Objective To find the potential risk factors for pancreatic fistula after distal pancreatectomy.Methods Clinical data of 125 cases of consecutive distal pancreatectomy in Ningbo Lihuili Hospital from January 2006 to June 2013 were retrospectively analyzed.Results In all the 125 patients with distal pancreatectomy,pancreatic fistula was the most common surgical complication (43/125,34.4％),including 27 cases of grade A fistula,16 cases of grade B pancreatic fistula.Multivariate analysis showed that the texture of the pancreas and main pancreatic duct ligation were the independent risk factors for pancreatic fistula (all P ＜ 0.05).Conclusions Pancreatic fistula was the most common surgical complication of distal pancreatectomy.The texture of the pancreas and main pancreatic duct ligation effect the occurrence of postoperative pancreatic fistula.

AIM: To study the curative efficacy of retetrexel combined with laparoscopic hepatectomy in treatment of patients with primary liver cancer and its effects on liver function and the effects of diurnal transcription suppressor (CIART), fetoprotein heterosomes (AFP-l3), golgi membrane protein-73 (GP73). METHODS: A total of 100 patients with primary liver cancer who were treated in our hospital from July 2012 to July 2019 were selected as study subjects, the patients were divided into observation group (n=52) and control group (n=48) according to the order of admission. The control group was treated with laparoscopic hepatectomy, and the observation group was treated with retetroxel on the basis of the control group. Serum CIART, AFP-L3, GP73, ALT, AST, TBIL, 1-year, 3-year, 5-year tumor recurrence rates and adverse reactions were compared between the two groups before and after treatment. RESULTS:Before treatment, CIART, AFP-L3, GP73, ALT, AST and TBIL levels were not significantly different between the two groups. After treatment, the levels of CIART, AFP-L3 and GP73 in the observation group were significantly lower than those in the control group (P<0.05). There was no significant difference in serum ALT, AST and TBIL levels between the two groups (P>0.05). The 5-year recurrence rate in the observation group was significantly lower than that in the control group (P<0.05). There was no significant difference in the 1-year and 3-year recurrence rates between the two groups (P>0.05). The total incidence of adverse reactions in the two groups was 53.84% and 52.08%, respectively, with no significant difference (P>0.05). CONCLUSION:Laparoscopic resection combined with letetrexed in the treatment of primary liver cancer can effectively reduce the level of ciart, AFP-L3 and GP73, and it is safe.

Osteoarthritis(OA)is the most common degenerative disease in clinical practice.Joint pain is the main manifestation of OA,and in severe cases,it can lead to joint deformity.The main pathological changes include destruction of articular cartilage,synovitis,thickening of subchondral bone,bone redundancy,degeneration of articular ligaments,and enlargement of articular periosteum.Clinicopathological changes and pain degrees in OA patients vary from person to person,and treatment options vary from person to person.Clinically,non-steroidal anti-inflammatory drugs are used to treat the pain of OA patients now,but the effect is not ideal,and long-term use of these drugs will bring obvious toxic and side effects.Traditional Chinese medicine obtains good results in relieving the pain of OA patients.Therefore,this paper reviews the research on traditional Chinese medicine treatment and pain mechanisms of OA,with a view to providing ideas and references for clinical relief of pain in OA patients.

Objective:To investigate the correlation between modified Glasgow prognostic score (mGPS) and prognosis of intrahepatic cholangiocarcinoma (ICC) patients after radical surgical resection.Methods:The clinical data of 126 patients with intrahepatic cholangiocarcinoma undergoing radical surgical resection at Ningbo Medical Centre Lihuili Hospital from Jan 2011 to Dec 2020 were retrospectively analyzed. The patients were scored according to the mGPS-related scoring standards, and the differences in tumor clinicopathological characteristics and prognosis were compared between patients with different score levels.Results:Firty-eight cases were included in group 0, 41 cases in group 1, and 27 cases in group 2. The 1- and 3-year survival rates in group 0 were 85.8% and 52.3%, the 1- and 3-year survival rates in group 1 were 73.2% and 23%, and the 1- and 3-year survival rates in group 2 were 73.3% and 0. The difference was statistically significant ( P<0.05). Univariate analysis showed that age, mGPS, CA19-9, tumor diameter, and tumor differentiation were related at the prognosis of ICC. Multivariate analysis showed that age, tumor differentiation, tumor diameter and mGPS were independent risk factors for the prognosis of ICC. Conclusion:mGPS is an independent risk factor affecting the prognosis of ICC patients.

Objective To investigate the clinical outcomes of liver transplantation by using donation after cardiac death (DCD) in single center.Methods The clinical data of 115 DCD donors and recipients of liver transplantation from Jan 2012 to Sep 2017 at our institution were analyzed,including preoperative general data,intraoperative status,and postoperative early complications.Patients were followed up to Oct 30th,2017.The measurement data with normal distribution were analyzed by t test,the enumeration data were analyzed by chi-square test or Fisher exact probability test,and the Kaplan-Meier method was used for survival analysis.Results All of the 115 donors were within China category Ⅲ using the classification of China donor after cardiac death.Donor graft mean warm ischemic time and cold ischemic time was (10 ± 4) min and (6.1 ± 1.7) h,respectively.All of the recipients underwent liver transplantation successfully.The mean preoperation MELD score was 14 ± 7.Seven patients were ABO-incompatible liver transplantation (A→O,3 cases,B→O 2 cases,AB→O 1 case,AB→A 1 case).19 patients (16.5％) had postoperative complications (Clavien-Dindo classification grade Ⅲ-Ⅴ).The perioperative mortality was 2.6％ (3 cases).All patients were followed up for an average (21 ± 17) mon.Patients 1-,3-,and 5-year survival rates were 93.6％,81.8％,and 77.5％,respectively.Conclusion The outcome of DCD liver transplantation is favorable at our institution under careful donor and recipient selection and intensive perioperative management.

Objective:To evaluate the feasibility and efficacy of total hilar en bloc resection and reconstruction(THERR) and portal vein resection and reconstruction(PVRR) in treatment of perihilar cholangiocarcinoma(PHC).Methods:Data of a total of 101 consecutive patients with PHC who underwent bile duct resection with various types of hepatectomies from June 2013 to December 2019 at Department of Hepatopancreatobiliary,Lihuili Hospital were retrospectively analyzed. Patients who underwent PHC resection combined with THERR or PVRR were identified and grouped accordingly. Fourteen patients(6 males, 8 females, aged (64.3±9.7)years old) underwent hepatectomy combined with THERR, 19 patients(11 males, 8 females, aged (63.8±8.6)years old) underwent hepatectomy combined with PVRR. Indications and surgical procedures of THERR and PVRR were reported. The clinicopathological characteristics and operation data, as well as the short and long-term outcomes of patients of the two groups were compared by Student′s t-test and the χ 2 test or Fisher exact test, respectively. The actual survivals rates were calculated by using the Kaplan-Meier method, and compared using the Log-rank test. Results:There were no statistically significant differences between the two groups in respect to age,sex and whether they had preoperative biliary drainage or not. The types of combined hepatectomy carried out predominately between the two groups were statistically different with the left side being predominant in the THERR group(10/14, P=0.010) and right side in PVRR group(12/19, P=0.001). There were no significant differences between the two groups in respect to whether they received preoperative portal vein embolization,intraoperative blood loss,curative degree,number of lymph node dissections, and whether there was lymphatic metastasis or not. However, both the times of operation and continuous Pringle maneuver were statistically longer in the THERR group((586±158)minutes and (32.5±7.3)minutes)than those in the PVRR group((453±88)minutes and (12.4±3.8)minutes),respectively( t=3.087, P=0.004; t=10.325, P<0.01). One patient in the THERR group died of liver failure 9 days postoperative, the cumulative 1-, 3- and 5-year survival rates were 84.9%, 57.1% and 37.0% for the THERR group and 81.9%, 37.8% and 30.2% for the PVRR group, respectively. There was no statistically significant differences between the two groups(χ2=0.150, P=0.698). Conclusions:Compared to the role of PVRR in the treatment of PHC, THERR is a novel and technically demanding procedure that is feasible in selected patients for the treatment of advanced PHC with invasion of both the hepatic artery and portal vein. However,due to the small size of this primary study,the value of THERR needs further evaluation.

Objective:To evaluate the feasibility and efficacy of total hilar en bloc resection and reconstruction(THERR) and portal vein resection and reconstruction(PVRR) in treatment of perihilar cholangiocarcinoma(PHC).Methods:Data of a total of 101 consecutive patients with PHC who underwent bile duct resection with various types of hepatectomies from June 2013 to December 2019 at Department of Hepatopancreatobiliary,Lihuili Hospital were retrospectively analyzed. Patients who underwent PHC resection combined with THERR or PVRR were identified and grouped accordingly. Fourteen patients(6 males, 8 females, aged (64.3±9.7)years old) underwent hepatectomy combined with THERR, 19 patients(11 males, 8 females, aged (63.8±8.6)years old) underwent hepatectomy combined with PVRR. Indications and surgical procedures of THERR and PVRR were reported. The clinicopathological characteristics and operation data, as well as the short and long-term outcomes of patients of the two groups were compared by Student′s t-test and the χ 2 test or Fisher exact test, respectively. The actual survivals rates were calculated by using the Kaplan-Meier method, and compared using the Log-rank test. Results:There were no statistically significant differences between the two groups in respect to age,sex and whether they had preoperative biliary drainage or not. The types of combined hepatectomy carried out predominately between the two groups were statistically different with the left side being predominant in the THERR group(10/14, P=0.010) and right side in PVRR group(12/19, P=0.001). There were no significant differences between the two groups in respect to whether they received preoperative portal vein embolization,intraoperative blood loss,curative degree,number of lymph node dissections, and whether there was lymphatic metastasis or not. However, both the times of operation and continuous Pringle maneuver were statistically longer in the THERR group((586±158)minutes and (32.5±7.3)minutes)than those in the PVRR group((453±88)minutes and (12.4±3.8)minutes),respectively( t=3.087, P=0.004; t=10.325, P<0.01). One patient in the THERR group died of liver failure 9 days postoperative, the cumulative 1-, 3- and 5-year survival rates were 84.9%, 57.1% and 37.0% for the THERR group and 81.9%, 37.8% and 30.2% for the PVRR group, respectively. There was no statistically significant differences between the two groups(χ2=0.150, P=0.698). Conclusions:Compared to the role of PVRR in the treatment of PHC, THERR is a novel and technically demanding procedure that is feasible in selected patients for the treatment of advanced PHC with invasion of both the hepatic artery and portal vein. However,due to the small size of this primary study,the value of THERR needs further evaluation.

Objective: To explore the predictive significance of logarithm of lymph node positive number to lymph node negative number (LODDS) in patients with gallbladder cancer, and to establish a predictive model of gallbladder cancer based on LODDS. Methods: The clinical data of 1321 gallbladder cancer patients who underwent lymphadenectomy in SEER database from 2010 to 2014 were collected. They were randomly divided into test group (n=793) and verification group (n=528). COX multivariate analysis was used to determine independent prognostic factor, and a Nomogram prediction model was established. C index was used to evaluate the accuracy of patient Nomogram and TNM. ROC curve was used to evaluate the accuracy of the contour map and TNM staging in predicting survival rates. Results: Independent risk factors for COX analysis were selected including age, tumor size, grade, TNM stage and LODDS analysis, and the contour map was drawn. In the experimental group, the C index was 0.744 (95% CI, 0.707-0.781), and the AUC values of ROC curves predicting 3-year and 5-year survival were 0.815 and 0.823, respectively. The predictive value of C index for TNM staging in the test group was 0.699 (95% CI, 0.662-0.736), and the AUC value of ROC curve for TNM staging predicting 3-year and 5-year survival was 0.779 and 0.790, respectively. Conclusion LODDS is an independent prognostic factor for gallbladder cancer. The prediction model based on LODDS is more accurate than TNM staging.