Concomitant Precise Hemihepatectomy to Improve the Efficacy of Surgical Treatment for Hilar Cholangiocarcinoma: Analysis of 38 Cases.

UNLABELLED: Background/Aims: Hilar cholangiocarcinoma (HC) is associated with low rates of resectability and curability, high morbidity and mortality, and poor long-term survival. Radical tumor resection with negative surgical margins provides the only chance of cure and long-term survival. The present study was to investigate the efficacy of concomitant precise hemihepatectomy for HC. METHODOLOGY: The clinical data of 38 patients who underwent surgery for HC with concomitant precise hemihepatectomy at our center from January 2009 to October 2012 were analyzed retrospectively. Survival curves were generated using the Kaplan-Meier method. Univariate and multivariate analysis were performed using the Cox proportional hazards model. RESULTS: R0 resection was performed in 32 patients (84.2%), R1 resection in 4 (10.5%), and R2 resection in 2 (5.3%). Two patients died during the perioperative period (mortality rate 5.3%). The most common postoperative complications were bile leakage (28.9%, 11/38) and hepatic dysfunction (21.1%, 8/38). The overall 1-, 2-, and 3-year survival rates were 65.8%, 36.8%, and 21.1%, respectively. The median survival time was 22.0 months. There were significant differences in survival between R0 and R1/R2 resection (χ2 = 4.516, P < 0.05) and between N0 and N1/N2 disease (χ2 = 10.397, P < 0.05). Univariate and multivariate analysis identified a positive surgical margin, lymph node metastasis and hepatic artery resection as prognostic indicators. CONCLUSIONS: Concomitant precise hemihepatectomy significantly improves the efficacy of radical surgical resection for HC. Precise liver resection, preservation of the hepatic artery, and selective preoperative biliary drainage are important to minimize postoperative morbidity and mortality.

Magnetic compression anastomosis to restore biliary tract continuity after obstruction following major abdominal trauma: A case report.

BACKGROUND: The combination of magnetic compression anastomosis (MCA) and endoscopy has been used to treat biliary stricture after liver transplantation. However, its use for the treatment of complex biliary obstruction after major abdominal trauma has not been reported. This case report describes the successful use of MCA for the treatment of biliary obstruction resulting from major abdominal trauma. CASE SUMMARY: A 23-year-old man underwent major abdominal surgery (repair of liver rupture, right half colon resection, and ileostomy) following a car accident one year ago. The abdominal drainage tube, positioned at the Winslow foramen, was draining approximately 600-800 mL of bile per day. During the two endoscopic retrograde cholangiopancreatography procedures, the guide wire was unable to enter the common bile duct, which prevented placement of a biliary stent. MCA combined with endoscopy was used to successfully achieve magnetic anastomosis of the peritoneal sinus tract and duodenum, and then a choledochoduodenal stent was placed. Finally, the external biliary drainage tube was removed. The patient achieved internal biliary drainage leading to the removal of the external biliary drainage tube, which improved the quality of life. CONCLUSION: Magnetic compression technique can be used for the treatment of complex biliary obstruction with minimal operative trauma.

Novel magnetic compression technique for the treatment of postoperative anastomotic stenosis in rectal cancer: A case report.

BACKGROUND: The treatment of postoperative anastomotic stenosis after excision of rectal cancer is challenging. Endoscopic balloon dilation and radial incision are not effective in all patients. We present a new endoscopy-assisted magnetic compression technique (MCT) for the treatment of rectal anastomotic stenosis. We successfully applied this MCT to a patient who developed an anastomotic stricture after radical resection of rectal cancer. CASE SUMMARY: A 50-year-old man had undergone laparoscopic radical rectal cancer surgery at a local hospital 5 months ago. A colonoscopy performed 2 months ago indicated that the rectal anastomosis was narrow due to which ileostomy closure could not be performed. The patient came to the Magnetic Surgery Clinic of the First Affiliated Hospital of Xi'an Jiaotong University after learning that we had successfully treated patients with colorectal stenosis using MCT. We performed endoscopy-assisted magnetic compression surgery for rectal stenosis. The magnets were removed 16 d later. A follow-up colonoscopy performed after 4 months showed good anastomotic patency, following which, ileostomy closure surgery was performed. CONCLUSION: MCT is a simple, non-invasive technique for the treatment of anastomotic stricture after radical resection of rectal cancer. The technique can be widely used in clinical settings.

Clinical study of extrahepatic biliary adenoma.

BACKGROUND: Biliary adenomas that occur in the extrahepatic biliary tree are rare. It is difficult to distinguish it from cholangiocarcinoma or cholangiolithiasis by various imaging examinations, and it is very easy to be misdiagnosed. AIM: To evaluate the cumulative experiences including clinical characteristics and treatments of nine patients diagnosed with extrahepatic biliary adenoma admitted to the First Affiliated Hospital of Xi'an Jiaotong University from 2016 to 2022. METHODS: A total of nine patients were included in our study. The laboratory examinations, disease diagnosis, therapy and pathological characteristics, and follow-up of every patient were evaluated. RESULTS: Our cohort consisted of six females and three males with an average diagnosis age of 65.1 years (range 46-87). Six extrahepatic biliary adenomas were located in the common bile ducts and three in the hepatic duct. On initial presentation, all of the patients have symptom of biliary origin, including obstructive jaundice (4/9, 44.4%), abdominal pain (6/9, 66.7%), and fever (3/9, 33.3%). Preoperative imaging examination considered bile duct carcinoma in 6 cases and bile duct calculi in 3 cases. All the patients received surgical treatment and were confirmed by pathology as biliary adenoma. The symptoms improved significantly in all 9 patients after surgery. Seven of nine patients recovered well at follow-up without tumor recurrence. One patient died 2 mo after the surgery due to heart failure. One patient developed jaundice again 8 mo after surgery, underwent endoscopic retrograde cholangiopancreatography and biliary stent placement. CONCLUSION: Benign extrahepatic biliary tumors are rare and difficult to diagnosis preoperatively. Intraoperative choledochoscopy and timely biopsy may offer great advantages.

Attraction of Culex pipiens pallens (Diptera: Culicidae) to Floret Volatiles and Synthetic Blends of Its Nectar Host Plant Abelia chinensis (Rubiales: Caprifoliaceae).

Abelia chinensis R. Br. (Dipsacales: Caprifoliaceae) is one of the preferred nectar host plants for Culex pipiens pallens Coquillett (Diptera: Culicidae). However, the volatile compounds of its flowers that might be involved in directing mosquitoes' orientation to its nectaries remain unknown. In the present study, the volatile compounds released by A. chinensis florets were collected by solid phase microextraction fiber and analyzed by gas chromatography-mass spectrometry system. Based on the major component species in the volatile profile, a synthetic phytochemical blend (Blend B, composed of six compounds at their most attractive concentrations) was formulated, and its attractiveness was tested against the pentane extract of A. chinensis florets at most attractive concentration (Blend A) and a formerly developed synthetic phytochemical blend (Blend C) in the olfactometer, respectively. The results revealed that the volatile profile of A. chinensis florets was mainly composed of aromatic compounds, most of which had been reported to be attractive to other mosquito species. The synthetic Blend B was as attractive as Blend A (10-1-fold of the crude pentane extract) in the olfactometer bioassays, but they were not as attractive as the formerly developed Blend C. The present study indicated that quantitative and qualitative differences in the constituents of phytochemical blends could significantly affect their attractiveness to Cx. pipiens pallens, and the capture efficiency of phytochemical attractants deserves further research before being applied in the field.