ObjectiveTo explore it's advantages and disadvantages through analyzed the data of associating liver partition with portal vein ligation for staged hepatectomy (ALPPS) operation in 3 cases of liver cancer patients with cirrhosis. MethodsThe data of 3 patients perfomed ALPPS operation were retrospectively analyzed, through the preoperative evaluation, intraoperative and postoperative treatment points analyzed to explore the pros and cons. ResultsOne case died of hepatic failure, and the remaining two cases were still alive. The highest score of MELD of liver failure in death case was 18.8 scores, and the other cases of MELD score were decreased after second operation. The average increased volume of liver was 225 mL, and the liver volume was significantly increased (P=0.002). ConclusionsALPPS make a portion of huge liver cancer patients combining with cirrhosis having a chance to surgery. But it is necessary to consider in patients with preoperative state, surgical risk, prognosis and economic conditions,in order to determine whether patients can benefit from ALPPS.
ObjectiveTo summarize the progress of associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) and evolution of surgical procedure improvement, so as to summarize experience in selecting appropriate surgical method for patients. MethodThe domestic and foreign literature on the evolution of ALPPS surgical procedure improvement in recent years was reviewed. ResultsIn the decade since the emergence of ALPPS, the ALPPS had been rapidly developed in the hepatobiliary surgery. The ALPPS promoted a rapid increase in future liver remnant during a relatively shorter period to contribute to resectability of liver tumors and reduce the rate of postoperative liver failure, the patients with intermediate to advanced and huge liver cancer could obtain the surgical radical resection. In recent years, the domestic and foreign experts had refined the ALPPS procedure, which mainly focused on the operation of hepatic section separation and hepatic artery flow restriction in stage Ⅰ surgery, including partial ALPPS, radiofrequency ablation ALPPS, tourniquet ALPPS, transcatheter arterial embolization ALPPS, hepatic artery ringed and operation ALPPS, as well as laparoscopic ALPPS and robotic ALPPS with minimally invasive approach. ConclusionsDespite the ongoing controversy over ALPPS, with the continuous progress and innovation of improved procedures and the utilization of laparoscope and robot in surgery, the trauma of ALPPS surgery has a further reduction, and the morbidity and mortality have gradually been decreased. It is believed that with the continuous advancement and improvement of ALPPS surgery technology, the indications and safety of ALPPS will be further enhanced, bringing hope to more patients with intermediate to advanced liver cancer with huge tumors.
Objective The current study aimed to compare the differences in clinical characteristics and prognosis of elderly patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection between patients who were vaccinated and those not and to explore the clinical significance of vaccination for the elderly.Methods A total of 92 elderly patients (≥60 years old) with SARS-CoV-2 infection who were admitted to Chengdu Public Health Clinical Center from December 10, 2020, to May 2, 2022, were included, and they were grouped according to whether vaccinated. The differences in clinical manifestations, laboratory examinations, imaging, treatment, prognosis, hospitalization time, and nucleic acid conversion time between the two groups were compared in this study. Results A total of 92 elderly patients were included, with a male-to-female ratio of 1.3:1, and a median age of 66 (62, 71) years old. There were 79 patients in the vaccinated group and 13 in the unvaccinated group. The positive rate of total SARS-CoV-2 antibody in 92 patients was 91.3%, and those of IgG and IgM of SARS-CoV-2 antibody were 89.1% and 37%, respectively. The positive rates of total SARS-CoV-2 antibody and IgG of SARS-CoV-2 antibody in the vaccinated group were higher than those in the unvaccinated group (97.5% vs. 53.8%, 96.2% vs. 46.2%) (P<0.01), and COI values of total antibody, IgM and IgG were higher than those of unvaccinated group (P<0.01). The proportions of the initial symptoms of sputum, ground-glass opacity or patchy opacity involving both lungs in chest CT in the unvaccinated group were higher than those in the vaccinated group (P<0.05). The white blood cell counts and platelet counts in the vaccinated group were higher than those in the unvaccinated group, whereas the prothrombin time and D-dimer were lower than those in the unvaccinated group (P<0.05). COI values of total antibody in the 3-doses group were higher than those in the 2-doses group, and the white blood cell counts in the 3-doses group were higher than those in the 2-doses group (all P<0.05). During hospitalization, asymptomatic infection (58.2%) and general type (53.8%) was the most common in the vaccinated and unvaccinated group, respectively. Patients in the unvaccinated group were more likely to progress to severe status than the vaccinated group during hospitalization (15.4% vs. 0%, P=0.019). The unvaccinated group received more treatments of intravenous immune globulin, non-invasive and invasive mechanical ventilation, plasma after immunization of vaccine and convalescent plasma of SARS-CoV-2 infected patients than those of the vaccinated group (P<0.05). Patients in the unvaccinated group developed a higher proportion of respiratory failure, secondary infection, acute respiratory distress syndrome, and heart failure than in the vaccinated group (P< 0.05). The median lengths of hospitalization and nucleic acid conversion in the unvaccinated group were 22 (7, 32) days and 13 (2, 20) days, which were longer than those in the vaccinated group [8 (7, 12) days, 2 (2, 7) days] (all P<0.05). Conclusions Vaccination of SARS-CoV-2 can improve the positive rate of total SARS-CoV-2 antibody and IgG of SARS-CoV-2 antibody in elderly patients with SARS-CoV-2 infection, milder disease status, and can shorten the time of hospitalization and nucleic acid conversion. These results suggest that the COVID-19 vaccine can reduce the disease and improve the prognosis in the elderly.
ObjectiveTo explore the clinical application and effectiveness of antibiotic-loaded cement spacer combined with free fibular graft in the staged treatment of infectious long bone defect in the lower extremity. MethodsA retrospective analysis was made on the clinical data from 12 patients with infectious long bone defect in the lower extremity between June 2010 and June 2012. Of the 12 cases, there were 9 males and 3 females with an average age of 33 years (range, 19-46 years), including 3 cases of femoral shaft bone defect, 7 cases of tibial shaft bone defect, and 2 cases of metatarsal bone defect. The causes were traffic accident injury in 7 cases, crashing injury in 3 cases, and machine extrusion injury in 2 cases. The length of bone defect ranged from 6 to 14 cm (mean, 8 cm). The soft tissue defect area ranged from 5.0 cm×3.0 cm to 8.0 cm×4.0 cm companied with tibial shaft and metatarsal bone defect in 9 cases. The sinus formed in 3 femoral shaft bone defects. The time between injury and operation was 1-4 months (mean, 2 months). At first stage, antibiotic-loaded cement spacer was placed in the bone defect after debridement and the flaps were used to repair soft tissue defect in 9 cases; at second stage (6 weeks after the first stage), defect was repaired with free fibular graft (7-22 cm in length, 14 cm on average) after antibiotic-loaded cement spacer removal. The area of the cutaneous fibular flap ranged from 6.0 cm×4.0 cm to 10.0 cm×5.0 cm in 10 cases. ResultsAll wounds healed by first intention, and the healing time was 12-18 days, 14 days on average. Twelve cases were followed up 12-36 months (mean, 17 months). Bone healing time ranged from 4 to 6 months (5.5 months on average). The cutaneous fibular flap had good appearance. The function at donor site was satisfactory; no dysfunction of the ankle joint or tibial stress fracture occurred after operation. The mean Enneking score was 25 (range, 20-28) at last follow-up. ConclusionInfection can be well controlled with the antibiotic-loaded cement spacer during first stage operation, and free fibular graft can increase the bone defect healing rate at second stage. Staged treatment is an optimal choice to treat infectious long bone defect in the lower extremity.
ObjectiveTo evaluate the effectiveness and safety of associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) combined with laparoscopic-assisted microwave ablation (Lap-MWA) for the liver resection in the treatment of unresectable primary hepatic carcinoma. Methods This study analyzed the clinical data of 12 hepatic carcinoma patients who underwent ALPPS combined with Lap-MWA for the liver resection from January 2019 to June 2021 in the Department of Hepato-Pancreato-Biliary Surgery of Qinzhou First People’s Hospital. The patients had insufficient future liver remnant (FLR) and different degrees of liver cirrhosis. The 1-stage ALPPS was to perform after the laparoscopic-assisted ligation of the portal vein of the loaded tumor. At the same time, the microwave ablation was used for the liver parenchyma segmentation under the guidance of laparoscopic ultrasound (LUS) without separating liver parenchyma. Other steps were the same as classic ALPPS. Results All the 12 patients successfully completed the operation. The 1-stage ALPPS lasted 90–130 min, (110.25±35.34) min; the blood loss was 80–140 mL, (100.37±42.24) mL. The interval between 2 stages was 12–16 d, (14.0±2.5) d. The FLR/standard liver volume (SLV) increased to (58.00±3.30) %. The 2-stage ALPPS lasted 120–180 min, (150±30) min; the blood loss was 300–1 200 mL, (453.50±107.70) mL; the hospital stay after 2 stages of ALPPS operations was 11–16 d, (14±2) d. Among all patients, 4 U of leukocyte suspension was transfused in 1 patient, and pleural ascites occurred in 3 patients. There were no serious complications such as liver failure and severe infection, and no death cases. The total hospital stay was 14–22 d, (17±3) d. After the 1-stage ALPPS, the total bilirubin, white blood cells, glutamic-pyruvic transaminase level increased (P＜0.05), and total bilirubin and white blood cells gradually returned to the normal level on the 5th day after 1-stage ALPPS. On the 1st day after finishing the 2-stage ALPPS, albumin and hemoglobin decreased, while white blood cells, total bilirubin, prothrombin time and glutamic-pyruvic transaminase increased in varying degrees (P<0.05). And on the 5th day after the 2-stage ALPPS, all indicators gradually returned to normal. All the patients were followed up for 6–30 months, (20±6) months. Two patients died of tumor recurrence and metastasis at 6.2 months and 13 months after the surgery, respectively. No recurrence was found in other patients, and their life quality was good. Conclusion Preliminary results of this study indicate that ALPPS combined with Lap-MWA is safe and effective for the treatment of unresectable primary hepatic carcinoma.
ObjectiveTo investigate the effectiveness of combined tissue transplantation for repair of serially damaged injuries on radial side of hand and function reconstruction. MethodsBetween May 2013 and May 2017, 34 cases of serially damaged injuries on radial side of hand were treated. There were 29 males and 5 females; aged 17-54 years, with an average of 32.1 years. There were 23 cases of crushing injuries, 5 cases of bruising injuries, 4 cases of machine strangulation injuries, and 2 cases of explosion injuries. The time from injury to admission was 40 minutes to 3 days, with an average of 10 hours. According to the self-determined serially damaged injuries classification standard, there were 1 case of typeⅠa, 2 cases of typeⅠb, 10 cases of typeⅡa, 5 cases of type Ⅱb, 3 cases of type Ⅱc, 1 case of type Ⅱd, 7 cases of type Ⅲa, 3 cases of type Ⅲb, 1 case of type Ⅲc, and 1 case of type Ⅲd. According to the classification results, the discarded finger, nail flap, the second toe, anterolateral thigh flap, ilium flap, fibula flap, and other tissue flaps were selected to repair hand wounds and reconstruct thumb, metacarpal bones, and fingers. ResultsAfter operation, 2 cases of flaps developed vascular crisis and survived after symptomatic treatment; the other transplanted tissue survived smoothly. All cases were followed up 1 to 7 years, with an average of 2.4 years. The average fracture healing time was 7.4 weeks (range, 5.3-9.0 weeks). At last follow-up, the reconstructed fingers and the grafted flaps recovered good sensory function, with a two-point discrimination of 5 to 11 mm (mean, 9 mm). According to the evaluation standard of the upper limb function evaluation of the Chinese Medical Association Hand Surgery Society, the reconstructed thumb was rated as excellent in 24 thumbs, good in 8 thumbs, and fair in 2 thumbs; the reconstructed finger was rated as excellent in 18 fingers, good in 2 fingers, and fair in 1 finger. ConclusionFor the serially damaged injuries on radial side of hand, according to its classification, different tissues are selected for combined transplantation repair and functional reconstruction, which can restore hand function to the greatest extent and improve the quality of life of patients.
Objective To explore current results after staged operations in patients with functional single ventricle anomalies and pulmonary hypertension. Methods We retrospectively analyzed the clinical data of 129 patients with functional single ventricle anomalies and pulmonary hypertension undergoing pulmonary artery banding in our hospital between April 2008 and December 2015. There were 81 males and 48 females. There were 71 patients with double outlet of right ventricle, 17 patients with tricuspid atresia, 7 patients with transposition of great arteries, 33 patients with uni-ventricular heart, and one patient with complete atrio-ventricular septal defect. The surgical results, transition to Glenn procedure and subsequent transition to Fontan procedure were analyzed. Results The 129 patients underwent 159 operations of pulmonary artery banding totally. Hospital mortality was 4.7% (6/129). Nine patients were lost to follow-up. Eighty-seven (67.4%) patients underwent the second-stage Glenn procedure, and 43 patients(33.3%) underwent third-stage Fontan procedure. Two patients died after Glenn and 3 patients died after Fontan separately. There were 32 patients who accompanied with coarctation, interruption of aortic arch, heterotaxy, total anomalous pulmonary venous connection or atrio-ventricular valve regurgitation. Fifteen (46.9%) patients succeeded in transition to Glenn, and 6 (18.8%) patients succeeded in transition to Fontan. Fourteen patients developed obstruction of left ventricular outlet tract or bulbo-ventricular foramen. Conclusion Early pulmonary artery banding is an acceptable strategy for patients with single ventricle anomalies and pulmonary hypertension. Outcomes and results of subsequent Glenn and Fontan procedures are generally good. Accompanied complex anomalies are risk factors for lower ratio of transition to Glenn and Fontan procedure.
ObjectiveTo analyze the clinical effects of staged repair for severe tetralogy of Fallot (TOF), and to investigate a better individual treatment of TOF. MethodsWe retrospectively analyzed the clinical data of 110 children with TOF in our hospital from January 2009 through December 2014. The patients were divided into a severe TOF group (Group A, n=23) and a mild TOF group (Group B, n=87). In the group A, all 23 patients underwent staged surgery (modified Blalock-Taussig and radical operation of TOF). In the Group B, all 87 patients only received a radical operation of TOF. The patients' preoperative and postoperative arterial oxygen saturation, McGoon ratio, left ventricular end-diastolic volume index (LVEDVI), the results of perioperation and follow-up were compared. ResultsIn the group A, there was no death after modified Blalock-Taussig (MBT). The median interval time between MBTs and radical operation was 9 months (ranged from 6.3 to 25.3 months). Compared with that before MBTs, the McGoon ratio and LVEDVI were significantly increased at the time of radical operation. And the pulmonary artery development and left ventricle volume reached the standard of radical operation of TOF (P < 0.01). After the radical operation, one patient died for pneumonia in the early postoperation period. In the group B, three patients died for low cardiac output syndrome during perioperation. There was no significant difference between the group A and the group B in in-hospital mortality, length of hospital stay, intensive care unit (ICU) stay, ventilation time, cardiopulmonary bypass time, aortic cross-clamp time, rate of using trans-annular repair path, or drainage of pleural fluid. ConclusionStaged repair of severe TOF is safe and effective for children, who are not suitable for one-stage radical operation. Severe TOF received staged repair can achieve the similar outcomes with that of mild TOF underwent one-stage radical operation.
ObjectiveTo investigate the role of endoplasmic reticulum stress in liver regeneration after associating liver partition and portal vein ligation for staged hepatectomy (ALPPS).MethodsSeventy-two C57bl/6 mice were randomly divided into ALPPS group, portal vein ligation group (PVL group), and sham operation group (Sham group), 24 mice in each group. And then one-stage ALPPS operation, simple PVL, and sham operation will be performed. Six mice were randomized selected of the three groups on the 1st, 2nd, 4th, and 7th day after surgery, respectively, the liver weight to body weight ratio (FLR/BW) of each group was measured, and the liver tissues were taken for immunohistochemical staining to calculate the proportion of Ki-67 positive cells, Western blot was used to detect the expression levels of X-box binding protein 1 (XBP1) and inositol-requiring enzyme 1α (IRE1α) proteins.Results① FLR/BW: On the 4th day and the 7th day after operation, the FLR/BW of the Sham group, PVL group, and ALPPS group increased in sequence at the same time, and the difference between the three groups was statistically significant (P<0.05). ② Ki-67 positive cell ratio: On the 2nd day after operation, the ratio of Ki-67 positive cells in the Sham group, PVL group, and ALPPS group increased sequentially, and the difference between the two groups was statistically significant (P<0.05). On the 4th day after operation, the ratio of Ki-67 positive cells in the PVL group and the ALPPS group were still higher than that of the Sham group (P<0.05). ③ Expression levels of XBP1 and IRE1α: On the 2nd and 4th postoperative day, the expression levels of XBP1 and IRE1α in the ALPPS group were higher than those in the Sham group and the PVL group (P<0.05). On the 7th day after surgery, the expression levels of XBP1 and IRE1α in the ALPPS group were higher than those in the Sham group (P<0.05), while compared with the PVL group, the expression level of XBP1 in the ALPPS group was still higher (P<0.05).ConclusionsALPPS-induced liver regeneration is more advantageous than traditional PVL in mice. It may be attributed to the obvious endoplasmic reticulum stress activation after ALPPS leading to the up-regulation of IRE1α-XBP1 expression, which is involved in the regulation of hepatocyte cell cycle and promotes hepatocyte proliferation, thus promoting rapid liver regeneration.
Objective To explore application value of multi-disciplinary team (MDT) model in patient underwent associating liver partition and portal vein occlusion for staged hepatectomy (ALPPS). Methods A huge mass of liver right lobe about 90.9 mm×75.5 mm×77.5 mm was found by the preoperative abdominal CT examination, which was considered as the primary liver cancer. The ALPPS was decided to perform through the discussion by the Departments of Radiology, Anesthesiology, Infectious disease, Oncology, and Hepatobiliary surgery. The first step operation included the exploratory laparotomy, associating ligation of the right branch of portal vein and disconnection of left and right hemi liver, radiofrequency ablation, and cholecystectomy. The second step operation was performed at 45 d after the first step operation, which included the release of the abdominal adhesion and the resection of the right lobe of liver. Results During the period of the two steps surgeries, though the patient had the liver failure, hepatic encephalopathy, and poor proliferation of the left lobe of liver, and so on, the ALPPS was finished smoothly and the R0 resection was achieved through the collboration of MDT. After the surgery, the related complications were treated by the MDT, the patient got great recovery and no recurrence or metastasis occurred during the following-up. Conclusion It is feasible to use ALPPS in treatment of primary giant liver cancer under MDT model, it will be more conducive to clinical brainstorming for the best treatment and better income of patient.