Objective:To study the factors influencing survival after radical resection in patients with intrahepatic cholangiocarcinoma (ICC), and to construct a nomogram on survival prediction.Methods:The clinical data of 139 patients with ICC who underwent radical resection at the People's Hospital of Zhengzhou University from June 2018 to December 2021 were retrospectively analyzed. There are 69 males and 70 females, aged (59.5±10.2) years old. These patients were divided into two groups based on a 3: 1 ratio by using the random number method: the test group ( n=104) and the validation group ( n=35). Data from the test group was used to construct a nomagram and data from the validation group was used to validate the predictive power of the nomagram. Univariate and multivariate Cox regression analyses were used to analyse factors influencing survival on the test group patients and to construct a nomogram. The predictive accuracy of the nomogram was determined by receiver operating characteristic (ROC) curves, concordance index (C-index) and calibration curves. Results:The results of the multivariate regression analysis showed that a combined hemoglobin, albumin, lymphocyte and platelet immunoinflammation (HALP) score <37.1 ( HR=1.784, 95% CI: 1.047-3.040), CA19-9 > 35U/ml ( HR=2.352, 95% CI: 1.139-4.857), poorly differentiated tumor ( HR=2.475, 95% CI: 1.237-4.953) and vascular invasion ( HR=1.897, 95% CI: 1.110-3.244) were independent risk factors that affected prognosis of patients with ICC after radical resection (all P<0.05). The AUCs of the nomogram in the test group in predicting the overall survival at 1, 2 and 3 years of patients with ICC after radical resection were 0.808, 0.853 and 0.859, respectively. There was good consistency between the prediction of the nomogram and actual observation. The predicted C-index of the total survival period of the test group was 0.765 (95% CI: 0.704-0.826), and the C-index of the validation group was 0.759 (95% CI: 0.673-0.845). Conclusion:A HALP score <37.1, CA19-9>35 U/ml, poorly differentiated tumour and vascular invasion were independent risk factors for prognosis of ICC patients after radical resection. The nomogram was established based on the above factors and showed good performance in predicting overall survival after radical resection in patients with ICC.

Objective:To construct a nomogram prediction model for survival after radical surgical resection of intrahepatic cholangiocarcinoma (ICC) based on the albumin-bilirubin index (ALBI), and to evaluate its predictive efficacy.Methods:From January 2016 to January 2020, 170 patients with ICC who underwent radical surgical resection at the People's Hospital of Zhengzhou University were retrospectively analyzed. There were 90 males and 80 females, aged (58.5±10.6) years old. Based on a ratio of 7∶3 by the random number table, the patients were divided into the training set ( n=117) and the internal validation set ( n=53). The training set was used for nomogram model construction, and the validation set was used for model validation and evaluation. Follow up was conducted through outpatient reexamination and telephone contact. The Kaplan-Meier method was used for survival analysis, and a nomogram was drawn based on variables with a P<0.05 in multivariate Cox regression analysis. The predictive strength of the predictive model was evaluated by analyzing the consistency index (C-index), calibration curve, and clinical decision curve of the training and validation sets. Results:Multivariate Cox regression analysis showed that carbohydrate antigen 19-9 (CA19-9) ≥37 U/ml ( HR=1.99, 95% CI: 1.10-3.60, P=0.024), ALBI≥-2.80 ( HR=2.43, 95% CI: 1.40-4.22, P=0.002), vascular tumor thrombus ( HR=2.34, 95% CI: 1.40-3.92, P=0.001), and the 8th edition AJCC N1 staging ( HR=2.18, 95% CI: 1.21-3.95, P=0.010) were independent risk factors affecting postoperative survival of ICC patients after curative resection. The predictive model constructed based on the above variables was then evaluated, and the C-index of the model was 0.76. Calibration curve showed the predicted survival curve of ICC patients at 3 years after surgery based on the model was well-fitted to the 45° diagonal line which represented actual survival. Clinical decision curve analysis showed that the model had a significant positive net benefit in both the training and validation sets. Conclusion:The nomograph model for survival rate after radical resection of ICC was constructed based on four variables: ALBI, CA19-9, vascular tumor thrombus, and AJCC N staging (8th edition) in this study. This model provided a reference for more accurate prognosis evaluation and treatment selection plan for ICC patients.

Objective:To determine the risk factors for development of combined hepatocellular-cholangiocarcinoma (CHC) and intrahepatic cholangiocarcinoma (ICC).Methods:The clinical data of patients with ICC or CHC confirmed by pathology at Henan Provincial People's Hospital from January 2012 to December 2018 were retrospectively analyzed. Of 225 patients with ICC or CHC, there were 90 males and 135 females, aged (58.7±10.4) years old. Based on the pathological type, there were 172 patients in the ICC group and 53 patients in the CHC group. The healthy control group was selected from 450 individuals who underwent routine health examination in the same hospital, and there were 189 males and 261 females, aged (56.7±9.3) years old. Univariate and multivariate logistic regression were used to analyze the risk factors of ICC and CHC.Results:The risk factors of ICC included hepatitis B surface antigen (HBsAg) (+ )/hepatitis B core antibody (anti-HBc) (+ ) ( OR=9.373, 95% CI: 4.784-18.363, P<0.001), hepatitis C virus antibody (HCV-Ab) (+ ) ( OR=7.151, 95% CI: 1.195-42.776, P=0.031), diabetes mellitus ( OR=3.118, 95% CI: 1.733-5.612, P<0.001) and hepatolithiasis ( OR=18.650, 95% CI: 5.210-66.767, P<0.001). The risk factors of CHC included HBsAg (+ )/anti-HBc(+ )( OR=54.891, 95% CI: 17.434-172.822, P<0.001) and HCV-Ab (+ ) ( OR=37.785, 95% CI: 5.720-249.611, P<0.001). Conclusion:HBV infection, HCV infection, hepatolithiasis, diabetes mellitus and cirrhosis were risk factors for ICC. HBV and HCV infection were risk factors of CHC.

目的 评估分层选择性离断在腹腔镜贲门周围血管离断术联合脾切除术的应用价值.方法 回顾性分析2012年6月至2018年12月在郑州大学人民医院行贲门周围血管离断术联合脾切除术治疗肝硬化门脉高压症378例患者的临床资料,分为腹腔镜组126例,开腹组252例.结果 腹腔镜组手术时间(151.6±19.9)min少于开腹组(157.9±16.7)min,术中出血量(268.5±159.4)mL少于开腹组(341.6±160.9)mL,术后住院时间(7.6±1.7)d短于开腹组(9.5±1.8)d,经口进食时间(1.9±0.9)d短于开腹组(3.1±0.9)d(均P＜0.05).术后并发胰瘘、门静脉血栓形成及胸腔积液均少于开腹组(均P＜0.05).术后随访,中位随访时间为16个月,腹腔镜组上消化道再出血率2.4％(3/126)低于开腹组7.1％(18/252)(P＜0.05).结论 采用分层选择性离断腹腔镜贲门周围血管离断术联合脾切除术,安全、有效、易行,可减少术中出血,缩短手术时间,同时降低术后再发消化道出血风险.

目的 加强对气肿性胰腺炎的临床认识,合理实施外科干预,提高治愈率.方法 分析2009年7月—2014年7月河南省人民医院收治的8例气肿性胰腺炎的临床资料.结果 8例重症急性胰腺炎患者腹部CT检查提示胰腺及胰周游离气体存在.在营养支持基础上给予积极抗感染治疗,仍有反复发热等感染征象.8例患者均实施胰腺、胰周坏死组织及感染灶清创术并置管冲洗引流,全部治愈出院.结论 气肿性胰腺炎在营养支持、抗生素应用以及影像学动态评估的基础上,掌握合理的手术时机实施外科清创引流术,能获得较好的预后.

目的 探讨血清和肽素联合急性生理学与慢性健康状况评分系统Ⅲ(APACHEⅢ)在重症急性胰腺炎(SAP)患者病情及预后评估中的应用.方法 选取某医院2017年6月-2018年6月收治的SAP患者64例作为研究对象,并在入院时进行APACHEⅢ评分,同时测定血清和肽素水平,分析APACHEⅢ评分和血清和肽素水平与SAP患者病情及预后的关系.结果 随着APACHEⅢ评分的增高,SAP患者的血清和肽素水平也呈上升趋势,且各计分段血清和肽素水平比较,差异有统计学意义(P＜0.05);存活患者的APACHEⅢ评分和血清和肽素水平明显低于死亡患者(P＜0.05);APACHEⅢ评分的最佳临界值为60分;血清和肽素水平最佳临界值为3.48 ng/mL.APACHEⅢ评分和血清和肽素水平与SAP患者预后的ROC曲线下面积分别为0.926、0.878(P＞ 0.05);两者联合预测时ROC曲线下面积为0.956,其准确度大于其中任何一项单独预测(P＜0.05).结论 血清和肽素水平和APACHEⅢ评分均可用于判断SAP患者的病情程度及预后,且两者联合测定时可明显提高对SAP患者预后的准确度.

Objective To explore the safety, feasibility, validity and superiority of accelerated rehabilitation in laparoscopicsurgery concept accurate liver resection. Methods Totally 126 cases of hepatectomy in the patients of hepatobiliary surgery in Henan provincial people's hospital from January 2015 to February 2017, of which 63 cases were treated by ERAS, were treated as control group. The personal data, clinical data and follow - up data of two groups were analyzed statistically. Results The experimental group and control group cure rate and postoperative1, 3, 7days no difference between the white blood cells (P ＞ 0.05); Experimental operation time, postoperative exhaust time, defecation time and hospital stay were shorter than those of the control group, on the day of surgery transfusion volume and hospitalization cost less than the control group, postoperative1, 3, 7days CRP was lower than those of control group, the differences were statistically significant (P ＜ 0.05). Conclusion The eras in laparoscopic accurate hepatectomy is safe, feasible and effective, and has obvious advantages in postoperative rehabilitation, hospital cycle and medical cost. However, require the joint efforts of multidisciplinary integrated treatment group, actively carry out multi - center clinical study under the guidance of evidence - based medicine.