[Application values of computer-assisted preoperative planning of hilar cholangiocarcinoma].

OBJECTIVE: To explore the application value of computer-assisted preoperative planning of hilar cholangiocarcinoma. METHODS: Retrospective analyses were conducted for the clinical data of 47 patients with hilar cholangiocarcinoma undergoing radical resection plus hemihepatectomy from January to December 2013. According to whether computer-assisted preoperative planning was used, they were divided two groups of computer-assisted surgical planning (CASP) and without computer-assisted surgical planning (WCASP). Then we analyzed the data including preoperative examinations, preoperative planning, intraoperative findings and postoperative complications. RESULTS: There were 31 cases of hilar vascular invasion by tumor. Among 29 cases of CASP, left hepatic artery originated from left gastric artery (n = 6), right posterior bile duct drained into left hepatic bile duct (n = 1) and right posterior bile duct run into common hepatic bile duct (n = 2). The mean operative duration of CASP was (6.5 ± 1.3) h and the mean volume of intraoperative bleeding (672.0 ± 214.3) ml; while the mean operative duration of WCASP was (7.9 ± 2.9) h and the mean volume of intraoperative bleeding (870.0 ± 330.1) ml. By statistical analysis, the inter-group differences of mean operative duration had statistical difference (P = 0.028) and the inter-group differences of mean volume of intraoperative bleeding had statistical difference (P = 0.016). The ratio of first negative test in group CASP was higher than that of group WCASP and the inter-group differences had statistical significance (P = 0.043). But the inter-group rate of postoperative complications had no significant difference (P = 0.419). CONCLUSIONS: The computer-assisted surgical planning system provides accurate information so that an optimal surgical protocol may be designed by surgeons. And it has great application values in preoperative surgical planning for hilar cholangiocarcinoma and enjoys wide prospects in precise liver surgery.

[Clinical efficacies of different surgical strategies for advanced pancreatic carcinoma].

OBJECTIVE: To explore the clinical efficacies of different surgical strategies for patients with advanced pancreatic carinoma. METHODS: Retrospective analyses were conducted for the clinical data of 223 advanced pancreatic carinoma patients between January 2009 and December 2013 according to the inclusion criteria. And, according to different surgical strategies, they were divided into seed group (n = 49), radio frequency ablation group (n = 51), radiotherapy group (n = 17) and control group (n = 106). The general data, postoperative complications and follow-up profiles between 4 groups were statistically analyzed. RESULTS: The general profiles between four groups were not statistically significant (P > 0.05). There was no mortality. The postoperative complication rate was the highest at 43% (21/49) in seed group. However all complications were of Clavien grade II. The follow-up endpoint was until March 2014. The median follow-up period was 7 (1-52) months. The overall follow-up rate was 88.3% (197/223). And their survival rates of one month, half a year, one year and two years were 95.9%, 53.7%, 19.1% and 7.3% respectively. The average survival time was (9.6 ± 0.3) months. In seed group, the rates were 97.7%, 61.9%, 27.7% and 13.2% respectively. The average survival time was (12.9 ± 1.1) months. In radio frequency ablation group, the rates 88.9%, 54.9%, 22.9% and 7.6% respectively. The average survival time was (9.6 ± 0.9) months. In radiotherapy group, the rates were 93.7%, 56.2%, 18.7% and 6.2% respectively. The average survival time was (8.6 ± 1.4) months. In control group, the rates were 97.8%, 48.9%, 13.8% and 5.4% respectively. The average survival time was (8.5 ± 0.5) months. The survival curves of seed, radio frequency ablation and radiotherapy groups were compared separately with that of control group. The Log-rank test results suggested that the survival rate and mean survival time of seed group were higher than those of control group (P < 0.05). However the radio frequency ablation and radiotherapy groups had no significant difference with control group. CONCLUSIONS: The advanced pancreatic carinoma patients have poor outcomes with a short survival time. The intraoperative implantation of seeds is effective for advanced pancreatic cancer patients, but it also has a high incidence of postoperative complications. Radio frequency ablation and intraoperative radiotherapy fail to effectively prolong the patient survival time.

[Follow-up studies for long-term postoperative complications of Warshaw operation].

OBJECTIVE: To explore the long-term postoperative complications of Warshaw operation for distal pancreatectomy with preservation of spleen. METHODS: Retrospectively analyzed the clinical data of distal pancreatectomy on 84 cases between January 2006 and January 2012. Among them, 35 patients underwent Warshaw operation for distal pancreatectomy with preservation of spleen and another 23 had distal pancreatectomy with Kimura operation. All of them were followed up. RESULTS: All procedures were successful. There was no perioperative mortality. During the follow-up period, 2 patients undergoing Warshaw operation were lost. The median follow-up period was 2.6 years (range: 0.75-6.75). Twenty-six patients with the recent neuroimaging data showed: 5 patients were diagnosed of splenic infarction and the incidence rate was 19.2% (5/26) and 6 with gastric varices and the incidence rate was 23.1% (6/26). But none of them developed gastrointestinal hemorrhage or splenic abscess. CONCLUSION: The Warshaw operation for distal pancreatectomy with preservation of spleen may increase the risk of long-term postoperative complications so that its operative indication must be strictly mastered.

Technical points of total laparoscopic choledochal cyst excision.

BACKGROUND: Choledochal cyst excision and biliary enteric reconstruction constitute the best therapy for choledochal cyst. And laparoscopy is currently used to cure this disease now. METHODS: We retrospectively analyzed the clinical data of 34 cases of total laparoscopic choledochal cyst excision between January 2007 and August 2011. All patients underwent in vitro Roux-en-Y hepatoenterostomy. RESULTS: All 34 patients underwent successful total laparoscopic choledochal cyst excision. The operation time was 200 - 360 minutes. The duration of hospital stay was 3 - 7 days. Follow-up observations lasted 1 - 56 months. One patient developed an anastomotic stoma stricture, but no other cases had postoperative complications. No patients died. CONCLUSION: Total laparoscopic choledochal cyst excision is safe and feasible.

[Observation of laparoscopic distal pancreatectomy in hepatobiliary surgery: a report of 25 cases].

OBJECTIVE: To explore the clinical application of laparoscopic distal pancreatectomy (LDP) in hepatobiliary operations. METHODS: The clinical data of LDP from 25 cases from June 2008 to December 2011 were retrospectively analyzed. Among them, 9 patients underwent LDP with excision of spleen while another 16 patients had LDP with preservation of spleen. And during the same period, 42 patients undergoing open distal pancreatectomy were selected into the control group. And the patient data of two groups were compared. RESULTS: All of them underwent successfully LDP. Among 16 patients with preservation of spleen, 11 patients undergone the Kimura procedure while another 5 undergone the Warshaw operation. The operative duration was (4.5 ± 1.2) hours, volume of blood loss (256 ± 188) ml, length of incision (4.6 ± 0.9) cm, mean time of oral food taking (1.5 ± 0.9) days and mean postoperative hospital stay (7.1 ± 1.9) days. Pathological examinations showed benign tumor (n = 20), malignant tumor (n = 4) and borderline tumor (n = 1). The mean data of LDP group was significantly less than that of open distal pancreatectomy group in terms of anal exsufflation time, length of incision, postoperative hospital stay time and complication rate, etc. (P < 0.05). Four patients were diagnosed of post-LDP pancreatic fistula (3 A level vs 1 B level) and all of them became cured after conservative treatment. There was no mortality. CONCLUSION: As a safe and feasible procedure, LDP is worthy of wider applications.

Diagnosis and treatment of fungal infection after liver transplantation.

BACKGROUND: Liver transplantation is the most effective treatment for end-stage liver diseases; however, infections after transplantation can seriously affect the patient's health. The aim of this research was to investigate the diagnosis and treatment of fungal infection following liver transplantation. METHODS: Clinical data for 232 liver transplant patients at risk of fungal infection were examined for the presence of fungus in the blood, fluid, sputum, urine and stools of patients and by chest or abdominal CT scans. Patients diagnosed with a fungal infection were treated with Fluconazole or, if this was not effective, Voriconazole or Amphotericin B. Immunosuppressive therapy was also reviewed. RESULTS: Thirty-seven of 232 (15.9%) patients were diagnosed with a fungal infection, which occurred 4 to 34 days post-transplantation. Candida infections were diagnosed in 23 cases (62.2%) and Aspergillus infections in 12 cases (32.4%). Twenty-one cases were effectively treated with Fluconazole, 11 cases with Voriconazole, and two cases with Amphotericin B; however, three cases were not effectively treated with any of the antifungal agents. Overall, treatment was effective in 91.9% of patients. CONCLUSIONS: Fungal infection has a significant influence on survival rate after liver transplantation. Imaging studies, and pathogenic and biopsy examinations can diagnose fungal infections, which can be effectively treated with antifungal agents such as Fluconazole, Voriconazole or Amphotericin B.