Multimodal therapy and twenty years of valid management of a patient with chronic hepatitis B in a less developed Western Region in China---case report and review of the literature.

BACKGROUND: For patients with chronic hepatitis B and cirrhosis in less developed western regions in China, due to constraints of local economic conditions, the choice of treatment measures is often limited. However if patients recieved valid management and effective treatment, they were able to maintain their health and benign prognosis. CASE PRESENTATION: This study narrates the long-term treatment and careful follow-up of a patient with chronic hepatitis B and cirrhosis in a less developed western region in China, and analyzes the prognosis of the disease and countermeasures. CONCLUSIONS: This would partly reflect the development of antiviral therapy for chronic hepatitis B and multidisciplinary comprehensive treatment for cirrhosis-related complications in remote region with limited resources in the past 20 years.

[Comparison of hand-assisted laparoscopic surgery and open surgery for portal hypertension: a meta-analysis].

OBJECTIVE: To evaluate the clinical efficacy and safety of hand-assisted laparoscopic surgery (HALS) vs. open surgery (OS) for portal hypertension. METHODS: Relevant literature was retrieved from databases including PubMed, EMBASE, Cochrane Library, Chinese Biomedical Literature Database, Chinese Journal Full Text Database, Chinese Vip Datebase, and Chinese Wanfang. All the relevant trials were collected and then we performed the literature screening. The quality of the included trials was assessed by Cochrane Systematic Review Handbook 5.1. Meta-analyses were conducted by RevMan 5.1 software. RESULTS: Eight studies were involved and 435 patients were included. Meta-analysis showed that there was significant difference in intraoperative blood loss [MD = -140.95, 95% CI = (-233.58--48.32), P=0.003], total abdominal drainage volume [MD = -544.32, 95% CI= (-789.97--298.67), P<0.0001], postoperative exhaust time [MD = -28.30, 95% CI= (-41.90--14.69), P<0.0001], length of postoperative hospital stay [MD =-3.61, 95% CI= (-4.16--3.07), P<0.00001], postoperative complication [OR=0.35, 95% CI= (0.15-0.82), P=0.02] between HALS group and OS group. However, the operative time was not significantly different between these two groups [MD = -7.44, 95% CI = (-36.00 -21.12), P=0.61]. CONCLUSIONS: Compared with the traditional OS, HALS can reduce intraoperative bleeding, postoperative exhaust time, hospitalization time, surgical trauma, and postoperative complications.The patients often recover more quickly from the HALS. However, its long-term effictiveness and safety still needs to be further verified by randomized controlled trials.