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Short-term outcomes after liver resection with vascular reconstruction: Results from a study with the National Clinical Database of Japan 血管重建肝切除术后的短期疗效:日本国家临床数据库的研究结果
IF 3.2 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-04-28 DOI: 10.1002/jhbp.1435
Akihiko Soyama, Hiroyuki Yamamoto, Susumu Eguchi, Atsushi Nanashima, Yoshihiro Kakeji, Yuko Kitagawa, Masafumi Nakamura, Itaru Endo

Background

Although curative resection with vascular reconstruction improves the prognosis of blood-invading locally advanced hepatobiliary tumors, the mortality and morbidity of the procedure remains unclear. This study aimed to clarify the risk factors associated with mortality and morbidity in patients undergoing liver resection with vascular reconstruction.

Methods

This retrospective observational study included 1215 patients undergoing hepatectomy of more than one section with vascular reconstruction, except for left lateral sectionectomy registered in the National Clinical Database (NCD) between 2015 and 2019. The rates of surgical mortality and relevant clinical factors were evaluated.

Results

Among the four types of vascular reconstruction, portal venous reconstruction was frequently performed in 724 patients (59.6% of the enrolled patients). Surgical mortality was 8.1%. Patients with hepatic artery reconstruction had the highest surgical mortality rate of 15.8%. In other types of reconstruction, surgical mortality was 9.1% in the portal vein, 5.2% in inferior vena cava, and 4.9% in hepatic vein. Factors significantly associated with surgical mortality include age, sex (male), preoperative comorbidity (American Society of Anesthesiologists grade >3, respiratory distress, diabetes, preoperative pneumonia, weight loss, and obstructive jaundice), poorer liver functional reserve (indocyanine green retention rate at 15 min and prothrombin time/international normalized ratio >1.1) and accompanying biliary reconstruction.

Conclusions

The NCD revealed the detailed status of liver resection combined with vascular reconstruction in Japan. Based on the results of this analysis, understanding the factors that influence the outcome and postoperative course of each procedure will provide patients with accurate information and opportunities to improve future outcomes.

背景虽然血管重建的根治性切除术可改善局部晚期肝胆肿瘤的预后,但该手术的死亡率和发病率仍不清楚。方法这项回顾性观察研究纳入了2015年至2019年期间在国家临床数据库(NCD)中登记的1215例接受肝切除术的患者,除左外侧切口切除术外,均接受了一个以上切口的肝切除术,并进行了血管重建。对手术死亡率和相关临床因素进行了评估。结果在四种类型的血管重建中,门静脉重建在 724 例患者(占入组患者的 59.6%)中频繁实施。手术死亡率为 8.1%。肝动脉重建患者的手术死亡率最高,为 15.8%。在其他重建类型中,门静脉手术死亡率为9.1%,下腔静脉为5.2%,肝静脉为4.9%。与手术死亡率明显相关的因素包括年龄、性别(男性)、术前合并症(美国麻醉医师协会 3 级、呼吸困难、糖尿病、术前肺炎、体重减轻和阻塞性黄疸)、较差的肝功能储备(吲哚青绿 15 分钟保留率和凝血酶原时间/国际标准化比率 1.1)以及伴随的胆道重建。根据这一分析结果,了解影响每种手术的结果和术后过程的因素将为患者提供准确的信息和改善未来结果的机会。
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引用次数: 0
Cap-fitted ultrathin endoscope-assisted endoscopic retrograde cholangiopancreatography (ERCP) for patients with hidden papillae in duodenal diverticula 针对十二指肠憩室隐藏乳头患者的帽式超薄内镜辅助内镜逆行胰胆管造影术(ERCP)
IF 3.2 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-04-24 DOI: 10.1002/jhbp.1434
Shintaro Hayashi, Yuichiro Ito, Reiji Higashi

Hayashi and colleagues developed a novel salvage technique using a cap-fitted ultrathin endoscope to cannulate the bile duct when a papilla concealed within a duodenal diverticulum is inaccessible with conventional methods. It can be a useful and safe option for endoscopic retrograde cholangiopancreatography in patients with papillae hidden in duodenal diverticula.

Hayashi 及其同事开发了一种新型抢救技术,当隐藏在十二指肠憩室内的乳头无法通过传统方法进入时,可使用带帽的超薄内镜对胆管进行插管。对于乳头隐藏在十二指肠憩室内的患者来说,这是内镜逆行胰胆管造影术的一种有用而安全的选择。
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引用次数: 0
Multicenter comparative study on the usefulness of the optimal electrosurgical unit setting in endoscopic papillectomy for ampullary neoplasms (with video) 关于内窥镜乳头切除术治疗胰腺肿瘤的最佳电外科单元设置的实用性的多中心比较研究(附视频)
IF 3.2 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-04-24 DOI: 10.1002/jhbp.1433
Kenjiro Yamamoto, Takao Itoi, Akio Katanuma, Tatsuya Ishii, Eisuke Iwasaki, Shintaro Kawasaki, Takayoshi Tsuchiya, Ryosuke Tonozuka, Kazumasa Nagai, Shuntaro Mukai

Background

Endoscopic papillectomy (EP) is less invasive than surgery but procedure-related adverse events (AEs) still frequently occur. This study compared the benefits of EP using a new optimal endoCUT setting on the VIO (Erbe) electrosurgical unit (VIO-EP) with those using the conventional electrosurgical unit setting (ICC-EP, Erbe).

Methods

This multicenter, retrospective, comparative cohort study included 57 patients who underwent VIO-EP and 91 who underwent ICC-EP. The primary outcome was occurrence of EP-related AEs. Secondary outcomes were pathological findings (the resection margins, the R0 resection, and residual lesions).

Results

Pancreatitis tended to be less common in the VIO-EP group (5.3% vs. 9.9%, p = .248). Evaluation of computed tomography images showed that pancreatitis was confined to the pancreatic head in 77.8% of cases in the ICC-EP group and in 33.3% of those in the VIO-EP group. After exclusion of cases of delayed bleeding, pancreatitis tended to be less common in the VIO-EP group; this finding was not statistically significant (2.3% vs. 8.2%, p = .184). In pathological findings, residual lesions were significantly less common in the VIO-EP group.

Conclusions

The risks of pancreatitis and residual lesions after EP may be lower when the VIO electrosurgical unit is used with the optimal setting.

背景内窥镜乳头切除术(EP)比外科手术创伤更小,但与手术相关的不良事件(AEs)仍时有发生。这项研究比较了在 VIO(Erbe)电外科装置(VIO-EP)上使用新的最佳内切设置(endoCUT)和使用传统电外科装置设置(ICC-EP,Erbe)进行 EP 的益处。主要结果是发生 EP 相关的 AE。次要结果是病理结果(切除边缘、R0切除和残留病灶)。结果胰腺炎在VIO-EP组中较少见(5.3%对9.9%,P = .248)。计算机断层扫描图像评估显示,ICC-EP 组中 77.8% 的病例和 VIO-EP 组中 33.3% 的病例的胰腺炎局限于胰头。在排除延迟出血病例后,VIO-EP 组的胰腺炎发生率较低;但这一结果并无统计学意义(2.3% 对 8.2%,P = .184)。在病理结果中,VIO-EP 组残留病灶的发生率明显较低。结论如果在最佳设置下使用 VIO 电外科装置,EP 后发生胰腺炎和残留病灶的风险可能较低。
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引用次数: 0
The extraction of difficult bile duct stones in a patient with surgically altered anatomy using a novel retrieval basket and a short-type single-balloon enteroscopy 使用新型取石篮和短型单气囊肠镜为一名解剖结构发生手术改变的患者取出疑难胆管结石
IF 3.2 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-04-09 DOI: 10.1002/jhbp.1427
Masanari Sekine, Taku Mizutani, Ryo Hashimoto, Goya Sasaki, Azumi Sato, Shu Kojima, Keita Matsumoto, Takeshi Uehara, Takeharu Asano, Hirosato Mashima

Sekine and colleagues report successful stone extraction using a novel retrieval basket and a short-type single-balloon enteroscope in a patient with surgically altered anatomy. Its unique shape makes the basket with a 0.018-inch guidewire the first choice for removal of small bile duct stones in patients with surgically altered anatomy.

总胆管和肝内胆管结石一般通过内窥镜取出。1, 2 其中一个原因是,由于工作通道的长度和大小,可用于球囊肠镜的设备有限。据报道,一种具有独特螺旋形状的新型取石篮(VolticCatch V;日本东京奥林巴斯医疗系统公司;图 1)可用于使用工作通道直径为 3.7 毫米的结肠镜为 SAA 患者取出胆管结石。之前使用 0.018 英寸导丝的 VolticCatch V 型无法通过短型单气囊肠镜(SIF-H290S;奥林巴斯医疗系统公司)直径为 3.2 毫米、长 152 厘米的工作通道,例如在困难的情况下无法形成环路,但改进后的型号可以通过(图 2)。我们报告了两例 SAA 患者使用这种带有 0.018 英寸导丝的取石篮成功取出胆管结石的病例,由于其独特的形状,可能成为 SAA 患者取出小胆管结石的首选。插入线圈鞘时,0.018 英寸导丝在曲线上受到的阻力很大(箭头)。(b)改进模型:线圈鞘的顶部为圆形,尾部为方形。插入线圈鞘时,0.018 英寸导丝在曲线上的阻力减弱。患者因胃癌接受了全胃切除术,并进行了 Roux-en-Y 重建。使用 SIF-H290S 进行了内镜逆行胰胆管造影术(ERCP)。胆管造影显示多处缺损。我们使用了机械碎石机和球囊导管,但结石滑过了靠近乳头的篮子和球囊。因此,在将导丝从 0.025 英寸改为 0.018 英寸后,我们使用了一种新型篮筐。在另一个病例中,一名 25 岁的女性因先天性胆道扩张接受了胆总管空肠吻合术。ERCP使用SIF-H290S进行取石。胆管造影显示右肝管缺损。我们使用带有 0.018 英寸导丝的新型篮子,轻松取出了肝内胆管结石。
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引用次数: 0
Improvement in aged liver regeneration using cell transplantation with chemically induced liver progenitors 利用化学诱导肝脏祖细胞移植改善老年肝脏再生
IF 3.2 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-04-03 DOI: 10.1002/jhbp.1425
Kunihito Matsuguma, Takanobu Hara, Daisuke Miyamoto, Akihiko Soyama, Hajime Matsushima, Masayuki Fukumoto, Hajime Imamura, Mampei Yamashita, Tomohiko Adachi, Susumu Eguchi

Background

A decrease in the regenerative capacity of age-damaged liver tissue has been reported. Liver progenitor cells may play an important role in the regeneration of injured livers. In the present study we aimed to investigate improvements in the regenerative capacity of age-damaged livers using chemically induced liver progenitors (CLiPs) derived from mature hepatocytes.

Methods

Old (>90 weeks) and young (<20 weeks) mice underwent 70% hepatectomy, with or without trans-splenic CLiP administration. The residual liver/bodyweight (LW/BW) ratio was measured on postoperative days 1 and 7, and changes in liver regeneration and histology were evaluated.

Results

At 7 days post-hepatectomy, LW/BW ratios were significantly better in CLiP-treated old mice than in untreated old mice (p = .02). By contrast, no effect of CLiP transplantation was observed in young mice (p = .62). Immunofluorescence staining of liver tissue after CLiP administration showed an increase in Ki67-positive cells (p < .01). Flow cytometry analysis of green fluorescent protein-labeled CLiPs indicated that transplanted CLiPs differentiated into mature hepatocytes and were present in the recipient liver.

Conclusions

CLiP transplantation appears to ameliorate the age-related decline in liver regeneration in mice.

背景据报道,受年龄损伤的肝组织再生能力下降。肝祖细胞可能在损伤肝脏的再生过程中发挥重要作用。本研究旨在利用从成熟肝细胞中提取的化学诱导肝祖细胞(CLiPs),研究如何提高老化损伤肝脏的再生能力。方法对老龄(90 周)和幼龄(20 周)小鼠进行 70% 的肝切除术,同时给予或不给予经脾脏 CLiP。术后第 1 天和第 7 天测量了残肝/体重(LW/BW)比率,并评估了肝脏再生和组织学方面的变化。相比之下,CLiP 移植对年轻小鼠没有影响(p = .62)。服用 CLiP 后,肝组织的免疫荧光染色显示 Ki67 阳性细胞有所增加(p = 0.01)。对绿色荧光蛋白标记的CLiPs进行流式细胞术分析表明,移植的CLiPs分化为成熟的肝细胞,并存在于受体肝脏中。
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引用次数: 0
Novel navigation for laparoscopic cholecystectomy fusing artificial intelligence and indocyanine green fluorescent imaging 融合人工智能和吲哚青绿荧光成像的新型腹腔镜胆囊切除术导航。
IF 3 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-04-01 DOI: 10.1002/jhbp.1422
Yoshihiko Tashiro, Takeshi Aoki, Nao Kobayashi, Kodai Tomioka, Kazuhiko Saito, Kazuhiro Matsuda, Tomokazu Kusano

This preliminary study is the first to demonstrate that AI can precisely identify loose connective tissue during laparoscopic cholecystectomy and ICG fluorescent cholangiography. Tashiro and colleagues conclude that this novel real-time navigation modality fusing AI and ICG fluorescent imaging may enhance safety and provide more reliable laparoscopic or robotic surgery.

这项初步研究首次证明,人工智能可以在腹腔镜胆囊切除术和 ICG 荧光胆管造影术中精确识别疏松结缔组织。Tashiro 及其同事总结说,这种融合了人工智能和 ICG 荧光成像的新型实时导航模式可提高安全性,并提供更可靠的腹腔镜或机器人手术。
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引用次数: 0
Arsenic's shadowy influence: A systematic review of its carcinogenic role in gallbladder cancer 砷的阴暗影响:关于砷在胆囊癌中致癌作用的系统回顾。
IF 3.2 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-04-01 DOI: 10.1002/jhbp.1428
Anas Elgenidy, Ramez M. Odat, Horiah Amer Al-Ghorbany, Hatim Nasruldin Shahin, Ibrahim S. Abdel-bary, Roaa AbdulTawab AbdulHamid, Amal Dhahab, Moustafa Salem, Youmna A. Negm, Nada Mostafa El Attar, Ahmed Assem Abdelfattah, Mai M. Khaliel, Shehab M. Moawad, Ahmed M. Afifi

Introduction

Gallbladder carcinoma (GBC) and cholangiocarcinoma are aggressive forms of cancer developed in the gallbladder and biliary tracts which are related to the liver. This systematic review aimed to highlight the significant association between gallbladder, biliary cancers, and arsenic exposure.

Methods

An extensive search was conducted in Embase, Cochrane, Scopus, PubMed, and Web of Science. We included studies that assessed arsenic levels in gallbladder cancer patients, without restrictions on age, sex, or language. Biological samples, such blood, bile, gallbladder tissue, gallstones, and hair were obtained, and arsenic levels were measured. Also, arsenic water and soil concentrations were collected.

Results

A total of 13 studies were included in our review. These studies included 2234 non-gallbladder carcinoma patients and 22 585 gallbladder carcinoma cases. The participant demographics showed a gender distribution of 862 males and 1845 females, with an age range of 20–75 years. The average body mass index (BMI) was 19.8 kg/m2 for nongallbladder carcinoma patients and 20.1 kg/m2 for gallbladder carcinoma cases. The selected studies examined arsenic concentrations across various biological samples, including blood, hair, gallstones, and bile. Blood arsenic levels ranged from 0.0002 to 0.3893 μg/g and were significantly associated with increased gallbladder carcinoma risk in several studies. Hair also demonstrated a significant correlation, with arsenic concentrations ranging from 0.0002 to 6.9801 μg/g.

Conclusion

There is a strong link between arsenic exposure and gallbladder cancer or cholangiocarcinoma. Even chronic exposure to low-moderate amounts could lead to gallbladder carcinoma. These findings stress the need for more comprehensive and dedicated studies, to control arsenic water/soil levels and seek other preventive measures for this high mortality disease.

简介胆囊癌(GBC)和胆管癌是发生在胆囊和胆道的侵袭性癌症,与肝脏有关。本系统综述旨在强调胆囊癌、胆道癌与砷暴露之间的重要关联:我们在 Embase、Cochrane、Scopus、PubMed 和 Web of Science 中进行了广泛的搜索。我们纳入了评估胆囊癌患者体内砷水平的研究,对年龄、性别或语言均无限制。我们采集了血液、胆汁、胆囊组织、胆结石和毛发等生物样本,并测量了砷含量。此外,还收集了砷在水和土壤中的浓度:结果:共有 13 项研究被纳入我们的综述。这些研究包括 2234 例非胆囊癌患者和 22 585 例胆囊癌患者。参与者的性别分布为 862 名男性和 1845 名女性,年龄范围为 20-75 岁。非胆囊癌患者的平均体重指数(BMI)为 19.8 kg/m2,胆囊癌患者的平均体重指数(BMI)为 20.1 kg/m2。所选研究检测了各种生物样本中的砷浓度,包括血液、毛发、胆结石和胆汁。在多项研究中,血液砷含量从 0.0002 到 0.3893 μg/g 不等,与胆囊癌风险增加有显著关联。头发中的砷浓度从 0.0002 到 6.9801 微克/克不等,也显示出明显的相关性:结论:砷暴露与胆囊癌或胆管癌之间存在密切联系。即使长期接触中低量的砷也可能导致胆囊癌。这些研究结果表明,有必要进行更全面、更专门的研究,以控制水/土壤中的砷含量,并寻求其他预防措施来治疗这种死亡率很高的疾病。
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引用次数: 0
Endoscopic retrieval of the torn pancreatic stent by pushing out through the EUS-PD fistula tract 通过 EUS-PD 管路推出,在内窥镜下取出撕裂的胰腺支架。
IF 3.2 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-03-27 DOI: 10.1002/jhbp.1426
Kenta Yoshida, Haruka Toyonaga, Tsuyoshi Hayashi, Masayo Motoya, Toshifumi Kin, Kuniyuki Takahashi, Akio Katanuma

Yoshida and colleagues report the “pushing-the-stent method” for endoscopic retrieval of a torn pancreatic stent through the fistula tract after EUS-PD. Because the pancreatic stent is thin, tearing or migration may occur during removal. If the stent was placed by EUS-PD, this method can offer safe and effective retrieval.

Yoshida 及其同事报告了一种 "推支架法",用于在 EUS-PD 后通过瘘道在内镜下取出撕裂的胰腺支架。由于胰腺支架很薄,取出时可能会发生撕裂或移位。如果支架是通过 EUS-PD 放置的,这种方法可以提供安全有效的取出。
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引用次数: 0
The efficacy of bile liquid biopsy in the diagnosis and treatment of biliary tract cancer 胆汁液体活检在诊断和治疗胆道癌中的疗效。
IF 3 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-03-24 DOI: 10.1002/jhbp.1432
Yoshifumi Miura, Hiroshi Ohyama, Rintaro Mikata, Yosuke Hirotsu, Kenji Amemiya, Hitoshi Mochizuki, Junichiro Ikeda, Masayuki Ohtsuka, Naoya Kato, Masao Omata

Background

Diagnosing biliary tract cancer is difficult because endoscopic retrograde cholangiopancreatography (ERCP) is performed fluoroscopically, and the sensitivity of bile cytology is low. Liquid biopsy of bile using targeted sequencing is expected to improve diagnosis and treatment, but few studies have been conducted. In this study, we examined whether liquid biopsy of bile improves the diagnostic sensitivity of biliary strictures.

Methods

A total of 72 patients with biliary strictures who underwent ERCP at Chiba University Hospital between April 2018 and March 2021 were examined. Of these, 43 and 29 were clinically and pathologically diagnosed as having malignant and benign biliary strictures, respectively. We performed targeted sequencing of bile obtained from these patients, and the sensitivity of this method was compared with that of bile cytology. Detection of at least one oncogenic mutation was defined as having malignancy.

Results

The sensitivity of bile cytology was 27.9%, whereas that of genomic analysis was 46.5%. Comparing bile cytology alone with the combination of cytology and genomic analysis, the latter was more sensitive (53.5%, p < .001). Among the 43 patients with malignant biliary strictures, mutations with FDA-approved drugs were detected in 11 (26%).

Conclusions

Liquid biopsy of bile can potentially diagnose malignancy and detect therapeutic targets.

背景:由于内镜逆行胰胆管造影术(ERCP)是在透视下进行的,而胆汁细胞学检查的灵敏度较低,因此诊断胆道癌十分困难。使用靶向测序技术进行胆汁液体活检有望改善诊断和治疗,但相关研究很少。在这项研究中,我们探讨了胆汁液体活检是否能提高胆道狭窄的诊断敏感性:共检查了 2018 年 4 月至 2021 年 3 月期间在千叶大学医院接受 ERCP 的 72 例胆道狭窄患者。其中,43 例和 29 例分别被临床和病理诊断为恶性和良性胆道狭窄。我们对这些患者的胆汁进行了靶向测序,并将这种方法的灵敏度与胆汁细胞学进行了比较。检测到至少一种致癌突变即被定义为恶性肿瘤:胆汁细胞学的灵敏度为 27.9%,而基因组分析的灵敏度为 46.5%。将单独的胆汁细胞学检查与细胞学检查和基因组分析相结合进行比较,后者的灵敏度更高(53.5%,P 结论:胆汁细胞学检查的灵敏度和基因组分析的灵敏度均高于单独的胆汁细胞学检查:胆汁液体活检可诊断恶性肿瘤并发现治疗靶点。
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引用次数: 0
Venous outflow reconstruction in living-donor liver transplantation for Budd–Chiari syndrome involving vena cava 涉及腔静脉的巴德-卡氏综合征活体肝移植中的静脉流出重建。
IF 3.2 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-03-24 DOI: 10.1002/jhbp.1430
Koichiro Hata, Takahiro Nishio, Motoyuki Kumagai, Yuki Masano, Shoichi Kageyama, Shinya Okumura, Takashi Ito, Kazuhiro Yamazaki, Kenji Minatoya, Etsuro Hatano

Ironically, the hepatic vena cava is mostly involved in Budd-Chiari syndrome in the Asia-Pacific region, whereas living-donor liver transplantation is predominant, which cannot replace the hepatic cava. Hata and colleagues introduced a new surgical technique for venous reconstruction in living-donor liver transplantation, providing a novel solution to this longstanding dilemma.

具有讽刺意味的是,在亚太地区,Budd-Chiari 综合征大多累及肝腔静脉,而活体肝移植是主流,无法替代肝腔静脉。Hata 及其同事引入了一种新的外科技术,用于活体肝移植中的静脉重建,为这一长期存在的难题提供了新的解决方案。
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引用次数: 0
期刊
Journal of Hepato‐Biliary‐Pancreatic Sciences
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