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Surgical techniques to prevent delayed gastric emptying after pancreaticoduodenectomy

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hepatobiliary & Pancreatic Diseases International 2024年第5期23卷 449-457页

作者： Peng Duan Lu Sun Kai Kou Xin-Rui Li Ping Zhang Department of hepatobiliary and Pancreatic surgery General Surgery Centerthe First Hospital of Jilin UniversityChangchun 130021China Department of Dental Implantology Hospital of StomatologyJilin UniversityChangchun 130021China

Background: Delayed gastric emptying(DGE) is one of the most common complications after pancreaticoduodenectomy(PD). DGE represents impaired gastric motility without significant mechanical obstruction and is associated with an increased length of hospital stay, increased healthcare costs, and a high readmission rate. We reviewed published studies on various technical modifications to reduce the incidence of DGE. Data sources: Studies were identified by searching Pub Med for relevant articles published up to December 2022. The following search terms were used: “pancreaticoduodenectomy”, “pancreaticojejunostomy”, “pancreaticogastrostomy”, “gastric emptying”, “gastroparesis” and “postoperative complications”. The search was limited to English publications. Additional articles were identified by a manual search of references from key articles. Results: In recent years, various surgical procedures and techniques have been explored to reduce the incidence of DGE. Pyloric resection, Billroth II reconstruction, Braun's enteroenterostomy, and antecolic reconstruction may be associated with a decreased incidence of DGE, but more high-powered studies are needed in the future. Neither laparoscopic nor robotic surgery has demonstrated superiority in preventing DGE, and the use of staplers is controversial regarding whether they can reduce the incidence of DGE. Conclusions: Despite many innovations in surgical techniques, there is no surgical procedure that is superior to others to reduce DGE. Further larger prospective randomized studies are needed.

关键词： Pancreaticoduodenectomy Delayed gastric emptying Postoperative complications Surgical techniques

Achieving laparoscopic anatomic resection for hepatocellular carcinoma by fluorescence guided positive staining of hepatic cone unit

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hepatobiliary & Pancreatic Diseases International 2024年第4期23卷 406-411页

作者： Jun-Fang Deng Chuan-Hui Peng Yu Zhang Xiao-Feng Xu Rong-Liang Tong Zheng-Long Zhai Di-Yu Chen Cheng Zhang Li-Ming Wu Jian Wu Division of hepatobiliary Pancreatic surgery the First Affiliated HospitalZhejiang University School of MedicineHangzhou 310003China

Laparoscopic anatomical liver resection has been increasingly reported worldwide,but how to demarcate the resection planes is technically challenging[1].Positive staining technique with intraoperative indocyanine green(ICG)-fluorescence imaging has been introduced as an effective tool for real-time intraoperative guidance[2].Liver anatomy is ***,liver is composed of 9 segments,each is composed of two to three subsegments,and each subsegment contains several hepatic cone units.A hepatic cone unit is dominated by a tertiary or quaternary hepatic pedicles[3].

关键词： hepatic resection anatomy

Comparison of the clinical effects of dual-modality endoscopy and traditional laparotomy for the treatment of intra-and extrahepatic bile duct stones

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World Journal of Gastrointestinal surgery 2024年第3期16卷 759-767页

作者： Wei Wang Hui Xia Bin Dai Department of hepatobiliary surgery Wuhan No.1 HospitalWuhan 430030Hubei ProvinceChina

BACKGROUND Bile duct stones(BDSs)may cause patients to develop liver cirrhosis or even liver ***,the success rate of surgical treatment for intrahepatic and extrahepatic BDSs is not satisfactory,and there is a risk of postoperative *** To compare the clinical effects of dual-modality endoscopy(duodenoscopy and laparoscopy)with those of traditional laparotomy in the treatment of intra-and extrahepatic *** Ninety-five patients with intra-and extrahepatic BDSs who sought medical services at Wuhan No.1 hospital between August 2019 and May 2023 were selected;45 patients in the control group were treated by traditional laparotomy,and 50 patients in the research group were treated by dual-modality *** following factors were collected for analysis:curative effects,safety(incision infection,biliary fistula,lung infection,hemobilia),surgical factors[surgery time,intraoperative blood loss(IBL)volume,gastrointestinal function recovery time,and length of hospital stay],serum inflammatory markers[tumor necrosis factor(TNF)-α,interleukin(IL)-6,and IL-8],and oxidative stress[glutathione peroxidase(GSH-Px),superoxide dismutase(SOD),malondialdehyde(MDA),and advanced protein oxidation products(AOPPs)].RESULTS The analysis revealed markedly better efficacy(an obviously higher total effective rate)in the research group than in the control *** addition,an evidently lower postoperative complication rate,shorter surgical duration,gastrointestinal function recovery time and hospital stay,and lower IBL volume were observed in the research ***,the posttreatment serum inflammatory marker(TNF-α,IL-6,and IL-8)levels were significantly lower in the research group than in the control *** with those in the control group,the posttreatment GSH-Px,SOD,MDA and AOPPs in the research group were equivalent to the pretreatment levels;for example,the GSH-Px and SOD levels were significantly higher,while the MDA and AOPP levels were

关键词： Dual-modality endoscopy Traditional laparotomy Intra-and extrahepatic bile duct stones Clinical efficacy

Predicting the prognosis of hepatic arterial infusion chemotherapy in hepatocellular carcinoma

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World Journal of Gastrointestinal Oncology 2024年第6期16卷 2380-2393页

作者： Qi-Feng Wang Zong-Wei Li Hai-Feng Zhou Kun-Zhong Zhu Ya-Jing Wang Ya-Qin Wang Yue-Wei Zhang Department of hepatobiliary Pancreatic Center Beijing Tsinghua Changgung Hospital Affiliated to Tsinghua UniversityBeijing 102218China Department of hepatobiliary and Pancreatic surgery Qinghai University Affiliated HospitalXining 810000Qinghai ProvinceChina

Hepatic artery infusion chemotherapy(HAIC)has good clinical efficacy in the treatment of advanced hepatocellular carcinoma(HCC);however,its efficacy *** review summarized the ability of various markers to predict the efficacy of HAIC and provided a reference for clinical *** of October 25,2023,51 articles have been retrieved based on keyword predictions and *** eligible articles were selected for inclusion in this *** literature analysis found that methods used to predict the efficacy of HAIC include serological testing,gene testing,and imaging *** above indicators and their combined forms showed excellent predictive effects in retrospective *** review summarized the strategies currently used to predict the efficacy of HAIC in middle and advanced HCC,analyzed each marker's ability to predict HAIC efficacy,and provided a reference for the clinical application of the prediction system.

关键词： Hepatocellular carcinoma Hepatic artery infusion chemotherapy Prediction Prognosis Imaging Biomarkers Genomics

Classification of anatomical morphology of cystic duct and its association with gallstone

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World Journal of Gastrointestinal surgery 2024年第2期16卷 307-317页

作者： Jia-Hai Zhu Song-Ling Zhao Qiang Kang Ya Zhu Li-Xin Liu Hao Zou Department of hepatobiliary Pancreatic surgery The Second Affiliated Hospital of Kunming Medical UniversityKunming 650106Yunnan ProvinceChina Department of hepatobiliary surgery The Second Affiliated HospitalKunming Medical UniversityKunming 650106Yunnan ProvinceChina

BACKGROUND Gallstones are common lesions that often require surgical ***-scopic cholecystectomy is the treatment of choice for symptomatic ***,the anatomical morphology of the cystic duct(CD),needs to be accurately recognized,especially when anatomical variations occur in the CD,which is otherwise prone to bile duct ***,at present,there is no optimal classification system for CD morphology applicable in clinical practice,and the relationship between anatomical variations in CDs and gallstones remains to be *** To create a more comprehensive clinically applicable classification of the morphology of CD and to explore the correlations between anatomic variants of CD and *** A total of 300 patients were retrospectively enrolled from October 2021 to January *** patients were divided into two groups:The gallstone group and the nongallstone *** clinical data and anatomical data of the CD based on magnetic resonance cholangiopancreatography(MRCP)were collected and analyzed to propose a morphological classification system of the CD and to explore its relationship with *** analysis was performed using logistic regression analyses to identify the independent risk factors using variables that were significant in the univariate *** Of the 300 patients enrolled in this study,200(66.7%)had *** mean age was 48.10±13.30 years,142(47.3%)were male,and 158(52.7%)were female.A total of 55.7%of the patients had a body mass index(BMI)≥24 kg/*** on the MRCP,the CD anatomical typology is divided into four types:Type I:Linear,type II:n-shaped,type III:S-shaped,and type IV:*** analysis revealed differences between the gallstone and nongallstone groups in relation to sex,BMI,cholesterol,triglycerides,morphology of CD,site of CD insertion into the extrahepatic bile duct,length of CD,and angle between the common hepatic duct and *** to

关键词： Cystic duct Gallstone Classification Anatomy Magnetic resonance cholangiopancreatography Risk factor

Biotin-modified Galactosylated Chitosan-gene Carrier in Hepatoma Cells Targeting Delivery

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Journal of Wuhan University of Technology(Materials Science) 2024年第2期39卷 522-531页

作者：程明荣张锋李清王华 Department of General surgery Nanxiang Branch of Ruijin HospitalShanghai 201802China Minhang District Pujin Community Health Service Center Shanghai 201112China hepatobiliary surgery Center Tongji Hospital Affiliated to Tongji UniversityShanghai 200065China

Our previous studies have successfully grafted biotin and galactose onto chitosan(CS)and synthesized biotin modified galactosylated chitosan(Bio-GC).The optimum N/P ratio of Bio-GC and plasmid DNA was 3:*** this N/P ratio,the transfection efficiency in the hepatoma cells was the highest with a slow release ***-GC nanomaterials exhibit the protective effect of preventing the gene from nuclease degradation,and can target the transfection into hepatoma cells by combination with galactose and biotin *** transfection rate was inhibited by the competition of galactose and ***-GC nanomaterials were imported into cells’cytoplasm by their receptors,followed by the imported exogenous gene transfected into the ***-GC nanomaterials can also cause inhibitory activity in the hepatoma cells in the model of orthotopic liver transplantation in mice,by carrying the gene through the blood to the hepatoma *** together,bio-GC nanomaterials act as gene vectors with the activity of protecting the gene from DNase degradation,improving the rate of transfection in hepatoma cells,and transporting the gene into the cytoplasm in vitro and in ***,they are efficient hepatoma-targeting gene carriers.

关键词： gene vector hepatocellular carcinoma nanoparticles sustained release gene therapy

Acute suppurative terminal cholangitis:Clinical characteristics of a new subtype of acute cholangitis

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hepatobiliary & Pancreatic Diseases International 2024年第3期23卷 293-299页

作者： Rong-Tao Zhu Ye Li Chi-Xian Zhang Wei-Jie Wang Ruo-Peng Liang Jian Li Kai Bai Yu-Ling Sun Department of hepatobiliary and Pancreatic surgery the First Affiliated Hospital of Zhengzhou UniversityZhengzhou 450052China Zhengzhou Key Laboratory of hepatobiliary and Pancreatic Diseases Zhengzhou 450052China Institute of hepatobiliary and Pancreatic Diseases Zhengzhou UniversityZhengzhou 450052China Department of Pathology the First Affiliated Hospital of Zhengzhou UniversityZhengzhou 450052China

Background:Acute suppurative terminal cholangitis(ASTC)is rarer than acute obstructive cholangitis and is not well *** explore this subtype of acute cholangitis,we described our clinical experience with ***:We performed a retrospective review of patients with ASTC admitted to our center from September 2014 to August *** analyzed their clinical characteristics,including etiology,clinical manifestations,imaging features,treatment and ***:A total of 32 ASTC patients were included in the *** majority of the patients had a history of biliary operations,and clinical manifestations were occult and *** positive rate of bacterial culture was 46.9%.All the patients had typical imaging features on computed tomography and magnetic resonance *** with effective antibiotics was provided as soon as diagnosis was *** treatment,most patients had a good *** levels of total bilirubin,aspartate aminotransferase,procalcitonin and gamma-glutamyltransferase were the characteristics of critically ill patients and were associated with relatively poor ***:Our results demonstrated that ASTC should be recognized as a new subtype of acute cholangitis,and that earlier diagnosis and more personalized treatments are needed.

关键词： Acute suppurative terminal cholangitis Acute cholangitis Gram-negative bacterial infections Diagnosis Treatment

T-tube bridging fistula jejunal anastomosis for treatment of pancreatic lumbar dorsal fistula after necrotizing pancreatitis

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hepatobiliary & Pancreatic Diseases International 2024年第4期23卷 428-430页

作者： Su-Lai Liu Guo-Guang Li Wei Cheng Chuang Peng Ying-Hui Song Department of hepatobiliary surgery Hunan Provincial People’s Hospital/The First Affiliated Hospital of Hunan Normal UniversityChangsha 410000China

Infectious pancreatic necrosis causes external pancreatic fistula in some ***,external pancreatic fistula requires fistula-gastric and/or intestinal anastomosis,and digestive endoscopic interventional treatment[1–3].It is especially difficult to treat external pancreatic fistulas with small fistulas where the external fistula is located in the lower *** common treatment is to remove the body and tail of the pancreas and the *** operation is very traumatic.A new pancreatic fistula may still occur at the pancreatic *** above operations may lead to unnecessary resection of the spleen,colon injury and other *** order to solve this problem,we innovatively used T-tube bridging fistula jejunal anastomosis plus continuous negative pressure suction to treat three cases of external pancreatic fistulas in the lower back,and all of them achieved good results.

关键词： fistula anastomosis spleen

Middle hepatic vein variation provides a safe path for anterior transection of hepatocellular carcinoma in caudate lobe

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hepatobiliary & Pancreatic Diseases International 2024年第4期23卷 438-440页

作者： Bing-Yi Lin Qi-Jun Zhang Zhe Yang Shu-Sen Zheng Department of hepatobiliary and Pancreatic surgery The First Affiliated HospitalZhejiang University School of MedicineHangzhou 310003China Department of Thyroid surgery The First Affiliated HospitalZhejiang University School of MedicineHangzhou 310003China Division of hepatobiliary Pancreatic surgery Shulan(Hangzhou)HospitalZhejiang Shuren University School of MedicineHangzhou 310000China

To the Editor:Hepatocellular carcinoma(HCC)is one of the main causes of cancer related death worldwide,and new cases are expected to continue to increase in future[1].Surgical resection is still the best way to remove the tumor and improve patient’s ***,resection of caudate lobe often presents a technical challenge,even to accomplished hepatic *** lobe is located anterior to the inferior vena cava(IVC)and posterior to the bifurcation of the portal vein(PV),generally consists of three regions:the paracaval portion,the left Spiegel lobe and the process portion[2].The anatomy of the paracaval portion includes the liver parenchyma ventral to the hepatic IVC and the area between the Spiegel lobe and the right lobe adjacent to the middle hepatic vein(MHV)ventrally,which was classified by Couinaud as segment IX[3].Here,we presented a case of HCC with successful downstaging therapy,as well as variation of MHV,which provides a safe path for anterior transection of segment IX.

关键词： hepatic anatomy Middle