脑科专用手术贴膜在多科手术中的应用

脑科专用手术贴膜是根据脑科手术的特点设计制成的，并在脑科手术中广泛应用，其实用性得到了手术医生、护士一致认可。其实用性主要表现在以下几个方面：（1）脑科手术切皮时出血较多，应用了脑科专用手术贴膜，可以比较准确的测定出血量。（2）应用了脑科专用手术贴膜，血液及冲洗液不再渗入敷料及流到病人的颜面部，而是通过脑科专用手术贴膜的漏斗端导流管流入容器内。（3）血液及冲洗液沿脑科专用手术贴膜的漏斗端、导管端流入容器中，避免污染手术医生，医护人员得到了良好的保护。（4）洁净部手术间的地面，避免了被大量血污冲洗液污染，防止了交叉感染的发生。

改良莎式手术及其改进方法治疗先天性髋关节脱位

目的 :报告用莎式手术及其改进方法治疗先天性髋关节脱位 (CDH )的临床效果。方法 :1996年 1月～1999年 7月手术治疗 11男、14女共 2 5位CDH患者 ,15例作改良莎式手术 ,10例采用改进的方法 :不截断大粗隆、保留髋臼缘和关节囊、作粗隆下股骨截骨。结果 :随访 6～ 36个月 ,平均 18个月 ,按 4级分类法评定 ,用改良莎式手术治疗的 ,优 3例 ,良 8例 ,中 3例 ,差 1例 ;用改进方法治疗的 ,优 8例 ,良 2例。结论 :改进后的莎式手术具有损伤小、并发症少、疗效好的优点 ,是治疗CDH的有效方法。

Patterns of local recurrence in rectal cancer after a multidisciplinary approach

Improvements in surgery and the application of combined approaches to fight rectal cancer have succeeded in reducing the local recurrence (LR) rate and when there is LR it tends to appear later and less often in isolation. Moreover, a subtle change in the distribution of LRs with respect to the pelvis has been observed. In general terms, prior to total mesorectal excision the most common LRs were central types (perianastomotic and anterior) while lateral and posterior forms (presa-cral) have become more common since the growth in the use of combined treatments. No differences have been reported in the current pattern of LRs as a function of the type of approach used, that is, neo-adjuvant therapies (short-term or long-course radiotherapy, orchemoradiotherapy versus extended lymphadenectomy, though there is a trend towards posterior or presacral LR in patients in the Western world and lateral LR in Asia. Nevertheless, both may arise from the same mechanism. Moreover, as well as the mode of treatment, the type of LR is related to the height of the initial tumor. Nowadays most LRs are related to the advanced nature of the disease. Involvement of the circumferential radial margin and spillage of residual tumor cells from lymphatic leakage in the pelvic side wall are two plausible mechanisms for the genesis of LR. The patterns of pelvic recurrence itself (pelvic subsites) also have important implications for prognosis and are related to the potential success of salvage curative approach. The re-operability for cure and prognosis are generally better for anastomotic and anterior types than for presacral and lateral recurrences. Overall survival after LR diagnosis is lower with radio or chemoradiotherapy plus optimal surgery approaches, compared to optimal surgery alone.

Multi-disciplinary treatment for cholangiocellular carcinoma

Cholangiocarcinoma(CC)is rare malignant tumors composed of cells that resemble those of the biliary tract.It is notoriously difficult to diagnose,and is associated with a high mortality.Traditionally,CC is divided into intrahepatic and extraheaptic disease according to its location within the biliary tree.Intrahepatic cholangiocellular carcinoma(IH-CCC)or peripheral cholangiocellular carcinoma(CCC)appears within the second bifurcation of hepatic bile duct,and is the second most common primary liver cancer following hepatocellular carcinoma(HCC),IH-CCC or peripheral CCC often presents with advanced clinical features,and the cause for this cancer rise is still unclear.MRI,CT and PET provide useful diagnostic information in those patients.Surgical resection is the only chance for cure,with results depending on selected patients and careful surgical technique.Liver transplantation could offer long-term survival in selected patients when combined with chemotherapy.Chemotherapy,radiation therapy or combination therapies remain as the only treatment for inoperable patients.However,these are uniformly ineffective in patients' survival.

Impact of lymphatic and/or blood vessel invasion in stage Ⅱ gastric cancer

AIM： To determine the prognostic value of lymphatic and/or blood vessel invasion （LBVI） in patients with stage 11 gastric cancer. METHODS： From January 2001 to December 2006, 487 patients with histologically confirmed primary gas- tric adenocarcinoma were diagnosed with stage 11 gas- tric cancer according to the new 7th edition American Joint Committee on Cancer stage classification at the Department of Gastric Cancer and Soft Tissue Surgery, Fudan University Shanghai Cancer Center. All patients underwent curative gastrectomy with standard lymph node （LN） dissection. Fifty-one patients who died in the postoperative period, due to various complications or other conditions, were excluded. Clinicopathologicalfindings and clinical outcomes were analyzed. Patients were subdivided into four groups according to the status of LBVI and LN metastases. These four patient groups were characterized with regard to age, sex, tumor site, pT category, tumor grading and surgical procedure （subtotal resection vs total resection）, and compared for 5-year overall survival by univariate and multivariate analysis. RESULTS： The study was composed of 320 men and 116 women aged 58.9 ± 11.5 years （range： 23-88 years）. The 5-year overall survival rates were 50.7% and the median survival time was 62 too. Stage Ⅱ a cancer was observed in 334 patients, including 268 T3N0, 63 T2N1, and three TIN2, and stage Ⅱb was observed in 102 patients, including 49 patients T3N1, 51 T2N2, one TIN3, and one T4aN0. The incidence of LBVI was 28.0% in stage II gastric cancer with 19.0% （51/269） and 42.5% （71/167） in LN-negative and LN- positive patients, respectively. In 218 patients （50.0%）, there was neither a histopathologically detectable LBVI nor LN metastases （LBVI-/LN-, group I）; in 51 patients （11.7%）, LBVI with no evidence of LN me- tastases was detected （LBVILN-, group 11）. In 167 patients （38.3%）, LN metastases were found. Among those patients, LBVI was not determined in 96 patients （22.0%） （LBVI-γLN, group Ⅲ）, and was determined in 71 patients （16.3%） （LBVI＋LN＋, group Ⅳ）. Correla- tion analysis showed that N category and the number of positive LNs were significantly associated with the presence of LBVI （P 〈 0.001）. The overall 5-year sur- vival was significantly longer in LN-negative patients compared with LN-positive patients （56.1% vs 42.3%, P = 0.015）. There was a significant difference in the overall 5-year survival between LBVI-positive and LBVI- negative tumors （39.6% vs 54.8%, P = 0.006）. Overall 5-year survival rates in each group were 58.8% （ Ⅰ）, 45.8% （Ⅱ）, 45.7% （Ⅲ） and 36.9% （Ⅳ）, and there was a significant difference in overall survival between the four groups （P=-0.009）. Multivariate analysis in stage 11 gastric cancer patients revealed that LBVI in- dependently affected patient prognosis in LN-negativepatients （P = 0.018） but not in LN-positive patients （P = 0.508）. CONCLUSION： In LN-negative stage 11 gastric cancer patients, LBVI is an additional independent prognostic markeF, and may provide useful information to identify patients with poorer prognosis.

Study of the Value of Combined Multiorgan Resection in Surgical Treatment of Carcinoma of the Gastric Cardia

OBJECTIVE： To determine the value of resection of combined visceral organs in surgical treatment of gastric cardiac carcinoma. METHODS： We retrospectively analyzed 217 random patients with carcinoma of the gastric cardia who underwent a gastric cardiac resection. The patients had been treated as follows： 186 with partial gastrectomy, 31 with total gastrectomy, 97 with a combined-visceral resection, of which 82 underwent a splenectomy plus partial pancreatectomy, 10 with splenectomy alone and 5 with partial hepatectomy and diaphragmatectomy. RESULTS： The total patients were divided into 3 groups： 128 with a gastrectomy alone, 10 with gastrectomy and splenectomy, and 82 with gastrectomy and splenectomy plus pancreatectomy. The operating times for these 3 groups were respectively 3.0 h, 3.1 h and 3.8 h. The hospitalization times were respectively 23.8 d, 31.2 d and 25.9 d. No differences in post-operative complications were found between these 3 groups. There were 92 patients who underwent a gastrectomy combined with a splenectomy and （or） the pancreatectomy, in which 92 No.10 lymph nodes were eliminated, with an average of one in each patient. Among the 125 patients not receiving a splenectomy but with elimination of lymph nodes, 82 underwent a gastrectomy combined with partial pancreatectomy, of which 107 lymph nodes were eliminated for the No. 11 group, with an average of 1.3 in each patient. There was a statistically significant difference between the 2 groups. The overall survival rates were similar in the 3 groups showing no statistical differences, but was higher in the Stage Ⅲ patients with a combined resection of multi-organs. For patients in the Stage Ⅳ without resection of multi-organs, the survival rate was higher, but there was no significant difference between the 2 groups. CONCLUSION： It is difficult to determine precisely the involvement of para-tumorous organs with the eye during an operation. Combining a splenectomy with a pancreatectomy does not increase the post-operative complications following surgical treatment for carcinoma of the gastric cardia. The combination of a splenectomy and partial pancreatectomy results in a higher survival rate and has an important significance for eliminating the lymph nodes of group 10 and 11, especially for patients in Stage Ⅲ. In the application of a resection combining multi-organs, the doctor should make every effort to decrease the trauma and the complications based on the condition that the cancerous tissue is totally resected.

Unstable mallet fractures： a comparison between three different techniques in a multicenter study

Objective： Management of mallet fractures is still a matter of discussion throughout the literature. For some authors, mallet fractures involving more than 1/3 of the articular surface and palmar subluxation of the distal phalanx require surgical treatment. In this study we retrospectively compared three different techniques for mallet fractures： Kirschner wire fixation with extension block pinning （EBP） of the distal interphalangeal joint, Kirschner wires used as joysticks （KWJ） and interfragmentary miniscrews for open reduction and internal fixation （ORIF）. Methods： Fifty-eight mallet fractures with palmar subluxation in 58 patients were treated with the aforementioned surgical techniques. Twenty mallet fractures in 20 patients 18 to 70 years old （average 42 years） were operated upon by EBP, 16 patients 22 to 56 years old （average 56 years） were operated upon using KWJ and 22 patients 22 to 54 years old （average 36 years） received OR/F. Follow-up time was 6 to 58 months （average 21 months）. The following intraoperative parameters were considered： intraoperative time, number of Kirschner wires/screws and technical problems. Postoperative parameters included work absence and complications. The radiological evaluation was based on A-P and lateral views preoperatively and interviews at follow-up time. Bone union was defined by radiological evidence of bone trabeculae crossing the fracture site on at least one view. Clinical evaluation involved range of motion （ROM） test with a goniometer. Based on these measurements, a functional Crawford score was established. Results： All fractures healed. In the KWJ group, intraoperative time was shorter and total ROM was wider （72° vs 58° and 54 °）; in the ORIF group, return to work was faster （2.7 weeks vs 7.2 weeks and 6 weeks） but a little higher complication rate due to screw positioning has been found. Functional results as to total ROM, distal interphalangeal lag extension and Crawford classification were similar. Conclusions： We demonstrate the advantages of the use of the three techniques and bone consolidation in all cases with no signs ofosteoarthritis. Screw fixation is more technically demanding （longer intraoperative time and more complications） but allows earlier mobilization and faster returning to work. EBP and KWJ techniques are faster to perform with no complications but require a careful management of the pin tracts. There is no statistically significant difference as to functional results.