Entrapped duct-to-mucosa pancreaticojejunostomy in pancreaticoduodenectomy / 中华肝胆外科杂志

Objective:To study the safety and efficacy of using entrapped duct-to-mucosa pancreaticojejunostomy for patients with small pancreatic ducts of less than 3 mm in diameter.Methods:The clinical data of patients who underwent entrapped duct-to-mucosa pancreaticojejunostomy at Henan Province People's Hospital from January 2017 to December 2019 were retrospectively analyzed. The incidences of complication including pancreatic fistula and abdominal hemorrhage were studied. The duration to carry out the pancreaticojejunostomy and postoperative hospital study were also analyzed.Results:Of 98 patients included in this study, there were 58 males and 40 females, with an average age of 62.3 (aged 24 to 73) years. The average time of completing the pancreaticoenterostomy was (10.2±3.1) min. There were 10 patients (10.2%) who developed grade A pancreatic fistulae. There were no grade B or C pancreatic fistulae, no portoperative bleeding and no perioperative deaths. The postoperative hospital stay was (13.4±4.6) days.Conclusion:Entrapped duct-to-mucosa pancreaticojejunostomy was simple, quick, safe and effective in patients with small pancreatic ducts.

Diagnosis and treatment of Budd-Chiari syndrome accompanied with hepatic nodules / 中华肝胆外科杂志

Objective:To summarize our experience in diagnosis and treatment of Budd-Chiari syndrome(BCS) accompanied with hepatic nodules.Methods:The clinical data of 33 patients with BCS accompanied with hepatic nodules who were treated at Henan Provincial People's Hospital from January 2012 to December 2018 were retrospectively analysed. A total of 33 patients were enrolled, including 17 males and 16 females, with an average age of 51 years. Analyze the treatment and prognosis of different types of nodules.Results:Of 33 patients, 27 were diagnosed to have hepatocellular carcinoma and 6 benign proliferative nodules. Treatment of patients with hepatocellular carcinoma included, transcatheter arterial chemoembolization ( n=1) and hepatectomy ( n=26). The survival time of these patients with hepatocellular carcinoma ranged from 10.0 to 78.0 months (mean 37.8 months). For the remaining 6 patients with benign nodules, the nodules were multiple and no malignant changes were observed on follow-up. Conclusion:For patients with BCS associated with benign nodules, no specific treatment was required. Hepatocellular carcinoma assocated with BCS had good prognosis. An aggressive surgical resectional approach is recommended to treat and to relieve the hepatic outflow obstruction.

Predictive Value of Child-Pugh, MELD, MELD-Na and iMELD Score in Assessing 3-Month and 1-Year Survival Rates in Patients With Hepatitis B Cirrhosis / 胃肠病学

Background:The evaluation system for predicting prognosis in patients with liver cirrhosis includes Child-Pugh,model for end-stage liver disease (MELD) and its derivative system,which provides important guiding value for evaluating the prognosis.However,its value still needs to be verified by further clinical studies.Aims:To investigate the predictive value of Child-Pugh,MELD,MELD-Na and iMELD score in assessing 3-month and 1-year survival rates in patients with hepatitis B cirrhosis.Methods:A total of 236 patients with hepatitis B cirrhosis from January 2012 to December 2016 at Fukang Hospital were enrolled.The 3-month and 1-year survival rates of patients with hepatitis B cirrhosis were determined,and Child-Pugh,MELD,MELD-Na and iMELD score were calculated.Area under ROC curve (AUC) was used to evaluate the accuracy of Child-Pugh,MELD,MELD-Na and iMELD score for predicting 3-month and 1-year survival rates.Results:Of the 236 patients with hepatitis B cirrhosis,43 died within 3 months,and 71 died within 1 year.The causes of death were upper gastrointestinal bleeding,hepatic encephalopathy,hepatorenal syndrome,spontaneous peritonitis and infection.Child-Pugh,MELD,MELD-Na and iMELD score in 3-months and 1-year survival group were significantly decreased than those in death group (P ＜ 0.05 or 0.01).AUC of Child-Pugh,MELD,MELD-Na and iMELD score for predicting 3-month survival were 0.791,0.818,0.853 and 0.897,respectively,and the difference among the four groups was significant (P ＜ 0.05).AUC of Child-Pugh,MELD,MELD-Na and iMELD score for predicting 1-year survival were 0.772,0.832,0.861 and 0.906,respectively,and the difference among the four groups was significant (P ＜ 0.05).The accuracy of Child-Pugh,MELD,MELD-Na and iMELD score for predicting 3-month and 1-year survival were 70.1％,79.8％,86.2％ and 89.3％,respectively.Conclusions:The accuracy of Child-Pugh,MELD,MELD-Na and iMELD score for assessing 3-month and 1-year survival rates of patients with hepatitis B cirrhosis is high,and is worthy to be applied in clinical practice.

Associating liver partition and portal vein ligation for staged hepatectomy combined with hepatic artery reconstruction in the treatment of hilar cholangiocarcinoma / 中华肝胆外科杂志

Objective To study the combined use of ALPPS (associating liver partition and portal vein ligation for staged hepatectomy) with hepatic artery reconstruction in the treatment of hilar cholangiocarcinoma with hepatic arterial involvement.Methods The clinical data of 7 patients with hilar cholangiocarcinoma who underwent ALPPS combined with hepatic arterial resection and reconstruction were analyzed retrospectively.The technical points and the perioperative management were analyzed.Methods At the first stage,the relationship between the tumor and the vessels were explored,the portal vein of the part of the liver to be resected was ligated and the liver was transected with a CUSA (Cavitron Ultrasound Surgical Aspirator).Then the bile duct was cut and a hepaticojejunostomy was completed.Finally,under ultrasound guidance,a bile duct drainage tube was inserted transhepatically into the part of the liver which was to be resected.Two to three weeks later,and after enough hypertrophy of the liver remnant size was confirmed,tumor resection was completed with reconstruction of the hepatic artery.Results Seven patients underwent the second stage operation,with no perioperative death.Six patients developed pulmonary infection and were treated successfully with conservative treatment.Two patients developed postoperative bile leak with secondary abdominal infection.One patient developed postoperative hepatic artery thrombosis secondary to biliary tract infection.Conclusion ALPPS combined with hepatic artery reconstruction was safe and feasible in the treatment of hilar cholangiocarcinoma with hepatic arterial involvement.

Use of a saline-coupled bipolar sealer (Aquamantys(R)) in liver resection for primary hepatic malignancy: a retrospective cohort study / 中华肝胆外科杂志

Objective To evaluate the efficacy and outcomes with the use of a saline-coupled bipolar sealer during liver resection.Methods 101 patients underwent liver resection for primary hepatic carcinoma at the People's Hospital Affiliated to Zhengzhou University from August 2015 to December 2016.The patients were divided into two groups according to whether the Aquamantys(R) system was used or not.In group A (n =62) the clamp crushing technique was used for liver parenchymal transection.In group B (n =39) the Aquamantys(R) system was used.The intraoperative and postoperative complication rates were compared.Results The operation time in group B was significantly longer than group A (216.4 min vs.253.5 min,P ＜ 0.05).The intraoperaitve blood loss in group B was significantly less than group A (381.1 ml vs.257.2 ml,P ＜ 0.05),and less blood transfusion was required (211.3 ml vs.90.9 ml,P ＜ 0.05).The volume of abdominal drainage fluid in group B in the first and the 5th day was significantly less than group A (242.6 ml vs.199.2 ml,P＜0.05;84.3 ml vs.70.4 ml,P＜0.05,respectively).The drainage tube in group B was taken off earlier than in group A (8.1 d vs.7.0 d,P ＜ 0.05).The average hospitalization stay after surgery in group B was also significantly shorter (13.4 d vs.11.6 d,P ＜ 0.05).There was no significant difference in the overall postoperative complication rate (P ＞ 0.05) between the 2 groups,and no death was observed.Conclusion The use of a saline-coupled bipolar sealer (Aquamantys(R)) in liver resection for hepatocellular carcinoma was associated with less intraoperative blood loss and was better for the patients' postoperative recovery.

Clinical analysis of 37 patients with pancreatic portal hypertension / 中华肝胆外科杂志

Objective To study the pathogenesis,diagnosis and treatment of pancreatic portal hypertension (PPH).Methods The clinical data of 37 patients with PPH treated in Henan Province People's Hospital from January 2008 to January 2016 were retrospectively analyzed.Result Nine patients underwent conservative treatment and 28 patients underwent surgical treatment.No deaths were observed in the perioperative and follow-up periods.One patient underwent a second operation becausc of gastrointestinal bleeding.The clinical symptoms of the remaining patients were significantly relieved after surgery.Conclusions Treatment should be individualized and directed at the underlying cause.The anatomy of the coronary vein and the location of obstruction of the splenic vein determined the degree of the variceal veins and the surgical methods.Splenectomy was the basic treatment for PPH.Subcapsular splenectomy was effective in some challenging cases.

Analysis of clinical and physical factors for acute bone marrow suppression induced by concurrent chemoradiotherapy in rectal cancer / 中国肿瘤临床

Objective:To analyze the clinical and physical tactors associated with acute bone marrow suppression in concurrent chemo-radiotherapy for rectal cancer and to provide a reference standard for the best clinical treatment plan. Methods:Retrospective analy-sis was performed on 62 patients with rectal cancer who received concurrent radiotherapy and chemotherapy in our department. The pelvis was contoured for each patient in the radiotherapy treatment planning system and divided into three subsites: lumbosacral spine, ilium, and lower pelvis. Prognostic clinical and physical factors were analyzed by univariate and multivariate analyses. Evaluated prognostic clinical factors included sex, age, clinical stage, original hemoglobin levels, and chemotherapy, operation, and radiation modes;physical factors included V5, V10, V15, V20, V25, V30, V35, V40, V45, V50, Dmax, and Dmean of lumbosacral spine, ilium, low-er pelvis, and pelvis. Results:The percentage of patients who developed acute bone marrow suppression (≥2 grade) was 61.3%(38/62).Univariate analysis of related factors revealed statistically significant differences were sex, chemotherapy, lumbosacral spine V45, il-ium V20, and ilium V30. Multivariate logistic regression analysis indicated that chemotherapy and ilium V30 are the risk factors for acute bone marrow suppression. The receiver operating curve showed that the threshold of ilium V30 was 44%. Conclusion:Acute bone marrow suppression is influenced by more than one factor;local control rate of the tumor and acute bone marrow suppression are tradeoffs in rectal cancer treatment. An appropriate chemotherapy method should be selected, and ilium V30 must be maintained below 44%to prevent bone marrow suppression in rectal cancer patients.

Diagnosis and surgical treatment of solid pseudopapillary tumor of the pancreatic head / 中华肝胆外科杂志

Objective To discuss the diagnosis and surgical treatment of solid pseudopapillary tumor (SPTP) of the pancreatic head.Methods From January 2008 to August 2013,the clinicopathological data of 12 patients who were diagnosed and surgically treated in our hospital for this condition were analyzed retrospectively.Results There were 11 women and 1 man,the mean age was 28.7 years,with a range from 11 to 43.The mean diameter of the tumor was 7.5 cm(2 ～ 15 cm),6 of 12 of these tumors were more than 10 cm.Seven patients underwent pancreaticoduodenectomy,2 duodenum-preserving pancreatic head resection,2 local resection of tumor,1 palliative resection,1 pancreaticoduodenectomy combined with resection of part of the portal vein.All the diagnoses were confirmed by postoperative histopathology.In a follow-up which ranged from 3 to 65 months,all the patients were alive with no evidence of disease recurrence.Conclusions Most of the SPTPs of the pancreatic head were huge.The diagnosis was difficult.Complete tumor resection is the best treatment.

Duodenum-preserving pancreatic head resection (DPPHR) in treating patients with benign lesions in the head of the pancreas / 中华普通外科杂志

Objective To evaluate the procedure and the therapeutic efficacy of duodenumpreserving pancreatic head resection (DPPHR) in treating benign lesions in the head of the pancreas.Methods From February 2003 to August 2011,DPPHR was performed in 21 patients with benign lesions in the head of the pancreas.Thirteen patients were male and eight were female.Age ranged from 30 to 48 years,and the lesions ranged from 2.0 cm to 5.6 cm in diameter.Posterior superior pancreaticoduodenal artery was conserved in all patients.Results There was no hospital death.Pancreatic fistula was the main and the most often morbidity,occurring in 33.3％.After operation all patients with preoperative abdominal pain were completely pain free.Preoperative hypoglycemia in 2 patients turned to eugycemia.There was no recurrences report during following up.Concl~ions DPPHR was safe and effective in treating benign lesion in the head of pancreas.It was important in preserving blood supply to the duodenum by posterior superior pancreaticoduodenal artery.

Diagnosis and treatment of abdominal compartment syndrome secondary to fulminant acute pancreatitis / 中华肝胆外科杂志

Objective To study the treatment of abdominal compartment syndrome(ACS) secondary to fulminant acute pancreatitis (FAP).Method A retrospective study was conducted from Jan.2009 to Dec.2011 to analyze the therapeutic results of 18 patients with ACS secondary to FAP.Results Three out of 7 patients who received non-operative therapy died (mortality rate 42.9％).Three out of 11 patients treated with early surgery died (mortality rate 27.3％),which was significantly better than those patients treated conservatively.Conclusion A reduction in intra-abdominal pressure improved the function of the viscera in the treatment of ACS secondary to FAP.The decompressive effects of early surgery was efficacious,and it reduced the mortality rate.

Fast track program for esophagectomy patients.

BACKGROUND: A fast track (FT) program for esophagectomy patients is rarely used. We streamlined care using an algorithm for the postoperative care of patients who underwent esophagectomy to try to reduce hospital stays to 7 days while maintaining safety and patient satisfaction. METHODS: A consecutive series of 80 patients with esophageal carcinoma who underwent elective esophageal resection from 2007 to 2008 in our department was taken into the FT program. An algorithm for FT to guide postoperative care was used, featuring avoidance of the intensive care unit, early ambulation, removal of nasogastric tube and oral nutrition starting on postoperative day (POD) 1, with discharge on POD 7. RESULTS: All patients were operated upon through a left posterolateral thoracotomy with a cervical esophagogastrostomy. Seventy-eight (97.5%) patients completed the FT program. Discharge home was proposed for POD7. None was readmitted within 30 days of discharge. None suffered from anastomotic leakage. The time to first passage of flatus was 51.7 ± 8.4 h. CONCLUSION: The majority of patients with esophageal carcinoma can tolerate FT surgery. Oral nutrition starting on POD1 is safe and FT surgery is feasible for patients scheduled for elective esophageal cancer resections without compromising quality.

Optimization of the craniospinal radiation technique by synthesizing multiple advanced radiation techniques / 生物医学工程学杂志

Craniospinal radiation is one of essential components in the treatment flow for a number of central nervous system malignancies. Meticulous attention to technique and dosimetry is required to produce optimum tumor control. In this paper, an optimized treatment regimen was proposed based on multiple techniques. The CT images for a 17-year-old male patient in need of craniospinal radiation were acquired for 3D conformal treatment planning. The split-beam technique, the extended penumbra fields matching technique, and the multiple leaf collimator segments and extended SSD technique were synthesized in the treatment regimen so as to work out an optimized treatment plan. The added few segments improved the dose homogeneity in spinal cord. The maximal point dose was decreased from 124% to 108% of the prescribed dose in it. Comparative study on the anthropomorphic phantom showed that the data collected by thermoluminescent detectors and the data obtained by calculation were basically coincident. These results suggest that the proposed technique be clinically acceptable.

Repeated CT scan in improving the reproducibility of grass tumor volume for moving target / 中华放射肿瘤学杂志

Objective To find a method to improve the range accuracy of moving target such as peripheral lung tumors, since a single CT snapshot may not be accurate during the treatment process.Methods A simple harmonic motion phantom, embedded with a cube and a circular ball, was used to simulate the tumor motion. Individualized moving targets were scanned 24 times with different amplitudes and frequencies. Then the images were fused from every 1, 2 or 3 sets of CT scans. The GTV volume variation of circular target and the length variation of the cube target along the z axis were contoured and analyzed. Results As motion amplitude increased, the maximum of both circular target volume and cube target length was increased, while the minimum of the factors was decreased. Motion frequency affected the target volume less than amplitude. For a cube target with the length of 3.3 cm at stationary phase, when motion frequencies was 20 and motion amplitude was 2 cm, the maximal length was 2. 4 times of the minimal length (5. 1 cm vs. 2. 1 cm). When it came to the cube target groups fused from every 1,2 and 3 sets of CT scans, the average length and standard deviation were (3.77 ± 1.20) cm, (4.18 ±0. 91)cm and (4.52 ±0. 59) cm, respectively. With the increase of fused scan number, targets became bigger, the standard deviation decreased, and the change of center positions was decreased. Conclusions The motion amplitude, frequency and the number of CT scans are the main factors affecting target definition, though, the optimized scanning phase is not certained. When 4DCT and respiration gating technique are not available,the efficient and practical method to solve this problem is to scan the target three or more times and fuse them in planning system, which will generate a larger, more reproducible GTV volume for moving targets.

Deferoxamine pretreatment for hepatic ischemia reperfusion injury in liver auto-transplantation in rats / 中华普通外科杂志

Objective To investigate the role of deferoxamine pretreatment for hepatic ischemia reperfusion injury in liver auto-transplantation in rats. Method Murine liver auto-transplantation model was established. Ninety six male Sprague-Dawley rats were randomly divided into three groups: 32 rats in deferoxamine pretreatment group (D), 32 rats in control group with aqua pro injection pretreatment(C) and 32 rats in sham-operation group (S). The animals were killed at 30 min, 2 h, 6 h, 24 h after operation respectively. ALT and AST level, superoxide dismutase (SOD) and malondialdehyde (MDA), liver histological change(HE), the protein expression of HIF-1α、TNF-α and IL-1 were measured. Results At 30 min, 2 h, 6 h, 24 h after operation, the levels of ALT,AST,MDA and the expression of IL-1 protein and TNF-α protein were higher in group C than group D significantly,while the expression of HIF-1α and SOD were higher in group D [SOD(411±70; 384±53; 379±46)、H1F-1α(0.0413±0.0040; 0.0684± 0.0032; 0.0583±0.0032; 0.0491±0.0026)] than group C significantly (P<0.01) [SOD(341±21; 323±25; 303±25)、HIF-1α (0.0254±0.0024; 0.0312±0.0022; 0.0381±0.0022; 0.0257± 0.0015)] (F>59.881;P<0.01). Conclusion The up-regulated expression of HIF-1α, decreased liver lipid peroxidation injury and TNF-α and IL-1 levels, may be involved in the mechanism hy which deferoxamine pretreatment protects liver from ischemia reperfusion injury in rats' liver auto-transplantation.

Buspirone Hydrochloride Sustained-release Tablets:Preparation and Release in Vitro / 中国药房

OBJECTIVE:To prepare buspiron hydrochloride sustained-release tablets and to study its release characterization in vitro and the factors affecting drug release.METHODS:Buspiron hydrochloride sustained-release tablets were prepared with hydroxypropyl methylcellulose(HPMC)as hydrophilic gel-matrix material and ethylcellulose(EC)as retarder by wet granulation.The impacts of releasing transmitters,contents of HPMC and EC,and viscosity on the drug release in vitro of the tablets were studied.RESULTS:For the prepared sustained release tablets,the 24h drug release amount was over 90%,and the drug release curve conformed to Higuchi equation.The more contents of HPMC and EC and the higher viscosity of HPMC in the tablets,the slower drug release velocity was obtained;but the viscosity of EC and the releasing transmitters had no significant impacts on the drug release velocity.CONCLUSION:With HPMC and EC as matrix materials,the 24h continuous drug release is available for buspirone hydrochloride sustained-tablets.

Preparation of Mitomycin for Injection Nanoparticles by Microfluidization and Its Hemolytic Test / 中国药房

OBJECTIVE: To prepare Mitomycin C for injection-Polybutylcyanoacrylate Nanoparticles (MMC-PBCA-NPs) freeze drying preparation by microfluidization and to investigate its hemolytic feature. METHODS: The crude emulsion of MMC-PBCA-NPs was prepared by emulsion polymerization method, from which MMC-PBCA-NPs solution was prepared by microfluidization method; the encapsulation efficiency (EE) and the drug loading (DD) of the preparation were detected by ultraviolet spectrophotometry. The particle size and appearances of which were observed. A hemolytic test was performed on rabbits to observe the blood reaction of the preparation. RESULTS: The prepared MMC-PBCA-NPs freeze drying preparation was uniformly distributed and in round shape, with EE, DD and mean diameter at (85.1?3.8)%, (7.0?0.2)% and (113.5?3.86)nm, respectively. The hemolytic test was negative. CONCLUSION: It is feasible to prepare MMC-PBCA-NPs by microfluidization method.

[Pharmacological study on "zishen huayu fang" on treatment of mesangial proliferative glomerulonephritis in rats].

OBJECTIVE: To explore the effects and the mechanisms of "zishen huayu fang" (ZSHYF) on treatment of mesangial proliferative glomerulonephritis (MPG) in rats. METHODS: The rat model of MPG was induced by injecting anti-thymocyte serum (ATS) through caudal vein. The effects of ZSHYF on renal function and morphology were studied. RESULTS: ZSHYF can remarkably reduce urine protein, urine red blood cell and serum levels of BUN and Scr, increase serum albumin content, decrease immune complex IgG and C3 under epithelial cells of glomerulus capillary and alleviate the pathological injury in MPG rats. CONCLUSIONS: ZSHYF can lessen pathological changes of glomerulus and stramo in MPG rats, stabilize and ameliorate their renal function.

Observations on the Curative Effects of Haemocoagulase for TUPKVP on Patients with Reduced Coagulation / 中国药房

OBJECTIVE: To observe the curative effects of haemocoagulase on patients with reduced coagulation after the transurethraal plasmakentic vaporization of prostrate(TUPKVP).METHODS: 132 cases were randomly divided into two groups,one treated with haemocoagulase,and the other as control group.Then two groups were compared for the time of operation,quantity of blood transfusion during the operation and the time difference in continuous bladder-washing after the operation.RESULTS: There was an obvious difference(P

Research advances in marine antineoplastic agents / 中国海洋药物

Owing to their unique mechanism of action, marine antineoplastic compounds have been got more and more attention and the study of marine antineoplastic drugs is becoming a focus now. The development in the study of marine antineoplastic drugs was summarized in this paper.