ABSTRACT
Objective:To explore the current status of surgery for portal hypertension to grasp current status and future development of surgery in China.Methods:This study is jointly sponsored by China Hepatobiliary & Pancreatic Specialist Alliance & Portal Hypertension Alliance in China (CHESS).Comprehensive surveying is conducted for basic domestic situations of surgery for portal hypertension, including case load, surgical approaches, management of postoperative complications, primary effects, existing confusion and obstacles, liver transplantation(LT), laparoscopic procedures and transjugular intrahepatic portosystemic shunt(TIPS), etc.Results:A total of 8 512 cases of portal hypertension surgery are performed at 378 hospitals nationwide in 2021.Splenectomy plus devascularization predominated(53.0%)and laparoscopy accounted for 76.1%.Primary goal is preventing rebleeding(67.0%) and 72.8% of hospitals used preventive anticoagulants after conventional surgery.And 80.7% of teams believe that the formation of postoperative portal vein thrombosis is a surgical dilemma and 65.3% of hospitals practiced both laparoscopy and TIPS.The major reasons for patients with portal hypertension not receiving LT are due to a lack of qualifications for LT(69.3%)and economic factors(69.0%).Conclusions:Surgery is an integral part of management of portal hypertension in China.However, it is imperative to further standardize the grasp of surgical indications, the handling of surgical operation and the management of postoperative complications.Moreover, prospective, multi-center randomized controlled clinical studies should be performed.
ABSTRACT
Objective:To study the use of three-dimensional reconstruction in preoperative evaluation of complicated hepatic echinococcosis in Tibet.Methods:Sixty patients with complex hepatic hydatidosis admitted to the People's Hospital of Tibet Autonomous Region from April 2020 to August 2020 and planned to undergo radical hepatectomy were enrolled in this prospective randomized controlled study. The patients were randomly divided into the preoperative CT group and preoperative 3D reconstruction group by computer generated random numbers, with 30 patients in each group. Those with odd random numbers were enrolled in the preoperative CT group, and those with even random numbers were enrolled in the preoperative 3D reconstruction group. According to the imaging results, the operation plan was developed, and the coincidence rates of the preoperation plan with intraoperative decision, and postoperative complications were compared between the two groups.Results:There were 27 males and 33 females, aged (40.7±12.7) years. In the preoperative CT group, 53.3% (16/30) of the operation carried out were consistent with the preoperative planned operations. The corresponding figure for the preoperative 3D reconstruction group was 86.7% (26/30). The difference between the two groups was significant ( P<0.05). In the preoperative CT group, the operative time was (220.0±32.3) min, the intraoperative blood loss was (523.0±47.1) ml, the number of patients requiring hepatic blood inflow occlusion was 25 (83.3%), and the time of hepatic blood inflow occlusion was (32.1±5.8) min. In the preoperative 3D reconstruction group, the operative time was (156.0±17.6) min, the intraoperative blood loss was (212.0±21.5) ml, the number of patients requiring of hepatic blood inflow occlusion was 15 (50.0%), and the time of hepatic blood inflow occlusion was (16.2±3.4) min. The differences between the two groups were also significant (all P<0.05). Conclusion:Preoperative three-dimensional reconstruction of complex hepatic echinococcosis in Tibet effectively improved the safety of surgery.