Objective To summarize the current status of pedicled flaps for defect repair and reconstruction after head and neck tumor resection, and to present its application prospects. Methods Related literature was reviewed, and the role evolution of pedicled flaps in the reconstruction of head and neck defects were discussed. The advance, anatomical basis, indications, advantages, disadvantages, and modification of several frequently used pedicled flaps were summarized. Results The evolution of pedicled flaps application showed a resurgence trend in recent years. Some new pedicled flaps, e.g., submental artery island flap, supraclavicular artery island flap, submandibular gland flap, and facial artery musculomucosal flap, can acquire equivalent or even superior outcome to free flaps in certain cases. Technological modification of some traditional pedicled flaps, e.g., nasolabial flap, pectoralis major myocutaneous flap, latissimus dorsi musculocutaneous flap, temporalis myofascial flap, and temporoparietal fascial flap, can further broaden their indications. These traditional flaps still occupy an irreplaceable role, especially in patients with poor condition and institution with immature microsurgical techniques. Conclusion The pedicled flaps still plays an important role in head and neck reconstruction after tumor resection. In certain cases, they demonstrate some advantages over free flaps, e.g., more convenient harvest, more rapid recovery, less expenditure, and better functional and aesthetic effect.
Objective To investigate the changes of lumbar bone histomorphometry after exposure to low frequency pulsed electromagnetic fields (PEMFs), and to further understand the effect of PEMFs on osteoporosis (OP) in ovariectomizedOP rats. Methods Sixty-six 3-month-old Sprague Dawley rats were randomly divided into 4 groups: group A(n=12), groupB (n=12), group C (n=12), and group D (n=30). In group A, the ovaries were not resected as sham-ovariectomy; in groupsB, C, and D, the ovaries were resected. At 12 weeks after ovariectomy, the rats were exposed to PEMFs at 8 Hz, 3.8 mT, and 40 minutes/ day for 30 days in group B; the rats were administered with premarin [0.065 mg/(kg·d) by gavage for 30 days] in group C; in group D, the rats were housed as ovariectomy control. The hair and activity of rats were observed; the levels of serum estradiol were determined. At 30 days after intervention, all rats were sacrificed to harvest the L4 vertebrae for bone histomorphometry. Results General observation showed hair loss and decreased activity in group D, and no abnormal appearances in groups A, B, and C. The level of serum estradiol in group A was significantly higher than that in group D [(54.93 ± 23.52) pg/mL vs. (31.99 ± 23.45) pg/mL] (t=2.345, P=0.029). Histological observation showed thinness of sclerotin, bigger medullary cavity, and sparse and thinner bone trabecula in group D; uniform bone trabecula with no breakage in groups A, B, and C at 30 days after intervention. The ratio of trabecular bone area in group B was significantly higher than that in group D (P lt; 0.05); it was higher than that in groups A and C, showing no significant difference (P gt; 0.05). The trabecular thickness in group B was significantly higher than that in group D (P lt; 0.05), but it was lower than that in groups A and C, showing no significant difference (P gt; 0.05). The trabecular number in group B was significantly lower than that in group D (P lt; 0.05), but it was higher than that in groups A and C, showing no significant difference (P gt; 0.05). The trabecular separation in group B was higher than that in group D and lower than that in groups A and C, showing no significant difference (P gt; 0.05). Conclusion PEMFs at 8 Hz and 3.8 mT can significantly improve the character of bone microstructure in ovariectomized OP rats, increase the ratio of bone trabecular area and trabecular thickness, and decrease the trabecular number.
Objective To summarize the research progress of digestive tract reconstruction after total gastrectomy in gastric cancer. Methods The domestic and international published literatures about digestive tract reconstruction after total gastrectomy in gastric cancer were retrieved and reviewed. Results More and more attention had been paid to the postoperative quality of life after total gastrectomy in gastric cancer， and the most related factor for postoperative quality of life was the type of digestive tract reconstruction. The pouch reconstruction and preservation of enteric myoneural continuity showed beneficial effects on clinical outcomes. Current opinion considered the pouch reconstruction might be safe and effective， and was able to improve the postoperative quality of life of patients with gastric cancer. However， the preservation of duodenal pathway didn’t show significant benefits. Conclusion The optimal digestive tract reconstruction after total gastrectomy is still debating， in order to resolve the controversies， needs more in-depth fundamental researches and more high-quality randomized controlled trials.
Objective To investigate the primary peripheral non-small cell lung cancer (NSCLC) in stage T1 of TNM (UICC2011) (the tumor size≤3 cm) and to find out the lymphadenectomy way which will benefit patients most. Methods We retrospectively analyzed the clinical data of 60 patients with primary peripheral NSCLC in our hospital between November 2014 and May 2015. There were 26 males and 34 females at age of 34-76 (57.91±7.75) years. The lymph nodes dissection and metastasis were recorded. Results The total number of intrathoracic lymph nodes dissection is 1 208,with an average of 20.1, including 33 metastasis lymph nodes. The metastasis rate was 2.73%. A total of 51 patients were not found the mediastinum and hilum metastasis lymph node through the routine pathological detection method，while metastasis lymph node in section 12 and (or) 13 and (or) 14 group were found in 3 patients in our trial. The detection rate was 5.89%. For stage T1 primary peripheral NSCLC, with increasing tumor size, lymph node metastasis rate was gradually increased. The patients with solid lesions were more likely to have lymph node metastasis than those with non-solid lesions (pure ground-glass nodules or mixed ground-glass nodules) which generally did not find lymph node metastasis. Conclusion The lymph node metastasis rate in stage T1 primary peripheral NSCLC is related to the tumor size, nature, histological type, local pleural stretch in imaging. The dissection of lung lymph node (12+13+14 groups)may be able to find simple intrapulmonary lymph nodes metastasis. It is important to the selection of delineated staging and treatment program in stage T1 primary peripheral NSCLC.
The aim of this study is to compare the planning quality and delivery efficiency between dynamic intensity modulated radiation therapy (d-IMRT) and dual arc volumetric modulated arc therapy (VMAT) systematically for nasopharyngeal carcinoma (NPC) patients with multi-prescribed dose levels, and to analyze the correlations between target volumes and plan qualities. A total of 20 patients of NPC with 4–5 prescribed dose levels to achieve simultaneous integrated boost (SIB) treated by sliding window d-IMRT in our department from 2014 to 2015 were re-planned with dual arc VMAT. All optimization objectives for each VMAT plan were as the same as the corresponding d-IMRT plan. The dose parameters for targets and organ at risk (OAR), the delivery time and monitor units (MU) in two sets of plans were compared respectively. The treatment accuracy was tested by three dimensional dose validation system. Finally, the correlations between the difference of planning quality and the volume of targets were discussed. The conform indexes (CIs) of planning target volumes (PTVs) in VMAT plans were obviously high than those in d-IMRT plans (P < 0.05), but no significant correlations between the difference of CIs and the volume of targets were discovered ( P > 0.05). The target coverage and heterogeneity indexes (HIs) of PTV 1 and PGTVnd and PTV3 in two sets of plans were consistent. The doses of PTV2 decreased and HIs were worse in VMAT plans. VMAT could provide better spinal cord and brainstem sparing, but increase mean dose of parotids. The average number of MUs and delivery time for d-IMRT were 3.32 and 2.19 times of that for VMAT. The γ-index (3 mm, 3%) analysis for each plans was more than 97% in COMPASS® measurement for quality assurance (QA). The results show that target dose coverages in d-IMRT and VMAT plans are similar for NPC with multi-prescribed dose levels. VMAT could improve the the CIs of targets, but reduce the dose to the target volume in neck except for PGTVnd. The biggest advantages of VMAT over d-IMRT are delivery efficiency and QA.
ObjectiveTo explore an effective and safe drainage method, by comparing open thoracic drainage and conventional thoracic drainage for lung cancer patients after thoracoscopic pneumonectomy.MethodsThe clinical data of 147 patients who underwent thoracoscopic pneumonectomy from January 2015 to March 2018 in our hospital were retrospectively analyzed, including 128 males and 19 females. Based on drainage methods, they were divided into an open drainage group (open group) and a conventional drainage group (regular group). The incidence of postoperative complications, chest tube duration, drainage volume at postoperative 3 days, postoperative hospital stay, hospitalization cost and quality of life were compared between the two groups.ResultsPostoperative complication rate was lower in the open group than that in the regular group (10.20% vs. 23.47%, P=0.04). The chest tube duration of the open group was longer compared with the regular group (5.57±2.36 d vs. 3.22±1.23 d, P<0.001). The drainage volume at postoperative 3 days was less in the regular group. In the open group, ambulation was earlier, thoracocentesis was less and re-intubation rate was lower (all P<0.001). The postoperative hospital stay in the regular group was significantly longer than that in the open group (8.37±2.56 d vs. 6.35±1.87 d, P<0.001) and hospitalization cost was significantly higher (66.2±5.4 thousand yuan vs. 59.6±7.3 thousand yuan, P<0.001). Besides, quality of life in 1 and 3 months after operation was significantly better than that in the open group (P<0.001).ConclusionCompared with the regular chest drainage, the effect of open thoracic drainage is better, which can help reduce postoperative complications, shorten the length of hospital stay, reduce the hospitalization cost and improve the quality of postoperative life. It is worthy of clinical promotion.
ObjectiveTo investigate indications,technical points,and outcomes of laparoscopic liver resection in treatment for hepatic hemangioma. MethodThe clinical data of 78 patients with hepatic hemangioma underwent laparoscopic liver resection in our institute from January 2014 to December 2014 were analyzed retrospectively. ResultsSeventy-seven patients were underwent laparoscopic liver resection successfully,1 patient was conversed to open procedure.Operation method:laparoscopic anatomical liver resections were performed in 35 patients including 23 patients with left lateral segmentectomy,4 patients with left hemihepatectomy,3 patients with right hemihepatectomy,1 patient with Ⅲ segmentectomy,1 patient with Ⅵ segmentectomy,2 patients with Ⅵ and Ⅶ segmentectomy,1 patient with left lateral segmentectomy combined with Ⅵ and Ⅶ segmentectomy.Laparoscopic non-anatomical liver resection were performed in 43 patients.The operation time was (163.6 ±62.3) min,the intraoperative blood loss was (273.6±282.4) mL.No operative death occurred.One patient with postoperative functional bowel obstruction and 3 patients with pleural effusion had been recorded.All the patients recovered well.The postoperative hospital stay was (7.2±2.5) d.The results of postoperative pathology confirmed that all the tumors were hepatic cavernous hemangiomas. ConclusionsLaparoscopic liver resection for hepatic cavernous hemangioma is a safe and feasible method with small trauma,rapid recovery,cosmetic incision.Key of this technology is to strictly select surgical indications,to transect liver parenchyma along right plane,effective control of hepatic blood inflow,and properly management of cutting surface of liver.
ObjectiveTo systematically review the effectiveness of appendicectomy versus antibiotics for uncomplicated acute appendicitis (UAA). MethodsDatabases including PubMed, EMbase, The Cochrane Library (Issue 8, 2016), Web of Science, CBM, WanFang Data and CNKI were searched to collect randomized controlled trials (RCTs) about appendicectomy versus antibiotics for uncomplicated acute appendicitis from inception to September 2016. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Then meta-analysis was performed using RevMan 5.3 software. ResultsA total of 10 RCTs studies involving 2 028 patients were included. The results of meta-analysis showed that, compared with antibiotics, the appendicectomy could shorten duration of hospital stay (MD=–1.89, 95%CI –2.75 to –1.04, P<0.000 01), the therapeutic time of antibiotics (MD=–4.42, 95%CI –5.06 to –3.79, P<0.000 01), improve the efficiency of clinical treatment (OR=23.48, 95%CI 7.99 to 68.96, P<0.000 01), decrease the recurrence rate (OR=0.02, 95%CI 0.01 to 0.05, P<0.000 01), however, there was no significant difference in the incidence of postoperative complications between two groups (OR=1.35, 95%CI 0.31 to 5.87, P=0.69). ConclusionThe current evidence shows that, compared with antibiotics, the appendicectomy for uncomplicated acute appendicitis can shorten duration of hospital stay and the therapeutic time of antibiotics, improve the efficiency of clinical treatment, decrease the recurrence rate. Due to the limited quality of included studies, more high quality studies are needed to verify the above conclusion.