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.

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 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.