BACKGROUND Biliary stone disease is a highly prevalent condition and a leading cause of hospitalization worldwide.Hepatolithiasis with associated strictures has high residual and recurrence rates after traditional mul...BACKGROUND Biliary stone disease is a highly prevalent condition and a leading cause of hospitalization worldwide.Hepatolithiasis with associated strictures has high residual and recurrence rates after traditional multisession percutaneous transhepatic cholangioscopic lithotripsy(PTCSL).AIM To study one-step PTCSL using the percutaneous transhepatic one-step biliary fistulation(PTOBF)technique guided by three-dimensional(3D)visualization.METHODS This was a retrospective,single-center study analyzing,140 patients who,between October 2016 and October 2023,underwent one-step PTCSL for hepatolithiasis.The patients were divided into two groups:The 3D-PTOBF group and the PTOBF group.Stone clearance on choledochoscopy,complications,and long-term clearance and recurrence rates were assessed.RESULTS Age,total bilirubin,direct bilirubin,Child-Pugh class,and stone location were similar between the 2 groups,but there was a significant difference in bile duct strictures,with biliary strictures more common in the 3D-PTOBF group(P=0.001).The median follow-up time was 55.0(55.0,512.0)days.The immediate stone clearance ratio(88.6%vs 27.1%,P=0.000)and stricture resolution ratio(97.1%vs 78.6%,P=0.001)in the 3D-PTOBF group were significantly greater than those in the PTOBF group.Postoperative complication(8.6%vs 41.4%,P=0.000)and stone recurrence rates(7.1%vs 38.6%,P=0.000)were significantly lower in the 3D-PTOBF group.CONCLUSION Three-dimensional visualization helps make one-step PTCSL a safe,effective,and promising treatment for patients with complicated primary hepatolithiasis.The perioperative and long-term outcomes are satisfactory for patients with complicated primary hepatolithiasis.This minimally invasive method has the potential to be used as a substitute for hepatobiliary surgery.展开更多
BACKGROUND Lymph node metastasis(LNM)significantly impacts the treatment and prognosis of early gastric cancer(EGC).Consequently,the precise prediction of LNM risk in EGC patients is essential to guide the selection o...BACKGROUND Lymph node metastasis(LNM)significantly impacts the treatment and prognosis of early gastric cancer(EGC).Consequently,the precise prediction of LNM risk in EGC patients is essential to guide the selection of appropriate surgical approaches in clinical settings.AIM To develop a novel nomogram risk model for predicting LNM in EGC patients,utilizing preoperative clinicopathological data.METHODS Univariate and multivariate logistic regression analyses were performed to examine the correlation between clinicopathological factors and LNM in EGC patients.Additionally,univariate Kaplan-Meier and multivariate Cox regression analyses were used to assess the influence of clinical factors on EGC prognosis.A predictive model in the form of a nomogram was developed,and its discrimination ability and calibration were also assessed.RESULTS The incidence of LNM in the study cohort was 19.6%.Multivariate logistic regression identified tumor size,location,degree of differentiation,and pathological type as independent risk factors for LNM in EGC patients.Both tumor pathological type and LNM independently affected the prognosis of EGC.The model’s performance was reflected by an area under the curve of 0.750[95%confidence interval(CI):0.701-0.789]for the training group and 0.763(95%CI:0.687-0.838)for the validation group.CONCLUSION A clinical prediction model was constructed(using tumor size,low differentiation,location in the middle-lower region,and signet ring cell carcinoma),with its score being a significant prognosis indicator.展开更多
基金Supported by The Key Medical Specialty Nurturing Program of Foshan During The 14th Five-Year Plan Period,No.FSPY145205The Medical Research Project of Foshan Health Bureau,No.20230814A010024+1 种基金The Guangzhou Science and Technology Plan Project,No.202102010251the Guangdong Science and Technology Program,No.2017ZC0222.
文摘BACKGROUND Biliary stone disease is a highly prevalent condition and a leading cause of hospitalization worldwide.Hepatolithiasis with associated strictures has high residual and recurrence rates after traditional multisession percutaneous transhepatic cholangioscopic lithotripsy(PTCSL).AIM To study one-step PTCSL using the percutaneous transhepatic one-step biliary fistulation(PTOBF)technique guided by three-dimensional(3D)visualization.METHODS This was a retrospective,single-center study analyzing,140 patients who,between October 2016 and October 2023,underwent one-step PTCSL for hepatolithiasis.The patients were divided into two groups:The 3D-PTOBF group and the PTOBF group.Stone clearance on choledochoscopy,complications,and long-term clearance and recurrence rates were assessed.RESULTS Age,total bilirubin,direct bilirubin,Child-Pugh class,and stone location were similar between the 2 groups,but there was a significant difference in bile duct strictures,with biliary strictures more common in the 3D-PTOBF group(P=0.001).The median follow-up time was 55.0(55.0,512.0)days.The immediate stone clearance ratio(88.6%vs 27.1%,P=0.000)and stricture resolution ratio(97.1%vs 78.6%,P=0.001)in the 3D-PTOBF group were significantly greater than those in the PTOBF group.Postoperative complication(8.6%vs 41.4%,P=0.000)and stone recurrence rates(7.1%vs 38.6%,P=0.000)were significantly lower in the 3D-PTOBF group.CONCLUSION Three-dimensional visualization helps make one-step PTCSL a safe,effective,and promising treatment for patients with complicated primary hepatolithiasis.The perioperative and long-term outcomes are satisfactory for patients with complicated primary hepatolithiasis.This minimally invasive method has the potential to be used as a substitute for hepatobiliary surgery.
基金Supported by the 14th Five-Year Plan National Key R&D Program,No.2021YFA0910100Zhejiang Upper Gastrointestinal Cancer Diagnosis and Treatment Technology Research Center,No.JBZX-202006+1 种基金Zhejiang Provincial Medical and Health Program-Provincial and Ministerial Joint Construction Project,No.WKJ-ZJ-2104the National Natural Science Foundation of China,No.82074245 and No.81973634。
文摘BACKGROUND Lymph node metastasis(LNM)significantly impacts the treatment and prognosis of early gastric cancer(EGC).Consequently,the precise prediction of LNM risk in EGC patients is essential to guide the selection of appropriate surgical approaches in clinical settings.AIM To develop a novel nomogram risk model for predicting LNM in EGC patients,utilizing preoperative clinicopathological data.METHODS Univariate and multivariate logistic regression analyses were performed to examine the correlation between clinicopathological factors and LNM in EGC patients.Additionally,univariate Kaplan-Meier and multivariate Cox regression analyses were used to assess the influence of clinical factors on EGC prognosis.A predictive model in the form of a nomogram was developed,and its discrimination ability and calibration were also assessed.RESULTS The incidence of LNM in the study cohort was 19.6%.Multivariate logistic regression identified tumor size,location,degree of differentiation,and pathological type as independent risk factors for LNM in EGC patients.Both tumor pathological type and LNM independently affected the prognosis of EGC.The model’s performance was reflected by an area under the curve of 0.750[95%confidence interval(CI):0.701-0.789]for the training group and 0.763(95%CI:0.687-0.838)for the validation group.CONCLUSION A clinical prediction model was constructed(using tumor size,low differentiation,location in the middle-lower region,and signet ring cell carcinoma),with its score being a significant prognosis indicator.
