Treatment of Cavernous Transformation of Portal Vein Caused by Hepatic Cystic Echinococcosis Using Ex Vivo Liver Resection and Autotransplantation.

BACKGROUND Hepatic cystic echinococcosis (HCE) is a frequently overlooked parasitic liver disease, for which the commonly recommended treatment is radical resection. However, this approach is often associated with severe comorbidities such as HBV/HCV, cirrhosis, and hepatic carcinoma, among others. CASE REPORT In this report, we present a case successfully managed by ex vivo liver resection and autologous liver transplantation (ELRA). In the described case, ex vivo resection was not feasible due to recurrent lesions and infections invading the portal vein, which resulted in portal vein cavernous transformation. CONCLUSIONS Through this paper, we aim to detail the treatment process, showcasing the feasibility and advantages of ELRA. Additionally, we propose a novel approach for the treatment of this disease, while emphasizing the importance of radical resection surgery to prevent long-term complications.

Study on the characteristics of 18F-flurodeoxyglucose uptake in the microenvironment of hepatic alveolar echinococcosis / 中华肝胆外科杂志

Objective:To investigate characteristics of the 18F-flurodeoxyglucose ( 18F-FDG) uptake intensity and ranges in distinct hepatic alveolar echinococcosis lesions. Methods:The clinical data of 39 patients with position emission tomography during Jan 2017 to Dec 2019 in the First Affiliated Hospital of Xinjiang Medical University were enrolled. Among them, there were 17 males and 22 females, aging from 15 to 65 years (median 34 years). Lesions were classified into six groups based on heterogenic scales of calcification and liquefaction: A. non-calcified and non-liquefied ( n=7); B. obvious calcified and non-liquefied ( n=7); C. partial calcified and partial liquefied( n=10); D. obvious calcified and partial liquefied ( n=5); E. partial calcified and subtotal liquefied ( n=5); F. obvious calcified and subtotal liquefied ( n=5). Tumor to background ratio (TBR) and width (W) of lesion infiltrative boundary were measured and calculated. Statistical comparison using Mann-Whitney U test as well as correlation analysis was performed. Results:TBR values [ M( Q1, Q3)] for each group were 4.40(3.66, 7.03), 2.55(1.69, 3.60), 3.73(3.37, 5.21), 2.90(2.75, 3.60), 3.80(3.49, 6.36), 2.49(2.21, 3.97), among which A>B, A>D, A>F, C>B, E>B ( U=3.0, 4.0, 4.5, 11.0, 5.0, all P<0.05); From the perspective of the calcification in each group, it was found that the lighter the calcification was, the greater the TBR value was. W values [ M( Q1, Q3)] for each group were [12.5(10.0, 19.5), 11.2(10.5, 12.5), 12.2(10.9, 13.2), 7.8(7.3, 9.3), 10.0(7.3, 13.4), 7.3(6.8, 7.6)] mm, among which A>D, A>F, B>D, B>F, C>D, C>F (all U=0, all P<0.05); According to the degree of calcification and liquefaction of lesions in each group, the lighter the calcification was, the greater the W value was; The heavier the liquefaction was, the smaller the W value was. A mild strength linear correlation has been observed between the TBR value and W value ( r=0.4136, P<0.05). Conclusions:Less calcification and liquefaction implicated higher 18F-FDG uptake intensity and wider range. Radical resection margins and tissue sampling should be individualized based on different lesion features in surgical treatment.

Clinical characteristics of choledocholithiasis combined with periampullary diverticulum and influencing factor analysis for difficult cannulation of endoscopic retrograde cholangiopan-creatography: a report of 1 920 cases / 中华消化外科杂志

Objective:To investigate the clinical characteristics of choledocholithiasis com-bined with periampullary diverticulum and influencing factor for difficult cannulation of endoscopic retrograde cholangiopancreatography (ERCP).Methods:The retrospective case-control study was conducted. The clinical data of 1 920 patients who underwent ERCP for choledocholithiasis in 15 medical centers, including the First Hospital of Lanzhou University, et al, from July 2015 to December 2017 were collected. There were 915 males and 1 005 females, aged (63±16)years. Of 1 920 patients, there were 228 cases with periampullary diverticulum and 1 692 cases without periampullary diverticulum. Observation indicators: (1) clinical characteristics of patients with choledocholithiasis; (2) intraoperative and postoperative situations of patients undergoing ERCP for choledocholithiasis; (3) influencing factor analysis for difficult cannulation in patients undergoing ERCP for choledocholithiasis. Measurement data with normal distribution were represented as Mean±SD, and comparison between groups was conducted using the independent sample t test. Measurement data with skewed distribution were represented as M(range) or M( Q1, Q3), and com-parison between groups was conducted using the Wilcoxon rank sum test. Count data were described as absolute numbers or percentages, and comparison between groups was conducted using the chi-square test or Fisher exact probability. The Logistic regression model was used for univariate and multivariate analyses. Results:(1) Clinical characteristics of patients with choledocholithiasis. Age, body mass index, cases with complications as chronic obstructive pulmonary disease, diameter of common bile duct, cases with diameter of common bile duct as <8 mm, 8?12 mm, >12 mm, diameter of stone, cases with number of stones as single and multiple were (69±12)years, (23.3±3.0)kg/m 2, 16, (14±4)mm, 11, 95, 122, (12±4)mm, 89, 139 in patients with choledocholithiasis combined with periampullary diverticulum, versus (62±16)years, (23.8±2.8)kg/m 2, 67, (12±4)mm, 159, 892, 641, (10±4)mm, 817, 875 in patients with choledocholithiasis not combined with periampullary diver-ticulum, showing significant differences in the above indicators between the two groups ( t=?7.55, 2.45, χ2=4.54, t=?4.92, Z=4.66, t=?7.31, χ2=6.90, P<0.05). (2) Intraoperative and postoperative situations of patients undergoing ERCP for choledocholithiasis. The balloon expansion diameter, cases with intraoperative bleeding, cases with hemorrhage management of submucosal injection, hemostatic clip, spray hemostasis, electrocoagulation hemostasis and other treatment, cases with endoscopic plastic stent placement, cases with endoscopic nasal bile duct drainage, cases with mechanical lithotripsy, cases with stone complete clearing, cases with difficult cannulation, cases with delayed intubation, cases undergoing >5 times of cannulation attempts, cannulation time, X-ray exposure time, operation time were 10.0(range, 8.5?12.0)mm, 56, 6, 5, 43, 1, 1, 52, 177, 67, 201, 74, 38, 74, (7.4±3.1)minutes, (6±3)minutes, (46±19)minutes in patients with choledocholithiasis combined with periampullary diverticulum, versus 9.0(range, 8.0?11.0)mm, 243, 35, 14, 109, 73, 12, 230, 1 457, 167, 1 565, 395, 171, 395, (6.6±2.9)minutes, (6±5)minutes, (41±17)minutes in patients with choledocholithiasis not combined with periampullary diverticulum, showing significant differences in the above indicators between the two groups ( Z=6.31, χ2=15.90, 26.02, 13.61, 11.40, 71.51, 5.12, 9.04, 8.92, 9.04, t=?3.89, 2.67, ?3.61, P<0.05). (3) Influencing factor analysis for difficult cannulation in patients undergoing ERCP for choledocholithiasis. Results of multivariate analysis showed total bilirubin >30 umol/L, number of stones >1, combined with periampullary diverticulum were indepen-dent risk factors for difficult cannulation in patients with periampullary diverticulum who underwent ERCP for choledocholithiasis ( odds ratio=1.31, 1.48, 1.44, 95% confidence interval as 1.06?1.61, 1.20?1.84, 1.06?1.95, P<0.05). Results of further analysis showed that, of 1 920 patients undergoing ERCP for choledocholithiasis, the incidence of postoperative pancreatitis was 17.271%(81/469) and 8.132%(118/1 451) in the 469 cases with difficult cannulation and 1 451 cases without difficult cannula-tion, respectively, showing a significant difference between them ( χ2=31.86, P<0.05). In the 1 692 patients with choledocholithiasis not combined with periampullary diverticulum, the incidence of postopera-tive pancreatitis was 17.722%(70/395) and 8.250%(107/1 297) in 395 cases with difficult cannula-tion and 1 297 cases without difficult cannulation, respectively, showing a significant difference between them ( χ2=29.00, P<0.05). In the 228 patients with choledocholithiasis combined with peri-ampullary diverticulum, the incidence of postoperative pancreatitis was 14.865%(11/74) and 7.143%(11/154) in 74 cases with difficult cannulation and 154 cases without difficult cannulation, respectively, showing no significant difference between them ( χ2=3.42, P>0.05). Conclusions:Compared with patients with choledocholithiasis not combined with periampullary divertioulum, periampullary divertioulum often occurs in choledocholithiasis patients of elderly and low body mass index. The proportion of chronic obstructive pulmonary disease is high in choledocholithiasis patients with periampullary diverticulum, and the diameter of stone is large, the number of stone is more in these patients. Combined with periampullary diverticulum will increase the difficult of cannulation and the ratio of patient with mechanical lithotripsy, and reduce the ratio of patient with stone complete clearing without increasing postoperative complications of choledocholithiasis patients undergoing ERCP. Total bilirubin >30 μmol/L, number of stones >1, combined with periampullary diverticulum are independent risk factors for difficult cannulation in patients of periampullary diverticulum who underwent ERCP for choledocholithiasis.

Application value of endoscopic retrograde biliary drainage for acute obstructive suppurative cholangitis in the elderly / 中华消化内镜杂志

Objective:To evaluate the safety and efficacy of endoscopic retrograde biliary drainage (ERBD) for acute obstructive suppurative cholangitis (AOSC) in the elderly.Methods:A retrospective analysis was performed on the clinical data of AOSC patients admitted to the First Affiliated Hospital of Xinjiang Medical University from January 2018 to January 2020. Patients aged 75 years and over ( n=49) were assigned to the elderly group and patients under 75 years old were assigned to the control group ( n=63). General data, American Society of Anesthesiologists (ASA) grading, procedure-related indicators, incidence of postoperative complications and mortality were compared. Results:There were significant differences in age (82.6±5.1 years VS 64.6±4.5 years, t=19.98, P<0.001), albumin levels (29.1±5.9 g/L VS 34.6±8.8 g/L, t=-3.94, P<0.001) and ASA grade ( χ2=8.37, P=0.015) in the elderly group and the control group . The elderly group were accompanied by more basic diseases, i.e. hypertension [57.14% (28/49) VS 34.9% (22/63), χ2=5.51, P=0.019], coronary heart disease [55.1% (27/49) VS 27.0% (17/63), χ2=9.14, P=0.003], chronic obstructive pulmonary diseases/asthma [24.5% (12/49) VS 6.3% (4/63), χ2=7.41, P=0.006]. There were no significant differences in the operation time (31.4±8.1 min VS 30.4±8.0 min, t=-0.61, P=0.543) or hospital stay (6.1±1.7 days VS 5.7±1.4 days, t=1.35, P=0.182). The incidences of postoperative complications were 14.3% (7/49) in the elderly group and 12.7% (8/63) in the control group, showing no significant difference ( χ2=0.06, P=0.807). No ERBD-related death was observed in either group during hospital stay. Conclusion:For elderly patients with AOSC over 75 years old, emergency ERBD, which can quickly relieve the disease, is safe and effective. Advanced age is not an absolute contraindication for emergency ERBD.

Clinical efficacy of laparoscopic surgery for hepatic cystic echinococcosis: a meta-analysis / 中华肝胆外科杂志

Objective:To explore the curative effect of laparoscopic surgery for hepatic cysticercosis.Methods:Search the literature from February 2010 to February 2020 on literature platforms such as Wanfang Data, VIP, CNKI, Pubmed, ScienceDirect, Web of Science, etc. the key words were "肝囊型包虫病" , "细粒棘球蚴" , "手术" , "开腹手术" , "腹腔镜" , "微创手术" , " echinococcosis " , " liver or hepatic " , " laparoscopic or minimal invasive " . Data on intraoperative indicators (e.g., operation time, bleeding volume), postoperative complications, hospital stay, recurrence rate, etc. in the literature included in the study were extracted and meta-analyzed.Results:A total of 9 articles were included, including 2 prospective studies and 7 retrospective case-control studies. A total of 1031 patients were enrolled, including 272 in the laparoscopic group and 759 in the laparotomy group. The results of the meta-analysis showed that the total postoperative complication rate in the laparoscopic group was lower than that in the laparotomy group ( OR=1.64, 95% CI: 1.10-2.45, P<0.05). Incision-related complications in the laparoscopy group and laparotomy group the difference was statistically significant ( OR=2.81, 95% CI: 1.03-7.70, P<0.05), and the hospital stay in the laparoscopic group was shorter ( SMD=1.21, 95% CI: 0.47-1.96, P<0.05). There was no significant difference between the two groups in operation time, postoperative bile leakage, residual cavity infection and effusion, and postoperative recurrence rate ( P>0.05). Conclusions:Under the premise of strictly grasping the indication of laparoscopic surgery, the incidence of complications after laparoscopic surgery is low, the hospitalization time is short.

Current progress on lesion classification of hepatic alveolar echinococcosis / 中华肝胆外科杂志

Human alveolar echinococcosis is a chronic infectious disease caused by Echinococcus multilocularis infection. It predominantly injuries the liver and grows like the malignant tumor. The therapeutic options and prognosis depend on types of human alveolar echinococcosis, clinical stages, biological activity, vascular invasion, pathological characteristics, and patient's immune status. However, despite of multiple classification methods, there are still lacking of comprehensive typing schemes. which leads to inappropriate diagnosis and therapy. This research systematically reviewed the recent studies on human alveolar echinococcosis at home and abroad and analyzed the classifications based on ultrasound, computer tomography, magnetic resonance imaging, positron emission computed tomography, serology and pathology, and some novel technologies and summarized the individual advantage and disadvantage for each classification Relationships and their advantages plus disadvantages have been assessed comprehensively. Meanwhile, the possible reference factors or theoretical basis for optimized future classification are proposed, in order to establish a unified classification system to provide guidance for clinical diagnosis and treatment.

Simultaneous combined surgery for hepatic and renal cystic echinococcosis: a study on 11 cases / 中华普通外科杂志

Objective:To investigate the feasibility, safety and efficacy of simultaneous combined surgery for hepatic and renal cystic echinococcosis (CE).Methods:Clinical data of consecutive 11 hepatic and renal CE patients undergoing surgical treatment at the First Affiliated Hospital of Xinjiang Medical University from Oct 2009 to Feb 2017 were analyzed retrospectively.Results:There were 8 males and 3 females, median age was 44 years (22-60 years). Main symptoms were abdominal and/or flank pain and fever; nine and 2 patients respectively had cysts in liver plus right kidney and left kidney; median volume of cyst load for each patient was 944.1 cm 3 (67.1-9 310.4 cm 3). All patients were treated simultaneously by combined surgery, including total and subtotal cystectomies, hepatic or renal resections as well as extra lesions resection. All surgeries went uneventfully, radical rate was 63.6% (7/11), There was no postoperative liver or kidney dysfunctions. Median operative time, bleeding and length of hospital stay were 2.5 h (1.4-4.5 h), 100 ml (50-200 ml) and 7 d (5-10 d) respectively. All were followed-up for median 42 mouths (34-123 mouths) and all doing well without disease recurrence. Conclusions:Simultaneous combined surgery for recurrent or primary hepatic and renal double organ CE patients could be a feasible and effective approach.

Hepatectomy for hepatic alveolar echinococcosis complicating cavernous transformation of the portal vein / 中华普通外科杂志

Objective:To investigate the safety and feasibility of hepatectomy in the treatment of hepatic alveolar echinococcosis with secondary cavernous transformation of the portal vein.Methods:The clinical data of 7 patients undergoing surgery at the First Affiliated Hospital of Xinjiang Medical University from Jan 2010 to Dec 2019 were retrospectively analyzed.Results:There were 1 case of cavernous type Ⅰ transformation of the portal vein and 6 cases of type Ⅱ. All patients underwent partial hepatectomy. The average operation time was (9.24±4.09) h. Two patients underwent resection of cavernous segment of portal vein and reconstruction by graft, Albendazole was taken orally for 2 years after discharge. Anticoagulants were taken orally in patients with artificial vascular reconstruction. No recurrence and vascular complications were found. Five patients underwent palliative resection without resection of the cavernous segment of the portal vein. During the follow-up, cavernous transformation of the portal vein progressed in 3 patients, 2 of them esophageal varices rupture and bleeding.Conclusion:Radical hepatectomy and revascularization are the first choice for the treatment of hepatic alveolar echinococcosis complicated with secondary cavernous transformation of portal vein the result was fair.

Different reconstruction methods of inferior vena cava in the ex-vivo liver resection and auto-transplantation for hepatic alveolar echinococcosis / 中华器官移植杂志

Objective:To explore the application of different reconstruction methods of retrohepatic inferior vena cava (RHIVC) in the ex-vivo liver resection and auto-transplantation(ELRA)for hepatic alveolar echinococcosis (AE).Methods:The 88 patients with end-stage hepatic AE treated by ELRA from August 2010 to December 2018 were divided into 3 groups according to the different methods of RHIVC reconstruction, respectively , group A, autologous vascular repair and reconstruction group (n=50); group B, RHIVC replacement group (n=31); group C, RHIVC resection without reconstruction group (n=7), and the clinical data were analyzed and followed up.Results:The average operation time of group A, B and C was 16.32±3.20 h, 15.99±3.32 h, 16.86±4.18 h ( P>0.05), The average anhepatic phase was398.48±104.12 min, 389.41±135.25 min, 337.43±108.65 min( P>0.05), The differences were not statistically significant. The average hospital stays after surgery in the three groups were 30.64±18.54 d, 25.94±16.37 d, 51.29±29.43 d ( P<0.05), There were significant statistical differences, and the results showed that the group B was significantly less than other two groups. The incidence of IVC related complications in group A and B was 20.0% and 9.7%. Among all the subjects, RHIVC stenosis was found in 9 patients and thrombus was formed in 4 patients in postoperative. Conclusions:RHIVC reconstruction methods can be selected appropriately according to the defect degree of lumen after resection.

Enhanced recovery after surgery in the application of day surgery laparoscopic cholecystectomy / 中华普通外科杂志

Objective To investigate the feasibility and safety of the concept of enhanced recovery after surgery (ERAS) in the perioperative application of ambulatory laparoscopic cholecystectomy (ALC).Methods A retrospective analysis was made on 168 patients (ALC group) undergoing ALC in the daytime ward from Aug 2017 to Aug 2018 in our hospital vs conventional laparoscopic cholecystectomy CLC in the general ward in 165 patients (CLC group).Clinical data,operation time,intraoperative blood loss,conversion to laparotomy,postoperative complication,readmission,pain score after 6h,patient satisfaction,first postoperative anal exhaust,average length of hospital stay,and hospitalization expenses were compared between the two groups.Results In the ALC group,the pain score,the first anal exhaust time,the average length of hospital stay,and the hospitalization cost were significandy lower than those in the CLC group.Compared with the CLC group,the satisfaction of patients in the ALC group was significantly improved.There was no significant difference in the incidence of postoperative complications (biliary leakage,postoperative bleeding,bile duct injury,infection of the incision) and readmission rate.Conclusion Use of enhanced recovery after surgery in laparoscopic cholecystectomy in day surgery is safe and feasible.It has many advantages such as reducing hospitalization costs and postoperative pain and accelerating postoperative recovery.

Enhanced recovery after surgery in the application of day surgery laparoscopic cholecystectomy / 中华普通外科杂志

Objective@#To investigate the feasibility and safety of the concept of enhanced recovery after surgery (ERAS) in the perioperative application of ambulatory laparoscopic cholecystectomy (ALC).@*Methods@#A retrospective analysis was made on 168 patients (ALC group) undergoing ALC in the daytime ward from Aug 2017 to Aug 2018 in our hospital vs conventional laparoscopic cholecystectomy CLC in the general ward in 165 patients (CLC group) . Clinical data, operation time, intraoperative blood loss, conversion to laparotomy, postoperative complication, readmission, pain score after 6h, patient satisfaction, first postoperative anal exhaust, average length of hospital stay, and hospitalization expenses were compared between the two groups.@*Results@#In the ALC group, the pain score, the first anal exhaust time, the average length of hospital stay, and the hospitalization cost were significantly lower than those in the CLC group. Compared with the CLC group, the satisfaction of patients in the ALC group was significantly improved. There was no significant difference in the incidence of postoperative complications (biliary leakage, postoperative bleeding, bile duct injury, infection of the incision) and readmission rate.@*Conclusion@#Use of enhanced recovery after surgery in laparoscopic cholecystectomy in day surgery is safe and feasible. It has many advantages such as reducing hospitalization costs and postoperative pain and accelerating postoperative recovery.

Application of enhanced recovery after surgery in ambulatory laparoscopic appendectomy / 中华全科医师杂志

Objective To assess the safety and feasibility of ambulatory laparoscopic appendectomy (ALA) with the concept of enhanced recovery after surgery (ERAS).Methods The clinical data of patients with appendicitis undergoing surgical treatment in the First Affiliated Hospital of Xinjiang Medical University from August 2017 to August 2018 were retrospectively analyzed.Among 196 patients,100 cases received ambulatory laparoscopic appendectomy with ERAS (ERAS group) and 96 cases received conventional laparoscopic appendectomy (control group).The average length of hospital stay,hospitalization expenses,NRS pain score at 6 h,12 h,24 h after surgery,patient satisfaction,time of postoperative off-bed activity,time of gastrointestinal function recovery,and postoperative complications were compared between two groups.Results There were significant differences in average length of hospital stay [(36.5± 1.3) h vs.(74.5±4.4) h,t=80.986),hospitalization expenses[(9 617.5±637.5) Yuan vs.(13 740.1±640.6) Yuan,t=45.150],6 h NRS pain score[(3.4± 1.4) vs.(4.1±1.3),t=3.360],12 h NRS pain score(2.0±1.3 vs.2.5±1.1,t=-2.929),time of postoperative off-bed activity[(5.7 ± 0.9) h vs.(11.5 ± 2.0) h,t=26.237],time of gastrointestinal function recovery(6.8± 1.1) h vs.(12.2±2.3) h,t=20.341]and patient satisfaction [(95.6±3.0) vs.(90.5±4.9),t=-8.644]between ERAS group and control group (all P＜0.05).There was no significant difference in the NRS pain score at 24 h(1.0±0.7 vs.1.0±0.8,t=0.287)and postoperative complications (x2=0.025)between the two groups (P＞0.05).Conclusion The ambulatory laparoscopic appendectomy with enhanced recovery after surgery is safe and feasible,with the advantages of low hospitalization cost,short hospitalization time,and high patient satisfaction.

Value of preoperative computed tomography and three-dimensional reconstruction of major vascular structures before ex vivo liver resection and autotransplantation for hepatic alveolar echinococcosis / 中华器官移植杂志

Objective To evaluate the application value of preoperative computed tomography (CT) and three-dimensional reconstruction (3DR) of major vessels regarding lesion infiltration severity,vascular morphology & function and predict vascular surgeries during ex vivo liver resection and autotransplantation (ELRA) for end-stage hepatic alveolar echinocoecosis (AE).Methods Preoperative radiological & angiographical,intraoperative photographic and pathological materials were retrospectively collected in 40 consecutive patients undergoing ELRA for end-stage hepatic alveolar echinococcosis from January 2017 to January 2019.Severity of lesion infiltration,morphological & functional status as well as predictive value for surgical planning of hepatic venous system (HVs),inferior vena cava (IVC),portal venous system (PVs) and hepatic arterial supply system (HAs) were estimated,then compared with those built golden standards:angiography,intraoperative diagnosis and pathological examinationss.Results Evaluation accuracy of CT and 3DR for lesion infiltration severity,vascular morphology & function and predicting vascular surgeries respectively were 68.1％,71.9％,78.9％ and 57.5％,89.2％,71.1％ and all paired data had statistical significance (all P＜0.05).Furthermore,CT had a higher certainty of predicting the use of vascular prosthesis during surgery than 3DR (77.5％ and 70.0％,P＜0.05).Conclusions Pre-ELRA CT is recommended for evaluating lesion infiltration severity and predicting corresponding vascular surgery.However,3DR has more certainty in evaluating vascular morphology & function.Furthermore,CT is more reliable than 3DR in predicting vascular prosthesis during ELRA.However,optional better solutions should be studied for higher assurance.

Timing for laparoscopic cholecystectomy after ERCP + EST in patients of gall stones and choledocholithiasis / 中华普通外科杂志

Objective To evaluate the timing of postoperative laparoscopic cholecystectomy (LC after ERCP for the treatment of gallstones.Method A retrospective analysis was made on 120 patients with choledocholithiasis and cholecystolithiasis from Feb 2015 to Feb 2018 in the First Affiliated Hospital of Xinjiang Medical University,including 62 patients receiving LC at 48-72 h after ERCP + EST (observation group),and 58 patients receiving LC at 72h after ERCP + EST (control group).The hospital stay,hospitalization costs,operation time,intraoperative blood loss,convertion to open laparotomy,the postoperative complications were compared between the two groups.Results The difference of age,gender,ERCP operation time,common bile duct stones diameter,postoperative complications were not statistically significant in two groups.Operation time,intraoperative blood loss,hospital stay,incidence of laparotomy and hospitalization costs in group A were significantly less than that in group B (P ＜ 0.05).Conclusions ERCP + EST followed by LC for choledocholithiasis with cholecystolithiasis within 48-72 hours were with shorter operation time,lower hospital costs,without an increase of postoperative complications compared with ERCP + EST followed by LC after 72 hours.

"Double ""T"" tube drainage in hepatic echinococcosis which ruptured into the common bile duct" / 中华肝胆外科杂志

Objective To investigate the double T tube drainage method in the treatment of hepatic echinococcosis which ruptured into the common bile duct.Methods A retrospective study was conducted on 86 patients who were treated surgically for hepatic echinococcosis which had ruptured into the common bile duct at the First Affiliated Hospital of Xinjiang Medical University from June 2012 to December 2014.The average postoperative hospitalization,postoperative complications (residual cavity bile leakage and residual cavity effusion,residual cavity infection) and biliary complications of biliary tract infection were analyzed.Results Significant differences were found on the postoperative residual cavity complications in group A:(2,7.1％) when compared with Group B:(9,15.5 ％),and also on the postoperative hospitalization between the double T tube drainage group [group A:(7.1 ± 1.3) d] and the traditional T type tube decompression group [B group:(8.2 ± 1.5) d] (P ＜ 0.05).Conclusions The doubleT tube drainage in the treatment of hepatic echinococcosis which had ruptured into the common bile duct was simple,safe and effective.This treatment could completely cure residual cavity bile leakage,and it had the advantage of avoiding occurrence of common bile duct related complications caused by the traditional suture method for bile leakage.

Clinical comparative analysis on LCBDE + LC and ERCP/EST + LC for gall stones and choledocholithiasis / 中华普通外科杂志

Objective To Compare the therapeutic effects of laparoscopic cholecystectomy (LC) + laparoscopic common bile duct exploration (LCBDE) and primary suture with endoscopic retrograde cholangiopancreatography (ERCP)/endoscopic sphincterotomy (EST) + LC for cholecystolithiasis combined with choledocholithiasis.Methods The clinical data of 144 patients with cholecystolithiasis and choledocholithiasis who were treated in First Affiliated Hospital,Xinjiang Medical University from Dec 2014 to Jan 2016 were retrospectively analyzed,72 cases being treated by LC + LCBDE (group A) and 72 cases by ERCP/EST + LC (group B).The hospitallization time,hospitalization costs and complication rate were compared between the two groups.Results There were no statistically differences in terms of incidence of postoperative complication (P ＞ 0.05) in two groups.However,hospital stay [(10.25 ± 1.26) d vs.(14.25 ± 1.50)d),P =0.006] and hospitalization costs [(19 600 ± 1 521) yuan vs.(23 931 ± 1 629) yuan,P =0.008] were in favor of LC + LCBDE group than those in ERCP/EST + LC group.Conclusions LC + LCBDE is better than ERCP/EST + LC in the treatment of gall stone and choledocholithiasis.

Application of PBL in cardiovascular intervention training of continuing education / 中华医学教育探索杂志

Objective To compare the application effect between problem-based learning (PBL) and traditional teaching in cardiovascular intervention . Methods 39 training physicians were divided randomly into the PBL group (n=20) and control group (n=19). The control group was trained with the tradi-tional teaching method while PBL group used PBL seven step method, namely they were trained through the process of clarifying unfamiliar terms—defining the problem—brainstorming—restructuring problem—defining learning goals—collecting information, personal learning, information sharing, and group discus-sion. After the end of the training, the two groups were tested by using the unified test questions and skills test, and the questionnaire survey of teaching satisfaction. SPSS 18.0 was used to do line t test or chi square test to the data of both groups. Results PBL group training physicians' cardiovascular intervention oper-ation [(30.07±1.67) vs. (28.54±1.98), P=0.036], their comprehensive analysis of clinical cases, [(34.47± 1.77) vs. (32.08 ±1.80), P=0.002], and the total score [(86.47 ±2.75) vs. (82.23 ±3.63), P=0.002], were better than the control group, and the difference was statistically significant. The survey results showed that the PBL group's evaluation on how the teaching methods stimulate the training physicians' interest in learning, enhance their ability of independent thinking and cultivate their teamwork ability, improve their language expression and clinical thinking and other aspects was higher than the control group (P Conclusion Compared with the traditional teaching, the application effect of PBL in the training of car-diovascular intervention can better exert training physicians' subjective initiative and improve the teaching effect.

Hydatid liver cysts: radical vs conservative surgery: a Meta-analysis / 中华肝胆外科杂志

Objective To evaluate the effectiveness and safety of radical versus conservative surgery for hydatid liver cysts.Methods The Pubmed, EMBASE, MEDLINE, Cochrane Library, Chinese Biomedicine Database, CNKI, Wan Fang Databases, VIP Databases, Chinese scientific and technical journals full-text database and Chinese Journal of full text database were searched for randomized clinical trials or none-randomized clinical trials from January 2000 to January 2015.A Meta-analysis was performed with RevMan5.1.Results 10 studies with 2 123 patients were included into the final analysis.Meta-analysis demonstrated that the radical group was significantly longer in operation time [weighted mean difference (WMD) =25.11;95％ CI: 16.18-34.05;P ＜ 0.05], was significantly shorter in the length of hospital stay (WMD =-3.94;95％CI:-7.57-0.32;P ＜0.05), was significantly lower in the incidence of bile leak (OR =0.19;95％ CI: 0.07-0.49;P ＜ 0.05), was significantly lower in the incidence of residual cavity infection (OR =0.08;95 ％ CI: 0.04-0.15;P ＜ 0.05), and in the incidence of local recurrence (OR =0.10;95 ％ CI: 0.05-0.18;P ＜ 0.05) when compared with the conservative surgery group.Conclusions For hydatid liver cysts, radical surgical procedures had significantly lower rates of complications and recurrence.Thus, they are better treatments for hepatic cystic echinococcosis.

Multidisciplinary team approach in individualized treatment for refractory hepatic alveolar echinococcosis / 中华肝胆外科杂志

Objective To analyze the use of multidisciplinary team approach (MDT) for advanced and refractory hepatic alveolar echinococcosis in individualized treatment.Methods A retrospective study was conducted on the use of multidisciplinary team approach in individualized diagnosis and treatment for 137 patients with advanced and refractory hepatic alveolar echinococcosis (with invasion of major blood vessels and bile ducts,and/or with lung and brain metastasis) in our hospital from January 2005 to December 2013.The patients were divided into two groups:The MDT group (n =49) and the non-MDT group (n =88).The MDT group was further divided into two subgroups:subgroup A was the surgical treatment group (n =26),and subgroup B was the non-surgical treatment group (n =26).In the subgroup B,13 patients underwent late radical surgery.The non-MDT group was also further divided into two subgroups:subgroup a was the surgical treatment group (n =61),and subgroup b was the non-surgical treatment group (n =27).In subgroup b,5 patients underwent late radical surgery.The time taken to confirm the diagnosis,perioperative hospital stay,operation time,blood loss,postoperative drainage time,postoperative hospital stay,early postoperative complications (pleural and peritoneal effusions,bile leak,anastomotic leak),late postoperative complications (jaundice,anastomotic stenosis,recurrence),and rates of radical surgery were compared between subgroup A and subgroup a.The rates of late radical resection were compared between subgroup B with subgroup b.All data were analyzed using the Mann-Whitney rank sum test or the Chi-square test.Results Subgroup A had significantly shorter perioperative hospital stay,postoperative hospital stay,and total length of hospital stay than subgroup a (P ＜ 0.05).The incidence of late postoperative complications (jaundice,anastomotic stenosis,recurrence) was also significantly less than subgroup a (P ＜ 0.05),and the radical surgery rate was significantly higher than subgroup a (P ＜ 0.05).There was no significant difference in the time taken to confirm the diagnosis,operation time,blood loss,postoperative drainage time,early postoperative complications (pleural and peritoneal effusions,bile leak,anastomotic leak) (P ＜ 0.05) between subgroup A and subgroup a.The ratio of subgroup B receiving chemotherapy alone or drainage + chemotherapy,and the rate of late implement of radical resection were significantly higher than subgroup b (P ＜0.05).Conclusions A multidisciplinary team approach in individualized treatment comprehensively combined the advantages of the effects of drugs,intervention,surgery and systemic nutritional support.The best individualized treatment plan could be used which improved the rates of radical surgery in advanced and refractory hepatic alveolar echinococcosis,reduced postoperative complications,improved quality of life,and offered chances of radical resection in the patients who had lost the opportunities for surgery.

Value of MR diffusion weighted imaging in assessing the viability of hepatic alveolar echinococcosis / 中华放射学杂志

Objective To evaluate DWI in the assessment of viability of hepatic alveolar echinococcosis (HAE) by comparing DWI with PET-CT results. Methods 18-fluorodeoxy glucose(18F-FDG) PET-CT and DWI(b values=0, 800 s/mm2) were retrospectively analyzed in 8 patients with clinically verified HAE. The metabolic activity of HAE lesions in both techniques were determined by two independent radiologists respectively. Kappa test was assessed between the results of two observers. Results Sixteen lesions (composed of 14 HAE and 2 cystic echinococcosis, CE) were detected. (1)Eight lesions (≥2 cm) showed perilesional hyper-signal intensity on DWI, mainly around the lesion bounding by normal liver parenchyma. One patient (≥2 cm) had oral drug therapy for three years, and the lesion showed discontinuous perilesional hyper-signal intensity on DWI after the therapy. Five lesions (<2 cm) were depicted as nodular high signal on DWI.(2)Eight lesions (≥2 cm) showed perilesional increased FDG uptake on PET-CT, while 5 lesions (<2 cm) displayed as“hot pot”. One patient (leison≥2 cm) who had oral drug therapy for three years showed hepatic defect without any FDG uptake in post-treatment PET-CT. Two CE lesions showed negative results on both DWI and PET-CT. The Kappa value of 0.880 indicated a good coincidence between DWI and PET-CT in depicting the metabolic activity of HAE (P=0.006). Conclusions This preliminary study showed the value of DWI in assessing HAE viability. DWI should be routinely used as one of the techniques in the evaluation of HAE.