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Objective:To compare safety and efficacy of one-stage laparoscopic common bile duct exploration plus laparoscopic cholecystectomy (LCBDE+ LC) with endoscopic retrodrade cholangiopancreatography plus laparoscopic cholecystectomy (ERCP+ LC) in elderly patients with concomitant gallbladder and common bile duct (CBD) stones.Methods:This is a two-center retrospective study with clinical data on 492 patients aged over 80 years diagnosed with concomitant gallbladder and CBD stones treated between January, 2014 and December, 2020 at The First Affiliated Hospital of Wenzhou Medical University and Quzhou Hospital Affiliated to Wenzhou Medical University. There were 254 males and 238 females, aged (83.9±3.0) years. These patients were divided into two groups based on their operative methods: the one-stage group (LCBDE+ LC, n=186) and the two-stage group (ERCP+ LC, n=306). Differences in surgery, stones and hospitalization costs were compared between the two groups. Results:When compared with the ERCP+ LC group, the LCBDE+ LC group had significantly higher incidences of previous gastrectomy [21.5%(40/186) vs 4.2%(13/306)], multiple stones [77.4%(144/186) vs 49.3%(151/306)], larger stone diameter [13.7(6.4, 18.6)mm vs 10.9(5.7, 16.1) mm], and increased hospitalization expenditure [(2.37±0.31) Wanyuan vs (3.26±0.44) Wanyuan] (all P<0.05). However, the rates of residual stone [2.7%(5/186) vs 1.3%(4/306)], stone recurrence [2.2%(4/186) vs 5.2%(16/306)], postoperatively overall complications [3.2%(6/186) vs 1.3%(4/306)], and total hospital stay [(10.7±6.2) d vs (11.3±5.4) d] were not significantly different between the two groups (all P>0.05). Conclusions:Allowing for the similar safety and effectiveness, and lower hospitalization expenditure, LCBDE+ LC was a preferred choice for patients aged over 80 year, especially in patients who had previous gastrectomy, multiple large CBD stones, or who could not accept endoscopic procedures for treatment of CBD stones.
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Objective:To determine the clinical efficacy of selective decongestive devascularization of gastrosplenic (SDD-GSR) and splenectomy combined with pericardial vascularization in the treatment of portal hypertension in cirrhosis.Methods:A total of 134 patients with cirrhosis portal hypertension admitted to the First Affiliated Hospital of Wenzhou Medical University were enrolled in the study, including 102 males and 32 females, with an average age of 51 years. Of 61 cases of SDD-GSR were included in the SDD-GSR group, and 73 cases of splenectomy combined with pericardial vascularization were included in the control group. Preoperative and postoperative white blood cell count, platelet count, Child-Pugh grade of liver function, free portal pressure (FPP) and postoperation tomplication were analyzed in the two groups. Operation time, intraoperative blood loss, free portal pressure (FPP), Child-Pugh grade of liver function, preoperative and postoperative white blood cell count, platelet count, and postoperative complications were analyzedin the two groups.Results:The operation time and intraoperative blood loss of SDD-GSR group were 165 (110, 198) min and 280 (100, 650) ml, which were lower than those of control group [190 (135, 605) min and 895 (300, 3 500) ml], the differences were statistically significant ( P<0.05). Postoperative FPP of SDD-GSR group and control group was 39 (35, 44) cmH 2O (1 cmH 2O=0.098 kPa) and 38 (34, 44) cmH 2O, respectively, which were lower than those before operation, with statistical significance (both P<0.05). Postoperative platelet count and white blood cell count in SDD-GSR group were lower than those in control group, and the differences were statistically significant (all P<0.05). The Child-Pugh grading of recent postoperative liver function in SDD-GSR group was better than that in control group, with statistical significance ( P<0.05). The complication rate (abdominal infection and portal vein thrombosis) of control group was higher than SDD-GSR group. Conclusion:SDD-GSR is better than splenectomy combined with pericardial vascularization since it has less intraoperative bleeding, obvious improvement of liver function and fewer complications, and it may be an effective surgical option for the treatment of portal hypertension of cirrhosis.
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Objective To analyze long-term efficacy after surgical treatment of primary liver cancer with fluorouracil plus oxaliplatin plus gemcitabine joint implementation to prevent the overall intervention effect of hepatic arterial infusion chemotherapy and radical resection of hepatocellular carcinoma following ascension.Methods60 cases of primary hepatocellular carcinoma were randomly divided into study group and control group according to the random number method in our hospital from February 2011 to November2013, 30 cases in each group.All patients underwent radical resection of liver cancer and liver (partial) resection.In the control group, the patients were treated with anti viral or immune enhancement after surgery, and the follow-up treatment was not carried out.In study group were given anti-virus or immune intensive treatment and at the end of surgery 3 and 7 weeks after the implementation of a prophylactic transcatheter arterial infusion chemotherapy and selecting drug 5-FU, oxaliplatin and gemcitabine.During 3 years of follow-up, the incidence of adverse reactions in the 3 groups was statistically analyzed, and the recurrence free survival rate, disease-free survival rate and overall survival rate of the two groups were statistically analyzed.ResultsAll patients completed the follow-up, there was no loss of follow-up cases.In adverse reactions, the study group patients were successfully tolerated hepatic artery infusion chemotherapy, no obvious adverse reactions or drug toxicity, more no interruption of chemotherapy cases.The recurrence free survival rate, disease-free survival rate and overall survival rate of the study group were 83.33%, 70.00%, 86.67%, respectively, which were significantly higher than those in the control group (60.00%, 43.33%, 63.33%) (P<0.05).ConclusionPrimary hepatocellular carcinoma should be treated with prophylactic hepatic arterial infusion chemotherapy in time after radical operation, which can greatly improve the survival rate of patients and ensure long-term curative effect.