中文English
ISSN 1001-5256 (Print)
ISSN 2097-3497 (Online)
CN 22-1108/R

2017 No. 4

Display Method:
Editorial
How to make better use of gastrointestinal endoscopy in diagnosis and treatment of biliary and pancreatic diseases
Zhang ShuTian, Wang YongJun
2017, 33(4): 607-610. DOI: 10.3969/j.issn.1001-5256.2017.04.001
Abstract:
The techniques for endoscopic diagnosis and treatment of biliary and pancreatic diseases mainly include endoscopic retrograde cholangiopancreatography and endoscopic ultrasonography, which have achieved great progress in recent years. Meanwhile, new techniques including combined therapy with endoscopy and laparoscopy and natural orifice transluminal endoscopic surgery have gradually been applied in clinical practice. In the future, it is necessary to cultivate interdisciplinary experts in the field of endoscopy who master various endoscopic techniques and integrated talents with experience in both transluminal operation and gastrointestinal surgery outside lumens. At present, there are still controversies over the application of new techniques in the treatment of biliary and pancreatic diseases. The diagnosis and treatment of biliary and pancreatic diseases can be further improved by promoting the application of biliary and pancreatic endoscopy and standardization, accumulating experience and improving devices, evaluating clinical research, and promoting the bench-to-bedside translation of new techniques.
Therapeutic guidelines
Guideline for the diagnosis and therapy of gallbladder carcinoma(2016)
Chinese Anti-Cancer Association
2017, 33(4): 611-620. DOI: 10.3969/j.issn.1001-5256.2017.04.002
Abstract(243) PDF (367KB)(1546)
Abstract:
An excerpt of AASLD guidelines for the treatment of hepatocellular carcinoma (2016)
Li Jing, Qi XingShun, Han Tao, Li HongYu
2017, 33(4): 621-622. DOI: 10.3969/j.issn.1001-5256.2017.04.003
Abstract:
International consensus for the treatment of autoimmune pancreatitis (2016) 
Zhao XuDong, Ma YongSu, Yang YinMo
2017, 33(4): 623-626. DOI: 10.3969/j.issn.1001-5256.2017.04.004
Abstract:
An excerpt of pancreatic anastomosis after pancreatoduodenectomy: a position statement by the International Study Group of Pancreatic Surgery (2016)
Hu YaNan, Yang GuiYuan, Qian ZhuYin, Yang XiaoJun
2017, 33(4): 627-631. DOI: 10.3969/j.issn.1001-5256.2017.04.005
Abstract:
An excerpt of ACG clinical guideline: evaluation of abnormal liver chemistries
Yang YaTing, Yan LiTing, Chen Hong, Li JunFeng
2017, 33(4): 632-637. DOI: 10.3969/j.issn.1001-5256.2017.04.006
Abstract:
An excerpt of NASPGHAN clinical practice guideline for the diagnosis and treatment of nonalcoholic fatty liver disease in children
Huang XinYu, Zhang QiuZan
2017, 33(4): 638-642. DOI: 10.3969/j.issn.1001-5256.2017.04.007
Abstract:
Discussions by experts
Laparoscopic hepatectomy: the choice in the era of minimally invasive surgery
Liu Bin, Li WenGang, Chen FuZhen
2017, 33(4): 643-646. DOI: 10.3969/j.issn.1001-5256.2017.04.008
Abstract:

Since Reich completed the first laparoscopic hepatectomy ( LH) in 1991, LH has been developed rapidly with the continuous improvement of surgeons' technique and the technological changes in devices and related processes. This article elaborates on the safety and efficacy of LH, the value of 3D visualization, 3D printing technology, and 3D laparoscopic technology in guiding precise hepatectomy, control of hemorrhage during LH, and safety and efficacy of robotic hepatectomy.

Prevention and treatment of complications after radiofrequency ablation for hepatic tumors in high-risk locations
Song Li, Zou YingHua
2017, 33(4): 647-650. DOI: 10.3969/j.issn.1001-5256.2017.04.009
Abstract:

Percutaneous radiofrequency ablation ( RFA) has been widely used in the treatment of malignant hepatic tumors and has achieved satisfactory effects. Complications after RFA have been taken seriously and the risk of the development of complications is closely associated with tumor location. It is a great challenge for physicians to perform RFA for hepatic tumors in high-risk locations due to related difficulties and risks. This article reviews the complications after RFA for hepatic tumors in high-risk locations and analyzes related control strategies.

Application of combination of various endoscopic techniques in treatment of bile duct stones
Zhang QingKai, Shang Dong
2017, 33(4): 651-655. DOI: 10.3969/j.issn.1001-5256.2017.04.010
Abstract:

Bile duct stones are a common disease in clinical practice in China, and due to a high incidence rate of complications and complex causes, its clinical diagnosis and treatment has become a difficult problem which needs to solved urgently. With the development of science and technology and the enhanced knowledge of this disease, many treatment methods for this disease have emerged. This article summarizes the successful experience in the treatment of bile duct stones in the Center for Integrated Traditional Chinese and Western Medicine Therapy for Biliary and Pancreatic Diseases in our hospital. With reference to the type and distribution characteristics of bile duct stones, a combination of various endoscopic techniques, such as laparoscopy, choledochoscopy, and duodenoscopy, can achieve the goal of minimally invasive, diverse, and individualized diagnosis and treatment and provide feasible thoughts and strategies for the treatment of bile duct stones.

Features and strategies of endoscopic retrograde cholangiopancreatography in elderly patients aged above 60 years with biliary and pancreatic diseases
Nie ZhanGuo, Dai ZhongMing
2017, 33(4): 656-660. DOI: 10.3969/j.issn.1001-5256.2017.04.011
Abstract:

Elderly patients with biliary and pancreatic diseases are often complicated by other underlying diseases and have poor cardiopulmonary function, and most of them cannot tolerate general anesthesia. The patients aged above 80 years who have undergone bile duct exploration have high mortality rate and incidence rate of complications. Endoscopic retrograde cholangiopancreatography ( ERCP) is applicable to elderly patients with biliary and pancreatic diseases. This article elaborates on the features of perioperative treatment and technical operation of ERCP in elderly patients.

Current status of laparoscopic central pancreatectomy
Cao Yang, Liu DaRen, Li JiangTao
2017, 33(4): 661-663. DOI: 10.3969/j.issn.1001-5256.2017.04.012
Abstract:

Central pancreatectomy is an ideal surgical procedure for the treatment of benign or low-grade malignant tumors in the pancreatic neck or the proximal body of the pancreas, and it can preserve more normal pancreatic tissue in order to reduce the incidence of endocrine and exocrine insufficiency after surgery. Although some clinical studies have demonstrated the feasibility and safety of this procedure, laparoscopic central pancreatectomy was technically challenging with a few number of cases. This article reviews the current status of laparoscopic central pancreatectomy and introduces our clinical experience of laparoscopic central pancreatectomy and pancreaticojejunostomy.

Original articles_Viral hepatitis
Impact of HBV DNA detection methods on evaluating the clinical effect of PEG-IFNɑ-2b in treatment of HBeAg-positive chronic hepatitis B: a comparative analysis
Guo ChunXia, Li Jia, Xu CengLi, Guo Jie, Zhai Lu, Han Xu
2017, 33(4): 664-667. DOI: 10.3969/j.issn.1001-5256.2017.04.013
Abstract:

Objective To investigate the impact of different HBV DNA detection methods on evaluating the clinical effect of PEG-IFNα-2b in the treatment of HBeAg-positive chronic hepatitis B (CHB) .Methods A total of 83 CHB patients who were admitted to Tianjin Second People's Hospital from September 2014 to January 2016 and treated with PEG-IFNa-2b for less than 24 weeks with clearance for the first time detected by HBV DNA low-sensitivity method (the lower limit of detection was 500 IU/ml) and negative results within 36 weeks obtained by low-sensitivity detection.Among these patients, 33 patients with negative results within 36 weeks obtained by high-sensitivity detection (the lower limit of detection was 20 IU/ml) were enrolled in negative group, and 50 with positive results were enrolled in positive group.The reductions in HBeAg and HBsAg and HBeAg seroconversion rate at 12, 24, and 36 weeks were compared between the two groups.The independent-samples t test was used for comparison of normally distributed continuous data between groups, the Mann-Whitney U rank sum test was used for comparison of non-normally distributed continuous data between groups, and the chi-square test was used for comparison of categorical data between groups.Results At 12, 24, and 36 weeks after negative results were obtained by HBV DNA low-sensitivity detection, the negative group had a significant reduction in HBeAg than the positive group[12 weeks:0.32 (0.16-0.92) log10 COI vs 0.14 (0.01-0.30) log10 COI, Z=-3.061, P =0.002;24 weeks:0.44 (0.19-1.15) log10 COI vs 0.16 (0.04-0.35) log10 COI, Z=-3.043, P =0.002;36 weeka:0.51 (0.36-1.21) log10 COI vs 0.24 (0.10-0.46) log10 COI, Z=-3.880, P< 0.001].At 12 weeka after negative reaulta were obtained by HBV DNA low-aenaitivity detection, there waa no aignificant difference in the reduction in HBaAg (P-0.067) , while at 24 and 36 weeka, the negative group had a aignificant reduction in HBaAg than the poaitive group[24 weeka:0.13 (-0.02-0.33) log10 IU/ml vs 0.08 (-0.02-0.16) log10 IU/ml, Z =-2.207, P =0.021;36 weeka:0.16 (0.03-0.47) log10 IU/ml va 0.03 (-0.08-0.20) log10 IU/ml, Z =-2.363, P =0.018].At 12 weeka after negative reaulta were obtained by HBV DNA low-aenaitivity detection, there waa no aignificant difference in the HBeAg aeroconveraion rate between the negative group and the poaitive group (30.30%va 16.00%, P = 0.174) , while at 24 and 36 weeka, there were aignificant differencea between the two groupa (36.36%val6.00%and39.39%val8.00%, x2=4.507 and 4.671, P =0.040 and 0.042) .Conclusion In the treatment of HBeAg-poaitive CHB uaing PEG-IFN, high-aenaitivity detection methoda ahould be uaed to accurately evaluate the effect of antiviral therapy.

Construction of HBV whole-genome 1. 3 ploid HepG2 cell model and expression of HBV biomarkers
Qiu Hua, Gao YueQiu, Mao DeWen, Zhou ZhenHua, Long FuLi, Wang MingGang
2017, 33(4): 668-673. DOI: 10.3969/j.issn.1001-5256.2017.04.014
Abstract:
Objective To construct an HepG2 cell model containing HBV whole-genome 1. 3 ploid ( HBV 1. 3P) , and to investigate the expression of HBV biomarkers. Methods HepG2 cells were transfected with the 1. 3-ploid whole-genome HBV DNA sequence using the adenovirus vector to construct an HBV 1. 3P-HepG2 cell model. Agarose gel electrophoresis was used to identify HBV 1. 3P recombinant adenovirus plasmids, and the ABI 3730 sequencer was used to confirm whether the recombinant adenovirus plasmids had correct HBV 1. 3P sequence. The optimal multiplicity of infection ( MOI) of HepG2 cells infected by the HBV 1. 3P adenovirus was determined under a fluorescence microscope. Quantitative real-time PCR was used to measure the expression of HBV DNA and ccc DNA in the HBV 1. 3P-HepG2 cell model at 0-9 days, and chemiluminescence and immunofluorescence assay were used to measure the expression of HBs Ag and HBe Ag, respectively, in supernatant and cells. An analysis of variance was used for comparison of continuous data between multiple groups, and the SNK-q test was used for comparison between any two groups. Results When MOI was 40, the efficiency of HepG2 cells being infected by HBV 1. 3P recombinant adenovirus reached above 90%. On the second day of infection, the expression of the biomarkers HBV DNA, ccc DNA, HBs Ag, and HBe Ag was detected in supernatant and cells, and the levels of these biomarkers reached peak values at 4-6 days and gradually decreased after 7 days. Conclusion This HBV 1. 3P-HepG2 cell model can express HBV biomarkers stably, which lays a foundation for future research on HBV.
Original articles_Liver neoplasms
Clinical features of HBsAg-negative HBV-related hepatocellular carcinoma
Ma Yan, Chen Yan, An LinJing, Qu JianHui, Wang ChunPing, Yang YongPing
2017, 33(4): 674-678. DOI: 10.3969/j.issn.1001-5256.2017.04.015
Abstract:
Objective To investigate the clinical features of HBsAg-negative HBV-related hepatocellular carcinoma (HCC) .Methods The patients who were newly diagnosed with HCC from January 2005 to January 2012 were enrolled.According to the HBV-related serological markers, the patients were divided into HBsAg-negative HBV-related HCC group and hepatitis B-related HCC group.A retrospective analysis was performed for the clinical and laboratory examination data at initial diagnosis, including sex, age, hepatitis B virus markers, total bilirubin (TBil) , albumin (Alb) , alpha-fetoprotein (AFP) , HBV DNA, body mass index (BMI) , drinking history, history of diabetes, therapies, and follow-up results.The t-test was used for comparison of normally distributed continuous data between groups;the non-normally distributed data were expressed as median and interquartile range (Q1 and Q3) , and the Wilcoxon rank sum test was used for comparison of non-normally distributed continuous data between groups;the chi-square test or Fisher's exact test were used for comparison of categorical data.The log-rank test was used to compare survival curves between the two groups, and the Kaplan-Meier method was used to calculate survival rates.Results Compared with the hepatitis B group and all patients, the HBsAg-negative group had a significantly higher mean age (59.42 ± 11.13 years) and significantly higher proportions of patients with age > 60 years (46.85%) , low body weight (12.24%) , and overweight (20.98%) (all P < 0.01) .Compared with all patients and the hepatitis B group, the HBsAg-negative group had a significantly lower male-to-female ratio (2.86:1) , a significantly lower proportion of patients regularly undergoing physical examination every year (10.41%) , a significantly lower HBV DNA positive rate (1.77%) , and significantly lower proportions of patients with smoking and drinking histories (all P <0.01) .Of all patients in the HBsAg-negative group, 64.08%had positive anti-HBs, antiHBe, and anti-HBc, 21.13%had positive anti-HBe and anti-HBc, and 14.79%only had positive anti-HBc.The HBsAg-negative group had a significantly lower AFP level than all patients and the hepatitis B group (P = 0.039) .Compared with the hepatitis B group and all patients, the HBsAg-negative group had a significantly higher proportion of multiple lesions, a significantly greater mean maximum tumor diameter, and a significantly higher number of patients with extrahepatic metastasis (all P < 0.001) .Compared with the hepatitis B group, the HBsAg-negative group had a higher proportion of patients with an Eastern Cooperative Oncology Group Performance Status score of 0 at initial diagnosis (17.69%) and a lower proportion of patients with early-to-medium Barcelona Clinic Liver Cancer stage (stages A and B) (30.26%vs 51.60%, P<0.001) ;the number of patients with stages C and D in the HBsAg-negative group was 1.83 times that in the hepatitis B group (P <0.001) .The HBsAg-negative group had a significantly lower median survival time (15.22 months) than all patients and the hepatitis B group (P = 0.024、0.031) .Compared with all patients and the hepatitis B group, the HBsAg negative group had significantly lower 1-and 3-year survival rates (1-year survival rate:56.0%vs 61.7%and 66.2%, x2=-4.93, P-0.026;3-year survival rate:24.0%vs45.2%and 44.1%, x2= 6.867, P = 0.009) .Conclusion HBsAg-negative HBV-related HCC is commonly seen in patients aged >60 years with positive anti-HBs, anti-HBe, and anti-HBc.The population aged >60 years with HBV infection should be the high-risk population for HCC, and it is recommended to perform HCC screening every 6 months to increase the early diagnostic rate of HBsAg-negative HBV-related HCC.
Clinical features of patients developing primary hepatocellular carcinoma during anti-HBV therapy with nucleos (t) ide analogues
Zhang Ying, Liu Ming, Peng XiaoHua, Sun LinLin, Wang YaoHui, Xie ShiBin
2017, 33(4): 679-683. DOI: 10.3969/j.issn.1001-5256.2017.04.016
Abstract:
Objective To investigate the clinical features of patients developing hepatocellular carcinoma ( HCC) during anti-hepatitis B virus ( HBV) therapy with nucleos ( t) ide analogues ( NAs) . Methods A total of 542 patients who were diagnosed with HCC for the first time in The Third Affiliated Hospital of Sun Yat-Sen University from January 2008 to September 2014 were enrolled, and they all had chronic HBV infection. According to the presence or absence of standard therapy with NAs, they were divided into antiviral group ( 130 patients) and non-antiviral group ( 412 patients) . A retrospective analysis was performed for their clinical data, including age, sex, family history of tumor, duration of HBV infection, the time when a confirmed diagnosis of liver cirrhosis was made, history of drinking, history of diabetes, history of medication, laboratory parameters, liver pathology, and imaging findings, and these data were compared between the two groups.The t-test was used for comparison of normally distributed continuous data between groups, the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups, and the chi-square test was used for comparison of categorical data between groups. Results Compared with the non-antiviral group, the antiviral group had significant increases in the proportion of patients with liver cirrhosis ( 90. 0% vs 78. 4%, χ2= 8. 528, P = 0. 003) and HBe Ag-positive rate ( 29. 4% vs 18. 5%, χ2= 6. 794, P = 0. 009) .There was a significant difference in the constitution of HBV DNA between the two groups ( χ2= 173. 142, P < 0. 001) , as well as significant differences in alanine aminotransferase, gamma-glutamyl transpeptidase, and alpha-fetoprotein ( all P < 0. 001) . Compared with the non-antiviral group, the antiviral group had a higher proportion of patients with early-or intermediate-stage liver cancer, smaller and fewer cancer lesions, and a lower proportion of patients with vascular invasion or distant metastasis ( all P < 0. 001) . Among the patients in the antiviral group, 80% ( 104/130) developed HCC within 5 years of anti-HBV therapy. Conclusion Some patients with chronic HBV infection who receive long-term NAs as the anti-HBV therapy still develop HCC, especially those with liver cirrhosis, and most of these cases occur within 5 years of anti-HBV therapy. Most patients treated with NAs are diagnosed at the early stage of HCC, suggesting that standard follow-up is of vital importance.
Effect of different minimally invasive therapies on the prognosis of patients with HBV-related primary liver cancer complicated by portal vein tumor thrombus
Li MengGe, Zhao YaLin, Liu XiaoLi, Wang XinHui, Jiang YuYong, Yang ZhiYun
2017, 33(4): 684-688. DOI: 10.3969/j.issn.1001-5256.2017.04.017
Abstract:
Objective To investigate the effect of minimally invasive therapy on the 1-year survival of patients with HBV-related primary liver cancer ( PLC) complicated by portal vein tumor thrombus ( PVTT) , and to provide a guidance for clinical treatment. Methods A total of 191 patients who were diagnosed with HBV-related PLC complicated by PVTT in Beijing Ditan Hospital, Capital Medical University, from January 2012 to December 2014 and met the inclusion criteria were enrolled. The patients were followed up to observe their survival time, and they were divided into survival group and death group. The demographic features and related clinical indices were collected. The t-test was used for comparison of normally distributed continuous data between groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups; the chi-square test was used for comparison of categorical data between groups. The Cox regression model was used for multivariate analysis. Results Of all patients, 80 achieved a 6-month survival time, among whom 52 ( 65%) underwent minimally invasive therapy, and 57 achieved a 1-year survival time, among whom 36 ( 63. 16%) underwent minimally invasive therapy. In patients with HBV-related PLC complicated by PVTT, minimally invasive therapy had a significant effect on the 6-month survival rate ( χ2= 5. 419, P = 0. 009) and had no significant effect on the 1-year survival rate ( χ2= 1. 881, P = 0.093) , with a significant effect on survival time ( P = 0. 001) . The Cox multivariate analysis showed that direct bilirubin and gamma-glutamyl transpeptidase were risk factors for 1-year survival in patients with HBV-related PLC complicated by PVTT, while minimally invasive therapy was a protective factor for 1-year survival ( RR = 0. 812, 1. 007, and 1. 002, P < 0. 001, P = 0. 002, and P = 0. 017) . Conclusion Radiofrequency ablation combined with transcatheter arterial chemoembolization should be performed as early as possible for patients with HBV-related PLC complicated by PVTT and can prolong survival time.
Correlation between microRNA-520a and clinicopathological features of HBV-related hepatocellular carcinoma
Zhang YuRui
2017, 33(4): 689-693. DOI: 10.3969/j.issn.1001-5256.2017.04.018
Abstract:
Objective To investigate the correlation between microRNA-520 a and clinicopathological parameters in patients with hepatocellular carcinoma (HCC) .Methods The medical records and tissue specimens of 183 HCC patients, who received surgical treatment in the Affiliated Hospital of Taishan Medical College from January 2010 to December 2015, were collected.Quantitative real-time PCR was used to measure the expression of microRNA-520 a in HCC tissues and corresponding adjacent tissues from 183 patients with HCC, and its correlation with clinicopathological parameters was analyzed.A one-way analysis of variance was used for comparison between multiple groups, and the independent samples t-test was used for comparison between two groups; Spearman correlation analysis was also performed.Results HCC tissues had significantly lower expression of microRNA-520 a than corresponding adjacent tissues (1.92 ± 0.76 vs 2.73 ±1.15, t=-6.731, P<0.001) .The area under the receiver operating characteristic (ROC) curve was 0.711 (95% CI:0.64-0.79, P<0.001) .There were significant reductions in the expression of microRNA-520 a in HCC tissues in patients with distant metastasis (P=0.031) , advanced TNM stage (P=0.022) , positive serum hepatitis B virus (HBV) (P<0.001) , or tumor separation (P=0.026) .The Spearman correlation analysis showed that the expression of microRNA-520 a was significantly correlated with HBV infection (r=-0.351, P<0.001) and tumor separation (r=-0.207, P=0.044) .Conclusion The expression of microRNA-520 a is significantly downregulated in HCC tissues and it may inhibit the progression of HCC.
Clinical effect of Cyber Knife stereotactic radiosurgery in treatment of patients with small hepatocellular carcinoma
Zhang Tao, Sun Jing, He WeiPing, Li Huan, Wang Hui, Sun YingZhe, Po JunJie, Zhang JunHua, Xu HuiJun, Duan XueZhang
2017, 33(4): 694-698. DOI: 10.3969/j.issn.1001-5256.2017.04.019
Abstract:
Objective To investigate the clinical effect and safety of Cyber Knife stereotactic radiosurgery in the treatment of small hepatocellular carcinoma ( s HCC) . Methods Twenty-eight patients with s HCC who underwent Cyber Knife radiosurgery in 302 hospital of PLA form March 2011 to December 2012 were enrolled. The total dose of Cyber Knife radiosurgery was 35-60 Gy in 3-5 fractions for 3-6 consecutive days. The median follow-up was 36 months. Modified Response Evaluation Criteria in Solid Tumors was used as assessment indices for short-term therapeutic effect, and the 1-, 2-, and 3-year overall survival rates and local control rates were used as assessment indices for long-term therapeutic effect. The Kaplan-Meier method was used to calculate cumulative survival rate and local control rate. Results Among the 28 patients, 17 achieved complete remission ( CR) , 8 achieved partial remission ( PR) , 2 achieved a stable disease, and1 had a progressive disease, resulting in a short-term response rate ( CR + PR) of 89. 28%. The 1-, 2-, and 3-year survival rates were 92. 86%, 85. 71%, and 78. 57%, respectively, and the 1-, 2-, and 3-year local control rates were 96. 43%, 92. 86%, and89. 28%, respectively. Toxic reactions were mainly grade 1 and 2 events. Conclusion Cyber Knife is a safe and effective option for s HCC and has the features of high local control rate, high survival rate, and few toxic reactions. Therefore, it can be used as an alternative treatment for patients with inoperable s HCC.
Clinical effect of hepatectomy versus extracapsular peeling in treatment of hepatic hemangioma
Chen Kai, Li XiangNong, Liu Kun, Nan YunGuang, Yang Jun
2017, 33(4): 699-704. DOI: 10.3969/j.issn.1001-5256.2017.04.020
Abstract:
Objective To investigate the clinical effect of hepatectomy versus extracapsular peeling in the treatment of hepatic hemangioma, and to provide a basis for selection of surgical procedure in clinical practice.Methods A retrospective analysis was performed for the clinical data of 115 patients who underwent surgical treatment in The Affiliated Hospital of Xuzhou Medical University from January 2010 to May2016.According to the surgical procedure, these patients were divided into peeling group (79 patients) and hepatectomy group (36 patients) .According to the tumor diameter, the patients were further divided into two subgroups for stratified comparison:89 patients with hepatic hemangioma who had a tumor diameter of 5-10 cm were divided into large peeling group with 64 patients and large hepatectomy group with 25 patients; 26 patients with a tumor diameter of >10 cm were divided into giant hemangioma peeling group with 15 patients and giant hemangioma hepatectomy group with 11 patients.The preoperative, intraoperative, and postoperative clinical data were compared between groups.The two-independent-samples t test was used for comparison of normally distributed continuous data, and the Mann-Whitney U test was used for comparison of non-normally distributed data between groups.The chi-square test and Fisher' s exact test were used for comparison of categorical data between groups.Results There were no significant differences between the hepatectomy group and the peeling group in intraoperative blood loss [300 (200-400) ml vs 300 (225-500) ml, Z=-1.065, P=0.287 ], time of operation [120 (105-160) min vs 140 (95-150) min, Z =-0.036, P = 0.971], postoperative drainage volume [280 (165-520) ml vs 310 (105-546) ml, Z=0.413, P=0.679], length of hospital stay [16 (14-19) d vs 14 (13-19.5) d, Z=-1.283, P=0.200], and hospital costs (27 973.64 ± 10 028.32 RMB vs 28 680.85 ± 10 662.87 RMB, Z=-0.344, P=0.732) .The subgroup analysis showed that there were also no significant differences between the hepatectomy group and the peeling group in intraoperative blood loss, time of operation, postoperative drainage volume, length of hospital stay, and hospital costs (all P>0.05) .Conclusion Hepatectomy and hemangioma peeling have similar clinical effects in the treatment of hepatic hemangioma.
Original articles_Biliary diseases
The most appropriate timing for selective laparoscopic cholecystectomy after percutaneous transhepatic gallbladder drainage in patients with acute severe cholecystitis aged above 60 years
Zhao HongGuang, Liu Kai, Liu YaHui
2017, 33(4): 705-710. DOI: 10.3969/j.issn.1001-5256.2017.04.021
Abstract:
Objective To investigate the clinical effect of selective laparoscopic cholecystectomy (LC) after percutaneous transhepatic gallbladder drainage (PTGD) in the treatment of elderly patients with acute severe cholecystitis, as well as the most appropriate timing for selective operation.Methods A total of 90 patients with acute severe cholecystitis aged above 60 years who were admitted to Department of Hepatobiliary Surgery in The First Hospital of Jilin University from January 2015 to June 2016 were enrolled, and according to the time of selective LC, they were divided into group A (with 2 months) , group B (2-4 months) , and group C (>4 months) , with 30 patients in each group.The clinical effects of PTGD and selective LC were observed.The t-test was used for comparison of continuous data between two groups, an analysis of variance was used for comparison between three groups, and LSD-t test was used for comparison between any two groups; the chi-square test was used for comparison of categorical data between groups.Results All the patients underwent successful PTGD, and the time to abdominal pain remission was 2.52 ± 0.76 hours.Body temperature returned to normal with 24-72 hours after surgery, and there were significant improvements in laboratory markers (white blood cell count, neutrophil count, and liver function) (all P<0.05) .No patient experienced complications such as bile leakage, hematobilia, pneumothorax, and colon perforation caused by puncture, and there was no case of PTGD after the tube was detached.There were significant differences between the three groups in gallbladder wall thickness before LC (F=8.029, P<0.001) , time of operation (F=24.674, P<0.001) , intraoperative blood loss (F=12.864, P<0.001) , length of hospital stay (F=22.844, P<0.001) , rate of conversion to laparotomy (χ2=12.345, P=0.002) , and incidence rate of complications (χ2=8.750, P=0.013) .Compared with group A, groups B and C had significantly lower gallbladder wall thickness before LC, intraoperative blood loss, length of hospital stay, rate of conversion to laparotomy, and incidence rate of complications (all P<0.05) , and group B had significantly lower time of operation, intraoperative blood loss, and length of hospital stay than group C (all P<0.05) .Conclusion Selective LC with 2-4 months after PTGD has a marked clinical effect and high safety in the treatment of elderly patients with acute severe cholecystitis.
Original articles_Others
A multivariate logistic regression analysis of short-term prognosis of patients with hepatic encephalopathy
Wang FengJiao, Liu MingJiang, Wu RuiHong, Niu JunQi
2017, 33(4): 711-714. DOI: 10.3969/j.issn.1001-5256.2017.04.022
Abstract:

Objective To investigate the risk factors for poor short-term prognosis of patients with hepatic encephalopathy (HE) .Methods A retrospective analysis was performed for the clinical data of 316 patients with HE who were hospitalized and treated in The First Hospital of Jilin University from January 2013 to December 2015, and according to their prognosis, they were divided into survival group (229patients) and death group (87 patients) .The univariate and multivariate analyses were performed for their general data and biochemical parameters to screen out the risk factors for poor prognosis of HE.The t-test or Mann-Whitney U test was used for comparison of continuous data between groups, and the chi-square test was used for comparison of categorical data between groups.The multivariate logistic regression analysis was performed for the variables with statistical significance identified in the univariate analysis.Results All the patients were followed up for 30 days, and 87 patients died, resulting in a mortality rate of 27.5%.The male/female ratio was 1.72∶ 1, and 269 patients (85.13%) were aged ≥45 years.The univariate analysis showed that there were significant differences between the two groups in age, a combination of primary liver cancer, HE stage, white blood cell count, neutrophil count, hemoglobin, platelet count, international normalized ratio, prothrombin time, prothrombin time activity (PTA) , blood urea nitrogen, creatinine, serum sodium, serum potassium, alanine aminotransferase, aspartate aminotransferase, gamma-glutamyl transpeptidase, albumin, indirect bilirubin, total bilirubin (TBil) , and prealbumin (all P<0.05) .The multivariate analysis showed that a combination of primary liver cancer (OR=3.278, 95% CI: 1.494-7.194, P=0.003) , HE stage (OR=2.402, 95% CI: 1.711-3.372, P<0.001) , PTA (OR=0.969, 95% CI:0.951-0.988, P=0.001) , serum sodium (OR=0.956, 95% CI: 0.922-0.992, P=0.018) , and TBil (OR=1.004, 95% CI:1.003-1.006, P<0.001) were independent risk factors for the prognosis of patients with HE.Conclusion A combination of primary liver cancer, advanced HE stage, low serum sodium, low PTA, and increased TBil are independent risk factors for poor prognosis of HE, and the equation based on these indices has a certain reference value in clinical practice.

Clinical effect of plasma perfusion combined with plasma exchange in treatment of patients with acute-on-chronic liver failure
Zhou Jian, Wan Hong, Yang ZhengMao, Wang ZhaoXun
2017, 33(4): 715-718. DOI: 10.3969/j.issn.1001-5256.2017.04.023
Abstract:

Objective To investigate the clinical effect of plasma perfusion (PP) combined with plasma exchange (PE) in the treatment of acute-on-chronic liver failure (ACLF) .Methods A total of 72 patients with ACLF who were admitted to The Second People's Hospital of Lanzhou from January 2014 to December 2015 were enrolled.In addition to internal medication, all the patients were treated with the artificial liver support system (once every 3-4 days based on the patients' conditions, 1-3 times on average for each patient) .According to the difference in therapies, the patients were divided into combination group with 40 patients (PP combined with PE and a total of 107 case times) and control group with 32 patients (PE alone and a total of 85 case times) .Total bilirubin (TBil) , alanine aminotransferase (ALT) , and prothrombin time were recorded before treatment, after surgery, and at 72 hours after surgery.Clinical outcome was evaluated after 4 weeks of treatment.The t-test was used for comparison of continuous data between groups, and the chi-square test was used for comparison of categorical data between groups.Results The overall response rate of all patients was 63.89% (46/72) .At 72 hours after surgery, there was a significant difference in the level of ALT between the combination group and the control group (319.54 ± 86.23 U/L vs354.75 ± 100.76 U/L, t=2.60, P<0.05) .Both groups had significant reductions in TBil and ALT after surgery (combination group: t =6.69 and 15.84, P<0.05; control group: t=5.34 and 14.38, P<0.05) and at 72 hours after surgery (combination group: t=3.24 and8.83, P<0.05; control group: t=2.40 and 4.61, P<0.05) .Both groups had significant changes in prothrombin time activity after surgery (t=4.83 and 5.01, both P<0.05) .There were no significant differences in the incidence rates of pruritus and rash between the two groups, while there was a significant difference in the incidence rate of perioral or limb numbness between the two groups (10.28% vs31.76%, χ2=9.11, P<0.05) .Conclusion Both PE combined with PP and PE alone can effectively improve the clinical outcome of ACLF patients with similar response rates; however, PE combined with PP can save the amount of plasma by 40%-50% and reduce the incidence of the adverse effects of PE and has higher safety.Meanwhile, it is in accordance with the social reality of a shortage of blood resources.Therefore, it is a better choice in clinical treatment.

A risk factors analysis of acute-on-chronic liver failure complicated by spontaneous bacterial peritonitis
Liu ZhengFang, Huang Wei, Li Qin
2017, 33(4): 719-722. DOI: 10.3969/j.issn.1001-5256.2017.04.024
Abstract:

Objective To investigate the influencing factors for spontaneous bacterial peritonitis (SBP) in patients with acute-on-chronic liver failure (ACLF) , and to provide a reference for clinical diagnosis and prognosis evaluation.Methods A retrospective analysis was performed for the clinical data of 667 patients with ACLF who were hospitalized and treated in our hospital from January 2009 to December2014, and according to the presence or absence of SBP, they were divided into ACLF group (n=232) and ACLF-SBP group (n=435) .The general information, laboratory markers, and incidence of complications were compared between the two groups.The t-test was used for comparison of normally distributed continuous data between groups, and the Mann-Whitney U test was used for non-normally distributed continuous data between groups; the chi-square test was used for comparison of categorical data between groups, and a logistic regression analysis was used to identify independent risk factors for ACLF complicated by SBP.Results The comparison of laboratory markers and comorbidities showed that there were significant differences between the two groups in albumin (Alb) (t=-4.110, P<0.001) , alanine aminotransferase (U=-6.653, P<0.001) , aspartate aminotransferase (t=-8.045, P<0.001) , blood sodium (t=-2.879, P=0.006) , prothrombin time activity (t=-2.140, P=0.037) , international normalized ratio (t=1.453, P=0.042) , hemoglobin (t=-3.446, P=0.001) , upper gastrointestinal bleeding (χ2=48.252, P=0.002) , hepatorenal syndrome (χ2=16.244, P=0.031) , and pulmonary infection (χ2=13.564, P<0.001) .The multivariate logistic regression analysis showed that there were significant differences in Alb (OR=1.119, 95% CI: 1.052 ~ 1.189) , platelet count (PLT) (OR=1.035, 95% CI: 0.755 ~ 1.084) , upper gastrointestinal bleeding (OR=1.117, 95% CI: 0.072 ~ 1.135) , and pulmonary infection (OR=2.275, 95% CI: 0.978 ~ 5.292) (P=0.002, 0.038, 0.022, and0.036) .Conclusion In the treatment of ACLF patients, risk factors including low Alb, low PLT, upper gastrointestinal bleeding, and pulmonary infection should be prevented, and early diagnosis and intervention of these risk factors helps to reduce the incidence of SBP.

Brief reports
Clinical effect in joint use of laparoscope and cholecystoscope for treatment of gallbladder and common bile duct stones
Liu JiaNing, Feng Wei, Zhu MeiLing, Lin Bin
2017, 33(4): 723-724. DOI: 10.3969/j.issn.1001-5256.2017.04.025
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Case reports
Acute hepatitis B complicated by EB virus infection: a case report
Wang HongSha, Wei Qi, Lei ManMan, Jin QingLong, Wen XiaoYu, Guo YuYing
2017, 33(4): 725-727. DOI: 10.3969/j.issn.1001-5256.2017.04.026
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A case of subacute severe hepatitis caused by HEV and EBV coinfection
Qi LiNa, Wang ShuHua, Guo XiangLing, Gao RunPing
2017, 33(4): 728-729. DOI: 10.3969/j.issn.1001-5256.2017.04.027
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Long-term relief in patients with hepatocellular carcinoma treated with donafenib tosylate: a report of two cases
Hu Yue, Lou JinFeng, Liu JingRui, Ding YanHua, Ma Yun, Niu JunQi
2017, 33(4): 730-731. DOI: 10.3969/j.issn.1001-5256.2017.04.028
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A case of primary hepatocellular carcinoma with lung adenocarcinoma and liver metastasis
Pan Meng, Wang Le, Li Xu, Gao PuJun
2017, 33(4): 732-734. DOI: 10.3969/j.issn.1001-5256.2017.04.029
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Severe liver injury caused by chronic inhalation of toluene and xylene: a case report
Mi HongMei, Liu Ning, Shang Li, Wang Lei
2017, 33(4): 735-737. DOI: 10.3969/j.issn.1001-5256.2017.04.030
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A case of idiopathic portal hypertension
Zhang Yong, Tang ShanHong, Mou Dong, Zheng ShuMei, Ceng WeiZheng
2017, 33(4): 738-739. DOI: 10.3969/j.issn.1001-5256.2017.04.031
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Laparoscopic cholecystectomy for cold agglutinin syndrome with gallstones: a case report
Wang Bin, Luo Xiao, Sun BaoZhen, Yang Guang, Meng ZiHui, Ji DeGang
2017, 33(4): 740-741. DOI: 10.3969/j.issn.1001-5256.2017.04.032
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A case of hemochromatosis with anemia and severe jaundice
Zhu Min, Li DongYing, Du BaiXue, Li JianSheng
2017, 33(4): 742-743. DOI: 10.3969/j.issn.1001-5256.2017.04.033
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Laparoscopic splenectomy in treatment of splenic angiosarcoma: a case report
Zhang YiWei, Zhang Wei, Liu Feng, Liu YaHui
2017, 33(4): 744-745. DOI: 10.3969/j.issn.1001-5256.2017.04.034
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Reviews
Research advances in the application of telbivudine during pregnancy to prevent HBV mother-to-child transmission
Wang Chong, Cao MengZhuo, Wang Chuan, Jiang Jing, Li Jie, Niu JunQi
2017, 33(4): 746-750. DOI: 10.3969/j.issn.1001-5256.2017.04.035
Abstract:
Almost 10% of neonates whose mothers have a high HBV DNA load may have HBV infection, even after the preventive treatment with hepatitis B vaccine and immune interruption. In pregnant women with a high HBV DNA load, nucleos ( t) ide analogues ( lamivudine, telbivudine, and tenofovir) have been used in the second and third trimesters to improve the interruption of mother-to-child transmission of hepatitis B. This article reviews the strategies for antiviral therapy with telbivudine for pregnant women with a high HBV DNA load in their third trimester, changes in maternal HBV DNA level after antiviral therapy, whether the success rate of interruption of mother-to-child transmission can be further increased, safety in mothers and infants, the most appropriate time for drug administration and withdrawal, and breastfeeding issues.
Research advances in hepatitis B virus reactivation
Li MengYuan, Ye ChuanTao, Zhang Ying, Jia ZhanSheng
2017, 33(4): 751-756. DOI: 10.3969/j.issn.1001-5256.2017.04.036
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In non-active or cured patients with hepatitis B virus ( HBV) infection, when the body's immune homeostasis is broken, HBV reactivation may occur, with the manifestations of liver inflammation and increased HBV DNA level, and lead to varying degrees of abnormal liver function, liver failure, and even death. Systematic management from the aspects of the screening of HBV reactivation, risk stratification of immunosuppression regimens, and patient's individual information needs to be solved urgently. It is very important to perform the screening of HBV serological markers before immunosuppressive therapy and chemotherapy, evaluate the risk of HBV reactivation, and develop individualized prophylactic antiviral therapy. Complete removal of covalently closed circular DNA in hepatocytes is essential for preventing HBV reactivation. This article summarizes related research advances in HBV reactivation from the aspects of its etiology, pathogenesis, diagnosis, prevention, and treatment.
Diabetes mellitus and primary liver cancer: risk factor or real cause?
Liang Jing, Han Tao
2017, 33(4): 757-762. DOI: 10.3969/j.issn.1001-5256.2017.04.037
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With an increasing prevalence all over the world, diabetes mellitus is considered as a potential cause of liver cancer in patients with non-viral hepatitis. Whether diabetes mellitus is the cause of liver cancer and related pathogenesis remain unknown. The article reviews recent large-sample cohort studies and confirms that diabetes mellitus increases the incidence rate of liver cancer and affects its prognosis. This article also investigates the association of hepatitis C, obesity, and nonalcoholic fatty liver disease with diabetes mellitus and liver cancer and finds that insulin resistance and activation of chronic inflammatory factors may be involved in the generation and proliferation of cancer cells. This article elaborates on the influence of anti-insulin resistance drugs on the development and progression of liver cancer and points out that diabetes mellitus may be the cause of liver cancer. Effective control of insulin resistance can help to reduce the development and progression of diabetes-associated liver cancer.
Research advances in insulin-like growth factor 1 receptor and its pathway in diagnosis and treatment of primary liver cancer
Zhao Zhao, Qi WenQian, Zhao Ping
2017, 33(4): 763-768. DOI: 10.3969/j.issn.1001-5256.2017.04.038
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The main biological functions of insulin-like growth factor 1 receptor ( IGF-1R) include formation and maintenance of transformed cell phenotype, involvement in cell proliferation and differentiation, and inhibition of cell apoptosis. In addition, IGF-1R regulates cell cycle and works with epidermal growth factor and platelet-derived growth factor to mediate cells to enter S phase from G1 phase. Overexpressed IGF-1R has become one of the target proteins for diagnostic imaging and localization therapy for primary liver cancer. Inhibition of the expression or function of IGF-1R can effectively control the growth and metastasis of tumor cells and enhance their sensitivity to chemotherapy and radiotherapy. This article reviews the role and significance of IGF-1R and its pathway in the diagnosis and treatment of primary liver cancer.
Research advances in the pathogenesis of nonalcoholic fatty liver disease
Wang Hu, Teng Tian, Wang Li, Zhou Meng, Yan HongRu, Sun Ying
2017, 33(4): 769-773. DOI: 10.3969/j.issn.1001-5256.2017.04.039
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Nonalcoholic fatty liver disease ( NAFLD) has been developing rapidly in recent years and has become one of the most common liver diseases. However, its pathogenesis remains unclear, and there are no widely accepted therapeutic regimens. NAFLD has a complex pathogenesis with multiple factors involved, including insulin resistance, oxidative stress, bile acid metabolic disorders, and autophagy. This article reviews the pathogenesis of NAFLD in order to provide a reference for further research and clinical treatment in the future.
Gut microbiota and nonalcoholic fatty liver disease
Xiao Li, Yang Ling
2017, 33(4): 774-779. DOI: 10.3969/j.issn.1001-5256.2017.04.040
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Nonalcoholic fatty liver disease ( NAFLD) is a common liver disease with multiple factors involved, and its incidence is gradually increasing around the world. Recent studies have found that gut microbiota is involved in the development and progression of NAFLD. This article summarizes the association between gut microbiota and NAFLD from the aspects of influencing factors for gut microbiota and the roles of gut microbiota and its metabolites in the development and progression of NAFLD and points out that the intervention of gut microbiota and its metabolites may be a new target for the prevention and treatment of NAFLD.
Research advances in association between blood neutrophil/lymphocyte ratio and prognosis of related liver diseases
Li Qiao, Guo HongHua
2017, 33(4): 780-784. DOI: 10.3969/j.issn.1001-5256.2017.04.041
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Recent studies have found that inflammatory response is positively associated with the progression of liver cirrhosis, acute-on-chronic liver failure, and primary liver cancer and can affect their prognosis, and as a marker for inflammatory response, neutrophil/lymphocyte ratio ( NLR) is easy to calculate, has good repeatability, and holds promise for prognostic evaluation. This article introduces the research advances in the association of NLR with the prognosis of liver cirrhosis, acute-on-chronic liver failure, and primary liver cancer and points out that NLR plays an important role in evaluating the prognosis of liver cirrhosis, acute-on-chronic liver failure, and primary liver cancer. However, there are still controversies over the selection of optimal cut-off values for different diseases, and further studies are needed.
Research advances in minimally invasive treatment of infectious pancreatic necrosis
Wu DongDong, Yang XiaoYan, Gao Feng
2017, 33(4): 785-789. DOI: 10.3969/j.issn.1001-5256.2017.04.042
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Infectious pancreatic necrosis ( IPN) is a challenging complication of acute pancreatitis and can lead to poor prognosis. Over the years, open necrosectomy has become the main treatment modality for IPN, but it will cause high incidence rate of complications and mortality rate. In recent years, with the rapid development of minimally invasive surgery, many scholars have performed minimally invasive treatment for IPN patients and achieved good outcomes. This article introduces five minimally invasive treatment techniques, i. e., percutaneous catheter drainage, minimally invasive retroperitoneal necrosectomy, endoscopic drainage + necrosectomy, laparoscopic necrosectomy, and“advanced”therapeutic strategy, pointed out that different minimally invasive techniques had different indications, and minimally invasive therapies should be selected based on IPN patients' general conditions to improve their outcome.
Research advances in insulin-like growth factor-1 receptor in pancreatic cancer
Wang YueChao, Qi WenQian, Zhao Ping
2017, 33(4): 790-794. DOI: 10.3969/j.issn.1001-5256.2017.04.043
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Insulin-like growth factor-1 receptor ( IGF-1R) widely exists in the surface of various types of cells and is closely associated with the formation and development of tumor cells. It also provides a new direction for the targeted therapy for tumors. This article reviews the expression, development, and progression of IGF-1R in pancreatic cancer and research advances in IGF-1R as a target for tumor treatment.
Conference overviews
Minutes of the meeting on new diagnostic techniques for portal hypertension at the 26th Conference of the Asian Pacific Association for the Study of the Liver
Qi XiaoLong, Xiang Yi, Hou JinLin
2017, 33(4): 795-796. DOI: 10.3969/j.issn.1001-5256.2017.04.044
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