手助腹腔镜与开腹脾切除、贲门周围血管离断术的临床分析

Objective To investigate the changes in liver function and the efficacy of either hand-assisted laparoscopic surgery (HALS) or open splenectomy (OS) in combination with pericardial devascularization in the treatment of portal hypertension. Methods The clinical data of 94 patients who received splenectomy combined with pericardial devascularization to treat portal hypertension due to cirrhosis from Jan 2002 to May 2008 were analyzed retrospectively. 56 patients received OS and 38patients HALS. The operating time, intraoperative blood loss, postoperative complications, liver dysfunction and mortality were analyzed according to the Child's grading. Results There was no difference in the operating time between HALS and OS (P＞0. 05). The intraoperative blood loss and postoperative complications were 5.6% and 10.8%, respectively (P＜0. 05). There was no significant difference in the serum ALT between HALS and OS, but there was a significant difference in the ALB (P＜0. 05). The AST also had a significant difference on postoperative day 5 (P＜0. 05). The serum ALT and AST were elevated after HALS, but there was a significant difference only for AST (P＜0.05). The serum ALT and AST in OS were significantly higher after than before operation (P＜0. 05). The serum ALB in OS was significantly lower after operation (P＜0.05), but it was significantly lower only on postoperative days 1 and 3 (P＜0.05) in HALS. Conclusions Compared with OS, HALS combined with pericardial devascularization caused less damage to the intestinal tract and the liver function. It is a feasible and safe operation and it had fewer postoperative complications.     

Predictive values of neutrophil to lymphocyte ratio,monocyte to lymphocyte ratio and platelet to lym-phocyte ratio for delirium after hip fracture surgery in the elderly北大核心CSCD

Objective To explore the predictive values of neutrophil to lymphocyte ratio (NLR), monocyte to lymphocyte ratio (MLR) and platelet to lymphocyte ratio (PLR) for postoperative delirium in the elderly patients with hip fracture. Methods The data of 1,278 elderly patients with hip fracture were analyzed retrospectively who had been admitted to Department of Orthopedics, The 7th Medical Center, General Hospital of Chinese People's Liberation Army from January 2012 to December 2018. There were 418 males and 860 females, with a median age of 81 (75, 90) years. There were 728 intertrochanteric fractures and 550 femoral neck fractures. The working characteristic curves (ROC) of NLR, MLR, and PLR used to predict postoperative delirium in the elderly patients with hip fracture were worked out to obtain the best cutoff points (sensitivity, specificity, and area under the curve) respectively. According to the best cutoff points, the NLR, MLR, and PLR were respectively divided into an increase group and a normal group. According to whether postoperative delirium occurred or not, the patients were divided into a delirium group and a delirium-free group. After univariable analysis was conducted to screen out the risk factors, binary logistic regression analysis was conducted of the factors with P<0.05 to determine the risk factors. Results The median values of NLR, MLR and PLR in the 1,278 elderly patients with hip fracture at admission were 5.43 (3.87, 7.88), 0.40 (0.29, 0.54) and 158.40 (118.00, 222.50), respectively. Postoperative delirium occurred in 153 patients (12.0%). In the study of the predictive values of NLR, MLR, and PLR using ROC curves for postoperative delirium in the elderly patients with hip fracture, the best cutoff points (sensitivity, specificity, and area under the curve) for prediction were 7.613 (57.5%, 77.1%, 0.726), 0.512 (52.3%, 74.0%, 0.663), and 201.125 (68.6%, 73.3%, 0.751), respectively. The risk factors for postoperative delirium were increased NLR (OR=2.046, 95% CI: 1.322 to 3.166, P<0.001), increased MLR (OR=1.568, 95% CI: 1.039 to 2.367, P=0.032), and increased PLR (OR=3.489, 95% CI: 2.290 to 5.317, P<0.001). Conclusion As NLR≥7.613, MLR≥0.512 and PLR≥201.125 may be risk factors for postoperative delirium in elderly patients with hip fracture, NLR, MLR and PLR may have a positive value in prediction of postoperative delirium. © 2023 Chinese Journal of Orthopaedic Trauma. All rights reserved.     

TROP2基因mRNA在左半结肠癌和右半结肠癌组织中的表达及其临床意义

Objective To investigate the expression of TROP2 in the left-sided and right-sided colon cancer and its clinical significance. Methods A total of eighty patients, who received radical resection of colon cancer between June 2001 and April 2005 and were staged as Ⅱ and Ⅲ, were identified, including forty with left-sided colon cancer(LSCC)and forty with right-sided colon cancer (RSCC). The expression of TROP2 was detected by real-time quantitative RT-PCR in paired cancer and normal tissue. Subsequently, the relationship between TROP2 expessian and clinicopathoiogical variables as well as the effect on the patients' prognosis were analyzed. Results The expression of TROP2 mRNA in the cancer tissue was significantly higher than that in normal tissue (P<0.01, paired Wilcoxon test). However, its expression in LSCC was markedly higher than that in RSCC with significant difference (P=0.009, Mann-Whitney U test). The patients with TROP2 high expression were found more frequently in LSCC than in RSCC (67.5% vs 32.5%, P=0.002, χ2 test). Cancer-related mortality of the patients with TROP2 high expression was four times as high as low expression (40% vs 10%, P=0.002, χ2 test). From the stratified survival analysis through Kaplan-Meier curve, the TBOP2 high expression group had a significantly poorer median survival time than the low expression group for the patients with LSCC (45.9:63.1 months, P=0.032, log-rank test). By contrast, for the patients with RSCC, TROP2 expression had no marked effect on the survival time (P=0.235, log-rank test). In multivariable analysis, for the cohort of the present study, serosal invasion and lymphatic/vascular invasion were the independent prognostic factors of RSCC. Serosal invasion, lymph node metastasis and lymphatic/vascular invasion were the independent prognostic factors of LSCC. TROP2 high expression showed marginal significance (RR:6.244, 95% CI:0.755-51.636, P=0.089). Conclusion (1)TROP2 is a differentially expressed gene between RSCC and LSCC. (2)TROP2 high expression is closely related to the factors indicating poor prognosis. (3)TROP2 has distinct clinical significance to the patients with different tumor sites. TROP2 high expression is potentially an independent prognostic factor of LSCC. (4)LSCC and RSCC seem to be two distinct diseases with significant molecular heterogeneity.     

TROP2基因mRNA在左半结肠癌和右半结肠癌组织中的表达及其临床意义

Objective To investigate the expression of TROP2 in the left-sided and right-sided colon cancer and its clinical significance. Methods A total of eighty patients, who received radical resection of colon cancer between June 2001 and April 2005 and were staged as Ⅱ and Ⅲ, were identified, including forty with left-sided colon cancer(LSCC)and forty with right-sided colon cancer (RSCC). The expression of TROP2 was detected by real-time quantitative RT-PCR in paired cancer and normal tissue. Subsequently, the relationship between TROP2 expessian and clinicopathoiogical variables as well as the effect on the patients' prognosis were analyzed. Results The expression of TROP2 mRNA in the cancer tissue was significantly higher than that in normal tissue (P<0.01, paired Wilcoxon test). However, its expression in LSCC was markedly higher than that in RSCC with significant difference (P=0.009, Mann-Whitney U test). The patients with TROP2 high expression were found more frequently in LSCC than in RSCC (67.5% vs 32.5%, P=0.002, χ2 test). Cancer-related mortality of the patients with TROP2 high expression was four times as high as low expression (40% vs 10%, P=0.002, χ2 test). From the stratified survival analysis through Kaplan-Meier curve, the TBOP2 high expression group had a significantly poorer median survival time than the low expression group for the patients with LSCC (45.9:63.1 months, P=0.032, log-rank test). By contrast, for the patients with RSCC, TROP2 expression had no marked effect on the survival time (P=0.235, log-rank test). In multivariable analysis, for the cohort of the present study, serosal invasion and lymphatic/vascular invasion were the independent prognostic factors of RSCC. Serosal invasion, lymph node metastasis and lymphatic/vascular invasion were the independent prognostic factors of LSCC. TROP2 high expression showed marginal significance (RR:6.244, 95% CI:0.755-51.636, P=0.089). Conclusion (1)TROP2 is a differentially expressed gene between RSCC and LSCC. (2)TROP2 high expression is closely related to the factors indicating poor prognosis. (3)TROP2 has distinct clinical significance to the patients with different tumor sites. TROP2 high expression is potentially an independent prognostic factor of LSCC. (4)LSCC and RSCC seem to be two distinct diseases with significant molecular heterogeneity.     

TROP2基因mRNA在左半结肠癌和右半结肠癌组织中的表达及其临床意义

Objective To investigate the expression of TROP2 in the left-sided and right-sided colon cancer and its clinical significance. Methods A total of eighty patients, who received radical resection of colon cancer between June 2001 and April 2005 and were staged as Ⅱ and Ⅲ, were identified, including forty with left-sided colon cancer(LSCC)and forty with right-sided colon cancer (RSCC). The expression of TROP2 was detected by real-time quantitative RT-PCR in paired cancer and normal tissue. Subsequently, the relationship between TROP2 expessian and clinicopathoiogical variables as well as the effect on the patients' prognosis were analyzed. Results The expression of TROP2 mRNA in the cancer tissue was significantly higher than that in normal tissue (P<0.01, paired Wilcoxon test). However, its expression in LSCC was markedly higher than that in RSCC with significant difference (P=0.009, Mann-Whitney U test). The patients with TROP2 high expression were found more frequently in LSCC than in RSCC (67.5% vs 32.5%, P=0.002, χ2 test). Cancer-related mortality of the patients with TROP2 high expression was four times as high as low expression (40% vs 10%, P=0.002, χ2 test). From the stratified survival analysis through Kaplan-Meier curve, the TBOP2 high expression group had a significantly poorer median survival time than the low expression group for the patients with LSCC (45.9:63.1 months, P=0.032, log-rank test). By contrast, for the patients with RSCC, TROP2 expression had no marked effect on the survival time (P=0.235, log-rank test). In multivariable analysis, for the cohort of the present study, serosal invasion and lymphatic/vascular invasion were the independent prognostic factors of RSCC. Serosal invasion, lymph node metastasis and lymphatic/vascular invasion were the independent prognostic factors of LSCC. TROP2 high expression showed marginal significance (RR:6.244, 95% CI:0.755-51.636, P=0.089). Conclusion (1)TROP2 is a differentially expressed gene between RSCC and LSCC. (2)TROP2 high expression is closely related to the factors indicating poor prognosis. (3)TROP2 has distinct clinical significance to the patients with different tumor sites. TROP2 high expression is potentially an independent prognostic factor of LSCC. (4)LSCC and RSCC seem to be two distinct diseases with significant molecular heterogeneity.     

TROP2基因mRNA在左半结肠癌和右半结肠癌组织中的表达及其临床意义

Objective To investigate the expression of TROP2 in the left-sided and right-sided colon cancer and its clinical significance. Methods A total of eighty patients, who received radical resection of colon cancer between June 2001 and April 2005 and were staged as Ⅱ and Ⅲ, were identified, including forty with left-sided colon cancer(LSCC)and forty with right-sided colon cancer (RSCC). The expression of TROP2 was detected by real-time quantitative RT-PCR in paired cancer and normal tissue. Subsequently, the relationship between TROP2 expessian and clinicopathoiogical variables as well as the effect on the patients' prognosis were analyzed. Results The expression of TROP2 mRNA in the cancer tissue was significantly higher than that in normal tissue (P<0.01, paired Wilcoxon test). However, its expression in LSCC was markedly higher than that in RSCC with significant difference (P=0.009, Mann-Whitney U test). The patients with TROP2 high expression were found more frequently in LSCC than in RSCC (67.5% vs 32.5%, P=0.002, χ2 test). Cancer-related mortality of the patients with TROP2 high expression was four times as high as low expression (40% vs 10%, P=0.002, χ2 test). From the stratified survival analysis through Kaplan-Meier curve, the TBOP2 high expression group had a significantly poorer median survival time than the low expression group for the patients with LSCC (45.9:63.1 months, P=0.032, log-rank test). By contrast, for the patients with RSCC, TROP2 expression had no marked effect on the survival time (P=0.235, log-rank test). In multivariable analysis, for the cohort of the present study, serosal invasion and lymphatic/vascular invasion were the independent prognostic factors of RSCC. Serosal invasion, lymph node metastasis and lymphatic/vascular invasion were the independent prognostic factors of LSCC. TROP2 high expression showed marginal significance (RR:6.244, 95% CI:0.755-51.636, P=0.089). Conclusion (1)TROP2 is a differentially expressed gene between RSCC and LSCC. (2)TROP2 high expression is closely related to the factors indicating poor prognosis. (3)TROP2 has distinct clinical significance to the patients with different tumor sites. TROP2 high expression is potentially an independent prognostic factor of LSCC. (4)LSCC and RSCC seem to be two distinct diseases with significant molecular heterogeneity.     

TROP2基因mRNA在左半结肠癌和右半结肠癌组织中的表达及其临床意义

Objective To investigate the expression of TROP2 in the left-sided and right-sided colon cancer and its clinical significance. Methods A total of eighty patients, who received radical resection of colon cancer between June 2001 and April 2005 and were staged as Ⅱ and Ⅲ, were identified, including forty with left-sided colon cancer(LSCC)and forty with right-sided colon cancer (RSCC). The expression of TROP2 was detected by real-time quantitative RT-PCR in paired cancer and normal tissue. Subsequently, the relationship between TROP2 expessian and clinicopathoiogical variables as well as the effect on the patients' prognosis were analyzed. Results The expression of TROP2 mRNA in the cancer tissue was significantly higher than that in normal tissue (P<0.01, paired Wilcoxon test). However, its expression in LSCC was markedly higher than that in RSCC with significant difference (P=0.009, Mann-Whitney U test). The patients with TROP2 high expression were found more frequently in LSCC than in RSCC (67.5% vs 32.5%, P=0.002, χ2 test). Cancer-related mortality of the patients with TROP2 high expression was four times as high as low expression (40% vs 10%, P=0.002, χ2 test). From the stratified survival analysis through Kaplan-Meier curve, the TBOP2 high expression group had a significantly poorer median survival time than the low expression group for the patients with LSCC (45.9:63.1 months, P=0.032, log-rank test). By contrast, for the patients with RSCC, TROP2 expression had no marked effect on the survival time (P=0.235, log-rank test). In multivariable analysis, for the cohort of the present study, serosal invasion and lymphatic/vascular invasion were the independent prognostic factors of RSCC. Serosal invasion, lymph node metastasis and lymphatic/vascular invasion were the independent prognostic factors of LSCC. TROP2 high expression showed marginal significance (RR:6.244, 95% CI:0.755-51.636, P=0.089). Conclusion (1)TROP2 is a differentially expressed gene between RSCC and LSCC. (2)TROP2 high expression is closely related to the factors indicating poor prognosis. (3)TROP2 has distinct clinical significance to the patients with different tumor sites. TROP2 high expression is potentially an independent prognostic factor of LSCC. (4)LSCC and RSCC seem to be two distinct diseases with significant molecular heterogeneity.     

TROP2基因mRNA在左半结肠癌和右半结肠癌组织中的表达及其临床意义

Objective To investigate the expression of TROP2 in the left-sided and right-sided colon cancer and its clinical significance. Methods A total of eighty patients, who received radical resection of colon cancer between June 2001 and April 2005 and were staged as Ⅱ and Ⅲ, were identified, including forty with left-sided colon cancer(LSCC)and forty with right-sided colon cancer (RSCC). The expression of TROP2 was detected by real-time quantitative RT-PCR in paired cancer and normal tissue. Subsequently, the relationship between TROP2 expessian and clinicopathoiogical variables as well as the effect on the patients' prognosis were analyzed. Results The expression of TROP2 mRNA in the cancer tissue was significantly higher than that in normal tissue (P<0.01, paired Wilcoxon test). However, its expression in LSCC was markedly higher than that in RSCC with significant difference (P=0.009, Mann-Whitney U test). The patients with TROP2 high expression were found more frequently in LSCC than in RSCC (67.5% vs 32.5%, P=0.002, χ2 test). Cancer-related mortality of the patients with TROP2 high expression was four times as high as low expression (40% vs 10%, P=0.002, χ2 test). From the stratified survival analysis through Kaplan-Meier curve, the TBOP2 high expression group had a significantly poorer median survival time than the low expression group for the patients with LSCC (45.9:63.1 months, P=0.032, log-rank test). By contrast, for the patients with RSCC, TROP2 expression had no marked effect on the survival time (P=0.235, log-rank test). In multivariable analysis, for the cohort of the present study, serosal invasion and lymphatic/vascular invasion were the independent prognostic factors of RSCC. Serosal invasion, lymph node metastasis and lymphatic/vascular invasion were the independent prognostic factors of LSCC. TROP2 high expression showed marginal significance (RR:6.244, 95% CI:0.755-51.636, P=0.089). Conclusion (1)TROP2 is a differentially expressed gene between RSCC and LSCC. (2)TROP2 high expression is closely related to the factors indicating poor prognosis. (3)TROP2 has distinct clinical significance to the patients with different tumor sites. TROP2 high expression is potentially an independent prognostic factor of LSCC. (4)LSCC and RSCC seem to be two distinct diseases with significant molecular heterogeneity.     

谷胱甘肽转硫酶基因多态性与湖北汉族人群溃疡性结肠炎的关系

Objective To investigate the correlation between genetic polymorphisms of glutathione S-transferases (GSTs) and ulcerative colitis (UC) in Hubei Han population. Methods Genetic polymorphisms of GSTM1 and GSTT1 of 270 patients with UC (UC group) who were admitted to the Zhongnan Hospital, People's Hospital of Wuhan University, Tongji Hospital and Union Hospital of Huazhong University of Science and Technology from August 2002 to December 2009 and 623 healthy people ( control group) were detected by restriction fragment length polymorphism-polymerase chain reaction. All UC patients were allocated to distal UC group (n= 229) and extensive UC group (n =41 ) according to the location of the lesions; and all UC patients were also allocated to mild-moderate group (n = 237) and severe group (n = 33 ). The genetic polymorphisms of GSTP1 of these patients and healthy people were detected by polymerase chain reaction. The genotypes of GSTM1, GSTT1 and GSTP1 were also detected. GSTM1 and GSTT1 containing small DNA segments ( 157 bp and 480 bp) were defined as GSTM1 (+) and GSTT1 (+), otherwise, GSTM(-) and GSTT1 (-), respectively. All data were analyzed by chisquare test. Results The frequencies of GSTM1(-), GSTT1(-) and GSTP1 (Val/Val) were 70.7% (191/270),64.8% (175/270) and 48.9% (132/270) in the UC group, and 41.7% (260/623), 47.2% ( 294/623 ) and 34.3% (214/623) in the control group, with a significant difference between the two groups (x2 = 63. 404,22. 320, 25. 384, P ＜0.05 ). The frequencies of GSTT1 (-) and GSTP1 (Val/Val) were 71.6% (164/229) and 57.6% (132/229) in the distal UC group, which were significantly higher than 31.7% (13/41) and 29.3%( 12/41 ) in the extensive UC group ( x2 = 24.528, 9.609, P ＜ 0.05 ). The frequencies of GSTM1 (-) were 65.1%(149/229) in the distal UC group and 56.1% (23/41) in the extensive UC group, with no significant difference between the two groups ( x2 = 1. 210, P ＞ 0.05 ). The frequencies of GSTT1 (-) and GSTP1 ( Val/Val ) were 71.6%(164/229), 31.7% ( 13/41 ) in the distal UC group and 57.6% ( 132/229), 29.3% ( 12/41 ) in the extensive UC group, with a significant difference between the two groups ( x2 = 24. 528, 9. 609, P ＜ 0. 05 ). There was no significant difference in the frequencies of GSTM1 (-), GSTT1 (-), GSTP1 (Val/Val) in the mild-moderate group and the severe group( x2 = 0. 623, 1. 884, 3. 403, P ＞ 0. 05 ). Conclusions Variant genotypes of GSTs are significantly correlated with UC in Hubei Han population. The severity of UC may not be correlated with variant genotypes of GSTs.     

Risk factors and urinary biomarkers of non-albuminuric and albuminuric chronic kidney disease in patients with type 2 diabetes

BACKGROUND A number of recent studies indicate a transformation in the natural course of chronic kidney disease(CKD) in type 2 diabetes(T2 D) patients: an increasing prevalence of declined renal function without proceeding to the accompanying elevation of albuminuria. It has been suggested that albuminuric and nonalbuminuric CKD patterns could be different in their phenotypes and pathogenic mechanisms.AIM To identify the risk factors and biomarkers of albuminuric and non-albuminuric patterns of CKD in patients with T2 D.METHODS Three hundred sixty patients with T2 D duration ≥ 10 years were included in this observational cross-sectional study. The associations of a panel of demographic and clinical characteristics, complications, comorbidities, and metabolic and hematology parameters with albuminuric and non-albuminuric CKD patterns were analyzed. The urinary excretion of nephrin and podocin, two podocytespecific markers, and WAP-four-disulfide core domain protein 2(WFDC-2), a marker of tubulointerstitial fibrosis, was determined by ELISA in comparison with healthy controls.RESULTS Non-albuminuric CKD was associated with age ≥ 65 years(P = 0.0001), female sex(P = 0.04), diabetes duration ≥ 15 years(P = 0.0009), and the use of diuretics(P= 0.0005). Male sex(P = 0.01), smoking(P = 0.01), waist-to-hip ratio 1.0(P = 0.01)and hemoglobin A1 c(Hb A1 c) 8.0%(P = 0.005) were risk factors for elevated albuminuria not accompanied by a decrease in estimated glomerular filtration rate(e GFR). Duration of diabetes ≥ 15 years and the use of calcium channel blockers were risk factors for albuminuria with decreased e GFR(both P = 0.01).In multivariate logistic regression analysis, age, Hb A1 c, female sex and diuretics were significant predictors for reduced e GFR, while waist-to-hip ratio, Hb A1 c and male sex were associated with elevated urinary albumin-to-creatinine ratio(UACR). Excretion of nephrin and podocin was increased in patients with albuminuria, regardless of decline in renal function(P 0.001), correlating positively with UACR. The urinary excretion of WFDC-2 was markedly higher in men than in women(P 0.000001). Men with T2 D demonstrated increased WFDC-2 levels independently of the CKD pattern(all P 0.05). In T2 D women,WFDC-2 excretion was increased in those with reduced renal function(P ≤ 0.01),correlating negatively with e GFR.CONCLUSION The data provide further evidence that albuminuric and non-albuminuric CKD phenotypes correspond to different pathways of diabetic kidney disease progression.     

Surgical resection for metastatic melanoma to the liver: the John Wayne Cancer Institute and Sydney Melanoma Unit experience

HYPOTHESIS: Metastatic melanoma to the liver is not incurable; complete surgical resection can achieve long-term survival in selected patients. BACKGROUND: Metastases to the liver are diagnosed in 10% to 20% of patients with American Joint Committee on Cancer stage IV melanoma. Surgical resection has not been generally accepted as a therapeutic option, as most patients will have other sites of disease that limit their survival to a median of only 4 to 6 months. However, there is little information on outcomes following resection in those patients with disease limited to the liver. PATIENTS AND METHODS: Review of the prospective melanoma databases at the John Wayne Cancer Institute, Santa Monica, Calif, and the Sydney Melanoma Unit, Sydney, Australia, identified 1750 patients with hepatic metastases, of whom 34 (2%) underwent exploration with intent to resect the metastases. Prognostic factors within the group of patients who underwent resection were examined by univariate and multivariate analysis, and median disease-free survival (DFS) and overall survival (OS) were calculated. RESULTS: Of 34 patients undergoing exploratory celiotomy, 24 (71%) underwent hepatic resection and 10 (29%) underwent exploration but not resection. Eighteen patients (75%) underwent complete surgical resection, while the remaining 6 underwent palliative or debulking procedures with incomplete resection. The operative resections included lobectomy (n=14), segmentectomy (4), nonanatomic resection (5), and extended lobectomy (1). The median number of resected lesions was 1, and median lesion size was 5 cm (range, 0.7-22 cm). The median disease-free interval between initial diagnosis of melanoma and development of hepatic metastases was 58 months (range, 0-264 months). Median DFS and OS estimates in the 24 patients who underwent surgical resection were 12 months (range, 0-147 months) and 28 months (range, 2-147 months), respectively. Five-year DFS and OS in this group were 12% and 29%. Macroscopically, complete resection of disease (P =.001) and histologically negative resection margins (P =.03) significantly improved DFS by univariate analysis. Patients rendered surgically free of disease also tended to have improved OS (P =.06). Median OS was 28 months for patients who underwent surgical resection compared with 4 months for patients who underwent exploration only (P<.001). CONCLUSIONS: Resection of metastatic melanoma to the liver may improve DFS and OS in selected patients, similar to resection of other metastatic sites. Therefore, patients with limited metastatic sites, including the liver, who can be rendered free of disease should be considered for complete surgical resection, as their prognosis is otherwise dismal.     

手助腹腔镜与开腹脾切除、贲门周围血管离断术的临床分析

目的 探讨肝硬化门脉高压症继发食管胃底静脉曲张、脾功能亢进患者行手助腹腔镜(hand-assisted laparoscopic surgery,HALS)脾切除、贲门周围血管离断术与开腹脾切除、贲门周围血管离断术(open splenectomy,OS)的肝功能变化及临床疗效.方法 回顾分析2002年1月至2008年5月施行脾切除责门周围血管离断术治疗肝硬化门静脉高压症94例,其中手助腹腔镜手术(HALS组)38例,开腹手术(OS组)56例.术前按Child法进行肝功能分级,对比分析两组手术时间、术中失血、术后并发症发生率、肝功能损害和病死率.结果 手助腹腔镜组与开腹组两组手术用时差异无显著性(P＞0.05);术中平均出血量、并发症发生率分别为5.6%和10.8%,差异有统计学意义(P＜0.05);两组术后ALT比较差异无统计学意义,ALB比较差异有统计学意义(P＜0.05),AST第5天比较差异有统计学意义(P＜0.05);HALS组ALT、AST术后均较术前升高,但只有AST升高有统计学意义(P＜0.05);OS组ALT、AST术后均比术前显著升高,差异均有统计学意义(P＜0.05);两组ALB术后均比术前降低,OS组差异均有统计学意义(P＜0.05),HALS组仅第1、3天差异有统计学意义(P＜0.05).结论 手助腹腔镜脾切除、贲门周围血管离断术对肠道和肝功能影响较开腹组小,术后并发症少,是安全可行的.

Abstract：

Objective To investigate the changes in liver function and the efficacy of either hand-assisted laparoscopic surgery (HALS) or open splenectomy (OS) in combination with pericardial devascularization in the treatment of portal hypertension. Methods The clinical data of 94 patients who received splenectomy combined with pericardial devascularization to treat portal hypertension due to cirrhosis from Jan 2002 to May 2008 were analyzed retrospectively. 56 patients received OS and 38patients HALS. The operating time, intraoperative blood loss, postoperative complications, liver dysfunction and mortality were analyzed according to the Child's grading. Results There was no difference in the operating time between HALS and OS (P＞0. 05). The intraoperative blood loss and postoperative complications were 5.6% and 10.8%, respectively (P＜0. 05). There was no significant difference in the serum ALT between HALS and OS, but there was a significant difference in the ALB (P＜0. 05). The AST also had a significant difference on postoperative day 5 (P＜0. 05). The serum ALT and AST were elevated after HALS, but there was a significant difference only for AST (P＜0.05). The serum ALT and AST in OS were significantly higher after than before operation (P＜0. 05). The serum ALB in OS was significantly lower after operation (P＜0.05), but it was significantly lower only on postoperative days 1 and 3 (P＜0.05) in HALS. Conclusions Compared with OS, HALS combined with pericardial devascularization caused less damage to the intestinal tract and the liver function. It is a feasible and safe operation and it had fewer postoperative complications.     

合并原发性肝细胞癌的门静脉高压症临床特征及生存分析

目的：探讨合并原发性肝细胞癌(HCC)的门静脉高压症(PH)的临床特征及预后。
方法：回顾性分析8年间收治的HCC-PH患者与同时期肝硬化PH(LC-PH)患者的临床资料。采用Cox比例风险模型行生存单因素和多因素分析,ROC曲线确定连续变量截点值。
结果：与LC-PH患者临床特征比较,HCC-PH患者表现为食管胃底静脉曲张、门静脉高压性胃病和合并门静脉栓子发生率高,但门静脉内径代偿性扩张(≥1.3 cm)发生率低,脾功能亢进表现轻,肝功能及上消化道出血发生后生存明显较差。多因素分析显示合并HCC,AST≥65.6 U/L,合并门静脉(癌)栓,TBIL≥34.0 μmol/L,ALB界值是PH患者生存的影响因素。
结论：HCC-PH临床特征有别于LC-PH,对其治疗不能简单等同于LC-PH。合并HCC是PH患者生存最重要的影响因素。     

Chronic mesenteric ischemia: open surgery versus percutaneous angioplasty and stenting

OBJECTIVE: The aim of the study was to evaluate the safety and efficacy of percutaneous angioplasty and stenting (PAS) in comparison with traditional open surgical (OS) revascularization for the treatment of chronic mesenteric ischemia. METHODS: Over a 3.5-year period, 28 patients (32 vessels) underwent PAS (balloon angioplasty alone, 5 [18%] of 28; angioplasty and stenting, 23 [82%] of 28) for symptoms of chronic mesenteric ischemia. These patients were compared with a previously published series of 85 patients (130 vessels) treated with OS (bypass grafting, 60 [71%] of 85; transaortic endarterectomy, 19 [22%] of 85; or patch angioplasty, 6 [7%] of 85). RESULTS: The PAS and OS groups were similar with respect to baseline comorbidities, duration of symptoms (median: 6.7 vs 10.5 months, P =.52), and the number of vessels involved, but the patients differed in their age at presentation (median: 72 vs 65 years, P =.005). Fewer vessels were revascularized per patient in the PAS group (1.1 +/- 0.4) compared with the OS group (1.5 +/- 0.6, P =.001). Overall, 85.7% (24/28) had one vessel and 14.3% (4/28) had two vessels revascularized in the PAS group versus 48.2% (41/85) with one-vessel and 47.1% (40/85) with two-vessel revascularization in the OS group. No difference was noted in the early in-hospital complications (median: 17.9% [PAS] vs 32.9% [OS], P =.12) or mortality rate (10.7% [PAS] vs 8.2% [OS], P =.71). A reduced length of hospital stay in the PAS patients did not attain statistical significance (median: 5 days [PAS] vs 13 days [OS], P =.08). Although the 3-year cumulative recurrent stenosis (P =.62) and mortality rate (P =.99) did not differ, the PAS treatment group had a higher incidence of recurrent symptoms (P =.001). CONCLUSION: Although the results of PAS and OS were similar with respect to morbidity, death, and recurrent stenosis, PAS was associated with a significantly higher incidence of recurrent symptoms. These findings suggest that OS should be preferentially offered to patients deemed fit for open revascularization.     

糖链抗原19-9与胰腺癌体积比值对胰腺癌术后远期生存的意义

目的评估糖链抗原19-9(CA19-9)与胰腺癌体积(TTV)比值(CA19-9/TTV)作为预后标志物,对行胰十二指肠切除术的胰腺导管腺癌患者远期生存的预测价值和意义。方法回顾性分析2011年1月至2019年12月在首都医科大学附属北京朝阳医院因胰腺导管腺癌行胰十二指肠切除术的203例患者资料。通过单因素及多因素分析,筛选出影响胰腺癌术后远期预后的危险因素。根据术前血清CA19-9水平及TTV计算CA19-9/TTV,并依据CA19-9/TTV与患者1年生存情况绘制ROC曲线,由此确定CA19-9/TTV的最佳cut-off值,并将患者分组。比较两组患者的临床一般资料及术后并发症差异,探究其与胰腺癌患者行胰十二指肠切除术远期预后的关系。结果患者总体中位生存时间为18个月,术后1、3、5年总体生存率分别为64.1%、25.6%、15.2%。肿瘤分化程度、CA19-9/TTV是影响胰腺导管腺癌远期预后的独立危险因素(P=0.002、0.005)。ROC曲线最佳cut-off值为5.62(曲线下面积:0.633,95%CI:0.548~0.718),CA19-9/TTV≤5.62组和CA19-9/TTV>5.62组患者的一般临床资料差异无统计学意义,总体中位生存时间分别为26个月和15个月,术后1、3、5年总体生存率分别为82.7%、40.8%、24.8%和57.5%、19.0%、11.2%(P=0.002)。结论高水平的CA19-9/TTV提示胰腺癌患者行胰十二指肠切除术预后不良。CA19-9/TTV可以作为预测胰腺癌术后远期预后的标志物。     

合并肝硬化的原发性肝细胞癌行根治性肝切除术后早期复发及生存分析

目的 探讨合并肝硬化的原发性肝细胞癌(hepatocellular carcinoma,HCC)行根治性肝切除术后早期复发和总体生存影响因素.方法 回顾性分析62例HCC患者的临床资料.KaplanMeier法计算术后复发和生存时间,Log-Rank检验行单因素分析.COX比例风险模型行多因素分析.ROC曲线评估影响因素预测能力,作风险等级划分.结果 至随访截止,53例出现HCC肝内复发,其中早期复发47例.总体1,2,3和5年累积复发率分别为62.9%(39/62),75.8%(47/62),80.7%(50/62)和83.9%(53/62),1、3和5年生存率分别为59.7%(37/62),21.0%(13/62)和1.61%(1/62).多因素分析显示BCLC分级,肝硬化程度和切缘肿瘤细胞阳性是早期复发风险因素.截点值≥2.171时,预测早期复发灵敏度85.1%,特异度77.8%,AUC 0.874(95%CI,0.757～0.990).肝硬化程度,术后早期复发和复发后治疗是术后总体生存影响因素.截点值≥2.893时,预测总体生存灵敏度86.8%,特异度88.9%,AUC 0.894(95%CI,0.798～0.990).结论 BCLC分级,肝硬化程度和切缘肿瘤细胞阳性是合并肝硬化HCC术后早期复发风险因素.肝硬化程度,术后早期复发和复发后治疗是术后总体生存影响因素.划分肝硬化程度和风险等级有助于预后评估.     

Endothelial nitric oxide synthase gene polymorphism in intron 4 affects the progression of renal failure in non-diabetic renal diseases.

BACKGROUND: Nitric oxide is a very potent regulator of intrarenal haemodynamics and is thought to be an important factor in the deterioration of renal function. Our study sought to verify the hypothesis that endothelial nitric oxide synthase (ecNOS) gene polymorphism in intron 4 might have some relevance to progression in chronic renal failure. METHODS: We studied the frequencies of gene polymorphism of ecNOS intron 4 in patients with end-stage renal disease (302 cases) and compared it with that of healthy subjects (248 cases). ecNOS genotypes were determined by the polymerase chain reaction, followed by agarose gel electrophoresis. RESULTS: Two alleles of ecNOS intron 4, labelled a and b could be detected; a has four and b has five tandem 27-bp repeats. The frequencies of ecNOS4b/b, ecNOS4b/a, ecNOS4a/a genotypes were 81.0% (201/248), 19. 0% (47/248), 0.0% (0/248) in the control group, and 74.8% (226/302), 23.5% (71/302), l.7% (5/302) in all the patients, 72.7% (168/231), 25.1% (58/231), 2.2% (5/231) in the group with end-stage renal diseases, excluding diabetic nephropathy (non-DM group), and 81.7% (58/71), 18.3% (13/71), 0.0% (0/71) in diabetic nephropathy (DM group) respectively. The frequency of the ecNOS4a (ecNOSb/a, and ecNOSa/a) in all the patients and in the non-DM group were significantly higher than that in the control group (P=0.021; P=0. 0096 respectively). In contrast, there was no significant difference in the frequencies of ecNOS genotypes between the DM group and the control group (P=0.81). CONCLUSION: Among the frequencies of ecNOS intron 4 gene polymorphism, a allele displayed a significantly higher frequency in cases with end-stage renal failure (ESRF) not caused by diabetic nephropathy. ecNOS gene polymorphism in intron 4 appears, therefore, to affect the progression of renal failure in non- diabetic renal diseases, but the same conclusion could not be drawn in diabetic nephropathy.     

Prognostic significance of pseudocapsule status in patients with metastatic renal cell carcinoma treated with tyrosine kinase inhibitors

BackgroundWe sought to determine whether pseudocapsule (PS) features have prognostic implications in patients with metastatic renal cell carcinoma (mRCC).MethodsWe retrospectively reviewed 231 patients diagnosed with mRCC and treated with tyrosine kinase inhibitors; 188 patients with data available regarding the tumor-parenchyma interfacial PS of the primary tumor were enrolled for analysis. PS status was evaluated as intact (grade 0), merely involved (grade 1), penetrated (grade 2), and absent (grade 3). We applied the Kaplan-Meier method and Cox regression model to assess the survival impact.ResultsOf the 188 patients, 19 (10.1%), 61 (32.4%), 96 (51.1%) and 12 (6.4%) had grade 0, 1, 2 and 3 PS, respectively. PS status was significantly associated with histology (P=0.0206), venous tumor embolus (P=0.0511), microvascular invasion (P=0.0108) and microsatellite formation (P=0.0097). Patients without a PS had the worst overall survival (OS), with a 3-year OS rate of 12.7%, whereas the OS rates for grades 0, 1 and 2 were 78.8%, 50.8% and 43.6%, respectively. Adjusted by other variables, grade 3 and grade 2 PS gave rise to a much higher risk of death across the cohort [hazard ratio (HR) =5.217, P=0.0182; HR =3.765, P=0.0281, respectively]. Sarcomatoid change was also an independent factor for OS (HR =2.932, P=0.0075). In contrast, microsatellite formation was not associated with survival in the cohort.ConclusionsPS status has prognostic implications for OS in metastatic renal cancer. The absence of the PS and sarcomatoid change are two pathological features related to an extremely poor prognosis.     

Influence of the tumor site and histopathology after resection for non-colorectal non-neuroendocrine liver metastases. A single center experience

IntroductionIt remains unclear whether liver resection is justified in patients with non-colorectal non-neuroendocrine liver metastases (NCNNLM). A single-center study was conducted to analyse overall survival (OS), disease-free survival (DFS), and potential prognostic factors in patients with different types of NCNNLM.MethodA retrospective analysis of all patients who underwent liver resection of NCNNLM from January 2006 to July 2019 was performed.ResultsA total of 62 patients were analyzed. 82.3% presented metachronous metastases and 74.2% were unilobar. The most frequent primary tumor site (PTS) were breast (24.2%), urinary tract (19.4%), melanoma (12.9%), and pancreas (9.7%). The most frequent primary tumor pathologies were breast carcinoma (24.2%), non-breast adenocarcinoma (21%), melanoma (12.9%) and sarcoma (12.9%). The most frequent surgical procedure performed was minor hepatectomy (72.6%). R0 resection was achieved in 79.5% of cases. The major complications’ rate was 9.7% with a 90-day mortality rate of 1.6%. The 1, 3 and 5-year OS/DFS rate were 65%/28%, 45%/36% and 46%/28%, respectively. We identified the response to neoadjuvant therapy and PTS as possible prognostic factors for OS (P =0.06) and DFS (P =0.06) respectively.ConclusionBased on the results of our series, NCNNLM resection produces beneficial outcomes in terms of OS and DFS. PTS and the response to neoadjuvant therapy could be the main prognostic factors after resection.     

小野寺营养预后指数在胃癌患者预后评估中的价值

目的探讨应用小野寺营养预后指数(Onodera's prognostic nutritional index,Onodera's PNI)评估胃癌患者预后的价值。方法 2000年1月~2014年1月收治的胃癌患者386例,收集患者术前血液检查结果(包括血清白蛋白水平、外周血总淋巴细胞计数),计算每~例患者术前Onodera's PNI。根据PNI分为营养较好组(201例,PNI≥48)和营养较差组(185例,PNI48)。分析PNI与临床病理特征、术后并发症及预后的相关性,并通过Cox回归模型筛选影响胃癌患者的预后因素。结果 386例患者术前平均PNI为50.6±5.7。年龄≥65岁者平均PNI为48.5±5.7,65岁者为51.8±5.4,两组比较差异有统计学意义(P0.01);pT3/T4期及有淋巴结转移者与pT1/T2期及无淋巴结转移者比较平均PNI均明显降低(P0.01)。两组患者术后总体并发症发生率分别为6.5%(13/201)和15.6%(29/185),差异有统计学意义(P0.01)。有并发症组平均PNI值为(49.2±5.4),无并发症组为(51.6±5.3),两组比较差异有统计学意义(P0.05)。相关分析显示,PNI与患者年龄、肿瘤侵润深度、淋巴结转移状况、术后总体并发症率具有相关性(P0.05)。营养较好组和营养较差组术后5年总体生存(OS)率及无瘤生存(DFS)率分别为86.2%比52.1%(χ~2=9.28,P0.01)及83.5%比53.7%(χ~2=9.36,P0.01)。多因素Cox回归分析证实,营养预后指数是影响胃癌患者预后的独立预测因素(HR=2.16,95%CI:1.57~3.26,P0.01)。结论小野寺营养预后指数能较好地反映胃癌患者的营养状态、手术风险及预后,是独立于TNM分期的一种胃癌患者长期结果的预测指标,其获得简单方便。