Clinical evaluation on three-dimensional laparoscopic splenectomy for massive splenomegaly secondary to liver cirrhosis / 中华普通外科杂志

Objective To investigate the clinical effect of three-dimensional laparoscopic splenectomy for massive splenomegaly secondary to liver cirrhosis.Methods The clinical data of 67 patients who underwent laparoscopic splenectomy for massive splenomegaly at Henan Province People's Hospital from Jan 2013 to Dec 2018 were collected.Results Operation time,volume of intraoperative blood loss and blood transfusion,number of patients with intraoperative blood transfusion,and conversion to laparotomy were in favor of 3D group,with statistically differences (t =12.900,18.255,19.711,x2 =10.747,0.685,P ＜ 0.05).Postoperative intraabdominal bleeding,pancreatic fistula,and postoperative hospital stay in 2D group were more than those in 3D group,with statistically differences (x2 =3.511,4.527,t =12.969,P ＜ 0.05).All patients were followed up for 5 to 60 months.Portal thrombosis occurred in 6 patients vs 5 patients,respectively (x2 =0.028,P ＞ 0.05) and resolved with oral coumarin.Conclusions Three-dimensional laparoscopic splenectomy can provide more realistic visual effects of surgical procedures and has an obvious advantage in laparoscopic splenectomy for massive splenomegaly secondary to liver cirrhosis.

The prognostic value of tumor budding in intrahepatic cholangiocarcinoma / 中华普通外科杂志

Objective To evaluate the role of tumor budding in the prognostic value of intrahepatic cholangiocarcinoma(ICC) after radical resection.Methods The clinicopathological data of patients undergoing radical resection for intrahepatic cholangiocarcinoma between 2011 and 2016 were retrospectively analyzed.The number of tumor budding was counted in a ×200 microscopic field (0.785mm2).Based on receiver operation curve (ROC),the number of tumor budding ≥ 15 was defined as high-grade group,and ＜ 15 was low-grade group.Multivariate analysis were performed on predictors of the tumor.Results Low-grade group was observed in 32 cases and high-grade group in 50.High-grade group appeared to develop tumors with higher CA199,poor differentiation,larger tumor diameter,advanced stage and high risks of lymphnode metastasis (respectively x2 =5.470,4.359,5.101,4.696,5.960,all P ＜ 0.05).Univariate analysis showed that tumor budding,CA199,differentiation,tumor diameter,T classification and lymphnode metastasis were related to the overall survival of patients with ICC (respectively x2 =11.704,4.876,5.056,5.152,8.442,16.725,all P ＜ 0.05).On multivariable analysis,high-grade group was a significant independent predictor of worse OS (HR =2.707 95％ CI 1.558-4.705,P ＜ 0.001).Conclusions High-grade tumor budding is an important negative prognostic factor for ICC.

Effects of laparoscopic splenectomy and esophagogastric devascularization on stress and immune function in patients with cirrhotic portal hypertension / 中华普通外科杂志

Objective To evaluate the effects of laparoscopic splenectomy and esophagogastric devascularization(LSPD) vs.open procedure(OSPD) on stress and immune function in patients with portal hypertension due to cirrhosis.Methods From June 2015 to June 2017 a total of 66 patients underwent LSPD or OSPD procedures.Results Plasma cortisol concentration in the LSPD group was lower than that in the OSPD group (Fgroup =18.85,P =0.020).Cortisol concentration in the two groups increased firstly and then decreased with time extension (Ftime =532.08,P =0.000).The level of CD3 +,CD4 +,CD4 +/CD8 + in LSPD group was higher than that in OSPD group,and the level of CD8 + was lower than that in OSPD group (Fgroup =3.55,21.47,154.84,64.29,P ＜ 0.05),the levels of CD3 +,CD4 + and CD4 +/CD8 + in the two groups first decreased and then increased with the extension of time,and the levels of CD8 + increased firstly and then decreased (Ftime =199.22,298.48,864.33,510.23,P ＜ 0.05),the increase range of CD3 +,CD4 +,and CD4 +/CD8 + in LSED group was higher than that in OSPD group (Finteraction =19.27,18.21,79.55,35.21,P ＜ 0.05);there was no statistical significance in the complications such as:rebleeding,thrombosis and splenic fever in the two groups (x2 =0.05,0.67,0.07,0.16,P=0.829,0.413,0.789,0.693).But the postoperative chest/cavity effusion and fever (＞ 38.0 ℃,and ＞ 3 days) is OSPD group is higher than in the LSPD group(x2 =5.49,6.68,P =0.019,0.010).Conclusion LSPD effectively reduces postoperative stress,protects immune function,decreases postoperative pleural and abdominal effusion and fever.

Laparoscopic choledochoscopy in patients of common bile duct stones with history of previous abdominal surgery / 中华普通外科杂志

Objective To evaluate the feasibility and safety of laparoscopic choledochoscopy for common bile duct exploration in patients of common bile duct stones with a history of previous abdominal surgery.Methods From March 2015 to May 2016,100 cases were divided into laparoscopic and open common bile duct exploration in our department.Hospital stay,costs and complications were compared.Results The blood loss,cost,fasting time and hospital stay in the laparoscopy group were less than those in the open group.There were no significant differences in alanine aminotransferase,total bilirubin,albumin,prothrombin time,leukocyte,C-reactive protein,operative time and complications between the two groups.Conclusion Laparoscopic choledochoscopy for common bile duct exploration is an effective and safe method for the treatment of common bile duct stones in patients with previous history of abdominal surgery.

Laparoscopic hepatectomy vs open surgery in the treatment of hepatic malignant tumors / 中华普通外科杂志

Objective To explore the feasibility and safety of laparoscopic hepatectomy in the treatment of hepatic malignant tumors.Methods 136 liver cancer patients were divided into:laparoscopic surgery group (LR group,51 cases) and open surgery group (OR group,85 cases).Serum enzyme,inflammatory factors and postoperative complications were compared between the 2 groups.Results The operative time of LR group was significantly longer than that of OR group (252 ± 123) min vs.(169 ± 63 min),hospitalization time (10 ± 5) d vs.(12 ± 5) d and intraoperative blood loss in LR group were lower than those in OR group (381 ±156) ml vs.(523 ±325) ml (all P＜0.05).ALT,AST,ALP in LR group was significantly lower than that in OR group [ALT:(227 ±101) U/L vs.(690 ±575) U/L,AST:(187±107) U/Lvs.(551 ±529) U/L,ALP:(63 ±25)U/Lvs.(86 ±40)U/L,allP＜0.05].Prothrombin time in LR group was shorter than that in OR group [(14.3 ±0.8) s vs.(15.3 ± 1.6)s,P =0.000].The postoperative IL-6,TNF-α in LR group was lower than that in OR group [IL-6:(154 ±31)pg/ml vs.(182 ±34) pg/ml,TNF-α:(22 ±6) pg/ml vs.(30 ±7) pg/ml,all P ＜0.05].Postoperative complications in laparoscopic group were significantly lower than those in laparotomy group (3.9％ vs.11.8％,P ＜ 0.05).Conclusions Laparoscopic resection of liver malignant tumors is safer and has less complications,lower inflammatory stress response and liver injury.

The effect of modified basin-forming biliary-intestinal anastomosis on recurrent stones after choledochojejunostomy / 中华普通外科杂志

Objective To evaluate the effect of modified basin-forming anastomosis for recurrent stones after choledochojejunostomy.Methods A total of 83 patients suffering from recurrent choledocholithiasis undergoing re-operation at our department from Jan 2013 to Dec 2017 were divided into two groups.46 patients treated by routine choledochojejunostomy (controls),and 37 patients by modified basin-forming biliary-intestinal anastomosis(study group).Results Control vs study group:intraoperative blood loss were(262 ±86)ml vs(121 ±77) ml,blood transfusion:(139 ±256)ml vs(22 ± 92) ml,and operative time:(316 ± 75) min vs (245 ± 73) min,the number of patients with liver resection were 8 vs 3 (all P＜0.05).The number of patients with fever,biliary tract infection,abdominal infection,anemia,and postoperative hospital stay were 14 vs 4,12 vs 3,7 vs 0,11 vs 1,(11.5 ± 1.8) d vs (8.5 ± 1.9) d (all P ＜ 0.05).Conclusions The modified basin-forming biliary-intestinal anastomosis is a simple,safe and effective surgical method for recurrent choledocholithiasis after choledochojejunostomy.

The effect of modified basin-forming biliary-intestinal anastomosis on recurrent stones after choledochojejunostomy / 中华普通外科杂志

Objective@#To evaluate the effect of modified basin-forming anastomosis for recurrent stones after choledochojejunostomy.@*Methods@#A total of 83 patients suffering from recurrent choledocholithiasis undergoing re-operation at our department from Jan 2013 to Dec 2017 were divided into two groups. 46 patients treated by routine choledochojejunostomy(controls), and 37 patients by modified basin-forming biliary-intestinal anastomosis(study group).@*Results@#Control vs study group: intraoperative blood loss were(262±86)ml vs(121±77)ml, blood transfusion: (139±256)ml vs(22±92)ml , and operative time: (316±75)min vs(245±73)min , the number of patients with liver resection were 8 vs 3(all P<0.05). The number of patients with fever, biliary tract infection, abdominal infection, anemia, and postoperative hospital stay were 14 vs 4, 12 vs 3, 7 vs 0, 11 vs 1, (11.5±1.8) d vs (8.5±1.9) d (all P<0.05).@*Conclusions@#The modified basin-forming biliary-intestinal anastomosis is a simple, safe and effective surgical method for recurrent choledocholithiasis after choledochojejunostomy.

Laparoscopic splenectomy via spleen bed in combination with esophagogastric devascularization for the treatment of portal hypertension / 中华普通外科杂志

Objective To evaluate the feasibility and safety of laparoscopic splenectomy and esophagogastric devascularization (LSPD) via spleen bed using endoscopic linear stapler (Echelon Flex 60 Endopath) versus open splenectomy and esophagogastric devascularization (OSPD) for cirrhotic portal hypertension.Methods A total of 390 patients suffering from liver cirrhosis and portal hypertension operated in our department from Jun 2012 to Jul 2016 were divided into two groups:145 for LSPD and 245 for OSPD.Characteristics,clinical data and postoperative complications were compared.Results There were no significant differences in estimated intraoperative blood loss between LSPD and OSPD groups.The operation time of LSPD group was longer than OSPD group.However,the time of hospital stay and time of oral intake were shorter in the LSPD group than the OSPD group (P ＜ 0.05).No significant differences were detected for liver function such as ALT,AST,T-BIL and ALB after operation,nor in the rate of postoperative complications between the 2 groups such as portal vein thrombosis,pancreatic leakage,pleural effusion and PLT ＞800 x 109/L.But amount of ascites and fever (＞38.0 ℃,＞3 d) in OSPD group was higher than LSPD group (P ＜ 0.05).Conclusions LSPD via spleen bed combined with endoscopic linear stapler for liver cirrhosis and portal hypertension is a safe and feasible procedure.

Single-incision laparoscopic splenectomy: a Meta-analysis / 中华肝胆外科杂志

Objective To explore security and efficacy of single-incision laparoscopic splenectomy (SILS).Methods All the studies comparing SILS and laparoscopic splenectomy (LS) for splenic resection were searched on the available databases including the Cochrane Central Register of Controlled Trials,Medline,Science Citation Index,EMBASE,China National Knowledge Infrastructure,Wanfang Database and China Biomedical Database.The data were analyzed using the Review Manager Software version 5.0.Results After the literature search,nine studies were included in the meta-analysis,which involved 259 patients:109 in the SILS group and 150 in the LS group.The operative time in the SILS group was not significantly longer than the LS group (RR,-4.66;95％ CI,-53.02 to 43.70;P ＞ 0.05).The estimated intraoperative blood loss in the SILS group was not significantly more than the LS group (RR,-14.94;95％ CI,-64.93 to 35.06;P ＞ 0.05).The time of oral intake in the SILS group was the same as in the LS group (RR,-0.13;95％ CI,-0.8 to 0.54;P ＞ 0.05).The time of postoperative hospital stay in the SILS group was the same as in the LS group (RR,-0.83;95 ％ CI,-1.98 to 0.31;P ＞ 0.05).Conclusions This meta-analysis demonstrated that SILS was as safe,effective,and minimally invasive as LS.The current evidence suggested that it could be used routinely in splenic resection.

Method comparison between INNOVANCE D-Dimer and PLUS D-Dimer / 中华检验医学杂志

Objective To evaluate the clinical performance of INNOVANCE D-Dimer,and provide information for clinical application.Methods 402 cases of sodium citrate anticoagulant blood were tested with INNOVANCE assay and PLUS assay on CA7000 analyzer to measure plasma D-Dimer levels.VIDAS-30 immunology analyzer was also used to validate the two assays.4 patients with elevated D-Dimer were monitored continuously during 5 days using INNOVANCE assay and PLUS assay respectively,then the consistency of trend between 2 assays was analyzed.Plasma specimens added with hemoglobin,bilimbin and triglyceride were used to verify the anti-interference capability of INNOVANCE D-Dimer assay.Results In 402 specimens,the result ranges of INNOVANCE D-Dimer and PLUS D-Dimer were [2.15 (0.33,8.63)]mg/L FEU and [325.50 (123.75,974.00)] μ,g/L DDU,respectively.The consistency between two assays was poor (Z =-17.375,P =0.000),especially the results in the range of PLUS D-Dimer (201-300) μg/L DDU and (301-400) μg/L DDU,the coincidence rates were only 25％ and 15％,respectively; the coincidence rate was up to 85％ during PLUS D-Dimer (500-600) μg/L DDU; the coincidence rate was close to 100％ when PLUS D-Dimer over 700 μg/L DDU.Totally 47 of 402 cases were unmatched between two assays.Verified by VIDAS 30,83.0％ (39/47) was false negative for PLUS assay,4.3％ (2/47) was false negative for INNOVANCE assay,12.7％ (6/47) was false positive for PLUS assay.There were 5 false positives and 39 false negative for PLUS assay,totally 45 cases; Two false negative for INNOVANCE assay.Four patients with elevated D-Dimer were monitored and the results showed similar trend between 2 assays.For INNOVANCE assay,the capacity of anti-interference to free bilirubin,unconjugated bilirubin,hemoglobin,and triglyceride was up to 217 μmol/L,337 μmol/L,41.04 g/L,18.35 mmol/L,respectively.Conclusions INNOVANCE assay can markedly reduce false negative results of D-Dimer compared with PLUS assay.INNOVANCE D-Dimer has good performance on anti-interference to jaundice,hemolysis and lipemia samples.

Polymorphism of HLA class I alleles of HIV-infected individuals and its impact on HIV-1 viral load in central China / 中华微生物学和免疫学杂志

Objective To explore the polymorphism of HLA class I alleles of HIV-infected former plasma donors and to investigate its impact on HIV-1 viral load in central China.Methods 106 subjects chronically infected with HIV-1 were recruited and HLA class I alleles were genotyped with PCR-SSP assay.HLA class I genotypes and haplotypes were determined and their association with plasma viral loads were analyzed.Gag-specific CTL responses were detected by an IFN-λ EUSPOT assay by using overlapping peptides,and their association with plasma viral loads were also analyzed.Results Subjects homozygous at HLA class I locus had higher plasma viral loads(P=0.0098);HLA-A*30,-B*13,-Cw*06,-Cw*14 alleles and HLA-A*30/B*13/Cw*06 haplotype were associated with lower plasma viral loads(P=0.0004,0.0103,0.0058,0.0371 and 0.0006);an inverse correlation between p2p7p1p6-specific CTL responses and viral loads in subjects with HLA-A*30/B*13/Cw*06 haplotype as well as an inverse correlation between p17-specific CTL responses and viral loads in subjects with HLA-Cw*14 allele were observed.Conclusion HLA-A*30,-B*13,-Cw*06,-Cw*14 alleles and HLA-A*30/B*13/Cw*06 haplotype were associated with lower plasma viral loads and Gag-specific CTL responses restricted by these HLA alleles may contribute to the protection.