Transjugular intrahepatic portosystemic shunt versus open splenectomy and esophagogastric devascularization for portal hypertension with recurrent variceal bleeding

BACKGROUND： Transjugular intrahepatic portosystemic shunt（TIPS） and open splenectomy and esophagogastric devascularization（OSED） are widely used to treat patients with portal hypertension and recurrent variceal bleeding（PHRVB）. This study aimed to compare the effectiveness between TIPS and OSED for the treatment of PHRVB.METHODS： The data were retrospectively retrieved from 479 cirrhotic patients（Child-Pugh A or B class） with PHRVB, who had undergone TIPS（TIPS group） or OSED（OSED group） between January 1, 2010 and October 31, 2014.RESULTS： A total of 196 patients received TIPS, whereas 283 underwent OSED. Within one month after TIPS and OSED, the rebleeding rates were 6.1% and 3.2%, respectively（P=0.122）. Significantly lower incidence of pleural effusion,splenic vein thrombosis, and pulmonary infection, as well as higher hepatic encephalopathy rate, shorter postoperative length of hospital stay, and higher hospital costs were observed in the TIPS group than those in the OSED group. During the follow-up periods（29 months）, significantly higher incidences of rebleeding（15.3% vs 4.6%, P=0.001） and hepatic encephalopathy（17.3% vs 3.9%, P=0.001） were observed in the TIPS group than in the OSED group. The incidence of instent stenosis was 18.9%. The survival rates were 91.3% in the TIPS group and 95.1% in the OSED group. The long-term liver function did not worsen after either TIPS or OSED.CONCLUSION： For the patients with liver function in the Child-Pugh A or B class, TIPS is not superior over OSED in terms of PHRVB treatment and rebleeding prevention.

Pancreatic panniculitis and solid pseudopapillary tumor of the pancreas: A case report

Solid pseudopapillary tumor of the pancreas(SPTP), also known as solid and papillary epithelial neoplasm of the pancreas, is a rare pancreatic exocrine tumor that is difficult to diagnose before surgery. Pancreatic panniculitis is a rare type that occurs in less than 3% of all patients with pancreatic diseases. We here report a 19-year-old woman who presented with persistent left upper quadrant pain without obvious cause for 1 d. The patient also developed subcutaneous nodules involving lower abdomen bilaterally and lower limbs, and subcutaneous nodules were pathologically diagnosed as pancreatic panniculitis. Plain abdominal computed tomography revealed a soft-tissue mass in the body and tail of the pancreas, which was closely associated with the gastric wall. Contrast-enhanced ultrasound showed inhomogeneous echogenicity in the anterior pancreatic body, which had blurred parenchymal demarcation of the body and tail of the pancreas. Contrast-enhanced abdominal computed tomography revealed a mixed density mass with solid and cystic components in the body and tail of the pancreas, and the solid component was markedly enhanced. The lesion was pathologically diagnosed as SPTP after laparoscopic resection. Clinicians should be aware of the clinical manifestation, diagnosis, and treatment of pancreatic panniculitis and SPTP.

Liver transplantation in patients with intrahepatic stones: report of two cases

To investigate the feasibility and rationality of liver transplantation as an indication for patients with intrahepatic stones. Methods: Liver transplantation was successfully per- formed for a 28-year-old man and a 42-year-old woman, both with intrahepatic stones. Results: Patient 1 had digestive tract bleeding on the postoperative day 6 and he was discharged from the hospital on the postoperative day 25. He is in good health 14 months after operation. Patient 2 also had hemorrhage from the digestive tract on the postope- rative day 44 and a leakage of end-to-side intestinal anastomosis on the postoperative day 47. She has re- sumed her work and is in good health from the post- operative month 12. Conclusion: Liver transplantation is safe and effec- tive for patients with intrahepatic stones.

Standard Versus Extended Pancreaticoduodenectomy in Treating Adenocarcinoma of the Head of the Pancreas

Objectives To compare the postoperative complications and survival of standard pancreatoduodenectomy （SPD） and extended pancreatoduodenectomy （EPD） in patients with resectable adenocarcinoma of the head of the pancreas. Methods Between January 1994 and December 2011, 165 patients with biopsy-proven adenocardnoma of the pancreatic head were treated in West China Hospital, among whom 93 underwent SPD and 72 had EPD. Complications and survival after the surgery were analyzed retrospectively. Results The median operation time of the EPD group was longer compared with the SPD group （375 minutes vs. 310 minutes, P〈O.O1）, the volume of blood transfusion was larger （700 mL vs. 400 mL, P〈0.05）, while the median hospital stay （13.5 days vs. 12 days, P = 0.79） and the total complication rates were comparable （34.7% vs. 32.4%, P=0.93）. The total recurrence rates of the SPD and EPD groups were not significantly different （52.7% vs. 43.1%, P=0,83）. No significant differences were found between the SPD and EPD groups in 1-year （81.7% vs. 86.1%）, 3-year （38.7% vs. 43.1%）, 5-year （16.7% vs. 19.4%）, and median survivals （19.8 months vs. 23.2 months, P= 0.52）. Conclusion The postoperative complications and survival donot differ significantly between SPD and EPD.