Postoperative complications of ex vivo liver resection combined with autologous liver transplantation in treatment of advanced hepatic alveolar echinococcosis at high altitude and related prevention and treatment strategies / 临床肝胆病杂志

Objective To investigate the postoperative complications of ex vivo liver resection combined with autologous liver transplantation in the treatment of end-stage hepatic alveolar echinococcosis at high altitude and related prevention and treatment strategies. Methods Surgical data and follow-up data were collected from 11 patients with end-stage hepatic alveolar echinococcosis who underwent autologous liver transplantation in Qinghai People's Hospital from January 2013 to March 2019, and intraoperative and postoperative conditions were analyzed. Results All 11 patients underwent autologous liver transplantation successfully, without intraoperative death, among whom 2(18.18%) underwent hemi-extracorporeal hepatectomy and 9 (81.82%) underwent total extracorporeal hepatectomy. For the reconstruction of the retrohepatic inferior vena cava, 2 patients (18.18%) underwent reconstruction with the autologous great saphenous vein, 4 patients (36.36%) underwent reconstruction with artificial vessels, and the autologous retrohepatic inferior vena cava was preserved in 5 patients (45.45%). For biliary reconstruction, 8 patients (72.73%) underwent choledochoenterostomy and 3 (27.27%) underwent choledochocholedochostomy. The main postoperative complications of the 11 patients included bleeding in 2 patients (18.18%), bile leakage and abdominal infection in 4 patients (36.36%), bilioenteric anastomotic stenosis in 1 patient (9.09%), thrombus in 2 patients (18.18%), pulmonary infection and pleural effusion in 2 patients (18.18%), and echinococcosis recurrence in 1 patient (9.09%). Of all 11 patients, 2 (18.18%) died during the perioperative period, and the other 9 patients (81.82%) were improved and discharged. Conclusion Bleeding, biliary complications, and infection are the main causes of death in patients undergoing autologous liver transplantation at high altitude. An accurate understanding of surgical indication, careful multidisciplinary evaluation before surgery, superb operation during surgery, standardized surgical procedures, and fine perioperative management are the key to reducing perioperative mortality, avoiding and reducing postoperative complications, and achieving good long-term survival in patients undergoing autologous liver transplantation.

Present situation and progress of treatment of advanced hepatic alveolar echinococcosis / 中华肝胆外科杂志

Hepatic alveolar echinococcosis is a zoonotic parasitic disease. The therapeutic options of advanced hepatic alveolar echinococcosis mainly include: operation combined with drug treatment, percutaneous transhepatic biliary drainage, focus puncture drainage, drug treatment, liver transplantation. The individualized and comprehensive treatment mainly based on surgery is an ideal treatment method for advanced hepatic alveolar echinococcosis. This paper summarized the related literature at home and abroad, combined with clinical practice, and summarized the current situation and progress of the treatment of advanced hepatic alveolar echinococcosis.

Comparison of different methods of hepatic blood flow occlusion in hepatectomy for hepatic alveolar echinococcosis / 中华肝胆外科杂志

Objective:To compare the different methods of hepatic blood flow occlusion in hepatectomy for hepatic alveolar echinococcosis.Methods:A total of 49 patients with hepatic alveolar echinococcosis who underwent radical hepatectomy from January 2018 to January 2019 in Department of General Surgery, Qinghai Provincial People's Hospital were retrospectively studied. There were 22 males and 27 females, aged 10-62 years. The patients were divided into the Glisson group ( n=22) and the Pringle group ( n=27) according to the method used for hepatic blood flow occlusion during operation. For the Glisson group, intrahepatic blood flow was occluded at the Glisson pedicle. For the Pringle group, intrahepatic blood flow was occluded using the Pringle’s maneuvre. Intraoperative blood loss, operation time, postoperative liver function and postoperative complications were compared between the two groups. Results:There were no significant differences between the two groups in operation time, intraoperative blood loss and intraoperative blood transfusion (all P>0.05). The vascular occlusion time of blood flow in the Pringle group was 35 (30, 45) min, which was significantly longer than that of 20 (15, 26) min in the Glisson group ( P<0.05). The drainage tube in the Pringle group was removed after 8 (7, 12) d, which was significantly longer than that of 7 (6, 9) d in the Glisson group ( P<0.05). After operation, alanine aminotransferase, aspartate aminotransferase, total bilirubin and direct bilirubin in the Glisson group were significantly better than those in the Pringle group (all P<0.05). Postoperative complications occurred in 9 patients (40.9%, 9/22) in the Glisson group and 15 patients (55.6%, 15/27) in the Pringle group ( P>0.05). Conclusion:The liver function, and time of removal of abdominal drainage tube after Glisson pedicle hepatic blood flow occlusion in patients who underwent hepatectomy for hepatic alveolar echinococcosis were significantly better than the Pringle method.

Safety and efficacy of reduced-volume hepatectomy for advanced hepatic alveolar echinococcosis / 中华肝胆外科杂志

Objective@#To evaluate the efficacy and safety of reduced volume hepatectomy in treatment of advanced hepatic alveolar echinococcosis.@*Methods@#The clinical data of 90 patients with advanced hepatic alveolar echinococcosis treated at the Qinghai Provincial People's Hospital from January 2017 to January 2019 were retrospectively analyzed. There were 41 males and 49 females, with an average age of 32 (range 11 to 58) years. The locations of the lesions, operations, complications and follow-up were analyzed.@*Results@#90 patients were treated with reduced volume focal hepatectomy, 38 with radical resection and 52 with quasi radical resection. The operation time was (361±22) min. The hospital stay was (22±2) day, and the blood loss was (781±37) ml. Red blood cells were transfused in 19 patients and plasma in 39 patients. Pringle’s maneuver was used in 12 patients, regional hepatic blood flow occlusion in 42 patients, and Glisson sheath occlusion in 26 patients. The total bilirubin, alanine aminotransferase and aspartate aminotransferase returned to normal in 3 to 14 days after operation. There were 12 patients who developed bile leakage, 41 pleural effusion and 26 effusion in the operation sites. A total of ninety patients were followed up for 2 to 24 months. There was no recurrence of echinococcosis after radical resection and no enlargement of residual lesions after quasi-radical resection.@*Conclusion@#Reduced-volume hepatectomy reduced the risk and difficulty of operation. The follow-up results were good. This approach provides a feasible scheme for treatment of advanced hepatic alveolar echinococcosis.

Study on the expression of MMP-9 in SAP-induced lung injury in rats exposed to high altitude hypoxia / 中国医师杂志

Objective To investigate whether the expression of metal matrix protease-9 (MMp-9) changes with altitude in severe acute pancreatitis (SAP) lung injury by establishing SAP model in rats.The related indexes of pancreas and lung injury and MMp-9 were measured.Methods 280 SPF male Wistar rats were randomly assigned to different altitude groups to establish SAP model,then the serum amylase (AMY) content of each group were detected.The degree of pancreatic injury and pancreatic pathological score were observed under light microscope.The expression level of MMP-9 in lung tissues was measured and analyzed by statistical methods.Results (1) At the same altitude,the expression of MMP-9 in each time group increased with time,with statistically significant difference (P ≤ 0.05).(2) AMY value,pathological score of pancreas and expression of MMP-9 in lung tissue increased with the altitude in the same time group at different altitudes,with statistically significant difference (P ≤ 0.05).Conclusions The higher the altitude,the more severe the damage of SAP and lung,and the higher the expression level of MMP-9.

Correlation between the liver injury and the expression of interleukin-10 in severe acute pancreatitis at high altitude: a rat experimental result / 中华危重病急救医学

Objective To observe the indexes of liver injury and the expression of inflammation-related factor interleukin-10 (IL-10) in rats with severe acute pancreatitis (SAP), and to discuss the correlation between the expression of IL-10 and the related factors of liver injury in SAP rats at different altitudes. Methods 280 male Wistar rats with SPF grade aged 5 to 6 months were divided into four groups according to random number table with 70 rats in each group, and the rats were placed in different altitudes such as Xi'an (at an altitude of 1 027 m), Xining (at an altitude of 2 260 m), Xinghai (at an altitude of 3 300 m) and Wenquan (at an altitude of 3 950 m). The rats in each altitude were randomly divided into sham operation group (Sham group, n = 10) and SAP 1, 6, 12, 24 hours groups (all n = 15). SAP rat model was reproduced by injecting sodium cholate into the posterior membrane of pancreas, and the rats of Sham group were only turned pancreas over several times after opening the abdomen and then closed the abdomen. The rats were sacrificed at the corresponding time points after model reproduction in SAP groups, and rats in Sham group were sacrificed at 6 hours after sham operation. At the same time, the abdominal aorta blood was harvested, and the contents of serum amylase (AMY), alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were determined by automatic biochemical analyzer. Liver tissues were harvested, and the expression level of IL-10 was determined by immunohistochemistry. Pancreatic tissues were harvested, and hematoxylin-eosin (HE) staining was performed to observe the pathological changes under light microscopy. The correlations among the indicators were analyzed by Pearson correlation. Results At different altitudes, no significant abnormality was found in the pancreas of Sham group, but significant pathological changes were found in the pancreas of all SAP groups, mainly manifested as pancreatic acinar swelling, inflammatory cell infiltration, vascular congestion and hemorrhage, acinar cell degeneration and dissolution, changes in glandular lobule structure, peri-pancreatic fat necrosis, and continuous aggravation with the increasing of time and altitude. At the same altitude, the pancreatic pathology score, the serum AMY, ALT and AST levels, and the hepatic IL-10 expression were all significantly increased in all the SAP groups as compared with those in Sham group, and they were continuously increased with time. In Sham group, there was no statistically significant difference in pancreatic pathology score, AMY, ALT, AST, or IL-10 level among different altitudes. At the corresponding time point after model reproduction, the pancreatic pathology score, AMY, ALT, AST and IL-10 levels in the SAP groups were also shown a continuous rising tendency with altitude increase, and the differences in above parameters of SAP 24 hours group in Wenquan area were statistically significant as compared with those of Sham group [pathology score: 11.06±0.94 vs. 0.23±0.15, AMY (mmol/L): 2 706.6±208.3 vs. 336.5±94.3, ALT (U/L): 267.00±5.37 vs. 52.00±4.84, AST (U/L): 465.88±11.02 vs. 139.00±11.61, IL-10 (A value): 0.579±0.006 vs. 0.281±0.006, all P < 0.05]. It was shown by correlation analysis that IL-10 of SAP rats at different altitudes was positively correlated with pancreatic pathology score, AMY, ALT and AST, the correlation coefficient (r value) between IL-10 and the above indicators in the Wenquan area with the highest altitude was 0.959, 0.928, 0.977, 0.983, respectively (all P < 0.01). Conclusions The severity of SAP rats was positively correlated with altitude. IL-10 was involved in the pathological expression process of SAP liver damage, and its expression level was positively correlated with altitude and the degree of SAP liver damage.

Progress in researches of benzimidazole in treatment of echinococcosis / 中国血吸虫病防治杂志

Echinococcosis is a severe zoonosis parasitic disease and mainly caused by the larvae of Echinococcus granulosus and E. multilocularis. Because of the limitation of operation level,such as recurrence and death,the drug treatment is still the most important method in our country. Meanwhile,the annual number of drug treatments is far greater than surgical treatments. Drugs play a significant role in the preoperative reduction of lesions,reducing pain,extending the life of patients .This article re-views the status of animals treatment and clinical treatment of echinococcosis treated by the benzimidazole drugs and their new formulations,provides the basis for exploring the development direction of anti-echinococcosis drug treatment research.

Effect of long non-coding RNA ROR on proliferation and apoptosis of pancreatic cancer cells by regulating notch1 protein / 实用医学杂志

Objective To explore the mechanism of long chain noncoding RNA RORin regulating prolifer-ation and apoptosis of pancreatic cancer cell. Methods Pancreatic cancer cell line BxPC-3 was selected. The RNA level of lncRNA ROR and notch1 was detected by RT-PCR.Notch1 protein level was detected by Western blot. The regulating relationship between lncRNA ROR and notch1 was analyzedby RNAhybird and luciferase re-porter assay. At last ,CCK-8 and TUNEL were applied to detectthe proliferation and apoptosis of cell line. Re-sults lncRNA ROR and notch1 were highly expressed in pancreatic cancer tissue ,compared with normal tis-sues. There was positive correlation between them. lncRNA ROR was over-expressed in BxPC-3,cell proliferation activity was increased and the percentagesof DNA damaged positive cells was decreased ,accompanied by in-creased levels of notch1 mRNA and protein. Luciferase assay confirmed that ROR could bind to notch1and inhibit its activity by miR-137. Compared with control group ,the proliferation of pcDNA-ROR + si-notch1 cells reduced and the proportion of TUNEL positive cells increased. The differences were statistically significant. Conclusionl ncRNA ROR regulated the proliferation and apoptosis of pancreatic cancer cells by promoting the expression of notch1.

Analysis of postoperative complications after autologous liver transplantation in hepatic alveolar echinococcosis patients from plateau area / 器官移植

Objective To analyze common postoperative complications after autologous liver transplantation in patients diagnosed with hepatic alveolar echinococcosis (HAE)from plateau area. Methods Clinical data of 6 patients with advanced HAE undergoing ex-situ or partially ex-situ hepatectomy combined with autologous liver transplantation were retrospectively analyzed. Clinical characteristics of postoperative complications were analyzed. Results Postoperative complications mainly included biliary tract complications (n=4),intra-abdominal hemorrhage (n=1 ),infection (n=3). Two cases presented with bile leakage complicated with intra-abdominal infection and died from infectious shock and multiple organ dysfunction syndrome. One patient had intra-abdominal hemorrhage and died from hemorrhagic shock and disseminated inravascular coagulation. Biliary tract complication and intra-abdominal hemorrhage were primary causes of mortality. Conclusions Biliary tract complication,intra-abdominal hemorrhage and infection are the main prognostic factors for HAE patients undergoing autologous liver transplantation.

Surgery combined with albendazole liposomes for advanced hepatic alveolar echinococcosis / 中华肝胆外科杂志

Objective To investigate the outcomes of surgery combined with albendazole liposomes in the treatment of advanced hepatic alveolar echinococcosis.Methods This is a retrospective study on 71 patients with advanced hepatic alveolar echinococcosis treated from January 2002 to November 2013.The patients were divided into 4 groups according to the surgical methods and whether surgery was combined with albendazole liposomes.Results On follow-up from 5 ～ 44 months,the mortality rates for the volume-reduction surgery group was 82.3％,the volume-reduction surgery + albendazole group 52.3％,the radical operation group 28.5％,and the radical operation + albendazole group 21.1％.The mortality rate of the radical operation + albendazole group,when compared with the radical operation group and the volume-reduction surgery + albendazole group was significantly different (P ＜ 0.05).The mortality rate of the radical operation group,when compared with the volume-reduction surgery + albendazole group showed no significant difference (P ＞ 0.05).The mortality rate of the volume-reduction surgery group,when compared with the volume-reduction surgery + albendazole group,the radical operation group,and the radical operation + albendazole group was significantly different (P ＜ 0.05).Conclusions The treatment of radical operation combined with albendazole liposomes for advanced hepatic alveolar echinococcosis reduced recurrence,improved quality of life and prolonged survival.It is a feasible method to treat these patients.

Expression of TNF-α and IL-10 at various altitudes in rats with severe acute pancreatitis / 中华肝胆外科杂志

Objective To observed the expression of serum TNF-α and IL-10 in rats with severe acute pancreatitis (SAP) at different altitudes,and to explore the relationships between TNF-α and IL-10,the pathological changes of the pancreas,and the experimental basis for clinical diagnosis and treatment of SAP.Methods 72 specific pathogen free (SPF) Wistar male rats were divided randomly into three groups:1 500 meters altitude (group L),3 300 meters altitude (group M),and 4 300 meters altitude (group H).These three groups were then each divided randomly into four subgroups:control (group n),6 hours after pancreatitis (group p 6 h),12 hours after pancreatitis (group p 12 h),and 24 hours after pancreatitis (group p 24 h).Pancreatitis was induced by intraductal administration of 5％ sodium taurocholate hydrate (NaTc).The rats were killed at 6,12,and 24 hours after NaTc injection in groups p.The group n rats were killed after 6 hours of pancreas observation.Blood samples and pancreatic tissues were collected post mortem and enzyme-linked immunosorbent assay (ELISA) measured serum TNF-α and IL-10.Results Compared with the control (group n),histopathological scores,IL-10,and TNF-α in the same altitude had a significant difference (P ＜ 0.05) in group p at each time point.In the same altitude of group p,histopathological scores and IL-10 were increased with time elapsed (P ＜ 0.05),while TNF-α was decreased with time elapsed (P ＜ 0.05).There was a significant difference between group Mp and Lp in histopathological scores,IL-10,and TNF-α (P ＜ 0.05),and the same result between group Hp and Lp (P ＜ 0.05),but there was no significant difference between group Hp and Mp (P ＜ 0.05).Meanwhile,IL-10 had a positive relationship with histopathological score,but TNF-α had a negative relationship with histopathological score.Conclusions The level of TNF-α increased with increasing altitude but significantly reduced with elapsed time.The level of IL-10 increased with both increasing altitude elapsed time.These results suggested that TNF-o and IL-10 might play a important role at different times in severe acute pancreatitis.

Advances in diagnosis and treatment of incidental cholangiocarcinoma / 中华肝胆外科杂志

Carcinoma of gallbladder is the most frequently encountered malignancy of the biliary system. Early diagnosis is very difficult and the tumour resection rate is low,and the prognosis of carcinoma of gallbladder is very poor. With the increasingly widespread acceptance of laparoscopic cholecystectomy (LC),the number of cases of unsuspected gallbladder carcinoma (UGC) has increased. However,management of UGC is a difficult issue in the absence of established guidelines. High age and history of stones are the risk factors for gallbladder carcinoma and they are related to UGC. Surgical handling and pneumoperitoneum play an important role in the metastasis. The surgical approach used for cholecystectomy would not seem to influence the outcome in patients with UGC. The tumour stage is the most important prognostic factor. To understand UGC better, we review its clinical characteristics,investigation,prognosis and especially the recent advances in the diagnosis and treatment of this disease.