AIM： To evaluate the efficacy and safety of Heller myotomy （HM） for recurrent achlasia, performed after different methods of first-line treatment. METHODS： We searched for studies published in PubMed from 1966 to ...AIM： To evaluate the efficacy and safety of Heller myotomy （HM） for recurrent achlasia, performed after different methods of first-line treatment. METHODS： We searched for studies published in PubMed from 1966 to March 2008 on treatment of recurrent achalasia with HM after failure with different methods of first-line treatment. The efficacy of HM was assessed by a pooled estimate of response rate with individual studies weighted proportionally to sample size. RESULTS： Sixteen studies were eligible and included in the review, The results showed that HM has a better remission rate for recurrent achalasia after failure of HM [weighted mean （SD）] of 86.9% （21,8%） compared with 81.6% （23.8%） for pneumatic dilatation （PD）. One study evaluated the efficacy of HM after failure of PD combined with botulinum toxin injection （83%）, The most common complications were perforation and gastroesophageal reflux, CONCLUSION： HM has the best efficacy in patients with recurrent achiasia who were treated with HM as first-line treatment, Future studies should focus on how to increase the success rate and decrease the complications of HM.展开更多
AIM:To conduct a meta-analysis to determine the safety and efficacy of laparoscopic liver resection(LLR) and open liver resection(OLR) for hepatocellular carcinoma(HCC).METHODS:PubMed(Medline),EMBASE and Science Citat...AIM:To conduct a meta-analysis to determine the safety and efficacy of laparoscopic liver resection(LLR) and open liver resection(OLR) for hepatocellular carcinoma(HCC).METHODS:PubMed(Medline),EMBASE and Science Citation Index Expanded and Cochrane Central Register of Controlled Trials in the Cochrane Library were searched systematically to identify relevant comparative studies reporting outcomes for both LLR and OLR for HCC between January 1992 and February 2012.Two authors independently assessed the trials for inclusion and extracted the data.Meta-analysis was performed using Review Manager Version 5.0 software(The Cochrane Collaboration,Oxford,United Kingdom).Pooled odds ratios(OR) or weighted mean differences(WMD) with 95%CI were calculated using either fixed effects(Mantel-Haenszel method) or random effects models(DerSimonian and Laird method).Evaluated endpoints were operative outcomes(operation time,intraoperative blood loss,blood transfusion requirement),postoperative outcomes(liver failure,cirrhotic decompensation/ascites,bile leakage,postoperative bleeding,pulmonary complications,intraabdominal abscess,mortality,hospital stay and oncologic outcomes(positive resection margins and tumor recurrence).RESULTS:Fifteen eligible non-randomized studies were identified,out of which,9 high-quality studies involving 550 patients were included,with 234 patients in the LLR group and 316 patients in the OLR group.LLR was associated with significantly lower intraoperative blood loss,based on six studies with 333 patients [WMD:-129.48 mL;95%CI:-224.76-(-34.21) mL;P = 0.008].Seven studies involving 416 patients were included to assess blood transfusion requirement between the two groups.The LLR group had lower blood transfusion requirement(OR:0.49;95%CI:0.26-0.91;P = 0.02).While analyzing hospital stay,six studies with 333 patients were included.Patients in the LLR group were found to have shorter hospital stay [WMD:-3.19 d;95%CI:-4.09-(-2.28) d;P < 0.00001] than their OLR counterpart.Seven studies including 416 patients were pooled together to estimate the odds of developing postoperative ascites in the patient groups.The LLR group appeared to have a lower incidence of postoperative ascites(OR:0.32;95%CI:0.16-0.61;P = 0.0006) as compared with OLR patients.Similarly,fewer patients had liver failure in the LLR group than in the OLR group(OR:0.15;95%CI:0.02-0.95;P =0.04).However,no significant differences were found between the two approaches with regards to operation time [WMD:4.69 min;95%CI:-22.62-32 min;P = 0.74],bile leakage(OR:0.55;95%CI:0.10-3.12;P = 0.50),postoperative bleeding(OR:0.54;95%CI:0.20-1.45;P = 0.22),pulmonary complications(OR:0.43;95%CI:0.18-1.04;P = 0.06),intra-abdominal abscesses(OR:0.21;95%CI:0.01-4.53;P = 0.32),mortality(OR:0.46;95%CI:0.14-1.51;P = 0.20),presence of positive resection margins(OR:0.59;95%CI:0.21-1.62;P = 0.31) and tumor recurrence(OR:0.95;95%CI:0.62-1.46;P = 0.81).CONCLUSION:LLR appears to be a safe and feasible option for resection of HCC in selected patients based on current evidence.However,further appropriately designed randomized controlled trials should be undertaken to ascertain these findings.展开更多
AIM: To describe endoscopic treatment of bile leaks in these patients and to identify risk factors in these patients which can predict the development of bile leaks. METHODS: Retrospective case-control study examining...AIM: To describe endoscopic treatment of bile leaks in these patients and to identify risk factors in these patients which can predict the development of bile leaks. METHODS: Retrospective case-control study examining consecutive patients who underwent partial hepatectomy for polycystic liver disease (PLD) and developed a postoperative bile leak managed endoscopically over a ten year period. Each case was matched with two controls with PLD who did not develop a postoperative bile leak. RESULTS: Ten cases underwent partial hepatectomy with fenestration for symptoms including abdominal distention, pain and nausea. Endoscopic retrograde cholangiopancreatography (ERCP) showed anatomic abnormalities in 1 case. A biliary sphincterotomy was performed in 4 cases. A plastic biliary stent was placed with the proximal end at the site of the leak in 9 cases; in 1 case two stents were placed. The overall success rate of ERCP to manage the leak was 90%. There were no significant differences in age, gender, comorbidities, duration of symptoms, history of previous surgery or type of surgery performed between cases and controls. CONCLUSION: ERCP with stent placement is safe and effective for management of post-hepatectomy bile leak in patients with PLD.展开更多
Objective： Three mainstream techniques-laparoscopic hepatectomy （LH）, percutaneous radiofrequency ablation （pRFA）, and open hepatectomy （OH）--were compared in this study, in terms of their efficacies in the tre...Objective： Three mainstream techniques-laparoscopic hepatectomy （LH）, percutaneous radiofrequency ablation （pRFA）, and open hepatectomy （OH）--were compared in this study, in terms of their efficacies in the treat- ment of small hepatocellular carcinoma （HCC）. Methods： A comparative study was performed within a total of 94 patients diagnosed with small HCC in our hospital from 2005 to 2010, who underwent LH （28）, RFA （33）, or OH （33）. They had either a single tumor lesion of less than 5 cm or up to three nodules with diameters of less than 3 cm each. Outcomes were carefully evaluated throughout a 3-year follow-up interval and statistically interpreted. Results： The pRFA group had a significantly lower disease-free survival rate compared with the two surgical groups （P=0.001） and significantly shorter overall survival （P=-0.005）, while the LH group and the OH group had no difference in survival results. For patients younger than 60 years old, surgical approaches offered a better long-term overall survival prognosis （P=0.008）. There were no statistically significant differences among the three groups in overall survival for elderly patients （P=0.104）. Conclusions： Among patients with small HCC, LH may provide better curative effects than pRFA without increasing complication rates, pRFA leads to faster recurrence than surgical resections. LH has similar therapeutic effects to OH and causes less trauma. For patients younger than 60 years old, LH may be the best curative treatment. Elderly patients may choose either surgery or pRFA.展开更多
文摘AIM： To evaluate the efficacy and safety of Heller myotomy （HM） for recurrent achlasia, performed after different methods of first-line treatment. METHODS： We searched for studies published in PubMed from 1966 to March 2008 on treatment of recurrent achalasia with HM after failure with different methods of first-line treatment. The efficacy of HM was assessed by a pooled estimate of response rate with individual studies weighted proportionally to sample size. RESULTS： Sixteen studies were eligible and included in the review, The results showed that HM has a better remission rate for recurrent achalasia after failure of HM [weighted mean （SD）] of 86.9% （21,8%） compared with 81.6% （23.8%） for pneumatic dilatation （PD）. One study evaluated the efficacy of HM after failure of PD combined with botulinum toxin injection （83%）, The most common complications were perforation and gastroesophageal reflux, CONCLUSION： HM has the best efficacy in patients with recurrent achiasia who were treated with HM as first-line treatment, Future studies should focus on how to increase the success rate and decrease the complications of HM.
文摘AIM:To conduct a meta-analysis to determine the safety and efficacy of laparoscopic liver resection(LLR) and open liver resection(OLR) for hepatocellular carcinoma(HCC).METHODS:PubMed(Medline),EMBASE and Science Citation Index Expanded and Cochrane Central Register of Controlled Trials in the Cochrane Library were searched systematically to identify relevant comparative studies reporting outcomes for both LLR and OLR for HCC between January 1992 and February 2012.Two authors independently assessed the trials for inclusion and extracted the data.Meta-analysis was performed using Review Manager Version 5.0 software(The Cochrane Collaboration,Oxford,United Kingdom).Pooled odds ratios(OR) or weighted mean differences(WMD) with 95%CI were calculated using either fixed effects(Mantel-Haenszel method) or random effects models(DerSimonian and Laird method).Evaluated endpoints were operative outcomes(operation time,intraoperative blood loss,blood transfusion requirement),postoperative outcomes(liver failure,cirrhotic decompensation/ascites,bile leakage,postoperative bleeding,pulmonary complications,intraabdominal abscess,mortality,hospital stay and oncologic outcomes(positive resection margins and tumor recurrence).RESULTS:Fifteen eligible non-randomized studies were identified,out of which,9 high-quality studies involving 550 patients were included,with 234 patients in the LLR group and 316 patients in the OLR group.LLR was associated with significantly lower intraoperative blood loss,based on six studies with 333 patients [WMD:-129.48 mL;95%CI:-224.76-(-34.21) mL;P = 0.008].Seven studies involving 416 patients were included to assess blood transfusion requirement between the two groups.The LLR group had lower blood transfusion requirement(OR:0.49;95%CI:0.26-0.91;P = 0.02).While analyzing hospital stay,six studies with 333 patients were included.Patients in the LLR group were found to have shorter hospital stay [WMD:-3.19 d;95%CI:-4.09-(-2.28) d;P < 0.00001] than their OLR counterpart.Seven studies including 416 patients were pooled together to estimate the odds of developing postoperative ascites in the patient groups.The LLR group appeared to have a lower incidence of postoperative ascites(OR:0.32;95%CI:0.16-0.61;P = 0.0006) as compared with OLR patients.Similarly,fewer patients had liver failure in the LLR group than in the OLR group(OR:0.15;95%CI:0.02-0.95;P =0.04).However,no significant differences were found between the two approaches with regards to operation time [WMD:4.69 min;95%CI:-22.62-32 min;P = 0.74],bile leakage(OR:0.55;95%CI:0.10-3.12;P = 0.50),postoperative bleeding(OR:0.54;95%CI:0.20-1.45;P = 0.22),pulmonary complications(OR:0.43;95%CI:0.18-1.04;P = 0.06),intra-abdominal abscesses(OR:0.21;95%CI:0.01-4.53;P = 0.32),mortality(OR:0.46;95%CI:0.14-1.51;P = 0.20),presence of positive resection margins(OR:0.59;95%CI:0.21-1.62;P = 0.31) and tumor recurrence(OR:0.95;95%CI:0.62-1.46;P = 0.81).CONCLUSION:LLR appears to be a safe and feasible option for resection of HCC in selected patients based on current evidence.However,further appropriately designed randomized controlled trials should be undertaken to ascertain these findings.
文摘AIM: To describe endoscopic treatment of bile leaks in these patients and to identify risk factors in these patients which can predict the development of bile leaks. METHODS: Retrospective case-control study examining consecutive patients who underwent partial hepatectomy for polycystic liver disease (PLD) and developed a postoperative bile leak managed endoscopically over a ten year period. Each case was matched with two controls with PLD who did not develop a postoperative bile leak. RESULTS: Ten cases underwent partial hepatectomy with fenestration for symptoms including abdominal distention, pain and nausea. Endoscopic retrograde cholangiopancreatography (ERCP) showed anatomic abnormalities in 1 case. A biliary sphincterotomy was performed in 4 cases. A plastic biliary stent was placed with the proximal end at the site of the leak in 9 cases; in 1 case two stents were placed. The overall success rate of ERCP to manage the leak was 90%. There were no significant differences in age, gender, comorbidities, duration of symptoms, history of previous surgery or type of surgery performed between cases and controls. CONCLUSION: ERCP with stent placement is safe and effective for management of post-hepatectomy bile leak in patients with PLD.
文摘Objective： Three mainstream techniques-laparoscopic hepatectomy （LH）, percutaneous radiofrequency ablation （pRFA）, and open hepatectomy （OH）--were compared in this study, in terms of their efficacies in the treat- ment of small hepatocellular carcinoma （HCC）. Methods： A comparative study was performed within a total of 94 patients diagnosed with small HCC in our hospital from 2005 to 2010, who underwent LH （28）, RFA （33）, or OH （33）. They had either a single tumor lesion of less than 5 cm or up to three nodules with diameters of less than 3 cm each. Outcomes were carefully evaluated throughout a 3-year follow-up interval and statistically interpreted. Results： The pRFA group had a significantly lower disease-free survival rate compared with the two surgical groups （P=0.001） and significantly shorter overall survival （P=-0.005）, while the LH group and the OH group had no difference in survival results. For patients younger than 60 years old, surgical approaches offered a better long-term overall survival prognosis （P=0.008）. There were no statistically significant differences among the three groups in overall survival for elderly patients （P=0.104）. Conclusions： Among patients with small HCC, LH may provide better curative effects than pRFA without increasing complication rates, pRFA leads to faster recurrence than surgical resections. LH has similar therapeutic effects to OH and causes less trauma. For patients younger than 60 years old, LH may be the best curative treatment. Elderly patients may choose either surgery or pRFA.
