RESUMO
Objective:To determine the safety and efficacy of controlled first hepaticportal blood flow occlusion in hepatectomy.Methods:Patients who underwent hepatectomy from 1 September 2018 to 1 September 2020 at the Department of Hepatobiliary Surgery of the First Affiliated Hospital of Anhui Medical University were studied. There were 133 males and 70 females, with age of (52.9±19.2) years old. They were prospectively randomized into three groups: the intermittent Pringle’s maneuver group ( n=72), the controlled first hepaticportal blood flow occlusion group ( n=66) and the selective portal vein occlusion group ( n=65). The clinical data of these three groups before, during and after operation were analysed. Results:The amount of intraoperative bleeding in the selective portal vein occlusion group was significantly more than the intermittent Pringle’s maneuver group [(226.7±117.9) vs. (115.7±84.2) ml, P<0.05] and the controlled first hepaticportal blood flow occlusion group [(226.7±117.9) vs. (128.1±103.6) ml, P<0.05]. The total duration of operation in the selective portal vein occlusion group was significantly longer than the intermittent Pringle’s maneuver group [(173.6±51.7) vs. (128.4±36.5) min, P<0.05] and the controlled first hepaticportal blood flow occlusion group [(173.6±51.7) vs. (136.1±40.7) min, P<0.05]. The postoperative data showed the AST indexes on day 1 after surgery to be significantly different between the intermittent Pringle’s maneuver group with the controlled first hepaticportal blood flow occlusion group [(587.5±189.2) vs. (361.2±158.3) U/L, P<0.05], and the selective portal vein occlusion group [(587.5±189.2) vs. (358.2±162.7) U/L, P<0.05]. The ALT indexes on day 1 after surgery were significantly different between the intermittent Pringle’s maneuver group with the controlled first hepaticportal blood flow occlusion group [(609.4±172.5) vs. (414.8±162.2) U/L, P<0.05], and the selective portal vein occlusion group[(609.4±172.5) vs. (395.6±158.7) U/L, P<0.05]. The AST and ALT indexes on day 3 after surgery were significantly different between the intermittent Pringle’s maneuver group the controlled first hepaticportal blood flow occlusion group, and the selective portal vein occlusion group. Other liver functions, postoperative complications and recovery indexes showed no significantly differences among the three groups. Conclusions:All the three methods of hepatic blood flow occlusion were safe and efficacious. The controlled first hepaticportal blood flow occlusion method was simple to use and it provided some protective effect in alleviating hepatic ischemia reperfusion injury.
RESUMO
Objective:To investigate the epidemiological characteristics of classic human astrovirus (HAstV) among children under five years old with acute diarrhea, and to understand the role of HAstV in children acute diarrhea.Methods:A total of 1 010 fecal specimens were collected in 1 010 outpatients under five years old with acute diarrhea admitted to Children′s Hospital of Fudan University, Shanghai from January 2012 to December 2016. Reverse transcription polymerase chain reaction (PCR) or PCR was used for screening classic HAstV, group A rotavirus, norovirus and adenovirus. Genotypes of classic HAstV were determined by nucleotide sequencing and phylogenetic tree analysis.Results:The overall positive rate of classic HAstV was 2.7%(27/1 010). The detection rates of classic HAstV from 2012 to 2016 were 6.9%(10/144), 3.5%(5/144), 2.1%(3/144), 1.5%(4/265) and 1.6%(5/313), respectively. Almost 96.3%(26/27) of children infected with HAstV were 0 to 36 months of age. The prevalence of classic HAstV infections displayed a typical autumn/winter seasonality except in 2016. All the positive classic HAstV strains were genotyped as HAstV-1 with two lineages of HAstV-1a and HAstV-1b. Among them, the lineage of HAstV-1a was the predominant subtype (63.0%, 17/27). There were 77.8%(21/27) of the children with acute diarrhea only infected with classic HAstV, whereas for the remaining cases a variety of other enteric viruses were detected (three cases co-infected with HAstV and group A rotavirus, two cases co-infected with HAstV and adenovirus, and one case co-infected with HAstV, group A rotavirus and adenovirus).Conclusions:Children infected with HAstV are mainly less than 36 months of age. Although the genotype of classic HAstV detected in this study is single, but the lineages are in a state of dynamic change. Long-time and continuous monitor for the epidemiology of classic HAstV is needed to avoid outbreak of diarrhea in children.