内镜直视硬化与外科脾切除门奇断流手术治疗肝硬化食管胃底曲张静脉破裂出血疗效观察

目的:探讨内窥镜硬化治疗术与外科脾切除加门奇断流手术治疗肝炎肝硬化食管胃底曲张静脉破裂出血的效果。方法:对两组出院病人进行持续跟踪治疗并观察两组患者再出血发生率、5年存活率。结果:内镜治疗组复发出血率36.4%,明显高于外科手术组9.6%,内镜治疗组五年生存率(52.71%)与外科治疗组(63.46%)比较无显著差异(P>0.05)。结论:内镜治疗和外科手术治疗,均能达到较好止血效果,提高患者五年存活率。

缝扎切除术治疗巨大尖锐湿疣36例

巨大尖锐湿疣治疗，药物、激光、冷冻等常不能彻底去除疣体，且创面大、出血多，复发率高。因此根据其组织病理特点．我科于2005—2011年应用缝扎功除术治疗巨大尖锐湿疣36例，疗效满意，报道如下。

胃癌根治术中系统性扩大淋巴结切除术

1982年我院按日本习用方法施行胃癌根治性扩大淋巴结切除术,现将远期结果分析如下: 1982～1989年共358例胃癌中,226例作系统性扩大淋巴结切除术(SELD),占63.1%,而1987～1989年84%(157/187)病例施行 SELD,显示用SELD 病例显著增加。所有病例中,70.

Expression of tumor necrosis factor-alpha converting enzyme in liver regeneration after partial hepatectomy

AIM:To study the expression of tumor necrosis factor- alpha converting enzyme (TACE) and evaluate its significance in liver regeneration after partial hepatectomy in vivo. METHODS: Male SD rats underwent 70% partial hepatec- tomy. The remaining liver and spleen tissue samples were collected at indicated time points after hepatectomy. TACE expression was investigated by Western blotting, immunohistochemistry, and serial section immunostaining. RESULTS: Expression of TACE in liver and spleen tissues after partial hepatectomy was a time-dependent alteration, reaching a maximal level between 24 and 48 h and remaining elevated for more than 168 h. TACE protein was localized to mononuclear cells (MNC), which infiltrated the liver from the spleen after hepatectomy. The kinetics of TACE expression was in accordance with the number of TACE-staining MNCs and synchronized with those of transforming growth factor-α (TGFα). In addition, TACE-staining MNC partially overlapped with CD3+ T lymphocytes. CONCLUSION: TACE may be involved in liver regenera- tion by pathway mediated with TGFα-EGFR in the cell- cycle progressive phase in vivo. TACE production and effect by paracrine may be a pathway of involvement in liver regeneration for the activated CD3+ T lymphocytes.

Effects of Acute Normovolemic Hemodilution on Perioperative Coagulation and Fibrinolysis in Elderly Patients Undergoing Hepatic Carcinectomy

Objective To observe the effects of acute normovolemic hemodilution （ANH） on coagulation function and fibrinolysis in elderly patients undergoing hepatic carcinectomy. Methods Thirty elderly patients （aged 60-70 years） with liver cancer （American Society of Anesthesiologists physical status I-II） scheduled for hepatic carcinectomy from February 2007 to February 2008 were randomly divided into ANH group （n= 15） and control group （n= 15）. After tracheal intubation, patients in ANH group and control group were infused with 6% hydroxyethyl starch （HES） （130/0.4）, and basic liquid containing 6% HES and routine Ringer＇s solution, respectively. In all the studied patients, blood samples were drawn at five different time points： before anesthesia induction （T1）, 30 minutes after ANH （T2）, 1 hour after start of operation （T3）, immediately after operation （T4）, and 24 hours after operation （Ts）. Then co- agulation function, soluble fibrin monomer complex （SFMC）, prothrombin fragment （F1＋2）, and platelet membrane glycoprotein （activated GPIIb/GPIIIa and P-selectin） were measured. Results The perioperative blood loss was not significantly different between the two groups （P〉 0.05）. The volume of allogeneic blood transfusion in ANH group was significantly smaller than that in control group （350.5±70.7 mL vs. 457.8±181.3 mL, P〈0.01）. Compared with the data ofT1, prothrombin time （PT） and activated partial thromboplastin time in both groups prolonged significantly after T3 （P〈0.05）, but still within normal range. There were no significant changes in thrombin time and D-dimer between the two groups and between different time points in each group （all P〉0.05）. SFMC and F1 ＋2 increased in both groups, but without statistical significance. P-selectin expression on the platelet surface of ANH group was significantly lowered atT2 andT3 compared with the level atT1 （P〈 0.05）. Compared with control group, P-selectin was sig-nificantly lower in ANH group atT2-T3 （all P〈0.05）. Conclusions In elderly patients undergoing resection of liver cancer, ANH may not hamper fibri- nolvsis and coagulation function. It coukt therefore be safe to largely reduce allogeneic blood transfusion.

Antiviral therapy for hepatitis B virus-related hepatocellular carcinoma after radical hepatectomy

Objective： To assess the effect of antiviral therapy for hepatitis B virus （HBV）-related hepatocellular carcinoma （HCC） after radical hepatectomy. Methods： A total of 478 HBV-related HCC patients treated by radical hepatectomy were retrospectively collected. Patients in the treatment group （n=141） received postoperative lamivudine treatment （100 rag/d）, whereas patients in the control group （n=337） did not. Recurrence-free survival （RFS） rates, overall survival （OS） rates, treatments for recurrent HCC and cause of death were compared between the two groups. Propensity score matching （PSM） analysis was also conducted to reduce confounding bias between the two groups. Results： The 1-, 3-, and 5-year RFS rates didn＇t significantly differ between the two groups （P=0.778）; however, the 1-, 3-, and 5-year OS rates in the treatment group were significantly higher than those in the control group （P=0.002）. Similar results were observed in the matched data. Subgroup analysis showed that antiviral treatment conferred a significant survival benefit for Barcelona Clinical Liver Cancer stage A/B patients. Following HCC recurrence, more people in the treatment group were able to choose curative treatments than those in the control group （P=0.031）. For cause of death, fewer people in the treatment group died of liver failure than those in the control group （P=0.041）. Conclusion： Postoperative antiviral therapy increases chances of receiving curative treatments for recurrent HCC and prevents death because of liver failure, thereby significantly prolonging OS, especially in early- or intermedian-stage tumors.

Effect of controlled low central venous pressure on renal function in major liver resection

Objective： To investigate the effects of low central venous pressure （LVCP） on blood loss and evaluate its influence on renal function in patients undergoing hepatectomy. Methods： Forty-six patients, ASA classification Ⅰ-Ⅲ, undergoing liver resection were randomized into LCVP group （n = 23） and control group （n = 23）. In LCVP group, CVP was maintained at 2-4 mmHg and MBP above 60 mmHg during hepatectomy, while in control group hepatectomy was performed routinely without lowering CVP. Volume of blood loss during hepatectomy, volume of blood transfusion, and changes of renal functions were compared between the two groups. Results： There were no significant differences in demographics, ASA score, type of hepatectomy, duration of inflow occlusion, operation time, weight of resected liver tissues, and renal functions between the two groups. LCVP group had a significantly lower volume of total intraoperative blood loss （P 〈 0.01） and RBC transfusion （P 〈 0.05）. Conclusion： Lowering the CVP to less than 5 mmHg is a simple and effective technique to reduce blood loss and blood infusion during liver resection, and has no detrimental effects on renal functions.

Intraoperative awake anesthesia applied for tumor excision in cerebral functional areas

Objective:To observe the feasibility and safety of awake anesthesia for tumor excisions in pa- tients with brain tumors involving cerebral functional areas.Methods:Fifty patients with brain tumors in- volving cerebral functional areas,ASAⅠ-Ⅱgrade,were enrolled in this study.Propofol and remifentanil were used for total intravenous anesthesia,and a laryngeal mask airway(LMA)was inserted for the air- way opening and synchronized intermittent mandatory ventilation(SIMV).At the surgeon's request for an intraoperative wake-up test,the propofol infusion was stopped advance of 10-15 min,the remifentanil in- fusion rate was decreased to 0.050-0.075μg/kg from 0.10-0.20μg/kg per min for easing surgical pain. The LMA was removed until the patient awakened.The anesthesiologist then kept up an on-going neuro- logical examination.After that,anesthesia was re-deepened and LMA was re-inserted until the whole surgery was accomplished.Results:Forty-six of 50 patients(92%)were successfully awakened and 4 (8%)failed to complete the intraoperative wake-up test because of dyspnea,over-sedation,or severe hy pertension.No severe complications occurred during the whole process.Conclusions:During the awake anesthetic period,the intraoperative wake-up test combined with navigation,evoked potential and ultra- sound techniques can help surgeons excise maximumly and precisely the brain tumors near to or in the functional areas.

Surgical Treatment and Prognosis of Synchronous Double Primary Lung Cancer： a Report of 31 Cases

OBJECTIVE The concept of double primary lung cancer （DPLC） has been generally accepted. Recently, an increasing incidence of synchronous DPLC has been reported, while the diagnostic standard and treatment strategies remain to be improved. This study was conducted to investigate effective surgical treatment and prognosis of synchronous DPLC. METHODS From January 1983 to April 2004, 31 patients with synchronous DPLC were operated in our department. Clinical data, such as surgical pattern, postoperative complications, and survival status, of all these patients were reviewed retrospectively. RESULTS The 31 patients with synchronous DPLC accounted for 0.67% of all the 4,649 patients operated for primary lung cancer in our department during the same period. Both tumors of the synchronous DPLC were resected with Iobectomy or pneumonectomy in 12 patients, while among the other 19 patients at least 1 tumor was treated with partial pulmonary resection. The postoperative morbidity was 29%（9/31）, including 1 case of respiratory insufficiency, 3 cases of atelectasis, 2 cases of atrial fibrillation, 1 case of haemoptysis, 1 case of pleural effusion, and 1 case of wound fat necrosis. No deaths occurred during the operations or within 30 days postoperatively. The postoperative 1 -, 3-, and 5-year survival rates were 52%, 29%, and 20%, respectively. CONCLUSION The incidence of synchronous DPLC is low. An aggressive and reasonable surgical approach can achieve a satisfactory outcome in patients with synchronous DPLC. The postoperative morbidity is low. Some patients might achieve long-term survival.

Predictive factors for liver dysfunction and failure after hepatectomy:Analysis of 467 patients with hepatocellular carcinoma

Objective： The aim of our study was to analyze hepatic dysfunction and failure after hepatocellular carcinoma （HCC） resection and relationship of clinical and pathological factors. Methods： Clinical and pathological data of 467 HCC patients was retrospectively reviewed, who underwent liver resection from January 2002 to December 2008 in the Affiliated Hospital of Medical College, Qingdao University, and the post-resectional liver dysfunction and failure risk factors were analyzed by univariate and multivariate analysis. Results： The morbidity of post-resectional liver dysfunction and failure was 1.7% and 2.1%. The post-resectional liver dysfunction and failure after HCC hepatectomy into the statistical analysis： univariate analysis revealed preoperative platelet level （〈 100 × 10^9）, serum albumin level （〈 35 g/L）, serum gamma-Glutamyl transferase （〉 64 U/L）, Child-Pugh classification （B）, MELD score （≥ 9）, intraoperative bleeding （-〉 1000 mL）, blood transfusion were positive factors, multivariate analysis （Logistic） revealed that preoperative platelet level （0.983, 95% CI = 0.971-0.995） and intraoperative blood transfusion （3.145, 95% CI = 1.027-12.028） were independent risk factors for post-resectional liver dysfunction and failure. Conclusion： Prevented liver failure and liver dysfunction occurring after liver resection, it is the key to accurate preoperative assessment of liver function and the patient＇s reserved liver functional, precise hepatectomy and reasonable blockage of hepatic inflow.

Laparoscopic rectal cancer surgery: Where do we stand?

Large comparative studies and multiple prospective randomized control trials (RCTs) have reported equivalence in short and long-term outcomes between the open and laparoscopic approaches for the surgical treatment of colon cancer which has heralded widespread acceptance for laparoscopic resection of colon cancer. In contrast, laparoscopic total mesorectal excision (TME) for the treatment of rectal cancer has been welcomed with significantly less enthusiasm. While it is likely that patients with rectal cancer will experience the same benefits of early recovery and decreased postoperative pain from the laparoscopic approach, whether the same oncologic clearance, specifically an adequate TME can be obtained is of concern. The aim of the current study is to review the current level of evidence in the literature on laparoscopic rectal cancer surgery with regard to short-term and long-term oncologic outcomes. The data from 8 RCTs, 3 metaanalyses, and 2 Cochrane Database of Systematic Reviews was reviewed. Current data suggests that laparoscopic rectal cancer resection may benefit patients with reduced blood loss, earlier return of bowel function, and shorter hospital length of stay. Concerns that laparoscopic rectal cancer surgery compromises short-term oncologic outcomes including number of lymph nodes retrieved and circumferential resection margin and jeopardizes long-term oncologic outcomes has not conclusively been refuted by the available literature. Laparoscopic rectal cancer resection is feasible but whether or not it compromises short-term or long-term results still needs to be further studied.

Analysis of results of two kinds of hemi-pelvic arthroplasty after wide resection of pelvic tumors

Objective The Patients with pelvic tumors were treated with tumor resection,hemi-pelvic allografting or artificial hemi-pelvic replacement for the improvement of their life quality.Methods Seven cases of pelvic tumor were treated with wide resection and hemi-pelvic allografting,and 35 cases with resection of pelvic tumors and artificial hemi-pelvic replacement.Results These 42 cases were all successfully operated upon without operative mortality.The results of long term following-up of 2.5 to 12 years(mean 5.4 years)showed that the increased and satisfactory functional recovery(50.0%).Conclusion Hemi-pelvic allografting or artificial hemi-pelvic replacement after wide resection of pelvic tumors can improve the survival rate of patients,as well as reconstruction of the pelvis and the hip joint with satisfactory function.

Patient-controlled intravenous fentanyl for cystospasm after transurethral resection of the prostate

Objective： To evaluate the clinical efficacy and safety of patient-controlled intravenous analgesia （PCIA） with fentanyl for cystospasm after transurethral resection of the prostate. Methods： Sixty benign prostatic hyperplasia （BPH） patients scheduled for transurethral resection of the prostate （TURP） under general anesthesia with laryngeal mask airway （LMA） were randomly divided into groups F and S. Group F （n=30） received PCIA device with fentanyl 10 ug/kg＋8 mg ondansetron, and Group S （n=30） received placebo （PCIA device with 8 mg ondansetron）. The visual analog scale （VAS） scores for pain were evaluated at 0, 2, 4, 8, 16, 24, and 48 h by the same staff. And recorded were incidence of cystospasm, side effects, application of hemostatic, duration of drawing Foley catheter and continuous bladder irrigation, time of exhaust after operation, time of post-operative stay and cost of hospitalization. Results： The incidence of cystospasm in Group F was significantly lower than that in Group S in the 48 h after operation （P〈0.05）, the VAS scores for pain in Group F was significantly lower than that in Group S within the 48 h after operation （P〈0.01）. The time of exhaust after operation in Group F was significantly later than in Group S （P〈0.05）. No significant difference was observed in applications of hemostatic, duration of drawing Foley catheter, duration of continuous bladder irrigation, time of post-operative stay and cost of hospitalization between the 2 groups. Conclusion： PCIA with fentanyl （10 ug/kg） relieves pain with little side effect and reduces cystospasm satisfactorily.

Reconstruction of laryngeal function in subtotal laryngectomy with preservation of monoarytenoid cartilage

Objective: To evaluate subtotal laryngectomy with preservation of monoarytenoid cartilage to re-construct laryngeal function in the treatment of advanced laryngeal cancer. Methods: We retrospectively re-viewed 48 patients with advanced laryngeal cancer (T3 or T4 on the primary site) treated by subtotal laryngec-tomy with preservation of monoarytenoid cartilage to reconstruct laryngeal function. Eighteen of them under-went neck dissection. Ipsilateral recurrent laryngeal nerve was preserved during this surgery. The cricoid cartilage was anastomosed to hypopharynx accordingly. Results: The overall 3- and 5-year survival rates were 81.25% (39/45) and 66% 67% (32/48), respectively. All patients had good phonation and swallowing function after surgery. Decannulation rate was 93. 75%. Conclusion: Subtotal laryngectomy with preserva-tion of monoarytenoid cartilage is satisfactory for treatment of elected advanced laryngeal cancers. The effect of this surgery is more satisfactory than that of the near-total laryngectomy (Pearson''s technic).

INFLUENCE OF ALLOFERIN ON NEUROMUSCULAR FUNCTION IN MYASTHENIA PATIENTS UNDERGOING THYMECTOMY

Myasthenia gravis patients are hypersensitive to nondepolarizing relaxants, such as alcuronium, an intermediate-long nondepolarizing agent. This study observed the effects of alcuronium treatment in myasthenia gravis patients as compared with non-MG patients during operation. Ten MG patients (Ossermann class I - IV, scheduled for thymectomy) and 10 non-MG patients (ASA class I-Ⅱ, scheduled for operation) were selected. An induction dose of alcuronium 0. 2 mg/kg and thiopental 4-6 mg/kg was given , followed by intubation and ventilation with 50% nitrous oxide in oxygen and 0.5-1. 5% ethrane. Neuromuscular transmission was monitored using an accelerogragh and degrees of neuromuscular function at different depths were recorded. There were statistically significant differences between the two groups. The effect of alloferin in the MG group was quicker and deeper.This study also found a relation between MG class and the recovery of respiration: Respiratory recovery was quicker in classes I-Ⅱthan in classes Ⅲ-Ⅳ.

Simultaneous bile duct and portal venous branch ligation in two-stage hepatectomy

Hepatectomy is an effective surgical treatment for multiple bilobar liver metastases from colon cancer;however,one of the primary obstacles to completing surgical resection for these cases is an insufficient volume of the future remnant liver,which may cause postoperative liver failure.To induce atrophy of the unilateral lobe and hypertrophy of the future remnant liver,procedures to occlude the portal vein have been conventionally used prior to major hepatectomy.We report a case of a 50-year-old woman in whom two-stage hepatectomy was performed in combination with intraoperative ligation of the portal vein and the bile duct of the right hepatic lobe.This procedure was designed to promote the atrophic effect on the right hepatic lobe more effectively than the conventional technique,and to the best of our knowledge,it was used for the first time in the present case.Despite successful induction of liver volume shift as well as the following procedure,the patient died of subsequent liver failure after developing recurrent tumors.We discuss the first case in which simultaneous ligation of the portal vein and the biliary system was successfully applied as part of the first step of two-stage hepatectomy.

CASTLEMAN＇S DISEASE OF THE ABDOMINAL REGION IN ADOLESCENT

Objective To describe the CT features of abdominal Castleman's disease(CD)in adolescent.Methods Abdomen CT of four adolescents ranging in age from 7 years to 17 years diagnosed as abdominal region CD were reviewed.One case was retroperitoneal CD;one case was lesser omentum CD;and the other two cases were mesenteric CD.Three of four cases underwent post enhancement,and one case was only done no contrast CT as the reason of media hypersusceptibility.One case underwent needle biopsy.Three cases were removed by surgical resection.Results Isolated or multiple well-defined homogenous masses with homogenously enhanced after underwent enhancement was the common finding in these four cases.Conclusion Recognition of the CT features and highlights the histological specimen of CD is helpful to diagnose CD.

Laparoscopic surgery in endometrial carcinoma staging operation:analysis of 39 cases

Objective:The purpose of our study was to investigate the feasibility and short-term therapeutic effects of laparoscopic staging operation in women with endometrial carcinoma.Methods:We analyzed 86 patients with endometrial carcinoma in PLA general hospital between 2006 and 2009 retrospectively.Thirty-nine patients were performed laparoscopic modified radical hysterectomy plus systemic retroperitoneal lymphadenectomy.Forty-seven patients received traditional abdominal radical hysterectomy plus systemic retroperitoneal lymphadenectomy.We compared the operation time,blood loss,number of lymph nodes retrieved,time for restoration of gastrointestinal function,postoperative complications and morbidity,the incidence of wound infection,the length of hospital stay,and hospital charges.Results:There was no significant deviation between the two groups in age,clinical stage,and pathology.We found that there was no significant deviation between the two groups in the number of lymph nodes retrieved,postoperative complications,the rate of wound infection or hospital charge(P > 0.05).The laparoscopic group had an advantage in blood loss,time for restoration of gastrointestinal function,time for postoperative hospital stay(P < 0.05).Conclusion:Laparoscopic surgery,as a primary surgical intervention,seems to be a safe and feasible option especially in patients with early endometrial cancer.

Clinical observation on functional gastrointestinal motility disorder of postoperation of gastrointestinal tumor treated with electroacupuncture

Objective To observe the effects on functional gastrointestinal motility disorder of postoperation of gastrointestinal tumor treated with electroacupuncture. Methods Twenty-nine cases of functional gastrointestinal motility disorder of postoperation of gastrointestinal tumor were randomized into electroacupuncture group （19 cases） and control group （10 cases）. In electroacupuncture group, routine treatment after gastrointestinal operation and electroacupucture treatment were applied, Zusanli （足三里 ST 36）, Shangjuxu （上巨虚 ST 37）, Xiajuxu （下巨虚 ST 39） and Hegu （合谷 LI 4） were applied with electroacupuncture; in control group, the routine treatment after gastrointestinal operation was only applied. Anus exhaust, defecation, abdominal distension, stomachache, amount of gastrointestinal decompression drainage and changes of borborygmus were observed in two groups. Results Anus exhaust, defecation, abdominal distension, stomachache, amount of gastrointestinal decompression drainage and changes of borborygmus were relieved in two groups; and the effects of abdominal distension, anus exhaust, defecation, amount of gastrointestinal decompression drainage and borborygmus in electroacupuncture group were superior to those in control group （all P〈0.05）. Conclusion For the functional gastrointestinal motility disorder of postoperation of gastrointestinal tumor, the theraputic effect of electroacupuncture combined with routine treatment after operation is better than the routine treatment after operation.

Preservation of laryngeal function in treatment of hypopharyngeal carcinoma

OBJECTIVE: To study the surgical technique and results of laryngeal function preservation in treatment of hypopharyngeal carcinoma. METHODS: A retrospective review of 305 patients with malignant neoplasms of the hypopharynx (279 males, 26 females, age ranging from 14 to 77 years) was performed from 1978 to 1996. In the 305 patients (stage I, n = 6; stage II, n = 12; stage III, n = 82; stage IV, n = 205), the sites of origin were pyriform sinus (n = 234), postcricoid (n = 21), posterior pharyngeal wall (n = 35) and superior hypopharynx (n = 15). Of the 305 patients, 206 (67.54%, stage I, n = 6; stage II, n = 12; stage III, n = 65; stage IV, n = 123) were surgically treated with laryngeal function preserved and 99 (32.46%, stage III, n = 17; stage IV, n = 82) had no laryngeal function preserved.All had 55-75 Gy radiotherapy according to their need. RESULTS: A total of 206 patients (67.54%) were surgically treated with laryngeal function preserved, totally (voice, respiration and deglutition) in 139 (67.5%) and partially (voice and deglutition) in 67 (32.5%). 99 patients (32.46%) had no laryngeal function preserved. The overall 5-year survival rate of the 305 patients was 44.8%, which segregated to 83% (stage I), 71% (stage II), 58% (stage III), and 36% (stage IV). The 5-year survival of the laryngeal function preserved group was 48% (n = 66), the rate of complications 28% (n = 58) and the rate of residual tumor 5.8% (n = 12), compared with the no laryngeal function preserved group 37% (n = 20), 31.3% (n = 31), and 6% (n = 6) (P > 0.05). CONCLUSION: Only a small proportion of patients (31/305, 10%) with hypopharyngeal carcinoma who require total laryngectomy and preservation of the laryngeal function is feasible for eradication of tumor and preservation of laryngeal function.