目的基于机器学习构建和验证肝移植术后患者重症监护室(intensive care unit,ICU)住院时间延长(prolonged ICU stay,pLOS-ICU)的预测模型。方法回顾性纳入2013年4月至2024年4月的新疆医科大学第一附属医院接受肝移植并收治ICU的成年患...目的基于机器学习构建和验证肝移植术后患者重症监护室(intensive care unit,ICU)住院时间延长(prolonged ICU stay,pLOS-ICU)的预测模型。方法回顾性纳入2013年4月至2024年4月的新疆医科大学第一附属医院接受肝移植并收治ICU的成年患者。基于10种机器学习方法建立预测模型,通过比较受试者工作特征曲线下面积(area under the curve,AUC)、临床决策曲线等评估模型预测能力,使用可解释机器学习算法(shapley additive explanations,SHAP)对变量进行解释。结果本研究纳入230例患者,分为训练集162例,内部验证集68例。在训练集中对术前人口学特征、基础疾病、术中情况、术后早期实验室指标及支持治疗等共20个变量进行筛选,最终选取术后8 h中性粒细胞占比、术后8 h血红蛋白、术后8 h白蛋白、术后8 h非结合胆红素、术后24 h丙氨酸氨基转移酶(alanine aminotransferase,ALT)、术后是否使用多巴胺及术后是否使用肠外营养支持7个变量进行模型构建,其中Logistic模型为最佳模型(训练集AUC=0.797,内部验证集AUC=0.819)。采用SHAP值评估特征重要性,其中早期肝功能指标、营养指标和全身炎症反应在pLOS-ICU预测中占据核心地位。结论术后早期肝功能指标、炎症状态、循环与营养支持及基础疾病是肝移植患者PLOS-ICU的关键预测因素,SHAP值分析有助于个体化风险评估与早期干预决策。展开更多
BACKGROUND Repeated application of the Pringle maneuver is a key obstacle to safe minimally invasive repeat liver resection(MISRLR).However,limited technical guidance is available.AIM To study the utility of newly dev...BACKGROUND Repeated application of the Pringle maneuver is a key obstacle to safe minimally invasive repeat liver resection(MISRLR).However,limited technical guidance is available.AIM To study the utility of newly developed Pringle taping method guided by liver surface in MISRLR.METHODS We retrospectively reviewed 72 cases of MISRLR performed by a single surgeon at two centers from August 2015 to July 2024.Beginning in October 2019,a liver surface-guided encirclement of hepatoduodenal ligament(LSEH)was used for repeat Pringle taping.Perioperative outcomes including Pringle taping success,operative time,blood loss,conversion rate,morbidity,and mortality were assessed.RESULTS Laparoscopic and robotic approaches were used in 63 patients and 9 patients,respectively.The median operative time,blood loss,and hospital stay were 331.5 minutes,70 mL,and 8 days,respectively.Open conversion occurred in two cases(2.8%)due to severe adhesions and right renal vein injury.Clavien-Dindo grade≥III complications occurred in 5.6%of cases with no mortality.Anti-adhesion barriers were used in 54 patients(75.0%).LSEH was attempted in 57 cases,improving Pringle taping success from 33.0%to 91.4%(P<0.001).LSEH succeeded in all patients with prior open liver resection(n=11).Among 6 patients in whom LSEH failed,3 patients(50.0%)had undergone a third liver resection,and 1 patient had a history of distal gastrectomy with choledochoduodenostomy.CONCLUSION The newly developed LSEH technique for Pringle taping in MISRLR was feasible,enhancing safety and reproducibility even in patients with a history of open liver resection.展开更多
BACKGROUND Robotic assistance is increasingly used for donor and recipient hepatectomy in liver transplantation,yet existing evidence is fragmented and variably indirect.AIM To evaluate clinical outcomes,surgical perf...BACKGROUND Robotic assistance is increasingly used for donor and recipient hepatectomy in liver transplantation,yet existing evidence is fragmented and variably indirect.AIM To evaluate clinical outcomes,surgical performance,and economic effects of robotic-assisted donor and recipient hepatectomy in the transplant pathway.METHODS Following Preferred Reporting Items for Systematic reviews and Meta-Analyses 2020 and a priori registration,systematic reviews were included with or without meta-analysis.Four databases were searched through July 2025.Methodological quality was appraised with a measurement tool to assess systematic reviews(AMSTAR 2),and certainty was graded with grading of recommendations assessment,development and evaluation(GRADE).Evidence overlap was calculated via a citation-matrix-based corrected covered area(CCA).Effect sizes were prespecified as risk ratios(RR)for dichotomous outcomes and mean differences for continuous outcomes.RESULTS Five reviews met the inclusion criteria,four with meta-analyses and one consensus review used only for context.Donor(direct)findings were more favorable for robotics in terms of estimated blood loss(≈-117 mL)and length of stay(≈-0.6 days),although with longer operative time(≈+105 minutes).Absolute risks for donor complications were not estimable from ratio-only data.Recipient(indirect)meta-analysis indicated robotics to be favorable in terms of conversion(RR≈0.41)and severe morbidity(RR≈0.81),with a trend toward lower overall morbidity(RR≈0.92)and no difference in 30-day mortality.Differences in length of stay and operative time were small and heterogeneous.Economic evidence(indirect,network meta-analysis)suggested higher procedural costs for robotic vs laparoscopic intervention,but lower hospitalization costs vs open intervention,with laparoscopy the least expensive overall.AMSTAR 2 ratings were moderate-to-high across the reviews,GRADE certainty was low for key donor continuous outcomes,and low-to-moderate for recipient and economic outcomes.Overlap was slight(graded-corpus CCA=0.0%;including a contextual non-transplant review increased CCA to≈1.25%).CONCLUSION Robotic donor hepatectomy confers perioperative advantages at the cost of longer operative time.Recipient and economic findings are indirect and considered hypothesis-generating.Transplant-specific,prospective comparisons using a minimum standardized dataset and uniform outcome definitions are needed to resolve remaining uncertainties and to clarify the cost-utility correlation.展开更多
Echinococcus is a zoonotic parasite and 1 of 17 neglected tropical diseases with a worldwide distribution.The World Health Organization(WHO)targeted for control or elimination by 2050[1,2].Two main species of Echinoco...Echinococcus is a zoonotic parasite and 1 of 17 neglected tropical diseases with a worldwide distribution.The World Health Organization(WHO)targeted for control or elimination by 2050[1,2].Two main species of Echinococcus infect humans:Echinococcus granulosus,causing cystic echinococcosis(CE),and Echinococcus multilocularis(EM),causing alveolar echinococcosis(AE)[3].AE is much rarer but far more severe than CE and ranks as one of the most dangerous helminthic zoonoses in the world[4,5].Humans are rare aberrant intermediate hosts and typically become infected through the ingestion of EM eggs shed in the feces of definitive hosts[6].After an incubation period of many years,humans may develop AE[7].While slow-growing,AE is a devastating clinical condition characterized by silent progression and infiltrative proliferation of the parasite,mimicking a malignancy[7].Without appropriate treatment,AE has a death rate of more than 90%within 10 years of diagnosis[5].For this reason,AE must be considered in the differential diagnosis of patients presenting with a hepatic mass or malignancy.展开更多
BACKGROUND While varices and variceal bleeds are well-known and feared complications of advanced cirrhosis and portal hypertension,omental variceal bleed are a rare sequala even in patients with known esophageal or ga...BACKGROUND While varices and variceal bleeds are well-known and feared complications of advanced cirrhosis and portal hypertension,omental variceal bleed are a rare sequala even in patients with known esophageal or gastric varices.While rare,omental varices pose a risk for hemoperitoneum if ruptured,which is a lifethreatening complication with high mortality rates despite surgical intervention.CASE SUMMARY This report reviews the case of a patient 36-year-old female with alcohol related cirrhosis decompensated by ascites,but no history of varices admitted for hemorrhagic shock from spontaneous rupture of omental varices requiring emergency surgery.She underwent the first documented successful orthotopic liver transplantation the same admission.CONCLUSION This case report and literature review stresses the importance of early consideration and identification of intraabdominal variceal sources in cirrhotic patients with refractory shock.展开更多
Situs inversus totalis(SIT)is a rare congenital anomaly in which the major organs are reversed from their normal positions.In patients with SIT,the right-lobe graft must be placed in the left upper quadrant(LUQ).Howev...Situs inversus totalis(SIT)is a rare congenital anomaly in which the major organs are reversed from their normal positions.In patients with SIT,the right-lobe graft must be placed in the left upper quadrant(LUQ).However,hepatic outflow obstruction is a critical issue,often requiring radiologic intervention because of compression or kinking following graft regeneration of the vessels[1–3].Therefore,preoperative planning is essential to address the challenges of graft placement and vein reconstruction.Despite these complexities,we previously reported techniques using a reversed modified right-lobe(mRL)graft from a donor in a conventional recipient with SIT[2].Here,we successfully applied a similar concept.展开更多
文摘BACKGROUND Repeated application of the Pringle maneuver is a key obstacle to safe minimally invasive repeat liver resection(MISRLR).However,limited technical guidance is available.AIM To study the utility of newly developed Pringle taping method guided by liver surface in MISRLR.METHODS We retrospectively reviewed 72 cases of MISRLR performed by a single surgeon at two centers from August 2015 to July 2024.Beginning in October 2019,a liver surface-guided encirclement of hepatoduodenal ligament(LSEH)was used for repeat Pringle taping.Perioperative outcomes including Pringle taping success,operative time,blood loss,conversion rate,morbidity,and mortality were assessed.RESULTS Laparoscopic and robotic approaches were used in 63 patients and 9 patients,respectively.The median operative time,blood loss,and hospital stay were 331.5 minutes,70 mL,and 8 days,respectively.Open conversion occurred in two cases(2.8%)due to severe adhesions and right renal vein injury.Clavien-Dindo grade≥III complications occurred in 5.6%of cases with no mortality.Anti-adhesion barriers were used in 54 patients(75.0%).LSEH was attempted in 57 cases,improving Pringle taping success from 33.0%to 91.4%(P<0.001).LSEH succeeded in all patients with prior open liver resection(n=11).Among 6 patients in whom LSEH failed,3 patients(50.0%)had undergone a third liver resection,and 1 patient had a history of distal gastrectomy with choledochoduodenostomy.CONCLUSION The newly developed LSEH technique for Pringle taping in MISRLR was feasible,enhancing safety and reproducibility even in patients with a history of open liver resection.
文摘BACKGROUND Robotic assistance is increasingly used for donor and recipient hepatectomy in liver transplantation,yet existing evidence is fragmented and variably indirect.AIM To evaluate clinical outcomes,surgical performance,and economic effects of robotic-assisted donor and recipient hepatectomy in the transplant pathway.METHODS Following Preferred Reporting Items for Systematic reviews and Meta-Analyses 2020 and a priori registration,systematic reviews were included with or without meta-analysis.Four databases were searched through July 2025.Methodological quality was appraised with a measurement tool to assess systematic reviews(AMSTAR 2),and certainty was graded with grading of recommendations assessment,development and evaluation(GRADE).Evidence overlap was calculated via a citation-matrix-based corrected covered area(CCA).Effect sizes were prespecified as risk ratios(RR)for dichotomous outcomes and mean differences for continuous outcomes.RESULTS Five reviews met the inclusion criteria,four with meta-analyses and one consensus review used only for context.Donor(direct)findings were more favorable for robotics in terms of estimated blood loss(≈-117 mL)and length of stay(≈-0.6 days),although with longer operative time(≈+105 minutes).Absolute risks for donor complications were not estimable from ratio-only data.Recipient(indirect)meta-analysis indicated robotics to be favorable in terms of conversion(RR≈0.41)and severe morbidity(RR≈0.81),with a trend toward lower overall morbidity(RR≈0.92)and no difference in 30-day mortality.Differences in length of stay and operative time were small and heterogeneous.Economic evidence(indirect,network meta-analysis)suggested higher procedural costs for robotic vs laparoscopic intervention,but lower hospitalization costs vs open intervention,with laparoscopy the least expensive overall.AMSTAR 2 ratings were moderate-to-high across the reviews,GRADE certainty was low for key donor continuous outcomes,and low-to-moderate for recipient and economic outcomes.Overlap was slight(graded-corpus CCA=0.0%;including a contextual non-transplant review increased CCA to≈1.25%).CONCLUSION Robotic donor hepatectomy confers perioperative advantages at the cost of longer operative time.Recipient and economic findings are indirect and considered hypothesis-generating.Transplant-specific,prospective comparisons using a minimum standardized dataset and uniform outcome definitions are needed to resolve remaining uncertainties and to clarify the cost-utility correlation.
文摘Echinococcus is a zoonotic parasite and 1 of 17 neglected tropical diseases with a worldwide distribution.The World Health Organization(WHO)targeted for control or elimination by 2050[1,2].Two main species of Echinococcus infect humans:Echinococcus granulosus,causing cystic echinococcosis(CE),and Echinococcus multilocularis(EM),causing alveolar echinococcosis(AE)[3].AE is much rarer but far more severe than CE and ranks as one of the most dangerous helminthic zoonoses in the world[4,5].Humans are rare aberrant intermediate hosts and typically become infected through the ingestion of EM eggs shed in the feces of definitive hosts[6].After an incubation period of many years,humans may develop AE[7].While slow-growing,AE is a devastating clinical condition characterized by silent progression and infiltrative proliferation of the parasite,mimicking a malignancy[7].Without appropriate treatment,AE has a death rate of more than 90%within 10 years of diagnosis[5].For this reason,AE must be considered in the differential diagnosis of patients presenting with a hepatic mass or malignancy.
文摘BACKGROUND While varices and variceal bleeds are well-known and feared complications of advanced cirrhosis and portal hypertension,omental variceal bleed are a rare sequala even in patients with known esophageal or gastric varices.While rare,omental varices pose a risk for hemoperitoneum if ruptured,which is a lifethreatening complication with high mortality rates despite surgical intervention.CASE SUMMARY This report reviews the case of a patient 36-year-old female with alcohol related cirrhosis decompensated by ascites,but no history of varices admitted for hemorrhagic shock from spontaneous rupture of omental varices requiring emergency surgery.She underwent the first documented successful orthotopic liver transplantation the same admission.CONCLUSION This case report and literature review stresses the importance of early consideration and identification of intraabdominal variceal sources in cirrhotic patients with refractory shock.
文摘Situs inversus totalis(SIT)is a rare congenital anomaly in which the major organs are reversed from their normal positions.In patients with SIT,the right-lobe graft must be placed in the left upper quadrant(LUQ).However,hepatic outflow obstruction is a critical issue,often requiring radiologic intervention because of compression or kinking following graft regeneration of the vessels[1–3].Therefore,preoperative planning is essential to address the challenges of graft placement and vein reconstruction.Despite these complexities,we previously reported techniques using a reversed modified right-lobe(mRL)graft from a donor in a conventional recipient with SIT[2].Here,we successfully applied a similar concept.
