Background: Partial peri-cystectomy is one of the major surgical approaches for hepatic cystic echinococcosis (CE) and has been practiced in most centers worldwide. Cysto-biliary communication (fistula, leakage, rupture) is a problematic issue in CE patients. T-tube is a useful technique in situations where exploration and decompression are needed for common bile duct (CBD), however, postoperative biliary complications for cystic cavity still remains to be studied in depth. Materials and Methods: A retrospective cohort analysis of CE cases in our single center database from 2007 March to 2012 December was performed. Patients (n=51) were divided into two cohorts: double T-tube drainage (one at CBD for decompression and one at the fistula for sustaining in cystic cavity, n=23) group and single T-tube drainage cohort (only one at CBD for decompression, n=28). Short-/long-term postoperative complication focusing on biliary system was recorded in detail and they were followed-up for median 11 years.Results: Overall biliary complication rates for double and single T-tube drainages were 17.4% vs. 35.7%. Short-term complications ranged from minor to major leakages, cavity infection and abscess formation, and prevalence was 17.4% vs. 21.4% respectively for double and single T-tube groups; most importantly, double T-tube drainage group had predominant advantage regarding long-term complications (0% vs. 14.3%), which was biliary stricture needing surgery and it was observed in single T-tube drainage group.Conclusions: Double T-tube drainage had better outcomes without procedure specific postoperative biliary complications than single T-tube drainage. Meanwhile, we recommend long-term follow-up when comparing residual cavity related biliary complication in CE patients as it could happen lately.
Background: For patients with obstructive jaundice caused by cholangiocarcinoma (CCA), drainage methods, including endoscopic biliary drainage (EBD) and percutaneous suprahepatic biliary drainage (PTBD), may be applied. Here, this study aims to compare short-term efficiency of primary EBD and PTBD during the treatment process of obstructive jaundice caused by hilar cholangiocarcinoma (HCCA).Methods: Clinical data of 114 patients with obstructive jaundice caused by HCCA were retrospectively analyzed form January 2016 to December 2020. According to treatment options, the patients were divided into EBD group (n=37) and PTBD group (n=77), and 19 pairs of patients were obtained after propensity score matching (PSM) analysis. Liver function, technical success rate, postoperative complications and hospitalization expenses were compared between groups.Results: After PSM analysis all baseline parameters were comparable . Among PTBD group patients, technical success was observed in 75 cases (97.40%), which was found in 26 cases in EBD group (70.27%). The difference in technical success rate between groups was significant (P<0.001). Compared with EBD group, postoperative total bilirubin was significantly decreased in PTBD group (P=0.019), and there was significant difference in the decrease degree between groups (P=0.041). The incidence of postoperative complications (P=0.049) and acute pancreatitis ( P=0.046) in EBD group were higher than those in PTBD group.Conclusion: Compared with EBD, PTBD had higher success rate, greater decrease in total bilirubin level and lower incidence rate of overall postoperative complications and acute pancreatitis. Therefore, PTBD may be given priority in the treatment of obstructive jaundice caused by HCCA.
Background: Alveolar echinococcosis (AE) lesion microenvironment (LME) is crucial site where parasite-host interactions happen and of great significance during surgery and obtaining liver samples for basic research targeting immunology. However, little is known about quantification of LME range and its’ metabolic activity regarding different lesion types.Methods: A prospective analysis of LME from consecutive surgical AE cases with relevant imaging results was performed. Patients (n=39) received abdominal computed tomography (CT) and position emission tomography/computed tomography using 18F-fluodeoxyglucose (18F-FDG-PET/CT) within one week prior to surgery. Tumor to background ratios (TBRs) of standard uptake value (SUV) in PET/CT was calculated for corresponding LME regions. Multi-site sampling method (MSS, n=26) was introduced to obtain histological slides from LME at different levels off the lesion to evaluate immune cell infiltrative ranges quantitatively. At last, data was statistically analyzed from the perspective of different lesion types.Results: Altogether six major lesion categories have been identified based on different morphology and calcification pattern (A: non-calcified uniform density lesion; B: diffuse calcified solid lesion; C: half necrotic and half solid lesion with minor calcification; D: half necrotic and half solid lesion with obvious calcification; E: subtotal necrotic lesion with minor calcification; F: total necrotic lesion with obvious calcification). Statistical significances were resulted from TBRs calculation (A>B, A>D, A>F, B<C, B<E, A+C+E>B+D+F, etc.). Less calcified lesions were evidenced with higher TBRs, however, not much was valuable for necrosis. The 95% CI of LME ranges were (10.0, 12.1) mm and (9.9, 14.0) mm by PET/CT and MSS. And, weak regressions between TBRs and LME ranges indicated by PET/CT or MSS (r2 respectively were 0.2436 and 0.3171) were observed.Conclusions: PET/CT showed distinct TBRs for different lesion types with heterogenic calcification. PET/CT and MSS had similar discoverability for LME ranges, which also varied among different lesion types. Higher activity meant wider LME range within certain limit. This pioneering study would be able to provide references for both surgical removal of lesions and sample acquisitions more accurately for basic research targeted to immunology.
Background: Alveolar echinococcosis (AE) lesion microenvironment (LME) is crucial site where parasite-host interactions happen and of great significance during surgery and obtaining liver samples for basic research targeting immunology. However, little is known about quantification of LME range and its’ metabolic activity regarding different lesion types. Materials and Methods: A prospective analysis of LME from consecutive surgical AE cases with relevant imaging results was performed. Patients (n=39) received abdominal computed tomography (CT) and position emission tomography/computed tomography using 18F-fluodeoxyglucose (18F-FDG-PET/CT) within one week prior to surgery. Tumor to background ratios (TBRs) of standard uptake value (SUV) in PET/CT was calculated for corresponding LME regions. Multi-site sampling method (MSS, n=26) was introduced to obtain histological slides from LME at different levels off the lesion to evaluate immune cell infiltrative ranges quantitatively. At last, data was statistically analyzed from the perspective of different lesion types. Results: Altogether six major lesion categories have been identified based on different morphology and calcification pattern (A: non-calcified uniform density lesion; B: diffuse calcified solid lesion; C: half necrotic and half solid lesion with minor calcification; D: half necrotic and half solid lesion with obvious calcification; E: subtotal necrotic lesion with minor calcification; F: total necrotic lesion with obvious calcification). Statistical significances were resulted from TBRs calculation (A>B, A>D, A>F, BB+D+F, etc.). Less calcified lesions were evidenced with higher TBRs, however, not much was valuable for necrosis. The 95% CI of LME ranges were (10.0, 12.1) mm and (9.9, 14.0) mm by PET/CT and MSS. And, weak regressions between TBRs and LME ranges indicated by PET/CT or MSS (r2 respectively were 0.2436 and 0.3171) were observed. Conclusions: PET/CT showed distinct TBRs for different lesion types with heterogenic calcification. PET/CT and MSS had similar discoverability for LME ranges, which also varied among different lesion types. Higher activity meant wider LME range within certain limit. This pioneering study would be able to provide references for both surgical removal of lesions and sample acquisitions more accurately for basic research targeted to immunology.
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