Persistent ascites is a rare complication in the perioperative period after liver transplantation,it will seriously affect patients' prognosis.The reasons of persistent ascites may be associated with chyle leakage,abdominal infection,portal hypertension and so on.There are also some reasons still unclear.The related examination should be completed as soon as possible to find out the probable reasons.The key to successful treatment depends on the definite diagnosis of the reasons.The treatment strategy and prognosis of persistent ascites due to different reasons.This article focuses on the reasons,risk factors and treatment methods of persistent ascites after liver transplantation.

Objective To analyze the application and effect of non-penetrating vascular and tubular tissue closure system in radical resection of adenocarcinoma of pancreatic head combined with venous resection and reconstruction.Methods A retrospective analysis was made on the clinical data of 78 patients with pancreatic head cancer who underwent radical resection of venous vessels from Feb 2014 to Feb 2018.According to the intraoperative venous resection and anastomosis,the patients were divided into vascular clip group (41 cases) and traditional suture group (37 cases).The preoperative data,intraoperative and postoperative recovery of the two groups were analyzed and compared.Results There were no perioperative deaths and no significant differences in perioperative complications between the two groups (P ＞ 0.05).The anastomotic time of the clip group was (18.6 ± 3.3) min,which was significantly shorter than that of the traditional suture group (39.7 ± 8.5) min,(P ＜ 0.05).There were no significant differences in operation time,intraoperative bleeding volume,ICU time,hospital stay and anastomotic stenosis between the two groups(P＞ 0.05).Conclusion It is safe and feasible to use vascular clip in venous vascular reconstruction in radical resection of carcinoma of the head of the pancreas combined with venous vascular resection.

Objective To evaluate the prognosis and related risk factors in patients with primary liver cancer after liver transplantation. Methods We retrospectively analyzed the clinical data of 298 patients who underwent liver transplantation between January 2013 and December 2017 at Beijing Chaoyang Hospital of Capital Medical University. 121 patients with primary liver cancer on postoperative pathological diagnosis were included into this study. The patients included 108 males and 13 females, aged from 31 to 70 years, with an average of (52. 7 ± 8. 7) years. The prognosis and the related risk factors on prognosis were analyzed. The survival curve was drawn by the Kaplan-Meier method, and the survival rate was compared by the log-rank test. Multivariate Cox regression was used to analyze the prognostic factors. Results Of the 121 patients who were enrolled in this study, 5 patients died during the perioperative period, making a perioperative mortality rate of 4. 1% (5/121). The remaining 115 patients were followed up and the followed up rate was 95. 0% (115/121). The overall 1-, 2- and 3-year survival rates were 81. 0% , 74. 6% and 70. 2% , respectively. The median survival was 41. 5 months. Multivariate analysis showed that preoperative Child grading (RR=3. 028, 95% CI: 1. 625～5. 643) and microvascular invasion (RR=7. 165, 95% CI: 2. 237～22. 951) were independent risk factors of prognosis. The worse the preoperative Child grading, the worse was the prognosis. The prognosis of patients with microvascular invasion was also poor. Conclusions The overall prognosis of patients with primary liver cancer after liver transplantation was good. Preoperative Child grading and pathological microvascular invasion were the main risk factors of prognosis after liver transplantation carried out for primary liver cancer.

Objective: To analyze the application of vascular replacement technique with allogenic blood vessel in radical resection for pancreatic carcinoma. Methods: The clinical data of 33 patients with vascular invasion of pancreatic carcinoma who underwent radical resection from April 2013 to April 2017 in Department of Hepatobiliary Surgery, Beijing Chaoyang Hospital were retrospectively analyzed. There were 14 males and 19 females with age of (62.5±10.6)years(ranging from 35 to 78 years). Vascular replacement technique with allogenic blood vessel was used on all patients who underwent radical resection for pancreatic carcinoma. The operation procedure was made according to the specific location of the carcinoma, and the allogenic blood vessel was selected according to the type of vascular invasion. The matching vessel was selected for replacement to the patient who was invaded only one vessel. And the "Y" type of iliac vein was selected for replacement to the patient who was invaded the confluence of portal vein, splenic vein and superior mesenteric vein. After the operation, the patients were followed up by telephone and outpatient review. Results: All of 33 patients were successfully completed the operations. There were 28 patients underwent pancreaticoduodenectomy with vascular replacement, and 5 patients underwent total pancreatectomy with vascular replacement. All the patients were confirmed pancreatic carcinoma and R0 resection according to the postoperative pathology. There were 16 patients with the carcinoma invasion the confluence of portal vein, splenic vein and superior mesenteric vein, 12 patients with the carcinoma invasion the superior mesenteric vein, and 5 patients with the carcinoma invasion the portal vein. There was no perioperative death in this group and no complications related to allogenic blood vessel. The incidence of postoperative complications was 18.2% (6/33), and the incidence of pancreatic fistula was 6.1% (2/33), all of which were biochemical fistula. There were 32 patients were followed up, and the follow-up rate was 96.9%. The median survival time was 14.6 months. The half-year, 1-year and 2-year survival rates were 75.6%, 37.6% and 27.4%. Conclusion The application of vascular replacement technique with allogenic blood vessel for pancreatic carcinoma has a great significance for improving the R0 resection rate and the prognosis of patients.

Objective:To analyse the correlation between the lymph nodes, the number of positive lymph nodes, the positive rate of lymph nodes and the long-term prognosis of patients with distal cholangiocarcinoma.Methods:The clinical data and follow-up results of 104 patients with distal cholangiocarcinoma admitted to Beijing Chaoyang Hospital Affiliated to Capital Medical University from January 2015 to December 2021 were retrospectively analyzed using a retrospective cohort study. All patients underwent pancreaticoduodenectomy. According to the nature of the patients′ lymph nodes, the number of positive lymph nodes, and the positive rate of lymph nodes, the X-tile software was used to analyze data respectively, and the critical value of SUVmax were determined, and the patients were divided into low-risk group and high-risk group by critical values. Based on this critical value, the patients were divided into low-risk groups and high-risk groups. There were 37 patients in the lymph node positive group and 67 patients in the negative group. In the lymph node positive group, according to the number of positive lymph nodes (the cut-off value=2), they were divided into the low-risk group( n=14), the high-risk group( n=23); grouped according to the lymph node positive rate (the cut off=0.13), and divided into the low-risk group( n=15), and the high-risk group( n=22). After grouping according to different lymph node parameters, the preoperative general data such as age, gender, laboratory examination, etc., the correlation between perioperative complications and long-term prognosis were analyzed. The measurement data conforming to the normal distribution was expressed as mean ± standard deviation( ± s), and the t test was used for comparison between groups; the measurement data that was not normally distributed was expressed as M ( Q1, Q3), and the comparison between groups was performed by the rank sum test. The enumeration data were expressed by the number of cases, and the comparison between groups was performed using the chi-square test. If the total number of cases was less than 50, and Fisher′s exact test was used. The optimal cut-off values for different lymph node parameters were determined using the x-tile 3.6.1 software. Survival curves were calculated and drawn using the Kaplan-Meier method, and the survival rates were compared using the Log-rank test. Results:All patients successfully underwent the operation, 5 patients(4.8%) died during the perioperative period. The median postoperative survival time of lymph node-positive patients and lymph node-negative patients was 17 months and 36 months, respectively, and the overall survival rates at 1, 3, and 5 years were 64.9%, 23.9%, 23.9%, and 81.5%, 49.8%, 41.7%( P=0.003). Among the patients grouped according to the number of positive lymph nodes, the median postoperative survival time of patients in the low-risk group and the high-risk group was 21 months and 17 months, and the 1-, 3-, and 5-year overall survival rates of the two groups were were 77.1%, 42.9%, 42.9% and 58.2%, 13.8%, 13.8%( P=0.284), respectively. Among the patients grouped according to the positive rate of lymph nodes, the median postoperative survival time of the patients in the low-risk group and the high-risk group was 30 months and 15 months, and the 1-, 3-, and 5-year overall survival rates of the two groups were 85.6%, 42.7%, 42.7% and 51.3%, 10.3%, 0.3%( P=0.020), respectively. Conclusions:Radical pancreaticoduodenectomy is the standard procedure for patients with distal cholangiocarcinoma. The prognosis of patients with positive lymph nodes is worse. For patients with positive lymph nodes, the positive rate of lymph nodes is a better predictor of the long-term prognosis compared with the number of positive lymph nodes.

Objective To investigate the clinical characteristics and the related risk factors of pulmonary infection in patients after liver transplantation.Methods The clinical data of 298 patients who underwent liver transplantation in the Beijing Chaoyang Hospital between January 2013 and December 2017 were retrospectively stndied.The patients were divided into the infection group (n =58) and the control group (n =240) according to whether they had pulmonary infection.The characteristics,diagnosis,treatment,prognosis and risk factors of pulmonary infection were analyzed.Results Pulmonary infection occurred in 58 patients (19.5％) after liver transplantation.Eight patients died in the infection group of pulmonary infection.The mortality rate was 13.8％.The most common pathogenic bacteria were Acinetobacter bauman,Pseudomonas aeruginosa and Klebsiella pneumoniae,which accounted for 28.8％,20％ and 13.8％,respectively for the pulmonary infection.Multivariate analysis showed that the neutrophil ratio,and intensive care unit (ICU) hospitalization time were independent risk factors of pulmonary infection (P ＜ 0.05).Conclusions Pulmonary infection was common after liver transplantation.The treatment strategy should be the use of rational antibiotics and intensive pulmonary management.The neutrophil ratio and ICU hospitalization time were the risk factors of pulmonary infection.

Objective To assess the feasibility and efficacy of multi-modality three dimensional imaging reconstructive technology in diagnosing the urethral stricture.Methods Totally,121 male patients,suffered with urethral strictures,were enrolled in this study between January 2012 and June 2017.Their age ranged from 17 to 63 years old.The etiology included pelvic fracture in 71 cases,straddle injury in 16 cases,iatrogenic injury in 25 cases,infection in 9 cases.All patients accepted the routine antegrade and retrograde urethrography.The slim CT scan and 3D image reconstruction were performed in patients with posterior urethral stricture.The 3D ultrasound detection and image reconstruction were used in patients with anterior urethral strictures.The fly-through mode was used in each 3D image in order to simulate the process of endoscopic examination.The length of stricture was compared between that in traditional urethrography and in 3D dimensional image,based on the results from anastomotic procedure and substitution.Result Among patients,71 cases were diagnosed as posterior urethral stricture and 50 cases were diagnosed as anterior urethral stricture.In those patients with posterior urethral stricture,no statistical significant difference of stricture length was noticed between traditional urethrography and 3 D dimensional image [(2.30 ± 1.60)cm vs.(2.18 ± 1.55)cm,P =0.91)].In patients who complained about the urine leakage from anus,higher detective rate of fistula could be seen in the CT 3D image than that in traditional endoscopic examination (87.9％ vs.77.6％).To patients with anterior urethral strictures,no statistical significant difference of stricture length was noticed between traditional urethrography and 3D dimensional image [Penile:(2.13 ±0.34) cm vs.(2.24 ± 0.31) cm,P =0.13;Bulbar:(1.98 ± 0.47) cm vs.(2.13 ± 0.32) cm,P =0.23)].However,the advantage of 3D image could be shown in detecting the lesion of navicular fossa and periurethral pathologic fibrosis.In the fly-through mode,the effect of 3D CT image seems to be superior to that in the 3D ultrasound image,which could show more smooth urethral wall and longer urethral segment.The limitation of those 3D image reconstructive technology was that long time consuming was needed during the 3D image reconstruction.Conclusion Our study showed that the multi-modality three dimensional imaging reconstructive technology can improve the sensitivity and specify in diagnosing the urethral stricture.After some modification,it will become the alternative method in diagnosing the urethral stricture.

Objective To analyze the application effect of non-penetrating vascular closure system in portal vein reconstruction of allogenic liver transplantation in adults. Methods Clinical data of 222 patients undergoing allogeneic liver transplantation were retrospectively analyzed. According to whether vascular closure system was used in portal vein reconstruction during operation, all patients were divided into vascular clip group (n=137) and traditional suture group (n=85). Perioperative conditions, clinical prognosis and complications were statistically compared between two groups. Results All patients successfully completed the surgery. The success rate of one-time portal vein anastomosis was 93.4% (128/137) in the vascular clip group. A total of 14 patients died during perioperative period in this study with a mortality rate of 6.3% (14/222). No portal vein-related complications occurred during perioperative period in both groups. The time of portal vein anastomosis in the vascular clip group was (5.6±1.7) min, which was significantly shorter than (10.7±3.6) min in the traditional suture group (P<0.05). The incidence and grade of perioperative complications did not significantly differ between two groups (all P>0.05). Conclusions It is safe and feasible to utilize vascular closure system to reconstruct the portal vein during liver transplantation. Compared with traditional suture, it can effectively shorten the time of portal vein anastomosis.

Objective To analyse the experience and prognosis of surgical treatment of hilar cholangiocarcinoma.Methods Clinical data of 49 patients of hilar cholangiocarcinoma underwent surgical treatment were analyzed retrospectively from January 2011 to December 2017 in Department of Hepatobiliary Surgery,Beijing Chaoyang Hospital affiliated to Capital Medical University.Of the 49 patients,29 patients underwent R0 resection and 10 patients underwent R1 resection according to the patient's condition.The overwall prognosis and R0 resection rate were analyzed.All patients were followed up by outpatient or telephone.The follow-up deadline was December 2017.The long-term prognosis of R0 and R1 resection were compared.Normal distribution data were expressed as (Mean ± SD),while non-normal distribution data were expressed as M(P25,P75).Survival curve was depicted by Kaplan-Meier method,and survival rate was compared by Log-Rank test.Results All patients underwent surgical treatment.There were 5 complications (10.2％) during the perioperative period,and no deaths occurred.Radical resection was performed in 39 patients,with a radical resection rate of 79.6％.The overall median survival time was (27.0± 1.2) months.The survival rates in 6 months,1,3 and 5 years were 95.9％,85.6％,34.5％,6.6％ respectively.The total median survival time of R0 resection and R1 resection was (28.0 ± 6.5) months and (16.0 ± 0.7) months respectively.The 6 months,1,2,and 3 years survival rates were 94.9％,89.7％,43.5％,8.3 ％ and 80.0％,68.6％,0,0 respectively.Conclusion Surgical treatment is safe and effective,and it can improve the prognosis of patients.

Objective To evaluate rapid frozen pathology in the operation of hilar cholangiocarcinoma.Methods Clinical data of 49 patients of hilar cholangiocarcinoma undergoing surgical treatment were analyzed retrospectively from Jan 2011 to Dec 2017 at Department of Hepatobiliary Surgery,Beijing Chaoyang Hospital Affiliated to Capital Medical University to evaluate rapid frozen pathology on operative strategy of hilar cholangiocarcinoma and the prognosis of patients.Results All patients with hilar cholangiocarcinoma underwent intraoperative frozen pathological examination.5 patients adjusted the operation approach because of the discrepancy between frozen pathological examination and preoperative imaging results.47 intraoperative frozen pathological results were consistent with postoperative pathological diagnosis,and the accuracy rate was 95.9％,sensitivity 90％,specificity 97.4％,false positive rate 2.6％,false negative rate 10％.Frozen section margin negative patients had significantly longer survival time(P ＜ 0.05).Conclusions Intraoperative frozen pathological examination can guide the operation approach,greatly improve the resection rate of R0 and the prognosis of patients.