Objective To analyze the risk factors of postoperative pancreatic fistula (POPF) after distal pancreatectomy (DP) and to explore the effective index of predicting POPF after DP. Methods The clinical data of 120 patients with pancreatic disease who were treated with DP in the Department of Tumor Surgery of Xuzhou Medical University from January 2010 to November 2017 were analyzed retrospectively. The influencing factors of POPF after DP were analyzed by non-conditional logistic regression. Results Of the 120 patients, 15 patients (12.5%) had clinically significant POPF, including 13 cases of grade B pancreatic fistula and 2 cases of grade C pancreatic fistula. The results of non-conditional logistic regression showed that, the soft pancreas and preoperative pancreatic CT value of the pancreas less than 40 Hu were the independent risk factors of POPF after DP (P<0.05). Conclusions Pancreatic texture and preoperative CT value are important factors influencing the occurrence of POPF after DP. Evaluating the preoperative CT value and intraoperative pancreatic texture can effectively predict the risk of POPF after DP.
ObjectiveTo screen long non-coding RNAs (lncRNAs) relevant to programmed cell death (PCD) and construct a nomogram model predicting prognosis of hepatocellular carcinoma (HCC). MethodsThe HCC patients selected from The Cancer Genome Atlas (TCGA) were randomly divided into training set and validation set according to 1∶1 sampling. The lncRNAs relevant to PCD were screened by Pearson correlation analysis, and which associated with overall survival in the training set were screened by univariate Cox proportional hazards regression (abbreviation as “Cox regression”), and then multivariate Cox regression was further used to analyze the prognostic risk factors of HCC patients, and the risk score function model was constructed. According to the median risk score of HCC patients in the training set, the HCC patients in each set were assigned into a high-risk and low-risk, and then the Kaplan-Meier method was used to draw the overall survival curve, and the log-rank test was used to compare the survival between the HCC patients with high-risk and low-risk. At the same time, the area under receiver operating characteristic curve (AUC) was used to evaluate the value of the risk score function model in predicting the 1-, 3-, and 5-year overall survival rates of HCC patients in the training set, validation set, and integral set. Then the nomogram was constructed based on the risk score function model and factors validated in clinic, and its predictive ability for the prognosis of HCC patients was evaluated. ResultsA total of 374 patients with HCC were downloaded from the TCGA, of which 342 had complete clinicopathologic data, including 171 in the training set and 171 in the validation set. Finally, 8 lncRNAs genes relevant to prognosis (AC099850.3, LINC00942, AC040970.1, AC022613.1, AC009403.1, AL355974.2, AC015908.3, AC009283.1) were screened out, and the prognostic risk score function model was established as follows: prognostic risk score=exp1×β1+exp2×β2...+expi×βi (expi was the expression level of target lncRNA, βi was the coefficient of multivariate Cox regression analysis of target lncRNA). According to this prognostic risk score function model, the median risk score was 0.89 in the training set. The patients with low-risk and high-risk were 86 and 85, 86 and 85, 172 and 170 in the training set, validation set, and integral set, respectively. The overall survival curves of HCC patients with low-risk drawn by Kaplan-Meier method were better than those of the HCC patients with high-risk in the training set, validation set, and integral set (P<0.001). The AUCs of the prognostic risk score function model for predicting the 1-, 3-, and 5-year overall survival rates in the training set were 0.814, 0.768, and 0.811, respectively, in the validation set were 0.799, 0.684, and 0.748, respectively, and in the integral set were 0.807, 0.732, and 0.784, respectively. The multivariate Cox regression analysis showed that the prognostic risk score function model was a risk factor affecting the overall survival of patients with HCC [<0.89 points as a reference, RR=1.217, 95%CI (1.151, 1.286), P<0.001]. The AUC (95%CI) of the prognostic risk score function model for predicting the overall survival rate of HCC patients was 0.822 (0.796, 0.873). The AUCs of the nomogram constructed by the prognostic risk score function model in combination with clinicopathologic factors to predict the 1-, 3-, and 5-year overall survival rates were 0.843, 0.839, and 0.834. The calibration curves of the nomogram of 1-, 3-, and 5-year overall survival rates in the training set were close to ideal curve, suggesting that the predicted overall survival rate by the nomogram was more consistent with the actual overall survival rate. ConclusionThe prognostic risk score function model constructed by the lncRNAs relevant to PCD in this study may be a potential marker of prognosis of the patients with HCC, and the nomogram constructed by this model is more effective in predicting the prognosis (overall survival) of patients with HCC.
ObjectiveTo compare the clinical effect of laparoscopic Heller myotomy (LHM) combined with Dor fundoplication and peroral endoscopic myotomy (POEM) in treatment of patients with achalasia.MethodsThe clinical data of 67 patients with achalasia from January 2014 to December 2018 in the Affiliated Hospital of Xuzhou Medical University were retrospectively analyzed. Among them, 19 patients received the LHM combined with Dor fundoplication (LHM group), 48 patients received the POEM (POEM group). The clinical efficacy and safety of the two groups were compared.ResultsThere were no significant differences in the baseline data such as the gender, age, course of disease, body mass index, preoperative Eckardt score, preoperative maximum diameter of esophagus, and previous treatment history between the two groups (P>0.05). There were no significant differences in the operation time, bleeding volume, the Eckardt points at 3 and 12 months after operation, the decrease degree of maximum diameter of esophagus, complications (except for gastroesophageal reflux, P=0.029), and recurrence rate between the two groups (P>0.05). The total hospitalization time, postoperative hospitalization time, and total hospitalization costs of the POEM group were lower than those of the LHM group (P<0.05).ConclusionsBoth LHM and POEM could effectively relieve clinical symptoms, short-term efficacy and safety of the two kinds of operations are similar. Postoperative recovery of POEM is fast and hospitalization cost is less, but incidence of gastroesophageal reflux is higher.
ObjectiveTo explore effect of preoperative prognostic nutritional index (PNI) on clinically related postoperative pancreatic fistula (CR-POPF) after distal pancreatectomy (DP) and analyze its influencing factors in order to provide a basis for clinical prediction of CR-POPF. MethodsThe clinicopathologic data of patients who successfully completed DP in the Affiliated Hospital of Xuzhou Medical University and met the inclusion and exclusion criteria of this study from January 1, 2017 to January 31, 2021 were collected retrospectively. The preoperative PNI value was calculated and the optimal cut-off value was obtained according to the receiver operative characteristic (ROC) curve. The patients were divided into low and high PNI based on the optimal cut-off value. The clinicopathologic characteristics were compared between the patients with low and high PNI and CR-POPF or not. At the same time, multivariate logistic regression was used to analyze the influencing factors of CR-POPF. ResultsA total of 143 patients who met the inclusion and exclusion criteria were included in this study. The CR-POPF occurred in 33 cases (23.08%) after DP, and the average preoperative PNI was 52.26 (39.20–65.10), the optimal cut-off value of PNI was 50.55, with 49 cases in the low PNI group and 94 cases in the high PNI group. In patient with low PNI, the proportions of patients aged ≥65 years and with CR-POPF were higher than those with high PNI (P<0.05). In the patients with CR-POPF, the proportions of patients with soft pancreatic texture and with low preoperative PIN were higher than those without CR-POPF (P<0.05). Further, the multivariate logistic regression showed that the the preoperative low PNI (OR=5.417, P<0.001) and soft pancreatic texture (OR=4.126, P=0.002) increased the risk of CR-POPF. ConclusionLow preoperative PNI and soft pancreatic texture increase risk of CR-POPF after DP, and it is necessary to preoperatively evaluate PNI status of patients.
Objective To investigate the risk factors associated with the formation of parastomal hernia after Miles operation, and to provide scientific evidence for the prevention of parastomal hernia. Methods The clinical data of 218 patients with rectal cancer who undergoing Miles operation in the Affiliated Hospital of Xuzhou Medical University between May 2011 and May 2015 were analyzed retrospectively. Fifteen possible factors affecting the occurrence of parastomal hernia were selected. The fifteen related factors were analyzed by single factor analysis and two elements logistic regression analysis. Results A total of 55 patients with parostomy hernia occurred in 218 patients during follow-up period, and the incidence of parastomal hernia was 25.23%. Univariate analysis showed that age, thickness of subcutaneous fat in abdomen, BMI, stoma pathway, and hypertension were related to the formation of parastomal hernia after Miles operation (P<0.05). Further two elements logistic regression analysis showed that, advanced age, thickness of subcutaneous fat in abdomen, BMI>25 kg/m2, and transperitoneal were independent risk factors for the formation of parastomal hernia after Miles operation (P<0.05). Conclusion For patients with risk factors, it is very important to choose optimum stoma pathway during Miles operation to avoid the occurrence of formation of parastomal hernia after Miles operation.