The diagnostic value of metabolomics in patients with acute heart failure / 中华急诊医学杂志

Objective:To investigate the difference of metabolomics between acute heart failure (AHF) patients and control. To find and validate new metabolic biomarkers.Methods:This was a single-center case-control study which included 89 acute heart failure patients admitted to the emergency department of Henan Provincial People's Hospital from January 2018 to June 2019. Eighty people without heart failure and diastolic dysfunction were enrolled as control group whose age and sex were matched to the study group. The fasting blood samples were collected from femoral arterial. Qualitative and quantitative analyses of plasma metabolites were performed in 2 groups by high performance liquid chromatography tandem mass spectrometry (UHPLC-MS), Orthogonal partial least squares-discriminant analysis (OPLS-DA) model and ROC curve method were applied.Results:Compared with the control group, we found that AHF group had higher likelihood to groups with coronary heart disease (37% vs. 7%, P<0.001), hypertension (58% vs. 28%, P<0.001), diabetes (33% vs. 18%, P=0.033), atrial fibrillation (24% vs. 4%, P<0.001), smoking history (42% vs. 18%, P=0.001), and that AHF group had higher creatinine level [(121.6 ± 78.4) vs. (69.0 ± 21.0), P<0.001], higher urea level [(11.5 ± 7.6) vs. (6.2 ± 2.0), P<0.001], higher heart rate [(92 ± 23) vs. (78 ± 14), P<0.001], hypoproteinemia [(32.4 ± 5 .2) vs. (40.4 ± 2.2), P<0.001], and significantly increased BNP level [(4 200 ± 5 229) vs. (100 ± 68), P<0.001], lower left ventricular ejection fraction[(45 ± 8) vs. (57 ± 6), P<0.001], low serum sodium level ( P<0.001). The metabolites of AHF group were significantly different from those of the control group. The metabolites involved amino acids, fatty acids, lipids, nucleosides and their derivatives. Adenine, N-acetyl-L-glutamic, pseudouridine and Gamma-Glutamylcysteine had certain diagnostic value for AHF comparing to control. The AUC were 0.995, 0.932, 0.920 and 0.900. And the AUC value for BNP diagnosis of AHF is 0.978. Conclusions:There were significant differences in metabolism between AHF group and control group including multiple substances. Adenine, N-acetyl-L-glutamic, pseudouridine and Gamma-Glutamylcysteine has similar diagnostic value compared with BNP for diagnosing AHF.

Risk factors leading to bile leakage after hepatectomy for hepatic alveolar echinococcosis / 中华普通外科杂志

Objective To analyze the risk factors of bile leakage after operation of hepatic alveolar echinococcosis.Methods The clinical manifestations,laboratory examination,imaging features and operative data of 137 patients with hepatic alveolar echinococcosis were retrospectively analyzed.The clinical characteristics of bile leakage group (n =22) and non-bile leakage group (n =115) were compared and analyzed,and the Logistic regression model was used to explore the related factors of bile leakage.Results Preoperative liver function (AST,ALP,LDH),blood loss,blood transfusion,hepatic hilum invasion,preoperative PTCD,and regular resection were significantly different between the two groups.Logistic regression analysis showed that regular hepatectomy was a protective factor to avoid bile leakage.Hepatic hilum invasion was a risk factor for bile leakage.Conclusion The invasion of the hepatic hilum is an important factor of postoperative bile leakage.Regular hepatectomy can reduce the incidence of postoperative bile leakage.

Prevention of bile leakage after laparoscopic primary suturing of common bile duct by transabdominal placement of nasal bile duct / 中华肝胆外科杂志

Objective To study the advantages of laparoscopic primary suturing of common bile duct plus transabdominal nasobiliary drainage in reducing the rate of bile leakage.Methods The clinical data of laparoscopic primary suturing of common bile duct with or without nasal bile duct drainage in Second People's Hospital of Chengdu were analyzed retrospectively.Results During laparoscopic common bile duct exploration,286 patients were treated by primary suturing without nasobiliary drainage (group without drainage),including 32 (11.2％) patients with bile leakage;350 patients were treated by primary suturing with transabdominal nasobihary drainage (group with drainage),including 11 (3.1％) patients with bile leakage.The incidences of bile leakage of the two groups were significantly different (P ＜ 0.05).When the diameter of the common bile duct was less than 11.0 mm,the incidence of bile leakage in the non-drainage group and the drainage group were 18.5％ (20/108) and 2.1％ (3/143),respectively.The incidence in the drainage group was significantly lower than that in the non-drainage group,and the difference was statistically significant (P ＜ 0.05).When the diameter of common bile duct was larger than 11.0 mm,there was no significant difference in the incidences of bile leakage between the two groups (P ＞ 0.05).Conclusions The choice after laparoscopic primary suturing of common bile duct between with or without nasobiliary drainage should be determined according to the diameter of common bile duct.When a common bile duct diameter of less than 11.0 mm,nasobiliary drainage is recommended to reduce the rate of bile leakage.

Diagnosis and treatment of hepatic angiomyolipoma: an analysis of 81 patients / 中华肝胆外科杂志

Objective To study the clinical manifestations,imaging and pathological features of,and to analyse our experience in diagnosing and treatment of,hepatic angiomyolipoma.Methods The clinical manifestations,imaging features,pathological morphology and immunohistochemical characteristics of hepatic angiomyolipoma from 81 patients were analyzed retrospectively.Results Twenty patients had clinical symptoms.A preoperative imaging diagnosis was made in 20 patients.Radical liver resection was performed in 61 patients,liver biopsy in 2 patients,and radiofrequency ablation after liver biopsy in 18 patients.All tumor cells expressed the markers of melanoma cells (HMB 45,mart-1) and smooth muscle cells.Recurrence of tumor was found in one patient after operation (1.2％,1/81).No patients died on follow-up.Conclusions The imaging manifestations of hepatic angiomyolipoma were varied,and the diagnosis depended on pathological findings and immunohistochemistry staining.The treatment strategy should be selected according to tumor size,location and clinical symptoms.Patients should be followed-up closely after surgery because of the malignant potential of hepatic angiomyolipoma.

Clinical efficacy of primary closure in laparoscopic common bile duct exploration (A report of 2 429 cases) / 中华消化外科杂志

Objective To investigate the clinical efficacy of primary closure in laparoscopic common bile duct exploration (LCBDE).Methods The retrospective cross-sectional study was conducted.The clinicopathological data of 2 429 patients who underwent primary closure in LCBDE in the Second Hospital of Chengdu City from March 1992 to December 2017 were collected.Patients underwent laparoscopic cholecystectomy (LC) + stone extraction using LCBDE or extracorporeal shock wave lithotripsy (ESWL),laparoscopic endoscopic sphincteropapillotomy (LEST) was performed selectively,then underwent laparoscopic endoscopic nasobiliary drainage (LENBD) or laparoscopic transabdominal antegrade-guide common bile duct stent implantation,finally underwent primary closure of common bile duct.Observation indicators:(1) surgical situations;(2) postoperative recovery;(3) postoperative short-term complications;(4) follow-up situation.Follow-up using outpatient examination and telephone interview was performed to observe long-term surgical complications once every 3 months up to 1 year postoperatively.Measurement data with normal distribution were represented as (x) ± s.Measurement data with skewed distribution were described as M (range).Results (1) Surgical situations:of 2 429 patients,2 251 underwent successful stone extraction using LCBDE,relief of the obstruction and primary closure of common bile duct,with depletion of stones;15 underwent stone extraction using conversion to open surgery,with depletion of stones;163 had residual stones or surgery-related complications.Of 2 429 patients,1 144,898,223,110 and 54 were respectively detected in grade N or 0,1,2,3 and 4 of laparoscopic distal of the common bile duct smooth classification (LDSC);599 underwent LEST,367 underwent LENBD,207 indwelled urinary catheter through cystic duct stump,125 underwent laparoscopic transabdominal antegrade-guide common bile duct stent implantation and 1 131 underwent primary closure in LCBDE only.Number of removing the stones,diameter of common bile duct,volume of intraoperative blood loss and operation time was (2.5±0.2)per case,(0.7±0.4)cm,(22.4±2.6)mL and (100±12) minutes,respectively.(2) Postoperative recovery:time of postoperative gastrointestinal function recovery,duration of hospital stay and treatment expenses were respectively (2.5±0.5) days,(7.3± 1.2) days and (2.7±0.3) × 104 yuan.Of 2 429 patients,367 removed nasobiliary catheter at 3-7 days postoperatively,207 removed urinary catheter at 3-6 weeks postoperatively,and 125 removed common bile duct stent through duodenoscope port at 1-4 months postoperatively.(3) Postoperative short-term complications:incidence of postoperative short-term complications in 2 429 patients was 6.711％ (163/2 429).① Ninety-four patients with bile leakage were cured after drainage and symptomatic and supportive treatment.② Of 29 patients with residual stones:25 with residual stones of common bile duct were cured by stone extraction using endoscopic sphincterotomy of duodenal papilla,and 4 with residual stones of intrahepatic bile duct didn't receive treatment.③ One patient died at 15 days after surgery for pancreatic cancer.④ Of 39 with postoperative other complications:2 with postoperative hemorrhage were cured by laparoscopic reoperation;12,19 and 3 were respectively complicated with postoperative inflammatory stenosis of duodenal papilla induced to short-term obstructive jaundice,mild acute pancreatitis and stress ulcer bleeding of upper digestive tract,and they were improved by endoscopy or non-operation treatment;2 with stenosis of bile duct didn't receive treatment;1 had a miss ligation at bending section of front zone of nasobiliary catheter,and ligation was removed by endoscopic retrograde cannulation of the pancreatic at 19 days postoperatively.(4) Follow-up situation:of 2 429 patients,1 749 were followed up for 3-12 months,with a median time of 6 months.During the follow-up,of 1 749 patients,2 had mild stenosis in the primary closure area of common bile duct incision and 1 had stenosis of duodenal papilla,they were not treated,and other patients didn't have related complications.Conclusion Controlling strictly the operative indication,primary closure of common bile duct in LCBDE is safe and feasible,with satisfactory clinical outcomes.

Primary closure of common bile duct after laparoscopic bile duct exploration: a report of 2 740 patients / 中华肝胆外科杂志

Objective To analyze our experience in primary closure of common bile duct after laparoscopic bile duct exploration.Methods From June 1992 to March 2018,2 740 patients underwent primary closure of common bile duct after laparoscopic common bile duct exploration in the Second People's Hospital of Chengdu.Results The operations were successfully carried out in 2 534 (92.4％) out of 2 740 patients,of whom 15 patients (0.6％) were converted to open common bile duct exploration.Bile leakage occurred in 113 patients (4.1％).Residual stones were found in 29 patients (1.1％).One patient (0.1％) who had a pancreatic carcinoma died on postoperation day 15.48 patients (1.8％) developed other complications.The total postoperative complication rate was 7.0％ (191/2 740).Conclusion In suitable patients,laparoscopic bile duct exploration with primary closure was feasible,safe and effective.

Endoscopic papillotomy and nasobiliary drainage during the course of common bile duct exploration: a report of 219 cases / 中华肝胆外科杂志

To explore the operation methods and indications of the duodenoscopic papillotomy (IEST) with endoscopic nasobiliary drainage (IENBD) for the treatment of duodenal papilla stenosis during the course of common bile duct operation.The clinical data of 219 cases of cholecystolithiasis with choledocholith and the stenosis of papillary underwent endoscopic sphincterotomy (IEST) plus endoscopic nasobiliary drainage (IENBD) in the Second People's Hospital of Chengdu were retrospectively analyzed.It was successful in 198 cases who had the gallbladder and common bile duct stones removed,and endoscopic papillary dissection was performed and the nasobiliary tube was successfully inserted.Nasobiliary drainage was successful in 186 cases (93.9％) of 198 cases.No liquid outflow was observed in nasobiliary drainage in 7 cases (3.5％).Nasal bile duct slipped early in 5 case (2.5％).Primary closure of bile duct incision was completed in 198 cases.It failed in 4 cases (2.0％) who had the bile leakage with primary closure of duct incision.Mild pancreatitis after operation occurred in 3 cases (1.5％).Nose bile duct ligation was performed in 1 case (0.5％).The overall postoperative complication rate was 4.0％ (8/198).IEST + IENBD in open laparotomy was successful in 21 cases.No perforation of intestine and bile duct,bleeding,severe pancreatitis and other complications and death were detected postoperatively in two groups.During the course of laparoscopy and open laparotomy,IEST + IENBD in treating cholecystolithiasis with choledocholith and the stenosis of papillary and primary closure of duct incision after the endoscopic nasobiliary drainage is safe and effective.

A comparative study using the transabdominal route versus the transoral route in establishing nasobiliary drainage in laparoscopic surgery / 中华肝胆外科杂志

Objective To compare using the transabdominal route versus the transoral route in establishing naso-biliary drainage in laparoscopic surgery.Methods The combined use of laparoscopy with choledochoscopy and duodenoscopy to establish naso-biliary drainage was carried out in 204 patients with gallbladder and common bile duct calculi.In 162 patients,the naso-biliary drainage was established transabdominally and in 42 patients it was established transorally.The success and the complication rates in the two groups were compared.Results Of 162 patients using the transabdominal route,4 patients failed.There were 6 patients (3.7％) who had no output from the nasobiliary drain.There were 3 patients (1.8％) who had only intestinal juice outflow from the nasobiliary drain.Primary closure failed in 3 patients (1.8％),all resulting in bile leak.Pancreatitis occurred in 2 patients (1.2％) after the operation.There was 1 patient (0.6％) whose nasobiliary drain was wrongly ligated.Of 42 patients with nasobiliary drainage using the transoral route,6 patients failed.There was 1 patient (2.4％) who had no output from the nasobiliary drain.There was 1 patient (2.4％) who had intestinal juice output from the nasobiliary drain.Primary closure failed in 1 patient (2.4％) with resultant bile leakage.Pancreatitis occurred in 4 patients (9.5％) after the operation.The success rate of establishing a nasobiliary drainage in the transabdominal group was significantly higher than that in the transoral group,but the complications were less.Conclusions Nasobiliary drainage established through the transabdominal route in laparoscopy surgery for patients with gallbladder and common bile duct calculi was technically easier and had a high success rate.It had less complications.

Postpancreaticoduodenectomy hemorrhage: a report of 34 patients / 中华肝胆外科杂志

Objective To study the cause,prevention and treatment of postpancreaticoduodenectomy hemorrhage.Method The clinical data of 422 patients who underwent PD in our hospital between January 2000 and January 2012 were retrospective analyzed.Results The incidence of postoperative hemorrhage was 8.1％ (34/422),and the mortality was 20.6％ (7/34).Early and delayed hemorrhage occurred in 19 and 15 patients,respectively.Intra-abdominal and gastrointestinal hemorrhage occurred in 20 and 14 patients,respectively.For the 19 patients who underwent reoperation,the mortality was 20.6％ (7/34).When compared with the delayed hemorrhage group,the mortality of the early hemorrhage group was significantly lower (P＜0.05).Conclusions Meticulous operation and reliable hemostasis during operation and prevention of pancreatic fistula,biliary fistula and peritoneal fluid collection after operation are the key points in reducing postoperative hemorrhage.A timely and decisive reoperation is important to manage postoperative hemorrhage.