Grading-therapeutic strategy for pancreatic injury after blunt abdominal trauma: therapy based on the condition of pancreatic duct and report of 95 cases.

BACKGROUND/AIMS: Pancreatic injury after blunt abdominal trauma is always associated with a high morbidity and mortality. The purpose of this study was to evaluate the effect of a grading-therapeutic strategy and to highlight various challenges in the management of blunt pancreatic injury. METHODOLOGY: All cases of pancreatic injury after blunt abdominal trauma from January 1, 2008, to December 30, 2012, were retrospectively reviewed, and the clinical data were collected. RESULTS: Ninety-five patients formed the group, out of which 76 (80.0%) undertook operative management, 19 (20.0%) undertook non-operative management; 18 underwent ERCP for pancreatic duct evaluation, with 7 (38.9%) undergoing nasopancreatic drain placement and 4 (22.2%) transpapillary pancreatic duct stent placement. Operation was performed for patients according to pancreatic injury grading and results of intra-operative selective pancreatography. Twenty-three (30.3%) developed various pancreatic-related complications. CONCLUSIONS: Grading-therapeutic strategy for blunt pancreatic injury based on condition of the pancreatic duct could be performed safely and effectively. It not only expanded the scope of non-operative management, but also preserved the normal pancreatic tissue.

Left-sided portal hypertension secondary to pancreatic cancer: clinical features, surgical treatment and outcome of 48 cases.

BACKGROUND/AIMS: Features of LSPH secondary to pancreatic cancer is ambiguous, and controversy remains in the treatment. METHODS: 48 cases from our department were retrospectively analyzed to evaluate the clinical features, as well as the feasibility and effect of surgical treatment. RESULTS: 16 patients had gastrointestinal hemorrhage history. Laboratory findings showed normocytic and normochromic anemia, thrombocytopenia, lymphocyte reduction, and elevated liver enzyme. Tumor markers were normal in 12 patients. Ultrasonography showed splenic venous obstruction in 40 patients and splenomegaly in 35. Esophagogastric varices could be detected by endoscopy in 40 patients and by CT in 37. Radical resection was performed in 43 patients and splenectomy or additional devascularization in 29. 15 patients had gastrointestinal bleeding during follow-up, and the median survival time was 11.0 months. CONCLUSION: Associated LSPH brought special features to pancreatic cancer. Radical resection, as well as splenectomy or additional devascularization for varices above Grade II, was worth performing.

The role of hepatic arteriography before precise hepatectomy in primary liver cancer / 中华肝胆外科杂志

ObjectiveTo study the role of hepatic arteriography before precise hepatectomy in primary liver cancer,Methods207 patients with primary liver cancers resected from 2005 to 2010 at Air Force General Hospital of Chinese PLA were studied retrospectively.There were 81 patients who received routine hepatectomy and 126 who received precise hepatectomy with hepatic arteriography before surgery.ResultsAnalysis showed that precise hepatectomy was superior to routine hepatectomy for lesions less than 1.0 cm (81.48％ vs 18.18％),with less operative time (168.20±35.81 min vs 221.75±30.33 min),volume of resection,blood loss (168.20±35.81 min vs 221.75±30.33 min),transfusion rate (256.13±185.24 ml vs 436.97±590.12 ml),and hospital stay (20.53± 12.41 d vs 25.72±17.27 d),(all P＜0.05).Hepatic arteriography did not affect liver function before precise hepatectomy.ConclusionsHepatic arteriography was significantly better in showing blood vessels of the primary liver cancer,and in detecting liver metastases or satellite lesions of less than 1.0 cm before surgery.

Comparative studies of perioperative period correlation factor of hepatectomy treatment for liver malignant tumor / 中华肝胆外科杂志

Objective To compare superiorities of liver malignant tumors underwent regular and irregular hepatectomies through approaching perioperative factors.Methods 1019 consecutive hepatectomies of liver malignant tumor from 1986 to 2009 at Air Force General Hospital and General Hospital of Chinese PLA were investigated retrospectively according to their medical documentation.Results Multivariate analysis showed that liver malignant tumors on which regular hepatectomy and irregular hepatectomy were performed,there was no significant difference in the blood loss,complications,mortality related to operation,hospital stay,and so on.But the operating time of regular hepatectomy was obvious more than that of irregular hepatectomy (P＜ 0.001,OR=1.004).Conclusions Although for liver malignant tumor,regular hepatectomy seems to be superior to irregular hepatectomy based on oncological theory,in clinical practice,there were no significant difference between the perioperative risk of regular hepatectomy and that of irregular hepatectomy.

Efficacy of precise sequential therapy for primary liver cancer / 中华消化外科杂志

Objective To investigate the construction and implementation of the concept of precise sequential therapy for primary liver cancer.Methods The clinical data of 207 patients with resectable liver cancer who were admitted to the Air Force General Hospital from May 2005 to June 2010 were retrospectively analyzed.Of all the patients,81 received conventional therapy (conventional therapy group),and the other 126 patients received precise sequential therapy (precise sequential therapy group).The conditions of the patients in perioperative phase,during postoperative sequential treatment and the period of follow-up between the 2 groups were compared.All data were analyzed by using the covariance analysis,analysis of variance,chi-square test or rank sum test.Results The detection rates of lesions with a diameter less than 1 cm,operation time,liver resection volume,intraoperative blood loss,rate of perioperative blood transfusion,duration of postoperative hospital stay,incidences of postoperative complications were 81％ (22/27),( 186 ± 36) minutes,(75 ± 29) ml,( 189 ± 60) ml,24％(30/126),(21 ± 12)days and 13％ (17/126) in the precise sequential therapy group,and 18％ (2/11),(222 ± 30)minutes,(133 ±88)ml,(327 ±46)ml,51％ (41/81),(26 ± 17)days and 20％ (16/81) in the conventional therapy group,respectively,with significant differences between the 2 groups (F =10.876,7.390,46.996,31.025,14.556,6.315,4.017,P ＜ 0.05).No significant difference was observed on the levels of alanine transaminase,albumin and the Child-Pugh score before and after the intervention in the precise sequential therapy group,but significant differences were observed in the conventional therapy group.The 1-,2-,3-year tumor recurrence rates and the 1-,2-,3-year survival rates were 17％ (21/126),22％ (17/76),26％ (8/31) and 87％ (110/126),87％ (66/76),84％ (26/31) in the precise sequential therapy group,and 31％ (25/81),38％ (27/71),48％(31/65 ) and 77％ (62/81),75％ (53/71 ) and 60％ (39/65) in the conventional therapy group,respectively.There were significant differences in the prognosis of the patients in the 2 groups ( x2 =4.958,4.292,4.168,4.062,3.640,5.470,P ＜ 0.05 ).Conclusion Through accurate assessment of the patients' condition before surgery,precise hepatectomy and precise postoperative intervention,the goal of effective control of tumor recurrence,maximum protection of the liver function and improvement of the survival rate can be achieved.