Pilot study of the relationship between clinical classification of gallbladder cancer and prognosis: a retrospective multicenter clinical study / 中华外科杂志

Objectives@#To propose a novel clinical classification system of gallbladder cancer, and to investigate the differences of clinicopathological characteristics and prognosis based on patients who underwent radical resection with different types of gallbladder cancer.@*Methods@#The clinical data of 1 059 patients with gallbladder cancer underwent radical resection in 12 institutions in China from January 2013 to December 2017 were retrospectively collected and analyzed.There were 389 males and 670 females, aged (62.0±10.5)years(range:22-88 years).According to the location of tumor and the mode of invasion,the tumors were divided into peritoneal type, hepatic type, hepatic hilum type and mixed type, the surgical procedures were divided into regional radical resection and extended radical resection.The correlation between different types and T stage, N stage, vascular invasion, neural invasion, median survival time and surgical procedures were analyzed.Rates were compared by χ2 test, survival analysis was carried by Kaplan-Meier and Log-rank test.@*Results@#Regional radical resection was performed in 940 cases,including 81 cases in T1 stage,859 cases in T2-T4 stage,119 cases underwent extended radical resection;R0 resection was achieved in 990 cases(93.5%).The overall median survival time was 28 months.There were 81 patients in Tis-T1 stage and 978 patients in T2-T4 stage.The classification of gallbladder cancer in patients with T2-T4 stage: 345 cases(35.3%)of peritoneal type, 331 cases(33.8%) of hepatic type, 122 cases(12.5%) of hepatic hilum type and 180 cases(18.4%) of mixed type.T stage(χ2=288.60,P<0.01),N stage(χ2=68.10, P<0.01), vascular invasion(χ2=128.70, P<0.01)and neural invasion(χ2=54.30, P<0.01)were significantly correlated with the classification.The median survival time of peritoneal type,hepatic type,hepatic hilum type and mixed type was 48 months,21 months,16 months and 11 months,respectively(χ2=80.60,P<0.01).There was no significant difference in median survival time between regional radical resection and extended radical resection in the peritoneal type,hepatic type,hepatic hilum type and mixed type(all P>0.05).@*Conclusion@#With application of new clinical classification, different types of gallbladder cancer are proved to be correlated with TNM stage, malignant biological behavior and prognosis, which will facilitate us in preoperative evaluation,surgical planning and prognosis evaluation.

Radiofrequency ablation for treatment of giant hepatic hemangiomas / 中华全科医师杂志

The clinical data of 32 patients with giant hepatic hemangioma (GHH) who underwent radiofrequency ablation(RFA)treatment in the PLA General Hospital and Affiliated Peace Hospital of Changzhi Medical College from June 2011 to May 2016 were retrospectively analyzed, including 26 cases treated with laparoscopy-guided RFA and 6 cases treated with ultrasound-guided percutaneous transhepatic RFA+laparoscopy. A Total of 41 lesions were ablated, the diameters of lesions ranged from 2.0 to 12.0 cm. The RFA time ranged from 18 to 72 min and the volume of intraoperative bleeding varied from 5 ml to 150 ml. The incidence of postoperative complications was 56％, which mainly were fever and hemoglobinuria. Patients were followed up for 12 to 60 months; the lesions were incompletely ablated in 3 cases. Radiofrequency ablation is an effective and safe method for the treatment of giant hepatic hemangiomas .

Imaging manifestations of giant cell tumor in the thoracic vertebrae / 实用放射学杂志

Objective To analyze the X-ray,CT and MRI findings of giant cell tumor in the thoracic vertebrae,in order to improve its diagnostic accuracy.Methods X-ray,CT and MRI findings of 9 cases of pathologically proved giant cell tumor were analyzed retrospectively. X-ray examination was performed in 7 cases,CT in 6 cases,and MRI in 7 cases.Results Of the 9 cases with thoracic vertebrae giant cell tumors,8 involved a single vertebra while 1 case involved the left ninth posterior segment of rib simultaneously.On X-rays studies, 6 cases of bone destruction were dispensability,and 1 case was osteolysis.Three cases of vertebral destructive margin were clear. The body of vertebra was flattened in 3 cases.Pore-vertebral soft tissue masses were found in 4 cases.On CT examinations,5 cases of bone destruction were dispensability,and 1 case was osteolysis.3 cases of vertebral margin were clear with partial sclerotic rim. 4 cases of vertebral body had shade of bone-cristae.There were soft tissue masses around vertebrae in 5 cases,with vertebrae accessory,dural sac and the spinal cord involved to varying degrees.On MRI studies,hypointense were showed in 5 cases while isointense in 2 cases on T1 WI;On T2 WI,isointense was showed in 1 case,hyperintense in 4 cases,and mixed-intense in 2 cases.Conclusion Giant cell tumor in the thoracic vertebrae is uncommon.Full understanding X-ray,CT,MRI characteristics is useful to improve the diagnosis, guide clinical surgical treatment and forecast prognosis.

The imaging diagnosis and differential diagnosis of Ewing’s sarcoma in ilium,pubis,and ischium / 实用放射学杂志

Objective To investigate the imaging findings of Ewing’s sarcoma in ilium,pubis,and ischium,and to improve the diagnostic veracity.Methods The imaging manifestations of 1 5 patients with pathologically proved Ewing’s sarcoma in ilium,pubis or ischium were retrospectively analyzed.All the 1 5 patients were underwent X-ray examination.Among them,12 cases performed CT examination and 1 1 cases performed MRI examination.Results In all the 1 5 Ewing’s sarcoma patients,8 lesions located at the iliac.7 lesions located at the pubic and ischial.12 cases showed simple osteolytic bone destruction on X-ray images,3 cases showed mixed bone destruction.All the 1 5 cases showed soft-tissue mass around the lesion.On CT images,7 cases showed swelling in the periphery of the lesion areas and internal osteolytic bone destruction,5 cases showed irregular oateomas,hyperosteogeny or osteo-sclerosis surrounding bone destruction areas,6 cases showed irregular periosteal reactionsurrounding the lesion areas,12 cases showed soft-tissue mass surrounding the lesion areas.On MRI,7 cases showed long T1 and long T2 signal,4 caese showd T1 low and T2 heterogeneous high signal,5 cases showed high signal in the fat suppression sequences.All the 1 1 cases who underwent MRI examination showed bone destruction and soft tissue mass on MRI.Conclusion Although rare,Ewing’s sarcomas of the ilium,pu-bis,and ischium have some certain image features.X-ray,CT and MRI examinations play an important role in the diagnosis and dif-ferent diagnosis of these conditions.

Preoperative neutrophil-lymphocyte ratio is an independent prognostic factor for hepatocellular carcinoma after radical resection / 临床肝胆病杂志

ObjectiveTo evaluate the effect and predictive value of preoperative neutrophil-lymphocyte ratio (NLR) on the prognosis of patients undergoing radical resection for hepatocellular carcinoma (HCC). MethodsThe clinical data of 245 patients who received radical resection for HCC in our hospital from 2004 to 2009 were retrospectively analyzed. The effects of clinicopathological parameters including NLR on overall survival (OS) time were assessed by univariate analysis using the log-rank test. The significant variables were further analyzed by multivariate analysis using the Cox regression model. ResultsUsing NLR=1.5, 2, and 3 as cut-off points, the patients were divided into four groups. The median OS time in groups with NLR＜1.5, 1.5≤NLR＜2, 2≤NLR＜3, and NLR≥3 was 39.6, 38.3, 25.4, and 19.9 months, respectively (P=0.003). Multivariate analysis showed that preoperative NLR, levels of alpha-fetoprotein and alanine aminotransferase in peripheral blood, number of tumor nodules, maximum size of tumor, and portal vein tumor thrombus were independent prognostic factors for HCC (P＜0.05). ConclusionPreoperative NLR in peripheral blood is a novel prognostic biomarker for HCC after radical resection.

Application of hepatic pedicle exclusion and low central venous pressure in right lobe tumor resection / 中国医师进修杂志

Objective To investigate the effects of hepatic pedicle exclusion and low central venous pressure (LCVP) on blood loss in right lobe tumor resection and evaluate its influence on hepatic and renal function. Methods Forty-eight patients with right lobe tumor admitted from December 2006 to June 2008 were randomly allocated to the LCVP group (23 cases) and routine hepatectomy, (control group 25 cases). During the parenchymal transection phase of surgery, CVP < 5 mm Hg ( 1 mm Hg = 0.133 kPa) and SBP ≥90 mm Hg were maintained in the LCVP group by drugs. However, no special management of CVP and SBP was done in control group. The parenchymal transection blood loss, postoperative hospital stay, postoperative hepatic and renal function changes between two groups were compared, and the incidence of comphcation was also observed. Results There were no significant difference in type of hepatectomy, time of vascular clamping, period of operation, postoperative complication rate, postoperative hepatic and renal functions between two groups. Parenchymal transection blood loss in the LCVP group was significantly lower than that in the control group (326.67 ± 109.13 ) ml vs (538.33 ± 177.07 ) ml, (P < 0.01 ). Postoperative hospital stay in the LCVP group was significantly shorter than that in the control group (8.52 ± 1.78) d vs (9.40±1.68) d, (P < 0.05). Conclusions Hepatic pedicle exclusion and LCVP during hepatectomy is safe. It can reduced blood loss during parenchymal transection and decrease postoperative hospital stay. It is no detrimental effect to hepatic or renal function.

Diagnosis and treatment of 20 cases of pseudotumorous pancreatitis / 中华肝胆外科杂志

Objective To investigate the diagnosis and treatment of pseudotumorous pancreatitis. Methods A retrospective clinical analysis was made on 20 cases with pseudotumorous pancreatitis in one stage from 1983.7 to 2004.5. Resulds There were 14 males and 6 females. Jaundice and abdominal pain were the major complaints. 17 cases underwent surgery, including cholangiojejunum Roux-en-Y anastomosis in 11cases, pancreatoduodenectomy in 3 cases, laparotomy and biopay in 3 cases . 3 cases underwent US-guided needle biopsy. All the 15 cases who were followed up had no jaundice at all after operation and abdominal pain relief was achieved to various degree. Conclusion It's difficult to diagnose pseudotumorous pancreatitis before operation. Hepatojejunal Roux-en-Y anastomosis was suitable for the patients with obstructive jaundice. When refractory abdominal pain was encountered or intraoperative pathologic diagnose was diffcult, pancreaticoduodenectomy should be recommended.