) Factors analysis affecting PHLF of HCC patients:results of univariate analysis showed that gender,total bilirubin (TBil),albumin (Alb),prothrombin time (PT),international normalized ratio (INR),platelet (PLT),peritoneal effusion,volume of intraoperative blood loss,Child-Pugh score and ALBI score were related factors affecting PHLF of HCC patients [Odds ratio (OR) =O.490,1.077,0.763,1.613,26.342,0.990,2.458,5.052,2.875,34.570,95％ confidence interval (CI):0.248-0.971,1.030-1.127,0.699-0.833,1.248-2.087,2.722-254.936,0.985-0.995,1.386-4.361,2.467-10.347,1.807-4.576,11.674-102.376,P＜0.05].Child-Pugh score and ALBI score in the multivariate analysis were respectively analyzed using the logistic regression model for avoiding multicollinearity.Excluding TBil,Alb,PT and peritoneal effusion,logistic regression model of Child-Pugh score showed that PLT,volume of intraoperative blood loss and Child-Pugh score were independent factors affecting PHLF of HCC patients (OR=0.991,4.462,2.412,95％CI:0.986-0.996,2.090-9.527,1.479-3.934,P＜0.05).Excluding TBil and Alb,Logistic regression model of ALBI score showed that PLT,volume of intraoperative blood loss and ALBI score were independent factors affecting PHLF of HCC patients (OR=O.990,4.867,42.947,95％CI:O.984-0.995,2.088-11.346,12.409-148.637,P＜ 0.05).(3) ROC analysis of Child-Pugh and ALBI scores predicting PHLF:area under the ROC was respectively 0.652 (95％CI:0.577-0.727) in the Child-Pugh score and 0.801 (95％CI:0.741-0.861) in the ALBI score,with a statistically significant difference (Z=3.590,P＜0.05).The best critical value,sensitivity and specificity of PHLF that were predicted by ALBI score were-2.58,68.5％ and 86.9％,respectively.Further analysis showed that area under the ROC was respectively 0.642 (95％CI:0.554-0.731) in Child-Pugh score and 0.813 (95％CI:0.744-0.882) in ALBI score,excluding factors of extensive liver resection affecting PHLF,with a statistically significant difference (Z=3.407,P＜0.05).(4)Follow-up and survival situations:of 226 patients,217 were followed up for 1.3-79.5 months,with a median time of 29.5 months.During the follow-up,134 patients had survival and 92 died.(5) Prognosis analysis of HCC patients after hepatectomy:results of univariate analysis showed that Alb,PLT,alpha-fetoprotein (AFP),peritoneal effusion,tumor diameter,extent of resection,combined portal vein tumor thrombus (PVTT),combined vascular tumor thrombus and Child-Pugh score were related factors affecting prognosis of HCC patients [Hazard Ratio (HR)=0.954,1.003,2.958,1.698,1.155,1.785,2.326,3.001,1.324,95％CI:0.911-0.999,1.000-1.005,1.955-4.476,1.115-2.585,1.103-1.209,1.138-2.802,1.310-4.130,1.983-4.546,1.037-1.690,P ＜ 0.05].Excluding Alb and peritoneal effusion for avoiding multicollinearity,results of multivariate analysis showed that AFP,tumor diameter,combined vascular tumor thrombus and Child-Pugh score were independent factors affecting prognosis of HCC patients (HR =2.237,1.080,2.122,1.309,95％ CI:1.439-3.476,1.028-1.134,1.362-3.305,1.010-1.697,P＜0.05).Further analysis of Kaplan-Meier curve showed that median survival time in patients with grade A and B of Child-Pugh score were respectively 30.6 months and 25.2 months,with a statistically significant difference in survival (x2 =4.491,P＜0.05).The median survival time in patients with grade 1 and 2 of ALBI score were respectively 29.6 months and 31.0 months,with no statistically significant difference in survival (x2 =0.539,P＞0.05).Conclusion Preoperative ALBI score in predicting PHLF is superior to that of Child-Pugh score,but ALB1 score is not independent factor affecting prognosis of HCC patients.

Expression of ANLN in HCC and predictive value for long-term survival of patients after liver transplantation / 中华器官移植杂志

Objective To explore the expression of ANLN in HCC and study the clinical value of ANLN expression for HCC patients after liver transplantation.Methods The protein and mRNA expression of ANLN was detected by immunohistochemistry and RNA-seq from TCGA respectively.Chi-square test and t test were used for correlation analysis between ANLN expression and clinicopathological characteristics.The predictive value of ANLN expression for HCC patients after liver transplantation was estimated by log-rank test and cox proportional hazards regression model.Results The positive protein expression rate of ANLN in HCC detected by immunohistochemistry was 37.0％ (34/92),significantly higher than 6.5 ％ (6/92) in para-carcinoma non-tumor tissue (P＜0.001,x2 =25.044).Upregulation of ANLN mRNA expression in HCC was also detected by the analysis of RNA-seq from the TCGA (P ＜ 0.000 1).The positive ANLN protein expression was positively correlated with AFP＞400 ng/L (P＜0.001,x2 =11.952) and tumor size ＞8 cm (P =0.034,x2 =4.506).The independent risk factors for poorer 5-year survival of patients after liver transplantation were confirmed,including positive ANLN protein expression (P =0.031,OR =1.965,95 ％CI =1.064-3.630),tumor size ＞8 em (P =0.003,OR =2.841,95 ％CI =1.437-5.617),worse differentiation degree (P =0.001,OR =3.613,95％ CI =1.646-7.928),peritumor intravascular cancer emboli (P =0.041,OR =1.896,95％CI =1.028-3.498) and tumor necrosis or hemorrhage (P=0.010,OR=2.195,95 ％CI=1.211-3.979).Conclusion The expression of ANLN in HCC is upregulated and the positive protein expression indicates the poor prognosis for long-term survival of patients after liver transplantation.

Risk factors for pancreaticoduodenectomy in elderly patients / 中华普通外科杂志

Objective To investigate the complication and risk factors in elderly patients undergoing pancreaticoduodenectomy (PD).Methods From Jan 2005 to Dec 2016,358 consecutive patients undergoing PD were divided into ≥ 70 years group (98 cases) and ＜ 70 years group (260patients).Perioperative complications were compared and risk factors explored between the two groups.Results There were differences in coronary heart disease between the two groups in the preoperative medical comorbidities (P =0.008),and that of albumin,alanine aminotransferase,alkaline phosphatase and creatinine (all P ＜ 0.05).Perioperative mortality was higher in the elderly group than in the younger group (P =0.038),probably related to higher systemic complications (P =0.001).The independent risk factors influencing the postoperative medical complications were preoperative total bilirubin ≥ 171 μmol/L and intraoperative blood loss ≥ 1 000 ml.Conclusions Patients over 70 years old have a comparatively higher perioperative mortality rate after pancreaticoduodenectomy,which were probably derived from a higher postoperative vital organ dysfunction.

Therapeutic effect and safety of selective paraesophagogastric devascularization with or without splenectomy for treatment of esophagogastric variceal hemorrhage / 中华普通外科杂志

Objective To evaluate the therapeutic effect or safety of selective paraesophagogastric devascularization with or without splenectomy for treatment of esophagogastric variceal hemorrhage.Methods The clinical data of 70 patients with a history of esophagogastric variceal hemorrhage from 2009 to 2015 were analyzed.29 cases received spleen preserving paraesophagogastric devascularization and 41 were given portoazygous devascularization plus splenectomy.Results Postoperative portal pressure in spleenpreserving group decreased 14％,that in splenectomy group decreased 23％ (t =2.87,P =0.01).The average blood loss in without splenectomy group was (829 ± 720) ml in contrast to (1 400 ± 1 329) ml in splenectomy group (t =2.311,P =0.024).Postoperative WBC and platelet count in without splenectomy group were lower (t =-5.379,t =-4.924,all P ＜0.01).The postoperative complication rate (24％ vs.39％),and portal venous thrombosis (10％ vs.31％) were all in favour of splenectomy free group (x2 =0.036,P ＜0.05).The 1-and 3-year's recurrent bleeding rate were 4％ and 8％ compared with 4％ and 8％ (all P ＞ 0.05).Conclusion Paraesophagogastric devascularization without splenectomy has less blood loss during the surgery,lower rate of PVT and comparable effect against post-op recurrent bleeding in contrast to devascularization plus splenectomy.

Expression of tumor stem cell marker EpCAM in patients undergoing liver transplantation for hepatocellular carcinoma and its relationship with tumor recurrence and metastasis / 中华普通外科杂志

Objective To investigate the expression of EpCAM (epithelial cell adhesion molecule) in patients undergoing liver transplantation for hepatocellular carcinoma (HCC),and to explore the relationship between EpCAM expression level and HCC recurrence.Methods 83 HCC tissue samples were collected and analyzed retrospectively.EpCAM was detected by immunohistochemistry staining and the correlation between EpCAM and clinicopathological features,prognosis and recurrence were analyzed retrospectively from patients undergoing liver transplantation in Peking University People's Hospital from 2000 to 2010.Results Log-rank univariate survival analysis showed that the 5-year overall survival (41.2％ vs.73.3％,x2 =4.935,P =0.026) and 5-year disease free survival (41.2％ vs.73.3％,x2 =4.634,P =0.031)of HCC patients with high EpCAM expression level was significantly lower than that with low expression level of EpCAM.COX multivariate survival analysis showed patients with high EpCAM expression had a higher risk of recurrence(HR =2.860,95％ CI:1.012-8.083) and death (HR =2.909,95％ CI:1.030-8.217)after liver transplantation than those with low EpCAM expression,which was an independent predictor of 5-year overall survival and 5-year disease free survival recurrence (P =0.044).Furthermore,EpCAM expression level was highly related to tumor distant metastasis (P =0.01).Conclusion There was positive relation between high expression of EpCAM and high HCC recurrence after liver transplantation,suggesting that EpCAM can be a predictor for HCC recurrence and long-term survival of patients with HCC after transplantation.

Analysis of risk factors of tumor recurrence after liver transplantation for HBV-related hepatocellular carcinoma patients / 中华肝脏病杂志

Objective@#To explore the characteristics of tumor recurrence after liver transplantation in patients with hepatocellular carcinoma (HCC) associated with hepatitis B and to analyze the risk factors that influence the recurrence and prognosis.@*Methods@#The clinicopathological and survival data of 162 patients with hepatitis B –associated liver cancer who underwent liver transplantation in Peking University People’s Hospital from January 2002 to December 2016 were retrospectively analyzed. The postoperative survival rate (OS) and tumor free survival rate (DFS) was statistically analyzed by using the log-rank test. Univariate analysis was performed for various clinicopathological indicators, and the Cox proportional risk regression model was used for multivariate analysis.@*Results@#Univariate analysis showed that the age of the recipients (POS = 0.047, PDFS = 0.045), the maximum tumor size (P < 0.001, PDFS < 0.001), preoperative AFP levels (POS < 0.001, PDFS < 0.001), preoperative HBV-DNA levels (POS = 0.035, PDFS = 0.029), vein tumor thrombosis (POS < 0.001, PDFS < 0.001), and tumor differentiation degree (POS <0.001, PDFS < 0.001) were associated with overall prognosis and tumor recurrence. Multivariate analysis revealed that preoperative AFP levels (POS = 0.014, PDFS = 0.013), the maximum tumor size (POS < 0.001, PDFS = 0.001), vein tumor thrombosis (POS = 0.012, PDFS < 0.004), and tumor differentiation degree (POS = 0.004, PDFS = 0.009) were independent risk factors affecting overall prognosis and tumor recurrence.@*Conclusion@#The major prognostic factors linked to tumor biological characteristics after liver transplantation in HBV-related HCC patients are preoperative AFP levels, the largest tumor size, and vein tumor thrombosis and tumor differentiation degree.

Effects of infusion per unit of weight on emerging pulmonary complications in patients with cirrhosis after liver transplantation / 中华器官移植杂志

Objective To explore the effects of infusion per unit of weight on pulmonary edema and acute respiratory distress syndrome (ARDS).Methods The clinical data of 70 patients with cirrhosis who had accepted liver transplantation were retrospectively collected,including the age,height,weight,BMI,preoperative liver function,indexes during liver transplantation and the postoperative intake and output records in the first 5 days,and the emerging postoperative pulmonary complications (EPPCs) in the first 2 weeks were screened.The relationship between clinical data and new pulmonary edema and ARDS was analyzed.Results The incidence rate of NPPCs was 82.9 ％,in which the incidence rate of pleural effusion,atelectasis,pulmonary edema,ARDS and pulmonary infection was 60.0％,14.7％,8.6％,31.4％ and 10％ respectively.In the pulmonary edema group (n =6),the preoperative Child-Pugh score (9.3 ± 1.6),the total volume (2 667 ± 1 164) ml and the volume of unit weight (39.4 ± 19.0) ml/kg of plasma transfusion,the total volume (1 417 ± 376) ml of artificial colloid during operation,and the input of unit weight (53.2 ± 9.3 ml/kg) on the 3rd day after operation were significantly different from those (7.6 ± 1.9,1 753 ± 1 040 ml,24.2 ± 15.7 ml/ kg,2 347 ± 1 088 ml,and 44.6 ± 10.1 ml/kg) in the group (n =64) without pulmonary edema.Their P values in the order were 0.028,0.046,0.029,0.046,and 0.046.In the ARDS group (n =22),the plasma transfusion volume per unit of weight during operation (31.3 ± 20.4 ml/kg),the total balance volume equaled with the difference of input and output (1 504 ± 894 ml) and the balance volume per unit of weight (22.1 ± 13.1 ml/kg) on the first postoperative day and the total input volume per unit of weight on the third postoperative day (49.0 ± 10.1 ml/kg) were significantly distinguished with those (22.7 ± 13.4 ml/kg,910 ± 684 ml,12.7 ± 9.9 ml/kg,and 43.6 ± 9.9 ml/kg) in the group (n =48) without ARDS.The P values in the order were 0.045,0.003,0.001 and 0.042 respectively.Conclusion The incidence rate of NPPCs in the patients with cirrhosis receiving the liver transplantation is relatively higher.In order to reduce the risk of NPPCs,based on the hemodynamic stability during operation,the artificial colloids should be appropriately increased and excessive plasma transfusion reduced.In addition,the redundant input should be limited according to the weigh,in the first and third postoperative days.

Diagnosis and treatment of pancreatic arteriovenous malformation / 中华普通外科杂志

Objective To discuss the clinical presentation and management of pancreatic arteriovenous malformation.Methods The data pool for the analysis was collected from pancreatic arteriovenous malformation cases encountered by our hospital and sporadic case reports in the literature.Results A total of 95 cases were collected,including 83 males (87.37％) and 12 females (12.63％).The most common presenting symptom was epigastric pain (45.26％),followed by melena (17.89％),epigastric pain accompanied melena (14.74％) and haematemesis (8.42％).The most commonly associated complications were gastrointestinal bleeding (48.42％),pancreatitis (23.16％),duodenal ulcer (16.84％),portal hypertension (11.58％),pseudocyst (4.21％) and hemobilia (3.16％).Most cases were of singular lesion,located in the pancreatic head (61.05 ％) in 58 cases and in the pancreatic body-tail (20％) in 19 cases.Surgery (51.58％) was the most common treatment for pancreatic arteriovenous malformation cases,followed by transarterial embolization (17.89％),a combination of surgery and transarterial embolization (7.37％) and radiotherapy (4.21％).Watchful conservation was adopted in 20％ cases.Conclusions Pancreatic arteriovenous malformation occurs most commonly in males.Epigastric pain and gastrointestinal bleeding are the main clinical presentations.Surgical resection is indicated in symptomatic patients.