Prognostic analysis of surgical treatment of peripheral cholangiocarcinoma: Two decades of experience at Chang Gung Memorial Hospital

AIM: To analyze the prognostic factors influencing the overall survival of peripheral cholangiocarcinoma (PCC) patients undergoing surgical treatment during 25 years at a single institution. METHODS: This study retrospectively reviewed prospectively collecting data about 373 patients with historically proven PCC who underwent surgical treatment between 1977 and 2001. RESULTS: Three hundred and seventy-three PCC patients (159 men and 214 women) underwent surgical treatment from 1977 to 2001. Among them, 187 PCC patients underwent hepatectomy and 135 had curative resection (curative resectability rate: 36.2%). The follow-up duration ranged from 1.05 to 167.6 mo (mean/median = 14.1/7.2 mo). Overall cumulative survival rates at 1, 3, and 5 years were 32.5%, 9.2%, and 4.1%, respectively. Univariate log-rank analysis identified the following as adverse influences on overall survival: presence of symptoms, absence of mucobilia, elevated CEA and CA 19-9 levels, non-papillary tumor type, receiving non-hepatectomy, advanced tumor staging, lack of post-operative chemotherapy, and radiotherapy. Meanwhile, multivariate Cox's proportional hazard analysis demonstrated that absence of mucobilia, non-papillary tumor type, advanced tumor staging, non-hepatectomy, and lack of post-operative chemotherapy were the five independent prognostic factors that adversely affected overall survival. CONCLUSION: Favorable overall survival of PCC patients undergoing surgical treatment depends on early tumor stage, presence of mucobilia, papillary tumor type, hepatic resection, and post-operative chemotherapy.

Alteration of peripheral blood lymphocyte subsets in acute pancreatitis

AIM： To evaluate peripheral blood lymphocyte subsets in patients with acute pancreatitis （AP）. METHODS： Twenty patients with mild AP （M-AP） and 15 with severe AP （SAP） were included in our study. Peripheral blood lymphocytes were examined at d 1-3, 5, 10 and 30 by means of flow cytometry. RESULTS： A significant depletion of circulating lymphocytes was found in AP. In the early AP, the magnitude of depletion was similar for T- and B- lymphocytes. In the late course of S-AP, B-lymphocytes were much more depleted than T-lymphocytes. At d 10, strong shift in the CD7＋/CD19＋ ratio implicating predominance of T- over B-lymphocytes in S-AP was found. Among T-lymphocytes, the significant depletion of the CD4＋ population was observed in M-AP and S-AP, while CDS＋ cells were in the normal range. Lymphocytes were found to strongly express activation markers： CD69, CD25, CD28, CD38 and CD122. Serum interleukin-2 （IL-2）, IL-4, IL-5, IL-10, interferon-γ （IFN-γ） and tumor necrosis factor-α （TNF-α） levels were significantly increased in both forms of AP. The magnitude of elevation of cytokines known to be produced by Th2 was much higher than cytokines produced by Th1 cells. CONCLUSION： AP in humans is characterized by significant reduction of peripheral blood T- and B-lymphocytes.

Congenital H-type anovestibuler fistula

The congenital H-type fistula between the anorectum and genital tract besides a normal anus is a rare entity in the spectrum of anorectal anomalies. We described a girl with an anovestibuler H-type fistula and left vulvar abscess. A 40-day-old girl presented symptoms after her parents noted the presence of stool at the vestibulum. On the physical examination, anus was in normal location and size, and had normal sphincter tone. A vestibuler opening was seen in the midline just below of the hymen. A fistulous communication was found between the vestibuler opening and the anus, just above the dentate line. There was a vulvar abscess which had a left lateral vulvar drainage opening 15 mm left lateral to the perineum. After the management of local inflammation and abscess, the patient was operated for primary repair of the fistula. A protective colostomy wasn′t performed prior the operation. A profuse diarrhea started after 5 hours of postoperation. After the diarrhea, a recurrent fistula was occurred on the second postoperative day. A divided sigmoid colostomy was performed. 2 months later, and anterior sagital anorectoplasty was reconstructed and colostomy was closed 1 month later. Various surgical techniques with or without protective colostomy have been described for double termination repair. But there is no consensus regarding surgical management of double termination.

CLINICAL ANALYSIS ON INTEGRATED TREATMENT OF 2240 CASES OF PERIPHERAL FACIAL PARALYSIS BY STAGES IN PLATEAU REGION

Objective. To observe the therapeutic effect of integrated treatment of peripheral facial paralysis by stages in Qinghai plateau area. Methods： A total of 2 240 cases of peripheral facial paralysis treated with integrated approaches by stages were assigned to treatment group, and other 75 cases treated with acupuncture therapy assigned to control group. In treatment group, patients were treated with 1 ） medication （ Prednisone, Dipazol, etc） and TDP （“special electromagnetic spectrum”） plus ultrashort irradiation in the early stage;2） TDP plus ultrasonic wave irradiation and acupuncture of Yangbai （阳白 GB 14） to Yuyac （鱼腰EX-HN 4, penetration needling）, etc in the medium stage; 3） medium-frequency irradiation and electroacupuncture （EA） of muscle motor joints and acupoints （GB-14, etc）. Patients of control group were treated with conventional acupuncture therapy （GB-14, etc）. Results： After treatment, of the 2 240 patients in treatment group, 2 072 （92.5%） were cured, 120 （5.3%） effective, 33 （ 1.5% ） improved, and 15 （0.7%） failed. The total effective rate was 99.3%. Of the 75 cases in control group, 46 （61.3%） were cured, 16 （21.3%） effective, 9 （12.0%） improved, and 4 （5.4%） ineffective. The total effective rate was 94.6%. The cure rate and the total effective rate of treatment group were significantly higher than those of control group respectively （x^2=29.379, P〈0.01; x^2 =5. 716, P〈0. 025）. Conclusion： The therapeutic effect of integrated approaches （medication, acupuncture, electromagnetic ＋ ultrashort wave ＋ ultrasonic wave ＋ medium-frequency wave irradiation） is significantly superior to that of simple acupuncture therapy in treating peripheral facial paralysis.

血管外科“杂交”手术的进展

随着血管腔内介入治疗和影像学的发展,"杂交"手术成为一个新的研究热点,是血管疾病领域发展的最新趋势。可以在同一单元、同一时间进行影像诊断和常规血管外科手术,打破了学科壁垒,体现了微创的优势,给患者提供完整、系统的、科学的医疗服务,现已广泛应用于各类血管外科疾病。

Efficiency and therapeutic effect of modified pigtail probe in anastomosing lacerated lacrimal canaliculus

Objective： To investigate the necessity of modification to the traditional pigtail probe and evaluate its efficiency and therapeutic effect in searching the nasal cut ends and anastomosing the lacerated lacrimal canaliculus. Methods： Eighty-seven patients （including 87 eyes） suffering from canalicular laceration were randomized into two groups： 41 patients treated with traditional pigtail probes （Group A） and 46 with modified pigtail probes （Group B）. During the reconstruction of the lacerated canaliculi, the traditional pigtail probe and the modified pigtail probe were used respectively to seek for the nasal cut ends of lacerated lacrimal canaliculi. Peripherally inserted central catheter （PICCTM） silicone tube with diameter of 0.95 mm was intubated as a stent for 4-6 months. The surgical outcomes were retrospectively analyzed after stent removal. Results： In Group B, the primary success rate of searching the nasal cut ends of lacerated lacrimal canaliculi was 93.48% （43/46） and the final success rate was 97.83% （45/46）. No false passage formed in Group B. Statistical sig- nificance was found between Group A and Group B as the primary success rates of searching the nasal cut ends （ x^2 = 10.522, P〈0.01） and the false passage forming rates were concerned （ x^2=4.704, P〈0.05）, whereas no significance was found between the two groups as the final success rates were concerned （ x^2=0.007, P〉0.05）. The mean time of searching the nasal cut ends of lacerated lacrimal canaliculi in Group B was （5.02±2.73） minutes and the mean time of operation was （33.90±4.84） minutes, and both were significantly shorter than those of Group A （t1=9.779, t2=10.700, P〈0.01）. The cure rate of Group B was 95.65%, though higher than that of Group A, no statistical significance was found （Z=-1.007, P〉0.05）. Totally, 2 patients （2.30%） were found to be absent of common canaliculus and underwent bicanalicular nasal intubation in the two groups. Conclusions： Pigtail probes are efficient and convenient apparatus for searching the nasal cut ends of the lacerated lacrimal canaliculi in the reconstruction of canalicular laceration. Necessary or proper modifications to the pigtail probes can minimize the risk of iatrogenic damages or complications and enhance the efficiency and therapeutic effect of canalicular repair.