Hepatic Artery Resection for Bismuth Type III and IV Hilar Cholangiocarcinoma: Is Reconstruction Always Required?

Objective

The objective of the study is to examine the feasibility of hepatic artery resection (HAR) without subsequent reconstruction (RCS) in specified patients of Bismuth type III and IV hilar cholangiocarcinoma.

Methods

We retrospectively reviewed 63 patients who underwent hepatic artery resection for Bismuth type III and IV hilar cholangiocarcinoma. These patients were subsequently enrolled into two groups based on whether the artery reconstruction was conducted. Postoperative morbidity and mortality, and long-term survival outcome were compared between the two groups.

Results

There were 29 patients in HAR group and 34 patients in the HAR + RCS group. Patients with hepatic artery reconstruction tended to have longer operative time (545.6?±?143.1 min vs. 656.3?±?192.8 min; P?=?0.013) and smaller tumor size (3.0?±?1.1 cm vs. 2.5?±?0.9 cm; P?=?0.036). The R0 resection margin was comparable between the HAR group and HAR?+?RCS group (86.2 vs. 85.3%; P?>?0.05). Twelve patients (41.4%) with 24 complications in HAR group and 13 patients (38.2%) with 25 complications in HAR?+?RCS group were recorded (P?=?0.799). The postoperative hepatic failure rate (13.8 vs. 5.9%) and postoperative mortality rate (3.4% vs. 2.9%) were also comparable between the two groups. In the HAR group, the overall 1-, 3-, and 5-year survival rates were 72, 41, and 19%, respectively; while in the HAR?+?RCS group, the overall 1-, 3-, and 5-year survival rates were 79, 45, and 25%, respectively (P?=?0.928).

Conclusions

Hepatic artery resection without reconstruction is also a safe and feasible surgical procedure for highly selected cases of Bismuth type III and IV hilar cholangiocarcinoma.

     

An outbreak of angiostrongyliasis in Guanging, People's Republic of China: migrants vulnerable to an emerging disease

Angiostrongyliasis has been frequently reported from the People's Republic of China during the last decade. An outbreak of angiostrongyliasis among migrant laborers in Guangning, Guangdong Province is described here. A questionnaire was developed to collect epidemiological and clinical information about 17 migrant laborers from the Bai ethnic group in Dali, Yunnan Province. Serum samples were collected and tested by enzyme-linked immunosorbent assay. Rats and mollusks from the same area where patients had collected Pomacea canaliculata were examined for presence of Angiostrongylus cantonensis. All 17 Bai migrant laborers consumed P. canaliculata and six had meningitis 3-19 days after consumption of P. canaliculata. Headache, myalgia and fatigue were the most common symptoms. Blood samples from 5 patients were positive for antibodies to A. cantonensis. The places where the migrant laborers collected P. canaliculata were identified as endemic areas for A. cantonensis. This outbreak highlights the vulnerability of migrants to angiostrongyliasis.     

Relationship between pancreaticobiliary maljunction and gallbladder carcinoma: a meta-analysis

BACKGROUND: Reports on the relationship between pancreaticobiliary maljunction (PBM) and gallbladder carcinoma (GBC) are conflicting. The frequency of PBM in GBC patients and the clinical features of GBC patients with PBM vary in different studies. DATA SOURCES: English-language articles describing the association between PBM and GBC were searched in the PubMed and Web of Science databases. Nine case-control studies fulfilled the inclusion criteria and addressed the relevant clinical questions of this analy...     

Effect of Acupuncture on Immunomodulation in Patients with Malignant Tumors

ＥｆｆｅｃｔｏｆＡｃｕｐｕｎｃｔｕｒｅｏｎｌｍｍｕｎｏｍｏｄｕｌａｔｉｏｎｉｎＰａｔｉｅｎｔｓｗｉｌｈＭａｌｉｇｎａｎｔＴｕｍｏｒｓｗｕＢｉｎ（吴滨）；ＺＨＯＵＲｏｎｇ－ｘｉｎｓ（周荣兴）；ＣＨＥＮＭｉｎｓ－ｊｉｎ（陈名金）；ＺＨＡＮＧＹｏｎｇ－ｌｉ...     

Measurement of myocardial extracellular volume using cardiac dual-energy computed tomography in patients with ischaemic cardiomyopathy: a comparison of different methods

The International Journal of Cardiovascular Imaging - To clarify the consistency and efficiency of four methods for myocardial extracellular volume (ECV) measurement (manual method using...     

北京市丰台区8～10岁儿童尿碘水平影响因素研究

目的:探讨北京市丰台区8~10岁儿童尿碘水平的影响因素,为儿童碘营养工作提出相应的建议。方法:采用整群随机抽样的方法,在丰台区按照东、西、南、北、中的方位抽取5所小学,每所学校再随机抽查8~10岁学生80人,做尿碘检测、甲状腺触诊检查和自填式结构问卷调查,对数据进行单因素及多因素分析。结果:家用盐不含碘或含碘量过低、不食用海带等高碘食品、不喝牛奶等因素是碘缺乏的危险因素;过量食用海带等高碘食品是碘过量的危险因素。结论:尿碘水平偏低和尿碘偏高儿童在被调查儿童中都占有相当的比例,应引起重视;注重食物中碘的摄入,儿童食用海带等高碘食品要适量,应采取针对食盐、食品的综合干预措施使儿童碘营养保持在适宜的水平。     

Negative short-term impact of intraoperative biliary lavage in patients with hepatolithiasis

AIM: To evaluate short-term outcomes following intraoperative biliary lavage for hepatolithiasis.METHODS: A total of 932 patients who were admitted to the West China Medical Center of Sichuan University between January 2010 and January 2014 and underwent bile duct exploration and lithotomy were retrospectively included in our study. The patients were divided into the lavage group and the control group. Related pre-, intra-, and postoperative factors were recorded, analyzed, and compared between the two groups in order to verify the effects of biliary lavage on the short-term outcome of patients with hepatolithiasis. RESULTS: Amongst the patients who were included, 678 patients with hepatolithiasis were included in the lavage group, and the other 254 patients were enrolled in the control group. Data analyses revealed that preoperative baseline and related intraoperative variables were not significantly different. However, patients who underwent intraoperative biliary lavage had prolonged postoperative hospital stays(6.67 d vs 7.82 d, P = 0.024), higher hospitalization fees(RMB 28437.1 vs RMB 32264.2, P = 0.043), higher positive rates of bacterial cultures from blood(13.3% vs 25.8%, P = 0.001) and bile(23.6% vs 40.7%, P= 0.001) samples, and increased usage of advanced antibiotics(26.3% vs 38.2%, P = 0.001). In addition, in the lavage group, more patients had fever( 37.5℃, 81.4% vs 91.1%, P = 0.001) and hyperthermia( 38.5℃,39.7% vs 54.9%, P = 0.001), and higher white blood cell counts within 7 d after the operation compared to the control group.CONCLUSION: Intraoperative biliary lavage might increase the risk of postoperative infection, while not significantly increasing gallstone removal rate.     

Repair of a common bile duct defect with a decellularized ureteral graft

AIM To evaluate the feasibility of repairing a common bile duct defect with a decellularized ureteral graft in a porcine model.METHODS Eighteen pigs were randomly divided into three groups. An approximately 1 cm segment of the common bile duct was excised from all the pigs. The defect was repaired using a 2 cm long decellularized ureteral graft over a T-tube(T-tube group, n = 6) or a silicone stent(stent group, n = 6). Six pigs underwent bile duct reconstruction with a graft alone(stentless group). The surviving animals were euthanized at 3 mo. Specimens of the common bile ducts were obtained for histological analysis.RESULTS The animals in the T-tube and stent groups survived until sacrifice. The blood test results were normal in both groups. The histology results showed a biliary epithelial layer covering the neo-bile duct. In contrast, all the animals in the stentless group died due to biliary peritonitis and cholangitis within two months post-surgery. Neither biliary epithelial cells nor accessory glands were observed at the graft sites in the stentless group.CONCLUSION Repair of a common bile duct defect with a decellularized ureteral graft appears to be feasible. A T-tube or intraluminal stent was necessary to reduce postoperative complications.