Objective:To investigate the independent risk factors of post-pancreaticoduodenectomy hemorrhage (PPH).Methods:The clinical data of 350 patients who underwent pancreaticoduodenectomy at the Department of Hepatobiliary Surgery of the First Affiliated Hospital of Chongqing Medical University from Jul 2014 to Oct 2018 were retrospectively analyzed, the chi-square test and Logistic regression were used for univariate and multivariate analysis.Results:Of the 350 cases, PPH occurred in 35, including intra-abdominal hemorrhage in 20 cases, gastrointestinal hemorrhage in 15 cases, the incidence of PPH was 10.0%. Seven of the 35 PPH cases died. Univariate analysis showed that preoperative bilirubin (χ 2=4.162, P=0.041), pancreatic fistula (χ 2=37.451, P=0.000), biliary fistula (χ 2=7.945, P=0.005), and intro-abdominal infection (χ 2=34.577, P=0.000) infection were significantly associated with PPH; multivariate analysis results indicated that pancreatic fistula ( P=0.000, OR=10.426, 95% CI=3.512-30.955), biliary fistula ( P=0.000, OR=15.754, 95% CI=3.500-70.902), and intro-abdominal infection ( P=0.003, OR=4.530, 95% CI=1.644-12.483) were independent risk factors of PPH. Conclusions:Pancreatic fistula, biliary fistula, and intro-abdominal infection are independent risk factors for PPH.

Objective To study the association between ratio of peritumoral hepatic stellate cells to γδ T cells ratio (SGR) and prognosis of patients with hepatocellular carcinoma (HCC) after curative resection.Methods From January 2011 to December 2013,the clinical data of 320 patients with HCC who underwent curative resection at the Department of Hepatobiliary Surgery,the First Affiliated Hospital of Chongqing Medical University were collected and analyzed retrospectively.Immunohistochemistry was used to calculate the SGR in adjacent cancer tissues.Survival was estimated by Kaplan-Meier method.Prognosis of HCC patients was analyzed by univariate and multivariate analyses.Results Multivariate analysis revealed multiple tumors (HR =1.895,95％ CI:1.155-3.108),microvascular invasion (HR =1.665,95％ CI:1.104-2.512),tumor size ＞ 5 cm (HR =2.400,95％ CI:1.603-3.594) and peritumoral SGR ＞ 18 (HR =1.880,95％ CI:1.257-2.810) were independent risk factors of the overall survival rate in HCC patients.Preoperative AFP ＞ 20 μg/L (HR =1.631,95％ CI:1.151-2.311),microvascular invasion (HR =2.145,95％ CI:1.536-2.994),tumor size ＞ 5 cm (HR =1.866,95％ CI:1.342-2.592) and peritumoral SGR ＞ 18 (HR =1.517,95％ CI:1.084-2.122) were independent risk factors of the tumor-free survival rate in HCC patients.Patients were then divided into the low SGR (ratio≤ 18,n =222) and high SGR groups (ratio ＞ 18,n =98) using SGR in adjacent cancer tissues.The overall survival and tumor-free survival rates of the low SGR group were significantly better than the high SGR group (P ＜ 0.05).Conclusion Peritumoral SGR was an independent prognostic factor of patients with HCC following radical resection.The prognosis of patients with low SGR was better.

Objective: To investigate the correlation between Ishak inflammation score and the clinicopathological characteristics and recurrence of patients with hepatocellular carcinoma (HCC) after curative resection, and then set up a recurrence nomogram for HCC. Methods: A total of 326 patients with HCC after curative resection from January 2006 to December 2009 were studied retrospectively as training cohort and 110 HCC patients after surgery from January 2010 to December 2012 were used as validation cohort.Clinical follow-up data and peritumoral Ishak inflammation score in training cohort were used to set up a nomogram predicting recurrence of HCC, which was verified by validation cohort. Kaplan-Meier and Cox proportional hazard regression model were used to analyzed accuracy of model prediction. Results: According to Ishak inflammation score, patients were divided into four subgroups: Grade Ⅰ(1-4 scores), Grade Ⅱ(5-8 scores), Grade Ⅲ (9-12 scores) and Grade Ⅳ(13-18 scores). Ishak inflammation score were associated with aspartate transaminase(median 36.0 U/L, P=0.011), γ-glutamyl transpeptidase(median 54.5 U/L, P=0.005), HBV-DNA load(20.5%>10⁶ copies/ml, P=0.015) and microvascular invasion(26.7% positive, P=0.021). Multivariate analysis showed that Ishak inflammation score(P=0.007), HBV-DNA load(P<0.01), tumor size(P=0.001) and microvascular invasion(P=0.001) were related with the recurrence of HCC patients.These four risk factors were incorporated into the nomogram.Calibration curves of the nomogram had good agreement between prediction and observation in the probability of recurrence.Both C-indexes and receiver operating characteristic curve analyses revealed that this nomogram had better predictive abilities than those of the AJCC and Barcelona Clinic Liver Cancer (BCLC) stage systems.These results were verified by the validation cohort. Conclusion A nomogram based on Ishak inflammation score could accurately predict the recurrence of HCC and contribute to HCC relapse surveillance after curative hepatectomy.

Objective To study the feasibility and efficacy of prevention and treatment of rethrombosis with an implantable pump of the portal veinafter liver transplantation.Methods The clinical data of adult patients who underwent orthotopic liver transplantation from Feb.1999 to Dec.2007 were analyzed retrospectively.Results The 404 orthotopic liver transplantation (LT) patients were divided into three groups:PVT patients with an implantable pump (PVT + implantable pump,n =28),PVT patients without an implantable pump (PVT,n =20),and patients without pre-existing PVT (non-PVT,n =356).The following parameters in the 3 groups of patients were compared:(1) pre-operative parameters including baseline data of the donors,recipients,and duration of graft ischemia;(2) intra-operative and postoperative parameters including operative time,red blood cell and plasma transfusion,platelet concentrate transfusion,amount of bleeding,primary graft malfunction,and durations of hospitalization and intensive care unit (ICU) stay;and (3) follow-up data on patency of portal vein,rethrombosis rate,stenosis and reoperation (relaparotomy or retransplantation),in-hospital mortality,and actuarial one-year survival rate.Results among the 3 groups of recipients,there were no significant differences detected in the pre-operative and intra-operative parameters.However,when compared to PVT patients without an implantable pump,PVT patients with an implantable pump showed a remarkable reduction (P ＜ 0.05) in post-operative hospital stay [(21.7 ±8.9) vs.(26.5 ± 6.1)],rethrombosis rate (7.14％ vs.30％),reoperation rate (0 vs.25％),and in-hospital mortality (3.57％ vs.25％).Conclusions Patients with pre-existing PVT had a higher risk of rethrombosis following liver transplantation which was significantly prevented and/or treated with an implantable pump.Implantable pump placement should be considered for PVT patients undergoing liver transplantation.

Objective To systematically evaluate the clinical efficacy of ABO-incompatible living donor liver transplantation (ABO-I LDLT) and compare with ABO-compatible LDLT (ABO-C LDLT). Methods A systematic search of multiple databases at home and abroad was conducted to retrieve the literatures related to the statistical comparison of clinical efficacy between ABO-I LDLT and ABO-C LDLT. The literature screening was conducted, the quality of literatures was evaluated and data extraction was performed. Using Rev Man 5.3 software, a Meta-analysis was performed by random effect model or fixed effect model. Results A total of 432 articles were searched, and 6 articles published in English were eventually included according to the inclusion criteria. The Meta-analysis demonstrated that there was no significant difference in the postoperative 1-, 3- and 5-year survival rate of the recipients and grafts and the incidence of rejection responses between the ABO-I LDLT and ABO-C LDLT groups (all P≥0.05). The incidence of postoperative biliary complications and hepatic artery embolization in the ABO-I LDLT group was significantly higher than that in the ABO-C LDLT group [odds ratio (OR)=2.08, 95% confidence interval (CI) 1.25-3.45, P=0.005; OR=2.24, 95%CI 1.03-4.89, P=0.04]. Conclusions Compared with the ABO-C LDLT, ABO-I LDLT yields lower clinical efficacy, whereas it is still an effective method for the treatment of end-stage liver disease.

Objective To investigate the effect of tumor cells supernatant on treatment of diabetic foot ulcer in mice and on the expression of VEGF-A,α-SMA and Vimentin.Methods A total of 45 male BALB/c mice were randomly divided into three groups:normal control group (group A),tumor cell supernatant treated group (group B),and diabetic control group (group C).Mouse models of type 2 diabetic foot ulcers were established in group B and group C.After the first day of modeling,group B were treated with tumor cells supernatant and the other two groups were injected with equal volume of medium.At the 1st,3rd and 7th day following model established,mouse ulcer area was observed in each group.The ulcer infection rate and mortality of mice were compared between each group.The ulcer tissue of each group was HE-stained and the expression of VEGF-A,α-SMA and Vimentin in each group was detected by immunohistochemistry (IHC).ELISA assay was used to detect the relative protein levels and stability in tumor cells supernatant.Results The healing degree in group A (66.7％) and group B(80.0％) was better than that in group C(33.3％) and the infection rate (group A=0,group B=7.1％) and mortality (group A=0,group B=6.7％) were significantly lower than those of group C (40.0％,33.3％),and the difference was statistically significant(P＜0.05).Compared with group C,HE staining showed that the healing time of group A and B was shorter than group C,and the epidermal coverage was more obvious.The expression levels of VEGF-A,α-SMA and Vimentin detected by IHC in group A and B were significantly higher than those in group C.ELISA results showed high-level and stable TGF-β expression in the tumor cells supernatant.Conclusion The tumor cells supernatant can effectively promote the healing of diabetic foot ulcers in mice and TGF-β,VEGF-A,α-SMA and Vimentin play a very important role in ulcers healing process.

Objective: To investigate the correlation between FIB-4 and the clinicopathological characteristics and prognosis of patients with hepatocellular carcinoma (HCC) after curative resection. Methods: From January 2009 to December 2012, the clinicopathological and follow-up data of 245 patients with HCC after curative resection were retrospectively studied. Their survival was calculated using the Kaplan-Meier method. The Cox proportional hazard regression model was used for the multivariate analysis. Results: According to FIB-4 index, patients were divided into two subgroups: FIB-4Ⅰ(≤3.25) and FIB-4Ⅱ(>3.25). FIB-4 could predict liver cirrhosis severity (Ishak grade, Grade 1-5 vs. Grad 6, r=0.681, P<0.001). It was associated with liver function such as:aspartate transaminase (P<0.001)、total bilirubin (P=0.009)、albumin (P=0.001) and platelet count (P<0.001) other than tumor clinicopathologic features. Both univariate and multivariate analysis showed FIB-4 could predict the prognosis of HCC patients (Overall survival: P=0.037 and 0.011; Recurrencefree survival: P=0.027 and P=0.043, respectively). Conclusion: The preoperative FIB-4 index could be used as a prognostic marker for the prognosis of HCC after curative hepatectomy.

Early portal vein thrombosis is a rare but serious complication after liver transplantation,also is one of the main causes which lead to graft loss and receptor death. We collected domestic and foreign relevant data,and summarized and discussed the causes, clinical manifestation, imaging diagnosis of early portal vein thrombosis after liver transplantation. Early portal vein thrombosis after liver transplantation caused by multiple risk factors synergy. It was reported incidence of 1% to 2%. Clinical manifestations were concealment and lacked of specificity. Abdominal ultrasound and computed tomography angiography ( CTA) imaging methods of combi?ning could help early clinical findings,When necessary magnetic resonance angiography( MRA) . If each check negative,portal vein angiography could make a definitive diagnosis. Intravascular interventional therapy with small trauma, less complications and high success rate for advantages gradually became first?line treat?ments. Surgical treatment is not only as traditional effective treatments,but also an effective remedial measures after interventional treatment failure.

Objective To explore the prognostic factors of patients with hepatocellular carcinoma(HCC) after radical resection.Methods From June 2006 to November 2009,preoperative peripheral blood and the clinicopathological data of 208 patients with HCC after curative resection treated in Department of Hepatobiliary Surgery,the First Affiliated Hospital of Chongqing Medical University,were collected and analyzed,including 173 male and 35 female patients with mean age of 53 years.Univariate analyses were applied by the Kaplan-Meier method,and then,significant clinical factors were used for further multivariate analyses by Cox proportional hazard regression model.The patients were divided into low-lymphocyte-monocyte ratio (MLR) group (MLR ≤ 1.2) and high-MLR group (MLR ＞ 1.2) according to preoperative MLR.Results The enrolled 208 patients with median overall survival time for 38 months (1.5-82.2 months),median recurrence-free survival time for 36 months(1.0-82.0 months).Univariate analyses revealed alanine aminotransferase,serum albumin,tumor differentiation,tumor size,TNM stage and clinical stages and MLR might affect the prognosis significantly (all P ＜ 0.05),and multiple analyses showed that TNM stage and MLR could influence patients with HCC after radical resection of overall survival time and recurrence-free survival time(all P ＜ 0.05).The overall survival time(42.1 months) and recurrence-free survival time (38.1 months) of low-MLR group were longer than high-MLR group (32.7 months and25.3 months) (both P ＜ 0.01).Conclusions MLR might be associated with prognosis of patients with HCC after curative resection was significantly negative correlation.TNM stage and MLR might be used as an independent prognostic factors for the prognosis of patients with HCC after curative resection.

Objective To explore the prognostic factors of patients with hepatocellular carcinoma(HCC) after radical resection.Methods From June 2006 to November 2009,preoperative peripheral blood and the clinicopathological data of 208 patients with HCC after curative resection treated in Department of Hepatobiliary Surgery,the First Affiliated Hospital of Chongqing Medical University,were collected and analyzed,including 173 male and 35 female patients with mean age of 53 years.Univariate analyses were applied by the Kaplan-Meier method,and then,significant clinical factors were used for further multivariate analyses by Cox proportional hazard regression model.The patients were divided into low-lymphocyte-monocyte ratio (MLR) group (MLR ≤ 1.2) and high-MLR group (MLR ＞ 1.2) according to preoperative MLR.Results The enrolled 208 patients with median overall survival time for 38 months (1.5-82.2 months),median recurrence-free survival time for 36 months(1.0-82.0 months).Univariate analyses revealed alanine aminotransferase,serum albumin,tumor differentiation,tumor size,TNM stage and clinical stages and MLR might affect the prognosis significantly (all P ＜ 0.05),and multiple analyses showed that TNM stage and MLR could influence patients with HCC after radical resection of overall survival time and recurrence-free survival time(all P ＜ 0.05).The overall survival time(42.1 months) and recurrence-free survival time (38.1 months) of low-MLR group were longer than high-MLR group (32.7 months and25.3 months) (both P ＜ 0.01).Conclusions MLR might be associated with prognosis of patients with HCC after curative resection was significantly negative correlation.TNM stage and MLR might be used as an independent prognostic factors for the prognosis of patients with HCC after curative resection.