AIM: To investigate outcomes and predictors of inhospital morbidity and mortality after total pancreatectomy(TP) and islet autotransplantation. METHODS: The nationwide inpatient sample(NIS) database was used to identi...AIM: To investigate outcomes and predictors of inhospital morbidity and mortality after total pancreatectomy(TP) and islet autotransplantation. METHODS: The nationwide inpatient sample(NIS) database was used to identify patients who underwent TP and islet autotransplantation(IAT) between 2002-2012 in the United States. Variables of interest were inherent variables of NIS database which included demographic data(age, sex, and race), comorbidities(such as diabetes mellitus, hypertension, and deficiency anemia), and admission type(elective vs nonelective). The primary endpoints were mortality and postoperative complications according to the ICD-9 diagnosis codes which were reported as the second to 25 th diagnosis of patients in the database. Risk adjusted analysis was performed to investigate morbidity predictors. Multivariate regression analysis was used to identify predictors of in-hospital morbidity.RESULTS: We evaluated a total of 923 patients who underwent IAT after pancreatectomy during 2002-2012. Among them, there were 754 patients who had TP + IAT. The most common indication ofsurgery was chronic pancreatitis(86%) followed by acute pancreatitis(12%). The number of patients undergoing TP + IAT annually significantly increased during the 11 years of study from 53 cases in 2002 to 155 cases in 2012. Overall mortality and morbidity of patients were 0% and 57.8 %, respectively. Postsurgical hypoinsulinemia was reported in 42.3% of patients, indicating that 57.7% of patients were insulin independent during hospitalization. Predictors of inhospital morbidity were obesity [adjusted odds ratio(AOR): 3.02, P = 0.01], fluid and electrolyte disorders(AOR: 2.71, P < 0.01), alcohol abuse(AOR: 2.63, P < 0.01), and weight loss(AOR: 2.43, P < 0.01). CONCLUSION: TP + IAT is a safe procedure with no mortality, acceptable morbidity, and achieved high rate of early insulin independence. Obesity is the most significant predictor of in-hospital morbidity.展开更多
Multilevel aortic disease presents a formidable challenge for vascular surgeons. In the past,multilevel aortic surgery was performed simultaneously or subsequently. Single-stage intervention is thought to be associate...Multilevel aortic disease presents a formidable challenge for vascular surgeons. In the past,multilevel aortic surgery was performed simultaneously or subsequently. Single-stage intervention is thought to be associated with a high incidence of complications, and sequential repair requires several major surgical interventions. The rupture of residual lesion, however, may take place while waiting the second operation. Endovascular treatment is recognized as a viable alternative to the treatment of the diseased aortic areas especially in the high-risk patient, as it could markedly lower the incidence of complications compared with other procedures. However, thoracic aortic anatomy must be favorable to the placement of a stent-grafi （SG）. Sufficient proximal and distal landing zone is mandatory to deploy the SG and ensure a satisfactory exclusion result. Therefore, complex dissection with multiple-tear located extremely near the orifice of the visceral arteries is excluded from orthodox endovascular therapy. Here we present a case of multi-teared dissecting aneurysm treated by a four-staged hybrid surgery with placement of 5 SGs.展开更多
目的:探讨甲状旁腺全切加自体移植(PTX+AT)术后移植物成活率,及其对继发性甲状旁腺功能亢进(SHPT)患者预后和生活质量的影响。方法:选取2011-02-01至2015-11-30在安徽医科大学第二附属医院成功切除甲状旁腺并行前臂移植的160例维持性血...目的:探讨甲状旁腺全切加自体移植(PTX+AT)术后移植物成活率,及其对继发性甲状旁腺功能亢进(SHPT)患者预后和生活质量的影响。方法:选取2011-02-01至2015-11-30在安徽医科大学第二附属医院成功切除甲状旁腺并行前臂移植的160例维持性血液透析(MHD)患者进行随访。术后2周同时测定双侧前臂甲状旁腺激素(PTH)值,判断移植物存活情况。收集患者术后第1、3、6、9、12月检查钙、磷等生化指标,观察临床症状改善及术后并发症和SHPT复发情况。结果:(1)术后移植物成活率为66.25%。手术成功患者骨痛、瘙痒等症状显著改善。(2)与术前相比,术后血钙、磷、全段甲状旁腺激素(i PTH)、碱性磷酸酶水平显著下降,血红蛋白、总蛋白、白蛋白水平明显上升(P<0.05)。移植物成活组术后3月和12月血钙水平、术后12月i PTH水平明显高于未成活组(P<0.05)外,其余指标两组间差异无统计学意义。移植物未成活组中因低钙血症再入院人数略高于成活组,而两组严重低钙血症均好发于透析龄长、术前PTH高及骨骼畸形严重的患者。(3)术后1年内,未成活组死亡2例,成活组死亡1例。成活组术后SHPT复发率高于未成活组(10/106 vs 2/54,P<0.05)。结论:PTX+AT后移植物成活与否均可显著改善患者预后和生存质量。术后严重低钙血症主要与SHPT的严重程度相关。展开更多
Background Surgical treatment options for patients with cirrhosis and portal hypertension are complicated. In this study we evaluated the effectiveness of a new treatment strategy, splenic auto-transplantation and oes...Background Surgical treatment options for patients with cirrhosis and portal hypertension are complicated. In this study we evaluated the effectiveness of a new treatment strategy, splenic auto-transplantation and oesophageal transection anastomosis. We report results from clinical observations, splenic immune function and portal dynamics in 274 patients. Methods From 1979 to 2005, 274 cirrhosis patients with portal hypertension underwent the new treatment strategy, and were followed up to compare results with those patients who underwent traditional surgical treatment. From 1999 to 2002 a randomized controlled trial （RCT） was performed on 40 patients to compare their post-operative immune function. From 1994 to 2006, another RCT enrolled 28 patients to compare portal dynamics using three-dimensional dynamic contrast-enhanced magnetic resonance angiography （3D DEC MRA） investigation post operation. Results Among 274 patients （mean age 41.8 years）, the emergency operative mortality （4.4%）, selective operative mortality （2.2%）, complication rate （17.9%）, prevalence of hepatic encephalopathy （〈1%）, rate of portal hypertension gastritis （PHG） bleeding （9.1%）, and morbidity of hepatic carcinoma （8%） were similar to those patients undergoing traditional operation; the spleen immunology function （Tuftsin, IgM） decreased in both groups 2 months post operation, but this decrease did not reach statistical significance. Through 3D DCE MRA, the cross sectional area and the velocity and volume of blood flow of the main portal vein decreased significantly after operation in both groups. The velocity and volume of blood flow in the auto-transplantation group was significantly lower than that in the control group. Conclusions Splenic auto-transplantation and esophageal transection anastomosis is a safe, effective, and reasonable treatment strategy for patients with portal hypertension with varicial bleeding. It not only can correct hypersplenism, but may also achieve complete hemosta展开更多
Hepatectomy is still the major curative treatment for patients with liver malignancies.However,it is still a big challenge to remove the tumors in the central posterior area,especially if their location involves the r...Hepatectomy is still the major curative treatment for patients with liver malignancies.However,it is still a big challenge to remove the tumors in the central posterior area,especially if their location involves the retrohepatic inferior vena cava and hepatic veins.Ex vivo liver resection and auto-transplantation(ELRA),a hybrid technique of the traditional liver resection and transplantation,has brought new hope to these patients and therefore becomes a valid alternative to liver transplantation.Due to its technical difficulty,ELRA is still concentrated in a few hepatobiliary centers that have experienced surgeons in both liver resection and liver transplantation.The efficacy and safety of this technique has already been demonstrated in the treatment of benign liver diseases,especially in the advanced alveolar echinococcosis.Recently,the application of ELRA for liver malignances has gained more attention.However,standardization of clinical practice norms and international consensus are still lacking.The prognostic impact in these oncologic patients also needs further evaluation.In this review,we summarized the principles and recent progresses on ELRA.展开更多
文摘AIM: To investigate outcomes and predictors of inhospital morbidity and mortality after total pancreatectomy(TP) and islet autotransplantation. METHODS: The nationwide inpatient sample(NIS) database was used to identify patients who underwent TP and islet autotransplantation(IAT) between 2002-2012 in the United States. Variables of interest were inherent variables of NIS database which included demographic data(age, sex, and race), comorbidities(such as diabetes mellitus, hypertension, and deficiency anemia), and admission type(elective vs nonelective). The primary endpoints were mortality and postoperative complications according to the ICD-9 diagnosis codes which were reported as the second to 25 th diagnosis of patients in the database. Risk adjusted analysis was performed to investigate morbidity predictors. Multivariate regression analysis was used to identify predictors of in-hospital morbidity.RESULTS: We evaluated a total of 923 patients who underwent IAT after pancreatectomy during 2002-2012. Among them, there were 754 patients who had TP + IAT. The most common indication ofsurgery was chronic pancreatitis(86%) followed by acute pancreatitis(12%). The number of patients undergoing TP + IAT annually significantly increased during the 11 years of study from 53 cases in 2002 to 155 cases in 2012. Overall mortality and morbidity of patients were 0% and 57.8 %, respectively. Postsurgical hypoinsulinemia was reported in 42.3% of patients, indicating that 57.7% of patients were insulin independent during hospitalization. Predictors of inhospital morbidity were obesity [adjusted odds ratio(AOR): 3.02, P = 0.01], fluid and electrolyte disorders(AOR: 2.71, P < 0.01), alcohol abuse(AOR: 2.63, P < 0.01), and weight loss(AOR: 2.43, P < 0.01). CONCLUSION: TP + IAT is a safe procedure with no mortality, acceptable morbidity, and achieved high rate of early insulin independence. Obesity is the most significant predictor of in-hospital morbidity.
文摘Multilevel aortic disease presents a formidable challenge for vascular surgeons. In the past,multilevel aortic surgery was performed simultaneously or subsequently. Single-stage intervention is thought to be associated with a high incidence of complications, and sequential repair requires several major surgical interventions. The rupture of residual lesion, however, may take place while waiting the second operation. Endovascular treatment is recognized as a viable alternative to the treatment of the diseased aortic areas especially in the high-risk patient, as it could markedly lower the incidence of complications compared with other procedures. However, thoracic aortic anatomy must be favorable to the placement of a stent-grafi （SG）. Sufficient proximal and distal landing zone is mandatory to deploy the SG and ensure a satisfactory exclusion result. Therefore, complex dissection with multiple-tear located extremely near the orifice of the visceral arteries is excluded from orthodox endovascular therapy. Here we present a case of multi-teared dissecting aneurysm treated by a four-staged hybrid surgery with placement of 5 SGs.
文摘目的:探讨甲状旁腺全切加自体移植(PTX+AT)术后移植物成活率,及其对继发性甲状旁腺功能亢进(SHPT)患者预后和生活质量的影响。方法:选取2011-02-01至2015-11-30在安徽医科大学第二附属医院成功切除甲状旁腺并行前臂移植的160例维持性血液透析(MHD)患者进行随访。术后2周同时测定双侧前臂甲状旁腺激素(PTH)值,判断移植物存活情况。收集患者术后第1、3、6、9、12月检查钙、磷等生化指标,观察临床症状改善及术后并发症和SHPT复发情况。结果:(1)术后移植物成活率为66.25%。手术成功患者骨痛、瘙痒等症状显著改善。(2)与术前相比,术后血钙、磷、全段甲状旁腺激素(i PTH)、碱性磷酸酶水平显著下降,血红蛋白、总蛋白、白蛋白水平明显上升(P<0.05)。移植物成活组术后3月和12月血钙水平、术后12月i PTH水平明显高于未成活组(P<0.05)外,其余指标两组间差异无统计学意义。移植物未成活组中因低钙血症再入院人数略高于成活组,而两组严重低钙血症均好发于透析龄长、术前PTH高及骨骼畸形严重的患者。(3)术后1年内,未成活组死亡2例,成活组死亡1例。成活组术后SHPT复发率高于未成活组(10/106 vs 2/54,P<0.05)。结论:PTX+AT后移植物成活与否均可显著改善患者预后和生存质量。术后严重低钙血症主要与SHPT的严重程度相关。
文摘Background Surgical treatment options for patients with cirrhosis and portal hypertension are complicated. In this study we evaluated the effectiveness of a new treatment strategy, splenic auto-transplantation and oesophageal transection anastomosis. We report results from clinical observations, splenic immune function and portal dynamics in 274 patients. Methods From 1979 to 2005, 274 cirrhosis patients with portal hypertension underwent the new treatment strategy, and were followed up to compare results with those patients who underwent traditional surgical treatment. From 1999 to 2002 a randomized controlled trial （RCT） was performed on 40 patients to compare their post-operative immune function. From 1994 to 2006, another RCT enrolled 28 patients to compare portal dynamics using three-dimensional dynamic contrast-enhanced magnetic resonance angiography （3D DEC MRA） investigation post operation. Results Among 274 patients （mean age 41.8 years）, the emergency operative mortality （4.4%）, selective operative mortality （2.2%）, complication rate （17.9%）, prevalence of hepatic encephalopathy （〈1%）, rate of portal hypertension gastritis （PHG） bleeding （9.1%）, and morbidity of hepatic carcinoma （8%） were similar to those patients undergoing traditional operation; the spleen immunology function （Tuftsin, IgM） decreased in both groups 2 months post operation, but this decrease did not reach statistical significance. Through 3D DCE MRA, the cross sectional area and the velocity and volume of blood flow of the main portal vein decreased significantly after operation in both groups. The velocity and volume of blood flow in the auto-transplantation group was significantly lower than that in the control group. Conclusions Splenic auto-transplantation and esophageal transection anastomosis is a safe, effective, and reasonable treatment strategy for patients with portal hypertension with varicial bleeding. It not only can correct hypersplenism, but may also achieve complete hemosta
文摘Hepatectomy is still the major curative treatment for patients with liver malignancies.However,it is still a big challenge to remove the tumors in the central posterior area,especially if their location involves the retrohepatic inferior vena cava and hepatic veins.Ex vivo liver resection and auto-transplantation(ELRA),a hybrid technique of the traditional liver resection and transplantation,has brought new hope to these patients and therefore becomes a valid alternative to liver transplantation.Due to its technical difficulty,ELRA is still concentrated in a few hepatobiliary centers that have experienced surgeons in both liver resection and liver transplantation.The efficacy and safety of this technique has already been demonstrated in the treatment of benign liver diseases,especially in the advanced alveolar echinococcosis.Recently,the application of ELRA for liver malignances has gained more attention.However,standardization of clinical practice norms and international consensus are still lacking.The prognostic impact in these oncologic patients also needs further evaluation.In this review,we summarized the principles and recent progresses on ELRA.
