BACKGROUND Despite the increased use of total pancreatectomy with islet autotransplantation(TPIAT),systematic evidence of its outcomes remains limited.AIM To evaluate the outcomes of TPIAT.METHODS We searched PubMed,E...BACKGROUND Despite the increased use of total pancreatectomy with islet autotransplantation(TPIAT),systematic evidence of its outcomes remains limited.AIM To evaluate the outcomes of TPIAT.METHODS We searched PubMed,EMBASE,and Cochrane databases from inception through March 2019 for studies on TPIAT outcomes.Data were extracted and analyzed using comprehensive meta-analysis software.The random-effects model was used for all variables.Heterogeneity was assessed using the I2 measure and Cochrane Q-statistic.Publication bias was assessed using Egger’s test.RESULTS Twenty-one studies published between 1980 and 2017 examining 1011 patients were included.Eighteen studies were of adults,while three studied pediatric populations.Narcotic independence was achieved in 53.5%[95% Confidence Interval(CI):45-62,P<0.05,I2=81%]of adults compared to 51.9%(95%CI:17-85,P<0.05,I2=84%)of children.Insulinindependence post-procedure was achieved in 31.8%(95%CI:26-38,P<0.05,I2=64%)of adults with considerable heterogeneity compared to 47.7%(95%CI:20-77,P<0.05,I2=82%)in children.Glycated hemoglobin(HbA1C)12 mo post-surgery was reported in four studies with a pooled value of 6.76%(P=0.27).Neither stratification by age of the studied population nor metaregression analysis considering both the study publication date and the islet-cell-equivalent/kg weight explained the marked heterogeneity between studies.CONCLUSION These results indicate acceptable success for TPIAT.Future studies should evaluate the discussed measures before and after surgery for comparison.展开更多
BACKGROUND Ex vivo liver resection and autotransplantation(ELRA)is an essential approach for treating patients with end-stage hepatic alveolar echinococcosis(AE),and its surgical indications involve severe invasion of...BACKGROUND Ex vivo liver resection and autotransplantation(ELRA)is an essential approach for treating patients with end-stage hepatic alveolar echinococcosis(AE),and its surgical indications involve severe invasion of important hepatic vessels,which makes in vivo resection impossible.Revascularization is a major step in the process of ELRA,which is extremely challenging when the invaded vessels have huge defects.CASE SUMMARY Herein,we have reported the case of a 26-year-old patient with hepatic AE in an autologous liver graft who underwent complex inferior vena cava(IVC)reconstruction using disease-free IVC,autologous portal vein fragments,and umbilical vein within the ligamentum teres hepatis.The patient showed good surgical recovery without vascular-related complications during the long-term follow-up.CONCLUSION We reviewed three studies that have reported complex revascularization of the IVC.This case report and systematic review showed that the use of autologous perihepatic vessels prevents donor-area trauma,immune rejection,and other adverse reactions.When the blood vessel is severely invaded and a single vascular material cannot repair and reconstruct the defect,ELRA may provide a safe and feasible surgical approach,which has good prospects for clinical application.展开更多
BACKGROUND Perihilar cholangiocarcinoma(pCCA)is a highly malignant tumor arising from the biliary tree.Radical surgery is the only treatment offering a chance of long-term survival.However,limited by the tumor’s anat...BACKGROUND Perihilar cholangiocarcinoma(pCCA)is a highly malignant tumor arising from the biliary tree.Radical surgery is the only treatment offering a chance of long-term survival.However,limited by the tumor’s anatomic location and peri-vascular invasion,most patients lose the chance for curative treatment.Therefore,more methods to increase the resectability of tumors as well as to improve outcomes are needed.CASE SUMMARY A 68-year-old female patient had a hepatic hilar mass without obvious symptoms.Laboratory results showed hepatitis B positivity.Magnetic resonance imaging indicated that the mass(maximum diameter:41 mm)invaded the left and right branches of the main portal vein,as well as the middle,left and right hepatic veins;enlarged lymph nodes were also detected in the hilum.The patient was diagnosed with pCCA,and the clinical stage was determined to be T4N1M0(stage IIIC).Considering the tumor’s anatomic location and vascular invasion,systematic conversion therapy followed by ex vivo liver resection and autotrans-plantation(ELRA)was determined as personalized treatment for this patient.Our original systemic sequential therapeutic strategy(lenvatinib and tislelizumab in combination with gemcitabine and cisplatin)was successfully adopted as conversion therapy because she achieved partial response after three cycles of treatment,without severe toxicity.ELRA,anastomotic reconstruction of the middle hepatic vein,right hepatic vein,root of portal vein,inferior vena cava and right hepatic artery,and lymph node dissection were performed at one month after systemic therapy.Pathological and immunohistochemical examination confirmed the diagnosis of pCCA with lymph node metastasis.Although the middle hepatic vein was partially obstructed four months later,hepatic vein stent implantation successfully addressed this problem.The patient has survived for 22 mo after the diagnosis,with no evidence of recurrence or metastasis.CONCLUSION An effective therapeutic strategy for conversion therapy greatly increases the feasibility and efficiency of ELRA.展开更多
BACKGROUND:Hepatocyte apoptosis is a severe form of cell death after hepatic ischemia-reperfusion injury(HIRI), and its relief is an important issue in liver transplantation. Hypoxic preconditioning(HP)is considered t...BACKGROUND:Hepatocyte apoptosis is a severe form of cell death after hepatic ischemia-reperfusion injury(HIRI), and its relief is an important issue in liver transplantation. Hypoxic preconditioning(HP)is considered to have protective effects on HIRI.This study was designed to explore the impact of HP on apoptosis and its possible mechanism during orthotopic liver autotransplantation. METHODS:A modified orthotopic liver autotransplantation model was used to simulate HIRI.Sprague-Dawley rats were randomly divided into normal control,autotransplantation (AT)and HP groups.The HP group was subjected to an 8%oxygen atmosphere for 90 minutes before surgery.At 1,6 and 24 hours after surgery,the rats were killed and their liver tissue was sampled to assess the expression of Bcl-2 protein.The samples were subjected to blood chemistry study,morphological study under a light or transmission electron microscope,and quantitative study of mitochondria. RESULTS:The serum levels of ALT and AST in the HP group were lower than those in the AT group at 1,6 and 24 hours after orthotopic liver autotransplantation(P<0.05).Bcl-2 protein expression was increased in the HP group at each measurement point(P<0.05).Light microscopy showed that hepatic injury in the AT group was much more severe than in the HP group.Hepatocytes in the AT group showed typical apoptosis signs under a transmission electron microscope.The ultrastructural appearance of hepatocytes in the HP group was much better than in the AT group,and the area,perimeter and diameter of the mitochondria were smaller in the HP group than in the AT group(P<0.05). CONCLUSIONS:Hepatocytes sense and respond to decreased tissue oxygenation.Stimulation by HP relieves apoptosis by upregulating expression of Bcl-2 protein and its protection of mitochondria after orthotopic liver autotransplantation.展开更多
The effectiveness of liver autotransplantation for patients with partial hepatic alveolar echinococcosis was analyzed.We retrospectively studied 6 patients with hepatic alveolar echinococcosis who underwent liver auto...The effectiveness of liver autotransplantation for patients with partial hepatic alveolar echinococcosis was analyzed.We retrospectively studied 6 patients with hepatic alveolar echinococcosis who underwent liver autotransplantation in our hospital from 2008 to 2010.We also summarized the surgical indications of liver autotransplantation for hepatic alveolar echinococcosis and our experience in the management of postoperative complications of liver autotransplantation.Of 6 patients,5 achieved good curative results,and one died of multiple organ failure caused by portal vein thrombosis.Main complications included postoperative bleeding,bile leak and small-for-size liver graft syndrome.Liver autotransplantation offers a new approach to cure hepatic alveolar echinococcosis with non-resectable lesions.It could be the most effective method to cure intractable hepatic alveolar echinococcosis if correct handling in operation and proper prevention of complications are performed.But the long-term outcomes are still needed to be confirmed in longer follow-up.展开更多
Background: The University of Wisconsin (UW) and histidine-tryptophan-ketoglutarate (HTK) solutions are the two most frequently used liver graft preservation fluids. The present study aimed to compare their efficacy i...Background: The University of Wisconsin (UW) and histidine-tryptophan-ketoglutarate (HTK) solutions are the two most frequently used liver graft preservation fluids. The present study aimed to compare their efficacy in end-stage hepatic alveolar echinococcosis patients who underwent ex-situ liver resection and autotransplantation (ELRA). Methods: A total of 81 patients received ELRA from August 2010 to March 2018. They were allocated into UW ( n = 48) and HTK groups ( n = 33) based on the type of solutions used. Demographic and operational data were retrospectively analyzed. Primary outcomes included 90-day mortality, incidence of early graft loss, primary dysfunction, and postoperative complications. Results: Demographic and operational characteristics were similarly distributed in the two groups. No statistically significant differences were observed with regard to 90-day mortality (12.77% vs. 12.12%) and early graft loss rate (8.51% vs. 9.09%) between the two groups. Patients in the UW and HTK groups showed a primary dysfunction rate of 27.66% and 27.27%, respectively. The UW group exhibited a higher incidence tendency of biliary complications, albeit with no statistical significance. Conclusions: This is the largest cohort study comparing the efficacy of the UW and HTK organ-preserving solutions in end-stage hepatic alveolar echinococcosis patients in ELRA settings. UW and HTK solutions presented similar efficacy and safety. A randomized clinical trial with larger scale is needed for further investigation in future clinical applications.展开更多
BACKGROUND Radical resection of gastric cancer liver metastases(GCLM)can increase the 5-year survival rate of GCLM patients.However,patients may lose the theoretical feasibility of surgery due to the critical location...BACKGROUND Radical resection of gastric cancer liver metastases(GCLM)can increase the 5-year survival rate of GCLM patients.However,patients may lose the theoretical feasibility of surgery due to the critical location of liver metastasis in some cases.CASE SUMMARY A 29-year-old woman had a chief complaint of chronic abdominal pain for 1 year.Abdominal computed tomography and magnetic resonance imaging examinations suggested a mass of unknown pathological nature located between the first and second hila and the margin of the lower segment of the right lobe of the liver.The anterior wall of the gastric antrum was unevenly thickened.The diagnosis of(gastric antrum)intramucosal well-differentiated adenocarcinoma was histopathologically confirmed by puncture biopsy with gastroscopy guidance.She underwent radical resection(excision of both gastric tumors and ex vivo liver resection followed by autotransplantation simultaneously)followed by XELOX adjuvant chemotherapy.Without serious postoperative complications,the patient was successfully discharged on the 20th day after the operation.Pathological examination of the excised specimen indicated that gastrectomy with D2 lymph node dissection for primary gastric tumors and R0 resection for liver metastases were achieved.The resected mass was confirmed to be poorly differentiated gastric carcinoma(hepatoid adenocarcinoma with neuroendocrine differentiation)with liver metastases in segments VIII.No recurrence or metastasis within the liver was found during a 7.5-year follow-up review that began 1 mo after surgery.CONCLUSION Application of ex vivo liver resection followed by autotransplantation in radical resection for GCLM can help selected patients with intrahepatic metastases located in complex sites obtain a favorable clinical outcome.展开更多
The aim of this study was to evaluate the outcome of autotransplantation or replantation of extracted teeth combining with reconstruction of alveolar bone defects in use of artificial bone grafting clinically and radi...The aim of this study was to evaluate the outcome of autotransplantation or replantation of extracted teeth combining with reconstruction of alveolar bone defects in use of artificial bone grafting clinically and radiographically. This article presents a more useful and convenient method for repairing tooth and reconstruction of bone defecting with some interesting cases. Eleven patients (seven men and four women) in whom teeth with complete root formation were extracted and autotransplanted, the bone of receiving area was Insufficient. All transplanted teeth were stabilized with orthodontic wire and resin or 4-0 silk sutures;at the same time, artificial bone powder was filled. In 11 cases, the missing teeth were restored by autogenous teeth and the alveolar bone defect was restored by artificial bone, the improvement in the radiographic and clinical parameters strongly suggest that it may be a useful therapy to solve the problem of the missing teeth and alveolar bone insufficiency simultaneously. However, the risk of replacement root resorption remains.展开更多
Autotransplantation of premolars to anterior region after incisor loss due to trauma is accepted as the best restoration procedure with very long follow-ups. There are two main protocols: Premolars with only two third...Autotransplantation of premolars to anterior region after incisor loss due to trauma is accepted as the best restoration procedure with very long follow-ups. There are two main protocols: Premolars with only two thirds of the root or premolars with complete root development. Premolars with two thirds of the root completed remain vital and show complete pulp obliteration while premolars with closed apex require root canal treatment. The problem arises when the child is very young and the root of the donor premolar is developed for only one third. This case report describes the outcome of an autotransplantation of a lower first premolar with only a third of developed root to the anterior region. The donor tooth was extracted with his follicle and placed instead of tooth No. 21. For the first month esthetics was restored with a glass-fibers ribbon attached to tooth No. 11 and composite material. After a month, the crown erupted and was reshaped to mimic an incisor with composite. Orthodontic movement was performed after 5 mo, in order to alleviate the gingival contour. The final restoration was performed after 15 mo. Follow up showed full root development with normal mobility, continuous periodontal ligament and complete pulp obliteration. A multidisciplinary approach and meticulous preparation are necessary for a positive result in autotransplantation of premolars with only a third of root development to the anterior region and this case report show that this method can be performed in very young children.展开更多
Pancreatic ductal adenocarcinoma(PDAC)remains a devastating disease,and selecting patients who might benefit from complex arterial resection continues to be a challenge.However,in the era of modern multimodal treatmen...Pancreatic ductal adenocarcinoma(PDAC)remains a devastating disease,and selecting patients who might benefit from complex arterial resection continues to be a challenge.However,in the era of modern multimodal treatments,surgery for pancreatic cancer has become increasingly safe.Neoadjuvant chemotherapy regimens such as modified-FOLFIRINOX(mFOLFIRINOX)and nab-paclitaxel/gemcitabine are effective in a significant proportion of patients.展开更多
离体肝切除和自体肝移植术(ex-vivo liver resection and autotransplantation,ELRA)是肝脏外科中的一种复杂术式。ELRA适合于侵犯下腔静脉、门静脉与肝静脉及它们分支的复杂病灶的切除。近几年,经过众多学者对ELRA进行大量的手术实践...离体肝切除和自体肝移植术(ex-vivo liver resection and autotransplantation,ELRA)是肝脏外科中的一种复杂术式。ELRA适合于侵犯下腔静脉、门静脉与肝静脉及它们分支的复杂病灶的切除。近几年,经过众多学者对ELRA进行大量的手术实践与研究分析后,ELRA迅速发展。在疾病的适应证中,ELRA着重于晚期肝恶性肿瘤与终末期肝泡型棘球蚴病的治疗。最新的研究中,肝脏Child-Pugh评分B级和残余肝脏体积与标准肝脏体积之比为0.35~0.40的病人也能满足ELRA的肝脏要求。另外,体内临时的门腔静脉分流技术也因其术后死亡率低于过去的体外静脉-静脉转流技术而成为术中首选。术中的血管重建,重点围绕肝后下腔静脉重建方式的选择。对于需重建肝后下腔静脉的病人,则根据病灶切除后肝后下腔静脉壁缺损的程度,采用直接缝合、使用补片、使用人工血管的方式进行重建。现结合文献,对上述领域进行综述。展开更多
继发性甲状旁腺功能亢进(secondary hyperparathyroidism,SHPT)是晚期慢性肾病病人常见的并发症之一。1977年提出了甲状旁腺全切术+自体移植术(total parathyroidectomy with autotransplantation,TPTX+AT)以来,关于自体移植的部分相关...继发性甲状旁腺功能亢进(secondary hyperparathyroidism,SHPT)是晚期慢性肾病病人常见的并发症之一。1977年提出了甲状旁腺全切术+自体移植术(total parathyroidectomy with autotransplantation,TPTX+AT)以来,关于自体移植的部分相关问题尚未形成共识。本文就自体移植的依据及临床价值、移植部位、移植方法、移植物存活与功能监测、复发的诊断与处理等进行综述。展开更多
Total pancreatectomy with islet autotransplantation(TPIAT)is an effective treatment option for non-diabetic patients with intractable chronic pancreatitis.The outcome and potential benefits for pre-diabetic and diabet...Total pancreatectomy with islet autotransplantation(TPIAT)is an effective treatment option for non-diabetic patients with intractable chronic pancreatitis.The outcome and potential benefits for pre-diabetic and diabetic patients are less well established.Thirty-four patients underwent TPIAT were retrospectively divided into 3 groups according to pre-operative glycemic control:diabetes mellitus(DM)(n=5,15%),pre-DM(n=11,32%)and non-DM(n=18,54%).Pre-operative fasting c-peptide was detectable and similar in all 3 groups.Islet yield in the DM group was comparable to pre-DM and non-DM groups(median islet equivalents[IEQ]was 191,800,111,800,and 232,000 IEQ,respectively).Patients received islet mass of over the target level of 2000 IEQ/kg in pre-DM and DM at lower but clinically meaningful rates compared to the non-DM group:45%(5/11)and 60%(3/5)for a combined 50%(8/16)rate,respectively,compared to 83%(15/18)for the non-DM group.At 1 year,fasting c-peptide and HbA1c did not differ between DM and pre-DM groups but c-peptide was significantly higher in non-DM.Islet transplantation failed(negative c-peptide)only in 1 patient.Preoperatively,all patients experienced pancreatic pain with daily opioid dependence in 60%to 70%.Pancreatic-type pain gradually subsided completely in all groups with no differences in other painful somatic symptoms.Diabetic patients with measurable pre-operative c-peptide can achieve similar benefit from TPIAT,with comparable outcomes to pre-diabetic and non-diabetic patients including pain relief and the metabolic benefit of transplanted islets.Not surprisingly,endocrine outcomes for diabetic and prediabetics patients are substantially worse than in those with normal pre-operative glucose control.展开更多
文摘BACKGROUND Despite the increased use of total pancreatectomy with islet autotransplantation(TPIAT),systematic evidence of its outcomes remains limited.AIM To evaluate the outcomes of TPIAT.METHODS We searched PubMed,EMBASE,and Cochrane databases from inception through March 2019 for studies on TPIAT outcomes.Data were extracted and analyzed using comprehensive meta-analysis software.The random-effects model was used for all variables.Heterogeneity was assessed using the I2 measure and Cochrane Q-statistic.Publication bias was assessed using Egger’s test.RESULTS Twenty-one studies published between 1980 and 2017 examining 1011 patients were included.Eighteen studies were of adults,while three studied pediatric populations.Narcotic independence was achieved in 53.5%[95% Confidence Interval(CI):45-62,P<0.05,I2=81%]of adults compared to 51.9%(95%CI:17-85,P<0.05,I2=84%)of children.Insulinindependence post-procedure was achieved in 31.8%(95%CI:26-38,P<0.05,I2=64%)of adults with considerable heterogeneity compared to 47.7%(95%CI:20-77,P<0.05,I2=82%)in children.Glycated hemoglobin(HbA1C)12 mo post-surgery was reported in four studies with a pooled value of 6.76%(P=0.27).Neither stratification by age of the studied population nor metaregression analysis considering both the study publication date and the islet-cell-equivalent/kg weight explained the marked heterogeneity between studies.CONCLUSION These results indicate acceptable success for TPIAT.Future studies should evaluate the discussed measures before and after surgery for comparison.
基金Supported by Key Laboratory Opening Topic Fund Subsidization:The Regulation of Sympathetic Nerve in Liver Regeneration in Hepatic Alveolar Echinococcosis,No.2021D04024.
文摘BACKGROUND Ex vivo liver resection and autotransplantation(ELRA)is an essential approach for treating patients with end-stage hepatic alveolar echinococcosis(AE),and its surgical indications involve severe invasion of important hepatic vessels,which makes in vivo resection impossible.Revascularization is a major step in the process of ELRA,which is extremely challenging when the invaded vessels have huge defects.CASE SUMMARY Herein,we have reported the case of a 26-year-old patient with hepatic AE in an autologous liver graft who underwent complex inferior vena cava(IVC)reconstruction using disease-free IVC,autologous portal vein fragments,and umbilical vein within the ligamentum teres hepatis.The patient showed good surgical recovery without vascular-related complications during the long-term follow-up.CONCLUSION We reviewed three studies that have reported complex revascularization of the IVC.This case report and systematic review showed that the use of autologous perihepatic vessels prevents donor-area trauma,immune rejection,and other adverse reactions.When the blood vessel is severely invaded and a single vascular material cannot repair and reconstruct the defect,ELRA may provide a safe and feasible surgical approach,which has good prospects for clinical application.
文摘BACKGROUND Perihilar cholangiocarcinoma(pCCA)is a highly malignant tumor arising from the biliary tree.Radical surgery is the only treatment offering a chance of long-term survival.However,limited by the tumor’s anatomic location and peri-vascular invasion,most patients lose the chance for curative treatment.Therefore,more methods to increase the resectability of tumors as well as to improve outcomes are needed.CASE SUMMARY A 68-year-old female patient had a hepatic hilar mass without obvious symptoms.Laboratory results showed hepatitis B positivity.Magnetic resonance imaging indicated that the mass(maximum diameter:41 mm)invaded the left and right branches of the main portal vein,as well as the middle,left and right hepatic veins;enlarged lymph nodes were also detected in the hilum.The patient was diagnosed with pCCA,and the clinical stage was determined to be T4N1M0(stage IIIC).Considering the tumor’s anatomic location and vascular invasion,systematic conversion therapy followed by ex vivo liver resection and autotrans-plantation(ELRA)was determined as personalized treatment for this patient.Our original systemic sequential therapeutic strategy(lenvatinib and tislelizumab in combination with gemcitabine and cisplatin)was successfully adopted as conversion therapy because she achieved partial response after three cycles of treatment,without severe toxicity.ELRA,anastomotic reconstruction of the middle hepatic vein,right hepatic vein,root of portal vein,inferior vena cava and right hepatic artery,and lymph node dissection were performed at one month after systemic therapy.Pathological and immunohistochemical examination confirmed the diagnosis of pCCA with lymph node metastasis.Although the middle hepatic vein was partially obstructed four months later,hepatic vein stent implantation successfully addressed this problem.The patient has survived for 22 mo after the diagnosis,with no evidence of recurrence or metastasis.CONCLUSION An effective therapeutic strategy for conversion therapy greatly increases the feasibility and efficiency of ELRA.
基金supported by grants from the Health Bureau(H200770)Technology Bureau(BS2005038)of Jiangsu Province,China
文摘BACKGROUND:Hepatocyte apoptosis is a severe form of cell death after hepatic ischemia-reperfusion injury(HIRI), and its relief is an important issue in liver transplantation. Hypoxic preconditioning(HP)is considered to have protective effects on HIRI.This study was designed to explore the impact of HP on apoptosis and its possible mechanism during orthotopic liver autotransplantation. METHODS:A modified orthotopic liver autotransplantation model was used to simulate HIRI.Sprague-Dawley rats were randomly divided into normal control,autotransplantation (AT)and HP groups.The HP group was subjected to an 8%oxygen atmosphere for 90 minutes before surgery.At 1,6 and 24 hours after surgery,the rats were killed and their liver tissue was sampled to assess the expression of Bcl-2 protein.The samples were subjected to blood chemistry study,morphological study under a light or transmission electron microscope,and quantitative study of mitochondria. RESULTS:The serum levels of ALT and AST in the HP group were lower than those in the AT group at 1,6 and 24 hours after orthotopic liver autotransplantation(P<0.05).Bcl-2 protein expression was increased in the HP group at each measurement point(P<0.05).Light microscopy showed that hepatic injury in the AT group was much more severe than in the HP group.Hepatocytes in the AT group showed typical apoptosis signs under a transmission electron microscope.The ultrastructural appearance of hepatocytes in the HP group was much better than in the AT group,and the area,perimeter and diameter of the mitochondria were smaller in the HP group than in the AT group(P<0.05). CONCLUSIONS:Hepatocytes sense and respond to decreased tissue oxygenation.Stimulation by HP relieves apoptosis by upregulating expression of Bcl-2 protein and its protection of mitochondria after orthotopic liver autotransplantation.
文摘The effectiveness of liver autotransplantation for patients with partial hepatic alveolar echinococcosis was analyzed.We retrospectively studied 6 patients with hepatic alveolar echinococcosis who underwent liver autotransplantation in our hospital from 2008 to 2010.We also summarized the surgical indications of liver autotransplantation for hepatic alveolar echinococcosis and our experience in the management of postoperative complications of liver autotransplantation.Of 6 patients,5 achieved good curative results,and one died of multiple organ failure caused by portal vein thrombosis.Main complications included postoperative bleeding,bile leak and small-for-size liver graft syndrome.Liver autotransplantation offers a new approach to cure hepatic alveolar echinococcosis with non-resectable lesions.It could be the most effective method to cure intractable hepatic alveolar echinococcosis if correct handling in operation and proper prevention of complications are performed.But the long-term outcomes are still needed to be confirmed in longer follow-up.
基金supported by grants from Xinjiang Uyghur Autonomous Region Key Laboratory Open Research Program(No.2018D03002)the National Natural Science Foundation of China(No.81560329)+1 种基金Xinjiang Uyghur Autonomous Region Key Scientific Research Program(No.201430123–2)State Key Laboratory of Pathogenesis,Prevention,Treatment of High Incidence Diseases in Central Asia Fund(No.SKL-HIDCA-2017-Y2)
文摘Background: The University of Wisconsin (UW) and histidine-tryptophan-ketoglutarate (HTK) solutions are the two most frequently used liver graft preservation fluids. The present study aimed to compare their efficacy in end-stage hepatic alveolar echinococcosis patients who underwent ex-situ liver resection and autotransplantation (ELRA). Methods: A total of 81 patients received ELRA from August 2010 to March 2018. They were allocated into UW ( n = 48) and HTK groups ( n = 33) based on the type of solutions used. Demographic and operational data were retrospectively analyzed. Primary outcomes included 90-day mortality, incidence of early graft loss, primary dysfunction, and postoperative complications. Results: Demographic and operational characteristics were similarly distributed in the two groups. No statistically significant differences were observed with regard to 90-day mortality (12.77% vs. 12.12%) and early graft loss rate (8.51% vs. 9.09%) between the two groups. Patients in the UW and HTK groups showed a primary dysfunction rate of 27.66% and 27.27%, respectively. The UW group exhibited a higher incidence tendency of biliary complications, albeit with no statistical significance. Conclusions: This is the largest cohort study comparing the efficacy of the UW and HTK organ-preserving solutions in end-stage hepatic alveolar echinococcosis patients in ELRA settings. UW and HTK solutions presented similar efficacy and safety. A randomized clinical trial with larger scale is needed for further investigation in future clinical applications.
文摘BACKGROUND Radical resection of gastric cancer liver metastases(GCLM)can increase the 5-year survival rate of GCLM patients.However,patients may lose the theoretical feasibility of surgery due to the critical location of liver metastasis in some cases.CASE SUMMARY A 29-year-old woman had a chief complaint of chronic abdominal pain for 1 year.Abdominal computed tomography and magnetic resonance imaging examinations suggested a mass of unknown pathological nature located between the first and second hila and the margin of the lower segment of the right lobe of the liver.The anterior wall of the gastric antrum was unevenly thickened.The diagnosis of(gastric antrum)intramucosal well-differentiated adenocarcinoma was histopathologically confirmed by puncture biopsy with gastroscopy guidance.She underwent radical resection(excision of both gastric tumors and ex vivo liver resection followed by autotransplantation simultaneously)followed by XELOX adjuvant chemotherapy.Without serious postoperative complications,the patient was successfully discharged on the 20th day after the operation.Pathological examination of the excised specimen indicated that gastrectomy with D2 lymph node dissection for primary gastric tumors and R0 resection for liver metastases were achieved.The resected mass was confirmed to be poorly differentiated gastric carcinoma(hepatoid adenocarcinoma with neuroendocrine differentiation)with liver metastases in segments VIII.No recurrence or metastasis within the liver was found during a 7.5-year follow-up review that began 1 mo after surgery.CONCLUSION Application of ex vivo liver resection followed by autotransplantation in radical resection for GCLM can help selected patients with intrahepatic metastases located in complex sites obtain a favorable clinical outcome.
文摘The aim of this study was to evaluate the outcome of autotransplantation or replantation of extracted teeth combining with reconstruction of alveolar bone defects in use of artificial bone grafting clinically and radiographically. This article presents a more useful and convenient method for repairing tooth and reconstruction of bone defecting with some interesting cases. Eleven patients (seven men and four women) in whom teeth with complete root formation were extracted and autotransplanted, the bone of receiving area was Insufficient. All transplanted teeth were stabilized with orthodontic wire and resin or 4-0 silk sutures;at the same time, artificial bone powder was filled. In 11 cases, the missing teeth were restored by autogenous teeth and the alveolar bone defect was restored by artificial bone, the improvement in the radiographic and clinical parameters strongly suggest that it may be a useful therapy to solve the problem of the missing teeth and alveolar bone insufficiency simultaneously. However, the risk of replacement root resorption remains.
文摘Autotransplantation of premolars to anterior region after incisor loss due to trauma is accepted as the best restoration procedure with very long follow-ups. There are two main protocols: Premolars with only two thirds of the root or premolars with complete root development. Premolars with two thirds of the root completed remain vital and show complete pulp obliteration while premolars with closed apex require root canal treatment. The problem arises when the child is very young and the root of the donor premolar is developed for only one third. This case report describes the outcome of an autotransplantation of a lower first premolar with only a third of developed root to the anterior region. The donor tooth was extracted with his follicle and placed instead of tooth No. 21. For the first month esthetics was restored with a glass-fibers ribbon attached to tooth No. 11 and composite material. After a month, the crown erupted and was reshaped to mimic an incisor with composite. Orthodontic movement was performed after 5 mo, in order to alleviate the gingival contour. The final restoration was performed after 15 mo. Follow up showed full root development with normal mobility, continuous periodontal ligament and complete pulp obliteration. A multidisciplinary approach and meticulous preparation are necessary for a positive result in autotransplantation of premolars with only a third of root development to the anterior region and this case report show that this method can be performed in very young children.
基金partially supported by the Advanced Clinician Scientist Program of the Medical Faculty of the Martin-Luther University Halle-Wittenberg,Halle(Saale),Germany(No.FKZ ACS23/06).
文摘Pancreatic ductal adenocarcinoma(PDAC)remains a devastating disease,and selecting patients who might benefit from complex arterial resection continues to be a challenge.However,in the era of modern multimodal treatments,surgery for pancreatic cancer has become increasingly safe.Neoadjuvant chemotherapy regimens such as modified-FOLFIRINOX(mFOLFIRINOX)and nab-paclitaxel/gemcitabine are effective in a significant proportion of patients.
文摘离体肝切除和自体肝移植术(ex-vivo liver resection and autotransplantation,ELRA)是肝脏外科中的一种复杂术式。ELRA适合于侵犯下腔静脉、门静脉与肝静脉及它们分支的复杂病灶的切除。近几年,经过众多学者对ELRA进行大量的手术实践与研究分析后,ELRA迅速发展。在疾病的适应证中,ELRA着重于晚期肝恶性肿瘤与终末期肝泡型棘球蚴病的治疗。最新的研究中,肝脏Child-Pugh评分B级和残余肝脏体积与标准肝脏体积之比为0.35~0.40的病人也能满足ELRA的肝脏要求。另外,体内临时的门腔静脉分流技术也因其术后死亡率低于过去的体外静脉-静脉转流技术而成为术中首选。术中的血管重建,重点围绕肝后下腔静脉重建方式的选择。对于需重建肝后下腔静脉的病人,则根据病灶切除后肝后下腔静脉壁缺损的程度,采用直接缝合、使用补片、使用人工血管的方式进行重建。现结合文献,对上述领域进行综述。
文摘继发性甲状旁腺功能亢进(secondary hyperparathyroidism,SHPT)是晚期慢性肾病病人常见的并发症之一。1977年提出了甲状旁腺全切术+自体移植术(total parathyroidectomy with autotransplantation,TPTX+AT)以来,关于自体移植的部分相关问题尚未形成共识。本文就自体移植的依据及临床价值、移植部位、移植方法、移植物存活与功能监测、复发的诊断与处理等进行综述。
基金The Work was supported by Islet Core University of Chicago Diabetes Research and Training Center,US Public Health Service Grant P30DK020595.
文摘Total pancreatectomy with islet autotransplantation(TPIAT)is an effective treatment option for non-diabetic patients with intractable chronic pancreatitis.The outcome and potential benefits for pre-diabetic and diabetic patients are less well established.Thirty-four patients underwent TPIAT were retrospectively divided into 3 groups according to pre-operative glycemic control:diabetes mellitus(DM)(n=5,15%),pre-DM(n=11,32%)and non-DM(n=18,54%).Pre-operative fasting c-peptide was detectable and similar in all 3 groups.Islet yield in the DM group was comparable to pre-DM and non-DM groups(median islet equivalents[IEQ]was 191,800,111,800,and 232,000 IEQ,respectively).Patients received islet mass of over the target level of 2000 IEQ/kg in pre-DM and DM at lower but clinically meaningful rates compared to the non-DM group:45%(5/11)and 60%(3/5)for a combined 50%(8/16)rate,respectively,compared to 83%(15/18)for the non-DM group.At 1 year,fasting c-peptide and HbA1c did not differ between DM and pre-DM groups but c-peptide was significantly higher in non-DM.Islet transplantation failed(negative c-peptide)only in 1 patient.Preoperatively,all patients experienced pancreatic pain with daily opioid dependence in 60%to 70%.Pancreatic-type pain gradually subsided completely in all groups with no differences in other painful somatic symptoms.Diabetic patients with measurable pre-operative c-peptide can achieve similar benefit from TPIAT,with comparable outcomes to pre-diabetic and non-diabetic patients including pain relief and the metabolic benefit of transplanted islets.Not surprisingly,endocrine outcomes for diabetic and prediabetics patients are substantially worse than in those with normal pre-operative glucose control.
