ABSTRACT
Objective:To compare the impact of different portal exposure techniques in the Kasai surgery on children with type Ⅲ. biliary atresia during their different perioperative periods.Methods:A retrospective study was performed on the data of children with type Ⅲ. biliary atresia who underwent Kasai surgery at Fujian Children's Hospital from January 2017 to October 2020. Of 45 children enrolled in this study, there were 24 males and 21 females, aged (71.3±21.0) days. Patients who had left and right branches of the portal vein and the left and right hepatic arteries in the portal area being completely freed and elastically stretched during the Kasai operation were included into the free group ( n=22) and the remaining patients were included in the control group ( n=23). Postoperative hospital stay, postoperative direct bilirubin levels, postoperative complications and transplant-free survival after the Kasai operation were compared between the 2 groups. Results:Postoperative hospital stay of (17.1±4.4) d in the free group was significantly lower than that in the control group (20.1±5.4) d, ( t=2.07, P=0.044). The direct bilirubin level at 3 months after surgery for the control group was 30.0 (109, 108.0)μmol/L, which was significantly higher than that of 14.5 (4.0, 37.5) μmol/L in the free group ( Z=-2.16, P=0.031). Twenty-one patients (91.3%) in the control group had frequent attacks of postoperative cholangitis, compared with 13 patients (59.1%) in the free group. The difference was statistically significant (χ 2=4.69, P=0.030). Eleven surviving patients (47.8%) in the control group did not undergo liver transplantation at one year after surgery, compared with 15 patients (68.2%) in the free group. At two years after surgery, 7 surviving patients (30.4%) in the control group did not undergo liver transplantation compared with 10 patients (45.5%) in the free group. Conclusion:For children with type Ⅲ. biliary atresia, completely freeing the left and right branches of portal vein, and left and right hepatic arteries in the liver portal area, and elastically stretching these vessels to expose the portal area of the liver during Kasai surgery increased surgical safety and reduced hospital stay.
ABSTRACT
Downstaging treatment by local therapy combined with systemic therapy before liver transplantation for patients with recurrent hepatocellular carcinoma (HCC) can control tumor progression and reduce tumor burden, which resulting in reducing the push-out rate of patients during the waiting period for liver transplantation, providing an oncological observation window, enabling patients of beyond Milan criteria downstaged with better survival benefit. The authors introduce the clinical experience of a case with recurrent HCC of beyond Milan criteria who under-went liver transplantation after receiving atezolizumab plus bevacizumab combined with local therapy. Results show the patient achieving pathological complete remission without postoperative rejection and obtaining a good prognosis with life status improved.
ABSTRACT
Objective To explore the clinical characteristics of chronic obstructive pulmonary disease (COPD)in the patients with pulmonary interstitial fibrosis.Methods Twenty-seven COPD patients with pulmonary fibrosis and thirty patients with COPD who were diagnosed from July 2001 to October 2010 were analyzed for their clinical symptoms,physical signs,pulmonary function,arterial blood-gas,radiographic features,CT and high resolution computed tomography(HRCT)of the chest.Results The clinical features of COPD with pulmonary fibrosis shared that of the two diseases.Eighteen cases of COPD with pulmonary fibrosis had mixed ventilatory dysfunction(P ＜ 0.01).COPD were all obstructive ventilatory dysfunction(P ＜ 0.01).For arterial blood-gas test,PF-COPD showed progressing hypoxemia and little PaCO2 retention,but no significant difference was observed.Chest X-ray showed that 30 cases in the COPD group had an increased anteroposterior diameter of the thorax,while it was 14 cases in the PF-COPD group(P ＜0.05).Twenty four cases in the PF-COPD group showed nodular,meshy or honeycomb-like lesions,but none in COPD group(P ＜ 0.01).Chest CT and HRCT showed that there were higher chances of frosted glass-like and grid-like nodular lesions in the lungs of PF-COPD group than in COPD group(9 vs.0,19 vs.0 ;x2 =10.85,17.36,P ＜ 0.01).Conclusions Patients with chronic obstructive pulmonary disease and pulmonary fibrosis sharing the clinical features of both diseases.Chest HRCT can provide important information for clinical diagnosis.
