目的 探讨传统带线打结技术（不依赖现代高频电刀、超声刀、锁扣夹等器材）在腹腔镜阑尾切除术中的可行性。方法 回顾性分析2009年1月至2011年12月期间笔者所在医院科室应用传统带线打结技术行腹腔镜阑尾切除术的64例患者的临床资料。结果 除1例中转开腹外，其余患者均全部完成手术，无需特殊器材。手术时间20～90min （平均45min），术中出血10～25mL （平均15mL），术后6～24h （平均16h）下床活动，术后2～4d （平均3d） 拔除腹腔引流管，住院时间3～7d （平均5d），住院费用3 500～7 000元（平均4 362 元）。术后均无活动性出血、切口感染等并发症发生。术后患者均获访6～12个月 （平均9个月），均无肠梗阻、戳孔疝等并发症发生。结论 采用单纯传统带线打结技术行腹腔镜阑尾切除术安全、便捷，降低了医疗费用。
ObjectiveTo explore the safety-related factors for total thyroidectomy in differentiated thyroid carcinoma. MethodsThe clinical data of 72 patients with differentiated thyroid carcinoma treated by total thyroidectomy from January 2002 to January 2010 were retrospectively analyzed, the laryngeal recurrent nerve injury and hypoparathyroidism were observed. ResultsThe incidences of hypoparathyroidism and laryngeal recurrent nerve injury were 15.28% （11/72) and 4.17%（3/72）, respectively. The hypoparathyroidism was significantly related to the thyroid reoperation, the lymph nodes metastases of central compartment, or the extraglandular invasion of the primary tumor (Plt;0.05), but not to the dissection of neck lymph nodes (Pgt;0.05). The laryngeal recurrent nerve injury was not relative to those factors (Pgt;0.05). ConclusionThe safetyrelated factors of total thyroidectomy in differentiated thyroid carcinoma include thyroid reoperation, the lymph node metastasis of central compartment, and the extraglandular invasion of the primary tumor.
Objective To explore the value of dual-channel anastomosis of residual stomach and jejunum in radical resection of the upper gastric cancer. Methods Forty patients with upper gastric cancer had undergone proximal gastrectomy and dualchannel digestive tract reconstruction, including esophagus-jejunum side to side anastomosis, residual stomachjejunum anastomosis, and jejunum-jejunum anastomosis. Results The cutting margin away from tumor in all the cases was more than 5 cm and no carcinoma residual. The number of lymph nodes dissection was 21±6, reaching the requirement of D2 radical surgery. There was no case appearing complications such as anastomotic leakage, obstruction or bleeding. Barium meal examination after operation showed that most of barium was directly into the jejunum, the remaining went through the duodenum into the jejunum without gastroesophageal reflux. Followed up 6-30 months with average 18 months, there were no visible reflux esophagitis in all the cases, and only 1 case appeared minor dumping syndrome. The hemoglobin increased and the quality of life was satisfactory after operation. Conclusions In regard to dual-channel anastomosis of residual stomach and jejunum, resection range is reasonable, dissection scope accords with the protocol and residual stomach has a certain pouch effect. The anastomosis has a favorable prevention from reflux esophagitis and dumping syndrome and retains the duodenum pathway, so that improves the quality of patients’ life and is a relatively ideal digestive tract reconstruction.
ObjectiveTo investigate the clinical value of veress needle with thread for laparoscopic high ligation of hernia sac in children. MethodsThe clinical data of 56 cases of pediatric inguinal hernia using laparoscopic high ligation of hernia sac with veress needle from May 2013 to May 2014 were analyzed retrospectively. ResultsAll patients were successfully carried out operation by laparoscopic high ligation of hernia sac.Forty-one cases underwent unilateral surgery, and operative time was 6-18 min (mean 9.6 min); 15 cases underwent bilateral surgery, and operative time was 10-32 min (mean 14.3 min).Nine cases of contralateral recessive hernia were found and ligated during operation.There was no complications, such as scrotal edema, scrotal gas or incision infection after operation, and all patients were discharged in l-2 days after operation.No recurrence or testicular dysplasia was found during 3 to 15 months (mean 10.8 months) follow-up. ConclusionsThere are many advantages in laparoscopic high ligation of hernia sac with veress needle, such as less damage, hidden incision, faster recovery, shorter hospital stay, simple operation, and better efficacy.We can find contralateral recessive hernia during operation and avoid second surgery with high clinical value, therefore it is worthy of clinical application.
ObjectiveTo explore the expressions of survivin, p53, and Ki67 in recurrence or metastasis breast cancer tissue, and explore their correlations and clinical significance. MethodsEighty-six patients with the chest wall local recurrence, axillary or supraclavicular lymph node metastases get treated in this hospital between January 2005 and January 2010 were excised and the expressions of survivin, p53, and Ki67 were detected by immunohistochemistry test, then compared them between the recurrence and metastasis breast cancer tissues and the primary breast cancer tissues. ResultsThe positive expression rate of survivin, p53, and Ki67 in the recurrence and metastasis breast cancer tissues were significantly higher than those in the primary breast cancer tissues, survivin: 90.70% (78/86) versus 61.63% (53/86), χ2=20.014 895, Plt;0.001; p53: 68.60% (59/86) versus 52.33% (45/86), χ2=4.766 968, Plt;0.05; Ki67: 62.79% (54/86) versus 46.51% (40/86), χ2=4.597 927，Plt;0.05. The positive expression rates of survivin in the recurrence and metastasis patients with p53, Ki67 negative expression were significantly higher than those of the primary breast cancer tissue (70.37% versus 24.39%, χ2=14.071 113, Plt;0.05; 75.00% versus 39.13%, χ2=6.540 373, Plt;0.05). The correlation coefficient of survivin with p53 and Ki67 positive expressions in the recurrence and metastasis breast cancer tissue and the primary breast cancer tissue were 0.876 214, 0.773 643 and 0.725 164, 0.698 112, respectively, Plt;0.05. ConclusionThe positive expression rates of survivin, p53, and Ki67 which increase in recurrence and metastasis breast cancer tissue indicate bad prognosis.
ObjectiveTo study the expressions of cyclooxygenase-2(COX-2) and Ki-67 in the invasive ductal carcinoma (IDC) of breast and to analyze its clinical significance. MethodsImmunohistochemical SP method was performed to detect the expressions of COX-2 and Ki-67 in 82 cases of IDC of breast and corresponding tumor-adjacent normal breast tissues, and the relationship of these expressions to clinicopathologic characteristics was analyzed. Results①The positive rates of COX-2 and Ki-67 protein expressions in the IDC of breast tissues were significantly higher than those in the corresponding tumor-adjacent normal breast tissue [COX-2:71.95%(59/82) versus 8.54%(7/82), χ2=68.56, P < 0.001;Ki-67:64.63%(53/82) versus 13.42%(11/82), χ2=45.20, P < 0.001].②The positive rates of COX-2 and Ki-67 protein expressions were positively correlated with TNM staging (COX-2:rs=0.349, P < 0.05;Ki-67:rs=0.305, P < 0.05), lymph node metastasis (COX-2:rs=0.336, P < 0.05;Ki-67:rs=0.419, P < 0.01), vascular invasion (COX-2:rs=0.235, P < 0.05;Ki-67:rs=0.461, P < 0.01), and histological grade (COX-2:rs=0.434, P < 0.01;Ki-67:rs=0.378, P < 0.05).The positive rate of Ki-67 protein expression was positively correlated with tumor diameter (rs=0.365, P < 0.01), but the positive rate of COX-2 protein expression wasn't correlated with it (rs=0.135, P > 0.05).The positive rates of COX-2 and Ki-67 protein expressions weren't correlated with menstrual status (COX-2:rs=0.172, P > 0.05;Ki-67:rs=0.163, P > 0.05).③The positive rate of COX expression was positively correlated with the positive rate of ki-67 expression (rs=0.475, P < 0.01). ConclusionsThere are high-expressions of COX-2 and Ki-67 in IDC of breast.COX-2 and Ki-67 are significantly correlated with the clinicopathologic characteristics in IDC of breast.Combined detection of COX-2 and Ki-67 might calculate the biological behaviors of IDC of breast.COX-2 might be a target of molecular targeted therapy to breast cancer.
ObjectiveTo investigate the correlation between the expressions of matrix metalloproteinase-3 (MMP-3) and vascular endothelial growth factor (VEGF) in the three negative breast cancer (TNBC) and analyze their clinicopathologic significances. MethodsOne hundred and twelve patients confirmed TNBC from January 2008 to January 2013 in this hospital were collected. The cases of luminal type with the similar pathological type and pathological staging were chosen as control. The expressions of MMP-3 and VEGF were detected by immunohistochemistry. Results①The positive expression rates of MMP-3 and VEGF in the TNBC tissues were significantly higher than those in the luminal tissues[MMP-3:90.18%(101/112) versus 49.11%(55/112), P < 0.05;VEGF:84.82%(95/112) versus 48.21%(54/112), P < 0.05]. 2 The positive expressions of MMP-3 and VEGF in the TNBC tissues were correlated with age, menopausal status, tumor size, axillary lymph node metastasis, and TNM stage(P < 0.05).③The expression of MMP-3 was positively correlated with VEGF in the TNBC tissues(rs=0.711, P < 0.01).④The results of follow-up showed that the recurrence and metastasis rate within 3 years was 73.21%, the survival rate within 5 years was 36.61% in the patients with TNBC. ConclusionsThere is a close relation between MMP-3 and VEGF in TNBC, the expressions of MMP-3 and VEGF may serve as important biomarkers for evaluating invasion and metastasis in TNBC. There is a higher metastasis rate within 3 years and a lower survival rate within 5 years in TNBC. According to intervening the expressions of MMP-3 and VEGF, and inhibiting cancer cells matrix degradation and vascular formation, then cancer cells metastasis could be blocked, it may be important to reduce the 3-year recurrence rate and improve 5-year survival rate.
ObjectiveTo explore the clinical significance of hepatectomy combined with vascular reconstruction in hilar cholangiocarcinoma with vascular invasion. MethodsThe clinical data of 62 cases of hilar cholangiocarcinoma with vascular invasion in Suqian People's Hospital of Nanjing Drum-Tower Hospital Group from January 2006 to January 2014 were analyzed retrospectively. All cases were divided into two groups according to assessment of surgical trauma tolerance, nutritional status, and family's wishes. Thirty-three cases underwent hilar cholangiocarcinoma radical operation and hepatic artery combined with portal vein resection and reconstruction (combined resection group), while 29 cases of hilar cholangiocarcinoma underwent palliative surgery for treating jaundice in synchronization (palliative operation group). ResultsThe median survivals in combined resection group and palliative operation group was 26.3 and 9.6 months, respectively. The survival rates of 1-year, 2-year, and 3-year between combined resection group and palliative operation group were 84.85% vs. 26.32%, 66.67% vs. 15.79%, and 42.42% vs. 0, respectively, there were significant differences between both groups in survival time and survival rate (t=4.470, P=0.000; χ2=28.338, 20.348, and 15.891, P=0.000). Among of 33 cases in combined resection group, postoperative complications occurred in 9 cases, the rate of complications was 27.27% and the mortality rate in perioperative period was 3.03%; while postoperative complications in palliative operation group occurred in 5 cases, the rate of complications was 17.24%, no case died in the perioperative period. There were no significant difference between both groups in the rate of postoperative complications and the mortality rate in perioperative period (χ2=0.888, P=0.346; χ2=0.893, P=0.345). ConclusionsHepatectomy combined with vascular resection and reconstruction can significantly improve the radical resection (R0) rate of HCCA, and greatly increase the 1-year, 2-year, and 3-year survival rates of patients. Furthermore, complications can be controlled, and the mortality rate in perioperative period does not increase.
Objective To explore value of multidisciplinary team (MDT) model in diagnosis and treatment of patients with advanced special thyroid cancer who lost chance of operation. Method Two patients with the advanced special thyroid cancer who lost chance of operation were treated by low dose apatinib (250 mg/d) after the MDT discussion. Results One medullary thyroid cancer patient with the compressing of the trachea for mediastinal metastatic lymphadenopathy and inability to lie down underwent the multiple surgical treatment, the therapeutic effect was poor. Then low dose apatinib (250 mg/d) was performed, the patient could supine, breathe smoothly, and move freely, whose life quality was obviously improved, the mediastinal lymph nodes reduced and no serious drug toxicity occurred on month 1 after the treatment. One undifferentiated thyroid cancer patient with the lung metastasis, hemoptysis, and tumor invasion resulted in the inability to lie down and having difficulty in breathing, these symptoms still existed and more pleural effusion occurred after the resection of the invaded trachea. Then low dose apatinib (250 mg/d) was performed, the patient could supine, the pleural effusion disappeared, the hemoptysis stopped, the breathing was smooth, and could do some minor housework, no drug toxicity occurred on month 1 after the treatment. Conclusion After MDT discussion, low dose apatinib in treatment of advanced special thyroid cancer is reliable and safe and has a good short-term effect, which could be used as a new remedy, but long-term effect should be further researched by increasing case samples and a long-term following-up.
Objective To explore therapeutic effect of endocrine therapy in breast cancer patients with negative hormone receptor (HR–) of primary lesion and positive HR (HR+) of metastatic axillary lymph node lesion. Methods Sixty-seven cases of breast cancer with HR– of primary lesion and HR+ of metastatic axillary lymph node lesion from January 2011 to January 2016 were selected. All the patients were randomly divided into endocrine therapy group (33 cases) and control group (34 cases). The patients were given the oral drug of tamoxifen on the basis of conventional chemotherapy in the endocrine therapy group after the surgery, 10 mg/time, twice daily, 5 years; while the patients in the control group were not given the oral drug of tamoxifen but the other therapy same as the endocrine therapy group. The survivals were compared in both groups. Results There were no significant differences in the age, menstrual condition, tumor diameter, preoperative TNM stage, and so on between the endocrine therapy group and the control group (P>0.05). All the patients were followed up for 12–60 months with a 48.5 months of median time. There were no significant differences in the rates of the local recurrence and metastasis, or death rate due to the recurrence and metastasis in both groups (P>0.05). The progression-free survival and overall survival in the endocrine therapy group were significantly higher than those in the control group (P<0.05). The 5-year cumulative progression-free survival and overall survival in the endocrine therapy group were significantly better than those in the control group (P<0.05). Conclusion Pay attention to molecular classification of primary lesion and metastatic axillary lymph node lesion in patients with breast cancer, and endocrine therapy might be able to improve survival rate of breast cancer patients with primary lesion HR– and metastatic axillary lymph node lesion HR+.