ObjectiveTo investigate the systemic stress responses after laparoscopic resection in colorectal cancer patients.MethodsSixty patients were randomized into the laparoscopic resection group (30 cases) and open resection group (30 cases) from October 2001 to September 2002 in our hospital.Analgesic dosages, recovery time of intestinal peristalsis, postoperative temperatures, C reactive protein(CRP), IL6 and white blood cell (WBC) counts were recorded after operation. ResultsThe changes of postoperative temperatures and WBC counts showed no significant difference between two groups.But in the laparoscopic resection group, the recovery time of intestinal peristalsis, postoperative analgesic dosages, CRP and IL6 significantly decreased (P＜0.01,P＜0.05).ConclusionCompared with traditional open resection, laparoscopic resection of colorectal cancer can diminish the systemic stress responses and decrease the injury to patients.
【Abstract】Objective To establish and assess the rat model of postoperative fatigue syndrome (POFS). Methods The rat model of POFS was developed by the partial resection of the liver. The behavioral changes prior and post to operation, the disorder of nutritive intake after operation, stress reaction (pathological changes of mucous membrane in small intestine) and the hepatic albumin gene expression were observed. Results Low body temperature, lower sensitivity and reactivity were found. The serum levels of the iron, total protein, albumin, globulin and so on as the indexes of nutrition obviously dropped. The injury of the mucous membrane resulted from the stress reaction after the resection of the liver. The gene expression of the albumin decreased in the model group.Conclusion The experimental rat model of POFS by partial resection of the liver can be used for the investigation of POFS.
Objective To investigate the feasibility and indication of synchronous resection of colonic carcinoma and its hepatic metastasis. Methods Radical sigmoidectomy and right hemi-hepatectomy plus left lateral segment resection were performed at the same time in a 71-year-old patient with sigmoid carcinoma and multiple hepatic metastasis. Results The operation lasted for 5 hours and 10 minutes with 300ml blood lost during the procedure. The patient recovered smoothly and was discharged 2 weeks after operation. Follow-up showed no reoccurrence up to the day of this presentation(4 months).Conclusion The operation could be performed safely by experienced surgeon in good-equipment hospital.
Seven hundred and eighty three cases of rectal carcinoma were treated in this hospital Jan. 1986 to Dec. 1994. There were 552 cases(70.5%)in which the tumor located in the middle and lower portion of the rectum. Of this group, 201 cases were treated with the operations of preservation of sphincter ani. The operations included transabdomino-sacral resection(5 cases), transpubic resection(5 cases), Dixon’s operation(67 cases), perineal pull through anastomosis(44 cases), Welch’s operation(68 cases), and local resection(12 cases). The 3-year survival rate was 90.9%. We consider that anal sphincter preservation is rational in the treatment of rectal cancer of middle and lower segment, As often os the radical resection and maintenauce of normal defecation is concerned, it is suitable for rectal carcinomas in Duke’s A and B1 stages. Combined treatment is necessary to prevent the recurrence and increase the survival rate.
Objective To investigate and evaluate the clinical features, diagnostic methods, surgical management and postoperative adjuvant therapy of thymic carcinoma so as to improve the treatment outcome. Methods Forty-three patients of thymic carcinoma , surgically intervened and pathologically confirmed in Peking Union Medical College Hospital through June 1961 to June 2004, were retrospectively analysed. Complete resection of the tumor was performed in 15 patients, partial or incomplete expiration in 23 , exploratory thoracotomy and biopsy in 5. Results All tumors were found inencapsulated and invading the surroundings,including pericardium, superior vena cava, left or right innominate vein, rnediastinal pleura, phrenic nerve and lung. In this series there was no perioperative death. Eight patients died within the first year postoperatively, 4 died within the second year postoperatively, 2 and 1 patients died in the 5th and 8th year postoperatively respectively. Through half to 18 years follow-up, according to the life table method, the 1,3,5 and 8 year survival rate were 68.29%, 56. 67%, 41.56% and 27. 71% respectively. Conclusions Thymic carcinoma is different from malignant thymoma in clinical manifestations, radiological features, pathological characteristics and prognosis, hence it is very important for thoracic surgeons to pay more attention to those differentiation. Chest CT is an effective method for diagnosis of thymic carcinoma. It is emphasized on that aggressive radical resection of the tumor with involved tissue or organs, even removal of superior vena cava and subsequent reconstruction of vessel, will effectively extend long-term survival. Postoperative radiotherapy and combination adjuvant chemotherapy, especially based on cisplatin, play a significant role in improvement of prognosis.
【Abstract】 Objective To di scus s the resect ion of tumors of pelvic ring and i t s recons truct ion ofdefects. Meth ods From January 1999 to December 2006, 48 patients with tumors in pelvic ring were treated and defects were reconstructed. There were 32 males and 16 females, aged 14-72 years(mean 45.1 years), including 12 cases of benign tumor and 36 cases of mal ignant tumor. Fourteen cases had lesions in region Ⅰ , 11 cases in region Ⅱ , 12 cases in region Ⅲ , 3 cases in region Ⅳ and 8 cases had two or more regions. The selection of surgical method: benign tumor in wing of il ium or in sacro-il iac articulation was curettaged , mal ignant tumors were resected radically or boardly . Benign or mal ignant tumor in pubis, ischium or pubic symphysis was resected radically , defects were reconstructed with plastic plate or not. For tumor affecting aceta bulum , resection of tumor and replacement of the peri- pelvic prothetic or artificial hip joint replacement were performed to reconstructthe function of hip joint. Results Twelve patients with benign tumors were followed up 12-72 months and could walk well, only 1 case relapsed locally. Thirty-six patients with mal ignant tumor were followed up 6 - 72 months, the survival time was 6-12 months in 2 cases (5.6%), 12-24 months in 2 cases(5.6%), 24-36 mongths in 6 cases (16.7%), 36-72 months in 14 cases (38.8%), and more than 72 months in 12 cases (33.3%); 28 patients (77.8%) could walk normally, 6 (16.7%) could walk with the help of walking stick , 2(5.5%) needed wheel chair to move. Compl ications occurred in 6 cases( including 2 venous thrombus,1 anoxic encephalopathy, 2 wound delayed heal ing, and 1 dislocation after total hip joint replacement); the patients’ condition took a turn for the better. Conclusion Operation is a favorable way for the treatment of pelvic tumor. Selecting convenient operation methods to resect tumors or reconstruction defects according the position of the tumor will do good favor to good results,increase the survival time and improve qual ity of l ife.
Objective To estimate the clinical curative effect of replacement of inverttype artificial total scapula and shoulder joint prosthesis and reserving arm with rehabilitation of function in the treatment of malignant tumor in shoulder. Methods From February 2001 and November 2004, five youth patients with primary malignant shoulder tumors were treated operatively by resection of neoplasmsthoroughly, replacement of inverttype artificial total shoulder blade and joint prosthesis, the functional reconstruction. Of them, there were 4 males and 1 female, aging from 19 to 26 years with an average of 23.6 years. Two cases were diagnosed as having osteosarcoma, one as having chondrosarcoma, and 2 as having Ewing sarcoma. After operation, the upper limbs was immobilized for 3 weeks. The rehabilitation training including passive exercise and initiative exercise. Results The average operative time was 425 min (380 to 530 min), and the blood loss ranged from 1 250 ml to1 900 ml(1 540 ml on average). The follow-up ranged from 7 to52 onths,with an average of 24.6 months. Postoperative complication included 1 case of pneumothorax, one case of shoulder incision skin part necrosis and 1 case of clavicle stump raising and pierce skin with shallow infection. No complication of postoperative incision deeply infection, nerve damage and prosthesis exposure or dislocation occurred. According to the scoring system of JOA(Japan orthopaedics association), the average score was 65 (60 to 72). The flexion and extension function of elbow joint recovered to normal. Conclusion The replacement of inverttype artificial total scapula and shoulder joint prosthesis is an efficacious method for the treatment of malignant tumor in shoulder. There are advantages of numerous adaption, wide range of motion and goodstability. It can not only reserve arm but also rehabilitate function.
Objective To evaluate the methods of the pedicle screw-rod fixationsystem combined with allograft bone or polymethylmethacrylate (PMMA) for the reconstruction of pelvic girdle after the complete resections of primary malignantbone tumor and the metastatic lesion of ilium. Methods From July 1999 to July2004, 16 patients with iliac malignant bone tumor were treated with the techniques of the complete resection and reconstruction. There were 9 males and 7 females at the age of 16 to 80 years. The 10 patients with primary malignant bone tumor included 4 cases of chondrosarcomas, 3 cases of osteosarcomas, 2 cases of Ewing sarcomas, and 1 case of malignant giant cell tumor of bone. The 6 patients with the metastatic lesion consisted of 2 cases of breast carcinoma, 1 case of lung carcinoma, 1 case of kidney carcinoma, 1 case of thyroid carcinoma and 1 case of prostate carcinoma. A solitary skeletal metastatic lesion was demonstrated in all metastases. There were 2 cases of stage ⅠA and 8 cases of stage ⅡB in primary malignant bone tumor according to the Enneking classification. The pedicle screwrod fixationsystem combined with allograft bone was used to reconstruct the pelvic girdle in primary malignant tumor. The patients with metastases underwent the pedicle screwrod system fixation with PMMA or without PMMA. The postoperative complication of reconstruction, local recurrence and bone healing were investigated. The postoperative function was analyzed according to the method reported by Enneking. Results The average followup was 35.6 months (5 to 65 months). Of all patients, 2had suspected deep infection, 2 had internal fixation loosening and 1 had nonunion of allograft bone. The mean healing time of the osteotomy site was 5.8 months (4.2 to 8.4 months). No immune rejection was seen. There were 2 patients with local recurrences, 3 patients with pulmonary metastases and 2 deaths due to metastases. The average functional score was 24.8(82.7%) in 8 survival. The functional results also were classified as excellent in 4, good in 3 and fair in 1. The median survival was 11.8 months (4.6 to 48.5 months) in metastases. Four patientshad lived for 1 year or longer after surgical intervention. The internal fixation loosening occurred in 2 patients, new destruction in 3 patients and no infectionoccurred. All patients immediately alleviated the pain and could walk with or without support after operation. At follow-up after 1 year, the average functional score was 21.7(72.3%). The functional results also were classified as excellent in 2 and good in 2. Conclusion Because of less complication and good function, the pedicle screwrod fixation system combined with allograft bone orPMMA are advisable for the reconstructions of pelvic stability after the complete iliac resections of primary malignant bone tumor and the metastatic lesion.
OBJECTIVE To investigate the reconstructional method of posterior wall of vagina after the resection of rectum carcinoma. METHODS From August 1991 to March 1996, 10 patients with rectum carcinoma were adopted in this study, among them, there were 4 cases belong to B stage of Dukas, and 6 cases belong to C stage of Dukes. In operation, rectum carcinoma and posterior wall of vagina were resected, and concurrent reconstruction was finished by using pedicled muscular flap of uterus. RESULTS The effect of operation were satisfactory except one case who was failed because of insufficient blood supply of the flap. Followed-up for 3-6 months, the posterior wall of vagina healed in 7 cases, the width of vagina was 2-3 fingers and the depth was 5-6 cm. CONCLUSION Reconstruction of the posterior wall of vagina with pedicled muscular flap of uterus was available in clinic. For its simplicity and feasibility, it’s suitable for the resection of rectum carcinoma in which the posterior wall of vagina was infiltrated.
The influence on the wrist stability following ulnar head resection (Darrach s procedure)was studied. A series of X-ray films and arthrography of the wrist joint were taken before and after ulnar head re- section. The results showed that after ulnar head resection the radial deviation increased 3 degree(Plt;0.01). and the ulnar deviation 11.92 degree (Plt;0.001). The position of the lunate remained unchanged. Arthrography of the wrist joint demonstrated that 11 specimens had injury of the triangular fibrocartilage.The stability of the wrist joint would no doubt be certainly affected following the ulnar head resction.