中文English
ISSN 1001-5256 (Print)
ISSN 2097-3497 (Online)
CN 22-1108/R

2014 No. 12

Display Method:
Editorial
Endoscopic management of large common bile duct stones
Liu ChunTao, Zhang ShuTian
2014, 30(12): 1233-1235. DOI: doi:10.3969/j.issn.1001-5256.2014.12.001
Abstract:
Therapeutic guidelines
Prophylaxis of post-ERCP pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) Guideline-Updated June 2014
Li XiaoQing, Qian JiaMing
2014, 30(12): 1236-1239. DOI: 10.3969/j.issn.1001-5256.2014.12.002
Abstract:
Guidelines for the management of pancreatic cancer (2014)
Group of Pancreas Surgery, Chinese Society of Surgery, Chinese Medical Association
2014, 30(12): 1240-1245. DOI: 10.3969/j.issn.1001-5256.2014.12.003
Abstract(163) PDF (362KB)(1347)
Abstract:
Guidelines for the management of pancreatic neuroendocrine neoplasms (2014)
Group of Pancreas Surgery, Chinese Society of Surgery, Chinese Medical Association
2014, 30(12): 1246-1248. DOI: 10.3969/j.issn.1001-5256.2014.12.004
Abstract:
Interpretation of radiotherapy document in Chinese expert consensus on comprehensive diagnosis and treatment of pancreatic cancer (2014 Edition)
Ren Gang, Wang Jing, Xia TingYi
2014, 30(12): 1249-1252. DOI: 10.3969/j.issn.1001-5256.2014.12.005
Abstract:
Discussions by experts
Strategy of endoscopic retrograde cholangiopancreatography in elderly patients aged over 80 with pancreaticobiliary diseases
Ma ShuRen
2014, 30(12): 1253-1254. DOI: 10.3969/j.issn.1001-5256.2014.12.006
Abstract:

As an aging society, China has an increasing number of elderly patients (≥80 years) . Given the characteristics of pancreaticobiliary diseases in elderly patients, therapeutic endoscopic retrograde cholangiopancreatography (TERCP) has become the main approach for these patients. When TERCP is performed in elderly patients with pancreaticobiliary diseases, a more detailed strategy is needed in addition to active preoperative evaluation and emergency treatment of medical and surgical complications. TERCP provides a good therapy for elderly patients with pancreaticobiliary diseases, and it is simple, safe, and convenient.

Diagnostic value of endoscopic ultrasonography for pancreatic head mass
Hou XiaoJia, Jin ZhenDong
2014, 30(12): 1255-1258. DOI: 10.3969/j.issn.1001-5256.2014.12.007
Abstract:

The differential diagnosis of pancreatic head mass has been clinical difficulties. Endoscopic ultrasonography is now recognized as one of the sensitive and effective methods for the diagnosis of pancreatic diseases. This paper discusses the diagnostic performance of endoscopic ultrasonography for various common types of pancreatic head mass, as well as the radiological features of this disease, reviews the diagnostic value and safety of endoscopic ultrasonography-guided fine needle aspiration for pancreatic head mass, and briefly introduces the advances in the application of additional new techniques of endoscopic ultrasonography for this disease. Finally, it is pointed out that endoscopic ultrasonography has a high diagnostic value for pancreatic head mass.

Recent progress in ERCP for biliary and pancreatic diseases
Mou Lin, Wang Fei
2014, 30(12): 1259-1266. DOI: 10.3969/j.issn.1001-5256.2014.12.008
Abstract:
In recent years, with the continuous development of endoscopic and interventional techniques, many new devices and methods have been used in clinical practice, and the application of endoscopic retrograde cholangiopancreatography (ERCP) in biliary and pancreatic diseases has developed rapidly. This paper reviews and summarizes the recent progress in ERCP among patients with biliary and pancreatic diseases, including those with altered gastrointestinal anatomy, pregnant patients, patients with benign and malignant biliary strictures, and patients with pancreatic pseudocysts, as well as the application of Spy Glass, photodynamic therapy, and radiofrequency ablation, the management of ERCP-related duodenal perforation, and the prevention of post-ERCP pancreatitis. All the progress has made a great contribution to the diagnosis and treatment of biliary and pancreatic diseases.
Original articles_Endoscopic diagnosis and treatment for hepatobiliary and pancreases disease
Comparative study on safety of endoscopic retrograde cholangiopancreatography in patients with cirrhosis
Wu JuShan, Li Lei, Song YanMing, Feng Li, Li Bing
2014, 30(12): 1267-1271. DOI: 10.3969/j.issn.1001-5256.2014.12.009
Abstract:

Objective To evaluate the safety of endoscopic retrograde cholangiopancreatography (ERCP) in patients with cirrhosis. Methods A retrospective analysis was performed on the clinical data of 347 patients who were admitted to Beijing You'an Hospital and received ERCP from January 2010 to November 2013. Patients were divided into three groups: patients without liver diseases (n = 258) , patients with chronic hepatitis (n = 40) , and patients with cirrhosis (n = 49) . One-way ANOVA or Kruskal-Wallis H test was performed to compare changes in alanine aminotransferase (ALT) , aspartate transaminase (AST) , albumin (Alb) , total bilirubin (TBil) , white blood cells (WBC) , percentage of neutrophils (NEUT) , and serum amylase between the three groups of patients after ERCP. The incidence rates of complications, including hyperamylasemia, acute pancreatitis, infection, hemorrhage, and perforation, and distribution of disease spectrum diagnosis the changes in liver function and blood amylase after ERCP were analyzed compared between the three groups using chi-square test. Results Patients with cirrhosis had significantly lower levels of serum Alb, ALT, and AST than patients in the other two groups before ERCP (H = 3. 68, P = 0. 028; H = 14. 03, P = 0. 001, and H = 8. 00, P = 0. 018, respectively) . After ERCP, the TBil level was significantly higher in the cirrhosis group than in the other two groups (H = 6. 69, P = 0. 035) . Compared with the serum levels of AST and TBil before ERCP, 44. 9% (22 /49) of patients with cirrhosis had higher levels of AST and TBil 3 days after ERCP, the incidence of which was the highest among all three groups. The percentage of NEUT 1 day after ERCP in patients with cirrhosis was 73. 9% ± 12. 7%, which was similar to that in patients without liver diseases (74. 8% ± 11. 0%) and higher than that in patients with chronic hepatitis; the difference between the three groups was statistically significant (H = 7. 31, P = 0. 026) . Although no significant difference in the percentage of patients who had > 80%NEUT 3 days after ERCP was observed between the three groups, the percentage was the highest in the group of patients with cirrhosis (18. 4%, 9 /258) . The incidence rate of hyperamylasemia 24 hours after ERCP 24 h was significantly higher in patients with cirrhosis (53. 1%) than in patients without liver diseases (31. 8%) or with chronic hepatitis (40. 0%) (χ2= 8. 48, P = 0. 014) . The overall complication rates in patients with cirrhosis (18. 4%) was significantly higher than that in patients without liver diseases (8. 1%) or with chronic hepatitis (7. 5%) (χ2= 26. 73, P < 0. 001) . Conclusion ERCP is a safe and effective therapeutic intervention and well tolerated by patients with cirrhosis. Hyperamylasemia should be closely monitored after ERCP.

Efficacy and safety of transjugular intrahepatic portosystemic shunt versus endoscopic therapy for prevention of variceal rebleeding in patients with cirrhosis: a meta-analysis
Wu JiYuan, Zhang DongQin, Zhang HaiYue, Wang LuWen, Gong ZuoJiong
2014, 30(12): 1272-1278. DOI: 10.3969/j.issn.1001-5256.2014.12.010
Abstract:

Objective To compare the efficacy and safety of transjugular intrahepatic portosystemic shunt (TIPS) versus endoscopic therapy (ET) in reducing recurrent variceal hemorrhage in patients with cirrhosis. Methods Data from randomized controlled trials (RCTs) ranging from January 1st, 1970 to January 1st, 2014 that compared the use of TIPS with ET for the prophylaxis of recurrent variceal bleeding in cirrhosis patients were retrieved from databases including Pub Med, Ovid, Science Direct, Embase, Wanfang Data, and CNKI. The quality of eligible RCTs was assessed, and a meta-analysis was performed on the incidence of variceal rebleeding (VRB) and post-treatment encephalopathy, deaths due to rebleeding and other causes, and hospitalization days using the Cochrane Collaboration's Rev Man 5. 2 software. Heterogeneity test and sensitivity analysis were performed, and publication biases were evaluated. Results Thirteen RCTs involving 475 cases of TIPS and480 cases of ET were recruited in our study following the inclusion criteria. The meta-analysis showed that compared with the ET group, the TIPS group had a lower incidence of VRB [relative risk (RR) = 0. 48, 95% confidence interval (CI) : 0. 39-0. 58, P < 0. 001 ], reduced deaths due to rebleeding (RR = 0. 37, 95% CI: 0. 20-0. 69, P = 0. 001) , but a higher incidence of post-treatment encephalopathy (RR = 1. 84, 95% CI: 1. 47-2. 30, P < 0. 001) . No significant differences were found in overall mortality and hospitalization days between the two groups (RR = 1. 09, 95% CI: 0. 88-1. 35, P = 0. 44; weighted mean difference =-0. 44, 95% CI:-3. 25-2. 38, P= 0. 76) . Conclusions Compared with ET, TIPS increases the risk of hepatic encephalopathy. However, in some special cases, it remains the first choice of treatment to prevent variceal rebleeding.

Study on efficacy of endoscopic ligation therapy for esophageal varices and risk factors for postoperative rebleeding
Gu Chuan, Li Lu, Wang Jun, Hou FengQin, Xu XiaoYuan
2014, 30(12): 1279-1282. DOI: 10.3969/j.issn.1001-5256.2014.12.011
Abstract:

Objective To examine the efficacy of endoscopic variceal ligation (EVL) as a secondary prophylaxis for cirrhotic patients associated with esophageal varices, and to identify the risk factors for postoperative rebleeding. Methods A retrospective analysis was performed on the clinical data of cirrhotic patients with esophageal variceal bleeding (EVB) in the Peking University First Hospital from 2000 to2012. Patients were divided into ligation and control (conservative treatment) groups and their prognosis was followed up. According to the outcome, the ligation group was further divided into rebleeding and non-rebleeding groups for comparative analysis of clinical data. Continuous data were compared between groups using the independent samples t-test, and data were converted before t-test when necessary.Ranked data were analyzed using the Mann-Whitney U test, and categorical data were compared between groups using the χ2test. Results A total of 139 patients were enrolled, 119 assigned to the ligation group and 20 to the control group. At the end of the follow-up period (1 to 24 months) , the rebleeding, early rebleeding, and mortality rates significantly differed between the ligation and control groups (P<0. 05) , i. e., 41. 2%, 8. 4% and 7. 6% in the ligation group versus 70. 0%, 20. 0% and 40. 0% in the control group, respectively. In the ligation group, comparative analysis showed that the history of hepatic encephalopathy, ascites, Child-Pugh score, and platelet count significantly differed between the rebleeding and non-rebleeding groups (P < 0. 05) . Conclusion As a secondary prophylaxis therapy, EVL can effectively improve the prognosis of cirrhosis associated with EVB. The deterioration of liver function may indicate a higher risk of rebleeding. Therefore, it is necessary to improve patients basic conditions during EVL therapy.

Comparison of endoscopic variceal ligation and pericardial devascularization in treatment of portal hypertension
Bai Lan, Guo XiaoZhong, Li HongYu
2014, 30(12): 1283-1286. DOI: 10.3969/j.issn.1001-5256.2014.12.012
Abstract:

Objective To compare the clinical efficacy of endoscopic variceal ligation versus pericardial devascularization in the treatment of portal hypertension. Methods The clinical data of 101 cirrhotic patients with gastroesophageal varices and variceal hemorrhage from January2010 to January 2012 were analyzed. Fifty-three patients received endoscopic variceal ligation, and forty-eight patients received pericardial devascularization. Postoperative changes in liver function and hypersplenism were compared between the two groups. The rate of rehaemorrhagia and incidence of postoperative complications after surgery were compared as well. Continuous data were expressed as mean ± SD, and categorical data were expressed as number of cases or percentage. Comparison of continuous data between the two groups was made by independent-samples t test, and comparison of categorical data was made by chi-square test. Results After surgery, the variceal ligation group showed no significant changes in liver reserve function, while the albumin level was significantly decreased in the pericardial devascularization group (t =2. 512, P < 0. 05) . There were no significant changes in the counts of white blood cells and platelets in the endoscopic variceal ligation group after surgery (P > 0. 05) , but significant increases in the counts of white blood cells and platelets were detected in the pericardial devascularization group (P < 0. 05) . The rates of postoperative haemorrhage in the two groups were: 3 months, 7. 5% vs 6. 2% (χ2= 0. 066, P > 0. 05) , 6 months, 7. 5% vs 8. 3% (χ2= 0. 021, P > 0. 05) , and 1 year, 9. 4% vs 8. 3% (χ2= 0. 038, P > 0. 05) . The incidence rates of postoperative complications in the two groups were 24. 5% and 50%, respectively (χ2= 7. 040, P < 0. 05) . Conclusion Compared with pericardial devascularization, endoscopic variceal ligation causes fewer microlesions, preserves liver function, and leads to a lower incidence of postoperative complications. However, if hypersplenism is observed in the cirrhotic patients with gastroesophageal varices and variceal hemorrhage, pericardial devascularization can be used to control the hypersplenism and prevent esophageal hemorrhage.

Clinical effect of laparoscopic hepatectomy in treating liver metastasis of colon cancer: a systematic review and meta-analysis
Shen YiNan, Huang ShengYu, Hu XianRong, Wang Jie, Yu HongMing, Lu Wen, Lu JunHua, Yang GuangShun, Wu MengChao
2014, 30(12): 1287-1291. DOI: 10.3969/j.issn.1001-5256.2014.12.013
Abstract:

Objective To evaluate the clinical effects of laparoscopic hepatectomy (LH) versus open hepatectomy (OH) in treating liver metastasis of colon cancer. Methods Relevant literature published up to October 2014 was retrieved from databases including Pub Med, Medline, Embase, and Cochrane Library. Extended search was done with reference to the retrieved articles. The quality of selected studies was assessed by the Jadad scale. Meta-analysis was performed using the Cochrane Review Manager software (Version 5. 3. 4) . Results A total of 10 studies involving 786 patients met the inclusion criteria. Meta-analysis showed no significant differences in duration of operation, perioperative mortality, and 5-year overall survival rate between patients undergoing LH and OH (95% CI:-61. 98-23. 68, 0. 08-4. 05, and 0. 60-1. 58, respectively, P > 0. 05 for all) , but there were significant differences in intraoperative blood loss, incidence of postoperative complications, and length of hospital stay (95% CI:-323. 17- (-113. 00) , 0. 38-0. 77, and-5. 01- (-2. 04) , respectively, P < 0. 05) . Conclusion The results of this meta-analysis suggest that LH has comparable efficacy and safety to OH in treating liver metastasis of colon cancer and LH has its own advantage.

Clinical effects of different approaches to laparoscopic cholecystectomy
He ChengPing
2014, 30(12): 1292-1294. DOI: 10.3969/j.issn.1001-5256.2014.12.014
Abstract:

Objective To analyze the clinical effects of several different approaches to laparoscopic cholecystectomy. Methods A total of400 patients who received cholecystectomy in our hospital from January 2013 to September 2014 were divided into four groups according to the approaches to laparoscopy (n = 100 per group) : single-port laparoscopic cholecystectomy, two-trocar laparoscopic cholecystectomy, three-trocar laparoscopic cholecystectomy, and four-trocar laparoscopic cholecystectomy. All clinical data were systematically analyzed on six indicators: blood loss during surgery, operation time, time to ambulation after surgery, time to taking meal after surgery, length of hospital stay after surgery, and the degree of pain at 6 h after surgery (rating of pain scale) . The clinical effects of the different approaches were compared between the four groups. Results Significant differences were observed in the following indicators: the degree of pain at 6 h after surgery between the groups of single-port and two-trocar laparoscopic cholecystectomy [ (2. 7 ± 0. 4 vs 1. 9 ± 0. 8) , P = 0. 036]; operation time between the groups of single-port and three-trocar laparoscopic cholecystectomy [ (55. 6 ± 23. 5) min vs (36. 0 ± 24. 3) min, P =0. 028]; length of hospital stay between the groups of single-port and three-trocar laparoscopic cholecystectomy [ (3. 0 ± 2. 3) d vs (5. 2± 3. 3) d, P = 0. 042]. All other indicators showed no significant differences between groups (P > 0. 05) . Statistical analysis of the six indicators indicated that all four approaches did not significantly influence the incidence of surgical complications (P > 0. 05) . Conclusion All the four approaches to laparoscopic cholecystectomy are safe and feasible, but the operation techniques should be standardized, anatomical knowledge should be mastered, and any changes in the surgical situation should be strictly monitored. Before the surgery, the patients' wishes and their physical conditions should be considered to choose the appropriate surgical approach and improve the surgical safety.

Application of fast track surgery in elderly patients during perioperative period of laparoscopic cholecystectomy
Zhang Yong, Chen YanShan
2014, 30(12): 1295-1298. DOI: 10.3969/j.issn.1001-5256.2014.12.015
Abstract:

Objective To investigate the safety and superiority of fast track surgery (FTS) in elderly patients during the perioperative period of laparoscopic cholecystectomy (LC) . Methods The clinical data of 124 elderly patients who underwent LC at the Department of General Surgery in our institution between January 2010 and March 2014 were assessed, with 62 cases assigned to FTS group and 62 cases to conventional method group. Anal exhaust time, feeding time, off-bed activity time, and length of hospital stay were compared between the two groups, and postoperative results and adverse reactions were recorded. Continuous data were analyzed using the independent-samples t test, and categorical data were compared using the chi-square test. Results Compared with the control method group, patients in the FTS group showed earlier postoperative anal exhaust, feeding, and off-bed activity, a shorter length of hospital stay, and a lower incidence of postoperative cardiovascular and cerebrovascular complications (P < 0. 05) . Conclusion FTS is an effective approach to accelerate rehabilitation in elderly patients after LC.

Clinical analysis of risk factors for ERCP-related perforation
Zhou HaiHua, Su JinGen, Lu YiNing, Wang JianPing
2014, 30(12): 1299-1302. DOI: 10.3969/j.issn.1001-5256.2014.12.016
Abstract:

Objective To evaluate the causes, diagnostic and therapeutic principles, and prevention of the perforation related to endoscopic retrograde cholangiopancreatography (ERCP) . Methods All patients who developed perforation after ERCP in the Central Hospital of Shanghai Jiading District from January 2009 to December 2013 were recruited. The causes, types, and diagnosis and treatment of perforation were analyzed retrospectively. Results ERCP was done in 459 cases during the 4 years, and 6 (1. 3%) of them developed perforation.The causes of perforation were as follows: endoscope insertion (3 cases) , catheterization or sphincterotomy (2 cases) , and guide wire or Dormia basket (1 case) . Two cases received conservative management successfully and were discharged; four cases underwent surgical treatment, and one of them died. Conclusion Patients with ERCP-related perforation can achieve ideal prognosis through individualized treatment based on the causes and types of perforation. Careful and cautious operation, especially for the elderly or the patients with a history of upper abdominal operation, will reduce the incidence of ERCP-related perforation.

Original articles_Viral hepatitis
Analysis of ERα-29 polymorphisms between Han nationality and Hui minority populations with chronic hepatitis B in Gansu Province, China
Zhou Ning, Zhang YueRong, Wei ShiFang, Wu LiYang, Li XiangLin
2014, 30(12): 1303-1306. DOI: 10.3969/j.issn.1001-5256.2014.12.017
Abstract:
Objective To investigate the genetic polymorphisms in the estrogen receptor (ER) alpha gene at position 29 (ERα-29) in patients with chronic hepatitis B (CHB) from Han nationality and Hui minority populations in Gansu Province, China. Methods Polymorphisms of ERα-29 were analyzed in 84 Han and 84 Hui CHB patients who were admitted to our hospital from August 2012 to November 2013 by polymerase chain reaction-restriction fragment length polymorphism analysis. Allele frequencies were determined by gene counting and tested for expectations of Hardy-Weinberg equilibrium. Unconditional logistic regression analysis was applied to adjust the confounding factors. Comparison of the genotype and allele frequencies was performed by chi-square test. Results The genotype frequencies of ERα-29 in Han versus Hui CHB patients from Gansu Province were as follows: TT, 52. 4% vs 60. 7%; TC, 40. 5% vs 34. 5%; CC, 7. 1% vs 4. 8%. The allele frequencies were 72. 6% vs 78. 0% for the T allele and 27. 4% vs 22. 0% for the C allele. No significant differences in the allele and genotype frequencies of ERα-29 were found between Han and Hui CHB patients in Gansu Province (P > 0. 05) . Conclusion The genetic polymorphisms in ERα-29 are not significantly different between Han and Hui CHB patients in Gansu Province, China.
Analysis of HBV genotype distribution and its association with liver cirrhosis in Xinjiang Uygur Autonomous Region, China
Wang XiaoZhong, Wang Yan, Ma Yan, Guo Feng, Zhuang XiaoFang
2014, 30(12): 1307-1309. DOI: 10.3969/j.issn.1001-5256.2014.12.018
Abstract:
Objective To investigate the distribution of hepatitis B virus (HBV) genotypes among patients in Xinjiang Uygur Autonomous Region, China, and to explore its association with liver cirrhosis. Methods HBV genotypes of 1018 hepatitis B patients were determined by PCR analysis. The relationship of HBV genotype with clinical outcomes and relevant chronic liver diseases was assessed by contingency chi-square test, Kruskal-Wallis test, and multivariate unconditional logistic regression analysis. Results Among the 828 patients whose HBV genotyping was completed in this study, type C was the major genotype and the percentage was 54. 11% (448 /828) , 25. 15% (200 /828) had type B, and 16. 18% (134 /828) had type D. Among the 116 patients with liver cirrhosis, 20. 84% had type C, which was significantly more frequent than other genotypes (P < 0. 00) . The multivariate unconditional logistic regression model identified several risk factors for liver cirrhosis, including duration of hepatitis B≥10 years, C genotype, high HBV DNA viral load, and impaired liver function characterized by abnormal alanine aminotransferase test. Among all these factors, genotype C had the highest relevance to liver cirrhosis (OR =2. 819, 95% CI: 1. 582-5. 021) . Conclusion The leading genotype of HBV in Xinjiang Uygur Autonomous Region is type C, followed by type B and type D. Genotype C is an independent risk factor for HBV-related liver cirrhosis.
Analysis of predictive factors for rapid virologic response in treating patients with chronic hepatitis C
Zhang DanDan, Ye PeiYan, Huang YuXian, Xu GuoGuang, Zhang Yi, Li XinYan, Chen Liang
2014, 30(12): 1310-1314. DOI: 10.3969/j.issn.1001-5256.2014.12.019
Abstract:
Objective To analyze the predictive factors for rapid virologic response (RVR) in patients with chronic hepatitis C (CHC) who received combination therapy with pegylated interferon (PEG-IFN) and ribavirin. Methods A total of 127 CHC patients who were admitted to our department from 2010 to 2012 and received PEG-IFN combined with ribavirin were enrolled in this retrospective cohort study. The patients were divided into RVR group and non-RVR (NRVR) group according to their virologic responses after 4 weeks of antiviral therapy.Demographic characteristics and the clinical features prior to treatment were compared between the two groups, and the potential factors that contributed to the acquisition of RVR were analyzed. Comparison of categorical data between groups was made by chi-square test, predictive factors were analyzed by nonparametric test for two independent samples (Mann-Whitney U test) , independent predictive factors were tested by univariate and multivariate logistic regression analyses, and the continuous variables of predictive factors were analyzed using receiver operating characteristic curves. Results Of the 127 CHC patients, 86 were males and 41 females. There were 11 confirmed cases of liver cirrhosis. There were 100 patients (78. 74%) who achieved an RVR, and 27 (21. 26%) with NRVR. Nonparametric analysis showed that eight factors, which were age, time of infection, level of pre-treatment alanine aminotransferase, level of pre-treatment hyaluronic acid, development of hypertension, type of interferon, pathway of infection, and hepatitis C virus (HCV) genotype, were significantly different between the RVR and NRVR groups (P < 0. 05) . The logistic regression analysis identified the following factors as independent predictive factors for RVR: non-genotype 1 (OR: 0. 203, 95% CI: 0. 051-0. 802, P < 0. 05) , time of infection (OR: 0. 925, 95% CI: 0. 868-0. 987, P < 0. 05) , and absence of hypertension (OR: 0. 129, 95% CI: 0. 032-0. 521, P < 0. 05) . Conclusion Patients with shorter history of HCV infection, absence of complicated hypertension, and non-genotype 1 HCV infection have an increased likelihood of achieving an RVR.
Evaluation of two generations of HCV RNA quantitative kits: a comparative study of 556 cases of hepatitis C
Sun Mei, Tan GuoLei, Wang JianFang, Wu XuPing
2014, 30(12): 1315-1318. DOI: 10.3969/j.issn.1001-5256.2014.12.020
Abstract:
Objective To evaluate the clinical application of two generations of HCV nucleic acid quantitative kits: COBASAmpli Prep /COBASTaq Man HCV, v2. 0 and COBASAmpli Prep / COBASTaq Man HCV Test. Methods HCV RNA levels in 556 samples that were collected in our hospital were measured using the COBASAmpli Prep / COBASTaq Man HCV, v2. 0 and COBASAmpli Prep / COBASTaq Man HCV Test. The samples included 93 ones that were HCV RNA negative, 350 ones that were HCV RNA positive, 52 paired plasma and serum samples, and 61 ones with previous interferon therapy. HCV RNA-positive samples were divided into low-concentration group (≤103, 61 cases) , medium-concentration group (104-105, 191 cases) , and high-concentration group (≥106, 89 cases) . Comparison between groups was made by linear analysis to compute the correlation coefficient (r) and establish the regression equation. Results There was a significant correlation between the two generations of HCV nucleic acid quantitative kits (r = 0. 948, P < 0. 05) . The correlation between the two kits in the low-concentration group (y = 0. 9809 x + 0. 1359, r = 0. 8047, P > 0. 06) was higher than that in the medium-concentration group (y = 0. 8130 x + 1. 0727, r = 0. 6956, P < 0. 01) and that in the high-concentration group (y = 0. 6746 x + 1. 8914, r =0. 3088, P < 0. 01) . A high correlation between the two kits in paired serum and plasma samples was observed (y = 0. 9368 x + 0. 4469, r =0. 9698, P > 0. 05) . Conclusion The two generations of HCV RNA quantitative kits produce consistent results. A stronger correlation was shown in the low-concentration group, suggesting that the quantitative kits are more sensitive in detecting low level of HCV RNA in the clinical setting.
Original articles_Liver fibrosis and liver cirrhosis
Effects of entecavir on liver fibrosis indices in patients with hepatogenous diabetes
Gou Wei, Wang YanLing, Zhou Yong, Xun ShuLing
2014, 30(12): 1330-1333. DOI: 10.3969/j.issn.1001-5256.2014-12.023
Abstract:
Objective To investigate the effects of entecavir on liver fibrosis indices in patients with hepatogenous diabetes. Methods A total of 98 patients, who were admitted to our hospital from June 2008 to August 2013, were diagnosed with hepatitis B cirrhosis complicated by hepatogenous diabetes, and were randomly and equally divided into treatment group and control group. All patients were given diabetic diet, as well as liver protection, symptomatic treatment, and supportive care. The treatment group was orally administered entecavir 0. 5 mg once daily for 52 weeks. Live fibrosis indices and Fibro Scan value were analyzed after treatment. Comparison of continuous data between the two groups was made by t test, and comparison of categorical data was made by χ2test. Results Compared with the control group, the treatment group had significantly lower levels of laminin, type Ⅳ collagen, hyaluronic acid, and type Ⅲ procollagen (t = 2. 71, P < 0. 01; t =3. 53, P < 0. 01; t = 2. 34, P < 0. 05; t = 2. 28, P < 0. 05) , a significantly lower Fibro Scan value (t = 3. 22, P < 0. 01) , a significantly higher serum HBV DNA clearance rate (χ2= 12. 69, P < 0. 01) , a significantly lower blood glucose level (t = 16. 01, P < 0. 01) , significantly lower levels of total bilirubin and alanine aminotransferase (t = 5. 53, P < 0. 01; t = 4. 73, P < 0. 01) , and a significantly higher albumin level (t = 2. 42, P < 0. 05) . Conclusion Entecavir leads to improvements in liver fibrosis indices, Fibro Scan value, viral DNA replication, blood glucose, and liver function indices and has good efficacy in HBV DNA-positive hepatitis B cirrhosis patients complicated by hepatogenous diabetes.
Effect of splenectomy plus pericardial devascularization on coagulation function in patients with cirrhotic portal hypertension
Yu ZhenNing, Yang Lin, Lu JianGuo
2014, 30(12): 1334-1336. DOI: 10.3969/j.issn.1001-5256.2014.12.024
Abstract:
Objective To determine platelet count (PLT) , mean platelet volume (MPV) , and hemodynamic changes in patients with cirrhotic portal hypertension (CPH) post splenectomy plus pericardial devascularization (SPPD) , and to assess the surgical effect on coagulation function. Methods A retrospective analysis was performed on 83 CPH patients undergoing SPPD in our hospital from January 2008 to December 2012. Results Compared with preoperative levels, postoperative portal venous pressure decreased, blood flow was reduced, and portal vein diameter was significantly reduced; additionally, postoperative hepatic artery diameter was increased, and hepatic artery blood flow increased. Blood alanine aminotransferase, albumin, total protein, and fibrinogen levels, thrombin time, and MPV did not significantly change 30 days postoperatively versus 7 days preoperatively (P > 0. 05) ; the corresponding total bilirubin, activated partial thromboplastin time and prothrombin time relatively declined (P < 0. 05) , whereas PLT and prothrombin time activity increased (P < 0. 05) . There was a significant increase in PLT (P < 0. 05) but no significant change in MPV 30 days postoperatively versus 7 days preoperatively (P > 0. 05) .Conclusion SPPD can significantly improve liver functional reserve and coagulation function in patients with CPH.
Original articles_Fatty liver
Systematic review of metformin versus vitamin E in treatment of nonalcoholic fatty liver disease
Luo JingYi, Zhang LiTing, Lu MingXia, Liu YaLi, Xiao Ping
2014, 30(12): 1319-1324. DOI: 10.3969/j.issn.1001-5256.2014.12.021
Abstract:

Objective To compare the clinical efficacy and adverse effects of metformin versus vitamin E in the treatment of nonalcoholic fatty liver disease (NAFLD) . Methods Randomized controlled trials (RCTs) of NAFLD treatment with metformin and vitamin E, which were published before April 10, 2014, were retrieved from international and domestic biomedical databases including the Pub Med, EMbase, Cochrane Library, Web of Science, CNKI, WANFANG, VIP, and CBM. Clinical trials that met the inclusion criteria were chosen for meta-analysis. Results Four RCTs were included, of which three were published in English and one in Chinese. Meta-analysis data showed that metformin had a significantly higher effective rate than vitamin E in terms of serum alanine aminotransferase (ALT) alternation post oral treatment (P < 0. 0001) . There were no significant differences in body mass index (BMI) and serum aspartate aminotransferase (AST) , fasting blood glucose (FBG) , and triglyceride (TG) levels post oral treatment (P = 0. 30, 0. 39, 0. 82, and 0. 74, respectively) . Liver biopsy showed that after metformin treatment, the alterations in fatty degeneration and lobular inflammation scores, as well as balloon-like changes, were less than those post vitamin E treatment. Regarding clinical safety, metformin effectively reduced serum ALT and gamma-glutamyl transferase levels without causing hepatocyte damage (P = 0. 008 and 0. 01, respectively) . Only one RCT mentioned the occurrence of mild diarrhea and abdominal pain or discomfort in the metformin group, but there was no significant difference from the vitamin group. Conclusion Among NAFLD patients, metformin reduces serum ALT levels more significantly than vitamin E, while the latter has its advantage in improving the results of liver biopsy. However, these two drugs have no significant differences in reducing BMI and AST, FBG, and TG levels. This study included limited numbers of original references and patients, and it might involve selection and implementation biases. RCTs of higher quality are expected to provide more effective evidence for assessing the clinical efficacy and adverse reactions of metformin versus vitamin E.

Effect of salvianolic acid B on hepatocyte apoptosis in rats with nonalcoholic steatohepatitis
Wang YingChun, Kong WeiZong, Jin QingMei, Chen Juan
2014, 30(12): 1325-1329. DOI: 10.3969/j.issn.1001-5256.2014.12.022
Abstract:

Objective To investigate the effect of salvianolic acid B on hepatocyte apoptosis in rats with nonalcoholic steatohepatitis (NASH) and the efficacy of salvianolic acid B in the treatment of NASH. Methods Sixty clean male SD rats were randomly divided into control group, NASH model group, and salvianolic acid B treatment group, with 20 rats in each group. The control group was fed with normal diet, while the other two groups with high-fat diet for 12 continuous weeks to establish a NASH model. From week 13, rats in the treatment group were gavaged with 1 mg / ml salvianolic acid B (20 ml / kg b. w. daily) ; while the model group with distilled water (20 ml / kg b. w daily) . After 12 weeks of treatment, the rats were sacrificed; blood and hepatic tissues were sampled, liver index (liver weight / body weight) calculated, serum levels of alanine aminotransferase (ALT) , aspartate aminotransferase (AST) , triglycerides (TG) , and total cholesterol (TC) measured, and the pathologic changes in hepatic tissues observed. The protein expression of caspase-3 and cytochrome C (Cyt C) in hepatic tissues was measured by immunohistochemical methods. The mRNA expression of p53, Bax, and Bcl-2 in hepatic tissues was measured by RT-PCR. Results Compared with the normal group, the model group showed higher liver index and serum levels of ALT, AST, TG, and TC and more obvious inflammation of hepatic tissues; the protein expression of Cyt C and caspase-3 was significantly increased (P < 0. 01 for both) ; the mRNA expression of Bcl-2 was significantly reduced (P < 0. 01) , while that of Bax and p53 was significantly increased (P < 0. 01 for both) . Compared with the model group, the treatment group showed alleviated inflammation and reduced liver index and serum levels of ALT, AST, TG, and TC; the protein expression of Cyt C and caspase-3 was significantly reduced (P < 0. 01 for both) ; Bcl-2 mRNA expression was significantly increased (P < 0. 05) , p53 mRNA expression significantly reduced (P < 0. 05) , and Bax mRNA expression also significantly reduced (P < 0. 01) . Conclusion Salvianolic acid B can inhibit hepatocyte apoptosis and treat NASH by regulating the mRNA expression of Bcl-2, p53, and Bax and reducing the protein expression of Cyt C and caspase-3.

Original articles_Hepatopancreatobiliary tumor
Clinical efficacy of oxaliplatin-based systemic chemotherapy in treating advanced hepatocellular carcinoma: a comparative study of two regimens
Chen XiaoWen, Zhou SiLang
2014, 30(12): 1337-1340. DOI: 10.3969/j.issn.1001-5256.2014.12.025
Abstract:

Objective To evaluate the therapeutic efficacy and toxicity of oxaliplatin (OXA) -based systemic chemotherapy in patients with advanced hepatocellular carcinoma (HCC) . Methods Thirty patients with advanced HCC admitted to our hospital from June 2009 to June 2013 were randomly divided into Cape OX group (15 patients, treated with OXA and capecitabine or CAP) and FOLFOX group (15 patients, treated with OXA and calcium folinate or CF, followed by fluorouracil or 5-FU) . The therapeutic effects were evaluated after two cycles of treatment using the Response Evaluation Criteria in Solid Tumors (RECIST 1. 1) . Assessment criteria included overall response rate (OR) , time to tumor progression (TTP) , and overall survival (OS) analyzed by Kaplan-Meier survival curves, as well as the toxicity profile of the combination chemotherapy. Comparison of OR was made by chi-square test; assessment of tumor response and toxicity profile was performed by Mann-Whitney U test; OS and TTP were analyzed by log-rank test. Results In the Cape OX group, the OR was13. 3%, and the mean OS and TTP were 10. 4 months and 5. 0 months, respectively. In the FOLFOX group, the OR was 6. 7%, and the mean OS and TTP were 9. 0 months and 4. 7 months, respectively. The differences between the two groups had no statistical significance in all three parameters (P = 0. 543, 0. 606, and 0. 769, respectively) . Compared with the FOLFOX group, the Cape OX group had significantly lower toxicity rates in gastrointestinal tract and myelosuppression (P = 0. 006 and 0. 002, respectively) . Conclusions The OXA-based systemic chemotherapy shows anti-tumor effects for advanced HCC, and there is no significant difference in efficacy between the two regimens. Decisions regarding the choice of specific treatment should be based on the patients' clinical conditions.

Brief reports
Clinical effect of laparoscopic left lateral segment liver resection
Lin JianQuan, He Qian, Huang CanPo
2014, 30(12): 1341-1343. DOI: 10.3969/j.issn.1001-5256.2014.12.026
Abstract:
Application of precutsphincterotomy for endoscopic retrograde cholangiopancreatography with difficult biliary cannulation
Huang YunFei, Li ZhaoXin, Liu MingHui, Fu JiNing
2014, 30(12): 1344-1346. DOI: 10.3969/j.issn.1001-5256.2014.12.027
Abstract:
Case reports
Laparoscopic fenestration for treating severe polycystic liver disease complicated by giant liver abscess: a report of one case
Yu YouXi, Yu Gang, Fang XiZhu, Zhang Ping
2014, 30(12): 1347-1348. DOI: 10.3969/j.issn.1001-5256.2014.12.028
Abstract:
Diagnosis and treatment of liver cirrhosis with watermelon stomach: a report of one case
Qi LingXia, Hua Rui, Tang TongYu, Pan Yu
2014, 30(12): 1349-1351. DOI: 10.3969/j.issn.1001-5256.2014.07.12.029
Abstract:
Reviews
Diagnosis and treatment of acute kidney injury in patients with cirrhosis
Cai JunJun, Han Tao
2014, 30(12): 1352-1356. DOI: 10.3969/j.issn.1001-5256.2014.12.030
Abstract:
Acute kidney injury is a common complication in patients with cirrhosis. It is characterized by a sudden drop in glomerular filtration rate, retention of metabolic waste products, water-electrolyte imbalance, and acid-base disturbance. It markedly increases mortality in cirrhotic patients. Therefore, early diagnosis and treatment of acute kidney injury are essential to reduce mortality and improve prognosis.The development of the diagnostic criteria for acute kidney injury, the clinical application of new biomarkers of renal function such as cystatin C, kidney injury molecule-1, and neutrophil gelatinase-associated lipocalin, and the management of acute kidney injury in cirrhotic patients are reviewed. Although creatinine test and monitoring of urinary output have their disadvantages, they remain the main diagnostic criteria for acute kidney injury. Development of new biomarkers for clinical use and elucidation of the underlying mechanisms of acute kidney injury have become a hotspot of basic and clinical research.
Early diagnosis of nonalcoholic fatty liver cirrhosis
Chen YangQin, Li Peng, Li Lei, Li Bing, Ding HuiGuo
2014, 30(12): 1357-1360. DOI: 10.3969/j.issn.1001-5256.2014.12.031
Abstract:
Nonalcoholic fatty liver disease (NAFLD) / nonalcoholic steatohepatitis (NASH) has become one of the important causes of liver cirrhosis in the world and may be an important cause of unexplained liver cirrhosis in China. The mechanism of NAFLD progression and early diagnosis are described. The causes and clinical features of NAFLD progression, which are different from HBV or HCV-related cirrhosis, need to be further identified, and the effective noninvasive methods for early diagnosis remain to be well studied.
Research advances in molecular prediction of recurrence and metastasis of primary liver cancer after liver transplantation
Chen Man, Zhang Xia
2014, 30(12): 1361-1365. DOI: 10.3969/j.issn.1001-5256.2014.12.032
Abstract:
Liver transplantation is an essential treatment of primary liver cancer, but the postoperative high risk of recurrence and metastasis has seriously affected the effect of liver transplantation. With the development of molecular biology, researchers have found numerous molecular markers potentially related to the recurrence and metastasis of liver cancer after liver transplantation. These markers, including genes, proteins, tumor markers, and serum viruses, are summarized, and their predictive values for tumor recurrence and metastasis after liver transplantation are analyzed. A growing number of molecular markers have been found, but which is not enough for clinical guidance. Therefore, more studies are needed to identify appropriate molecular markers of tumor recurrence and metastasis after liver transplantation.
Role of liver nonparenchymal cells in hepatic ischemia-reperfusion injury
Wu Gang, Zheng Jie, Hu GuoXin, Peng YanZhong
2014, 30(12): 1366-1369. DOI: 10.3969/j.issn.1001-5256.2014.12.033
Abstract:
Liver nonparenchymal cells play a very important role in the liver. Recent studies on the role of liver nonparenchymal cells, such as Kupffer cells, hepatic sinusoidal endothelial cells, hepatic stellate cells, and dendritic cells, in hepatic ischemia-reperfusion injury (HIRI) are reviewed. This review shows that liver nonparenchymal cells, which could aggravate or alleviate HIRI in various ways, play a very important role in HIRI.