ObjectiveTo compare the clinical outcomes of laparoscopic magnetic compression cholangiojejunostomy (LMCCJ) with laparoscopic hand-sutured cholangiojejunostomy (LHSCJ). MethodsA retrospective case-control study was performed. From January 2019 to May 2022, 37 patients, who underwent laparoscopic treatment in this hospital, were enrolled in this study. There were 16 cases in the LMCCJ group and 21 cases in the LHSCJ group. The demographic information, procedure time to complete bilioenteric reconstruction, postoperative hospital stay, operative complications, magnets expulsion time, and follow-up results were collected and analyzed. ResultsThere were no statistical differences in the baseline data such as the gender, age, composition of primary diseases, preoperative total bilirubin, and preoperative common bile duct diameter between the two groups (P＞0.05). The outer diameter of the magnets was (10.50±0.97) mm, the expulsion time of the magnets was (49.69±37.58) d, and the expulsion rate of the magnets was 100% (16/16). There was no intestinal obstruction or gastrointestinal perforation caused by the retention of the magnets. The procedure time to complete bilioenteric reconstruction in the LMCCJ group was statistically shorter than that in the LHSCJ group [(11.31±3.40) min vs. (24.81±3.40) min, t=11.96, P＜0.01]. There was no statistical difference in the total bilirubin level at the first week after surgery between the two groups (U=142.0, P=0.80). The postoperative hospital stay in the LMCCJ group was longer than that in the LHSCJ group [(28.31±14.11) d vs. (16.19±7.56) d, t=3.36, P＜0.01]. During the perioperative period, there was no bleeding or biliary infection in the two groups, but one case of biliary leak in the LHSCJ group. In all 37 patients were followed-up for (548.8±259.2) d. During the follow-up period, the incidence rates of biliary intestinal anastomosis stenosis, tumor recurrence, and mortality had no statistical differences between the two groups (P＞0.05). ConclusionFrom the results of comparative analysis in this study, it can be concluded that LMCCJ is not only safe equally, but also easier and less time-consuming as compared with LHSCJ.
【摘要】目的探讨外科手术治疗原发性肝癌致阻塞性黄疸的方法及疗效。方法自1991年1月至2001年12月期间我院对17例原发性肝癌致阻塞性黄疸的患者进行外科手术治疗，其中行肝叶切除及胆总管切开取癌栓者14例,行同种异体原位肝移植术3例。结果患者平均生存时间为8个月,最长24个月。结论外科治疗原发性肝癌致阻塞性黄疸明显改善了患者生活质量,延长了生存时间。
ObjectiveTo investigate the potential role of caudal type homeobox transcription factor-2 (CDX-2) and liverintestine cadherin (LI-cadherin) in the development and progression of gastric tumor by detecting their expressions in gastric cancer and benign lesions. MethodsThe expressions of CDX-2 and LI-cadherin protein were detected by immunohistochemistry in normal gastric mucosa (n=28), chronic superficial gastritis (n=30), chronic atrophic gastritis (n=42), intestinal metaplasia (n=58), gastric adenocarcinoma (n=46), vicinity cancerous tissue (n=30), and gastric stromal tumor (n=10)．Then, the relationship between expression of CDX-2 or LI-cadherin protein and clinicopathologic features was analyzed． Results①The expressions of CDX-2 and LI-cadherin were all negative in normal gastric mucosa, chronic superficial gastritis, vicinity cancerous tissue, and gastric stromal tumor. The positive rates of CDX-2 protein expression in intestinal metaplasia and gastric adenocarcinoma were 91.4% (53/58) and 80.4% (37/46), respectively, and the positive rates of LI-cadherin protein expression were 82.8% (48/58) in intestinal metaplasia and 65.2% (30/46) in gastric adenocarcinoma. The positive rates of CDX-2 and LI-cadherin protein expression in intestinal type gastric adenocarcinoma 〔90.6% (29/32) and 78.1% (25/32)〕 were higher than those in diffuse type gastric adenocarcinoma 〔57.1% (8/14) and 35.7% (5/14)〕, Plt;0.05． ② CDX-2 protein expression was associated with degree of differentiation (P=0.007), and LI-cadherin protein expression was associated with lymph node metastasis (P=0.007) and cancer staging (P=0.013). ③ In the mucosa of intestinal metaplasia, the coexpression positive rate of CDX-2 protein expression in nucleus with LI-cadherin protein in cytoplasm or membrane was 83.0% (44/53), while the coexpression positive rate was 67.6% (25/37) in gastric adenocarcinoma. Although b tendency between CDX-2 and LI-cadherin protein expression was showed, it was not confirmed by the correlation analysis (r=238， P=0.115). ConclusionsThe abnormal expressions of CDX-2 and LI-cadherin may be involved in the development and progress of intestinal metaplasia and gastric adenocarcinoma, respectively, and further studies are needed to determine if they have synergistic effect.
ObjectiveTo verify the feasibility of a self-designed magnetic anchoring and traction device (MATD) for assisting two-port video-assisted thoracoscopic esophagectomy.MethodsThree Beagle dogs were selected as animal models with age ranging from 1-6 years and weight ranging from 8-12 kg, and they underwent two-port video-assisted thoracoscopic esophagectomy after general anesthesia. We used the MATD to retract the esophagus to different directions, which assisted mobilizing esophagus, detecting the nerves along esophagus and dissecting paraesophagus lymph nodes. The operation time, blood loss and feasibility of the MATD were recorded.ResultsWith the aid of the MATD, we successfully retracted and mobilized the esophagus, detected the nerves and dissected the lymph nodes in three Beagle dog models. During the operation, the MATD provided sufficient and steady traction of esophagus to achieve a good exposure of the operative field, effectively decreasing the interference between working instruments. The MATD worked well. The mean operation time was 30 min, and the mean intraoperative blood loss was about 10 mL.ConclusionIt is effective to use the MATD to assist retracting esophagus during video-assisted thoracoscopic esophagectomy. The magnetic anchoring and traction technique can assist to expose the surgical field, decrease the interference between the working instruments and have the potential clinical application.
ObjectiveTo investigate the survival of liver cancer cells in hypotonic solution, and provide a theoretical basis for the clinical application of warm distilled water to kill free intraperitoneal liver cancer cells. MethodsThe hepatocellular carcinoma cell line Hep3B were cultured by using different osmotic HEPES buffered solution (148 mOsmol/kg, 90 mOsmol/kg, and 0 mOsmol/kg) in vitro, and then the activity and status of the cells were observed by using the MTT assay and flow cytometry. ResultsOne hundred and forty-eight mOsmol/kg and 90 mOsmol/kg osmotic pressure solution had no obvious killing effect for hepatocellular carcinoma cell line Hep3B, the cells still had strong activity after 30 min. The 0 mOsmol/kg osmotic pressure distilled water had particular killing effect for hepatocellular carcinoma cells, with the prolongation of time and the killing effect was enhanced. It needs 10 min to destruct free cancer cells. ConclusionApplication of warm distilled water lavage in liver cancer surgery requires the continuing role of 10 min to kill the intraperitoneal free cancer cells, thereby preventing the occurrence of postoperative peritoneal metastasis.
The quality of a donor liver after cardiac death is closely associated with energy metabolism during preservation. Ex vivo mechanical perfusion has broad application prospects because this technique can help energy metabolism and repair ischemia injury of donors′ livers. Some core issues are presented in this review in order to provide references for propelling secure application of liver transplantation based on donation after cardiac death.
This study was to build a canine portal hypertension model by intra-portal administration of high polymer material polyurethane and organic solvent tetrahydrofuran mixed solutions in order to evaluate the effectiveness of the model. Twelve local crossbreed dogs were selected randomly, with intra-portal administration of 8% (weight/volume) polyurethane-tetrahydrofuran solutions through an incision in the upper abdomen to build the portal hypertension model. We measured the portal vein pressure before modeling, during modeling, and four-, eight-, and twelve-weeks after modeling, respectively. Then we evaluated the effectiveness of the model comparing values of data with those data obtained before modeling started, which were regarded as the normal values. The results showed that the portal vein pressure rose by 2.5 times after the solution administrated instantly as much as that before modeling, and maintained at 1.5 times after 4 weeks. This method presents an easy operation, low animal mortality and reliable model of portal hypertension. Its less abdominal adhesions and its ability in keeping normal anatomic structure specially make it suit for surgical research of portal hypertension.
ObjectiveTo investigate the feasibility of magnamosis rings designed based on magnetic compression technique in esophageal anastomosis reconstruction.MethodsAccording to the anatomical characteristics of esophagus in SD rats, the esophageal magnamosis rings were designed. SD rats were used as animal models (n=10, 5 males and 5 females) to complete the magnetic anastomosis reconstruction of the cervical esophagus using magnamosis rings, and the operation time, animal survival, postoperative complications, magnetic rings excretion time were recorded. Two weeks after operation, the rats were killed, and the esophageal anastomotic specimens were obtained. The blasting pressure of the anastomotic site was measured and the formation of the anastomotic site was observed with naked eyes.ResultsEsophageal magnamosis was successfully performed in 10 SD rats, and the median operation time was 11 (8-13) min. All rats survived without anastomotic leakage, anastomotic stenosis, or magnetic rings incarceration. The magnetic rings were discharged after 8 (5-10) days and the burst pressure was higher than 300 mm Hg. Visual observation showed that the anastomotic muscle healed well and the mucosa was smooth.ConclusionThe magnetic compression technique can be used for anastomosis reconstruction of esophagus, which has the advantages of simple operation and reliable anastomosis effect, and has clinical application prospect.
Chronic obstructive pulmonary disease (COPD) is the most common chronic respiratory disease around the world, and pharmacotherapy is the foremost treatment method currently. In recent decades, with the rapid development of bronchoscopic interventional therapy, endoscopic physical ablation technology presents a therapeutic effect in treating COPD, with few treatment-related side effects, showing excellent application prospects in treating COPD. Since ablation techniques in this field are emerging technologies with low patient acceptance, they are not widely used in the clinical treatment of COPD. This article reviews the development process of physical ablation techniquesc. Moreover, their current application status and the prospects in the field of COPD treatment were also summarized and analyzed. We hope to promote the application of physical ablation in the clinical treatment of COPD and provide practical references and a theoretical basis for the clinical treatment of COPD.