ObjectiveTo summarize recent research advancement on radically surgical therapy of carcinoma of the body and tail of pancreas． MethodsRelevant literatures about radically surgical therapy of carcinoma of the body and tail of pancreas were collected and reviewed． ResultsRecent experimental researches indicated that distal pancreatectomy was the common used surgical way to treat carcinoma of the body and tail of pancreas. Besides， spleenpreserving distal pancreatectomy, distal pancreatectomy with en bloc celiac axis resection, and laparoscopic distal pancreatectomy were also the choices to the treatment of carcinoma of the body and tail of pancreas. ConclusionThe surgical way to treat carcinoma of the body and tail of pancreas has advanced for these years, but furthermore development requires more great efforts.
Objective To explore the diagnosis and relapse factors of thyroid cancer. Methods Two hundreds fifty-six cases of thyroid cancer approved by surgery and pathology from 1999 to 2006 were analyzed retrospectively. Results Two hundred and thirty-five cases were approved papillary thyroid carcinoma (91.8%)，11 cases were follicular thyroid carcinoma (4.3%)， 7 cases were medullary thyroid carcinoma (2.7%)， 3 cases were anaplastic thyroid cancer (1.2%). All patients underwent surgery. The operation procedures included thyroidectomy and lymph nodes dissection in central zone of affecting side and subtotal thyroidectomy of contralateral side. Total or subtotal thyroidectomy of both sides and the dissection in unilateral or bilateral Ⅵ region lymph nodes or functional cervical lymph nodes dessection plus contralateral side Ⅵ region lymph nodes dissection in multi-focal cancer and double leaf gland cancer. Functional cervical lymph nodes dessection if existing lymph nodes metastasis or thyroid cancer invading anterior cervical muscle. Two hundreds twentyeight cases were followed up with complete clinical information about (6.5±1.3) years (3-9 years). Six cases died during follow-up because of relapse or metastasis.Conclusions Imaging evaluation is the main method for diagnosis of thyroid cancer. Needle biopsy is reliable and accurate for diagnosis of thyroid tumor. Diameter of tumor is related with cervical lymph node metastasis. Patho-type and stage of tumor, local invasion extent, lymph node metastasis and operation procedure are related with the relapse closely.
Objective To review the advancement of surgical therapy for cavernous transformation of portal vein. Methods The relevant literatures on therapy for cavernous transformation of portal vein in recent years were collected and reviewed. Results The main symptoms of the patients are repeated haematemesis and hemafecia, hypersplenotrophy and hypersplenia. Most cases can be detected by ultrasonography or portal venography. Splenectomy and by-pass technique plus disconnection are the preferred operation. Conclusion Therapy for cavernous transformation of portal vein will be further developed.
【Abstract】Objective To study the surgical therapy and staging investigation about stage Ⅳ breast carcinoma. Methods The clinical data of 38 patients with stage Ⅳ breast carcinoma were summarized, and the patients were followed up. Results The stage Ⅳ patients who had isolated metastasis and removable primary tumor were treated by radical surgery with good effect. On the other hand, the stage Ⅳ patients who had extensive metastasis and primary tumor unresectable were treated by palliative operation with the living quality of patients becoming better and chemotherapy load cutting down. Conclusion The stage Ⅳ patients should be divided into stage Ⅳa and stage Ⅳb. And the stage Ⅳa patients should be treated by radical operation, and the stage Ⅳb by palliative operation.
Objective To Analyze the high risk factors correlated to the perioperative complications of patients with lung cancer, aiming to study their predictive value on surgical safety and guide the perioperative treatment. Methods The clinical experience of 452 lung cancer patients undergone operation from June 2000 to May 2006 were retrospectively study. The risk factors which closely related to the occurrence of postoperative complications were analyze by multivariate statistical analysis with logistic regression. Results The operative mortality was 0.66%（3/452）, and the incidence rate of postoperative complications was 8.85%(40/452), including pulmonary infection, pulmonary atelectasis, arrhythmia, respiratory function failure, empyema, bronchopleural fistula, thoracic bleeding, etc. Multivariate statistical analysis with logistic regression demonstrated that the risk factors which closely related to the occurrence of postoperative complications were age over 70 year (OR=17.823), smoking index over 400 piece year(OR=5.666), concomitance with diseases of vital organs(OR=8.290), modus operandi of pneumonectomy(OR=7.991), forced expiratory volume in one second (FEV1.0%)≤60% (OR=0.922). Conclusion To evaluate above factors of lung cancer patients before operation, the probability of postoperative complications occurrence can be roughly forecasted. This can provide actively clinical guide to help the patients overcome the perioperation successfully and to increase the safety of surgery.
ObjectiveTo explore the surgical method and its clinical efficacy for complicated proximal ulnar fracture. MethodsFrom February 2006 to July 2014, 22 patients with complicated proximal ulnar fracture were treated by open reduction with internal fixation. There were 17 males and 5 females with an average age of 32 years. According to AO classification, there were 4 cases of type C1, 13 of type C2, and 5 of type C3. Among the, there were 4 cases combined with posterior elbow dislocation, 2 cases combined with anterior elbow dislocation, and there were 2 Monteggia Ⅳ cases. Nineteen cases were close fractures, and the other 3 were open fractures. Nerve and vessel injury was not found in all cases. The time before operation was 7 to 12 days, with an average of 8 days. All patients were treated with open reduction and internal fixation. Mayo standard for evaluation of elbow joint was used to evaluate the therapeutic effect after operation. ResultsAll the patients were followed up from 8 to 18 months, with an average of 14 months. All fractures were completely healed. The healing time ranged from 12 to 30 weeks averaging 16 weeks. No failure of internal fixation occurred; no elbow anchyloses or instability occurred. The range of motion of elbow joint was between 120° and 140°, with an average of 135°. Mayo elbow score showed that 16 cases were excellent, 4 good, and 2 fair with an excellent and good rate of 90.9%. ConclusionEarly surgical treatment and rehabilitative training can facilitate satisfactory effects on complicated proximal ulnar fracture.
Objective To compare the therapy effect between surgical therapy and endoscopic therapy for chronic pancreatitis (CP) combined with pancreatic ductal stones (PDS). Methods Clinical data of 113 cases of CP combined with PDS who got treatment in Southwest Hospital of The Third Military Medical University between January 2010 and December 2015 were analyzed retrospectively, 84 of them underwent surgery (surgery group), and 29 of them got endoscopic therapy (endoscopy group). Results The operative time, intraoperative bleeding volume, postoperative hospital stay, and days in hospital, mortality, incidence of complication (pancreatic fistula, delayed gastric emptying, diabetes mellitus, and acute pancreatitis) of the surgery group were all higher than those of endoscopy group (P ＜0.05), but the ratios of the two-stage surgery and recurrence of PDS were all lower (P ＜00.05). The differences between symptom remission rate and residual stones rate were not statistically significant (P>0.05). Conclusions For cases of CP combined with PDS, the clinical therapy effect in symptom remission and residual stones between surgical and endoscopic therapy is similar, but compared with the endoscopic therapy, the operative time, intraoperative bleeding volume, postoperative hospital stay, and days in hospital of the surgical therapy are both longer. However, the ratios of the two-stage surgery and recurrence of PDS in the endoscopy group is significantly higher than those of surgery group.
Objective To summarize the diagnosis and surgical treatment experience of pancreatic ductal stones combined with pancreatic cancer. Methods Nine cases of pancreatic ductal stones combined with pancreatic cancer who treated in our hospital from January 2005 to December 2015 were collected to make a retrospective analysis, summarizing the clinical features, imaging diagnosis, and surgical treatment. Results Four of 9 cases received ultrasound combined with CT angiography, and all of them were diagnosed as pancreatic ductal stones combined with pancreatic cancer; 4 cases received magnetic resonance cholangiopancreatography (MRCP)/magnetic resonance angiography (MRA), and 3 cases were considered as pancreatic ductal stones combined with pancreatic cancer; 3 cases received endoscopic retrograde cholangiopancreatography (ERCP), and all of them were diagnosed as pancreatic cancer. All of the 9 cases underwent surgery, including 4 cases of pancreaticoduodenectomy, 3 cases of distal pancreatectomy with splenectomy, 1 case of pancreatolithotomy plus distal pancreaticojejunostomy, and 1 case of laparoscopic exploration with biopsy. No one died after surgery, but gastric stress ulcer bleeding happened in 1 case, and class B pancreatic fistula happened in 1 case. All of the 9 cases were followed-up for 5-36 months, with the median were 13 months. Seven cases died during follow up period, 5 cases survived longer than 1 year, and 2 cases survived longer than 3 years. Conclusions For patients with recurrent pancreatic stones, we should be wary of the possibility of combining pancreatic cancer, CT and MRCP can be used as further examination of this disease, a variety of imaging methods combination can improve the diagnosis. If imaging examination reveals swollen pancreas without surgical contraindications, surgery is necessary, and standard pancreaticoduodenectomy or pancreas body and tail resection is recommended.
Objective To discuss the imaging characteristics and clinical treatment methods of congenital biliary dilation. Methods Clinical data of 70 cases of congenital biliary dilation who treated in The Third Affiliated Hospital of Henan University of TCM and Henan Provincial People’s Hospital from Jan. 2010 to Jan. 2015 was collected and analyzed. Methods Along the bile duct region (all cases received ultrasound), the ultrasound of 57 cases (81.4%) showed irregular spherical, spindle, or prismatic area without echo connected to the proximal part of the bile duct, the intracavity wall of it was skin pass rolling, and part of it had the spotty detailed or slightly strong stones sound shadow, 1 case combined spindle or capsular area without echo connected to the intrahepatic bile duct partly and along with it. CT of 45 cases (64.3%, 43 cases were diagnosed as congenital biliary dilation) without and with enhancement scanning showed low-density and irregular oblate, cystiform, columniform or fusiform expansion shadow, slight mass effect, no difference before and after the enhancement of partial intrahepatic bile duct and choledoch, and that the structure of surrounding tissues were compressed, lapsed, and deformed. The MRI and magnetic resonance cholangiopancreatography (MRCP) inspection of 65 cases (92.8%, all of 65 cases were diagnosed as congenital biliary dilation) showed tadpole-shaped, irregular cystiform, columniform or fusiform expansion with long T2 and high MRCP signal shadow image of partial intrahepatic bile duct and choledoch, the dilated bile duct also being connected to biliary tree. Of the 70 cases, there were 66 cases (94.3%) of type Ⅰ, 1 case (1.4%) of type Ⅱ, 1 case (1.4%) of type Ⅳa, 2 cases (2.9%) of type Ⅳb. Sixty eight cases (65 cases of type Ⅰ, 1 case of type Ⅱ, 2 cases of type Ⅳb) underwent cholecystectomy+dilated bile ducts resection+common hepatic duct jejunum anastomosis (Roux-en-Y), 1 case underwent cholecystectomy+dilated bile ducts resection+pancreatic duodenal resection, another 1 case underwent cholecystectomy+dilated bile ducts resection+common hepatic duct jejunum anastomosis (Roux-en-Y)+resection of left hepatic lobe. All the cases were successfully recovered without severe complications and had no dead case, but 13 cases (18.6%) suffered from minor complications, including 6 cases of short-term abdominal pain and abdominal distension, 1 case of bile leak, 2 cases of incision infection, 3 cases of pulmonary infection, and 1 case of alteration of intestinal flora. All of the 70 cases were followed-up for 6-56 months (average of 36 months). During the follow up period, 2 cases died in reason of other incidence, 4 cases suffered from simple cholangitis, 3 cases suffered from cholangitis combined with intrahepatic bile duct stone, 2 cases suffered from cholangitis combined with intrahepatic bile duct stone, slight anastomotic stoma stenosis, and mild jaundice, 2 cases suffered from cholangitis. Conclusion Congenital biliary dilation has no typical clinical feature, but it has identifiable imaging manifestation, which can provide a theoretical foundation for congenital biliary dilation in diagnosing, preoperative evaluation, and chosing operative methods. Ultrasound is the first choice, MRI and MRCP are propitious to diagnose, locate, and classfy. The treatment of congenital biliary dilation is resecting the dilated bile ducts fully and performing the common hepatic duct jejunum anastomosis.
Objective To investigate the relative factors on tumor reocurrance or matastasis for over five years survival patients after esophageal carcinoma resection. Method We followed up the patients underwent esophageal carcinoma resection in our hospital and discharged between October 1997 and October 2002. We analyzed the clinical data of 181 over five years survival patients with complete follow-up data. There were 148 males and 33 females with the mean age of 63.9 years ranging from 60-70 years. We summarized the follow-up data and carried on the univariate analysis of relatively recurrent data. Result The result of univariate analysis showed that tumor recurrence as well as matastasis statistically related with degree of differentiation, pTNM stage, whether there was lymph node metastasis or not, and the number of lymph node metastasis (P<0.05), but not with gender, age, the length of tumor, the site of tunor, or other clinicopathologic characteristics (P>0.05). Conclusion The main factors influencing over five years survival rate after esophageal carcinoma resection are pTNM staging when operating, lymph node metastasis or not, and the number of lymph node metastasis.