Comment on: Laparoscopic transperitoneal ureterolithotomy for large ureteric stone

Risk factors for hepatic encephalopathy in patients with hepatitis B liver failure

AIM: To analyze the risk factors for hepatic encephalopathy in patients with hepatitis B liver failure.

METHODS: Three hundred and fifty-six patients with hepatitis B liver failure were included and divided into either a hepatic encephalopathy group or a non-hepatic encephalopathy group. The relevant factors affecting the occurrence of hepatic encephalopathy were selected, and Logistic regression analysis was used to analyze the risk factors for hepatic encephalopathy.

RESULTS: There were 120 patients with hepatic encephalopathy, accounting for 33.7%. Hepatic encephalopathy occurred in all 8 (100.0%) patients with acute liver failure patients, in 3 (25.0%) patients with sub-acute liver failure, in 75 (27.8%) patients with acute/sub-acute on chronic liver failure, and in 34 (51.5%) patients with chronic liver failure. Age, total bilirubin (TBIL), alanine aminotransferase (ALT), aspartate aminotransferase (AST), blood urea nitrogen (BUN), serum creatinine (Scr) and hepatitis B virus deoxyribonucleic acid (HBV DNA) levels in the hepatic encephalopathy group were significantly higher than those in the non-hepatic encephalopathy group (P < 0.05). Patients in the hepatic encephalopathy group were more easily combined with liver cirrhosis, upper gastrointestinal bleeding, diabetes, and lung infection. Multivariable analysis found that combined liver cirrhosis, upper gastrointestinal bleeding, lung infection, AST, BUN and HBV DNA levels were independent risk factors for hepatic encephalopathy (P < 0.05).

CONCLUSION: HBV-infected patients presenting with upper gastrointestinal haemorrhage, pulmonary infection, elevated AST, or liver cirrhosis should be carefully monitored for possible hepatic encephalopathy to initiate timely therapeutic interventions.

Laparoscopic surgery in patients with liver cirrhosis with gallbladder stones: Effect on immunity and complications

AIM: To study the effect of laparoscopic surgery on immunity and complications in patients with liver cirrhosis and gallbladder stones.

METHODS: Eighty patients with liver cirrhosis and gallbladder stones were randomly divided into either an observation group or a control group. Patients in the observation group underwent laparoscopic surgery, and patients in the control group underwent open surgery. Arterial blood samples were taken to determine plasma concentrations of adrenaline, norepinephrlne and dopamine. Intraoperative blood loss, operative time, flow rate, and length of hospital stay were recorded. C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), and T lymphocyte subsets (CD4, CD8) were determined.

RESULTS: Intraoperative blood loss, operative time, postoperative flow and drainage time, anal exhaust time and hospital stay in the observation group were significantly lower than those in the control group (165.84 mL ± 50.23mL vs 240.33 mL ± 150.56 mL, 91.78 min ± 21.74 min vs 137.94 min ± 30.55 min, 274.37 mL ± 121.15 mL vs 418.53 mL ± 132.24 mL, 2.34 d ± 1.46 d vs 5.72 d ± 1.84 d, 1.33 d ± 0.73 d vs 2.73 d ± 1.33 d, 8.43 d ± 1.24 d vs 11.54 d ± 3.22 d, P < 0.05 for all). The levels of CRP, IL-6 and TNF-α in the observation group were significantly lower than those in the control group (6.13 mg/L ± 1.64 mg/L vs 14.24 mg/L ± 2.52 mg/L, 9.44 pg/mL ± 1.65 pg/mL vs 12.82 pg/mL ± 1.54 pg/mL, 10.42 pg/mL ± 1.64 pg/mL vs 19.83 pg/mL ± 1.53 pg/mL, P < 0.05 for all). Preoperatively, there were no significant differences in the percentages of CD4⁺ and CD8⁺ lymphocytes or CD4/CD8 ratio between the observation group and control group (42.53% ± 4.63% vs 42.42% ± 4.64%, 29.32% ± 2.44% vs 29.13% ± 2.64%, 1.65 ± 0.26 vs 1.66 ± 0.24, P > 0.05 for all). On postoperative days 1 and 3, the percentages of CD4⁺ and CD8⁺ lymphocytes and CD4/CD8 ratio were significantly higher in the observation group than in the control group (day 1: 33.22% ± 2.52% vs 28.24% ± 2.74%, 19.83% ± 2.53% vs 14.24% ± 2.52%, 1.11 ± 0.23 vs 0.73 ± 0.33, P < 0.05 for all; day 3: 39.42% ± 2.64% vs 34.12% ± 2.34%, 24.44% ± 2.65 vs 19.82% ± 2.54%, 1.43 ± 0.24 vs 1.04 ± 0.22, P < 0.05 for all). The percentages of CD4⁺ and CD8⁺ lymphocytes and CD4/CD8 ratio were significantly higher on postoperative days 1 and 3 in both groups compared with preoperative values (P < 0.05 for all). The percentages of patients developing infection and hypoalbuminemia were significantly lower in the observation group than in the control group (7.5% vs 25.0%, 10.0% vs 30.0%, P < 0.05). The incidence of blood coagulation dysfunction did not differ significantly between the two groups (20.0% vs 25.0%, P > 0.05).

CONCLUSION: Compared with open surgery, laparoscopic surgery is associated with less trauma, more rapid recovery, lower effect on immune function and response, and lower incidence of adverse reactions in patients with liver cirrhosis and gallbladder stones.