Duodenum-preserving resection and Roux-en-Y pancreatic jejunostomy in benign pancreatic head tumors

This study was conducted to explore the feasibility of partial pancreatic head resection and Roux-en-Y pancreatic jejunostomy for the treatment of benign tumors of the pancreatic head(BTPH). From November 2006 to February 2009, four patients(three female and one male) with a mean age of 34.3 years(range: 21-48 years) underwent partial pancreatic head resection and Roux-en-Y pancreatic jejunostomy for the treatment of BTPH(diameters of 3.2-4.5 cm) using small incisions(5.1-7.2 cm). Preoperative symptoms include one case of repeated upper abdominal pain, one case of drowsiness and two cases with no obvious preoperative symptoms. All four surgeries were successfully performed. The mean operative time was 196.8 min(range 165-226 min), and average blood loss was 138.0 m L(range: 82-210 m L). The mean postoperative hospital stay was 7.5 d(range: 7-8 d). In one case, the main pancreatic duct was injured. Pathological examination confirmed that one patient suffered from mucinous cystadenoma, one exhibited insulinoma, and two patients had solid-pseudopapillary neoplasms. There were no deaths or complications observed during the perioperative period. All patients had no signs of recurrence of the BTPH within a follow-up period of 48-76 mo and had good quality of life without diabetes. Partial pancreatic head resection with Roux-en-Y pancreatic jejunostomy is feasible in selected patients with BTPH.

HBV recurrence lowered by lamivudine/HBIG combination therapy in liver transplant patients:ten-year experience

BACKGROUND: Lamivudine and hepatitis B immunoglobulin (HBIG) are widely used to treat patients with hepatitis B recurrence after liver transplantation. However, the outcomes are inconclusive. The present study was undertaken to evaluate the effect of combined therapy on patients with hepatitis B recurrence after liver transplantation. METHODS: Twenty-two patients with hepatitis B recurrence after liver transplantation from August 2000 to October 2011 were enrolled in this study. Of these patients, 16 received lamivudine plus HBIG (combination therapy group) and 6 were treated with lamivudine alone (lamivudine-treated group) The clinical features were matched in the two groups. HBV recurrence parameters, HBsAg clearance rate, patient survival rate, and survival time were compared. RESULTS: The average time of follow-up was 47.2 months (range 13-99). Significant difference was noted in the HBsAg clearance rate in the lamivudine-treated and combination therapy groups (50% vs 93.8%, P【0.05). There was no significant difference in the time of HBV recurrence, patient survival rate and survival time between lamivudine-treated and combination therapy groups (P】0.05). CONCLUSION: Compared with lamivudine monotherapy combination therapy significantly increased the HBsAg clearance rate in patients with HBV recurrence after liver transplantation.

Prevention and treatment of hepatitis B recurrence after liver transplantation

OBJECTIVE: To study the efficacy of liver transplantation on end-stage hepatitis B related liver diseases, and the prevention and treatment strategies of hepatitis B recurrence after the transplantation. METHODS: The efficacy of combined treatment of lamivudine and hepatitis B immune globulin (HBIG) therapy on 24 patients who had received liver transplantation was retrospectively studied. RESULTS: All the 24 patients with end-stage hepatitis B-related liver diseases treated with lamivudine alone or combined therapy of lamivudine and HBIG showed normal liver function and 21 of them lost hepatitis B virus (HBV) markers. However, the remaining 3 patients became HBsAg positive again soon after liver transplantation. CONCLUSIONS: Liver transplantation is effective for patients with end-stage hepatitis B-related liver diseases. Combined treatment of lamivudine and HBIG may prevent the recurrence of hepatitis B after the operation.

Progressive liver injury and increased mortality risk in COVID-19 patients:A retrospective cohort study in China

BACKGROUND Liver injury is common and also can be fatal,particularly in severe or critical patients with coronavirus disease 2019(COVID-19).AIM To conduct an in-depth investigation into the risk factors for liver injury and into the effective measures to prevent subsequent mortality risk.METHODS A retrospective cohort study was performed on 440 consecutive patients with relatively severe COVID-19 between January 28 and March 9,2020 at Tongji Hospital,Wuhan,China.Data on clinical features,laboratory parameters,medications,and prognosis were collected.RESULTS COVID-19-associated liver injury more frequently occurred in patients aged≥65 years,female patients,or those with other comorbidities,decreased lymphocyte count,or elevated D-dimer or serum ferritin(P<0.05).The disease severity of COVID-19 was an independent risk factor for liver injury(severe patients:Odds ratio[OR]=2.86,95%confidence interval[CI]:1.78-4.59;critical patients:OR=13.44,95%CI:7.21-25.97).The elevated levels of on-admission aspartate aminotransferase and total bilirubin indicated an increased mortality risk(P<0.001).Using intravenous nutrition or antibiotics increased the risk of COVID-19-associated liver injury.Hepatoprotective drugs tended to be of assistance to treat the liver injury and improve the prognosis of patients with COVID-19-associated liver injury.CONCLUSION More intensive monitoring of aspartate aminotransferase or total bilirubin is recommended for COVID-19 patients,especially patients aged≥65 years,female patients,or those with other comorbidities.Drug hepatotoxicity of antibiotics and intravenous nutrition should be alert for COVID-19 patients.

Pure Laparoscopic Liver Resection for Malignant Liver Tumor： Anatomic Resection Versus Nonanatomic Resection

Background： Laparoscopic liver resection （LLR） has been considered to be safe and feasible. However, few studies focused on the comparison between the anatomic and nonanatomic LLR. Therefore, the purpose of this study was to compare the perioperative factors and outcomes of the anatomic and nonanatomic LLR, especially the area of liver parenchymal transection and blood loss per unit area. Methods： In this study, surgical and oncological data of patients underwent pure LLR procedures for malignant liver tumor were prospectively collected. Blood loss per unit area of liver parenchymal transection was measured and considered as an important parameter. All procedures were conducted by a single surgeon. Results： During nearly 5 years, 84 patients with malignant liver tumor received a pure LLR procedure were included. Among them, 34 patients received anatomic LLR and 50 received nonanatomic LLR, respectively. Patients of the two groups were similar in terms of demographic features and tumor characteristics, despite the tumor size was significantly larger in the anatomic LLR group than that in the nonanatomic LLR group （4.77 ± 2.57 vs. 2.87 ± 2.10 cm, P = 0.001）. Patients who underwent anatomic resection had longer operation time （364.09 ± 131.22 vs. 252.00±135.21 min, P 〈 0.001） but less blood loss per unit area （7.85 ± 7.17 vs. 14.17 ± 10.43 ml/cm2, P = 0.018）. Nonanatomic LLR was associated with more blood loss when the area of parenchymal transection was equal to the anatomic LLR. No mortality occurred during the hospital stay and 30 days alter the operation. Moreover, there was no difference in the incidence of postoperative complications. The disease-free and overall survival rates showed no significant differences between the anatomic LLR and nonanatomic LLR groups. Conclusions： Both anatomic and nonanatomic pure LLR are safe and feasible. Measuring the area of parenchymal transection is a simple and effective method to estimate the outcomes of the liver resection surgery＇. Blood loss per unit area is an important parameter which is comparable between the anatomic LLR and nonanatomic LLR groups.

Shark mouth pancreaticojejunostomy: a new enteric reconstruction procedure of pancreatic stump

Background:The enteric reconstruction procedure of pancreatic stump after pancreaticoduodenectomy remains to be the critical factor influencing the mortality and morbidity.No widely accepted surgical procedure for the pancreaticojejunostomy has been erected yet.We have developed a new technique of pancreaticojejunostomy named "shark mouth pancreaticojejunostomy." The aim of this study is to assess the efficacy of "shark mouth pancreaticojejunostomy."Methods:This is a prospective single-arm observational study to evaluate the clinical efficacy of "shark mouth pancreaticojejunostomy." Patients with diseases,in whom a pancreaticoduodenectomy is indicated,would be recruited from Peking University Third Hospital.The hypothesis to be tested is that a "shark mouth pancreaticojejunostomy" will reduce fistula rate from around 20% to less than 10%.A sample size of 120 patients will be needed.The primary endpoint is the incidence rate of postoperative pancreatic fistula (POPF).The secondary endpoints of the study are anastomosis time,postoperative hospital stay,and morbidities besides the POPF such as the hemorrhage.Enrolled patients will undergo pancreaticoduodenectomy and be followed up for 3 months.The relevant data will be monitored and recorded.Conclusions:The current trial will explore the therapeutic value of the newly raised pancreaticojejunostomy procedure as the "shark mouth pancreaticojejunostomy." Its theoretical base and pragmatic feature will promise high external validity.Trial registration:Clinical Trials.gov:NCT03366038;https://www.clinicaltrials.gov.