Efficacy analysis of hybrid operating room-based laparoscopic cholecystectomy combined with intraoperative endoscopic retrograde cholangiopancreatography in the treatment of cholelithiasis combined with choledocholithiasis - A case-control study.

Objective: The objective is to compare the therapeutic effects of laparoscopic cholecystectomy (LC) combined with intraoperative endoscopic retrograde cholangiopancreatography (ERCP) in hybrid operating room and ERCP + LC under traditional conditions in the treatment of cholelithiasis and choledocholithiasis. Materials and Methods: Data of 82 patients with cholelithiasis complicated with choledocholithiasis treated by our centre from November 2018 to March 2021 were retrospectively analysed. Amongst them, 40 patients treated with LC combined with intraoperative ERCP in a hybrid operating room were placed into Group A, and 42 patients treated with ERCP first followed by LC under traditional conditions were placed into Group B. The differences in operative time, intraoperative blood loss, surgical success rate, stone clearance rate, pain score, exhaust time, ambulation time, post-operative complications, length of hospital stay, hospitalisation cost and other indicators between the two groups were compared. Results: There were no significant differences in operative time, intraoperative blood loss, surgical success rate and stone clearance rate between the two groups (P > 0.05), while there were significant differences in post-operative pain score, exhaust time, ambulation time, length of hospital stay, hospitalisation cost and complications (P < 0.05). Conclusion: LC combined with intraoperative ERCP in hybrid operating room for the treatment of cholelithiasis combined with choledocholithiasis has a better therapeutic effect than traditional ERCP followed by LC, which is worthy of further popularization. Notably, the reasonable selection should be made based on patients' own conditions and hospital facilities.

Titanium Clip-dental Floss Traction-assisting Endoscopy in Patients With Difficulty in Cannulation Into the Duodenal Peridiverticular Papilla.

OBJECTIVE: To assess titanium clip-dental floss traction-assisting endoscopy in patients with difficulty in cannulation into the papilla located at the lower, left or right side of the periampullary diverticulum. MATERIALS AND METHODS: Sixty-eight patients who had difficulty in cannulation into the papilla located at the lower, left, or right side of the periampullary diverticulum upon endoscopic retrograde cholangiopancreatography (ERCP) were recruited at Taizhou Hospital from July 2016 to June 2020. A random number table was used to divide the patients into an intervention (with titanium clip-dental floss traction) group and a control group (n=34 in each group). Patients in both groups underwent ERCP. The cannulation time, cannulation success rate, incidence of postprocedural complications after ERCP, hospitalization time, and hospitalization expenses in the 2 groups were compared. RESULT: The cannulation time was 15.3±4.1 minutes in the intervention group, which was less than that in the control group (25.7±6.5 min). The cannulation success rate was 77±12.1% in the intervention group, which was higher than that in the control group (43±16.7%). Postprocedural complications occurred in 2 patients in the intervention group and 6 patients in the control group, with no significant differences. The hospitalization time and expenses were 3.8±2.6 days and 11.1±6 thousand yuan in the intervention group, respectively, and 6.1±3.7 days and 18.2±8 thousand yuan in the control group, respectively. The differences were statistically significant ( P <0.05). CONCLUSION: Titanium clip-dental floss traction-assisting endoscopy achieved excellent efficacy in patients with difficulty in cannulation into the papilla located at the lower, left or right side of the periampullary diverticulum. The cannulation success rate was improved after treatment, with good safety and prognosis.

Liver retraction using n-butyl-2-cyanoacrylate glue during laparoscopic cholecystectomy.

ABSTRACT: There might be a thick "protrusion" in the visceral surface of hepatic quadrate lobe during the laparoscopic cholecystectomy (LC), which affects the surgical fields and consequently triggers high risks of biliary tract injury. Although n-butyl-2-cyanoacrylate (NBCA) glue has been applied to laparoscopic upper abdominal surgery for liver retraction, there is still no consensus on its safety and feasibility in LC. In this study, we investigated the safety, feasibility, and effectiveness of liver retraction using NBCA glue for these patients which have the thick "protrusion" on the square leaf surface of the liver during LC.Fifty-seven patients presenting thick "protrusion" hepatic quadrate lobe were included in our retrospective study. We performed LC in the presence of NBCA glue (n = 30, NBCA group) and absence of NBCA glue (n = 27, non-NBCA group), respectively. NBCA was used to fix the thick "protrusion" of the liver leaves to the hepatic viscera surface, which contributed to the revelation of the gallbladder triangle. The operation time, blood loss, postoperative hospitalization, and liver function were compared between the 2 groups.Both the groups' patients accomplished the operation in the laparoscopy. There was no mortality and no additional incision during operation. No severe complications including bile duct injury were available after surgery and no postoperative NBCA-related complications occurred after 9- to 30 months' follow-up. The time of operation in NBCA group showed significant decrease compared with that of non-NBCA group (48.33 ±â€Š16.15 vs 65.00 ±â€Š22.15 minutes, P < .01). There were no significant differences in blood loss, postoperative hospital stays, and the preoperative and postoperative liver function between the two groups (P > .05). Besides, no significant differences were noticed in major clinical characteristics between the 2 groups (P > .05).Liver retraction using NBCA during LC for thick "protrusion" hepatic quadrate lobe patients is safe, effective, and feasible.

A novel technique to prepare a single cell suspension of isolated quiescent human hepatic stellate cells.

To explore a simple and easy-to-learn procedure for the isolation of human quiescent hepatic stellate cells (HSCs) that requires no advanced training. Thus reducing costs and increasing efficiency. This protocol will provide sufficient primary cells with minimal contaminants for future basic research on diseases associated with human HSCs. Normal liver tissues were isolated from patients undergoing hepatic hemangioma resection, and a single cell suspension of these tissues was prepared using the Gentle MACS tissue processor. By using this method, the difficulty of the procedure was reduced, fewer cells were lost during the preparation treatments, and the maximal activity of single cells was maintained. Following preparation of the cell suspension, the HSCs were further isolated using a Nycodenz density gradient. Cell viability was examined by trypan blue staining, and the purity of the quiescent human HSCs was determined by autofluorescence and oil red O staining. Activated and quiescent human HSCs were identified using immunofluorescence and Western blotting. The cell cycle distribution in activated and quiescent human HSCs was analyzed by flow cytometry.The recovery rate of the HSCs was approximately (2.1 ± 0.23) × 106 of tissue, with 94.43 ± 1.89% cell viability and 93.8 ± 1.52% purity. The technique used in this study is a simple, high-yield, and repeatable method for HSC isolation that is worthy of recommendation.

Liver Retraction Using n-Butyl-2-Cyanoacrylate (NBCA) Glue during Laparoscopic Splenectomy and Azygoportal Disconnection in Cirrhotic Patients.

BACKGROUND: Although liver retraction using n-butyl-2-cyanoacrylate (NBCA) glue has been applied to laparoscopic upper abdominal surgery in noncirrhotic patients, there is still no consensus on its safety and feasibility for cirrhotic patients. In this study, we aimed to investigate the safety and effectiveness of liver retraction using NBCA glue during laparoscopic splenectomy and azygoportal disconnection (LSD) for gastroesophageal varices and hypersplenism secondary to liver cirrhosis and portal hypertension. METHODS: Thirty-nine gastroesophageal varices and hypersplenism secondary to liver cirrhosis and portal hypertension patients were included in our study. We performed LSD in the presence of NBCA glue (n = 22, NBCA group) and absence of NBCA glue (n = 17, n-NBCA group), respectively. The operation time, blood loss, postoperative hospitalization, and liver function were compared between the two groups. RESULTS: There was no mortality during the operation. One patient in non-NBCA group received open surgery due to parenchyma hemorrhage. Postoperative pleural effusion occurred in 2 cases of the NBCA group and 1 of the non-NBCA group. One showed left subphrenic abscess in the non-NBCA group. No postoperative bleeding occurred after 9-30 months of follow-up. The time of operation in NBCA group was significantly shorter than those in n-NBCA group (198.86±17.86 versus 217.81±20.25min, P<0.01). Blood loss in NBCA group was significantly lower than non-NBCA group (159.09±56.98 versus 212.50±88.51 ml, P<0.05). The levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were increased on day 1 after LSD and decreased to normal level on day 7 after LSD in both groups. There was no significant difference in postoperative hospitalization and liver function between the two groups. CONCLUSION: Liver retraction using NBCA glue during LSD for gastroesophageal varices and hypersplenism secondary to liver cirrhosis and portal hypertension is safe, effective, and feasible.

KIAA1199 overexpression is associated with abnormal expression of EMT markers and is a novel independent prognostic biomarker for hepatocellular carcinoma.

PURPOSE: To determined KIAA1199 expression and investigate its correlation with the clinicopathologic data and prognosis of hepatocellular carcinoma (HCC), as well as markers of epithelial-mesenchymal transition (EMT); N-cadherin, E-cadherin and vimentin. MATERIALS AND METHODS: Western blot, quantitative real-time PCR, and immunohistochemical staining were used to measure KIAA1199 expression in human HCC specimens. Subsequently, the correlation between KIAA1199 expression and the pathological characteristics of HCC patients was analyzed. Univariate and multivariate analyses were used to explore the risk factors associated with disease-free survival (DFS) and overall survival (OS). RESULTS: KIAA1199 expression was remarkably increased in hepatocellular carcinoma tissues compared to paracarcinomatous tissues. This phenomenon was accompanied by aberrant expression of EMT-associated markers. In addition, high KIAA1199 expression was associated with severe pathological symptoms, low DFS, and low OS. Results of the multivariate analysis showed that KIAA1199 expression may be an independent predictor of low disease-free survival and OS of HCC patients. CONCLUSION: KIAA1199 overexpression in HCC patients is associated with aberrant expression of EMT-associated markers and severe clinicopathological symptoms, and thus may function as a marker of poor prognosis in HCC.

Surgical Technique and Clinical Analysis of Twelve Cases of Isolated Laparoscopic Resection of the Hepatic Caudate Lobe.

OBJECTIVE: To describe the surgical procedures of laparoscopic caudate lobectomy and analyze its clinical efficiency for treating cancer. METHODS: Twelve consecutive patients of hepatocellular carcinoma, hepatic hemangioma, and focal nodular hyperplasia who received laparoscopic caudate lobectomy in Qilu Hospital of Shandong University from January 2013 to January 2017 were included in this study. The clinical data, intraoperative parameters, and postoperative outcomes were assessed. RESULTS: All 12 patients received totally laparoscopic technique. The operative time was 140.8 ± 95.34 minutes. The average estimated blood loss was 97.92 ± 90.54 ml, and no blood transfusions were required. The mean duration of hospital stay was 9.17 ± 2.88 days. There was no perioperative complication or patient mortality in this series. CONCLUSIONS: Laparoscopic caudate lobectomy is safe and feasible in the selected patients.

Adjuvant transarterial chemoembolization after radical resection contributed to the outcomes of hepatocellular carcinoma patients with high-risk factors.

We aim to investigate the effects of postoperative adjuvant transarterial chemoembolization (TACE) on survival and recurrence in hepatocellular carcinoma (HCC) patients after radical resection. A total of 320 HCC patients underwent radical resection between January 2010 and January 2014 in Qilu Hospital, Shandong University were divided into 4 groups according to the frequency of postoperative adjuvant TACE. Patients were further stratified into subgroups (tumor diameter ≤5 or >5 cm) with low or high risk factors for recurrence or death. A low risk factor for recurrence or death was defined as Edmondson grade I/II without microvascular invasion (MiVI), while a high risk factor was defined as Edmondson grade III/IV or with MiVI. Survival data and recurrence rates were compared using the Kaplan-Meier method. Uni- and multivariate analyses were based on the Cox proportional analysis. Compared to those received no TACE, patients underwent 2 (log-rank, χ = 9.054, P = .003) or 3 (log-rank, χ = 4.228, P = .04) TACE showed delayed recurrence. Patients received 2 or 3 TACE showed extended overall survival (OS) compared with the other patients. No statistical differences were found between all the disease-free survival (DFS) and OS in low-risk subgroups. In the patients of the high-risk subgroup with a tumor diameter of ≤5, those received 2 TACE showed delayed recurrence compared with those received no TACE, and TACE (twice or thrice) can improve OS. For those of the high-risk subgroup with a tumor diameter of >5, TACE (twice or thrice) can delay recurrence and improve OS. Adjuvant TACE (twice or thrice) after radical resection is beneficial for HCC patients with poor differentiation and MiVI, especially for those with a tumor diameter of >5 cm.