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Objective@#To study the clinical outcomes using laparoscopic complete dissection of cysts, subtotal cystectomy and partial hepatectomy in the treatment of hepatic cystic echinococcosis.@*Methods@#A retrospective study was conducted on 40 patients with hepatic cystic echinococcosis treated by laparoscopic surgery from January 2014 to June 2018 at the First Affiliated Hospital of Xinjiang Medical University. According to the different surgical methods, these patients were divided into three groups: group A (n=14): the laparoscopic complete capsulectomy group, group B (n=14): the laparoscopic subtotal capsulectomy group, group C (n=12): the laparoscopic partial hepatectomy group. The operation time, intraoperative blood loss, time to pass first flatus, duration of drainage tube placement, days of hospitalization after operation, hospitalization expenses, complications of the residual cavity and local recurrence were compared among the 3 groups.@*Results@#In this study, all the 40 patients with hepatic cystic hydatidosis were cured, and no death occurred during the perioperative period. The intraoperative blood loss, postoperative duration of drainage tube placement, and hospitalization cost of the three groups were significantly the highest in group C (all P<0.05). The operative time and the time to pass first flatus in group C were both significantly greater than group B (P<0.05). The length of postoperative hospitalization in group A was significantly less than in group C (P<0.05). Postoperative recurrence and complications in group B were significantly worse than those in group A and group C (all P<0.05).@*Conclusion@#Laparoscopic complete dissection of the external capsule turned out to be the best laparoscopic treatment of hepatic cystic echinococcosis, followed by laparoscopic partial hepatectomy. Open surgery should be considered in patients with lesions which are evaluated preoperatively to have difficulty in carrying out laparoscopic complete dissection of capsule or partial hepatectomy.
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Objective To study the clinical outcomes using laparoscopic complete dissection of cysts,subtotal cystectomy and partial hepatectomy in the treatment of hepatic cystic echinococcosis.Methods A retrospective study was conducted on 40 patients with hepatic cystic echinococcosis treated by laparoscopic surgery from January 2014 to June 2018 at the First Affiliated Hospital of Xinjiang Medical University.According to the different surgical methods,these patients were divided into three groups:group A (n =14):the laparoscopic complete capsulectomy group,group B (n =14):the laparoscopic subtotal capsulectomy group,group C (n =12):the laparoscopic partial hepatectomy group.The operation time,intraoperative blood loss,time to pass first flatus,duration of drainage tube placement,days of hospitalization after operation,hospitalization expenses,complications of the residual cavity and local recurrence were compared among the 3 groups.Results In this study,all the 40 patients with hepatic cystic hydatidosis were cured,and no death occurred during the perioperative period.The intraoperative blood loss,postoperative duration of drainage tube placement,and hospitalization cost of the three groups were significantly the highest in group C (all P ＜ 0.05).The operative time and the time to pass first flatus in group C were both significantly greater than group B (P ＜ 0.05).The length of postoperative hospitalization in group A was significantly less than in group C (P ＜ 0.05).Postoperative recurrence and complications in group B were significantly worse than those in group A and group C (all P ＜ 0.05).Conclusion Laparoscopic complete dissection of the external capsule turned out to be the best laparoscopic treatment of hepatic cystic echinococcosis,followed by laparoscopic partial hepatectomy.Open surgery should be considered in patients with lesions which are evaluated preoperatively to have difficulty in carrying out laparoscopic complete dissection of capsule or partial hepatectomy.
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<p><b>BACKGROUND</b>First generation drug-eluting stents (DES) were associated with a high incidence of late stent thrombosis (ST), mainly due to delayed healing and re-endothelization by the durable polymer coating. This study sought to assess the safety and efficacy of the Nano polymer-free sirolimus-eluting stent (SES) in the treatment of patients with de novo coronary artery lesions.</p><p><b>METHODS</b>The Nano trial is the first randomized trial designed to compare the safety and efficacy of the Nano polymer-free SES and Partner durable-polymer SES (Lepu Medical Technology, Beijing, China) in the treatment of patients with de novo native coronary lesions. The primary endpoint was in-stent late lumen loss (LLL) at 9-month follow-up. The secondary endpoint was major adverse cardiac events (MACE), a composite of cardiac death, myocardial infarction or target lesion revascularization.</p><p><b>RESULTS</b>A total of 291 patients (Nano group: n = 143, Partner group: n = 148) were enrolled in this trial from 19 Chinese centers. The Nano polymer-free SES was non-inferior to the Partner durable-polymer DES at the primary endpoint of 9 months (P < 0.001). The 9-month in-segment LLL of the polymer-free Nano SES was comparable to the Partner SES (0.34 ± 0.42) mm vs. (0.30 ± 0.48) mm, P = 0.21). The incidence of MACE in the Nano group were 7.6% compared to the Partner group of 5.9% (P = 0.75) at 2 years follow-up. The frequency of cardiac death and stent thrombosis was low for both Nano and Partner SES (0.8% vs. 0.7%, 0.8% vs. 1.5%, both P = 1.00).</p><p><b>CONCLUSIONS</b>In this multicenter randomized Nano trial, the Nano polymer-free SES showed similar safety and efficacy compared with the Partner SES in the treatment of patients with de novo coronary artery lesions. Trials in patients with complex lesions and longer term follow-up are necessary to confirm the clinical performance of this novel Nano polymer-free SES.</p>
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Coronary Artery Disease , Drug Therapy , General Surgery , Drug-Eluting Stents , Immunosuppressive Agents , Therapeutic Uses , Prospective Studies , Sirolimus , Therapeutic UsesABSTRACT
Objective To explore the efficacy of various managements of indurative biliary fistula after HCE operation.Methods 31 patients who underwent surgery for indurative biliary fistula after HCE operation in Xinjiang Medical University were studied retrospectively.Cholangiography and common bile duct exploration through a T tube were done in 15 patients,cholangiography and decompression through a T tube which led to the orifice of the fistula of the cavity in 8 patients,hepatectomy in 4 patients,lobe resection + choledochojejunostomy in 2 patients,total pericystectomy in 1 patient,and cavity abscess debridement in 1 patient for severe infection of the abdominal cavity,followed by hemihepatectomy after half a year.Result On follow-up of 1-8 years,choledochojejunostomy had to be done in 1 patient for stricture of the bile duct after T tube drainage,hepatectomy in 1 patient for bile leakage after the cavity abscess debridement operation,and bile leakage in 1 patient after hepatectomy although with drainage the patient was cured.Conclusion The results suggested that hepatectomy and total pericystectomy completely solved the problems arising from indurative biliary fistula.However,these procedures are complicated,and have higher operative risks.Cholangiography and common bile duct exploration solved the cavity-related problems.For patients with severe calcified cavities which communicated with large hepatic ducts,cholangiography and decompression through a T tube put into the orifice of the fistula of the cavity solved the indurative biliary fistula efficaciously and safely.
