Meta-analysis of Liver Resection Versus Nonsurgical Treatments for Pancreatic Neuroendocrine Tumors with Liver Metastases.

PURPOSE: Studies have reported limited evidence of the benefits and harms of various regimens, such as liver resection and medical therapy, for the treatment of pancreatic neuroendocrine tumors (pNETs) with liver metastases. This meta-analysis aimed to evaluate the efficacy of liver resection versus nonsurgical treatments in patients with pNET. METHODS: Relevant studies published in English were retrieved from the computerized databases Medline, Embase, and Cochrane. A meta-analysis was performed to investigate the differences in the efficacy of liver resection and nonsurgical treatments based on the evaluation of 30-day mortality, symptom relief rate, median survival time, and 2-, 3-, or 5-year survival using a random-effects model. Studies were independently reviewed by two investigators. Data from eligible studies were extracted, and the meta-analysis was performed using the comprehensive meta-analysis program version 2. RESULTS: A total of seven studies were included in the analysis. The results demonstrated that liver resection was significantly associated with a higher rate of symptom relief, longer median survival time, higher 2- or 3-year survival rates, as well as a higher 5-year survival rate. There was no significant difference in 30-day mortality among patients with pNETs who were treated by liver resection and nonsurgical therapy or survival between functional and nonfunctional pNETs. No publication bias was detected. CONCLUSIONS: Liver resection has a favorable prognostic outcome in terms of higher postoperative symptom relief rates and longer survival rates. Further randomized, controlled trials with longer follow-up periods are required to confirm the advantages of liver resection for pNETs.

Duodenum-preserving resection and Roux-en-Y pancreatic jejunostomy in benign pancreatic head tumors.

This study was conducted to explore the feasibility of partial pancreatic head resection and Roux-en-Y pancreatic jejunostomy for the treatment of benign tumors of the pancreatic head (BTPH). From November 2006 to February 2009, four patients (three female and one male) with a mean age of 34.3 years (range: 21-48 years) underwent partial pancreatic head resection and Roux-en-Y pancreatic jejunostomy for the treatment of BTPH (diameters of 3.2-4.5 cm) using small incisions (5.1-7.2 cm). Preoperative symptoms include one case of repeated upper abdominal pain, one case of drowsiness and two cases with no obvious preoperative symptoms. All four surgeries were successfully performed. The mean operative time was 196.8 min (range 165-226 min), and average blood loss was 138.0 mL (range: 82-210 mL). The mean postoperative hospital stay was 7.5 d (range: 7-8 d). In one case, the main pancreatic duct was injured. Pathological examination confirmed that one patient suffered from mucinous cystadenoma, one exhibited insulinoma, and two patients had solid-pseudopapillary neoplasms. There were no deaths or complications observed during the perioperative period. All patients had no signs of recurrence of the BTPH within a follow-up period of 48-76 mo and had good quality of life without diabetes. Partial pancreatic head resection with Roux-en-Y pancreatic jejunostomy is feasible in selected patients with BTPH.

[Ultrasound guided ablation therapy of hepatic colorectal metastases: initial experience of real time virtual sonography navigation system].

OBJECTIVE: To evaluate the feasibility, accuracy and efficacy of the real time virtual sonography navigation and planning system in radio frequency ablation (RFA) of hepatic colorectal metastases. METHODS: Seventeen hepatic colorectal metastases lesions in 12 patients diagnosed pathologically or clinically in Peking University Third Hospital from Oct. 2011 to Apr. 2013 were enrolled, and all the lesions were diagnosed by CT/MRI but invisible in B-mode ultrasound. The patients included 9 males and 3 females, who were 45-82 years old, with an average age of (64.6±19.2) years. Before RFA, the puncture ablation plan of each lesion was made in the planning system, and during RFA the lesion and the 5 mm ablative margin around were ablated according to the puncture ablation plan. After the image fusion between the ultrasound and CT/MRI, the navigation system could decide the location and boundary of the hepatic colorectal metastases in the ultrasound image. Navigation assisted contrast-enhanced ultrasound (CEUS) was employed right after ablation to decide whether the area of the ablative zone had covered the whole tumor. Additional puncture was applied if the ablative zone had not completely covered the tumor. All the patients received CT/MRI one month after ablation to decide whether the carcinoma had been completely ablated. RESULTS: The image fusion was successfully applied in all the 17 hepatic colorectal metastases, and on average, 12 min (8-21 min) was spent in the image fusion. One tumor (1/17, 14.3%) received extra one puncture after navigation assisted CEUS. No severe complications and death occurred in all the 12 patients. Complete ablation of the 17 lesions were observed through CT or MRI scan one month after RFA, showing that all the 17 lesions had been completely ablated. CONCLUSION: The real time virtual sonography navigation system had high detection rate for invisible focal liver lesions in B-mode ultrasound. Navigation assisted CEUS could decide whether the area of the ablative zone had covered the whole tumor. Ultrasound CT or MRI navigation and planning system is safe, feasible and accurate in assisting ablation of hepatic colorectal metastases lesions with satisfactory clinical efficacy.

[Laparoscopic liver tumor resection of clinical experience in 126 patients].

OBJECTIVE: To explore the clinical application technology of completely laparoscopy hepodectomy (LH). METHODS: From June 2006 to December 2011, the 126 cases of LH were performed, the data including operating time, blood loss and postoperative complications, etc, were analyzed retrospectively. The patients included 87 males and 39 female and they were 28-83 years old with an average age of 44.5 years old. The parenchyma was transected using laparoscopic ultrasonic scalpel and ligasure, accomplished with endoscopic linear stapler. Of all the patients, the diseases performed LH including primary liver carcinoma (45 cases), liver hemoangioma (58 cases), colon carcinoma with livermetastasis (23 cases), liver focar (5 cases), liver granuloma (1 case), liver adenoma (4 cases). The operations included left hemihepatectomy (n = 17), left lateral lobectomy (n = 34), right hemihepatectomy (n = 15), segmentectomy (n = 22), local resection (n = 59). RESULTS: Of all the patients, mean blood loss was 180 ml (10-1250 ml), mean surgical time was 142 minutes (43-220 minutes), mean postoperative hospital day was 2.2 days (3-12 days). Postoperative complications including eight cases of bile leakage, recovered after 1-3 weeks by appropriately draining. The patients with malignant tumor were followed up for 18 months (12-46 months), recurrence happened in 12 cases and four cases was died of recurrence and metastasis. CONCLUSIONS: LH is a safe, feasible and effective procedure for the treatment of benign liver disease and malignant liver neoplasm as long as the patient is properly selected, it should be recommended for radical resection of hepatocellular carcinoma.

[Analysis and management of the biliary complications after liver transplantations].

OBJECTIVE: To discuss the relevant factors of biliary complications after liver transplantation and to investigate the value of comprehensive management for the complications. METHODS: The data of 366 patients undergoing liver transplantation from October 2000 to March 2012 was analyzed retrospectively, and the risk factors were analyzed by univariate analysis and Stepwise Logistic regression. The cases with biliary leak were administered thorough drainage. The cases with anastomotic biliary stricture were administered sacculus dilatation through percutaneous transhepatic cholangiography (PTC) and endoscopicretrograde cholangiopancreatography (ERCP). If necessary, some cases were placed biliary tract brackets. The patients with nonanastomotic biliary stricture were treated with PTC plus choledochoscope. RESULTS: All the 366 patients were followed up for 58.5 (10 to 129) months. Biliary complications after liver transplantation were diagnosed in 42 cases among these patients. The incidence for biliary complications was 11.5%. The univariate analysis and multivariate Logistic regression analysis showed that the second warm ischemia period and the blood loss and the damage of blood supply and the diameter of biliary anastmosis were significantly associated with biliary complications after liver transplantations (Wald = 9.474 to 17.208, P < 0.05). Twelve cases with biliary leak were cured through abdominal and nasobiliary drainage. Twenty-two cases with anastomotic biliary stricture were administered sacculus dilatation through ERCP or PTC and were cured, including 6 cases were placed biliary tract brackets. Among 8 cases with nonanastomotic biliary stricture, 6 cases were cured through PTC associating with choledochoscope. One case was treated second liver transplantation and another case got worse. CONCLUSIONS: Ischemic injury and the diameter of anastmosis are risk factors for biliary complications after liver transplantations. The interventional management of biliary stricture and bile leakage after liver transplantation is safe and effective.

HBV recurrence lowered by lamivudine/HBIG combination therapy in liver transplant patients: ten-year experience.

BACKGROUND: Lamivudine and hepatitis B immunoglobulin (HBIG) are widely used to treat patients with hepatitis B recurrence after liver transplantation. However, the outcomes are inconclusive. The present study was undertaken to evaluate the effect of combined therapy on patients with hepatitis B recurrence after liver transplantation. METHODS: Twenty-two patients with hepatitis B recurrence after liver transplantation from August 2000 to October 2011 were enrolled in this study. Of these patients, 16 received lamivudine plus HBIG (combination therapy group) and 6 were treated with lamivudine alone (lamivudine-treated group). The clinical features were matched in the two groups. HBV recurrence parameters, HBsAg clearance rate, patient survival rate, and survival time were compared. RESULTS: The average time of follow-up was 47.2 months (range 13-99). Significant difference was noted in the HBsAg clearance rate in the lamivudine-treated and combination therapy groups (50% vs 93.8%, P<0.05). There was no significant difference in the time of HBV recurrence, patient survival rate and survival time between lamivudine-treated and combination therapy groups (P>0.05). CONCLUSION: Compared with lamivudine monotherapy, combination therapy significantly increased the HBsAg clearance rate in patients with HBV recurrence after liver transplantation.

[Clinical characteristics and diagnosis and treatment of malignant tumor of the duodenum].

OBJECTIVE: To analyze the clinical characteristics of the malignant tumor of the duodenum and to improve the diagnosis and treatment. METHODS: The clinical data of 100 cases with malignant tumor of the duodenum at Peking University Third Hospital from 1974 to 2010 were summarized retrospectively. According to the different location of the tumors,the cases were divided into two groups: papilla tumor group and non-papillary region tumor group.Then the clinical manifestations, treatment and prognosis in the two groups were separately statistically compared. RESULTS: Most of duodenal tumors were located in the descendent part, especially in the duodenal papilla. Common clinical manifestations included upper abdominal pain, jaundice, black stool, intestinal obstruction and abdominal mass. Jaudice often occurred in papilla tumors (42/59), and black stool was usually detected in the tumors outside papilla (12/41). Intestinal obstruction and palpable abdominal mass often indicated advanced stage. Duodenofiberscope, combined with air barium double contrast radiography, could increase the diagnosis rate(90%). For papilla tumors, endoscopic retrograde cholangio-pancreatography (ERCP) was the best diagnostic method (100%). In the study, 56 cases underwent standard pancreaticoduodenectomy, 9 cases underwent simple tumor resection and 12 cases received segmental duodenectomy, and other 15 cases underwent palliative short-cut procedures. The resection rate was 84.2%(80/95) and radical resection rate was 62.1%(59/95). Either resection rate [91.4%(53/58) vs.72.9%(27/37), χ(2)=5.756,P=0.016] or radical resection rate [87.9% (51/58) vs.21.6%(8/37), χ(2)=42.204,P<0.0001] in the group of papilla tumors was significantly higher than in the group of non-papillary region tumors. Accordingly, the postoperative five year survival rate of the papillary carcinoma group was 44.8% (26/58) while that of the non-papillary region tumor group only 29.7% (11/37). CONCLUSION: It will help the clinician to early diagnose the maligment tumors of the duodenum if the rational examinations were performed timely for the doubtable cases, especially for non-papillary region tumor. Pancreaticoduodenectomy is still the best way to treat this disease.

[Clinicopathologic features, diagnosis and treatment with solid-pseudopapillary tumor of the pancreas: a report of 33 cases].

OBJECTIVE: To study the clinicopathologic and immunohistochemical features, biological behavior, diagnosis and treatment of solid pseudopapillary tumor of the pancreas (SPTP). METHODS: A retrospective clinical and clinicopathologic analysis was made on 33 cases of SPTP admitted from May 2001 to 2010 July. There were 7 male and 26 female patients, aging from 13 to 66 years with a mean of 34.3 years. RESULTS: The tumor was located in pancreatic head of 10 patients, in pancreatic neck of 5 patients, in pancreatic body and tail of 18 patients. Of the 33 patients treated with surgery, 8 underwent simple resection of pancreatic tumor, 6 underwent pancreaticoduodenectomy, 3 underwent tumor resection plus pancreaticojejunostomy, 1 underwent tumor resection plus pancreaticogastrostomy, 11 underwent distal pancreatectomy, 4 underwent distal pancreatectomy plus spleen resection (1 underwent mesohepatectomy for hepatic metastasis). Sixteen of the 33 operations were completed by laparoscopy. Histologically, tumors were composed of papillary and microcystic solid structures, with uniformed population of cells. The pancreas and blood vessels invasion were identified in 3 cases, one of them was combined with liver metastasis, and they are male. Immunohistologically, the tumors were positive for α1-antitrypsin, α1-antichymotrypsin, ß-catenin, CD10, CD56 and vimentin (all cases), neuron-specific enolase (3 cases), synaptophysin (6 cases), chromogranin A (4 cases), progesterone receptor (28 cases), estrogen receptor (3 cases), S-100 (6 cases). Totally 33 cases were followed up with a median period of 49 months without tumor recurrence. CONCLUSIONS: SPTP is of low graded malignancy. It primarily affects young women. It may be located in any part of pancreas. Immunohistochemistry is very important for the diagnosis and differential diagnosis of SPTP. Surgical resection is recommended as the treatment of choice. Laparoscopic distal pancreatectomy or tumor resection is feasible and safe for some selected patients, and the prognosis is good.

[Laparoscopic anatomical right hemihepatectomy for liver tumor in 16 patients].

OBJECTIVE: To explore the clinical application of laparoscopic anatomical right hemihepatectomy in the treatment of liver tumor. METHODS: From October 2007 to October 2011, 16 cases of laparoscopic anatomical right hemihepatectomy were performed. The data of operative duration, blood loss volume and postoperative complications, etc, were analyzed retrospectively. Parenchyma was transected with a laparoscopic ultrasonic scalpel and ligature and accomplished with an endoscopic linear stapler. RESULTS: Among them, postoperative pathologic examinations revealed primary liver carcinoma (n = 7), liver hemangioma (n = 6), colon carcinoma with liver metastasis (n = 2) and pancreatic non-function neuroendocrine carcinoma with liver metastasis (n = 1). The mean volume of blood loss was 550 (200 - 1550) ml, mean surgical time 310 (260 - 450) minutes and mean postoperative hospital stay 7 (5 - 14) days. Postoperative complications included 3 cases of bile leakage recovered after 2 - 3 weeks by appropriate draining. The patients with malignant tumor were followed up for 15 (12 - 52) months. Recurrence occurred in 4 cases and another 2 died of recurrence and metastasis. CONCLUSIONS: Laparoscopic anatomical right hemihepatectomy is a safe, feasible and effective procedure for the treatment of benign liver disease and malignant liver neoplasms in properly selected patients. It should be recommended for radical resection of hepatocellular carcinoma.

[The influential factors and clinical significance of acute renal failure complicated to orthotopic liver transplantation].

OBJECTIVE: To analyze the risk factors for acute renal failure (ARF) early after liver transplantation. METHODS: The data of 362 patients undergoing liver transplantation from August 2000 to December 2010 were retrospectively analyzed, including 71 patients with ARF (ARF group) and 291 without ARF (non-ARF group). Thirty-six variables, including clinical and experimental variables, were analyzed by t test for continuous variables and χ(2) test for discrete variables. The variables with significance (P < 0.05) were then analyzed with Stepwise logistic regression. RESULTS: Twelve variables, including pretransplant serum creatinine, hemoglobin, thrombinogen activity, total bilirubin, MELD scores, total operation time, intraoperative blood loss, intraoperative blood transfusion, preoperative urine output, preoperative hepatic encephalopathy, intraoperative low blood pressure and postoperative infection, had significant difference between two groups (F = 10.30 - 182.70, P = 0.000 - 0.041). The Stepwise logistic regression analysis for 12 variables demonstrated that the high level of pretransplant serum creatinine, the low pretransplant thrombinogen activity, the high MELD scores, the large volume of intraoperative blood loss, postoperative infection were the independent risk factors of ARF complicated to orthotopic liver transplantation (P < 0.05). CONCLUSIONS: Early ARF is a key negative factor for the survivors after orthotopic liver transplantation. The reason for ARF complicated to OLT is multiple. The high level of pretransplant serum creatinine, the low pretransplant thrombinogen activity, the high MELD scores, the large volume of intraoperative blood loss, postoperative infection were the independent risk factors of ARF complicated to orthotopic liver transplantation.

[The pathological feature of primary hepatic carcinoma on explanted liver and its significance].

OBJECTIVE: To investigate the pathological feature of primary hepatic carcinoma and the clinical significance. METHODS: From August 2000 to December 2007, there were 89 patients with cirrhosis and carcinoma of liver who accepted whole liver resection. The whole liver was cut into 10 mm slices to examine the tumor size, number, distribution, capsule, satellite nodes, portal vein tumor thrombi (PVTT). The invaded adjacent tissue and lymph nodes were recorded, the distance from satellite to major tumor was measured, then histological examinations were carried out, and the final diagnosis was made by pathologists. RESULTS: The total of 89 cases included hepatocellular carcinoma in 86 cases and cholangiocarcinoma in 3 cases; 53 cases with multiple tumors and 36 cases with solitary tumor; complete capsule only in 14 cases, no obvious margin in 11 cases, 13 cases had a major tumor in the right lobe and a small tumor in the left lobe; 8 of 25 cases with gross invaded tissue were confirmed by histological examination, 7 of 16 cases with swollen lymph nodes were infiltrated by cancer cells. There were 47 cases with PVTT (47.2%) and 39 cases with satellite nodes (43.8%). PVTT and satellite nodes increased with the increase of sizes and the numbers of the tumors. The distance from satellite node to major tumor mostly were 0.5 - 3.0 cm. CONCLUSIONS: The whole explanted liver can completely reflect the characteristics of growth and infiltration of hepatic carcinoma. Attention must be paid to the small cancer lesions in another lobe, distal satellite nodes from major tumor, and tumor thrombi in a small branch of portal vein, which can not be found by imaging, and might influence the curative effectiveness after liver resection or transplantation.

[Long naso-intestinal tube decompression versus octreotide in the treatment of early post-operative inflammatory ileus].

OBJECTIVE: To evaluate and compare the effect of naso-intestinal tube decompression and octreotide in conservative management of early post-operative inflammatory ileus (EPII). METHODS: From March 2005 to January 2009, forty-five patients diagnosed with EPII, who failed to improve with conventional conservative management including nasogastric tube decompression, were enrolled in this study. All patients were prospectively nonrandomized into naso-intestinal tube group (n = 23) or Octreotide group (n = 22). The outcomes were compared between nasogastric tube, naso-intestinal tube and Octreotide groups. RESULTS: All the forty-five patients with EPII refractory to conservative management with nasogastric decompression were treated successfully with the naso-intestinal tube decompression or octreotide in 3-12 days. Compared with the Octreotide group, the first passage of flatus was earlier [(4.7 +/- 1.9) d vs (6.7 +/- 1.6) d] and abdominal circumference recovered faster [(90.4 +/- 2.0)% vs (95.1 +/- 1.3)%] in the naso-intestinal tube group (P < 0.05). But the volume of cumulative and daily gastrointestinal decompression were more in naso-intestinal tube group than those in Octreotide group [(4037 +/- 1155) ml vs (3316 +/- 1038) ml; (890 +/- 181) ml vs (492 +/- 83) ml; P < 0.05]. CONCLUSIONS: Patients with EPII could be safely and effectively managed by naso-intestinal tube decompression or octreotide. It is possible for those patients to avoid second laparotomy. Naso-intestinal tube decompression and octreotide are associated with faster recovery and less fluid loss respectively.

Long-term outcomes of choledochoduodenostomy for hepatolithiasis.

BACKGROUND: Oddi sphincter plays an important role in preventing reflux cholangitis. There exists the controversy on application of choledochoduodenostomy in hepatolithiasis management. The present study aimed at evaluating long-term outcomes of choledochoduodenostomy for the treatment of hepatolithiasis. METHODS: Forty-six consecutive cases of hepatolithiasis who underwent choledochoduodenostomy were analyzed retrospectively. The pre- and postoperative rates of recurrent cholangitis and acute cholangitis severe type were compared. Paired chi-square test was applied. RESULTS: The mean follow-up time was 17.3 years ranging from 1.6 to 40 years with a follow-up rate of 97.8% (45/46). High rates of remnant stones (39.1%, 18/46), recurrent stones (31.1%, 14/45), uncorrected strictures (85%, 17/20), and mortality (24.4%, 11/45) were observed in this group. Regurgitation of food debris and duodenal content into the biliary tract through the anastomosis was observed. The rate of recurrent cholangitis was equal to the preoperative period (93.3%, 42/45). The rate of acute cholangitis severe type after choledochoduodenostomy (46.7%, 21/45) increased significantly (P<0.01) when compared to the preoperative period (20.0%, 9/45). CONCLUSIONS: Choledochoduodenostomy did not entirely achieve the goal of clearance of stones, correction of strictures, and removing of hepatobiliary lesions by itself. Choledochoduodenostomy without cholangioplasty resulted in an increase of severe reflux cholangitis due to the loss of the anti-reflux function of the sphincter of Oddi. Therefore, choledochoduodenostomy is not an ideal approach to reduce cholangitis in hepatolithiasis and is not the best choice in the management of hepatolithiasis.

[Analysis of in-hospital morbidity and mortality of colorectal cancer and accuracy of POSSUM models for mortality risk].

OBJECTIVE: To develop the modified P-POSSUM equation and the modified Cr-POSSUM equation and compare their performances with POSSUM in forecasting in-hospital morbidity and mortality of colorectal cancer. METHODS: Data of 903 patients undergone operation of colon and rectal cancers from 1992 to 2005 in our department were enrolled in this study. ROC curve was applied to judge the differentiation ability of each score. Model goodness-or-fit was tested by the Hosmer-Lemeshow statistic and subgroup analysis was performed by the ratio of observed to expected deaths (O:E ratio). A 70:30 percent split-sample validation technique was adopted for model development and testing. Stepwise logistic regression was used to develop the modified P-POSSUM and the modified Cr-POSSUM. Their performance in validating sample, colonic cancer sample, rectal cancer sample, elective surgery sample, emergency surgery sample, curative surgery sample and palliative surgery sample was tested by ROC curve, Hosmer-Lemeshow statistic and O:E ratio. RESULTS: The modified P-POSSUM showed good discrimination in all samples except the emergency surgery and palliative surgery. The predicted mortality of modified P-POSSUM was very close to the observed mortality. However, the modified Cr-POSSUM showed good discrimination in all samples except the palliative surgery. The predicted mortality was higher than the observed mortality, but still within the 95% confidence interval (CI) of the observed mortality. Both the modified models offered better accuracy than the P-POSSUM. CONCLUSION: The modified P-POSSUM and the modified Cr-POSSUM model provide an accurate prediction of inpatient mortality in Chinese colorectal cancer patients.

[Clinical effects of subcutaneous tunnel hepatocholangioplasty on the treatment of hepatolithiasis].

OBJECTIVE: To evaluate the therapeutic effect of subcutaneous tunnel hepaticoplasty on the treatment of hepatolithiasis. METHODS: The early complications and clinical effects of 99 hepatolithiasis cases who underwent subcutaneous tunnel hepaticoplasty from January 1993 to August 2006 were analyzed retrospectively. The stones of 28 (28.3%) patients were in the left lobe, 24.2% (24/99) in the right, and 47.5% (47/99) in bilateral lobe. Sixty-six patients (66.7%) had both stones and biliary strictures. During the procedure, a portion of the liver habouring stone was resected if necessary. The hepatic duct and strictures were opened, the stones were removed, and the porta hepatis was repaired by one end of a segment of jejunum. The other end of the jejunum was set subcutaneously. The gall bladders of 27 patients (27.3%) were used as subcutaneous tunnel instead. RESULTS: Ninety-five out of ninety-nine cases were followed up with an average of 4.2 years (1 month to 13.5 years). The rates of residual stone, recurrent stone and cholangitis were 23.2% (23/99), 20.0% (19/95) and 14.7% (14/95) respectively. Postoperatively, 34 cases who had residual or recurrent stones were underwent lithotomy by choledochoscope through the subcutaneous blind loop and the achievement ratio was 91.2% (31/34). CONCLUSIONS: Subcutaneous tunnel hepatocholangioplasty decreases the relapsing cholangitis effectively, and makes an easy way to take out residual or recurrent stones.

[Clinical values of color doppler ultrasound and magnetic resonance angiography in diagnosis of the tumor emboli and thrombi in portal venous system].

OBJECTIVE: To evaluate the clinical values of color Doppler ultrasound (BUS?) and magnetic resonance angiography (MRA) in diagnosis of the tumor emboli and thrombi in portal venous system. METHODS: Examination of the portal venous system by BUS and MRA was conducted on 165 patients with undergoing liver transplantation because of cirrhosis or primary hepatic carcinoma before the operation. The extrahepatic portal vein was observed during operation and pathological examination was conducted after the operation. The results of BUS and MRA were compared as regards the sensitivity and specificity in discovering the tumor emboli and thrombi in portal venous system. RESULTS: The overall sensitivity, specificity, and positive predictive rate of BUS for the portal vein embolus were 86.5%, 97.4%, and 85.3% respectively. The overall sensitivity, specificity, and positive predictive rate of MRA for the portal vein embolus were 90.5%, 99.3%, and 95.7% respectively. However the accuracy in diagnosing the nature of the portal venous embolus was less than 70% for these 2 methods. CONCLUSION: Non-invasive, both BUS and MRA help discover the portal vein embolus. However, false positivity and false negativity still exist. And both fail to diagnose the nature of the portal venous embolus.

[Pyoderma gangrenosum: a report of 3 cases].

OBJECTIVE: To improve the surgeon's understanding of pyoderma gangrenosum (PG) and avoid misdiagnosis and incorrect treatment. METHODS: Three cases of PG managed in the department of general surgery during the past 10 years were retrospectively reviewed. RESULTS: All of the 3 cases mainly presented with necrosis of skin and soft tissues, followed by formation of painful and extensive creeping ulcer. They all had fever and were initially diagnosed and managed as "infection", but repeated wound exudates culture showed negative results and antimicrobial therapy was not effective. The ulcers were enlarged quickly despite of active debridement. Histopathology of ulcer biopsy suggested nonspecific inflammation. After the diagnosis of PG was established, systemic therapy with steroids and immunosuppressants were administered together with local wound care. The progress of the disease was controlled soon and fully resolved finally. CONCLUSIONS: Pyoderma gangrenosum is misdiagnosed frequently. For severe patients, systemic therapy with steroids and immunosuppressants should be used as early as possible and skin lesions would heal together with mild local wound care.

[Comparison of efficacy between procedure for prolapse and hemorrhoids and open hemorrhoidectomy].

OBJECTIVE: To compare the results of procedure for prolapse and hemorrhoids (PPH) and open hemorrhoidectomy. METHODS: A standard questionnaire was given to all patients after PPH or open hemorrhoidectomy from March 2001 to March 2004. In combination with proctological examination, the results including symptoms relief and recurrence were compared between the two groups. RESULTS: There were 184 effective questionnaires, including 96 cases in PPH group and 88 in open hemorrhoidectomy group. PPH and open hemorrhoidectomy both relieved prolapse (92.7% vs 96.8%, P=0.282), bleeding (91% vs 81%, P=0.241) and pain (91.7% vs 91.5%, P=0.977). There were no statistical differences in the overall complication rate (30.2% and 29.5%, P=0.923) and recurrence rate (21.8% vs 20.5%, P=0.814) between the two groups. The overall satisfactory degree was 87.5% in PPH group and 84.8% in open hemorrhoidectomy group (P=0.218). CONCLUSION: PPH is a safe and effective option for prolapsed hemorrhoids compared with open hemorrhoidectomy.

[Prognostic analysis of T1 and T2 stage gallbladder cancer with invasion within the gallbladder wall].

OBJECTIVE: To explore the impact of different treatment procedure on the prognosis of T1 and T2 stage gallbladder cancer with the invasion within the gallbladder wall. METHODS: A retrospective analysis was conducted on 45 patients with pathologic stage T1 and T2 gallbladder cancer who had undergone surgical resection from 1990 and 2005. RESULTS: Depth of invasion (T), radical cholecystectomy and postoperative adjuvant chemotherapy were independent prognostic factors on Cox multivariate analysis. The 5-year survival rates of patients with T1a, T1b and T2 stage gallbladder cancer who underwent simple cholecystectomy without postoperative adjuvant chemotherapy were 100%, 67% and 0, respectively. The survival rate in T2 was significantly lower than those in T1a and T1b. Without postoperative adjuvant chemotherapy, the 5-year survival rates of patients with T2 stage gallbladder cancer who underwent simple cholecystectomy and radical cholecystectomy were 0 and 63%, respectively. There was significant difference between the survival time of T2 patients who had undergone simple cholecystectomy with and without postoperative adjuvant chemotherapy. CONCLUSIONS: The prognosis of patients with T1 stage gallbladder cancer is much better than that of T2 stage. The 5-year survival rates of patients with T1a and T1b stage gallbladder cancer who received simple cholecystectomy are relatively good. Radical cholecystectomy and postoperative adjuvant chemotherapy can improve the prognosis of patients with T2 gallbladder cancer.