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Objective:To study the impact of anticoagulant therapy starting at different platelet levels on the incidences of portal vein thrombosis (PVT) after splenectomy and devascularization.Methods:From January 2014 to January 2017, 125 patients with liver cirrhosis and portal hypertension underwent splenectomy and pericardial devascularization in Beijing Ditan Hospital, Capital Medical University. All patients routinely received anticoagulant therapy. There were 85 patients who had a platelet count greater than >100×10 9/L (the study group) and 40 patients who had a platelet count greater than >300×10 9/L (the control group). The incidence of PVT was compared between the two groups. Results:A total of 125 patients were included in the study, including 91 males and 34 females, aged 20-59 years. Age, gender, preoperative platelet level, preoperative splenic vein and portal vein width, preoperative coagulation function, preoperative liver function (Child classification), preoperative esophageal and gastric varices, operation time, preoperative bleeding time, preoperative venous blood flow velocity, coagulation function 1 week and 2 weeks after operation between the two groups were not significantly different (all P>0.05). Of 125 patients undergoing splenectomy and pericardial devascularization, PVT was not found in all patients before operation. The incidence of PVT was 39.2% (49/125) within one month after operation. Among the 85 patients in the study group, 28 patients developed PVT, and the incidence of thrombosis was 32.9% (28/85). In the control group, 21 patients developed PVT, and the thrombosis rate was 52.5% (21/40). The difference was significant (χ 2=4.366, P=0.037). After anticoagulant therapy, the incidence of bleeding in the study group was 4.7% (4/85), and that in the control group was 5.0% (2/40), the difference was no significant ( P>0.05). Conclusion:Early anticoagulation (platelet >100×10 9/L) does not increase the risk of postoperative bleeding, but can reduce the incidence of PVT.
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Objective:To study factors influencing postoperative pancreatic fistula rates with a view to prevent postoperation pancreatic fistula from happening.Methods:This is a retrospective study on 281 patients who underwent distal pancreatectomy at the First Affiliated Hospital of China Medical University from March 2011 to April 2018. There were 89 males and 192 females, with the age of (51.01±13.65) years. Univariate and multivariate logistic regression analyses were used to analyze the following factors on the occurrence of pancreatic fistula after operation: gender, age, body mass index(BMI), tumor characteristics, preoperative fasting blood glucose, blood biochemistry, liver function and surgical indications.Results:Of the 281 patients who underwent distal pancreatectomy in this study, 245 (87.2%) did not develop pancreatic fistula / biochemical leakage, while 36(12.8%) patients developed clinically significant pancreatic fistula (B/C grade). Univariate analysis showed the factors which affected the incidence of pancreatic fistula after surgery to include: BMI, preoperative fasting blood glucose, and whether the main pancreatic duct was ligated (all P<0.05). Multivariate logistic regression analysis showed that the independent factors affecting pancreatic fistula incidence after surgery were BMI≥25 kg/m 2 ( OR=2.354, 95% CI: 1.137-4.873, P<0.05), and main pancreatic duct was not ligated ( OR=4.067, 95% CI: 1.191-13.885, P<0.05). Conclusions:A high BMI increased the risk of postoperative pancreatic fistula, while ligation of main pancreatic duct during surgery reduced the risk.
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Objective:To study the efficacy and safety of Hassab operation combined with either radiofrequency ablation(RFA) or liver resection in treatment of liver cancer associated with portal hypertension.Methods:A retrospective analysis was conducted on the clinical data of patients with primary liver cancer associated with portal hypertension operated at the Department of General Surgery of Beijing Ditan Hospital from June 2013 to June 2015. These patients were divided into the RFA combined with Hassab operation group and the liver resection combined with Hassab operation group according to the surgical procedures. The general patient information, operation time, intraoperative blood loss, intraoperative blood transfusion, postoperative hospital stay, postoperative complications and the 1-, 3-, and 5-years cumulative survival rates and recurrence-free survival rates were compared.Results:Of 53 patients who were included in the study, 30 patients were in the RFA combined with Hassab operation group (including 28 males and 2 females, average age 46.3 (27.0~64.0) years, and 23 patients in the liver resection combined with Hassab operation group (including 20 males and 3 females), average age 44.7(33.0~59.0) years. There were no significant differences in the general patient information including age, gender, maximum tumor diameter, preoperative laboratory tests (including blood routine, liver function, tumor markers), and Child-Pugh classification between the two groups (all P>0.05). Intraoperative blood loss in the RFA combined with Hassab operation group was significantly less than those in the liver resection combined with Hassab operation group [(401.67±183.12) ml vs (552.17±333.88) ml, P<0.05]. There were also no significant differences between the two groups in operation time, blood transfusion during operation, postoperative hospital stay, and postoperative complications ( P>0.05). The incidence of severe postoperative complications (Clavein-Dindo grade ≥ IIIb) in the liver resection combined with Hassab operation group was 47.8% (11/23), which was significantly higher than the 20.0% (6/30) in the RFA combined with Hassab operation group ( P<0.05). The 1-, 3-, and 5-year cumulative survival rates of patients in the RFA combined with Hassab operation group were 82.8%, 49.9%, and 33.2%, respectively, while the corresponding survival rates of patients in the liver resection combined with Hassab operation group were 81.0%, 58.2%, 43.7%, respectively. There was no significant difference between the two groups ( P>0.05). The recurrence-free survival rates of patients in the RFA combined with Hassab operation group at 1-, 3-, and 5-years after surgery were 79.2%, 38.8%, and 21.6%, respectively. The corresponding recurrence-free survival rates of patients in the liver resection combined with Hassab operation group were 76.4%, 41.7%, and 27.8%, respectively, and there was no significant difference between the two groups ( P>0.05). Conclusion:RFA combined with Hassab operation was safe and efficacious to treat primary liver cancer associated with portal hypertension.
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In recent years, immunotherapy for hepatocellular carcinoma has gradually become a hot spot in clinical research. The characteristic of its immunotherapy is to stimulate specific immune response, enhance the immune rejection of tumors, inhibit and kill tumor cells, thereby reducing the possibility of tumor recurrence and metastasis. A large number of previous experimental studies have shown that immunotherapy has the potential advantages of monotherapy or combination therapy in the treatment of primary liver cancer. As we all know, whether it is to kill tumor cells in the short term or to control tumor recurrence in the long term, the necessary condition for immune drugs to work is a healthy immune environment. This article reviews the immune microenvironment in patients with liver cancer and the changes in the tumor immune microenvironment after various operations or treatments. It provides references for exploring mutually synergistic treatment plans for liver cancer, and hopes to help improve the prognosis of these patients.
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OBJECTIVE:To study the effects of the collaboration application of hospital information system (HIS) andsmart chaininventory automation management system(SPD)in drug distribution enterprises on drug logistics management,and achieve the centralized distribution of drugs. METHODS:Related countermeasures in achieving the informatization and scientiza-tion of drug inventory management after the collaboration application of HIS and SPD were introduced,and effectiveness analysis was conducted for the inventory management by comparing related indicators before and after collaboration application. RESULTS:Through the establishment ofunified receiving platformsystem and barcode technology that combined with HIS and SPD,drug barcode acceptance was achieved;setting drug fixed package and scanning fixed cards in outer packing in theunified receiving platformsystem can achieve automatic out-and into-storehouse and generating purchase plan;the collaboration application of HIS and SPD achieved drug concentration distribution. Compared with before,monthly inventory amount was decreased 27.07%(P<0.05)in the condition that both drug purchases and sales amount were increased,into-warehouse time of pharmacy acceptance was decreased from 6-12 s in each drug to 10-15 s in each order,pharmacy staff dropped from 2.5 to 2 persons. CONCLUSIONS:The collaboration application of HIS and SPD in drug logistics management has improved efficiency of warehouse,reduced drug inven-tory and achieved the informatization and scientization of drug inventory management.
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<p><b>OBJECTIVE</b>To analyze the non-invasive indexes for predicting esophageal varices (EV) in liver cirrhosis, and to establish a model for predicting the degree of EV.</p><p><b>METHODS</b>A total of 294 patients with liver cirrhosis and portal hypertension were divided into the following groups according to EV grade as assessed by endoscopy: non-EV and grade I EV, grade II EV and grade III EV. The non-invasive EV predictive measures of liver stiffness (LS), platelet (PLT) count, spleen thickness (ST), PLT/ST ratio, portal vein diameter, portal vein flow velocity and Child-Pugh score (CPS) were assessed by univariate analysis and multivariate logistic regression analysis, and used to generate a predictive model. The t-test, chi-square test, logistic analysis and receiver operating characteristic (ROC) curve were used in statistical analyses.</p><p><b>RESULTS</b>The area under the ROC for the new model was 0.990. The best cutoff value for the score was 0.898, as defined from the ROC. The sensitivity of the model was 96.5%, and the specificity was 99.2%.</p><p><b>CONCLUSIONS</b>The model for predicting EV was composed of LS, PLT count, ST, PLT/ST and CPS, which was accurate and sensitive, and could be used to predict EV in clinic.</p>