Clinical analysis of choledchojejunostomy combined with T tube external drainage in the treatment of hepatolithiasis / 中国实用外科杂志

OBJECTIVE: To investigate the curative effect of choledchojejunostomy combined with T-tube drainage on patients with hepatolithiasis.METHODS: The clinical data of 95 patients with hepatolithiasis electivly undergoing choledchojejunostomy from January 2014 to July 2018 in the First Affiliated Hospital,Anhui Medical University were retrospectively analyzed.According to the operation methods,the patients were divided into two groups:choledchojejunostomy group and choledchojejunostomy group with T-tube drainage group.The short-term and longterm clinical efficacy of T tube external drainage were analyzed.RESULTS: Among 95 cases of hepatolithiasis,71 cases were treated with choledchojejunostomy and 24 cases were treated with choledchojejunostomy combined with T tube drainage.There was no significant difference in incision infection,hemorrhage and hepatic insufficiency between the two groups(P>0.05).The incidence of bile leakage in the choledchojejunostomy group was significantly higher than that in the choledchojejunostomy with T tube drainage group(P0.05).CONCLUSION: Choledochojejunostomy plus T-tube drainage can effectively reduce the incidence of bile leakage in patients with hepatolithiasis who can not remove all the stones during operation,and improve the stone clearance rate.

Endoscopic papillary balloon dilatation vs. endoscopic sphincteropapillotomy for common bile duct stones: a meta analysis / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the safety and efficacy between endoscopic papillary balloon dilatation (EPBD) and endoscopic sphincteropapillotomy ( EST) for common bile duct stones using meta-analysis method.</p><p><b>METHODS</b>Randomizd controlled trials comparing EPBD with EST for common bile duct stones and published from January 1990 to July 2012 were recruited. This meta-analysis was conducted to estimate short-term and long-term complications. Fixed random effect model or random effect model was established to analyze the data.</p><p><b>RESULTS</b>Twelve randomizd controlled trials were included in this analysis. These studies included 1865 patients, 925 of them were treated with EPBD and 940 were treated with EST. The analysis of basic characteristics of these included studies showed that: compared to EST, patients in the EPBD group were younger (OR = -1.16, 95% CI: -1.49 to -0.84, P = 0.00), while in two groups, there were no significant difference (P > 0.05) in gender proportion, average size of stones, number of gallstones, previous cholecystectomy, the number of merged duodenal diverticulum, common bile duct diameter, the total follow-up time. Also, compared to EST, the overall stone clearance in the EPBD group was lower (OR = 0.64, 95% CI: 0.42 to 0.96, P = 0.03), pancreatitis incidence was higher (OR = 2.67, 95% CI: 1.61 to 4.43, P = 0.00), incidence of bleeding (OR = 0.12, 95% CI: 0.04 to 0.34, P = 0.00), acute cholecystitis (OR= 0.39, 95% CI: 0.18 to 0.84, P = 0.02), total long-term complication rate (OR = 0.53, 95% CI: 0.36 to 0.77, P = 0.01), stone recurrence rate more than a year were lower (OR= 0.48, 95% CI: 0.26 to 0.90, P = 0.02). While in two groups, there were no significant difference (P > 0.05) in the stone removal on 1 '' attempt, the total near-term complications and acute cholangitis.</p><p><b>CONCLUSIONS</b>On the basis of lower rates of bleeding, EPBD seems to be preferred strategy over EST for endoscopic remove of common bile duct stones in patients who have coagulopathy. Although stone recurrence rate more than a year of EPBD is lower, but the overall stone clearance rate is lower and the risk of pancreatitis is higher than that of EST.</p>

Family survey and clinical analysis of von Hippel-Lindau syndrome / 中华外科杂志

<p><b>OBJECTIVE</b>To study the clinical characteristics and summary diagnostic and therapeutical experience of von Hippel-Lindau syndrome.</p><p><b>METHODS</b>von Hippel-Lindau syndrome genealogy and clinical characteristics was investigated. Then a dendrogram was drawn and a genetic analysis was performed. Last the diagnostic and therapeutical experience of von Hippel-Lindau syndrome was investigated according to literatures.</p><p><b>RESULTS</b>There are 6 members attacked by the von Hippel-Lindau syndrome of 5 generations which includes 42 members. Three patients underwent operation. Two of the three patients who suffered operation had been removed of right lobe of liver tumor and one cerebellar hemangioblastomas independently. The third patient sustained three operations for removal of three cerebellar hemangioblastomas and left renal clear cell carcinoma. Three patients died of this syndrome.</p><p><b>CONCLUSIONS</b>The characteristic of this kindred is according with that of autosomal dominant inheritance disease. Until now, von Hippel-Lindau syndrome involves in multisystem, the prognosis of this syndrome is not very well. However, patients and their family members may get much benefit from genetic testing, periodic surveillance, early diagnosis and prompt treatment.</p>

Percutaneous radiofrequency ablation versus hepatic resection for small hepatocellular carcinoma: a meta analysis / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the curative effect of percutaneous radiofrequency ablation (RFA) and hepatic resection (RES) for small hepatocarcinoma eligible for Milan criterion using meta analysis method.</p><p><b>METHODS</b>Retrieved clinical trials comparing percutaneous radiofrequency ablation with RES for small hepatocarcinoma published from 1990 to 2010. A meta-analysis was conducted to estimate overall survival and disease free survival. A fixed random effect model or random effect model was established to collect the data.</p><p><b>RESULTS</b>Four randomized controlled trials were included in this analysis. These studies included a total of 539 patients: 252 treated with percutaneous RFA and 287 treated with RES. The differences in overall survival were not statistically significant between RFA and RES (P > 0.05). In the patients treated with RES group, the 2-, 3- and 4-years disease free survival rates were significantly better than that in the patients treated with percutaneous RFA (P < 0.05). The postoperative morbidity rate was significant lower in patients treated with percutaneous RFA (OR: 0.14, 95%CI: 0.09 - 0.22, P = 0.000). But percutaneous RFA had a higher rate of tumor recurrence compared to RES (OR: 2.63, 95%CI: 1.67 - 4.15, P = 0.000).</p><p><b>CONCLUSIONS</b>For small hepatocarcinoma eligible for Milan criterion, percutaneous RFA had a similar overall survival to RES. Percutaneous RFA was the invasive lesser and had a lower postoperative morbidity rate than RES, but RES may had a better prevention of the tumor recurrence than percutaneous RFA. For those patients who don't want to be treated by RES, percutaneous RFA may be a recommendable choice.</p>

The influence of rotary manipulation on the internal pressure of cervical nucleus pulposus / 中国骨伤

<p><b>OBJECTIVE</b>To measure the pressure changes inside the cervical nucleus pulposus in fresh human cervical specimen by imitating different rotary manipulations.</p><p><b>METHODS</b>The load of 100 N was applied for 5 second on the six fresh male cervical samples by using material test system, which imitated the human head weigh and the strength of cervical extensor muscle. After that, traction, rotation and pulling on the samples were performed in different sequence under the force of 150, 200, 300 N respectively. Three states were included in adding the load state A: samples were loaded with traction and then rotation to the biggest angle, pulling backward for 15 degrees; state B: samples were loaded with rotary stress to the biggest angle and then loaded with traction, pulling backward for 15 degrees; state C: samples were loaded simultaneously with traction and rotary stress to the biggest angle, pulling backward for 15 degrees. The internal pressure of cervical nucleus pulposus at segment of C(3,4), C(4,5), C(5,6), and C7 was measurred by micro-pressure sensors for state A, B, C and for the imitation of head weight and the strength of cervical extensor muscle.</p><p><b>RESULTS</b>The pressure inside the cervical nucleus pulposus at segments C(5,6), C(6,7) was higher than that at segments C(3,4) and C(4,5) (P < 0.05) by loading stress with 100 N for 5 seconds. The internal pressure of the nucleus pulposus decreased with the increase of traction (P < 0.05), and increased when traction and rotary force were loaded. State A, the value of increased pressure within the nucleus pulposus became smaller and smaller while increasing of the traction force loaded (P < 0.05). State B, the increase of internal pressure in nucleus pulposus became obvious as loading pressure increased (P < 0.05). State C, the internal pressure in nucleus pulposus was not increased obviously (P > 0.05). There was a transitional pressure raise inside all cervical nucleus pulposus when pulling added after different sepuence traction and rotary strength was applied, however, the internal pressure of state A was significantly higher than that of state B or C (P < 0.05). There was also a transitional pressure raise inside all cervical nucleus pulposus when pulling added in different strength (P < 0.05),the internal pressure by pulling with 150 N was obviously higher than that with 200 N and 300 N (P < 0.05).</p><p><b>CONCLUSION</b>The order of rotation first and traction second should be avoided when practice of rotary manupuplation in case protrusion of the nucleus pulposus. Meanwhile, proper traction should be applied along with rotary manipulation in order to increase its safety.</p>

Anatomy problems in the radical resection for hilar cholangiocarcinoma / 中华外科杂志

<p><b>OBJECTIVE</b>To analyze the clinical data, surgical strategies and results from the patients with hilar cholangiocarcinoma (HCCA), and to explore the anatomic factors related to the radical resection.</p><p><b>METHODS</b>The data from 52 patients with HCCA who underwent radical resection between January 1984 to December 2008 were investigated retrospectively, which included clinical diagnosis, Bismuth-Corlette classification, pathologic features, surgical procedures and follow-up results.</p><p><b>RESULTS</b>According to the Bismuth-Corlette classification, 5, 12, 6, 16 and 13 patients belonged to type I, II, IIIa, IIIb and IV respectively. There were 24 cases underwent combined hepatic lobectomy. The 1-, 3- and 5-year survival rates were 78.8%, 36.4% and 12.1% respectively. Postoperative complications rate was 30.8% with the 3.8% mortality rate. The frequency of surgical complications was significantly higher in patients with higher level of serum total bilirubin (> 340 micromol/L) than that in patients with a relatively lower one (170 micromol/L) before operation (P < 0.05).</p><p><b>CONCLUSIONS</b>Some anatomical factors should be considered during the radical resection of hilar cholangiocarcinoma, especially evaluation of potential hepatectomy, resection of caudate lobe, hepatic artery resection and/or reconstruction. The prognosis of the patients underwent R(0) radial resection could be significantly improved.</p>

Influence of JDTL injection on inflammatory factors in rat experimental cerebral ischemia / 中国中药杂志

<p><b>OBJECTIVE</b>To stydy the protective mechanism of Jiedu Tongluo (JDTL) injection on experimental cerebral ischemia.</p><p><b>METHOD</b>Radioimmunoassay (RIA) was utilized to identify the content of TNF-alpha and IL1-beta in brain tissue of rats suffered from 6 h and 24 h ischemia with MCAO, Enzyme-linked immunoadsordent assay (ELISA) was used to observe the level of MCP-1 and ICMA-1.</p><p><b>RESULT</b>After 6 h and 24 h of ischemia, the increased contents of TNF-alpha, IL1-beta, MCP-1 as well as ICMA-1 was observed. JDTL injection dramatically inhibited the increase of TNF-alpha, IL1-beta after 6 h and 24 h of ischemia.</p><p><b>CONCLUSION</b>JDTL injection had inhibiting effect on TNF-alpha, IL1-beta, MCP-1 as well as ICMA-1 caused by cerebral ischemia, the result suggested that JDIL injection can protect cerebral tissue from ischemic injury by inhibiting inflammatory factors.</p>