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| 1 | Prognostic factors and long-term outcomes of hilar cholangiocarcinoma:A single-institution experience in China显示文摘AIM: To evaluate the prognostic factors of hilar cholangiocarcinoma in a large series of patients in a single institution.METHODS: Eight hundred and fourteen patients with a diagnosis of hilar cholangiocarcinoma that were evaluated and treated between 1990 and 2014, of which 381 patients underwent curative surgery, were included in this study. Potential factors associated with overall survival(OS) and disease-free survival(DFS) were evaluated by univariate and multivariate analyses.RESULTS: Curative surgery provided the best long-term survival with a median OS of 26.3 mo. The median DFS was 18.1 mo. Multivariate analysis showed that patients with tumor size > 3 cm [hazard ratio(HR) = 1.482, 95%CI: 1.127-1.949; P = 0.005], positive nodal disease(HR = 1.701, 95%CI: 1.346-2.149; P < 0.001), poor differentiation(HR = 2.535, 95%CI: 1.839-3.493; P < 0.001), vascular invasion(HR = 1.542, 95%CI: 1.082-2.197; P = 0.017), and positive margins(HR = 1.798, 95%CI: 1.314-2.461; P < 0.001) had poor OS outcome. The independent factors for DFS were positive nodal disease(HR = 3.383, 95%CI: 2.633-4.348; P < 0.001), poor differentiation(HR = 2.774, 95%CI: 2.012-3.823; P < 0.001), vascular invasion(HR = 2.136, 95%CI: 1.658-3.236; P < 0.001), and positive margins(HR = 1.835, 95%CI: 1.256-2.679; P < 0.001). Multiple logistic regression analysis showed that caudate lobectomy [odds ratio(OR) = 9.771, 95%CI: 4.672-20.433; P < 0.001], tumor diameter(OR = 3.772, 95%CI: 1.914-7.434; P < 0.001), surgical procedures(OR = 10.236, 95%CI: 4.738-22.116; P < 0.001), American Joint Committee On Cancer T stage(OR = 2.010, 95%CI: 1.043-3.870; P = 0.037), and vascular invasion(OR = 2.278, 95%CI: 0.997-5.207; P = 0.051) were independently associated with tumorfree margin, and surgical procedures could indirectly affect survival outcome by influencing the tumor resection margin. CONCLUSION: Tumor margin, tumor differentiation, vascular invasion, and lymph node status were independent factors for OS and DFS. Surgical procedures can indirectly affect survival outcome by influencing the tumor resection margin. | Hai-Jie Hu Hui Mao Anuj Shrestha Yong-Qiong Tan Wen-Jie Ma Qin Yang Jun-Ke Wang Nan-Sheng Cheng Fu-Yu Li | 2016 | World Journal of Gastroenterology2016，22，8： | 40 |
| 2 | Xanthogranulomatous cholecystitis mimicking gallbladder carcinoma:An analysis of 42 cases显示文摘AIM: To review and evaluate the diagnostic dilemma of xanthogranulomatous cholecystitis(XGC) clinically.METHODS: From July 2008 to June 2014, a total of 142 cases of pathologically diagnosed XGC were reviewed at our hospital, among which 42 were misdiagnosed as gallbladder carcinoma(GBC) based on preoperative radiographs and/or intra-operative findings. The clinical characteristics, preoperative imaging, intra-operative findings, frozen section(FS) analysis and surgical procedure data of these patients were collected and analyzed.RESULTS: The most common clinical syndrome in these 42 patients was chronic cholecystitis, followed by acute cholecystitis. Seven(17%) cases presented with mild jaundice without choledocholithiasis. Thirtyfive(83%) cases presented with heterogeneous enhancement within thickened gallbladder walls on imaging, and 29(69%) cases presented with abnormal enhancement in hepatic parenchyma neighboring the gallbladder, which indicated hepatic infiltration. Intra-operatively, adhesions to adjacent organs were observed in 40(95.2%) cases, including the duodenum, colon and stomach. Thirty cases underwent FS analysis and the remainder did not. The accuracy rate of FS was 93%, and that of surgeon's macroscopic diagnosis was 50%. Six cases were misidentified as GBC by surgeon's macroscopic examination and underwent aggressive surgical treatment. No statistical difference was encountered in the incidence of postoperative complications between total cholecystectomy and subtotal cholecystectomy groups(21% vs 20%, P > 0.05).CONCLUSION: Neither clinical manifestations and laboratory tests nor radiological methods provide apractical and effective standard in the differential diagnosis between XGC and GBC. | Yi-Lei Deng Nan-Sheng Cheng Shui-Jun Zhang Wen-Jie Ma Anuj Shrestha Fu-Yu Li Fei-Long Xu Long-Shuan Zhao | 2015 | World Journal of Gastroenterology2015，21，44： | 13 |
| 3 | Hepatic epithelioid hemangioendothelioma: Dilemma and challenges in the preoperative diagnosis显示文摘Hepatic epithelioid hemangioendothelioma(HEHE) is a rare category of vascular tumor with uncertain malignant potential. It commonly presents nonspecific and variable clinical manifestations, ranging from asymptomatic to hepatic failure. In addition, laboratory measurements and imaging features also lack specificity in the diagnosis of HEHE. The aim of the present study is to highlight the dilemma and challenges in the preoperative diagnosis of HEHE, and to enhance awareness of the range of hepatobiliary surgery available in patients with multiple hepatic nodular lesions on imaging. In these patients, HEHE should at least be considered in the differential diagnosis. | Hai-Jie Hu Yan-Wen Jin Qiu-Yang Jing Anuj Shrestha Nan-Sheng Cheng Fu-Yu Li | 2016 | World Journal of Gastroenterology2016，22，41： | 8 |
| 4 | Healing time of incision infection after hepatobiliary surgery treated by needle-free incision suture closure显示文摘AIM:To compare the effectiveness of needle-free incision suture closure with butterfly tape and traditional secondary suturing techniques in treating incision infection.METHODS:Two hundred and twenty-three patients with incision infection following hepatobiliary surgery at a tertiary hospital were randomly divided into three groups:90 patients were closed by needle-free incision suture closure,which gradually closed the incision wound when drainage from incision infection was visibly decreased and healthy granulation tissues had grown;79 patients were closed by butterfly bandage;another 54 patients were closed by traditional secondary suturing technique.Healing time of incision infection was calculated from the beginning of dressing change to the healing of the incision.RESULTS:Healing time in the needle-free incision suture closure group(24.2±7.2 d)was significantly shorter than that in the butterfly bandage group(33.3±11.2 d)and the traditional secondary suturing group(36.2±15.3 d)(P<0.05).Healing time in the butterfly bandage group appeared to be slightly shorter than that in the secondary suture group,but the difference was not statistically significant(P>0.05).CONCLUSION:Needle-free incision suture closure could gradually close the infection wound at the same time of drainage and dressing change,thereby shortening the healing time. | Wen-Jie Ma Yong Zhou Hui Mao Rui-Hua Xu Anuj Shrestha Fu-Yu Li Alex Lorance Qin Yang Yong-Qiong Zhang Ting Jiang Huan Feng Wei Zhang Nan-Sheng Cheng | 2014 | World Journal of Gastroenterology2014，20，42： | 8 |
| 5 | Effects of epidermal growth factor receptor inhibitor on proliferative cholangitis in hepatolithiasis显示文摘BACKGROUND: There is currently no effective medication to prevent stone recurrence after choledochoscopic lithotomy or to treat proliferative cholangitis(PC), which is the pathologic basis of hepatolithiasis. This study aimed to investigate whether gefitinib, an epidermal growth factor receptor(EGFR) inhibitor, inhibited cholangio hyperplasia and lithogenesis in PC.METHODS: After cholangioscopic lithotomy, indwelling catheters were placed in the diseased bile duct lumens in 94 patients with hepatolithiasis. Subsequently, 49 of the 94 patients were treated with 250 mg gefitinib solution via a catheter twice a week, and they were subjected to choledochoscopic biopsy at 6 and 12 weeks. The rest 45 hepatolithiasis patients without gefitinib treatment served as controls.RESULTS: The expressions of EGFR, PCNA and procollagen I were significantly reduced in the patients treated with gefitinib in 12 weeks compared with those in the control group. Patients in the gefitinib group had a much lower degree of hyperplasia of the biliary epithelium, submucosal glands and collagen fibers compared with those in the control group. Gefitinib treatment significantly decreased mucin 3 expression and β-glucuronidase activity.CONCLUSION: Postoperative gefitinib treatment could significantly inhibit PC-mediated hyperplasia and lithogenesis, which might provide a novel strategy for the prevention of biliary restenosis and stone recurrence in patients with hepatolithiasis. | Qin Yang Yong Zhou Fu-Yu Li Hui Mao Anuj Shrestha Wen-Jie Ma Nan-Sheng Cheng Wei Zhang | 2015 | Hepatobiliary & Pancreatic Diseases International2015，14，5： | 7 |
| 6 | 腹腔镜胆囊切除术后常规病理检查的必要性探讨显示文摘目的:探讨腹腔镜胆囊切除术(LC)后胆囊常规病理检查的必要性。方法:搜集华西医院病理科5年间的全部胆囊病理报告,找出其中LC术后意外胆囊癌患者,并分析其临床资料。结果:LC术后意外胆囊癌的发生率约为0.28%(36/12 969),88.9%(32/36)为腺癌,58.3%(21/36)为原位癌和早期胆囊癌(T1a和T1b)。结合术前影像学检查,术中通过观察及胆囊标本触摸,成功辨认出34例(94.4%)意外胆囊癌患者存在的可疑病变,遗漏1例原位癌和1例T1a期患者。结论:绝大多数意外胆囊癌患者均可在术中发现可疑病变,极少数肿瘤处于极早期无法发现者,单纯的胆囊切除已达有效治疗。因此,LC术后常规的行胆囊病理检查的必要性有待商榷。 | 曹贵章 邓毅磊 SHRESTHA Anuj 吴昊钧 | 2015 | 中国普通外科杂志2015，24，8： | 5 |
| 7 | Puzzle and Challenge in Differentiating Immunoglobulin G4?related Cholangitis from Hilar Cholangiocarcinoma显示文摘 | Hai-Jie Hu Rong-Xing Zhou Anuj Shrestha Yong Zhou Fu-Yu Li | 2017 | Chinese Medical Journal2017，，21： | 2 |
| 8 | Sequential embolization of the branches of the bile duct and portal vein to the targeted hepatic lobe in rats显示文摘BACKGROUND: The high recurrence rate of hepatolithiasis and the high operative risk of right posterior, caudate or multiple lobe hepatectomy are the unsettled problems in hepatobiliary surgery. The present study was to investigate the efficacy of chemical hepatectomy performed via applying sequential embolization of the branches of the bile duct and portal vein to the targeted hepatic lobe. METHODS: The bile duct and portal vein branches of the median hepatic lobe of rats were treated with: 1) bile duct embolization followed by portal vein ligation(BDE+PVL) and 2) portal vein ligation followed by bile duct embolization(PVL+BDE). The efficacy of chemical hepatectomy in BDE+PVL and PVL+BDE groups was compared with that of sole BDE by histology and Western blotting analysis of collagen I expression. RESULTS: After six weeks of the chemical hepatectomy, rats in the BDE group showed hepatocyte damages, fibrosis and 'selfcut' only in the periphery of the embolized lobe. In contrast, rats in the PVL+BDE and BDE+PVL groups exhibited complete necrosis of hepatocytes and replacement with proliferative ductules and collagen fibers, leading to complete fibrosis and 'self-cut' phenomenon in the whole targeted lobe. Collagen I expression in the PVL+BDE group was slightly higher than that in the BDE+PVL group; however, no statistically significant difference was noted. CONCLUSION: The sequential embolization of the bile duct and portal vein branches to the targeted hepatic lobe may bea feasible and effective approach to acheive the ideal effect of chemical hepatectomy in a short period of time. | Anuj Shrestha Yong Zhou Hui Mao Fu-Yu Li Wen-Jie Ma Nan-Sheng Cheng Ri-Hua Xu Yong-Qiong Zhang Ting Jiang Huan Feng Wen Li Qiang Han | 2014 | Hepatobiliary & Pancreatic Diseases International2014，13，1： | 2 |
| 9 | Histological examination of frozen sections for patients with acute cholecystitis during cholecystectomy显示文摘BACKGROUND:Unexpected gallbladder cancer may present with acute cholecystitis-like manifestations.Some authors recommended that frozen section analysis should be performed during laparoscopic cholecystectomy for all cases of acute cholecystitis.Others advocate selective use of frozen section analysis based on gross examination of the specimen by the surgeon.The aim of the present study was to evaluate whether surgeons could effectively identify suspected gallbladder with macroscopic examination alone.If not,is routine frozen section analysis worth advocating?METHODS:A total of 1162 patients with acute cholecystitis who had undergone simple cholecystectomy in our hospital from February 2009 to February 2014 were enrolled in the study.The data of patients with acute cholecystitis especially those with concurrent gallbladder cancer in terms of clinical characteristics,operative records,frozen section diagnosis and histopathology reports were analyzed.RESULTS:Thirteen patients with acute cholecystitis were found to have concurrent gallbladder cancer,with an incidence of 1.1%in acute cholecystitis.Forty patients with acute cholecystitis were suspected to have gallbladder cancer by macroscopic examination and specimens were taken for frozen section analysis.Six patients with gallbladder cancer were correctly identified by macroscopic examination alone but 7patients with gallbladder cancer missed,including 3 patients with advanced cancer(2 T3 and 1 T2).Meanwhile,in 6 gallbladder cancer specimens sent for frozen section analysis,3 early gallbladder cancers(2 Tis and 1 T1a)were missed by frozen section analysis.However,the remaining 3 patients with advanced gallbladder cancers(2 T3 and 1 T2)were correctly diagnosed.CONCLUSIONS:The incidence of comorbidity of gallbladder cancer and acute cholecystitis is higher than that of non-acute cholecystitis.The accurate diagnosis of gallbladder cancer by surgeons is poor and frozen section analysis is necessary. | Zhen You Wen-Jie Ma Yi-Lei Deng Xian-Ze Xiong Anuj Shrestha Fu-Yu Li Nan-Sheng Cheng | 2015 | Hepatobiliary & Pancreatic Diseases International2015，14，3： | 2 |
| 10 | 不同胆管空肠吻合技术治疗成人Ⅰ型胆总管囊肿的比较分析显示文摘目的:比较囊肿完全切除与不完全切除(残留近端1 cm胆总管囊壁)的Roux-en-Y胆管空肠吻合治疗成人Ⅰ型胆总管囊肿的安全性和可行性。方法:回顾性分析1998年1月至2015年12月间收治的267例成人Ⅰ型胆总管囊肿患者的病例资料,其中171例行囊肿完全切除的Rouxen-Y胆管空肠吻合术(PBD 0-cm组),96例行囊肿不完全切除的Rouxen-Y胆管空肠吻合术(PBD 1-cm组)。比较两组患者术后短期及长期并发症发生情况。结果:两组患者在手术时间和吻合口直径方面的差异均无统计学意义。PBD 1-cm组围手术期并发症发生率显著高于PBD 0-cm组(28.1%vs 14.0%,P=0.005),尤其是术后胆管炎(7.3%vs 1.2%,P=0.021)。两组患者术后吻合口狭窄、反流性胆管炎、肝内胆管结石和胆漏等长期并发症的差异均无统计学意义(均P>0.05)。PBD 1-cm组和PBD 0-cm组各有1例患者分别于术后5月和术后25月出现胰胆管恶变。而PBD 1-cm组有1例患者于术后10月出现吻合口恶变。结论:虽然保留部分囊壁可以降低Ⅰ型胆总管囊肿切除术中的吻合难度,但由于相对较高的术后并发症发生率和恶变概率,该吻合方式值得商榷。对于Ⅰ型胆总管囊肿患者,囊肿完全切除后以健康的近端胆管进行吻合是必要的。 | Wenjie Ma Yongqiong Tan Anuj Shrestha Fuyu Li Rongxing Zhou Junke Wang Haijie Hu Qin Yang | 2018 | Gastroenterology Report2018，6，1： | 0 |
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