AIM To analyze the risk factors for pancreatic fistula after pancreaticoduodenectomy.METHODS We conducted a retrospective analysis of 539 successive cases of pancreaticoduodenectomy performed at our hospital from Marc...AIM To analyze the risk factors for pancreatic fistula after pancreaticoduodenectomy.METHODS We conducted a retrospective analysis of 539 successive cases of pancreaticoduodenectomy performed at our hospital from March 2012 to October 2015. Pancreatic fistula was diagnosed in strict accordance with the definition of pancreatic fistula from the International Study Group on Pancreatic Fistula. The risk factors for pancreatic fistula were analyzed by univariate analysis and multivariate logistic regression analysis.RESULTS A total of 269(49.9%) cases of pancreatic fistula occurred after pancreaticoduodenectomy,including 71(13.17%) cases of grade A pancreatic fistula,178(33.02%) cases of grade B,and 20(3.71%) cases of grade C. Univariate analysis showed no significant correlation between postoperative pancreatic fistula(POPF) and the following factors: age,hypertension,alcohol consumption,smoking,history of upper abdominal surgery,preoperative jaundice management,preoperative bilirubin,preoperative albumin,pancreatic duct drainage,intraoperative blood loss,operative time,intraoperative blood transfusion,Braun anastomosis,and pancreaticoduodenectomy(with or without pylorus preservation). Conversely,a significant correlation was observed between POPF and the following factors: gender(male vs female: 54.23% vs 42.35%,P = 0.008),diabetes(non-diabetic vs diabetic: 51.61% vs 39.19%,P = 0.047),body mass index(BMI)(≤ 25 vs > 25: 46.94% vs 57.82%,P = 0.024),blood glucose level(≤ 6.0 mmol/L vs > 6.0 mmol/L: 54.75% vs 41.14%,P = 0.002),pancreaticojejunal anastomosis technique(pancreatic duct-jejunum double-layer mucosa-to-mucosa pancreaticojejunal anastomosis vs pancreatic-jejunum single-layer mucosa-tomucosa anastomosis: 57.54% vs 35.46%,P = 0.000),diameter of the pancreatic duct(≤ 3 mm vs > 3 mm: 57.81% vs 38.36%,P = 0.000),and pancreatic texture(soft vs hard: 56.72% vs 29.93%,P = 0.000). Multivariate logistic regression analysis showed that gender(male),BMI > 25,pancreatic duct-jejunum double-layer mucosa-to-mucosa pancreaticojejunal anastomosis,pancreatic duct diameter ≤ 3 mm,and soft pancreas were risk factors for pancreatic fistula after pancreaticoduodenectomy.CONCLUSION Gender(male),BMI > 25,pancreatic duct-jejunum double-layer mucosa-to-mucosa pancreaticojejunal anastomosis,pancreatic duct diameter ≤ 3 mm,and soft pancreas were risk factors for pancreatic fistula after pancreaticoduodenectomy.展开更多
We present a female patient with preterm labor, severe viral hepatitis B of acute phase, hepatic encephalopathy stage Ⅲ and coma.After delivery, the illness was exacerbated and the patient presented with clinical sig...We present a female patient with preterm labor, severe viral hepatitis B of acute phase, hepatic encephalopathy stage Ⅲ and coma.After delivery, the illness was exacerbated and the patient presented with clinical signs of vital organ dysfunctions such as acute respiratory distress syndrome, cerebral edema and hypoxemia that needed mechanical ventilation.Emergency liver transplantation was recommended after multidisciplinary panel consultations.The donor, her mother, consented to donate her right liver.Auxiliary partial orthotopic living donor liver transplantion(APOLDLT) was performed.After operation, the patient was on triple medication of tacrolimus plus mofetil mycophenolate and prednisone for immunosuppression.The combination of antihepatitis B virus(HBV) immunoglobulin and entecavir was initiated for anti-HBV therapy.Both the patient and the donor recovered well without any complications.The patient was followed up regularly.Her liver function, clinical signs and symptoms improved significantly.Until now, the recipient has been living for more than 78 mo free of any complications.The APOLDLT is a life-saving modality for rescuing patients with high-risk acute liver failure following HBV infection without available donor and hence is recommended under standardized antiviral therapy coverage as stated above.展开更多
Background:Minimally invasive surgeries are increasingly central to modern medicine,particularly in liver transplantation.These techniques,which offer reduced trauma,precise operations,minimal bleeding,and swift recov...Background:Minimally invasive surgeries are increasingly central to modern medicine,particularly in liver transplantation.These techniques,which offer reduced trauma,precise operations,minimal bleeding,and swift recovery,are,however,unevenly adopted across China.Only a limited number of centers routinely perform minimally invasive donor hepatectomies,indicating a significant imbalance in the development and application of these advanced procedures.Additionally,there lacks a set of standardized guidelines that are tailored to meet China’s unique healthcare challenges and conditions.Methods:In August 2023,the Branch of Organ Transplant of Chinese Medical Association and the Branch of Organ Transplant Physicians of Chinese Medical Doctor Association convened a group of national liver transplantation experts to establish a guideline development committee.This committee conducted a thorough review of relevant literature,evaluated existing guidelines and consensus,and assessed factors such as the evidence base,patient preferences,and the cost-effectiveness of interventions within China.After multiple rounds of discussions,both online and offline,the committee finalized the guidelines.Results:This collaborative effort led to the creation of the“Chinese guidelines for minimally invasive donor hepatectomy in living donor liver transplantation(2024 edition)”.These guidelines address crucial aspects such as the safety and advantages of minimally invasive surgery for living donor liver transplantation,donor selection criteria,anesthesia strategies,surgical technical details,and learning curves associated with these procedures,resulting in a comprehensive set of 26 recommendations.Conclusions:The formulation of these guidelines represents a significant advancement towards standardizing minimally invasive liver transplantation surgeries in China.They are designed to enhance outcomes for both donors and recipients by synthesizing expert consensus with contemporary research and clinical practices.Moreover,they serve as a crucial reference for surgeons and medical institutions,promoting the refinement and adoption of minimally invasive surgical techniques in liver transplantation.展开更多
文摘AIM To analyze the risk factors for pancreatic fistula after pancreaticoduodenectomy.METHODS We conducted a retrospective analysis of 539 successive cases of pancreaticoduodenectomy performed at our hospital from March 2012 to October 2015. Pancreatic fistula was diagnosed in strict accordance with the definition of pancreatic fistula from the International Study Group on Pancreatic Fistula. The risk factors for pancreatic fistula were analyzed by univariate analysis and multivariate logistic regression analysis.RESULTS A total of 269(49.9%) cases of pancreatic fistula occurred after pancreaticoduodenectomy,including 71(13.17%) cases of grade A pancreatic fistula,178(33.02%) cases of grade B,and 20(3.71%) cases of grade C. Univariate analysis showed no significant correlation between postoperative pancreatic fistula(POPF) and the following factors: age,hypertension,alcohol consumption,smoking,history of upper abdominal surgery,preoperative jaundice management,preoperative bilirubin,preoperative albumin,pancreatic duct drainage,intraoperative blood loss,operative time,intraoperative blood transfusion,Braun anastomosis,and pancreaticoduodenectomy(with or without pylorus preservation). Conversely,a significant correlation was observed between POPF and the following factors: gender(male vs female: 54.23% vs 42.35%,P = 0.008),diabetes(non-diabetic vs diabetic: 51.61% vs 39.19%,P = 0.047),body mass index(BMI)(≤ 25 vs > 25: 46.94% vs 57.82%,P = 0.024),blood glucose level(≤ 6.0 mmol/L vs > 6.0 mmol/L: 54.75% vs 41.14%,P = 0.002),pancreaticojejunal anastomosis technique(pancreatic duct-jejunum double-layer mucosa-to-mucosa pancreaticojejunal anastomosis vs pancreatic-jejunum single-layer mucosa-tomucosa anastomosis: 57.54% vs 35.46%,P = 0.000),diameter of the pancreatic duct(≤ 3 mm vs > 3 mm: 57.81% vs 38.36%,P = 0.000),and pancreatic texture(soft vs hard: 56.72% vs 29.93%,P = 0.000). Multivariate logistic regression analysis showed that gender(male),BMI > 25,pancreatic duct-jejunum double-layer mucosa-to-mucosa pancreaticojejunal anastomosis,pancreatic duct diameter ≤ 3 mm,and soft pancreas were risk factors for pancreatic fistula after pancreaticoduodenectomy.CONCLUSION Gender(male),BMI > 25,pancreatic duct-jejunum double-layer mucosa-to-mucosa pancreaticojejunal anastomosis,pancreatic duct diameter ≤ 3 mm,and soft pancreas were risk factors for pancreatic fistula after pancreaticoduodenectomy.
基金Supported by Beijing Municipal Commission of Education,Grant No.KM201110025026Projects of State Commission of Science and Technology of China,Grant No.2012BAI06B01Organ Transplantation Research Fund from the Ministry of Health,Grant No.RHECC08-2012-08
文摘We present a female patient with preterm labor, severe viral hepatitis B of acute phase, hepatic encephalopathy stage Ⅲ and coma.After delivery, the illness was exacerbated and the patient presented with clinical signs of vital organ dysfunctions such as acute respiratory distress syndrome, cerebral edema and hypoxemia that needed mechanical ventilation.Emergency liver transplantation was recommended after multidisciplinary panel consultations.The donor, her mother, consented to donate her right liver.Auxiliary partial orthotopic living donor liver transplantion(APOLDLT) was performed.After operation, the patient was on triple medication of tacrolimus plus mofetil mycophenolate and prednisone for immunosuppression.The combination of antihepatitis B virus(HBV) immunoglobulin and entecavir was initiated for anti-HBV therapy.Both the patient and the donor recovered well without any complications.The patient was followed up regularly.Her liver function, clinical signs and symptoms improved significantly.Until now, the recipient has been living for more than 78 mo free of any complications.The APOLDLT is a life-saving modality for rescuing patients with high-risk acute liver failure following HBV infection without available donor and hence is recommended under standardized antiviral therapy coverage as stated above.
基金supported by grants from National Key R&D Program of China(No.2022YFC2304705 to Jiayin Yang)National Natural Science Foundation of China(No.82270691 to Jiayin Yang)+2 种基金Sichuan Province Key Research and Development Project(Nos.2023YFS0026 and 23ZDYF2182 to Jiayin Yang)Chengdu Province Key Research and Development Project(No.2022YF0900009SN to Jiayin Yang)1.3.5 Project for Disciplines of Excellence from West China Hospital of Sichuan University(No.ZYGD24002 to Jiayin Yang).
文摘Background:Minimally invasive surgeries are increasingly central to modern medicine,particularly in liver transplantation.These techniques,which offer reduced trauma,precise operations,minimal bleeding,and swift recovery,are,however,unevenly adopted across China.Only a limited number of centers routinely perform minimally invasive donor hepatectomies,indicating a significant imbalance in the development and application of these advanced procedures.Additionally,there lacks a set of standardized guidelines that are tailored to meet China’s unique healthcare challenges and conditions.Methods:In August 2023,the Branch of Organ Transplant of Chinese Medical Association and the Branch of Organ Transplant Physicians of Chinese Medical Doctor Association convened a group of national liver transplantation experts to establish a guideline development committee.This committee conducted a thorough review of relevant literature,evaluated existing guidelines and consensus,and assessed factors such as the evidence base,patient preferences,and the cost-effectiveness of interventions within China.After multiple rounds of discussions,both online and offline,the committee finalized the guidelines.Results:This collaborative effort led to the creation of the“Chinese guidelines for minimally invasive donor hepatectomy in living donor liver transplantation(2024 edition)”.These guidelines address crucial aspects such as the safety and advantages of minimally invasive surgery for living donor liver transplantation,donor selection criteria,anesthesia strategies,surgical technical details,and learning curves associated with these procedures,resulting in a comprehensive set of 26 recommendations.Conclusions:The formulation of these guidelines represents a significant advancement towards standardizing minimally invasive liver transplantation surgeries in China.They are designed to enhance outcomes for both donors and recipients by synthesizing expert consensus with contemporary research and clinical practices.Moreover,they serve as a crucial reference for surgeons and medical institutions,promoting the refinement and adoption of minimally invasive surgical techniques in liver transplantation.
