ObjectiveTo summarize the effect of the multi-disciplinary treatment (MDT) for a patient with giant pancreatic cystic lymphangioma.MethodsThe clinical data of a patient with pancreatic lymphangioma admitted to the Affiliated Hospital of North Sichuan Medical College in March 2020 was retrospectively analyzed, then reviewed the literatures, and summarized the preoperative diagnosis, treatment, and management of perioperative period and long-term period after surgery of this rare disease.ResultsAfter admission, the patient was diagnosed as pancreatic tumor by various imaging and laboratory examinations. The nature was unknown. After discussion by MDT, it was decided to undergo a total pancreatectomy (TP). After the operation, drugs and diet were given to regulate blood glucose. The patient’s tumor disappeared after the operation, and no tumor recurrence was found in the three months after discharge.ConclusionsPancreatic lymphangioma is rare and lacks a clear diagnosis and treatment plan. The MDT mode can bring a clearer diagnosis and more effective treatment for it.
目的探讨经脐单孔腹腔镜胆囊切除术（LC）的临床应用。方法分析我院2009年1月至2010年5月期间120例因结石性胆囊炎和胆囊息肉行经脐单孔LC患者的临床资料。结果98例患者手术成功，手术时间38～126 min，平均50.3 min。22例单孔手术失败改成两孔完成手术。住院时间2～4 d，平均2.5 d。全组患者无出血及漏胆并发症发生，仅2例（1.7%）脐部戳孔处术后轻度感染，经局部换药治疗2周愈合。89例（90.8%）采用单孔法患者获得1～15个月（平均7.3个月）随访，均无并发症发生。结论单孔LC安全可行，但使用现有腹腔镜设备操作难度较大，器械及技术尚需进一步完善。
ObjectiveTo investigate and analysis the data of patients with hepatic echinococcosis in Ganzi County in 2018, and to understand the epidemiological characteristics of hepatic echinococcosis in Ganzi County, Sichuan Province.MethodsA total of 811 patients were enrolled. The basic information of sex, age, weight, occupation, nation, educational level, family address and so on were recorded. The location, number, classification, transverse diameter and longitudinal diameter of hepatic echinococcosis masses were recorded by abdominal color Doppler ultrasonography.ResultsIn 2018, 811 new cases of hepatic echinococcosis were reported in Ganzi County, with a prevalence rate of 4.6% (811/17 650), and 17.81% (572/3 212) in the Datongma area. Patients ranged in age from 6 to 92, the average age was (44.8±16.6) years old. The majority of patients were Tibetans (98.5%), herdsmen (71.8%) and illiterates (83.5%). The most common lesions were in right liver (84.2%) and single (91.4%).ConclusionsThere is serious transmission of hepatic echinococcosis in Ganzi County, especially in pure pastoral areas, and HAE is more prevalent than HCE. Most of the infected people are Tibetan herdsmen with illiterate educational background and more females than males. The peak incidence of hepatic echinococcosis is 30-55 years old. Close monitoring should be carried out for these people.
ObjectiveTo understand the research progress of the matrix metalloproteinases (MMPs) family in regulating the development of hepatocellular carcinoma (HCC) and its mechanism, in order to provide a reference for the basic research and clinical diagnosis and treatment of HCC. MethodThe relevant literature on the regulation of HCC occurrence, development, and mechanisms by MMPs both domestically and internationally in recent years was reviewed. ResultsThe extracellular matrix (ECM) microenvironment of HCC cells determined the invasiveness and degree of metastasis of tumor cells. The degradation and remodeling of ECM during epithelial mesenchymal transition (EMT) were the main factors contributing to the invasion and metastasis of HCC. The abnormal expression of most members of the MMPs family could lead to ECM breakdown, cell invasion and attachment, and markedly accelerate the process of EMT, thereby promoting the invasion and metastasis of HCC cells. At present, there were many MMPs related to the development of HCC, including MMP-1, 2, 3, 7, 9, 12, 13, 14. The relevant research on the relation between MMP-8, 10, 11, 15, 16, 20, 21, 26 or 28 and the development of HCC was relatively limited, while the exact research on the relationship between the MMP-17, 19, 23, 24, 25 or 27 and HCC development had not been retrievaled. ConclusionsThe MMPs family members (especially MMP-2, 3, 7, 9, 10, 12) play a crucial role in the progression of HCC, including proliferation, invasion, and metastasis. Further exploration of the potential intrinsic relation between all members of the MMPs family members and the development of HCC is crucial for predicting HCC metastasis potentiality and prognosis, as well as developing new or improved targeted anti-cancer therapies for HCC.
ObjectiveTo summarize the surgical management of complicated mediastinal tumor involving the heart or great vessels. MethodsWe retrospectively analyzed the clinical data of 38 patients with complicated mediastinal tumor invading the heart and large blood vessels underwent extended thymectomy in our hospital between February 1997 and May 2014. There were 26 males and 12 females at age of 41.3± 13.6 years ranking from 4 to 68 years. Multiple personalized procedures were applied within the 38 patients and some patients underwent more than one procedure. Besides the resection of mediastinal tumor, 3 patients underwent partial right atrial resection. Sixteen patients underwent resection, plasty or grafting vessels. Ten patients took partial excision and repair of pericardium. Eight patients underwent pulmonary wedge resection. Two patients underwent lobectomy. Two patients required cardiopulmonary bypass. ResultAll operations were completed successfully. There was no perioperative mortality. The operating time was 105-282 min and blood loss was 200-1 500 ml. The postoperative complications rate was 23.7%. The incidence of ICU admission was 47.4% with an average ICU stay of 1.8 days. The average length of post-operative hospital stay was 11.2 days. The five-year survival rate was 57.0%. ConclusionSurgical resection of mediastinal tumor invading the heart or great vessels is complicated and highly risky. However, desirable clinical outcome can be achieved with comprehensive perioperative assessment and appropriate surgical procedures.
ObjectiveTo develop a symptom and function assessment scale for patients after Nuss procedure for pectus excavatum and to test its reliability and validity. MethodsFollowing the principles and procedures of patient-reported outcome (PRO) scale development stipulated by the U.S. Food and Drug Administration, an initial draft was formed through literature analysis, qualitative interviews, and Delphi expert consultation. The preliminary draft was used to conduct a pre-survey on patients who underwent Nuss procedure for pectus excavatum at Guangdong Provincial People's Hospital, and the reliability and validity of the scale were tested. ResultsA preliminary PRO-based symptom and function scale was constructed, covering two domains: symptoms and impact on daily functions. The symptom dimension includes six items: chest tightness, palpitations, pain, shortness of breath, foreign body sensation of the steel plate, and distress; while the impact on daily functions includes four items: difficulty in getting out of bed or lying down, raising arms, bending over, and standing or sitting for a long time. A total of 73 patients who underwent Nuss procedure for pectus excavatum were included in the questionnaire survey, with 70 valid questionnaires collected, including 64 males and 6 females, with 56 patients aged 12-17 years and 14 patients≥18 years. Through exploratory factor analysis, two common factors were extracted, with a cumulative variance contribution rate of 70%. The Cronbach's α coefficient of the scale is 0.917. ConclusionThe scale developed in this study has good reliability and validity, high reliability and stability, and can be used as an evaluation tool for the recovery status of patients after Nuss procedure for pectus excavatum.
ObjectiveTo investigate the feasibility, safety and effectiveness of video-assisted thoracic surgery (VATS) sympathectomy under monitored anesthesia care (MAC) and local anesthesia (LA) without endotracheal intubation as a new fast track recovery surgical strategy for the treatment of palmar hyperhidrosis. MethodsA total of 124 patients with intermediate or severe hyperhidrosis who were admitted to Guangdong General Hospital were enrolled in this study. With SPSS18 random number generator, all the patients were divided into MAC+LA group and general anesthesia (GA) group with 62 patients in each group. There were 43 males and 19 females in MAC+LA group with their age of 22.25±6.22 years, and 42 males and 20 females in GA group with their age of 23.98±6.67 years. During the surgery, MAC+LA group patients received MAC and oxygen via nasal tube or face mask instead of endotracheal intubation, and GA group patients received GA, endotracheal intubation and controlled ventilation. Clinical outcomes were compared between the 2 groups. ResultsAll the patients received their operations safely. None of MAC+LA group patients received conversion to GA and controlled ventilation. There was statistical difference in operation time (47.18±12.06 minutes vs. 39.33±13.21 minutes, P=0.002) and length of theatre stay 84.52±22.56 minutes vs. 134.68±26.12 minutes, P=0.000) between MAC+LA and GA group patients. There was no statistical difference in blood loss, incidence of intraoperative SpO2 lower than 95% (2 patients vs. 0 patient), postoperative hospital stay, incidence of postoperative compensatory sweating (86.5% vs. 89.0%) and patient satisfaction rate (94.59% vs.95.12%) between the 2 groups. No intraoperative pain, postoperative complication or symptom recurrence was observed in either group. There was statistical difference in anesthetic preparation time (20.52±10.55 minutes vs. 36.47±12.16 minutes), duration between operation finish and returning to ward (11.26±7.09 minutes vs. 59.39±19.89) minutes and hospitalization cost (RMB 6 376.86±746.00 yuan vs. RMB 8 812.04±867.93 yuan) between the 2 groups. The incidence of postoperative sore throat (0% vs. 100%), monitor time (4 hours vs. 12 hours) and time to resume oral intake (2 hours vs. 6 hours) of MAC+LA group were significantly lower or shorter than those of GA group. ConclusionVATS sympathectomy under MAC and LA can avoid complications of GA and endotracheal intubation, and provide a safe, feasible, effective and more minimally invasive fast track alternative for the treatment of palmar hyperhidrosis.