Table of Content

20 August 2024, Volume 24 Issue 04

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Original Articles and Clinical Research

The relationship between preoperative serum hepatitis B virus DNA load and postoperative liver function in patients with hepatocellular carcinoma resection

TAN Yong, LIU Hui, WU Li-ming, LIU Wen-ying, OU-YANG Zai-xing, HU Le-sheng, SONG Hao, HUANG Cong-yun, WU Qing-song

2024, 24(04):  209-214.  DOI: 10.3969/j.issn.1009-976X.2024.04.001

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Objective The purpose of this study was to explore the effect of preoperative serum hepatitis B virus DNA（HBV-DNA） load on postoperative liver function in patients with hepatocellular carcinoma （HCC）. Methods Ninety-one patients were divided into high replication group （30 cases in Group A, preoperative serum HBV-DNA load ≥10⁴ IU/ml）, medium replication group（23 cases in Group B, preoperative serum HBV-DNA load ≥500 IU/ml and <10⁴ IU/ml）, and low replication group （38 cases in Group C, preoperative serum HBV-DNA load <500 IU/ml）based on preoperative serum HBV-DNA load. The operating time, intraoperative blood loss, liver function indexes, postoperative hospital stay of patients were analyzed and compared between the three groups. Results The group A demonstrated a longer operating time compared with the group B and Group C（P<0.05）. The vakues of alanine aminotransferase （ALT） and aspartate aminotransferase （AST） of three groups achieved peak on the 1st day after operation. The values of ALT and AST of patients on the 1st day after operation, group A>group B>group C（P<0.05）. The ALT values of patients on the 3rd day after operation, group A>group B>group C（P<0.05）. The prothrombin time （PT） of Group C was significantly shorter than the Group A and group B on the 1st day after operation（P<0.05）. However, there was no significant difference in intraoperative blood loss, postoperative hospital stay, albumin （ALB） and total bilirubin （TBIL） after operation, and the AST on the 3rd day after operation among the groups（P>0.05）. The group A, the group B and the group C were divided into smaller groups according to preoperative antiviral therapy for 10 days. The operating time, the ALT and AST of patients on the 1st day after operation in the group that the preoperative serum HBV-DNA load ≥10⁴ IU/ml and the preoperative antiviral therapy less than 10 days were significantly higher than those in other groups（P<0.05）. There were two patients in the group that the preoperative serum HBV-DNA load ≥10⁴ IU/ml and the preoperative antiviral therapy was less than 10 days experienced postoperative liver failure, of which one died. Conclusion The HCC patients with highly preoperative serum HBV-DNA load who experienced more severely liver injury after operation, and properly prolonging the time of antiviral therapy before operation may help reduce the occurrence of postoperative liver failure and death.

Application of critical view of safety （CVS） concept in laparoscopic cholecystectomy in southern Xinjiang Region

ZHANG Ji-hao, SALAMU Mi-ji-ti, CAO Yan-long, TANG Hao-ze, KAHAER Tu-er-xun, LIAO Hao, CHEN Ya-jin, CHEN Jie

2024, 24(04):  215-219.  DOI: 10.3969/j.issn.1009-976X.2024.04.002

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Objective To investigate the impact of the critical view of safety （CVS） concept on the safety and prognosis of laparoscopic cholecystectomy （LC） in the southern Xinjiang region. Methods A retrospective analysis was conducted on the clinical data of 104 LC cases performed at the First People's Hospital of Kashgar from May 2023 to August 2023, designated as the control group. Starting in September 2023, the CVS concept was introduced to the clinical doctors performing LC, and 67 LC patients meeting the inclusion criteria from the same period and center were designated as the CVS group. Perioperative indicators of the CVS group were collected, and the safety and postoperative recovery between the control group and the CVS group were compared and analyzed. Results There was no statistically significant difference in the general preoperative conditions between the two groups （P>0.05）. The incidence of intraoperative bile duct injury and delayed postoperative bile duct injury was lower in the CVS group compared to the control group. Additionally, blood loss and postoperative AST and ALT levels were significantly lower in the CVS group, with the differences being statistically significant （P<0.05）. Conclusion The CVS concept can significantly enhance the safety of LC procedures in primary regions like southern Xinjiang and effectively improve prognosis and prevent bile duct injuries.

Distribution and significance of hepatic artery variation in liver surgery

WU Hai-feng, HUANG Ya-zhen, LI Fen, YAO Pei-xu

2024, 24(04):  220-224.  DOI: 10.3969/j.issn.1009-976X.2024.04.003

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Objective To investigate the anatomical variations of hepatic artery, to direct the operation, to reduce the incidence of hepatic artery injury and surgical complications. Methods A retrospectively analyze the data of patients who underwent liver operation in Jieyang People′s Hospital in recent 5 years, and analyze the variations of hepatic artery. Results There were 229 cases with normal anatomical structure of hepatic artery and 49 cases with anatomical variations of hepatic artery in 278 patients. Conclusion The variations of hepatic artery are common and complex. Hepatic arterial injury can be significantly reduced by increased familiarity with the variation of hepatic artery and making a plan before operation.

Expression of RAD54B in liver hepatocellular carcinoma and its influence on clinical prognosis

ZHENG Biao, CHEN Xu, QIAN Junlin, XU Baoshi, ZHEN Chaohui, LIANG Rui

2024, 24(04):  225-230.  DOI: 10.3969/j.issn.1009-976X.2024.04.004

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Objective To explore the significance of RAD54B expressionin liver hepatocellular carcinoma （LIHC）, and the difference of RAD54B expression level between LIHC and normal tissues, analyze its influence on patient prognosis. Methods Analyze the mRNA expression of RAD54B in LIHC and its impact on survival by using the TCGA online database. By using the human liver cancer tissue microarray （TMA）, evaluate the expression of RAD54B in LIHC by using immunohistochemical staining, and explore the impact of RAD54B on patient prognosis and its correlation with clinical pathological characteristics.Chi-square test was performed according to the correlation between antibody expression and clinical indicators of patients with LIHC, and univariate COX regression analysis and multivariate COX regression analysis were performed to screen out independent prognostic factors. The TCGA database was used to construct the nomogram and prognostic risk score model for RAD54B. Results TCGA database analysis showed that the expression level of RAD54B mRNA in LIHC tissues was higher than that in normal liver tissues. Immunohistochemical staining results also showed that the level of RAD54B protein expressed in LIHC tissue was significantly higher than that in normal liver tissue. The bioinformatics analysis of TCGA database and survival analysis of immunohistochemistry staining showed that the overall survival of the RAD54B high expression group was significantly reduced compared to the low expression group. Moreover, the expression of RAD54B is significantly correlated with multiple clinical features such as tumor size, TNM staging, and tumor grade in LIHC patients. Conclusion RAD54B as a prognostic factor for LIHC, is correlated with the size, stage, and differentiation of the patient's tumor. RAD54B may provide a new therapeutic target for LIHC treatment.

Impact of diabetes mellitus on pathogenic bacteria resistance, disease severity, and clinical outcomes among septic patients： a retrospective cohort study

MAI Lan, QIN Wei-qiang, XU Chang-qin, WU Na

2024, 24(04):  231-237.  DOI: 10.3969/j.issn.1009-976X.2024.04.005

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Objective The aim of this study was to investigate in depth the effect of diabetes mellitus （DM）on pathogenic bacterial resistance and its correlation with the severity of the disease by retrospectively analyzing the clinical data of patients with sepsis. Methods Adult patients diagnosed with sepsis from January 2020 to December 2021 were retrospectively collected. Patients' clinical data, laboratory data, infection indicator data, and clinical diagnosis and treatment data were collected. According to whether the patients were accompanied by type 2 diabetes mellitus or not, the patients were categorized into two groups, DM group and non-DM group, and the clinical data, laboratory data, infection index data, and clinical diagnosis and treatment data of the two groups were compared. In addition, multifactorial analysis was performed to explore the independent risk factors affecting clinical mortality outcomes in the DM group compared with the non-DM group. Results A total of 189 patients with sepsis were included, with a mean age of 70.9±9.7 years. Compared with patients in the non-DM group, patients in the DM group had significantly higher levels of glucose （224.6±64.3 vs. 84.9±7.1, P<0.001） and glycosylated hemoglobin （8.2±2.0 vs. 6.7±0.9, P<0.001） and significantly lower levels of albumin （40.2±3.7 vs. 41.6±2.7, P=0.006） on admission. were significantly lower. Moreover, a significantly higher proportion of patients in the DM group had drug-resistant drug sensitization results compared to the non-DM group （86.7% vs. 49.5%, P<0.001）. In addition, patients in the DM group had higher SOFA scores （16.3±5.4 vs. 11.8±3.9, P<0.001）, APACHE Ⅱ scores （38.4±8.9 vs. 16.8±12.9, P<0.001） compared to those in the non-DM group.A higher percentage of patients died of clinical outcomes in the DM group （41.8% vs. 14.3%, P<0.001）. Finally, only glucose on admission （OR=9.711, 95% CI：2.889~32.639, P<0.001） was found to be independently associated with clinical outcome （death）. Conclusion Patients with sepsis combined with diabetes had a higher proportion of bacterial resistance; more severe disease severity and a higher proportion of clinical outcome （death）. And high glucose on admission was an independent risk factor for patient death.

Analysis of safety and effectiveness of middle meningeal artery embolization combined with external drainage in the treatment of chronic subdural hematoma in hybrid operating room

LIANG Xiao-long, LI Ai-guo, YANG Yu-min, LONG Xiao-dong, HAN Yang-yun

2024, 24(04):  238-243.  DOI: 10.3969/j.issn.1009-976X.2024.04.006

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Objective To evaluate the safety and effectiveness of combined middle meningeal artery （MMA）embolization and external drainage in the treatment of chronic subdural hematoma （cSDH） under hybrid operating room. Methods Eighty patients with cSDH who received surgical intervention from September 2021 to October 2023 in our hospital, were included in the study. Among them, 41 cases received external drainage, 39 patients received MMA embolization combined with external drainage. One patient had a collateral anastomosis between the middle meningeal artery and the ophthalmic artery branch and did not receive embolization. In another case, the embolization was terminated due to severe arteriosclerosis and tortuousness which led to microcatheter being unable to bein place. The clinical symptoms, hematoma absorption, recurrence and related complications were observed within 3 months after operation. Results The successful rate of operation was 100% in all 80 cSDH patients. The hematoma was cleared well in all patients, and there were no surgical related complications. Fourty-ome patients were treated with external drainage. Only 7 patients （8.7%） recrudesced, and 37 patients received middle meningeal artery embolization combined with external drainage for 30 patients with primary cSDH and 7 patient with recurrence. No recurrence was found during the follow-up period and the mRS score was≤2.There were statistically significant differences in the thickness of cSDH and the first and last follow-up results of mRS （P<0.01）. Conclusion Middle meningeal artery embolization combined with external drainage is safe, effective and economical for the treatment of chronic subdural hematoma in hybrid operating room, especially for the treatment of refractory chronic subdural hematoma.

Relationship between glomerular filtration rate and clinical stage and prognosis of primary gastric adenocarcinoma

REN Xue-kang, ZHU Shao-gong, XIA Yun-zhan

2024, 24(04):  244-248.  DOI: 10.3969/j.issn.1009-976X.2024.04.007

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Objective To explore the relationship between estimated glomerular filtration rate （eGFR） and clinical stage and prognosis of primary gastric adenocarcinoma （GA）. Methods A total of 102 patients with GA in Zhengzhou People's Hospital from June 2020 to June 2023 were retrospectively selected as the research objects. Clinical data such as age, gender, tumor location, maximum diameter, histological differentiation, lymph node metastasis, distant metastasis, and clinical stage were recorded. The results of related indicators of renal function within 1 week before surgery were recorded. The eGFR levels and their correlation in patients with different clinical stages were compared. Patients were divided into metastasis group and non-metastasis group according to the presence or absence of distant metastasis, and eGFR levels were compared between the two groups. The diagnostic efficacy of eGFR was analyzed by ROC curve. Kaplan-Meier method and Cox proportional hazard model were used for survival analysis to evaluate the relationship between eGFR level and prognosis. Results There were significant differences in eGFR levels between patients with different clinical stages （P<0.001）, eGFR level was negatively correlated with clinical stage （r=-0.862,P<0.001）. The level of eGFR in patients with metastasis was lower than that in patients of non-metastasis （P<0.001）. The AUC of eGFR in the diagnosis of tumor metastasis was 0.940. By eGFR stratification, the results showed that the survival time of the higher stratification group was longer than that of the lower stratification group. Cox proportional hazards regression analysis showed that eGFR level（P=0.021）, distant metastasis （P=0.038）, and degree of differentiation （P=0.009） were independent factors affecting the prognosis of GA. Conclusion The level of eGFR is closely related to the clinical stage of patients, and it is an independent factor affecting the prognosis of patientsandhas important predictive value in evaluating the metastasis and prognosis of GA.

Clinical observation on the postoperative impact of PPH and MMH on sexual function in the treatment of severe mixed hemorrhoids

LIU Fan, YU Zhi-tao, WEN Sheng-rong

2024, 24(04):  249-253.  DOI: 10.3969/j.issn.1009-976X.2024.04.008

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Objective To investigate the impact of Procedure for Prolapse and Hemorrhoids （PPH） and Milligan-Morgan hemorrhoidectomy （MMH） on sexual function in patients with severe mixed hemorrhoids. Methods The data from 81 patients who underwent surgery for severe mixed hemorrhoids in our hospital from October 2022 to June 2023 were collected. The PPH group consisted of 41 patients who underwent PPH, while the MMH group consisted of 40 patients who underwent MMH. The International Index of Erectile Function （IIEF-5; score： ≥22 indicates no impairment） was used to evaluate male sexual function, and the Female Sexual Function Index（FSFI; score： >26.55 indicates no impairment） was used to evaluate female sexual function. A total of 62 patients completed the sexual function assessment questionnaires before and after surgery. The impact of the two most commonly used surgical methods on patients′ sexual function was assessed based on the scales. Results There was no statistically significant difference in the baseline data between the two groups. In the PPH group, the preoperative male sexual function score was 22.0 （3.5）, and the postoperative score was 22.0 （5.0）, P>0.05; the preoperative female score was 21.4 （8.1）, and the postoperative score was 23.6 （6.8）, P>0.05. In the MMH group, the preoperative male sexual function score was 22.5 （4.0）, and the postoperative score was 23.0 （5.0）, P>0.05; the preoperative female score was 24.6±7.5, and the postoperative score was 22.4±8.0, P>0.05. The median IIEF-5 scores of male patients before and after surgery in both groups were ≥22, and there were no statistically significant differences in the six dimensions of the FSFI scores for female patients before and after surgery. Conclusion PPH and MMH treatments for severe mixed hemorrhoids do not result in significant changes in patients′ sexual function, indicating that the surgeries are safe in terms of their impact on sexual function.

Comparative analysis of laparoscopic sleeve gastrectomy and sleeve gastrectomy combined with jejunal bypass in the treatment of non-alcoholic fatty liver disease

TONG Si-yu, CAO Guan-yi, WANG Shi-ping, LIU Guo-dong

2024, 24(04):  254-259.  DOI: 10.3969/j.issn.1009-976X.2024.04.009

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Objective To analyze the effect of laparoscopic sleeve gastrectomy （LSG） and sleeve gastrectomy combined with jejunal bypass （LSG-JJB） in the treatment of non-alcoholic fatty liver disease（NAFLD. Methods The clinical data and postoperative follow-up data of eligible bariatric patients in our hospital from January 2018 to December 2022 were analyzed. A historical cohort study was conducted, patients were divided into LSG group and LSG+JJB group according to different surgical methods. Two groups were matched 1∶1 using the PSM method. The general data of the two groups before and after PSM were compared, and the NAFLD indexes remission of the two groups after PSM were compared at 6 months and 12 months after operation. Results Seventy-five pairs of patients in the two groups were successfully matched by PSM. There was no significant difference in preoperative clinical data between the two groups after matching （P>0.05）. 6 months after operation, There was no significant difference in BMI, body weight, EWL% and LSM between the two groups （P>0.05）. Compared with LSG+JJB group,ALT（P<0.001）, AST （P<0.001）,GGT （P<0.001） and CAP （P=0.017） in LSG group were superior to LSG+JJB group, with statistical significance. TC （P<0.001） and TG （P=0.002） in the LSG group were inferior to those in the LSG+JJB group. Twelve months after surgery： There were no significant differences in ALT、AST、GGT、LSM and CAP between the two groups. LSG+JJB group were superior to LSG group in BMI （P=0.007）, EWL% （P=0.004）, body weight （P=0.001）, TC （P=0.004） and TG（P<0.001）. Conclusion There is no significant difference in ameliorating hepatic steatosis and fibrosis between the two surgical methods at 1 year after operation. LSG has advantage on ameliorating steatosis in the early postoperative period, LSG+JJB is superior to LSG in total cholesterol （TC） and triglyceride （TG） remission.

Application of non-invasive skin closure disposable device after excision of medium or small facial nevus of children

CHEN Chen, SHI Fen, ZHANG Jia-qi

2024, 24(04):  260-263.  DOI: 10.3969/j.issn.1009-976X.2024.04.010

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Objective To summarize the effect of one-stage application of single-use non-invasive skin closure disposable device on the wounds of the children after medium or small facial nevus excision. Methods From July 2019 to September 2023, 67 children ged 1~9 years old with medium or small facial nevus, a. The nevus was located on the face, with the longest diameter of 15 mm~50 mm. Using tension-reducing suture when the nevus was excised, then single-use non-invasive skin closure disposable device was used for external wound tension-reducing. disposable device on the wounds of the children after medium or small facial nevus excision. Results All of 67 children healed well after surgery, no bleeding, infection, dehiscence or other complication, wound scars were linear, no obvious scar widening, scar hyperplasia during follow-up. Conclusion The rational application of single-use non-invasive skin closure disposable device on the wounds of the children after medium or small facial nevus excision has good effects on reducing wound tension, promoting wound healing and alleviating postoperative scar.