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1.
Article in Chinese | WPRIM | ID: wpr-885710

ABSTRACT

Objective:To discuss the type, treatment and results of different therapies of biliary fistula after orthotopic liver tansplantation(OLT).Methods:Data of 24 patients who developed biliary fistula after OLT in the First Affiliated Hospital of Xi′an Jiaotong University from January 2000 to March 2019 were retrospectively analyzed. Patients with biliary fistula were classified into 4 types according to presence or absence of stricture. All patients were treated by endoscopic retrograde cholangiopancreatography (ERCP) or interventional therapy, including endoscopic nasobiliary drainage (ENBD), endoscopic retrograde biliary drainage (ERBD) or percuteneous transhepatic cholangial drainage (PTCD). Main outcome measurements were the onset time of biliary fistula, the site of biliary fistula, the complications of ERCP or PTCD, the time of removing abdominal or biliary drainage tube, and the onset of new biliary stricture.Results:Biliary fistula was found in (46.5±36.6) days (6-122 days) after OLT. The numbers of patients in four types of biliary fistula were 6, 14, 2 and 2, respectively. Biliary fistula was cured in 22 patients, with clinical cure rate of 91.7%. All patients underwent ERCP first, and the technical success rate and clinical cure rate were 87.5% (21/24) and 85.7% (18/21), respectively. The clinical cure rates of ERCP forⅠ-Ⅳ biliary fistula were 6/6, 84.6%(11/13), 1/2, and 0, respectively. The clinical cure rates of ENBD and ERBD were 8/10 and 6/8, respectively. Five cases in whom ERCP failed, underwent PTCD, with technical success and clinical cure rates of 4/5 and 3/4 respectively. Eight patients(33.3%)developed cholangitis after treatment, and the incidence rate seemed higher in type Ⅱ biliary fistula than that in type Ⅰ [35.7% (5/14) VS 16.7% (1/6)]. Incidence of cholangitis was higher in patients with non-anastomotic stricture than those with anastomotic stricture [83.3%(5/6) VS 16.7%(3/18)].Conclusion:The first line treatment for biliary fistula after OLT is ERCP, followed by PTCD. The best procedures of biliary fistula typeⅠ-Ⅳ were ENBD, ENBD combined with ERBD, ENBD and PTCD, respectively.

2.
Article in Chinese | WPRIM | ID: wpr-884612

ABSTRACT

Objective:To study our initial experience on feasibility and safety of magnetic compression anastomosis in laparoscopic pancreaticoduodenectomy(LPD).Methods:A retrospective analysis was conducted on the data of 7 patients who underwent LPD with laparoscopic magnetic compression choledochojejunostomy (LMC-CJ) or pancreaticojejunostomy (LMC-PJ) at the Department of Hepatobiliary Surgery, the First Affiliated Hospital of Xi’an Jiaotong University from May 2018 to September 2019. There were 6 males and 1 female. The median age of patients was 63 (56-83) years. Data analyzed included the model of the magnetic anastomosis device, operation time of the LMC-CJ or LMC-PJ, other operation-related parameters, postoperative complications, time to perform magnetic anastomosis, and time of discharge of the magnet from patients’ body.Results:All 7 patients completed LPD successfully, including 7 LMC-CJ and 2 LMC-PJ. The median operation time was 340 (310-450) minutes. The median diameter of the biliary-enteric magnetic anastomosis ring used was 10 (9-12) mm, and the median time of the biliary-enteric magnetic anastomosis was 11 (8-16) min. The diameter of the pancreaticojejunal magnetic anastomosis ring was 5 mm in the two anastomoses, and the times taken were 12 min and 15 min. Complications occurred in 4 patients, including 1 patient each for grade A and grade B pancreatic fistula, 2 patients with abdominal infection, 2 patients with postoperative gastric emptying disorder, and 1 patient with abdominal hemorrhage. All patients responded to conservative treatment. There was no biliary or pancreatic fistula at the magnetic anastomoses. Pancreaticojejunostomy functioned at 24 and 30 days after operation. The median time for the magnets to pass out from the body of all patients was 50 (40-170) days. The median follow-up was 11 (4-18) months. No biliary-enteric or pancreaticojejunostomy stenosis was detected.Conclusion:Magnetic compressive anastomosis was simple, feasible, and safe for choledochojejunostomy or pancreaticojejunostomy in LPD.

3.
Article in Chinese | WPRIM | ID: wpr-868872

ABSTRACT

Objective:To review experience on the diagnosis and treatment of patients with pancreatic injury.Methods:There were 65 patients with pancreatic injuries who were managed in the First Affiliated Hospital of Xi’an Jiaotong University between January 1995 and December 2017. After excluding 6 patients with inadequate data and 4 patients with other associated injuries, the remaining 55 patients were enrolled in this retrospective study. All data, including the type of abdominal trauma, general information of patients, clinical manifestations, methods of diagnosis, treatment, operation and complication were collected and analysed. Analyze the cause, degree of injury, treatment measures, treatment results and complications of patients with pancreatic injury.Results:The most common cause of pancreatic injury was traffic accidents (23 patients, 41.8%), with a correct preoperative diagnostic rate of 61.8% for pancreatic injury. Compute tomography (CT) had a significantly higher sensitivity than sonography (80% vs. 37.5%, P<0.05). The number of patients with grade I-V pancreatic injury were 7, 19, 24, 1 and 4, respectively. Sixteen patients were successfully managed by conservative treatment, and 39 patients underwent various surgeries depending on the injury grade. Significantly more patients having severe grades (III-V) underwent surgical treatment than those having mild grades (I-II) (53.8% vs. 86.2%, P<0.05). Two patients died after surgery (mortality rate 5.1%, 2/39). Pancreatic fistula developed in 29 patients (74.4%), intra-abdominal infection in 10 patients (25.6%) and these were the main surgical complications. Patients having severe grades had a significantly higher pancreatic fistula rate than those having mild grades. Pancreatic pseudocyst was the most common complication on long-term follow-up (8 patients, 14.5%). This complication was significantly higher in patients who were managed with consecutive treatment than with operation (31.2% vs. 7.7%, P<0.05). Conclusions:The preoperative diagnosis of pancreatic injury was difficult, and CT should be the first line investigation. Grade I -II injuries could be managed by conservative treatment, while grade III-V should be treated by operations. The most common short- and long-term complications of pancreatic injury were pancreatic fistula and pancreatic pseudocyst, respectively.

4.
Article in Chinese | WPRIM | ID: wpr-865085

ABSTRACT

Objective:To investigate the clinical efficacy of endoscopic magnetic compression bilio-enteric anastomosis for the treatment of biliary obstruction after complex abdominal surgery.Methods:The retrospective and descriptive study was conducted. The clinical data of 3 patients with biliary obstruction after complex abdominal surgery who were admitted to the First Affiliated Hospital of Xi′an Jiaotong University between January 2012 and December 2019 were collected. There were 2 males and 1 female, aged from 27 to 57 years, with a median age of 56 years. The 3 patients underwent endoscopic magnetic compression bilio-enteric anastomosis to complete internal drainage of bile ducts after several unsuccessful endoscopic or interventional therapy. Observation indicators: (1) surgical situations; (2) postoperative situations; (3) follow-up. Follow up using outpatient examination was performed to detect the biliary stent, liver function and patency of anastomotic stoma up to December 2019.Results:(1) Surgical situations: all the 3 patients underwent successful endoscopic magnetic compression bilio-enteric anastomosis, including 2 cases with magnetic compression choledochoduodenal anastomosis and 1 case with magnetic compression choledochojejunostomy. The length of biliary stricture, length and width of magnetic device subsidiary magnet/patent magnet, time of magnetic compression for the 3 patients were 7.1 mm, 3.0 mm, 2.0 mm, 7 mm/8 mm, 6 mm/6 mm, 5 mm/5 mm, 130 minutes, 90 minutes, 75 minutes, respectively. (2) Postoperative situations: the time to biliary tract recanalization after operation for the 3 patients were 15 days, 8 days, 9 days, respectively. None of the patients encountered gastrointestinal perforation, hemorrhage or infection. (3) Follow-up: the biliary stents were inserted into the anastomotic stoma for the 3 patients after biliary tract recanalization, including a catheter of percutaneous transhepatic cholangiodrainage (PTCD) with 12 Fr size, a biliary plastic stent with 7 Fr size, a catheter of PTCD with 14 Fr size, respectively. The biliary stents were removed after 17 months, 2 months, and 6 months from the 3 patients, respectively. The 3 patients were followed up for 40 months, 20 months, and 5 months respectively after removing biliary stents, and the concentration of total bilirubin, concentration of aspartate aminotransferase, concentration of alanine aminotransferase for the 3 patients were 5-19 μmol/L, 25-40 U/L, and 20-35 U/L, respectively. The results of ultrasonic examination or magnetic resonance cholangiopancreatography examination showed that no intra-hepatic bile duct dilation or stricture of choledochojejunostomy was found within the 3 patients. One of the 3 patients was hospitalized for biliary tract infection after 37 months from removing biliary stents, and the results of ultrasonic examination or magnetic resonance cholangiopancreatography examination showed intrahepatic cholelithiasis. The cholelithiasis was removed under endoscopy and stricture of choledochojejunostomy was not found within patient by the endoscopic examination or cholangiography examination.Conclusion:The endoscopic magnetic compression bilio-enteric anastomosis is a safe and feasible technique for the treatment of biliary obstruction after complex abdominal surgery with good long-term effects.

5.
Article in Chinese | WPRIM | ID: wpr-796944

ABSTRACT

In recent years, the incidence of adenocarcinoma of esophagogastric junction (AEG) keeps increasing. Siewert type II and type III AEG invades at 2-4 cm in the lower esophagus, and it has a higher rate of lower mediastinal lymph node metastasis. Lower mediastinal lymph node clearing through the abdomino-transhiatal (TH) approach is preferred, which can be accomplished by entering the lower mediastinum through the hiatus and mobilize the esophagus upward and the surrounding lymph and connective tissue for approximately 6.5 cm. Using the infracardiac bursa (IBC) as an anatomical landmark improves the safety and operability of the thorough dissection of the lower mediastinum. Total resection of the mesenterium at the esophagogastric junction can entirely dissect the lower mediastinal lymph nodes, which conforms to the safety principles in oncology.

6.
Organ Transplantation ; (6): 200-204, 2018.
Article in Chinese | WPRIM | ID: wpr-731729

ABSTRACT

Objective To develop a pulling device using magnetic positioning to optimize the procedures of repairment of donor liver from organ donation . Methods The pig liver specimens were used to measure the pull force of repairment of donor liver, magnetic spiderman was developed based on the measurement results. The magnetic spiderman was applied to simulate the repairment of donor liver from organ donation on the pig liver specimens. The effectiveness of magnetic spiderman was also evaluated. Results The pulling force was required all less than 2 N during the repairment of donor liver. The magnetic spiderman was successfully manufactured. The magnets of magnetic spiderman could generate 3 N magnetic forces with paramagnetic basin of hepatic repairment. The self-retraction pull wire of the magnetic spiderman could provide 2.5 N pulling forces. The magnetic spiderman was successfully applied to the simulated experiment of repairment of donor liver from organ donation in 6 cases. The operation time was (54±5) min. No clip slippage,displacement and slippage of the base occurred during the operation. With the cooperation of multiple magnetic spidermen,the remaining surgical procedures were performed by one single surgeon except for the vascular ligation. Conclusions The magnetic spiderman has small volume and implements flexible positioning, can perform pulling operation and nottake up operational space. It can effectively optimize the procedures of repairment of donor liver from organ donation and reduce the quantity of surgeons.

7.
Organ Transplantation ; (6): 130-136, 2018.
Article in Chinese | WPRIM | ID: wpr-731721

ABSTRACT

Objective To analyze the risk factors of early acute kidney injury (AKI) after liver transplantation from donation after cardiac death(DCD) donor liver. Methods Clinical data of 184 donors and recipients undergoing liver transplantation from DCD donor liver were retrospectively analyzed. According to the incidence of early AKI, all participants were divided into the AKI and non-AKI groups. The patients in the AKI group were subject to AKI staging. Baseline data, preoperative, intraoperative and postoperative related parameters were statistically compared between two groups. The cumulative survival rate and clinical prognosis of patients in non-AKI group and AKI group with different staging were statistically analyzed by Kaplan-Meier curve analysis. Results Among 184 patients, 68 cases (37.0%) presented with early AKI after liver transplantation including 31 stage 1 AKI, 26 stage 2 AKI and 11 stage 3 AKI, mainly occurring within postoperative 3 d. Univariate analysis revealed that preoperative levels of albumin <35 g/L, preoperative levels of serum sodium ≤137 mmol/L, operation time>7.5 h, intraoperative hemorrhage volume>3 000 mL, intraoperative red cell infusion volume>15 U and intraoperative urine amount ≤100 mL/h were the risk factors of early AKI after liver transplantation (all P<0.05). Multi-variate Logistic regression analysis demonstrated that intraoperative red cell infusion >15 U was an independent risk factor of early AKI after liver transplantation [odds ratio(OR) 1.061, 95% confidence interval(CI)1.008-1.118,P=0.024].Result of Kaplan-Meier survival curve suggested that the cumulative survival rate was gradually reduced along with the aggravation of AKI with statistical significance (all P<0.05). Conclusions The incidence of early AKI following liver transplantation is relatively high. The severity of early AKI is intimately correlated with the short- and long-term prognosis of the recipients. A large quantity of intraoperative red blood cell infusion is an independent risk factor of AKI.

8.
Article in Chinese | WPRIM | ID: wpr-708466

ABSTRACT

Objective To study the safety and efficacy of magnetic compression anastomosis (MCA) in treatment of biliary anastomotic stricture after orthotopic liver transplantation (LT).Methods Five patients who were treated unsuccessfully by ERCP were admitted to The First Affiliated Hospital of Xi'an Jiaotong University from 2012 January to 2018 May to undergo MCA.The treatment results were analyzed retrospectively.Results In four patients,the treatment was successful while in one patient it failed.For the four successful patients,the biliary stricture length was 2~4 mm.Re-canalization was achieved within 7~12 days and these patients were discharged home without any adverse events.Multiple plastic stents (in 2 patients) or full-covered self-expansion mental stents (in 2 patients) were inserted into the new fistulae after re-canalization.In two patients whose stents were removed,there was no recurrence of biliary strictures after follow-up for 64 months and 59 months,respectively.Conclusion The MCA technique is a revolutionary and effective method of performing interventional choledochocholedochostomy in patients with biliary anastomotic stricture after LT for whom the conventional endoscopic procedures were not successful.

9.
Article in Chinese | WPRIM | ID: wpr-699150

ABSTRACT

Objective To investigate the risk factors and prognosis of acute kidney injury (AKI) after orthotopic liver transplantation (OLT).Methods The retrospective case-control study was conducted.The clinical data of 127 patients who underwent OLT in the First Affiliated Hospital of Xi'an Jiaotong University from January 2013 to December 2015 were collected.Of 127 patients,24 were complicated with postoperative AKI,including 17 in grade 1,5 in grade 2 and 2 in grade 3,and 103 were not complicated with AKI.AKI after OLT was treated according to the diagnostic criteria of AKI from 2012 guidelines of Kidney Disease:Improving Global Outcomes (KDIGO).Observation indicators:(1) risk factors analysis affecting AKI after OLT;(2) comparison of postoperative recovery in patients with different AKI grade;(3) follow-up and survival situations.Follow-up using outpatient examination and telephone interview was performed up to July 2017.Measurement data with nornal distribution were represented as x±-s,and measurement data with skewed distribution were described as M (range).Univariate analysis was done using the t test and rank sum test.Comparisons of count data and univariate analysis were done using chi-square test or Fisher exact probability.Multivariate analysis was done using the logistic regression model.The survival rate and curve were respectively calculated and drawn by the KaplanMeier method,and Log-rank test was used for survival analysis.Results (1) Risk factors analysis affecting AKI after OLT:results of univariate analysis showed that age,combined hypertension,preoperative Child-Pugh score,preoperative model for end-stage liver disease score (MELD),preoperative hemoglobin,preoperative serum albumin,preoperative blood urea nitrogen,preoperative glomerular filtration rate,preoperative prothrombin time,operation time,inferior vena cava occlusion time,duration of anhepatic phase,volume of intraoperative blood loss,total volume of intraoperative blood transfusion,volumes of intraoperative plasma and red blood cells transfusion,duration of postoperative ICU stay,use time of postoperative vasoactive drugs,time of postoperative mechanical ventilation,cases with postoperative infection,body mass index of donor and donor liver cold-ischemia time were related factors affecting occurrence of AKI after OLT (t =4.154,x2 =8.482,t =5.129,3.694,1.294,9.223,5.418,Z=4.287,t=2.105,5.168,8.182,10.042,Z=1.074,0.664,6.274,3.712,1.289,t=1.056,x2 =10.617,t=2.447,3.371,1.476,P<0.05).Results of multivariate analysis showed that age,preoperative MELD score,preoperative serum albumin,volume of intraoperative blood loss and donor liver cold-ischemia time were independent factors affecting occurrence of AKI after OLT [odds ratio (OR) =0.812,0.866,1.392,1.001,0.516,95% confidence interval:0.717-0.919,0.751-0.997,1.104-1.755,1.000-1.001,0.282-0.944,P<0.05].(2) Comparison of postoperative recovery in patients with different AKI grade:cases with complete recovery,partial recovery and chronic renal failure were respectively 14,3,0 in 17 patients with grade 1 of AKI and 3,2,0 in 5 patients with grade 2 of AKI and 0,1,1 in 2 patients with grade 3 of AKI,with a statistically significant difference (x2=14.140,P<0.05).(3) Follow-up and survival situations:127 patients were followed up for 9-44 months,with a median of 23 months.The 1-year overall survival rate of 127 patients was 95.3%.During the follow-up,22 patients died,including 9 with multiple organ failure,8 with primary disease recurrence and 5 with respiratory complication.The median overall survival time after OLT was 36 months in 24 patients with AKI and 40 months in 103 patients without AKI,with no statistically significant difference (x2=3.033,P>0.05).Conclusion Age,preoperative MELD score,preoperative serum albumin,volume of intraoperative blood loss and donor liver cold-ischemia time are independent factors affecting occurrence of AKI after OLT,and there is better recovery in patients with grade 1 of AKI.

10.
Article in Chinese | WPRIM | ID: wpr-711199

ABSTRACT

Objective To investigate the diversity of gut microbiota and its dynamic changes in very low birth weight infants (VLBWIs) during the first six months after birth.Methods From January to December in 2015,53 VLBWIs admitted to the Neonatal Intensive Care Unit (NICU) were recruited.Stool samples were collected from each subject on day 1,7,14 and 28 after birth as well as on day 180 during a follow-up visit.High-throughput 16S rRNA gene sequencing and bioinformatics analysis of bacterial DNA extracted from stool samples were performed using Illumina MiSeq platform double-end sequencing.Results (1) Phyla level:At all five time points,the dominant phyla were all Proteobacteria,Firmicutes,Bacteroidetes and Actinobacteria.The median relative abundance of Proteobacteria was 0.598 5 (0.122 3~0.942 6) on day 1,then rose to 0.893 2 (0.478 1~0.987 0) after one week,maintained at 0.943 2~0.966 0 within 28 days,and later dropped back to the same level as day 1 on day 180 (all P<0.05).In contrast,the median relative abundance of Actinobacteria on day 180 was significantly higher than that on days 1,7,14 and 28 (all P<0.05).(2) Genus level:The relative abundance of Klebsiella increased significantly between days 7 and 28 as compared with the lower level on day 1 [0.326 5~0.368 2 vs 0.003 1(0.000 8~0.026 0),all P<0.05],but significantly decreased to a lower level on day 180 [0.008 1 (0.000 5~0.067 1)].There was no significant difference in the relative abundance of Escherichia within 14 days after birth.However,it significantly increased since day 28 (P<0.05) and reached a peak on day 180 (P<0.05).Infants were born with a certain abundance of Bifidobacterium [0.000 5 (0.000 1~0.004 2)],which remained at a very low level for 28 days before reaching to a higher level of 0.045 1 (0.010 2~0.124 8) on day 180 (P<0.05).(3)The Shannon index on day 14 and 28 were lower than that of day 1 and day 180 (1.81±0.71,1.89±1.270.56 vs 2.33±1.29,2.2±0.5,all P<0.05),respectively.Conclusions The diversity of gut microbiota in VLBWIs decreases during NICU hospitalization as compared with that at birth when Proteobacteria and Klebsiella becoming the dominant bacteria.However,the diversity was regained after discharge with the increase of Bifidobacterium,Escherichia and other residential bacteria,which indicates that NICU hospitalization is a risk factor for dysbiosis in VLBWIs.

11.
Article in Chinese | WPRIM | ID: wpr-689819

ABSTRACT

Magnetic anchor technique can reduce the number of trocar in laparoscopic surgery. The laparoscopic magnetic anchor system consists of an external anchor magnet and the magnetic clutch system. Electromagnetic control laparoscopic surgery clutch system includes the internal grasper and the operating forceps. In this design, a permanent magnet is set at the tail of the internal grasper, and an electromagnetic device is installed at the head of the operating forceps. The magnetic field direction of the electromagnetic device can be changed by switching the positive pole and the negative pole of the electromagnetic device, so as to control the separation and combination of the operating forceps and the internal grasper. The design of this system is ingenious, easy to manufacture and the operation is simple.


Subject(s)
Electromagnetic Phenomena , Equipment Design , Laparoscopy , Magnetics , Surgical Instruments
12.
Organ Transplantation ; (6): 445-449, 2017.
Article in Chinese | WPRIM | ID: wpr-731706

ABSTRACT

Objective To summarize the experience of clinical diagnosis and treatment of portal vein stenosis after liver transplantation. Methods Clinical data of 18 patients presenting with portal vein stenosis after undergoing liver transplantation were retrospectively analyzed. The incidence, treatment and prognosis of portal vein stenosis were summarized. Results Seventeen patients had a medical history of liver cirrhosis before liver transplantation, 7 cases with a medical history of portal vein thrombosis and 8 cases with a medical history of devascularization or shunt with splenectomy. Three cases received the pediatric liver grafts. Eighteen patients suffered from portal vein stenosis from postoperative 23 d to 24 months with a median time of 2.2 months, which was detected by color Doppler ultrasound (CDU) and diagnosed by CT angiography (CTA) of the portal vein or interventional therapy. After the diagnosis was confirmed,all cases received anticoagulant treatment by warfarin. Five patients with portal hypertension underwent balloon dilatation,and one of them received endovascular stent implantation simultaneously. The remaining 13 patients received conservative therapy. After corresponding treatment, 9 cases were mitigated, 7 patients remained unchanged and 2 cases were aggravated. Conclusions For the recipients with a medical history of liver cirrhosis before liver transplantation, portal vein stenosis should be monitored by conventional CDU and diagnosed by CTA or interventional therapy after transplantation. Patients without clinical symptoms can receive conservative treatment. Those complicated with portal hypertension can undergo interventional therapy. Favorable clinical prognosis is obtained in most cases.

13.
Organ Transplantation ; (6): 381-385, 2017.
Article in Chinese | WPRIM | ID: wpr-731698

ABSTRACT

Objective To summarize the clinical efficacy of liver transplantation from donation after cardiac death (DCD). Methods Clinical data of both the donors and recipients (n=182) undergoing liver transplantation from DCD were retrospectively analyzed. According to the type of primary diseases, 182 recipients were divided into the benign group (n=135) and hepatocellular carcinoma (liver cancer) group (n=47). Perioperative conditions, 1- and 3-year survival rate of the recipients were statistically compared between two groups. Clinical prognosis and the incidence of postoperative complications of the recipients were summarized. Postoperative complications mainly included early allograft dysfunction (EAD), vascular complications, acute kidney injury (AKI), pulmonary infection, acute rejection, cytomegalovirus (CMV) infection and billiary tract complication. Results No statistical significance was identified in the anhepatic phase, operation time and length of intensive care unit (ICU) stay between two groups (all P>0.05). The 1-year survival rates of the 182 recipients and grafts were 93.1%, and 84.9% for the 3-year survival rates. In the benign group, the 1- and 3-year survival rates of the recipients were 92.5% and 88.1%. In the liver cancer group, the 1-year survival rate of the recipients was 95%, 91% for the disease-free survival rate, and 78% for the 3-year survival rate, respectively. No statistical significance was noted in the overall survival rate of the recipients between two groups (P=0.879). In terms of postoperative complications, billiary tract complications occurred in 26 patients, vascular complications in 14, AKI in 34, pulmonary infection in 22, acute rejection in 11, EAD in 11 and CMV infection in 10. The incidence of postoperative billiary tract complications in patients with T-tube insertion was significantly lower than that in their counterparts without T-tube insertion (8% vs. 19%, P<0.05). Conclusions Liver transplantation from DCD is an efficacious treatment for end-stage liver diseases and liver cancer, which yields relatively high short-term clinical efficacy.

14.
Article in Chinese | WPRIM | ID: wpr-615549

ABSTRACT

Objective To design a new type of biliary stent to be used in the common bile duct probe and evaluate its biocompatibility, safety and effectiveness in a canine model.Methods Magnesium alloy (AZ 31B) was used to make biliary stents.A canine model of acute obstructive jaundice was established by ligating the distal end of the common bile duct.These dogs were divided into two groups with either placement of magnesium stent or not.The incidence of bile duct leakage and survival were evaluated.Meanwhile, we determined the concentration of magnesium in various body fluids and organs, liver function test, and ultrasonic and histological studies.Results The concentrations of magnesium in the blood, feces, liver, heart, brain and lungs were similar between the two groups.Bile leakage rate in experimental group and control group was 0% and 16.7%, respectively.The mortality was 16.7% and 33.3%.There were no significant differences in ALP and TBIL between experimental group and control group (P>0.05) before building and bile duct exploration.There were significant differences in ALP andTBIL between the two groups one and three months after bile duct probe (P<0.05).Biliary tract specimens showed obviously anastomotic stenosis performances and expansion performances of extrahepatic biliary in the control group, but in experimental group such changes were not observed.Ultrasonography showed that the patency of biliary anastomosis was good and there was no anastomotic biliary stricture in experimental group.However, progressive stenosis and expansion performances of extrahepatic biliary occurred in control group.There were fewer collagen fibers but more muscle fibers in experimental group than in control group.Conclusion Biliary stent made of magnesium alloy is of good biocompatibility and has the potential to prevent the postoperative stenosis in the common bile duct probe.

15.
Article in Chinese | WPRIM | ID: wpr-606991

ABSTRACT

BACKGROUND: Gene therapy and cell transplantation therapy, especially their combined use, have certain therapeutic effects on retinitis pigmentosa. However, little attention has been paid to the combination of gene therapy and cell transplantation in the treatment of retinitis pigmentosa.OBJECTIVE: To investigate the protective effect of adipose-derived mesenchymal stem cells (ADMSCs) modified by growth-associated protein-43 (GAP-43) gene on the retina of rats with retinitis pigmentosa. METHODS: ADMSCs from rats with retinitis pigmentosa were isolated and cultured, and then transfected with GAP-43 lentiviral vector. Sixty retinitis pigmentosa rats were randomized into experimental group (subretinal injection of GAP-43-transfected ADMSCs), control group (subretinal injection of ADMSCs) and sham operation group (PBS injection). The expressions of GAP-43 protein, Rho protein and GS protein in the retina of rats were determined by western blot. The outer nuclear layer thickness of the retina was determined by hematoxylin-eosin staining. RESULTS AND CONCLUSION: After transfected cell transplantation, the expression of GAP-43 protein in the retina was gradually increased with time and showed significant differences at different time post-transplantation (P the control group > the sham group, and there was significant difference between groups (P < 0.05). These results show that the ADMSCs modified by GAP-43 gene have protective effect on the retina of rats with retinitis pigmentosa.

16.
Article in Chinese | WPRIM | ID: wpr-668270

ABSTRACT

Objective To investigate the relationship of central venous pressure (CVP) and organ function in early period after orthotopic liver transplantation (OLT).Methods A retrospective study was conducted on 111 patients who underwent OLT.According to the value of mean CVP after OLT,all patients were divided into three groups:low CVP group (CVP<8 rnmHg,1 rnmHg =0.133 kPa),normal CVP group (CVP 8-12 mmHg) and high CVP group (CVP >12 mmHg).Meanwhile,According to whether the CVP dropped below 8 mmHg or not in the past 48h after surgery,all patients were divided into two groups.Results There were significant differences in serum total bilirubin,serum creatinine and serum lactate among low,normal,and high CVP groups (P<0.05).The time of vasoactive agent,fluid balance,time of mechanical ventilation and incidence of acute kidney injury in groups with CVP not dropped below 8 rnmHg were higher than those in groups with CVP dropped below 8 mmHg (P<0.05).Conclusion CVP was associated with liver,kidney,lung function and lactate.Controlling a lower CVP can significantly shorten the time of mechanical ventilation and reduce the incidence of acute kidney injury after OLT.

17.
Article in Chinese | WPRIM | ID: wpr-496897

ABSTRACT

Objective To investigate the predictive value of preoperative Aspartate Transaminase and Platelet Ratio Index (APRI) for postoperative complications in patients with hepatocellular carcinoma after liver resection.Methods The clinical data of 278 patients who underwent hepatic resection for hepatocellular carcinoma from January 2010 to December 2013 were retrospectively analyzed.The receiver operating characteristic (ROC) curve was used to determine the cutoff value of APRI.Based on this preoperative APRI,patients were divided into the low-risk group (APRI ≤ 0.37) and the high-risk group (APRI > 0.37).Using univariate analysis and multivariate logistic regression,21 risk factors that might be relevant to postoperative complications were analyzed.Results 159 patients (57.2%) developed postoperative complications.The AUC for APRI in predicting complications was 0.677 (0.615-0.740,P < 0.05).At a cutoff value of APRI at 0.37,the sensitivity was 0.616 and the specificity was 0.697.Univariate analysis and logistic regression analysis showed that APRI (P < 0.05,OR =2.138),degree of ASA (P < 0.05,OR =1.864),prognostic nutritional index (PNI) (P < 0.05,OR =0.354) and volume of blood loss during operation (P < 0.05,OR =2.836) were independent risk factors of postoperative complications.Conclusions A high APRI (> 0.37) was a simple and practicable preoperative index to predict postoperative complications in patients with hepatocellular carcinoma after hepatectomy.

18.
Article in Chinese | WPRIM | ID: wpr-357833

ABSTRACT

The quality of a donor liver after cardiac death is closely associated with energy metabolism during preservation. Ex vivo mechanical perfusion has broad application prospects because this technique can help energy metabolism and repair ischemia injury of donors' livers. Some core issues are presented in this review in order to provide references for propelling secure application of liver transplantation based on donation after cardiac death.


Subject(s)
Death , Humans , Liver , Liver Transplantation , Organ Preservation , Methods , Perfusion , Methods , Warm Ischemia
19.
Article in Chinese | WPRIM | ID: wpr-265627

ABSTRACT

A new anastomat for digestive tract operations, based on the magnetic compressive technique and mechanical transmission mechanism, is composed of a removable head and a reusable body. The head includes two parts: the proximal end can be fixed to the body, and the distal end could be used for performing a purse string suture. The procedure of anastomosis is similar to that of the stapler, and the anastomoses is established using a pair of magnetic rings. The instrument makes magnamosis more simple and feasible, and it would facilitate the clinical application. The body of the anastomat is reusable and the head could be replaced according to the clinical scenarios, these could reduce the medical cost. The magnetic rings would be excreted with the feces, and there is no foreign body response at last.


Subject(s)
Anastomosis, Surgical , Methods , Gastrointestinal Tract , General Surgery , Humans , Magnetics
20.
Article in Chinese | WPRIM | ID: wpr-333690

ABSTRACT

<p><b>OBJECTIVE</b>To develop a method for preparing a decellularized scaffold based on human liver tissue.</p><p><b>METHODS</b>A surgical specimen of the left lateral lobe of the liver was obtained from a patients with hepatic hemangioma. The decellularization process was performed by repeated freezing-thawing, sequential perfusion with 0.01% SDS, 0.1% SDS and 1% Triton X-100 through the portal vein, and sterilization with peracetic acid. L-02 cells were then engrafted onto the decellularized liver scaffold.</p><p><b>RESULTS</b>HE staining, DAPI staining and scanning electron microscopy all verified the absence of residual cellular components in the decellularized scaffold. The residual DNA content in the decellularized scaffolds was 25.3∓14.6 ng/mg (dry weight), which was less than 1% of the total DNA content in a fresh human liver. Immunohistochemistry demonstrated that type I and IV collagens, fibronectin and elastin were all retained in the scaffold. The engrafted L-02 cells survived well on the scaffold with active proliferation and expressed albumin and G6pc.</p><p><b>CONCLUSION</b>It is feasible to prepare decellularized scaffolds using surgical specimens of human liver, which can be a new approach to constructing a tissue-engineered liver for clinical purposes.</p>


Subject(s)
Humans , Liver , Microscopy, Electron, Scanning , Octoxynol , Perfusion , Tissue Engineering , Tissue Scaffolds
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