Model for end-stage liver disease score versus Child score in predicting the outcome of surgical procedures in patients with cirrhosis

AIM： To determine factors affecting the outcome of patients with cirrhosis undergoing surgery and to compare the capacities of the Child-Turcotte-Pugh （CTP） and model for end-stage liver disease （MELD） score to predict that outcome. METHODS： We reviewed the charts of 195 patients with cirrhosis who underwent surgery at two teaching hospitals over a five-year period. The combined endpoint of death or hepatic decompensation was considered to be the primary endpoint. RESULTS： Patients who reached the endpoint had a higher MELD score, a higher CTP score and were more likely to have undergone an urgent procedure. Among patients undergoing elective surgical procedures, no statistically significant difference was noted in the mean MELD （12.8 ＋ 3.9 vs 12.6 ＋ 4.7, P = 0.9） or in the mean CTP （7.6 ± 1.2 vs 7.7 ± 1.7, P = 0.8） between patients who reached the endpoint and those who did not. Both mean scores were higher in the patients reaching the endpoint in the case of urgent procedures （MELD： 22.4 ± 8.7 vs 15.2 ± 6.4, P = 0.0007; CTP： 9.9 ± 1.8 vs 8.5 ± 1.8, P = 0.008）. The performances of the MELD and CTP scores in predicting the outcome of urgent surgery were only fair, without a significant difference between them （AUC = 0.755 ± 0.066 for MELD vs AUC = 0.696 ± 0.070 for CTP, P = 0.3）. CONCLUSION： The CTP and MELD scores performed equally, but only fairly in predicting the outcome of urgent surgical procedures. Larger studies are needed to better define the factors capable of predicting the outcome of elective surgical procedures in patients with cirrhosis.equally, but only fairly in predicting the outcome of urgent surgical procedures. Larger studies are needed to better define the factors capable of predicting the outcome of elective surgical procedures in patients with cirrhosis.

Cancellation Causes of Elective Surgical Procedures in a Major Pediatric Surgery Department

Introduction: Cancellation of surgical operation is a surgical operation registered in the official schedule the day before or added to the list after and not carried out on the operating day. The purpose of this work was to determine the causes of cancellation of elective surgical operations in a major pediatric surgery department in Senegal. Patients and methods: It was a prospective and descriptive study of 278 patients scheduled during a period of 13 weeks. The study took place between April 3rd, 2017, and January 31st, 2018. Mean age was 2.9 years with extremes of 3 days and 15 years. The age group of 29 days to 30 months was the most represented (62.2%). Sex ratio was 1.41. Causes of cancellation were categorized into administrative and organizational causes, patient-related causes and staff-related causes. Results: Cancellation rate was 29.4%. Patient-related causes were most common (51.2%). Upper Respiratory tract infection (URTI) was commonest reason within this category (57.5%). Organizational causes (28.1%) came second and were mainly represented by the unavailability of the operating room (60.8%) related to breakdowns of anesthesia equipment. Finally, staff-related causes (20.7%) were due for most to the unavailability of the anesthesiologist (12 cases/17). Conclusion: Majority of causes that led to cancellation of elective surgical operations in our Pediatric surgery department are related to intercurrent illnesses affecting the patient, in particular URTI.

Surgical procedures of thoracic ossification of the ligamentum flavum

Objective To investigate different surgical procedures for treatment of thoracic ossification of ligamentum flavum.Methods From January 1994 to June 2008,56 cases of thoracic ossification of ligamentum flavum underwent

CHANGES OF INTERLEUKIN-6 AND RELATED FACTORS AS WELL AS GASTRIC INTRAMUCOSAL pH DURING COLORECTAL AND ORTHOPAEDIC SURGICAL PROCEDURES

Objective To investigate the changes of perioperative serum levels of interleukin-6(IL-6), C-reactive protein (CRP), and cortisol, as well as gastric intramucosal pH (pHi) and plasma lactate, aiming to compare systemic changes and tissue perfusion during colorectal and orthopaedic surgical procedures. Methods Twenty patients were randomly assigned to two groups, 10 cases of operation on vertebral canal, 10 cases of colorectal radical operation.Venous blood was drawn at 1 day before operation, 2, 4, and 6 hours following skin incision, and 1 day after operation, in order to measure serum IL-6, CRP, and cortisol.pHi and plasma lactate were also measured at the same time points.Results Serum concentrations of IL-6 and cortisol increased gradually following operation, reaching the peak value at 6 hours from the beginning of operation.CRP was not detectable until the first day after operation.Peak concentration of IL-6 had positive relationship with CRP.These variables changed more significantly in colorectal group than that in orthopaedic group (P<0.05).pHi decreased gradually, reaching the lowest level at 4 hours from the beginning of operation, and to more extent in colorectal group than that in orthopaedic group (P<0.05).Conclusion IL-6 may reflect tissue damage more sensitively than CRP.Colorectal surgery might induce systemic disorder to more extent, in terms of immuno-endocrinal aspect as well as tissue perfusion, reflected with pHi.

Application of Plan-Do-Check-Action cycle and fishbone diagram analysis in optimizing surgical procedures to improve satisfaction degree of doctor-nurse-patient

Background:To study the application of management tools such as Plan-Do-Check-Action(PDCA)cycle and fishbone diagram in optimizing surgical procedures to improve the satisfaction of doctor-nurse-patient.Methods:The fundus surgery nursing team of our hospital began to implement the PDCA cycle management mode to optimize the surgical procedure from July 2017,set up a project activity improvement team,unified the surgical labeling processing plan,and made the fundus surgery procedure,and established the preoperative health education for surgical patients,and standardized the training content of post-rotating doctors and interns.Results:The satisfaction degree to surgical procedure after implementation of doctors and nurses was higher than that before implementation.Conclusions:Using PDCA cycle and fishbone diagram analysis tools to manage the surgical procedure optimization can better integrate doctor-nurse medical care,improve the efficiency and accuracy of the surgical procedure delivery and operation,and optimize the satisfaction of the three parties of doctor-nurse-patient.

Comparison of the Efficacy of Ultrasound-Guided Microwave Ablation of Parathyroid Adenoma with Surgical Procedures

Objective: To compare the clinical efficacy and safety of ultrasound-guided microwave ablation with surgery for the treatment of primary parathyroid adenoma. Methods: The clinical data of patients with primary parathyroid adenoma admitted to the First Hospital of Yangtze University from January 2010 to May 2020 were retrospectively analyzed, and they were divided into 43 cases in the microwave ablation group (MWA) and 39 cases in the surgical procedure group (SR) according to the different treatment methods. The surgical condition, postoperative complications, and changes in serum parathyroid hormone (PTH) and serum calcium and phosphorus levels were analyzed in both groups. Results: The hospital stay and operation time of patients in the microwave ablation group were shorter than those in the surgical group, and the intraoperative bleeding was significantly less than that in the surgical group (P < 0.05);the serum parathyroid hormone (PTH), blood calcium and blood phosphorus levels of patients in both groups were significantly lower than those before treatment (P < 0.05) after surgery of 1, 3 and 6 months respectively, and the differences between groups were not statistically significant (P > 0.05). There was no statistically significant difference in the incidence of postoperative complications between the two groups (P > 0.05). Conclusion: Microwave ablation can achieve the same therapeutic effect as surgery. It is a safe and feasible clinical technique worthy of clinical promotion with its short hospitalization time, less bleeding and less trauma.

Comparison of Surgical Techniques Used in Treating Acromioclavicular Dislocation in Patients Participating in Sports: A Systematic Review

Introduction: The acromioclavicular joint is a superficial diarthrodial joint that surrounds the medial articular facet of the acromion and the distal portion of the clavicle. Due to its anatomy and biomechanics, it is highly susceptible to trauma and in young men who play contact sports, acromioclavicular dislocation is common. This article aimed to systematically review the literature and compare the surgical techniques used in the treatment of acromioclavicular dislocation in patients who practice sports. Methods: This systematic review was conducted according to the International Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. Eligible studies for this systematic review included articles in English or Spanish published between 2013 and 2023, which mention the occurrence of acromioclavicular dislocation during sports practices. Additionally, only studies that addressed the surgical treatment of acromion-clavicular dislocation and contained original data on the topic were included. Results: We found 144 eligible studies after searching the LILACS and PubMed databases. Based on the inclusion and exclusion criteria and the reviewers’ consensus, we selected four studies for the systematic review. 133 patients with AC joint displacement were evaluated. Mean Age: approximately 31.90 years. 81.92 of these injuries occurred during sports practice. Surgical Procedures Used: titanium plates fixation (49 patients), arthroscopy (24), single tunnel technique (30) and coracoid sling technique (30). The results of the visual analog scale and Constant-Murley scores varied between the techniques used. Twenty-two complications after surgical treatment were identified. Conclusion: A significant variability of operative techniques can be used in the surgical approach of acromioclavicular dislocation, such as arthroscopy, single tunnel, coracoid sling and titanium plates. Although it presented excellent functional results compared to the other three techniques evaluated by this review, using titanium plates is not the gold standard since other techniques not assessed by this work may be more effective.

Nasal cavity fungus ball discovered accidentally:A case report

BACKGROUND Fungal balls within the nasal cavity are an exceedingly rare clinical entity,typically presenting with nonspecific symptoms or being identified incidentally.CASE SUMMARY This report presents an incidental discovery of a fungal ball in the nasal cavity during routine imaging,with no associated clinical symptoms.CONCLUSION This case underscores the importance of considering the possibility of asympto-matic presentations of nasal fungal balls,which may be detected incidentally during imaging evaluations.

Robotic surgical systems in maxillofacial surgery:a review

Throughout the twenty-first century, robotic surgery has been used in multiple oral surgical procedures for the treatment of head and neck tumors and non-malignant diseases. With the assistance of robotic surgical systems, maxillofacial surgery is performed with less blood loss, fewer complications, shorter hospitalization and better cosmetic results than standard open surgery.However, the application of robotic surgery techniques to the treatment of head and neck diseases remains in an experimental stage, and the long-lasting effects on surgical morbidity, oncologic control and quality of life are yet to be established. More well-designed studies are needed before this approach can be recommended as a standard treatment paradigm. Nonetheless,robotic surgical systems will inevitably be extended to maxillofacial surgery. This article reviews the current clinical applications of robotic surgery in the head and neck region and highlights the benefits and limitations of current robotic surgical systems.

Recent advances in the surgical treatment of pancreatic cancer

INTRODUCTIONPancreatic cancer remains the fourth commonest cause of cancer related death in the western world[1]. The prognosis remains dismal due partly to late presentation, with associated low resectability rates, and the aggressive biological nature of these tumors. The median survival time from diagnosis in unresectable tumors remains only 4 6 months.For those patients amenable to surgical resection over the last 20 years have seen marked improvements in postoperative mortality and morbidity, especially in specialist pancreatic centres 23. Despite these changes long-term survival remains low. with a total 5-year survival rate remaining less than 5%.Patients with ampullary cancer have a better 5-year survival of 40°%-60°%.

Surgical Treatment of Carcinoma of Esophagus and Gastric Cardia—A 34—year Investigation

Objective To understand the progress in surgical treatment of 12 970 patients with carcinoma of esophagus and gastric cardiac during 1965-1998.Methods The patients were divided into A, B and C groups: 3 155 patients (group A) were treated surgically in the first 14 years, 5952 patients (group B) in the next 10 years, and 3 863 patients (group C) in the last 10 years. The early stage lesions (Tis, Tl) were assigned as a separate group. The results of these groups were compared.Results The resectability for esophageal and gastric cardiac carcinoma was 94.0% and 84.4% respectively, and the overall resectability was 91.3% . The resectabih'ty for groups A, B, C and the early stage group was 82.1% , 85.1% , 90.2% and 100% , respectively. The overall operative mortality was 1.8%, it was 4.4% for group A, 1.6% for group B, and 0.5% for group C. The overall 5-year survival was 31.6% . The 5-year survival for groups A, B, C and the early stage group was 27.0% , 29.1%, 32.0% and 92.6%, respectively . Among the 3 temporal groups, differences were observed in terms of lesion stage, location and size, surgery with or without combined therapy and postoperative complications.Conclusion Best results were achieved in the early cases, with a resectability of 100% and a 5-year survival of 92.6% . The indications for surgical treatment were extended with increased resectability and decreased mortality. Subtotal esophagectomy combined with cervical esophagogastrostomy was advocated as the procedure of first choice for esophageal carcinoma in attempt to diminish the chance of recurrence, and to achieve better outcomes by using combined therapy for patients with e" stage b! lesion.

Surgical spacer placement and proton radiotherapy for unresectable hepatocellular carcinoma

Few potentially curative treatment options exist apart from hepatic resection for patients with huge hepatocellular carcinoma (HCC). Proton radiotherapy is a promising new modality which has an inherent antitumor effect against HCC. However, the application of proton radiotherapy for tumors adjacent to the gastrointestinal tract is restricted because the tolerance dose of the intestine is extremely low. A novel two-step treatment was developed with surgical spacer placement and subsequent proton radiotherapy to administer proton radiotherapy with curative intent. This report presents a case of a patient with a huge unresectable HCC treated by this method who achieved disease-free survival of more than 2 years. This new strategy may potentially be an innovative and standard therapy for unresectable HCC in the near future.

What is the best surgical procedure of transverse colon cancer?An evidence map and minireview

Colorectal cancers comprise a large percentage of tumors worldwide,and transverse colon cancer(TCC)is defined as tumors located between hepatic and splenic flexures.Due to the anatomy and embryology complexity,and lack of large randomized controlled trials,it is a challenge to standardize TCC surgery.In this study,the current situation of transverse/extended colectomy,robotic/laparoscopic/open surgery and complete mesocolic excision(CME)concept in TCC operations is discussed and a heatmap is conducted to show the evidence level and gap.In summary,transverse colectomy challenges the dogma of traditional extended colectomy,with similar oncological and prognostic outcomes.Compared with conventional open resection,laparoscopic and robotic surgery plays a more important role in both transverse colectomy and extended colectomy.The CME concept may contribute to the radical resection of TCC and adequate harvested lymph nodes.According to published studies,laparoscopic or robotic transverse colectomy based on the CME concept was the appropriate surgical procedure for TCC patients.

Surgical strategy for cerebral arteriovenous malformation with acute hemorrhage

BACKGROUND： Presently, there have been craniocerebral operation, interventional embolization,stereotactic radiotherapy and other methods in treating cerebral arteriovenous malformation （AVM）.However, the standard of different therapeutic regimens of cerebral AVM at the acute stage of hemorrhage has not been completely identified.OBJECTIVE： To observe the clinical characteristics and therapeutic effects of AVM at the acute stage of hemorrhage in patients, and to analyze corresponding therapeutic strategies.DESIGN： Non-randomized clinical observation.SETTING： Department of Neurosurgery, Foshan First People＇s Hospital, Sun Yat-sen University.PARTICIPANTS： Forty-six patients with cerebral AVM complicated by hemorrhage admitted to Department of Neurosurgery, Foshan First People＇s Hospital between January 1999 and December 2006,were involved in this study. All the patients were confirmed as cerebral AVM complicated by hemorrhage by brain angiography or/and postoperational pathology. The involved patients, 32 males and 14 females,averaged 25 years old, ranging from 6 to 62 years. Informed consents of therapeutic items were obtained from the relatives of all the patients.METHODS： ①On admission, skull CT and brain angiography were conducted in the involved subjects. ②The therapeutic method was confirmed according to the consciousness, hematoma region, hematoma volume,imageological results following comprehensive analysis： DSA examination was permitted to identify the size and position of abnormal vessel mass, and the distribution of feeding artery and draining vein. Craniocerebral operation was carried out as early as possible in patients with severe or progressive conscious disturbance, in which most of hematoma with obvious occupied effect or cerebral hernia was located in lobe of brain. The primary thing was to clean intracerebral hematoma for in time decompression. According to different situations, corresponding therapeutic measures were used for resecting abnormal vessel mass, and the treatments of patients were observed. ③The therapeutic effects were assessed following Glasgow outcome scale（GOS） at 3 months after hemorrhage.MAIN OUTCOME MEASURES： ①The examination results of skull CT and brain angiography of patients on admission. ②Treatment of patients. ③GOS results at 3 months after hemorrhage.RESULTS： Forty-six patients were involved, and all of them participated in the final analysis. ① Examination results of skull CT and brain angiography： Bleeding part： frontal lobe in 7 cases, parietal lobe 15, temporal lobe 19, occipital lobe 3, cerebellar hemisphere 2, and hemorrhage rupturing into ventricle 10. Haematoma volume： small volume of hematoma （〈20 mL） in 4 cases, moderate volume of hematoma （20 - 50 mL） 14, large volume of hematoma （ 50 - 80 mL） 21, great volume of hematoma （〉80 mL） 7; Abnormal vessel mass： Among 17 patients undergoing aortocranial angiography, abnormal vessel mass was found in 16 patients, including cortex 13 patients, basal ganglia and thalamencephalon（deep part） 2 patients, and posterior cranial fossa 1 patient. The size of abnormal vessel mass： small （〈3 cm） 4 patients, moderate （3 -6 cm） 9 patients, and large （〉6 cm） 3 patients. The type of feeding artery： perforating branch blood-supply 1 patient, cortical branch blood supply 13 patients, mixed branch blood supply 2 patients. The type of draining vein： cortical draining （superficial part） 10 patients, deep part draining 2 patients, and mixed draining 4 patients. ② Treatment condition： Among 17 patients undergoing brain angiography followed by craniocerebral operation, hematoma was removed and AVM was completely resected in 12 patients, hematoma was removed and AVM was partially resected in 3 patients, and only hematoma was resected in 2 patients; Among 24 patients undergoing emergent craniocerebral operation, hematoma was removed and AVM was completely resected in 5 patients, hematoma was removed and AVM was partially resected in 9 patients, and only hematoma was resected in 10 patients; Expectant treatment was carried out in the early stage in 5 patients. When disease condition was stable, AVM resection was separately or complicatedly conducted in 13 patients, embolization in 4 patients, and γ - radiotherapy in 5 patients. ③GOS： 5 patients died in postoperative complications, and among the other patients, 19 had moderate or had not functional impairment, 13 had moderate disability, 6 had severe disability, 2 were vegetative state, and 2 died. ④Post-operative re-examination of brain angiography： Among 16 patients undergoing AVM, vessel mass disappeared in 9 patients.CONCLUSION： Good therapeutic effects can be obtained by choosing proper therapeutic regimen according to clinical and imageological characteristics of patients with arteriovenous malformation complicated by hemorrhage at the acute stage.

Surgical treatment of chronic pancreatitis

Objective: To summarize the experience in the surgi- cal treatment of chronic pancreatitis. Methods: 189 patients with pancreatitis admitted from May 1983 to August 1999 to our hospital were reviewed. Results: 136 (72 %) patients received surgical treat- ment including pancreatoduodenectomy (15 pa- tients), distal pancreatectomy (12), internal drain- age of pancreatic pseudocyst (28), side-to-side pan- creaticojejunostomy (16), relief of biliary stenosis (58), and pancreatic biopsy (7). Pain was relieved in 97.8 % of the patients, and the complication rate was 1.5%. Conclusions: It is crucial to select various surgical strategies at a proper time for chronic pancreatitis patients. Patients with chronic pancreatitis compli- cated by dilation or obstruction of the pancreatic duct or with biliary pancreatitis should be operated on in early stages, whereas those with other types of chronic pancreatitis should receive the therapy focu- sing on the alleviation of their symptoms, not on ear- ly surgical intervention. The timing and modality of surgery are important in improving the life quality of the patients and changing their natural history of the disease.

Surgical treatment effects in cancer of the cardia and esophagogastric junction

Objective： To evaluate the treatment effects of total gastrectomy （TG） and proximal gastrectomy （PG） for cancer of the cardia and esophagogastric junction. Methods： forty-five patients with cancer of the cardia and esophagogastric junction underwent surgical resection. Of them, 29 were treated using proximal gastrectomy and 16 total gastrectomy. The 3-year and 5-year survival rate and the postoperative complication rate and mortality rate were followed up and compared between the two groups. Results： The 3-year and 5-year survival rates of group PG were 44.8% and 20.7%, of group TG were 37.5% and 18.8%, respectively, and the differences were not statistically significant （X^2= 3.84, P 〉 0.05; X^2= 3.89, P 〉 0.05）. The postoperative complication and mortality rate of group PG were 13.7% and 6.8%, of group TG was all 6%, respectively. Conclusion： Proximal and total gastrectomy treatment effects can not significantly influence the prognosis of patients in progressive stage of cancer of cardia and esophagogastric junction.

Feasibility and safety of minimally invasive multivisceral resection for T4b rectal cancer:A 9-year review

BACKGROUND Colorectal cancer is the third most common cancer and the second highest cause of cancer-related mortality worldwide.About 5%-10%of patients are diagnosed with locally advanced rectal cancer(LARC)on presentation.For LARC invading into other structures(i.e.T4b),multivisceral resection(MVR)and/or pelvic ex-enteration(PE)remains the only potential curative surgical treatment.MVR and/or PE is a major and complex surgery with high post-operative morbidity.Minimally invasive surgery(MIS)has been shown to improve short-term post-operative outcomes in other gastrointestinal malignancies,but there is little evi-dence on its use in MVR,especially so for robotic MVR.This is a single-center retrospective cohort study from 1st January 2015 to 31st March 2023.Inclusion criteria were patients diagnosed with cT4b rectal cancer and underwent MVR,or stage 4 disease with resectable systemic metastases.Pa-tients who underwent curative MVR for locally recurrent rectal cancer,or me-tachronous rectal cancer were also included.Exclusion criteria were patients with systemic metastases with non-resectable disease.All patients planned for elective surgery were enrolled into the standard enhanced recovery after surgery pathway with standard peri-operative management for colorectal surgery.Complex sur-gery was defined based on technical difficulty of surgery(i.e.total PE,bladder-sparing prostatectomy,pelvic lymph node dissection or need for flap creation).Our primary outcomes were the margin status,and complication rates.Cate-gorical values were described as percentages and analysed by the chi-square test.Continuous variables were expressed as median(range)and analysed by Mann-Whitney U test.Cumulative overall survival(OS)and recurrence-free survival(RFS)were analysed using Kaplan-Meier estimates with life table analysis.Log-rank test was performed to determine statistical significance between cumulative estimates.Statistical significance was defined as P<0.05.Meier estimates with life table analysis.Log-rank test was performed to determine statistical significance between cumulative estimates.Statistical significance was defined as P<0.05.RESULTS A total of 46 patients were included in this study[open MVR(oMVR):12(26.1%),miMVR:36(73.9%)].Patients’American Society of Anesthesiologists score,body mass index and co-morbidities were comparable between oMVR and miMVR.There is an increasing trend towards robotic MVR from 2015 to 2023.MiMVR was associated with lower estimated blood loss(EBL)(median 450 vs 1200 mL,P=0.008),major morbidity(14.7%vs 50.0%,P=0.014),post-operative intra-abdominal collections(11.8%vs 50.0%,P=0.006),post-operative ileus(32.4%vs 66.7%,P=0.04)and surgical site infection(11.8%vs 50.0%,P=0.006)compared with oMVR.Length of stay was also shorter for miMVR compared with oMVR(median 10 vs 30 d,P=0.001).Oncological outcomes-R0 resection,recurrence,OS and RFS were comparable between miMVR and oMVR.There was no 30-d mortality.More patients underwent robotic compared with laparoscopic MVR for complex cases(robotic 57.1%vs laparoscopic 7.7%,P=0.004).The operating time was longer for robotic compared with laparoscopic MVR[robotic:602(400-900)min,laparoscopic:Median 455(275-675)min,P<0.001].Incidence of R0 resection was similar(laparoscopic:84.6%vs robotic:76.2%,P=0.555).Overall complication rates,major morbidity rates and 30-d readmission rates were similar between la-paroscopic and robotic MVR.Interestingly,3-year OS(robotic 83.1%vs 58.6%,P=0.008)and RFS(robotic 72.9%vs 34.3%,P=0.002)was superior for robotic compared with laparoscopic MVR.CONCLUSION MiMVR had lower post-operative complications compared to oMVR.Robotic MVR was also safe,with acceptable post-operative complication rates.Prospective studies should be conducted to compare short-term and long-term outcomes between robotic vs laparoscopic MVR.

Safety and efficacy of wireless capsule endoscopy in patients with surgically altered upper gastrointestinal anatomy

Background:Wireless capsule endoscopy(WCE)is an effective,minimally invasive tool used for evaluation of the small intestine.To date,there are no studies evaluating the diagnostic yield of WCE in patients with surgically altered upper gastrointestinal anatomy.Aim:To evaluate the diagnostic yield,technical success and safety of WCE in patients with surgically altered upper gastrointestinal anatomy.Methods:Retrospective chart review of all patients with surgically altered upper GI anatomy who underwent WCE between 2006 and 2016 at the Medical University of South Carolina.Technical success,diagnostic yield,adverse events and therapeutic yield data was collected.Results:Thirty-one cases met inclusion criteria.Two were excluded as they did not undergo WCE due to failed patency capsule.The mean age was 58(69%female).The capsule was ingested in 18 cases and endoscopically placed in 11.The most common surgical anatomy was Roux-en-Y gastric bypass(n=13).Technical success,defined as the capsule reaching the cecum,was achieved in 89.7%of cases.The diagnostic yield was 44.8%,with the most common finding being angioectasia.No intra-or postprocedural adverse events were noted.Discussion:Capsule endoscopy in patients with surgically altered upper GI anatomy appears to show no elevated risk of adverse events and shows similar technical success and diagnostic yield as in patients with native anatomy.

低温等离子治疗儿童鼻咽部第二鳃裂囊肿分析

目的探讨儿童鼻咽部第二鳃裂囊肿的临床特征和治疗方式,提高诊治能力。方法回顾性分析河北省儿童医院收治的4例儿童鼻咽部第二鳃裂囊肿的临床资料,包括年龄、性别、症状、影像学资料和治疗过程。总结分析病变部位特点,B超、CT或MRI特征,术后病理结果及治疗方式。结果4例鼻咽部第二鳃裂囊肿患儿均表现为鼻咽侧壁咽鼓管咽口与腭咽弓后上方连线上的囊性肿物,囊壁较厚,影像学检查结果均为囊性病变。4例患儿选择内镜下低温等离子病变切除术,其中2例为内侧囊壁大部分切除术,将囊腔充分敞开,2例为囊肿全部切除术。术后病理提示衬覆纤毛柱状上皮或复层上皮,周围淋巴组织增生。术后随访1.5~3年无复发。结论儿童鼻咽部第二鳃裂囊肿临床罕见,诊断主要依靠病变部位及术后病理结果,内镜下低温等离子切除病变组织是微创、安全、有效的治疗方式。

Surgical management of 143 patients with adult primary retroperitoneal tumor

AIM： To analyze the surgical management of adult primary retroperitoneal tumors （APRT） and the factors influencing the outcome after operation. METHODS： Data of 143 cases of APRT from 1990 to 2003 in the First Affiliated Hospital of China Hedical University were evaluated retrospectively. RESULTS： A total of 143 cases of APRT were treated surgically. Among them, 122 （85.3%） underwent complete resection, 16 （11.2%） incomplete resection, and 3 （3%） surgical biopsies. Twenty-nine （20.2%） underwent tumor resection plus multiple organ resections. Ninety-five malignant cases were followed up for 1 mo to 5 years. The 1-year, 3-year, and 5-year survival rates of the patients subject to complete resection was 94.9%, 76.6% and 34.3% and that of patients with incomplete resection was 80.4%, 6.7%, and 0%, respectively （P 〈 0.001）. The Cox multi-various regression analysis showed the completeness of tumor, sex and histological type were associated closely with local recurrence. CONCLUSION： Sufficient preoperative preparation and complete tumor resection play important roles in redudng recurrence and improving survival.