Objective:To investigate the efficacy of laparoscopic versus open hepatectomy for intrahepatic bile duct stones based on propensity score matching. Methods:This study used a case-control design to retrospectively analyze 163 patients with intrahepatic bile duct stones who were treated at The Second Hospital of Anhui Medical University between February 2014 and February 2024. Based on the surgical approach, the patients were divided into two groups: the laparoscopic hepatectomy group ( n = 72) and the open hepatectomy group ( n = 91). Using 1:1 PSM, two groups with similar baseline clinical characteristics were created to compare perioperative outcomes, stone residual rates, and recurrence rates. Results:After PSM, a total of 52 matched pairs were successfully obtained. Compared with the laparoscopic hepatectomy group, the open hepatectomy group demonstrated a significantly shorter operative time [233.00 (180.00, 315.00) minutes vs. 313.00 (222.25, 405.75) minutes, Z = 3.41, P = 0.01]. However, no statistically significant differences were observed between the open hepatectomy and laparoscopic hepatectomy groups in terms of pre- to postoperative hemoglobin change [(22.69 ± 14.27) g/L vs. (20.63 ± 14.36) g/L, t = 0.73, P = 0.465], postoperative bile leakage [5.77% (3/52) vs. 11.54% (6/52), χ2 = 1.10, P = 0.25], hypoalbuminemia [82.69% (43/52) vs. 84.62% (44/52), χ2 = 0.07, P = 0.791], pulmonary infection [28.85% (15/52) vs. 40.38% (21/52), χ2 = 1.53, P = 0.216], surgical site infection [5.77% (3/52) vs. 1.92% (1/52), χ2 = 1.04, P = 0.308], intra-abdominal infection [1.92% (1/52) vs. 5.77% (3/52), χ2 = 1.04, P = 0.308], postoperative drainage tube removal time [8.00 (6.00, 11.75) days vs. 8.00 (6.25, 10.00) days, t = 0.05, P = 0.958], postoperative hospital stay [8.00 (9.00, 15.00) days vs. 9.00 (7.00, 12.50) days, t = -1.22, P = 0.222], residual stone rate [11.54% (6/52) vs. 9.62% (5/52), χ2 = 0.10, P = 0.750], and stone recurrence rate [13.46% (7/52) vs. 3.85% (2/52), χ2 = 3.04, P = 0.081]. All differences were statistically significant (all P > 0.05). Conclusions:Laparoscopic hepatectomy and open hepatectomy have comparable efficacy in the treatment of intrahepatic bile duct stones.

Objective:To investigate the efficacy of laparoscopic versus open hepatectomy for intrahepatic bile duct stones based on propensity score matching. Methods:This study used a case-control design to retrospectively analyze 163 patients with intrahepatic bile duct stones who were treated at The Second Hospital of Anhui Medical University between February 2014 and February 2024. Based on the surgical approach, the patients were divided into two groups: the laparoscopic hepatectomy group ( n = 72) and the open hepatectomy group ( n = 91). Using 1:1 PSM, two groups with similar baseline clinical characteristics were created to compare perioperative outcomes, stone residual rates, and recurrence rates. Results:After PSM, a total of 52 matched pairs were successfully obtained. Compared with the laparoscopic hepatectomy group, the open hepatectomy group demonstrated a significantly shorter operative time [233.00 (180.00, 315.00) minutes vs. 313.00 (222.25, 405.75) minutes, Z = 3.41, P = 0.01]. However, no statistically significant differences were observed between the open hepatectomy and laparoscopic hepatectomy groups in terms of pre- to postoperative hemoglobin change [(22.69 ± 14.27) g/L vs. (20.63 ± 14.36) g/L, t = 0.73, P = 0.465], postoperative bile leakage [5.77% (3/52) vs. 11.54% (6/52), χ2 = 1.10, P = 0.25], hypoalbuminemia [82.69% (43/52) vs. 84.62% (44/52), χ2 = 0.07, P = 0.791], pulmonary infection [28.85% (15/52) vs. 40.38% (21/52), χ2 = 1.53, P = 0.216], surgical site infection [5.77% (3/52) vs. 1.92% (1/52), χ2 = 1.04, P = 0.308], intra-abdominal infection [1.92% (1/52) vs. 5.77% (3/52), χ2 = 1.04, P = 0.308], postoperative drainage tube removal time [8.00 (6.00, 11.75) days vs. 8.00 (6.25, 10.00) days, t = 0.05, P = 0.958], postoperative hospital stay [8.00 (9.00, 15.00) days vs. 9.00 (7.00, 12.50) days, t = -1.22, P = 0.222], residual stone rate [11.54% (6/52) vs. 9.62% (5/52), χ2 = 0.10, P = 0.750], and stone recurrence rate [13.46% (7/52) vs. 3.85% (2/52), χ2 = 3.04, P = 0.081]. All differences were statistically significant (all P > 0.05). Conclusions:Laparoscopic hepatectomy and open hepatectomy have comparable efficacy in the treatment of intrahepatic bile duct stones.

Objective:To explore the correlation between systemic inflammatory response index (SIRI) and clinical outcome of patients with massive cerebral infarction (MCI) after craniotomy and decompression.Methods:The clinical data of 50 MCI patients who were treated in the Affiliated Hospital of Qingdao University from January 2016 to December 2020 and underwent craniotomy and decompression were retrospectively analyzed. The measurement data of normal distribution were expressed as xˉ± s, and the measurement data of non normal distribution were expressed as M( Q1, Q3). T-test or rank sum test was used for comparison between the two groups. Multivariate Logistic regression was used to analyze the relationship between SIRI and prognosis of MCI patients and establish a prediction model. The predictive value and optimal cutoff value of SIRI were analyzed by receiver operating characteristic curve (ROC). Results:Among the 50 MCI patients who underwent craniotomy and decompression, 12 (24%, 12/50) had a good prognosis; In the poor prognosis group, 38 cases (76%, 12/50), of which 9 cases (18%, 9/50) died during hospitalization. The age of patients in the good prognosis group and the poor prognosis group ((54±11) years and (63±9) years; t=2.72, P=0.015), body mass index (BMI): ((23.91±2.64) kg/m 2 and (26.72±3.28) kg/m 2, t=3.01, P=0.006)), neutrophil count (7.08 (5.12, 7.38))×10 9/L and 10.59 (8.91,14.64)×10 9/L, Z=5.72, P<0.001), white blood cell count ((9.09±2.80)×10 9/L and (13.20±3.49) ×10 9/L; t=4.16, P<0.001), SIRI (2.49(1.78, 4.75) and 8.34(5.17, 13.61); Z=3.84, P<0.001), Glasgow Coma Score (12(9,14) and 8(6,10); Z=3.36, P=0.002) and lymphocyte count (1.58(0.91, 1.91)×10 9/L and 0.77(0.59,1.02) ×10 9/L; Z=3.30, P=0.001).The difference between the two groups was statistically significant. The prognosis of patients with dominant hemisphere infarction was worse than that of patients with non-dominant hemisphere infarction (22 cases (91.67%, 22/24) vs. 16 cases (61.54%, 16/26); χ 2=6.21, P=0.013). The ICU stay in the good prognosis group was significantly shorter than that in the poor prognosis group (2 (1, 5) days vs. 8 (3, 19) days; Z=2.78, P=0.005). Multivariate Logistic regression analysis showed that SIRI and GCS were correlated with clinical prognosis: SIRI ( OR: 2.378; 95% CI: 1.131-5.003; P=0.022); GCS at admission ( OR: 0.548; 95% CI: 0.307-0.980; P=0.043). The ROC curve analysis of SIRI prediction of poor prognosis: Area under the curve (AUC): 0.871, (95% CI: 0.765-0.976, P<0.001), sensitivity was 78.9%, specificity was 88.3%, and the optimal cut-off value was 4.96. The sensitivity, specificity and AUC of GCS for predicting poor prognosis after MCI craniotomy decompression were 89.5%, 58.3% and 0.791 (95% CI: 0.638~0.943, P=0.003), and the best truncation value was 11.5. Conclusion:SIRI was an effective predictor of clinical outcome for MCI patients underwent Craniotomy for decompression, and SIRI value greater than 4.96 indicates adverse clinical outcome.

Objective: To examine the relative factors of transmural intestinal necrosis(TIN) during multidisciplinary stepwise management facilitating the decision making in patients with acute superior mesenteric vein thrombosis (ASMVT). Methods: Clinical data of patients with ASMVT admitted to Department of General Surgery, Jinling Hospital from January 2009 to June 2017 were reviewed retrospectively. There were 52 males and 37 females, aging (45.9±12.6) years (range: 20 to 69 years). According to the postoperative pathological results and follow-up, the patients were divided into TIN group (n=31) and non-TIN group(n=58, including 18 cases of intestinal stricture). The related factors were compared between ASMVT patients with TIN and patients without TIN by univariate analysis using t test, U test and χ² test accordingly, and factors with statistically significance were subsequently submitted to binary Logistic regression analysis. The predictive value and cut-off point of factors were evaluated by receiver operator characteristic(ROC) curve and area under the curve. Results: In univariate analysis, smoking, hypertension, peritonitis, white blood cell count,haemoglobin, international normalized ratio, blood albumin, thrombosis of superior mesenteric branches vein, free intraperitoneal fluid, decrease of bowel wall enhancement and pneumatosis intestinalis were TIN risk factors (all P<0.05). According to the binary Logistic regression analysis, white blood cell count (OR=1.093, 95%CI: 1.010 to 1.182, P=0.027), thrombosis of the superior mesenteric branches vein (OR=11.519, 95%CI: 1.906 to 69.615, P=0.008), pneumatosis intestinalis (OR=11.140, 95%CI: 2.360 to 52.585, P=0.002) were independent relative factors of TIN in patients with AMI, and the area under the ROC curve of the above factors and predictive model was 0.759 (95%CI: 0.647 to 0.871), 0.745 (95%CI: 0.641 to 0.848), 0.737 (95%CI: 0.621 to 0.854), 0.909 (95%CI: 0.847 to 0.971), respectively. The cutoff value of white blood cell count was 18.1×10⁹/L. Conclusion White blood cell levels, superior mesenteric vein branch thrombosis and pneumatosis intestinalis are independent predictors of TIN in ASMVT.

Objective To examine the relative factors of transmural intestinal necrosis(TIN) during multidisciplinary stepwise management facilitating the decision making in patients with acute superior mesenteric vein thrombosis (ASMVT). Methods Clinical data of patients with ASMVT admitted to Department of General Surgery, Jinling Hospital from January 2009 to June 2017 were reviewed retrospectively. There were 52 males and 37 females, aging (45.9 ± 12.6) years (range: 20 to 69 years). According to the postoperative pathological results and follow?up, the patients were divided into TIN group (n=31) and non?TIN group(n=58, including 18 cases of intestinal stricture). The related factors were compared between ASMVT patients with TIN and patients without TIN by univariate analysis using t test, U test and χ2 test accordingly, and factors with statistically significance were subsequently submitted to binary Logistic regression analysis. The predictive value and cut?off point of factors were evaluated by receiver operator characteristic(ROC) curve and area under the curve. Results In univariate analysis, smoking, hypertension, peritonitis, white blood cell count,haemoglobin, international normalized ratio, blood albumin, thrombosis of superior mesenteric branches vein, free intraperitoneal fluid, decrease of bowel wall enhancement and pneumatosis intestinalis were TIN risk factors (all P<0.05). According to the binary Logistic regression analysis, white blood cell count (OR=1.093, 95%CI: 1.010 to 1.182, P=0.027), thrombosis of the superior mesenteric branches vein ( OR=11.519, 95%CI : 1.906 to 69.615, P=0.008), pneumatosis intestinalis ( OR=11.140, 95%CI : 2.360 to 52.585, P=0.002) were independent relative factors of TIN in patients with AMI, and the area under the ROC curve of the above factors and predictive model was 0.759 (95%CI : 0.647 to 0.871), 0.745 (95%CI : 0.641 to 0.848), 0.737 (95%CI : 0.621 to 0.854), 0.909 (95%CI: 0.847 to 0.971), respectively. The cutoff value of white blood cell count was 18.1×109/L. Conclusion White blood cell levels, superior mesenteric vein branch thrombosis and pneumatosis intestinalis are independent predictors of TIN in ASMVT.

Objective To examine the relative factors of transmural intestinal necrosis(TIN) during multidisciplinary stepwise management facilitating the decision making in patients with acute superior mesenteric vein thrombosis (ASMVT). Methods Clinical data of patients with ASMVT admitted to Department of General Surgery, Jinling Hospital from January 2009 to June 2017 were reviewed retrospectively. There were 52 males and 37 females, aging (45.9 ± 12.6) years (range: 20 to 69 years). According to the postoperative pathological results and follow?up, the patients were divided into TIN group (n=31) and non?TIN group(n=58, including 18 cases of intestinal stricture). The related factors were compared between ASMVT patients with TIN and patients without TIN by univariate analysis using t test, U test and χ2 test accordingly, and factors with statistically significance were subsequently submitted to binary Logistic regression analysis. The predictive value and cut?off point of factors were evaluated by receiver operator characteristic(ROC) curve and area under the curve. Results In univariate analysis, smoking, hypertension, peritonitis, white blood cell count,haemoglobin, international normalized ratio, blood albumin, thrombosis of superior mesenteric branches vein, free intraperitoneal fluid, decrease of bowel wall enhancement and pneumatosis intestinalis were TIN risk factors (all P<0.05). According to the binary Logistic regression analysis, white blood cell count (OR=1.093, 95%CI: 1.010 to 1.182, P=0.027), thrombosis of the superior mesenteric branches vein ( OR=11.519, 95%CI : 1.906 to 69.615, P=0.008), pneumatosis intestinalis ( OR=11.140, 95%CI : 2.360 to 52.585, P=0.002) were independent relative factors of TIN in patients with AMI, and the area under the ROC curve of the above factors and predictive model was 0.759 (95%CI : 0.647 to 0.871), 0.745 (95%CI : 0.641 to 0.848), 0.737 (95%CI : 0.621 to 0.854), 0.909 (95%CI: 0.847 to 0.971), respectively. The cutoff value of white blood cell count was 18.1×109/L. Conclusion White blood cell levels, superior mesenteric vein branch thrombosis and pneumatosis intestinalis are independent predictors of TIN in ASMVT.

Objective To investigate the influential factors of surgical treatment for ischemic enteropathy secondary to portal venous system thrombosis (PVST).Methods Clinical data of 27 patients with ischemic enteropathy secondary to PVST admitted in our department from January 2009 to Jun 2016 were analyzed retrospectively.These patients were divided into two groups according to different surgical procedures:ischemic bowel resection with primary anastomosis or ostomy.Results There were significant differences between the groups in albumin and prealbumin level (t =3.585,4.194,P ＜0.05).There were also significant differences for BMI and body fat (t =2.325,2.430,P ＜ 0.05).The average time from the onset PVST to ischemic enteropathy was 20 d.Conclusion There should be awareness of ischemic enteropathy.Intestinal resection and anticoagulation therapy is necessary.The choice of surgical procedures depends on the preoperative nutrition level (albumin,prealbumin).

Objective: To evaluate the application of intestinal stomas in mesenteric ischemia (MI) according to the concept of damage control surgery. Methods: Clinical data of 59 MI patients received intestinal stomas at Jinling Hospital, Nanjing University School of Medicine from January 2010 to June 2017 were analyzed retrospectively. There were 41 male and 18 female patients aging of (51±14) years (ranging from 20 to 86 years). All the patients were divided to two groups according to the degree of bowel ischemia: acute MI group (AMI, bowel necrosis, n=43) and chronic MI group (CMI, bowel stricture, n=16). The medium time from onset to consult of AMI was 7(12) days (M(Q_R)) and the time of CMI was 80(51) days. After the resection of irreversible ischemic intestine, ostomy was carried out for all 59 patients. Patients received oral anticoagulation, enteral nutrition and succus entericus reinfusion therapy for about 6 months after discharge. Then definite surgery to restore digestive tract was preferred. Results: In AMI group, APACHEⅡ score in admission was (16±3). The length of infarcted intestine resected was (160±95) cm, normal bowel left was (220±106) cm. Twelve patients had complications during first post-operation period including sepsis (n=8), acute renal failure (n=4), acute respiratory distress syndrome (n=4), short bowel syndrome (n=4). 30-day mortality was 18.6%. Total 30 patients received operation to restore the continuity of intestinal tract after 202(42) days and APACHEⅡ score was 4±2. Two patients suffered from sepsis and were cured after anti-infection. In CMI group, APACHEⅡ score was 16±3 and NRS2002 score was more than 3. The length of infarcted intestine resected was (43±33) cm. All patients had restored the continuity of intestinal tract after 176 (47) days. No major complications occurred during the first and second post-operation period. Conclusions According to damage control surgery, after early revascularization, patients with acute intestinal necrosis should be treated with infarcted bowel resection and stomas. Besides, second operation to restore the continuity of intestinal tract should be conducted after nutritional support for 6 months. Patients with ischemic enteropathy who cannot be corrected with severe malnutrition should achieve stomas during first operation.

Objective To evaluate the effectiveness of color doppler ultrasound(CDU)in combination of computed tomographie angiography(CTA)in diagnosis of the arteriosclerosis occlusion.Methods:43 patients with arteriosclerosis occlusion were assessed by color doppler ultrasound,CTA and digital subtraction angiography(DSA).By using DSA as the reference standard,the results were compared.Results The sensitivity.specificity,positive and negative predictive values for CDU were 82.96%,95.2%,94.92%,83.8% respectively.Those for CTA were 88.89%,96.75%,96.77%,88.81% respectively,and for the two combination,were 94.81%,99.17%,99.22%,94.44% respectively.Conclusion The color doppler ultrasound combined with CTA is an effective way in diagnosing arteriosclerosis occlusion.

Objective To explore the clinical results and operation experiences for benign breast mass by ultrasound guided mammotome minimally invasive biopsy system (MMIBS). Methods 212 benign breast masses in 186 patients were resected by ultrasound guided MMIBS. Clinical data of 186 patients were retrospectively analyzed. Results Needle position in 186 patients was visualized. Lesions were completely removed in 134 cases of 186 (72%) patients. The complete resection rate for tumors on major pectoral muscle or near areola were 31.5% (6/19) and 33.3% (4/12) respectively. Identified by postoperative ultrasound, 118 out of 134 patients (88.0%) with tumor sizes 0.5 to 2.5 cm and 16 out of 38 patients (42.1% ) with sizes 2.5 to 3.0 cm were completely removed. No lesions larger than 3.0 cm were completely removed. All 52 cases in which the tumors were not completely removed by MMIBS were converted to open surgery. Ultrasound follow-up after 4 weeks showed that all the 134 cases that had had masses completely removed had no residual masses, whereas 6 months after operation, 16 out of the 112 cases proved tumor recurrent necessitating open reoperation in 6 cases and second MMIBS operation in 10 cases, among them one case recurred after six months and received open operation. Conclusions For small benign breast mass, MMIBS has therapeutic effect with significantly minimal invasion.