The medical education system,particularly the fellowship training system,of China has been continuously developing and improving.China established the fellowship training system in 2016,with the period for general sur...The medical education system,particularly the fellowship training system,of China has been continuously developing and improving.China established the fellowship training system in 2016,with the period for general surgeons being 3 years.Among the various general surgery subspecialties,hepatopancreatobiliary(HPB)surgery has a specialized training period of approximately 6 months.Ho-wever,owing to the intricate anatomical knowledge and sophisticated surgical skills involved in HPB surgery,training excellent HPB surgeons in such a short period has always been a major challenge in the field of surgical education.This editorial summarizes the current situation,existing problems that need to be implemented for improving HPB fellowship in China.Finally,we hope to build a qualified HPB fellowship system that continually adapts to social development.展开更多
BACKGROUND Pancreatoduodenectomy(PD)is one of the most important operations in hepatobiliary and pancreatic surgery.AIM To evaluate the advantages and disadvantages of pancreaticojejunostomy(PJ)and pancreaticogastrost...BACKGROUND Pancreatoduodenectomy(PD)is one of the most important operations in hepatobiliary and pancreatic surgery.AIM To evaluate the advantages and disadvantages of pancreaticojejunostomy(PJ)and pancreaticogastrostomy(PG).METHODS This meta-analysis was performed using Review Manager 5.3.All clinical randomized controlled trials,in which patients underwent PD with pancreaticodigestive tract reconstruction via PJ or PG,were included.RESULTS The search of PubMed,Wanfang Data,EMBASE,and the Cochrane Library provided 125 citations.After further analysis,11 trials were included from nine counties.In all,909 patients underwent PG and 856 underwent PJ.Meta-analysis showed that pancreatic fistula(PF)was a significantly lower morbidity in the PG group than in the PJ group(odds ratio[OR]=0.67,95%confidence interval[CI]:0.53-0.86,P=0.002);however,grades B and C PF was not significantly different between the two groups(OR=0.61,95%CI:0.34-1.09,P=0.09).Postoperative hemorrhage showed a significantly lower morbidity in the PJ group than in the PG group(OR=1.47,95%CI:1.05-2.06,P=0.03).Delayed gastric emptying was not significantly different between the two groups(OR=1.09,95%CI:0.83-1.41,P=0.54).CONCLUSION There is no difference in the incidence of grades B and C PF between the two groups.However,postoperative bleeding is significantly higher in PG than in PJ.Binding PJ or binding PG is a safe and secure technique according to our decades of experience.展开更多
AIM To establish the surgical flow for anatomic isolated caudate lobe resection. METHODS The study was approved by the ethics committee of the Second Affiliated Hospital Zhejiang University School of Medicine(SAHZU). ...AIM To establish the surgical flow for anatomic isolated caudate lobe resection. METHODS The study was approved by the ethics committee of the Second Affiliated Hospital Zhejiang University School of Medicine(SAHZU). From April 2004 to July 2014, 20 patients were enrolled who underwent anatomic isolated caudate lobectomy at SAHZU. Clinical and postoperative pathological data were analyzed. RESULTS Of the total 20 cases, 4 received isolated complete caudate lobectomy(20%) and 16 received isolated partial caudate lobectomy(80%). There were 4 caseswith the left approach(4/20, 20%), 6 cases with the right approach(6/20, 30%), 7 cases with the bilateral combined approach(7/20, 35%), 3 cases with the anterior approach(3/20, 15%), and the hanging maneuver was also combined in 2 cases. The median tumor size was 5.5 cm(2-12 cm). The median intraoperative blood loss was 600 m L(200-5700 m L). The median intra-operative blood transfusion volume was 250 m L(0-2400 m L). The median operation time was 255 min(110-510 min). The median post-operative hospital stay was 14 d(7-30 d). The 1-and 3-year survival rates for malignant tumor were 88.9% and 49.4%, respectively. CONCLUSION Caudate lobectomy was a challenging procedure. It was demonstrated that anatomic isolated caudate lobectomy can be done safely and effectively.展开更多
BACKGROUND Pancreatic solitary fibrous tumor(SFT) is a rare neoplasm of intermediate biological potential. So far, only 22 cases have been reported since 1999. All the cases, except one, exhibited benign features. Her...BACKGROUND Pancreatic solitary fibrous tumor(SFT) is a rare neoplasm of intermediate biological potential. So far, only 22 cases have been reported since 1999. All the cases, except one, exhibited benign features. Here, we report the first case of malignant pancreatic SFT with typical Doege-Potter syndrome, along with the clinical and pathologic evidence of its systemic metastasis.CASE SUMMARY The patient was a 48-year-old man with a 1-year history of pancreatic and liver masses and refractory hypoglycemia. Increased uptake of the tracer fluorodeoxyglucose(FDG) was found in the liver and bones by fluorine-18 FDG positron emission tomography/computed tomography. After multidisciplinary discussion, a distal pancreatectomy procedure was performed, and histological examination showed a lesion composed of abundant heterogeneous spindle cells with localized necrosis. On immunohistochemistry evaluation, STAT6 was found to be diffusely expressed in the tumor. Based on the overall evidence, the patient was diagnosed with malignant pancreatic SFT with liver and bone metastases.CONCLUSION The diagnosis of malignant SFT requires comprehensive evidence including clinical, immunohistochemistry, and histological features. This case may be presented as a reference for diagnoses and management of malignant pancreatic SFTs with systemic metastasis.展开更多
BACKGROUND Hepatic solitary fibrous tumor(SFT)is a rare neoplasm.Up to now,only 90 cases have been reported in the English language literature.This report describes a case of SFT of the liver misdiagnosed as hepatocel...BACKGROUND Hepatic solitary fibrous tumor(SFT)is a rare neoplasm.Up to now,only 90 cases have been reported in the English language literature.This report describes a case of SFT of the liver misdiagnosed as hepatocellular carcinoma.CASE SUMMARY A 42-year-old male had a two-year history of a gradually enlarging intrahepatic nodule.The preoperative imaging revealed a mass with a size of 2.7 cm×2.3 cm located in the segment IV of the liver.The patient was subjected to the resection of the segment IV,such as the medial segment of the left lobe of the liver.The histological examination of the mass showed various spindled cells irregularly arranged in the stroma.The immunohistochemistry of this mass revealed a positive staining for CD34 and STAT6.The history of intracranial tumor and postoperative pathological results led to the diagnosis of SFT of the liver(SFTL)due to a metastasis from the brain.CONCLUSION SFTL is an uncommon mesenchymal neoplasm that can be easily overlooked or misdiagnosed.The best treatment choice is the complete surgical resection of the mass.A regular follow-up after the surgery should be performed due to the poor prognosis of metastatic or recurrent SFT.展开更多
The incidence and mortality of hepatic carcinoma(HCC)remain high,and early diagnosis of HCC is seen as a key approach in improving clinical outcomes.However,the sensitivity and specificity of current early screening m...The incidence and mortality of hepatic carcinoma(HCC)remain high,and early diagnosis of HCC is seen as a key approach in improving clinical outcomes.However,the sensitivity and specificity of current early screening methods for HCC are not satisfactory.In recent years,research around exosomal miRNA has gradually increased,and these molecules have emerged as attractive candidates for early diagnosis and treatment of HCC.This review summarizes the feasibility of using miRNAs in peripheral blood exosomes as early diagnostic tools for HCC.展开更多
Partial hepatectomy(PH)can lead to severe complications,including liver failure,due to the low regenerative capacity of the remaining liver,especially after extensive hepatectomy.Liver sinusoidal endothelial cells(LSE...Partial hepatectomy(PH)can lead to severe complications,including liver failure,due to the low regenerative capacity of the remaining liver,especially after extensive hepatectomy.Liver sinusoidal endothelial cells(LSECs),whose proliferation occurs more slowly and later than hepatocytes after PH,compose the lining of the hepatic sinusoids,which are the smallest blood vessels in the liver.Vascular endothelial growth factor(VEGF),secreted by hepatocytes,promotes LSEC proliferation.Supplementation of exogenous VEGF after hepatectomy also increases the number of LSECs in the remaining liver,thus promoting the reestablishment of the hepatic sinusoids and accelerating liver regeneration.At present,some shortcomings exist in the methods of supplementing exogenous VEGF,such as a low drug concentration in the liver and the reaching of other organs.Moreover,VEGF should be administered multiple times and in large doses because of its short half-life.This review summarized the most recent findings on liver regeneration and new strategies for the localized delivery VEGF in the liver.展开更多
Hydrogen fuel has been embraced as a potential long-term solution to the growing demand for clean energy.A membrane-assisted separation is promising in producing high-purity H_(2).Molecular sieving membranes(MSMs)are ...Hydrogen fuel has been embraced as a potential long-term solution to the growing demand for clean energy.A membrane-assisted separation is promising in producing high-purity H_(2).Molecular sieving membranes(MSMs)are endowed with high gas selectivity and permeability because their well-defined micropores can facilitate molecular exclusion,diffusion,and adsorption.In this work,MXene nanosheets intercalated with Ni^(2+) were assembled to form an MSM supported on Al_(2)O_(3) hollow fiber via a vacuum-assisted filtration and drying process.The prepared membranes showed excellent H_(2)/CO_(2) mixture separation performance at room temperature.Separation factor reached 615 with a hydrogen permeance of 8.35×10^(-8) mol·m^(-2)·s^(-1) ·Pa^(-1).Compared with the original Ti_(3)C_(2)T_(x)/Al_(2)O_(3) hollow fiber membranes,the permeation of hydrogen through the Ni^(2+)-Ti_(3)C_(2)T_(x)/Al_(2)O_(3) membrane was considerably increased,stemming from the strong interaction between the negatively charged MXene nanosheets and Ni^(2+).The interlayer spacing of MSMs was tuned by Ni^(2+).During 200-hour testing,the resultant membrane maintained an excellent gas separation without any substantial performance decline.Our results indicate that the Ni2+tailored Ti_(3)C_(2)T_(x)/Al_(2)O_(3) hollow fiber membranes can inspire promising industrial applications.展开更多
Dear Editor Verticillium wilt, caused by the soil-borne fungus Verticillium dahliae, poses a major threat to a broad host range of more than 400 plant species, including economically important cotton （Bell, 1992）. V...Dear Editor Verticillium wilt, caused by the soil-borne fungus Verticillium dahliae, poses a major threat to a broad host range of more than 400 plant species, including economically important cotton （Bell, 1992）. V. dahliae is especially difficult to control because it persists in soil as resting structures, called microsclerotia, for several years in the absence of a host plant. The dormant microsclerotia are the primary infectious propagules and germinate when they are stimulated by root exudates. Infection of cotton roots by V. dahliae in soi~ naturally leads to the colonization of vascular tissues, from the parasitic to saprophytic phase, when mycelia and melanized dormancy microsclerotia are produced in the infected cotton, resulting in vessel blockage and cotton wilt disease （Gerik and Huisman, 1988）.展开更多
Dear Editor, Verticillium wilt, caused by the soil-borne fungus Verticillium dahlia Klep., poses a major threat to a broad host range of more than 400 plant species, including economically impor- tant cotton, and caus...Dear Editor, Verticillium wilt, caused by the soil-borne fungus Verticillium dahlia Klep., poses a major threat to a broad host range of more than 400 plant species, including economically impor- tant cotton, and causes serious loss of lint yield in China, the USA and may other countries （Bell, 1992; Bejorano-Alcazar et al., 1995; Zhang et al., 2012）. The colonization of cotton roots by V. dahliae in soil naturally leads to the colonization of vascular tissues in cotton （Garber and Houston, 1966; Gerik and Huisman, 1988）. Recently, the development of confocal laser scanning microscopy （CLSM） has significantly increased our knowledge of the colonization process of V. dahliae on various plant roots （Eynck et al., 2007; Vallad and Subbarao, 2008; Prieto et al., 2009; Zhang et al., 2012）. However, the comprehensive observation of the cotton living root colonization process by V. dahliae under CLSM is not likely to be practicable due to the large size of cotton roots.展开更多
Aim:The transjugular intrahepatic portosystemic shunt(TIPS)procedure has been performed in China for 30 years,but our understanding of the status and difficulties associated with the use of TIPS for portal hypertensio...Aim:The transjugular intrahepatic portosystemic shunt(TIPS)procedure has been performed in China for 30 years,but our understanding of the status and difficulties associated with the use of TIPS for portal hypertension is incomplete.This study aims to investigate the current situation of the use of TIPS for portal hypertension,which should aid the development of TIPS in China.Methods:This study involved a questionnaire survey,initiated by the China Portal Hypertension Alliance(CHESS)to investigate the use of TIPS for portal hypertension in China.Questionnaires were released on the Internet between August 16,2022 and September 16,2022.Detailed information was collected from 545 hospitals contracted by the CHESS in China,which performed TIPS surgery in 2021.Results:The 545 hospitals covers the majority of hospitals in China that conduct TIPS intervention.In the survey,a total of 13,527 TIPS interventions were carried out with 94.1%(498/545)of them had a system of routine follow‐up after TIPS.The majority(42.6%[232/545])believed that the main indication of TIPS was the control of acute bleeding.Overall,48.1%(262/545)carried out early or pre‐emptive TIPS,53.0%(289/545)carried out TIPS for cavernous transformation of the portal vein,and 81.0%(441/545)chose routine embolization of collateral circulation during operation.Most used coils(97.0%[475/490])and biological glue(72.0%[353/490])as embolic materials,and 78.5%(428/545)routinely performed intraoperative portal pressure gradient measurements.When selecting TIPS stents,57.1%(311/545)chose viator‐specific stents,and 57.2%(312/545)chose conventional anticoagulation after TIPS.Conventional anticoagulation after TIPS is over a time interval of 3–6 months(55.4%[173/312]).The limitation of TIPS surgery is mainly its cost(72.3%[394/545])and insufficient understanding of the procedure by doctors in other related departments(77.4%[422/545]).Most of the hospital teams accept the use of domestic instruments in TIPS surgery(92.7%[505/545]).Conclusions:This survey shows that TIPS is an essential part of the treatment of portal hypertension in China.TIPS is widely used in Chinese patients with portal hypertension,and this survey presents a more comprehensive picture of the options and difficulties encountered in the implementation of TIPS.In the future,it is necessary to promote TIPS technology and further standardize surgical indications,routine operations,and instrument application.展开更多
文摘The medical education system,particularly the fellowship training system,of China has been continuously developing and improving.China established the fellowship training system in 2016,with the period for general surgeons being 3 years.Among the various general surgery subspecialties,hepatopancreatobiliary(HPB)surgery has a specialized training period of approximately 6 months.Ho-wever,owing to the intricate anatomical knowledge and sophisticated surgical skills involved in HPB surgery,training excellent HPB surgeons in such a short period has always been a major challenge in the field of surgical education.This editorial summarizes the current situation,existing problems that need to be implemented for improving HPB fellowship in China.Finally,we hope to build a qualified HPB fellowship system that continually adapts to social development.
文摘BACKGROUND Pancreatoduodenectomy(PD)is one of the most important operations in hepatobiliary and pancreatic surgery.AIM To evaluate the advantages and disadvantages of pancreaticojejunostomy(PJ)and pancreaticogastrostomy(PG).METHODS This meta-analysis was performed using Review Manager 5.3.All clinical randomized controlled trials,in which patients underwent PD with pancreaticodigestive tract reconstruction via PJ or PG,were included.RESULTS The search of PubMed,Wanfang Data,EMBASE,and the Cochrane Library provided 125 citations.After further analysis,11 trials were included from nine counties.In all,909 patients underwent PG and 856 underwent PJ.Meta-analysis showed that pancreatic fistula(PF)was a significantly lower morbidity in the PG group than in the PJ group(odds ratio[OR]=0.67,95%confidence interval[CI]:0.53-0.86,P=0.002);however,grades B and C PF was not significantly different between the two groups(OR=0.61,95%CI:0.34-1.09,P=0.09).Postoperative hemorrhage showed a significantly lower morbidity in the PJ group than in the PG group(OR=1.47,95%CI:1.05-2.06,P=0.03).Delayed gastric emptying was not significantly different between the two groups(OR=1.09,95%CI:0.83-1.41,P=0.54).CONCLUSION There is no difference in the incidence of grades B and C PF between the two groups.However,postoperative bleeding is significantly higher in PG than in PJ.Binding PJ or binding PG is a safe and secure technique according to our decades of experience.
基金Supported by the National Natural Science Foundation of China,No.81570559 and No.812726732014 Zhejiang Provincial Program for the Cultivation of High-level Innovative Health Talents
文摘AIM To establish the surgical flow for anatomic isolated caudate lobe resection. METHODS The study was approved by the ethics committee of the Second Affiliated Hospital Zhejiang University School of Medicine(SAHZU). From April 2004 to July 2014, 20 patients were enrolled who underwent anatomic isolated caudate lobectomy at SAHZU. Clinical and postoperative pathological data were analyzed. RESULTS Of the total 20 cases, 4 received isolated complete caudate lobectomy(20%) and 16 received isolated partial caudate lobectomy(80%). There were 4 caseswith the left approach(4/20, 20%), 6 cases with the right approach(6/20, 30%), 7 cases with the bilateral combined approach(7/20, 35%), 3 cases with the anterior approach(3/20, 15%), and the hanging maneuver was also combined in 2 cases. The median tumor size was 5.5 cm(2-12 cm). The median intraoperative blood loss was 600 m L(200-5700 m L). The median intra-operative blood transfusion volume was 250 m L(0-2400 m L). The median operation time was 255 min(110-510 min). The median post-operative hospital stay was 14 d(7-30 d). The 1-and 3-year survival rates for malignant tumor were 88.9% and 49.4%, respectively. CONCLUSION Caudate lobectomy was a challenging procedure. It was demonstrated that anatomic isolated caudate lobectomy can be done safely and effectively.
基金Supported by National Natural Science Foundation of China,No.81770614 and No.81570559Training project of health high level talents in Zhejiang Province(2014)
文摘BACKGROUND Pancreatic solitary fibrous tumor(SFT) is a rare neoplasm of intermediate biological potential. So far, only 22 cases have been reported since 1999. All the cases, except one, exhibited benign features. Here, we report the first case of malignant pancreatic SFT with typical Doege-Potter syndrome, along with the clinical and pathologic evidence of its systemic metastasis.CASE SUMMARY The patient was a 48-year-old man with a 1-year history of pancreatic and liver masses and refractory hypoglycemia. Increased uptake of the tracer fluorodeoxyglucose(FDG) was found in the liver and bones by fluorine-18 FDG positron emission tomography/computed tomography. After multidisciplinary discussion, a distal pancreatectomy procedure was performed, and histological examination showed a lesion composed of abundant heterogeneous spindle cells with localized necrosis. On immunohistochemistry evaluation, STAT6 was found to be diffusely expressed in the tumor. Based on the overall evidence, the patient was diagnosed with malignant pancreatic SFT with liver and bone metastases.CONCLUSION The diagnosis of malignant SFT requires comprehensive evidence including clinical, immunohistochemistry, and histological features. This case may be presented as a reference for diagnoses and management of malignant pancreatic SFTs with systemic metastasis.
基金Supported by National Natural Science Foundation of China,No.81770614.
文摘BACKGROUND Hepatic solitary fibrous tumor(SFT)is a rare neoplasm.Up to now,only 90 cases have been reported in the English language literature.This report describes a case of SFT of the liver misdiagnosed as hepatocellular carcinoma.CASE SUMMARY A 42-year-old male had a two-year history of a gradually enlarging intrahepatic nodule.The preoperative imaging revealed a mass with a size of 2.7 cm×2.3 cm located in the segment IV of the liver.The patient was subjected to the resection of the segment IV,such as the medial segment of the left lobe of the liver.The histological examination of the mass showed various spindled cells irregularly arranged in the stroma.The immunohistochemistry of this mass revealed a positive staining for CD34 and STAT6.The history of intracranial tumor and postoperative pathological results led to the diagnosis of SFT of the liver(SFTL)due to a metastasis from the brain.CONCLUSION SFTL is an uncommon mesenchymal neoplasm that can be easily overlooked or misdiagnosed.The best treatment choice is the complete surgical resection of the mass.A regular follow-up after the surgery should be performed due to the poor prognosis of metastatic or recurrent SFT.
基金Supported by the Quzhou Science and Technology Guided Project Planning,No.2019133。
文摘The incidence and mortality of hepatic carcinoma(HCC)remain high,and early diagnosis of HCC is seen as a key approach in improving clinical outcomes.However,the sensitivity and specificity of current early screening methods for HCC are not satisfactory.In recent years,research around exosomal miRNA has gradually increased,and these molecules have emerged as attractive candidates for early diagnosis and treatment of HCC.This review summarizes the feasibility of using miRNAs in peripheral blood exosomes as early diagnostic tools for HCC.
基金the Natural Science Foundation of Zhejiang Province,No.LQ21H030005
文摘Partial hepatectomy(PH)can lead to severe complications,including liver failure,due to the low regenerative capacity of the remaining liver,especially after extensive hepatectomy.Liver sinusoidal endothelial cells(LSECs),whose proliferation occurs more slowly and later than hepatocytes after PH,compose the lining of the hepatic sinusoids,which are the smallest blood vessels in the liver.Vascular endothelial growth factor(VEGF),secreted by hepatocytes,promotes LSEC proliferation.Supplementation of exogenous VEGF after hepatectomy also increases the number of LSECs in the remaining liver,thus promoting the reestablishment of the hepatic sinusoids and accelerating liver regeneration.At present,some shortcomings exist in the methods of supplementing exogenous VEGF,such as a low drug concentration in the liver and the reaching of other organs.Moreover,VEGF should be administered multiple times and in large doses because of its short half-life.This review summarized the most recent findings on liver regeneration and new strategies for the localized delivery VEGF in the liver.
基金This work was financially supported by the National Natural Science Foundation of China(Grant Nos.21776165,21878179 and 21978157)Naitao Yang gratefully thanks the support via Natural Science Foundation of Shandong Province(ZR2019MB056)Shaomin Liu acknowledges the financial support provided by the Australian Research Council(DP180103861).
文摘Hydrogen fuel has been embraced as a potential long-term solution to the growing demand for clean energy.A membrane-assisted separation is promising in producing high-purity H_(2).Molecular sieving membranes(MSMs)are endowed with high gas selectivity and permeability because their well-defined micropores can facilitate molecular exclusion,diffusion,and adsorption.In this work,MXene nanosheets intercalated with Ni^(2+) were assembled to form an MSM supported on Al_(2)O_(3) hollow fiber via a vacuum-assisted filtration and drying process.The prepared membranes showed excellent H_(2)/CO_(2) mixture separation performance at room temperature.Separation factor reached 615 with a hydrogen permeance of 8.35×10^(-8) mol·m^(-2)·s^(-1) ·Pa^(-1).Compared with the original Ti_(3)C_(2)T_(x)/Al_(2)O_(3) hollow fiber membranes,the permeation of hydrogen through the Ni^(2+)-Ti_(3)C_(2)T_(x)/Al_(2)O_(3) membrane was considerably increased,stemming from the strong interaction between the negatively charged MXene nanosheets and Ni^(2+).The interlayer spacing of MSMs was tuned by Ni^(2+).During 200-hour testing,the resultant membrane maintained an excellent gas separation without any substantial performance decline.Our results indicate that the Ni2+tailored Ti_(3)C_(2)T_(x)/Al_(2)O_(3) hollow fiber membranes can inspire promising industrial applications.
文摘Dear Editor Verticillium wilt, caused by the soil-borne fungus Verticillium dahliae, poses a major threat to a broad host range of more than 400 plant species, including economically important cotton （Bell, 1992）. V. dahliae is especially difficult to control because it persists in soil as resting structures, called microsclerotia, for several years in the absence of a host plant. The dormant microsclerotia are the primary infectious propagules and germinate when they are stimulated by root exudates. Infection of cotton roots by V. dahliae in soi~ naturally leads to the colonization of vascular tissues, from the parasitic to saprophytic phase, when mycelia and melanized dormancy microsclerotia are produced in the infected cotton, resulting in vessel blockage and cotton wilt disease （Gerik and Huisman, 1988）.
文摘Dear Editor, Verticillium wilt, caused by the soil-borne fungus Verticillium dahlia Klep., poses a major threat to a broad host range of more than 400 plant species, including economically impor- tant cotton, and causes serious loss of lint yield in China, the USA and may other countries （Bell, 1992; Bejorano-Alcazar et al., 1995; Zhang et al., 2012）. The colonization of cotton roots by V. dahliae in soil naturally leads to the colonization of vascular tissues in cotton （Garber and Houston, 1966; Gerik and Huisman, 1988）. Recently, the development of confocal laser scanning microscopy （CLSM） has significantly increased our knowledge of the colonization process of V. dahliae on various plant roots （Eynck et al., 2007; Vallad and Subbarao, 2008; Prieto et al., 2009; Zhang et al., 2012）. However, the comprehensive observation of the cotton living root colonization process by V. dahliae under CLSM is not likely to be practicable due to the large size of cotton roots.
文摘Aim:The transjugular intrahepatic portosystemic shunt(TIPS)procedure has been performed in China for 30 years,but our understanding of the status and difficulties associated with the use of TIPS for portal hypertension is incomplete.This study aims to investigate the current situation of the use of TIPS for portal hypertension,which should aid the development of TIPS in China.Methods:This study involved a questionnaire survey,initiated by the China Portal Hypertension Alliance(CHESS)to investigate the use of TIPS for portal hypertension in China.Questionnaires were released on the Internet between August 16,2022 and September 16,2022.Detailed information was collected from 545 hospitals contracted by the CHESS in China,which performed TIPS surgery in 2021.Results:The 545 hospitals covers the majority of hospitals in China that conduct TIPS intervention.In the survey,a total of 13,527 TIPS interventions were carried out with 94.1%(498/545)of them had a system of routine follow‐up after TIPS.The majority(42.6%[232/545])believed that the main indication of TIPS was the control of acute bleeding.Overall,48.1%(262/545)carried out early or pre‐emptive TIPS,53.0%(289/545)carried out TIPS for cavernous transformation of the portal vein,and 81.0%(441/545)chose routine embolization of collateral circulation during operation.Most used coils(97.0%[475/490])and biological glue(72.0%[353/490])as embolic materials,and 78.5%(428/545)routinely performed intraoperative portal pressure gradient measurements.When selecting TIPS stents,57.1%(311/545)chose viator‐specific stents,and 57.2%(312/545)chose conventional anticoagulation after TIPS.Conventional anticoagulation after TIPS is over a time interval of 3–6 months(55.4%[173/312]).The limitation of TIPS surgery is mainly its cost(72.3%[394/545])and insufficient understanding of the procedure by doctors in other related departments(77.4%[422/545]).Most of the hospital teams accept the use of domestic instruments in TIPS surgery(92.7%[505/545]).Conclusions:This survey shows that TIPS is an essential part of the treatment of portal hypertension in China.TIPS is widely used in Chinese patients with portal hypertension,and this survey presents a more comprehensive picture of the options and difficulties encountered in the implementation of TIPS.In the future,it is necessary to promote TIPS technology and further standardize surgical indications,routine operations,and instrument application.
