Background Pancreatic cancer is very difficult to detect in its early stages, and its rapid progression and poor prognosis make it a significant therapeutic challenge. Existing treatment modalities, whether standalone or combined, offer limited efficacy, highlighting an urgent need for more effective and less toxic therapeutic strategies.Patients We analyze six cases of pancreatic cancer, each undergoing a novel treatment regimen integrating chemotherapy, targeted therapy, immune therapy, and icaritin.Results The outcomes demonstrate varying degrees of improvement in all cases. Partial responses were observed in cases 1 and 3, with some tumor shrinkage. Cases 4 and 5 showed limited relief following a slight decrease in tumor size. In cases 2 and 6, no significant progression of the lesion was observed. These results highlight the potential efficacy of this multifaceted approach.Conclusion Integrating icaritin with chemotherapy, immunotherapy, and/or targeted therapies shows potential as an exploratory approach in managing advanced, locally progressive, or metastatic pancreatic cancer, though further validation is required.

Hepatic venous pressure gradient (HVPG) is considered the gold standard for diagnosing portal hypertension (PHT). Laparoscopic splenectomy plus esophagogastric devascularization (LSED) is an important surgery for treating PHT. However, the variation trend of HVPG after surgery is not clear. Moreover, whether HVPG can provide precise prognostic information for patients undergoing surgery remains to be further studied. This study aimed to investigate the independent prognostic value of HVPG in LSED. From January 2016 to March 2023, 135 patients with PHT underwent LSED at our hospital were retrospectively evaluated. We analyzed the correlations between clinical indicators and history of upper gastrointestinal bleeding (UGIB). Among them, 57 patients remeasured postoperative HVPG. We further investigated the postoperative alterations of HVPG and correlative factors, as well as the relationship between the HVPG and postoperative UGIB. In this study, we found that 94 patients with preoperative UGIB (16.27 ± 5.73 mmHg) had a higher baseline HVPG than the other 41 patients without (14.02 ± 5.90 mmHg) (p = 0.04). The mean postoperative HVPG significantly decreased (-3.57 ± 8.09 mmHg, p = 0.001) compared to the baseline, and 66

Background Hepatic venous pressure gradient (HVPG) is considered the gold standard for diagnosing portal hypertension (PHT). Laparoscopic splenectomy plus esophagogastric devascularization (LSED) is an important surgery for treating PHT. However, the variation trend of HVPG after surgery is not clear. In addition, whether HVPG could provide precise prognostic information for patients undergoing surgery remains to be further studied. This study aimed to investigate the independent prognostic value of HVPG in LSED. Methods From January 2016 to March 2023, 134 patients with PHT underwent LSED at our hospital were retrospectively evaluated. The correlations between clinical indicators and history of upper gastrointestinal bleeding (UGIB) were analyzed. Among them, 57 patients remeasured postoperative HVPG. Postoperative alterations of HVPG and correlative factors, as well as the relationship between the HVPG and postoperative UGIB, were further investigated. Results In this study, we found that 93 patients with preoperative UGIB (16.27 ± 5.73mmHg) had a higher baseline HVPG than the other 41 patients without (14.02 ± 5.90mmHg) (P = 0.04). The mean postoperative HVPG significantly decreased (-3.57 ± 8.09 mmHg, P = 0.001) than baseline, 66% of patients (38/57) experienced the decreased HVPG-response after surgery. The baseline HVPG and preoperative CTP class B were associated with the decreased HVPG-response. Additionally, the patients with postoperative HVPG decreased>20% from baseline exhibited better recurrent hemorrhage-free survival rates than those without (log-rank, P = 0.013). Conclusion We found that LSED led to a significantly decreased HVPG, and patients with postoperative HVPG decreased >20% obtained better UGIB-free survival benefits than those without.

Introduction and objectivesLaparoscopic splenectomy and esophagogastric devascularization (LSED) are minimally invasive, effective, and safe in treating esophageal-fundic variceal bleeding with portal hypertension (PHT). The study aimed to assess the learning curve of LSED by cumulative summation (CUSUM) analysis. The 10-year follow-up data for LSED and open surgery were also examined.Patients and methodsFive hundred and ninety-four patients were retrospectively analyzed. Operation time, intraoperative blood loss, open operation conversion, and postoperative complications were selected as the evaluation indicators of surgical ability. The learning curve of LESD was assessed by the CUSUM approach. Patient features, perioperative indices, and 10-year follow-up data were examined.ResultsTotally 236 patients underwent open surgery, and 358 underwent LSED. Patient characteristics were similar between groups. The LSED patients experienced less intraoperative blood loss, fewer complications, and faster recovery compared to the open surgery cohort. The learning curve of LESD was maximal for a case number of 50. Preoperative general characteristics were comparable for both stages. But the skilled stage had decreased operation time, reduced blood loss, less postoperative complications, and better recovery compared to the learning stage. The LSED group had higher recurrent hemorrhage-free survival rate and increased overall survival in comparison with cases administered open surgery in the 10-year follow-up. Free-liver cancer rates were similar between two groups.ConclusionsAbout 50 cases are needed to master the LSED procedure. Compared to open surgery, LSED is a safer, feasible, and safe procedure for PHT patients, correlating with decreased rebleeding rate and better overall survival.

背景与目的:胰管出血(HP)是罕见的上消化道出血的原因,目前尚无公认的诊疗标准.本研究总结近40年来文献报道的HP患者的临床特征,以期加深对HP的认识,提高早期识别与诊断的能力,为临床规范诊疗策略方面提供一定的理论依据.方法:收集1977年1月—2021年12月公开发表关于HP的相关文献,分析HP患者的病因、临床表现、实验室检查、影像学检查、诊断治疗及预后情况.结果:纳入文献151篇,共333例患者,其中男性267例,女性66例,男女比例约为4∶1;年龄3～94岁,平均45.9岁.病因以胰腺炎(82.3%)最常见,其中慢性胰腺炎占89.1%,其次为胰周动脉瘤(6.0%)和胰腺肿瘤(5.4%).最常见的临床表现为黑便(74.2%)和腹痛(53.8%).影像学诊断主要依靠上消化道内镜、腹部增强CT及腹腔相关动脉造影,282例行上消化道内镜检查,共140例(49.6%)可以经内镜检查明确诊断.204例行腹部CT检查,其中假性动脉瘤120例(58.8%)、假性囊肿46例(22.5%)、胰腺肿瘤15例(7.4%)、胰周动脉瘤13例(6.4%)、胰管结石4例(2.0%).193例患者行腹腔相关动脉造影检查,112例(58.0%)显示阳性结果.最常见出血源是脾动脉(41.2%),其次是胃十二指肠动脉(16.7%)、囊壁出血(9.9%)、胰十二指肠动脉(9.6%).36例患者选择保守治疗.180例患者尝试了介入治疗,147例(81.7%)患者成功;140例患者接受手术治疗.9例患者选择其他治疗方式.218例患者的随访结果显示,197例(91.4%)无复发性出血,13例(6.0%)再出血,5例(2.3%)死亡.结论:HP确诊较为困难,应结合病史、临床表现综合判断,必要时进行重复的影像学检查以提高诊断率.治疗以针对病因为主导的综合治疗为主,同时根据疾病的临床进程选择恰当的治疗方式.

Abstract Background: Alterations in the genetic landscape of papillary thyroid carcinoma (PTC) compared with coincidental benign thyroid nodules, especially adenomatoid nodules, remain to be demonstrated. Methods: Multi-omics profiling of whole-exome sequencing, assay for transposase-accessible chromatin using sequencing (ATAC-seq), and transcriptome sequencing were used for analysis. Results: Chromatin accessibility in the PTC was lower than that in the benign nodules around the transcription start sites (distance <1 kb) with high interpatient heterogeneity of chromatin profiles and distinct open chromatin accessibility. The gene regions around the mutation loci that were only detected in PTC exhibited altered chromatin accessibility between the PTC and benign nodules. Through integrated ATAC-Seq and RNA-Seq analysis, ARHGEF28 and ARHGEF24, genes not previously related to PTC or adenomatoid nodules, were identified. They were overexpressed and hyperaccessible in adenomatoid nodules compared to those in PTC. They were regulated by TEAD4, and hyperaccessible binding sites were enriched in differentially accessible regions in benign nodules. In addition, extrachromosomal circular DNA (eccDNA) analysis derived from ATAC-sequencing showed indolent character, but no PTC-diver genes in the eccDNA was found. Conclusions: This compendium of multi-omics data provides valuable insights and a resource for understanding the landscape of open chromatin features and regulatory networks in PTC and benign nodule pathogeneses.

Objective:To investigate the expression level and clinical significance of cellular communication network factor 4 (CCN4) gene in hepatocellular carcinoma (HCC) based on bioinformatics.Methods:The expression level of CCN4 protein in HCC tissues and its relationship with clinicopathological parameters were analyzed by TCGA database. The correlation between the expression of CCN4 protein and tumor purity and immune cell infiltration was analyzed by TIMER database. Kaplan-Meier Plotter database was used to analyze the relationship between the expression of CCN4 protein and clinical prognosis in HCC. Protein-protein interaction (PPI) network was constructed by using STRING database, and the correlation between proteins was assessed. The relationship between CCN4 expression and clinicopathological parameters was analyzed by Chi-square test. Correlation analysis was conducted by Spearman's rank correlation.Results:Clinical information and corresponding RNA sequencing data of 371 patients were obtained from TCGA HCC dataset. Data analysis showed that the expression of CCN4 protein in HCC patients was correlated with race, T stage and pathological G grade (χ2=9.055, 14.012, 17.163; P<0.05). Kaplan-Meier Plot demonstrated that HCC patients with high expression of CCN4 obtained shorter overall survival (HR=1.50, 95%CI: 1.05-2.14, P<0.05). TIMER database analysis showed that the expression level of CCN4 in HCC was negatively correlated with tumor purity (rs=-0.397, P<0.05), whereas positively correlated with the infiltration levels of B cells, CD8+T cells, CD4+T cells, macrophages, neutrophils, dendritic cells and M2 macrophages (rs=0.306, 0.279, 0.460, 0.490, 0.465, 0.404, 0.532; P<0.05). PPI network analysis indicated that decorin was the main protein interacting with CCN4 (score=0.953).Conclusions:The expression level of CCN4 protein is associated with race, T stage and pathological G grade, which can be used as a biomarker for poor prognosis of HCC. The underlying mechanism may be related to the infiltration of immune cells, the polarization of M2 macrophages and the formation of stromal fibers.

目的 建立结肠癌的恶性转化细胞模型.方法 以1-甲基-3-硝基-1-亚硝基胍(MNNG)为启动剂、佛波酯(PMA)为促癌剂,对永生化的正常人结肠上皮细胞(NCM460细胞)进行多代诱导处理.采用MTT实验、细胞克隆形成实验和细胞划痕实验鉴定NCM460细胞恶性转化的倾向性和恶性生物学特征,采用Western blot检测神经钙黏附蛋白(N-cadherin)、转化生长因子β1(TGF-β1)和表皮生长因子受体(EGFR)的蛋白表达水平.结果 正常NCM460细胞形态为梭形,排列有序,呈单层生长;诱导后的第30代NCM460细胞形态发生显著变化,大小不一,排列紊乱,呈团块状生长.正常NCM460细胞、第17代NCM460细胞、第30代NCM460细胞的增殖能力依次升高,克隆形成数量依次增多,48 h迁移距离和迁移率依次增加或升高(P＜0.05).第30代NCM460细胞中N-cadherin、EGFR、TGF-β1的蛋白表达水平高于正常NCM460细胞(P＜0.05).结论 经过MNNG和PMA连续多代诱导处理后,NCM460细胞的生物学功能(增殖、克隆形成和迁移能力)发生明显改变,具备恶性细胞的生物学特征.该模型可用于结肠癌的发病机制和治疗方法研究.

Background: Portal veinous system thrombosis (PVST) is a common complication after laparoscopic splenectomy plus esophagogastric devascularization (LSED). Anticoagulation therapy was still in debate in LSED perioperation. This study aimed to determine the postoperative risk factors of PVST, the efficacy and safety of the anticoagulation therapy after LSED procedure, and the potential impact of anticoagulation on patients' liver function and overall survival (OS).Methods: Three hundred patients who underwent LSED were retrospectively enrolled and analyzed in the study. The characteristics of patients, perioperative parameters, risk of PVST, and long-term follow-up data were recorded and analyzed.Results: One hundred eighty six of 300 patients received perioperative anticoagulation therapy (p-AT) postoperation, while 114 patients did not receive p-AT (non-p-AT). The non-p-AT group had more intraoperative blood loss, PVST, longer abdominal drain days, and postoperative hospital stays separately compared with the p-AT group. No significant difference of postoperative complications was found between the two groups. In the 1-year follow-up postoperation, both groups had great improvement in hypersplenism and the portal vein hemodynamics. During the 10-year follow-up period, the incidence of PVST was significantly higher in the non-p-AT group than in the p-AT group. Anticoagulation therapy, sex, variceal hemorrhage history, portal vein diameter, and portal vein velocity were the independent prognostic factors determined by the Cox regression analysis for PVST. The thrombosis-free survival rate (P = .002), recurrent hemorrhage-free survival rate (P < .01), and the OS rate (P < .01) were significantly lower in the non-p-AT group than in the p-AT group.Conclusions: The initiate use of anticoagulation therapy in postoperation of LSED is effective and safe in cirrhotic patients. The anticoagulation therapy after LSED will help decrease portal vein thrombosis, the rebleeding rate, and extend the OS of the patients, especially among women, with variceal hemorrhage history, high portal vein diameter, and low portal vein velocity.

BackgroundAlthough hepatectomy plus splenectomy is not regularly recommended for hepatocellular carcinoma (HCC) with portal hypertension related hypersplenism due to the high risk accompanied with surgical procedures for now. Many researchers still believe that hypersplenism is a controversial adverse prognostic factor for HCC patients. Thus, the primary objective of the study was to determine the effects of hypersplenism on the prognosis of these patients during and after hepatectomy.MethodsA total of 335 patients with HBV-related HCC who underwent surgical resection as primary intervention were included in this study and categorized into three groups. Group A consisted of 226 patients without hypersplenism, Group B included 77 patients with mild hypersplenism, and Group C contained 32 patients with severe hypersplenism. The influence of hypersplenism on the outcome during the perioperative and long-term follow-up periods was analyzed. The independent factors were identified using the Cox proportional hazards regression model.ResultsThe presence of hypersplenism is associated with longer hospital stays, more postoperative blood transfusions, and higher complication rates. The overall survival (OS, P = 0.020) and disease-free survival (DFS, P = 0.005) were significantly decreased in Group B compared to those in Group A. Additionally, the OS (P = 0.014) and DFS (P = 0.005) were reduced in Group C compared to those in Group B. Severe hypersplenism was a significant independent prognostic variable for both OS and DFS.ConclusionSevere hypersplenism prolonged the hospital stay, increased the rate of postoperative blood transfusion, and elevated the incidence of complications. Furthermore, hypersplenism predicted lower overall and disease-free survivals.

Background and aims:Splenomegaly often occurs in cirrhotic patients with portal hypertension (PHT), and therefore, the efficacy and accuracy of conventional methods for measuring splenic volume are a matter of question in these patients. Here, we developed a novel approach to assess true splenic volume more precisely. Methods:High-quality thin-slice computed tomography data of 112 cirrhotic patients with PHT were obtained and reviewed. Both the conventional measurement and a novel formula obtained from 3-dimensional reconstruction software were used to estimate splenic volume, and the accuracy was compared and verified. Results:In PHT patients, the splenic volume calculated using the conventional method was significantly less than that calculated using the 3-dimensional software. We found that the splenic volume was significantly positively correlated with splenic indices of length (L), thickness (T), and width (W) and also the diameter of the splenic vein. Using these indices, we propose 2 novel formulas using the software to estimate the splenic volume more accurately: SV = 69.686 × L + 53.077 × W + 103.525 × T + 314.510 × diameter of splenic vein -2266.209 (p < 0.01, R 2  = 0.805). And a more practical simplified formula: SV' = 0.504 × L × W × Τ + 319.762 × diameter of splenic vein -81.66 (p < 0.01, R 2  = 0.784). Conclusion:Although the conventional formula has been widely used for years, it is not suitable for an enlarged spleen. We developed 2 novel formulas for estimating splenic volume from clinical data that were more appropriate for cirrhotic patients with PHT.

Aim: Hepatic fibrosis is one of the most common conditions worldwide, and yet no effective antifibrotic therapy is available. This study aimed to reverse hepatic fibrosis via exosome-mediated delivery of the CRISPR/dCas9-SAM system. Materials & methods: The authors constructed a modified-exosome delivery system targeting hepatic stellate cells (HSCs), and constructed the CRISPR/dCas9-SAM system inducing HSCs convert into hepatocyte-like cells in vitro and in vivo. Results: RBP4-modified exosomes could efficiently load and deliver the CRISPR/dCas9 system to HSCs. The in vitro CRISPR/dCas9 system induced the conversion from HSCs to hepatocyte-like cells via targeted activation of HNF4α/HGF1/FOXA2 genes. Importantly, in vivo targeted delivery of this system significantly attenuated CCl4-induced hepatic fibrosis. Conclusion: Targeted activation of HNF4α/HGF1/FOXA2 reverses hepatic fibrosis via exosome-mediated delivery of the CRISPR/dCas9-SAM system, which provides a feasible antifibrotic strategy.

Objective:To evaluate the application value of the full-process management of minimally invasive surgery, primarily laparoscopic splenectomy combined with pericardial devascularization (devascularization), for portal hypertension.Methods:Clinical data of 263 patients with cirrhosis complicated with portal hypertension undergoing devascularization in Tangdu Hospital Affiliated to Air Force Medical University from January 2009 to December 2018 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 159 patients were male and 104 female, aged 17-77 years with a median age of 46 years. According to different managements, all the patients were divided into the new mode group (n=129) and control group (n=134). In the new mode group, the full-process surgery management of laparoscopic devascularization was adopted. In the control group, traditional perioperative management of open devascularization was performed. Perioperative conditions and complications were observed between two groups. Perioperative conditions were statistically compared between two groups by rank-sum test or t test. The incidence of complications was compared by Chi-square test.Results:In the new mode group, intraoperative blood loss was 562(500) ml, significantly less than 1 405(900) ml in the control group (Z=-9.472, P<0.05); The indwelling time of drainage tube and length of postoperative hospital stay were (4.2±2.3) d and (7.7±3.0) d, significantly shorter than (6.3±2.7) d and (9.6±2.9) d in the control group (t=-6.778, -5.223; P<0.05). In the new mode group, the AST and TB levels at postoperative 3 d were 33(17) U/L and 24(13) μmol/L, significantly lower than 41(21) U/L and 40(22) μmol/L in the control group (Z=-2.708, -4.775; P<0.05); PT was (13.5±1.5) s, significantly shorter than (16.3±2.8) s in the control group (t=-8.594, P<0.05). The incidence of severe postoperative complications in the new mode group was 15%(19/129), significantly lower compared with 51%(68/134) in the control group (χ2=38.520, P<0.05).Conclusions:The full-process management of minimally invasive surgery, mainly laparoscopic devascularization, is safe and efficacious for portal hypertension, which can guarantee the perioperative safety, reduce the risk of surgical complications and accelerate recovery of patients.

Background In China, laparoscopic splenectomy and esophagogastric devascularization (LSED) are effective and safe tools that are used to treat esophageal-fundic variceal bleeding with portal hypertension (PHT) with minimal trauma; however, due to the increased difficulty of operation, their application in massive splenomegaly (MS) remains limited. This study sought to determine the efficacy and safety of LSED in treating MS patients with PHT. Methods The data of 124 patients who underwent LSED by a single surgical team at our department from January 2015 to December 2020 were retrospectively analyzed. The characteristics of the patients, perioperative parameters, and long-term follow-up data were examined. Results A total of 61 MS and 63 mild-to-moderate splenomegaly (MMS) patients underwent LSED. Much larger spleen and significant lower of white blood cells and platelets was found in MS group compared the MMS group preoperation (P<0.05). The MS group had a significantly longer operation time (P=0.009), more blood loss (P=0.003), and more abdominal drainage days (P=0.017) than the MMS group. Four patients in the MS group and 0 patients in the MMS group were converted to open surgery. No significant difference was found between the 2 groups in terms of postoperative complications. Nine patients in the MMS group and 10 in the MMS group experienced recurrent bleeding in the follow-up period, but no significant differences were observed in terms of recurrent bleeding and overall survival (OS) between the 2 groups. Conclusions LSED can be used to treat MS patients with PHT under careful perioperative management. For experienced surgeons, LSED is a safe, feasible, and minimally invasive procedure with satisfactory long-term outcomes that can be used to treat MS patients with PHT. Keywords Laparoscopic splenectomy (LS); massive splenomegaly (MS); devascularization; portal hypertension (PHT)

BACKGROUND:Activated hepatic stellate cells (HSCs) are primarily involved in liver fibrosis and portal hypertension (PHT). We aimed to investigate the effect of miR-20b-5p on HSCs, liver fibrosis, and PHT.METHODS:MiR-20b-5p expression in HSCs and in mouse liver fibrosis was determined by qPCR. Further, the effects of miR-20b-5p mimic on HSCs migration, proliferation, and apoptosis were investigated in vitro. A dual-luciferase reporter assay was performed to confirm the direct interaction between miR-20b-5p and STAT3. In vivo, mouse liver fibrosis was established by common bile duct ligation and intervened by agomiR-20b-5p. Sirius red staining and hydroxyproline content were used to evaluate collagen deposition. The α-SMA expression in the liver was detected by IHC and Western blotting. The STAT3 signaling pathway and its downregulated cytokines as well as portal pressure and angiogenesis were explored.RESULTS:MiR-20b-5p was significantly downregulated during HSCs activation and in mouse liver fibrosis. The functional analyses demonstrated that miR-20b-5p inhibited cell proliferation, activation, and promoted apoptosis in HSCs in vitro. Moreover, miR-20b-5p regulated STAT3 expression by binding to the 3'UTR of its miRNA directly. Overexpression of miR-20b-5p facilitated HSC activation and proliferation by inhibiting the STAT3 signaling pathway. MiR-20b-5p overexpression suppressed the STAT3 and its downstream cytokines and ameliorated liver fibrosis in mice. The intra- and inter-hepatic angiogenesis were also effectively inhibited. The inhibition of liver fibrosis and neoangiogenesis contributed to the decrease of portal pressure.CONCLUSIONS:MiR-20b-5p plays an important role in the fibrosis and angiogenesis of liver fibrosis by targeting the STAT3 signaling pathway.

Papillary thyroid carcinoma (PTC) has a high incidence, and its proper treatment remains challenging. Therefore, identifying PTC progression markers is essential. Here, using 16S RNA sequences, we analyzed the PTC intratumor microbiome and its role in tumor progression. Substantial microbial abundance was detected in PTC from all patients. The tumor bacterial diversity in patients with advanced lesions (T3/T4) was significantly higher than that in patients with relatively mild lesions (T1/T2). Importantly, we identified signatures of eight tumor bacterial taxa highly predictive of PTC invasion status. Hence, microbial host factors-independent of the genomic composition of the tumor-may determine tumor behaviors and patient outcomes. Furthermore, the correlation between specific bacterial genus and thyroid hormones or autoimmune thyroid disease-related antibodies may indicate the potential contribution of the microbiome in the relationship between autoimmune thyroid disease or irregular thyroid function and PTC progression, intervention of which might therefore be worth exploring for advancing oncology care.

Objective:To establish a risk prediction model of conversion to open surgery during laparoscopic splenectomy and esophagogastric devascularization (LSED) and evaluate the impact of this conversion on patients' short-term prognosis.Methods:A total of 358 cirrhotic portal hypertension patients admitted to the Department of General Surgery , Second Affiliated Hospital, Air Force Military Medical University from Feb 2011 to Nov 2020 were retrospectively analyzed. All patients underwent attempted LSED. Univariate and least absolute shrinkage and selection operator (LASSO) Logistic regression were used to analyze the independent risk factors for conversion to laparotomy, and the R language was used to build a nomogram prediction model for conversion to laparotomy. The intraoperative and postoperative conditions of the two groups were compared.Results:A total of 358 patients were included in this study, of which 31(8.7%). patients were converted to open surgery. In univariate analysis, high MELD score, BMI ≥24 kg/m 2, history of upper abdominal surgery, red sign of the varicose, low platelet count and prolonged PT are risk factors for conversion . LASSO regression finally identified 5 factors: MELD, BMI, PLT, history of surgery, and red sign. In the nomogram prediction model the area under ROC curve was 0.831. The conversion led to longer operation time; increased blood loss; prolonged postoperative abdominal drainage , longer hospital stay, and increased perioperative complications ( t=-2.167, P=0.031; Z=-4.350, P<0.01; Z=-3.102, P=0.002; Z=-3.454, P=0.001; χ2=8.773, P=0.003). Conclusions:LASSO regression selected five indicators with greatest impact on intraoperative conversion: MELD, BMI, PLT, red sign, and previous history of abdominal surgery. The nomogram prediction model established has good prediction ability. Patients converted to open surgery had worse short-term outcomes.

Background and aims:Portal hypertension (PHT) is common in end-stage cirrhosis, and variceal bleeding is the main complication associated with mortality. Surgery is usually performed in patients with PHT with a high risk of variceal bleeding in China. This study aimed to introduce an individualized and precise total laparoscopic surgical procedure based on 3D remodeling for PHT.Methods:From March 2013 to December 2018, 146 patients with cirrhotic PHT underwent a laparoscopic surgical procedure in our department. An individualized 3D remodeling evaluation was carried out for surgical planning.Results:The operation time was 319.96 ± 91.53 min. Eight of 146 patients were converted to open surgery. Acute portal vein system thrombosis occurred in 10 patients (6.85%). During the first year, 11 patients (8.15%) experienced rebleeding and two (1.48%) died. 18 patients (13.33%) experienced rebleeding and three died, giving a 3-year mortality rate of 3.66%. Compared with preoperatively, the portal vein showed significant postoperative decreases in diameter, flow velocity, and flow amount, while the hepatic artery showed significant postoperative increases in diameter, flow velocity, and flow amount. A 3D liver volume evaluation found that 19 of 21 patients had a significantly increased liver volume postoperatively, and a significantly decreased MELD score.Conclusion:This retrospective study introduced a safe, feasible, and effective individualized surgical procedure. Our results show that this surgical treatment may not only act as an effective symptomatic treatment for PHT to prevent esophageal and gastric hemorrhage, but also as an etiological treatment to increase liver function and long-term survival.

Background: Laparoscopic splenectomy and esophagogastric devascularization (LSED) are minimal invasive, effective and safe in treating esophageal-fundic variceal bleeding with portal hypertension (PHT). The study aimed to determine the efficacy of LSED on liver regeneration and function. Methods: Sixty-three patients were retrospectively analyzed. Liver volume (LV) was measured by a 3-D simulation imaging system. Clinical data and long-term follow-up data were recorded.Results: 45 patients were found LV increased after LSED operation. Portal vein hemodynamics, hypersplenism and liver function were improved after LSED. Patients with larger splenic length and higher albumin levels before LSED showed an increased rate of postoperative LV. Anticoagulation therapy after LSED also contributed to the LV.Conclusions: LSED in patients with cirrhotic PHT improved pancytopenia, liver function, and portal vein hemodynamics. Patients with huge splenomegaly and higher albumin levels combined with postoperative anticoagulation therapy were expected to have more chance of LV increase and liver function improvement.

Introduction Laparoscopic splenectomy and esophagogastric devascularization (LSED) is becoming increasingly popular in the treatment of esophageal-fundic variceal bleeding with portal hypertension (PHT) in China, and its high safety and minimal trauma have been proven. Fast-track (FT) surgery improves patient recovery and decreases postoperative complications. Aim To determine whether LSED with fast-track principles can provide better outcomes than traditional treatment for patients with PHT. Material and methods A total of 140 patients who underwent LSED with either traditional treatment or fast-track principles in our department were retrospectively analyzed. The postoperative outcomes, complications, inflammatory mediators, portal vein thrombosis (PVT) and recurrent esophagogastric variceal bleeding rate were recorded. Results No significant differences were found in the patients’ preoperative characteristics. The FT group had better outcomes than the non-FT group with respect to gastrointestinal function recovery, resumption of oral intake, and postoperative hospitalization. The incidence of postoperative complications, including pneumonia, severe ascites, and urinary tract infection, were significantly lower in the FT than the non-FT group. The C-reactive protein and interleukin 6 concentrations and the incidence of PVT were significantly lower in the FT than the non-FT group. The overall recurrent bleeding rate is 11.5% and no significant difference was found between the two groups in the follow-up period. Conclusions LSED with fast-track principles was superior to LSED with traditional treatment in terms of postoperative outcomes, complications, postoperative inflammatory reactions, and the incidence of PVT. This strategy is safe and effective for the treatment of PHT.