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25 June 2022, Volume 27 Issue 03 Previous Issue    Next Issue

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Minimally invasive treatment of common bile duct stone FENG Qiushi 2022, 27 (03):  185-188.  DOI: 10.16139/j.1007-9610.2022.03.001 Abstract ( 354 )   HTML ( 4 )   PDF (449KB) ( 418 )   References | Related Articles | Metrics

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Diagnostic and therapeutic ERCP for difficult bile duct stone HU Bing 2022, 27 (03):  189-192.  DOI: 10.16139/j.1007-9610.2022.03.002 Abstract ( 399 )   HTML ( 1 )   PDF (409KB) ( 207 )   Figures and Tables | References | Related Articles | Metrics

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Ultrasound endoscopy in diagnosis and management of suspected common bile duct stone ZHANG Minmin, ZOU Duowu 2022, 27 (03):  193-197.  DOI: 10.16139/j.1007-9610.2022.03.003 Abstract ( 315 )   HTML ( 6 )   PDF (547KB) ( 108 )   Figures and Tables | References | Related Articles | Metrics

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Scheme selection of minimally invasive therapy combined with laparoscope, choledochoscope and duodenoscope for cholecysto⁃choledocolithiasis CHEN Sheng 2022, 27 (03):  198-202.  DOI: 10.16139/j.1007-9610.2022.03.004 Abstract ( 328 )   HTML ( 3 )   PDF (565KB) ( 258 )   References | Related Articles | Metrics

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Key and strategy using side-viewed duodenoscope in ERCP treatment of choledocolithiasis after gastrectomy and Billroth Ⅱ reconstruction WENG Hao, WANG Xuefeng 2022, 27 (03):  203-209.  DOI: 10.16139/j.1007-9610.2022.03.005 Abstract ( 520 )   HTML ( 1 )   PDF (1280KB) ( 320 )   Figures and Tables | References | Related Articles | Metrics

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A prospective study on endoscopic papillary balloon dilatation and mechanical lithotripsy in treatment of choledocholithiasis: dilatation or lithotripsy first WENG Hao, WENG Mingzhe, SHU Yijun, GU Jun, ZHANG Wenjie, WANG Xuefeng 2022, 27 (03):  210-214.  DOI: 10.16139/j.1007-9610.2022.03.006 Abstract ( 496 )   HTML ( 6 )   PDF (545KB) ( 219 )   Objective To investigate endoscopic retrograde cholangiopancreatography (ERCP) in the treatment of large common bile duct stone with endoscopic papillary balloon dilatation (EPBD) first or mechanical lithotripsy first. EPBD first or lithotripsy first were compared for stone removal efficiency and post-ERCP complications. Methods A prospective study of 40 patients with choledocholithiasis from January 2021 to January 2022 was done. Patients were divided into lithotripsy first group and EPBD first group each 20 cases using random number table. Stone remove time, stone removal efficiency (cm3/min), the rate of residual stones and rate of post-ERCP pancreatitis were compared between two groups. Results All cases underwent stone removal one time successfully. There was no statistically significant difference in maximum diameter of stone, single or multiple stone, stone volumes (cm3), time for stone remove and operative time between two groups. The stone removal efficiency (cm3/min) in lithotripsy first group was significantly higher than that in EPBD first group, (0.91±0.58) cm3/min vs. (0.51±0.17) cm3/min, P=0.048. While the procedure numbers of stone tool passing papilla in lithotripsy first group were less than those in EPBD first group, (4.9±1.7) vs. (7.9±2.2), P=0.021. The differences in the rate of residual stone and the rate of post-ERCP complications were not significant statistically. Post-ERCP serum amylase level [(196±158) U/L vs. (332±265) U/L, P=0.02] and the cases with hyperamylasemia (2 cases vs. 8 cases, P=0.028) in lithotripsy first group were significantly lower than those in EPBD first group. No case with severe pancreatitis,gastrointestinal bleeding or duodenal perforation occurred in either group. Conclusions Using lithotripsy before EPBD procedure in treatment of difficult common bile duct stone could increase stone removal efficiency and reduce both procedure number of stone tool passing papilla and rate of post-ERCP hyperamylasemia. Figures and Tables | References | Related Articles | Metrics

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SpyGlass direct visualization system in treatment of choledocholithiasis patients after treating failure through endoscopic and surgical approach GONG Xiaoyong, CHEN Sheng, REN Jiajun, YE Feng, CAI Qiang, CAI Linyan, LIU Yuanbin, SUI Liang 2022, 27 (03):  215-220.  DOI: 10.16139/j.1007-9610.2022.03.007 Abstract ( 497 )   HTML ( 3 )   PDF (986KB) ( 237 )   Objective To evaluate the efficacy and safety of SpyGlass direct visualization system (DS) in treatment of patients with difficult choledocholithiasis after removing failure through endoscopic retrograde cholangiopancreatography (ERCP) and surgical approach. Methods The clinical data of 8 patients with choledocholithiasis who had undergone lithotripsy with SpyGlass DS combined with ERCP in department of surgery Ruijin Hospital, from January 2020 to December 2021 were analyzed retrospectively. The diagnosis and treatment and adverse events incidence were evaluated. All cases were with difficult choledocholithiasis. Seven cases had removal stone failure of ERCP including 4 cases with 1 time, 1 case with 5 times, and the other 2 cases with 6 times. One case had history of surgical treatment failure. Results A total of 8 cases received 10 times of Spyglass DS procedures with all cases successful visualization of bile duct stones and complete stone removal. Four cases (50%) underwent successful stone removal at the first procedure. The other 4 cases (50%) were successful stone removal after treatment again from 1 week to 4 months post procedures. One case was diagnosed both common bile duct stone and bile duct tumor and treated by surgery after endoscopy. There were 2 cases (20%) with slight epigastric pain, 3 cases (30%) with fever, 1 case (10%) with hyperamylasemia, 4 cases (40%) with abnormal liver function and 1 case (10%) with acute cholangitis. All cases with symptom were mild and improved after treatment. No procedure-related pancreatitis, gastrointestinal perforation or massive hemorrhage was found. Conclusions SpyGlass DS with ERCP and lithotripsy would be effective and safe in diagnosis and treatment of the patients with difficult choledocholithiasis who had previous treatment failure by conventional methods. Figures and Tables | References | Related Articles | Metrics

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Relationship between surgical margin and prognosis of patients with intrahepatic cholangiocarcinoma YIN Yanjiang, LUO Zhiwen, CHEN Xiao, ZHANG Yefan, HUANG Zhen, ZHAO Hong, ZHAO Jianjun, LI Zhiyu, ZHOU Jianguo, CAI Jianqiang, BI Xinyu 2022, 27 (03):  221-228.  DOI: 10.16139/j.1007-9610.2022.03.008 Abstract ( 622 )   HTML ( 4 )   PDF (929KB) ( 229 )   Objective To analyze the effect of surgical margin on the prognosis of patients with intrahepatic cholangiocarcinoma (ICC), and to explore the distance of margin of ICC hepatectomy to be recommended. Methods The clinical and pathological data of patients with ICC were collected from January 2011 to January 2017 in the Cancer Hospital in Beijing. Single-factor and multi-factor Cox analysis were used to explore risk factors that affected the prognosis of ICC. Kaplan-Meier method was used for recurrent free survival (RFS) and overall survival (OS) curves. Restricted cubic splines (RCS) were used to study the relationship between R0 margin distance and OS or RFS, and the recommended distance of surgical margin. Results There were 71 patients with median RFS 8 months and OS 17 months after follow-up from 2 to 107 months in this study. One, 3 and 5 year RFS were 35%, 20% and 10%, and OS 68%, 38%, and 23%, respectively. It was shown by Cox regression analysis that the American Joint Committee on Cancer (AJCC) staging, surgical margin, alpha-fetoprotein, carbohydrate antigen 19-9 were independent risk factors of the prognosis of ICC patients. R0 resection was in 59 (83%) cases and R1 resection in 12 (17%) cases. R0 resection was found to be more likely in the patients when tumor was single, in stage Ⅰ or stage Ⅱ of AJCC or of Liver Cancer Study Group of Japan (LCSGJ) after comparison the preoperative clinicopathological factors between R0 resection and R1 resection. Original data was pathological margin and for the shrinkage during preparation of pathological specimens, the pathological margin converted to surgical margin. Using restricted cubic spline and Kaplan-Meier method it was shown that wider margin group (>0.5 cm-<2.8 cm) had longer RFS than more narrow margin group (>0.1 cm-≤0.5 cm). Conclusions R1 resection would be an independent risk factor for the prognosis of ICC patients. When the tumor is single, AJCC staging or LCSGJ staging in stage Ⅰ or stage Ⅱ, it could be more likely to have R0 resection and surgical margin at least 0.5 cm or more could improve the prognosis. Figures and Tables | References | Related Articles | Metrics

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A comparative study on breast cancer between smaller and larger diameters using conventional ultrasound and contrast-enhanced ultrasound LIU Miao, SHEN Yan, FU Xiaohong, HU Jiaojiao, CHEN Qingqing, YING Tao 2022, 27 (03):  229-233.  DOI: 10.16139/j.1007-9610.2022.03.009 Abstract ( 475 )   HTML ( 2 )   PDF (737KB) ( 156 )   Objective To investigate the features of breast cancer with different sizes of tumor examined using conventional ultrasound and contrast-enhanced ultrasound (CEUS). Methods A total of 107 cases with breast cancer diagnosed by pathology were retrospectively analyzed. There were one group(group≤2.0 cm) with tumor maximum diameter ≤2.0 cm (50.5%, 54 cases) and other group (group >2.0 cm) with that >2.0 cm (49.5%, 53 cases) based on diameter of breast cancer. The features shown with both conventional ultrasound and CEUS examination were compared between two groups. Results Non-parallel orientation was more present in group ≤2.0 cm than in group >2.0 cm by conventional ultrasound [19 cases(35.2%) vs. 6 cases(11.3%), P=0.004]. More cases with Alder grade of blood flow 0-Ⅰ were found in group ≤2.0 cm than those in group >2.0 cm [41 (75.9%) cases vs. 25 (47.2%) cases, P=0.002]. There were four characteristics with differences between two groups in CEUS examination. First was there were 23(42.6%) cases of breast cancer with hypo-enhancement and iso-enhancement in ≤2.0 cm group and 5 (9.4%) cases in group >2.0 cm with statistically significant differences, P<0.001. Second, more cases without perforating vessels around tumor were in group ≤2.0 cm than those in group >2.0 cm [34 (63.0%) cases vs. 20 (37.7%) cases, P=0.009]. Third, the cases with filling defect of contrast in tumor were more in group ≤2.0 cm than in group >2.0 cm [49(90.7%) cases vs. 30(56.6%) cases, P<0.001]. Last was more cases with clearance time early (not late) of contrast after the enhancement in group ≤2.0 cm were than in group >2.0 cm [48(88.9%) cases vs. 37(69.8%) cases, P=0.038]. The differences between two groups were significant statistically. Conclusions The results in this study showed that the difference in the characteristics of conventional ultrasound and CEUS imaging is clear in different size of breast cancer. The size of focus should be considered in the analysis of CEUS. Figures and Tables | References | Related Articles | Metrics

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Clinical study on lateral internal partial sphincterotomy and ligation in treatment of chronic anal fissure HAO Shuang, YIN Lixin, BAI Lipeng 2022, 27 (03):  234-238.  DOI: 10.16139/j.1007-9610.2022.03.010 Abstract ( 329 )   HTML ( 1 )   PDF (672KB) ( 122 )   Objective To study the effect of lateral internal partial sphincterotomy and ligation on chronic anal fissure. Methods A total of 160 patients with chronic anal fissure were randomly divided into two groups. Eighty cases both in study group treated with lateral internal partial sphincterotomy combined with ligation and in control group treated with internal sphincter resection were studied. Incision size, pain score, bleeding score, anal function, hospital stay and incision would healing day on different days after operation in two groups were analyzed. Results Treatment efficacy was 100% in both groups. Cure rates was 100% in study group and 97.50% in control group (P<0.05). Incision sizes on the 1st, 3rd, 5th and 7th day after operation in study group were significantly smaller than those same-day in control group(P<0.05). Both pain score and bleeding score on the 1st, 3rd, 5th and 7th day after operation in study group were significantly lower than those same-day in control group (P<0.05). Wexner anal incontinence scores after wound healing in study group were significantly lower than those in control group(P<0.05). Hospital stay and incision wound healing day in study group were less than those in control group significantly (P<0.05). Conclusions Lateral internal partial sphincterotomy and ligation would be effective and safe in treatment of chronic anal fissure with advantages including less days of wound healing, less postoperative bleeding and pain combined with protection of anal function. Figures and Tables | References | Related Articles | Metrics

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Rouviere′s sulcus guided retro-gallbladder tunnel dissection in difficult laparoscopic cholecystectomy MAN Gaoya, DANG Tongke, WU Qingsong, FENG Feiling 2022, 27 (03):  239-243.  DOI: 10.16139/j.1007-9610.2022.03.011 Abstract ( 788 )   HTML ( 8 )   PDF (524KB) ( 227 )   Objective To explore Rouviere′s sulcus guided retro-gallbladder tunnel dissection cholecystectomy used in difficult laparoscopic cholecystectomy. Methods A retrospective analysis of 1 081 patients with laparoscopic cholecystectomy in Tengzhou Central People′s Hospital from January 2019 to October 2020 was done. A total of 125 cases had scores ≥6 indicating difficult laparoscopic cholecystectomy based on preoperative scoring system to predict difficult laparoscopic cholecystectomy by Gupta. There were 65 cases(study group) with laparoscopic cholecystectomy using Rouviere′s sulcus guided retro-gallbladder tunnel dissection and 60 cases(control group) with routine laparoscopic cholecystectomy. Clinical data with operation and postoperative complication were compared between two groups. Results Operative time of two groups was [(61±23) min vs. (88±24) min], operative blood loss [(46±16) mL vs. (62±23) mL, hospital length of stay [(3.5±1.5) d vs. (5.8±2.2) d] and hospital cost [(12 236±316) yuan vs. (14 199±552) yuan] with statistical significant difference (P<0.05). Visual analog scale at 12 h and 24 h after operation in study group were (2.7±1.1) and (3.0±1.1), less than those in control group (5.9±1.0) and (6.4±1.5) significantly(P<0.05). One case with conversion of laparotomy was present in study group and 6 cases in control group (P<0.05). There was no case with bile leakage in study group and 4 cases in control group (P<0.05). Liver function was more improved significantly 72 hours postoperative in study group than in control group (P<0.05). There was no bile duct injury in study group and 1 bile duct injury in control group (P>0.05). Conclusions Rouviere′s sulcus guided retro-gallbladder tunnel dissection in difficult cholecystectomy could be safe laparoscopic cholecystectomy. Figures and Tables | References | Related Articles | Metrics

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Effect of nutritional therapy on body composition and resting energy expenditure post bariatric surgery XUAN Chengjie, BIAN Dongsheng, JIANG Yongmei, CHEN Yufei, JIN Jiabin, SHI Yongmei 2022, 27 (03):  244-248.  DOI: 10.16139/j.1007-9610.2022.03.012 Abstract ( 381 )   HTML ( 3 )   PDF (490KB) ( 103 )   Objectives To investigate the effect of nutritional therapy on body composition and resting energy expenditure(REE) post bariatric surgery in patients with obesity. Methods Six-step post-operative nutrition therapy during 3 months was performed for 47 patients undergoing bariatric surgery with laparoscopic sleeve gastrectomy. Body composition, REE and nutritonal biochemical indexes were determined in pre-surgery and post-surgery 1, 3 months. Predictive REE was calculated with Bernestin Formula. Repeated ANOVA analysis was done for the changes in the indicators of patients. Results Muscle mass reduced 8.33%±3.49% in post-surgery 1 month, and 2.86%±3.96% in post-surgery 3 months. Fat mass reduced 14.73%±5.44% in post-surgery 1 month and 16.61%±8.26% in post-surgery 3 months. There was no significant difference between REE and predicted REE with (9 339.16±2 620.59) kJ vs. (9 058.06±2 098.61) kJ in pre-surgery, P=0.593; and (7 228.20±2 066.61) kJ vs. (7 973.15±1 747.49) kJ in post-surgery 3 months, P=0.098. However, predicted REE (8 286.81±1 764.25) kJ was significant higher than REE (7 418.33±1 764.25) kJ in post-surgery 1 month, P=0.032. There was no significant difference in levels of vitamin-A, vitamin-B1, vitamin-B2, vitamin-B6, vitamin-C and serum ferritin between pre-surgery and post-surgery 1 month and post-surgery 3 months(P>0.05). A significant reduction of C-reactive protein was present with (9.03±9.42) mg/L in pre-surgery, (6.61±7.89) mg/L in post-surgery 1 month and (4.69±4.66) mg/L in post-surgery 3 months, P=0.020. Conclusions Nutritional therapy after bariatric surgery 3 months could delay the loss of skeletal muscle mass and adapt REE and reduce the inflammation level in patients with obesity. Figures and Tables | References | Related Articles | Metrics

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Study on myopectineal orifice anatomy using CT three-dimensional imaging YAO Junliang, YU Jianping, JIANG Xiaoming, GU Chao, SUN Rongxun 2022, 27 (03):  249-252.  DOI: 10.16139/j.1007-9610.2022.03.013 Abstract ( 878 )   HTML ( 1 )   PDF (553KB) ( 139 )   Objective To study myopectineal orifice anatomy of the patients with inguinal groin hernia using three-dimensional imaging technology after reconstructing of myopectineal orifice. Methods Preoperative CT images of 90 patients with inguinal hernia including 79 cases with indirect, 9 cases with direct and 2 cases with femoral were collected in our hospital from March 2019 to December 2019. The data of CT imaging were imported into software for three-dimensional reconstruction. The data of myopectineal orifice anatomy after reconstruction were measured and compared after grouping of age, gender and body mass index. Results The mean total width of myopectineal orifice was(7.67±0.75) cm, length (7.34±0.38) cm, length of upper edge(5.79±0.79) cm, length of lower edge(6.57±0.50) cm, and the upper lower angle (120.10±9.36) °. Difference in total width, length, and upper edge length was statistically significant between male group and female group (P<0.05). There was difference in upper edge length between adult group and old group (P<0.05) and in upper lower angle between body mass index low group and high group (P<0.05). Conclusions Three-dimensional CT ima-ging technology could be feasible to measure the morphology of myopectineal orifice. The data of myopectineal orifice collected in this study would be used to direct prosthetic mesh of inguinal hernia according to different age, gender and body mass index. Figures and Tables | References | Related Articles | Metrics

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Clinical study on tacrolimus reducing incidence of post ERCP pancreatitis in patients with liver transplantation YANG Xue, LIU Jin, WANG Zheng, TAO jie, HAO jie, LI yu, SUN hao 2022, 27 (03):  253-255.  DOI: 10.16139/j.1007-9610.2022.03.014 Abstract ( 328 )   HTML ( 4 )   PDF (380KB) ( 100 )   References | Related Articles | Metrics

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Gut microbiota and mechanism of liver cancer CHEN Congyan, WANG Junqing, CHEN Yongjun 2022, 27 (03):  256-260.  DOI: 10.16139/j.1007-9610.2022.03.015 Abstract ( 406 )   HTML ( 6 )   PDF (515KB) ( 171 )   Liver cancer incidence in China is higher with new cancer cases accounted for 46.7% of global prevalence and death cases 47.1%. Hepatic virus, aflatoxin and alcohol drinking are the risk factors associated with the mechanism of liver cancer. Study on gut microbiota in recent years was ongoing deeply, indicating gut microbiota associated with the development of liver cancer. Liver cancer with gut microbiota was studied in this paper for microbiota displacement, intestinal endotoxemia, and changes in bacterial metabolite, including the new ideas in treatment of liver cancer via gut microbiota from probiotics, fecal microbiota transplantation, antibiotics and Toll-like receptor 4 antagonist pathways. References | Related Articles | Metrics

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Impact of pelvic anatomical features on rectal cancer surgery and postoperative anastomotic leakage FU Zhanwei, MA Junjun, ZHENG Minhua 2022, 27 (03):  261-265.  DOI: 10.16139/j.1007-9610.2022.03.016 Abstract ( 350 )   HTML ( 8 )   PDF (498KB) ( 111 )   Rectal cancer is common in digestive system malignant tumors. The effect of surgical treatment for patients with rectal cancer is influenced by the anatomical characteristics of pelvis. Narrow pelvic space increases the difficulty in surgery and the incidence of postoperative complications including anastomotic leakage. The study on difficulty in rectal cancer surgery due to pelvic anatomy and risk factors for postoperative anastomotic leakage was reviewed in this article. References | Related Articles | Metrics

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Neoadjuvant therapy in patients with locally advanced colon cancer XU Zifeng, ZONG Yaping, LU Aiguo 2022, 27 (03):  266-270.  DOI: 10.16139/j.1007-9610.2022.03.017 Abstract ( 468 )   HTML ( 1 )   PDF (500KB) ( 175 )   It is still unclear about neoadjuvant therapy in patients with locally advanced colon cancer (LACC). This review summarized neoadjuvant chemotherapy, neoadjuvant chemotherapy combined with targeted therapy and combined radio-chemotherapy for the patients with LACC to increase the survival of patients focusing on the efficacy and safety of neoadjuvant therapy. References | Related Articles | Metrics

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Progress of study on medullary thyroid carcinoma with serum calcitonin-negative and large mass LI Rui, LIU Zhuoran, YAN Jiqi 2022, 27 (03):  271-275.  DOI: 10.16139/j.1007-9610.2022.03.018 Abstract ( 554 )   HTML ( 8 )   PDF (435KB) ( 200 )   The characteristics of medullary thyroid carcinoma (MTC) include strong invasiveness, early lymph node metastasis and distant metastasis. MTC is aggresive only less than anaplastic carcinoma in all thyroid malignancies. Serum calcitonin is the most sensitive tumor marker for detecting MTC, which correlates with tumor size. However, it is difficult to diagnose some MTC patients with tumor diameter greater than 1 cm and serum calcitonin negative. This review focuses on recent advances in study on MTC with diameter greater than 1 cm and serum calcitonin negative. Figures and Tables | References | Related Articles | Metrics

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Diagnosis and treatment of medullary thyroid carcinoma-an update CHEN Chengkun, GUO Bomin, DENG Xianzhao, WU Bo, FAN Youben 2022, 27 (03):  276-280.  DOI: 10.16139/j.1007-9610.2022.03.019 Abstract ( 1032 )   HTML ( 23 )   PDF (543KB) ( 461 )   Medullary thyroid carcinoma (MTC) arising from the parafollicular cell (C cell) of the thyroid gland, is an aggressive neuroendocrine tumor and a special rare thyroid malignancy. Calcitonin and carcinoembryonic antigen are still commonly used markers now, whose elevation can reliably diagnose MTC. The preoperative value and postoperative doubling time of these markers are of great significance for range of lymph node dissection and evaluation of prognosis. It is recommended that total thyroidectomy and central lymph node dissection would be needed and lateral lymph node dissection would be added when necessary. Routine detection of RET gene is recommended. Targeted therapy is considered for non-operable patients or the patients with distant metastasis. The pathological mechanism of MTC still needs to be paid attention. Figures and Tables | References | Related Articles | Metrics