外周血免疫球蛋白G4(immunoglobulin G4,IgG4)异常升高以及病变组织中大量IgG4阳性浆细胞浸润是IgG4相关性疾病(IgG4 related disease,IgG4⁃RD)最显著的临床病理特征。IgG4⁃RD临床表现多样,病变几乎可以累及任何组织/器官,已引起学者们...外周血免疫球蛋白G4(immunoglobulin G4,IgG4)异常升高以及病变组织中大量IgG4阳性浆细胞浸润是IgG4相关性疾病(IgG4 related disease,IgG4⁃RD)最显著的临床病理特征。IgG4⁃RD临床表现多样,病变几乎可以累及任何组织/器官,已引起学者们的广泛关注。随着研究的深入,发现IgG4表达异常不仅可引起IgG4⁃RD,作为一种免疫反应负向调控因子,IgG4与恶性肿瘤的发生与预后、肿瘤免疫均有一定相关性。本文回顾了IgG4与恶性肿瘤的关系及其在肿瘤免疫中的作用进展。展开更多
Objectives:Timing of drain removal and its effects on complications after major pancreatectomy remain controversial.We designed this study to assess whether early drain removal after major pancreatectomy influences th...Objectives:Timing of drain removal and its effects on complications after major pancreatectomy remain controversial.We designed this study to assess whether early drain removal after major pancreatectomy influences the incidence of complications in the patients with low risk of postoperative pancreatic fistula(POPF).Methods:This is a single-center randomized controlled trial(RCT).A total of 144 patients undergoing pancreaticoduodenectomy(PD)and distal pancreatectomy(DP)who met the criteria,including drain amylase on postoperative day(POD)1 and 3 less than 5000 U/L and drain output within POD 3 less than 300 mL/d,were randomly assigned to early drain removal(POD 3)or standard drain removal(≥POD 5).The primary outcome was major complications(Clavien-Dindo grades 2-4),and the secondary outcome was POPF,reintervention treatment,readmission,and total medical expense within 3 months after surgery.Results:A total of 5 patients in early drain removal group had at least 1 major complications(grades 2-4),compared to 15 patients in standard drain removal group(P=.028).The incidence of grade B/C pancreatic fistula was not significantly different(2.8%vs 0%).Multivariate analysis demonstrated that early drain removal was an independent factor associated with a reduced risk of major complications(P=.039,odds ratio=0.314).Majority of major complications occurred in PD patients,and only very few cases occurred in DP patients.Stratified analysis showed that early drain removal significantly reduced the major complications only in the patients undergoing PD.Conclusion:This single-center RCT shows early drain removal on POD 3 is safe for both DP and PD patients,under our criteria.Early drain removal could reduce the incidence of major complications in patients undergoing PD.展开更多
文摘外周血免疫球蛋白G4(immunoglobulin G4,IgG4)异常升高以及病变组织中大量IgG4阳性浆细胞浸润是IgG4相关性疾病(IgG4 related disease,IgG4⁃RD)最显著的临床病理特征。IgG4⁃RD临床表现多样,病变几乎可以累及任何组织/器官,已引起学者们的广泛关注。随着研究的深入,发现IgG4表达异常不仅可引起IgG4⁃RD,作为一种免疫反应负向调控因子,IgG4与恶性肿瘤的发生与预后、肿瘤免疫均有一定相关性。本文回顾了IgG4与恶性肿瘤的关系及其在肿瘤免疫中的作用进展。
基金This study was supported by the project of application and promotion of capital special clinical research from Beijing Municipal Science&Technology Commission(Z171100001017017018).
文摘Objectives:Timing of drain removal and its effects on complications after major pancreatectomy remain controversial.We designed this study to assess whether early drain removal after major pancreatectomy influences the incidence of complications in the patients with low risk of postoperative pancreatic fistula(POPF).Methods:This is a single-center randomized controlled trial(RCT).A total of 144 patients undergoing pancreaticoduodenectomy(PD)and distal pancreatectomy(DP)who met the criteria,including drain amylase on postoperative day(POD)1 and 3 less than 5000 U/L and drain output within POD 3 less than 300 mL/d,were randomly assigned to early drain removal(POD 3)or standard drain removal(≥POD 5).The primary outcome was major complications(Clavien-Dindo grades 2-4),and the secondary outcome was POPF,reintervention treatment,readmission,and total medical expense within 3 months after surgery.Results:A total of 5 patients in early drain removal group had at least 1 major complications(grades 2-4),compared to 15 patients in standard drain removal group(P=.028).The incidence of grade B/C pancreatic fistula was not significantly different(2.8%vs 0%).Multivariate analysis demonstrated that early drain removal was an independent factor associated with a reduced risk of major complications(P=.039,odds ratio=0.314).Majority of major complications occurred in PD patients,and only very few cases occurred in DP patients.Stratified analysis showed that early drain removal significantly reduced the major complications only in the patients undergoing PD.Conclusion:This single-center RCT shows early drain removal on POD 3 is safe for both DP and PD patients,under our criteria.Early drain removal could reduce the incidence of major complications in patients undergoing PD.
